Smoking and schizophrenia: is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use?
OBJECTIVE
Smoking rate is disproportionately high among patients with schizophrenia, resulting in significant morbidity and mortality. However, cigarette smoking has been reported to have beneficial effects on negative symptoms, extrapyramidal symptoms, cognitive functioning and mood symptoms. Therefore, smoking cessation may worsen disability in schizophrenia. The association between smoking and these key clinical parameters was examined. Additionally, severity of smoking across four different antipsychotic treatment groups was explored.


METHODS
One hundred and forty-six patients with schizophrenia were assessed for smoking using expired carbon monoxide and smoking history. They were administered the Positive and Negative Symptom Scale, The Extrapyramidal Symptom Rating Scale, the Barnes Akathisia Rating Scale, Reitans Trail-making Test (A and B) and General Health Questionnaire-28.


RESULTS
There was no difference in the chlorpromazine equivalent dose of any of the medications studied. Atypical agents were associated with significantly lower levels of smoking when compared with typical medications. There was no difference in smoking severity between the individual atypical medications examined. Similarly, there were no significant differences between smoking and non-smoking groups with regard to Positive and Negative Symptom Scale, Extrapyramidal Symptom Rating Scale, Trail-making Test and General Health Questionnaire-28. However, there was a significant difference between these groups with the smoking group demonstrating less akathisia.


CONCLUSIONS
Smoking is not associated with positive, negative cognitive and mood symptoms in schizophrenia. Smoking is associated with lower levels of antipsychotic induced akathisia. Clinicians should not be discouraged from helping patients stop smoking for fear of worsening symptoms. However, akathisia may emerge upon cessation of smoking. Switching patients from typical to atypical antipsychotics may assist patients with schizophrenia to give up smoking.
Barnes
Mark
M
Division of Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. mark_barnes@health.qld.gov.au
Lawford
Bruce R
BR
Burton
Simon C
SC
Heslop
Karen R
KR
Noble
Ernest P
EP
Hausdorf
Karrin
K
Young
Ross McD
RM
D000328:Adult; D000339:Affect; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D001944:Breath Tests; D002248:Carbon Monoxide / Q000378:metabolism; D003072:Cognition Disorders / Q000139:chemically induced / Q000453:epidemiology; D004298:Dopamine / Q000378:metabolism; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009538:Nicotine / Q000378:metabolism / Q000493:pharmacokinetics; D011595:Psychomotor Agitation / Q000453:epidemiology / Q000209:etiology; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism; D012701:Serotonin / Q000378:metabolism; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods*; D011795:Surveys and Questionnaires; D014145:Trail Making Test
D014150:Antipsychotic Agents; D012701:Serotonin; D009538:Nicotine; D002248:Carbon Monoxide; D004298:Dopamine