Nicotine Dependence and Psychiatric Symptoms in Schizophrenic Patients

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Nuth Graipaspong, M.D.


Objectives: To examine prevalence of nicotine dependence in patients with schizophrenia, association between nicotine dependence and severity of psychiatric symptoms in schizophrenia and related factors.

Methods: This cross-sectional study enrolled 193 schizophrenic patients at outpatient unit, Galya Rajanagarindra Institute. Collecting data was proceeded during December 2018 to March2019. Participants were evaluated with Thai version of Positive and negative syndrome scale (PANSS) for severity of psychiatric symptoms and Thai version of Fagerstrom test of nicotine dependence (FTND) for severity of nicotine dependence. Data was analyzed using descriptive statistics, Chi-square test, unpaired t-test and Mann-Whitney U test

Results: Prevalence of nicotine dependence in schizophrenic patients was 34.2 % (95% CI 27.54-41.36). Mean FTND was 4.53 (SD=2.08). Male, younger age, educational level below bachelor’s degree, being employed, use of other substances, severity of psychiatric symptoms and not being treated with atypical antipsychotics (except clozapine) were associated with nicotine dependence (p-value ≤ 0.05). Multivariate analysis revealed that the risk factors for nicotine dependence were every 10 points of higher severity of psychiatric symptoms (OR 2.60, 95% CI 1.87-3.63), 10 years younger age (OR 1.69, 95%CI 1.12-2.56), being employed (OR 5.11, 95% CI 2.11-13.26) and not being treated with atypical antipsychotics (except clozapine) (OR 4.00, 95%CI 1.54-12.50).

Conclusion: One-third of schizophrenic patients had nicotine dependence. Related factors were severity of psychiatric symptoms, age, employment status and not being treated with atypical antipsychotics (except clozapine).


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1 McEvoy JP, Allen TB. The importance of nicotinic acetylcholine receptors in schizophrenia, bipolar disorder and Tourette's syndrome. Curr Drug Targets CNS Neurol Disord. 2002;1:433-42.

2. Ziaaddini H, Kheradmand A, Vahabi M. Prevalence of cigarette smoking in schizophrenic patients compared to other hospital admitted psychiatric patients. Addict Health. 2009;1:38-42.

3. Esterberg ML, Compton MT. Smoking behavior in persons with a schizophrenia-spectrum disorder: a qualitative investigation of the transtheoretical model. Soc Sci Med. 2005;61:293-303.

4. Salokangas RK, Honkonen T, Stengard E, Koivisto AM, Hietala J. Cigarette smoking in long-term schizophrenia. Eur Psychiatry. 2006;21:219-23.

5. ธีรศักดิ์ สาตรา, กมลเนตร วรรณเสวก, วัลลภ อัจสริยะสิงห์, จิรัฏฐ์ธาร ลุยศิริโรจนกุล. ความชุกของภาวะติดสารนิโคติน ในผู้ป่วยโรคจิตเภท โรงพยาบาลศิริราช กรุงเทพมหานคร [Prevalence of Nicotine dependence in Schizophrenic patients, Siriraj hospital, Bangkok]. วารสารสมาคมจิตแพทย์แห่งประเทศไทย. 2560;62:289-98. Thai.

6. Liang Y, Huang J, Tian J, Cao Y, Zhang G, Wang C, et al. The prevalence and risk factors of stroke in patients with chronic schizophrenia. Neuropsychiatr Dis Treat. 2016;12:1131-4.

7. Lasebikan VO. Tobacco smoking and medical co-morbidities among patients with schizophrenia in a Nigerian clinical setting. Afr J Med Med Sci. 2014;43:315-25.

8. Dervaux A, Laqueille X. [Tobacco and schizophrenia: therapeutic aspects]. Encephale. 2007;33(4 Pt 1):629-32. French.

9. Sagud M, Mihaljevic-Peles A, Muck-Seler D, Pivac N, Vuksan-Cusa B, Brataljenovic T, et al. Smoking and schizophrenia. Psychiatr Danub. 2009;21:371-5.

10. Dickerson F, Stallings C, Origoni A, Schroeder J, Khushalani S, Yolken R. Mortality in schizophrenia: clinical and serological predictors. Schizophr Bull. 2014;40:796-803.

11. Lucatch AM, Lowe DJE, Clark RC, Kozak K, George TP. Neurobiological determinants of tobacco smoking in Schizophrenia. Front Psychiatry. 2018;9:672.

12. 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(2-3):193-9.

13. Aguilar MC, Gurpegui M, Diaz FJ, de Leon J. Nicotine dependence and symptoms in schizophrenia: naturalistic study of complex interactions. Br J Psychiatry. 2005;186:215-21.

14. Patkar AA, Gopalakrishnan R, Lundy A, Leone FT, Certa KM, Weinstein SP. Relationship between tobacco smoking and positive and negative symptoms in schizophrenia. J Nerv Ment Dis. 2002;190:604-10.

15. Krishnadas R, Jauhar S, Telfer S, Shivashankar S, McCreadie RG. Nicotine dependence and illness severity in schizophrenia. Br J Psychiatry. 2012;201:306-12.

16. Yee A, Bt Nek Mohamed NN, Binti Hashim AH, Loh HS, Harbajan Singh MK, Ng CG, et al. The effect of nicotine dependence on psychopathology in patients with schizophrenia. Biomed Res Int. 2015;2015:730291.

17. Barnes M, Lawford BR, Burton SC, Heslop KR, Noble EP, Hausdorf K, et al. Smoking and schizophrenia: is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use? Aust N Z J Psychiatry. 2006;40(6-7):575-80.

18. Kotov R, Guey LT, Bromet EJ, Schwartz JE. Smoking in schizophrenia: diagnostic specificity, symptom correlates, and illness severity. Schizophr Bull. 2010;36:173-81.

19. Nilchaikovit T, Uneanong S, Kessawai D, Thomyangkoon P. The Thai version of the Positive and Negative Syndrome Scale (PANSS) for schizophrenia: criterion validity and interrater reliability. J Med Assoc Thai. 2000;83:646-51.

20. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37:360-3.

21. Klinsophon T, Janwantanakul P, Thaveeratitham P. Reliability of the Thai Version of the Fagerstrom Test for Nicotine Dependence. J Med Assoc Thai. 2017;100:1130-4.

22. Gardner DM, Murphy AL, O'Donnell H, Centorrino F, Baldessarini RJ. International consensus study of antipsychotic dosing. Am J Psychiatry. 2010;167:686-93.

23. Simosky JK, Stevens KE, Freedman R. Nicotinic agonists and psychosis. Curr Drug Targets CNS Neurol Disord. 2002;1:149-62.

24. Martin LF, Kem WR, Freedman R. Alpha-7 nicotinic receptor agonists: potential new candidates for the treatment of schizophrenia. Psychopharmacology (Berl). 2004;174:54-64.

25. Martin LF, Freedman R. Schizophrenia and the alpha7 nicotinic acetylcholine receptor. Int Rev Neurobio. 2007;78:225-46.

26. Freedman R. alpha7-nicotinic acetylcholine receptor agonists for cognitive enhancement in schizophrenia. Annu Rev Med. 2014;65:245-61.

27. Zhang XY, Liang J, Chen DC, Xiu MH, He J, Cheng W, et al. Cigarette smoking in male patients with chronic schizophrenia in a Chinese population: prevalence and relationship to clinical phenotypes. PloS One. 2012;7(2):e30937.

28. Combs DR, Advokat C. Antipsychotic medication and smoking prevalence in acutely hospitalized patients with chronic schizophrenia. Schizophr Res. 2000;46(2-3):129-37.

29. Procyshyn RM, Tse G, Sin O, Flynn S. Concomitant clozapine reduces smoking in patients treated with risperidone. Eur Neuropsychopharmacol. 2002;12:77-80.

30. Wijesundera H, Hanwella R, de Silva V. Antipsychotic medication and tobacco use among outpatients with schizophrenia: a cross-sectional study. Ann Gen Psychiatry. 2014;13(7):1-5.

31. Matthews AM, Wilson VB, Mitchell SH. The role of antipsychotics in smoking and smoking cessation. CNS drugs. 2011;25:299-315.

32. George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkel J, et al. Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry. 2000;157:1835-42.