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nearly three times the rate in the general population and higher than the elevated rates
of smoking in patients with other psychiatric illnesses. Usually they start smoke at
mid teens and start before their illness began. Patients with schizophrenia who smoke
are also heavier smokers than those in the general population and those with other
psychiatric disorders.
Discussion: They are three possibility why patient with schizophrenia smoke
at excessive rates. The three possibility are something about the illness leads patients
to smoke; smoking is another risk factor for schizophrenia; or a third factor leads to
Conclusion: As we know, smoke will affect patient’s life. Smoke influence the
health, financial and social life of patient with schizophrenia. So, cessation smoking in
behavior. The expression of these manifestations varies across patients and over time,
but the effect of the illness is always severe and is usually long lasting. The disorder
usually begins before age 25, persists throughout life, and affects person of all social
class. (6)
According to The World Health Organization (WHO), there are one billion smokers
worldwide, and they smoke six trillion cigarettes a year. The WHO also estimates that
In schizophrenia, the number of patients who smoke is very high. One study
reported the prevalence to be 88%, nearly three times the rate in the general
population and higher than the elevated rates of smoking in patients with other
psychiatric illnesses. The increased prevalence persists even after adjustment for
marital status, alcohol use and socio-economic status. A number of more recent cross-
sectional studies from different countries have reported high rates of smoking in
patients with schizophrenia. Smoking occurs at much higher rates than other types of
substance misuse or dependence, which have been shown also to be elevated among
The average age when patients with schizophrenia started smoking was the
same as in the general population, namely mid-teens; 90% of patients who smoked
had started smoking before their illness began. Patients with schizophrenia who
smoke are also heavier smokers than those in the general population and those with
as heavy smokers (25 or more cigarettes daily) compared with only 11% of the
general population who smoke. Patients with schizophrenia who smoked had much
higher levels of the nicotine metabolite cotinine in comparison with other smokers.
The proportion of those who quit is lower than in the general population. (4)
capable of causing gum disease and oral cancer. When tobacco is burned, the resultant
smoke contains, in addition to nicotine, carbon monoxide and 4000 other compounds
that result from volatilization, pyrolysis, and pyrosynthesis of tobacco and various
receptors. About 25 percent of the nicotine inhaled during smoking reaches the brain
within 15 seconds. The half life of nicotine is about 2 hours. Nicotine is believed to
dopaminergic pathway projecting from the ventral tegmental area to the cerebral
cortex and the limbic system. In addition to activating this dopamine reward system,
are three possible explanations for the association: something about the illness leads
patients to smoke; smoking is another risk factor for schizophrenia; or a third factor
The first possibility has received most attention. It has been suggested that
smoking may be a marker of a more severe illness process. Smokers are more often
young and male; they have an earlier onset of illness, increased numbers of hospital
average doses of antipsychotics with lower blood levels in smokers compared with
nonsmokers. (2, 4)
associated with cigarette smoking, ranging from 44% to 67% for orally administered
haloperidol and fluphenazine and 133% for fluphenazine decanoate. Most surveys
has also been shown that nicotine administration enhances cognitive performance on a
number of tasks. However, in general, patients with schizophrenia who smoke report
similar reasons to other smokers ("addicted", "relaxation" and "to calm down"). (4)
Smoking may increase dopamine release in the pre-frontal cortex and alleviate
nicotine receptors. Nicotine also acutely elevates levels of the enzyme tyrosine
nicotinic receptors. So, patients with schizophrenia may smoke heavily as a result of
Possibly, a very high level of smoking is necessary to overcome this blockade and
patients who smoked were as children more poorly adjusted socially than those who
smoking is that smoking acts as an etiological risk factor for schizophrenia. It may be
that repeated activation by nicotine of the mesolimbic system over a long time
that the earlier the age of starting smoking, the earlier was the onset of psychotic
illness in women. Among the adolescents in one study, who had been screened and
associated with greater risk for later hospitalization for schizophrenia. This higher
associated with smoking behavior. There was a significant association between the
number of cigarettes smoked and the risk for schizophrenia, with heavier smoking
Interestingly, nicotine acts like other drugs of addiction such as cocaine and
critical importance for the reinforcing and reward properties of the drug. The nicotine
psychosis, thus giving cigarettes a causative role in the pathway toward the later
appearance of schizophrenia. Also, nicotine has been shown to increase burst activity
in the dopamine neurons of the ventral tegmental area, a form of firing pattern of these
develop both schizophrenia and nicotine addiction. The modes of genetic transmission
that smoking is normalizing gene expression in the patients. The regulatory region
was strongly associated with abnormal auditory gating (P50). Two haplotypes were
associated with both smoking and schizophrenia, but the association was strongest
with smoking. The data suggest that the CHRNA7 genotype may regulate smoking
behavior. Much work in the genetics of both schizophrenia and nicotine addiction has
special attention. Several crosssectional reports have suggested that cigarette smoking
been speculated that this may be due to the effect of nicotine on striatal dopamine
systems affected in this condition. Similarly, there is evidence to suggest that smoking
smokers than among nonsmokers with schizophrenia who were treated with
neuroleptics. (2)
to members of the general population. Besides health, tobacco use results in other
Despite the magnitude of tobacco use problems, quit rates for seriously
mentally ill smokers are significantly lower than in the general population. Individuals
with schizophrenia are able to quit smoking, although the success is about half that of
other groups. Contributing factors likely include lower motivation to quit tobacco use,
fewer lifetime quit attempts, and increased severity of nicotine dependence. (8)
Conclusion
three times the rate in the general population and higher than the elevated rates of
usually start smoking about mid-teens and start smoking before their illness began.
habit among patients with schizophrenia. So, it is not easy for patient with
There are three possible explanations for the association: something about the illness
leads patients to smoke; smoking is another risk factor for schizophrenia; or a third
The first possibility is related with the medication. Cigarette smoking may
for patient and nicotine enhances cognitive performance of the patient. Another
possibility is that smoking acts as an etiological risk factor for schizophrenia. And the
both schizophrenia and nicotine addiction. Much work in the genetics of both
schizophrenia and nicotine addiction has focused on the dopamine receptor system.
tobacco use results in other consequences, with smokers suffering financially and
socially. But there is one problem, quit rates for seriously mentally ill smokers are
significantly lower than in the general population. But, still patient is able to quit
smoke.
References
1. Burns DM. Nicotine Addiction. In: Kasper DL, Fauci AS, Longo DL, et al,ed.
1998; 1490-1501.
by
Osman Wijaya
03005165
Faculty of Medicine
Trisakti University
Jakarta
2008