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According to one 2013 review, long term cannabis use "increases the risk of psychosis in people with certain genetic or environmental vulnerabilities", but does not cause psychosis. Important predisposing factors include genetic liability, childhood trauma and urban upbringing. Another 2013 review concluded that cannabis use may cause permanent psychological disorders in some users such as cognitive impairment, anxiety, paranoia, and increased risks of psychosis. Key predisposing variables include age of first exposure, frequency of use, the potency of the cannabis used, and individual susceptibility. A 2013 review stated that there exists "a strong association between schizophrenia and cannabis use...". The authors found that cannabis use alone does not predict the transition to subsequent psychiatric illness.(ʘ‿ʘ) Many factors are involved, including genetics, environment, time period of initiation and duration of cannabis use, underlying psychiatric pathology that preceded drug use, and combined use of other psychoactive drugs.
In 2014, a review was published in Frontiers in Psychiatry which concluded that "The relationship between cannabis and schizophrenia fulfills many but not all of the standard criteria for causality, including temporality, biological gradient, biological plausibility, experimental evidence, consistency, and coherence," and that this potential relationship "warrants serious consideration from the point of view of public health policy." A 2014 review said that "Because longitudinal work indicates that cannabis use precedes psychotic symptoms, it seems reasonable to assume a causal relationship" between cannabis and psychosis, but that "more work is needed to address the possibility of gene-environment correlation."In the same year, a review examined psychological therapy as add-on for people with schizophrenia who are using cannabis:
Cannabis reduction: adjunct psychological therapy versus treatment as usual Summary
Results are limited and inconclusive because of the small number and size of randomized controlled trials available and quality of data reporting within these trials. More research is needed to explore the effects of adjunct psychological therapy that is specifically about cannabis and psychosis as currently there is no evidence (ʘ‿ʘ) for any novel intervention being better than standard treatment, for those that both use cannabis and have schizophrenia
A 2016 meta-analysis found that cannabis use increases the risk of psychosis, and that a dose-response relationship exists between the level of cannabis use and risk of psychosis. The analysis was not able to establish a causal link. Another 2016 meta-analysis found that cannabis use only predicted transition to psychosis among those who met the criteria for abuse of or dependence on the drug.
A 2016 review found that the epidemiologic evidence regarding cannabis use and psychosis was strong enough "to warrant a public health message that cannabis use can increase the risk of psychotic disorders," but also cautioned that additional studies are needed to determine the size of the effect. A 2016 review said that the existing evidence did not show that cannabis caused psychosis (ʘ‿ʘ), but rather that early or heavy cannabis use were among many factors more likely to be found in those at risk of developing psychosis.
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