Funcionamiento cognitivo en pacientes consumidores de cannabis con esquizofrenia. Un análisis comparativo.

Luz Angela Rojas Bernal; Guillermo Alonso  Castaño Pérez; Alejandra Marí­a Zapata Villa; Liliana Calderón Delgado; Jorge Mauricio Cuartas Arias; Ana Benito

doi:10.21134/1001

Authors

Luz Angela Rojas Bernal Grupo de Investigación en Salud Mental, Universidad CES, Medellín-Colombia https://orcid.org/0000-0002-0175-407X
Guillermo Alonso Castaño Pérez Grupo de Investigación Farmacodependencia y otras adicciones. Universidad Católica Luis Amigo, Medellín-Colombia.
Alejandra María Zapata Villa Centro de Atención en Neurología Pediátrica Integral CENPI, Medellín-Colombia
Liliana Calderón Delgado Programa de Psicología, Instituto de Ciencias Sociales y Humanas, Universidad de Medellín-Colombia
Jorge Mauricio Cuartas Arias Grupo Psicología y Neurociencia, Universidad San Buenaventura, Medellín, Colombia
Ana Benito TXP Research Group, Universidad Cardenal Herrera-CEU, Castellón, España Unidad Salud Mental Torrente, Hospital General Universitario de Valencia, Valencia, España

DOI:

https://doi.org/10.21134/1001

Keywords:

Schizophrenia, Cannabis, Dual diagnosis, Cognition, Neuropsychology

Abstract

Introduction. The growing evidence of cannabis (CN) use in patients with schizophrenia (SCZ) has increased interest in the study of the cognitive effects of CN in this population. Although some studies report superior cognitive functioning, other studies are contradictory. The objective was to compare cognitive functioning in CN users with SCZ (n=25), patients with SCZ without substance use (n=26) and healthy controls (n=25) between 18 and 35 years old. Method. Comparisons in sociodemographic and clinical variables and use characteristics were carried out using general linear models, Student's t and Chi squared test. Variables with significant differences were used to predict inclusion in the groups using multinomial and binary logistic regression. Neuropsychological tests and characteristics of CN consumption were correlated. Results. Although no differences in cognitive functioning were observed between groups with SCZ, the affected domains differed when compared to healthy controls. Age and results on different neuropsychological tests predicted inclusion in the SCZ+CN group. Significant correlations were found between the number of cannabis cigarettes (CN) consumed per week and the composite score of the perceptual reasoning index. Additionally, a significant relationship was observed between the CN abstinence period and performance on the Card Sorting subtest of the CCB within the BANFE. Conclusions. CN consumers with SCZ constitute a different subgroup of patients. Cannabis use characteristics correlate with scores from cognitive domains. Therefore, the approach must be differential.

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Author Biography

Luz Angela Rojas Bernal, Grupo de Investigación en Salud Mental, Universidad CES, Medellín-Colombia

MD Psychiatrist from the Universidad de Nuestra Señora del Rosario, Bogotá DC – Colombia. Magister in Epidemiology and Magister in Public Health from Universidad CES, Medellín - Colombia. Doctor in Health Sciences from the CES University, Medellín - Colombia. Pair recognized by MinCiencias and Junior Researcher (IJ). Member of the Mental Health Research Group of the CES University since 2015. Professor and Researcher of the Department of Clinics of the Faculty of Health at the Universidad Surcolombiana, Neiva - Colombia.

References

Alekseichuk, I., Turi, Z., Amador de Lara, G., Antal, A., & Paulus, W. (2016). Spatial Working Memory in Humans Depends on Theta and High Gamma Synchronization in the Prefrontal Cortex. Current Biology, 26(12), 1513–1521. https://doi.org/10.1016/j.cub.2016.04.035

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). Cuestionario de Identificación de los Transtornos debidos al Consumo de Alcohol. Pautas Para Su Utilización En Atención Primaria. Ginebra: Organización Mundial de La Salud.

Barch, D. M., & Ceaser, A. (2012). Cognition in schizophrenia: Core psychological and neural mechanisms. Trends in Cognitive Sciences, 16(1), 27–34. https://doi.org/10.1016/j.tics.2011.11.015

Beck, L. H., Bransome, E. D., Mirsky, A. F., Rosvold, H. E., & Sarason, I. (1956). A continuous performance test of brain damage. Journal of Consulting Psychology, 20(5), 343–350. https://doi.org/10.1037/h0043220

Bogaty, S. E., Lee, R. S., Hickie, I. B., & Hermens, D. F. (2018). Meta-analysis of neurocognition in young psychosis patients with current cannabis use. Journal of Psychiatric Research, 99, 22–32. https://doi.org/10.1016/j.jpsychires.2018.01.010

Broyd, S. J., van Hell, H. H., Beale, C., Yuecel, M., & Solowij, N. (2016). Acute and chronic effects of cannabinoids on human cognition—A systematic review. Biological Psychiatry, 79(7), 557–567. https://doi.org/10.1016/j.biopsych.2015.12.002

Coulston, C. M., Perdices, M., & Tennant, C. C. (2007). The neuropsychology of cannabis and other substance use in schizophrenia: Review of the literature and critical evaluation of methodological issues. The Australian and New Zealand Journal of Psychiatry, 41(11), 869–884. https://doi.org/10.1080/00048670701634952

Dehais, F., Hodgetts, H. M., Causse, M., Behrend, J., Durantin, G., & Tremblay, S. (2019). Momentary lapse of control: A cognitive continuum approach to understanding and mitigating perseveration in human error. Neuroscience and Biobehavioral Reviews, 100, 252–262. https://doi.org/10.1016/j.neubiorev.2019.03.006

Díaz-Soto, C. M., Castaño-Pérez, G. A., & Pineda-Salazar, D. A. (2020). Cannabis, schizophrenia and cognition: The contribution of brain connectivity. Adicciones, 0(0), 1307. https://doi.org/10.20882/adicciones.1307

D’Souza, D. C., Sewell, R. A., & Ranganathan, M. (2009). Cannabis and psychosis/schizophrenia: Human studies. European Archives of Psychiatry and Clinical Neuroscience, 259(7), 413–431. https://doi.org/10.1007/s00406-009-0024-2

Fried, P., Watkinson, B., James, D., & Gray, R. (2002). Current and former marijuana use: Preliminary findings of a longitudinal study of effects on IQ in young adults. Cmaj, 166(7), 887–891.

García, J., Palacio, C., Garcés, I., Arbeláez, M., Sánchez, R., & López, C. (2003). Inferencias fenomenológicas y nosológicas en la esquizofrenia a partir de la validación de las escalas de síntomas positivos (SAPS) y de síntomas negativos (SANS) en Colombia. Revista de Neuro-Psiquiatría, 66, 195–214.

Gavilán, J. M., & García-Albea, J. E. (2015). La función ejecutiva en la esquizofrenia y su asociación con las habilidades cognitivas sociales (mentalistas). Revista de Psiquiatría y Salud Mental, 8(3), 119–129. https://doi.org/10.1016/j.rpsm.2014.01.008

Gebreegziabhere, Y., Habatmu, K., Mihretu, A., Cella, M., & Alem, A. (2022). Cognitive impairment in people with schizophrenia: An umbrella review. European Archives of Psychiatry and Clinical Neuroscience, 272(7), 1139–1155. https://doi.org/10.1007/s00406-022-01416-6

Gil, D., Bengochea, R., Arrieta, M., Fernández, M., Álvarez, A., Sánchez, R., Prat, R., & Arce, A. (2009). Validez del factor cognitivo de la PANSS como medida del rendimiento cognitivo en esquizofrenia. Revista de Psiquiatría y Salud Mental, 2(4), 160–168. https://doi.org/10.1016/S1888-9891(09)73234-3

Harvey, P. D. (2014). What is the evidence for changes in cognition and functioning over the lifespan in patients with schizophrenia? The Journal of Clinical Psychiatry, 75 Suppl 2, 34–38. https://doi.org/10.4088/JCP.13065su1.08

Heaton, R., & Crowley, T. (1981). Effects of psychiatric disorders and their somatic treatments on neuropsychological test results. Handbook of Clinical Neuropsychology, 1, 481–525.

Jager, G., Kahn, R. S., Van Den Brink, W., Van Ree, J. M., & Ramsey, N. F. (2006). Long-term effects of frequent cannabis use on working memory and attention: An fMRI study. Psychopharmacology, 185(3), 358–368. https://doi.org/10.1007/s00213-005-0298-7

Jauhar, S., Johnstone, M., & McKenna, P. J. (2022). Schizophrenia. The Lancet, 399(10323), 473–486. https://doi.org/10.1016/S0140-6736(21)01730-X

Jockers-Scherübl, M. C., Wolf, T., Radzei, N., Schlattmann, P., Rentzsch, J., Gómez-Carrillo de Castro, A., & Kühl, K.-P. (2007). Cannabis induces different cognitive changes in schizophrenic patients and in healthy controls. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 31(5), 1054–1063. https://doi.org/10.1016/j.pnpbp.2007.03.006

Kambeitz, J., Kambeitz-Ilankovic, L., Cabral, C., Dwyer, D. B., Calhoun, V. D., Van Den Heuvel, M. P., Falkai, P., Koutsouleris, N., & Malchow, B. (2016). Aberrant Functional Whole-Brain Network Architecture in Patients With Schizophrenia: A Meta-analysis. Schizophrenia Bulletin, 42(suppl 1), S13–S21. https://doi.org/10.1093/schbul/sbv174

Keefe, R. S. E. (2014). The longitudinal course of cognitive impairment in schizophrenia: An examination of data from premorbid through posttreatment phases of illness. The Journal of Clinical Psychiatry, 75 Suppl 2, 8–13. https://doi.org/10.4088/JCP.13065su1.02

Khan, R., Naveed, S., Mian, N., Fida, A., Raafey, M. A., & Aedma, K. K. (2020). The therapeutic role of Cannabidiol in mental health: A systematic review. Journal of Cannabis Research, 2(1), 2. https://doi.org/10.1186/s42238-019-0012-y

Khandaker, G. M., Barnett, J. H., White, I. R., & Jones, P. B. (2011). A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia. Schizophrenia Research, 132(2–3), 220–227. https://doi.org/10.1016/j.schres.2011.06.017

Kraepelin, E. (1919). Dementia praecox and paraphrenia. Livingstone.

Kroon, E., Kuhns, L., & Cousijn, J. (2021). The short-term and long-term effects of cannabis on cognition: Recent advances in the field. Current Opinion in Psychology, 38, 49–55. https://doi.org/10.1016/j.copsyc.2020.07.005

Krysta, K., Krupka-Matuszczyk, I., Janas-Kozik, M., Stachowicz, M., Szymszal, J., & Rybakowski, J. K. (2012). Inferior performance on selected neuropsychological tests in abstinent schizophrenia patients who have used cannabis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 18(9), CR581-586. https://doi.org/10.12659/msm.883355

Lázaro, J. C. F., Solís, F. O., & Gutiérrez, A. L. (2008). Batería de funciones frontales y ejecutivas: Presentación. Revista Neuropsicología, Neuropsiquiatría y Neurociencias, 8(1), 141–158.

Lev-Ran, S., Segev, A., Braw, Y., & Levkovitz, Y. (2012). Neurocognitive functions of heavy cannabis using schizophrenia patients. European Psychiatry: The Journal of the Association of European Psychiatrists, 27(5), 365–368. https://doi.org/10.1016/j.eurpsy.2011.04.010

Leweke, F., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. (2012). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational Psychiatry, 2(3), e94–e94. https://doi.org/10.1038/tp.2012.15

Løberg, E.-M., Hugdahl, K., & Jørgensen, H. A. (2008). 97 – Lower neurocognitive vulnerability in schizophrenia with a history of cannabis abuse? Schizophrenia Research, 98, 73. https://doi.org/10.1016/j.schres.2007.12.164

Lu, H.-C., & Mackie, K. (2021). Review of the Endocannabinoid System. Biological Psychiatry. Cognitive Neuroscience and Neuroimaging, 6(6), 607–615. https://doi.org/10.1016/j.bpsc.2020.07.016

Lustig, C., & Sarter, M. (2016). Attention and the Cholinergic System: Relevance to Schizophrenia. Current Topics in Behavioral Neurosciences, 28, 327–362. https://doi.org/10.1007/7854_2015_5009

Mata, I., Rodriguez-Sanchez, J., Pelayo-Teran, J., Perez-Iglesias, R., Gonzalez-Blanch, C., Ramirez-Bonilla, M., Martinez-Garcia, O., Vazquez-Barquero, J., & Crespo-Facorro, B. (2008). Cannabis abuse is associated with decision-making impairment among first-episode patients with schizophrenia-spectrum psychosis. Psychological Medicine, 38(9), 1257. https://doi.org/10.1017/S0033291707002218

McCutcheon, R. A., Keefe, R. S. E., & McGuire, P. K. (2023). Cognitive impairment in schizophrenia: Aetiology, pathophysiology, and treatment. Molecular Psychiatry, 28(5), 1902–1918. https://doi.org/10.1038/s41380-023-01949-9

Miller, L. S., & Rohling, M. L. (2001). A statistical interpretive method for neuropsychological test data. Neuropsychology Review, 11(3), 143–169. https://doi.org/10.1023/a:1016602708066

Mucci, A., Galderisi, S., Green, M. F., Nuechterlein, K., Rucci, P., Gibertoni, D., Rossi, A., Rocca, P., Bertolino, A., Bucci, P., Hellemann, G., Spisto, M., Palumbo, D., Aguglia, E., Amodeo, G., Amore, M., Bellomo, A., Brugnoli, R., Carpiniello, B., … Italian Network for Research on Psychoses. (2018). Familial aggregation of MATRICS Consensus Cognitive Battery scores in a large sample of outpatients with schizophrenia and their unaffected relatives. Psychological Medicine, 48(8), 1359–1366. https://doi.org/10.1017/S0033291717002902

Murray, R. M., Englund, A., Abi-Dargham, A., Lewis, D. A., Di Forti, M., Davies, C., Sherif, M., McGuire, P., & D’Souza, D. C. (2017). Cannabis-associated psychosis: Neural substrate and clinical impact. Neuropharmacology, 124, 89–104. https://doi.org/10.1016/j.neuropharm.2017.06.018

Observatorio Interamericano de Drogas OAS CICAD. (2011). Protocolo de la encuesta sobre drogas en hogares. Instrumentos para la realización de los Estudios Nacionales de Drogas en Población General (pp. 1–80). Sistema Interamericano de Datos Uniformes. http://www.cicad.oas.org/oid/protocols/1_PROTOCOLO_Encuesta_Hogares_Julio_2011.pdf

Palacio, C. A., García, J., Arbeláez, M. P., Sánchez, R., Aguirre, B., Garcés, I. C., Montoya, G. J., Gómez, J., Agudelo, A., López, C. A., Calle, J. J., Cardeño, C. A., Cano, J. F., López, M. C., Montoya, P., Herrera, C. P., González, N., González, A., Bedoya, G., … Ospina, J. (2004). [Validation of the Diagnostic Interview for Genetic Studies (DIGS) in Colombia]. Biomédica: Revista Del Instituto Nacional De Salud, 24(1), 56–62.

Peters, K. Z., Cheer, J. F., & Tonini, R. (2021). Modulating the Neuromodulators: Dopamine, Serotonin, and the Endocannabinoid System. Trends in Neurosciences, 44(6), 464–477. https://doi.org/10.1016/j.tins.2021.02.001

Petker, T., Owens, M. M., Amlung, M. T., Oshri, A., Sweet, L. H., & MacKillop, J. (2019). Cannabis involvement and neuropsychological performance: Findings from the Human Connectome Project. Journal of Psychiatry & Neuroscience: JPN, 44(6), 414–422. https://doi.org/10.1503/jpn.180115

Pope, H. G., Gruber, A. J., Hudson, J. I., Huestis, M. A., & Yurgelun-Todd, D. (2002). Cognitive measures in long-term cannabis users. Journal of Clinical Pharmacology, 42(11 Suppl), 41S-47S. https://doi.org/10.1002/j.1552-4604.2002.tb06002.x

Rabin, R. A., Barr, M. S., Goodman, M. S., Herman, Y., Zakzanis, K. K., Kish, S. J., Kiang, M., Remington, G., & George, T. P. (2017). Effects of extended cannabis abstinence on cognitive outcomes in cannabis dependent patients with schizophrenia vs non-psychiatric controls. Neuropsychopharmacology, 42(11), 2259–2271. https://doi.org/10.1038/npp.2017.85

Rabin, R. A., Zakzanis, K. K., & George, T. P. (2011). The effects of cannabis use on neurocognition in schizophrenia: A meta-analysis. Schizophrenia Research, 128(1–3), 111–116. https://doi.org/10.1016/j.schres.2011.02.017

Rachid, H., Saif, Z., Raoui, S., Serhier, Z., & Agoub, M. (2024). Does cannabis affect cognitive functioning in patients with schizophrenia? Schizophrenia Research: Cognition, 36, 100299. https://doi.org/10.1016/j.scog.2023.100299

Raucher-Chéné, D., Thibaudeau, E., Sauvé, G., Lavigne, K. M., & Lepage, M. (2021). Understanding others as a mediator between verbal memory and negative symptoms in schizophrenia-spectrum disorder. Journal of Psychiatric Research, 143, 429–435. https://doi.org/10.1016/j.jpsychires.2021.10.007

Robison, A. J., Thakkar, K. N., & Diwadkar, V. A. (2020). Cognition and Reward Circuits in Schizophrenia: Synergistic, Not Separate. Biological Psychiatry, 87(3), 204–214. https://doi.org/10.1016/j.biopsych.2019.09.021

Rosas, R., Tenorio, M., Pizarro, M., Cumsille, P., Bosch, A., Arancibia, S., Carmona-Halty, M., Pérez-Salas, C. P., Pino, E., & Vizcarra, B. (2014). Estandarización de la Escala Wechsler de Inteligencia para Adultos: Cuarta edición en Chile. Psykhe (Santiago), 23(1), 1–18. https://doi.org/10.7764/psykhe.23.1.529

Sánchez-Gutiérrez, T., Fernandez-Castilla, B., Barbeito, S., González-Pinto, A., Becerra-García, J. A., & Calvo, A. (2020). Cannabis use and nonuse in patients with first-episode psychosis: A systematic review and meta-analysis of studies comparing neurocognitive functioning. European Psychiatry: The Journal of the Association of European Psychiatrists, 63(1), e6. https://doi.org/10.1192/j.eurpsy.2019.9

Schnell, T., Koethe, D., Daumann, J., & Gouzoulis-Mayfrank, E. (2009). The role of cannabis in cognitive functioning of patients with schizophrenia. Psychopharmacology, 205(1), 45–52. https://doi.org/10.1007/s00213-009-1512-9

Scholes, K., & Martin-Iverson, M. (2010). Cannabis use and neuropsychological performance in healthy individuals and patients with schizophrenia. Psychological Medicine, 40(10), 1635. https://doi.org/10.1017/S0033291709992078

Seabury, R. D., & Cannon, T. D. (2020). Memory Impairments and Psychosis Prediction: A Scoping Review and Theoretical Overview. Neuropsychology Review, 30(4), 521–545. https://doi.org/10.1007/s11065-020-09464-2

Sevy, S., Burdick, K. E., Visweswaraiah, H., Abdelmessih, S., Lukin, M., Yechiam, E., & Bechara, A. (2007). Iowa gambling task in schizophrenia: A review and new data in patients with schizophrenia and co-occurring cannabis use disorders. Schizophrenia Research, 92(1–3), 74–84. https://doi.org/10.1016/j.schres.2007.01.005

Solowij, N., Stephens, R. S., Roffman, R. A., Babor, T., Kadden, R., Miller, M., Christiansen, K., McRee, B., & Vendetti, J. (2002). Cognitive functioning of long-term heavy cannabis users seeking treatment. Jama, 287(9), 1123–1131. https://doi.org/10.1001/jama.287.9.1123

Thai, M. L., Andreassen, A. K., & Bliksted, V. (2019). A meta-analysis of executive dysfunction in patients with schizophrenia: Different degree of impairment in the ecological subdomains of the Behavioural Assessment of the Dysexecutive Syndrome. Psychiatry Research, 272, 230–236. https://doi.org/10.1016/j.psychres.2018.12.088

Thames, A. D., Arbid, N., & Sayegh, P. (2014). Cannabis use and neurocognitive functioning in a non-clinical sample of users. Addictive Behaviors, 39(5), 994–999. https://doi.org/10.1016/j.addbeh.2014.01.019

Urine testing for drugs of abuse. (1986). NIDA Research Monograph, 73, 1–114.

Wechsler, D. (2004). Escala de Memoria de Wechsler III: Manual de aplicación. Madrid: Tea Ediciones SA.

Wechsler, D., Meng, Y., Martínez, I., & Zhu, J. (2014). WAIS-IV: Escala Wechsler de Inteligencia para Adultos-IV. El Manual Moderno.

Weinberger, D. R. (2017). The neurodevelopmental origins of schizophrenia in the penumbra of genomic medicine. World Psychiatry, 16(3), 225–226. https://doi.org/10.1002/wps.20474

Woods, S. W. (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. The Journal of Clinical Psychiatry, 64(6), 663–667. https://doi.org/10.4088/jcp.v64n0607

Wu, J. Q., Tan, Y. L., Xiu, M. H., De Yang, F., Soares, J. C., & Zhang, X. Y. (2016). Cognitive impairments in first-episode drug-naive and chronic medicated schizophrenia: MATRICS consensus cognitive battery in a Chinese Han population. Psychiatry Research, 238, 196–202. https://doi.org/10.1016/j.psychres.2016.02.042

Yücel, M., Bora, E., Lubman, D. I., Solowij, N., Brewer, W. J., Cotton, S. M., Conus, P., Takagi, M. J., Fornito, A., Wood, S. J., McGorry, P. D., & Pantelis, C. (2012). The impact of cannabis use on cognitive functioning in patients with schizophrenia: A meta-analysis of existing findings and new data in a first-episode sample. Schizophrenia Bulletin, 38(2), 316–330. https://doi.org/10.1093/schbul/sbq079

Zamora, R. C., Von Seggern, B., Toledo, R., & Harrell, E. H. (1990). El inventario de Edimburgo: Evaluación de la lateralidad cerebral en una población mexicana. Salud Mental, 13(2), 11–17.