The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study.
The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study.
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DOI：
10.1016/s2215-0366(19)30048-3
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发表时间：
2019-05
期刊：
影响因子：
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通讯作者：
EU-GEI WP2 Group
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文献类型：
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作者：
Di Forti M;Quattrone D;Freeman TP;Tripoli G;Gayer-Anderson C;Quigley H;Rodriguez V;Jongsma HE;Ferraro L;La Cascia C;La Barbera D;Tarricone I;Berardi D;Szöke A;Arango C;Tortelli A;Velthorst E;Bernardo M;Del-Ben CM;Menezes PR;Selten JP;Jones PB;Kirkbride JB;Rutten BP;de Haan L;Sham PC;van Os J;Lewis CM;Lynskey M;Morgan C;Murray RM;EU-GEI WP2 Group
大麻的使用与后期精神障碍的风险增加有关，但它是否会影响这种疾病的发病率仍不清楚。我们的目的是确定大麻使用模式对整个欧洲精神病性障碍的几率影响最大，并探讨这些模式的差异是否会导致精神病性障碍发病率的变化。我们纳入了欧洲和巴西11个地点的18-64岁精神病服务中心的首发精神病患者，并招募了代表当地人群的对照组。我们将调整后的逻辑回归模型应用于数据，以估计哪些大麻使用模式对精神病性障碍的几率最高。使用欧洲范围内和国家范围内关于不同类型大麻中Δ9-四氢大麻酚（THC）预期浓度的数据，我们将参与者使用的大麻类型分为两类：低效力（THC <10%）和高效力（THC ≥10%）。假设因果关系，我们计算了与精神病最高几率相关的大麻使用模式的人群归因分数（PAF），以及这些模式与研究中心精神病发病率之间的相关性。在2010年5月1日至2015年4月1日期间，我们从11个研究中心的901例首发精神病患者和来自这些研究中心的1237例人群对照中获得了数据。与从未使用者相比，每日使用大麻与精神病性障碍的几率增加相关（调整后的比值比[OR] 3.2，95%CI 2.2 - 4.1），每日使用高效类型的大麻的几率增加近5倍（4.8，2.5 - 6.3）。计算的PAF表明，如果不再提供高效大麻，11个地点的首次精神病发作病例中有12.2%（95% CI 3.0 - 16.1）可以预防，伦敦上升到30.3%（15.2 - 40.0），阿姆斯特丹上升到50.3%（27.4 - 66.0）。在11个使用高效大麻（r = 0.7; p= 0.0286）和每日使用（r = 0.8; p= 0.0109）的地点，精神病性障碍的校正发病率与对照组的患病率呈正相关。 每日使用大麻和使用高效大麻的频率差异导致了11个研究地点精神障碍发病率的显著变化。鉴于高效力大麻的供应日益增加，这对公共卫生具有重要影响。医学研究理事会、欧洲共同体第七个框架方案赠款、圣保罗研究基金会、位于南伦敦的国家卫生研究所生物医学研究中心、莫兹利NHS基金会信托基金和伦敦国王学院以及位于伦敦大学学院的国家卫生研究所生物医学研究中心、惠康信托基金。
Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder. We included patients aged 18–64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ9-tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC <10%) and high potency (THC ≥10%). Assuming causality, we calculated the population attributable fractions (PAFs) for the patterns of cannabis use associated with the highest odds of psychosis and the correlation between such patterns and the incidence rates for psychotic disorder across the study sites. Between May 1, 2010, and April 1, 2015, we obtained data from 901 patients with first-episode psychosis across 11 sites and 1237 population controls from those same sites. Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3·2, 95% CI 2·2–4·1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4·8, 2·5–6·3). The PAFs calculated indicated that if high-potency cannabis were no longer available, 12·2% (95% CI 3·0–16·1) of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% (15·2–40·0) in London and 50·3% (27·4–66·0) in Amsterdam. The adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0·7; p=0·0286) and daily use (r = 0·8; p=0·0109). Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health. Medical Research Council, the European Community's Seventh Framework Program grant, São Paulo Research Foundation, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London and the NIHR BRC at University College London, Wellcome Trust.