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Why Do So Many Schizophrenics Smoke?

Content provided by: Better Medicine from Healthgrades

A whopping 75 percent to 90 percent of people with schizophrenia smoke. That's three times the rate of smoking in the general population. Compared with other smokers, people with schizophrenia also tend to smoke more often and inhale more deeply.

What's going on here? Scientists think the nicotine in tobacco smoke may temporarily reduce some symptoms of schizophrenia. People with the condition may not be consciously aware of why they're so drawn to cigarettes. But by smoking, they're actually self-medicating. Unfortunately, they're also increasing their risk for cancer, heart disease, stroke, lung disease, and early death.

To cut these health risks—by as much as 60 percent in the case of cardiovascular disease— quitting smoking is vital. That's why a recent review article in the journal Addiction is such good news. Based on eight previous studies, the authors found that quit-smoking strategies worked about as well for those with severe mental illness as for the population at large. When mental illness was well managed, giving up cigarettes also didn't make symptoms flare out of control.

It's About the Brain

Scientists are still studying how nicotine and schizophrenia may be linked. The brain contains several types of receptors—proteins on the surface of cells that receive chemical messages. Nicotine attaches to the same type of receptors as a brain chemical called acetylcholine. This brain chemical affects memory, attention, alertness, and mood. Nicotine receptors also affect levels of dopamine and glutamate, two other important brain chemicals. An imbalance in these chemicals is thought to occur in schizophrenia.

When people with schizophrenia smoke, nicotine attaches to its receptors. This may help brain chemicals get into better balance, and that may help the brain to work more smoothly. As a result, memory, learning, attention, and thinking speed may improve. Negative symptoms, such as lack of motivation and interest, may also lessen. Such improvements are short-lived, however, and the brain quickly adapts to the levels of nicotine. This is why a nicotine patch doesn't have the same effect as intermittent cigarette smoking.

Brain chemistry isn't the whole story. Social factors play a role in smoking as well. When you're around other smokers, it's tempting to join in. Some people with schizophrenia pick up the habit at a day program, hospital, or group home.

Stubbing Out Smoking

Studies show that doctors don't warn people with schizophrenia about the hazards of smoking the way they do other patients. Yet people with schizophrenia have a 1.5 time greater risk of dying prematurely than those without the illness. Their life expectancy is reduced by 20 to 30 years compared with the general population. Smoking plays a big part in that risk. It takes a harsh toll on the body. And it's hard on the wallet, too. If you're on a tight budget, affording cigarettes may mean skimping on food or medical care.

The two main tools to help with quitting smoking are counseling and medications. Studies show that both approaches can be helpful for people with schizophrenia.

When smokers first quit, withdrawal symptoms may occur as the body gets used to life without nicotine. These symptoms—such as dizziness, anxiety, irritability, trouble sleeping, and headaches—are temporary but unpleasant. And they may be worse than average for people with schizophrenia. Medications can help people get through this tough phase. Options include nicotine products, such as patches and gum, and non-nicotine medications, such as bupropion. Your doctor can also keep an eye on your response to antipsychotic drugs during this time. Smoking often makes such drugs less effective. So as a nice side benefit, you might be able to reduce your dose of antipsychotic medication once you stop smoking. However, changing your medications should only be tried together with your prescribing doctor.

Giving up smoking isn't easy. But it is possible. If you plan to quit, ask your doctor about the best approach for you. 

Medical Reviewer: L Marcellin, MD, MPH Last Annual Review Date: Nov. 11, 2012 Copyright: © 2013 Healthgrades, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades, Inc. Use of this information is governed by the Healthgrades User Agreement.
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