The effect of the severity of nicotine dependence on psychopathology, insight and illness severity in schizophrenia

Aim: Compared to the general healthy population, and other psychiatric disorders the prevalence of smoking is found to be much higher among people with schizophrenia. Our study aims to determine the prevalence of nicotine dependence and investigate the effects of the severity of nicotine dependence on psychopathology, illness severity and insight in a population of people with schizophrenia.Material and Methods: A cross-sectional study was carried out in a psychotic disorders outpatient clinic at Bakirkoy Training and Research Hospital. Four hundred and ten schizophrenia patients were administered by the Positive and Negative Symptom Scale (PANSS), Schedule for Assessment of Insight (SAI), Clinical Global Impression Severity of Illness (CGI-S) and the Turkish version of Fagerstrom Test for Nicotine Dependence (FTND).Results: The prevalence of nicotine dependence among the patients was 49.0%. The one-way analysis of variance revealed that subjects with severe nicotine dependence scored more in the positive subscale of PANSS and CGI-S compared with patients with mild-moderate nicotine dependence. Those with severe nicotine dependence were also prescribed higher doses of antipsychotic.Conclusions: Our findings indicate an association between nicotine dependence, positive symptoms and severity of illness. Identifying this relationship can be helpful in the management of smoking cessation treatment in patients with schizophrenia.

PDF

___

Gut-Fayand A, Dervaux A, Olié JP, Lôo H, Poirier MF, Krebs MO. Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity. Psychiatry Res 2001;102(1): 65–72.
B Brody AL, Olmstead RE, London ED, Farahi J, Meyer JH, Grossman P, et al. Smoking induced ventral striatum dopamine release. Am J Psychiatry 2004;161(7):1211–8.
George Y. Neurobiological links between nicotine addiction and schizophrenia. J Dual Diagn 2007;3:27–42.
Zhang XY, Li CB, Li M, Zheng YL, Zhang CX, Yan QZ, et al. Smoking initiation and schizophrenia: a replication study in a Chinese Han population. Schizophr Res 2010;119(1- 3):110-4.
De Leon J, Gurpegui M, Diaz FJ. Epidemiology of comorbid tobacco use and schizophrenia: Thinking about risks and protective factors. Journal of Dual Diagnosis 2007;3:9-25.
Chaves L, Shirakawa I. Nicotine use in patients with schizophrenia evaluated by the Fagerström Tolerance Questionnaire: a descriptive analysis from a Brazilian sample. Rev Bras Psiquiatr 2008;30(4):350-2.
Yee A, Bt Nek Mohamed NN, Binti Hashim AH, Loh HS, Harbajan Singh MK, Ng CG, et al. The effect of nicotine dependence on psychopathology in patients with schizophrenia. Biomed Res Int 2015;2015:730291.
Centers for Disease Control and Prevention Cigarette smoking among adults--United States, 2004. MMWR Morb Mortal Wkly Rep 2005;54(44):1121–24.
LLerena A, de la Rubia A, Peñas-Lledó EM, Diaz FJ, de Leon J. Schizophrenia and tobacco smoking in a Spanish psychiatric hospital. Schizophr Res 2003;60(2-3):313-7.
Küresel Yetişkin Tütün Araştırması Türkiye 2012. www. halksagligiens.hacettepe.edu.tr/KYTA_ TR.pdf.
Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003;64(6):663-7.
Atkins M, Burgess A, Bottomley C. Chlorpromazine equivalents: a consensus of opinion for both clinical and research applications. Psychiatric Bulletin 1997;21:224-6.
Uysal MA, Kadakal F, Karşıdağ Ç, Bayram NG, Uysal Ö, Yılmaz V. Fagerstrom nikotin bağımlılık testinin Türkçe versiyonun güvenirliği ve faktör analizi. Tuberk Toraks 2004;52(2):115-21.
Guy W. ECDEU Assessment manual for psychopharmacology. revised US dept health, education and welfare publication (ADM), Rockville, Md:National Institude of Mental Health 1976;76-338.
Arslan S, Günay Kılıç B, Karakılıç H. İçgörünün Üç Bileşenini Değerlendirme ölçeği güvenirlik ve geçerlik çalışması [Three Components of Insight Assessment Scale reliability and validity study]. Türkiye’de Psikiyatri. 2000;3:17-24.
David AS. Insight and psychosis. Br J Psychiatry 1990;156:798-808.
Kostakoğlu AE, Batur S, Tiryaki A. Pozitif ve Negatif Sendrom Ölçeğinin (PANSS) Türkçe Uyarlamasının Geçerlik ve Güvenilirliği [Validity and Reliability of Turkish Adaptation of Positive and Negative Syndrome Scale (PANSS)]. Türk Psikoloji Dergisi 1999;14(44):23-32.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2):261-76.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text rev. DC: Author; 2000. Washington.
Patkar AA, Gopalakrishnan R, Lundy A, Leone FT, Certa KM, Weinstein SP. Relationship between tobacco smoking and positive and negative symptoms in schizophrenia. J Nerv Ment Dis 2005;190(9):604-10.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, Washington, DC: Author; 1994.
Fagerström KO, Kunze M, Schoberberger R, Breslau N, Hughes JR, Hurt RD, Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers. Tob Control 1996;5(1):52-6.
Uludağ YT, Güleç G. Prevalence of Substance Use in Patients Diagnosed with Schizophrenia. Arch Neuropsychiatr 2016;53:4-11.
Karşıdag C, Alpay N, Kocabıyık A. Schizophrenia and Cigarette Dependence. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2005;18:13-20.
Uzun Ö, Cansever A, Basoğlu C, Ozsahin A. Smoking and substance abuse in outpatients with schizophrenia: A 2-year follow-up study in Turkey. Drug Alcohol Depend 2003;70(2):187-92.
Ekinci O, Ekinci A. Cigarette smoking in patients with schizophrenia in Turkey: relationships to psychopathology, socio-demographic and clinical characteristics. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2012;25:321-9.
Aguilar MC, Gurpegui M, Diaz FJ, De Leon J. Nicotine dependence and symptoms in schizophrenia: Naturalistic study of complex interactions. Br J Psychiatry 2005;186:215-21.
Kotov R, Guey LT, Bromet EJ, Schwartz JE. Smoking in schizophrenia: diagnostic specificity, symptom correlates, and illness severity. Schizophr Bull 2010;36(1):173-81.
Kao YC, Liu YP, Cheng TH, Chou MK. Cigarette smoking in outpatients with chronic schizophrenia in Taiwan: relationships to socio-demographic and clinical characteristics. Psychiatr Res 2011;190(2-3):193-9.
Krishnadas R, Jauhar S, Telfer S, Shivashankar S, McCreadie RG. Nicotine dependence and illness severity in schizophrenia. Br J Psychiatry 2012;201(4):306-12.
Wing VC, Wass CE, Soh DW, George TP. A review of neurobiological vulnerability factors and treatment implications for comorbid tobacco dependence in schizophrenia. Ann N Y Acad Sci 2011;1248: 89-106.
Yoshimasu K, Kiyohara C. Genetic influences on smoking behavior and nicotine dependence: a review. J Epidemiol 2003;13(4):183-92.
Lyon ER. A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatr Serv 1999;50(10):1346-50.
Kumari V, Postma P. Nicotine use in schizophrenia: the self medication hypotheses. Neurosci Biobehav Rev 2005;29(6):1021-34.
Kelly DL, McMahon RP, Wehring HJ, Liu F, Mackowick KM, Boggs DL, Cigarette smoking and mortality risk in people with schizophrenia, Schizophr Bull 2011;37(4):832-8.
de Leon J, Diaz FC. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 2005;76(2):135- 57.
Ucok, A, Polat A, Bozkurk O, Meteris H. Cigarette smoking among patients with schizophrenia and bipolar disorders. Psychiatry Clin Neurosci 2004;58(4):434-7.
Kelly C, McCreadie R. Cigarette smoking and schizophrenia. Adv Psychiatr Treat 2000;6:327-33.