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The impact of smoking status on cognition and brain morphology in schizophrenia spectrum disorders

Published online by Cambridge University Press:  14 January 2021

Elysha Ringin
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
Vanessa Cropley
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
Andrew Zalesky
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, VIC, Australia
Jason Bruggemann
School of Psychiatry, University of New South Wales, New South Wales, Australia Neuroscience Research Australia, New South Wales, Australia
Suresh Sundram
Florey Institute of Neuroscience and Mental Health, Melbourne, Australia Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Australia Mental Health Program, Monash Health, Clayton, Victoria, Australia
Cynthia Shannon Weickert
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia School of Psychiatry, University of New South Wales, New South Wales, Australia Neuroscience Research Australia, New South Wales, Australia Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York 13210, USA
Thomas W. Weickert
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia School of Psychiatry, University of New South Wales, New South Wales, Australia Neuroscience Research Australia, New South Wales, Australia Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York 13210, USA
Chad A. Bousman
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
Christos Pantelis
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
Tamsyn E. Van Rheenen*
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
Author for correspondence: Tamsyn E. Van Rheenen, E-mail:



Cigarette smoking is associated with worse cognition and decreased cortical volume and thickness in healthy cohorts. Chronic cigarette smoking is prevalent in schizophrenia spectrum disorders (SSD), but the effects of smoking status on the brain and cognition in SSD are not clear. This study aimed to understand whether cognitive performance and brain morphology differed between smoking and non-smoking individuals with SSD compared to healthy controls.


Data were obtained from the Australian Schizophrenia Research Bank. Cognitive functioning was measured in 299 controls and 455 SSD patients. Cortical volume, thickness and surface area data were analysed from T1-weighted structural scans obtained in a subset of the sample (n = 82 controls, n = 201 SSD). Associations between smoking status (cigarette smoker/non-smoker), cognition and brain morphology were tested using analyses of covariance, including diagnosis as a moderator.


No smoking by diagnosis interactions were evident, and no significant differences were revealed between smokers and non-smokers across any of the variables measured, with the exception of a significantly thinner left posterior cingulate in smokers compared to non-smokers. Several main effects of smoking in the cognitive, volume and thickness analyses were initially significant but did not survive false discovery rate (FDR) correction.


Despite the general absence of significant FDR-corrected findings, trend-level effects suggest the possibility that subtle smoking-related effects exist but were not uncovered due to low statistical power. An investigation of this topic is encouraged to confirm and expand on our findings.

Original Article
Copyright © The Author(s), 2021. Published by Cambridge University Press

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