The evaluation of neurological soft signs and cognitive function in cannabis use and not use schizophrenia patients

Objectives: Cannabis is a possible risk factor for the onset of schizophrenia in healthy individuals and causes neurocognitive, behavioral and motor coordination changes. The effects that it uncovered; shows difference of age at start, time used and in relation to dose. It has been observed that in patients with schizophrenia, the use of cannabis increases comorbidity and psychotic symptoms, while cognitive function and neurological manifestation are different. In this study, we aimed to investigate the effects of cannabis use on schizophrenia cognitive functions and neurological soft signs. Material and Methods: 33 schizophrenic patients with cannabis use and 40 schizophrenic patients without cannabis use who were diagnosed with schizophrenia according to DSM-V, 40 healthy individuals were included. Since female schizophrenia, which is a narrative of cannabis use, is not a reference to a patient, all groups are composed of male genders. Sociodemographic data form, PANSS and CGI severity scale were filled with clinical interview. Frontal Assement Batary (FAB), Number Series Learning Test (SDLT), Line Orientation Test, Stoop Test and Neurological Assessment Scale were administered to the control and patient groups. Results were compared between groups and between groups. SPSS 18.0 program was used for statistical data analysis. Results: In our work sociodemographic variables did not differ between control and patient groups in terms of age and duration of education (p>0,05). Study status (p<0,001) and duration of study (p=0,015) were greater in the control group than in the patient groups, among the schizophrenia groups, the working status and duration were higher in the group of schizophrenia without a history of cannabis use. The marital status (p=0,003) was the group with the highest number of single victims in the group of schizophrenia with narrative of cannabis use. There was a forensic history between control and patient groups (p<0,001) and a family history of psychiatric history (p=0,002) in schizophrenia group with the most cannabis use history. The groups were compared in terms of family history of psychosis, and the proportion of schizophrenic patients with cannabis use was significantly higher (x2=6,011 p=0,05). A comparison was made between PANSS, CGI-S, age at onset of illness, duration of illness, time without treatment, cognitive tests and neurological soft signs between patients with and without family history of psychosis in the family. Only significant relationship was found between STP 1 DÜSA (t=2,307 p=0,024) and ÇYBT (t=2,068 p=0,042). No other relationship was found with other items. Smoking (p=0,001) significantly differed between the groups. Smoking was more common in patients with schizophrenia, in schizophrenia groups it was seen that smoking with schizophrenia, which is a trait of cannabis use, was more common. The amount of smoking was also significantly different for the control and patient groups and the amount of smoking was higher in the patient group (p<0,05). The effects of cigarette use on cognitive functions and neurological manifestations were evaluated in cannabis use and nonuse groups. There was no relationship between cigarette use and cognitive functions and neurological manifestations in the group of patients without cannabis use. There was a positive correlation between the amount of cigarette consumption and STP 1 HATA, STP 1 DÜSA, STP 3 SÜRE, STP 3 HATA, STP 4 SÜRE (p<0,05) in patients with cannabis use narrative. There was a negative correlation between smoking cessation and neurological soft signs only SNB 'other' subscore (p=0,042). The schizophrenia groups performed poorly in the cognitive function tests compared to the control group, there was a significant difference STP 1, STP 2, STP 3, STP 4, STP 5 SÜRE, ÇYBT, SDÖT, SDÖT in the number of repetitions and FAB (p<0,05). In the comparison of schizophrenia groups, the performance of schizophrenia with cannabis use was better, but statistical analysis showed no significant difference between cognitive tests (p>0,05). According to neurological evaluation scale, there was a significant difference between the control group and the schizophrenia groups in all NSS subscale scores and total scores (p<0,001). Among the schizophrenia groups, schizophrenia group with trait history of cannabis use had less neurological deficits, significant differences were found especially between SNB motor coordination (p=0,009), SNB complex motor (p=0,004) and SNB total (p=0,027) scores. There was no difference between PANSS positive, negative, general, and total scores among the patient groups, and CGI-S was higher in the group of schizophrenia using cannabis (p=0,030). The duration of illness was longer in the group of schizophrenia without cannabis use (p=0,035). PANSS was compared with cognitive tests, especially negative subscale scores (p<0,05). The relationship between PANSS and SNB was significant; In the schizophrenic group without cannabis use, there was a positive correlation between PANSS positive, negative, general and total paired SNB motor coordination, sensory integration, complex motor, other and total puans. There was no correlation between PANSS positive and SNB sensory integration only (p>0,05). In the schizophrenic patient group with cannabis use narrative, there was a positive correlation between PANSS positive symptom and SNB 'other' subscale (p=0,027). There was a positive correlation between PANSS negative symptom and all SNB subscores and total score (p<0,05). PANSS general symptom and total score were positively correlated with all other SNB scores except for the complex motor subscore (p<0,05). In SCH patient group in SNB motor coordination and SNB total score with STP 1 SÜRE, STP 2 SÜRE, STP 3 SÜRE, STP 3 HATA, STP 4 SÜRE, STP 4 HATA, STP 4 DÜSA, STP 5 SÜRE, STP 5 HATA, SDÖT in the number of repetitions was detected positive correlation. Negative correlation was detected between MDCT, SDLT and FAB (p<0,05). There was a positive correlation between SNB sensory integration and STP 2 SÜRE, STP 3 SÜRE, STP 3 HATA, STP 4 SÜRE, STP 4 HATA, STP 4 DÜSA, STP 5 SÜRE, STP 5 HATA; Negative correlation was detected between ÇYBT, SDÖT and FAB (p<0,05). Positive correlation between SNB complex motor and STP 1 SÜRE, STP 2 SÜRE, STP 3 SÜRE, STP 3 HATA, STP 3 DÜSA, STP 4 SÜRE, STP 4 HATA, STP 4 DÜSA, STP 5 HATA, STP 5 HATA; Negative correlations were detected with ÇYBT, SDÖT, FAB (p<0,05). STP 3 SÜRE, STP 4 SÜRE, STP 4 HATA, STP 4 DÜSA, STP 5 SÜRE, STP 5 HATA, SDÖT in the number of repetitions positive correlation was detected with SNB 'other'; Negative correlations were detected with ÇYBT, SDÖT, FAB (p<0,05). In the SCH/cannabis patient group, the SNB in motor coordination compared to STP 1 SÜRE, STP 1 HATA, STP 1 DÜSA, STP 2 SÜRE, STP 3 SÜRE, STP 3 HATA, STP 4 SÜRE, STP 4 HATA, STP 5 SÜRE, STP 5 HATA positive correlation was detected; Negative correlation was detected with ÇYBT and FAB. Positive correlation was found between SNB sensory integration and STP 3 SÜRE, STP 4 SÜRE, STP 4 HATA, STP 5 HATA, SDÖT repeat number; Negative correlations were detected with ÇYBT, SDÖT, FAB (p<0,05). SNB complex motor and SNB total compared to STP 1 SÜRE, STP 1 HATA, STP 1 DÜSA, STP 2 SÜRE, STP 3 SÜRE, STP 3 HATA, STP 4 SÜRE, STP 4 HATA, STP 5 SÜRE, STP 5 HATA, SDÖT repeat number positive correlation was detected; Negative correlations were detected with STI, SDLT, FAB (p<0,05). Positive correlation was found between SNB 'other' and STP 1, STP 2, STP 3, STP 4, STP 5 SÜRE, STP 3 and STP 5 HATA, SDÖT repeat number; Negative correlations were detected with ÇYBT, SDÖT, FAB (p<0,05). The relationship between age and duration of education and cognitive functions was evaluated in the patient groups. There was no correlation between age and cognitive tests in the SCH group, and there was a negative correlation between the duration of training and the Stroop test, and a positive correlation was found between ÇYBT, SDÖT and FAB. A positive correlation between age and Stroop test was observed in the SCH/cannabis patient group; There was a negative correlation between the duration of training and Stroop test, there was a positive correlation between ÇYBT, SDÖT and FAB (p<0,05). The relationship between age and duration of education and neurological soft symptom was evaluated in the patient groups. In the SCH group, there was no relationship between age and neurological manifestations. There was a significant negative correlation between the duration of training and all subscores and total score of SNB (p<0,05). There was no correlation between SCH/cannabis age and neurological manifestations. There was a negative correlation between duration of training and SNB motor coordination, sensory integration, 'other' and total scores (p<0,05). The correlation between the cannabis initiation age and the cognitive function tests of the cannabis use period was examined in the schizophrenia group of cannabis use narratives. There was a positive correlation between cannabis initiation age and STP 1 HATA (r=,378* p=0,03), STP 1 DÜSA (r=,378* p=0,03). There was no correlation with other cognitive tests (p>0,05). However, when the age of 17 was determined as the cut-off point, having started before and after the age of 17 did not cause any effect on the cognitive performance. No statistically significant difference was observed. With the duration of cannabis use and between STP 2 SÜRE (r=, 486** p=0,004), STP 3 SÜRE (r=,480** p=0,005), STP 3 DÜSA (r=,437* p=0,011), STP 4 SÜRE (r=,47** p=0,006), STP 5 HATA (r=,502** p=0,003) and STP 5 HATA (r=,599** p<0,001) a significant positive correlation was detected. In the schizophrenic patient group, which is a trait of cannabis use, the relationship between the cannabis initiation age and the neurological manifestation period of the cannabis use period was examined. There was no correlation between cannabis initiation age and all subscores of SNB and totoal score. The cannabis use period was significantly correlated with the SNB complex motor (r=,385* p=0,027), SNB 'other' (r=,455** p=0,008) and SNB total (r=,425* p=0,014) positive correlation was detected. The incidence of cannabis use was assessed in the schizophrenic patient group with cannabis use. The incidence of 'daily', 'weekly', 'irregular' usage was found in the patients who were taken to work. Of the 33 patients with cannabis use history, 14 were using 'everyday' (43%), 11 using 'once a week' (33%) and 8 using 'irregular' (24%) cannabis. The frequency of cannabis use was assessed as age of onset, duration of illness, duration without treatment, Panss, CGI-S, cognitive function tests (Stroop, SDBT, SDLT, FAB) and neurological soft signs and only correlation with SNB motor coordination was detected (p=0,04). There was no correlation between the other parameters (p>0,05). Conclusion: In our study, schizophrenia group performed poorly in all cognitive functions, executive function, attention and response inhibition, learning and memory functions when compared with control and schizophrenia groups, neurological faintness was found more in the patient group. However, compared to the schizophrenia group, the group of schizophrenia with cannabis use narrative showed better cognitive function than the group without schizophrenia, but no significant difference was found in the statistical analysis. Neurological symptoms were less frequent in schizophrenia group with cannabis use. Educational level was the factor that affected cognitive function and neurologicalsoft signs. The increased level of education increased the cognitive test performance and resulted in the presence of fewer neurologicalsoft signs. There was no significant relationship between age, cognitive function, and neurological symptoms. The presence of family history of psychosis was similarly found to have no effect on cognitive function and neurological manifestation. Smoking cessation was associated with cognitive function and neurological manifestations in the schizophrenia group, which is a history of cannabis use. Especially attention has been given to the increase in the amount of cigarette use, which reduced cognitive performance and caused less neurological manifestation. While the age at onset of cannabis use did not have a significant effect on cognitive function, the increase in the duration of cannabis influenced cognitive performance in a significant manner. Stroop test completion time was longer. With the increase in the duration of cannabis use, more neurological deficits were observed. Key Words: Schizophrenia, cannabis, neurological soft signs, cognitive functions.