Published online by Cambridge University Press: 08 September 2022
Tobacco use is common in subjects with schizophrenia (SZ) and has sometimes been associated with better functioning in short-term studies. Only few studies embrace an extensive examination of tobacco influence on clinical, cognitive and therapeutic characteristics in stabilized SZ outpatients. The objective of the present study was to assess the association between cognitive performances and smoking status in SZ subjects.
In total, 1233 SZ participants (73.9% men, mean age 31.5) were included and tested with a comprehensive battery. Tobacco status was self-declared (never-, ex-, or current smokers). Multivariable analyses including principal component analyses (PCA) were used.
In total, 53.7% were smokers with 33.7% of them nicotine-dependent. Multiple factor analysis revealed that current tobacco smoking was associated with impaired general intellectual ability and abstract reasoning (aOR 0.60, 95% IC 0.41–0.88, p = 0.01) and with a lifetime alcohol use disorder (p = 0.026) and a lifetime cannabis use disorder (p < 0.001). Ex- and never-smokers differed for age, mean outcome, cannabis history and medication [ex-smokers being older (p = 0.047), likely to have higher income (p = 0.026), a lifetime cannabis use disorder (p < 0.001) and higher CPZeq doses (p = 0.005)]. Premorbid IQ in the three groups significantly differed with, from higher to lower: ex-smokers, never-smoker, current smokers (all p < 0.001).
This study is the largest to date providing strong evidence that chronic smoking is associated with cognitive impairment in SZ, arguing against the self-medication hypothesis as a contributor to the high prevalence of smoking in SZ. Ex-smokers may also represent a specific subgroup. Longitudinal studies are warranted to determine the developmental impact of tobacco on neurocognition.
List of FondaMental Advanced Center of Expertise (FACE-SZ) collaborators:
FACE-SZ Clinical Coordinating Center (Fondation FondaMental); F. Berna, E. Haffen, M. Leboyer, PM Llorca and F. Schürhoff;
FACE-SZ Data Coordinating Center (Fondation FondaMental); V. Barteau, S. Bensalem, O. Godin, H. Laouamri and K. Souryis;
FACE-SZ Clinical Sites and Principal Collaborators in France;
AP-HP, INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94000 Créteil, France; E. Bourguignon, M. Leboyer, B. Pignon, J. Petrucci, F. Schürhoff, A. Szöke, G. Wahiche; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, France: B. Aouizerate; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux; University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France: A. Deloge, D. Misdrahi and E. Vilà; CHU Clermont-Ferrand, Department of Psychiatry (service de psychatrie B), University of Clermont Auvergne, Clermont-Ferrand, France: O. Blanc, I. Chéreau, H. Denizot, RM. Honciuc, D. Lacelle, PM. Llorca and S. Pires; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm UMR1266, Institute of Psychiatry and Neurosciences of Paris, University Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France: C. Dubertret, J. Mallet and C. Portalier; Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France: J. Dubreucq, C. Fluttaz, F. Gabayet and C. Roman; University Claude Bernard Lyon 1, Le Vinatier Hospital Pole Est BP 300 39–95 bd Pinel – 69678 Bron Cedex, France: G. Chesnoy-Servanin, T. D'Amato, JM. Dorey, R. Rey and A. Vehier; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France: C. Lançon, C. Faget, E. Metairie, P. Peri and F. Vaillant; AP-HM, la Conception Hospital, Aix-Marseille Univ, School of medicine – La Timone Medical Campus, EA 3279: CEReSS – Health Service Research: L. Boyer and G. Fond; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France: F. Berna, P. Vidailhet and A. Zinetti-Bertschy; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France: D. Capdevielle and H. Yazbek; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94807, Villejuif, France: S. Esselin, M. Jarroir, C. Passerieux and M. Urbach