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Study breakdown

Does earlier cannabis use change brain structure networks in people with first psychosis?

Cross SectionalModerate evidence
The takeaway

In 102 cannabis users with recent-onset psychosis, earlier age of first cannabis use was associated with more severe positive symptoms and altered gray matter volume in cerebellar brain networks previously linked to schizophrenia.

Readers interested in how the timing of cannabis use may affect brain development and psychosis risk, particularly the role of the cerebellum.

102 patients from 2 multicentric studies

What the researchers found

Earlier cannabis initiation was linked to greater cerebellar gray matter volume in a network previously identified as altered in schizophrenia, independent of confounders. This cerebellar network was also associated with lower volume in an insula-temporal-frontal network implicated in schizophrenia. Earlier initiation correlated with more severe positive symptoms.

Why it matters

This study connects the timing of cannabis use to specific structural brain network changes that are also seen in schizophrenia, supporting the hypothesis that early cannabis use may disrupt developmental trajectories in a way that increases psychosis risk.

The numbers in context

102 patients with recent-onset psychosis; multicentric data from PRONIA and CIP studies; cerebellar network gray matter volume associated with early cannabis use; correlation with positive symptom severity

How the study worked

Cross-sectional analysis of 102 clinically relevant cannabis users with recent-onset psychosis from the multicentric PRONIA and CIP studies. Source-based morphometry analysis with spatial constraints applied to structural brain networks previously identified as altered in schizophrenia.

What this study cannot tell us

Cross-sectional design cannot determine if brain changes preceded or followed cannabis use. All participants had psychosis, so findings may not generalize to cannabis users without psychosis. Self-reported age of initiation.

How to read the evidence

Multicentric sample with sophisticated neuroimaging analysis, but cross-sectional design and all participants had psychosis.

When this study was published

Published in 2021; longitudinal studies are needed to confirm developmental causation.

The bigger picture

The cerebellum is increasingly recognized as important for cognition and psychosis, not just motor function. Finding that early cannabis use specifically affects cerebellar networks implicated in schizophrenia adds a new dimension to understanding the cannabis-psychosis relationship.

Questions still open

  • Do similar cerebellar changes appear in early cannabis users who never develop psychosis? Is there a specific age window during which cannabis use is most likely to affect these brain networks? Are these structural changes reversible with abstinence?

Common questions

Does starting cannabis younger change the brain differently?
In this study of psychosis patients, earlier cannabis initiation was associated with specific changes in cerebellar brain networks that are also altered in schizophrenia, even after accounting for other factors.
Why does the cerebellum matter for psychosis?
The cerebellum is increasingly recognized as playing roles in cognition and emotion, not just movement. Changes in cerebellar networks have been linked to schizophrenia, and this study suggests early cannabis use may affect these specific networks.

Read the original research

Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis.

Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 46(8), 1484-1493

Citation

Penzel, Nora; Antonucci, Linda A; Betz, Linda T; Sanfelici, Rachele; Weiske, Johanna; Pogarell, Oliver; Cumming, Paul; Quednow, Boris B; Howes, Oliver; Falkai, Peter; Upthegrove, Rachel; Bertolino, Alessandro; Borgwardt, Stefan; Brambilla, Paolo; Lencer, Rebekka; Meisenzahl, Eva; Rosen, Marlene; Haidl, Theresa; Kambeitz-Ilankovic, Lana; Ruhrmann, Stephan; Salokangas, Raimo R K; Pantelis, Christos; Wood, Stephen J; Koutsouleris, Nikolaos; Kambeitz, Joseph. (2021). Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis.. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 46(8), 1484-1493. https://doi.org/10.1038/s41386-021-00977-9

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