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Eur Arch Psychiatry Clin Neurosci. 2019 Jun;269(4):449-457. doi: 10.1007/s00406-018-0873-7. Epub 2018 Feb 2.

Tobacco smoking is associated with antipsychotic medication, physical aggressiveness, and alcohol use disorder in schizophrenia: results from the FACE-SZ national cohort.

Author information

1
Fondation FondaMental, Créteil, France. jasmina.mallet@aphp.fr.
2
AP-HP, Paris, France. jasmina.mallet@aphp.fr.
3
Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France. jasmina.mallet@aphp.fr.
4
Inserm U894, Paris, France. jasmina.mallet@aphp.fr.
5
Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France. jasmina.mallet@aphp.fr.
6
Fondation FondaMental, Créteil, France.
7
AP-HP, Paris, France.
8
Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.
9
Inserm U894, Paris, France.
10
Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France.
11
INSERM U955, Équipe de Psychiatrie Translationnelle, Créteil, France.
12
Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France.
13
Centre Hospitalier Charles Perrens, 33076, Bordeaux, France.
14
Université de Bordeaux, Bordeaux, France.
15
Bordeaux Sleep Clinique, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Research Unit, 33000, Bordeaux, France.
16
Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, 33000, Bordeaux, France.
17
Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
18
Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France.
19
CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France.
20
INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France.
21
Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France.
22
Pôle Psychiatrie Universitaire, CHU Sainte-Marguerite, 13274, Marseille Cedex 09, France.
23
Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle Universitaire de Psychiatrie, Marseille, France.
24
CNRS UMR 5287-INCIA, Bordeaux, France.
25
Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France.

Abstract

Tobacco smoking is common in schizophrenia and is one of the main causes of premature mortality in this disorder. Little is known about clinical correlates and treatments associated with tobacco smoking in patients with schizophrenia. Still, a better characterization of these patients is necessary, in a personalized care approach. Aggressiveness and childhood trauma have been associated with tobacco smoking in general population, but this association has never been explored in schizophrenia. Our study examines the clinical and therapeutic characteristics of tobacco smoking in schizophrenia. 474 stabilized patients (mean age = 32.2; 75.7% male gender; smokers n = 207, 54.6%) were consecutively included in the network of the FondaMental Expert centers for Schizophrenia and assessed with valid scales. Current tobacco status was self-declared. Aggressiveness was self-reported with Buss-Perry Aggressiveness Questionnaire and Childhood Trauma with Childhood Trauma Questionnaire. Ongoing treatment was reported. In univariate analysis, tobacco smoking was associated with lower education level (p < 0.01), positive syndrome (p < 0.01), higher physical aggressiveness (p < 0.001), alcohol dependence (p < 0.001), and First Generation Antipsychotics (FGAs) use (p = 0.018). In a multivariate model, tobacco smoking remained associated with physical aggressiveness (p < 0.05), current alcohol dependence (p < 0.01) and FGA use (p < 0.05). No association was observed with childhood trauma history, mood disorder, suicidal behavior, psychotic symptom, global functioning or medication adherence. Patients with tobacco use present clinical and therapeutic specificities, questioning the neurobiological links between tobacco and schizophrenia. They could represent a specific phenotype, with specific clinical and therapeutic specificities that may involve interactions between cholinergic-nicotinic system and dopaminergic system. Further longitudinal studies are needed to confirm the potential efficacy of second generation antipsychotics (SGAs) on tobacco use in schizophrenia and to develop effective strategies for tobacco cessation in this population.

KEYWORDS:

Aggressiveness; Alcohol dependence; Antipsychotics; Childhood trauma; Schizophrenia; Tobacco smoking

PMID:
29396753
DOI:
10.1007/s00406-018-0873-7

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