Adolescence & Development
Study register · detail Prospektive Geburtskohortenstudie (ALSPAC) · Adolescence & Development · 2011

Cannabis, COMT and psychotic experiences.

No benefit demonstrated GRADE Low 116 citations
Samplen = 2.630 Pat.
DurationAge 14 to age 16
ControlNo cannabis use
EndpointPsychotic experiences
Blindingn.a.
DesignProspektive Geburtskohortenstudie (ALSPAC)
Key finding

Cannabis increases psychosis risk independently of COMT genotype; a specific gene-environment interaction was not demonstrated.

Summary

n=2.630 ALSPAC birth cohort; cannabis use assessed at age 14, psychotic experiences at age 16. Cannabis use increases psychosis risk independently of COMT Val158Met genotype (no significant interaction effect under multiplicative models). Conclusion: risk from cannabis applies to the entire adolescent population, not only a genetically high-risk subgroup.

P
PopulationAdolescents from the ALSPAC birth cohort study, n=2630, cannabis use assessed at age 14, psychotic experiences at age 16
I
InterventionCannabis use (self-reported, age 14)
C
ControlNo cannabis use
O
OutcomeNo significant interaction effect between cannabis use and COMT genotype (rs4680) on risk of psychotic experiences in the primary analyses; inconsistent findings in sensitivity analyses
Confidence in the evidence
Low

The second of four GRADE levels, the effect estimate is of limited reliability.

Quality profile
Sample size
Blinding
Effect size No benefit
Citations / year
Authors
Zammit S, Owen MJ, Evans J, Heron J, Lewis G.
DOI 10.1192/bjp.bp.111.091421
Design: Prospektive Geburtskohortenstudie (ALSPAC)
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Abstract
<h4>Background</h4>A putative interaction between cannabis and variation at rs4680 within the catechol-methyl-transferase (COMT) gene on psychosis has been reported, but not adequately replicated.<h4>Aims</h4>To examine whether the relative risk of developing psychosis following use of cannabis is dependent upon variation within COMT.<h4>Method</h4>A longitudinal study of 2630 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort who completed questionnaire-based assessments for cannabis use at age 14 and incident psychotic experiences at age 16. Six SNPs within COMT were genotyped.<h4>Results</h4>There was no evidence of an interaction under multiplicative models between cannabis use and COMT on the risk of developing psychotic experiences in our primary analyses. In sensitivity analyses we observed highly variable evidence of interaction, whereby psychotomimetic effects of cannabis were greater in methionine homozygotes under some scenarios, but in valine homozygotes under others.<h4>Conclusions</h4>Cannabis increases risk of psychosis irrespective of underlying COMT genotypes. These findings argue against the widely held belief that the relative risk of developing psychosis following use of cannabis is dependent upon variation within COMT. The public health message about the potential increase in risk of psychotic disorders following cannabis use should not be tempered by reports that this harm is subgroup specific in the absence of robust evidence of replication.</h4>

The impediment to action advances action. — Marcus Aurelius