Department of Psychiatry, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
Curr Opin Psychiatry. 2010 Mar;23(2):112-9. doi: 10.1097/YCO.0b013e3283366643.
Among the mentally ill, smoking prevalence is highest in patients with schizophrenia ( approximately 70-80%). This can impose a significant financial burden on patients, not to speak of increased smoking-related morbidity and mortality. Therefore, it is critical for clinicians to understand why patients with schizophrenia smoke in order to adapt treatment schemes. Understanding the reasons may also help to develop new drugs that target the nicotinic system in the brain as well as smoking cessation programs that are specifically designed for this particular patient population.
So far, several reasons have been identified which are believed to explain tobacco consumption in patients with schizophrenia. Originally, it was widely believed that patients with schizophrenia smoke to increase hepatic clearance and to restore the dopamine blockade of certain antipsychotic drugs to diminish their side effects. However, more recently it became obvious that cigarette smoking may also be reinforcing for patients because it improves psychiatric symptoms, most notably negative and cognitive symptoms. The underlying molecular mechanisms of these nicotine effects are currently under intensive investigation.
Heavy smoking in schizophrenia cannot simply be viewed as a 'bad habit'. Rather, self-medication of clinical symptoms and side effects of antipsychotic drugs appear to play a major role.
在精神疾病患者中，吸烟率在精神分裂症患者中最高（约 70-80%）。这可能给患者带来巨大的经济负担，更不用说增加与吸烟相关的发病率和死亡率了。因此，临床医生必须了解精神分裂症患者吸烟的原因，以便调整治疗方案。了解这些原因也有助于开发针对大脑尼古丁系统的新药，以及专门针对这一特定患者群体的戒烟计划。
迄今为止，已经确定了几个被认为可以解释精神分裂症患者吸烟的原因。最初，人们普遍认为精神分裂症患者吸烟是为了增加肝脏清除率，并恢复某些抗精神病药物对多巴胺的阻断作用，以减轻其副作用。然而，最近人们越来越意识到，吸烟也可能对患者有强化作用，因为它可以改善精神症状，尤其是阴性和认知症状。这些尼古丁作用的潜在分子机制目前正在深入研究中。
精神分裂症患者的大量吸烟不能简单地视为“不良习惯”。相反，临床症状和抗精神病药物副作用的自我治疗似乎起着主要作用。
