Tobacco smoking and nicotine dependence in first episode and established psychosis

John Lally; Gilda Spaducci; Poonam Gardner-Sood; Zerrin Atakan; Kathryn Greenwood; Marta Di Forti; Khalida Ismail; Kieran C Murphy; Shubulade Smith; Ann McNeill; Robin M Murray; Fiona Gaughran

doi:10.1016/j.ajp.2019.05.002

Tobacco smoking and nicotine dependence in first episode and established psychosis

Asian J Psychiatr. 2019 Jun:43:125-131. doi: 10.1016/j.ajp.2019.05.002. Epub 2019 May 4.

Authors

Affiliations

¹ Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; St Vincent's Hospital Fairview, Dublin, Ireland. Electronic address: john.lally@kcl.ac.uk.
² Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK. Electronic address: gilda.1.spaducci@kcl.ac.uk.
³ University College London, London, UK. Electronic address: p.gardner-sood@ucl.ac.uk.
⁴ Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK.
⁵ Sussex Partnership NHS Foundation Trust, School of Psychology, University of Sussex, Brighton, UK. Electronic address: k.e.greenwood@sussex.ac.uk.
⁶ MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK. Electronic address: marta.diforti@kcl.ac.uk.
⁷ Psychological Medicine Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Denmark Hill, London, UK. Electronic address: khalida.2.ismail@kcl.ac.uk.
⁸ Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. Electronic address: kmurphy@rcsi.com.
⁹ Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK; Forensic Intensive Care Service, South London and Maudsley NHS Foundation Trust, London, UK. Electronic address: Shubulade.Smith@slam.nhs.uk.
¹⁰ Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK. Electronic address: ann.mcneill@kcl.ac.uk.
¹¹ Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy. Electronic address: robin.murray@kcl.ac.uk.
¹² Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, Reader, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK. Electronic address: Fiona.p.gaughran@kcl.ac.uk.

PMID: 31132542
DOI: 10.1016/j.ajp.2019.05.002

Abstract

Aim: People with psychotic disorders have increased premature mortality in comparison with the general population, with high rates of cigarette use a contributing factor. We aimed to describe the prevalence of cigarette use and nicotine dependence (ND) in first episode psychosis (FEP), and established psychosis; and to investigate associations between clinical symptoms and ND.

Methodology: Smoking and clinical data were collected from two cohorts: 181 people with FEP recruited as part of the Physical Health and Substance Use Measures in First Onset Psychosis (PUMP) study and from 432 people with established psychosis recruited as part of the Improving physical health and reducing substance use in psychosis randomised controlled trial (IMPaCT RCT).

Results: The prevalence of cigarette smoking was 78% in FEP and 62% in established psychosis. Forty nine percent (n = 60) of smokers in the FEP cohort and 69% (n = 183) of smokers with established psychosis were highly nicotine dependent. Being a highly nicotine dependent smoker was significantly associated with higher PANSS positive symptom scores (F = 5.480 p = 0.004), and with decreased scores on the Rosenberg self-esteem scale (F = 3.261, p = 0.039) in established psychosis. There was no diagnostic specificity identified in relation to smoking or ND in both groups.

Conclusion: High rates of cigarette usage and nicotine dependence are problems from the early stages of psychosis. ND is higher in people with established psychosis. Smoking cessation strategies as part of comprehensive management of psychotic disorders at every stage require further development and evaluation.

Keywords: Addiction; Physical health; Psychotic; Schizophrenia; Smoking; Substance use.

MeSH terms

Adolescent
Adult
Cigarette Smoking / epidemiology*
Comorbidity
Female
Humans
Male
Psychotic Disorders / epidemiology*
Randomized Controlled Trials as Topic
Tobacco Use Disorder / epidemiology*
United Kingdom / epidemiology
Young Adult

Grants and funding

RP-PG-0606-1049/DH_/Department of Health/United Kingdom