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Why do patients with schizophrenia smoke?

Winterer, Georg

Current Opinion in Psychiatry: March 2010 - Volume 23 - Issue 2 - p 112–119
doi: 10.1097/YCO.0b013e3283366643
Schizophrenia: Edited by W. Wolfgang Fleischhacker

Purpose of review Among the mentally ill, smoking prevalence is highest in patients with schizophrenia (∼70–80%). This can impose a significant financial burden on patients, not to speak of increased smoking-related morbidity and mortality. Therefore, it is critical for clinicians to understand why patients with schizophrenia smoke in order to adapt treatment schemes. Understanding the reasons may also help to develop new drugs that target the nicotinic system in the brain as well as smoking cessation programs that are specifically designed for this particular patient population.

Recent findings So far, several reasons have been identified which are believed to explain tobacco consumption in patients with schizophrenia. Originally, it was widely believed that patients with schizophrenia smoke to increase hepatic clearance and to restore the dopamine blockade of certain antipsychotic drugs to diminish their side effects. However, more recently it became obvious that cigarette smoking may also be reinforcing for patients because it improves psychiatric symptoms, most notably negative and cognitive symptoms. The underlying molecular mechanisms of these nicotine effects are currently under intensive investigation.

Summary Heavy smoking in schizophrenia cannot simply be viewed as a ‘bad habit’. Rather, self-medication of clinical symptoms and side effects of antipsychotic drugs appear to play a major role.

Department of Psychiatry, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany

Correspondence to Georg Winterer, MD, PhD, Department of Psychiatry, Heinrich-Heine University Duesseldorf, Bergische Landstr. 2, 40629 Duesseldorf, Germany Tel: +49 211 922 3495; fax: +49 211 922 3497; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.