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Cigarette smoking and psychotic symptoms in bipolar affective disorder

  • Aiden Corvin (a1), Ed O'Mahony (a1), Myra O'Regan (a2), Claire Comerford (a1), Robert O'Connell (a1), Nick Craddock (a3) and Michael Gill (a4)...
Abstract
Background

An association exists between smoking and schizophrenia, independent of other factors and related to psychotic symptomatology.

Aims

To determine whether smoking is associated with psychosis in bipolar affective disorder.

Method

Smoking data were collected from 92 unrelated patients with bipolar affective disorder. An ordinal logistic regression analysis tested the relationship between smoking severity and psychotic symptomatology, allowing for potential confounders.

Results

A significant relationship was detected between smoking/heavy smoking and history of psychosis (68.7%, n=44). Smoking was less prevalent in patients who were less symptomatic (56.5%, n=13) than in patients with a more severe psychosis (75.7%, n=31). Prevalence and severity of smoking predicted severity of psychotic symptoms (P=0.001), a relationship independent of other variables (P=0.0272).

Conclusion

A link between smoking and psychosis exists in bipolar affective disorder and may be independent of categorical diagnosis.

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Copyright
Corresponding author
Dr Aiden Corvin, Department of Psychiatry, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland. Fax: 353 1 6082441; e-mail: acorvin@tcd.ie
Footnotes
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Declaration of interest

A. C. is a WellcomeTrust Mental Health Research Fellow; N. C. is a Wellcome Trust Senior Research Fellow in Clinical Sciences.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Cigarette smoking and psychotic symptoms in bipolar affective disorder

  • Aiden Corvin (a1), Ed O'Mahony (a1), Myra O'Regan (a2), Claire Comerford (a1), Robert O'Connell (a1), Nick Craddock (a3) and Michael Gill (a4)...
Submit a response

eLetters

Suggestion for a Protocol to Determine if Smoking causes Psychosis

Richard C Campbell, Retired
02 May 2007

Dear Authors,

I have been diagnosed with Bipolar II illness for many years. Approximately 8 years ago, I stopped smoking by entering an intensive outpatient program for chemically dependent individuals. This was a 3 yearprogram specifically designed for nicotine cessation. The methods used were identical to the treatment of individuals addicted to other chemicalssuch as heroin, cocaine, or alcohol, but education and group counseling classes that concentrated on nicotine were an additional requirement for those addicted to nicotine.

I found breaking the addiction to be extremely difficult. Other individuals in the program who were diagnosed as bipolar had similar problems in quitting tobacco use. To my surprise and joy, I discovered that the depths and lengths of the depressive episodes were significantly less after I had quit smoking. In particular, the auditory hallucinations that had often accompanied many of the depressive episodes when I was smoking are now very rare.

My experience suggests that bipolar patients may not be smoking to alleviate the mental stresses. Rather, the fact that the psychotic episodes markedly decreased and the depressive episodes were not as frequent after I had become nicotine free indicates that tobacco may be a causative agent for both depression and psychosis.

An interesting test protocol would be to attempt to replicate the results of your study with a larger group, and then induce a sizable number of test subjects to stop smoking. Retesting the tobacco free subjects to measure whether or not their symptoms were less intensive could provide a clearer understanding of the correlation between tobacco and mental illness.

The obvious obstacle to this type of test is that unless a truly random subset chooses to stop smoking the results could be subject to errors. You would need to finance a very expensive smoking cessation program to have any hope of attaining a large number of bipolar patients to stop smoking. As an example, I had very strong cravings for approximately 10 months after I had quit smoking.

I had tried a number of those 6 to 8 week smoking cessation courses offered by the American Heart Association or the American Cancer Society. They were ineffective. The program that worked was one offered by the Kaiser Foundation Chemical Dependency Recovery Program in Vallejo, California. Perhaps that organization would be willing to work with a researcher on a long term study designed to determine if nicotine is actually a causative agent in mental illness. Sincerely,

Richard Campbell
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Conflict of interest: None Declared

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