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The Correlations BetweenSmoking and

Schizophrenia

Osman Wijaya

03005165

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Schizophrenia

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Nicotine

affects thecentral nervous system (CNS)

agonist at the nicotinic subtype of acetylcholinereceptors

positivereinforcing and addictive properties

activating the dopaminergic (ventral tegmental area to thecerebral cortex and the limbic system)

causes an increase in theconcentrations ofcirculatingnorepinephrine and epinephrine and an increase in therelease ofvasopressin, b-endorphin, adrenocorticotropichormone (ACTH), and cortisol

contribute to the basic stimulatory effects on the CNS.

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The Facts

Therate of smoking in people with

schizophrenia is at least two to threetimes that in general population

Patients who smoke, smoke at heavierrates than in general population

Most patients start smoking in theirteens, before the illness begins

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Thecorrelation

Aspects of illness

Smoking might be an etiological factor inschizophrenia

Genetic and/orenvironmental factors mightlead both to nicotine addiction and toschizophrenia

Movement disorders

Tardive dyskinesia

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Aspect of illness

Medication

lead patient to smokeheavily

(modulation of dopamine activity)

effect: decrease antipsychotic side

effects

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Aspect of illness

Affect schizophrenic symptoms

alleviate positive and negative symptoms

form of self-medication

enhances cognitive performance

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Aspect of illness

smoke before psychotic aspects of the

illness appearedpremorbid characteristics are perhapsimportant

(Patients who smoked were as childrenmore poorly adjusted socially than thosewho were not smokers)

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E

tiological Factor

theearlierthe age of starting smoking,

theearlierwas the onset of psychoticillness

repeated activation by nicotine of themesolimbic system overa long time

(forvulnerable individuals)

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Genetic factors

The CHRNA7 receptor

influential in schizophrenia

smoking:

normalizing geneexpression

regulate smoking behavior

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Movement disorders

Reduced incidence of neuroleptic-

induced parkinsonism

theeffect of nicotine on striatal

dopamine

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Tardive dyskinesia

Increased the incidence of dyskinesia

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Theeffect

Health

Social and economy

Cessation lower than in the general population

- lowermotivation to quit tobacco use

- fewer lifetime quit attempts- increased severity of nicotine dependence

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References Burns DM.Nicotine Addiction.In: KasperDL, Fauci AS, Longo DL, et al,ed.

Harrisons Principles ofInternal Medicinevolume 2 16thedition.McGraw Hill,2005. p 2573.

Dalack GW, Healy DJ, Meador-Woodruff JH.Nicotine Dependence inSchizophrenia: Clinical Phenomena and Laboratory Findings. Am J Psychiatry1998; 1490-1501.

Goff DC, Henderson DC, Amico A. CigaretteSmoking in Schizophrenia:Relationship to Psychopathology and Medication SideEffects. AmJ Psychiatry1992; 149:1189-1194

Kelly C, McCreadie R. CigaretteSmoking and Schizophrenia. Advances inPsychiatric Treatment (2000) 6: 327-331.

Leonard S. Human Genetic Determinants ofSchizophrenia and NicotineAddiction. Available at: http://www.nida.nih.gov/whatsnew/meetings/frontiers2005/neurobiological.htmlAccessed November23, 2008.

Sadock BJ, Sadock VA. Kaplan and Sadocks Synopsis ofPsychiatryBehavioral Sciences/Clinical Psychiatry 10thedition.Philadelphia: LippincottWilliams and Wilkins. 2007. p 438-40; 467-71

WeiserM, Reichenberg A, Grotto I, et al. HigherRates of CigaretteSmoking inMale Adolescents Before the Onset ofSchizophrenia: A Historical-ProspectiveCohort Study. Am J Psychiatry 2004; 161:1219-1223.

Williams JM, Foulds J.Successful Tobacco Dependence Treatment in

Schizophrenia. Am J Psychiatry 164:222-227, February 2007

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