A neuropsychological approach to differentiating cannabis-induced and primary psychotic disorders

Aim: Rates of cannabis use are elevated in early psychosis populations, rendering it difficult to determine if an episode of psychosis is related to cannabis use (e.g., cannabis-induced psychosis), or if substance use is co-occurring with a primary psychotic disorder (e.g., schizophrenia). Clinical presentations of these disorders are often indistinguishable, hindering assessment and treatment. Despite substantial research identifying cognitive deficits, eye movement abnormalities and speech impairment associated with primary psychotic disorders, these neuropsychological features have not been explored as targets for diagnostic differentiation in early psychosis. Methods: Eighteen participants with cannabis-induced psychosis (M_age = 21.9, SD_age = 4.25, 14 male) and 19 participants with primary psychosis (M_age = 29.2, SD_age = 7.65, 17 male) were recruited from early intervention programs. Diagnoses were ascertained by primary treatment teams after a minimum of 6 months in the program. Participants completed tasks assessing cognitive performance, saccadic eye movements and speech. Clinical symptoms, trauma, substance use, premorbid functioning and illness insight were also assessed. Results: Relative to individuals with primary psychosis, individuals with cannabis-induced psychosis demonstrated significantly better performance on the pro-saccade task, faster RT on pro- and anti-saccade tasks, better premorbid adjustment, and a higher degree of insight into their illness. There were no significant differences between groups on psychiatric symptoms, premorbid intellectual functioning, or problems related to cannabis use. Conclusions: In early stages of illness, reliance on traditional diagnostic tools or clinical interviews may be insufficient to distinguish between cannabis-induced and primary psychosis. Future research should continue to explore neuropsychological differences between these diagnoses to improve diagnostic accuracy.