A study on tobacco use in women with major mental illnesses- schizophrenia, bipolar disorder and recurrent depression

Substance use Specificities in Women with Psychosis: A Critical Review

BACKGROUND

Women with schizophrenia or other psychotic disorders differ from male patients in many respects, including psychopathology, prognosis, disease course, and substance use comorbidities. Most studies performed to date to investigate the association between drug use and psychosis have not evaluated gender differences, although this has started to change in recent years.

METHODS

We briefly summarize the available evidence on gender differences in drug use and substance use disorders (SUD) in psychotic patients during the early phases of the psychotic illness and during the course of schizophrenia.

RESULTS

Substance use and SUD are both less prevalent in women, both in the general population and at all phases of the psychotic spectrum. Some studies suggest that SUD may be under diagnosed in female patients, in part due to their more vulnerable profile. Substance use, especially cannabis, may more negatively impact females, especially on the disease course and prognosis. The available data suggest that it may be more difficult to treat SUD in female patients with schizophrenia, which could negatively impact prognosis.

CONCLUSION

Women with concomitant psychotic illness and SUD comprise a highly vulnerable subgroup. This should be considered when selecting the treatment approach, especially in the early phases of the illness, to ensure better outcomes.

Cognitive function in women with major mental illnesses who use tobacco

Cognitive effects of tobacco use among women with schizophrenia, bipolar disorder or depression have not been studied extensively as most studies focussed on men smokers. As part of a study on prevalence and cognitive effects of tobacco use, women with schizophrenia, bipolar disorder and depression were assessed for cognitive functioning using an information questionnaire derived from the Indian Post Graduate Institute Battery of Brain Dysfunction (PGIBBD) and the Trail Making Tests (TMT) A and B. The community dwelling women were clinically diagnosed and recruited from the outpatient department of a free tertiary care teaching hospital in India. The sample consisted of 321 women, 141 with schizophrenia (SZ), 80 with Bipolar Disorder (BD) and 100 with Recurrent Depressive Disorder (RDD). Tobacco users answered statistically significantly fewer questions on the PGIBBD Information Questionnaire. Users also took significantly more time to complete both TMT-A and TMT-B. Age, years of schooling and tobacco use were all significant co-variates for performance on cognitive tests. Tobacco users had lower motor speed and lesser visual scanning, poorer flexibility of thinking and working memory. Women with schizophrenia performed the worst. Tobacco use may exacerbate the cognitive dysfunction associated with major mental illnesses among women.