Growing evidence suggests that cannabis abuse/dependence is paradoxically associated with better cognition in schizophrenia. Accordingly, we performed a functional magnetic resonance imaging (fMRI) study of visuospatial abilities in 14 schizophrenia patients with cannabis abuse (DD), 14 nonabusing schizophrenia patients (SCZ), and 21 healthy controls (HCs). Participants performed a mental rotation task while being scanned. There were no significant differences in the number of mistakes between schizophrenia groups, and both made more mistakes on the mental rotation task than HC. Relative to HC, SCZ had increased activations in the left thalamus, while DD patients had increased activations in the right supramarginal gyrus. In both cases, hyper-activations are likely to reflect compensatory efforts. In addition, SCZ patients had decreased activations in the left superior parietal gyrus compared to both HC and DD patients. This latter result tentatively suggests that the neurophysiologic processes underlying visuospatial abilities are partially preserved in DD, relative to SCZ patients, consistently with the findings showing that cannabis abuse in schizophrenia is associated with better cognitive functioning. Further fMRI studies are required to examine the neural correlates of other cognitive dysfunctions in schizophrenia patients with and without comorbid cannabis use disorder. 1. Introduction Neuropsychological studies have shown that 70% to 75% of patients with schizophrenia have significant cognitive deficits [1]. These deficits encompass attention, reasoning and problem solving, speed of processing, verbal memory, visual memory, and working memory [2]. Cognitive performance of patients with schizophrenia is 1 to 1.5 standard deviations below the performance of the general population [3]. Importantly, cognitive deficits are better predictors of social and occupational functioning than positive and negative symptoms [4]. The cognitive deficits of schizophrenia may be further amplified by the chronic use of psychoactive substances. In schizophrenia, the lifetime prevalence of substance use disorders approaches 50%; this estimate represents a 3- to 5-fold increased risk relative to the general population [5, 6]. Noteworthy, in younger schizophrenia populations, cannabis is one of the most frequently used psychoactive substances with lifetime prevalence rates of cannabis abuse/dependence up to 45% [7]. In addition to producing acute psychotic-like experiences [8], cannabis smoking has been shown to increase the risk for psychotic outcomes in nonpsychosis
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