Mark Barnes, Bruce R. Lawford, Simon C. Burton, Karen R. Heslop,
Ernest P. Noble, Karrin Hausdorf, Ross McD. Young
Smoking rate is disproportionately high among patients with schizophrenia,
resulting in significant morbidity and mortality. However, cigarette smoking has been
reported to have beneficial effects on negative symptoms, extrapyramidal symptoms,
cognitive functioning and mood symptoms. Therefore, smoking cessation may worsen
disability in schizophrenia. The association between smoking and these key clinical
parameters was examined. Additionally, severity of smoking across four different
antipsychotic treatment groups was explored.
One hundred and forty-six patients with schizophrenia were assessed for
smoking using expired carbon monoxide and smoking history. They were administered the
Positive and Negative Symptom Scale, The Extrapyramidal Symptom Rating Scale, the
Barnes Akathisia Rating Scale, Reitans Trail-making Test (A and B) and General Health
Questionnaire-28.
There was no difference in the chlorpromazine equivalent dose of any of the
medications studied. Atypical agents were associated with significantly lower levels of
smoking when compared with typical medications. There was no difference in smoking
severity between the individual atypical medications examined. Similarly, there were no
significant differences between smoking and non-smoking groups with regard to Positive
and Negative Symptom Scale, Extrapyramidal Symptom Rating Scale, Trail-making Test
and General Health Questionnaire-28. However, there was a significant difference
between these groups with the smoking group demonstrating less akathisia.
Smoking is not associated with positive, negative cognitive and mood symptoms in schizophrenia. Smoking is associated with lower levels of antipsychotic
induced akathisia. Clinicians should not be discouraged from helping patients stop smoking
for fear of worsening symptoms. However, akathisia may emerge upon cessation of
576 SMOKING AND SCHIZOPHRENIA
© 2006 The Authors
Journal compilation © 2006 The Royal Australian and New Zealand College of Psychiatrists
smoking. Switching patients from typical to atypical antipsychotics may assist patients with
schizophrenia to give up smoking.
akathisia, antipsychotics, nicotine, schizophrenia, smoking
Australian and New Zealand Journal of Psychiatry 2006; 40:575–580
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