Tobacco smoking in Egyptian schizophrenia patients with and without obsessive–compulsive symptoms

Abstract

Background Nicotine dependence is common in schizophrenia patients but rare in patients with obsessive–compulsive disorder. Little is known, however, about smoking in schizophrenia patients with obsessive–compulsive symptoms (OCS) especially in a developing country, such as Egypt, that has the highest rate of tobacco consumption in the Middle East and North Africa. Objectives To test a hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without-OCS. Results Out of 87 consecutive schizophrenia patients attending a psychiatric out-patients clinic in Egypt, 34 patients (39%) had significant OCS, and a smoking rate (85.3%) not significantly lower than that of patients without-OCS (90.6%). Patients were reclassified by their Fagerström's scores into 3 groups of nicotine dependence: mild (37 patients), high (21 patients) and very high (29 patients). There were no differences between these groups in terms of YBOCS scores ( F = 0.324; p = 0.724). When comparing PANSS scores of patients, with and without-OCS, those of the former group were higher on the positive symptoms (mean = 24.2 versus 20.8; p = 0.002), and anxiety/depression (mean = 10.8 versus 10.1; p = 0.03) but lower on the negative symptoms (mean = 15.0 versus 19.4; p = 0.000), disorganized thoughts (mean = 14.5 versus 17.5; p = 0.002), and uncontrolled hostility/excitement) (mean = 7.5 versus 9.5; p = 0.002). However, there was no significant between-group difference in the total PANSS scores. Conclusions The high and equal rates of smoking in patients with-, and without-OCS, and the lack of difference between YBOCS scores of mild, high and very high nicotine dependence groups undermined our initial hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without them. Nevertheless, the finding of a distinctive PANSS scores, may support a suggestion that OCS in schizophrenia represent a distinct subtype or dimension.