Sex-specific vulnerabilities in cannabis-induced psychosis: A scoping review.
Valerio Ricci, Domenico de Berardis, Giovanni Martinotti, Giuseppe Maina
Asian Journal of Psychiatry July 8, 2026 DOI: 10.1016/j.ajp.2026.105086 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Topics | Cannabis |
| Key findings | The review identifies sex-based paradoxes in cannabis-induced psychosis: females may lose their typical advantage in age of onset, and there are sex-specific genetic vulnerabilities (e.g., BDNF polymorphisms), differential neurobiological responses, and age-dependent vulnerability patterns. These findings challenge traditional risk models and support sex-specific clinical approaches. |
Abstract
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.