Cigarette Smoking and Mortality Risk in People With Schizophrenia

Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 12/2009; 37(4):832-8. DOI: 10.1093/schbul/sbp152
Source: PubMed


This study examined effects of cigarette smoking on mortality risk in 1213 persons aged 19-69 years with schizophrenia-related psychotic disorders admitted to State of Maryland Hospitals between 1994 and 2000. Inpatient medical records from 7 hospitals were reviewed to obtain demographic information, diagnosis, medication use, as well as smoking and other substance use. Social Security Death Index data were used to identify deaths in the study group between 1994 and 2004. Death records were reviewed to obtain manner of death and underlying disorders. Of the 1213, 55% were smokers and 71% abused substances. There was an age × smoking interaction (χ(2) = 14.6, df = 1, P = .0001) for mortality, with estimated hazard ratios (HRs) for smokers vs nonsmokers of 2.1 among 35- to 54-year olds and HR of 0.7 among those aged 55-69 years. Five- and 10-year mortality rates for smokers aged 35-54 years were 7.0% and 14.2%, compared with 3.3% and 10.0% for nonsmokers, respectively (χ(2) = 5.53, df = 1, P = .019). Cardiac causes were identified in 43% of deaths in smokers but only 19% of deaths in nonsmokers (P < .006). For those aged 35-54 years, the odds of cardiac related death was increased by 12 fold in smokers relative to nonsmokers (HR = 12.4, χ(2) = 12.0, df = 1, P = .0005). Among people aged 35-54 years, those smoking greater than one pack daily have a significantly increased total mortality risk (HR = 2.7) vs nonsmokers. Cigarette smoking, particularly in people aged 35-54 years, contributes to an increased risk of death. Greater smoking severity significantly increases this risk. Smoking cessation in people with schizophrenia deserves significant attention.

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    • "Smoking is one of the major preventable causes of morbidity and premature mortality both in the general population and in schizophrenia (Kelly et al., 2011). In the past decades numerous studies examined smoking in schizophrenia patients in Western countries. "
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    ABSTRACT: The study objective was to perform a meta-analysis of the prevalence of current smoking in Chinese female patients with schizophrenia. A systematic literature search was conducted and studies fulfilling the following criteria were included: female schizophrenia patients; reporting current smoking rate computed from samples. Eight studies were included. The pooled current smoking prevalence was 4.3% (95% Confidence interval [CI]: 3.2-5.6%). The finding showed that smoking rate of female patients with schizophrenia in China was lower compared to their Western and other Asian counterparts.
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    • "reduction in life expectancy reported in this population [Kelly et al., 2011 [Kelly et al., , 2012. The adverse health consequences of smoking have been largely attributed to the abundance of reactive oxygen species (ROS) and reactive nitrogen species (RNS) that readily react with various biomolecules [Bar-Shai et al., 2006]. "

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    • "The T cells are also being associated with psychopathological symptoms and the outcome of neuroleptic treatment in schizophrenia (Muller et al. 1991; 1993). Cigarette smoking causes high mortality in schizophrenia patients (Kelly et al. 2011). Interestingly, cigarette smoking was found to be associated with increased T-cell proliferation in schizophrenia patients (Herberth et al. 2010). "
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    ABSTRACT: Schizophrenia is a severe and highly complex neurodevelopmental disorder with an unknown etiopathology. Recently, immunopathogenesis has emerged as one of the most compelling etiological models of schizophrenia. Over the past few years considerable research has been devoted to the role of innate immune responses in schizophrenia. The findings of such studies have helped to conceptualize schizophrenia as a chronic low-grade inflammatory disorder. Although the contribution of adaptive immune responses has also been emphasized, however, the precise role of T cells in the underlying neurobiological pathways of schizophrenia is yet to be ascertained comprehensively. T cells have the ability to infiltrate brain and mediate neuro-immune cross-talk. Conversely, the central nervous system and the neurotransmitters are capable of regulating the immune system. Neurotransmitter like dopamine, implicated widely in schizophrenia risk and progression can modulate the proliferation, trafficking and functions of T cells. Within brain, T cells activate microglia, induce production of pro-inflammatory cytokines as well as reactive oxygen species and subsequently lead to neuroinflammation. Importantly, such processes contribute to neuronal injury/death and are gradually being implicated as mediators of neuroprogressive changes in schizophrenia. Antipsychotic drugs, commonly used to treat schizophrenia are also known to affect adaptive immune system; interfere with the differentiation and functions of T cells. This understanding suggests a pivotal role of T cells in the etiology, course and treatment of schizophrenia and forms the basis of this review.
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