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Pattern of Tobacco Smoking Among Egyptian Patients With Bipolar Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strand JE, Nybäck H. Tobacco use in schizophrenia: a study of cotinine concentrations in the saliva of patients and controls. Eur Psychiatry 2020; 20:50-4. [PMID: 15642444 DOI: 10.1016/j.eurpsy.2004.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2001] [Revised: 08/16/2004] [Accepted: 08/23/2004] [Indexed: 10/26/2022] Open
Abstract
AbstractNicotine has been proposed to provide anxiety relief, oral gratification and self-medication of psychotic symptoms in psychiatric patients. In order to investigate the relations between psychopathology and tobacco use we measured the concentration of cotinine, the major metabolite of nicotine, in the saliva of psychiatric patients and healthy volunteers. In a sample of 42 schizophrenic patients we correlated smoking status, cotinine levels, symptom profiles (PANSS), and neuroleptic side effects (Simpson–Angus). Despite reporting the same amount of cigarettes consumed per day the saliva concentration of cotinine was significantly higher in patients with schizophrenia than in the controls. There were no significant differences in clinical characteristics between smoking and non-smoking schizophrenic patients, but smokers tended to be on higher drug doses. High cotinine concentrations correlated significantly with the negative symptoms Passive withdrawal and Social avoidance. The results indicate that the schizophrenic patients smoke cigarettes more intensely than other patients and healthy subjects. The correlation between high cotinine levels and negative symptomatology may reflect an attempt by schizophrenic patients to overcome the emotional withdrawal and thus the results may lend support to a self-medication hypothesis.
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Affiliation(s)
- Jan-Erik Strand
- Department of Psychiatry, Vasa Central Hospital, Vasa, Finland
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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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Medeiros GC, Lafer B, Kapczinski F, Miranda-Scippa Â, Almeida KM. Bipolar disorder and tobacco smoking: Categorical and dimensional clinical correlates in subjects from the Brazilian bipolar research network. Compr Psychiatry 2018; 82:14-21. [PMID: 29367058 DOI: 10.1016/j.comppsych.2017.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND People with bipolar disorder (BD) have high rates of smoking. However, the scientific literature examining the association between clinical outcomes in BD and tobacco smoking is still limited and there are conflicting results. The objective of the current study was to comprehensively investigate associations between BD and tobacco smoking in a large Brazilian sample. METHODS This study evaluated 336 outpatients from the Brazilian Bipolar Research Network, which is a collaboration between three large academic centers in Brazil. MAIN FINDINGS Regarding the categorical analysis (i.e. current smokers versus non-smokers), tobacco smokers showed: 1) a higher percentage of individuals identifying as Non-Caucasians; 2) a longer duration of illness; 3) a longer duration of untreated illness; 4) more severe manic symptoms; 4) a stronger family history of mood disorder; and 6) a higher current prevalence of alcohol/substance use disorder. The dimensional analysis in smokers (i.e. number of cigarettes per day versus clinical variables) found a positive correlation between number of cigarettes per day and a) age, b) age at onset of BD, c) duration of illness, and d) current diagnosis of panic disorder. CONCLUSION This study found important clinical correlates of tobacco smoking in BD subjects. We observed that the variables associated with current smoker status (categorical approach) are not necessarily correlated with number of cigarettes per day (dimensional approach). Duration of illness appears to be a particularly relevant clinical variable in the association between BD and tobacco smoking.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Flávio Kapczinski
- Bipolar Disorder Program (PROTAHBI), Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Department of Neurosciences and Mental Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Karla M Almeida
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Wolfe RM, Reeves LE, Gibson LE, Cooper S, Ellman LM. Attenuated Positive Psychotic Symptoms in Relation to Cigarette Smoking in a Nonclinical Population. Nicotine Tob Res 2016; 19:124-128. [PMID: 27651478 DOI: 10.1093/ntr/ntw240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explored the association between cigarette smoking and attenuated positive psychotic symptoms in a young adult nonclinical sample. METHODS Undergraduates (N = 930), aged 18-35 years (26.3% male), completed a battery of self-report measures assessing subthreshold psychotic symptoms, cigarette smoking behavior/dependence, and drug use. RESULTS Individuals endorsing a greater number of attenuated positive psychotic symptoms were more likely to be smokers. Exploratory analyses indicated that the odds of being a smoker were two times greater for those at potential higher risk for psychosis compared with individuals at lower risk. Results were consistent after adjusting for sex and other drug use. CONCLUSIONS In line with findings from psychotic populations, results suggest that attenuated positive psychotic symptoms, particularly those endorsed as distressing in a nonclinical, undergraduate population, are related to cigarette smoking. IMPLICATIONS Even in nonclinical, undergraduate populations, subthreshold psychotic symptoms are related to cigarette smoking, and cigarette smokers are twice as likely to be considered at potentially higher risk for psychosis compared with noncigarette smokers. In summary, there may be a threshold whereby psychotic symptoms confer increased risk for nicotine consumption, with endorsement of a greater number of distressing subthreshold psychotic symptoms increasing the likelihood of cigarette use.
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Affiliation(s)
- Rebecca M Wolfe
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Reeves
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Gibson
- Department of Psychology, Temple University, Philadelphia, PA
| | - Shanna Cooper
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
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Ospina LH, Russo M, Nitzburg GM, Cuesta-Diaz A, Shanahan M, Perez-Rodriguez MM, Mcgrath M, Levine H, Mulaimovic S, Burdick KE. The effects of cigarette smoking behavior and psychosis history on general and social cognition in bipolar disorder. Bipolar Disord 2016; 18:528-538. [PMID: 27650399 DOI: 10.1111/bdi.12420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/12/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Several studies have documented the prevalence and effects of cigarette smoking on cognition in psychotic disorders; fewer have focused on bipolar disorder (BD). Cognitive and social dysfunction are common in BD, and the severity of these deficits may be related both to illness features (e.g., current symptoms, psychosis history) and health-related behaviors (e.g., smoking, alcohol use). The current study assessed the influence of cigarette smoking on general and social cognition in a BD cohort, accounting for illness features with a focus on psychosis history. METHODS We assessed smoking status in 105 euthymic patients with BD, who completed a comprehensive battery including social (facial affect recognition, emotional problem-solving, and theory of mind) and general (the MATRICS Consensus Cognitive Battery and executive functioning) cognitive measures. We compared smokers vs nonsmokers on cognitive performance and tested for the effects of psychosis history, premorbid intellectual functioning, substance use, and current affective symptoms. RESULTS Within the nonpsychotic subgroup with BD (n=45), smokers generally outperformed nonsmokers; by contrast, for subjects with BD with a history of psychosis (n=41), nonsmokers outperformed smokers. This pattern was noted more globally using a general composite cognitive score and on social/affective measures assessing patients' ability to identify emotions of facial stimuli and solve emotional problems. CONCLUSIONS Cigarette smoking differentially affects performance on both general and social cognition in patients with BD as a function of psychosis history. These results suggest that there may be at least partially divergent underlying neurobiological causes for cognitive dysfunction in patients with BD with and without psychosis.
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Affiliation(s)
- Luz H Ospina
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manuela Russo
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George M Nitzburg
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Armando Cuesta-Diaz
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan Shanahan
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Meaghan Mcgrath
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Levine
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra Mulaimovic
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine E Burdick
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,James J. Peters VA Medical Center, Bronx, NY, USA.
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Estrada E, Hartz S, Tran J, Hilty D, Sklar P, Smoller JW, Pato CN, Pato MT. Nicotine dependence and psychosis in Bipolar disorder and Schizoaffective disorder, Bipolar type. Am J Med Genet B Neuropsychiatr Genet 2016; 171:521-4. [PMID: 26467098 PMCID: PMC4950843 DOI: 10.1002/ajmg.b.32385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/22/2015] [Indexed: 11/11/2022]
Abstract
Patients with Bipolar disorder smoke more than the general population. Smoking negatively impacts mortality and clinical course in Bipolar disorder patients. Prior studies have shown contradictory results regarding the impact of psychosis on smoking behavior in Bipolar disorder. We analyzed a large sample of Bipolar disorder and Schizoaffective disorder, Bipolar Type patients and predicted those with a history of psychosis would be more likely to be nicotine dependent. Data from subjects and controls were collected from the Genomic Psychiatry Cohort (GPC). Subjects were diagnosed with Bipolar disorder without psychosis (N = 610), Bipolar disorder with psychosis (N = 1544). Participants were classified with or without nicotine dependence. Diagnostic groups were compared to controls (N = 10065) using logistic regression. Among smokers (N = 6157), those with Bipolar disorder had an increased risk of nicotine dependence (OR = 2.5; P < 0.0001). Patients with Bipolar disorder with psychosis were more likely to be dependent than Bipolar disorder patients without psychosis (OR = 1.3; P = 0.03). Schizoaffective disorder, Bipolar Type patients had more risk of nicotine dependence when compared to Bipolar disorder patients with or without psychosis (OR = 1.2; P = 0.02). Bipolar disorder patients experiencing more severity of psychosis have more risk of nicotine dependence. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Elena Estrada
- University of Southern California, Department of Psychiatry
| | - Sarah Hartz
- Washington University in St. Louis, Department of Psychiatry
| | - Jeffrey Tran
- University of Southern California, Department of Psychiatry
| | - Donald Hilty
- University of Southern California, Department of Psychiatry
| | | | - Pamela Sklar
- Mount Sinai Medical School, Department of Psychiatry
| | | | - Carlos N. Pato
- University of Southern California, Department of Psychiatry
| | - Michele T. Pato
- University of Southern California, Department of Psychiatry,Corresponding author: Michele Pato, MD, University of Southern California, Department of Psychiatry, 2250 Alcazar St. CSC 220 Los Angeles, CA 90089 USA, , telephone 626-676-9108, telefax 323-442-4003
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Lagerberg TV, Icick R, Andreassen OA, Ringen PA, Etain B, Aas M, Henry C, Bjella TD, Melle I, Bellivier F. Cannabis use disorder is associated with greater illness severity in tobacco smoking patients with bipolar disorder. J Affect Disord 2016; 190:286-293. [PMID: 26544611 DOI: 10.1016/j.jad.2015.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/04/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cannabis use disorders (CUD) may influence the course of bipolar disorder (BD), but key confounding factors such as tobacco smoking have not been adequately addressed. This study examined whether CUD was associated with a more severe illness course in tobacco smoking BD patients. METHODS A sample of French and Norwegian tobacco smoking patients with BD I and II (N=642) was investigated. DSM-IV diagnoses and other characteristics were obtained through personal interviews using structured questionnaires. The association between CUD and illness course was assessed in regression analyses. RESULTS In bivariate analyses, CUD was associated with earlier BD onset, higher frequency of manic (in BD I) and depressive episodes and hospitalizations per illness year, and a higher occurrence of psychotic episodes. After controlling for potential confounders, the relationships with earlier BD onset (B=-5.60 95% CI=-7.65 to -3.64), and increased rates of manic episodes (OR=1.93, 95% CI: 1.15 to 3.23) and hospitalizations (OR=2.93, 95% CI: 1.85 to 4.64) remained statistically significant. LIMITATIONS Despite the multivariate approach, differences between the two samples may lead to spurious findings related to hidden confounders. Substance use and mood episode information was collected retrospectively, and potential birth cohort effects could not be controlled for. CONCLUSION Studies have found associations between tobacco smoking and poorer outcomes in BD. In this study on tobacco smoking BD patients we report an association between CUD and illness severity, suggesting that CUD exacerbates the disease evolution independently of tobacco smoking. Specific treatment and prevention programs addressing CUD in BD patients are warranted.
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Affiliation(s)
- T V Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
| | - R Icick
- Inserm, U1144, Paris F-7 5006, France; Université Paris Diderot, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris F-75010, France; FondaMental Foundation, Creteil F-94000, France
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - P A Ringen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - B Etain
- FondaMental Foundation, Creteil F-94000, France; Inserm, U955, Equipe Psychiatrie Génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU PePsy, Pôle de psychiatrie, Créteil 94000, France
| | - M Aas
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Creteil F-94000, France; Inserm, U955, Equipe Psychiatrie Génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU PePsy, Pôle de psychiatrie, Créteil 94000, France
| | - T D Bjella
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - I Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-7 5006, France; Université Paris Diderot, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris F-75010, France; FondaMental Foundation, Creteil F-94000, France
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Jackson JG, Diaz FJ, Lopez L, de Leon J. A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disord 2015; 17:575-97. [PMID: 26238269 DOI: 10.1111/bdi.12319] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/31/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Worldwide studies were combined to examine two hypotheses: (i) bipolar disorder is associated with smoking behaviors, compared with the general population; and (ii) smoking behavior prevalences in bipolar disorder are intermediate between those in major depressive disorder and those in schizophrenia. METHODS Combined analyses used 56 articles on adults obtained from a PubMed search or the senior author's article collection. Odds ratios (ORs) and their 95% confidence intervals (CIs) compared current smoking, heavy smoking among current smokers, smoking cessation in ever smokers, and ever smoking in bipolar disorder versus control groups. RESULTS The combined OR was 3.5 (CI: 3.39-3.54) in 51 current smoking studies of bipolar disorder versus the general population from 16 countries. More limited data provided an OR = 0.34 (CI: 0.31-0.37) for smoking cessation and an OR = 3.6 (CI: 3.30-3.80) for ever smoking. The combined OR was 0.76 (CI: 0.74-0.79) for current smoking in bipolar disorder versus schizophrenia in 20 studies from ten countries. Ever smoking may be lower in bipolar disorder than in schizophrenia (OR = 0.83, CI: 0.75-0.91). The OR was 2.05 (CI: 2.00-2.10) for current smoking in bipolar disorder versus major depression in 18 studies from seven countries. Ever smoking may be higher (OR = 1.5, CI: 1.40-1.70) and smoking cessation lower (OR = 0.51, CI: 0.45-0.59) in bipolar disorder than in major depression. CONCLUSIONS Increased current smoking in bipolar disorder versus the general population reflected increased ever smoking (initiation) and decreased smoking cessation. Smoking behavior frequencies in bipolar disorder may be between those in depressive disorder and schizophrenia, with schizophrenia showing the highest severity level.
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Affiliation(s)
| | - Francisco J Diaz
- Department of Biostatistics, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Lucelly Lopez
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, University of Kentucky, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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10
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Thomson D, Berk M, Dodd S, Rapado-Castro M, Quirk SE, Ellegaard PK, Berk L, Dean OM. Tobacco use in bipolar disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:1-11. [PMID: 25912533 PMCID: PMC4423166 DOI: 10.9758/cpn.2015.13.1.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
Abstract
Tobacco use in mental health in general and bipolar disorder in particular remains disproportionally common, despite declining smoking rates in the community. Furthermore, interactions between tobacco use and mental health have been shown, indicating the outcomes for those with mental health disorders are impacted by tobacco use. Factors need to be explored and addressed to improve outcomes for those with these disorders and target specific interventions for people with psychiatric illness to cease tobacco smoking. In the context of bipolar disorder, this review explores; the effects of tobacco smoking on symptoms, quality of life, suicidal behavior, the biological interactions between tobacco use and bipolar disorder, the interactions between tobacco smoking and psychiatric medications, rates and factors surrounding tobacco smoking cessation in bipolar disorder and suggests potential directions for research and clinical translation. The importance of this review is to bring together the current understanding of tobacco use in bipolar disorder to highlight the need for specific intervention.
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Affiliation(s)
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Marta Rapado-Castro
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Victoria, Australia.,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Maranon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Shae E Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong
| | - Pernille K Ellegaard
- Research Unit, Mental Health Services, Region of Southern Denmark, Esbjerg, Denmark
| | - Lesley Berk
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
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11
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Morisano D, Wing VC, Sacco KA, Arenovich T, George TP. Effects of tobacco smoking on neuropsychological function in schizophrenia in comparison to other psychiatric disorders and non-psychiatric controls. Am J Addict 2014; 22:46-53. [PMID: 23398226 DOI: 10.1111/j.1521-0391.2013.00313.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 03/21/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Compared to the general population cigarette smoking prevalence is elevated in psychiatric disorders such as schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD). These disorders are also associated with neurocognitive impairments. Cigarette smoking is associated with improved cognition in SZ. The effects of smoking on cognition in BD and MDD are less well studied. METHODS We used a cross-sectional design to study neuropsychological performance in these disorders as a function of smoking status. Subjects (N = 108) were SZ smokers (n = 32), SZ non-smokers (n = 15), BD smokers (n = 10), BD non-smokers (n = 6), MDD smokers (n = 6), MDD non-smokers (n = 10), control smokers (n = 12), and control non-smokers (n = 17). Participants completed a neuropsychological battery; smokers were non-deprived. RESULTS SZ subjects performed significantly worse than controls in select domains, while BD and MDD subjects did not differ from controls. Three verbal memory outcomes were improved in SZ smokers compared with non-smokers; smoking status did not alter performance in BD or MDD. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These data suggest that smoking is associated with neurocognitive improvements in SZ, but not BD or MDD. Our data may suggest specificity of cigarette-smoking modulation of neurocognitive deficits in SZ.
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Affiliation(s)
- Dominique Morisano
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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12
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Abstract
BACKGROUND Bipolar disorder is a relatively common, long-term, and disabling psychiatric illness that is associated with high levels of functional impairment, morbidity, mortality, and an increased risk of suicide. Psychiatric co-morbidity in bipolar disorder ranges from 57.3% to 74.3%, whereas medical co-morbidity varies from 2.7-70%. Indian scenario in this aspect is not clear. MATERIALS AND METHODS The objective was to ascertain the prevalence of physical and psychiatric co-morbidities in patients attending a tertiary care center over a period of 1 year and its relationship with socio-demographic and clinical variables. One hundred and twenty-five case record files were included in the review. OPCRIT software was used for re-establishing the diagnosis of bipolar disorder, which yielded 120 cases. A semi-structured pro-forma, specifically designed for the study, was used to collect the socio-demographic and clinical details. RESULTS Co-morbid psychiatric disorders were found in 52 (43.3%) of the sample, whereas co-morbid physical illness was present in 77 (64.2%) patients. The most common psychiatric disorder associated was substance use disorder (27.5%), whereas co-morbid cardiovascular disorder was the most frequent physical diagnosis in the sample (20%). DISCUSSION The prevalence of co-morbid psychiatric disorders in bipolar patients was lower than that reported in western literature. It could be related to retrospective nature of study or reflect true lower prevalence rates. Also, certain disorders such as eating disorders were absent in our sample, and migraine diagnosis was very infrequent.
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Rüther T, Bobes J, De Hert M, Svensson T, Mann K, Batra A, Gorwood P, Möller H. EPA Guidance on Tobacco Dependence and Strategies for Smoking Cessation in People with Mental Illness. Eur Psychiatry 2014; 29:65-82. [DOI: 10.1016/j.eurpsy.2013.11.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 11/13/2013] [Accepted: 11/13/2013] [Indexed: 12/16/2022] Open
Abstract
AbstractTobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.
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Umene-Nakano W, Yoshimura R, Hoshuyama T, Yoshii C, Hayashi K, Nakano H, Hori H, Ikenouchi-Sugita A, Katsuki A, Atake K, Nakamura J. Current smoking rate in patients with psychiatric disorders in Japan: questionnaire survey. Psychiatry Res 2013; 210:268-73. [PMID: 23601794 DOI: 10.1016/j.psychres.2013.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/25/2022]
Abstract
The association between smoking and psychiatric disorders (PD) has been known for many years. Support for smoking cessation among patients with PD is provided in advanced nations, but there is a little support for smoking cessation among patients with PD in Japan, where few studies have investigated the smoking rate. The aim of the present study is to determine the smoking rate and smoking habits of Japanese patients with PD. The subjects included outpatients who visited the outpatient psychiatric clinic at a University hospital between January and March of 2011. They answered a questionnaire consisting of questions about their sociodemographic background and smoking habits. In an analysis of 733 subjects, the overall smoking rate was 25.1%. The smoking rates among the patients with schizophrenia and depression were 17.3% and 23.9%, respectively, and these rates were lower than the results of previous studies. Among the current smokers, 43.4% had experienced smoking cessation, and only 26.1% were not interested in smoking cessation. Of the current smokers, 37.5% spent between US$128.88 and US$257 per month on cigarettes.
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Affiliation(s)
- Wakako Umene-Nakano
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Japan.
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15
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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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16
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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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Williams JM, Gandhi KK, Lu SE, Steinberg ML, Benowitz NL. Nicotine intake and smoking topography in smokers with bipolar disorder. Bipolar Disord 2012; 14:618-27. [PMID: 22938167 PMCID: PMC3641517 DOI: 10.1111/j.1399-5618.2012.01047.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cigarette smoking behavior in bipolar disorder (BPD), including the effects of mood-stabilizing medications, has not been well characterized. METHODS We compared serum nicotine, nicotine metabolite levels, and smoking topography in 75 smokers with BPD to 86 control smokers (CON). For some comparisons, an additional control group of 75 smokers with schizophrenia (SCZ) were included. RESULTS There were no differences between the BPD and CON groups in baseline smoking characteristics or serum nicotine or cotinine levels. Fifty-one smokers with BPD (68.9%) were taking one of the following mood stabilizers: valproic acid, lamotrigine, carbamazepine, oxcarbazepine, lithium, or topiramate. The 3-hydroxycotinine-to-cotinine ratio, a marker of cytochrome P450 2A6 (CYP2A6) metabolic activity, was significantly higher in BPD versus CON and versus SCZ (0.68 versus 0.49 versus 0.54; p =0.002). The difference between groups, however, was no longer significant when the analysis was repeated with those taking hepatic enzyme-inducing drugs (carbamazepine, oxcarbazepine, and topiramate) included as a covariate. The time between puffs, or interpuff interval (IPI), was shorter in BPD versus CON by an average of 3.0sec (p<0.05), although this was no longer significant when we removed smokers from the analysis of those taking hepatic enzyme inducers. CONCLUSIONS Smokers with BPD are not different from CON on most measures of nicotine intake and smoking topography. We found an increased rate of nicotine metabolism in smokers taking mood stabilizers that are hepatic enzyme inducers, including carbamazepine, oxcarbazepine, and topiramate. Smokers with rapid nicotine metabolism might be expected to smoke more intensely to compensate for the more rapid disappearance of nicotine from the blood and brain, and may have more difficulty in quitting smoking, although this requires further study.
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Affiliation(s)
- Jill M Williams
- University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-2008, USA.
| | - Kunal K Gandhi
- UMDNJ–School of Public Health, New Brunswick, NJ,GlaxoSmithKline
| | - Shou-En Lu
- University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School, New Brunswick, NJ,UMDNJ–School of Public Health, New Brunswick, NJ
| | - Marc L Steinberg
- University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School, New Brunswick, NJ,UMDNJ–School of Public Health, New Brunswick, NJ
| | - Neal L Benowitz
- University of California at San Francisco, San Francisco, CA, USA
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Kreinin A, Novitski D, Rabinowitz D, Weizman A, Grinshpoon A. Association between tobacco smoking and bipolar affective disorder: clinical, epidemiological, cross-sectional, retrospective study in outpatients. Compr Psychiatry 2012; 53:269-74. [PMID: 21664608 DOI: 10.1016/j.comppsych.2011.04.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 04/28/2011] [Accepted: 04/28/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Although high rates of smoking have been reported among psychiatric patients, only a few studies examined the prevalence of smoking in bipolar disorder, and findings are inconsistent. We investigated smoking among bipolar patients. METHODS We examined the prevalence of smoking in of 102 patients that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for bipolar I disorder in Israel and evaluated the relationship between smoking and demographic and clinical data. RESULTS Fifty-five of the bipolar patients (53.9%) smoked, with a rate that is 2.36 times higher than among the general population in Israel (22.8%). Significant relationships were revealed between smoking and lifetime history of alcohol dependence/abuse (P = .02), between smoking and history of drug use (P ≤ .01), and between smoking and age of illness onset (P = .04). LIMITATIONS The cross-sectional nature of the study and the relatively small sample size preclude generalization of the findings. Nicotine levels were not measured; thus, the information regarding smoking was subjective. CONCLUSIONS Bipolar patients smoke more than the general population. Bipolar patients that are moderate or heavy smokers are more likely than nonsmokers to consume alcohol and abuse psychoactive substances. Contrary to findings of previous studies, no association was found between clinical variables of bipolar patients and smoking.
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Affiliation(s)
- Anatoly Kreinin
- Tirat Carmel Mental Health Center affiliated to Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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George TP, Wu BS, Weinberger AH. A Review of Smoking Cessation in Bipolar Disorder: Implications for Future Research. J Dual Diagn 2012; 8:126-130. [PMID: 22737046 PMCID: PMC3378056 DOI: 10.1080/15504263.2012.671717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tobacco smoking is common in people with bipolar disorder, and rates of smoking cessation are lower than in the general population. A literature review found eleven clinical research publications on bipolar disorder and tobacco, including only one smoking cessation pharmacotherapy trial. This article will review these findings and discuss possible reasons for the high rates of tobacco addiction among persons with bipolar disorder, as well as specific vulnerability factors that may contribute to tobacco treatment failure. An approach to the clinical assessment and treatment of tobacco dependence is described for this sub-group of smokers. Finally, recommendations are made for planning future treatment studies in persons with bipolar disorder and nicotine dependence.
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Affiliation(s)
- Tony P George
- Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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20
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Abstract
Nicotine dependence is a significant addiction with many health consequences. Consistent attempts and efforts at addressing this condition, guiding and advising afflicted patients using motivational techniques and the 5-A stepwise strategies, and instituting appropriate therapies will result in better health outcomes and less incidence of diseases. In pharmacotherapy, Nicotine replacement therapy and oral medications can be used alone or in combination with varying degrees of success.
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Affiliation(s)
- Samuel N Grief
- Department of Family Medicine, University of Illinois at Chicago, 1919 West Taylor Street, Suite 159, Chicago, IL 60612, USA; CampusCare, University of Illinois at Chicago, 820 South Wood Street, W310 CSN, Chicago, IL 60612, USA.
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Gutiérrez-Rojas L, Jurado D, Gurpegui M. Factors associated with work, social life and family life disability in bipolar disorder patients. Psychiatry Res 2011; 186:254-60. [PMID: 20647154 DOI: 10.1016/j.psychres.2010.06.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 05/17/2010] [Accepted: 06/23/2010] [Indexed: 11/29/2022]
Abstract
We analyzed the presence of work, social life and family life disability in 108 outpatients with a Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) diagnosis of bipolar disorder and their association with previous course-of-illness variables and current psychopathology. Work disability was pragmatically defined as being on a disability pension or in the process of obtaining it; social life or family life disability was defined by a score ≥ 7 in the respective subscales of the Sheehan Disability Scale. At least one type of disability (for work, social life or family life) affected 52-54% of the patients; and two types, 37%. By logistic regression and multiple linear regression analyses we determined the variables independently associated with each type of disability: 1) Work disability was significantly associated with previous repeated manic episodes, three or more hospitalizations, with current depressive symptoms and inversely with the educational attainment. 2) Social life disability significantly increased with the number of hospitalizations and was associated with previous repeated depressive episodes and current depressive symptoms. In alternative models, nicotine dependence and lack of social support were significantly associated with work and social life disability respectively. And 3) family life disability significantly increased with number of hospitalizations, CAGE questionnaire score and age; and was associated with previous repeated manic episodes and current depressive symptoms. In conclusion, previous course-of-illness variables, particularly a high number of manic episodes, and current psychopathology - as indicated by the presence of nicotine dependence or depressive symptoms - may be indicators of disability; previous manic episodes appear to affect disability at work or at family life whereas previous depressive episodes seem to be related with social life disability.
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Affiliation(s)
- Luis Gutiérrez-Rojas
- Institute of Neurosciences, Center for Biomedical Research, University of Granada, Granada, Spain
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22
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Tobacco dependence, treatment and smoke-free policies: a survey of mental health professionals' knowledge and attitudes. Gen Hosp Psychiatry 2009; 31:576-82. [PMID: 19892217 DOI: 10.1016/j.genhosppsych.2009.08.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mental health inpatient units in England have to be smoke-free by law. Preliminary studies have indicated that staff may not have the necessary knowledge and resources to support the implementation of a smoke-free policy. OBJECTIVE The objective of this study was to investigate staff knowledge and attitudes relating to smoking prevalence, dependence, treatment and the relationship between smoking and mental illness. DESIGN This study used a questionnaire survey for all the clinical staff of 25 inpatient mental health units of a UK National Health Service mental health Trust. RESULTS Four hundred fifty-nine (68%) staff returned the questionnaire. Less than half (42%) of the participants agreed that dealing with patients' smoking was their responsibility as a mental health professional, and only half (50%) asserted that they could make time to treat smoking in their working routine. All professional groups demonstrated a lack of knowledge about tobacco dependence, treatment and its relation with mental illness, with healthcare assistants being least knowledgeable overall. Nevertheless, 41% of doctors were unaware that smoking can decrease blood levels of antipsychotic medications, and 36% were unaware that stopping smoking could reduce the dose needed. Staff overestimated the prevalence of smoking in the general population, and over a third (36.4%) believed that nicotine was carcinogenic. Staff smoking prevalence was 26% (10% of doctors, 22% of other qualified staff and 37% of nonqualified staff), and smokers were more likely to have reservations about the importance of the smoke-free policy and the treatment of nicotine dependence among patients. Reported participation in training was associated with greater knowledge related to some items of the questionnaire. CONCLUSIONS Support for inpatient smokers by staff is likely to be severely compromised by low levels of knowledge and awareness of tobacco dependence. Further training and support for all staff groups are urgently required.
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Dome P, Lazary J, Kalapos MP, Rihmer Z. Smoking, nicotine and neuropsychiatric disorders. Neurosci Biobehav Rev 2009; 34:295-342. [PMID: 19665479 DOI: 10.1016/j.neubiorev.2009.07.013] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/23/2009] [Accepted: 07/30/2009] [Indexed: 12/20/2022]
Abstract
Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.
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Affiliation(s)
- Peter Dome
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary.
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Morisano D, Bacher I, Audrain-McGovern J, George TP. Mechanisms underlying the comorbidity of tobacco use in mental health and addictive disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:356-67. [PMID: 19527556 DOI: 10.1177/070674370905400603] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We discuss potential explanations for the high prevalence of tobacco use and tobacco dependence (TD) in people with mental health and addictive (MHA) disorders. The biopsychosocial basis for this comorbidity is presented, integrating evidence from epidemiologic and clinical studies. We also review evidence that suggests a shared vulnerability related to biological, genetic, and environmental factors may be the most parsimonious mechanism to explain the association between TD and MHA disorders. Finally, we review the examples of various MHA disorders that are associated with TD, and suggest avenues for new investigation that could aid in the development of rationale and more effective treatments for tobacco and MHA disorder comorbidities.
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Affiliation(s)
- Dominique Morisano
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario
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Goldstein BI, Birmaher B, Axelson DA, Goldstein TR, Esposito-Smythers C, Strober MA, Hunt J, Leonard H, Gill MK, Iyengar S, Grimm C, Yang M, Ryan ND, Keller MB. Significance of cigarette smoking among youths with bipolar disorder. Am J Addict 2009; 17:364-71. [PMID: 18770078 DOI: 10.1080/10550490802266151] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cigarette smoking among adults with bipolar disorder (BP) correlates with psychosis, substance use disorders (SUD), and suicidality. Little is known regarding smoking among youths with BP. Youths with BP (n = 441) were divided into three smoking groups: Never, Ever, and Daily. Twenty-five percent reported any smoking (11% daily, 14% ever). Ever and Daily subjects had significantly greater lifetime prevalence of suicide attempts, physical abuse, conduct disorder, and SUD compared to Never subjects. Daily heavy smokers had greater prevalence of SUD and suicide attempts, and worse depression versus daily light smokers. Smoking among youths with BP is independently associated with suicide attempts and SUD.
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Affiliation(s)
- Benjamin I Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Law CW, Soczynska JK, Woldeyohannes HO, Miranda A, Brooks JO, McIntyre RS. Relation between cigarette smoking and cognitive function in euthymic individuals with bipolar disorder. Pharmacol Biochem Behav 2009; 92:12-6. [DOI: 10.1016/j.pbb.2008.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/31/2008] [Accepted: 10/10/2008] [Indexed: 11/29/2022]
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Heffner JL, DelBello MP, Fleck DE, Anthenelli RM, Strakowski SM. Cigarette smoking in the early course of bipolar disorder: association with ages-at-onset of alcohol and marijuana use. Bipolar Disord 2008; 10:838-45. [PMID: 19032716 DOI: 10.1111/j.1399-5618.2008.00630.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite the high prevalence of smoking among individuals with bipolar disorder, few studies have attempted to identify correlates of smoking status in this group. We examined illness characteristics of bipolar disorder as well as co-occurring alcohol and marijuana use as correlates of cigarette smoking, including the developmental timing of the onset of regular alcohol and cannabis use (i.e., three or more times per week for a month or more). METHODS Demographic and clinical characteristics of 134 patients with bipolar I disorder, the majority of whom were adolescents, who were hospitalized for their first manic episode were analyzed to identify correlates of smoking status. RESULTS A total of 61 (45.5%) of the patients were smokers at the time of their first hospitalization. Smokers were significantly more likely than nonsmokers to report recent use of marijuana (55.7% versus 18.1%) and alcohol (67.2% versus 25.4%). Among those who had ever used marijuana (48.5%) or alcohol (45.5%) regularly, current cigarette smokers reported a significantly earlier age-at-onset of regular use of both substances than reported by nonsmokers. Earlier age-at-onset of marijuana use was the only significant predictor of current smoking in a multivariate analysis. None of the bipolar disorder characteristics examined (i.e., symptom severity, age-at-onset of illness, rapid cycling, and psychosis) were correlated with smoking status. CONCLUSIONS Smoking status in the early course of bipolar disorder is related to both current and past alcohol and marijuana use, but not to characteristics of bipolar illness. Earlier initiation of regular marijuana use is associated with an increased risk of smoking cigarettes.
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Affiliation(s)
- Jaimee L Heffner
- Tri-State Tobacco and Alcohol Research Center, University of Cincinnati Genome Research Institute, Cincinnati, OH 45237, USA.
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28
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Berk M, Ng F, Wang WV, Tohen M, Lubman DI, Vieta E, Dodd S. Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania. J Affect Disord 2008; 110:126-34. [PMID: 18280579 DOI: 10.1016/j.jad.2008.01.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 01/16/2008] [Accepted: 01/16/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to compare the treatment responses between smokers and non-smokers in bipolar mania clinical trials. METHODS Post-hoc analysis was conducted on data collected from three double-blind, randomised controlled trials in bipolar mania that had similar inclusion criteria. Patients were randomised to olanzapine (N=70) or placebo (N=69) for 3 weeks in Trial 1, olanzapine (N=234) or haloperidol (N=216) for 12 weeks in Trial 2, and olanzapine (N=125) or divalproex (N=126) for 47 weeks in Trial 3. This study analysed the Young Mania Rating Scale (YMRS) total scores and Clinical Global Impressions scale for bipolar disorder (CGI-BP) mania severity scores between smokers and non-smokers for each trial and for the pooled data from all three trials, using a mixed-effects model repeated measures approach. RESULTS For the pooled data, non-smokers showed superior treatment outcomes on both the YMRS (P=0.002) and CGI-BP (P<0.001), as well as longer time to discontinuation for any cause utilising Kaplan-Meier survival curves. For the individual trials, non-smokers showed greater improvement than smokers on both CGI-BP and YMRS in both treatment arms of Trial 2 (CGI-BP: haloperidol P=0.011, olanzapine P=0.042; YMRS: haloperidol P=0.010, olanzapine P=0.019), and in the olanzapine arm of Trial 3 (CGI-BP: P=0.002; YMRS: P=0.006). No significant difference in outcomes was found between smokers and non-smokers in Trial 1. LIMITATIONS Post-hoc design, categorical definition of smoking status, unavailable antipsychotic drug levels, confounding effects of trial medications and substance abuse. CONCLUSIONS Smoking appears to be associated with worse treatment outcomes in mania.
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Poutanen O, Koivisto AM, Mattila A, Joukamaa M, Salokangas RKR. Predicting lifetime mood elevation in primary care patients and psychiatric patients. Nord J Psychiatry 2008; 62:263-71. [PMID: 18618367 DOI: 10.1080/08039480801963051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Unipolar depression is undoubtedly the most common affective disorder, but recently the role of bipolar disorders has become more and more significant. The aim of the study was to improve the detection of mood elevations by careful anamnestic assessment, especially family history and psychosocial functional skills. A sample, screened for depression, of 430 primary care patients and 423 psychiatric patients aged 18-64 were interviewed in 1991-1992 using the Present State Examination. Anamnestic information was obtained by questionnaire and interview. Participants were re-contacted in 1998-1999. Experienced lifetime mood elevation was assessed in the follow-up study using the main criteria of the ICD-10 in a telephone interview by three research psychiatrists. Patient's smoking, suicidality in the Hamilton Depression Scale (HAM-D), problems in making contact with the opposite sex when a teenager, and mental problems in either of the parents when the patient was < or = 15 years were associated with experienced lifetime mood elevation. Quick and easy questions about smoking and difficulties in making contact with the opposite sex may improve the detection of mood elevation.
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Affiliation(s)
- Outi Poutanen
- University of Tampere, Medical School/Tampere University Hospital, Psychiatric Clinic, Tampere, Finland.
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Shah A, Alshaher M, Dawn B, Siddiqui T, Longaker RA, Stoddard MF, El-Mallakh R. Exercise tolerance is reduced in bipolar illness. J Affect Disord 2007; 104:191-5. [PMID: 17442401 DOI: 10.1016/j.jad.2007.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 03/04/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiovascular and cerebrovascular disease is 2-3 times more common in bipolar patients than the general population. Asymptomatic bipolar patients have electrocardiogram abnormalities at high rates. The question of heart function in asymptomatic bipolar subjects arises. METHODS This study examined the impact of exhaustive exercise on cardiac function in untrained euthymic bipolar and control subjects. Twenty-four non-athletic adults, 10 controls and 14 with bipolar type I, exercised on a treadmill at 70% of maximal oxygen consumption until physical exhaustion. Two-dimensional and Doppler echocardiography were performed before and immediately after exercise. RESULTS Bipolar subjects had significantly reduced exercise duration (75.9+/-40.5min for bipolar and 95.0+/-40.1 min for control, P<0.01). There were no statistical differences between bipolar illness and normal controls in echocardiographic variables either at rest or after exhaustive exercise. CONCLUSION Medically asymptomatic, euthymic bipolar subjects appear to have reduced exercise tolerance but normal cardiac function. LIMITATIONS More bipolar patients smoked (28.6% vs. 0% controls) and patients tended to be heavier (189.1+/-29.3 vs. 165.0+/-29.5 lb, t=2.0, P=0.06). None of the normal controls were taking any medications. These variables could have impacted the reduced exercise tolerance.
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Affiliation(s)
- Amy Shah
- Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, United States
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Olivier D, Lubman DI, Fraser R. Tobacco smoking within psychiatric inpatient settings: biopsychosocial perspective. Aust N Z J Psychiatry 2007; 41:572-80. [PMID: 17558619 DOI: 10.1080/00048670701392809] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tobacco smoking remains a neglected issue within general psychiatry despite high rates of associated morbidity and mortality. While there has been a coordinated community campaign to reduce tobacco smoking within the general population, mental health facilities have been reluctant to adopt such regulatory controls, and rarely target smoking prevention or treatment. This paper summarizes and discusses evidence relating to the clinical impact of tobacco smoking within inpatient psychiatric settings. A selective review of psychiatric and psychological research on smoking within inpatient settings was conducted, with a particular focus on the influence of smoking on the physical and mental health, pharmacotherapy, and social interactions of patients during their inpatient stay. Patients frequently alter their smoking habits during inpatient treatment, which can affect both their presentation and pharmacotherapeutic management. Smoking also appears to play a central role in social interactions on the ward, with staff frequently using cigarettes to reinforce certain behaviours. Despite current guidelines, mental health professionals rarely address nicotine use among their patients. Nevertheless, programmes that assist patients to quit during an inpatient stay have been shown to be both efficacious and cost-effective. Strategies that address staff concerns and assist in the implementation of effective smoking bans on psychiatric units are also available. Cessation should be a key component of inpatient treatment planning because this setting provides a safe and timely opportunity to help patients quit. A flowchart of interventions that could be incorporated within standard inpatient settings is proposed.
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Affiliation(s)
- David Olivier
- ORYGEN Youth Health, Melbourne, Victoria, Australia.
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Iancu I, Sapir AP, Shaked G, Poreh A, Dannon PN, Chelben J, Kotler M. Increased suicidal risk among smoking schizophrenia patients. Clin Neuropharmacol 2006; 29:230-7. [PMID: 16855425 DOI: 10.1097/01.wnf.0000228178.75711.eb] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Schizophrenia patients display a high suicidal risk, although this risk is difficult to predict. One of the variables associated with increased suicide risk is smoking. In the present study, we assessed the suicidal risk in schizophrenia patients, smokers and nonsmokers. We also evaluated the impact of various variables such as psychotic symptoms, impulsivity, and extra-pyramidal side effects on suicidal risk. METHODS Sixty-one schizophrenia patients responded to a battery of measures, including the suicidal risk scale (SRS), the positive and negative syndrome scale (PANSS), the impulsivity control scale, and the Simpson Angus Scale for extrapyramidal side effects. The effect of smoking on the various measures, especially suicidal risk, was examined. RESULTS Schizophrenia patients who smoke obtained higher PANSS scores (both total score and positive and negative subscales), but did not differ on the Simpson Angus scale of extrapyramidal side effects. They also exhibited higher suicide risk as reflected by higher scores on the SRS, and a trend for higher impulsivity as measured by the impulsivity control scale. Women that smoked had higher SRS scores as compared with female nonsmokers, and also higher than in males, smokers and nonsmokers. Smoking and a history of suicide attempt predicted in our regression analysis a higher SRS score. When conducting separate analyses for the male and female patients, the significant contributors were the PANSS total score among the males and the number of pack-years among the female patients. CONCLUSIONS Despite hints toward the role of smoking in suicidal behavior in Schizophrenia, especially among female patients, more studies are needed to elucidate the association between smoking and suicidality in schizophrenia patients.
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Affiliation(s)
- Iulian Iancu
- Department of Psychiatry B, Beer Yaakov Mental Health Center, Beer Yaakov, Israel.
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Kumari V, Postma P. Nicotine use in schizophrenia: the self medication hypotheses. Neurosci Biobehav Rev 2005; 29:1021-34. [PMID: 15964073 DOI: 10.1016/j.neubiorev.2005.02.006] [Citation(s) in RCA: 327] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 02/23/2005] [Indexed: 01/11/2023]
Abstract
The behavioural and cognitive effects of nicotine in schizophrenia have received much interest in recent years. The rate of smoking in patients with schizophrenia is estimated to be two- to four-fold the rate seen in the general population. Furthermore such patients favour stronger cigarettes and may also extract more nicotine from their cigarettes than other smokers. The question has been raised whether the widespread smoking behaviour seen in this patient group is in fact a manifestation of a common underlying physiology, and that these patients smoke in an attempt to self-medicate. We present an overview of the explanations for elevated rates of smoking in schizophrenia, with particular emphasis on the theories relating this behaviour to sensory gating and cognitive deficits in this disorder that have been viewed as major support for the self-medication hypotheses.
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Affiliation(s)
- Veena Kumari
- Department of Psychology, Institute of Psychiatry, London SE5 8AF, UK.
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Waxmonsky JA, Thomas MR, Miklowitz DJ, Allen MH, Wisniewski SR, Zhang H, Ostacher MJ, Fossey MD. Prevalence and correlates of tobacco use in bipolar disorder: data from the first 2000 participants in the Systematic Treatment Enhancement Program. Gen Hosp Psychiatry 2005; 27:321-8. [PMID: 16168792 DOI: 10.1016/j.genhosppsych.2005.05.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 05/19/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Only a few small descriptive studies have examined the prevalence and correlates of tobacco use among bipolar patients. We predicted that poorly controlled manic, depressed and mixed states, and the presence of psychotic symptoms, would be associated with a greater prevalence of smoking among patients with bipolar disorder. METHOD We examined the prevalence of smoking in a cross-sectional sample of 1904 patients with bipolar disorder enrolled in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) database. We also examined the relationship between smoking and other factors including: bipolar subtype, current clinical status, illness severity (e.g., number of prior mood episodes), age of bipolar onset, gender, education, socioeconomic status, and concurrent substance use. RESULTS At STEP-BD program entry, 31.2% of patients reported that they were smokers. Patients who were male, less educated, and/or had lower income were more likely to be smokers (P<.01). Additionally, patients with rapid cycling, comorbid psychiatric disorders, and/or substance abuse, and those experiencing a current episode of illness were more likely to be smokers (P<.0001). More lifetime depressive and manic episodes as well as greater severity of depressive and manic symptoms were associated with smoking (P<.001). Use of atypical antipsychotic medications was more prevalent among smokers (P=.04). CONCLUSIONS Clinical and demographic variables are associated with smoking in this sample of bipolar patients. Longitudinal analyses are needed to determine how mood and bipolar symptoms interact with smoking over the episodic course of bipolar disorder. Additional studies should focus on whether controlling bipolar symptoms is associated with cessation of smoking.
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Affiliation(s)
- Jeanette A Waxmonsky
- Department of Psychiatry, University of Colorado Health Sciences Center, Denver, CO 80220, USA.
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Chandra PS, Carey MP, Carey KB, Jairam KR, Girish NS, Rudresh HP. Prevalence and correlates of tobacco use and nicotine dependence among psychiatric patients in India. Addict Behav 2005; 30:1290-9. [PMID: 16022927 PMCID: PMC2562741 DOI: 10.1016/j.addbeh.2005.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2004] [Revised: 01/20/2005] [Accepted: 01/20/2005] [Indexed: 10/25/2022]
Abstract
Tobacco use among psychiatric patients in developing countries has not been well-investigated. To address this issue, we screened consecutive admissions to a major psychiatric hospital in southern India, and assessed the prevalence and correlates of tobacco use and nicotine dependence. Patients (n=988) provided information about their use of tobacco products, and participated in an interview that included the Fagerström Test for Nicotine Dependence as well as measures of other substance use. Three hundred and fifty-one patients (36%) reported current tobacco use, with 227 (65% of all users) reporting moderate to severe nicotine dependence. Current tobacco use as well as nicotine dependence were associated with male gender, a diagnosis of bipolar disorder, and risk of other substance use problems. The cultural context of these findings, and the implications for tobacco control among psychiatric patients, are discussed.
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Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Sacco KA, Bannon KL, George TP. Nicotinic receptor mechanisms and cognition in normal states and neuropsychiatric disorders. J Psychopharmacol 2005. [PMID: 15582913 DOI: 10.1177/0269881104047273] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cigarette smoking rates in the American population are approximately 23%, whereas rates of smoking in clinical and population studies of individuals with neuropsychiatric disorders are typically two- to four-fold higher. Studies conducted in a variety of neuropsychiatric populations [e.g. attention-deficit hyperactivity disorder (ADHD), Alzheimer's disease, schizophrenia] have collectively suggested that nicotine may be efficacious in remediating selected cognitive deficits associated with these disorders, thus providing a framework for understanding the specific vulnerability of these patients to smoking initiation and maintenance. However, the specific gain in cognitive performance produced by nicotine administration in healthy subjects with normal cognitive function is less clear. This article reviews our current understanding of central nicotinic acetylcholine receptor (nAChRs) systems in normal and neuropsychiatric disease states and, specifically, their role with respect to cognitive dysfunction and clinical symptoms in several specific neuropsychiatric populations, including ADHD, Alzheimer's disease, Parkinson's disease, Tourette's Disorder, schizophrenia and affective disorders. The potential benefits of nicotinic agents for therapeutic use in neuropsychiatric disorders is discussed, as well as directions for further research in this area.
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Affiliation(s)
- Kristi A Sacco
- Program for Research in Smokers with Mental Illness, Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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38
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Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 2005; 14:106-23. [PMID: 16019961 PMCID: PMC1199553 DOI: 10.1080/10550490590924728] [Citation(s) in RCA: 409] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This article reviews cigarette smoking in patients with psychiatric disorders (PD) and substance use disorders (SUD). Rates of smoking are approximately 23% in the U.S. population but approximately two- to four-fold higher in patients with PD and SUD. Many remaining smokers have had repeated smoking cessation failures, possibly due to the presence of co-morbid PD and SUDs. There is modest, evidence-based support for effective treatment interventions for nicotine addiction in PD and SUD. Further research is needed to increase our understanding of nicotine addiction in PD and SUD and develop more effective treatment interventions.
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Affiliation(s)
| | | | - Tony P. George
- From the Department of Psychiatry, Boston University School of Medicine, Boston, Mass. (Drs. Kalman and Morissette); the Edith Nourse Rogers Veterans Affairs Medical Center, Bedford, Mass. (Dr. Kalman); the Anxiety Disorders Clinic and Psychology Service, VA Boston Healthcare System, Boston, Mass. (Dr. Morissette); and the Program for Research in Smokers with Mental Illness (PRISM), Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Dr. George)
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Döme P, Rihmer Z, Gonda X, Pestality P, Kovács G, Teleki Z, Mandl P. Cigarette smoking and psychiatric disorders in Hungary. Int J Psychiatry Clin Pract 2005; 9:145-8. [PMID: 24930798 DOI: 10.1080/13651500510028977] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Data from the United States and from several European countries show that patients with major mood disorders, schizophrenia and social phobia smoke at significantly higher rates than the general population. However, there are no published results on this field from Central Europe, including Hungary. In the present study, the rate of current and lifetime smoking of the consecutively screened outpatients with DSM-IV unipolar major depression (n=92), bipolar disorder (n=60), schizophrenia (n=80), schizoaffective disorder (n=42) and panic disorder without major depression (n=60) were assessed and the data were compared to the controls (n=5503), representative for the general population of Hungary. The results showed that, compared to controls, the rates of current and lifetime smoking were significantly higher among patients with unipolar major depression, bipolar disorder, schizophrenia and schizoaffective disorder, but not among patients with panic disorder without major depression. The findings support previous findings from other countries on the strong relationship between cigarette smoking and major mood and schizophrenic spectrum disorders.
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Affiliation(s)
- P Döme
- National Institute for Psychiatry and Neurology, Budapest, Hungary
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40
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Sacco KA, Bannon KL, George TP. Nicotinic receptor mechanisms and cognition in normal states and neuropsychiatric disorders. J Psychopharmacol 2004; 18:457-74. [PMID: 15582913 PMCID: PMC1201375 DOI: 10.1177/026988110401800403] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cigarette smoking rates in the American population are approximately 23%, whereas rates of smoking in clinical and population studies of individuals with neuropsychiatric disorders are typically two- to four-fold higher. Studies conducted in a variety of neuropsychiatric populations [e.g. attention-deficit hyperactivity disorder (ADHD), Alzheimer's disease, schizophrenia] have collectively suggested that nicotine may be efficacious in remediating selected cognitive deficits associated with these disorders, thus providing a framework for understanding the specific vulnerability of these patients to smoking initiation and maintenance. However, the specific gain in cognitive performance produced by nicotine administration in healthy subjects with normal cognitive function is less clear. This article reviews our current understanding of central nicotinic acetylcholine receptor (nAChRs) systems in normal and neuropsychiatric disease states and, specifically, their role with respect to cognitive dysfunction and clinical symptoms in several specific neuropsychiatric populations, including ADHD, Alzheimer's disease, Parkinson's disease, Tourette's Disorder, schizophrenia and affective disorders. The potential benefits of nicotinic agents for therapeutic use in neuropsychiatric disorders is discussed, as well as directions for further research in this area.
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Affiliation(s)
- Kristi A Sacco
- Program for Research in Smokers with Mental Illness, Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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Abstract
Tobacco dependence among individuals with a mental illness or an addiction is a tremendous problem that goes largely ignored. Studies of genetics, neuroimaging, and nicotinic receptors support a neurobiological link between tobacco use and alcohol dependence, drug dependence, schizophrenia, depression, attention-deficit hyperactivity disorder (ADHD), and anxiety disorders. This paper summarizes the recent literature on this topic and discusses how treatment for tobacco can no longer be ignored in mental-health and addiction-treatment settings. More research is needed as well as a national organized effort to address tobacco in this large segment of smokers.
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Affiliation(s)
- Jill M Williams
- UMDNJ-Robert Wood Johnson Medical School, Division of Addiction Psychiatry, UMDNJ-SPH, Tobacco Dependence Program, 317 George Street, Suite 210, New Brunswick, NJ 08901, USA.
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Craddock N, Jones I, Kirov G, Jones L. The Bipolar Affective Disorder Dimension Scale (BADDS)--a dimensional scale for rating lifetime psychopathology in bipolar spectrum disorders. BMC Psychiatry 2004; 4:19. [PMID: 15236660 PMCID: PMC481074 DOI: 10.1186/1471-244x-4-19] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Accepted: 07/05/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current operational diagnostic systems have substantial limitations for lifetime diagnostic classification of bipolar spectrum disorders. Issues include: (1) It is difficult to operationalize the integration of diverse episodes of psychopathology, (2) Hierarchies lead to loss of information, (3) Boundaries between diagnostic categories are often arbitrary, (4) Boundaries between categories usually require a major element of subjective interpretation, (5) Available diagnostic categories are relatively unhelpful in distinguishing severity, (6) "Not Otherwise Specified (NOS)" categories are highly heterogeneous, (7) Subclinical cases are not accommodated usefully within the current diagnostic categories. This latter limitation is particularly pertinent in the context of the increasing evidence for the existence of a broader bipolar spectrum than has been acknowledged within existing classifications. METHOD We have developed a numerical rating system, the Bipolar Affective Disorder Dimension Scale, BADDS, that can be used as an adjunct to conventional best-estimate lifetime diagnostic procedures. The scale definitions were informed by (a) the current concepts of mood syndrome recognized within DSMIV and ICD10, (b) the literature regarding severity of episodes, and (c) our own clinical experience. We undertook an iterative process in which we initially agreed scale definitions, piloted their use on sets of cases and made modifications to improve utility and reliability. RESULTS BADDS has four dimensions, each rated as an integer on a 0 - 100 scale, that measure four key domains of lifetime psychopathology: Mania (M), Depression (D), Psychosis (P) and Incongruence (I). In our experience it is easy to learn, straightforward to use, has excellent inter-rater reliability and retains the key information required to make diagnoses according to DSMIV and ICD10. CONCLUSIONS Use of BADDS as an adjunct to conventional categorical diagnosis provides a richer description of lifetime psychopathology that (a) can accommodate sub-clinical features, (b) discriminate between illness severity amongst individuals within a single conventional diagnostic category, and (c) demonstrate the similarity between the illness experience of individuals who have been classified into different disease categories but whose illnesses both fall near the boundaries between the two categories. BADDS may be useful for researchers and clinicians who are interested in description and classification of lifetime psychopathology of individuals with disorders lying on the bipolar spectrum.
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Affiliation(s)
- Nick Craddock
- Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
- Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Edgbaston, Birmingham B15 2QZ, UK
| | - Ian Jones
- Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
- Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Edgbaston, Birmingham B15 2QZ, UK
| | - George Kirov
- Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Lisa Jones
- Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
- Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Edgbaston, Birmingham B15 2QZ, UK
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Vanable PA, Carey MP, Carey KB, Maisto SA. Smoking among psychiatric outpatients: relationship to substance use, diagnosis, and illness severity. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2004; 17:259-65. [PMID: 14640821 PMCID: PMC2440500 DOI: 10.1037/0893-164x.17.4.259] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To understand the elevated smoking rates among psychiatric patients, the authors investigated whether psychiatric diagnosis, illness severity, and other substance use predicted smoking status in a diverse sample (N=2774) of psychiatric outpatients. Results indicated that 61% smoked daily and that 18% smoked heavily. Smoking was related to psychiatric diagnosis and illness severity as well as caffeine consumption and substance abuse. Diagnoses of bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking status, an association that was most pronounced among persons treated at clinics serving more impaired patients. Thus, diagnosis and illness severity contribute to elevated smoking rates, even after controlling for other substance use. Cessation programs are needed to reduce tobacco use in this vulnerable population.
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Affiliation(s)
- Peter A Vanable
- Department of Psychology, Syracuse University, Syracuse, NY 13244-2340, USA.
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Keck PE, McElroy SL, Havens JR, Altshuler LL, Nolen WA, Frye MA, Suppes T, Denicoff KD, Kupka R, Leverich GS, Rush AJ, Post RM. Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness. Compr Psychiatry 2003; 44:263-9. [PMID: 12923703 DOI: 10.1016/s0010-440x(03)00089-0] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although psychosis is common in bipolar disorder, few studies have examined the prognostic significance of psychotic features. In addition, some studies suggest that the presence of mood-incongruent psychosis, in particular, is associated with poorer outcome compared with mood-congruent psychosis. We assesses the phenomenology and prevalence of mood-congruent and mood-incongruent psychotic symptoms in 352 patients with bipolar I disorder participating in the Stanley Foundation Bipolar Treatment Network. We compared the demographic and clinical features, and measures of psychosocial and vocational functioning in patients with and without a history of psychosis. The phenomenology of psychosis in this cohort of patients with bipolar disorder was similar to that reported in earlier studies and supported the lack of diagnostic specificity of any one type of psychotic symptom. There were no significant differences between patients with and without a history of psychosis on any demographic, psychosocial, vocational, or course of illness variables. Only family history of bipolar disorder was significantly more common in patients with nonpsychotic bipolar disorder compared to patients with a history of psychosis. Among bipolar patients with a history of psychosis, only the proportion of women and lifetime prevalence rates of anxiety disorders occurred significantly more in patients with mood-incongruent delusions. In this large cohort of outpatients with bipolar I disorder, neither a history of psychosis nor of mood-incongruent psychosis had prognostic significance at entry into the Network. The lack of observable prognostic impact may have been, in part, due to the relatively high morbidity and poor functional outcome of a substantial portion of the total cohort.
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Affiliation(s)
- Paul E Keck
- Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559, USA
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Friedlander AH, Friedlander IK, Marder SR. Bipolar I disorder: psychopathology, medical management and dental implications. J Am Dent Assoc 2002; 133:1209-17. [PMID: 12356252 DOI: 10.14219/jada.archive.2002.0362] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental management of patients who have bipolar I disorder, or BD, previously known as manic-depressive disorder. TYPES OF STUDIES REVIEWED The authors conducted a MEDLINE search for the period 1995 through 2001 using the key terms "bipolar disorder," "epidemiology," "pathophysiology," "treatment" and "dentistry." The articles they selected for further review included those published in English in peer-reviewed journals; they gave preference to articles reporting randomized, controlled trials. RESULTS BD is a psychiatric illness characterized by extreme mood swings. Mania is accompanied by euphoria, grandiosity, racing thoughts and lack of insight. Depression is characterized by marked sadness or loss of interest or pleasure in daily activities. The unpredictable mood swings can distress the person, can impair social function and quality of life and are associated with a significant increase in the risk for substance abuse and suicide. BD is common in the United States, with a lifetime prevalence rate of 1.6 percent and recurrence rate of more than 50 percent. CLINICAL IMPLICATIONS The prevalence of dental disease usually is extensive because of poor oral hygiene and medication-induced xerostomia. Preventive dental education, saliva substitutes and anticaries agents are indicated. To avoid adverse drug interactions with the usually prescribed psychiatric medications, special precautions should be taken when administering certain antibiotics, analgesics and sedatives.
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