title: Is smoking linked to positive symptoms in acutely ill psychiatric patients?
abstract: BACKGROUND
  The self-medication hypothesis is commonly put forward to explain the high prevalence of smoking in psychiatric patients. However, studies supporting the self-medication hypothesis have most often been carried out on chronic patients stabilized by antipsychotics.
  
  
  OBJECTIVE
  Given that antipsychotics tend to erase psychiatric symptoms, the present study was undertaken on acutely ill patients usually receiving no medications, or on whom medications are ineffective.
  
  
  METHODS
  Participants were 492 consecutively hospitalized patients. They were evaluated the day of their hospitalization with the Brief Psychiatric Rating Scale (BPRS, 18 items). Urinary cotinine and creatinine were measured the morning following their hospitalization. The urinary cotinine/creatinine ratio and the cotinine/creatinine/number of cigarettes smoked per day ratio (nicotine extraction index) were calculated for each patient.
  
  
  RESULTS
  The positive symptoms subscale of the BPRS significantly correlated with smoking, whereas other BPRS subscales did not. In patients with mood disorder, the nicotine extraction index correlated with the positive symptoms, activation and hostility subscales, but not with the negative symptoms subscale. Analyses of individual BPRS items using the cotinine/creatinine ratio measure showed that smoking is positively associated with "unusual thought content" and "grandiosity" items and negatively associated with "guilt feeling", "depressed mood" and "motor retardation". Analyses of individual BPRS items using the nicotine extraction index showed a positive association only with "unusual thought content" and "grandiosity" items. Patients with schizophrenia extract more nicotine from cigarettes than other patients.
  
  
  CONCLUSIONS
  In acutely ill psychiatric patients, smoking is linked with positive symptoms and not with negative symptoms.
authors: Groupe Hospitalier Paul-Guiraud, 54, avenue de la République, 94806 Villejuif, France. debeaurepaire@wanadoo.fr
authors: Renaud
authors: R
authors: de Beaurepaire
authors: Pascal
authors: P
authors: Rat
authors: Patrick
authors: P
authors: Beauverie
authors: Michèle
authors: M
authors: Houery
authors: Philippe
authors: P
authors: Niel
authors: Sophie
authors: S
authors: Castéra
authors: Odile
authors: O
authors: Dagorne
authors: Renaud
authors: R
authors: Espaze
authors: Patrick
authors: P
authors: Giroult
authors: Georges
authors: G
authors: Mahuzier
authors: Isabelle
authors: I
authors: Matheron
authors: Pierre
authors: P
authors: Padovani
authors: Nicole
authors: N
authors: Poisson
authors: Jean-Paul
authors: JP
authors: Richier
authors: Jérôme
authors: J
authors: Rocher
authors: Odile
authors: O
authors: Ruetsh
authors: Didier
authors: D
authors: Touzeau
authors: André
authors: A
authors: Visinoni
authors: Robert
authors: R
authors: Molimard
mesh_terms: D000208:Acute Disease; D000437:Alcoholism / Q000523:psychology*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D057565:Apathy; D010054:Brief Psychiatric Rating Scale; D003367:Cotinine / Q000652:urine; D003404:Creatinine / Q000652:urine; D006760:Hospitalization; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy; D019964:Mood Disorders / Q000523:psychology*; D009538:Nicotine / Q000627:therapeutic use; D012565:Schizophrenic Psychology; D012651:Self Medication; D012907:Smoking / Q000523:psychology*; D062789:Tobacco Products
chemical_list: D014150:Antipsychotic Agents; D009538:Nicotine; D003404:Creatinine; D003367:Cotinine