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Tobacco smoking is associated with psychotic experiences in the general population of South London

Published online by Cambridge University Press:  28 June 2017

V. Bhavsar ,
S. Jauhar ,
R. M. Murray ,
M. Hotopf ,
S. L. Hatch ,
A. McNeill ,
J. Boydell  and
J. H. MacCabe
V. Bhavsar*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
S. Jauhar
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
R. M. Murray
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
M. Hotopf
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London South London and Maudsley NHS Foundation Trust, London
S. L. Hatch
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
A. McNeill
Affiliation:
National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience and UK Centre for Tobacco and Alcohol Studies, King's College London, London
J. Boydell
Affiliation:
Cornwall Partnership Foundation NHS Trust, Cornwall
J. H. MacCabe
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London South London and Maudsley NHS Foundation Trust, London
*
*Address for correspondence: V. Bhavsar, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London. (Email: [email protected])
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Abstract

Background

The association between cigarette smoking and psychosis remains unexplained, but could relate to causal effects in both directions, confounding by socioeconomic factors, such as ethnicity, or use of other substances, including cannabis. Few studies have evaluated the association between cigarettes and psychotic experiences (PEs) in diverse, inner-city populations, or relationships with number of cigarettes consumed.

Methods

We assessed associations and dose–response relationships between cigarette smoking and PEs in a cross-sectional survey of household residents (n = 1680) in South East London, using logistic regression to adjust for cannabis use, other illicit substances, and socioeconomic factors, including ethnicity.

Results

We found association between any PEs and daily cigarette smoking, which remained following adjustment for age, gender, ethnicity, cannabis and use of illicit stimulant drugs (fully adjusted odds ratio 1.47, 95% confidence interval 1.01–2.15). Fully adjusted estimates for the association, and with number of PEs, increased with number of cigarettes smoked daily, implying a dose–response effect (p = 0.001 and <0.001, respectively). Odds of reporting any PEs in ex-smokers were similar to never-smokers.

Conclusions

In this diverse epidemiological sample, association between smoking and PEs was not explained by confounders such as cannabis or illicit drugs. Daily cigarette consumption showed a dose–response relationship with the odds of reporting PEs, and of reporting a greater number of PEs. There was no difference in odds of reporting PEs between ex-smokers and never-smokers, raising the possibility that the increase in PEs associated with smoking may be reversible.

Keywords

Confoundingepidemiologyethnicitypsychosistobacco smoking
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 1 , January 2018 , pp. 123 - 131
Copyright
Copyright © Cambridge University Press 2017 

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References

Amos, A, Wiltshire, S, Bostock, Y, Haw, S, Mcneill, A (2004). ‘You can't go without a fag you need it for your hash’—a qualitative exploration of smoking, cannabis and young people. Addiction 99, 77–81.CrossRefGoogle Scholar
Action on Smoking and Health (2015). Smoking statistics: Who smokes and how much? http://ash.org.uk/information-and-resources/fact-sheets/smoking-statistics-who-smokes-and-how-much/ March 2015.Google Scholar
Barnes, M, Lawford, BR, Burton, SC, Heslop, KR, Noble, EP, Hausdorf, K, Young, RM (2006). Smoking and schizophrenia: is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use? Australian and New Zealand Journal of Psychiatry 40, 575–580.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
Bebbington, P, Nayani, T (1995). The psychosis screening questionnaire. International Journal of Methods in Psychiatric Research 5, 11–19.Google Scholar
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004). Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. British Journal of Psychiatry 185, 220–226.CrossRefGoogle ScholarPubMed
Best, D, Rawaf, S, Rowley, J, Floyd, K, Manning, V, Strang, J (2001). Ethnic and gender differences in drinking and smoking among London adolescents. Ethnicity & Health 6, 51–57.CrossRefGoogle ScholarPubMed
Chen, J, Bacanu, S-A, Yu, H, Zhao, Z, Jia, P, Kendler, KS, Kranzler, HR, Gelernter, J, Farrer, L, Minica, C, Pool, R, Milaneschi, Y, Boomsma, DI, Penninx, BWJH, Tyndale, RF, Ware, JJ, Vink, JM, Kaprio, J, Munafò, M, Chen, X (2016). Genetic relationship between schizophrenia and nicotine dependence. Scientific Reports 6, 25671.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
Dean, K, Murray, RM (2005). Environmental risk factors for psychosis. Dialogues in Clinical Neuroscience 7, 69–80.CrossRefGoogle ScholarPubMed
Gage, S, Hickman, M, Heron, J, Munafò, M, Lewis, G, Macleod, J, Zammit, S (2014). Associations of cannabis and cigarette use with psychotic experiences at age 18: findings from the Avon Longitudinal Study of Parents and Children. Psychological Medicine 44, 3435–3444.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
Greenland, S, Daniel, R, Pearce, N (2016). Outcome modelling strategies in epidemiology: traditional methods and basic alternatives. International Journal of Epidemiology 45, 565–575.CrossRefGoogle ScholarPubMed
Gurillo, P, Jauhar, S, Murray, RM, Maccabe, JH (2015). Does tobacco use cause psychosis? Systematic review and meta-analysis. Lancet Psychiatry 2, 718–725.CrossRefGoogle ScholarPubMed
Hatch, SL, Frissa, S, Verdecchia, M, Stewart, R, Fear, NT, Reichenberg, A, Morgan, C, Kankulu, B, Clark, J, Gazard, B (2011). Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: the South East London Community Health (SELCoH) study. BMC Public Health 11, 861.CrossRefGoogle Scholar
Johns, LC, Cannon, M, Singleton, N, Murray, RM, Farrell, M, Brugha, T, Bebbington, P, Jenkins, R, Meltzer, H (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185, 298–305.CrossRefGoogle ScholarPubMed
Johns, LC, Nazroo, JY, Bebbington, P, Kuipers, E (2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. British Journal of Psychiatry 180, 174–178.CrossRefGoogle Scholar
Johns, LC, Van Os, J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 1125–1141.CrossRefGoogle ScholarPubMed
Kendler, KS, Lönn, SL, Sundquist, J, Sundquist, K (2015). Smoking and schizophrenia in population cohorts of Swedish women and men: a prospective co-relative control study. American Journal of Psychiatry 172, 1092–1100.CrossRefGoogle Scholar
Koyanagi, A, Stickley, A, Haro, JM (2016). Psychotic symptoms and smoking in 44 countries. Acta Psychiatrica Scandinavica 133, 497–505.CrossRefGoogle ScholarPubMed
Krishnadas, R, Jauhar, S, Telfer, S, Shivashankar, S, Mccreadie, RG (2012). Nicotine dependence and illness severity in schizophrenia. British Journal of Psychiatry 201, 306–312.CrossRefGoogle ScholarPubMed
Kumari, V, Postma, P (2005). Nicotine use in schizophrenia: the self medication hypotheses. Neuroscience & Biobehavioral Reviews 29, 1021–1034.CrossRefGoogle ScholarPubMed
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555–561.CrossRefGoogle ScholarPubMed
Lewis, G, Pelosi, A (1990). Manual of the Revised Clinical Interview Schedule (CIS-R). Institute of Psychiatry, London.Google Scholar
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465–486.CrossRefGoogle ScholarPubMed
Linscott, RJ, Van Os, J (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43, 1133–1149.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.CrossRefGoogle ScholarPubMed
Matcham, F, Carroll, A, Chung, N, Crawford, V, Galloway, J, Hames, A, Jackson, K, Jacobson, C, Manawadu, D, Mccracken, L, Moxham, J, Rayner, L, Robson, D, Simpson, A, Wilson, N, Hotopf, M (2017). Smoking and common mental disorders in patients with chronic conditions: an analysis of data collected via a web-based screening system. General Hospital Psychiatry 45, 12–18.CrossRefGoogle Scholar
Mccambridge, J, Strang, J (2005). Can it really be this black and white? An analysis of the relative importance of ethnic group and other sociodemographic factors to patterns of drug use and related risk among young Londoners. Drugs: Education, Prevention and Policy 12, 149–159.Google Scholar
McManus, S, Meltzer, H, Campion, J (2010). Cigarette smoking and mental health in England: data from the Adult Psychiatric Morbidity Survey 2007. National Centre for Social Research: London, UK.Google Scholar
Mollon, J, David, AS, Morgan, C, Frissa, S, Glahn, D, Pilecka, I, Hatch, SL, Hotopf, M, Reichenberg, A (2016). Psychotic experiences and neuropsychological functioning in a population-based sample. JAMA Psychiatry 73, 129–138.CrossRefGoogle Scholar
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655–664.CrossRefGoogle Scholar
Morgan, C, Reininghaus, U, Reichenberg, A, Frissa, S, Hotopf, M, Hatch, SL (2014). Adversity, cannabis use and psychotic experiences: evidence of cumulative and synergistic effects. British Journal of Psychiatry 204, 346–353.CrossRefGoogle ScholarPubMed
Morral, AR, Mccaffrey, DF, Paddock, SM (2002). Reassessing the marijuana gateway effect. Addiction 97, 1493–1504.CrossRefGoogle ScholarPubMed
Pickles, A, Dunn, G, Vázquez-Barquero, JL (1995). Screening for stratification in two-phase (‘two-stage’) epidemiological surveys. Statistical Methods in Medical Research 4, 73–89.CrossRefGoogle ScholarPubMed
RCPSYCH (2013) Royal College of Psychiatrists. Smoking and Mental Health. Royal College of Psychiatrists Council Report CR178. Royal College of Psychiatrists: London.Google Scholar
Regier, DA, Farmer, ME, Rae, DS, Locke, BZ, Keith, SJ, Judd, LL, Goodwin, FK (1990). Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. Journal of the American Medical Association 264, 2511–2518.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
Saha, S, Scott, JG, Varghese, D, Degenhardt, L, Slade, T, Mcgrath, JJ (2011). The association between delusional-like experiences, and tobacco, alcohol or cannabis use: a nationwide population-based survey. BMC Psychiatry 11, 1.CrossRefGoogle ScholarPubMed
Semple, DM, Mcintosh, AM, Lawrie, SM (2005). Cannabis as a risk factor for psychosis: systematic review. Journal of Psychopharmacology 19, 187–194.CrossRefGoogle ScholarPubMed
Smith, MJ, Barch, DM, Wolf, TJ, Mamah, D, Csernansky, JG (2008). Elevated rates of substance use disorders in non-psychotic siblings of individuals with schizophrenia. Schizophrenia Research 106, 294–299.CrossRefGoogle ScholarPubMed
Smith, RC, Singh, A, Infante, M, Khandat, A, Kloos, A (2002). Effects of cigarette smoking and nicotine nasal spray on psychiatric symptoms and cognition in schizophrenia. Neuropsychopharmacology 27, 479–497.CrossRefGoogle ScholarPubMed
StataCorp (2014). Stata Statistical Software, Release 14. Special Edition. StataCorp: College Station, TX, USA.Google Scholar
Szatkowski, L, Mcneill, A (2014). Diverging trends in smoking behaviors according to mental health status. Nicotine & Tobacco Research 17, 356–360.CrossRefGoogle ScholarPubMed
Taylor, G, Mcneill, A, Girling, A, Farley, A, Lindson-Hawley, N, Aveyard, P (2014). Change in mental health after smoking cessation: systematic review and meta-analysis. British Medical Journal 348, g1151.CrossRefGoogle ScholarPubMed
Van Gastel, W, Maccabe, J, Schubart, C, Vreeker, A, Tempelaar, W, Kahn, R, Boks, M (2013). Cigarette smoking and cannabis use are equally strongly associated with psychotic-like experiences: a cross-sectional study in 1929 young adults. Psychological Medicine 43, 2393–2401.CrossRefGoogle ScholarPubMed
Wanigaratne, S, Dar, K, Abdulrahim, D, Strang, J (2003). Ethnicity and drug use: exploring the nature of particular relationships among diverse populations in the United Kingdom. Drugs: Education, Prevention and Policy 10, 39–55.Google Scholar
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
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population. Results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519–526.CrossRefGoogle ScholarPubMed
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