Unit on Treatment Resistance in Psychiatry and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University school of Medicine 'Federico II', Naples, Italy.
Neuropsychiatr Dis Treat. 2013;9:1113-20. doi: 10.2147/NDT.S47571. Epub 2013 Aug 7.
Tobacco smoking is common in schizophrenia patients. It has been reported that schizophrenia patients who are tobacco smokers have better cognitive performances compared to those who are nonsmokers. However, little is known on the effects of tobacco smoking in treatment-resistant schizophrenia (TRS) patients. The aim of this study was to compare cognitive performances, psychotic symptoms, and social adjustment in tobacco smoker TRS patients compared to nonsmoker TRS patients. Smoker and nonsmoker TRS patients did not differ in demographics and in mean daily antipsychotic dose. Smoker TRS patients had significantly higher scores than nonsmoker patients on the positive and negative syndrome scale (PANSS) and on the negative symptoms subscale. These patients also performed worse than nonsmoker patients on problem-solving cognitive domain. Social adjustment was not significantly different between the two groups. In both groups of patients, worse cognitive performances were mostly predicted by higher severity of negative symptoms. Worse performances on the verbal memory and problem-solving cognitive domains were correlated with social-functioning impairment in tobacco smoker TRS patients but not in nonsmoker ones. The results showed that tobacco smoking was not significantly associated with better cognitive performances in TRS patients, while it was significantly associated with higher negative symptoms. Even if a direct causative mechanism cannot be inferred and despite the fact that these patients may use tobacco to self-medicate, it could be speculated that these associations may, at least partially, be related to a tobacco-smoking-induced worsening of abnormal dopamine dysfunction, which has been suggested to occur in TRS patients.
吸烟在精神分裂症患者中很常见。据报道，与不吸烟者相比，吸烟的精神分裂症患者认知表现更好。然而，对于治疗抵抗性精神分裂症（TRS）患者吸烟的影响知之甚少。本研究旨在比较吸烟者与不吸烟者 TRS 患者的认知表现、精神病症状和社会适应情况。吸烟者和不吸烟者 TRS 患者在人口统计学特征和平均每日抗精神病药物剂量方面无差异。与不吸烟者相比，吸烟者 TRS 患者在阳性和阴性症状量表（PANSS）和阴性症状子量表上的得分明显更高。这些患者在解决问题的认知领域的表现也比不吸烟者差。两组患者的社会适应情况无显著差异。在两组患者中，认知表现越差主要是由更严重的阴性症状预测的。在吸烟者 TRS 患者中，言语记忆和解决问题的认知领域的较差表现与社会功能障碍相关，但在不吸烟者中则没有。结果表明，吸烟与 TRS 患者认知表现的改善无显著相关性，而与更严重的阴性症状相关。即使不能推断出直接的因果机制，而且这些患者可能使用烟草进行自我治疗，但可以推测，这些关联至少部分与吸烟引起的异常多巴胺功能障碍恶化有关，TRS 患者中已提出这种恶化。
