Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-25T04:26:33.342Z Has data issue: false hasContentIssue false
  • English
  • Français

Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case-control study

Published online by Cambridge University Press:  13 November 2012

X. Y. Zhang ,
D. C. Chen ,
M. H. Xiu ,
C. N. Haile ,
S. C. He ,
X. Luo ,
L. Zuo ,
R. Rosenheck ,
T. A. Kosten  and
T. R. Kosten
X. Y. Zhang*
Affiliation:
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
D. C. Chen
Affiliation:
Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
M. H. Xiu
Affiliation:
Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China
C. N. Haile
Affiliation:
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
S. C. He
Affiliation:
Department of Psychology, Peking University, Beijing, China
X. Luo
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
L. Zuo
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
R. Rosenheck
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
T. A. Kosten
Affiliation:
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
T. R. Kosten*
Affiliation:
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
*
*Author for correspondence: X. Y. Zhang, M.D., Ph.D., VA Medical Center, Research Building 109, Room 130, 2002 Holcombe Boulevard, Houston, TX 77030, USA. (Email: [email protected]) [X. Y. Zhang] (Email: [email protected]) [T. R. Kosten]
*Author for correspondence: X. Y. Zhang, M.D., Ph.D., VA Medical Center, Research Building 109, Room 130, 2002 Holcombe Boulevard, Houston, TX 77030, USA. (Email: [email protected]) [X. Y. Zhang] (Email: [email protected]) [T. R. Kosten]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although patients with chronic schizophrenia have substantially higher smoking rates than either the general population or patients with other mental illnesses, drug-naive patients with a first episode of schizophrenia have received little systemic study. This study examined smoking rates, the association between smoking and symptom severity and cognitive function in Chinese first-episode schizophrenia (FES) patients using cross-sectional and case-control designs.

Method

Two hundred and forty-four drug-naive FES patients and 256 healthy controls matched for gender, age and education completed the Fagerström Test for Nicotine Dependence (FTND) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients were also rated on the Positive and Negative Symptom Scale (PANSS).

Results

The rate and quantity of smoking were not significantly higher among FES patients compared to the general population. Among patients, smokers scored higher than non-smokers on the total PANSS and the positive symptom subscale scores. There were no significant associations between cognitive function and smoking in either FES patients or healthy controls.

Conclusions

In contrast to studies in patients with chronic schizophrenia, drug-naive FES patients did not smoke more frequently than the general population. Furthermore, patients with psychotic disorders who smoked did not exhibit significant cognitive differences compared with those who did not smoke. However, smoking may have other detrimental effects on physical and mental health, for example on positive symptoms.

Keywords

Cognitionfirst episodenicotinepsychopathologyschizophreniasmoking
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 8 , August 2013 , pp. 1651 - 1660
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aguilar, MC, Gurpegui, M, Diaz, FJ, de Leon, J (2005). Nicotine dependence and symptoms in schizophrenia: naturalistic study of complex interactions. British Journal of Psychiatry 186, 215–221.CrossRefGoogle ScholarPubMed
Barr, RS, Culhane, MA, Jubelt, LE, Mufti, RS, Dyer, MA, Weiss, AP, Deckersbach, T, Kelly, JF, Freudenreich, O, Goff, DC, Evins, AE (2008). The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology 33, 480–490.CrossRefGoogle ScholarPubMed
Dalack, GW, Healy, DJ, Meador-Woodruff, JH (1998). Nicotine dependence in schizophrenia: clinical phenomena and laboratory findings. American Journal of Psychiatry 155, 1490–1501.CrossRefGoogle ScholarPubMed
de Leon, J, Diaz, FJ (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research 76, 135–157.CrossRefGoogle ScholarPubMed
de Leon, J, Diaz, FJ (2012). Genetics of schizophrenia and smoking: an approach to studying their comorbidity based on epidemiological findings. Human Genetics 131, 877–901.CrossRefGoogle ScholarPubMed
de Leon, J, Gurpegui, M, Diaz, FJ (2007). Epidemiology of comorbid tobacco use and schizophrenia: thinking about risks and protective factors. Journal of Dual Diagnosis 3, 9–25.CrossRefGoogle Scholar
Dickerson, F, Stallings, C, Vaughan, C, Origoni, A, Khushalani, S, Dickinson, D, Medoff, D (2011). Cognitive functioning in recent onset psychosis. Journal of Nervous and Mental Disease 199, 367–371.CrossRefGoogle ScholarPubMed
Evins, AE, Deckersbach, T, Cather, C, Freudenreich, O, Culhane, MA, Henderson, DC, Green, MF, Schoenfeld, DA, Rigotti, NA, Goff, DC (2005). Independent effects of tobacco abstinence and bupropion on cognitive function in schizophrenia. Journal of Clinical Psychiatry 66, 1184–1190.CrossRefGoogle ScholarPubMed
Fagerström, KO (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors 3, 235–241.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Forchuk, C, Norman, R, Malla, A, Martin, ML, McLean, T, Cheng, S, Diaz, K, McIntosh, E, Rickwood, A, Vos, S, Gibney, (2002). C.Schizophrenia and the motivation for smoking. Perspectives in Psychiatric Care 38, 41–49.CrossRefGoogle Scholar
Freedman, R, Olincy, A, Ross, RG, Waldo, MC, Stevens, KE, Adler, LE, Leonard, S (2003). The genetics of sensory gating deficits in schizophrenia. Current Psychiatry Reports 5, 155–161.CrossRefGoogle ScholarPubMed
George, TP, Vessicchio, JC, Termine, A, Sahady, DM, Head, CA, Pepper, WT, Kosten, TR, Wexler, BE (2002). Effects of smoking abstinence on visuospatial working memory function in schizophrenia. Neuropsychopharmacology 26, 75–85.CrossRefGoogle ScholarPubMed
Goff, DC, Henderson, DC, Amico, E (1992). Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. American Journal of Psychiatry 149, 1189–1194.Google ScholarPubMed
Gu, D, Kelly, TN, Wu, X, Chen, J, Samet, JM, Huang, JF, Zhu, M, Chen, JC, Chen, CS, Duan, X, Klag, MJ, He, J (2009). Mortality attributable to smoking in China. New England Journal of Medicine 360, 150–159.CrossRefGoogle ScholarPubMed
Harris, JG, Kongs, S, Allensworth, D, Martin, L, Tregellas, J, Sullivan, B, Zerbe, G, Freedman, R (2004). Effects of nicotine on cognitive deficits in schizophrenia. Neuropsychopharmacology 29, 1378–1385.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Kelly, C, McCreadie, RG (1999). Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. American Journal of Psychiatry 156, 751–757.CrossRefGoogle ScholarPubMed
Kelly, DL, McMahon, RP, Wehring, HJ, Liu, F, Mackowick, KM, Boggs, DL, Warren, KR, Feldman, S, Shim, JC, Love, RC, Dixon, L (2011). Cigarette smoking and mortality risk in people with schizophrenia. Schizophrenia Bulletin 37, 832–838.CrossRefGoogle ScholarPubMed
Kumari, V, Postma, P (2005). Nicotine use in schizophrenia: the self medication hypotheses. Neuroscience and Biobehavioral Reviews 29, 1021–1034.CrossRefGoogle ScholarPubMed
Lee, S, Guo, WJ, Tsang, A, Huang, YQ, He, YL, Kessler, RC (2009). Prevalence and correlates of active and ever-smokers in metropolitan China. Addictive Behaviors 34, 969–972.CrossRefGoogle ScholarPubMed
Leonard, S, Gault, J, Hopkins, J, Logel, J, Vianzon, R, Short, M, Drebing, C, Berger, R, Venn, D, Sirota, P, Zerbe, G, Olincy, A, Ross, RG, Adler, LE, Freedman, R (2002). Association of promoter variants in the alpha7 nicotinic acetylcholine receptor subunit gene with an inhibitory deficit found in schizophrenia. Archives of General Psychiatry 59, 1085–1096.CrossRefGoogle ScholarPubMed
Leonard, S, Mexal, S, Freedman, R (2007). Smoking, genetics and schizophrenia: evidence for self medication. Journal of Dual Diagnosis 3, 43–59.CrossRefGoogle ScholarPubMed
Lieberman, JA, Javitch, JA, Moore, H (2008). Cholinergic agonists as novel treatments for schizophrenia: the promise of rational drug development for psychiatry. American Journal of Psychiatry 165, 931–936.CrossRefGoogle ScholarPubMed
Lyons, MJ, Bar, JL, Kremen, WS, Toomey, R, Eisen, SA, Goldberg, J, Faraone, SV, Tsuang, M (2002). Nicotine and familial vulnerability to schizophrenia: a discordant twin study. Journal of Abnormal Psychology 111, 687–693.CrossRefGoogle ScholarPubMed
Ma, X, Li, C, Meng, H, Du, L, Wang, Q, Wang, Y, Deng, W, Liu, X, Hu, X, Murray, RM, Collier, DA, Li, T (2010). Premorbid tobacco smoking is associated with later age at onset in schizophrenia. Psychiatry Research 178, 461–466.CrossRefGoogle ScholarPubMed
Martin, LF, Freedman, R (2007). Schizophrenia and the alpha7 nicotinic acetylcholine receptor. International Review of Neurobiology 78, 225–246.CrossRefGoogle ScholarPubMed
McEvoy, JP, Brown, S (1999). Smoking in first-episode patients with schizophrenia. American Journal of Psychiatry 156, 1120–1121.CrossRefGoogle ScholarPubMed
Mobascher, A, Winterer, G (2008). The molecular and cellular neurobiology of nicotine abuse in schizophrenia. Pharmacopsychiatry 41 (Suppl. 1), S51–S59.CrossRefGoogle ScholarPubMed
Moncrieff, J (2009). A critique of the dopamine hypothesis of schizophrenia and psychosis. Harvard Review of Psychiatry 17, 214–225.CrossRefGoogle ScholarPubMed
Montgomery, AJ, Lingford-Hughes, AR, Egerton, A, Nutt, DJ, Grasby, PM (2007). The effect of nicotine on striatal dopamine release in man: a [11C]raclopride PET study. Synapse 61, 637–645.CrossRefGoogle Scholar
Myles, N, Newall, HD, Curtis, J, Nielssen, O, Shiers, D, Large, M (2012). Tobacco use before, at, and after first-episode psychosis: a systematic meta-analysis. Journal of Clinical Psychiatry 73, 468–475.CrossRefGoogle ScholarPubMed
Olincy, A, Braff, DL, Adler, LE, Cadenhead, KS, Calkins, ME, Dobie, DJ, Green, MF, Greenwood, TA, Gur, RE, Gur, RC, Light, GA, Mintz, J, Nuechterlein, KH, Radant, AD, Schork, NJ, Seidman, LJ, Siever, LJ, Silverman, JM, Stone, WS, Swerdlow, NR, Tsuang, DW, Tsuang, MT, Turetsky, BI, Wagner, BD, Freedman, R (2010). Inhibition of the P50 cerebral evoked response to repeated auditory stimuli: results from the Consortium on Genetics of Schizophrenia. Schizophrenia Research 119, 175–182.CrossRefGoogle Scholar
Olincy, A, Harris, JG, Johnson, LL, Pender, V, Kongs, S, Allensworth, D, Ellis, J, Zerbe, GO, Leonard, S, Stevens, KE, Stevens, JO, Martin, L, Adler, LE, Soti, F, Kem, WR, Freedman, R (2006). Proof-of-concept trial of an alpha7 nicotinic agonist in schizophrenia. Archives of General Psychiatry 63, 630–638.CrossRefGoogle ScholarPubMed
Olincy, A, Young, DA, Freedman, R (1997). Increased levels of the nicotine metabolite cotinine in schizophrenic smokers compared to other smokers. Biological Psychiatry 42, 1–5.CrossRefGoogle ScholarPubMed
Phillips, MR, Shen, Q, Liu, X, Pritzker, S, Streiner, D, Conner, K, Yang, G (2007). Assessing depressive symptoms in persons who die of suicide in mainland China. Journal of Affective Disorders 98, 73–82.CrossRefGoogle ScholarPubMed
Randolph, C, Tierney, MC, Mohr, E, Chase, TN (1998). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology 20, 310–319.CrossRefGoogle ScholarPubMed
Sacco, KA, Termine, A, Seyal, A, Dudas, MM, Vessicchio, JC, Krishnan-Sarin, S, Jatlow, PI, Wexler, BE, George, TP (2005). Effects of cigarette smoking on spatial working memory and attentional deficits in schizophrenia: involvement of nicotinic receptor mechanisms. Archives of General Psychiatry 62, 649–659.CrossRefGoogle ScholarPubMed
Samele, C, Patel, M, Boydell, J, Leese, M, Wessely, S, Murray, R (2007). Physical illness and lifestyle risk factors in people with their first presentation of psychosis. Social Psychiatry and Psychiatric Epidemiology 42, 117–124.CrossRefGoogle ScholarPubMed
Scottish Schizophrenia Research Group (2000). Smoking habits and plasma lipid peroxide and vitamin E levels in never-treated first-episode patients with schizophrenia. British Journal of Psychiatry 176, 290–293.CrossRefGoogle Scholar
Smith, RC, Infante, M, Ali, A, Nigam, S, Kotsaftis, A (2001). Effects of cigarette smoking on psychopathology scores in patients with schizophrenia: an experimental study. Substance Abuse 22, 175–186.CrossRefGoogle ScholarPubMed
Smith, RC, Warner-Cohen, J, Matute, M, Butler, E, Kelly, E, Vaidhyanathaswamy, S, Khan, A (2006). Effects of nicotine nasal spray on cognitive function in schizophrenia. Neuropsychopharmacology 31, 637–643.CrossRefGoogle ScholarPubMed
Strand, JE, Nybäck, H (2005). Tobacco use in schizophrenia: a study of cotinine concentrations in the saliva of patients and controls. European Psychiatry 20, 50–54.CrossRefGoogle ScholarPubMed
Weiser, M, Reichenberg, A, Grotto, I, Yasvitzky, R, Rabinowitz, J, Lubin, G, Nahon, D, Knobler, HY, Davidson, M (2004). Higher rates of cigarette smoking in male adolescents before the onset of schizophrenia: a historical prospective cohort study. American Journal of Psychiatry 161, 1219–1223.CrossRefGoogle ScholarPubMed
Wing, VC, Bacher, I, Sacco, KA, George, TP (2011). Neuropsychological performance in patients with schizophrenia and controls as a function of cigarette smoking status. Psychiatry Research 188, 320–326.CrossRefGoogle ScholarPubMed
Winterer, G (2010). Why do patients with schizophrenia smoke? Current Opinion in Psychiatry 23, 112–119.CrossRefGoogle ScholarPubMed
Zanelli, J, Reichenberg, A, Morgan, K, Fearon, P, Kravariti, E, Dazzan, P, Morgan, C, Zanelli, C, Demjaha, A, Jones, PB, Doody, GA, Kapur, S, Murray, RM (2010). Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations. American Journal of Psychiatry 167, 78–85.CrossRefGoogle ScholarPubMed
Zhang, BH, Tan, YL, Zhang, WF, Wang, ZR, Yang, GG, Shi, C, Zhang, XY, Zhou, DF (2009). Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a screening test in Chinese: reliability and validity. Chinese Mental Health Journal 28, 865–869.Google Scholar
Zhang, XY, Li, CB, Li, M, Zheng, YL, Zhang, CX, Yan, QZ, Liu, WZ, Kang, YM, Wang, F, Chen, DC, Xiu, MH, Kosten, TR (2010). Smoking initiation and schizophrenia: a replication study in a Chinese Han population. Schizophrenia Research 119, 110–114.CrossRefGoogle ScholarPubMed
Zhang, XY, Liang, J, Chen, DC, Xiu, MH, He, J, Cheng, W, Wu, Z, Yang, FD, Haile, CN, Sun, H, Lu, L, Kosten, TA, Kosten, TR (2012). Cigarette smoking in male patients with chronic schizophrenia in a Chinese population: prevalence and relationship to clinical phenotypes. PLoS ONE 7, e30937.CrossRefGoogle Scholar
Ziedonis, D, Williams, JM, Smelson, D (2003). Serious mental illness and tobacco addiction: a model program to address this common but neglected issue. American Journal of the Medical Sciences 326, 223–230.CrossRefGoogle Scholar
Ziedonis, DM, Kosten, TR, Glazer, WM, Frances, RJ (1994). Nicotine dependence and schizophrenia. Hospital and Community Psychiatry 45, 204–206.Google ScholarPubMed