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Volume 16
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Case Report

Cariprazine in First-Episode Psychosis with Comorbid Cannabis Use: A Case Series of Eight Patients from Two Greek Early Intervention Units

by
Evangelos Ntouros
1,2,
Despina-Christina Partsanaki
1,
Stefanos Dimitrakopoulos
1,
Elena Ioanna Nazlidou
1,
Vasilis-Ilias Spatharas
1,
Venetsanos Mavreas
1 and
Vasilis P. Bozikas
2,*
1
Association for Regional Development and Mental Health (EPAPSY), 15124 Athens, Greece
2
2nd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 56430 Thessaloniki, Greece
*
Author to whom correspondence should be addressed.
Brain Sci. 2026, 16(8), 787; https://doi.org/10.3390/brainsci16080787
Submission received: 13 June 2026 / Revised: 22 July 2026 / Accepted: 25 July 2026 / Published: 26 July 2026
(This article belongs to the Topic Substance Use Disorder and Mental Health)
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Abstract

Background/Objectives: Cannabis use is prevalent in first-episode psychosis (FEP) and is associated with poor clinical outcomes. Cariprazine, a dopamine D3/D2 partial agonist with preferential D3 affinity, may offer clinical advantages for both psychotic symptoms and comorbid substance use; however, naturalistic data in FEP patients with active cannabis use are lacking. Methods: We conducted a retrospective naturalistic case series of eight FEP patients with active cannabis use treated with cariprazine for six months across two Greek Early Intervention Units (PNOES Athens and Thessaloniki, EPAPSY). Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) Five-Factor (Marder) model and cannabis use using the Cannabis Experience Questionnaire (CEQ) at baseline and six months. Analyses were descriptive, with exploratory Wilcoxon signed-rank tests. Results: At six months, lower mean PANSS scores were observed for positive symptoms (12.88 vs. 9.50), disorganization (11.38 vs. 9.13) and, to a lesser degree, anxiety/depression (9.38 vs. 8.50). Negative symptoms changed little (16.13 vs. 15.00), and hostility was essentially unchanged (10.63 vs. 11.63). Only the reduction in positive symptoms reached nominal significance (p = 0.047; dz = −1.05), which did not survive correction for multiple comparisons. Cannabis-use frequency decreased in seven of eight participants, with two reporting complete cessation. Conclusions: These preliminary, hypothesis-generating observations suggest that cariprazine may warrant further study in FEP with comorbid cannabis use. The findings cannot be interpreted as evidence of efficacy given the small, uncontrolled, diagnostically heterogeneous sample.
Keywords: first-episode psychosis; cannabis; cariprazine; dual diagnosis; early intervention; PANSS; case series first-episode psychosis; cannabis; cariprazine; dual diagnosis; early intervention; PANSS; case series
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MDPI and ACS Style

Ntouros, E.; Partsanaki, D.-C.; Dimitrakopoulos, S.; Nazlidou, E.I.; Spatharas, V.-I.; Mavreas, V.; Bozikas, V.P. Cariprazine in First-Episode Psychosis with Comorbid Cannabis Use: A Case Series of Eight Patients from Two Greek Early Intervention Units. Brain Sci. 2026, 16, 787. https://doi.org/10.3390/brainsci16080787

AMA Style

Ntouros E, Partsanaki D-C, Dimitrakopoulos S, Nazlidou EI, Spatharas V-I, Mavreas V, Bozikas VP. Cariprazine in First-Episode Psychosis with Comorbid Cannabis Use: A Case Series of Eight Patients from Two Greek Early Intervention Units. Brain Sciences. 2026; 16(8):787. https://doi.org/10.3390/brainsci16080787

Chicago/Turabian Style

Ntouros, Evangelos, Despina-Christina Partsanaki, Stefanos Dimitrakopoulos, Elena Ioanna Nazlidou, Vasilis-Ilias Spatharas, Venetsanos Mavreas, and Vasilis P. Bozikas. 2026. "Cariprazine in First-Episode Psychosis with Comorbid Cannabis Use: A Case Series of Eight Patients from Two Greek Early Intervention Units" Brain Sciences 16, no. 8: 787. https://doi.org/10.3390/brainsci16080787

APA Style

Ntouros, E., Partsanaki, D.-C., Dimitrakopoulos, S., Nazlidou, E. I., Spatharas, V.-I., Mavreas, V., & Bozikas, V. P. (2026). Cariprazine in First-Episode Psychosis with Comorbid Cannabis Use: A Case Series of Eight Patients from Two Greek Early Intervention Units. Brain Sciences, 16(8), 787. https://doi.org/10.3390/brainsci16080787

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