Caffeine intake in outpatients with schizophrenia

Several studies suggest that caffeine intake is high in patients with schizophrenia and a few of them suggest that caffeine may contribute to schizophrenia symptomatology. None of these studies control for the effect of tobacco smoking, which is associated with induction of caffeine metabolism. Therefore, the high amount of caffeine intake among patients with schizophrenia may be due to their high prevalence of smoking. This is the first large study to explore whether caffeine intake in patients with schizophrenia is related to tobacco (or alcohol) use or to the severity of schizophrenia symptomatology. The sample included 250 consecutive consenting outpatients with a diagnosis of DSM-IV schizophrenia from Granada, Spain. Fifty-nine percent (147/250) of patients consumed caffeine. Current caffeine intake was associated with current smoking and alcohol use. As none of the females used alcohol, the association with alcohol was only present in males with schizophrenia. Among caffeine consumers, smoking was associated with the amount of caffeine intake. Cross-sectional schizophrenia symptomatology was not associated with caffeine intake.     

Personality traits associated with caffeine intake and smoking

OBJECTIVES: Some studies find a relationship between certain personality traits, as impulsivity or sensation seeking, and caffeine consumption, but these studies do not consider the potential confounding effect of smoking on caffeine intake, a co-occurrence that has been well demonstrated in epidemiological and clinical studies. The main objective of this cross-sectional study was to analyze the association of personality with caffeine intake controlling for the effects of smoking; a secondary objective was to explore the effect of caffeine intake on the previously known relationship between personality and smoking. METHODS: A sample of 498 adults answered a self-questionnaire including socio-demographic variables, and items regarding consumption of tobacco and caffeine. Personality was measured by the Temperament and Character Inventory (TCI-125). We analyzed the association of personality traits with both caffeine intake and smoking, controlling the possible confounding effects of sex, age and each substance with the other one. RESULTS: Logistic regression analyses showed that the temperamental dimension of novelty seeking was associated with heavy caffeine consumption (>200 mg/day) (adjusted OR=2.0; 95% CI: 1.1-3.9), controlling for the effect of smoking. Moreover, novelty seeking was associated with both smoking (adjusted OR=1.8; 95% CI: 1.1-2.9) and heavy smoking (>20 cigarettes/day) (adjusted OR=1.8; 95% CI: 1.0-3.7), after controlling for the effect of caffeine intake. CONCLUSION: Our study offers an epidemiological evidence of the relationship of novelty seeking, considered to be associated with low basal dopaminergic activity, with both nicotine consumption and heavy caffeine intake, two substances that enhance dopaminergic neurotransmission.     

Effects of smoking cues on caffeine urges in heavy smokers and caffeine consumers with and without schizophrenia

Cigarette smoking and caffeine use are established and problematic drug-use behaviors in people with schizophrenia. Associative links between drugs of abuse may occur but the relationship between caffeine use and cigarette smoking has received little attention in schizophrenia. In this cross-cue reactivity laboratory study, we examined the effects of neutral and smoking cues on craving for caffeinated beverages in participants with schizophrenia or schizoaffective disorder (SS; n = 15) and non-psychiatric controls (CS; n = 18) all of whom were heavy smokers and daily caffeine users. Participants were tested under non-abstinent and 5-hour abstinent conditions. SS tended to report greater daily levels of caffeine use than CS. Although this difference was not significant, that may be due to the small sample sizes as the size of this effect was large. Daily caffeine intake was significantly correlated with daily smoking rate in SS but not CS. A significant interaction between group and cue type after controlling for caffeine intake indicated that exposure to smoking cues increased urge for caffeinated beverages in SS but not CS. These results indicate support for associative connections between cigarette smoking cues and craving for caffeine in smokers with schizophrenia.     

Caffeine and risk of Parkinson's disease in a large cohort of men and women

Caffeine consumption has been associated with a reduced risk of Parkinson's disease (PD). The association is strong and consistent in men, but uncertain in women, possibly because of an interaction with hormone replacement therapy (HRT). We sought to confirm these findings using data on PD incidence in the Cancer Prevention Study II Nutrition Cohort (CPS II-Nutrition), a large, prospective study of men and women. We conducted a prospective study of caffeine intake and risk of PD within the CPS II Nutrition Cohort. Intakes of coffee and other sources of caffeine were assessed at baseline. Incident cases of PD (n = 317; 197 men and 120 women) were confirmed by treating physicians and medical record review. Relative risks (RRs) were estimated using proportional hazards models, adjusting for age, smoking, and alcohol consumption. After adjustment for age, smoking, and alcohol intake, high caffeine consumption was associated with a reduced risk of PD. The RR comparing the 5th to the 1st quintile of caffeine intake was 0.43 (95% confidence interval [CI]: 0.26, 0.71; P trend = <0.002) in men, and 0.61 (95% CI: 0.34, 1.09; P trend = 0.05) in women. Among women, this association was stronger among never users of HRT (RR = 0.32) than among ever users (RR = 0.81; P interaction = 0.15). Consumption of decaffeinated coffee was not associated with PD risk. Findings from this large, prospective study of men and women are consistent with a protective effect of caffeine intake on PD incidence, with an attenuating influence of HRT in women. ? 2012 Movement Disorder Society.     

Sleep duration and caffeine consumption in a French middle-aged working population

OBJECTIVE/BACKGROUND: To explore the association between sleep duration and daily caffeine intake in a working population. Caffeine acutely disrupts sleep in the laboratory, but the inter-relations between sleep and caffeine intake in daily life are ill-known. METHODS: Questionnaire and diary based survey of 1498 persons from the GAZEL cohort of employees of the National Electricity and Gas Company (EDF-GDF) working in various locations in the Paris and South-West France areas. We analyzed total sleep time, our primary measure, and time in bed, both by sleep logs. We assessed daily intake of caffeine, consumption of alcohol and tobacco, use of hypnotics, and daytime somnolence, all by questionnaire. RESULTS: Multiple linear regression analysis did not find a significant relationship between total sleep time and daily caffeine intake less than 8 cups of coffee per day, after controlling for age, gender, alcohol intake, smoking status, and use of hypnotics. By contrast, time in bed was reduced as caffeine intake increased (beta=-0.125; P<0.001). Higher caffeine intake was not related to a higher daytime somnolence. CONCLUSION: Despite the well-known acute effects of caffeine on sleep, habitual use of up to 7 cups of coffee (or 600 mg of caffeine equivalent) per day was not associated with decreased duration of sleep.     

Nicotine dependence vs. daily smoking as a meaningful variable: implications for clinical and epidemiological psychiatric studies

Objective

As an indication of potential psychopathology, our aim was to compare, in a non-psychiatric sample, the variables associated to daily smoking with those associated to nicotine dependence. We also compared dependent and non-dependent smokers on these variables and on the age of onset of daily smoking (AODS).

Method

A sample of 290 persons aged 18 or older, recruited in a family medical clinic, were interviewed to inquire about their tobacco, caffeine, alcohol, and illegal drugs consumption, and on their practice of physical exercise. Psychiatric morbidity was assessed with the General Health Questionnaire (GHQ-28) and defined by a score > 6. They also were questioned on their use of psychotropic medication and previous suicide attempt. The smokers answered the Fagerström Test for Nicotine Dependence (FTND) and the question on their age of onset of daily smoking (AODS).

Results

In comparison with non-dependent smoking, nicotine dependence was associated with current use of psychotropic medication, psychiatric morbidity, previous suicide attempt, and earlier AODS. Logistic regression analyses showed that nicotine dependence was associated with antecedents of suicide attempt and primary or lower education as well as with high caffeine use and the regular use of illegal drugs; in contrast, daily smoking showed a significant association with high caffeine use, the regular use of illegal drugs and lack of physical exercise.

Conclusions

In terms of psychopathology or behavioral disturbance—particularly attempting suicide—nicotine dependence adds significant information as opposed to the simple daily smoking, with important implications in clinical and epidemiological psychiatric studies.     

Tobacco smoking among people living with a psychotic illness: The second Australian survey of psychosis

Objective: The aims of this study were to (a) describe patterns of tobacco smoking among Australians living with a psychotic illness and (b) explore the association between smoking and measures of psychopathology, psychiatric history, psychosocial functioning, physical health, substance use and demographic characteristics. Methods: Data were from 1812 participants in the 2010 Australian Survey of High Impact Psychosis. Participants were aged 18-64 years and resided in seven mental health catchment sites across five states of Australia. Bivariate statistics were used to compare smokers with non-smokers on the measures of interest, and to compare ICD-10 diagnostic categories on measures of smoking prevalence, nicotine addiction and quitting history. Multivariate logistic regression was used to test whether (a) demographics and psychiatric history were associated with having ever smoked and (b) whether symptoms and psychosocial functioning were independently associated with current smoking, after controlling for demographics, psychiatric history and substance use. Results: The prevalence of current tobacco smoking was 66.6% (72% of men and 59% of women); lifetime prevalence was 81%. In univariate analyses, individuals with a diagnosis of schizophrenia or schizoaffective disorder were most likely to be smoking tobacco (70%) and were more nicotine dependent. Smokers reported worse perceived physical health, lower body mass index and waist circumference, and more lifetime medical conditions. A younger age of illness onset, male gender and low education were associated with having ever smoked. Associations with current smoking included low education, male gender, no formal employment, worse negative symptoms, higher daily caffeine consumption, and alcohol dependence and substance abuse/dependence. Conclusions: The prevalence of tobacco smoking is high amongst people with a psychotic disorder, and is associated with adverse mental health symptoms as well as high rates of other substance use, poorer subjective physical health, and a higher risk of the many known health consequences of smoking.     

Schizophrenia and tobacco smoking: a replication study in another US psychiatric hospital

A prior study in a US state hospital suggested that schizophrenia is more closely associated with tobacco smoking when compared with other severe mental illnesses. This second study, in a neighborhood hospital, tries to (1) replicate that schizophrenia is associated with smoking and heavy smoking, and (2) rule out that this relationship is explained by substance use. The methodology was very similar to the first study. The sample included 588 inpatients. Logistic regression was used to develop models of variables associated with smoking or heavy smoking. The frequency of current smoking for the total, schizophrenic and non-schizophrenic samples were respectively 71, 75, and 55%. The sequence of frequencies from the highest to lowest was the same as in the first study: male schizophrenic patients, male non-schizophrenic patients, female schizophrenic patients and female non-schizophrenic patients. This second study consistently replicated the relationship between schizophrenia and smoking (after correcting for other variables) including history of alcohol and drug abuse or dependence. Only one of two definitions of heavy smoking showed a significant association with schizophrenia. In summary, these two studies suggest that schizophrenia is strongly associated with smoking. Neither substance use, antipsychotics, nor institutionalism can explain this relationship.     

Coffee and cigarette use: association with suicidal acts in 352 Sardinian bipolar disorder patients

Objective:  Abuse of illicit drugs and alcohol is prevalent in bipolar disorder (BPD) patients, and is an adverse prognostic factor. Much less is known about correlates of nicotine and caffeine consumption, but tobacco smoking is tentatively associated with suicidal behavior.
Methods:  Retrospective analysis of demographic and clinical factors among 352 longitudinally assessed DSM-IV types I and II BPD patients contrasted patients with versus without consumption of nicotine or caffeine, based on univariate comparisons and multiple regression modeling.
Results:  Current smoking (46%) and coffee drinking (74% of cases) were common, and significantly and independently associated with suicidal acts [coffee: odds ratio (OR) = 2.42, 95% confidence interval (CI): 1.15–5.09; smoking: OR = 1.79, CI: 1.02–3.15; both p < 0.001]. Risk increased with more smoking (cigarettes/day; r _s  =  0.383; p < 0.0001) and greater coffee consumption (cups/day; r _s  =  0.312; p = 0.008). Neither intake was related to yearly rates of all episodes, depressions, or manias.
Conclusions:  This is the first report to associate suicidal acts with coffee consumption in BPD patients, and it confirmed an association with smoking. Pending further evidence, the findings underscore the importance of monitoring use of even legal and mildly psychotropic substances by BPD patients.     

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.     

A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors

A meta-analysis of worldwide studies, found by a 10-year literature follow-up and/or by searching PubMed, was performed. Forty-two studies across 20 nations consistently demonstrated an association between schizophrenia and current smoking (weighted average odds ratio, OR=5.9; 95% confidence interval, CI 4.9--5.7). In 32 male studies across 18 nations, the weighted average OR was 7.2 (CI, 6.1--8.3). In 25 female studies across 15 nations, the weighted average OR was 3.3 (CI, 3.0--3.6). The association between schizophrenia and current smoking remained after using severe mentally ill controls (18 studies across 9 countries, weighted average OR was 1.9, CI 1.7--2.1) and controlling for other variables (3 studies, adjusted ORs ranged 2-3). Heavy smoking (6 studies across 4 countries, ORs ranged 1.9--6.4) and high nicotine dependence were more frequent in smokers with schizophrenia versus the general population. There was no consistent evidence that heavy smoking or high nicotine dependence was more frequent in smokers with schizophrenia versus severe mentally ill controls. Cessation rates were lower in schizophrenia smokers versus the general population. Schizophrenia patients had a higher prevalence of ever smoking than the general population (9 studies across 6 countries, weighted average OR=3.1, CI 2.4--3.8) and than severe mentally ill patients (5 studies across 5 countries, OR=2.0, CI 1.6--2.4). Moreover, in two studies adjusting for confounders schizophrenia patients had an increased risk of starting daily smoking than controls. Thus, people who are going to develop schizophrenia have risk factors that make them more vulnerable to start smoking.     

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.     

Risk factors for Parkinson's disease and impaired olfaction in relatives of patients with Parkinson's disease.

Our objective was to assess the association between risk factors for Parkinson's disease (PD) and abnormal olfaction in first-degree relatives of patients with PD. Factors including lower cigarette smoking and lower caffeine consumption have been associated with increased risk of PD. Idiopathic hyposmia has also been associated with an increased risk of PD. The relationship between risk factors for PD and impaired olfactory function has not been evaluated in relatives of PD patients. We conducted a mail survey of odor identification ability in 173 first-degree relatives of PD patients using the 40-item University of Pennsylvania Smell Identification Test (UPSIT). Respondents also completed a questionnaire inquiring about risk factors for PD including caffeine consumption, tobacco use, exercise, and exposures to heavy metals, well-water, and pesticides. There was a direct relationship between olfactory performance and lifetime caffeine intake. After adjustment for age, gender, and smoking status, subjects who reported drinking 2 to 3 cups of caffeinated beverages per day (2.6 points higher 95% CI: 0.5, 4.5) and 4 or more cups per day (3.7 points higher, 95% CI: 0.6, 6.7) had significantly better UPSIT scores than those who consumed less than 1 cup per day. There was no significant relationship between olfactory performance and other risk factors. In conclusion, abnormal olfaction is associated with significantly lower lifetime caffeine consumption in first-degree relatives of PD patients. Further research is warranted to determine whether a history of lower caffeine consumption confers additional risk for the development of PD in hyposmic relatives of PD patients.     

Relationship between impulsive sensation seeking traits, smoking, alcohol and caffeine intake, and Parkinson's disease

BACKGROUND: An inverse relation exists between smoking and coffee intake and Parkinson's disease (PD). The present study explored whether this is explained by low sensation seeking, a personality trait believed to characterise PD. METHODS: A total of 106 non-demented patients with PD and 106 age and sex matched healthy controls completed a short version of Zuckerman's Sensation Seeking Scale (SSS), the Geriatric Depression Scale, and the Trait Anxiety Inventory. Data were collected on past and current cigarette smoking, and participants also completed food frequency questionnaires to estimate current caffeine and alcohol intake. RESULTS: Patients with PD had lower sensation seeking and higher depression and anxiety scores. They were also less likely to have ever smoked, and had lower caffeine and alcohol intakes. Analysis of the data using conditional logistic regression suggested that the inverse association of PD risk with sensation seeking was independent of smoking, and caffeine and alcohol intake. Moreover, low sensation seeking explained some of the apparent effect of caffeine and alcohol intake on PD. However, the effect of smoking was weakened only slightly when SSS was included in the regression model. CONCLUSION: This study raises the possibility that there is a neurobiological link between low sensation seeking traits--which might underlie the parkinsonian personality--and the hypothetical protective effect of cigarette smoking and caffeine consumption on PD.     

Smoking and coffee intake following alcohol withdrawal in alcoholic inpatients

The aim of this study was to assess alcoholic inpatients' smoking and coffee intake variation following withdrawal. Only moderate smokers (less than 30 cigarettes/day) showed a significant increase of cigarette consumption after alcohol withdrawal. However, their urinary cotinine level did not vary, suggesting a behavioral, and not biological, compensation through smoking following alcohol withdrawal. Heavy smokers (30 cigarettes/day or more) showed no significant clinical or biological variation of smoking behavior. Coffee consumption increased after alcohol withdrawal in all patients, irrespective of smoking habits.     

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.     

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.     

Tobacco use among the elderly: The first Brazilian National Survey (BNAS)

Objective: This study describes the prevalence and pattern of tobacco use among the elderly in Brazil and establishes its association with socio-demographic characteristics, other substance use and depression.

Method: The analyses were performed in 400 individuals aged 60 years and over who participated in the first Brazilian national alcohol survey (BNAS) in 2000.

Results: Nearly 60% of the sample had ever smoked, of them one in three were still smoking at the time of the interview. Most (94.3%) of the tobacco users were smoking everyday and 34.3% consuming more than 20 cigarettes a day. Only 1% of the former smokers had received support to quit. Over half of the current users (65%) would use free treatment to quit if it existed in Brazil, and just under half of them (47.4%) would consider quitting if cigarettes’ price were higher. Currently, tobacco users were more likely to be men and alcohol abusers. Prevalence of depression was high regardless participant smoking status (33.0% among non-smokers, 34.7% among current smokers and 39.3% among former smokers). There was no significant association between smoking and depression.

Conclusion: This study found a disturbingly high proportion of tobacco users among the elderly in Brazil. According to the Global Burden of Disease project, tobacco has the highest mortality risk of all substance use categories, especially for the elderly. This study shows there is an urgent need to develop smoking cessation interventions targeted specifically to the elderly.     

Cigarette smoking in outpatients with chronic schizophrenia in Taiwan: relationships to socio-demographic and clinical characteristics

In individuals with schizophrenia, the prevalence of cigarette smoking is significantly higher than that of the general population; this appears to be associated with specific psychosocial and clinical characteristics. Indeed, some evidence suggests an increased risk of suicide among smokers with schizophrenia. The purpose of this study was to examine the characteristics of smokers with schizophrenia in Taiwan. In this cross-sectional study, 95 outpatients with DSM-IV diagnosis of schizophrenia were recruited and independently interviewed for nicotine dependency with tobacco use. The effects of cigarette smoking on the various measures, especially suicidality, were investigated. The results revealed that smokers with schizophrenia had higher rates of hospitalization, lifetime suicide attempts, antipsychotic treatment side effects, psychopathology, impulsivity, depression, anxiety, and suicidal risk than non-smokers with schizophrenia. When separate analyses were conducted in male and female patients, depressive symptoms were significant predictors of suicidality among males, whereas heavy smoking, anxious symptoms, and hopelessness were significant predictors among females. From this study, we may gain insights into the role of cigarette smoking in patients of schizophrenia in Taiwan. Furthermore, cigarette smoking may influence aspects of suicidality in schizophrenia.