A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder

Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, PO Box 281, Geelong VIC 3220, Australia.
Comprehensive psychiatry (Impact Factor: 2.25). 09/2010; 51(5):504-9. DOI: 10.1016/j.comppsych.2009.12.001
Source: PubMed


Tobacco smoking is more prevalent among people with mental illnesses, including bipolar disorder, than in the general community. Most data are cross-sectional, and there are no prospective trials examining the relationship of smoking to outcome in bipolar disorder. The impact of tobacco smoking on mental health outcomes was investigated in a 24-month, naturalistic, longitudinal study of 240 people with bipolar disorder or schizoaffective disorder.
Participants were interviewed and data recorded by trained study clinicians at 9 interviews during the study period.
Comparisons were made between participants who smoked daily (n = 122) and the remaining study participants (n = 117). During the 24-month study period, the daily smokers had poorer scores on the Clinical Global Impressions-Depression (P = .034) and Clinical Global Impressions-Overall Bipolar (P = .026) scales and had lengthier stays in hospital (P = .012), compared with nonsmokers.
Smoking status was determined by self-report. Nicotine dependence was not measured.
These findings suggest that smoking is associated with poorer mental health outcomes in bipolar and schizoaffective disorder.

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    • "There is a risk of escalation of smoking in people with depression [91], with some evidence for the existence of a shared genetic vulnerability to both smoking and depression [96]. In both unipolar depression and bipolar disorder (but perhaps not schizophrenia), smoking has not only a deleterious effect on symptom severity [97], but may also interfere with response to treatment [98,99]. A greater risk of continued smoking and lower abstinence rates may also be associated with sub-threshold depressive symptoms [100]. "
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    ABSTRACT: The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.
    BMC Psychiatry 04/2014; 14(1):107. DOI:10.1186/1471-244X-14-107 · 2.21 Impact Factor
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    • "However, there is a high rate of tobacco consumption among individuals that suffer from mental disorders such as, major depression disorder (MDD), schizophrenia , and post-traumatic stress disorder (PTSD; Leonard et al., 2001; Weaver and Etzel, 2003; Thorndike et al., 2006; Buggia-Prevot et al., 2008; Aubin et al., 2012). The idea that tobacco consumption in these populations is a form of self-medication is controversial and some evidence suggests that smoking is associated with poorer mental health outcomes in some mental disorders such as, bipolar and schizoaffective disorder (Dodd et al., 2010). The desire to identify the component of tobacco that may explain this correlation has encouraged the study of the mental effect(s) of nicotine [3-(1-methyl-2-pyrrolidinyl) pyridine], an alkaloid that is present in tobacco leaves, over the psychiatric symptoms. "
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    ABSTRACT: A greater incidence of tobacco consumption occurs among individuals with psychiatric conditions including post-traumatic stress disorder (PTSD), bipolar disorder, major depression, and schizophrenia, compared with the general population. Even when still controversial, it has been postulated that smoking is a form of self-medication that reduces psychiatric symptoms among individuals with these disorders. To better understand the component(s) of tobacco-inducing smoking behavior, greater attention has been directed toward nicotine. However, in recent years, new evidence has shown that cotinine, the main metabolite of nicotine, exhibits beneficial effects over psychiatric symptoms and may therefore promote smoking within this population. Some of the behavioral effects of cotinine compared to nicotine are discussed here. Cotinine, which accumulates in the body as a result of tobacco exposure, crosses the blood-brain barrier and has different pharmacological properties compared with nicotine. Cotinine has a longer plasma half-life than nicotine and showed no addictive or cardiovascular effects in humans. In addition, at the preclinical level, cotinine facilitated the extinction of fear memory and anxiety after fear conditioning, improved working memory in a mouse model of Alzheimer's disease (AD) and in a monkey model of schizophrenia. Altogether, the new evidence suggests that the pharmacological and behavioral effects of cotinine may play a key role in promoting tobacco smoking in individuals that suffer from psychiatric conditions and represents a new potential therapeutic agent against psychiatric conditions such as AD and PTSD.
    Frontiers in Pharmacology 10/2012; 3:173. DOI:10.3389/fphar.2012.00173 · 3.80 Impact Factor
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    • "Differences in functional impairment remained after controlling for mood symptoms, baseline weight and demographics Dodd et al. [37] "
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    ABSTRACT: Objective: To systematically review the literature to determine if health risk behaviors in patients with schizophrenia or bipolar disorder are associated with subsequent symptom burden or level of functioning. Method: Using the PRISMA systematic review method we searched PubMed, Cochrane, PsychInfo and EMBASE databases with key words: health risk behaviors, diet, obesity, overweight, BMI, smoking, tobacco use, cigarette use, sedentary lifestyle, sedentary behaviors, physical inactivity, activity level, fitness, sitting AND schizophrenia, bipolar disorder, bipolar illness, schizoaffective disorder, severe and persistent mental illness, and psychotic to identify prospective, controlled studies of greater than 6 months duration. Included studies examined associations between sedentary lifestyle, smoking, obesity, physical inactivity and subsequent symptom severity or functional impairment in patients with schizophrenia or bipolar disorder. Results: Eight of the 2130 articles identified met inclusion criteria and included 508 patients with a health risk behavior and 825 controls. Six studies examined tobacco use, and two studies examined weight gain/obesity. Seven studies found that patients with schizophrenia or bipolar illness and at least one health risk behavior had more severe subsequent psychiatric symptoms and/or decreased level of functioning. Conclusion: Tobacco use and weight gain/obesity may be associated with increased severity of symptoms of schizophrenia and bipolar disorder or decreased level of functioning.
    General hospital psychiatry 10/2012; 35(1). DOI:10.1016/j.genhosppsych.2012.08.001 · 2.61 Impact Factor
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