A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder
ABSTRACT 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.
- SourceAvailable from: Valentina Echeverria
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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. "
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.  "
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 · 2.90 Impact Factor
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- "In mood and psychotic disorders, alcohol abuse and dependence is associated with poorer functioning and higher rates of suicide attempts (Cardoso et al., 2008; Oquendo et al., 2010). Even smoking appears associated with poorer outcomes, particularly in mood disorders (Berk et al., 2008; Pasco et al., 2008; Ashton et al., 2010; Dodd et al., 2010; Mathews et al., 2010). It is therefore important that secondary causes of disability and treatment resistance such as substance abuse are actively managed. "
ABSTRACT: The concept of staging of disease in psychiatry has developed over the past years. A neglected component of this model pertains to people in the advanced stages of a mental illness, who remain symptomatic and functionally impaired despite treatment. These patients are often high service utilizers, receiving complex multimodal treatments where the balance of risk and benefit shifts perceptibly. In this paper, we argue the need to adopt 'palliative' models of care for some individuals, and consider changing the therapeutic goals to follow care pathways similar to those used in other chronic and refractory medical illnesses. Data was sourced by a literature search using Medline and a hand search of scientific journals. Relevant articles were selected. Clinical staging can help us better define subgroups of patients who will benefit from different goals and treatment. In the most advanced stage group, we find patients with persistent symptoms and treatment resistance. In these situations, it may be preferable to follow some of the principles of palliative care, which include the setting of attainable goals, reduction of side-effects, limited symptom control, targeting identified psychological and social problems, and attempting to attain the best quality of life for these patients and their families. It is in the interest of those in the advanced phases of a disorder that clinicians acknowledge the limitations of treatment and actively attempt to plan treatment utilizing alternate models. It is essential to be clear that such approaches do not equate to the abandonment of care, but rather to the reconceptualizing of feasible and personalized treatment goals, a rebalancing of the risks and benefits of intervention, the management of illness behaviour, and the approaches that allow the patient to live gainfully within their limitations.Australian and New Zealand Journal of Psychiatry 02/2012; 46(2):92-9. DOI:10.1177/0004867411432072 · 3.77 Impact Factor