Executive attention impairment in adolescents with schizophrenia who have used cannabis

Katherine A. Epstein, Sanjiv Kumra

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: Repeated exposure to cannabis in nonpsychotic adolescents is associated with impairments in executive control of attention, similar to those observed in young adults with first-episode schizophrenia. To assess the impact of recurrent exposure to cannabis on cognitive function, this study characterized attention performance in both nonpsychotic adolescents and adolescents with early-onset schizophrenia (EOS). Method: The Attention Network Test, a standard procedure that estimates the functional state of neural networks controlling the efficiency of three different attentional behaviors (alerting, orienting, and executive attention), was administered to four groups of participants: (1) adolescents with EOS and comorbid cannabis use disorder (EOS. +. CUD; n. = 18), (2) "Pure" schizophrenia (EOS; n. = 34), (3) "Pure" cannabis use disorder (CUD; n. = 29), and (4) Healthy controls (HC; n. = 53). Task performance was examined with a 2. ×. 2 design (EOS. + versus EOS. - and CUD. + versus CUD. -) using multivariate analysis of covariance. Correlative analyses were conducted between executive attention performance and measures of surface area in the right anterior cingulate cortex. Results: A significant EOS. ×. CUD interaction was observed. In the executive attention network, adolescents with EOS. +. CUD showed reduced efficiency relative to adolescents with pure EOS, whereas no group differences were found between adolescents with pure CUD and HC. Less efficient executive attention was significantly associated with smaller surface area in the right caudal anterior cingulate cortex in EOS. +. CUD. Conclusions: These preliminary data suggest that the presence of CUD has a moderating effect on attentional performance in adolescents with schizophrenia compared to nonpsychotic adolescents. These deficits could have a role in difficulties with self-regulation and predisposition to substance misuse in this patient group. The anatomic substrate of this cognitive deficit may be related to surface area in the right caudal anterior cingulate cortex.

Original languageEnglish (US)
Pages (from-to)48-54
Number of pages7
JournalSchizophrenia Research
Issue number1-3
StatePublished - Aug 2014

Bibliographical note

Funding Information:
Funded by National Institute of Mental Health Grant MH073150-05 (cannabis and schizophrenia; to S.K.). The funding source played no role in study design, in the collection, analysis, or interpretation of the data, in the writing of this manuscript, or in the decision to submit it for publication.

Funding Information:
Dr. Kumra has received research support from the National Alliance for Research on Schizophrenia and Depression (as a Lieber Investigator) and Otsuka Pharmaceutical Co., Ltd. Ms. Epstein has no financial disclosures or potential conflicts of interest to report.


  • Adolescent
  • Anterior cingulate
  • Attention Network Test
  • Cannabis
  • Schizophrenia


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