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Smoking and Schizophrenia: Self-medication?

Recently on a Difficult, Disturbing and Dangerous Behaviour course I was asked about a comment I made regarding the self-medicating aspects of smoking among patients suffering from schizophrenia. I thought that the following from:

http://www.mentalhealthcare.org.uk/research/expanded/index.php?id=21

may be of interest.

Happy reading

Iain Bourne (impact@dangerousbehaviour.com)

www.dangerousbehaiour.com

Smoking in schizophrenia – an attempt to self medicate?

3rd November 2005 | schizophrenia and psychosis

Just over one quarter of the UK population are smokers. In people with schizophrenia the rate of smoking is thought to be between two and four times higher. In addition, smokers with schizophrenia smoke more cigarettes per day and smoke stronger brands than other smokers.

Various theories have been put forward as to why so many people with schizophrenia smoke. It is thought that nicotine acts as a form of ‘self-medication’ for people with schizophrenia, producing a number of beneficial effects despite the negative impact of smoking on long term health.

Dr Veena Kumari and colleagues from the Institute of Psychiatry investigated the self-medication theory, examining evidence from previous research studies. Their findings are described below.

Symptom reduction

Many smokers with schizophrenia report that smoking helps to reduce their symptoms. This has been confirmed by studies showing that smoking is related to a reduction in the negative symptoms of schizophrenia, such as lack of motivation and social withdrawal. It is thought that this effect is caused by nicotine’s ability to raise dopamine levels in areas of the brain involved in attention and engaging with one’s surroundings. Atypical antipsychotic drugs that produce a reduction in negative symptoms, including Clozapine, are thought to act in a similar way.

However, there is no evidence that nicotine has any effect on the positive symptoms of schizophrenia such as hallucinations and delusions and if nicotine is withdrawn from smokers with schizophrenia there is no increase in these symptoms.

Reduction of medication side effects

There is also evidence that smoking may reduce the unpleasant side effects of antipsychotic medication including stiffness and rigidity of movement. Again, this effect is though to be produced by the action of nicotine stimulating dopamine release in the brain.

Nicotine has also been found to counteract the adverse side-effects of certain antipsychotics on some kinds of mental function. A study of patients taking the drug haloperidol who were given nicotine skin patches found them to be less affected by side effects such as the slowing of thought and reduction of attention span.

Improvements in attention and working memory

The areas of the brain thought to be involved in working memory, attention span and motivation have large numbers of receptors for the nicotine molecule. Experiments have shown that nicotine improves these functions both in smokers with schizophrenia and non smoking people with no mental illness. However, in general, people with schizophrenia show greater improvements than the general population. This suggests that there may be genetic differences that determine the extent to which a person will be affected by the effects of nicotine.

Given the negative effects of smoking on health, including greatly increased risk of heart disease and cancer, Dr Kumari believes there is an urgent need for treatments that provide the benefits of nicotine without the risks to long term health. Drugs are being developed that have a similar action to nicotine but these have not yet been tested on people with schizophrenia. Dr Kumari predicts that when these new treatments are available they will not only provide a valuable new way of treating the illness but also offer an alternative for the many people with schizophrenia who put their health at risk by smoking.

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