Abstract
The purpose of this study is to describe possible differences in cognitive functioning between smoking and non-smoking patients with first-episode psychosis and to determine whether there is a better cognitive profile associated with smoking. We assessed 61 first-episode psychosis patients with a neuropsychological battery that included computerized measurements of attention, working memory, and executive functioning. Patients were grouped into two categories: non-smokers (0 cigarettes/day; n = 30) and smokers (≥20 cigarettes/day; n = 31). No significant differences were detected in sociodemographic and clinical data between the two groups. For attention tasks, smokers exhibited shorter reaction times in the sustained attention test than non-smokers (P = 0.039) and needed less time to complete the Stroop interference test (P = 0.013). In the working memory task, smokers exhibited shorter reaction times (P = 0.029) and presented a significantly lower percentage of omission (P = 0.002) and commission errors (P = 0.020) than non-smokers. For executive functioning, no differences were detected between groups in performance on the Wisconsin Card Sorting Test. Results indicate that first-episode psychosis patients who are nicotine users have better cognitive functioning in the areas of attention and working memory than patients who are not nicotine users. This study supports the cognitive approach to the self-medication hypothesis, to explain the high rates of cigarette smoking among psychosis patients. These results may be relevant for developing new strategies involving nicotinic receptors for cognitive enhancement in psychosis.
Similar content being viewed by others
References
Addington J, Saeedi H, Addington D (2005) The course of cognitive functioning in first episode psychosis: changes over time and impact on outcome. Schizophr Res 78:35–43
Adler LE, Hoffer LD, Wiser A, Freedman R (1993) Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Am J Psychiatry 150:1856–1861
Adler LE, Olincy A, Waldo M, Harris JG, Griffith J, Stevens K, Flach K, Nagamoto H, Bickford P, Leonard S, Freedman R (1998) Schizophrenia, sensory gating, and nicotinic receptors. Schizophr Bull 24:189–202
American Psychiatric Association A (1994) Diagnostic and statistical manual of mental disorders. APA, Washington DC
Avila MT, Sherr JD, Hong E, Myers CS, Thaker GK (2003) Effects of nicotine on leading saccades during smooth pursuit eye movements in smokers and nonsmokers with schizophrenia. Neuropsychopharmacology 28:2184–2191
Barr RS, Culhane MA, Jubelt LE, Mufti RS, Dyer MA, Weiss AP, Deckersbach T, Kelly JF, Freudenreich O, Goff DC, Evins AE (2007) The Effects of Transdermal Nicotine on Cognition in Nonsmokers with Schizophrenia and Nonpsychiatric Controls. Neuropsychopharmacology 33(3):480–490
Chen WJ, Liu SK, Chang CJ, Lien YJ, Chang YH, Hwu HG (1998) Sustained attention deficit and schizotypal personality features in nonpsychotic relatives of schizophrenic patients. Am J Psychiatry 155:1214–1220
Coldham EL, Addington J, Addington D (2002) Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand 106:286–290
Dalack GW, Meador-Woodruff JH (1996) Smoking, smoking withdrawal and schizophrenia: case reports and a review of the literature. Schizophr Res 22:133–141
Davalos DB, Compagnon N, Heinlein S, Ross RG (2004) Neuropsychological deficits in children associated with increased familial risk for schizophrenia. Schizophr Res 67:123–130
Davidson M, Reichenberg A, Rabinowitz J, Weiser M, Kaplan Z, Mark M (1999) Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. Am J Psychiatry 156:1328–1335
de Leon J (2004) Psychopharmacology: atypical antipsychotic dosing: the effect of co-medication with anticonvulsants. Psychiatr Serv 55:125–128
de Leon J, Becona E, Gurpegui M, Gonzalez-Pinto A, Diaz FJ (2002) The association between high nicotine dependence and severe mental illness may be consistent across countries. J Clin Psychiatry 63:812–816
de Leon J, Diaz FJ (2005) A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 76:135–157
Decina P, Caracci G, Sandik R, Berman W, Mukherjee S, Scapicchio P (1990) Cigarette smoking and neuroleptic-induced parkinsonism. Biol Psychiatry 28:502–508
Depatie L, O’Driscoll GA, Holahan AL, Atkinson V, Thavundayil JX, Kin NN, Lal S (2002) Nicotine and behavioral markers of risk for schizophrenia: a double-blind, placebo-controlled, cross-over study. Neuropsychopharmacology 27:1056–1070
Eppolito AK, Smith RF (2006) Long-term behavioral and developmental consequences of pre- and perinatal nicotine. Pharmacol Biochem Behav 85:835–841
First M, Spittzer R, Gibbon M, Williams J (1995) Structured Clinical Interview for DSM-IV axis I disorders, patient ediction (SCID-P), Version 2. Biometrics Research, New York
George TP, Vessicchio JC, Termine A, Sahady DM, Head CA, Pepper WT, Kosten TR, Wexler BE (2002) Effects of smoking absinence on visuospatial working memory function in schizophrenia. Neuropsychopharmacology 26:75–85
Goff DC, Henderson DC, Amico E (1992) Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry 149:1189–1194
Gonzalez-Pinto A, Gutierrez M, Ezcurra J, Aizpuru F, Mosquera F, Lopez P, de Leon J (1998) Tobacco smoking and bipolar disorder. J Clin Psychiatry 59:225–228
González Pinto A, Gutiérrez M, de León J, Mosquera F, Elizagarate E, BR (1998) Tabaquismo en población psiquiátrica. Actas Luso-Españolas de Neurología, Psiquiatría y Ciencias Afines 26:48–50
Green MF (2006) Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. J Clin Psychiatry 67:e12
Griffith JM, O’Neill JE, Petty F, Garver D, Young D, Freedman R (1998) Nicotinic receptor desensitization and sensory gating deficits in schizophrenia. Biol Psychiatry 44:98–106
Guy W (1976) Assessment manual for psychopharmacology (revised). US Department of Health, Education and Welfare, Rockville, MD
Harris JG, Kongs S, Allensworth D, Martin L, Tregellas J, Sullivan B, Zerbe G, Freedman R (2004) Effects of nicotine on cognitive deficits in schizophrenia. Neuropsychopharmacology 29:1378–1385
Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12:426–445
Jacobsen LK, D’Souza DC, Mencl WE, Pugh KR, Skudlarski P, Krystal JH (2004) Nicotine effects on brain function and functional connectivity in schizophrenia. Biol Psychiatry 55:850–858
Keefe RS, Malhotra AK, Meltzer HY, Kane JM, Buchanan RW, Murthy A, Sovel M, Li C, Goldman R (2008) Efficacy and safety of donepezil in patients with schizophrenia or schizoaffective disorder: significant placebo/practice effects in a 12-week, randomized, double-blind, placebo-controlled trial. Neuropsychopharmacology 33(6):1217–1228
Kelly C, McCreadie RG (1999) Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. Am J Psychiatry 156:1751–1757
Levin ED, Conners CK, Sparrow E, Hinton SC, Erhardt D, Meck WH, Rose JE, March J (1996) Nicotine effects on adults with attention-deficit/hyperactivity disorder. Psychopharmacology (Berl) 123:55–63
Levin ED, Wilson W, Rose JE, McEvoy J (1996) Nicotine-haloperidol interactions and cognitive performance in schizophrenics. Neuropsychopharmacology 15:429–436
Martin LF, Freedman R (2007) Schizophrenia and the alpha7 nicotinic acetylcholine receptor. Int Rev Neurobiol 78:225–246
McEvoy JP, Brown S (1999) Smoking in first-episode patients with schizophrenia. Am J Psychiatry 156:1120–1121
Miller DD, Kelly MW, Perry PJ, Coryell WH (1990) The influence of cigarette smoking on haloperidol pharmacokinetics. Biol Psychiatry 28:529–531
Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389
Myers CS, Robles O, Kakoyannis AN, Sherr JD, Avila MT, Blaxton TA, Thaker GK (2004) Nicotine improves delayed recognition in schizophrenic patients. Psychopharmacology (Berl) 174:334–340
Nomikos GG, Schilstrom B, Hildebrand BE, Panagis G, Grenhoff J, Svensson TH (2000) Role of alpha7 nicotinic receptors in nicotine dependence and implications for psychiatric illness. Behav Brain Res 113:97–103
Olincy A, Johnson LL, Ross RG (2003) Differential effects of cigarette smoking on performance of a smooth pursuit and a saccadic eye movement task in schizophrenia. Psychiatry Res 117:223–236
Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497
Peralta V, Cuesta M (1994) Validación de la escala de los síndromes positivo y negativo (PANSS) en una muestra de esquizofrénicos españoles. Actas Luso Esp Neurol Psiquiatr 22:171–177
Sacco KA, Termine A, Seyal A, Dudas MM, Vessicchio JC, Krishnan-Sarin S, Jatlow PI, Wexler BE, George TP (2005) Effects of cigarette smoking on spatial working memory and attentional deficits in schizophrenia: involvement of nicotinic receptor mechanisms. Arch Gen Psychiatry 62:649–659
Sherr JD, Myers C, Avila MT, Elliott A, Blaxton TA, Thaker GK (2002) The effects of nicotine on specific eye tracking measures in schizophrenia. Biol Psychiatry 52:721–728
Smith RC, Singh A, Infante M, Khandat A, Kloos A (2002) Effects of cigarette smoking and nicotine nasal spray on psychiatric symptoms and cognition in schizophrenia. Neuropsychopharmacology 27:479–497
Smith RC, Warner-Cohen J, Matute M, Butler E, Kelly E, Vaidhyanathaswamy S, Khan A (2006) Effects of nicotine nasal spray on cognitive function in schizophrenia. Neuropsychopharmacology 31:637–643
Taiminen TJ, Salokangas RK, Saarijarvi S, Niemi H, Lehto H, Ahola V, Syvalahti E (1998) Smoking and cognitive deficits in schizophrenia: a pilot study. Addict Behav 23:263–266
Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429–435
Zammit S, Allebeck P, Dalman C, Lundberg I, Hemmingsson T, Lewis G (2003) Investigating the association between cigarette smoking and schizophrenia in a cohort study. Am J Psychiatry 160:2216–2221
Acknowledgments
This study was supported in part by the University of the Basque Country (UPV-EHU), the Spanish Department of Health, Instituto de Salud Carlos III, Mental Health CIBER-SAM, RETICS RD06/0011(REM-TAP Network), and by grants PI01/1455; PI05/1508 (Spanish Department of Health: Healthcare Research Fund).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zabala, A., Eguiluz, J.I., Segarra, R. et al. Cognitive performance and cigarette smoking in first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 259, 65–71 (2009). https://doi.org/10.1007/s00406-008-0835-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-008-0835-6