Schizophrenia and tobacco smoking

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Schizophrenia and tobacco smoking have been historically associated. [1] [2] [3] Smoking is known to harm the health of people with schizophrenia. [1]

Contents

Studies across 20 countries showed that people with schizophrenia were much more likely to smoke than those without this diagnosis. [2] For example, in the United States, 90% or more of people with schizophrenia smoked, compared to 20% of the general population in 2006. [4]

It is well established that smoking is more prevalent among people with schizophrenia than the general population as well as those with other psychiatric diagnoses. There is currently no definitive explanation for this difference. [5] Many social, psychological, and biological explanations have been proposed, but today research focuses on neurobiology. [4] [5]

One important reason people smoke cigarettes is due to finding it enjoyable. [5] However, increased rates of smoking among people with schizophrenia have a number of serious impacts, including increased rates of mortality, increased risks of suicidal behavior [1] and cardiovascular disease, reduced treatment effectiveness, and greater financial hardship. [4] [5] [6] [7] Studies have also shown that in a male population, having a schizophrenia spectrum disorder makes it likely for people to use more tobacco. [8] As a result, researchers believe it is important for mental health professionals to combat smoking among people with schizophrenia. [1] [4] [5]

Causes

A number of theories have been proposed to explain increased rates of smoking among people with schizophrenia.

Psychological and social theories

Several psychological and social explanations have been proposed. The earliest explanations were based on psychoanalytic theory.

The socioeconomic/environmental hypothesis proposed that smoking results because many people with schizophrenia are unemployed and inactive, so smoking relieves boredom. Research has found that this explanation alone cannot account for the extreme amount of smoking among people with schizophrenia. [5]

The personality hypothesis focused on the association between smoking and higher level of neuroticism and anxiety. This hypothesis proposed that anxiety as a symptom of schizophrenia may contribute to smoking. [5]

The psychological tool hypothesis argues that smokers use nicotine to manipulate their mental state in response to various environmental conditions, such as reducing stress and managing negative emotions. Research on this hypothesis notes that people with schizophrenia often cannot cope with problems in constructive ways, so use of smoking as a psychological tool may result in a vicious cycle of more and more smoking. [5]

The self-medication hypothesis argues that people with schizophrenia use nicotine to compensate for the cognitive deficits that result from schizophrenia, the antipsychotic medication used to treat schizophrenia, or both. [9]

The cognitive effects hypothesis suggests that nicotine has positive effects on cognition, so smoking is used to improve neurocognitive dysfunction. [5]

In these hypotheses, one factor often implicated is the effects of institutionalization and boredom. However, people with schizophrenia smoke at higher rates and for longer periods than other groups that experience both institutionalization and boredom. [2] [5]

Another factor often implicated is to the side effects of antipsychotics. Atypical antipsychotics may work against smoking cessation, as symptoms of smoking cessation such as irritable mood, mental dulling, and increased appetite overlap with side effects of atypical antipsychotics. Some also argue that smoking works to reduce the side effects of antipsychotics. However, research shows no association between smoking and antipsychotic use after controlling for schizophrenia. [2] [4] [5]

Another frequently implicated factor is increased mental acuity associated with smoking, important because of the mental dulling found over time in schizophrenia. However, both people with schizophrenia and the general population experience this effect, so it cannot fully explain increased smoking in people with schizophrenia. [2] [4] [5]

A 2003 study of over 50,000  Swedish conscripts found that there was a small but significant protective effect of smoking cigarettes on the risk of developing schizophrenia later in life. [10] Many people with schizophrenia have smoked tobacco products long before they are diagnosed with the illness, and a cohort study of Israeli conscripts found that healthy adolescent smokers were more likely to develop schizophrenia in the future than their nonsmoking peers. [11]

Criticisms

One major criticism of social and psychological explanations of smoking in schizophrenia is that most studies have failed to include personal perspectives of patients with schizophrenia. Studies including personal perspectives find that people with schizophrenia generally start smoking for the same reasons as the general population, including social pressures and cultural and socioeconomic factors. People with schizophrenia who are current smokers also cite similar reasons for smoking as people without schizophrenia, primarily relaxation, force of habit, and settling nerves. However, 28% cite psychiatric issues, including response to auditory hallucinations and reducing the side effects of medication. The major themes found in studies of personal perspectives are habit and routine, socialization, relaxation, and addiction to nicotine. It is argued that smoking provides structure and activity, both of which may be lacking in the lives of those with serious mental illness. [5]

Another major criticism is based on the finding that the association between smoking and schizophrenia is about as strong across all cultures. This finding implies that the association is not solely social or cultural, but rather has a strong biological component. [2] [4] [5]

Biological theories

Biological theories focus on the role of dopamine, particularly how negative symptoms such as social withdrawal and apathy may be caused by a deficiency of dopamine in the prefrontal cortex while positive symptoms such as delusions and hallucinations may be caused by excess dopamine in the mesolimbic pathway. Nicotine increases the release of dopamine, so it is hypothesized that smoking helps to correct dopamine deficiency in the prefrontal cortex and thus relieve negative symptoms. [4] [5]

It is unclear, however, how nicotine interacts with positive symptoms, as it would follow from this theory that nicotine would exacerbate excess dopamine in the mesolimbic pathway and thus positive symptoms as well. One theory argues that the beneficial effects of nicotine on negative symptoms outweigh possible exacerbation of positive symptoms. Another theory is based on animal models showing that chronic nicotine use eventually results in a reduction in dopamine, thus alleviating positive symptoms. However, human studies show conflicting results, including some studies that show that smokers with schizophrenia have the most positive symptoms and a reduction in negative symptoms. [5]

Another area of research is the role of nicotinic receptors in schizophrenia and smoking. Studies show increased numbers of exposed nicotinic receptors, which could explain the pathology of both smoking and schizophrenia. However, others argue that the increase in nicotinic receptors is a result of persistent heavy smoking, rather than schizophrenia. [5]

Another source of controversy is the relationship between smoking and sensory gating in schizophrenia. Nicotine may help improve auditory gating, the ability to screen out intrusive environmental sounds. This may help improve attention spans and reduce auditory hallucinations, allowing people with schizophrenia to perceive the environment more effectively and engage in smoother motor functions. However, research shows this effect alone cannot account for increased smoking rates. [4] [5]

Impacts

Increased smoking among people with schizophrenia has a number of impacts on this population. One well-documented consequence is the increase in premature death among people with schizophrenia. Life expectancy among people with schizophrenia is generally 80-85% that of the general population, which results from both unnatural causes such as suicide but also natural causes such as cardiovascular disease, to which smoking is an important contributor. People with schizophrenia have a higher incidence of smoking diseases, with heart disease deaths 30% more likely and respiratory disease deaths 60% more likely. 2/3 of people with schizophrenia die from coronary heart disease, versus less than 1/2 of the general population. Ten-year coronary heart disease risk is significantly elevated in people with schizophrenia, as well as diabetes and hypertension. [4] [5] [7]

Tobacco smoking increases the metabolism of some antipsychotics, by strongly activitating CYP1A2, the enzyme that breaks them down, and a significant difference is found in these levels between smokers and non-smokers. [12] [13] [14] It is recommended that the dosage for those smokers on clozapine be increased by 50%, and for those on olanzapine by 30%. [13] The result of stopping smoking can lead to an increased concentration of the antipsychotic that may result in toxicity, so that monitoring of effects would need to take place with a view to decreasing the dosage; many symptoms may be noticeably worsened, and extreme fatigue, and seizures are also possible with a risk of relapse. Likewise those who resume smoking may need their dosages adjusted accordingly. [15] [12] The altering effects are due to compounds in tobacco smoke and not to nicotine; the use of nicotine replacement therapy therefore has the equivalent effect of stopping smoking and monitoring would still be needed. [12]

Besides biological effects, smoking has a profound social impact on people with schizophrenia. One major impact is financial, as people with schizophrenia have been found to spend a disproportionate amount of their income on cigarettes. A study of people with schizophrenia on public assistance found that they spent a median amount of $142 per month on cigarettes out of a median monthly public assistance income of $596, or about 27.36%. Some argue that this results in further social impacts as people with schizophrenia are then unable to spend money on entertainment and social events that would promote well-being, or may even be unable to afford housing or nutrition. [4] [6]

Role of tobacco industry

Though the relationship between smoking and schizophrenia is well established, a factor to be considered in this relationship is the role of the tobacco industry. Research based on internal industry documents shows a concerted effort by the industry to promote belief that people with schizophrenia need to smoke and that it is dangerous for them to quit. Such promotion includes monitoring or supporting research that endorsed the idea that people with schizophrenia are uniquely immune to the health consequences of smoking (since proved false) and that tobacco is needed for people with schizophrenia to self-medicate. The industry also provided cigarettes to hospital wards and supported efforts to block hospital-based smoking bans. Although this does not discredit the effects of nicotine in schizophrenia, it is argued that the efforts of the tobacco industry slowed the decline in smoking prevalence in people with schizophrenia as well as the development of clinical policies to promote smoking cessation. [16]

Clinical implications

There is evidence that multimodal smoking cessation programs using both pharmacologic therapy (with varenicline or bupropion) and nicotine replacement can be effective without worsening symptoms of schizophrenia. [17] Historically, mental health providers have not attempted to prevent schizophrenics from smoking, based on the rationale that patients with serious mental illness already experience significant stress and disability and as such should be allowed to engage in smoking as an activity that is pleasurable, albeit destructive. There is also historical precedent of mental health providers, particularly in inpatient settings, to use cigarettes as a way to manipulate patient behavior, such as rewarding good behavior with cigarettes or withholding cigarettes to encourage medication compliance. [18] However, research showing that eliminating even one risk factor for disease can significantly improve long-term health outcomes has resulted in the dominant view among clinicians opposing smoking. [4] [5]

Though smoking cessation is generally now a goal of mental health clinicians, there is a lack of empirical research showing successful strategies for accomplishing this goal. However, all studies have shown a reduction in smoking, though not necessarily elimination. Evidence has been found to support the use of sustained-release bupropion, nicotine replacement therapy, atypical antipsychotics, and cognitive-behavioral therapy. Better outcomes are seen when two or more cessation strategies are employed, as well as for patients using atypical antipsychotics rather than typical antipsychotics. There is also no evidence for an increase in positive symptoms or side effects following smoking cessation, while there is evidence for a decrease in negative symptoms. [4] [5] [19]

Besides smoking cessation, the prevalence of smoking among people with schizophrenia also calls for additional measures in evaluation by mental health providers. Researchers[ who? ] argue that providers should incorporate tobacco use assessment into everyday clinical practice, as well as continuing assessments of cardiovascular health through measures such as blood pressure and diagnostics such as electrocardiography. Additionally there are ethical and practical concerns if healthcare facilities prohibit smoking without providing alternatives, particularly since withdrawal can alter the presentation of symptoms and response to treatment and may confuse or even exacerbate symptoms. Clinicians should also be aware of the consequences that can result from a lack of cigarettes, such as aggression, prostitution, trafficking, and general disruption. These consequences indicate that providers may need to help patients obtain cigarettes and/or monitor usage. [4] [5]

Experimental drugs that agonize the α7 nicotinic acetylcholine receptors targeted by nicotine such as GTS-21 have been suggested as candidates for symptomatic treatment of schizophrenia. [20]

Related Research Articles

<span class="mw-page-title-main">Nicotine</span> Chemical stimulant produced by some plants

Nicotine is a naturally produced alkaloid in the nightshade family of plants and is widely used recreationally as a stimulant and anxiolytic. As a pharmaceutical drug, it is used for smoking cessation to relieve withdrawal symptoms. Nicotine acts as a receptor agonist at most nicotinic acetylcholine receptors (nAChRs), except at two nicotinic receptor subunits where it acts as a receptor antagonist.

<span class="mw-page-title-main">Cigarette</span> Small roll of cut tobacco designed to be smoked

A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opposite end. Cigarette smoking is the most common method of tobacco consumption. The term cigarette, as commonly used, refers to a tobacco cigarette, but the word is sometimes used to refer to other substances, such as a cannabis cigarette or an herbal cigarette. A cigarette is distinguished from a cigar by its usually smaller size, use of processed leaf, and paper wrapping, which is typically white. Most modern cigarettes are filtered, although this does not make the smoke inhaled from them contain fewer carcinogens and harmful chemicals.

<span class="mw-page-title-main">Tobacco smoking</span> Practice of burning tobacco and breathing the resulting smoke

Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed to have begun as early as 5000–3000 BC in Mesoamerica and South America. Tobacco was introduced to Eurasia in the late 17th century by European colonists, where it followed common trade routes. The practice encountered criticism from its first import into the Western world onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.The World Health Organization states secondhand smoke—that from other people's smoking—causes 1.3 million of the 8 million annual deaths caused by smoking.

<span class="mw-page-title-main">Smoking cessation</span> Process of discontinuing tobacco smoking

Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes the process of quitting difficult.

<span class="mw-page-title-main">Cotinine</span> Alkaloid found in tobacco

Cotinine is an alkaloid found in tobacco and is also the predominant metabolite of nicotine, typically used as a biomarker for exposure to tobacco smoke. Cotinine is currently being studied as a treatment for depression, post-traumatic stress disorder (PTSD), schizophrenia, Alzheimer's disease and Parkinson's disease. Cotinine was developed as an antidepressant as a fumaric acid salt, cotinine fumarate, to be sold under the brand name Scotine, but it was never marketed.

<span class="mw-page-title-main">Nicotine replacement therapy</span> Treatment for tobacco use disorder

Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the chance of quitting tobacco smoking by about 55%. Often it is used along with other behavioral techniques. NRT has also been used to treat ulcerative colitis. Types of NRT include the adhesive patch, chewing gum, lozenges, nose spray, and inhaler. The use of multiple types of NRT at a time may increase effectiveness.

Nicotine gum is a chewing gum containing the active ingredient nicotine polacrilex. It is a type of nicotine replacement therapy (NRT) used alone or in combination with other pharmacotherapy for smoking cessation and for quitting smokeless tobacco.

<span class="mw-page-title-main">Nicotine marketing</span> Marketing technique

Nicotine marketing is the marketing of nicotine-containing products or use. Traditionally, the tobacco industry markets cigarette smoking, but it is increasingly marketing other products, such as electronic cigarettes and heated tobacco products. Products are marketed through social media, stealth marketing, mass media, and sponsorship. Expenditures on nicotine marketing are in the tens of billions a year; in the US alone, spending was over US$1 million per hour in 2016; in 2003, per-capita marketing spending was $290 per adult smoker, or $45 per inhabitant. Nicotine marketing is increasingly regulated; some forms of nicotine advertising are banned in many countries. The World Health Organization recommends a complete tobacco advertising ban.

<span class="mw-page-title-main">Health effects of tobacco</span> Circumstances, mechanisms, and factors of tobacco consumption on human health

Tobacco products, especially when smoked or used orally, have negative effects on human health. Researchers have addressed concerns about these effects for a long time. They have focused primarily on cigarette smoking.

<span class="mw-page-title-main">Nicotine withdrawal</span> Process of withdrawing from nicotine addiction

Nicotine withdrawal is a group of symptoms that occur in the first few weeks after stopping or decreasing use of nicotine. Symptoms include intense cravings for nicotine, anger or irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain, and difficulty concentrating. Withdrawal symptoms make it harder to quit nicotine products, and most methods for quitting smoking involve reducing nicotine withdrawal. Quit smoking programs can make it easier to quit. Nicotine withdrawal is recognized in both the American Psychiatric Association Diagnostic and Statistical Manual and the WHO International Classification of Diseases.


Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death, and reducing smoking is vital to public health.

<span class="mw-page-title-main">Electronic cigarette</span> Device that vaporizes a liquid nicotine solution for inhalation

An electronic cigarette (e-cigarette) or vape is a device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank filled with liquid. Instead of smoke, the user inhales vapor. As such, using an e-cigarette is often called "vaping". The atomizer is a heating element that vaporizes a liquid solution called e-liquid, which quickly cools into an aerosol of tiny droplets, vapor and air. E-cigarettes are activated by taking a puff or pressing a button. Some look like traditional cigarettes, and most kinds are reusable. The vapor mainly comprises propylene glycol and/or glycerin, usually with nicotine and flavoring. Its exact composition varies, and depends on several things including user behavior.

<span class="mw-page-title-main">Nicotine dependence</span> Chronic disease

Nicotine dependence is a state of dependence upon nicotine. Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of withdrawal symptoms. Tolerance is another component of drug dependence. Nicotine dependence develops over time as a person continues to use nicotine. The most commonly used tobacco product is cigarettes, but all forms of tobacco use and e-cigarette use can cause dependence. Nicotine dependence is a serious public health problem because it leads to continued tobacco use, which is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year.

<span class="mw-page-title-main">Youth smoking</span> Overview article

Smokingamong youth and adolescents is an issue that affects countries worldwide. While the extent to which smoking is viewed as a negative health behavior may vary across different nations, it remains an issue regardless of how it is perceived by different societies. The United States has taken numerous measures, ranging from changes in national policy surrounding youth cigarette access to changes in media campaigns, in attempts to eliminate the use of tobacco products among teenagers. Approximately 90% of smokers begin smoking prior to the age of 18.

<span class="mw-page-title-main">Cigarette smoking among college students</span> Smoking cigarettes during the college years

The majority of lifelong smokers begin smoking habits before the age of 24, which makes the college years a critical time for tobacco companies to convince college students to pick up the habit of cigarette smoking. Cigarette smoking in college is seen as a social activity by those who partake in it, and more than half of the students that are users do not consider themselves smokers. This may be because most college students plan to quit smoking by the time that they graduate.

<span class="mw-page-title-main">Smoking in Syria</span> Legality, popularity and history of smoking in Syria

Smoking in Syria is steadily increasing in popularity amongst the Syrian population, mainly in the forms of cigarettes or narghiles. In Syria, the General Organization of Tobacco manages the growth and exportation of tobacco products. Syrians collectively spend about $600 million per year on tobacco consumption. As of 2010, 20% of women and 60% of men smoke and 98% of the overall population is affected by passive smoking. Narghiles and cigarettes are the two main forms of tobacco consumption. Despite the assumption that smoking, specifically the narghile, is embedded in Syrian culture, this phenomenon has only recently become widespread. Health officials are currently working on smoking cessation programs and policies, to remove this idea that smoking in Syria is an essential part of the culture, to educate regarding health effects, and to prevent citizens from smoking in public places.

The use of electronic cigarettes (vaping) carries health risks. The risk depends on the fluid and varies according to design and user behavior. In the United Kingdom, vaping is considered by some to be around 95% less harmful than tobacco after a controversial landmark review by Public Health England.

The scientific community in the United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.

Jed Eugene Rose is an American academic professor, inventor and researcher in the field of nicotine and smoking cessation. Rose is presently the President and CEO of the Rose Research Center, LLC in Raleigh, North Carolina. Additionally, he is the Director of the Duke Center for Smoking Cessation at Duke University Medical Center.

Exposure to nicotine, from conventional or electronic cigarettes during adolescence can impair the developing human brain. E-cigarette use is recognized as a substantial threat to adolescent behavioral health. The use of tobacco products, no matter what type, is almost always started and established during adolescence when the developing brain is most vulnerable to nicotine addiction. Young people's brains build synapses faster than adult brains. Because addiction is a form of learning, adolescents can get addicted more easily than adults. The nicotine in e-cigarettes can also prime the adolescent brain for addiction to other drugs such as cocaine. Exposure to nicotine and its great risk of developing an addiction, are areas of significant concern.

References

  1. 1 2 3 4 Sagud M, Mihaljevic Peles A, Pivac N (September 2019). "Smoking in schizophrenia: recent findings about an old problem". Current Opinion in Psychiatry. 32 (5): 402–408. doi:10.1097/YCO.0000000000000529. PMID   31135490. S2CID   167219141.
  2. 1 2 3 4 5 6 De Leon, J; Diaz, FJ (2005). "A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors". Schizophrenia Research. 76 (2–3): 135–57. doi:10.1016/j.schres.2005.02.010. PMID   15949648. S2CID   32975940.
  3. ↑ Gage, Suzanne H.; Jones, Hannah J.; Taylor, Amy E.; Burgess, Stephen; Zammit, Stanley; Munafò, Marcus R. (2017-01-19). "Investigating causality in associations between smoking initiation and schizophrenia using Mendelian randomization". Scientific Reports. 7 (1): 40653. doi: 10.1038/srep40653 . ISSN   2045-2322. PMC   5244403 .
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Keltner, Norman L.; Grant, Joan S. (2006). "Smoke, Smoke, Smoke That Cigarette". Perspectives in Psychiatric Care. 42 (4): 256–61. doi:10.1111/j.1744-6163.2006.00085.x. PMID   17107571.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 McCloughen, A (2003). "The association between schizophrenia and cigarette smoking: a review of the literature and implications for mental health nursing practice". International Journal of Mental Health Nursing. 12 (2): 119–29. doi:10.1046/j.1440-0979.2003.00278.x. PMID   12956023.
  6. 1 2 Steinberg, ML; Williams, JM; Ziedonis, DM (2004). "Financial implications of cigarette smoking among individuals with schizophrenia". Tobacco Control. 13 (2): 206. PMC   1747846 . PMID   15175544.
  7. 1 2 Goff, DC; Sullivan, LM; McEvoy, JP; Meyer, JM; Nasrallah, HA; Daumit, GL; Lamberti, S; D'agostino, RB; et al. (2005). "A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls". Schizophrenia Research. 80 (1): 45–53. doi:10.1016/j.schres.2005.08.010. PMID   16198088. S2CID   21196294.
  8. ↑ Johnson, J.; Ratner, P.; Malchy, L.; Okoli, C.; Procyshyn, R.; Bottorff, J.; Groening, M.; Schultz, A.; Osborne, M. (2010). "Gender-specific profiles of tobacco use among non-institutionalized people with serious mental illness". BMC Psychiatry. 10: 101. doi: 10.1186/1471-244X-10-101 . PMC   3002315 . PMID   21118563.
  9. ↑ Quigley H, MacCabe JH (2019). "The relationship between nicotine and psychosis". Ther Adv Psychopharmacol. 9: 2045125319859969. doi:10.1177/2045125319859969. PMC   6604123 . PMID   31308936.
  10. ↑ Zammit S, Allebeck P, Dalman C, Lundberg I, Hemmingsson T, Lewis G (December 2003). "Investigating the association between cigarette smoking and schizophrenia in a cohort study". Am J Psychiatry. 160 (12): 2216–2221. doi:10.1176/appi.ajp.160.12.2216. PMID   14638593. S2CID   13411664.
  11. ↑ Mark Weiser, M.D.; Abraham Reichenberg; Itamar Grotto, M.D.; Ross Yasvitzky, B.Sc.; et al. (1 July 2004). "Higher rates of cigarette smoking in male adolescents before the onset of schizophrenia: A historical-prospective cohort study". American Journal of Psychiatry. 161 (12): 1219–1223. doi:10.1176/appi.ajp.161.7.1219. PMID   15229054.
  12. 1 2 3 Cather C, Pachas GN, Cieslak KM, Evins AE (June 2017). "Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations". CNS Drugs. 31 (6): 471–481. doi:10.1007/s40263-017-0438-8. PMC   5646360 . PMID   28550660.
  13. 1 2 Tsuda Y, Saruwatari J, Yasui-Furukori N (4 March 2014). "Meta-analysis: the effects of smoking on the disposition of two commonly used antipsychotic agents, olanzapine and clozapine". BMJ Open. 4 (3): e004216. doi:10.1136/bmjopen-2013-004216. PMC   3948577 . PMID   24595134.
  14. ↑ Li P, Snyder GL, Vanover KE (2016). "Dopamine Targeting Drugs for the Treatment of Schizophrenia: Past, Present and Future". Current Topics in Medicinal Chemistry. 16 (29): 3385–3403. doi:10.2174/1568026616666160608084834. PMC   5112764 . PMID   27291902.
  15. ↑ Lowe EJ, Ackman ML (April 2010). "Impact of tobacco smoking cessation on stable clozapine or olanzapine treatment". The Annals of Pharmacotherapy. 44 (4): 727–32. doi:10.1345/aph.1M398. PMID   20233914. S2CID   11456024.
  16. ↑ Prochaska, JJ; Hall, SM; Bero, LA (2008). "Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?". Schizophrenia Bulletin. 34 (3): 555–67. doi:10.1093/schbul/sbm117. PMC   2632440 . PMID   17984298.
  17. ↑ Pinho, Sofia; Rocha, Vânia; Vieira-Coelho, Maria A. (1 May 2021). "Effectiveness of multimodal interventions focused on smoking cessation in patients with schizophrenia: A systematic review". Schizophrenia Research. 231: 145–153. doi:10.1016/j.schres.2021.03.012. ISSN   0920-9964. PMID   33857662. S2CID   233215477.
  18. ↑ Jenkin G, McIntosh J, Hoek J, Mala K, Paap H, Peterson D, Marques B, Every-Palmer, S (Nov 2021). "There's no smoke without fire: Smoking in smoke-free acute mental health wards". PLOS ONE. 16 (11): e0259984. Bibcode:2021PLoSO..1659984J. doi: 10.1371/journal.pone.0259984 . PMC   8592473 . PMID   34780542.
  19. ↑ Bradshaw, T; Lovell, K; Harris, N (2005). "Healthy living interventions and schizophrenia: a systematic review". Journal of Advanced Nursing. 49 (6): 634–54. doi:10.1111/j.1365-2648.2004.03338.x. PMID   15737224.
  20. ↑ Martin LF, Kem WR, Freedman R (Jun 2004). "Alpha-7 nicotinic receptor agonists: potential new candidates for the treatment of schizophrenia". Psychopharmacology. 174 (1): 54–64. doi:10.1007/s00213-003-1750-1. PMID   15205879. S2CID   21557412.
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