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.
Psychiatrists in high-HIV-prevalence settings, global mental health researchers
HIV-positive cannabis users showed significantly elevated positive psychotic symptoms beyond cannabis-only effects
What the researchers 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).
Why it matters
The intersection of cannabis, psychosis, and HIV represents a triple disease burden in sub-Saharan Africa requiring integrated treatment.
The numbers in context
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 the study worked
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.
What this study cannot tell us
Cross-sectional; cannot determine temporal order; self-reported substance use; single geographic region; small HIV-positive subgroup.
How to read the evidence
Structured clinical assessments in a well-characterized sample, but cross-sectional design and single-site limit conclusions.
When this study was published
Published 2025
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.
Questions still open
- Does cannabis accelerate psychosis onset in HIV-positive individuals? Would integrated treatment improve outcomes? Are these patterns generalizable beyond South Africa?
Common questions
Did cannabis make psychosis worse?
Did HIV status matter?
Read the original research
Triple Burden of Cannabis Use, First Episode Psychosis and HIV in KwaZulu-Natal Province, South Africa.
Early intervention in psychiatry, 19(11), e70107
Citation
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
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