Fewer but heavier caffeine consumers in schizophrenia: a case-control study

According to the literature, there is an association between schizophrenia and caffeine consumption, but it is not clear whether schizophrenia is associated with either higher prevalence of daily caffeine intake or the amount consumed. In this study we compared our previously published schizophrenia patients (n=250) with a control sample (n=290) after controlling for demographic variables and tobacco and alcohol consumption. Current caffeine intake was less frequent in schizophrenia patients (59%, 147/250) than in controls (70%, 204/290). In the multivariate analyses, caffeine intake was less frequent at an older age and in schizophrenia patients, and more frequent in smokers and alcohol users. Among caffeine consumers, heavy caffeine intake (> or =200 mg/day) was significantly associated with schizophrenia (64%, 94/147 in schizophrenia versus 36%, 73/204 in controls), as well as older age and smoking. Daily amount of caffeine intake and smoked cigarettes correlated significantly in the schizophrenia group but not in the control group; the correlation of caffeine intake with nicotine dependence was low and non-significant in both groups. The association between current smoking and heavy caffeine intake may be partly explained by a pharmacokinetic effect: tobacco smoke compounds induce caffeine metabolism by the cytochrome P450 1A2. Although schizophrenia by itself may be associated with heavy caffeine intake in caffeine users, part of this association was explained by the association between schizophrenia and smoking. The relationship between caffeine and alcohol intake appeared to be more complex; alcohol and caffeine use were significantly associated, but within caffeine users alcohol was associated with less frequent heavy caffeine consumption among smokers. In future studies, the measurement of plasma caffeine levels will help both to better define heavy caffeine intake and to control for smoking pharmacokinetic effects.     

Nicotine exposure among nondependent smokers

Most theories of dependence imply that repeated exposure to an addictive drug leads inexorably to dependence. We examined nicotine exposure in "tobacco chippers," who smoke regularly without developing dependence. Blood samples were obtained before and after 10 chippers (smoking up to 5 cigarettes per day) and 12 dependent smokers (20 to 40 cigarettes per day) smoked a cigarette. Chippers' blood nicotine levels increased significantly, in amounts equaling those of dependent smokers. Assays of cotinine (a long-lasting nicotine metabolite) also suggested that chippers' per-cigarette nicotine absorption equaled that of dependent smokers. Chippers' cotinine levels were also compared with those of heavy smokers (38 cigarettes per day) whose consumption was reduced to 5 cigarettes per day in a previously published study. The heavy smokers compensated by tripling their per-cigarette nicotine intake. Chippers did not seem to be compensating; their cotinine values equaled those expected when regular smokers were not compensating for reduced cigarette availability.     

Coffee consumption,cigarette smoking and reporting of drowsiness in anxious patients treated with benzodiazepines or placebo

Data obtained from anxious outpatients treated with either chlordiazepoxide or diazepam (n= 533) or placebo (n= 285) were used to explore the impact of coffee/tea and cigarette consumption upon the frequency of reporting of drowsiness after 2 weeks of treatment. Strong evidence was provided that both cigarette smoking and coffee drinking afiect the frequency with which drowsiness is reported by patients receiving the two benzodiazepines. However, not only the magnitude but also the direction of the impact of coffee consumption upon drowsiness depends upon the level of cigarette smoking and vice versa. For patients smoking ≦ 1 pack of cigarettes/day, drowsiness is reported less frequently by heavy coffee users while for patients smoking > 1 pack of cigarettes/day, drowsiness is reported more frequently by heavy coffee users. Similarly, for patients drinking ≦ 2 cups of coflee/day, drowsiness occurs less frequently among heavier smokers while for patients drinking > 2 cups of coffee/day, drowsiness occurs more frequently among heavier smokers. These results are consistent with reports that particular substances contained in coffee and tea and in cigarette smoke stimulate the synthesis of hepatic enzymes which metabolize both the benzodiazepines here studied and the substances which have stimulated enzyme synthesis.     

Effects of acute abstinence, reinstatement, and mecamylamine on biochemical and behavioral measures of cigarette smoking in schizophrenia

BACKGROUND: Schizophrenics have higher rates of smoking than the general population, and more difficulty with smoking cessation. However, there has been little study of differences between schizophrenics and controls with respect to biochemical and behavioral indices of smoking. We compared smokers with schizophrenia (SS; n=27) and control smokers (CS; n=26) on smoking and psychiatric outcomes at baseline, during acute smoking abstinence and reinstatement, and with pre-treatment using the nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine (MEC) in a human laboratory setting. METHODS: Biochemical (e.g., plasma nicotine) and behavioral (e.g., craving, withdrawal) outcomes were assessed at baseline, after overnight abstinence, and after smoking reinstatement during three consecutive test weeks. Each week, participants received one of three doses of MEC (0.0, 5.0, or 10.0 mg/dayx3 days) in a randomized, counterbalanced manner. RESULTS: Compared to CS, SS displayed similar levels of craving and withdrawal, but higher plasma nicotine and cotinine levels, and cotinine/CPD ratio. During reinstatement, SS consumed significantly more cigarettes than CS, but MEC did not significantly alter indices of smoking, psychiatric symptoms, or cigarette consumption during reinstatement. CONCLUSIONS: 1) The reinforcing effects of smoking may be increased in SS versus CS after overnight abstinence; 2) the lack of effects of nAChR antagonism may suggest that non-nicotinic components of cigarettes may contribute to the behavioral effects of smoking in both SS and CS; and 3) consistent with previous studies, SS may exhibit higher baseline levels of nicotine and cotinine, and greater extraction of nicotine per cigarette than CS.     

The affinity for sweet substances and cigarette smoking in chronic alcoholism

The purpose of the present study was to examine the possible relationship between the consumption of alcohol and the smoking of cigarettes and the intake of sweet tasting substances in a group of in-patient chronic alcoholics residing in the Israeli governmental treatment center. Patients were interviewed regarding their alcohol intake, cigarette use and consumption of sweetened substances prior to entry to the center. No relationship between alcohol consumption and intake of sweetened substances or between alcohol intake and cigarette smoking was observed for the total sample. However, high alcohol consumption did have a significant correlation with cigarette smoking but not with the consumption of sweets. In contrast, low alcohol consumption had a significant relationship with consumption of sweets but not with cigarette smoking. In addition, a sub-group with an apparent family history of alcoholism had a significant correlation between alcohol intake and smoking but not sweets consumption. The data argue against a common central substrate mediating all three consummatory behaviors. The phenomena examined in the present study seem to be behavioral and motivational in nature rather than reflecting the effects of a direct biological mechanism.     

Cigarette smoking, alcohol use, and subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage remains a devastating disease. Identification of etiologic risk factors would allow the possibility of prevention. METHODS: We conducted a population-based case-control study in King County, Washington. Patients whose bleeds originated from a source other than an aneurysm were excluded. Two age- and gender-matched control subjects were identified for each case through random digit telephone dialing. A standardized in-person interview was conducted with the patient whenever possible, a proxy respondent for the case in all instances, the two control subjects, and their proxies. Analyses involved conditional logistic regression taking into account matching on age, gender and respondent type. RESULTS: Over 2 years, 169 cases were identified, and 149 participated in the case-control study. Compared with those who never smoked, the odds ratio for current heavy smokers (greater than 20 cigarettes/day) was 11.1 (95% confidence interval [CI], 5.0-24.9); for current light smokers (less than or equal to 20 cigarettes/day), 4.1 (95% CI, 2.3-7.3); and for former smokers, 1.8 (95% CI, 1.0-3.2). The risk associated with smoking was greatest in the 3 hours after a cigarette (odds ratio [OR] = 7.0; 95% CI, 3.7-13.1) and then fell, not reaching the risk in those who had never smoked until more than 10 years had passed since the last cigarette. Heavy alcohol use (greater than 2 drinks/day) was also associated with bleeds (OR = 2.2; 95% CI, 0.9-5.1, after adjusting for smoking status). These associations were not substantially altered after adjusting for several possible confounding factors, including a history of hypertension. CONCLUSIONS: Cigarette smoking and heavy alcohol use are associated with the occurrence of subarachnoid hemorrhage.     

Headache prevalence related to smoking and alcohol use. The Head-HUNT Study

The aim of this study was to examine a possible association between smoking, alcohol and headache in a large population-based cross-sectional study. A total of 51 383 subjects completed a headache questionnaire and constituted the 'Head-HUNT' Study. Questionnaire-based information on smoking was available in 95% and on alcohol in 89% of the individuals. Associations were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95% confidence intervals (CI). Prevalence rates for headache were higher amongst smokers compared with never smokers, most evident for those under 40 years smoking more than 10 cigarettes per day (OR 1.5, 95% CI 1.3–1.6). Passive smoking was also associated with higher headache prevalence. For alcohol use, there was a tendency of decreasing prevalence of migraine with increasing amounts of alcohol consumption compared with alcohol abstinence. Only with regard to symptoms indicating alcohol overuse, a positive association with frequent headache was found. The association between headache and smoking found in the present study raises questions about a causal relationship, e.g. that smoking causes headache or that it allays stress induced by headache. The observed negative association between migraine and alcohol consumption is probably explained by the headache precipitating properties of alcohol.     

Variations in smoking during hospitalization in psychiatric in-patient units and smoking prevalence in patients and health-care staff

BACKGROUND: Smoking and exposure to smoke are important concerns, especially in psychiatric in-patient services. AIMS: Our aims were to study variations in smoking after hospitalization for psychiatric in-patients, and to evaluate smoking-related concerns and prevalence for both patients and health-care staff. METHODS: A similar survey was mailed to staff members and proposed individually to all recently admitted patients; participation rates were 39% and 79% respectively. RESULTS: Three days after admission, 4/10 patients had increased and 3/10 had decreased their daily tobacco use. Univariate analysis of variance showed nicotine dependence scores to be associated with variations in consumption (p = .005): whereas 74% of heavy smokers decreased cigarette consumption, 80% of light and 57% of moderate smokers increased their consumption. The prevalence of current smoking was twice as high in patients (72%) as compared to health-care professionals (31%). Patients were also more nicotine dependent (Heaviness of Smoking Index (HSI) = 3.97/vs. 1.81), and half of the patients were heavy smokers (> 20 cigarettes/day), as opposed to only 6.3% of the staff. CONCLUSIONS: Smoking prevalence and daily tobacco consumption are very high in psychiatric patients. After hospitalization, light and moderate smokers increased whereas heavy smokers decreased smoking.     

Determinants of smoking behaviour in outpatients with schizophrenia

The present study is an assessment of the rate and severity of tobacco consumption in outpatients with schizophrenia, and the determinants of smoking behaviour. Sixty-four patients, assessed by the Item Group Checklist section of the SCAN interview and fitting DSM-IV criteria, were evaluated with CGI and the PANSS scales. In addition, they completed STAI (Spielberger), EPQ (Eysenck), and TPQ (Cloninger) questionnaires. Tobacco dependence was assessed by the Fagerstr?m test. One hundred and thirty-seven consecutive outpatients were psychiatric controls. Forty-one out of 64 patients with schizophrenia (64.1%) were current smokers, this rate being significantly higher than in other psychiatric patients and general population. The severity of cigarette consumption in smokers was greater (mean of 22.4 cigarettes/day) than in the general population, but it was not different from that of other psychiatric patients. For patients with schizophrenia, no one variable (except male sex) was different between smokers and non-smokers, but the number of cigarettes/day correlated with state anxiety, trait anxiety, and neuroticism. In the multivariate analysis, the only variable that remained significant was neuroticism. The relationship between clinical features and severity of smoking behaviour may be linked to non-specific variables such as neuroticism and anxiety, but not to psychotic symptoms.     

Effects of doxepin on withdrawal symptoms in smoking cessation

In a double-blind study, 15 cigarette smokers self-monitored 10 withdrawal symptoms. For the first 21 days (baseline), subjects received doxepin hydrochloride, up to 150 mg/day, or inert medication while continuing to smoke. On day 22, they were instructed to stop smoking; medication was continued. Withdrawal symptoms on the first 28 days of treatment (baseline and 7 days of attempted cessation) were analyzed. During cessation, subjects taking doxepin reported significantly less craving for cigarettes. Results from this study and others suggest that antidepressants may attenuate the severity of symptoms during withdrawal from addictive substances.     

Platelets of habitual smokers have reduced susceptibility to aggregating agent

Platelet aggregation to collagen, and productions of 6-keto-prostaglandin-F1-alpha and thromboxane B2 during aggregation were measured after an overnight fast, involving both food and cigarettes, in 19 clinically healthy habitual smokers (10 or more cigarettes/day) and 23 non-smokers receiving the same diet. The subjects (all males; ages = 21-30 years) were residents of a school hostel. Mean platelet aggregation was significantly lower in smokers than non-smokers (23.2 ohms vs 31.5 ohms, p less than 0.005). Non-smokers had significantly higher mean concentration of 6-keto-prostaglandin-F1-alpha than smokers (109.8 pmol/l vs 92.3 pmol/l, p less than 0.05). The level of thromboxane B2 did not differ significantly between the two groups. These observations suggest that the role of smoking as a risk factor for ischaemic heart disease is unlikely to be related to a direct enhancement of aggregation. On the contrary, the observations seem to suggest that habitual smoking may directly reduce platelet aggregability.     

Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects.

OBJECTIVE: The authors' goal was to study the relationship between smoking status and clinical characteristics in schizophrenic patients. METHOD: Seventy-eight schizophrenic outpatients were assessed by a single rater using the Brief Psychiatric Rating Scale (BPRS), the Abnormal Involuntary Movement Scale, and the Simpson-Angus Scale for extrapyramidal symptoms. Current smokers (N = 58) were compared with nonsmokers (N = 20) on clinical variables by independent t tests and chi-square tests. Differences in outcome variables were tested by multiple analysis of covariance (ANCOVA) with smoking status and gender as factors and age, neuroleptic dose, and caffeine consumption as covariates. RESULTS: Seventy-four percent of patients were current smokers and reported a mean of 19 cigarettes smoked per day. Compared to nonsmokers, current smokers were significantly more likely to be men, to be younger, and to have had an earlier age at onset and a greater number of previous hospitalizations. Current smokers and nonsmokers received mean neuroleptic doses of 1160 and 542 mg/day (chlorpromazine equivalents); the difference was significant. Current smokers also displayed significantly less parkinsonism and more akathisia and had higher total scores on the BPRS. Overall multiple ANCOVA demonstrated a significant main effect for smoking status but not gender or the interaction between gender and smoking status. Univariate ANCOVAs demonstrated a significant main effect of smoking status only for the Simpson-Angus Scale score. CONCLUSIONS: Cigarette smokers receive significantly higher neuroleptic doses, in part because of a smoking-induced increase in neuroleptic metabolism. Smoking is also associated with significant reduction in levels of parkinsonism. Smoking status is a significant factor that should be considered in assessment of neuroleptic dose requirements and neuroleptic side effects.     

When does cigarette fading increase the likelihood of future cessation?

Objective: To determine which smokers report cigarette fading, how much they fade, when fading leads to quitting, and, if not, whether it can be maintained. Methods: Subjects were 1,682 adult smokers interviewed by telephone in 1990 and 1992 as part of the California Tobacco Survey. Data from three timepoints in the same subjects were compared. At Time 1 (one year before the baseline survey), all respondents were daily smokers who recalled their average daily cigarette consumption retrospectively at baseline. At Time 2 (baseline survey), all respondents were current smokers who provided concurrent data on their average daily cigarette consumption. At Time 3 (follow-up), smoking status and current cigarette consumption among nonabstinent respondents were assessed. Results: Nearly 18% of smokers reduced consumption between Times 1 and 2. The mean reduction was 13 cigarettes per day. Only moderate to heavy smokers who reduced consumption to below 15 cigarettes per day were more likely to be in cessation at Time 3 (24.9% versus 5.8%, respectively). The cessation rate for moderate to heavy smokers that became light smokers by baseline was similar to that for smokers who were already light smokers 1 year before baseline. Continuing smokers who reduced consumption between Times 1 and 2 maintained a mean reduction of 11.4 cigarettes per day. Conclusions: Cigarette fading increases cessation among moderate to heavy smokers who become light smokers.     

Lifestyle factors and multiple sclerosis: A case-control study in Belgrade

The aim of this case-control study was to assess the risk of developing multiple sclerosis (MS) associated with certain lifestyle factors (cigarette smoking and coffee and alcohol consumption). The study groups consisted of 210 cases with clinically proven and/or laboratory-confirmed MS (Poser's criteria) and an identical number of sex- and age-matched hospital controls. In the MS patients, cigarette smoking was significantly more frequent than in the controls (OR = 1.6, p = 0.021). A dose-response relationship between the risk of MS and both duration (years) of smoking (p = 0.027) and number of cigarettes smoked daily (p = 0.021) was observed. Coffee consumption was significantly more frequent in the MS group (OR = 1.7, p = 0.047), with dose-response relationships. The analysis of alcohol drinking showed a significant association between consumption of hard liquor per day and risk of MS (OR = 6.7, p = 0.026). In multivariate logistic regression analysis, smoking was detected to be a significant independent risk factor for MS (OR = 2.4, p = 0.004).     

Clinical characteristics of heavy and non-heavy smokers with schizophrenia

Up to 50-90% of persons with schizophrenia smoke cigarettes. Limited data and theories suggest persons with schizophrenia may smoke for different reasons than persons without schizophrenia, making smoking cessation interventions particularly challenging in this population. Although health consequences of smoking are widely known, less information is available regarding characteristics of different amounts of smoking exposure in this population. This study was performed to investigate differences between heavy (≥ 1 pack per day) and non-heavy (<1 pack per day) smoking in patients with schizophrenia. Data from 745 patients, mean age 41.3+/-12.6 years, were drawn from a population of smokers admitted to State of Maryland inpatient mental health facilities (1994-2000). Records were reviewed to obtain demographic information, diagnosis, medication, smoking and substance use. 43% of patients were characterized as heavy smokers. Heavy and non-heavy groups did not differ in age, GAF, weight, or BMI. No differences were found in race, gender or antipsychotic treatments. However, patients smoking ≥ 1 packs per day were more likely to use other substances such as alcohol (χ(2)=6.67, df=1, p=0.01), cocaine (χ(2)=6.66, df=1, p=0.01), and other substances (χ(2)=9.95, df=1, p=0.003) compared to non-heavy smokers. No differences in cannabis or heroin use were found by smoking category. Controlling for age, race, sex and BMI, heavy smokers had higher total cholesterol (190.7(51.6)mg/dL) compared to non-heavy smokers (178.2 (43.0)mg/dL, p=0.03), but no differences were found in glucose or blood pressure. Heavy smoking may be a particular health risk in schizophrenia and significant efforts for smoking cessation or reduction are needed.     

Nicotine withdrawal induces subsensitivity of hypothalamic-pituitary-adrenal axis to stress in rats: implications for precipitation of depression during smoking cessation

Epidemiologic studies show that smokers with a past history of depression are more likely to relapse into depression after smoking cessation than those without a history of depression. These studies suggest the existence of a direct biological link between nicotine withdrawal and depression. To investigate the neuronal and hormonal mechanisms of the precipitation of depression during smoking cessation, we used an animal model of nicotine withdrawal and studied the function of the hypothalamic-pituitary-adrenal (HPA) axis, the abnormality of which is implicated in the pathogenesis of depression. Rats were implanted with a minipump delivering nicotine at 6.0 mg/kg/day for 12 days. The minipumps were removed in order to abruptly terminate nicotine infusion. The activity of the HPA axis was determined on day 2 of withdrawal using the stress-induced corticosterone response and the dexamethasone suppression test (DST). At the same time the expressions of glucocorticoid receptor (GR) mRNA in the hippocampus and paraventricular nucleus of hypothalamus (PVN) and corticotropin-releasing hormone (CRH) mRNA in PVN were determined by non-radioactive in situ hybridization. Nicotine withdrawal resulted in lower corticosterone levels during restraint stress, suggesting subsensitivity of the HPA axis to stress. The result of DST, however, did not show a significant difference between nicotine-withdrawal and control rats. These effects of nicotine withdrawal were not accompanied by any changes in the expressions of GR and CRH mRNA in either hippocampus or PVN. These results suggest that subsensitivity of the HPA axis to stress during nicotine withdrawal may be implicated in the precipitation of depression during smoking cessation, although GR and CRH in the HPA axis do not appear to play a significant role.     

Smoking reduction during inpatient alcohol detoxification: a controlled clinical pilot trial

Health care professionals tend to advise alcohol dependent patients to quit tobacco consumption only after longer periods of alcohol abstinence. This recommendation reflects concerns that smoking intervention programs may adversely interfere with the outcome of ongoing alcohol detoxification and rehabilitation treatment. However, the issue of appropriate time windows for initiating changes of smoking behaviour in alcoholic patients is still in need of empirical evaluation. Thus the aim of the present study is to investigate whether alcohol dependent smokers may be able to reduce cigarette consumption very early during alcohol detoxification and rehabilitation treatment. We performed a non-randomized controlled clinical pilot trial with 56 female and male alcohol dependent smokers in an inpatient setting providing a 3-weeks alcohol detoxification program. 28 individuals received a smoking reduction program consisting of a 6-sessions approach in a group format following behavioural principles. For the control group of 28 individuals the program was not available. Tobacco consumption was assessed daily by staff members. Alcohol dependent patients participating in the smoking reduction program reduced their daily cigarette consumption rates significantly, whereas the control group showed a tendency to increase tobacco consumption. According to the tentative findings of this pilot study early smoking interventions already during alcohol detoxification appear to be a feasible approach.     

Stroke Risk Due to Smoking Characterized by Sex Differences in Japan: The Jichi Medical School Cohort Study

ObjectivesSmoking is a risk factor for stroke. The relationship between smoking and the risk of different subtypes of stroke has not been fully elucidated. We investigated the relationship between smoking and the incidence of stroke in the Japanese population.Materials and methodsThis prospective, population-based cohort study included 11,324 participants (4447 men; 6877 women) from 12 districts in Japan, between April 1992 and July 1995. Participants were stratified according to smoking status (non-smoker [never smoked]/ex-smoker/current smoker). Male current smokers were further stratified according to the number of cigarettes smoked per day (1–14, 15–29, or ≥ 30). The non-smoking group was used as a reference. Cox proportional hazards analysis was used to determine the risk of stroke due to smoking.ResultsFour hundred and seventeen new stroke events (212 men; 205 women) were recorded during a mean follow-up of 10.7 years, including 95 intracerebral hemorrhages (48 men; 47 women), 267 cerebral infarctions (152 men; 115 women), and 54 subarachnoid hemorrhages (12 men; 42 women). In multivariable analysis, the hazard ratios (95% confidence intervals) for male current smokers (≥ 30 cigarettes/day) were 1.89 (1.08–3.31) and 3.41 (1.22–9.57) for all strokes and intracerebral hemorrhages, respectively; those for female current smokers were 2.78 (1.62–4.74), 3.14 (1.51–6.54), and 4.03 (1.64–9.93) for all strokes, cerebral infarctions, and subarachnoid hemorrhages, respectively.ConclusionsSmoking ≥ 30 cigarettes/day is a risk factor for stroke, especially intracerebral hemorrhage in men. Furthermore, smoking increases the risk of cerebral infarction and subarachnoid hemorrhage in women.     

The association of alcohol consumption and smoking with quality of life,disability and disease activity in an international sample of people with multiple sclerosis

BackgroundModifiable lifestyle factors represent important targets for preventive intervention in multiple sclerosis (MS). We aimed to explore the association of cigarette smoking and alcohol consumption with major MS morbidity outcomes.MethodsWe surveyed a large, international sample of people with MS recruited via Web 2.0 platforms about type of MS, relapse rates, disability, disease activity, health-related quality of life (HRQOL), alcohol use and smoking.ResultsOf 2469 respondents with confirmed MS, 11.7% were current and 40.3% former smokers. Most (61.5%) consumed less than 15 g alcohol weekly; few (0.8%) drank large amounts. Moderate alcohol consumption was associated with increased HRQOL; and after controlling for age and gender, was associated with lower odds of significant disability (41% decrease). After controlling for age, gender and alcohol use, smokers had an increased likelihood of major mobility requirements by 90% compared to never smokers. There was no association between alcohol or smoking and relapse rate or disease activity after controlling for age and gender, however among former smokers, a longer duration of smoking cessation was associated with reduced disease activity. Smokers had significantly lower HRQOL than never smokers and former smokers; heavier smoking was associated with greater decreases in HRQOL.ConclusionThis cross-sectional study supports previous research showing a link between morbidity indicators in MS and alcohol use and smoking. While people with MS should be advised of the potential risks of smoking, any risks and benefits of alcohol consumption require validation using a prospective cohort of people with MS.     

No increased levels of the nicotine metabolite cotinine in smokers with schizophrenia

The prevalence of smoking cigarettes has repeatedly been found to be greater in schizophrenia as compared with other psychiatric patients and the general population. Patients with schizophrenia have been found to engage in heavy smoking and consumption of higher doses of nicotine, probably by deeper inhalation of cigarettes. The aim of the current study was to assess nicotine exposure through smoking by measuring urinary cotinine, the major nicotine metabolite, in a group of smokers from Greece of smokers with schizophrenia and smokers from the general population. Participants were current smokers and belonged to one of two groups: 35 patients with schizophrenia and 48 healthy controls matched in age, education, and gender. The quantitative analysis of cotinine, the major metabolite of nicotine, in urine samples was performed by a modified high performance liquid chromatography (HPLC). Patients with schizophrenia who smoke presented a significantly larger time interval between last cigarette smoked and urine sample collection, as well as a significantly higher average number of cigarettes consumed daily than normal smokers. Urinary cotinine levels of patients with schizophrenia who smoke did not significantly differ from that of normal smokers when adjusted for average number of cigarettes per day and time interval between last cigarette smoked and urine collection. These results suggest that patients with schizophrenia did not present higher nicotine exposure through smoking compared with smokers from the community. The pharmacokinetic or pharmacodynamic properties of nicotine, as well as patient medications of the patients may explain our findings.