If patients with regular smoke
primarily to reverse the effects of antipsychotic drugs, those with chronic
schizophrenia should smoke at substantially higher prevalence rates than
first-episode patients.
We interviewed and observed 22 consecutively admitted, first-episode patients
with schizophrenia or schizophrenic disorder; all patients gave written informed
consent after the procedures were explained to them. The patients had less than
30 days’ previous lifetime exposure to antipsychotics; 17 (77%) smoked. Twelve
of these 22 patients had no previous exposure to antipsychotics; 11 of these 12
(92%) smoked.
The fact that first-episode patients smoke at the same prevalence rate as
chronic patients suggests that it is schizophrenia, not its treatment with
antipsychotic drugs, that determines this prevalence. Pharmacologic agents with
therapeutic effects on nicotine-sensitive pathophysiologic mechanisms in
schizophrenia may decrease a patient’s drive to smoke and reduce the associated
health risks.