Studies in 20 countries show a strong relationship between schizophrenia and smoking , in which people with schizophrenia are much more likely to smoke than those who do not have the disease. For example, in the United States, 80% or more people with schizophrenic fumes, compared with 20% of the general population in 2006.
Although it is well established that smoking is more common among people with schizophrenia than the general population as well as those with other psychiatric diagnoses, there is currently no definitive explanation for this difference. Many social, psychological, and biological explanations have been proposed, but today's research focuses on neurobiology.
Increased rates of smoking among people with schizophrenia have a number of serious effects, including increased mortality, increased risk of cardiovascular disease, reduced effectiveness of treatment, and greater financial difficulties. The study also showed that in the male population, having a schizophrenic spectrum disorder puts the patient at risk of excessive tobacco use. As a result, researchers believe that it is important for mental health professionals to fight smoking among people with schizophrenia.
Video Schizophrenia and smoking
Cause
A number of theories have been proposed to explain the increase in smoking rates among people with schizophrenia.
Several psychological and social explanations have been put forward. The earliest explanations are based on psychoanalytic theory.
The socioeconomic/environmental hypothesis proposes that smoking results because many people with schizophrenia are unemployed and inactive, so smoking reduces boredom. Research has found that this explanation alone can not account for the extreme amount of smoking among people with schizophrenia.
Personality hypothesis focuses on the relationship between smoking and higher levels of neuroticism and anxiety. This hypothesis suggests that anxiety as a symptom of schizophrenia may contribute to smoking.
The hypothetical psychological tool believes that smokers use nicotine to manipulate their mental state in response to various environmental conditions, such as reducing stress and managing negative emotions. The research on this hypothesis notes that people with schizophrenia often can not solve problems in a constructive way, so the use of cigarettes as a psychological tool can lead to a more vicious cycle of smoking.
The self-hypothetical hypothesis suggests that people with schizophrenia use nicotine to compensate for the cognitive deficits resulting from schizophrenia, an antipsychotic drug used to treat schizophrenia, or both.
The cognitive effect hypothesis shows that nicotine has a positive effect on cognition, so smoking is used to improve neurocognitive dysfunction.
In this hypothesis, one of the factors often involved is the effect of institutionalization and boredom. However, people with schizophrenia smoked at a higher rate and for longer periods than other groups who experienced institutionalization and boredom.
Another factor that is often involved is the side effects of the antipsychotic drug . Atypical antipsychotics can work against quitting smoking, such as the symptoms of quitting smoking such as irritability, mental obstruction, and increased appetite overlap with the side effects of atypical antipsychotics. Some also argue that smoking serves to reduce the side effects of antipsychotics. However, studies show no association between smoking and antipsychotic use after controlling schizophrenia.
Another factor that often involves increased mental acuity associated with smoking is important because mental stabbing is found from time to time in schizophrenia. However, both people with schizophrenia and the general population experience this effect, thus unable to fully explain the increase in smoking in people with schizophrenia.
Criticism
One of the main criticisms of the social and psychological explanations of smoking in schizophrenia is that most studies have failed to incorporate the personal perspective of patients with schizophrenia. Studies including a personal perspective find that people with schizophrenia generally start smoking for the same reasons as the general population, including social pressures and cultural and socioeconomic factors. People with schizophrenia who smokers today also cite the same reasons for smoking as people without schizophrenia, especially relaxation, strength of habit, and calming nerves. However, 28% cited psychiatric problems, including responses to auditory hallucinations and reduced drug side effects. The main themes found in the study of personal perspectives are habit and routine, socialization, relaxation, and nicotine addiction. It is said that smoking provides structure and activity, both of which may be lacking in the lives of people with serious mental illness.
Another major criticism is based on findings that the relationship between smoking and schizophrenia is equally strong in all cultures. These findings imply that associations are not merely social or cultural, but have strong biological components.
Biological Theory
The current theory focuses on the role of dopamine in schizophrenia, particularly how negative symptoms such as social withdrawal and apathy can be caused by a lack of dopamine in the prefrontal cortex while positive symptoms such as delusions and hallucinations may be caused by excess dopamine in mesolimbic pathways. Nicotine enhances the release of dopamine, so it is hypothesized that smoking helps improve dopamine deficiency in the prefrontal cortex and thereby reduce the negative symptoms.
However it is unclear how nicotine interacts with positive symptoms, as it would follow from this theory that nicotine will exacerbate the excess dopamine in the mesolimbic pathway and hence the positive symptoms as well. One theory holds that the beneficial effect of nicotine on negative symptoms is greater than the exacerbation of positive symptoms. Another theory is based on animal models that suggest that chronic use of nicotine ultimately results in decreased dopamine, thereby reducing the positive symptoms. However, human studies show conflicting results, including some studies showing that smokers with schizophrenia have the most positive symptoms and decreased negative symptoms.
Another area of ​​research is the role of nicotinic receptors in schizophrenia and smoking. Studies show an increase in the number of exposed nicotinic receptors, which may explain the pathology of smoking and schizophrenia. However, others argue that the increase in nicotinic receptors is a result of persistent persistent smoking, not schizophrenia.
Another source of controversy is the link between smoking and sensory disorders in schizophrenia. Nicotine can help improve auditory hearing, the ability to filter out the disturbing environment sounds. This can help increase attention span and reduce auditory hallucinations, allowing people with schizophrenia to see the environment more effectively and engage in more fine motor function. However, studies showing this effect alone can not account for an increase in smoking levels.
Maps Schizophrenia and smoking
Impact
Increased smoking among people with schizophrenia has some impact on this population. One well-documented consequence is an increase in early mortality among people with schizophrenia. Life expectancy among people with schizophrenia is generally 80-85% of the general population, resulting from both unnatural causes such as suicide but also natural causes such as cardiovascular disease, which smoking is an important contributor. People with schizophrenia have a higher incidence of smoking, with deaths from heart disease 30% more likely and respiratory disease deaths 60% more likely. 2/3 people with schizophrenia die from coronary heart disease, compared with less than 1/2 of the general population. The risk of ten-year coronary heart disease is significantly increased in people with schizophrenia, as well as diabetes and hypertension.
Although smoking can help alleviate the symptoms of schizophrenia, smoking also opposes the effects of antipsychotic drugs. Smoking produces faster antipsychotic metabolism, which causes smokers to be prescribed higher doses. The study is unclear whether smoking changes are caused by changes in symptoms, drug side effects, or drug main effects.
In addition to biological effects, smoking has a profound social impact on people with schizophrenia. One major impact is financial, because people with schizophrenia have been found to spend a disproportionate amount of their income on cigarettes. A study of people with schizophrenia on public aid found that they spent an average of $ 142 per month on cigarettes from an average monthly public assistance income of $ 596, or about 27.36%. Some argue that this produces further social consequences because people with schizophrenia can then not spend money on entertainment and social events that will improve their well-being, or may not even be able to pay for housing or nutrients.
The role of the tobacco industry
Although the relationship between smoking and schizophrenia is well established, the factor to be considered in this relationship is the role of the tobacco industry. Research based on internal industry documents shows an integrated effort by industry to promote the belief that people with schizophrenia need to smoke and are harmful to them to quit smoking. Such promotions include monitoring or supporting research that supports the idea that people with schizophrenia are uniquely immune to the health consequences of smoking (as proven wrong) and that tobacco is necessary for people with schizophrenia to self-medicate. The industry also provides cigarettes for hospital wards and supports efforts to block hospital-based smoking bans. While this does not discredit the effects of nicotine in schizophrenia, it is said that the tobacco industry's efforts slow the decline in the prevalence of smoking in people with schizophrenia as well as the development of clinical policies to promote smoking cessation.
Clinical implications
Given the contradictory evidence of the costs and benefits of smoking, controversy remains at what clinical response to smoking in people with schizophrenia should be. Historically, mental health providers have ignored smoking in schizophrenia, on the grounds that patients with serious mental illness already suffer significant stress and disability and thus should be allowed to engage in smoking as a fun, albeit destructive activity. There are also historical precedents of mental health service providers, particularly in patient settings, to use cigarettes as a way to manipulate patient behavior, such as rewarding good behavior with cigarettes or cutting cigarettes to encourage medication adherence. However, studies have shown that eliminating even one risk factor for the disease can significantly improve long-term health outcomes has resulted in a dominant view among physicians opposed to smoking.
Although quitting smoking in general is now the goal of mental health physicians, there is a lack of empirical research that demonstrates successful strategies to achieve this goal. However, all studies show a decrease in smoking, although not necessarily elimination. Evidence has been found to support the use of sustained release bupropion, nicotine replacement therapy, atypical antipsychotics, and cognitive behavioral therapy. Better results are seen when two or more termination strategies are used, as well as for patients using atypical antipsychotics rather than typical antipsychotics. There is also no evidence for improvement of positive symptoms or side effects after quitting smoking, while there is evidence for decreased negative symptoms.
In addition to quitting smoking, the prevalence of smoking among people with schizophrenia also requires additional action in evaluation by mental health providers. The investigators believe that providers should incorporate assessment of tobacco use into daily clinical practice, as well as ongoing assessment of cardiovascular health through measures such as blood pressure and diagnostics such as electrocardiography. In addition there are ethical and practical concerns if health facilities prohibit smoking without providing an alternative, especially since withdrawal may change the presentation of symptoms and response to treatment and may confuse or even aggravate symptoms. Doctors should also be aware of the consequences that can be caused by lack of cigarettes, such as aggression, prostitution, trafficking, and general disruption. These consequences indicate that providers may need to help patients get cigarettes and/or monitor usage, although this can cause ethical problems as well.
The 2007 study provides the first experimental evidence that nicotine-giving reverses hypofrontality in animal models of addiction and schizophrenia. Of course there is evidence that nicotine can improve cognitive abilities and may reduce the symptoms of schizophrenia. Experimental drugs that start with nicotine-targeted nicotinic acetylcholine 7 nicotine receptors like GTS-21 are interesting in treating schizophrenia.
References
Source of the article : Wikipedia
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