Abstract
Smoking is highly prevalent in people with psychotic disorders, even in the earliest phases of the illness. The neural mechanisms of nicotine dependence and psychosis overlap and may also be linked to deficits in neurocognition and motivation in psychosis. Both neurocognition and motivation are recognized as important clinical targets, though previous research examining the effects of smoking on these features has been inconsistent. Here, we examine the relationships between smoking status and neurocognition and motivation over the first two years of treatment for psychosis through a secondary analysis of the Recovery After an Initial Schizophrenia Episode–Early Treatment Program (RAISE–ETP) dataset. In a sample of 404 individuals with first-episode psychosis, we examined linear mixed-effects models with the group (smoker vs. non-smoker) by time (baseline, 12-month, 24-month) interaction as a predictor of global cognition and motivation. While all individuals showed enhanced global cognition and motivation over the 24-month course of treatment, non-smokers showed significantly greater gains in motivation. These changes in motivation also corresponded to improvements in functioning over the 24-month period. No significant effects of smoking were observed for global cognition. Our findings suggest that motivation and smoking cessation may be important early treatment targets for first-episode psychosis programs.
Highlights
People with schizophrenia spectrum disorders report cigarette use at a prevalence far higher than the general population [1], and an overwhelming majority (86–90%) initiate smoking before the onset of their illness [2,3]
The number of smokers did not differ between RAISE-ETP treatment groups (NAVIGATE vs. control condition (CC)), and t-tests showed no significant differences between RAISE-ETP treatment groups with regard to motivation or global cognition at any time point
The current analysis sought to determine how smoking relates to neurocognition and motivation over the first two years of treatment for first episode of psychosis (FEP) in a large sample drawn from the RAISE-ETP dataset
Summary
People with schizophrenia spectrum disorders report cigarette use at a prevalence far higher than the general population [1], and an overwhelming majority (86–90%) initiate smoking before the onset of their illness [2,3]. The only longitudinal study of neurocognitive outcomes related to smoking included a small sample size which may have been underpowered to detect associations or changes over time. It is unclear from previous research how the amount of cigarette smoking may relate to neurocognitive performance. To address these limitations, we conducted a secondary analysis of the RAISE–ETP dataset to determine how cigarette smoking at baseline is related to global cognition and motivation throughout the first two years of treatment for a first episode of psychosis. We examined whether the level of nicotine dependence is associated with performance in global cognition and motivation
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