Cannabis use worsened psychotic symptoms in first-episode patients, with added effects for those living with HIV
Among 182 first-episode psychosis patients in South Africa, lifetime cannabis use was associated with worse positive, disorganized, and excitement symptoms, with HIV-positive cannabis users showing particularly elevated positive symptoms.
Quick Facts
What This Study Found
Lifetime cannabis users scored higher on PANSS total, positive, disorganized, and excitement domains and lower on depression; HIV-positive cannabis users showed additional positive symptom elevation (p=0.023).
Key Numbers
182 patients; 71% male; mean age 26.27; 21.3% HIV-positive; cannabis users had higher PANSS total (p=0.009), positive (p=0.003), disorganized (p=0.009), excitement (p<0.001), lower depression (p=0.002).
How They Did This
Cross-sectional study of 182 adults (18-45) diagnosed with psychotic disorder per DSM-5 in KwaZulu-Natal; PANSS, WHO ASSIST, and HIV ELISA testing.
Why This Research Matters
The intersection of cannabis, psychosis, and HIV represents a triple disease burden in sub-Saharan Africa requiring integrated treatment.
The Bigger Picture
In settings with high HIV prevalence and widespread cannabis use, first-episode psychosis patients face compounding challenges that siloed services cannot address.
What This Study Doesn't Tell Us
Cross-sectional; cannot determine temporal order; self-reported substance use; single geographic region; small HIV-positive subgroup.
Questions This Raises
- ?Does cannabis accelerate psychosis onset in HIV-positive individuals?
- ?Would integrated treatment improve outcomes?
- ?Are these patterns generalizable beyond South Africa?
Trust & Context
- Key Stat:
- HIV-positive cannabis users showed significantly elevated positive psychotic symptoms beyond cannabis-only effects
- Evidence Grade:
- Structured clinical assessments in a well-characterized sample, but cross-sectional design and single-site limit conclusions.
- Study Age:
- Published 2025
- Original Title:
- Triple Burden of Cannabis Use, First Episode Psychosis and HIV in KwaZulu-Natal Province, South Africa.
- Published In:
- Early intervention in psychiatry, 19(11), e70107 (2025)
- Authors:
- Chhagan, Usha, Ntlantsana, Vuyokazi(2), Karim, Enver, Tomita, Andrew, Chiliza, Bonginkosi, Paruk, Saeeda
- Database ID:
- RTHC-06212
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Did cannabis make psychosis worse?
Cannabis users had significantly worse scores on positive, disorganized, and excitement symptom domains. Interestingly, they scored lower on depression.
Did HIV status matter?
Yes. HIV-positive patients who used cannabis had even higher positive psychotic symptoms than HIV-negative cannabis users, suggesting an additive effect.
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Cite This Study
https://rethinkthc.com/research/RTHC-06212APA
Chhagan, Usha; Ntlantsana, Vuyokazi; Karim, Enver; Tomita, Andrew; Chiliza, Bonginkosi; Paruk, Saeeda. (2025). Triple Burden of Cannabis Use, First Episode Psychosis and HIV in KwaZulu-Natal Province, South Africa.. Early intervention in psychiatry, 19(11), e70107. https://doi.org/10.1111/eip.70107
MLA
Chhagan, Usha, et al. "Triple Burden of Cannabis Use, First Episode Psychosis and HIV in KwaZulu-Natal Province, South Africa.." Early intervention in psychiatry, 2025. https://doi.org/10.1111/eip.70107
RethinkTHC
RethinkTHC Research Database. "Triple Burden of Cannabis Use, First Episode Psychosis and H..." RTHC-06212. Retrieved from https://rethinkthc.com/research/chhagan-2025-triple-burden-of-cannabis
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.