Developmental neurocognitive pathway of psychosis proneness and the impact of cannabis use

Following the worldwide initiative on intervening early in clinical high-risk individuals for psychosis, this thesis promotes a novel approach to identify those at risk for psychosis by studying children and adolescents from the community who report different trajectories of subclinical psychosis symptoms (i.e., psychotic-like experiences) without the confounds of iatrogenic effects such as major social and cognitive impairments. Early identification from this approach may not only reduce harm by shortening the duration of untreated symptoms, but may also have the capacity to prevent the emergence of clinically validated symptoms, particularly if early risk factors can be identified. Considering the long-standing notion that cannabis misuse is an important risk factor for psychosis and that jurisdictions around the world are currently revising their cannabis regulatory policies, there is a need to better understand how cannabis use may lead to psychosis in vulnerable youths. This thesis examined different mechanisms that may explain the complex relationship between cannabis use and psychosis risk. I first explored the temporal sequence between cannabis use and self-reported psychotic-like experiences in a population-based sample of 4000 adolescents, over a 4-year period when both phenomena have their onset. Second, in vulnerable youths, I investigated the role of impaired cognitive functioning as well as increased affective and anxious symptoms as mediators of the cannabis-to-psychosis relationship. And third, I explored the presence of early neurocognitive markers (both functional and structural) associated with the emergence of psychotic symptoms, and how cannabis use moderates these markers. Two longitudinal cohorts from the general population, the Co-Venture Study (n=4000, aged 12 years old, followed annually for 4 years) and the neuroimaging IMAGEN Study (n=2200, aged 14 years old, followed for 2 years), as well as the neuroimaging subsample from the Co-Venture Study (n=151, aged 12 years old, followed annually for 4 years) were used. It was found that an increase in cannabis use always preceded an increase in reported psychotic-like experiences throughout adolescence, but an increase in psychotic-like experiences rarely predicted an increase in cannabis use. Then, in vulnerable adolescents, the cannabis-to-psychosis risk relationship was better explained by increases in depression and anxiety symptoms relative to changes in cognitive functioning. It was demonstrated that reduced hippocampus and amygdala volumes, combined with hyperactivity of the same regions during neutral cues processing were associated with the emergence of psychotic symptoms in young adolescents reporting psychotic-like experiences. However, cannabis use did not exacerbate the structural alterations observed in youths with psychotic-like experiences. These findings have improved our understanding of the relationship between cannabis use and vulnerability to psychosis. They have also highlighted the important role of an impaired limbic network leading to an aberrant emotional salience attribution in vulnerable adolescents. Although cannabis use did not exacerbate brain structural alterations observed in vulnerable youths, it appears that cannabis will more likely interfere with depression and/or anxiety symptoms and their associated brain mechanisms underlying vulnerability to stress in the path towards psychosis risk. This thesis may inform the development of new evidence-based interventions that reduce demand for cannabis among vulnerable youths.

Keyphrases: Adolescence, Cannabis, Psychotic-like experiences, Vulnerability markers, Functional imaging, Structural imaging, Longitudinal design, Depression and anxiety symptoms, Limbic system, Aberrant salience