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Don H. Linszen, MD, PhD; Peter M. Dingemans, PhD; Marie E. Lenior, MA

Arch Gen Psychiatry. 1994;51(4):273-279.

Abstract
Objective
We sought to examine the relation between cannabis abuse and the symptomatic course of recent-onset schizophrenia and related disorders.

Design
A prospective cohort study over a year using monthly Brief Psychiatric Rating Scale assessments.

Participants
Cannabis-abusing patients (n=24) were compared with nonabusers (n=69). Eleven patients were mild and 13 were heavy cannabis-abusing patients.

Results
Significantly more and earlier psychotic relapses occurred in the cannabis-abusing group (P=.03). This association became stronger when mild and heavy cannabis abuse were distinguished (P=.002). No confounding effect of other variables, eg, other street drugs, was found. In all but one patient, cannabis abuse preceded the onset of the first psychotic symptoms for at least 1 year.

Conclusions
Cannabis abuse and particularly heavy abuse can be considered a stressor eliciting relapse in patients with schizophrenia and related disorders and possibly a premorbid precipitant.

Author Affiliations
From the Psychiatric Center of the Academic Medical Center and the Department of Psychiatry, University of Amsterdam, the Netherlands.

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