Introduction: The purpose of this study is to determine if an earlier age at onset of positive symptoms in schizophrenia is associated with cannabis use disorders (CUD).Methods: 49 first-episode schizophrenia subjects with CUD were compared to 51 first-episode schizophrenia subjects with no substance use disorders for demographic and clinical variables. A multivariate logistic regression was performed to determine the joint relationship between variables significantly associated with CUD on univariate testing and ascertain if these variables independently predict CUD. Significance level was set at p<0.05.Results: 74% of CUD subjects had the onset of CUD before the onset of positive symptoms. Compared to non-substance abusing subjects, CUD subjects were predominantly male, younger at study entry, had an earlier age at onset of positive symptoms, less educational attainment, a lower self-socioeconomic status, better premorbid childhood social adjustment, a trend for poorer premorbid childhood academic adjustment, less motor abnormalities but more severe hallucinations and delusions. In the multivariate analysis, only male gender, worse socioeconomic status, better premorbid childhood social adjustment, and more severe positive symptoms at study entry were associated with a lifetime history of CUD.Discussion: Although cannabis use precedes the onset of illness in most patients, there was no significant association between onset of illness and CUD that was not accounted for by demographic and clinical variables. Previous studies implicating CUD in the onset of schizophrenia may need to more comprehensively assess the relationship between CUD and schizophrenia, and take into account additional variables that we found associated with CUD. (C) 2010 Elsevier B.V. All rights reserved.

Objective: The authors compared 4-month treatment outcomes for olanzapine versus risperidone in patients with first-episode schizophrenia spectrum disorders.Method: One hundred twelve subjects (70% male; mean age = 23.3 years [SD = 5.1]) with first-episode schizophrenia (75%), schizophreniform disorder (17%), or schizoaffective disorder (8%) were randomly assigned to treatment with olanzapine (2.5 - 20 mg/ day) or risperidone (1 - 6 mg/ day).Results: Response rates did not significantly differ between olanzapine (43.7%, 95% CI = 28.8% - 58.6%) and risperidone (54.3%, 95% CI = 39.9% - 68.7%). Among those responding to treatment, more subjects in the olanzapine group (40.9%, 95% CI = 16.8% - 65.0%) than in the risperidone group (18.9%, 95% CI = 0% - 39.2%) had subsequent ratings not meeting response criteria. Negative symptom outcomes and measures of parkinsonism and akathisia did not differ between medications. Extrapyramidal symptom severity scores were 1.4 (95% CI = 1.2 - 1.6) with risperidone and 1.2 (95% CI = 1.0 - 1.4) with olanzapine. Significantly more weight gain occurred with olanzapine than with risperidone: the increase in weight at 4 months relative to baseline weight was 17.3% (95% CI = 14.2% - 20.5%) with olanzapine and 11.3% (95% CI = 8.4% - 14.3%) with risperidone. Body mass index at baseline and at 4 months was 24.3 (95% CI = 22.8 - 25.7) versus 28.2 (95% CI = 26.7 - 29.7) with olanzapine and 23.9 (95% CI = 22.5 - 25.3) versus 26.7 (95% CI = 25.2 - 28.2) with risperidone.Conclusions: Clinical outcomes with risperidone were equal to those with olanzapine, and response may be more stable. Olanzapine may have an advantage for motor side effects. Both medications caused substantial rapid weight gain,