SCHIZOPHRENIA& CIGARETTE-SMOKINGChidiebere John Uma

WHAT IS SCHIZOPHRENIA?Schizophrenia is an illness affecting the normal functioning of the brain.

It interferes with a person’s ability to think, feel and act.

SYMPTOMSConfused thinkingDelusionsHallucinationsAbnormal motor behaviorNegative symptoms

CIGARETTE SMOKING AND PLEASUREActivities such as eating and sex, which give you pleasure or a feeling of well-being, are correlated with a release of dopamine

Nicotine activates dopaminergic-neurons in the brain-reward system

Dopamine (DA) systemMesolimbic Dopamine systemVentral Tegmental Area (VTA)Nucleus Accumbens (NAc)Projections to Medial Prefrontal Cortex

BRAIN REWARD SYSTEMS

The combination of effects—i. increasing dopamine release and ii. decreasing the inhibitory [GABA]

response—results in an amplification of the rewarding properties of nicotine.

RATES OF CIGARETTE SMOKINGThe rate of smoking in people with schizophrenia is at least two to three times (88%) that in the general population.

Patients who smoke, smoke at heavier rates than in the general population.

57% of new cases of schizophrenia are of smokers.

WHY???

WHY DO PATIENTS WITH SCHIZOPHRENIA SMOKE?i. Aspects of the illness might lead

more patients to smokeii. Smoking might be an etiological

factor in schizophreniaiii. Genetic and/or environmental

factors might lead both to nicotine addiction and to schizophrenia

1. ADVANCED ILLNESSIt has been suggested that smoking may be a marker of a more severe illness process.

Smokers have more severe symptoms with higher scores on the Brief Psychiatric Rating Scale for positive and negative symptoms.

1. ADVANCED ILLNESSPatients smoke as a form of self-medication with nicotine, which may help regulate a dysfunctional mesolimbic dopamine system.

It may increase dopamine release in the pre-frontal cortex and alleviate positive and negative symptoms.

2. ETIOLOGICAL FACTORIt may be that repeated activation by nicotine of the mesolimbic system over a long time precipitates the onset of schizophrenia in vulnerable individuals.

The earlier the age of starting smoking, the earlier was the onset of psychotic illness in women.

3. GENETICSA small number of DNA sequences (called SNPs) are known to be implicated in both schizophrenia and smoking.

 SNPs within the NR4A3 gene (rs1131339 and rs1405209) were significantly associated with heavy smoking.

CONSEQUENCES OF SMOKINGMorbidity and mortalityMedication and side-effectsEconomic considerations

MORBIDITY AND MORTALITYThere is an increase in deaths from natural causes and the most common causes are cardiovascular and respiratory disease, both smoking-related.

MEDICATION AND SIDE-EFFECTSCigarette smoke also increases the activity of CYP 1A2 enzymes, thus decreasing the concentration of many drugs, including clozapine and olanzapine.

Patients who smoke require larger doses of drugs than non-smokers to achieve the same therapeutic effect.

MEDICATION AND SIDE-EFFECTSConversely, upon smoking cessation, smokers may require a reduction in the dosage of antipsychotics.

ECONOMIC CONSIDERATIONSThe average patient smokes about 26 cigarettes per day. At 3.19 Gel per packet, this works out at 1,164.35 Gel per year.

Very few patients work.

MANAGEMENT ISSUESSmoking must be implicated in the increased mortality in schizophrenia.

Smokers require higher doses of antipsychotic medication.

MANAGEMENT ISSUESA substantial proportion of the income of smokers with schizophrenia is spent on cigarettes.

Patients with schizophrenia have the right to be offered treatment for their nicotine addiction.

BUPROPIONIn schizophrenic patients, sustained-release bupropion, an antidepressant, alone or in combination with a nicotine patch, resulted in significantly higher long-term rates of smoking cessation (30.3 and 35.5%, respectively) than use of either the nicotine patch alone (16.4%) or placebo (15.6%).

REFERENCES http://www.ehd.org/health_tobacco_19.php https://

teens.drugabuse.gov/teachers/mind-over-matter/nicotine/how-does-nicotine-act-brain

http://www.livestrong.com/article/214868-dopamine-smoking/ https://en.wikipedia.org/wiki/Schizophrenia http://apt.rcpsych.org/content/6/5/327 http://www.schizophrenia.com/smoke.htm# https://www.sciencedaily.com/releases/2016/04/160418091346.htm