Cannabiskonsum erhöht das Risiko psychotischer Störungen dosisabhängig, während die Evidenz für affektive Outcomes schwächer und weniger konsistent ist.
Zusammenfassung
Systematische Review (k=35 longitudinale Populationsstudien); gepooltes adjustiertes OR für psychotisches Outcome bei je-Cannabis-Gebrauch = 1,41 (95% CI 1,20–1,65); Dosis-Wirkungs-Effekt: OR=2,09 (95% CI 1,54–2,84) bei häufigem Gebrauch. Evidenz konsistent mit unabhängigem Kausaleffekt von Cannabis auf Psychose-Risiko; Depression/Angst-Outcomes weniger konsistent belegt.
P
PopulationAllgemeinbevölkerung (longitudinale Populationsstudien), gepoolte Stichprobengröße nicht explizit berichtet
I
InterventionCannabiskonsum (jemals/häufig)
C
KontrolleKein Cannabiskonsum
O
OutcomeErhöhtes Risiko für psychotische Outcomes bei jemals-Konsum (gepooltes adjustiertes OR=1,41, 95%-KI 1,20–1,65); bei häufigstem Konsum OR=2,09 (95%-KI 1,54–2,84); weniger konsistente Befunde für Depression, Suizidgedanken und Angst
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
<h4>Background</h4>Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.<h4>Methods</h4>We searched Medline, Embase, CINAHL, PsycINFO, ISI Web of Knowledge, ISI Proceedings, ZETOC, BIOSIS, LILACS, and MEDCARIB from their inception to September, 2006, searched reference lists of studies included, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.<h4>Findings</h4>There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1.41, 95% CI 1.20-1.65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2.09, 1.54-2.84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately. Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding effect was present for both psychotic and affective outcomes.<h4>Interpretation</h4>The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.