Sex-specific vulnerabilities in cannabis-induced psychosis: A scoping review.

Background: Cannabis-induced psychosis presents complex sex-based disparities that challenge traditional epidemiological patterns. While males demonstrate higher cannabis use rates, emerging evidence reveals paradoxical vulnerability patterns where females may show heightened susceptibility to cannabis-related psychotic outcomes despite lower consumption rates.

Objective: To map evidence for sex-specific vulnerability windows in cannabis-induced psychosis, examining neurobiological mechanisms, genetic factors, and developmental periods contributing to gender disparities.

Methods: We conducted a systematic search of major databases for studies published between 2000 and 2024 examining gender differences in cannabis-induced psychosis, regardless of whether such differences were a primary or secondary objective. Two independent reviewers screened articles and extracted data using standardized forms following scoping review methodology. Study characteristics, including methodological rigor, were charted using the Newcastle-Ottawa Scale as a descriptive indicator rather than a basis for weighted synthesis.

Results: From 2847 initial records, 30 studies met inclusion criteria and were analyzed. The review identified several sex-based paradoxes in cannabis-induced psychosis: (1) elimination of typical female advantage in age of psychosis onset; (2) sex-specific genetic vulnerabilities, particularly Brain Derived Neurotrophic Factor (BDNF) polymorphisms; (3) differential neurobiological responses to cannabis exposure; (4) age-dependent vulnerability patterns varying by gender. These findings challenge traditional risk models and reveal complex interactions between biological sex, developmental timing, and cannabis exposure.

Conclusions: Sex-specific vulnerabilities in cannabis-induced psychosis reflect complex interactions between hormonal factors, genetic polymorphisms, and developmental timing. These findings necessitate sex-specific approaches to prevention, assessment, and treatment.