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Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Childhood adversity rates would be higher in subjects at ultra-high risk of psychosis than in the general population. In addition to reference ideas, magical thoughts and social dysfunction, subjects at ultra-high risk of psychosis with a history of childhood trauma would experience more severe and specific symptoms. Childhood trauma, especially sexual abuse, was associated with the transition to psychosis. Several models have been cited to explain the link between trauma and the subsequent onset of psychosis or prepsychotic states: dysfunctional cognitive patterns, affective dysregulation, attachment styles, biological mechanisms, and epigenetic regulation. No methods of trauma assessment has been developed or validated in subjects at ultra-high risk of psychosis. Current interventions aim to prevent or reduce the adversities of childhood and improve their coping skills. Neuroleptic prescription is only recommended if there is a significant increase in prepsychotic symptoms., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)