Revisión sobre el consumo de cannabis como factor de riesgo de la esquizofrenia

Francisco Arias Horcajadas

Resumen


El consumo de cannabis es altamente prevalente entre los jóvenes, existiendo controversia sobre los riesgos psicosociales de dicho consumo. De estos riesgos hay que destacar la posibilidad de que el cannabis sea un factor de riesgo de una enfermedad tan grave e incapacitante como la esquizofrenia. Sobre este tema ha surgido recientemente una avalancha de información que es pertinente revisar. Se dispone de una serie de estudios de cohortes que apoyan la idea del consumo de cannabis como inductor de síntomas psicóticos y como factor precipitante de la esquizofrenia. Dichos estudios presentan una serie de limitaciones metodológicas que analizamos de forma crítica, como son la medida de diversas variables resultado, la heterogeneidad en las medidas de vulnerabilidad a la psicosis, la dificultad para controlar todos los posibles factores de confusión o la interpretación inadecuada de los resultados obtenidos. Como conclusión, consideramos que el consumo de cannabis está claramente asociado con la inducción de síntomas psicóticos y, posiblemente, es un factor de riesgo de la esquizofrenia en personas con una vulnerabilidad genética o psicosocial, siendo necesarias medidas preventivas en los grupos de alto riesgo que son fundamentalmente los consumidores de grandes cantidades de cannabis y los que inician el consumo en la adolescencia.


Palabras clave


cannabis; psicosis; esquizofrenia; factor de riesgo; vulnerabilidad

Texto completo:

PDF

Referencias


Andreasson, S., Allebeck, P., Engstrom, A. y Rydberg U. (1987). Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet, 2, 1483-1486.

Arendt, M. y Munk-Jorgensen, P. (2004). Heavy cannabis users

seeking treatment- prevalence of psychiatric disorders. Social Psychiatry and Psychiatric Epidemiology, 39, 97-105.

Arendt, M., Rosenberg, R., Foldager, L., Perto, G. y Munk- Jorgensen, P. (2005). Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. British Journal of Psychiatry, 187, 510-515.

Arguello, P.A. y Jentsch, J.D. (2004). Cannabinoid CB1 receptor-mediated impairment of visuospatial attention in the rat. Psychopharmacology (Berlin), 177, 141-150.

Arias, F., Sánchez, S. y Padín, J.J. (2002a). Relevancia del consumo de drogas en las manifestaciones clínicas de la esquizofrenia. Actas Españolas de Psiquiatría, 30, 65-73.

Arias, F., Sánchez, S. y Padín, J.J. (2002b). Consumo de drogas y riesgo de recaída en la esquizofrenia. Psiquiatría Biológica, 9, 63-67.

Arseneault, L., Cannon, M., Poulton, R., Murray, R., Caspi, A. y Moffitt, T.E. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal, 325, 1212-1213.

Arseneault, L., Cannon, M., Witton, J. y Murray, R.M. (2004). Causal association between cannabis and psychosis: examination of the evidence. British Journal of Psychiatry, 184, 110-117.

Batel, P. (2000). Addiction and schizophrenia. European Psychiatry, 15, 115-122.

Barnes, T.R., Mutsatsa, S.H., Hutton, S.B., Watt, H.C. y Joyce, E.M. (2006). Comorbid substance use and age at onset of schizophrenia. British Journal of Psychiatry, 188, 237-242.

Bersani, G., Orlandi, V., Gherardelli, S. y Pancheri, P. (2002). Cannabis and neurological soft signs in schizophrenia: absence of relationship and influence on psychopathology. Psychopathology, 35, 289-295.

Buhler, B., Hambrecht, M., Loffler, W., van der Heiden, W. y Hafner, H. (2002). Precipitation and determination of the onset and course of schizophrenia by substance abuse--a retrospective and prospective study of 232 population-based first illness episodes. Schizophrenia Research, 54, 243-251.

Caspari, D. (1999). Cannabis and schizophrenia: results of a follow-up study. European Archives of Psychiatry and Clinical Neurosciences, 249, 45-49.

Caspi, A., Moffitt, T.E., Cannon, M., McClay, J., Murray, R. y Harrington, H., et al. (2005). Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-Omethyltransferase gene: longitudinal evidence of a gene X environment interaction. Biological Psychiatry, 57, 1117-1127.

Caton, C.L., Drake, R.E., Hasin, D.S., Dominguez, B., Shrout, P.E. y Samet, S., et al. (2005). Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses. Archives of General Psychiatry, 62, 137-145.

Chaudry, H.R., Moss, H.B., Bashir, A. y Suliman, T. (1991). Cannabis psychosis following bhang ingestion. British Journal of Addiction, 86, 1075-1081.

Chopra, G.S. y Smith, J.W. (1974). Psychotic reactions following cannabis use in East Indians. Archives of General Psychiatry, 30, 24-27.

Compton, M.T., Furman, A.C. y Kaslow, N.J. (2004). Lower negative symptom scores among cannabis-dependent patients with schizophrenia-spectrum disorders: preliminary evidence from an African American firstepisode sample. Schizophrenia Research, 71, 61-64.

Dean, B., Sundram, S., Bradbury, R., Scarr, E. y Copolov, D. (2001). Studies on [3H]CP-55940 binding in the human central nervous system: regional specific changes in density of cannabinoid-1 receptors associated with schizophrenia and cannabis use.

Neuroscience, 103, 9-15.

Degenhardt, L. (2003). The link between cannabis use and psychosis: furthering the debate. Psychological Medicine, 33, 3-6.

De Marchi, N., De Petrocellis, L., Orlando, P., Daniele, F., Fezza, F. y Di Marzo, V. (2003). Endocannabinoid signalling in the blood of patients with schizophrenia. Lipids Health Diseases, 2, 5.

DeQuardo, J.R., Carpenter, C.F. y Tandon, R. (1994). Patterns of substance abuse in schizophrenia: Nature and significance. Journal of Psychiatric Research, 28, 267-275.

Dubertret, C., Bidard, I., Ades, J. y Gorwood, P. (2006). Lifetime positive symptoms in patients with schizophrenia and cannabis abuse are partially explained by co-morbid addiction. Schizophrenia Research, 86; 284-290.

D’Souza, D.C., Perry, E., MacDougall, L., Ammerman, Y., Cooper, T. y Wu, Y.T., et al. (2004).The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology, 29, 1558-1572.

D’Souza, D.C., Abi-Saab, W.M., Madonick, S., Forselius- Bielen, K., Doersch, A. y Braley, G., et al. (2005). Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biological Psychiatry, 57, 594-608.

Emrich, H.M., Leweke, F.M. y Schneider, U. (1997). Towards a cannabinoid hypothesis of schizophrenia: cognitive impairments due to dysregulation of the endogenous cannabinoid system. Pharmacology, Biochemistry, and Behavior, 56, 803-807.

Favrat, B., Menetrey, A., Augsburger, M., Rothuizen, L.E., Appenzeller, M. y Buclin, T., et al. (2005). Two cases of “cannabis acute psychosis” following the administration of oral cannabis. BMC Psychiatry, 5, 17.

Fergusson, D.M., Horwood, L.J. y Swain-Campbell, N.R. (2003). Cannabis dependence and psychotic symptoms in young people. Psychological Medicine, 33, 15-21.

Giuffrida, A., Leweke, F.M., Gerth, C.W., Schreiber, D., Koethe, D. y Faulhaber, J., et al. (2004). Cerebrospinal anandamide levels are elevated in acute schizophrenia and are inversely correlated with psychotic symptoms. Neuropsychopharmacology, 29, 2108-2114.

Green, A.I., Tohen, M.F., Hamer, R.M., Strakowski, S.M., Lieberman, J.A. y Glick, I., et al. (2004). First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophrenia Research, 66, 125-135.

Green, B., Young, R. y Kavanagh, D. (2005). Cannabis use and misuse prevalence among people with psychosis. British Journal of Psychiatry, 187, 306-313.

Hall, W. (2006). Is cannabis use psychotogenic? Lancet, 367, 193-195.

Henquet, C., Krabbendam, L., Spauwen, J., Kaplan, C., Lieb, R. y Wittchen, H.U., et al. (2005a). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. British Medical Journal, 330, 11.

Henquet, C., Murray, R., Linszen, D. y van Os, J. (2005b). The environment and schizophrenia: the role of cannabis use. Schizophrenia Bulletin, 31, 608-612.

Hunt, G.E., Bergen, J. y Bashir, M. (2002). Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophrenia Research, 54, 253-264.

Irala, J., Ruiz-Canela, M. y Martínez-González, M.A. (2005). Causal relationship between cannabis use and psychotic symptoms or depression. Should we wait and see? A public health perspective. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 11, 355-358.

Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A. y Cooper, J.E., et al. (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study.

Psychological Medicine, Monograph Suppl. 20, 1-97. Jiménez, D., Sánchez, S., Zazo, J., Arias, F. y Soto, A. (pendiente de publicación). Ingresos de inmigrantes en una unidad de hospitalización psiquiátrica breve. Anales de Psiquiatría.

Kavanagh, D.J., Waghorn, G., Jenner, L., Chant, D.C., Carr, V. y Evans, M., et al. (2004). Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophrenia Research, 66, 115-124.

Kumra, S., Thaden, E., DeThomas, C. y Kranzler, H. (2005). Correlates of substance abuse in adolescents with treatment-refractory schizophrenia and schizoaffective disorder. Schizophrenia Research, 73, 369-371.

Leweke, F.M., Schneider, U., Radwan, M., Schmidt, E. y Emrich, H.M. (2000). Different effects of nabilone and cannabidiol on binocular depth inversion in man. Pharmacology, Biochememistry, and Behavior, 66, 175-181.

Leweke, F.M., Gerth, C.W. y Klosterkotter, J. (2004). Cannabis-associated psychosis: current status of research. CNS Drugs, 18, 895-910.

Linszen, D.H., Dingemans, P.M. y Lenior, M.E. (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry, 51, 273-279.

Luaute, J.P. (2004). Cannabis and psychosis. British Journal of Psychiatry, 185, 352-353 (letter).

Macleod, J., Oakes, R., Copello, A., Crome, I., Egger, M.y Hickman, M., et al. (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet, 363, 1579-1588.

Margolese, H.C., Negrete, J.C., Tempier, R. y Gill, K. (2006). A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: changes in psychiatric symptoms and substance use. Schizophrenia Research, 83, 65-75.

McGuire, P.K., Jones, P., Harvey, I., Bebbington, P., Toone, B. y Lewis, S., et al. (1994). Cannabis and acute psychosis. Schizophrenia Research, 13, 161-167.

Nuñez, L.A. y Gurpegui, M. (2002). Cannabis-induced psychosis: a cross-sectional comparison with acute schizophrenia. Acta Psychiatrica Scandinavica, 105, 173-178.

Potvin, S., Sepehry, A.A. y Stip, E. (2006). A meta-analysis of negative symptoms in dual diagnosis schizophrenia. Psychological Medicine, 36, 431-440.

Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J. y Judd, L.L., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. Journal of American Medical Association, 264, 2511-

Rey, J.M. y Tennant, C.C. (2002). Cannabis and mental health. More evidence establishes clear link between use of cannabis and psychiatric illness. British Medical Journal, 325, 1183-1184.

Rottanburg, D., Robins, A.H., Ben-Arie, O., Teggin, A. y Elk, R. (1982). Cannabis-associated psychosis with hypomanic features. Lancet, 2, 1364-1366.

Schiffman, J., Nakamura, B., Earleywine, M. y LaBrie, J. (2005). Symptoms of schizotypy precede cannabis use. Psychiatry Research, 134, 37-42.

Semple, D.M., McIntosh, A.M. y Lawrie, S.M. (2005). Cannabis as a risk factor for psychosis: systematic review. Journal of Psychopharmacology, 19, 187-194.

Shakir, S.A. y Layton, D. (2002). Causal association in pharmacovigilance and pharmacoepidemiology: thoughts on the application of the Austin Bradford-Hill criteria. Drug Safety, 25: 467-471.

Skosnik, P.D., Spatz-Glenn, L. y Park, S. (2001). Cannabis use is associated with schizotypy and attentional disinhibition. Schizophrenia Research, 48, 83-92.

Smit, F., Bolier, L. y Cuijpers, P. (2004). Cannabis use and the risk of later schizophrenia: a review. Addiction, 99, 425-430.

Steffens, M., Engler, C., Zentner, J. y Feuerstein, T.J. (2004). Cannabinoid CB1 receptor-mediated modulation of evoked dopamine release and of adenylyl cyclase activity in the human neocortex. British Journal of Pharmacology, 141, 1193-1203.

Stellman, S.D., Takezaki, T., Wang, L., Chen, Y., Citron, M.L. y Djordjevic, M.V., et al. (2001). Smoking and lung cancer risk in American and Japanese men: an international case-control study. Cancer Epidemiology, Biomarkers and Prevention, 10, 1193-1199.

Swartz, M.S., Wagner, H.R., Swanson, J.W., Stroup, T.S., McEvoy, J.P. y Canive, J.M., et al. (2006). Substance use in persons with schizophrenia: baseline prevalence and correlates from the NIMH CATIE study. Journal of Nervous and Mental Diseases, 194, 164-172.

Talamo, A., Centorrino, F., Tondo, L., Dimitri, A., Hennen, J. y Baldessarini, R.J. (2006). Comorbid substanceuse in schizophrenia: Relation to positive and negative symptoms. Schizophrenia Research, 86, 251-255.

Talbott, J.A. y Teague, J.W. (1969). Marihuana psychosis. Acute toxic psychosis associated with the use of Cannabis derivatives. Journal of American Medical Association, 210, 299-302.

Tanda, G., Pontieri, F.E. y Di Chiara, G. (1997). Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common mu1 opioid receptor mechanism. Science, 276, 2048-2050.

Tennant, F.S. Jr y Groesbeck, C.J. (1972). Psychiatric effects of hashish. Archives of General Psychiatry, 27: 133-136.

Tien, A.Y. y Anthony, J.C. (1990). Epidemiological analysis

of alcohol and drug use as risk factors for psychotic experiences. Journal of Nervous and Mental Diseases, 178, 473-480.

Thacore, V.R. y Shukla, S.R. (1976). Cannabis psychosis and paranoid schizophrenia. Archives of General Psychiatry, 33, 383-386.

Thomas, H. (1996). A community survey of adverse effects of cannabis use. Drug and Alcohol Dependence, 42, 201-207.

Tramer, M.R., Carroll, D., Campbell, F.A., Reynolds, D.J., Moore, R.A. y McQuay, H.J. (2001). Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. British Medical Journal, 323, 16-21.

Treffert, D.A. (1978). Marijuana use in schizophrenia: a clear hazard. American Journal of Psychiatry, 135, 1213-1215.

Ujike, H., Takaki, M., Nakata, K., Tanaka, Y., Takeda, T. y Kodama, M., et al. (2002). CNR1, central cannabinoid receptor gene, associated with susceptibility to hebephrenic schizophrenia. Molecular Psychiatry, 7, 515-518.

Van Mastrigt, S., Addington, J. y Addington, D. (2004). Substance misuse at presentation to an early psychosis program. Social Psychiatry and Psychiatric Epidemiology, 39, 69-72.

Van Os, J., Bak, M., Hanssen, M., Bijl, R.V., de Graaf, R. y Verdoux, H. (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology, 156, 319-327.

Veen, N.D., Selten, J.P., van der Tweel, I., Feller, W.G., Hoek, H.W. y Kahn, R.S. (2004). Cannabis use and age at onset of schizophrenia. American Journal of Psychiatry, 161, 501-506.

Verdoux, H., Gindre, C., Sorbara, F., Tournier, M. y Swendsen, J.D. (2003). Effects of cannabis and psychosis vulnerability in daily life: an experience sampling test study. Psychological Medicine, 33, 23-32.

Verdoux, H., Tournier, M. y Cougnard, A. (2005). Impact of substance use on the onset and course of early psychosis. Schizophrenia Research, 79, 69-75.

Voruganti, L.N., Slomka, P., Zabel, P., Mattar, A. y Awad, A.G. (2001). Cannabis induced dopamine release: an in-vivo SPECT study. Psychiatry Research, 107, 173-177.

Wade, D. (2005). Cannabis use and schizophrenia. American Journal of Psychiatry, 162, 401.

Weiser, M., Knobler, H.Y., Noy, S. y Kaplan, Z. (2002). Clinical characteristics of adolescents later hospitalized for schizophrenia. American Journal of Medical Genetics, 114: 949-955.

Zammit, S., Allebeck, P., Andreasson, S., Lundberg, I. y Lewis, G. (2002). Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. British Medical Journal, 325, 1199.

Zavitsanou, K., Garrick, T. y Huang, X.F. (2004). Selective antagonist [3H]SR141716A binding to cannabinoid CB1 receptors is increased in the anterior cingulate cortex in schizophrenia. Progress in Neuropsychopharmacology & Biological Psychiatry, 28, 355-360.




DOI: https://doi.org/10.20882/adicciones.316

Enlaces refback

  • No hay ningún enlace refback.