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Scholte-Stalenhoef AN, Pijnenborg GHM, Hasson-Ohayon I, Boyette LL. Personality traits in psychotic illness and their clinical correlates: A systematic review. Schizophr Res 2023; 252:348-406. [PMID: 36804473 DOI: 10.1016/j.schres.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 12/18/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Abstract
This systematic review focuses on personality traits according to both the Five Factor Model and Cloninger Psychobiological Model in relation to treatment related outcome variables across all stages of clinical psychotic illness. Search of Pubmed and Psychinfo databases led to final inclusion of 65 studies, which were ranked on quality and analyzed according to the associations between personality and outcome. Main findings are that higher levels of Harm Avoidance and Neuroticism are associated with higher symptom levels, tendency towards passive coping, greater self-stigma, lower quality of life, and Harm Avoidance to higher suicidality. Higher levels of Extraversion and higher levels of Self-Directedness are associated with more preference for active coping, more intrinsic motivation and higher self-esteem. Higher Novelty Seeking is related to more substance use and aggression, in men specifically. On outcome of trauma, care consumption and duration of untreated illness no consistent associations with personality traits were found. Combined evidence from both personality models however reveals a consistent pattern of personality traits related to clinical outcome in psychotic disorder, which is discussed in a dimensional manner.
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Affiliation(s)
- Anne Neeltje Scholte-Stalenhoef
- Ziekenhuis Groep Twente, Department of Psychiatry, Almelo, the Netherlands; University of Groningen, Department of Psychology, Groningen, the Netherlands.
| | | | | | - Lindy-Lou Boyette
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, the Netherlands
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2
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Kanniah G, Kumar R. A selective literature review exploring the role of the nicotinic system in schizophrenia. Gen Psychiatr 2023; 36:e100756. [PMID: 36937093 PMCID: PMC10016241 DOI: 10.1136/gpsych-2022-100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
Nicotine use is more prevalent in patients with psychiatric disorders, especially those diagnosed with psychotic illnesses. Previously, this higher prevalence has been partially attributed to the potential ameliorative effects of nicotine on symptom severity and cognitive impairment. Some healthcare professionals and patients perceive there is a beneficial effect of nicotine on mental health. Emerging data show that the harm associated with nicotine in the population of patients with mental health conditions outweighs any potential benefit. This paper will review the evidence surrounding the nicotinic system and schizophrenia, with a focus on any causality between nicotine and psychosis.
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Affiliation(s)
- Guna Kanniah
- Mental Health and Addictions Services, Waikato DHB, Waikato Hospital, Hamilton, New Zealand
| | - Rishi Kumar
- Department of General Medicine, Middlemore Hospital, Auckland, New Zealand
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3
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Spasova V, Mehmood S, Minhas A, Azhar R, Anand S, Abdelaal S, Sham S, Chauhan TM, Dragas D. Impact of Nicotine on Cognition in Patients With Schizophrenia: A Narrative Review. Cureus 2022; 14:e24306. [PMID: 35475247 PMCID: PMC9020415 DOI: 10.7759/cureus.24306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/20/2022] [Indexed: 12/24/2022] Open
Abstract
Nicotine is the psychoactive component given tobacco has several main components and acts as an agonist for nicotinic acetylcholine receptors (nAChRs) in the nervous system. Although the ligand-gated cation channels known as nAChRs are found throughout the nervous system and body, this review focuses on neuronal nAChRs. Individuals with psychiatric diseases such as schizophrenia, comorbid substance use disorders, attention-deficit hyperactivity disorder, major depression, and bipolar disorder have increased rates of smoking. These psychiatric disorders are associated with various cognitive deficits, including working memory, deficits in attention, and response inhibition functions. The cognitive-enhancing effects of nicotine may be particularly relevant predictors of smoking initiation and continuation in this comorbid population. Individuals with schizophrenia make up a significant proportion of smokers. Literature suggests that patients smoke to alleviate cognitive deficiencies due to the stimulating effects of nicotine. This narrative review examines the role of nicotine on cognition in schizophrenia.
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Biviá-Roig G, Soldevila-Matías P, Haro G, González-Ayuso V, Arnau F, Peyró-Gregori L, García-Garcés L, Sánchez-López MI, Lisón JF. The Impact of the COVID-19 Pandemic on the Lifestyles and Levels of Anxiety and Depression of Patients with Schizophrenia: A Retrospective Observational Study. Healthcare (Basel) 2022; 10:healthcare10010128. [PMID: 35052292 PMCID: PMC8776060 DOI: 10.3390/healthcare10010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population’s usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizophrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X2 = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.
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Affiliation(s)
- Gemma Biviá-Roig
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain; (L.P.-G.); (L.G.-G.); (M.I.S.-L.)
- Correspondence:
| | - Pau Soldevila-Matías
- State Reference Center for Psychosocial Rehabilitation (Creap), 46015 Valencia, Spain; (P.S.-M.); (V.G.-A.)
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, 46015 Valencia, Spain
| | - Gonzalo Haro
- TXP Research Group, Medicine & Surgery Department, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain;
- Mental Health Department, Consorcio Hospitalario Provincial de Castellón, 12002 Castellón, Spain;
| | - Victor González-Ayuso
- State Reference Center for Psychosocial Rehabilitation (Creap), 46015 Valencia, Spain; (P.S.-M.); (V.G.-A.)
| | - Francisco Arnau
- Mental Health Department, Consorcio Hospitalario Provincial de Castellón, 12002 Castellón, Spain;
| | - Loreto Peyró-Gregori
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain; (L.P.-G.); (L.G.-G.); (M.I.S.-L.)
| | - Laura García-Garcés
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain; (L.P.-G.); (L.G.-G.); (M.I.S.-L.)
| | - Maria I. Sánchez-López
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain; (L.P.-G.); (L.G.-G.); (M.I.S.-L.)
| | - Juan Francisco Lisón
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, 46115 Valencia, Spain;
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Carlos III Health Institute, 28029 Madrid, Spain
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Sud D, Laughton E, McAskill R, Bradley E, Maidment I. The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review. Syst Rev 2021; 10:92. [PMID: 33789745 PMCID: PMC8015120 DOI: 10.1186/s13643-021-01586-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. METHODS A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. RESULTS A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. CONCLUSIONS Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086411.
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Affiliation(s)
- Dolly Sud
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eileen Laughton
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Robyn McAskill
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Eleanor Bradley
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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6
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Wagner E, Oviedo-Salcedo T, Pelzer N, Strube W, Maurus I, Gutwinski S, Schreiter S, Kleymann P, Morgenroth CL, Okhuijsen-Pfeifer C, Luykx JJ, Falkai P, Schneider-Axmann T, Hasan A. Effects of Smoking Status on Remission and Metabolic and Cognitive Outcomes in Schizophrenia Patients Treated with Clozapine. PHARMACOPSYCHIATRY 2020; 53:273-283. [PMID: 32757178 DOI: 10.1055/a-1208-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Even though clozapine is the recommended last-resort antipsychotic, many patients fail to respond and show treatment-refractory psychotic symptoms. Smoking has been suggested as a possible risk factor for poor clozapine response, hampering remission and negatively impacting somatic outcomes. METHODS Our aim was to test whether smoking status is associated with remission rates and other symptomatic and somatic outcomes. We therefore assessed remission rates according to The Remission in Schizophrenia Working Group (RSWG) criteria, and metabolic and cognitive outcomes among patients with schizophrenia-spectrum disorders treated with clozapine for at least 6 months. For analyses, we grouped our cohort into 3 groups according to clozapine treatment duration (6 months, 2 years, 5 years). RESULTS One hundred five patients were included in our analyses and grouped according to their clozapine treatment duration. In the 6-months analyses, patients who smoked were significantly more likely to be younger of age (p=0.002) despite on average shorter duration of clozapine treatment (p=0.041) and significantly more likely to be treated with mood-stabilizing co-medication (p=0.030) compared to nonsmokers. Remission rates (p=0.490), as well as a set of metabolic and cognitive variables did not differ between the 2 groups. A related pattern could be observed for the 2- and 5-years analyses. CONCLUSIONS Smoking behavior among clozapine-treated schizophrenia patients might delineate a cohort with an earlier onset of the disease. Nevertheless, most findings comparing disease-specific and clinical outcomes among smokers and nonsmokers were negative. Further research is needed to identify strategies to overcome insufficient remission rates in this patient group.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Tatiana Oviedo-Salcedo
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Nicola Pelzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Phillip Kleymann
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | | | - Cynthia Okhuijsen-Pfeifer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,GGNet Mental Health, second opinion outpatient clinic
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
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7
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Salokangas RKR, Honkonen T, Stengård E, Koivisto AM, Hietala J. Cigarette smoking in long-term schizophrenia. Eur Psychiatry 2020; 21:219-23. [PMID: 16360309 DOI: 10.1016/j.eurpsy.2005.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 07/24/2005] [Indexed: 11/22/2022] Open
Abstract
AbstractPurposeCigarette smoking is a great health problem and prevalent among subjects with schizophrenia. Our aim was to investigate the prevalence and associations of cigarette smoking in patients with long-term schizophrenia.MethodsSeven hundred and sixty schizophrenia patients were interviewed and their cigarette smoking was recorded.ResultsSmoking was more prevalent men than in women patients. In logistic regression analysis, male gender, duration of illness (DUI) from 10 to 19 years, being divorced or separated, lower education and high daily doses of neuroleptics (DDN) associated significantly with regular smoking. Heavy smoking associated, in men, with hospital treatment.ConclusionsIn schizophrenia patients, smoking is associated with long DUI, high DDN and institutional care. Interventions for cessation and/or reduction of cigarette smoking should be a part of the treatment for patients with schizophrenia.
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Affiliation(s)
- R K R Salokangas
- Department of Psychiatry, University of Turku Psychiatric Clinic, Turku University Central Hospital, 20520 Turku, Finland.
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8
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Ho RKS, Lee GMT, Fok PWY, Chan HCH, Ching JKW. Characteristics of Chinese smokers with psychotic disorders
and their predictors on smoking cessation in Hong Kong. Tob Prev Cessat 2020; 6:7. [PMID: 32548344 PMCID: PMC7291916 DOI: 10.18332/tpc/115030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Raymond K. S. Ho
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Gina M. T. Lee
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Patrick W. Y. Fok
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Helen C. H. Chan
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Joe K. W. Ching
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
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9
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Abstract
The term "pseudoneurotic schizophrenia" was introduced in 1949 by Hoch and Polatin to describe apparently neurotic patients showing formal thought disorders, emotional dysregulation, and transient psychotic symptoms. Even if this diagnostic entity is no longer included in modern diagnostic systems, its evolution is intertwined with the history of schizophrenia in the 20th century. This article retraces the development of pseudoneurotic (or "borderline") schizophrenia in modern psychiatry, finding it a pioneering concept in psychopathology. In particular, we demonstrate that recent findings about the positive syndrome, good-outcome, type I "distress" subtype of schizophrenia (associated with high emotionality, including anxiety, depression, and sensitivity to stress) show surprising consistency with the clinical concept of pseudoneurotic schizophrenia. Finally, we discuss the historical development of pseudoneurotic schizophrenia in modern psychiatry as a meaningful example of the difficulty of confining severe psychological disturbances lying at the edge of full-blown schizophrenia within a widely accepted diagnostic category.
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Lally J, Spaducci G, Gardner-Sood P, Atakan Z, Greenwood K, Di Forti M, Ismail K, Murphy KC, Smith S, McNeill A, Murray RM, Gaughran F. Tobacco smoking and nicotine dependence in first episode and established psychosis. Asian J Psychiatr 2019; 43:125-131. [PMID: 31132542 DOI: 10.1016/j.ajp.2019.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 01/08/2023]
Abstract
AIM People with psychotic disorders have increased premature mortality in comparison with the general population, with high rates of cigarette use a contributing factor. We aimed to describe the prevalence of cigarette use and nicotine dependence (ND) in first episode psychosis (FEP), and established psychosis; and to investigate associations between clinical symptoms and ND. METHODOLOGY Smoking and clinical data were collected from two cohorts: 181 people with FEP recruited as part of the Physical Health and Substance Use Measures in First Onset Psychosis (PUMP) study and from 432 people with established psychosis recruited as part of the Improving physical health and reducing substance use in psychosis randomised controlled trial (IMPaCT RCT). RESULTS The prevalence of cigarette smoking was 78% in FEP and 62% in established psychosis. Forty nine percent (n = 60) of smokers in the FEP cohort and 69% (n = 183) of smokers with established psychosis were highly nicotine dependent. Being a highly nicotine dependent smoker was significantly associated with higher PANSS positive symptom scores (F = 5.480 p = 0.004), and with decreased scores on the Rosenberg self-esteem scale (F = 3.261, p = 0.039) in established psychosis. There was no diagnostic specificity identified in relation to smoking or ND in both groups. CONCLUSION High rates of cigarette usage and nicotine dependence are problems from the early stages of psychosis. ND is higher in people with established psychosis. Smoking cessation strategies as part of comprehensive management of psychotic disorders at every stage require further development and evaluation.
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Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; St Vincent's Hospital Fairview, Dublin, Ireland.
| | - Gilda Spaducci
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK.
| | | | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, School of Psychology, University of Sussex, Brighton, UK.
| | - Marta Di Forti
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Khalida Ismail
- Psychological Medicine Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Denmark Hill, London, UK.
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK; Forensic Intensive Care Service, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy.
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, Reader, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK.
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11
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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: 0.2] [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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12
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Dickinson D, Pratt DN, Giangrande EJ, Grunnagle M, Orel J, Weinberger DR, Callicott JH, Berman KF. Attacking Heterogeneity in Schizophrenia by Deriving Clinical Subgroups From Widely Available Symptom Data. Schizophr Bull 2018; 44:101-113. [PMID: 28369611 PMCID: PMC5768050 DOI: 10.1093/schbul/sbx039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Previous research has identified (1) a "deficit" subtype of schizophrenia characterized by enduring negative symptoms and diminished emotionality and (2) a "distress" subtype associated with high emotionality-including anxiety, depression, and stress sensitivity. Individuals in deficit and distress categories differ sharply in development, clinical course and behavior, and show distinct biological markers, perhaps signaling different etiologies. We tested whether deficit and distress subtypes would emerge from a simple but novel data-driven subgrouping analysis, based on Positive and Negative Syndrome Scale (PANSS) negative and distress symptom dimensions, and whether subgrouping was informative regarding other facets of behavior and brain function. PANSS data, and other assessments, were available for 549 people with schizophrenia diagnoses. Negative and distress symptom composite scores were used as indicators in 2-step cluster analyses, which divided the sample into low symptom (n = 301), distress (n = 121), and deficit (n = 127) subgroups. Relative to the low-symptom group, the deficit and distress subgroups had comparably higher total PANSS symptoms (Ps < .001) and were similarly functionally impaired (eg, global functioning [GAF] Ps < .001), but showed markedly different patterns on symptom, cognitive and personality variables, among others. Initial analyses of functional magnetic resonance imaging (fMRI) data from a 182-participant subset of the full sample also suggested distinct patterns of neural recruitment during working memory. The field seeks more neuroscience-based systems for classifying psychiatric conditions, but these are inescapably behavioral disorders. More effective parsing of clinical and behavioral traits could identify homogeneous target groups for further neural system and molecular studies, helping to integrate clinical and neuroscience approaches.
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Affiliation(s)
- Dwight Dickinson
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD,To whom correspondence should be addressed; 10 Center Drive, Building 10, Room 3c-115, Bethesda, MD 20814, US; tel: 301-451-2123, fax: 301-480-7795, e-mail:
| | - Danielle N Pratt
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Evan J Giangrande
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - MeiLin Grunnagle
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Jennifer Orel
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Daniel R Weinberger
- The Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
| | - Joseph H Callicott
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Karen F Berman
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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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: 3.4] [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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Smucny J, Tregellas JR. Targeting neuronal dysfunction in schizophrenia with nicotine: Evidence from neurophysiology to neuroimaging. J Psychopharmacol 2017; 31:801-811. [PMID: 28441884 PMCID: PMC5963521 DOI: 10.1177/0269881117705071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with schizophrenia self-administer nicotine at rates higher than is self-administered for any other psychiatric illness. Although the reasons are unclear, one hypothesis suggests that nicotine is a form of 'self-medication' in order to restore normal levels of nicotinic signaling and target abnormalities in neuronal function associated with cognitive processes. This brief review discusses evidence from neurophysiological and neuroimaging studies in schizophrenia patients that nicotinic agonists may effectively target dysfunctional neuronal circuits in the illness. Evidence suggests that nicotine significantly modulates a number of these circuits, although relatively few studies have used modern neuroimaging techniques (e.g. functional magnetic resonance imaging (fMRI)) to examine the effects of nicotinic drugs on disease-related neurobiology. The neuronal effects of nicotine and other nicotinic agonists in schizophrenia remain a priority for psychiatry research.
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason R Tregellas
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Research Service, Denver VA Medical Center, Denver, CO, USA
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15
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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: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [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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16
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Wehring HJ, Heishman SJ, McMahon RP, Liu F, Feldman S, Raley H, Weiner E, Kelly DL. Antipsychotic Treatment and Tobacco Craving in People With Schizophrenia. J Dual Diagn 2017; 13:36-42. [PMID: 28166471 PMCID: PMC5379991 DOI: 10.1080/15504263.2017.1288946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Nicotine dependence is high in schizophrenia, and craving is known to impact relapse during quit attempts. METHODS We compared tobacco craving in smokers with schizophrenia treated with different antipsychotics. RESULTS Mean craving scores were lowest in participants receiving first-generation antipsychotics, although these differences were not statistically significant. Craving with clozapine was not lower than with other antipsychotics. CONCLUSIONS Further research is needed to determine whether differences in craving exist between antipsychotic classes.
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Affiliation(s)
- Heidi J Wehring
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stephen J Heishman
- b National Institute of Health, National Institute on Drug Abuse, Intramural Research Program , Baltimore , MD , USA
| | - Robert P McMahon
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Fang Liu
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stephanie Feldman
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Heather Raley
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elaine Weiner
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Deanna L Kelly
- a Maryland Psychiatric Research Center, University of Maryland School of Medicine , Baltimore , MD , USA
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17
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Lee S, Black D, Held M. Associations of multiplicity of comorbid health conditions, serious mental illness, and health care costs. SOCIAL WORK IN HEALTH CARE 2016; 55:518-30. [PMID: 27285200 DOI: 10.1080/00981389.2016.1183551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Using a nationally representative U.S. sample, this study analyzed the effects of serious mental illness (SMI) and comorbid medical conditions on the cost of health care. The results of path model indicated that SMI and comorbid health conditions each increased total health care costs. Additionally, individuals with SMI were likely to have more comorbid medical conditions, which in turn, increased total health care costs. Findings raise awareness of an increased risk of medical conditions among individuals with SMI and the concern of high expenditures associated with comorbid SMI and medical conditions.
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Affiliation(s)
- Sungkyu Lee
- a School of Social Welfare , Soongsil University , Seoul , South Korea
| | - Denise Black
- b College of Social Work , University of Tennessee , Knoxville , Tennessee , USA
| | - Mary Held
- b College of Social Work , University of Tennessee , Knoxville , Tennessee , USA
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18
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Santos APSD, Ramos D, Oliveira GMD, Santos AASD, Freire APCF, Ito JT, Fernandes RPP, Vanderlei LCM, Ramos EMC. Influence of Smoking Consumption and Nicotine Dependence Degree in Cardiac Autonomic Modulation. Arq Bras Cardiol 2016; 106:510-8. [PMID: 27142649 PMCID: PMC4940150 DOI: 10.5935/abc.20160063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/23/2016] [Indexed: 12/19/2022] Open
Abstract
Background Smoking consumption alters cardiac autonomic function. Objective Assess the influence of the intensity of smoking and the nicotine dependence
degree in cardiac autonomic modulation evaluated through index of heart rate
variability (HRV). Methods 83 smokers, of both genders, between 50 and 70 years of age and with normal
lung function were divided according to the intensity of smoking consumption
(moderate and severe) and the nicotine dependency degree (mild, moderate and
severe). The indexes of HRV were analyzed in rest condition, in linear
methods in the time domain (TD), the frequency domain (FD) and through the
Poincaré plot. For the comparison of smoking consumption, unpaired t
test or Mann-Whitney was employed. For the analysis between the nicotine
dependency degrees, we used the One-way ANOVA test, followed by Tukey's post
test or Kruskal-Wallis followed by Dunn's test. The significance level was p
< 0,05. Results Differences were only found when compared to the different intensities of
smoking consumption in the indexes in the FD. LFun (62.89 ± 15.24 vs
75.45 ± 10.28), which corresponds to low frequency spectrum component
in normalized units; HFun (37.11 ± 15.24 vs 24.55 ± 10.28),
which corresponds to high frequency spectrum component in normalized units
and in the LF/HF ratio (2.21 ± 1.47 vs 4.07 ± 2.94). However,
in the evaluation of nicotine dependency, significant differences were not
observed (p > 0.05). Conclusion Only the intensity of smoking consumption had an influence over the cardiac
autonomic modulation of the assessed tobacco smokers. Tobacco smokers with
severe intensity of smoking consumption presented a lower autonomic
modulation than those with moderate intensity.
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Affiliation(s)
- Ana Paula Soares Dos Santos
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Dionei Ramos
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Gabriela Martins de Oliveira
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Ana Alice Soares Dos Santos
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Ana Paula Coelho Figueira Freire
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Juliana Tiyaki Ito
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, Presidente Prudente, SP, Brazil
| | | | - Luiz Carlos Marques Vanderlei
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Ercy Mara Cipulo Ramos
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
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Brunette MF, Ferron JC, Gottlieb J, Devitt T, Rotondi A. Development and usability testing of a web-based smoking cessation treatment for smokers with schizophrenia. Internet Interv 2016; 4:113-119. [PMID: 30135797 PMCID: PMC6096117 DOI: 10.1016/j.invent.2016.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Over half of people with schizophrenia and other psychotic disorders smoke tobacco. Web-based approaches to cessation have been effective for the general population, but are not usable by many with schizophrenia disorders due to cognitive impairments and low computer experience. We developed a prototype smoking cessation treatment website for this group of smokers with features to reduce cognitive load. Here we report results from initial office-based usability testing and home-based field testing. METHOD Five people were observed using the prototype website in the office with think-aloud cognitive interviewing. The website was modified based on these data. Six people then used the website on a home laptop after a single training session, with further coaching if needed. RESULTS Office-based testing showed that the website was usable, but required minor modifications. Further editing provided labels that were more explicit and concrete, limited the conceptual content on each page, and modified features of the support group forum. Home-based field-testing identified further functionality issues that were rapidly modified. Over half of users needed more than a single session of training to use the computer and website. Eighty three then used it independently and were very satisfied with the web-based program. Among the five smokers who field tested the prototype, 60% cut down and 20% had quit smoking after three weeks of home use. CONCLUSION The prototype website was usable and satisfactory. With training and support, home use of this cessation website appears to be feasible and promising for cessation among smokers with schizophrenia. Further research is needed to evaluate web-based cessation treatment in people with psychotic disorders.
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Affiliation(s)
- Mary F. Brunette
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 105 Pleasant St, Concord, NH 03301, United States
| | - Joelle C. Ferron
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 105 Pleasant St, Concord, NH 03301, United States
| | - Jennifer Gottlieb
- Boston University Center for Psychiatric Rehab, 940 Commonwealth Ave W. Boston, MA 02215, United States
| | - Timothy Devitt
- Thresholds Inc., 4101 N. Ravenswood Ave, Chicago, IL 60613, United States
| | - Armando Rotondi
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15261, United States
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Featherstone RE, Siegel SJ. The Role of Nicotine in Schizophrenia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 124:23-78. [PMID: 26472525 DOI: 10.1016/bs.irn.2015.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Schizophrenia is associated with by severe disruptions in thought, cognition, emotion, and behavior. Patients show a marked increase in rates of smoking and nicotine dependence relative to nonaffected individuals, a finding commonly ascribed to the potential ameliorative effects of nicotine on symptom severity and cognitive impairment. Indeed, many studies have demonstrated improvement in patients following the administration of nicotine. Such findings have led to an increased emphasis on the development of therapeutic agents to target the nicotinic system as well as increasing the impetus to understand the genetic basis for nicotinic dysfunction in schizophrenia. The goal of this review article is to provide a critical summary of evidence for the role of the nicotinic system in schizophrenia. The first part will review the role of nicotine in normalization of primary dysfunctions and endophenotypical changes found in schizophrenia. The second part will provide a summary of genetic evidence linking polymorphisms in nicotinic receptor genes to smoking and schizophrenia. The third part will summarize attempts to treat schizophrenia using agents specifically targeting nicotinic and nicotinic receptor subtypes. Although currently available antipsychotic treatments are generally able to manage some aspects of schizophrenia (e.g., positive symptoms) they fail to address several other critically effected aspects of the disease. As such, the search for novel mechanisms to treat this disease is necessary.
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Affiliation(s)
- Robert E Featherstone
- Translational Neuroscience Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Steven J Siegel
- Translational Neuroscience Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gates J, Killackey E, Phillips L, Álvarez-Jiménez M. Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis. Lancet Psychiatry 2015; 2:726-742. [PMID: 26249304 DOI: 10.1016/s2215-0366(15)00213-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/30/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility.
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Affiliation(s)
- Jesse Gates
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Mario Álvarez-Jiménez
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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22
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Esterlis I, Bois F, Pittman B, Picciotto MR, Shearer L, Anticevic A, Carlson J, Niciu M, Cosgrove KP, D’Souza DC, D'Souza DC. In vivo evidence for β2 nicotinic acetylcholine receptor subunit upregulation in smokers as compared with nonsmokers with schizophrenia. Biol Psychiatry 2014; 76:495-502. [PMID: 24360979 PMCID: PMC4019710 DOI: 10.1016/j.biopsych.2013.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 10/16/2013] [Accepted: 11/04/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schizophrenia is associated with very high rates of tobacco smoking. The latter may be related to an attempt to self-medicate symptoms and/or to alterations in function of high-affinity β2-subunit-containing nicotinic acetylcholine receptors (β2*-nAChRs). METHODS Smoking and nonsmoking subjects with schizophrenia (n=31) and age-, smoking-, and sex-matched comparison subjects (n=31) participated in one [123I]5-IA-85380 single photon emission computed tomography scan to quantify β2*-nAChR availability. Psychiatric, cognitive, nicotine craving, and mood assessments were obtained during active smoking, as well as smoking abstinence. RESULTS There were no differences in smoking characteristics between smokers with and without schizophrenia. Subjects with schizophrenia had lower β2*-nAChR availability relative to comparison group, and nonsmokers had lower β2*-nAChR availability relative to smokers. However, there was no smoking by diagnosis interaction. Relative to nonsmokers with schizophrenia, smokers with schizophrenia had higher β2*-nAChR availability in limited brain regions. In smokers with schizophrenia, higher β2*-nAChR availability was associated with lower negative symptoms of schizophrenia and better performance on tests of executive control. Chronic exposure to antipsychotic drugs was not associated with changes in β2*-nAChR availability in schizophrenia. CONCLUSIONS Although subjects with schizophrenia have lower β2*-nAChR availability relative to comparison group, smokers with schizophrenia appear to upregulate in the cortical regions. Lower receptor availability in smokers with schizophrenia in the cortical regions is associated with a greater number of negative symptoms and worse performance on tests of executive function, suggesting smoking subjects with schizophrenia who upregulate to a lesser degree may be at risk for poorer outcomes.
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Affiliation(s)
- Irina Esterlis
- Department of Psychiatry, School of Medicine, Yale University; Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
| | - Frederic Bois
- School of Medicine, Yale University,Departments of Psychiatry VACHS
| | | | | | | | | | - Jon Carlson
- School of Medicine, Yale University,Departments of Psychiatry VACHS
| | | | - Kelly P. Cosgrove
- School of Medicine, Yale University,Departments of Psychiatry VACHS
| | - D. Cyril D’Souza
- School of Medicine, Yale University,Departments of Psychiatry VACHS
| | - D Cyril D'Souza
- Department of Psychiatry, School of Medicine, Yale University; Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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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: 1.5] [Reference Citation Analysis] [Abstract] [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: 1.1] [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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Krishnadas R, Jauhar S, Telfer S, Shivashankar S, McCreadie RG. Nicotine dependence and illness severity in schizophrenia. Br J Psychiatry 2012; 201:306-12. [PMID: 22878134 DOI: 10.1192/bjp.bp.111.107953] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reasons for the increased prevalence of cigarette smoking in schizophrenia are unclear. Studies assessing clinical symptoms have sampled heterogeneous populations, with discrepant findings. AIMS To examine the relationship between clinical features, social adjustment and nicotine dependence in a geographically defined population of people with schizophrenia. METHOD Cross-sectional clinical study of 131 people with schizophrenia in Nithsdale, Scotland. RESULTS Smokers were younger, mostly males and three times more likely to be unemployed. Those with severe nicotine dependence had greater scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS), and were prescribed higher doses of antipsychotic. Those with mild-moderate dependence had greater scores on the PANSS negative subscale. Greater symptom severity was associated with poorer social adjustment. Psychopathology and social adjustment were similar in quitters and never-smokers. CONCLUSIONS Our findings indicate an association between nicotine dependence, clinical symptoms and social adjustment in schizophrenia. Although causal links cannot be inferred, identifying the relationship between nicotine dependence and psychopathology may have some value in the management of smoking in schizophrenia. Further longitudinal studies are required to explore this relationship.
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Affiliation(s)
- Rajeev Krishnadas
- Sackler Institute of Psychobiological Research, University of Glasgow, Southern General Hospital, Glasgow G51 4TF, UK.
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26
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de Beaurepaire R, Rat P, Beauverie P, Houery M, Niel P, Castéra S, Dagorne O, Espaze R, Giroult P, Mahuzier G, Matheron I, Padovani P, Poisson N, Richier JP, Rocher J, Ruetsh O, Touzeau D, Visinoni A, Molimard R. Is smoking linked to positive symptoms in acutely ill psychiatric patients? Nord J Psychiatry 2012; 66:225-31. [PMID: 21905972 DOI: 10.3109/08039488.2011.610468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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. AIM 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. CONCLUSION In acutely ill psychiatric patients, smoking is linked with positive symptoms and not with negative symptoms.
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Affiliation(s)
- Renaud de Beaurepaire
- Groupe Hospitalier Paul-Guiraud, 54, avenue de la République, 94806 Villejuif, France.
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Cooper J, Mancuso SG, Borland R, Slade T, Galletly C, Castle D. Tobacco smoking among people living with a psychotic illness: the second Australian Survey of Psychosis. Aust N Z J Psychiatry 2012; 46:851-63. [PMID: 22645396 DOI: 10.1177/0004867412449876] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aims of this study were to (a) describe patterns of tobacco smoking among Australians living with a psychotic illness and (b) explore the association between smoking and measures of psychopathology, psychiatric history, psychosocial functioning, physical health, substance use and demographic characteristics. METHODS Data were from 1812 participants in the 2010 Australian Survey of High Impact Psychosis. Participants were aged 18-64 years and resided in seven mental health catchment sites across five states of Australia. Bivariate statistics were used to compare smokers with non-smokers on the measures of interest, and to compare ICD-10 diagnostic categories on measures of smoking prevalence, nicotine addiction and quitting history. Multivariate logistic regression was used to test whether (a) demographics and psychiatric history were associated with having ever smoked and (b) whether symptoms and psychosocial functioning were independently associated with current smoking, after controlling for demographics, psychiatric history and substance use. RESULTS The prevalence of current tobacco smoking was 66.6% (72% of men and 59% of women); lifetime prevalence was 81%. In univariate analyses, individuals with a diagnosis of schizophrenia or schizoaffective disorder were most likely to be smoking tobacco (70%) and were more nicotine dependent. Smokers reported worse perceived physical health, lower body mass index and waist circumference, and more lifetime medical conditions. A younger age of illness onset, male gender and low education were associated with having ever smoked. Associations with current smoking included low education, male gender, no formal employment, worse negative symptoms, higher daily caffeine consumption, and alcohol dependence and substance abuse/dependence. CONCLUSIONS The prevalence of tobacco smoking is high amongst people with a psychotic disorder, and is associated with adverse mental health symptoms as well as high rates of other substance use, poorer subjective physical health, and a higher risk of the many known health consequences of smoking.
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Affiliation(s)
- Jae Cooper
- VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Australia
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28
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Kelly DL, Raley HG, Lo S, Wright K, Liu F, McMahon RP, Moolchan ET, Feldman S, Richardson CM, Wehring HJ, Heishman SJ. Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophr Bull 2012; 38:543-51. [PMID: 21041835 PMCID: PMC3330003 DOI: 10.1093/schbul/sbq124] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). METHODS Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. RESULTS There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 ± 5.4 vs 15.6 ± 5.5 y, P = .44), number of cigarettes daily (17.9 ± 11.6 vs 17.0 ± 7.9, P = 0.51), or in breath CO (28.0 ± 14.5 vs 22.9 ± 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). CONCLUSIONS This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.
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Affiliation(s)
- Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228,To whom correspondence should be addressed; tel: 410-402-6860, fax: 410-402-6038, e-mail:
| | - Heather G. Raley
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Suzanne Lo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Katherine Wright
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | | | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Charles M. Richardson
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Stephen J. Heishman
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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29
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D’Souza DC, Esterlis I, Carbuto M, Krasenics M, Seibyl J, Bois F, Pittman B, Ranganathan M, Cosgrove K, Staley J. Lower ß2*-nicotinic acetylcholine receptor availability in smokers with schizophrenia. Am J Psychiatry 2012; 169:326-34. [PMID: 22193533 PMCID: PMC3881431 DOI: 10.1176/appi.ajp.2011.11020189] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a strong association between cigarette smoking and schizophrenia. Nicotine's actions in the brain are mediated through nicotinic acetylcholine receptors. Those containing α(4) and β(2) subunits are the most abundant ones in the brain, have the highest affinity for nicotine, and are critical in mediating nicotine's reinforcing properties. Healthy tobacco smokers have significantly higher levels of β(2)*-nicotinic acetylcholine receptors than do nonsmokers. However, in postmortem studies, smokers with schizophrenia do not show these higher levels. The purpose of this study was to measure β(2)*-nicotinic acetylcholine receptors in vivo and to relate levels to concurrent behavioral measures of smoking and schizophrenia. METHOD By using single-photon emission computed tomography with the β(2)*-nicotinic acetylcholine receptor agonist radiotracer [(123)I]5-IA-85380, the availability of receptors was measured in smokers with schizophrenia (11 men) and matched comparison smokers after 1 week of confirmed smoking abstinence. RESULTS Smokers with schizophrenia showed significantly lower (21%-26%) β(2)*-nicotinic acetylcholine receptor availability relative to comparison smokers in the frontal cortex, parietal cortex, and thalamus (in descending order). There was a specific and robust negative correlation between regional β(2)*-nicotinic acetylcholine receptor availability and negative symptoms. CONCLUSIONS These are the first in vivo findings of lower β(2)*-nicotinic acetylcholine receptor availability in smokers with schizophrenia. The relationship between β(2)*-nicotinic acetylcholine receptor availability and negative symptoms may explain the high rates of smoking in schizophrenia and the relationship between smoking and negative symptoms. Findings support the development of medications targeting the β(2)*-nicotinic acetylcholine receptor system for the treatment of negative symptoms.
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Affiliation(s)
- Deepak Cyril D’Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michelle Carbuto
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Maegan Krasenics
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John Seibyl
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Institute for Neurodegenerative Disorders, New Haven, T 06510, USA
| | - Frederic Bois
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Pittman
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kelly Cosgrove
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Julie Staley
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Abstract
Personality and psychopathology are increasingly recognized as tightly linked domains of study, despite historical and theoretical divisions. In this paper, we discuss the history of these divisions, models of inter-relations between personality and psychopathology, and selected examples from the literature demonstrating personality/psychopathology inter-relations in clinical and community populations. We begin by summarizing how personality, temperament, and personality disorders are increasingly conceptualized as overlapping entities. We next address relationships between personality traits and common mental illnesses/symptoms (e.g. internalizing and externalizing problems). Then we discuss the various ways in which personality traits may relate to Axis I conditions causally, with methods for distinguishing between them. We conclude with a more in-depth example, relating personality traits to schizophrenia.
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Affiliation(s)
- Allan M Andersen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Shinozaki Y, Nakao M, Takeuchi T, Yano E. Smoking rates among schizophrenia patients in Japan. Psychiatry Res 2011; 186:165-9. [PMID: 20817269 DOI: 10.1016/j.psychres.2010.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 04/22/2010] [Accepted: 06/24/2010] [Indexed: 01/01/2023]
Abstract
According to the meta-analysis performed by de Leon and Diaz, the smoking rate was higher among schizophrenia patients than in the general population with the exception of the populations of Japan and Colombia. The purpose of this study was to reexamine the association between schizophrenia and smoking among Japanese schizophrenia patients using objective measures. The sample comprised 172 schizophrenia inpatients (mean age: 54years; 55% male). Participants were asked by a psychiatrist whether they currently smoked, and their answers were confirmed by the Fagerström Test for Nicotine Dependence and a measurement of the carbon monoxide level in expired air. Data on 7496 Japanese people obtained from the national survey of health were used as the control group. Seventy schizophrenia patients (40.7%) were identified as smokers; the smoking rate was higher among men in their 50s (66.7%) and among women in their 40s (54.6%). The smoking rate was 24.2% in the control group, and multiple logistic regression analysis showed that this percentage was significantly higher in the schizophrenia than in the control group (odds ratio: 2.17), adjusting for sex and age. The association between smoking rate and schizophrenia is consistent across countries, including Japan.
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Affiliation(s)
- Yasuko Shinozaki
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.
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Abstract
In the management of schizophrenia, mental health outcomes are the principal focus of treatment. The objective is to control the psychotic symptoms while minimising negative features of the illness, to achieve an overall improvement in the societal functioning of patients. Physical health is also important because if it is compromised, many of the benefits of improved mental health will be offset. Compared with the general population, schizophrenia patients are at increased risk of weight gain, abdominal obesity, diabetes, metabolic syndrome, and cardiovascular disease. These physical health problems can contribute to the decreased quality of life, lowered self-esteem and reduced life expectancy commonly reported in schizophrenia. For these reasons there is a pressing need to improve both the monitoring and the management of physical health in patients with schizophrenia as a part of their overall care. A consensus for metabolic monitoring of patients receiving treatment with antipsychotic drugs is available. However, the practicing clinician requires guidance about management of physical health in routine clinical practice. This should include recommendations for measurements that have strong predictive value about physical health risks yet are easy to make, and about the use of medications that have the least effect on physical health parameters. This article will review the gravity of the physical health risks facing schizophrenia patients.
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Kotov R, Guey LT, Bromet EJ, Schwartz JE. Smoking in schizophrenia: diagnostic specificity, symptom correlates, and illness severity. Schizophr Bull 2010; 36:173-81. [PMID: 18562340 PMCID: PMC2800136 DOI: 10.1093/schbul/sbn066] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cigarette smoking was consistently found to be more prevalent in individuals with schizophrenia than in other psychiatric groups and the general population. These findings have been interpreted as evidence of a specific association between schizophrenia and smoking. However, the supporting data come primarily from cross-sectional studies, which are susceptible to confounding. Our aim was to test specificity of this link longitudinally in an epidemiologic sample. METHODS A cohort of 542 inpatients with psychosis was followed for 10 years after first hospitalization, completing 5 face-to-face interviews. Assessments included ratings of specific symptoms (psychotic, negative, disorganized, and depressive), Global Assessment of Functioning, and a categorical measure of cigarette consumption. All participants were assigned longitudinal consensus diagnoses by study psychiatrists, and 229 were diagnosed with schizophrenia spectrum disorders (SZ). RESULTS At baseline, 52.4% of participants were current smokers and 69.3% were lifetime smokers. Smoking rates did not differ among the diagnostic groups (schizophrenia spectrum, major depressive, bipolar, or other psychotic disorder) at any assessment point. Smokers were more severely ill than nonsmokers but did not differ in specific symptoms either cross-sectionally or longitudinally. Among smokers, changes in cigarette consumption were linked only with changes in depression (beta = .16, P < .001). CONCLUSIONS Rates of smoking were elevated in subjects with schizophrenia but were just as high with other psychotic disorders. Smoking was not associated with psychotic symptoms, but cigarette consumption covaried with depression over time. Given the devastating health consequences of cigarette use, smoking cessation interventions are urgently needed in this population and should specifically address depression.
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Affiliation(s)
- Roman Kotov
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Putnam Hall-South Campus, Stony Brook, NY 11794-8790, USA.
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Abstract
This article reviews empirical studies of affective traits in individuals with schizophrenia spectrum disorders, population-based investigations of vulnerability to psychosis, and genetic and psychometric high-risk samples. The review focuses on studies that use self-report trait questionnaires to assess Negative Affectivity (NA) and Positive Affectivity (PA), which are conceptualized in contemporary models of personality as broad, temperamentally-based dispositions to experience corresponding emotional states. Individuals with schizophrenia report a pattern of stably elevated NA and low PA throughout the illness course. Among affected individuals, these traits are associated with variability in several clinically important features, including functional outcome, quality of life, and stress reactivity. Furthermore, evidence that elevated NA and low PA (particularly the facet of anhedonia) predict the development of psychosis and are detectable in high-risk samples suggests that these traits play a role in vulnerability to schizophrenia, though they are implicated in other forms of psychopathology as well. Results are discussed in terms of their implications for treatment, etiological models, and future research to advance the study of affective traits in schizophrenia and schizotypy.
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Affiliation(s)
- William P. Horan
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA 90095,To whom correspondence should be addressed; 300 UCLA Medical Plaza, Suite 2240, Los Angeles, CA 90095-6968, USA; tel: 310-206-8181, fax: 310-206-3651, e-mail:
| | - Jack J. Blanchard
- Department of Psychology, University of Maryland at College Park, College Park, MD 20742
| | - Lee Anna Clark
- Department of Psychology, University of Iowa, Iowa City, IA 52242
| | - Michael F. Green
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA 90095,VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073
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35
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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: 42] [Impact Index Per Article: 2.5] [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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36
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Discussion. Encephale 2007. [DOI: 10.1016/s0013-7006(07)78657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haupt DW, Fahnestock PA, Flavin KA, Schweiger JA, Stevens A, Hessler MJ, Maeda J, Yingling M, Newcomer JW. Adiposity and insulin sensitivity derived from intravenous glucose tolerance tests in antipsychotic-treated patients. Neuropsychopharmacology 2007; 32:2561-9. [PMID: 17375138 DOI: 10.1038/sj.npp.1301392] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular disease is more common in schizophrenia patients than in the general population, with a hypothesized contribution from increases in adiposity produced by antipsychotic medications. We sought to test the relationship between adiposity and insulin resistance using frequently sampled intravenous glucose tolerance tests (FSIVGTTs) to quantify whole-body insulin sensitivity in chronically treated patients with schizophrenia or schizoaffective disorder and untreated healthy controls. FSIVGTTs, body mass index (BMI), and waist circumference were obtained in nondiabetic patients (n=63) receiving olanzapine, risperidone, ziprasidone, or first generation antipsychotics, as well as in healthy controls (n=14). Subject groups (including untreated healthy controls) were matched for BMI and all treated patient groups were additionally matched for age. Bergman's minimal model (MinMod) was used to calculate insulin sensitivity (S(I)), as well as secondary measures of interest. BMI and waist circumference significantly predicted insulin sensitivity measured as MinMod S(I) (F(1,62)=35.11, p<0.0001 and F(1,46)=24.48, p<0.0001, respectively). In addition, BMI and waist circumference significantly predicted the acute plasma insulin response to the glucose challenge (AIR(G)), consistent with a beta cell compensatory response to insulin resistance (MinMod AIR(G) F(1,65)=22.42, p<0.0001 and F(1,49)=11.72, p=0.0013, respectively). Adiposity levels occurring during antipsychotic treatment are strongly related to insulin resistance, confirming that antipsychotic-induced weight gain can contribute to increased cardiometabolic risk in this population.
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Affiliation(s)
- Dan W Haupt
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA.
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38
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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: 1.5] [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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Abstract
Balancing efficacy with tolerability and safety of prescribed treatments is critical to optimizing antipsychotic treatment outcomes in the mentally ill. Symptom control, symptom remission, and functional recovery are only realistic goals when treatments are both effective and well tolerated. The consideration of predictable differences in antipsychotic adverse-effect profiles is central to successful illness management. Minimizing adverse effects on alertness, motivation, cognition, sexual/reproductive functioning, and physical health enhances mental health outcomes, partly through improving treatment adherence. Neuroendocrine and metabolic side effects of antipsychotics for cardiovascular morbidity and mortality need to be addressed proactively and aggressively. In view of the widespread lack of primary care engagement and the adverse effects of psychotropic medications on cardiovascular health, psychiatric care providers should function as key facilitators of an integrated mental and physical health management approach. In addition to psychoeducation and healthy lifestyle counseling, clinicians can improve psychiatric and physical health by selecting medications carefully, routinely screening and monitoring for reversible cardiovascular risk factors, and playing an active role in the prevention and interdisciplinary management of cardiovascular risk factors and medical illness in the vulnerable mentally ill.
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Rondina RDC, Gorayeb R, Botelho C. Características psicológicas associadas ao comportamento de fumar tabaco. J Bras Pneumol 2007; 33:592-601. [DOI: 10.1590/s1806-37132007000500016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 03/28/2007] [Indexed: 11/22/2022] Open
Abstract
Este artigo apresenta uma revisão da literatura sobre a psicologia do tabagismo, destacando características de personalidade do fumante como um dos obstáculos à cessação do tabagismo. Descreve-se a relação entre tabagismo e personalidade e, a seguir, a relação do tabagismo com os principais transtornos psiquiátricos. Estudos revelam que os fumantes tendem a ser mais extrovertidos, ansiosos, tensos, impulsivos e com mais traços de neuroticismo e psicoticismo, em comparação a ex-fumantes e não fumantes. A literatura revela, ainda, forte associação entre tabagismo e transtornos mentais, como esquizofrenia e depressão, entre outros. A compreensão dos fatores de natureza psicológica associados ao consumo e à dependência pode contribuir para a elaboração e aperfeiçoamento de estratégias terapêuticas para o tratamento da dependência e/ou programas de cunho educativo/preventivo.
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Palomo T, Kostrzewa RM, Beninger RJ, Archer T. Treatment consideration and manifest complexity in comorbid neuropsychiatric disorders. Neurotox Res 2007; 12:43-60. [PMID: 17513199 DOI: 10.1007/bf03033900] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Psychiatric disorders may co-occur in the same individual. These include, for example, substance abuse or obsessive-compulsive disorder with schizophrenia, and movement disorders or epilepsy with affective dysfunctional states. Medications may produce iatrogenic effects, for example cognitive impairments that co-occur with the residual symptoms of the primary disorder being treated. The observation of comorbid disorders in some cases may reflect diagnostic overlap. Impulsivity, impulsiveness or impulsive behaviour is implicated in a range of diagnostic conditions including substance abuse, affective disorder and obsessive-compulsive disorder. These observations suggest a need to re-evaluate established diagnostic criteria and disorder definitions, focusing instead on symptoms and symptom-profiles.
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Affiliation(s)
- Tomas Palomo
- Psychiatry Service, 12 de Octubre, University Hospital, Madrid 28041, Spain
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Dinzeo TJ, Docherty NM. Normal personality characteristics in schizophrenia: a review of the literature involving the FFM. J Nerv Ment Dis 2007; 195:421-9. [PMID: 17502808 DOI: 10.1097/01.nmd.0000253795.69089.ec] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Schizophrenia is generally viewed as a disruption of normal functioning because of an underlying core illness. A number of theorists have speculated that this core illness may unilaterally disrupt normal personality functioning. However, recent data suggests that the relationship may be more complex and reciprocal than previously conceptualized. Furthermore, basic personality characteristics appear to be associated with numerous clinical phenomena. This article reviews the empirical literature pertaining to normal personality characteristics [structured around the five-factor model (FFM) of personality] in individuals with schizophrenia. Evidence suggests that certain personality characteristics may be uniquely related to the etiology of psychosis, as well as symptom severity, occupational functioning, cigarette smoking, substance use and violent behavior, social isolation, and suicidality in patients with schizophrenia. The implications of these findings and suggestions for future research are discussed.
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Affiliation(s)
- Thomas J Dinzeo
- Department of Psychology, Kent State University, Kent, Ohio 44240, USA.
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Ames SC, Vickers KS, Decker PA, Patten CA, Colligan RC, Vargas-Chanes * D, Schroeder D, Offord KP. Select Minnesota Multiphasic Personality Inventory (MMPI) scales as predictors of tobacco abstinence following treatment for nicotine dependence. Psychol Health 2007. [DOI: 10.1080/08870440512331317643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Steven C. Ames
- a Nicotine Research Center , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
| | - Kristin S. Vickers
- a Nicotine Research Center , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
- b Department of Psychiatry and Psychology , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
| | - Paul A. Decker
- c Division of Biostatistics , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
| | - Christi A. Patten
- a Nicotine Research Center , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
- b Department of Psychiatry and Psychology , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
| | - Robert C. Colligan
- b Department of Psychiatry and Psychology , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
| | | | - Darrell Schroeder
- c Division of Biostatistics , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
| | - Kenneth P. Offord
- c Division of Biostatistics , Mayo Clinic , 200 First Street, SW Rochester, MN 55905
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Herrán A, Sierra-Biddle D, Cuesta MJ, Sandoya M, Vázquez-Barquero JL. Can personality traits help us explain disability in chronic schizophrenia? Psychiatry Clin Neurosci 2006; 60:538-45. [PMID: 16958935 DOI: 10.1111/j.1440-1819.2006.01577.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychotic features have been considered the main determinant of psychosocial function in schizophrenia. However, other variables are likely to affect dysfunction in these patients. The authors' hypothesis is that personality traits in outpatients with chronic schizophrenia differ from traits found in the healthy population and may be associated with disability in this disorder. A total of 62 patients with schizophrenia were evaluated with the Eysenck Personality Questionnaire (EPQ) and the Tridimensional Personality Questionnaire (TPQ). Psychotic features were measured with the help of the Positive and Negative Syndrome Scale (PANSS). Disability was assessed with the Disability Assessment Schedule (DAS). A total of 43 healthy subjects were used as controls for personality measurements. Normative data for the study population was also used to evaluate results in patients. Patients with schizophrenia had higher levels of neuroticism (median in percentile 65) and lower levels of extraversion (median in percentile 25) than the healthy population. Results of the TPQ showed higher harm avoidance and lower reward dependence levels compared to the healthy population. After multiple regression tests, negative symptoms were the strongest predictor of disability in patients with schizophrenia. Neuroticism contributed independently to the DAS overall behavior and global judgement subscales scores (more negative symptoms and higher neuroticism resulted in worse functioning), but not to the social role subscale. Outpatients with chronic schizophrenia showed high levels of neuroticism, harm avoidance, and introversion. Neuroticism significantly contributes to the long-term deficits found in patients with schizophrenia.
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Affiliation(s)
- Andrés Herrán
- Department of Psychiatry, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
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45
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Strassnig M, Brar JS, Ganguli R. Increased caffeine and nicotine consumption in community-dwelling patients with schizophrenia. Schizophr Res 2006; 86:269-75. [PMID: 16859897 DOI: 10.1016/j.schres.2006.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 05/14/2006] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION It is known that people with schizophrenia make poor dietary choices and smoke at alarmingly high rates. There is also anecdotal evidence that they may ingest large amounts of caffeine. However, while smoking habits in this population have been examined, no recent study has quantified caffeine consumption taking into account various dietary caffeine sources unrelated to coffee including convenience foods such as candy bars, chocolate or soft drinks, and compared results to US population data. METHODS We employed 24-h diet recalls to assess dietary habits in a sample of outpatients suffering from schizophrenia or schizoaffective disorder. Caloric intake and caffeine consumption were quantified and the relationship to various sociodemographic variables including body mass index (BMI) and dietary quality was examined. RESULTS 146 patients were recruited. Mean BMI in the sample was 32.7+/-7.9. Patients ingested 3,057+/-1,132 cal on average. Patients smoked at higher rates (59.6% vs. 23.4%, p< or =0.001), higher numbers of cigarettes/day (24+/-14.4 vs. 13.5+/-11.3, t=8.549, p<0.001) and ingested more caffeine (471.6+/-584.6 mg vs. 254.2+/-384.9 mg, t=6.664, p<0.001) than US population comparisons. Caffeine consumption was correlated to the number of cigarettes smoked daily (r=0.299, p< or =0.001), but not to BMI (r=0.134, p=0.107) or dietary parameters such as caloric intake (r=0.105, p=0.207). CONCLUSION Community-dwelling schizophrenia patients consume significantly more caffeine and nicotine than US population comparisons. Clinicians should be aware that while a significant proportion of patients are overweight and have poor dietary quality - which merits lifestyle counseling on its own - there is a lack of correlation between those factors and smoking and caffeine intake. Thus, lifestyle modification counseling in all patients should address smoking and caffeine intake concurrently.
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Affiliation(s)
- Martin Strassnig
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, UPMC Department of Psychiatry, Pittsburgh, PA 15213, USA
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46
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de Leon J, Diaz FJ, Aguilar MC, Jurado D, Gurpegui M. Does smoking reduce akathisia? Testing a narrow version of the self-medication hypothesis. Schizophr Res 2006; 86:256-68. [PMID: 16814524 DOI: 10.1016/j.schres.2006.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 05/06/2006] [Accepted: 05/11/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND The self-medication hypothesis proposes that schizophrenia patients smoke to decrease their schizophrenia symptoms or antipsychotic side effects, but they usually start smoking before their illness and heavy smoking is not consistently associated with fewer symptoms or side effects. A narrow version of the self-medication hypothesis, heavy smoking reduces akathisia, is explored. METHOD The sample included 250 outpatients with DSM-IV schizophrenia assessed with the Positive and Negative Syndrome Scale (PANSS) and the Barnes Akathisia Scale. Prevalences were 69% (173/250) for smoking, 39% (98/250) for heavy smoking (> or =30 cigarettes/day), 7% (17/250) for akathisia (Barnes Global score>1), 14% (35/250) for a broader akathisia definition (Barnes Global score>0) and 20% for excited symptoms (>1 on the PANSS factor score). RESULTS Heavy smoking was not associated with akathisia (41% of patients with akathisia were heavy smokers versus 39% of patients without akathisia; chi2=0.3, df=1, p=0.86), even after correcting for confounding factors and/or using a broader akathisia definition. Heavy smoking was associated with excited schizophrenia symptoms (possibly reflecting agitation). Particularly in patients taking lower doses of typical antipsychotics, excited symptoms, with or without akathisia, were strongly associated with heavy smoking and appear to interact with patients' reports of smoking's calming effect as the main reason for smoking. CONCLUSION The self-medication hypothesis does not explain increased smoking and heavy smoking in schizophrenia. Moreover, heavy smoking may be associated with more disturbed brain homeostatic mechanisms. Prospective studies need to explore whether temporary increases in cigarette smoking may be associated with periods of higher agitation, with or without akathisia.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY 40508, USA.
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Lawn S, Condon J. Psychiatric nurses' ethical stance on cigarette smoking by patients: determinants and dilemmas in their role in supporting cessation. Int J Ment Health Nurs 2006; 15:111-8. [PMID: 16643346 DOI: 10.1111/j.1447-0349.2006.00410.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has been argued that psychiatric nurses are ideally placed to provide smoking cessation interventions to patients with mental illness. This assumes that psychiatric nurses actively support smoking cessation. The current paper articulates some of the reasons why this has not occurred, in particular, some of the ethical beliefs held by nurses that may prevent such activity. Such an assumption also discounts the evidence that confirms psychiatric nurses to have among the highest smoking rates in nursing and in the health professions in general. The role and impact of the institution are also considered. In-depth interviews with seven community and inpatient psychiatric nurses were thematically analysed. Extensive individual and group discussions were also held with inpatient nurses from open and locked psychiatric settings during participant observation of the settings. The findings suggest that psychiatric nurses can be more effective in the primary care role of supporting patients' smoking cessation if they receive adequate institutional support to do so.
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Affiliation(s)
- Sharon Lawn
- Division of Mental Health/Flinders Medical Centre (now known as Southern Adelaide Health Service), Flinders University of South Australia, South Australia, Australia.
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Hooten WM, Ames SC, Vickers KS, Hays JT, Wolter TD, Hurt RD, Offord KP. Personality correlates related to tobacco abstinence following treatment. Int J Psychiatry Med 2005; 35:59-74. [PMID: 15977945 DOI: 10.2190/n9f1-1r9g-6edw-9bfl] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The five-factor model of personality was used to describe the correlates of smoking abstinence. METHODS Following treatment in the Mayo Clinic Nicotine Dependence Center, the six month abstinence status was determined by self-report. Sixteen months to 2.4 years following the initial treatment evaluation, and 10 months to 1.9 years after the abstinence status was determined, 475 patients were mailed a Neuroticism, Extraversion, Openness, Five-Factor Inventory questionnaire. Ninety-nine abstinent and 151 smoking patients returned a completed questionnaire. RESULTS Multivariate analysis showed that low scores on neuroticism and openness were associated with tobacco abstinence. In addition, high scores on neuroticism and low scores on agreeableness and conscientiousness were associated with predictors of poor outcome including greater number of cigarettes smoked per day, initiation of smoking prior to age 18, and a Fagerström Test for Nicotine Dependence score of > or = 6. CONCLUSIONS Personality characteristics as predictors of smoking abstinence following treatment warrant further investigation in prospective clinical trails. Treatment matching using personality profiling as a guide may be a valuable tool for improving abstinence rates following treatment for nicotine dependence.
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Ziedonis DM, Smelson D, Rosenthal RN, Batki SL, Green AI, Henry RJ, Montoya I, Parks J, Weiss RD. Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. J Psychiatr Pract 2005; 11:315-39. [PMID: 16184072 PMCID: PMC2599914 DOI: 10.1097/00131746-200509000-00005] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction. In response to the need for user-friendly recommendations on the treatment of schizophrenia and addiction, a consensus conference of experts from academic institutions and state mental health systems was organized to 1) frame the problem from clinical and systems-level perspectives; 2) identify effective and problematic psychosocial, pharmacological, and systems practices; and 3) develop a summary publication with recommendations for improving current practice. The results of the consensus meeting served as the foundation for this publication, which presents a broad set of recommendations for clinicians who treat individuals with schizophrenia. "Integrated treatment" is the new standard for evidence-based treatment for this population and recommendations are given to help clinicians implement such integrated treatment. Specific recommendations are provided concerning screening for substance use disorders in patients with schizophrenia, assessing motivation for change, managing medical conditions that commonly occur in patients with dual diagnoses (e.g., cardiovascular disease, liver complications, lung cancer, HIV, and hepatitis B or C infections) and selecting the most appropriate medications for such patients to maximize safety and minimize drug interactions, use of evidence-based psychosocial interventions for patients with dual diagnoses (e.g., Dual Recovery Therapy, modified cognitive-behavioral therapy, modified motivational enhancement therapy, and the Substance Abuse Management Module), and key pharmacotherapy principles for treating schizophrenia, substance use disorders, and comorbid anxiety, depression, and sleep problems in this population. Finally the article reviews programmatic and systemic changes needed to overcome treatment barriers and promote the best outcomes for this patient population. An algorithm summarizing the consensus recommendations is provided in an appendix.
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Affiliation(s)
- Douglas M Ziedonis
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 675 Hoes Lane, Rm. D-349, Piscataway, NJ 08854, USA
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de Leon J, Diaz FJ. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 2005; 76:135-57. [PMID: 15949648 DOI: 10.1016/j.schres.2005.02.010] [Citation(s) in RCA: 865] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2004] [Revised: 02/11/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
A meta-analysis of worldwide studies, found by a 10-year literature follow-up and/or by searching PubMed, was performed. Forty-two studies across 20 nations consistently demonstrated an association between schizophrenia and current smoking (weighted average odds ratio, OR=5.9; 95% confidence interval, CI 4.9--5.7). In 32 male studies across 18 nations, the weighted average OR was 7.2 (CI, 6.1--8.3). In 25 female studies across 15 nations, the weighted average OR was 3.3 (CI, 3.0--3.6). The association between schizophrenia and current smoking remained after using severe mentally ill controls (18 studies across 9 countries, weighted average OR was 1.9, CI 1.7--2.1) and controlling for other variables (3 studies, adjusted ORs ranged 2-3). Heavy smoking (6 studies across 4 countries, ORs ranged 1.9--6.4) and high nicotine dependence were more frequent in smokers with schizophrenia versus the general population. There was no consistent evidence that heavy smoking or high nicotine dependence was more frequent in smokers with schizophrenia versus severe mentally ill controls. Cessation rates were lower in schizophrenia smokers versus the general population. Schizophrenia patients had a higher prevalence of ever smoking than the general population (9 studies across 6 countries, weighted average OR=3.1, CI 2.4--3.8) and than severe mentally ill patients (5 studies across 5 countries, OR=2.0, CI 1.6--2.4). Moreover, in two studies adjusting for confounders schizophrenia patients had an increased risk of starting daily smoking than controls. Thus, people who are going to develop schizophrenia have risk factors that make them more vulnerable to start smoking.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA.
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