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Premorbid Adjustment and Cannabis Use in First-Episode-Psychosis Patients

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Premorbid Adjustment and Cannabis Use in First-Episode-Psychosis Patients Medicina Clinica e Scienze del Comportamento Neuroscienze e Disturbi del Comportamento: dalla Genesi alla Patologia Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) Settore Scientifico Disciplinare MED 25 – MPSI 08 Borsa di Studio Finanziata dall’Università degli Studi di Messina PREMORBID ADJUSTMENT AND CANNABIS USE IN FIRST-EPISODE-PSYCHOSIS PATIENTS A CROSS-EUROPEAN CASE-CONTROL STUDY DOTT.SSA LAURA FERRARO TUTOR COORDINATORE PROF. DANIELE LA BARBERA PROF. ANTONIO PINTO SUPERVISORS SIR PROF. ROBIN M. MURRAY PROF. JIM VAN OS CICLO XXIX ANNO 2017 1 Table of Contents Abstract ............................................................................................ 8 Acknowledgments ......................................................................... 10 Presentation Letter Sir. R. Murray ............................................. 12 Presentation Letter Prof. J. van Os ............................................. 13 Organization of the Thesis ........................................................... 14 Chapter 1 Definition of the Terms and Relevant Literature .... 15 1. Introduction ........................................................................................... 15 2. Psychosis ................................................................................................. 17 2.1. Epidemiology ........................................................................................................ 19 2.2. Risk Factors for Psychosis .................................................................................... 19 3. Premorbid Adjustment ......................................................................... 21 4. Intellectual Quotient (IQ) ..................................................................... 23 5. Premorbid IQ ......................................................................................... 27 5.1. Psychosis, Cognition and Premorbid Adjustment ................................................ 29 5.1.1. Psychosis and Cognition: life-long disease? .................................................. 32 5.1.2. Psychosis and Cognition: General vs. Specific .............................................. 34 5.1.2.1. Domains vs. General Factor .................................................................... 34 5.1.2.2. All Patients vs. Subgroups of Patients .................................................... 35 5.1.2.3. Continuum vs. Categorical Disorders ..................................................... 36 6. Cannabis ................................................................................................. 37 6.1. Cannabis and Intellectual Quotient (IQ) ............................................................... 40 2 6.2. Cannabis and Premorbid-IQ ................................................................................. 45 6.3. Cannabis and Premorbid Adjustment: Enlarging the View .................................. 50 6.3.1. Do Relationships Increase Opportunities for Cannabis Use? ........................ 53 6.3.2. Does School Prevent Individuals from Smoking Cannabis? ......................... 54 7. Cannabis and Psychosis ........................................................................ 55 7.1. Cannabis, Psychosis and IQ .................................................................................. 58 7.2. Cannabis, Psychosis and Premorbid IQ ................................................................ 60 7.3. Cannabis, Psychosis and Premorbid Adjustment ................................................. 61 Chapter 2 Aims and Hypotheses ................................................. 63 1. Introduction ........................................................................................... 63 2. Thesis Aims and Hypotheses ................................................................ 63 2.1. Data derived from different Countries .................................................................. 64 2.2. Cognition and premorbid adjustment of cases compared to controls ................... 64 2.3. Pattern of cannabis use of cases compared to controls ......................................... 64 2.4. IQ and premorbid adjustment in cases that used cannabis in their lifetime compared to those who did not and to their respective healthy controls ..................... 65 2.5. Premorbid adjustment and IQ in cases who never used cannabis in their lifetime compared to those who used cannabis on a daily basis or less than everyday and to their respective healthy controls .................................................................................. 65 Chapter 3 Methods and Statistical Analyses .............................. 66 1. Introduction ........................................................................................... 66 2. The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Project (EU-GEI) ............... 67 3. Study design ........................................................................................... 70 4. Cases ....................................................................................................... 71 5. Controls .................................................................................................. 73 3 6. Methods and Instruments ..................................................................... 74 6.1. Modified version of the Medical Research Council Scale (MRC) ....................... 74 6.2. Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT) .... 75 6.3. Cannabis Experience Questionnaire modified version (CEQmv) + CIDI ............ 75 6.4. Wechsler Adult Intelligence Scale (WAIS) – abbreviated version ...................... 75 6.5. Premorbid Adjustment Scale (PAS) – reduced version ........................................ 76 7. Data manipulation ................................................................................. 76 8. Statistical analysis .................................................................................. 77 9. Justification of sample size: power calculation ................................... 78 10. Ethics .................................................................................................... 79 11. Statment of contribution to the investigations .................................. 81 Chapter 4 Pilot study .................................................................... 82 1. Introduction ........................................................................................... 82 2. Aims and Hypotheses ............................................................................ 82 3. Methods .................................................................................................. 83 3.1. Sample .................................................................................................................. 83 3.1.1. Patients ........................................................................................................... 83 3.1.2. Controls .......................................................................................................... 84 3.2. Assessment ............................................................................................................ 84 3.3. Statistical analyses ................................................................................................ 85 4. Results ..................................................................................................... 86 4.1. Socio-demographic characteristics ....................................................................... 86 4.2. Pattern of cannabis use ......................................................................................... 87 4.3. Current IQ and premorbid IQ in cases and controls ............................................. 88 4.4. Association of IQ and premorbid IQ with cannabis use when stratifying by case/control groups ...................................................................................................... 88 4.5. Patterns of cannabis use and IQ ............................................................................ 89 4 4.6. IQ and premorbid IQ scores association with cannabis use: Case–control comparisons ................................................................................................................. 89 4.6.1. IQ ................................................................................................................... 89 4.6.2. Premorbid IQ ................................................................................................. 90 4.6.3. Difference between IQ and premorbid IQ ..................................................... 90 5. Discussion ............................................................................................... 90 5.1. Why is lifetime cannabis use associated with better premorbid IQ? .................... 91 5.2. Are IQ and premorbid IQ of patients and controls different in relation to cannabis use? .............................................................................................................................. 91 5.3. Difference between IQ and premorbid IQ in relation to cannabis use ................. 92 4.4. Limitations and strengths ...................................................................................... 92 6. Conclusions ............................................................................................ 93 Chapter 5 Results .........................................................................
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