Tobacco use and psychosis risk in persons at clinical high risk

Abstract

Aim: To evaluate the role of tobacco use in the development of psychosis in individuals at clinical high risk. Method: The North American Prodrome Longitudinal Study is a 2-year multi-site prospective case control study of persons at clinical high risk that aims to better understand predictors and mechanisms for the development of psychosis. The cohort consisted of 764 clinical high risk and 279 healthy comparison subjects. Clinical assessments included tobacco and substance use and several risk factors associated with smoking in general population studies.Results: Clinical high risk subjects were more likely to smoke cigarettes than unaffected subjects (light smoking odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-5; heavy smoking OR = 4.8, 95% CI = 1.7-13.7). In both groups, smoking was associated with mood, substance use, stress and perceived discrimination and in clinical high risk subjects with childhood emotional neglect and adaption to school. Clinical high risk subjects reported higher rates of several factors previously associated with smoking, including substance use, anxiety, trauma and perceived discrimination. After controlling for these potential factors, the relationship between clinical high risk state and smoking was no longer significant (light smoking OR = 0.9, 95% CI = 0.4-2.2; heavy smoking OR = 0.3, 95% CI = 0.05-2.3). Moreover, baseline smoking status (hazard ratio [HR] = 1.16, 95% CI = 0.82-1.65) and categorization as ever smoked (HR = 1.3, 95% CI = 0.8-2.1) did not predict time to conversion.Conclusion: Persons at high risk for psychosis are more likely to smoke and have more factors associated with smoking than controls. Smoking status in clinical high risk subjects does not predict conversion. These findings do not support a causal relationship between smoking and psychosis. K E Y W O R D Sclinical high risk, psychosis, schizophrenia, substance use disorder, tobacco

Impact of smoking behavior on cognitive functioning in persons at risk for psychosis and healthy controls: A longitudinal study

“…A secondary finding of the current study was the fact that 10.3% of UHR individuals were able to quit smoking over a 1-year follow-up period. Cessation rates were almost twice as high compared to an UHR population studied by Ward et al [56] (5.5% cessation) in which smoking cessation was evaluated over a longer follow-up period (2-year). Sustained quitting is associated with a shorter follow-up period [57] which might be a plausible explanation for higher cessation rates in the current study.…”

Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review

“…Studies indicate higher levels of perceived discrimination in a number of domains, including appearance, age, skin color, religion, disability, and sexual orientation, in PR individuals compared to a control group of healthy subjects (Saleem et al, 2014; Stowkowy et al, 2016; Ward et al, 2018). PR individuals reporting higher levels of perceived discrimination are also more likely to be older (Saleem et al, 2014) and smokers (Ward et al, 2018). Other studies suggest that racial discrimination is higher among PR individuals compared to healthy subjects (Shaikh et al, 2016).…”

“…Worryingly, convergent evidence suggests that PR individuals reporting stigmatizing experiences are more likely to have a poor outcome (Rusch et al, 2014a, 2014b), suicidality (Pyle et al, 2015; Xu et al, 2016a, 2016c), develop full-psychosis (Rüsch et al, 2015; Stowkowy et al, 2016), disengage from services (Ben-David et al, 2018; Ben-David et al, 2019; Kotlicka-Antczak et al, 2018; Rusch et al, 2013, 2014b; Xu et al, 2016b), and have family members distressed by associative stigma (Baron et al, 2019; He et al, 2019). Moreover, people at PR may suffer more than their healthy peers because of their age, ethnicity, religion, disability, sexual orientation, and habits (Anglin et al, 2016; Anglin et al, 2018; Saleem et al, 2014; Shaikh et al, 2016; Stowkowy et al, 2016; Ward et al, 2018). Thus, clinicians must remain cognizant of such risks, reconciling the interests and feelings of the young individual at PR with those of their parents in the interest of the family as well as facilitating any attempt to break down public stigma in the community.…”

“…Eight studies conducted follow-up assessments ranging from 6 months to 2 years (Morrison et al, 2013; Pyle et al, 2015; Rusch et al, 2014b, 2015; Stowkowy et al, 2016; Ward et al, 2018; Xu et al, 2016a, 2016b). Evidence indicates that stigma reduces overtime and may benefit from cognitive therapies (Morrison et al, 2013) while its persistence or increase overtime is decisive to induce stressful reactions and affect wellbeing (Rusch et al, 2014b) as well as increase suicidality (Xu et al, 2016a) and poor help-seeking attitudes (Xu et al, 2016b).…”

Cigarette Smoking and Schizophrenia: Etiology, Clinical, Pharmacological, and Treatment Implications

“…A third theory is that there is a shared genetic propensity in smoking and the development of schizophrenia [ 27 ]. One study investigated genetic variants associated with tobacco use and schizophrenia with data extracted from the genome-wide association studies.…”