TY - JOUR
T1 - Smoking, symptoms, and quality of life in patients with psychosis, siblings, and healthy controls
T2 - a prospective, longitudinal cohort study
AU - Vermeulen, Jentien
AU - Schirmbeck, Frederike
AU - Blankers, Matthijs
AU - van Tricht, Mirjam
AU - van den Brink, Wim
AU - de Haan, Lieuwe
AU - Genetic Risk and Outcome of Psychosis (GROUP) Investigators
AU - van Amelsvoort, Thérèse
AU - Delespaul, Philippe
AU - Simons, Claudia
AU - van Winkel, Ruud
N1 - Funding Information:
The infrastructure for the GROUP study is funded through the Geestkracht programme of the Dutch Health Research Council (ZonMw, grant number 10-000-1001) and matching funds from participating pharmaceutical companies (Lundbeck, AstraZeneca, Eli Lilly, Janssen Cilag) and universities and mental health-care organisations (Academic Psychiatric Center of Amsterdam UMC, Meibergdreef, and the mental health institutions GGZ inGeest, Arkin, Dijk en Duin, GGZ Rivierduinen, Erasmus Medical Center, GGZ Noord Holland Noord; University Medical Center Groningen, and the mental health institutions Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGNet Warnsveld, Yulius Dordrecht, and Parnassia psycho-medical center, The Hague; Maastricht University Medical Center and the mental health institutions GGzE, GGZ Breburg, GGZ Oost-Brabant, Vincent van Gogh voor Geestelijke Gezondheid, Mondriaan, Virenze riagg, Zuyderland GGZ, MET ggz, Universitair Centrum Sint-Jozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem; University Medical Center Utrecht and the mental health institutions Altrecht, GGZ Centraal, and Delta). We are grateful for the generosity of time and effort by the patients, their families, and healthy participants. We thank all research personnel involved in the GROUP project, in particular Joyce van Baaren, Erwin Veermans, Truda Driesen, Karin Pos, Erna van't Hag, and Jessica de Nijs.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/1
Y1 - 2019/1
N2 - Background The self-medication hypothesis postulates that the high prevalence of smoking in patients with psychosis can be explained by the ameliorating effect of smoking on symptoms. However, there are few large prospective studies testing this hypothesis. We aimed to examine the multi-cross-sectional and prospective associations of changes in smoking behaviour with symptoms and quality of life.Methods In this prospective cohort study we recruited patients with a non-affective psychosis (n=1094), unaffected siblings (n=1047), and healthy controls (n=579). Patients aged between 16 and 50 years and diagnosed with a non-affective psychosis according to DSM-IV were recruited by clinicians from four university medical centres and 36 associated mental health-care institutions in the Netherlands and Belgium between Jan 13, 2004, and March 6, 2014. Smoking status and number of cigarettes per day were assessed at baseline, and at 3-year and 6-year follow-up using the Composite International Diagnostic Interview (CIDI). Symptom frequency was self-rated with the Community Assessment of Psychotic Experience (CAPE), and quality of life was assessed by the WHO Quality of Life (WHOQOL) schedule. Multiple linear mixed-effects regression analyses were done accounting for multiple confounders.Findings At baseline, 729 (67%) of 1094 of patients smoked (mean 17.5 cigarettes per day, SD 8.8) compared with 401 (38%) of 1047 siblings and 145 (25%) of 579 healthy controls. Multi-cross-sectional results of linear mixed-effects analyses showed that smoking in patients and siblings was associated with more frequent positive symptoms (estimate 0.14, SE 0.02, p <0.0001 in patients; 0.03, 0.01, p=0.0019 in siblings), negative symptoms (0.15, 0.03, pInterpretation Our findings do not empirically support the self-medication hypothesis. The absence of long-term symptomatic relief from smoking should encourage clinicians to help patients with psychosis to quit smoking.Funding Dutch Health Research Council, Lundbeck, AstraZeneca, Eli Lilly, Janssen Cilag, Academic Psychiatric Center of the Academic Medical Center, GGZ inGeest, Arkin, Dijk en Duin, GGZ Rivierduinen, Erasmus Medical Center Amsterdam, GGZ Noord Holland Noord, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGNet Warnsveld, Yulius Dordrecht, Parnassia Psycho-medical Center, Maastricht University Medical Center, GGzE, GGZ Breburg, GGZ Oost-Brabant, Vincent van Gogh voor Geestelijke Gezondheid, Mondriaan, Virenze riagg, Zuyderland GGZ, MET GGZ, Universitair Centrum Sint-Jozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem, University Medical Center Utrecht, Altrecht, GGZ Centraal, and Delta. Copyright (c) 2018 Elsevier Ltd. All rights reserved.
AB - Background The self-medication hypothesis postulates that the high prevalence of smoking in patients with psychosis can be explained by the ameliorating effect of smoking on symptoms. However, there are few large prospective studies testing this hypothesis. We aimed to examine the multi-cross-sectional and prospective associations of changes in smoking behaviour with symptoms and quality of life.Methods In this prospective cohort study we recruited patients with a non-affective psychosis (n=1094), unaffected siblings (n=1047), and healthy controls (n=579). Patients aged between 16 and 50 years and diagnosed with a non-affective psychosis according to DSM-IV were recruited by clinicians from four university medical centres and 36 associated mental health-care institutions in the Netherlands and Belgium between Jan 13, 2004, and March 6, 2014. Smoking status and number of cigarettes per day were assessed at baseline, and at 3-year and 6-year follow-up using the Composite International Diagnostic Interview (CIDI). Symptom frequency was self-rated with the Community Assessment of Psychotic Experience (CAPE), and quality of life was assessed by the WHO Quality of Life (WHOQOL) schedule. Multiple linear mixed-effects regression analyses were done accounting for multiple confounders.Findings At baseline, 729 (67%) of 1094 of patients smoked (mean 17.5 cigarettes per day, SD 8.8) compared with 401 (38%) of 1047 siblings and 145 (25%) of 579 healthy controls. Multi-cross-sectional results of linear mixed-effects analyses showed that smoking in patients and siblings was associated with more frequent positive symptoms (estimate 0.14, SE 0.02, p <0.0001 in patients; 0.03, 0.01, p=0.0019 in siblings), negative symptoms (0.15, 0.03, pInterpretation Our findings do not empirically support the self-medication hypothesis. The absence of long-term symptomatic relief from smoking should encourage clinicians to help patients with psychosis to quit smoking.Funding Dutch Health Research Council, Lundbeck, AstraZeneca, Eli Lilly, Janssen Cilag, Academic Psychiatric Center of the Academic Medical Center, GGZ inGeest, Arkin, Dijk en Duin, GGZ Rivierduinen, Erasmus Medical Center Amsterdam, GGZ Noord Holland Noord, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGNet Warnsveld, Yulius Dordrecht, Parnassia Psycho-medical Center, Maastricht University Medical Center, GGzE, GGZ Breburg, GGZ Oost-Brabant, Vincent van Gogh voor Geestelijke Gezondheid, Mondriaan, Virenze riagg, Zuyderland GGZ, MET GGZ, Universitair Centrum Sint-Jozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem, University Medical Center Utrecht, Altrecht, GGZ Centraal, and Delta. Copyright (c) 2018 Elsevier Ltd. All rights reserved.
KW - NEGATIVE-SYNDROME-SCALE
KW - SCHIZOPHRENIA
KW - RISK
KW - CESSATION
KW - METAANALYSIS
KW - INDIVIDUALS
KW - ASSOCIATION
KW - RELIABILITY
KW - WHOQOL
U2 - 10.1016/S2215-0366(18)30424-3
DO - 10.1016/S2215-0366(18)30424-3
M3 - Article
SN - 2215-0374
VL - 6
SP - 25
EP - 34
JO - Lancet Psychiatry
JF - Lancet Psychiatry
IS - 1
ER -