Smoking is not associated with positive, negative cognitive and mood symptoms in schizophrenia. Smoking is associated with lower levels of antipsychotic induced akathisia. Clinicians should not be discouraged from helping patients stop smoking for fear of worsening symptoms. However, akathisia may emerge upon cessation of smoking. Switching patients from typical to atypical antipsychotics may assist patients with schizophrenia to give up smoking.
At around 15 years of age Jake began using drugs occasionally with his friends. During his late teenage years, he wanted to become a DJ and spent a lot of time at clubs, where he used amphetamine and ecstasy. His use of alcohol and cannabis also increased at this time, as he found these substances would "calm his nerves" and help him "chill out". When Jake was 21, his parents started to put pressure on him to get a "proper job", and he moved out of their home to live with his girlfriend, who occasionally used crack-cocaine. Eventually Jake tried crack-cocaine himself. Substance use was very common among Jake's friends, and he enjoyed the way it made him feel. His drug and alcohol use continued to increase to the point where, at the age of 22, Jake was spending all his money on alcohol/drugs, and his use was causing arguments with his girlfriend. Around this time, Jake began to experience auditory hallucinations. He noticed that following a period of intense drug use the voices became "worse" and more "intense" but found that if he continued to use the drugs he felt good again. He was admitted to an acute psychiatric inpatient unit, and on his discharge the voices had stopped. A few months later he began using crack-cocaine again, and whenever he had the money or could get credit from dealers, he would spend about £60 over one or two days on this. He was also spending about £30 per week on cannabis and drinking up to three cans of extra-strong lager every day. Simultaneously, Jake's auditory hallucinations became more intense and commanding, telling him that his next-door neighbour was "evil". Acting on the instructions of the voices, Jake tried to set fire to his next-door neighbour's flat. As a result of this, Jake was admitted to hospital for a second time.
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