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Letter to the Editor   |    
Smoking in First-Episode Patients With Schizophrenia
JOSEPH P. MCEVOY, M.D.; SHIRLEY BROWN, R.N.
Am J Psychiatry 1999;156:1120a-1121.

To the Editor: Patients with chronic schizophrenia smoke at substantially higher prevalence rates (70%–80%) than the general population (25%–30%) (1, 2). Reasons suggested to explain this include the following: 1) smoking lowers antipsychotic blood levels (and extrapyramidal side effects [2]) by stimulating hepatic microsomal enzymes (3), and 2) nicotine reverses antipsychotic-induced cognitive slowing (4). However, there is also evidence that smoking produces direct "therapeutic" effects (i.e., independent of its interactions with antipsychotics) for patients with schizophrenia. For example, nicotine corrects abnormalities in sensory gating seen in many patients with schizophrenia and in 50% of their first-degree relatives (5).

If patients with schizophrenia smoke primarily to reverse the effects of antipsychotic drugs, those with chronic schizophrenia should smoke at substantially higher prevalence rates than first-episode patients.

We interviewed and observed 22 consecutively admitted, first-episode patients with schizophrenia or schizophreniform disorder; all patients gave written informed consent after the procedures were explained to them. The patients had less than 30 days’ previous lifetime exposure to antipsychotics; 17 (77%) smoked. Twelve of these 22 patients had no previous exposure to antipsychotics; 11 of these 12 (92%) smoked.

The fact that first-episode patients smoke at the same prevalence rate as chronic patients suggests that it is schizophrenia, not its treatment with antipsychotic drugs, that determines this prevalence. Pharmacologic agents with therapeutic effects on nicotine-sensitive pathophysiologic mechanisms in schizophrenia may decrease a patient’s drive to smoke and reduce the associated health risks.

Hughes JR, Hatsukami DK, Mitchell JE, Dahlgren LA: Prevalence of smoking among psychiatric outpatients. Am J Psychiatry  1986; 143:993–997
[PubMed]
 
Goff DC, Henderson DC, Amico E: Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry 1992; 149:1189–  1194
 
Miller DD, Kelly MW, Perry PJ, Coryell WH: The influence of cigarette smoking on haloperidol pharmacokinetics. Biol Psychiatry  1990; 28:529–532
[PubMed]
[CrossRef]
 
Levin ED, Wilson WH, Rose JE, McEvoy JP: Nicotine-haloperidol interactions and cognitive performance in schizophrenia. Neuropsychopharmacology  1996; 15:429–436
[PubMed]
[CrossRef]
 
Griffith JM, O’Neill JE, Petty F, Garver D, Young D, Freedman R: Nicotinic receptor desensitization and sensory gating deficits in schizophrenia. Biol Psychiatry  1998; 44:98–106
[PubMed]
[CrossRef]
 
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References

Hughes JR, Hatsukami DK, Mitchell JE, Dahlgren LA: Prevalence of smoking among psychiatric outpatients. Am J Psychiatry  1986; 143:993–997
[PubMed]
 
Goff DC, Henderson DC, Amico E: Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry 1992; 149:1189–  1194
 
Miller DD, Kelly MW, Perry PJ, Coryell WH: The influence of cigarette smoking on haloperidol pharmacokinetics. Biol Psychiatry  1990; 28:529–532
[PubMed]
[CrossRef]
 
Levin ED, Wilson WH, Rose JE, McEvoy JP: Nicotine-haloperidol interactions and cognitive performance in schizophrenia. Neuropsychopharmacology  1996; 15:429–436
[PubMed]
[CrossRef]
 
Griffith JM, O’Neill JE, Petty F, Garver D, Young D, Freedman R: Nicotinic receptor desensitization and sensory gating deficits in schizophrenia. Biol Psychiatry  1998; 44:98–106
[PubMed]
[CrossRef]
 
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