How is smoking related to schizophrenia? 

Tobacco smoking is very common among people with schizophrenia, who often show particularly heavy usage. This poses considerable health risks, may interfere with antipsychotic medications and may place a financial burden on the individual. Heavy cigarette use may contribute to the increased mortality and reduced life expectancy reported within the schizophrenia population.

What is the evidence for smoking?

Compared to the general population, moderate quality evidence finds higher rates of current smoking, heavy smoking, and lifetime smoking, and lower rates of smoking cessation in people with schizophrenia. People with first-episode psychosis, and those at ultra-high risk of psychosis also show higher rates of smoking, with rates of ~57% and ~33% respectively. There is also a medium-sized increased risk of psychotic disorders, and an earlier age of psychosis onset in smokers compared to non-smokers.

Compared to people with other mental disorders, people with schizophrenia show a small to medium-sized effect of higher rates of current smoking, and lower rates of smoking cessation.

Moderate to high quality evidence found small effects of more severe positive symptoms but less severe extrapyramidal symptoms in smokers with schizophrenia compared to non-smokers with schizophrenia. There were no differences in negative symptoms, depression, anxiety, tardive dyskinesia, or parkinsonism.

Moderate quality evidence found the most commonly reported reasons for smoking were relaxation/stress reduction, dysphoria relief, sociability, and craving/addiction. The most commonly reported reasons for quitting were self-control, health concerns, and social influence.

August 2020

Last updated at: 2:50 am, 10th August 2020
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