Amongst smokers with schizophrenia spectrum disorders, smoking is associated with depressive symptoms, increased hospitalizations, stress, poor treatment outcomes, low quality of life, and enhanced psychotic symptoms.

Kennesaw State University

University of Michigan - Ann Arbor

Around 60-90% of people with schizophrenia are estimated to smoke, compared with 15-24% of the adult general population. The association between smoking and mental health conditions becomes stronger relative to the severity of the mental health condition, with the highest levels of 70% smoking found in psychiatric in-patients. Rates of cigarette smoking amongst adults in the United States and United Kingdom are two to four times higher in people with current mood, anxiety, and psychotic disorders than in those without mental illness. 

Effect of smoking on the mental health of people
with schizophrenia spectrum disorders

Caponnetto, P., Polosa, R., Robson, D., & Bauld, L. (2020). Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res, 8(1), 9042. https://doi.org/10.4081/hpr.2020.9042

Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders

Symptoms of Smoking with Schizophrenia Spectrum Disorder

It has been suggested that smoking could act as a trigger for mental ill-health (West & Jarvis, 2005). Two recent meta-analyses conducted respectively by Gurillo et al. (2015) and Hunter et al. (2018) showed that smokers of traditional cigarettes have a twofold increased risk of developing schizophrenia spectrum disorders.

Hypothesis for Smoking with Schizophrenia

Schizophrenia is linked to elevated dopamine levels in dorsal striatum and reduced cortical dopamine release. It has been suggested that in people with schizophrenia spectrum disorders, traditional cigarette smoking is a way to self-medicate by reducing problems associated with antipsychotic treatment and reducing positive and negative psychotic symptoms. However, some aspects of the above theories are questionable. For example, if smoking traditional cigarettes reduces problems associated with antipsychotic treatment, tobacco consumption in smokers with schizophrenia should be influenced by changes of antipsychotic drugs. 

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