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Am J Psychiatry 1992; 149:1189-1194
Copyright © 1992 by American Psychiatric Association
Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects
DC Goff, DC Henderson and E Amico
Erich Lindemann Mental Health Center, Massachusetts General Hospital, Boston.
OBJECTIVE: The authors' goal was to study the relationship between smoking
status and clinical characteristics in schizophrenic patients. METHOD:
Seventy-eight schizophrenic outpatients were assessed by a single rater
using the Brief Psychiatric Rating Scale (BPRS), the Abnormal Involuntary
Movement Scale, and the Simpson-Angus Scale for extrapyramidal symptoms.
Current smokers (N = 58) were compared with nonsmokers (N = 20) on clinical
variables by independent t tests and chi-square tests. Differences in
outcome variables were tested by multiple analysis of covariance (ANCOVA)
with smoking status and gender as factors and age, neuroleptic dose, and
caffeine consumption as covariates. RESULTS: Seventy-four percent of
patients were current smokers and reported a mean of 19 cigarettes smoked
per day. Compared to nonsmokers, current smokers were significantly more
likely to be men, to be younger, and to have had an earlier age at onset
and a greater number of previous hospitalizations. Current smokers and
nonsmokers received mean neuroleptic doses of 1160 and 542 mg/day
(chlorpromazine equivalents); the difference was significant. Current
smokers also displayed significantly less parkinsonism and more akathisia
and had higher total scores on the BPRS. Overall multiple ANCOVA
demonstrated a significant main effect for smoking status but not gender or
the interaction between gender and smoking status. Univariate ANCOVAs
demonstrated a significant main effect of smoking status only for the
Simpson-Angus Scale score. CONCLUSIONS: Cigarette smokers receive
significantly higher neuroleptic doses, in part because of a
smoking-induced increase in neuroleptic metabolism. Smoking is also
associated with significant reduction in levels of parkinsonism. Smoking
status is a significant factor that should be considered in assessment of
neuroleptic dose requirements and neuroleptic side effects.
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