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Sánchez-Gutiérrez T, Rodríguez-Toscano E, Roldán L, Ferraro L, Parellada M, Calvo A, López G, Rapado-Castro M, La Barbera D, La Cascia C, Tripoli G, Di Forti M, Murray RM, Quattrone D, Morgan C, van Os J, García-Portilla P, Al-Halabí S, Bobes J, de Haan L, Bernardo M, Santos JL, Sanjuán J, Arrojo M, Ferchiou A, Szoke A, Rutten BP, Stilo S, D'Andrea G, Tarricone I, Díaz-Caneja CM, Arango C. Tobacco use in first-episode psychosis, a multinational EU-GEI study. Psychol Med 2023; 53:7265-7276. [PMID: 37185055 DOI: 10.1017/s0033291723000806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis. METHODS The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use. RESULTS After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use. CONCLUSIONS Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.
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Affiliation(s)
- T Sánchez-Gutiérrez
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - E Rodríguez-Toscano
- Grupo de investigación en Psiquiatría, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy at the Complutense University of Madrid, Madrid, Spain
| | - L Roldán
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - L Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - M Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Calvo
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - G López
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, Victoria 3053, Australia
| | - D La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - C La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - G Tripoli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - M Di Forti
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Mental Health Trust, London, UK
| | - R M Murray
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - D Quattrone
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - C Morgan
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - P García-Portilla
- Department of Medicine-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - S Al-Halabí
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - J Bobes
- Department of Medicine-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - L de Haan
- Early Psychosis Department, Amsterdam UMC, University of Amsterdam, Academic Psychiatric Centre, Arkin, Amsterdam, The Netherlands
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, ISCIII, Barcelona, Spain
| | - J L Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital 'Virgen de la Luz', Cuenca, Spain
| | - J Sanjuán
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - M Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Ferchiou
- Fondation FondaMental, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopitaux Universitaires 'H. Mondor', DMU IMPACT, F-94010 Creteil, France
| | - A Szoke
- Fondation FondaMental, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopitaux Universitaires 'H. Mondor', DMU IMPACT, F-94010 Creteil, France
| | - B P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
| | - G D'Andrea
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - I Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - C Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
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De Micheli A, Provenzani U, Solmi M, Van Pabst AVL, Youssef E, McGuire P, Fusar-Poli P. Prevalence of tobacco smoking in people at clinical high-risk for psychosis: Systematic review and meta-analysis. Schizophr Res 2023; 254:109-115. [PMID: 36827942 DOI: 10.1016/j.schres.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
Several hypotheses have been proposed to explain why individuals with psychosis consume more tobacco compared with the general population, but the reasons remain unclear. The phases predating the onset of psychosis could provide an interesting framework to clarify this association. The aim of this systematic review and meta-analysis is to provide an updated and comprehensive synthesis of the association between tobacco smoking and Clinical High Risk for Psychosis (CHRP) status. We performed a multistep systematic PRISMA/MOOSE-compliant electronic search for articles published from inception until October 1st, 2021. Web of Science was searched, complemented by a manual search of original articles reporting the outcome of tobacco consumption (defined as the number of individuals which were smoking tobacco at baseline) in a group of CHR-P patients versus healthy controls (HC). We employed quality assessment of the included studies with Newcastle Ottawa Scale (NOS). The effect size for the primary outcome was the odds ratio (OR) of smoking tobacco in CHR-P samples vs HC. We performed a random-effects model meta-analysis, assessment of heterogeneity with I2 index, sensitivity analyses excluding one study at a time for primary outcome, meta-regressions with four independent moderators (mean age, female ratio, sample size, NOS) and assessment of publication bias with funnel plot and Egger's test. We included 21 independent articles, totalling 2018 CHR-P individuals (mean age of 21.35 ± 2.91 years and average female ratio of 41 ± 7 %) and 1160 HC (mean age of 22.42 ± 3.70 years and average female ratio of 45 ± 11 %). The NOS score was 6.52 ± 1.25 (range from 0 to 9). The OR of smoking status was 2.22 (95%CI 1.74-2.84, p < 0.01). Heterogeneity (I2) was 24.09 (p = 0.16). Sensitivity analyses, removing one study at a time, revealed the robustness of our main finding. Meta-regressions did not reveal any significant association between the moderators and the main outcome. Visual inspection of the funnel plot and Egger's test did not reveal evident publication bias. Our main finding of an increased OR of smokers in the CHR-P individuals compared to healthy controls corroborates the accumulation of unhealthy lifestyles in this vulnerable group. This does not demonstrate any causal association between tobacco smoking and incidence of psychosis, which should be investigated in future prospective cohorts. In conclusion, the window of opportunity represented by CHR-P status should involve more efficient physical health screening and better investigating the aetiological impact of smoking in the development of psychosis.
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Affiliation(s)
- Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Philip McGuire
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
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Provenzani U, De Micheli A, Damiani S, Oliver D, Brondino N, Fusar-Poli P. Physical Health in Clinical High Risk for Psychosis Individuals: A Cross-Sectional Study. Brain Sci 2023; 13:128. [PMID: 36672109 PMCID: PMC9857012 DOI: 10.3390/brainsci13010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The clinical high risk for psychosis (CHR-P) phase represents an opportunity for prevention and early intervention in young adults, which also could focus on improving physical health trajectories. METHODS We conducted a RECORD-compliant clinical register-based cohort study. The primary outcome was to describe the physical health of assessed CHR-P individuals, obtained via Electronic Health Records at the South London and Maudsley (SLaM) NHS Foundation Trust, UK (January 2013-October 2020). RESULTS The final database included 194 CHR-P subjects (46% female). Mean age was 23.70 ± 5.12 years. Percentage of tobacco smokers was 41% (significantly higher than in the age-matched general population [24%]). We found that 49% of subjects who consumed alcohol had an AUDIT-C (Alcohol Use Disorder Identification Test) score above 5 (hazardous drinking), with an average score of 4.94 (significantly higher than in the general population [2.75]). Investigating diet revealed low fiber intake in most subjects and high saturated fat intake in 10% of the individuals. We found that 47% of CHR-P subjects met the UK recommended physical activity guidelines (significantly lower than in the general population [66%]). Physical parameters (e.g., weight, heart rate, blood pressure) were not significantly different from the general population. CONCLUSIONS This evidence corroborates the need for monitoring physical health parameters in CHR-P subjects, to implement tailored interventions that target daily habits.
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Affiliation(s)
- Umberto Provenzani
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Andrea De Micheli
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Stefano Damiani
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Dominic Oliver
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Natascia Brondino
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London SE5 8AF, UK
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Smoking Is Related to Reduced Motivation, But Not Global Cognition, in the First Two Years of Treatment for First Episode Psychosis. J Clin Med 2021; 10:jcm10081619. [PMID: 33920376 PMCID: PMC8069411 DOI: 10.3390/jcm10081619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Smoking is highly prevalent in people with psychotic disorders, even in the earliest phases of the illness. The neural mechanisms of nicotine dependence and psychosis overlap and may also be linked to deficits in neurocognition and motivation in psychosis. Both neurocognition and motivation are recognized as important clinical targets, though previous research examining the effects of smoking on these features has been inconsistent. Here, we examine the relationships between smoking status and neurocognition and motivation over the first two years of treatment for psychosis through a secondary analysis of the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) dataset. In a sample of 404 individuals with first-episode psychosis, we examined linear mixed-effects models with the group (smoker vs. non-smoker) by time (baseline, 12-month, 24-month) interaction as a predictor of global cognition and motivation. While all individuals showed enhanced global cognition and motivation over the 24-month course of treatment, non-smokers showed significantly greater gains in motivation. These changes in motivation also corresponded to improvements in functioning over the 24-month period. No significant effects of smoking were observed for global cognition. Our findings suggest that motivation and smoking cessation may be important early treatment targets for first-episode psychosis programs.
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Gogos A, Skokou M, Ferentinou E, Gourzis P. Nicotine consumption during the prodromal phase of schizophrenia - a review of the literature. Neuropsychiatr Dis Treat 2019; 15:2943-2958. [PMID: 31802874 PMCID: PMC6801495 DOI: 10.2147/ndt.s210199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Recent research has fueled a debate concerning the role of nicotine in the emergence of schizophrenia. The three main hypotheses are: (a) the self-medication effect, (b) the causal relationship hypothesis, or (c) the shared diathesis hypothesis. To explore this role, the study of nicotine consumption during the initial prodromal phase of schizophrenia offers important opportunities. In the present work, 10 relevant studies are reviewed, out of 727 retrieved citations, in order to address questions regarding the prevalence of smoking in the prodromal period, the time of smoking initiation, existing patterns of tobacco use in relation with the escalation of prodromal symptoms into first psychotic episode, and potential differences in symptomatology between smokers and nonsmokers. Even though there was considerable heterogeneity among studies, relevant findings are discussed. Prevalence of nicotine use during the prodromal period was reported to be 16.6-46%. Tobacco use was found to be taken up most often before or during the prodromal period of schizophrenia. Even though a protective role of smoking has been reported by one study, other studies report an increased risk for psychosis, with hazard ratios 2.77 (95% CI: 2.34-3.43) and 2.21 (95% CI: 1.11-4.42) for female and male heavy smokers (11-20 and >20 cigarettes/day), respectively. In a different study, the risk of onset was associated with the progressive use of cannabis and tobacco prior to onset, particularly with rapid escalation to the highest levels of use. Also, nicotine use in ultra high risk (UHR) for developing psychosis subjects is associated with elevated cognitive performance, namely better processing speed, visual learning, and spatial working memory. As a conclusion, it appears that evidence accumulates supporting a possible etiologic role of smoking, in the emergence of schizophrenia along with diverse effects on patients' symptomatology, already demonstrable at the prodromal phase. Future research employing better-defined criteria should further explore the patterns of use and effects of nicotine during the schizophrenia prodrome.
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Affiliation(s)
| | - Maria Skokou
- Department of Psychiatry, University Hospital of Patras, Rion, Patras, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, Rion, Patras, Greece
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Nadalin S, Rebić J, Šendula Jengić V, Peitl V, Karlović D, Buretić-Tomljanović A. Association between PLA2G6 gene polymorphism for calcium-independent phospholipase A2 and nicotine dependence among males with schizophrenia. Prostaglandins Leukot Essent Fatty Acids 2019; 148:9-15. [PMID: 31492433 DOI: 10.1016/j.plefa.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/03/2019] [Accepted: 07/02/2019] [Indexed: 01/08/2023]
Abstract
We investigated the relationship between the rs10798059 (BanI) and rs4375 polymorphisms in the phospholipase A2 (PLA2)G4A and PLA2G6 genes and the risk of nicotine dependence in 263 Croatian patients with schizophrenia. We also examined whether interactions between these polymorphisms and smoking contributed to schizophrenia onset and Positive and Negative Syndrome Scale (PANSS) psychopathology. We found no significant differences in the distribution of PLA2G4A genotypes and alleles according to smoking status, and no effect of the PLA2G4A genotype-smoking interaction on disease onset or PANSS. The PLA2G6-TT homozygous genotype was significantly overrepresented in male smokers compared to nonsmokers (34.7% vs. 17.1%, p < 0.05). These patients had ∼2.6-fold higher risk of becoming smokers than males with heterozygous PLA2G6-CT and homozygous PLA2G6-CC genotypes. In addition, male smokers without the PLA2G6-C allele (PLA2G6-TT homozygous) experienced earlier onset than nonsmoking homozygous PLA2G6-TT males. Thus, the PLA2G6 polymorphism affected the risk of nicotine dependence in male patients and the PLA2G6 genotype-smoking interaction was linked to the age of disease onset.
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Affiliation(s)
- Sergej Nadalin
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000, Rijeka, Croatia.
| | - Jelena Rebić
- Psychiatry Clinic, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Vjekoslav Peitl
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center and Catholic University of Croatia, Zagreb, Croatia
| | - Dalibor Karlović
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center and Catholic University of Croatia, Zagreb, Croatia
| | - Alena Buretić-Tomljanović
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000, Rijeka, Croatia
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Hunter A, Murray R, Asher L, Leonardi-Bee J. The Effects of Tobacco Smoking, and Prenatal Tobacco Smoke Exposure, on Risk of Schizophrenia: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2018; 22:3-10. [DOI: 10.1093/ntr/nty160] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background
The association between cigarette smoking and schizophrenia is well established. However, up to 90% of people with schizophrenia begin smoking before the onset of their illness; thus, smoking could be an independent risk factor for schizophrenia. Prenatal exposure to maternal cigarette smoke is also associated with psychiatric problems in adolescence. Therefore, our aim was to undertake a systematic review and meta-analysis to explore the effect of smoking, and prenatal smoke exposure, on risk of schizophrenia.
Method
We systematically searched Medline, EMBASE, PsychInfo, Maternity and Infant Care, and Web of Science (from inception to February 2018) to identify comparative observational studies of the risk of schizophrenia in relation to smoking status. Measures of relative risk (RR) were pooled in a meta-analysis with 95% confidence intervals (CI), using random effects model.
Results
Twelve studies (9 cohort, 3 case-control) were included. Odds ratios (OR) and hazard ratios (HR) were pooled together to estimate pooled relative risks and estimates combined in a meta-analysis on an assumption of constant risk over time. Smokers had a significantly increased risk of schizophrenia compared with nonsmokers (RR = 1.99, 95% CI = 1.10% to 3.61%, I2 = 97%, 5 studies). Exposure to prenatal smoke increased the risk of schizophrenia by 29% (95% CI = 1.10% to 1.51%, I2 = 71%, 7 studies). Sensitivity analyses identified no significant differences between the results from studies reporting OR and hazard ratio.
Conclusions
Our findings suggest smoking, and prenatal smoke exposure, may be an independent risk factor for schizophrenia. Care should be taken when inferring causation, given the observational nature of the studies.
Implications
In this meta-analysis of 12 studies, smokers had a significantly increased risk of schizophrenia compared with nonsmokers. Exposure to prenatal tobacco smoke also increased the risk of schizophrenia by 29% compared with those with no exposure to prenatal tobacco smoke. Our findings suggest that smoking, and prenatal tobacco smoke exposure, may be independent risk factors for schizophrenia. These results may have important public health implications for decreasing the incidence of schizophrenia. The possibility of a causal link between smoking and schizophrenia warrants further investigation.
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Affiliation(s)
- Abby Hunter
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Rachael Murray
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Laura Asher
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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8
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Aguocha C, Uwakwe R, Olose E, Amadi K, Onyeama G, Duru C. Clinical implication of smoking among patients with schizophrenia at a Tertiary Institution in South East Nigeria. Afr Health Sci 2018; 18:102-110. [PMID: 29977263 PMCID: PMC6016984 DOI: 10.4314/ahs.v18i1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The chronic and debilitating nature of schizophrenia creates a disease with marked clinical and economic consequences. Smoking in schizophrenia appears to be associated with increased psychopathology and disability. Objective The aim of this study was to determine if cigarette smoking in schizophrenia is associated with increased disability and psychopathology. Materials and methods This was a cross-sectional descriptive study in which 367 out-patients with International Classification of Diseases (ICD) 10 diagnosis of schizophrenia were recruited. Socio-demographic questionnaire, Present State Examination (PSE) 10, Positive And Negative Syndrome Scale (PANSS) and World Health Organization Disability Assessment Schedule (WHODAS) were administered. Data was analyzed using a software package SPSS version 15. Results There was no significant difference in the mean PANSS scores of smokers and non-smokers. Current smoking was associated with increased disability (F=5.39, p=0.02). Total PANSS score significantly predicted disability F(3,71=5.60, p=0.002, R2=0.19). There was no significant association between positive or negative symptoms and being a smoker or non-smoker. Conclusion The results of this study revealed that smoking in Nigerian schizophrenia patients is associated with significant disability. Measures should be put in place to discourage cigarette smoking among Nigerian patients with schizophrenia.
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Affiliation(s)
- Chinyere Aguocha
- Imo state university Teaching Hospital, Orlu, imo state, Nigeria, Department of Medicine; Imo state university , owerri, imo state, Nigeria, Department of Medicine
| | - Richard Uwakwe
- Nnamdi Azikiwe University Teaching Hospital, Mental Health
| | - Emmanuel Olose
- Department of Psychiatry, University Of Calabar, Cross Rivers, Nigeria
| | - Kennedy Amadi
- University of Nigeria, Department of Psychological Medicine
| | | | - Chukwuma Duru
- Imo State University Teaching Hospital, Orlu, Nigeria., Community Medicine
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Mallet J, Le Strat Y, Schürhoff F, Mazer N, Portalier C, Andrianarisoa M, Aouizerate B, Berna F, Brunel L, Capdevielle D, Chereau I, D'Amato T, Denizot H, Dubreucq J, Faget C, Gabayet F, Lançon C, Llorca PM, Misdrahi D, Rey R, Roux P, Schandrin A, Urbach M, Vidailhet P, Fond G, Dubertret C. Cigarette smoking and schizophrenia: a specific clinical and therapeutic profile? Results from the FACE-Schizophrenia cohort. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:332-339. [PMID: 28663115 DOI: 10.1016/j.pnpbp.2017.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/17/2017] [Accepted: 06/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tobacco use is common in patients with schizophrenia (SZ) but little is known on the role of tobacco in the physiopathology or on the course of the disease. Only few studies embrace an extensive examination of clinical and therapeutic characteristics in stabilized patients. The objective of the present study was to determine the prevalence of tobacco smoking in stabilized SZ outpatients and the clinical and treatment characteristics associated with daily tobacco use in a large community-dwelling sample of patients. METHODS Three-hundred-and-sixty-one patients were included in the network of the FondaMental Expert Centers for Schizophrenia. Current tobacco status was self-declared. RESULTS 53.7% were smokers. Mean age at tobacco onset was 17.2years old. In multivariate analyses, after adjustment for confounding factors, positive symptoms and mean daily antipsychotic dose were associated with a higher frequency of tobacco use (OR=1.06 95%IC[1.02-1.12], for positive symptoms, OR=1.1, 95%IC[1.02-1.18] for daily antipsychotic dose). Education level, negative symptoms, anticholinergic agents, clozapine or aripiprazole administration were independently associated with a lower frequency of tobacco use (respectively OR=0.87, 95%IC [0.79, 0.95], OR=0.95, 95%IC[0.91-0.98], OR=0.41, 95%IC[0.22-0.76], OR=0.56, 95%IC=[0.32, 0.99] and OR=0.49, 95%IC [0.26-0.91]). CONCLUSION The prevalence of current tobacco smoking in a French community-dwelling SZ patients is higher that observed in the general population. Patients with tobacco use present clinical and therapeutic specificities that may involve interaction between cholinergic-nicotinic and dopaminergic systems. The present study suggests that some therapeutics may improve daily smoking behavior in smokers. These results should be confirmed in longitudinal studies.
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Affiliation(s)
- J Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France.
| | - Y Le Strat
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - N Mazer
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - C Portalier
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - M Andrianarisoa
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; Bordeaux Sleep Clinique, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Research Unit, 33000 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - L Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon,Université Claude Bernard Lyon 1, Equipe PSlYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - H Denizot
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France; Pôle psychiatrie universitaire, CHU Sainte-Marguerite, F-13274 Marseille Cedex 09, France
| | - F Gabayet
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Lançon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle universitaire de psychiatrie, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; CNRS UMR 5287-INCIA, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon,Université Claude Bernard Lyon 1, Equipe PSlYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - P Roux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - G Fond
- Fondation FondaMental, Créteil, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
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Wu BJ, Lan TH. Predictors of smoking reduction outcomes in a sample of 287 patients with schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2017; 267:63-72. [PMID: 26310877 DOI: 10.1007/s00406-015-0636-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/11/2015] [Indexed: 12/28/2022]
Abstract
Many studies have investigated whether a type of antipsychotics or type of adjuvant is associated with smoking reduction in patients with schizophrenia. However, there has been no study exploring a comprehensive range of factors related to smoking reduction in schizophrenia patients. We analyzed a dataset of 287 smoking patients with schizophrenia who participated in an 8-week open-label study with high- (n = 90) or low-dose nicotine dermal patches (n = 132) or bupropion (n = 65). A logistic regression model and a linear mixed model were used to explore factors associated with the outcomes of smoking cessation and reduction, i.e., the number of cigarettes smoked and the level of nicotine dependence. The total cessation rate was 6.3 % (18/287). There were no significant predictors of cessation. The time effect of reduction was significant during the program (p = 0.001). Type of antipsychotics (p = 0.018), readiness to quit (p = 0.014), baseline number of cigarettes smoked per day (p = 0.001), and nicotine dependence level (p = 0.001) were significantly associated with smoking reduction. Patients on first-generation antipsychotics (n = 129) or clozapine (n = 70) reduced their smoking more than those on non-clozapine second-generation antipsychotics (n = 74). Patients in the preparation stage (n = 97) or in the contemplation (n = 70) reduced their smoking more than those in the precontemplation stage (n = 120). The mechanisms of tobacco addiction need to be better understood for further development of effective cessation programs in patients with schizophrenia.
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Affiliation(s)
- Bo-Jian Wu
- Department of Psychiatry, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsuo-Hung Lan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
- Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Center for Neuropsychiatric Research, NHRI, Miaoli, Taiwan.
- Department of Psychiatry, Taichung Veterans General Hospital, 160, Sec.3, Chung-Kang Rd, Taichung, 40705, Taiwan.
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Hsu WY, Lin CL, Kao CH. A Population-Based Cohort Study on Peripheral Arterial Disease in Patients with Schizophrenia. PLoS One 2016; 11:e0148759. [PMID: 26871697 PMCID: PMC4752502 DOI: 10.1371/journal.pone.0148759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/21/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Peripheral arterial disease (PAD) is considered the leading cause of atherosclerotic cardiovascular morbidity. Several risk factors of PAD have been observed in patients with schizophrenia. Therefore, we hypothesize that the incidence of PAD is higher in the schizophrenia population than in the general population. Methods The patients in this population-based cohort study were selected from the Taiwanese National Health Insurance Research Database on the basis of the claims data from 2000 to 2011. We compared the incidence of PAD between schizophrenia and nonschizophrenia cohorts. Cox proportional hazard regression models were employed for analyzing the risk of PAD after adjustment for sex, age, and comorbidities. Results The adjusted hazard ratio (HR) for PAD in the schizophrenia cohort was 1.26-fold higher than that in the nonschizophrenia cohort. Furthermore, patients with schizophrenia using atypical antipsychotics exhibited a high adjusted HR for PAD. Conclusion Compared with the general population, the risk of PAD is higher among patients with schizophrenia. Early diagnosis and intervention can mitigate complications resulting from cardiovascular diseases and lower mortality.
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Affiliation(s)
- Wen-Yu Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Psychiatry, Lutung Christian Hospital, LuKang, Taiwan
- Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Abstract
The high prevalence of cigarette smoking and tobacco related morbidity and mortality in people with chronic mental illness is well documented. This review summarizes results from studies of smoking cessation treatments in people with schizophrenia, depression, anxiety disorders, and post-traumatic stress disorder. It also summarizes experimental studies aimed at identifying biopsychosocial mechanisms that underlie the high smoking rates seen in people with these disorders. Research indicates that smokers with chronic mental illness can quit with standard cessation approaches with minimal effects on psychiatric symptoms. Although some studies have noted high relapse rates, longer maintenance on pharmacotherapy reduces rates of relapse without untoward effects on psychiatric symptoms. Similar biopsychosocial mechanisms are thought to be involved in the initiation and persistence of smoking in patients with different disorders. An appreciation of these common factors may aid the development of novel tobacco treatments for people with chronic mental illness. Novel nicotine and tobacco products such as electronic cigarettes and very low nicotine content cigarettes may also be used to improve smoking cessation rates in people with chronic mental illness.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
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13
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Sankaranarayanan A, Mancuso S, Wilding H, Ghuloum S, Castle D. Smoking, Suicidality and Psychosis: A Systematic Meta-Analysis. PLoS One 2015; 10:e0138147. [PMID: 26372218 PMCID: PMC4570823 DOI: 10.1371/journal.pone.0138147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/25/2015] [Indexed: 12/22/2022] Open
Abstract
The aim of this study is to systematically review the literature that explored the association between smoking and suicidal risk among those with serious mental illness and to estimate the risk of suicidal behaviors attributable to smoking among this patient group. Multiple databases (CINAHL, PsycINFO, EMBASE, Informit Health Collection and the Cochrane Library databases) were searched from 1 January 1975 through 15 January 2014, along with references from relevant articles for observational studies that ascertained the association between smoking and suicidal behaviors among patients with psychotic disorders conducted in adult patients. Thirteen studies involving 6813 patients with severe mental illness were included. We found that smoking was significantly associated with suicidality in psychosis with an Odds Ratio of 2.12 (95% CI 1.67–2.7). Smoking is associated with suicidal risk amongst individuals with a severe mental illness; however, it is still unclear whether this represents a true risk factor or a confounder or a mediator via mechanisms, hitherto unknown, needs to be studied further.
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Affiliation(s)
- Anoop Sankaranarayanan
- Department of Geriatrics, Hamad Medical Corporation, Doha Qatar
- Department of Psychiatry, Weil Cornell Medical College, Doha Qatar
- * E-mail:
| | - Serafino Mancuso
- St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | | | - Suhaila Ghuloum
- Department of Psychiatry, Weil Cornell Medical College, Doha Qatar
- Department of Psychiatry, Hamad Medical Corporation, Doha Qatar
| | - David Castle
- St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Department of Psychiatry, Australian Catholic University, Melbourne, Australia
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14
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Gurillo P, Jauhar S, Murray RM, MacCabe JH. Does tobacco use cause psychosis? Systematic review and meta-analysis. Lancet Psychiatry 2015; 2:718-725. [PMID: 26249303 PMCID: PMC4698800 DOI: 10.1016/s2215-0366(15)00152-2] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although the association between psychotic illness and cigarette smoking is well known, the reasons are unclear why people with psychosis are more likely to smoke than are the general population. We aimed to test several hypotheses. First, that daily tobacco use is associated with an increased risk of psychotic illness in both case-control and prospective studies. Second, that smoking is associated with an earlier age at onset of psychotic illness. Finally, that an earlier age at initiation of smoking is associated with an increased risk of psychosis. We also aimed to derive an estimate of the prevalence of smoking in patients presenting with their first episode of psychosis. METHODS We searched Embase, Medline, and PsycINFO and selected observational studies in which rates of smoking were reported in people with psychotic disorders, compared with controls. We calculated the weighted mean difference for age at onset of psychosis and age at initiation of smoking. For categorical outcomes, we calculated odds ratios from cross-sectional studies and risk ratios from prospective studies. FINDINGS Of 3717 citations retrieved, 61 studies comprising 72 samples met inclusion criteria. The overall sample included 14 555 tobacco users and 273 162 non-users. The prevalence of smoking in patients presenting with their first episode of psychosis was 0·57 (95% CI 0·52-0·62; p<0·0001). In case-control studies, the overall odds ratio for the first episode of psychosis in smokers versus non-smokers was 3·22 (95% CI 1·63-6·33), with some evidence of publication bias (Egger's test p=0·018, Begg's test p=0·007). For prospective studies, we calculated an overall relative risk of new psychotic disorders in daily smokers versus non-smokers of 2·18 (95% CI 1·23-3·85). Daily smokers developed psychotic illness at an earlier age than did non-smokers (weighted mean difference -1·04 years, 95% CI -1·82 to -0·26). Those with psychosis started smoking at a non-significantly earlier age than did healthy controls (-0·44 years, 95% CI -1·21 to 0·34). INTERPRETATION Daily tobacco use is associated with increased risk of psychosis and an earlier age at onset of psychotic illness. The possibility of a causal link between tobacco use and psychosis merits further examination. FUNDING NIHR Maudsley Biomedical Research Centre.
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Affiliation(s)
| | - Sameer Jauhar
- Department of Psychosis Studies, King's College, London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, King's College, London, UK
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Chou KJ, Chen HK, Hung CH, Chen TT, Chen CM, Wu BJ. Readiness to quit as a predictor for outcomes of smoking-reduction programme with transdermal nicotine patch or bupropion in a sample of 308 patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:249-57. [PMID: 25005553 DOI: 10.1007/s00406-014-0515-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
Readiness to quit has been found to predict smoking-cessation outcomes in a general population. However, little is known about the relationship between the readiness to quit and smoking-reduction outcomes in patients with schizophrenia treated with pharmacological adjuvants. The aim of this study was to examine the association between readiness to quit and smoking-reduction outcomes in patients with schizophrenia. A total of 308 subjects using nicotine replacement therapy (NRT) (N = 242) or bupropion (N = 66) participated in an 8-week smoking-reduction programme. Participants were categorised into precontemplators (N = 127), contemplators (N = 76) and preparators (N = 105) to quit smoking based on the transtheoretical model. There was a significant difference in change in number of cigarettes (NOC) (p = 0.007) and Fagerstrom test for nicotine dependence (FTND) score (nicotine dependence level) (p = 0.029) across the stages of change. A linear regression model revealed trend of increasing reduction in NOC and FTND scores in different stages of change (NOC: B = -1.22, t = -2.81, p = 0.005; FTND: B = -0.43, t = -2.57, p = 0.011). However, the 7-day point prevalence of abstinence was 5.5% (18/308), but there was no significant association between stage of change and smoking cessation (p = 0.26), possibly due to a very small sample size of successful quitters. In summary, among a cohort of institutionalised chronic schizophrenia patients receiving 8-week NRT or bupropion, stage of change can predict smoking reduction and may serve as a useful indicator for patients' preparedness before a trial of smoking reduction.
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Affiliation(s)
- Kuan-Ju Chou
- Department of Psychiatry, Yuli Hospital, Ministry of Health and Welfare, No. 448 Chung-Hua Road, Yuli Township, 981, Hualien County, Taiwan
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Misiak B, Kiejna A, Frydecka D. Assessment of cigarette smoking status with respect to symptomatic manifestation in first-episode schizophrenia patients. Compr Psychiatry 2015; 58:146-51. [PMID: 25595518 DOI: 10.1016/j.comppsych.2014.11.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE It has been repeatedly found that cigarette smoking may influence schizophrenia psychopathology. However, little is known about the relationship between nicotine consumption and symptomatic manifestation of first-episode schizophrenia (FES). METHOD We recruited 109 minimally medicated FES patients. Cigarette smoking was assessed using the Fagerström test for nicotine dependence (FTND) and pack-year index. Psychopathology on the day of recruitment was examined using the Positive and Negative Syndrome Scale (PANSS). RESULTS Smokers had significantly lower severity of negative and depressive symptoms in comparison with non-smokers. Patients with severe nicotine dependence had significantly later age of psychosis onset in comparison with those with mild nicotine dependence and non-smokers. Significantly lower severity of negative and depressive symptoms was also observed in patients with severe nicotine dependence in comparison with non-smokers. The associations between the severity of nicotine dependence and scores of negative and depressive symptoms as well as age of psychosis onset remained significant after co-varying for gender, education, duration of untreated psychosis (DUP) and measures of antipsychotic treatment. CONCLUSION Our results indicate that cigarette smoking might be associated with less severe negative and depressive symptoms as well as delayed age of psychosis onset. However, longitudinal studies are required to indicate the direction of causality.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
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Manzella F, Maloney SE, Taylor GT. Smoking in schizophrenic patients: A critique of the self-medication hypothesis. World J Psychiatry 2015; 5:35-46. [PMID: 25815253 PMCID: PMC4369547 DOI: 10.5498/wjp.v5.i1.35] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/27/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
A common remark among laypeople, and notably also among mental health workers, is that individuals with mental illnesses use drugs as self-medication to allay clinical symptoms and the side effects of drug treatments. Roots of the self-medication concept in psychiatry date back at least to the 1980s. Observations that rates of smokers in schizophrenic patients are multiple times the rates for regular smoking in the general population, as well as those with other disorders, proved particularly tempting for a self-medication explanation. Additional evidence came from experiments with animal models exposed to nicotine and the identification of neurobiological mechanisms suggesting self-medication with smoking is a plausible idea. More recently, results from studies comparing smoking and non-smoking schizophrenic patients have led to the questioning of the self-medication hypothesis. Closer examination of the literature points to the possibility that smoking is less beneficial on schizophrenic symptomology than generally assumed while clearly increasing the risk of cancer and other smoking-related diseases responsible for early mortality. It is a good time to examine the evidence for the self-medication concept as it relates to smoking. Our approach is to focus on data addressing direct or implied predictions of the hypothesis in schizophrenic smokers.
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Aguocha CM, Aguocha JK, Igwe M, Uwakwe RU, Onyeama GM. Prevalence and correlates of cigarette smoking among patients with schizophrenia in southeast Nigeria. Acta Psychiatr Scand 2015; 131:206-12. [PMID: 25209175 DOI: 10.1111/acps.12334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of cigarette smoking among patients with schizophrenia and to explore their sociodemographic and clinical characteristics. METHOD A cross-sectional descriptive study of 367 patients with schizophrenia. Instruments administered included sociodemographic questionnaire, Present State Examination: schizophrenia section to confirm schizophrenia diagnosis and Present State Examination: tobacco section to those that smoked. RESULTS A total of 189 females (51.5%) and 178 (48.5%) males were studied. The mean age of the participants was 34.1 ± 9.94 years. Two hundred and forty-one (65.7%) had never being married. Two hundred and three (55.3%) had secondary school education. A lifetime prevalence of 25.9% and a current smoking rate of 20.4% were reported. Ninety five (53.4%) of the males had smoked at least once in their lifetime. None of the females smoked. Among those that smoked, being unmarried (ϰ² = 6.51, P < 0.01) and unemployed (ϰ² = 5.11, P < 0.02) were associated with prescription of high doses of antipsychotics. Of those that smoked, the managing psychiatrist identified or documented only twenty-five (26.3%) of them (kappa = 0.80, P < 0.00). CONCLUSION The rate of smoking in Nigerian patients with schizophrenia is considerably less than is reported for their Western counterparts.
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Affiliation(s)
- C M Aguocha
- Department of Medicine, Imo State University Teaching Hospital, Orlu, Imo State, Nigeria
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Zugno AI, Julião RF, Budni J, Volpato AM, Fraga DB, Pacheco FD, Deroza PF, Luca RD, de Oliveira MB, Heylmann AS, Quevedo J. Rivastigmine reverses cognitive deficit and acetylcholinesterase activity induced by ketamine in an animal model of schizophrenia. Metab Brain Dis 2013; 28:501-8. [PMID: 23775300 DOI: 10.1007/s11011-013-9417-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/28/2013] [Indexed: 01/27/2023]
Abstract
Schizophrenia is one of the most disabling mental disorders that affects up to 1 % of the population worldwide. Although the causes of this disorder remain unknown, it has been extensively characterized by a broad range of emotional, ideational and cognitive impairments. Studies indicate that schizophrenia affects neurotransmitters such as dopamine, glutamate and acetylcholine. Recent studies suggest that rivastigmine (an acetylcholinesterase inhibitor) is important to improve the cognitive symptoms of schizophrenia. Therefore, the present study evaluated the protective effect of rivastigmine against the ketamine-induced behavioral (hyperlocomotion and cognitive deficit) and biochemical (increase of acetylcholinesterase activity) changes which characterize an animal model of schizophrenia in rats. Our results indicated that rivastigmine was effective to improve the cognitive deficit in different task (immediate memory, long term memory and short term memory) induced by ketamine in rats. Moreover, we observed that rivastigmina reversed the increase of acetylcholinesterase activity induced by ketamine in the cerebral cortex, hippocampus and striatum. However, rivastigmine was not able to prevent the ketamine-induced hyperlocomotion. In conslusion, ours results indicate that cholinergic system might be an important therapeutic target in the physiopathology of schizophrenia, mainly in the cognition, but additional studies should be carried.
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Affiliation(s)
- Alexandra I Zugno
- Laboratório de Neurociências, Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), and Núcleo de Excelência em Neurociências Aplicadas de Santa Catarina (NENASC), Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, 88806-000, Criciúma, SC, Brazil.
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Do atypical antipsychotics really enhance smoking reduction more than typical ones?: the effects of antipsychotics on smoking reduction in patients with schizophrenia. J Clin Psychopharmacol 2013; 33:319-28. [PMID: 23609378 DOI: 10.1097/jcp.0b013e31828b2575] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Whether atypical antipsychotics (AAs) can enhance smoking reduction in schizophrenic patients remains controversial because of methodological limitations in existing studies. This study explored whether certain types of antipsychotics predict smoking reduction in schizophrenic patients. Three hundred eight smoking, predominantly male schizophrenic patients (271/308 [88.9%]) participated in an 8-week open-label study with antismoking medications (high-dose, low-dose nicotine transdermal patch and bupropion). Antipsychotics were classified into (1) typical antipsychotics (TAs) and (2) AAs, including multiacting receptor-targeted antipsychotics (clozapine, olanzapine, and quetiapine), serotonin-dopamine antagonists (risperidone), D2/D3 receptor antagonists (amisulpride), and partial dopamine receptor agonists (aripiprazole). A general linear model was used to explore whether types of antipsychotic predict changes in the number of cigarettes smoked per day (CPD) and the score of the Fagerstrom Test for Nicotine Dependence (FTND) while controlling for confounding factors. The type of antipsychotic (TAs or AAs) was not significantly associated with smoking cessation (n = 21; χ = 1.8; df = 4; P = 0.77). Regarding smoking reduction, the type of antipsychotic was significantly predictive of a change in the CPD (P = 0.027; partial eta square = 0.055) and FTND scores (P = 0.002; partial eta square = 0.073). The 95% confidence intervals of the estimated means of change in the CPD and FTND scores did not contain zero only among subjects on TAs or clozapine.These findings suggest that TAs and clozapine enhance smoking reduction compared with nonclozapine atypical antipsychotics in schizophrenic patients. The mechanisms underlying the effects of various antipsychotics on smoking reduction remain unclear and warrant future study.
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Perera V, Gross AS, Polasek TM, Qin Y, Rao G, Forrest A, Xu J, McLachlan AJ. Considering CYP1A2 phenotype and genotype for optimizing the dose of olanzapine in the management of schizophrenia. Expert Opin Drug Metab Toxicol 2013; 9:1115-37. [PMID: 23641727 DOI: 10.1517/17425255.2013.795540] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Schizophrenia, a mental disorder, is a debilitating condition which typically strikes young people in their early 20's. Antipsychotic medications are widely prescribed for the treatment of schizophrenia however a balancing act is necessary to provide the correct dose to each patient. It is suggested that a large number of patients discontinue antipsychotic pharmacotherapy because the treatments provided do not always reduce the positive symptoms of the disease, while many have adverse effects on the patients. This implies that neither the incorrect drug nor the optimal dosage for that patient is achieved. AREAS COVERED The current review investigates variability in response to olanzapine with a specific focus on the common intrinsic and extrinsic factors that influence both olanzapine and CYP1A2 activity. Furthermore, the authors discuss the utilization of phenotyping and genotyping of CYP1A2 and their potential utility in clinical practice for olanzapine dosing regimens. The authors also consider the potential of pharmacometrics compared to pharmacogenomics as a tool to personalize medicine. EXPERT OPINION Careful consideration must be given to the impact of a genetic variant on the disposition of a drug prior to implementing genetic 'tests' to determine response. CYP1A2 phenotypic assessment can yield important information regarding the disposition of olanzapine; however, it relies on the accuracy of the metric and the minimal impact of other metabolic pathways. The application of pharmacometrics provides an effective method to establish covariates that significantly influence olanzapine disposition which can incorporate phenotype and/or genotype.
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Affiliation(s)
- Vidya Perera
- University at Buffalo, The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA.
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Stewart DW, Vinci C, Adams CE, Cohen AS, Copeland AL. Smoking topography and outcome expectancies among individuals with schizotypy. Psychiatry Res 2013; 205:205-12. [PMID: 23261186 PMCID: PMC3760683 DOI: 10.1016/j.psychres.2012.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 11/12/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022]
Abstract
Compared to smokers in the general population, smokers with schizophrenia smoke more cigarettes per day and have higher nicotine dependence and biochemical indicators of nicotine intake. They also have more intense smoking topography and greater positive smoking expectancies. Little is known about the relationship between smoking and schizotypy, defined as the personality organization reflecting a vulnerability to schizophrenia-spectrum pathology. This study assessed schizotypy symptoms, smoking characteristics and behaviors, and smoking expectancies in young adults with psychometrically defined schizotypy and demographically matched controls without schizotypy. Smokers with schizotypy had higher nicotine dependence and smoked more cigarettes per week compared to control smokers. They were also more likely to endorse greater positive consequences (i.e., improved state enhancement, stimulation, social facilitation, taste/sensorimotor manipulation, reduced negative affect and boredom) and fewer negative consequences of smoking. Smokers with schizotypy and control smokers did not differ on smoking topography or carbon monoxide levels. This is the first known study to investigate relationships between these smoking-related variables in smokers with schizotypy. Individuals with schizotypy possessed certain smoking-related characteristics and smoking expectancies similar to those with schizophrenia. This offers preliminary insight into unique smoking-related factors among individuals with schizotypy and highlights the importance of continued research in this area.
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Affiliation(s)
- Diana W Stewart
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research-Unit 1440, P.O. Box 301402, Houston, TX 77230-1402, USA.
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Chen HK, Lan TH, Wu BJ. A double-blind randomized clinical trial of different doses of transdermal nicotine patch for smoking reduction and cessation in long-term hospitalized schizophrenic patients. Eur Arch Psychiatry Clin Neurosci 2013; 263:75-82. [PMID: 22729212 DOI: 10.1007/s00406-012-0338-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/05/2012] [Indexed: 01/08/2023]
Abstract
There have been many studies of smoking cessation using nicotine replacement therapy (NRT) with schizophrenic patients, but none exploring the smoking-reduction effects of varying doses of NRT in long-stay patients with schizophrenia. This study aimed to examine the effect of different doses of the nicotine transdermal patch on smoking-reduction and cessation outcomes in long-term hospitalized schizophrenic patients. A total of 184 subjects participated in a randomized, controlled, double-blind 8-week clinical trial. Participants were randomized into two groups using two different doses of NRT: a high-dose NRT group (31.2 mg for the first 4 weeks, then 20.8 mg for 4 weeks, n = 92) or a low-dose NRT group (20.8 mg for 8 weeks, n = 92). The 7-day point prevalence of abstinence was 2.7 % (5/184). Participants in the low-dose NRT group reduced smoking by 3.1 more cigarettes on average than those in the high-dose group (p = 0.005). However, a repeated measures analysis of variance revealed that the main effect of changes in the number of cigarettes smoked, comparing the two types of treatment across periods, was not significant (p = 0.35, partial eta square = 0.018). In summary, among a cohort of chronic institutionalized schizophrenic patients, smoking cessation and reduction outcomes were not correlated with NRT dose, and the cessation rate was much lower than rates in similar studies. It indicates that long-term hospitalized schizophrenic patients have more difficulties with quitting smoking. More effective integrative smoking cessation programs should be addressed for these patients.
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Ferchiou A, Szöke A, Laguerre A, Méary A, Leboyer M, Schürhoff F. Exploring the relationships between tobacco smoking and schizophrenia in first-degree relatives. Psychiatry Res 2012; 200:674-8. [PMID: 22939230 DOI: 10.1016/j.psychres.2012.07.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 06/20/2012] [Accepted: 07/29/2012] [Indexed: 11/17/2022]
Abstract
Up to 90% of individuals with schizophrenia suffer from nicotine dependence. Both schizophrenia and nicotine consumption have strong genetic components, which may overlap. The relationship between schizophrenia and nicotine dependence remains unclear, due in part to confounding factors. Studies of the relationship between nicotine consumption and milder schizophrenia-related phenotypes, such as schizotypy, in first-degree relatives of individuals with schizophrenia could help to better understand the relationship between smoking and schizophrenia while avoiding such confounders. We assessed the proportion of smokers, their level of nicotine dependence and their level of schizotypy in a sample of 98 first-degree relatives of schizophrenic subjects and 110 healthy controls. Partial correlation analysis was used to assess the relationship between schizotypal dimensions and smoking dependence. The prevalence of smoking and nicotine dependence levels were higher in the relatives than in the healthy control group. We found no relationship between nicotine dependence and the magnitude of schizotypal features in either group. Our results support the hypothesis that the relationship between schizophrenia and smoking is largely mediated by common familial factors, which may be genetic.
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Affiliation(s)
- Aziz Ferchiou
- AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil 94000, France
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Vatss S, Mehar H, Bhatia T, Richard J, Gur RC, Gur RE, Nimgaonkar VL, Deshpande SN. Patterns of Tobacco Consumption among Indian Men with Schizophrenia Compared to Their Male Siblings. Psychiatry Investig 2012; 9:245-51. [PMID: 22993523 PMCID: PMC3440473 DOI: 10.4306/pi.2012.9.3.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/30/2011] [Accepted: 05/10/2012] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Tobacco consumption among patients with schizophrenia has been investigated extensively in western countries, but there is a dearth of studies in India, where socio-economic and cultural variables are different. This study aims to investigate the patterns of tobacco consumption among schizophrenia patients compared with their non-psychotic siblings. METHODS Consenting, successive male outpatients diagnosed with schizophrenia (n=100, DSM-IV criteria), and their non-psychotic brothers (n=100) were compared. Following a structured diagnostic interview, detailed information about tobacco consumption (including smokeless tobacco) was obtained using the Fagerstrom Test for Nicotine Dependence for smoked tobacco, and FTND-smokeless tobacco. The University of Pennsylvania Computerized Neurocognitive battery (CNB) was administered to a sub-group of patients (n=48). RESULTS Schizophrenia patients initiated tobacco use at a significantly earlier age than their brothers, but there was no significant difference with regard to type, quantity or frequency of tobacco use (smoke or smokeless varieties). Patients who consumed tobacco had significantly higher positive symptom scores compared with non-users (p=0.043). There were no significant differences between nicotine dependent and non-dependent patients with regard to CNB domains except attention. CONCLUSION Patterns of tobacco consumption were similar among schizophrenia patients and their non-psychotic brothers. Tobacco use was associated with increased positive symptom scores, but there were no significant differences in cognitive measures among nicotine dependent and non-dependent patients.
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Affiliation(s)
- Saurabh Vatss
- Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, New-Delhi, India
| | - Harpreet Mehar
- Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, New-Delhi, India
| | - Triptish Bhatia
- Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, New-Delhi, India
| | - Jan Richard
- Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, PA, USA
| | - Vishwajit L. Nimgaonkar
- Departments of Psychiatry and Human Genetics, University of Pittsburgh, School of Medicine and Graduate School of Public Health, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Smita N. Deshpande
- Department of Psychiatry, PGIMER-Dr. Ram Manohar Lohia Hospital, New-Delhi, India
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Myles N, Newall H, Compton MT, Curtis J, Nielssen O, Large M. The age at onset of psychosis and tobacco use: a systematic meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1243-50. [PMID: 21901400 DOI: 10.1007/s00127-011-0431-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 08/23/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is a well-established but poorly understood association between tobacco use and psychotic illness. The aim of this study was to determine whether tobacco use is associated with an earlier age at onset of psychotic illness. METHODS Peer-reviewed publications in English reporting the age at onset of psychosis in tobacco-using and non-tobacco-using groups were located using searches of CINAHL, EMBASE, MEDLINE, PsycINFO and ISI Web of Science, and were supplemented by papers located by manual searches and unpublished data obtained by correspondence with primary researchers. A total of 29 samples reported age at onset data in a consecutive series of patients with a diagnosis of schizophrenia related psychosis or first episode psychosis. Information on study design, study population and effect size was extracted independently by three authors. A random effects meta-analysis was performed. RESULTS There was no significant difference between smokers and non-smokers in age at the onset of psychosis (standardized mean difference = -0.03). CONCLUSION Unlike cannabis use, tobacco use is not associated with an earlier onset of psychosis.
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Affiliation(s)
- Nicholas Myles
- Coffs Harbour Health Campus, Pacific Hwy, Coffs Harbour, Australia
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27
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Disordered eating attitudes in Egyptian antipsychotic naive patients with schizophrenia. Compr Psychiatry 2012; 53:259-68. [PMID: 21640339 DOI: 10.1016/j.comppsych.2011.04.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 04/09/2011] [Accepted: 04/29/2011] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The study aimed to test in a sample of Egyptian antipsychotic naive patients the hypotheses that the disordered eating attitudes co-occur with schizophrenia in a higher frequency than would be expected by chance in the general population and that the disordered eating comorbidity would be associated with more severe schizophrenia psychopathology. Previous studies have been mostly concerned with the impact of the antipsychotics. Studies relating abnormal eating behavior to the schizophrenia psychopathology rather than to its treatment are lacking. METHOD In this case-control cross-sectional study, 50 consecutive antipsychotic naive patients, newly attending the psychiatric outpatient clinic, University Hospital, Zagazig, Egypt, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia, were assessed by the Positive and Negative Syndrome Scale and compared with 50 nonpsychiatric controls using the Eating Attitudes Test (EAT40). RESULTS Patients with schizophrenia had an EAT40 mean score (23.4 ± 7.8) higher than that of controls (19.7 ± 7.2) (P = .015). Prevalence of disordered eating (defined by a score of ≥ 30 on the EAT40) in these patients was higher than in the control group (30% vs 12%, P = .027). Comparison between schizophrenia patients with and without disordered eating showed no significant differences in demographic and a number of clinical variables, but they differed in their scores on lifestyle characteristics and anthropometric measures. The group of patients with disordered eating had also higher scores on total and all scale factors but not on the negative symptom scale. CONCLUSIONS Data of this study show, perhaps for the first time, that "disordered" eating attitudes, as measured by the EAT40, are higher in a group of Egyptian patients with schizophrenia than in controls. However, the lack of difference between patients with and without disordered eating in terms of demographic and a number of clinical characteristics fail to explain the hypothesis that schizophrenia with disordered eating is a distinct subtype of schizophrenia. Data indicate, on the other hand, that the presence of disordered eating behavior in patients with schizophrenia is associated with the expression of more active psychotic symptoms.
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Kao YC, Liu YP, Cheng TH, Chou MK. Cigarette smoking in outpatients with chronic schizophrenia in Taiwan: relationships to socio-demographic and clinical characteristics. Psychiatry Res 2011; 190:193-9. [PMID: 21621853 DOI: 10.1016/j.psychres.2011.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 05/05/2011] [Accepted: 05/08/2011] [Indexed: 12/29/2022]
Abstract
In individuals with schizophrenia, the prevalence of cigarette smoking is significantly higher than that of the general population; this appears to be associated with specific psychosocial and clinical characteristics. Indeed, some evidence suggests an increased risk of suicide among smokers with schizophrenia. The purpose of this study was to examine the characteristics of smokers with schizophrenia in Taiwan. In this cross-sectional study, 95 outpatients with DSM-IV diagnosis of schizophrenia were recruited and independently interviewed for nicotine dependency with tobacco use. The effects of cigarette smoking on the various measures, especially suicidality, were investigated. The results revealed that smokers with schizophrenia had higher rates of hospitalization, lifetime suicide attempts, antipsychotic treatment side effects, psychopathology, impulsivity, depression, anxiety, and suicidal risk than non-smokers with schizophrenia. When separate analyses were conducted in male and female patients, depressive symptoms were significant predictors of suicidality among males, whereas heavy smoking, anxious symptoms, and hopelessness were significant predictors among females. From this study, we may gain insights into the role of cigarette smoking in patients of schizophrenia in Taiwan. Furthermore, cigarette smoking may influence aspects of suicidality in schizophrenia.
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Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Songshan Armed Forces General Hospital, Taipei, Taiwan, Republic of China.
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Segarra R, Zabala A, Eguíluz JI, Ojeda N, Elizagarate E, Sánchez P, Ballesteros J, Gutiérrez M. Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis. Eur Arch Psychiatry Clin Neurosci 2011; 261:241-50. [PMID: 20839003 DOI: 10.1007/s00406-010-0146-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 08/25/2010] [Indexed: 12/15/2022]
Abstract
The self-medication hypothesis attempts to explain the extraordinary high levels of cigarette smoking in schizophrenia; patients may smoke in an attempt to reduce their cognitive deficits, symptoms, or the side effects of antipsychotics. In a previous report, we detected beneficial performance in attention and working memory in patients with first-episode psychosis who smoked compared to non-smoking patients soon after stabilization. In the present study, we examine differences in the course of those deficits 12 months after the initiation of antipsychotic treatment. We also explore the association between smoking and symptoms and side effects of medication. Neuropsychological assessments were performed at baseline, month 6 and month 12 using a computerized battery that included measures of sustained attention (Continuous Performance Test CPT-O), selective attention (Stroop interference task) and working memory (CPT-XO). Patients met the criterion of fitting in the same smoking category throughout the study: non-smoker (n = 15; 0 cigarettes/day) and smoker (n = 26; >15 cigarettes/day). The non-smoking patients showed significant cognitive improvements, whereas smoking patients lost their superior baseline performance, which was probably obtained through nicotinic stimulation, at the 6- and 12-month assessments due to a static course of deficits. Smokers did not obtain any cognitive benefit after instauration of treatment and worsen their symptoms over the first year. These results suggest that smoking may constitute a marker of a more severe illness. Smoking was not associated with fewer extrapyramidal side effects. Smoking might improve attention and working memory to a similarly modest extent as atypical antipsychotics and could reflect an effort to ameliorate these cognitive dysfunctions previous to treatment instauration.
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Affiliation(s)
- Rafael Segarra
- Department of Psychiatry, Cruces Hospital, Osakidetza-Basque Health System, Vizcaya, Spain
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Torchalla I, Okoli CTC, Malchy L, Johnson JL. Nicotine dependence and gender differences in smokers accessing community mental health services. J Psychiatr Ment Health Nurs 2011; 18:349-58. [PMID: 21418435 DOI: 10.1111/j.1365-2850.2010.01674.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite evidence of differences in smoking behaviour between women and men, few studies have assessed these differences in individuals with mental illnesses. In this cross-sectional study, we explored gender differences in smoking behaviour among 298 individuals (60% male) accessing community mental health services. Individuals with a psychotic disorder as compared with a non-psychotic disorder, and individuals using a greater number of substances were more likely to be male. Readiness to change, daily cigarette consumption and level of nicotine dependence did not differ between men and women; however, subjective ratings of tobacco addiction were higher in women than in men. Among women, only scores on the subjective tobacco addiction scale were associated with nicotine dependence, while among men, a variety of variables were associated with nicotine dependence. These factors are important for understanding individual differences in tobacco dependence among clients with mental illnesses, and are expected to inform future studies examining tobacco use in mental health treatment populations.
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Affiliation(s)
- I Torchalla
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, BC, Canada.
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Stewart DW, Cohen AS, Copeland AL. Cigarette smoking across the schizotypy spectrum. Psychiatry Res 2010; 179:113-5. [PMID: 20483483 DOI: 10.1016/j.psychres.2010.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 03/26/2010] [Accepted: 04/25/2010] [Indexed: 12/15/2022]
Abstract
This study examined relationships between schizotypy symptom dimensions and smoking. Individuals with schizotypy (n=81) were twice as likely to smoke as individuals in a normative reference group (n=303). Among those with schizotypy, smokers reported more severe disorganization and less severe negative schizotypal symptoms. These findings offer insight into mechanisms underlying smoking in schizotypal individuals and suggest areas for further research.
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Affiliation(s)
- Diana W Stewart
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
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Ma X, Li C, Meng H, Du L, Wang Q, Wang Y, Deng W, Liu X, Hu X, Murray RM, Collier DA, Li T. Premorbid tobacco smoking is associated with later age at onset in schizophrenia. Psychiatry Res 2010; 178:461-6. [PMID: 20493556 DOI: 10.1016/j.psychres.2009.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 06/01/2009] [Accepted: 08/27/2009] [Indexed: 02/05/2023]
Abstract
Rates of cigarette smoking in individuals with schizophrenia well exceed those in the general population and in other mental illnesses. In the present study, we examined the relationship between smoking status, clinical characteristics and cognitive functions in 230 male Chinese schizophrenia patients. They were interviewed by experienced psychiatrists using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (SCID-P). Clinical symptoms were rated using the Positive and Negative Syndrome Scale (PANSS), and the Revised Tolerance Questionnaire (RTQ) used to evaluate the severity of nicotine dependence. Nine neuropsychological tests were used to assess cognitive function. We found that never-smokers had a younger age at examination and earlier onset and longer duration of illness than smokers and ex-smokers. The age of initiation of regular smoking in patients was significantly earlier than their age of illness onset. We found that longer duration of illness was significantly associated with higher RTQ scores. Ex-smokers with schizophrenia performed significantly more poorly on the Stroop C test than smokers. The results imply that smoking may affect cognitive function and illness onset time in patients with schizophrenia.
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Affiliation(s)
- Xiaohong Ma
- The Psychiatric Laboratory & the Department of Psychiatry, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
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Zhang XY, Li CB, Li M, Zheng YL, Zhang CX, Yan QZ, Liu WZ, Kang YM, Wang F, Chen DC, Xiu MH, Kosten TR. Smoking initiation and schizophrenia: a replication study in a Chinese Han population. Schizophr Res 2010; 119:110-114. [PMID: 20022218 DOI: 10.1016/j.schres.2009.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/22/2009] [Accepted: 11/25/2009] [Indexed: 11/28/2022]
Abstract
Schizophrenia is associated with a greater probability of ever smoking daily and with higher rates of initiation of daily smoking after age 20 in Caucasian populations. The aims of the current study were to replicate that schizophrenia is associated with smoking and higher risk of initiating daily smoking before schizophrenia starts among a large sample of male Chinese patients. A survival analysis of onset age for daily smoking compared 776 DSM-IV male inpatients with schizophrenia to 560 male controls. The results showed that the cumulative hazard curves for age of smoking initiation in schizophrenia and controls were significantly different (p<0.001), even after controlling for education (p<0.001). After excluding the patients who started smoking within 5 years before schizophrenia started, the cumulative hazard curve for schizophrenia was significantly different from ever-smoked controls (p<0.001), even after adjusting for education (p<0.001). These findings suggest that schizophrenic patients have a higher risk of starting daily smoking suggesting that vulnerability to schizophrenia may be associated with a higher risk of becoming a daily smoker.
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Affiliation(s)
- Xiang Yang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
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Herberth M, Krzyszton DN, Koethe D, Craddock MR, Bulger E, Schwarz E, Guest P, Leweke FM, Bahn S. Differential effects on T-cell function following exposure to serum from schizophrenia smokers. Mol Psychiatry 2010; 15:364-71. [PMID: 19002140 DOI: 10.1038/mp.2008.120] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cigarette smoking is more prevalent in subjects with schizophrenia compared to those with other psychiatric disorders or the general population and could therefore affect molecular pathways that impact the pathophysiology of this disorder. As smoking is also known to suppress immune responses, we investigated the effects of 'smoking-conditioned' serum obtained from schizophrenia and control subjects on healthy T cell in vitro. We found that T-cell proliferation was significantly increased following exposure to serum from smoking schizophrenia patients whereas no effect was observed when using serum from smoking control subjects or non-smoking patients and controls. We eliminated the possibility that these effects were due to quantitative differences in cigarette consumption as serum levels of the stable nicotine metabolite cotinine were similar in schizophrenic and control smokers. Molecular characterization showed that serum from patient smokers increased expression of T-cell activation markers CD69(high), CD25(high), co-stimulatory molecules CD26+, CD27+ and CD28+, and decreased T-cell receptor complex components TCRalpha/beta and CD3. Moreover, analysis of supernatants collected after T-cell exposure to serum from smoking patients showed a time-dependent decline in interleukin (IL)-2 levels, suggesting that the proliferation effect is promoted by enhanced IL-2 processing. These results suggest that cigarette smoking has selective effects on serum components that, in turn, lead to altered immune function in schizophrenia patients relative to healthy subjects. Further studies aimed at characterizing these components could result in a better understanding of the onset and aetiology of schizophrenia and potentially lead to novel therapeutic strategies.
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Affiliation(s)
- M Herberth
- Institute of Biotechnology, University of Cambridge, Cambridge CB2 1QT, UK
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Moukas G, Stathopoulou A, Gourzis P, Beratis IN, Beratis S. Relationship of "prodromal" symptoms with severity and type of psychopathology in the active phase of schizophrenia. Compr Psychiatry 2010; 51:1-7. [PMID: 19932819 DOI: 10.1016/j.comppsych.2009.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 01/28/2009] [Accepted: 02/02/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Both retrospective and prospective studies have identified a broad spectrum of "prodromal" symptoms, but their relationship to those of frank psychosis remains largely unexplored. METHOD In 73 successive hospitalized patients with schizophrenia in the first or second psychotic episode and with duration of illness 3 years or less from the onset of psychosis, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I diagnoses were made. In addition, within the first 5 days from the psychotic episode's onset, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). RESULTS Stepwise regression analyses showed that 8 prodromal symptoms carried an increased risk for high total PANSS and the components of the PANSS scores, independently of sex; 1 symptom was associated with mild psychopathology. However, the categories of negative- and positive-disorganization prodromal symptoms were not associated with the corresponding PANSS components. Similar findings were observed in the nonparanoid patients, whereas in the paranoid, only 2 nonspecific symptoms were associated with high PANSS psychopathology. In addition, there were significant associations between number of prodromal symptoms and total PANSS and the subscales positive and general scores in the patients with the nonparanoid subtypes, but there were not such associations in those with the paranoid. CONCLUSIONS Several prodromal symptoms, as well as the number of symptoms, are associated with the severity of the psychopathology of frank psychosis. In the nonparanoid subtypes there is a continuance in the transition from the prepsychotic to the psychotic stage, whereas in the paranoid, the transition appears to be disrupted.
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Affiliation(s)
- George Moukas
- Department of Psychiatry, General University Hospital of Patras, University of Patras Medical School, 265 04 Rion, Patras, Greece
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Weiser P, Becker T, Losert C, Alptekin K, Berti L, Burti L, Burton A, Dernovsek M, Dragomirecka E, Freidl M, Friedrich F, Genova A, Germanavicius A, Halis U, Henderson J, Hjorth P, Lai T, Larsen JI, Lech K, Lucas R, Marginean R, McDaid D, Mladenova M, Munk-Jørgensen P, Paziuc A, Paziuc P, Priebe S, Prot-Klinger K, Wancata J, Kilian R. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods. BMC Public Health 2009; 9:315. [PMID: 19715560 PMCID: PMC2741451 DOI: 10.1186/1471-2458-9-315] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/28/2009] [Indexed: 11/23/2022] Open
Abstract
Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities.
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Affiliation(s)
- Prisca Weiser
- Department of Psychiatry and Psychotherapy II, Ulm University, Günzburg, Germany.
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Jönsson AK, Horváth-Puhó E, Hägg S, Pedersen L, Sørensen HT. Antipsychotics and risk of venous thromboembolism: A population-based case-control study. Clin Epidemiol 2009; 1:19-26. [PMID: 20865083 PMCID: PMC2943162 DOI: 10.2147/clep.s4969] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
During the last decade, the risk of venous thromboembolism (VTE) has been reported in users of antipsychotic drugs. However, the reports have been inconclusive. This study aimed to determine the relative risk of VTE in antipsychotic drug users. Using data from medical databases in North Jutland and Aarhus Counties, Denmark, and the Danish Civil Registration System, we identified 5,999 cases with a first-time diagnosis of VTE and, based on risk set sampling, 59,990 sex- and age-matched population controls during 1997–2005. Users of antipsychotic drugs were identified from population-based prescription databases and categorized based on filled prescriptions prior to admission date for VTE or index date for controls as current (at least one prescription within 90 days), recent (at least one prescription within 91–180 days), former (at least one prescription within 181–365 days) or nonusers (no recorded prescription within 365 days). Compared with nonusers, current users of any antipsychotic drugs had an increased risk of VTE (adjusted relative risk [ARR]: 1.99, 95% confidence interval [CI]: 1.69–2.34). Former users of any antipsychotic drugs had a nonsignificant elevated risk of VTE compared with nonusers (ARR: 1.54, 95% CI: 0.99–2.40, p-value: 0.056). In conclusion, users of antipsychotic drugs have an increased risk of VTE, compared with nonusers, which might be due to the treatment itself, to lifestyle factors, to the underlying disease, or to residual confounding.
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Dome P, Lazary J, Kalapos MP, Rihmer Z. Smoking, nicotine and neuropsychiatric disorders. Neurosci Biobehav Rev 2009; 34:295-342. [PMID: 19665479 DOI: 10.1016/j.neubiorev.2009.07.013] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/23/2009] [Accepted: 07/30/2009] [Indexed: 12/20/2022]
Abstract
Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.
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Affiliation(s)
- Peter Dome
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary.
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Correlates of secondhand tobacco smoke exposure among persons with severe and persistent mental illness (SPMI) accessing community mental health services. Community Ment Health J 2009; 45:188-98. [PMID: 19189216 DOI: 10.1007/s10597-009-9180-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
Abstract
To examine the correlates of secondhand tobacco smoke (SHS) exposure in a sample of individuals with severe and persistent mental illness (SPMI) accessing community mental health services. Cross-sectional data were collected from a voluntary sample of 788 individuals with SPMI. Nonsmokers were more likely to be exposed on the street or at a bus stop, in a park or public place; whereas smokers were more likely to report SHS exposure where they lived and at their friend's homes. In a multivariate model, only number of acquaintances who smoked and the number of sources of SHS exposure remained significantly associated with perceived frequency of SHS exposure when accounting for other correlates. There is a need for the enactment and enforcement of policies to curtail SHS exposure in outdoor, public, settings. Future research will be necessary to better understand the extent and impact of SHS exposure in this population.
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Hägg S, Bate A, Stahl M, Spigset O. Associations between venous thromboembolism and antipsychotics. A study of the WHO database of adverse drug reactions. Drug Saf 2008; 31:685-94. [PMID: 18636787 DOI: 10.2165/00002018-200831080-00005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Concern has been raised about the occurrence of venous thromboembolism (VTE) during treatment with antipsychotics. However, to date, clozapine is the only antipsychotic agent for which recurring evidence supports an association with VTE. Therefore, the aim of this study was to investigate the association between antipsychotic drugs, including clozapine and VTE. STUDY DESIGN AND METHODS Data mining of the WHO database of adverse drug reactions (ADRs) using Bayesian statistics is in routine use for early alerting to possible ADRs. An information component measure was used to investigate the association between antipsychotic drugs and VTE reactions in the database. RESULTS A total of 754 suspected cases of VTE related to treatment with antipsychotics had been reported. After excluding cases related to clozapine, 379 cases remained. A robust association was found for the second-generation antipsychotics group but not for the high-potency, first-generation antipsychotics group or the low-potency first-generation antipsychotics group. The individual compounds with statistically significant associations were olanzapine, sertindole and zuclopenthixol. A time-dependent analysis showed that the associations were positive for these drugs in 2002, 2001 and 2003, respectively. Case analyses were undertaken after excluding ten suspected duplicate reports. Of the remaining 369 cases, 91 cases were associated with olanzapine, 9 with zuclopenthixol and 6 with sertindole. CONCLUSIONS VTE was more often reported with the antipsychotic drugs olanzapine, sertindole and zuclopenthixol than with other drugs in the WHO database. Further studies are warranted to explain this disproportional reporting. Since the associations found were based on incomplete clinical data, the results should be considered as preliminary and interpreted cautiously.
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Affiliation(s)
- Staffan Hägg
- Division of Clinical Pharmacology, Linköping University Hospital, Linköping, Sweden.
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Smith MJ, Barch DM, Wolf TJ, Mamah D, Csernansky JG. Elevated rates of substance use disorders in non-psychotic siblings of individuals with schizophrenia. Schizophr Res 2008; 106:294-9. [PMID: 18774264 PMCID: PMC2627404 DOI: 10.1016/j.schres.2008.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/21/2008] [Accepted: 07/28/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with schizophrenia use psychoactive substances more frequently than the general population. The genetic vulnerability to develop schizophrenia may also increase risk for the development of substance use disorders. We examine this hypothesis by assessing the rates of substance use disorders and nicotine use in non-psychotic siblings of individuals with schizophrenia. METHODS Participants included 59 individuals with DSM-IV schizophrenia, 53 of their siblings, 80 community controls, and 75 of their siblings. Statistical regression was used to assess the rates of substance use disorders and nicotine use in study participants while controlling for age, gender, lifetime diagnosis of a mood or anxiety disorder, and a family history of substance use disorder. RESULTS Individuals with schizophrenia and their non-psychotic siblings reported higher rates of alcohol and cannabis use disorders and nicotine use when compared to siblings of comparison subjects. CONCLUSIONS The vulnerability to develop schizophrenia may also extend to substance use disorders. Future research is needed to investigate the neurobiological basis of increased substance use in non-psychotic siblings and the psychosocial mechanisms that may contribute to increased substance use in non-psychotic siblings.
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Affiliation(s)
- Matthew J. Smith
- Northwestern University,Feinberg School of Medicine,Department of Psychiatry and Behavioral Sciences
| | - Deanna M. Barch
- Washington University,Department of Psychiatry,Department of Psychology,Department of Radiology
| | | | | | - John G. Csernansky
- Northwestern University,Feinberg School of Medicine,Department of Psychiatry and Behavioral Sciences
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Borras L, Mohr S, Brandt PY, Gillieron C, Eytan A, Huguelet P. Influence of spirituality and religiousness on smoking among patients with schizophrenia or schizo-affective disorder in Switzerland. Int J Soc Psychiatry 2008; 54:539-49. [PMID: 18974192 DOI: 10.1177/0020764008091424] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The rates of cigarette smoking among patients with schizophrenia are two to four times the rates observed in the community. Spirituality and religiousness have been shown to be associated with lower smoking rates in the general population. AIMS This study assessed the role of religion in cigarette smoking among patients with schizophrenia or schizo-affective disorder. METHODS Some 115 stabilized outpatients from Geneva's public psychiatric facilities were included. Interviews were conducted to investigate spiritual and religious beliefs, religious practices and religious coping. Cigarette smoking was assessed through interviews and medical records. RESULTS Some 58% of patients were smokers. Two-thirds of the total sample considered spirituality as very important or essential in their every day life. Religiosity was negatively associated with tobacco use: there were more current smokers without religious affiliation than non-smokers (p < 0.05). For non-smokers, the support of their faith community was significantly more important and they reported more frequent group religious practices than smokers ( p < 0.05). This relation persisted after controlling for demographic confounders (gender, age, ethnicity, education, civil status). CONCLUSION In patients with schizophrenia, religion and spirituality seem to be related to smoking behaviour. Similar results were previously found in the general population. These results underscore the need for a systematic exploration of religious issues in the care of smokers with schizophrenia.
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Affiliation(s)
- Laurence Borras
- University Hospital of Geneva, Department of Psychiatry, Division of Adult Psychiatry, Geneva, Switzerland.
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Abstract
There have been few investigations into the relationship of smoking to the presentation of anxiety and depression in clients with a primary diagnosis of schizophrenia. Using a survey design, the current study sought to determine if there was a significant difference between smoking and non-smoking clients in this clinical group on self-report measures of anxiety and depression. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. One hundred clients (male = 74) with a primary diagnosis of schizophrenia completed the HADS. No significant difference was observed in anxiety and depression scores as a function of smoking status. A logistic regression analysis revealed that gender was a significant predictor of smoking status. The notion that smoking behaviour and mood state are associated with schizophrenia was not supported. However, a high proportion of the cohort were smokers (69%), and male gender was a significant predictive factor in smoking status. Further research in this area is recommended in order to develop strategies which reduce this current level of smoking in clients with a primary diagnosis of schizophrenia.
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Affiliation(s)
- C R Martin
- School of Health, Nursing and Midwifery, University of the West of Scotland, University Campus Ayr, Beech Grove, Ayr, Scotland, UK.
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Affiliation(s)
- Chia-Hui Chen
- Division of Mental Health and Substance Abuse Research, National Health Research Institutes (NHRI), Taiwan
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45
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Dervaux A, Laqueille X. [Smoking and schizophrenia: epidemiological and clinical features]. Encephale 2007; 34:299-305. [PMID: 18558153 DOI: 10.1016/j.encep.2007.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 04/24/2007] [Indexed: 11/27/2022]
Abstract
FREQUENCY: The prevalence of cigarette smoking is significantly higher among patients with schizophrenia (60-90%) than in the general population (23-30%). While tobacco smoking decreases in the general population (from 45% in the 1960's to 23-30% in the 2000's), smoking in patients with schizophrenia remains high. Patients with schizophrenia smoke more cigarettes than control subjects. Patients smoke more deeply, thereby increasing their exposure to the harmful elements in tobacco smoke. IMPACT OF SMOKING IN SCHIZOPHRENIC PATIENTS: As in the general population, smoking contributes to the reduced life expectancy in patients with schizophrenia. Patients with schizophrenia are at increased risk for cardiovascular disease due to high rates of cigarette smoking. In the Department of Mental Health of the commonwealth of Massachusetts, cardiovascular disease was the factor the most strongly associated with excess mortality. Cardiac deaths were elevated more than six-fold. Weight gain, insulin resistance, metabolic syndrome and diabetes mellitus are frequent in patients with schizophrenia, and may worsen the risk of cardiovascular diseases. It has been reported that the risk for lung cancer in patients with schizophrenia is lower than that of the general population, despite increased smoking. However, in a study conducted in Finland, a slightly increased cancer risk was found in patients with schizophrenia. Half of the excess cases were attributable to lung cancer. IMPROVEMENT OF COGNITIVE DEFICITS: Patients with schizophrenia may use nicotine to reduce cognitive deficits and negative symptoms or neuroleptic side effects. Smoking may transiently alleviate negative symptoms in schizophrenic patients by increasing dopaminergic and glutamatergic neurotransmission in the prefrontal cortex. In patients with schizophrenia, nicotine improves some cognitive deficits: (1) sensory gating deficits and abnormalities in smooth pursuit eye movements associated with schizophrenia are transiently normalized with the administration of nicotine ; (2) high-dose nicotine transiently normalizes the abnormality in P50 inhibition in patients with schizophrenia and in their relatives; (3) in tasks that tax working memory and selective attention, nicotine may improve performance in schizophrenia patients by enhancing activation of and functional connectivity between brain regions that mediate task performance (Jacobsen et al. 2004; Paktar et al.2002); (4) cigarette smoking may selectively enhance visuospatial working memory and attentional deficits in smokers with schizophrenia. However, Harris et al., found that nicotine affects only the attention without effects of nicotine on learning, memory or visuospatial/constructional abilities. In addition, smoking could facilitate disinhibition in schizophrenic patients.
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Affiliation(s)
- A Dervaux
- Service d'Addictologie, centre hospitalier Sainte-Anne, 1 rue Cabanis, Paris, France.
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Esterberg ML, Jones EM, Compton MT, Walker EF. Nicotine consumption and schizotypy in first-degree relatives of individuals with schizophrenia and non-psychiatric controls. Schizophr Res 2007; 97:6-13. [PMID: 17897810 PMCID: PMC2819843 DOI: 10.1016/j.schres.2007.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 08/18/2007] [Accepted: 08/21/2007] [Indexed: 11/26/2022]
Abstract
Individuals with schizophrenia have very high rates of cigarette smoking, and much has been discovered about the influence of nicotine on brain functioning in schizophrenia. However, less is understood about the relationship between nicotine consumption and milder phenotypes related to schizophrenia, specifically schizotypy. This study examined the relationship between nicotine consumption and schizotypy in two unmedicated samples that included first-degree relatives and non-psychiatric controls. Forty-two first-degree relatives and 50 control participants were administered a self-report questionnaire on schizotypal features as well as a self-report questionnaire on smoking behavior. A positive relationship was found between smoking status and level of schizotypy, and higher levels of schizotypy significantly predicted the odds of being a smoker after controlling for gender and group status. Interestingly, group status was a significant moderator in the relationship between level of schizotypy and smoking status, such that the relationship between these two variables was only significant in the first-degree relatives. This is the first study to investigate the relationship between these variables in a sample of first-degree relatives of individuals with schizophrenia. Those individuals with more schizotypal features are presumably at greater risk for schizophrenia-spectrum disorders and thus may be more likely to smoke cigarettes given the known biochemical effects of nicotine on overt positive and negative symptoms of schizophrenia. Although relatives did not differ from controls in their level of self-reported schizotypy, the significant relationship between smoking status and schizotypy in the former group is likely explained by their genetic vulnerability to schizophrenia-spectrum disorders.
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Affiliation(s)
- Michelle L Esterberg
- Emory University Graduate School of Arts and Sciences, Department of Psychology, 1462 Clifton Road, Suite 235, Atlanta, GA 30322, United States.
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Fawzi MH, Fawzi MM, Khedr HH, Fawzi MM. Tobacco smoking in Egyptian schizophrenia patients with and without obsessive-compulsive symptoms. Schizophr Res 2007; 95:236-46. [PMID: 17662578 DOI: 10.1016/j.schres.2007.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 05/31/2007] [Accepted: 06/01/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nicotine dependence is common in schizophrenia patients but rare in patients with obsessive-compulsive disorder. Little is known, however, about smoking in schizophrenia patients with obsessive-compulsive symptoms (OCS) especially in a developing country, such as Egypt, that has the highest rate of tobacco consumption in the Middle East and North Africa. OBJECTIVES To test a hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without-OCS. RESULTS Out of 87 consecutive schizophrenia patients attending a psychiatric out-patients clinic in Egypt, 34 patients (39%) had significant OCS, and a smoking rate (85.3%) not significantly lower than that of patients without-OCS (90.6%). Patients were reclassified by their Fagerström's scores into 3 groups of nicotine dependence: mild (37 patients), high (21 patients) and very high (29 patients). There were no differences between these groups in terms of YBOCS scores (F=0.324; p=0.724). When comparing PANSS scores of patients, with and without-OCS, those of the former group were higher on the positive symptoms (mean=24.2 versus 20.8; p=0.002), and anxiety/depression (mean=10.8 versus 10.1; p=0.03) but lower on the negative symptoms (mean=15.0 versus 19.4; p=0.000), disorganized thoughts (mean=14.5 versus 17.5; p=0.002), and uncontrolled hostility/excitement) (mean=7.5 versus 9.5; p=0.002). However, there was no significant between-group difference in the total PANSS scores. CONCLUSIONS The high and equal rates of smoking in patients with-, and without-OCS, and the lack of difference between YBOCS scores of mild, high and very high nicotine dependence groups undermined our initial hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without them. Nevertheless, the finding of a distinctive PANSS scores, may support a suggestion that OCS in schizophrenia represent a distinct subtype or dimension.
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Affiliation(s)
- Mounir H Fawzi
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Beratis NG, Asimacopoulou A, Varvarigou A. Association of secondary sex ratio with smoking and parity. Fertil Steril 2007; 89:662-7. [PMID: 17517408 DOI: 10.1016/j.fertnstert.2007.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 03/07/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the sex ratio in offspring of smoking and nonsmoking mothers in relationship to parity. DESIGN Prospective study. SETTING University hospital. PATIENT(S) The authors studied 2,108 term singleton neonates born between 1993 and 2002, 665 from smoking mothers and 1,443 from nonsmoking mothers. INTERVENTION(S) A prospective recording of maternal age, parity and smoking status, and gender of neonates delivered over a 10-year period. MAIN OUTCOME MEASURE(S) Secondary sex ratio in regard to maternal smoking and parity. RESULT(S) The offspring sex ratio in the total sample studied was 1.09; in the offspring of smoking and nonsmoking mothers, it was 1.26 and 1.03, respectively, a statistically significant difference. In the offspring of smoking women who had parity 1, 2, and >or=3, it was 1.47, 1.35, and 0.92, whereas in those of nonsmoking women, it was 1.04, 1.00, and 1.03, respectively (the differences of the parity 1 and 2 groups between the offspring of smoking and nonsmoking mothers were statistically significant). Logistic regression analysis showed that the possibility of a boy being delivered by a mother who smoked was significantly greater in primiparous women than in women who had parity >or=3, independent of the maternal age. Conversely, parity did not affect significantly the sex ratio in the offspring of nonsmoking women. CONCLUSION(S) The findings suggest that among women who smoked, significantly more male than female offspring are born from primiparous women, whereas women who had parity >or=3 gave birth to more female offspring; biparous women give birth to significantly more male offspring, but the offspring sex ratio declined with the number of cigarettes when the mothers smoked >or=10 cigarettes per day.
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Affiliation(s)
- Nicholas G Beratis
- Department of Pediatrics, General University Hospital of Patras, University of Patras Medical School, Rio, Patras, Greece.
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Gurpegui M, Martínez-Ortega JM, Jurado D, Aguilar MC, Diaz FJ, de Leon J. Subjective effects and the main reason for smoking in outpatients with schizophrenia: a case-control study. Compr Psychiatry 2007; 48:186-91. [PMID: 17292710 DOI: 10.1016/j.comppsych.2006.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This study examines in daily smokers (1) subjective effects and main reason for smoking after controlling for nicotine dependence level in 100 controls and 173 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, schizophrenia and (2) the association of specific subjective effects and schizophrenia symptoms. The subjective effects and the main reason for smoking were studied using a questionnaire and the schizophrenia symptoms with the Positive and Negative Syndrome Scale. Proportions were compared by odds ratios controlling for the effects of sex, age, education, and level of nicotine dependence by logistic regression. Schizophrenia was strongly associated with subjective effects of cheerfulness, agility, alertness, concentration, and calmness. In patients with schizophrenia, a cheerfulness effect was associated with higher depressive symptoms; a calming effect, with higher anxiety symptoms; and a sociability effect, with lower negative symptoms. Compared with controls, desire for calmness as the main reason for smoking was more frequent in patients with schizophrenia. These survey data call for confirmation through experimental studies and may help in the design of more focused smoking cessation programs for these patients.
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Affiliation(s)
- Manuel Gurpegui
- Department of Psychiatry and Institute of Neurosciences, University of Granada Medical School, Av. Madrid 11, E-18071 Granada, Spain.
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Dome P, Teleki Z, Gonda X, Gaszner G, Mandl P, Rihmer Z. Relationship between obsessive-compulsive symptoms and smoking habits amongst schizophrenic patients. Psychiatry Res 2006; 144:227-31. [PMID: 16973220 DOI: 10.1016/j.psychres.2006.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 12/14/2005] [Accepted: 01/01/2006] [Indexed: 11/19/2022]
Abstract
The rate of smoking is especially high among patients with schizophrenia (SCH) and schizoaffective disorder (SCHAFF). Patients with obsessive-compulsive disorder (OCD) smoke less than the general population. OCD symptoms are more frequent among patients with SCH or SCHAFF than in the general population, but it is still unclear whether schizophrenia patients with OC symptoms suffer from SCH and comorbid OCD, or whether they represent a unique subgroup of SCH with presenting OC symptoms. In our study we hypothetised that the current smoking rate of schizophrenia patients with OC symptoms is lower than in schizophrenia patients without OC symptoms. We assessed OC symptoms with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), general state with the Brief Psychiatric Rating Scale (BPRS) and smoking habits with a questionnaire among 66 patients with SCH or SCHAFF. We formed two groups by dividing patients according to their Y-BOCS score. Group I consisted of patients with Y-BOCS scores under 16, while group II consisted of patients with Y-BOCS scores above 16, and we compared the current smoking rates of the two groups. We found that the rates did not differ significantly, so we came to the conclusion that OC symptoms are not in a tight relationship with smoking habits among patients with SCH/SCHAFF.
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Affiliation(s)
- Peter Dome
- National Institute of Psychiatry and Neurology, Budapest, Hungary.
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