Stop Turning a Blind Eye: Tobacco Smoking Among Egyptian Patients With Schizophrenia

Abstract

Background: Patients with schizophrenia have considerably higher rates of mortality than general population. Multiple factors may play a role in this. Despite being a major preventable cause of death, smoking is usually overlooked when dealing with patients with schizophrenia. Understanding the pattern of smoking, its severity, and the reasons to quit might be helpful in managing patients with schizophrenia and decreasing the mortality gap.Subjects and Methods: The study included smokers divided into two groups; the first included 346 patients with schizophrenia while the second group had 150 smokers with no mental illness. Both groups were assessed and compared regarding sociodemographic variables, pattern of smoking, severity of nicotine dependence, and motivation to quit smoking.Results: Earlier age of starting to smoke, higher number of cigarettes per day, and lower dependency scores were noted in patients with Schizophrenia. Positive correlation was found between positive symptoms and severity of dependence. Specific positive symptoms were correlated to number of cigarettes per day and time before first cigarette. Patients with Schizophrenia showed a significant difference in intrinsic reasons to quit (health concerns and self-control), which were also positively correlated to their positive symptoms score. Linear regression analysis for predictors of FTND score revealed that only age, sex, and schizophrenia were significant predictors of FTND score.Conclusion: Patients with schizophrenia smoke at earlier ages and smoke more cigarettes per day, yet, have less severe dependence than non-schizophrenic counterparts. Positive symptoms play a role in their smoking pattern and severity. Health concerns and self-control are their main motives to quit smoking.

Effects of Smoking Status on Remission and Metabolic and Cognitive Outcomes in Schizophrenia Patients Treated with Clozapine

“…Moreover, a large-scale prospective cohort study showed that smoking in schizophrenia patients was associated with significantly more frequent self-reported positive symptoms, negative symptoms, and depressive symptoms and lower quality of life compared to nonsmokers [21]. These results were reported to be similar in the sub-analyses for patients treated with clozapine [21] and thus were consistent with earlier research showing unfavourable outcomes in smoking schizophrenia patients compared to nonsmokers with regard to positive symptoms [22][23][24][25][26], depressive symptoms [15], functional outcomes [27,28], and cognition [28][29][30]. It may be speculated that PCS are more likely not to achieve symptomatic remission according to "Andreasen criteria" [6], as indicated in 1 cross-sectional study of 102 outpatients with schizophrenia [31].…”

Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban

“…Furthermore, tobacco increases the metabolism of psychotropic drugs, reducing their concentration in the bloodstream and consequently requiring higher dosis to reach the therapeutic effect (23)(24)(25) . This scenario explains the higher costs with psychotropic drugs when smoking is allowed in a mental health service, and the decrease in costs when smoking is prohibited.…”

Indicadores hospitalarios y comportamiento de pacientes internados en hospital psiquiátrico que adoptó la prohibición de fumar

“…Además de eso, el tabaco intensifica el metabolismo de los psicofármacos, disminuyendo su concentración en la corriente sanguínea, lo que resulta en la necesidad de aumentar la dosis ingeridas para que la dosimetría terapéutica pueda ser alcanzada (23)(24)(25) . Ese escenario, por sí solo, justifica los gastos más elevados con la adquisición de psicofármacos, cuando el fumar es permitido, en un servicio de salud mental y con la disminución de los gastos cuando el fumar es prohibido.…”