Cannabis use and psychotic-like experiences: A systematic review of biological vulnerability, potency effects, and clinical trajectories.
Valerio Ricci, Stefania Chiappini, Giovanni Martinotti, Giuseppe Maina
Psychiatry Research April 1, 2025 DOI: 10.1016/j.psychres.2025.116496 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Population | Non-clinical populations |
| Topics | Cannabis |
| Key findings | The authors conclude that PLEs in non-clinical populations are shaped by multiple interacting risk factors, including biological vulnerabilities, high-potency cannabis use, and socio-environmental influences such as digital media use and ethnic density. They report evidence for a bidirectional cannabis-PLE relationship and argue that early identification of PLEs in young cannabis users offers a target for preventive intervention. |
Abstract
Epidemiological data have provided evidence that psychotic-like experiences (PLEs) occur in the general population without clinical impairment. According to the psychosis continuum hypothesis, PLEs are subject to multiple risk factors. This review synthesizes current research on biological, substance use-related, and environmental risk factors for PLEs in non-clinical populations. PubMed/Medline and Scopus databases were searched for peer-reviewed studies published until January 2024 investigating risk factors for PLEs in non-clinical samples. Following PRISMA guidelines, 38 full-text articles were analyzed after title/abstract and full-text screening (PROSPERO registration ID: N 1001,807). Four main risk factor categories emerged. Biological vulnerabilities included specific metabolic profiles, genetic predisposition, and neurobiological alterations. Substance use patterns, particularly high-potency cannabis, showed significant associations with PLEs, with evidence for bidirectional relationships. Socio-demographic factors revealed influences of digital media use, ethnic density, and gender differences. Outcome studies demonstrated associations between PLEs and consequences including suicidal behavior and cognitive impairments. Findings suggest a complex interplay between multiple risk factors in PLE development. More attention should be paid to the interaction between biological vulnerabilities and environmental factors, as these experiences may represent important markers for mental health outcomes. A comprehensive assessment approach and proactive early intervention strategies are essential for the timely identification and management of at-risk individuals. Our findings support a multifactorial model where genetic vulnerabilities, cannabis use patterns, and socio-environmental factors influence PLE trajectories. The bidirectional cannabis-PLE relationship suggests self-regulatory mechanisms that could inform preventive interventions. Early identification of PLEs in young cannabis users represents a crucial opportunity for targeted clinical interventions.
Comparable studies
Other systematic reviews and meta-analyses on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Effects of cannabis use on outcomes of psychotic disorders: systematic review People with psychotic disorders, as examined in 13 longitudinal studies | 2008 | Systematic review | |
| The Impact of Cannabis Use on Cognitive Functioning in Patients With Schizophrenia: A Meta-analysis of Existing Findings and New Data in a First-Episode Sample Patients with established schizophrenia (meta-analysis: 572) and patients with... | 2010 | Meta-analysis and cross-sectional observational study | n = 700 |
| Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review | 2020 | Systematic review | |
| Neuroimaging in cannabis use: a systematic review of the literature Cannabis users and controls in neuroimaging studies | 2009 | Systematic review | |
| Human Laboratory Studies on Cannabinoids and Psychosis. Healthy human subjects and individuals with schizophrenia | 2016 | Systematic review |
Citations in the library
Cited by 4
- Clinical Management of Synthetic-Cannabinoid-Induced Psychosis: A Systematic Review of Treatment Strategies and Outcomes. Brain Sciences September 17, 2025
- A Systematic Review of Clinical Phenomenology, Differential Diagnosis and Prognostic Outcomes of Substance-Induced Psychotic Disorders. International Journal of Social Psychiatry April 26, 2026
- HLA Class II Immunogenetic Profiles Shape Psychosis Outcomes in Cannabis Users: DRB5/DRB1*16 Vulnerability and DRB4/DRB3-Linked Protection, Particularly Against Schizophrenia NeuroSci May 7, 2026
- Acute and long-term psychiatric consequences of synthetic cannabinoids and related novel psychoactive substances: A systematic review. Psychiatry Research February 1, 2026
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and 11 more in the library