Smoking & Schizophrenia
The relationship between schizophrenia and smoking is both interesting and complex. In schizophrenia, the very high rates of smoking could point to a form of self-medication that actually seems to improve attention and short-term memory. Yet other forms of smoking, notably cannabis and marijuana, are implicated in the onset of psychosis.
Smoking, as everyone knows, is bad for health. Yet people with schizophrenia frequently smoke up to four times more than average and use stronger brands. So the question is why?
Various studies have concluded that smoking acts as a form of self medication, but it is only recently that some of the specific effects of cigarette smoking have become known. Professor Tony George, MD, of the Department of Psychiatry, Yale Schhol of Medicine, found that when people with schizophrenia stop smoking, their attention and short-term memory were impaired. Cigarette smoking, it seems, stimulates nicotine receptors in the brain which have an positive effect on some cognitive processes.
People with schizophrenia may smoke heavily because of the side effects of anti-psychotic medication. There is some evidence to show that stiffness and rigidity can be reducing by smoking. There is very little evidence to show that smoking has any effect on positive symptoms such as delusions and hallucinations although one study by Dalack & Meador-Woodruff (1996) reported some worsening of symptoms as a result of nicotine withdrawal.
The earlier a person smokes, the more severe their symptoms appear to be. Young male smokers have an earlier onset of illness, receive higher doses of medication and appear to experience worse symptoms. Similar finding have been found in women (Kelly & McCreadie, 1999).
Other forms of smoking during youth, notably cannabis and marijuana, have been linked to a 40% increased risk of developing a psychotic illness later in life (Zammitt, 2007). Yet, as the study author concedes, “it’s always possible people who use cannabis may be different than those who don’t”. The relative ambivalence of research findings have been seized upon by organizations such as the National Organization for the Reform of Marijuana Laws (NORML), based in Washington. Speaking to WebMD, Paul Armentano, a senior policy analyst for NORML is quoted as saying, “the explosion of marijuana use amongst adults and young people [is not matched by] the explosion in cannabis-related mental illness”.
Assistant Professor of Clinical Psychiatry, Bruce Spring, MD, puts the statistics in a different way by explaining that 3 in every 100 people are likely to develop a psychotic illness such as schizophrenia, but one or two more might be expected if marijuana is factored in, depending on the strength and frequency of use.
So, the substance being smoked seems to be an important factor. If cigarette smoking does have the beneficial effects being reported, new research is needed to tease out the benefits of nicotine, but without the harmful effects of smoking.
Kelly, C & McCreadie, R. G. (1999) Smoking habits, current symptoms and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. American Journal of Psychiatry, 156, 1751-57.
Yale University (2005, July 11). Nicotine Helps Schizophrenics With Attention And Memory. ScienceDaily. Retrieved February 16, 2008, from http://www.sciencedaily.com /releases/2005/07/050710202418.htm