Grossman Michael, Bowie Christopher R, Lepage Martin, Malla Ashok K, Joober Ridha, Iyer Srividya N
Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada.
J Psychiatr Res. 2017 Feb;85:83-90. doi: 10.1016/j.jpsychires.2016.10.022. Epub 2016 Oct 27.
Elevated rates of cigarette smoking are observed prior to the onset of psychosis and remain stable early in the illness. Cannabis use frequently co-occurs with cigarette smoking and is independently associated with distinct clinical outcomes. However, past research has not controlled for cannabis use in cigarette smokers with first episode psychosis (FEP), limiting conclusions on the unique relationship of cigarette smoking to the demographic and clinical profiles of these patients. The present study therefore aimed to: (1) Determine the prevalence and patterns of cigarette smoking and its co-use with cannabis in FEP, and (2) Examine the demographic, clinical, cognitive, and functional characteristics associated with cigarette smoking status, after adjusting for frequency of cannabis use. Patients entering specialized treatment for FEP (N = 140) were divided into groups according to their current smoking status: 66 non-smokers (0 cigarettes/day), 47 light/moderate smokers (1-19 cigarettes/day; M = 9.81, SD = 3.93), and 27 heavy smokers (≥20 cigarettes/day; M = 26.39, SD = 6.31). The prevalence of cigarette smoking was 53% and smoking status was highly associated with frequency of cannabis use. After adjusting for cannabis use, significant between-group differences emerged. Heavy smokers were older at program entry and had a later age of onset of psychosis than light/moderate and non-smokers. Non-smokers had more education, better neurocognitive performance, and higher levels of functioning than light/moderate and heavy smokers. Prospective, longitudinal studies are needed to better understand the clinical significance of tobacco use and factors that contribute to the initiation and continuation of smoking behaviours in FEP.
在精神病发作之前就观察到吸烟率升高，并且在疾病早期保持稳定。大麻使用常常与吸烟同时出现，并且与不同的临床结果独立相关。然而，过去的研究没有对首次发作精神病（FEP）吸烟者中的大麻使用进行控制，限制了关于吸烟与这些患者的人口统计学和临床特征之间独特关系的结论。因此，本研究旨在：（1）确定FEP中吸烟及其与大麻同时使用的患病率和模式，以及（2）在调整大麻使用频率后，检查与吸烟状况相关的人口统计学、临床、认知和功能特征。进入FEP专门治疗的患者（N = 140）根据其当前吸烟状况分为几组：66名不吸烟者（每天0支香烟）、47名轻度/中度吸烟者（每天1 - 19支香烟；M = 9.81，SD = 3.93）和27名重度吸烟者（每天≥20支香烟；M = 26.39，SD = 6.31）。吸烟的患病率为53%，吸烟状况与大麻使用频率高度相关。在调整大麻使用后，出现了显著的组间差异。重度吸烟者在项目开始时年龄较大，精神病发作年龄比轻度/中度吸烟者和不吸烟者晚。不吸烟者比轻度/中度吸烟者和重度吸烟者受教育程度更高、神经认知表现更好、功能水平更高。需要进行前瞻性纵向研究，以更好地了解烟草使用的临床意义以及导致FEP中吸烟行为开始和持续的因素。
