Alexithymia and psychopathological dimensions in First-Episode Psychosis: Comparative patterns in natural cannabis versus synthetic cannabinoid users

Aims: This study aimed to investigate the differences in psychotic symptomatology, dissociative symptoms, alexithymia, and aberrant salience among three groups: non-cannabis users (NU), natural cannabis users (NC), and synthetic cannabinoid users (SCs). The study also explored the patterns of alexithymia and its associations with other psychopathological dimensions in these populations.

Methods: A total of 108 participants experiencing First Episode Psychosis (FEP) were recruited during psychiatric crisis presentations to emergency rooms in Italy and categorized into three groups (NU, NC, SCs; n = 36 each). Participants were initially assessed 48-72 h after inpatient admission following clinical stabilization. Psychopathological assessments were conducted using the Positive and Negative Syndrome Scale (PANSS), Dissociative Experiences Scale (DES-II), Aberrant Salience Inventory (ASI), and Toronto Alexithymia Scale (TAS-20). Evaluations occurred at baseline (T0), three months (T1), and six months (T2) post-admission. Statistical analyses included ANOVA and repeated-measures ANOVA comparisons across time points.

Results: SC users exhibited significantly higher positive psychotic symptoms, persistent aberrant salience, and limited recovery of alexithymia compared to NC users and non-users. Dissociative symptoms were more prominent in both NC and SCs users, with SCs users showing minimal improvement over time. Negative symptoms were higher in non-users but showed progressive reduction across all groups. Significant correlations were observed between alexithymia and specific aberrant salience subscales, particularly Feelings of Increased Significance and Sense Sharpening.

Conclusions: Synthetic cannabinoids are associated with more severe and persistent psychotic symptoms and emotional dysregulation compared to natural cannabis. Alexithymia and dissociation showed distinct patterns across user groups, with different trajectories of change over the six-month observation period. These findings underscore the need for targeted interventions addressing emotional regulation and salience processing in cannabis-related psychosis.