Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes

Frederike Schirmbeck; Els van der Ven; Lindy-Lou Boyette; Philip McGuire; Lucia R Valmaggia; Matthew J Kempton; Mark van der Gaag; Anita Riecher-Rössler; Neus Barrantes-Vidal; Barnaby Nelson; Marie-Odile Krebs; Stephan Ruhrmann; Gabriele Sachs; Bart P F Rutten; Merete Nordentoft; Lieuwe de Haan; Jentien M Vermeulen; EU-GEI High Risk Study Group

doi:10.3389/fpsyt.2022.869023

Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes

Frederike Schirmbeck^*, Els van der Ven, Lindy-Lou Boyette, Philip McGuire, Lucia R Valmaggia, Matthew J Kempton, Mark van der Gaag, Anita Riecher-Rössler, Neus Barrantes-Vidal, Barnaby Nelson, Marie-Odile Krebs, Stephan Ruhrmann, Gabriele Sachs, Bart P F Rutten, Merete Nordentoft, Lieuwe de Haan, Jentien M Vermeulen, EU-GEI High Risk Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: People at ultra-high risk (UHR) for psychosis have a high prevalence of tobacco smoking, and rates are even higher among the subgroup that later develop a psychotic disorder. However, the longitudinal relationship between the course of tobacco smoking and clinical outcomes in UHR subjects is unknown.

Methods: We investigated associations between tobacco smoking and clinical outcomes in a prospective study of UHR individuals (n = 324). Latent class mixed model analyses were used to identify trajectories of smoking severity. Mixed effects models were applied to investigate associations between smoking trajectory class and the course of attenuated psychotic symptoms (APS) and affective symptoms, as assessed using the CAARMS.

Results: We identified four different classes of smoking trajectory: (i) Persistently High (n = 110), (ii) Decreasing (n = 29), (iii) Persistently Low (n = 165) and (iv) Increasing (n = 20). At two-year follow-up, there had been a greater increase in APS in the Persistently High class than for both the Persistently Low (ES = 9.77, SE = 4.87, p = 0.046) and Decreasing (ES = 18.18, SE = 7.61, p = 0.018) classes. There were no differences between smoking classes in the incidence of psychosis. There was a greater reduction in the severity of emotional disturbance and general symptoms in the Decreasing class than in the High (ES = -10.40, SE = 3.41, p = 0.003; ES = -22.36, SE = 10.07, p = 0.027), Increasing (ES = -11.35, SE = 4.55, p = 0.014; ES = -25.58, SE = 13.17, p = 0.050) and Low (ES = -11.38, SE = 3.29, p = 0.001; ES = -27.55, SE = 9.78, p = 0.005) classes, respectively.

Conclusions: These findings suggests that in UHR subjects persistent tobacco smoking is associated with an unfavorable course of psychotic symptoms, whereas decrease in the number of cigarettes smoked is associated with improvement in affective symptoms. Future research into smoking cessation interventions in the early stages of psychoses is required to shine light on the potential of modifying smoking behavior and its relation to clinical outcomes.

Original language	English
Article number	869023
Number of pages	13
Journal	Frontiers in Psychiatry
Volume	13
DOIs	https://doi.org/10.3389/fpsyt.2022.869023
Publication status	Published - 22 Jul 2022

Keywords

CANNABIS
EXPERIENCES
GLOBAL ASSESSMENT
INDIVIDUALS
MODELS
RELIABILITY
SCHIZOPHRENIA
VALIDITY
affective symptoms
psychosis
smoking
tobacco
trajectories
ultra-high risk

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Schirmbeck, F., van der Ven, E., Boyette, L.-L., McGuire, P., Valmaggia, L. R., Kempton, M. J., van der Gaag, M., Riecher-Rössler, A., Barrantes-Vidal, N., Nelson, B., Krebs, M.-O., Ruhrmann, S., Sachs, G., Rutten, B. P. F., Nordentoft, M., de Haan, L., Vermeulen, J. M., & EU-GEI High Risk Study Group (2022). Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes. Frontiers in Psychiatry, 13, Article 869023. https://doi.org/10.3389/fpsyt.2022.869023

@article{dc3f9f4312ba43e69bb1b1b5bc2a44ac,

title = "Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes",

abstract = "Objective: People at ultra-high risk (UHR) for psychosis have a high prevalence of tobacco smoking, and rates are even higher among the subgroup that later develop a psychotic disorder. However, the longitudinal relationship between the course of tobacco smoking and clinical outcomes in UHR subjects is unknown.Methods: We investigated associations between tobacco smoking and clinical outcomes in a prospective study of UHR individuals (n = 324). Latent class mixed model analyses were used to identify trajectories of smoking severity. Mixed effects models were applied to investigate associations between smoking trajectory class and the course of attenuated psychotic symptoms (APS) and affective symptoms, as assessed using the CAARMS.Results: We identified four different classes of smoking trajectory: (i) Persistently High (n = 110), (ii) Decreasing (n = 29), (iii) Persistently Low (n = 165) and (iv) Increasing (n = 20). At two-year follow-up, there had been a greater increase in APS in the Persistently High class than for both the Persistently Low (ES = 9.77, SE = 4.87, p = 0.046) and Decreasing (ES = 18.18, SE = 7.61, p = 0.018) classes. There were no differences between smoking classes in the incidence of psychosis. There was a greater reduction in the severity of emotional disturbance and general symptoms in the Decreasing class than in the High (ES = -10.40, SE = 3.41, p = 0.003; ES = -22.36, SE = 10.07, p = 0.027), Increasing (ES = -11.35, SE = 4.55, p = 0.014; ES = -25.58, SE = 13.17, p = 0.050) and Low (ES = -11.38, SE = 3.29, p = 0.001; ES = -27.55, SE = 9.78, p = 0.005) classes, respectively.Conclusions: These findings suggests that in UHR subjects persistent tobacco smoking is associated with an unfavorable course of psychotic symptoms, whereas decrease in the number of cigarettes smoked is associated with improvement in affective symptoms. Future research into smoking cessation interventions in the early stages of psychoses is required to shine light on the potential of modifying smoking behavior and its relation to clinical outcomes.",

keywords = "CANNABIS, EXPERIENCES, GLOBAL ASSESSMENT, INDIVIDUALS, MODELS, RELIABILITY, SCHIZOPHRENIA, VALIDITY, affective symptoms, psychosis, smoking, tobacco, trajectories, ultra-high risk",

author = "Frederike Schirmbeck and {van der Ven}, Els and Lindy-Lou Boyette and Philip McGuire and Valmaggia, {Lucia R} and Kempton, {Matthew J} and {van der Gaag}, Mark and Anita Riecher-R{\"o}ssler and Neus Barrantes-Vidal and Barnaby Nelson and Marie-Odile Krebs and Stephan Ruhrmann and Gabriele Sachs and Rutten, {Bart P F} and Merete Nordentoft and {de Haan}, Lieuwe and Vermeulen, {Jentien M} and {EU-GEI High Risk Study Group}",

note = "Copyright {\textcopyright} 2022 Schirmbeck, van der Ven, Boyette, McGuire, Valmaggia, Kempton, van der Gaag, Riecher-R{\"o}ssler, Barrantes-Vidal, Nelson, Krebs, Ruhrmann, Sachs, Rutten, Nordentoft, Group, de Haan and Vermeulen.",

year = "2022",

month = jul,

day = "22",

doi = "10.3389/fpsyt.2022.869023",

language = "English",

volume = "13",

journal = "Frontiers in Psychiatry",

issn = "1664-0640",

publisher = "Frontiers Media S.A.",

}

Schirmbeck, F, van der Ven, E, Boyette, L-L, McGuire, P, Valmaggia, LR, Kempton, MJ, van der Gaag, M, Riecher-Rössler, A, Barrantes-Vidal, N, Nelson, B, Krebs, M-O, Ruhrmann, S, Sachs, G, Rutten, BPF, Nordentoft, M, de Haan, L, Vermeulen, JM & EU-GEI High Risk Study Group 2022, 'Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes', Frontiers in Psychiatry, vol. 13, 869023. https://doi.org/10.3389/fpsyt.2022.869023

TY - JOUR

T1 - Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis

T2 - Associations with clinical outcomes

AU - Schirmbeck, Frederike

AU - van der Ven, Els

AU - Boyette, Lindy-Lou

AU - McGuire, Philip

AU - Valmaggia, Lucia R

AU - Kempton, Matthew J

AU - van der Gaag, Mark

AU - Riecher-Rössler, Anita

AU - Barrantes-Vidal, Neus

AU - Nelson, Barnaby

AU - Krebs, Marie-Odile

AU - Ruhrmann, Stephan

AU - Sachs, Gabriele

AU - Rutten, Bart P F

AU - Nordentoft, Merete

AU - de Haan, Lieuwe

AU - Vermeulen, Jentien M

AU - EU-GEI High Risk Study Group

N1 - Copyright © 2022 Schirmbeck, van der Ven, Boyette, McGuire, Valmaggia, Kempton, van der Gaag, Riecher-Rössler, Barrantes-Vidal, Nelson, Krebs, Ruhrmann, Sachs, Rutten, Nordentoft, Group, de Haan and Vermeulen.

PY - 2022/7/22

Y1 - 2022/7/22

N2 - Objective: People at ultra-high risk (UHR) for psychosis have a high prevalence of tobacco smoking, and rates are even higher among the subgroup that later develop a psychotic disorder. However, the longitudinal relationship between the course of tobacco smoking and clinical outcomes in UHR subjects is unknown.Methods: We investigated associations between tobacco smoking and clinical outcomes in a prospective study of UHR individuals (n = 324). Latent class mixed model analyses were used to identify trajectories of smoking severity. Mixed effects models were applied to investigate associations between smoking trajectory class and the course of attenuated psychotic symptoms (APS) and affective symptoms, as assessed using the CAARMS.Results: We identified four different classes of smoking trajectory: (i) Persistently High (n = 110), (ii) Decreasing (n = 29), (iii) Persistently Low (n = 165) and (iv) Increasing (n = 20). At two-year follow-up, there had been a greater increase in APS in the Persistently High class than for both the Persistently Low (ES = 9.77, SE = 4.87, p = 0.046) and Decreasing (ES = 18.18, SE = 7.61, p = 0.018) classes. There were no differences between smoking classes in the incidence of psychosis. There was a greater reduction in the severity of emotional disturbance and general symptoms in the Decreasing class than in the High (ES = -10.40, SE = 3.41, p = 0.003; ES = -22.36, SE = 10.07, p = 0.027), Increasing (ES = -11.35, SE = 4.55, p = 0.014; ES = -25.58, SE = 13.17, p = 0.050) and Low (ES = -11.38, SE = 3.29, p = 0.001; ES = -27.55, SE = 9.78, p = 0.005) classes, respectively.Conclusions: These findings suggests that in UHR subjects persistent tobacco smoking is associated with an unfavorable course of psychotic symptoms, whereas decrease in the number of cigarettes smoked is associated with improvement in affective symptoms. Future research into smoking cessation interventions in the early stages of psychoses is required to shine light on the potential of modifying smoking behavior and its relation to clinical outcomes.

AB - Objective: People at ultra-high risk (UHR) for psychosis have a high prevalence of tobacco smoking, and rates are even higher among the subgroup that later develop a psychotic disorder. However, the longitudinal relationship between the course of tobacco smoking and clinical outcomes in UHR subjects is unknown.Methods: We investigated associations between tobacco smoking and clinical outcomes in a prospective study of UHR individuals (n = 324). Latent class mixed model analyses were used to identify trajectories of smoking severity. Mixed effects models were applied to investigate associations between smoking trajectory class and the course of attenuated psychotic symptoms (APS) and affective symptoms, as assessed using the CAARMS.Results: We identified four different classes of smoking trajectory: (i) Persistently High (n = 110), (ii) Decreasing (n = 29), (iii) Persistently Low (n = 165) and (iv) Increasing (n = 20). At two-year follow-up, there had been a greater increase in APS in the Persistently High class than for both the Persistently Low (ES = 9.77, SE = 4.87, p = 0.046) and Decreasing (ES = 18.18, SE = 7.61, p = 0.018) classes. There were no differences between smoking classes in the incidence of psychosis. There was a greater reduction in the severity of emotional disturbance and general symptoms in the Decreasing class than in the High (ES = -10.40, SE = 3.41, p = 0.003; ES = -22.36, SE = 10.07, p = 0.027), Increasing (ES = -11.35, SE = 4.55, p = 0.014; ES = -25.58, SE = 13.17, p = 0.050) and Low (ES = -11.38, SE = 3.29, p = 0.001; ES = -27.55, SE = 9.78, p = 0.005) classes, respectively.Conclusions: These findings suggests that in UHR subjects persistent tobacco smoking is associated with an unfavorable course of psychotic symptoms, whereas decrease in the number of cigarettes smoked is associated with improvement in affective symptoms. Future research into smoking cessation interventions in the early stages of psychoses is required to shine light on the potential of modifying smoking behavior and its relation to clinical outcomes.

KW - CANNABIS

KW - EXPERIENCES

KW - GLOBAL ASSESSMENT

KW - INDIVIDUALS

KW - MODELS

KW - RELIABILITY

KW - SCHIZOPHRENIA

KW - VALIDITY

KW - affective symptoms

KW - psychosis

KW - smoking

KW - tobacco

KW - trajectories

KW - ultra-high risk

U2 - 10.3389/fpsyt.2022.869023

DO - 10.3389/fpsyt.2022.869023

M3 - Article

C2 - 35942478

SN - 1664-0640

VL - 13

JO - Frontiers in Psychiatry

JF - Frontiers in Psychiatry

M1 - 869023

ER -