Tuesday, April 7, 2009

Smoking and Schizophrenia

The prevalence of smoking is higher in the psychiatric patient community than it is in the general population. For major depression, bipolar disorder, and schizophrenia the prevalence rates are approximately 50%, 70%, and 80-90%, respectively. Smoking, of course, carries adverse affects which we would ideally like to decrease in the clinical population (it has been noted that there is actually a lower than normal smoking related cancer mortality in schizophrenics) (1).

Of the seven motivations to smoke (social, sensorimotor, indulge, crave, stimulate, habit, and crutch), sensorimotor (enjoyment of the aesthetics of smoking) and stimulate were significantly greater in schizophrenics than in controls (1). The former may be a result of an inpatient population smoking to alleviate boredom while the latter motivation may be an attempt to relieve symptoms of schizophrenia such as decreased cognitive function and energy.

Additionally, these motivations, as well as anxiolytic incentives) may be related to the side effects of antipsychotic medications which block dopamine receptors leading to the above symptoms.

One interesting question is how to separate anxiety caused by nicotine withdrawals from that caused by pharmacological side effects. Since nicotine receptors are desensitized for a period of time after smoking a cigarette (about 45 minutes), some sort of temporal control could be introduced into a study, though this would be quite difficult to actually carry out.

References: 1, 2

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