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Hu Z, Cui E, Chen B, Zhang M. Association between cigarette smoking and the risk of major psychiatric disorders: a systematic review and meta-analysis in depression, schizophrenia, and bipolar disorder. Front Med (Lausanne) 2025; 12:1529191. [PMID: 40018351 PMCID: PMC11865063 DOI: 10.3389/fmed.2025.1529191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 01/27/2025] [Indexed: 03/01/2025] Open
Abstract
Background The prevalence of cigarette smoking among patients with major psychiatric conditions is significantly higher than that in the general population. However, whether there is a causal association between cigarette smoking and major psychiatric disorders remains unclear. Therefore, we conducted a systematic review and meta-analysis of cohort studies to elucidate the association between cigarette smoking and the risk of major psychiatric disorders, including depression, schizophrenia, and bipolar disorder. Methods We systematically searched PubMed, Embase, and the Cochrane Library for potentially eligible studies from their inception until March 2, 2024. All pooled analyses were performed using a random-effects model, and exploratory sensitivity and subgroup analyses were conducted. Results Twenty-five cohort studies involving 2,917,030 individuals were included in the meta-analysis. The summary results indicated that both current smoking (relative risk [RR], 1.30; 95% confidence interval [CI], 1.18-1.43; P < 0.001) and former smoking (RR, 1.16; 95% CI, 1.09-1.23; P < 0.001) were associated with an elevated risk of major depression. Additionally, current smoking was significantly associated with an elevated risk of schizophrenia (RR, 1.84; 95% CI, 1.07-3.19; P = 0.028) and bipolar disorder (RR, 1.54; 95% CI, 1.22-1.95; P < 0.001). Conclusion Current smoking is significantly associated with an elevated risk of major psychiatric disorders, including major depression, schizophrenia, and bipolar disorder. Former smokers also have an elevated risk of major depression. However, it should be noted that, despite these significant associations, due to the nature of the cohort studies included, this study cannot establish a causal relationship between cigarette smoking and major psychiatric disorders. Systematic review registration https://inplasy.com/inplasy-2024-3-0093/, identifier INPLASY202430093.
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Affiliation(s)
- Zhonghou Hu
- Third Department of Psychiatry, Yancheng Fourth People's Hospital, Yancheng, China
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Kromenacker B, Yassin W, Keshavan M, Parker D, Thakkar VJ, Pearlson G, Keedy S, McDowell J, Gershon E, Ivleva E, Hill SK, Clementz BA, Tamminga CA. Evaluating the Exposome Score for Schizophrenia in a Transdiagnostic Psychosis Cohort: Associations With Psychosis Risk, Symptom Severity, and Personality Traits. Schizophr Bull 2025:sbae219. [PMID: 39777534 DOI: 10.1093/schbul/sbae219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
BACKGROUND Investigations of causal pathways for psychosis can be guided by the identification of environmental risk factors. A recently developed composite risk tool, the exposome score for schizophrenia (ES-SCZ), which controls for intercorrelations between risk factors, has shown fair to good performance. We tested the transdiagnostic psychosis classifier performance of the ES-SCZ with the Bipolar-Schizophrenia Network for Intermedial Phenotypes data and examined its relationship with clinical-level outcomes. STUDY DESIGN We computed the case-control classifier performance for the ES-SCZ from cross-sectional data on 1055 volunteers with psychotic diagnoses (schizophrenia, schizoaffective, bipolar psychosis) and 510 controls. Multivariate regression models were used to control for the correlations between outcomes and to correct for the effects of age, sex, and family socioeconomic status across outcomes. We estimated association for the ES-SCZ with psychosis and mood symptom severity, the 5-factor model of personality, and function across biologically defined biotypes, traditional diagnostic categories, and controls. STUDY RESULTS ES-SCZ classifier performance for psychosis was fair to good. ES-SCZ associations with personality factor scores were qualitatively similar between psychosis groups and controls with decreased conscientiousness and agreeableness and increased neuroticism. The patterns of associations between ES-SCZ and symptoms differed across biotypes and diagnoses. Biotype 3 and bipolar disorder had consistent within-group associations where greater exposome score predicted more severe symptoms and worse function. CONCLUSIONS ES-SCZ performance was consistent with previous reports in this transdiagnostic psychosis sample (adjusted odds ratio: 3.331 [2.834, 3.915], P < .001; area under the curve: 0.762 [0.735, 0.789]). Individual differences in ES-SCZ magnitude may be useful for investigating causal pathways between developmentally relevant exposures and symptomatic expression of psychosis.
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Affiliation(s)
- Bryan Kromenacker
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Walid Yassin
- Department of Psychiatry, Harvard University, Cambridge, MA 02138, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard University, Cambridge, MA 02138, United States
| | - David Parker
- Department of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, United States
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Vishal J Thakkar
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Godfrey Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Sarah Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL 60637, United States
| | - Jennifer McDowell
- Department of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, United States
| | - Elliot Gershon
- Department of Psychiatry and Human Genetics, University of Chicago, Chicago, IL 60637, United States
| | - Elena Ivleva
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - S Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science North Chicago, IL 60064, United States
| | - Brett A Clementz
- Department of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, United States
| | - Carol A Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390, United States
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Brady DJ, Phalen PL, Roche DJO, Cowan T, Bennett ME. A reduction in cigarette smoking improves health-related quality of life and does not worsen psychiatric symptoms in individuals with serious mental illness. Addict Behav 2024; 151:107949. [PMID: 38176326 PMCID: PMC10863476 DOI: 10.1016/j.addbeh.2023.107949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Individuals with serious mental illness (SMI) smoke cigarettes at a much higher rate than the general population, increasing their risk for medical illnesses and mortality. However, individuals with SMI do not get enough support to quit smoking, partially because of concerns from medical providers that reducing smoking may worsen their symptoms or quality of life. METHODS Veterans with SMI and nicotine dependence (n = 178) completed a 12-week smoking cessation trial (parent trial dates: 2010-2014) including assessments of smoking status, psychiatric symptoms (Brief Psychiatric Rating Scale), and quality of life (Lehman Quality of Life Interview-Short Version) at up to four time points: baseline, post-treatment, three-month follow-up, and 9-month follow-up. Bayesian multilevel modeling estimated the impact of changes in the self-reported number of cigarettes per day in the past seven days on psychiatric symptoms and quality of life. RESULTS Between subjects, each additional pack of cigarettes smoked per day was associated with a 0.83 point higher score (95%CI: 0.03 to 1.7) on a negative symptoms scale ranging from 0 to 35. Within subjects, each one-pack reduction in the number of cigarettes smoked per day was associated with an improvement of 0.32 (95%CI = 0.12 to 0.54) on the health-related quality of life scale, which ranges from 0 to 7 points. There were no other significant between- or within-subjects effects of smoking on psychiatric symptoms or quality of life. CONCLUSIONS Individuals with SMI and their providers should pursue smoking cessation without fear of worsening psychiatric symptoms or quality of life.
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Affiliation(s)
- Daniel J Brady
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD 21228, United States
| | - Peter L Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD 21201, United States
| | - Daniel J O Roche
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD 21228, United States
| | - Tovah Cowan
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD 21201, United States
| | - Melanie E Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD 21201, United States.
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Hyatt AS, Mulvaney-Day N, Chow CM, Cook BL, DeLisi LE. Association between electronic nicotine product use and subsequent first episode psychosis. Psychiatry Res 2024; 334:115785. [PMID: 38377800 PMCID: PMC10984181 DOI: 10.1016/j.psychres.2024.115785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Tobacco use has been established as a possible risk factor for psychosis, but the effect of electronic nicotine delivery systems (ex. nicotine vapes) has not been independently established. Using the Population Assessment of Tobacco and Health study, we found that use of electronic nicotine products was significantly associated with later first episode psychosis after controlling for substance use and other confounders, and that this relationship was only significant among the heaviest users (>20 puffs/day). Given the rapid rise in electronic nicotine products use, clinicians and public health professionals should consider potential impacts and closely monitor trends in the coming years.
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Affiliation(s)
- Andrew S Hyatt
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Norah Mulvaney-Day
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Benjamin Lê Cook
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
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Franklin F, Rajamanikam A, Phang WK, Raju CS, Gill JS, Francis B, Sy-Cherng Woon L, Govind SK. Establishing associated risk factors, including fungal and parasitic infections among Malaysians living with schizophrenia. Sci Rep 2024; 14:385. [PMID: 38172146 PMCID: PMC10764362 DOI: 10.1038/s41598-023-50299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
The aetiology of schizophrenia is multifactorial, and the identification of its risk factors are scarce and highly variable. A cross-sectional study was conducted to investigate the risk factors associated with schizophrenia among Malaysian sub-population. A total of 120 individuals diagnosed with schizophrenia (SZ) and 180 non-schizophrenic (NS) individuals participated in a questionnaire-based survey. Data of complete questionnaire responses obtained from 91 SZ and 120 NS participants were used in statistical analyses. Stool samples were obtained from the participants and screened for gut parasites and fungi using conventional polymerase chain reaction (PCR). The median age were 46 years (interquartile range (IQR) 37 to 60 years) and 35 years (IQR 24 to 47.75 years) for SZ and NS respectively. Multivariable binary logistic regression showed that the factors associated with increased risk of SZ were age, sex, unemployment, presence of other chronic ailment, smoking, and high dairy consumption per week. These factors, except sex, were positively associated with the severity of SZ. Breastfed at infancy as well as vitamin and supplement consumption showed a protective effect against SZ. After data clean-up, fungal or parasitic infections were found in 98% (39/42). of SZ participants and 6.1% (3/49) of NS participants. Our findings identified non-modifiable risk factors (age and sex) and modifiable lifestyle-related risk factors (unemployment, presence of other chronic ailment, smoking, and high dairy consumption per week) associated with SZ and implicate the need for medical attention in preventing fungal and parasitic infections in SZ.
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Affiliation(s)
- Freddy Franklin
- Department of Parasitology, Universiti Malaya (UM), Kuala Lumpur, Malaysia
- Department of Medical Microbiology, Universiti Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Wei Kit Phang
- Department of Parasitology, Universiti Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Jesjeet Singh Gill
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Benedict Francis
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Luke Sy-Cherng Woon
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Bangi, Malaysia
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Sánchez-Gutiérrez T, Rodríguez-Toscano E, Roldán L, Ferraro L, Parellada M, Calvo A, López G, Rapado-Castro M, La Barbera D, La Cascia C, Tripoli G, Di Forti M, Murray RM, Quattrone D, Morgan C, van Os J, García-Portilla P, Al-Halabí S, Bobes J, de Haan L, Bernardo M, Santos JL, Sanjuán J, Arrojo M, Ferchiou A, Szoke A, Rutten BP, Stilo S, D'Andrea G, Tarricone I, Díaz-Caneja CM, Arango C. Tobacco use in first-episode psychosis, a multinational EU-GEI study. Psychol Med 2023; 53:7265-7276. [PMID: 37185055 DOI: 10.1017/s0033291723000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis. METHODS The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use. RESULTS After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use. CONCLUSIONS Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.
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Affiliation(s)
- T Sánchez-Gutiérrez
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - E Rodríguez-Toscano
- Grupo de investigación en Psiquiatría, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy at the Complutense University of Madrid, Madrid, Spain
| | - L Roldán
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - L Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - M Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Calvo
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - G López
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, Victoria 3053, Australia
| | - D La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - C La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - G Tripoli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - M Di Forti
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Mental Health Trust, London, UK
| | - R M Murray
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - D Quattrone
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - C Morgan
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - P García-Portilla
- Department of Medicine-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - S Al-Halabí
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - J Bobes
- Department of Medicine-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - L de Haan
- Early Psychosis Department, Amsterdam UMC, University of Amsterdam, Academic Psychiatric Centre, Arkin, Amsterdam, The Netherlands
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, ISCIII, Barcelona, Spain
| | - J L Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital 'Virgen de la Luz', Cuenca, Spain
| | - J Sanjuán
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - M Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Ferchiou
- Fondation FondaMental, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopitaux Universitaires 'H. Mondor', DMU IMPACT, F-94010 Creteil, France
| | - A Szoke
- Fondation FondaMental, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopitaux Universitaires 'H. Mondor', DMU IMPACT, F-94010 Creteil, France
| | - B P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
| | - G D'Andrea
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - I Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - C Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
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Du W, Ge MW, Hu FH, Jia YJ, Zhao DY, Cheng YJ, Chen HL. QTc prolongation in patients with schizophrenia taking antipsychotics: Prevalence and risk factors. J Psychopharmacol 2023; 37:971-981. [PMID: 37534722 DOI: 10.1177/02698811231190864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND QTc prolongation is one of the possible complications in patients with schizophrenia taking antipsychotics, which leads to malignant cardiac arrhythmia. No meta-analysis has been reported assessing the prevalence and correlated risk factors for QTc prolongation. METHODS This meta-analysis aimed to assess the evidence for the prevalence of QTc prolongation and correlated risk factors in patients with schizophrenia taking antipsychotics. Web of Science and PubMed were searched according to preset strategy. The quality of research was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS In all, 15 studies covering 15,540 patients with schizophrenia taking antipsychotics were included. Meta-analysis showed that the prevalence of QTc prolongation in patients with schizophrenia taking antipsychotics was about 4.0% (95% confidence interval (CI): 3.0%-5.0%, p < 0.001). The prevalence was about 4.0% in Asia (95%CI: 3.0%-6.0%, p < 0.001), about 5.0% in Europe (95%CI: 2.0%-7.0%, p < 0.001), and about 2.0% in America (95%CI: 1.0%-3.0%, p < 0.001). Sensitivity analyses indicated the robustness of the result. Publication bias analysis reported a certain publication bias (t = 3.37, p = 0.012). Meta-regression suggested that female and elderly patients were clinically associated with a higher prevalence of QTc prolongation. According to included studies, smoking, comorbidity of cardiovascular disease, and abnormal levels of high-density lipoprotein/low-density lipoprotein might be related to QTc prolongation in patients with schizophrenia taking antipsychotics. CONCLUSIONS The prevalence of QTc prolongation in patients with schizophrenia taking antipsychotics was about 4.0%. Female and elderly patients were more likely to experience QTc prolongation. Close electrocardiogram monitoring was suggested in these at-risk populations.
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Affiliation(s)
- Wei Du
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Yi-Jie Jia
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Yu-Jie Cheng
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China
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Xu Z, Tian Y, Li AX, Tang J, Jing XY, Deng C, Mo Z, Wang J, Lai J, Liu X, Guo X, Li T, Li S, Wang L, Lu Z, Chen Z, Liu XA. Menthol Flavor in E-Cigarette Vapor Modulates Social Behavior Correlated With Central and Peripheral Changes of Immunometabolic Signalings. Front Mol Neurosci 2022; 15:800406. [PMID: 35359576 PMCID: PMC8960730 DOI: 10.3389/fnmol.2022.800406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
The use of electronic cigarette (e-cigarette) has been increasing dramatically worldwide. More than 8,000 flavors of e-cigarettes are currently marketed and menthol is one of the most popular flavor additives in the electronic nicotine delivery systems (ENDS). There is a controversy over the roles of e-cigarettes in social behavior, and little is known about the potential impacts of flavorings in the ENDS. In our study, we aimed to investigate the effects of menthol flavor in ENDS on the social behavior of long-term vapor-exposed mice with a daily intake limit, and the underlying immunometabolic changes in the central and peripheral systems. We found that the addition of menthol flavor in nicotine vapor enhanced the social activity compared with the nicotine alone. The dramatically reduced activation of cellular energy measured by adenosine 5′ monophosphate-activated protein kinase (AMPK) signaling in the hippocampus were observed after the chronic exposure of menthol-flavored ENDS. Multiple sera cytokines including C5, TIMP-1, and CXCL13 were decreased accordingly as per their peripheral immunometabolic responses to menthol flavor in the nicotine vapor. The serum level of C5 was positively correlated with the alteration activity of the AMPK-ERK signaling in the hippocampus. Our current findings provide evidence for the enhancement of menthol flavor in ENDS on social functioning, which is correlated with the central and peripheral immunometabolic disruptions; this raises the vigilance of the cautious addition of various flavorings in e-cigarettes and the urgency of further investigations on the complex interplay and health effects of flavoring additives with nicotine in e-cigarettes.
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Affiliation(s)
- Zhibin Xu
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Ye Tian
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - A.-Xiang Li
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Department of Forensic Medicine, School of Medicine, Xi’an Jiaotong University, Xi’an, China
| | - Jiahang Tang
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiao-Yuan Jing
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chunshan Deng
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhizhun Mo
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jiaxuan Wang
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Juan Lai
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xuemei Liu
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xuantong Guo
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Tao Li
- Department of Forensic Medicine, School of Medicine, Xi’an Jiaotong University, Xi’an, China
| | - Shupeng Li
- State Key Laboratory of Oncogenomics, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, China
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Liping Wang
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Zhonghua Lu
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Zuxin Chen
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Neher Neural Plasticity Laboratory, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- *Correspondence: Zuxin Chen,
| | - Xin-an Liu
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Zuxin Chen,
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Sheng HW, Wang HG, Wang CZ, Wu J, Huo LJ, Wang RX, Zhou YJ, Zhang XY. Prevalence and clinical characteristics of COVID-19 in inpatients with schizophrenia in Wuhan, China. World J Psychiatry 2022; 12:140-150. [PMID: 35111585 PMCID: PMC8783160 DOI: 10.5498/wjp.v12.i1.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/29/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In contrast to many Western countries, China has maintained its large psychiatric hospitals. The prevalence and clinical characteristics of coronavirus disease 2019 (COVID-19) in inpatients with schizophrenia (SCZ) are unclear.
AIM To assess the prevalence of COVID-19 among inpatients with SCZ and compare the infected to uninfected SCZ patients in a Wuhan psychiatric hospital.
METHODS We retrospectively collected demographic characteristics and clinical profiles of all SCZ patients with COVID-19 at Wuhan’s Youfu Hospital.
RESULTS Among the 504 SCZ patients, 84 had COVID-19, and we randomly sampled 174 who were uninfected as a comparison group. The overall prevalence of COVID-19 in SCZ patients was 16.7%. Among the 84 SCZ patients with confirmed COVID-19, the median age was 54 years and 76.2% were male. The most common symptom was fever (82%), and less common symptoms were cough (31%), poor appetite (20%), and fatigue (16%). Compared with SCZ patients without COVID-19, those with COVID-19 were older (P = 0.006) and significantly lighter (P = 0.002), and had more comorbid physical diseases (P = 0.001). Surprisingly, those infected were less likely to be smokers (< 0.001) or to be treated with clozapine (P = 0.03). Further logistic regression showed that smoking [odds ratio (OR) = 5.61], clozapine treated (OR = 2.95), and male (OR = 3.48) patients with relatively fewer comorbid physical diseases (OR = 0.098) were at a lower risk for COVID-19. SCZ patients with COVID-19 presented primarily with fever, but only one-third had a cough, which might otherwise be the most common mode of transmission between individuals.
CONCLUSION Two unexpected protective factors for COVID-19 among SCZ inpatients are smoking and clozapine treatment.
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Affiliation(s)
- Hong-Wei Sheng
- Department of Psychiatry, Wuhan Youfu Hospital, Wuhan 430070, Hubei Province, China
| | - Hong-Gang Wang
- Qingdao Mental Health Center, Qingdao University, Qingdao 266000, Shandong Province, China
| | - Chun-Zhi Wang
- Qingdao Mental Health Center, Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jiang Wu
- Department of Psychiatry, Wuhan Youfu Hospital, Wuhan 430070, Hubei Province, China
| | - Li-Jian Huo
- CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing 10000, China
| | - Ruo-Xi Wang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei Province, China
| | - Yong-Jie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen 510810, Guangdong Province, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing 10000, China
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10
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Primary Psychosis: Risk and Protective Factors and Early Detection of the Onset. Diagnostics (Basel) 2021; 11:diagnostics11112146. [PMID: 34829493 PMCID: PMC8622963 DOI: 10.3390/diagnostics11112146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 01/15/2023] Open
Abstract
Primary psychosis, which includes schizophrenia and other psychoses not caused by other psychic or physical conditions, has a strong impact worldwide in terms of disability, suffering and costs. Consequently, improvement of strategies to reduce the incidence and to improve the prognosis of this disorder is a current need. The purpose of this work is to review the current scientific literature on the main risk and protective factors of primary psychosis and to examine the main models of prevention, especially those related to the early detection of the onset. The conditions more strongly associated with primary psychosis are socio-demographic and economic factors such as male gender, birth in winter, ethnic minority, immigrant status, and difficult socio-economic conditions while the best-established preventive factors are elevated socio-economic status and an economic well-being. Risk and protective factors may be the targets for primordial, primary, and secondary preventive strategies. Acting on modifiable factors may reduce the incidence of the disorder or postpone its onset, while an early detection of the new cases enables a prompt treatment and a consequential better prognosis. According to this evidence, the study of the determinants of primary psychosis has a pivotal role in designing and promoting preventive policies aimed at reducing the burden of disability and suffering of the disorder.
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