How environmental risk shapes cognition in psychosis differently for men and women

This study examined how environmental risk factors—including cannabis use, childhood adversity, urbanicity, and other exposures—affect cognitive performance in individuals experiencing first-episode psychosis (FEP) and their unaffected siblings. Researchers used the Maudsley Environmental Risk Score (ERS) to measure cumulative environmental exposure in 72 FEP patients and 98 unaffected siblings, assessing cognitive domains like memory, processing speed, attention, and executive function. The findings reveal important sex-specific patterns in how psychosis impacts the brain.

Both male and female FEP patients showed significantly poorer cognitive performance compared to their unaffected siblings. However, the specific cognitive deficits differed by sex: males with FEP showed lower motor dexterity, while females displayed impaired processing speed, visual memory, and global cognitive functioning. Surprisingly, when researchers accounted for cumulative environmental risk—including cannabis use history—these cognitive differences largely persisted, suggesting that environmental factors alone may not fully explain the cognitive disparities observed in individuals at familial risk for psychosis.

These findings have important implications for understanding psychosis vulnerability and cannabis use in family contexts. While cannabis is one component of the measured environmental exposome, the study suggests that the relationship between environmental risk and cognitive impairment in psychosis is complex and may involve biological or genetic factors beyond environmental exposure. This highlights the need for personalized approaches when considering cannabis use in individuals with psychotic symptoms or family histories of psychosis, particularly given evidence that cannabis can trigger or worsen psychotic symptoms in vulnerable populations.