Abstract
Background Studies in Western populations indicate that the prevalence of smoking in patients with schizophrenia ranges from 70-90%. Data from low and middle income countries is sparse. Aims To determine the prevalence of smoking in patients with schizophrenia, and to identify probable associations. Methodology The study was conducted at the psychiatry outpatient clinics of Colombo North Teaching Hospital, Ragama. Consecutive outpatients who met ICD-10 diagnostic criteria for schizophrenia were invited to answer an interviewer administered, pre-tested questionnaire on socio-demographic status, smoking habits, disease and treatment related characteristics. The Fagerstrom’s Test for Nicotine Dependence was used to grade the level of nicotine addiction. Results Of the 400 patients with schizophrenia, 171 (42.8%) were smokers. Of them 150 (87.7%) were dependent on nicotine. In terms of Fagerstrom’s Test, high dependence was seen in 3.3% ( n =5) while 39.2% ( n =59) and 57.3% ( n =86) reported moderate and low dependence respectively. All the smokers were male. For a majority of the patients the age of initiation of smoking was between 16-25 years, correlating with the onset of schizophrenia. Interestingly, most of the smokers (63.2%) were keen to quit smoking. Participants who smoked were significantly more likely to misuse other substances ( p =0.001) and to suffer from physical illnesses ( p =0.0001), compared to non-smokers. Smokers were also significantly more likely to be on intramuscular depot antipsychotics ( p =0.032), whereas non-smokers in contrast, were more likely to be on atypical antipsychotics ( p =0.0001). Conclusion A dual diagnosis of schizophrenia and nicotine dependence could be made in nearly half of our study population with schizophrenia. Although these rates are lower than in western populations, it is an issue that needs to be addressed in the treatment. DOI: http://dx.doi.org/10.4038/sljpsyc.v5i2.7816 Sri Lanka Journal of Psychiatry Vol 5(2):19-23
Highlights
According to the World Health Organisation (WHO), there are more than one billion smokers worldwide
Smoking rates in schizophrenia, as studies in western populations where patients are more likely to be on atypical antipsychotics show higher rates of smoking than of our study population
A dual diagnosis of schizophrenia and nicotine dependence can be made in nearly half of our study population with schizophrenia
Summary
According to the World Health Organisation (WHO), there are more than one billion smokers worldwide. It is estimated that tobacco use will cause one billion deaths worldwide during the 21st century, with three quarters of these deaths occurring in low-income countries [1]. Studies show that up to 70% of individuals with schizophrenia smoke cigarettes [3]. It is highlighted that a majority of those with schizophrenia who smoke, started smoking before the onset of the illness. Some studies have postulated that one of the major reasons for excess natural mortality among patients with schizophrenia is cigarette smoking [5]. A comprehensive meta-analysis highlighted that smoking can be regarded as a plausible explanation for the raised mortality from respiratory disease in this population [6]. Studies in Western populations indicate that the prevalence of smoking in patients with schizophrenia ranges from 70-90%.
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