Premorbid Adjustment, Cannabis Use and Global, Role, and Social Functioning in Individuals at Clinical High Risk for Psychosis Open Access

Abstract

The use of cannabis is associated with mixed outcomes in individuals at clinical high risk (CHR) for developing a psychotic disorder. While several studies have observed an increase in psychosis conversion rates and severity of positive symptoms, other research suggests that cannabis use is associated with reduced negative symptoms and improved cognitive performance in a CHR population. Several hypotheses aim to explain this discrepancy in findings, some arguing that cannabis itself has enhancing effects, while others argue that CHR individuals with higher pre-existing functioning are more likely to use cannabis. Important indices of prodromal course, such as global, social, and role functioning, have yet to be explored in relation to cannabis use in a CHR sample. The sample for the present study is from the third wave of the North American Prodrome Longitudinal Study- 3rd cohort (NAPLS-3)  and includes 710 participants who have been classified as clinical high risk (CHR) for developing a psychotic disorder. Cannabis use frequency at baseline was assessed using the Alcohol/Drug Use Scale and the three post-baseline variables were measured from the Global Functioning – Social (GF-S), and Global Functioning – Role (GF-R) scales. Premorbid Adjustment as a covariate was measured with the Premorbid Adjustment Scale (PAS). Linear regression analyses were conducted to test the relation of cannabis use with role and social functioning, controlling for premorbid functioning. A repeated measures ANCOVA, controlling for pre-baseline functioning tested the relation of cannabis use with global, role, and social functioning from baseline through the 2- and 4-month follow-up visits. Cannabis use prior to and/or at baseline was associated with significantly higher premorbid and baseline social functioning scores. Moderate cannabis users demonstrate significantly higher baseline social and role functioning scores compared to never and heavy users. Greater cannabis use levels significantly predicted higher baseline social and role functioning scores with and without controlling for premorbid social and scholastic adjustment scores. Baseline cannabis use predicted significantly greater improvement over four months in social, but not role functioning, after baseline. Findings appear to support the social skills hypothesis given the significant positive relationship between cannabis use and baseline and subsequent social functioning. Cannabis itself does not appear to exert a protective effect, given that moderate users demonstrate better outcomes than heavier users. Given that obtaining cannabis generally requires interpersonal relationships, it appears that the higher functioning exhibited by moderate cannabis use is more likely a reflection role played by social adjustment in access to the social connections and/or motivations required for access to cannabis. 

Table of Contents

Introduction..................................................................................................................................... 1 Methods..........................................................................................................................................13

Results ...........................................................................................................................................19

Discussion .....................................................................................................................................30

References .....................................................................................................................................36 Figures...........................................................................................................................................40 

Appendix A...................................................................................................................................49 

Appendix B...................................................................................................................................52 

Appendix C...................................................................................................................................55 

 

About this Honors Thesis

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School	Emory College
Department	Psychology
Subfield / Discipline	Clinical Psychology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Psychology, Clinical
Keyword	cannabis psychology psychosis
Committee Chair / Thesis Advisor	Elaine Walker, Emory University
Committee Members	Michael Treadway, Emory University Benjamin Druss, Emory University

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