The trajectory of two negative symptom dimensions in first-episode psychosis and the role of cannabis use: A 10-year follow-up study

Schizophr Res. 2023 Feb:252:317-325. doi: 10.1016/j.schres.2023.01.024. Epub 2023 Jan 25.


Objective: To investigate the trajectories of diminished expression and apathy over 10 years. Further, to explore the effects of baseline- and persistent cannabis use on the development of diminished expression and apathy during follow-up, while controlling other potential sources and predictors of secondary negative symptoms.

Methods: 351 participants with a first episode of non-affective psychosis were examined at baseline and invited to follow-up at one year and 10 years. The trajectories of diminished expression and apathy were investigated using linear mixed models. Subsequently, cannabis use and other potential predictors and sources of secondary negative symptoms were added to the model to investigate the respective impact on their trajectories.

Results: The severity of both diminished expression and apathy decreased during the follow-up period after the first episode of psychosis, with the most improvement observed from baseline to 1-year follow-up. Cannabis use at baseline was associated with a long-lasting higher symptom load for diminished expression, but not apathy. Introducing persistent cannabis use to the model further strengthened the association with diminished expression.

Conclusion: Both cannabis use at baseline and persistent cannabis use after a first episode of psychosis were associated with more severe symptoms of diminished expression. Our results imply a causal relationship between cannabis use and diminished expression and suggest that measures to reduce cannabis use both before and after psychosis onset may reduce expressive negative symptoms.

Keywords: Apathy; Cannabis; Diminished expression; Negative symptoms; Psychosis; Schizophrenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apathy*
  • Cannabis*
  • Follow-Up Studies
  • Humans
  • Linear Models
  • Psychotic Disorders* / psychology