Koster Merel, Mannsdörfer Lilli, van der Pluijm Marieke, de Haan Lieuwe, Ziermans Tim, van Wingen Guido, Vermeulen Jentien
Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
Schizophr Bull. 2025 May 8;51(3):608-624. doi: 10.1093/schbul/sbae088.
The high co-occurrence of tobacco smoking in patients with schizophrenia spectrum disorders (SSD) poses a serious health concern, linked to increased mortality and worse clinical outcomes. The mechanisms underlying this co-occurrence are not fully understood.
Addressing the need for a comprehensive overview of the impact of tobacco use on SSD neurobiology, we conducted a systematic review of neuroimaging studies (including structural, functional, and neurochemical magnetic resonance imaging studies) that investigate the association between chronic tobacco smoking and brain alterations in patients with SSD.
Eight structural and fourteen functional studies were included. Structural studies show widespread independent and additive reductions in gray matter in relation to smoking and SSD. The majority of functional studies suggest that smoking might be associated with improvements in connectivity deficits linked to SSD. However, the limited number of and high amount of cross-sectional studies, and high between-studies sample overlap prevent a conclusive determination of the nature and extent of the impact of smoking on brain functioning in patients with SSD. Overall, functional results imply a distinct neurobiological mechanism for tobacco addiction in patients with SSD, possibly attributed to differences at the nicotinic acetylcholine receptor level.
Our findings highlight the need for more longitudinal and exposure-dependent studies to differentiate between inherent neurobiological differences and the (long-term) effects of smoking in SSD, and to unravel the complex interaction between smoking and schizophrenia at various disease stages. This could inform more effective strategies addressing smoking susceptibility in SSD, potentially improving clinical outcomes.
精神分裂症谱系障碍（SSD）患者中吸烟现象高度共存，这引发了严重的健康问题，与死亡率增加和更差的临床结局相关。这种共存背后的机制尚未完全明了。
为满足对烟草使用对SSD神经生物学影响进行全面概述的需求，我们对神经影像学研究（包括结构、功能和神经化学磁共振成像研究）进行了系统综述，这些研究调查了慢性吸烟与SSD患者脑改变之间的关联。
纳入了八项结构研究和十四项功能研究。结构研究表明，与吸烟和SSD相关的灰质广泛独立且累加性减少。大多数功能研究表明，吸烟可能与改善与SSD相关的连接缺陷有关。然而，横断面研究数量有限、样本重叠度高，妨碍了对吸烟对SSD患者脑功能影响的性质和程度做出确定性判断。总体而言，功能研究结果暗示了SSD患者烟草成瘾存在独特的神经生物学机制，可能归因于烟碱型乙酰胆碱受体水平的差异。
我们的研究结果凸显了开展更多纵向研究和暴露依赖性研究的必要性，以区分SSD患者内在的神经生物学差异和吸烟的（长期）影响，并阐明吸烟与精神分裂症在疾病不同阶段的复杂相互作用。这可为解决SSD患者吸烟易感性的更有效策略提供依据，有可能改善临床结局。
