Multi-dimensional recovery trajectories in cannabis-induced psychosis: A systematic review examining symptomatic, functional, cognitive, and subjective outcomes.

Background: Cannabis-induced psychotic disorders represent 12-35% of first-episode psychosis presentations globally. Traditional clinical wisdom holds these conditions carry favorable prognosis based on rapid symptomatic improvement, yet this narrative rests almost exclusively on symptomatic outcomes, overlooking functional, cognitive, and subjective recovery dimensions.

Objective: To systematically review multi-dimensional recovery trajectories following cannabis-induced or cannabis-associated first-episode psychosis, characterizing patterns of concordance and discordance across outcome domains and identifying predictors of recovery profiles.

Methods: We searched five databases (PubMed/MEDLINE, PsycINFO, Embase, Web of Science, Cochrane Library) from inception to December 2024. INCLUSION CRITERIA longitudinal studies (≥6 months follow-up) assessing ≥ 2 outcome domains among symptomatic, functional, cognitive, and subjective recovery in cannabis-induced first-episode psychosis. Two independent reviewers screened studies and assessed quality using Newcastle-Ottawa Scale. Data were synthesized narratively.

Results: Thirty-three studies encompassing 18,117 participants were included (mean follow-up 24 months, range 6 months-10 years). While 50-70% achieved symptomatic remission within 6 months, functional recovery revealed substantial heterogeneity and frequent symptom-function dissociation. Continued cannabis use emerged as strongest predictor of poor outcomes across domains (persistence rates 35-65%), though cessation demonstrated significant benefits (functional recovery effect size 1.26). Cognitive findings were heterogeneous, and subjective outcomes remained poorly characterized (assessed in only 38% of studies). Only 15% of studies employed person-centered trajectory modeling, revealing five distinct recovery profiles.

Conclusions: Symptomatic improvement frequently fails to translate into functional recovery following cannabis-induced psychosis. The field's understanding of "favorable prognosis" inadequately captures comprehensive multi-dimensional recovery, necessitating interventions targeting functional, cognitive, and subjective domains beyond symptomatic remission.