Abstract
BackgroundThe high prevalence rates and impact of tobacco smoking in individuals with a psychotic disorder have become an increasing interest. Little is known about tobacco smoking in individuals at ultra-high risk of psychosis (UHR). MethodsWe studied 345 UHR individuals of the high-risk study of the European network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI). Smoking status and the number of cigarettes per day were assessed at multiple moments using the CIDI. Symptom severity at each time point was assessed using CAARMS. Linear mixed-effects analyses were conducted to examine the multi-cross-sectional and prospective associations between (change in) smoking behaviour and symptomatology. FindingsAt baseline, 175 individuals (53%) smoked tobacco with an average of 12.4 (SD = 9.0) cigarettes per day. Smokers did not significantly differ in symptom severity from non-smokers on general, positive, negative, emotional, cognitive, behavioural, or motor symptoms across time. However, associations were found between the number of cigarettes and the severity of general psychopathology (estimate 0.349, SE 0.146, p = 0.017). Change in the number of cigarettes had no significant effect on change in general symptom severity (estimate 0.330, SE 0.285, p = 0.248). InterpretationSmoking prevalence in UHR individuals is high. Cigarette consumption was associated with higher levels of general symptoms. However, we observed no association between change in number of cigarettes and symptom severity. Given the fact that smoking is associated with poorer health and worse outcomes in people with psychosis, the clinical high-risk phase offers a window of opportunity for prevention and cessation interventions.
Highlights
Tobacco use is the leading cause of preventable diseases, disabilities, and death in Western countries
No associa tions were found between smoking status and symptom severity in ultra-high risk of psychosis (UHR) individuals, nor between smoking status and transition rate
Cigarettes smoked per day and higher levels of general symptom severity in UHR individuals
Summary
Tobacco use is the leading cause of preventable diseases, disabilities, and death in Western countries. The prevalence of smoking has been decreased in daily life in Western countries: the overall global rate of current smoking aged over 15 years, declined from 23.5% in 2007 to 20.7% in 2015 (Organization WH, 2017) This is not the case for individuals with a psychiatric condition, and especially not in psy chosis: the smoking prevalence remains extremely high, with rates varying from 57.0% in first-episode psychosis (Gurillo et al, 2015) and 61.6% in schizophrenia (Zeng et al, Jun 6 2020). Due to previous conflicting results in individuals with a psychiatric condition (Taylor et al, Feb 13 2014) and individuals with psychosis (Kotov et al, Jan 2010; Vermeulen et al, 2019), we expected that change in smoking behaviour would not be associated with diminished nor increased symptom severity
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