Schizophrenia And Smoking Essay Assignment

Smoking prevalence for schizophrenic patients is higher than this for general population. More than 60% of schizophrenic patients are current smokers, which contributes to excessive mortality in these patients. The reasons for high frequency of both smoking prevalence and heavy smoking in schizophrenic patients is thought to be at least partially related to enhancement of brain dopaminergic activity, which, in turn, results in behavioral reinforcement due to stimulant effects. Schizophrenia And Smoking Essay Assignment Smoking stimulates dopaminergic activity in the brain by inducing its release and inhibiting its degradation. There is also evidence that cigarette smoking can reduce deficits relative to dopamine hypo function in prefrontal cortex. Recent neuroimaging studies have further contributed the evidence of complex influences of cigarette smoking on brain dopaminergic function. It has been suggested that smoking may be an attempt by schizophrenic patients to alleviate cognitive deficits and to reduce extra pyramidal side-effects induced by anti psychotic medication. Cigarette smoke also increases the activity of CYP 1A2 enzymes, thus decreasing the concentration of many drugs, including clozapine and olanzapine. There is also evidence that smoking is associated with increased clearance of tiotixene, fluphenazine and haloperidol. Given the high frequency of smoking in schizophrenic patients, clinicians need to check smoking status in each patient. Schizophrenic patients who smoke may require higher dosages of anti-psychotics than nonsmokers. Conversely, upon smoking cessation, smokers may require a reduction in the dosage of anti psychotics. Schizophrenia And Smoking Essay Assignment

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Risk for incident schizophrenia is doubled in patients who actively smoke tobacco, while prenatal exposure to cigarette smoke is associated with a higher risk of offspring developing schizophrenia later in life, according to a study published in Nicotine & Tobacco Research.

This systematic review and meta-analysis sought to explore the effect of tobacco smoking and prenatal smoke exposure on the risk for incident schizophrenia.

Researchers searched international databases, including Medline, EMBASE, PsychInfo, Maternity and Infant Care, and Web of Science, and identified 12 comparative observational studies relating the risk for schizophrenia to smoking status. Two investigators independently extracted relevant data and scored the articles for quality. Outcome measures were drawn from odds ratios and hazard ratios with 95% confidence intervals and were pooled together to estimate relative risks. These estimates were further used in a meta-analysis assuming constant risk over time. Schizophrenia And Smoking Essay Assignment

The prevalence of smoking is markedly elevated in schizophrenia. Low smoking cessation rates and reports that some smokers with schizophrenia experience an acute increase in symptoms during attempts to quit smoking, suggest a self-medication model. Alternatively, smoking may modulate medication side effects. The effects of treated and untreated smoking abstinence on psychotic symptoms and medication side effects were examined in this study. Nineteen outpatients with schizophrenia or schizo affective disorder participated in a randomized, double-blind, balanced crossover study: 1 day of ad libitum smoking followed by 3 days of acute smoking abstinence while wearing 22 mg/day active or placebo trans dermal nicotine patches, with a return to 3 days of smoking between patch conditions. Daily symptom and side-effect ratings, nicotine and cotinine blood levels were collected. Twelve subjects completed the study. Neither positive symptoms nor mood symptoms changed. An increase in negative symptoms during the first abstinent day occurred in both placebo and active patch conditions, but was not sustained over subsequent abstinent days. Despite physiological signs of withdrawal, complete rs did not endorse increased nicotine withdrawal symptoms. Dropouts reported higher withdrawal symptoms, but also had no increase in psychiatric symptoms in either phase of the study. Of note, dyskinesias decreased during abstinence and placebo patch treatment, but increased during abstinence and the active patch conditions. Acute exacerbation of psychiatric symptoms is an unlikely explanation for any difficulty smokers with schizophrenia have in early abstinence. Schizophrenia And Smoking Essay Assignment

Persons with severe and persistent mental illnesses, e.g. schizophrenia spectrum disorders and bipolar disorder, smoke at a much higher rate than the general population. Treatment options for schizophrenia spectrum disorders and bipolar disorder often include the first-generation (typical) and second-generation (atypical) anti psychotics, which have been shown to be effective in treating both psychotic and mood symptoms. This article reviews studies examining the relationship between anti psychotic medication and cigarette smoking. These studies suggest that in persons with schizophrenia and schizoaffective disorder, typical anti psychotics may increase basal smoking and decrease people's ability to stop smoking, whereas atypical anti psychotics decrease basal smoking and promote smoking cessation. However, we found that the data available were generally of moderate quality and from small studies, and that there were conflicting findings. The review also critically assesses a number of potential mechanisms for this effect: the use of smoking as a form of self-medication for the side effects of anti psychotics, the effect of anti psychotics on smoking-related cues and the effect of anti psychotics on the appreciation of the economic cost of smoking behaviour. Gaps in the research are noted and recommendations for further study are included. More study of this important issue is needed to clarify the effect of anti psychotics on smoking behaviors.

Smoking not only has the potential to cause death, but it also decreases the efficacy of many medications. For that reason, it’s important for pharmacists to know which medications are affected by smoking so that appropriate counseling measures and dosage adjustments can be provided to patients. Schizophrenia And Smoking Essay Assignment

Tobacco smoke induces many of the CYP450 enzymes in the liver, which play an important role in medication absorption, distribution, metabolism, and elimination. Drug interactions are caused by components of tobacco smoke itself, rather than nicotine.² This means nicotine replacement therapy (NRT) can be used without concern of drug interactions and medication changes.

Psychiatric medications such as anti psychotics, antidepressants, hypnotics, and analytics are widely affected by cigarette smoking. For these classes, the drug concentration in the blood can be decreased with smoking, and reduction in efficacy may lead to inappropriate higher dosage adjustments. Meanwhile, some non psychiatric medications such as insulin, wayfaring, and caffeine require higher dosages to reach appropriate efficacy with smoking.²

When a patient is a current smoker and is taking a medication that’s negatively affected by smoking, it’s the pharmacist’s goal to try to initiate a smoking cessation regimen or NRT. With smoking cessation, the risk of harming the patient still exists, as abruptly stopping cigarette smoking can make a patient feel uncomfortable and may even cause additional harm.

Since medications are sometimes dosed with consideration that the patient is a smoker, it’s important to make appropriate dosage adjustments when trying to initiate smoking cessations measures.

A specific CYP450 enzyme induced by smoking is CYP1A2. Common medications that are substrates of this enzyme include³: Schizophrenia And Smoking Essay Assignment
1. Duloxetine (Cymbalta)
2. Caffeine
3. Clopidogrel (Plavix)
4. Clozapine (Clozaril)
5. Cyclobenzaprine (Flexeril)
6. Diazepam (Valium)
7. Haloperidol (Hadol)
8. Mirtazapine (Remeron)
9. Naproxen (Aleve)
10. Nortriptyline (Pamelor)
11. Olanzapine (Zyprexa)
12. Ondansetron (Zofran)
13. Propanolol (Inderal)
14. Ropinirole (Requip)
15. Theophylline (Theo-24)

Since these medications are substrates of the enzyme being induced (CYP1A2), smoking will lower the drug concentration of the medication along with its efficacy in most cases. However, clopidogrel therapy has been shown to increase platelet inhibition and decrease aggregation in patients that are smokers, providing an exemption from logical belief.^4,5 In that case, the efficacy of the medication is enhanced in a sense since it’s following the appropriate physiological mechanism of action. Schizophrenia And Smoking Essay Assignment

When assessing certain therapies for patients, health care professionals must take all risks and benefits into consideration. If the risks tremendously outweigh benefits, the therapy shouldn’t be implemented.

When it comes to trying to initiate smoking cessation regimens, pharmacists still should consider the risks, even though the benefits will prevail in most situations because of the fact that smoking has a negative effect in many disease states, interacts with medications, and can potentially cause cancer.

Schizophrenia is a challenging disorder that often makes it difficult to distinguish between what is real and unreal, to think clearly, manage emotions, relate to others, and function normally. Suspecting that you or someone you love has schizophrenia can be a stressful and emotional experience. But that doesn’t mean there isn’t hope. Schizophrenia can be successfully managed. The first step is to recognize the signs and symptoms. The second step is to seek help without delay. With the right self-help, treatment, and support, you can learn to manage the disorder and lead a satisfying and fulfilling life.

What is schizophrenia or paranoid schizophrenia?

Common misconceptions about schizophrenia
Myth: Schizophrenia refers to a “split personality” or multiple personalities.Fact: Multiple personality disorder is a different and much less common disorder than schizophrenia. People with schizophrenia do not have split personalities. Rather, they are “split off” from reality.
Myth: Schizophrenia is a rare condition.Fact: Schizophrenia is not rare; the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100.
Myth: People with schizophrenia are dangerous.Fact: Although the delusional thoughts and hallucinations of schizophrenia sometimes lead to violent behavior, most people with schizophrenia are neither violent nor a danger to others.
Myth: People with schizophrenia can’t be helped.Fact: While long-term treatment may be required, the outlook for schizophrenia is far from hopeless. When treated properly, many people with schizophrenia are able to enjoy fulfilling, productive lives.

Early warning signs of schizophrenia

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Often, friends or family members will know early on that something is wrong, without knowing exactly what.

In this early phase of schizophrenia, you may seem eccentric, unmotivated, emotionless, and reclusive to others. You may start to isolate yourself, begin neglecting your appearance, say peculiar things, and show a general indifference to life. You may abandon hobbies and activities, and your performance at work or school can deteriorate. Schizophrenia And Smoking Essay Assignment

The most common early warning signs include:

1. Depression, social withdrawal
2. Hostility or suspiciousness, extreme reaction to criticism
3. Deterioration of personal hygiene
4. Flat, expressionless gaze
5. Inability to cry or express joy or inappropriate laughter or crying
6. Oversleeping or insomnia; forgetful, unable to concentrate
7. Odd or irrational statements; strange use of words or way of speaking

While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, getting treatment early will help.

Symptoms

There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all the symptoms, and the symptoms of schizophrenia may also change over time.

Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies, such as: Schizophrenia And Smoking Essay Assignment

Delusions of persecution – Belief that others, often a vague “they,” are out to get you. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).

Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, you might believe a billboard or a person on TV is sending a message meant specifically for you.

Delusions of grandeur – Belief that you are a famous or important figure, such as Jesus Christ or Napoleon. Alternately, delusions of grandeur may involve the belief that you have unusual powers, such as the ability to fly.

Delusions of control – Belief that your thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”). Schizophrenia And Smoking Essay Assignment

Hallucinations

Hallucinations are sounds or other sensations experienced as real when they exist only in your mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia, often occurring when you misinterpret your own inner self-talk as coming from an outside source.

Schizophrenic hallucinations are usually meaningful to you as the person experiencing them. Many times, the voices are those of someone you know, and usually they’re critical, vulgar, or abusive. Visual hallucinations are also relatively common, while all hallucinations tend to be worse when you’re alone.

Disorganized speech

Schizophrenia can cause you to have trouble concentrating and maintaining a train of thought, externally manifesting itself in the way that you speak. You may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.

Common signs of disorganized speech include:

Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.

Neologisms – Made-up words or phrases that only have meaning to you.

Perseveration – Repetition of words and statements; saying the same thing over and over.

Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head”). Schizophrenia And Smoking Essay Assignment

Disorganized behavior

Schizophrenia disrupts goal-directed activity, impairing your ability to take care of yourself, your work, and interact with others. Disorganized behavior appears as:

• A decline in overall daily functioning
• Unpredictable or inappropriate emotional responses
• Behaviors that appear bizarre and have no purpose
• Lack of inhibition and impulse control

Negative symptoms (absence of normal behaviors)

The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals, such as:

Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.

Lack of interest or enthusiasm – Problems with motivation; lack of self-care.

Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.

Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in a monotone.

Treatment for schizophrenia

As upsetting as a diagnosis of schizophrenia can be, ignoring the problem won’t make it go away. Beginning treatment as soon as possible with an experienced mental health professional is crucial to your recovery. At the same time, it’s important not to buy into the stigma associated with schizophrenia or the myth that you can’t get better. A diagnosis of schizophrenia is not a life-sentence of ever-worsening symptoms and recurring hospitalizations. With the right treatment and self-help, many people with schizophrenia are able to regain normal functioning and even become symptom-free.

Treatment basics

The most effective treatment strategy for schizophrenia involves a combination of medication, therapy, lifestyle changes, and social support.

Schizophrenia requires long-term treatment. Most people with schizophrenia need to continue treatment even when they’re feeling better to prevent new episodes and stay symptom-free. Treatment can change over time, though, so your doctor may be able to lower the dosage or change medication as your symptoms improve.

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Medication for schizophrenia works by reducing psychotic symptoms such as hallucinations, delusions, paranoia, and disordered thinking. But it is not a cure for schizophrenia and is much less helpful for treating symptoms such as social withdrawal, lack of motivation, and lack of emotional expressiveness. Finding the right drug and dosage is also a trial and error process. While medication should not be used at the expense of your quality of life, be patient with the process and discuss any concerns with your doctor. Schizophrenia And Smoking Essay Assignment

Therapy can help you improve coping and life skills, manage stress, address relationship issues, and improve communication. Group therapy can also connect you to others who are in a similar situation and gain valuable insight into how they’ve overcome challenges.

Self-help

Medication and therapy can take time to take full effect but there are still ways you can manage symptoms, improve the way you feel, and increase your self-esteem. The more you do to help yourself, the less hopeless and helpless you’ll feel, and the more likely your doctor will be able to reduce your medication.

Schizophrenia: The 7 keys to self-help

Seek social support. Not only are friends and family vital to helping you get the right treatment and keeping your symptoms under control, regularly connecting with others face-to-face is the most effective way to calm your nervous system and relive stress. Stay involved with others by continuing your work or education-or if that’s not possible, consider volunteering, joining a schizophrenia support group, or taking a class or joining a club to spend time with people who have common interests. As well as keeping you socially connected, it can help you feel good about yourself.

Manage stress. High levels of stress are believed to trigger schizophrenic episodes by increasing the body’s production of the hormone cortisol. As well as staying socially connected, there are plenty of steps you can take to reduce your stress levels, including relaxation techniques such as meditation, yoga, or deep breathing.

Get regular exercise. As well as all the emotional and physical benefits, exercise may help reduce symptoms of schizophrenia, improve your focus and energy, and help you feel calmer. Aim for 30 minutes of activity on most days, or if it’s easier, three 10-minute sessions. Try rhythmic exercise that engages both your arms and legs, such as walking, running, swimming, or dancing. Schizophrenia And Smoking Essay Assignment

Get plenty of sleep. When you’re on medication, you most likely need even more sleep than the standard 8 hours. Many people with schizophrenia have trouble with sleep, but getting regular exercise and avoiding caffeine can help.

Avoid alcohol, drugs, and nicotine. Substance abuse complicates schizophrenia treatment and worsens symptoms. Even smoking cigarettes can interfere with the effectiveness of some schizophrenia medications. If you have a substance abuse problem, seek help.

Eat regular, nutritious meals to avoid symptoms exacerbated by changes in blood sugar levels. Omega-3 fatty acids from fatty fish, fish oil, walnuts, and flaxseeds can help improve focus, banish fatigue, and balance your moods.

Causes

While the causes of schizophrenia are not fully known, it seems to result from a complex interaction between genetic and environmental factors.

Genetic causes

While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny.

Environmental causes

Studies suggest that inherited genes make a person vulnerable to schizophrenia, and then environmental factors act on this vulnerability to trigger the disorder. Schizophrenia And Smoking Essay Assignment

More and more research is pointing to stress, either during pregnancy or at a later stage of development, as a major environmental factor. Stress-inducing factors could include:

• Prenatal exposure to a viral infection
• Low oxygen levels during birth (from prolonged labor or premature birth)
• Exposure to a virus during infancy
• Early parental loss or separation
• Physical or sexual abuse in childhood

Abnormal brain structure

In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia development. However, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.

Diagnosing schizophrenia

A diagnosis of schizophrenia is based on a full psychiatric evaluation, medical history assessment, physical exam, and lab tests to rule out other medical causes of your symptoms.

Criteria to diagnose schizophrenia

The presence of two or more of the following symptoms for at least 30 days:

1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative symptoms (emotional flatness, apathy, lack of speech)

Other diagnosis criteria:

• Have had significant problems functioning at work or school, relating to other people, and taking care of yourself.
• Shown continuous signs of schizophrenia for at least six months, with active symptoms (hallucinations, delusions, etc.) for at least one month.
• Have no other mental health disorder, medical issue, or substance abuse problem that is causing the symptoms. Schizophrenia And Smoking Essay Assignment

Individuals with attention al and emotional dysfunctions are most at risk for smoking initiation and subsequent nicotine addiction. This article presents converging findings from human behavioral research, brain imaging, and basic neuroscience on smoking as self-medication for attention-al and emotional dysfunctions. Nicotine and other tobacco constituents have significant effects on neural circuitry underlying the regulation of attention and affect. Age, sex, early environment, and exposure to other drugs have been identified as important factors that moderate both the effects of nicotine on brain circuitry and behavior and the risk for smoking initiation. Findings also suggest that the effects of smoking differ depending on whether smoking is used to regulate attention or affect. Individual differences in the reinforcement processes underlying tobacco use have implications for the development of tailored smoking cessation programs and prevention strategies that include early treatment of attention al and emotional dysfunctions. Schizophrenia And Smoking Essay Assignment

When looking at the the epidemiology of psychiatric comorbidity in smokers,^[1] there is a considerable literature linking smoking with various forms of psychopathology. The early work in this field tended to focus on character pathology and aspects of negative affect, such as neuroticism, hopelessness, and general emotional distress, all of which were associated with smoking. Many early theorists speculated that the initiation of smoking was environmentally based but that the maintenance of smoking was more related to psychopathology. None of this work was particularly methodologically sound.

It is well documented by many studies that depression makes smoking more likely, and smokers are more likely to have symptoms of depression and anxiety. The Epidemiological Catchment Area study^[2] showed a 6.6% rate of depression in smokers and a 2.9% rate in nonsmokers. Seventy-six percent of depressed respondents said they had smoked at some point in their lives, compared with 52% of non depressed respondents. Smoking cessation had an even more dramatic difference, with 14% of depressed respondents saying they were able to quit vs 28% of non depressed respondents. Twin studies have shown that there is a genetic component to smoking, and this genetic vulnerability may be a common factor with depression and anxiety; the data show that one is not caused by the other. Schizophrenia And Smoking Essay Assignment

The diagnosis of anxiety as well as depression is linked to smoking. Nonsmokers appear to have the same vulnerability to anxiety disorders as non depressed people. It is important to note, however, that depression and anxiety are also associated with other psychiatric vulnerabilities, and vice versa. The association between smoking and a full diagnosis of an anxiety disorder becomes weak when controlled for comorbid depression.^[2] Active smokers seem to have a higher rate of panic attacks, perhaps secondary to the actual act of smoking. There is a very low prevalence of smoking in patients with obsessive-compulsive disorder.

A history of depression also has an impact on nicotine withdrawal. Seventy-five percent of smokers with depression had withdrawal symptoms, compared with 30% with no history of depression. Depression also causes increased failure rates and relapse rates in smoking cessation. It is interesting to note that many of the symptoms of nicotine withdrawal mimic depression, but the reported symptoms of depressed patients with nicotine withdrawal have much higher numbers for physical symptoms such as lack of concentration, sleep disturbances, fatigue, and weight gain (80% to 90%) vs subjective depression in the form of loss of interest or pleasure (63%).

Smokers as a group have twice as high a comorbidity with alcohol abuse as they do with depression (4.7% vs 2.4%).^[3] Comorbidity with depression and anxiety seems to result more often in nicotine dependency, while comorbidity with alcohol and drugs is more likely to result in nicotine use without dependence. Alcohol abusers who are actively drinking are 60% less likely to quit smoking than alcoholics who have become sober. Schizophrenia And Smoking Essay Assignment

Comorbidity of schizophrenia and smoking is extremely common.^[4] Multiple studies have shown the incidence of smoking among schizophrenics to range from 75% to 90%, compared with an incidence in the general population of approximately 25% to 30%. Ninety percent of schizophrenic smokers started smoking before they became symptomatic from schizophrenia. No association has been found between smoking in schizophrenia and medication.

Smoking increases the risk of suicide. The odds ratio of making a suicide attempt for a smoker is 2.0 compared with that of a nonsmoker. The odds ratio for having suicidal ideation as a smoker is 1.4 compared with a nonsmoker. This relative risk is less than that for depression but greater than that for schizophrenia.

Most smokers initiated their smoking during adolescence. Anxiety symptoms usually predate depressive symptoms in adolescence, and anxiety and impulsivity are particularly predictive of adolescent smoking. Also predictive are hostility, extra version, and sociopath behavior. The earlier adolescents start smoking, the more they will smoke, the harder it is for them to quit, and the longer they will end up smoking. The exceptions to this, however, are that they have a decreased risk for nicotine dependency if they start smoking before the age of 14 or after the age of 17.

Genes, Personality, and Smoking Cessation

Smoking is her editable; studies done with separated identical twins have interestingly shown a concordance of 80%. There is also evidence that one's predilection for starting and/or quitting smoking are independent genes.^[5] Risk factors that may be related to this heredity are: (1) vulnerability to nicotine addiction secondary to nicotine receptor genes, and (2) genes to determine personality. Personality traits that may predispose to smoking could include depression/anxiety and impulsivity/novelty seeking. As discussed in the previous section, there is a strong relationship between depression and anxiety traits and smoking. Schizophrenia And Smoking Essay Assignment Hamer^[5] used a scale that measured negative effects such as depression, anxiety, irritability, and impulsivity and were able to score subjects on the extent to which they had these character traits, referred to collectively as neuroticism. He found that current smokers had higher neuroticism scores compared with either ex-smokers or nonsmokers, who scored the same.^[6]

They then looked at the gene for the serotonin transporter because of the relationship between serotonin and these character traits. Although each person has only 1 type of serotonin transporter (compared with the at least 12 different kinds of serotonin receptors found in humans), there appeared to be 2 different forms of the gene, a long version and a short version, and the long version makes twice as much transporter as the short version. As a result, people who have the long version of this gene transport serotonin twice as much as people with the short version. There is a mild correlation between the short version and neuroticism, but a strong correlation between the combination of both the short version and a high neuroticism score and difficulty quitting smoking.

The authors also looked at the dopamine transporter, given dopa mine's relationship with impulsivity and novelty seeking. Novelty seeking appears to be elevated in current smokers, but not in ex-smokers or nonsmokers. There does not, however, appear to be a relationship between novelty seeking and the initiation of smoking. Smokers who scored high in novelty seeking were more likely to maintain smoking. The authors found a rare variant of the dopamine transporter gene that made smokers more likely to quit. They speculate that it may be possible in the future to look at the genotypes of smokers who wish to quit smoking to determine the best treatment, eg, dopaminergic vs serotonergic medications.

Evidence for and Against the Self-Medication Hypothesis for Smoking

Smoking as self-medication for psychiatric illness is certainly an interesting and controversial topic.^[7] There are 3 basic possibilities that can be explored: psychiatric comorbidity causes smoking, smoking causes psychiatric comorbidity (for which there is very little evidence, given the fact that 70% of all smokers have no psychiatric comorbidity), or something else causes both. When looking at the issue of causality, 2 important aspects are temporal precedence, or that A must come before B if A causes B, and biologic plausibility. Schizophrenia And Smoking Essay Assignment

Smoking starts, on average, around age 16. Of the illnesses that are associated with smoking, only attention deficit hyperactivity disorder (ADHD) starts before that. Other factors associated with smoking, including major depression, schizophrenia, and alcohol abuse and dependence, all occur later. The odds ratios for depression and smoking vary a great deal. The odds ratio for depressed patients smoking is 3.0, but for smokers becoming depressed is 1.9 and for depressed patients quitting smoking is 0.8. Thus, there may be different types of smokers in this population.

There is some evidence that nicotine may have anti-schizophrenic properties.^[4] This includes increasing dopamine in the cortex, improving sensory gating, and improving smooth eye pursuit. The deficit of sensory gating in schizophrenia is best demonstrated by playing 2 auditory tones in rapid succession. Normal subjects have some inhibition for startle response on the second tone, but schizophrenics and their first-degree relatives do not show this inhibition. Nicotine corrects this in schizophrenics and their first-degree relatives, but actually decreases inhibition in normals. Similarly, when schizophrenics and their first-degree relatives track a moving object with their eyes, their eye movements are not smooth compared with normals. Nicotine also corrects this.

Nicotine may also be effective in the treatment of depression. One of the better-accepted models of depression in laboratory animals is "learned helplessness," in which the animal will not try to escape an unpleasant or painful event. This behavior is thought to be the equivalent of a depressed human thinking that it is not worth protecting him(her)self. High-dose nicotine reverses this behavior in laboratory animals. There is also data showing that nicotine patches given to nonsmoking depressed patients for 4 days decreased their Hamilton Depression scores from 18 to 3. Then, when the patches were discontinued, the Hamilton scores went back up to baseline in 4 more days. There is also some evidence that cigarette smoke may have mono amine oxidase inhibition properties. Mono amine oxidase is significantly lower in smokers, but its activity returns to the level of nonsmokers after smokers quit. Since nicotine does not have mono amine oxidase inhibitory properties, it is felt that there is some other chemical in cigarette smoke that functions as an MAOI. Schizophrenia And Smoking Essay Assignment

Nicotine also appears to be effective for ADHD. It improves distractibility, impulsivity, and other symptoms of ADHD. In animal models of ADHD, in which animals must discern between similar stimuli, high-dose nicotine causes the animals to be more accurate, and it is believed that this is a function of their becoming less impulsive. In placebo-controlled studies of nicotine in ADHD patients, nicotine was found to be effective in both smokers and nonsmokers.^[6]

Nicotine holds great promise as a psychoactive drug. Smoking is associated with many psychiatric disorders, traits, and symptoms. Generally, it increases concentration, decreases hunger, decreases anxiety and depression, and decreases anger. In the form of a cigarette, it also has an extremely effective delivery system. However, it is important to note that it has a very small therapeutic index; the difference in dose between efficacy and toxicity is very small. As a result, nicotine's promise is probably not in the form of nicotine, but in the form of a nicotine analogue yet to be developed.

In addition to all the specific aspects of smoking and psychiatric illness, Dr. Hughes ended by describing his more nonspecific theory of self-medication with smoking. Smoking is not only associated with but also can also be viewed as helpful for psychiatric disorders. Psychiatric patients have very few behavioral reinforce rs and often have poor skills to get them. Moreover, psychiatric patients are often "hypohedonic" in that they are less responsive to reinforce rs. Smoking may be one of the few and the best reinforces available to many of them. Schizophrenia And Smoking Essay Assignment

Signs and Symptoms During the Acute Phase of Smoking Cessation

An important area to examine is the delineation of the signs and symptoms of smoking cessation.^[8] A working definition of withdrawal signs and symptoms could include termination of drug effects, temporary phenomena, and physical and psychological readjustment. Symptoms of smoking withdrawal include irritability, depression, restlessness, poor concentration, increased appetite, lightheartedness, nighttime awakenings, and craving. Smokers trying to quit often misunderstand both restlessness and lightheartedness. Smokers who recently quit often say that the hardest thing about quitting is the need to do something "with my hands." While they often understand this as missing the actual activity of smoking, it is actually withdrawal restlessness. Lightheartedness can also be difficult for smokers who have recently quit, because they mistakenly assume that stopping smoking will make them feel healthier immediately.

Most of the withdrawal symptoms from smoking are at a maximum at 24 hours, and all of them improve over 4 weeks except increased appetite, which appears to function separately from the rest of the withdrawal syndrome. Short-term signs of smoking withdrawal include decreased nor epinephrine and cortisol secretion, and a decrease in salivary antibodies that may be responsible for the higher incidence of upper respiratory infections and mouth ulcers in smokers who recently quit. Schizophrenia And Smoking Essay Assignment

The issue of anxiety in smoking cessation is controversial. There are some published reports that cigarette smoking is anxiolytic, and anxiety increases after quitting. More recent data have shown that anxiety increases in anticipation of stopping smoking but decreases after quitting. Anxiety self-reporting scales done 4 weeks into abstinence show lower levels than those measured at baseline before quitting. Anxiety does seem to be increased in those patients who dramatically decrease but do not eliminate their smoking, indicating that smoking may actually cause some anxiety.

Long-term effects of smoking cessation include a chronically decreased heart rate and an increase in body mass. It may be possible that cigarette smoking has a permanent effect on body metabolism. Craving may be a functional equivalent to hunger in ex-smokers. As such, besides the proven treatments for smoking cessation of nicotine replacement, bupropion, nortriptyline, and clonidine, some form of administration of glucose may be helpful in the short term. In addition, serotonergic agonists and precursors such as fenfluramine or tryptophan may be helpful.

Antidepressants in Smoking Cessation: Is Effectiveness Independent of the Antidepressant Effect?

Often antidepressants are prescribed in smoking cessation and it is important to evaluate whether their effect is independent of their antidepressant effect.^[9] Basic science research has documented that nicotine binds to mono amine neurons and releases mono amines. The authors reviewed all of the studies published about the use of antidepressants in smoking cessation. They showed very little positive effect for serotonergic drugs, but good results with bupropion and nortriptyline. None of the patients in the studies had a diagnosis of major depression. They had low scores on depression rating scales and no changes in those scores after treatment; high vs low depression rating scores did not predict treatment response. As a result, it is reasonable to hypothesize that there is a different mechanism of action for antidepressants facilitating smoking cessation. The mechanism for this is unknown, and there are no studies currently of antidepressants and smoking cessation in patients with major depressive disorder. Schizophrenia And Smoking Essay Assignment

Smoking and addiction

The biological factors involved in smoking relate to how the brain responds to nicotine. When a person smokes, a dose of nicotine reaches the brain within about ten seconds. At first, nicotine improves mood and concentration, decreases anger and stress, relaxes muscles and reduces appetite.

Regular doses of nicotine lead to changes in the brain, which then lead to nicotine withdrawal symptoms when the supply of nicotine decreases. Smoking temporarily reduces these withdrawal symptoms and can therefore reinforce the habit.

This cycle is how most smokers become nicotine dependent.

Social and psychological factors also play a part in keeping smokers smoking. Although many young people experiment with cigarettes, other factors influence whether someone will go on to become a regular smoker. These include having friends or relatives who smoke and their parents' attitude to smoking. As young people become adults, they are more likely to smoke if they misuse alcohol or drugs or live in poverty. These factors make it more likely that someone will encounter stress. Most adults say that they smoke because of habit or routine and/or because it helps them relax and cope with stress.

Smoking and stress

The idea that people smoke cigarettes to help ease the signs and symptoms of stress is known as 'self-medication'. Stress is very common, affecting us when we feel unable to cope with unwelcome pressure. It can cause physical symptoms like headaches or breathlessness as well as making people feel irritable, anxious or low. Schizophrenia And Smoking Essay Assignment

These feelings can alter our behaviour and feeling stressed often makes people drink alcohol or smoke more than usual. Long term stress is also related to anxiety and depression.

Smoking and anxiety

Research into smoking and stress has shown that instead of helping people to relax, smoking actually increases anxiety and tension. Nicotine creates an immediate sense of relaxation so people smoke in the belief that it reduces stress and anxiety. This feeling of relaxation is temporary and soon gives way to withdrawal symptoms and increased cravings.

Smoking reduces nicotine withdrawal symptoms, which are similar to the symptoms of anxiety, but it does not reduce anxiety or deal with the underlying causes.

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Smoking and depression

In the UK, smoking rates among adults with depression are about twice as high as among adults without depression. People with depression have particular difficulty when they try to stop smoking and have more severe withdrawal symptoms during attempts to give up.

Nicotine stimulates the release of the chemical dopamine in the brain. Dopamine is involved in triggering positive feelings. It is often found to be low in people with depression, who may then use cigarettes as a way of temporarily increasing their dopamine supply. However, smoking encourages the brain to switch off its own mechanism for making dopamine so in the long term the supply decreases, which in turn prompts people to smoke more. Schizophrenia And Smoking Essay Assignment

Most people start to smoke before they show signs of depression so it is unclear whether smoking leads to depression or depression encourages people to start smoking. The most likely explanation is that there is a complex relationship between the two.

Smoking and schizophrenia

People with schizophrenia are three times more likely to smoke than other people and they tend to smoke more heavily. One of the most common explanations of this is that people with schizophrenia use smoking to control or manage some of the symptoms associated with their illness and to reduce some of the side effects of their medication.

A recent study has shown that there could be a causal link between smoking and schizophrenia. However, there are various factors which may increase the risk for developing schizophrenia and further research is needed to fully understand the link and causal pathway.

Does smoking improve mental health?

Although many people with mental health problems say that they smoke to reduce their symptoms, they usually start smoking before their problems begin. Heavy smoking does not necessarily lead to fewer symptoms of mental health problems in the long term. Any short term benefits that smoking seems to have are outweighed by the higher rates of smoking-related physical health problems, such as lung cancer, that are common in people with mental health problems. Schizophrenia And Smoking Essay Assignment

Ways to help you quit

Stopping smoking suddenly through willpower alone ('going cold turkey') is the least effective way to quit. Stopping is more likely to be successful if you plan ahead, have support and choose the right time to try. Your attempt is less likely to work if you are feeling unstable, experiencing a crisis or undergoing significant changes in your life.

To prepare for change, think about your relationship with smoking. Understanding the effect that it has on you can boost your motivation to quit. Think about what you will gain by not smoking, for instance better physical health, fresher breath, improved concentration and more money in your pocket to spend on other things. You may find it helpful to write this down as a reminder of why you want to stop. Schizophrenia And Smoking Essay Assignment

Finding other ways to cope with stress

Because smoking is often used as a way of coping, smokers need other ways of dealing with stress, anxiety or other problems if they want to stop smoking. Methods that people have found helpful include meditation and breathing exercises, regular exercise, cutting down on alcohol, eating a well-balanced diet, acupuncture and clinical hypnosis. Counsel ling or talking things through with a supportive friend or family member and religious or spiritual activities can also help.

Making changes takes time and effort - progress is often slow. Be patient. You may not be able to control all the factors that contribute to your stress, but identifying the source of your anxiety and trying to find ways to reduce or overcome it are as important as finding new ways to cope with it.

Getting support from family and friends

Stopping smoking can be easier if you talk about it to family and friends and let them support you. If other people who live with you smoke, it may be harder for you to give up. You could try to get other household members who smoke, or friends who smoke, to stop smoking at the same time. At the least, encourage them not to smoke around you or leave their cigarettes, ashtrays or lighters where you will see them. Schizophrenia And Smoking Essay Assignment

Avoiding triggers linked to smoking

The mind is very sensitive to associations, so removing all tobacco products from your home can help lessen some of the cravings of nicotine withdrawal. Smokers are accustomed to smoking in certain situations like in the pub or after a meal. If you can identify your trigger situations and avoid them, the chances of relapse will be much lower.

Being prepared for withdrawal symptoms

Likely withdrawal symptoms include headaches, nausea, irritability, anxiety, craving cigarettes, feeling miserable, difficulty in concentrating, increased appetite and drowsiness. Drinking more fresh fruit juice or water, eating more high fibre foods and reducing the caffeine and refined sugar in your diet all help some people cope with withdrawal symptoms.

Talking therapies

Individual, group or telephone counseling can help people to stop smoking. Talking therapies can help people change their behaviour by thinking and acting more positively. Many counseling program mes use the techniques of cognitive behavioral therapy (CBT) and social skills development. Research has shown that CBT may be particularly effective in smokers with or without mental health problems.

Nicotine replacement therapy and medication

Nicotine replacement therapy (NRT), anti-depressants and other medication have all been shown to help smokers without mental health problems to stop smoking and they may also be helpful for people with depression or schizophrenia. NRT appears to be more effective when combined with a talking therapy.

For advice on stopping smoking and which treatments might be suitable for you, talk to your doctor, a pharmacist or a health visitor. They will also be able to point you to services for smokers in your area. Schizophrenia And Smoking Essay Assignment

The smoking rate among individuals with schizophrenia has been shown to be as high as 90 percent, compared to between 20 and 23 percent of the general population, or 50 percent among individuals with other mental disorders.

Uta Water house, who graduates from Victoria next week with a PhD in Psychology, wanted to find out what was driving this unusually high rate.

She examined the addictive effects of nicotine to see if it helped reduce symptoms of schizophrenia, and also looked for commonality in the neurological pathways in both addiction and schizophrenia.

“In ore-clinical studies, I found that nicotine improved the cognitive deficits associated with schizophrenia,” says Uta. “My findings did not support the theory that both schizophrenia and nicotine addiction share common neurological pathways, but it clearly showed that nicotine has a positive effect on the problematic changes to brain function that come with schizophrenia.

“This explains why so many patients with schizophrenia are smokers: it’s a way of self-medicating,” she explains. “This is particularly important, because at the moment there is no pharmacological treatment for the cognitive deficits—the negative changes in brain function—that are a symptom of schizophrenia. This might be an area that warrants further exploration by pharmaceutical companies, which could develop medications to suit.”

Uta says her findings also raise questions for policymakers. “Current legislation means smoking is not permitted in places like hospitals or other healthcare facilities—my findings show that this ban might be having a greater adverse impact on schizophrenic patients than previously thought.” Schizophrenia And Smoking Essay Assignment

After graduating, Uta plans to continue studying at Victoria and qualify as a clinical psychologist.

Smoking addiction in schizophrenia can be explained by significantly increased activation of the ventro-medial prefrontal cortex (vmPFC), a region involved in the brain reward system. These new data, the result of a study by researchers at the Institut universitaire en santé mentale de Montréal (CIUSSS EST, Montreal) and the University of Montreal confirms the tendency to smoke and low smoking cessation rates of people with schizophrenia.