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Nicotine dependence and symptoms in schizophrenia

Naturalistic study of complex interactions

Department of Psychiatry, University of Granada

Manuel Gurpegui, MD

Department of Psychiatry and Institute of Neurosciences, University of Granada, Granada, Spain

Francisco J. Diaz, PhD

Department of Statistics, Universidad Nacional, Medellin, Colombia

Jose De Leon, MD

Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA

Correspondence: Manuel Gurpegui, Department of Psychiatry and Institute of Neurosciences, Faculty of Medicine, Av. Madrid 11, E-18071 Granada, Spain. Tel: +34 958240704; Fax: +34 958246187; e-mail: gurpegui{at}ugr.es

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Smoking may have a beneficial effect on either schizophrenic symptoms or antipsychotic side-effects, but studies are hampered by the lack of control of confounding factors.

Aims To explore the self-medication hypothesis in a large sample of stable out-patients with schizophrenia.

Method Symptoms, assessed with the Positive and Negative Syndrome Scale (PANSS), and number of hospitalisations were compared in 250 out-patients with DSM-IV schizophrenia classified into three categories: highly dependent smokers, mildly dependent smokers and non-smokers. Log-linear analysis was used to control for potential confounding and interacting variables.

Results High PANSS total scores and positive symptoms were less frequent in mildly dependent smokers than in non-smokers or highly dependent smokers. The highly dependent smokers had the worst outcome.

Conclusions The data do not generally support the self-medication hypothesis but rather suggest a complex interaction between nicotine dependence and nicotine dependence and schizophrenic symptoms.

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