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Schizophrenia in users and nonusers of cannabis (Andrasson et al)

Roshnee Mrinalini Chatterjee

Remedial For Quiz 6

The question of the effects of cannabis on the mental health of schizophrenics has been a very important one which we need to answer. It is known that many schizophrenics smoke cannabis, however, it is unclear whether the effects are harmful or beneficial for patients. In a study by Andrasson et al, they tried to find a link between the two.

In studies before this, it had been found that there was a strong association between the level of cannabis consumption in conscripts (a person enlisted compulsorily, typically into armed forces). It is known that cannabis has psychoactive properties which could hypothetically alter the mental well being of a person. However, in these studies, it was difficult to analyse the effects because there is a lack of baseline data on cannabis exposure in conscripts where schizophrenia prospectively followed. The relative risk for schizophrenia developing among those who had an intake of cannabis for over 50 occasions was very high. An association was formed and persisted after controlling for other possible psychological illnesses and social background, thus indicating that cannabis is an independent risk factor for schizophrenia. 

However, the previous researchers did have issues with diagnostic precision, exposure to other drugs acting as a confound and the cause and effect relationship of cannabis and schizophrenia (much like the chicken and egg conundrum). Andrasson et al tried to overcome these issues by acknowledging the possible role of other drugs in the causation of schizophrenia. They kept a watch for whether cannabis abuse preceded mental symptoms of schizophrenia or not. They also tracked the mode of onset and prognosis of the schizophrenia in cannabis users versus nonusers. 

The study's longitudinal method includes two questionnaires during the time the participants are being conscripted, a psychological consultation and check-ups throughout the years. The first questionnaire concerns the social background, upbringing and education of the participants. The second questionnaire pertained to their habits in use of drugs, tobacco and solvent sniffing. Those who did not cooperate with the second questionnaire were removed from the study. Conscripts were made to meet a psychologist for a structured interview. Those with psychological symptoms were referred to a psychiatrist who diagnosed them according to ICD-8. The medical records were retrieved for those men who reported having used cannabis on more than ten occasions. Over time the results showed that there was a very strong association formed between the level of cannabis consumption during the time conscripts were enlisted and the treatment for schizophrenia. It was found that cannabis was depicted as the dominant drug linked to schizophrenia, and any symptoms of mental illness were presented after cannabis abuse in a majority of cases. 

The confounds in this study include the fact that the participants were only men, hence there is a gross gender bias and no means of generalisability across genders. Moreover, the researchers did not account for any signs of comorbidity which may have been triggered by stressful events during their time in the armed forces, possibly resulting in OCD, generalised anxiety disordersor PTSD which may have overlapping symptoms with schizophrenia and hence perhaps required a differential diagnosis. 



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