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Mortality Rates: 20% shorter life expectancy in schizophrenia 50% of people with serious mental illness who smoke regularly will die prematurely One in two regular smokers dies 15 years prematurely One in four dies 23 years prematurely Two-thirds of people with schizophrenia die of coronary heart disease 10 times higher risk of death from respiratory disease in schizophrenia Prevalence of Smoking: 70% of psychiatric inpatients smoke 50% of inpatients smoke heavily 64% of those with probable psychosis are smokers 29% of those without psychosis are smokers 22% of UK adults were smokers (2006) Two-thirds of smokers wanted to give up Disease Risk from Passive Smoking: 25% increased risk of lung cancer and ischaemic heart disease 50-60% increase in risk of coronary heart disease from heavy passive smoking Mental Health Association: Double probability of any mental health problem in smokers versus non-smokers (22.4% vs 12.2%) About half of people with schizophrenia misuse illicit substances and alcohol Cessation Statistics: 90% of lung cancer mortality risk can be avoided if quitting before middle age 2-3% per year permanent remission rate in UK 15% of smokers stopped completely following workplace bans Smoking and Depression: People with depressive/anxiety disorders are twice as likely to smoke Evidence suggests smoking increases risk of depression Ex-smokers report less depression than current smokers Clear relationship between smoking prevalence and number of depressive/anxiety symptoms Higher suicide rates and thoughts among smokers Smoking and Anxiety: Cigarette smoking increases risk of anxiety disorders in late adolescence/early adulthood Daily smoking associated with increased risk of first panic attack Perceived stress levels reduce on stopping smoking and increase on return to smoking Anxiety decreases after first week of abstinence Evidence suggests smoking is chronically anxiogenic (anxiety-causing) rather than anxiolytic (anxiety-reducing) Smoking and Schizophrenia: Contradictory findings in two areas: As Precipitator or Protector: Some studies show 90% started smoking before illness onset (potential risk factor) Other studies show early smoking associated with lower rate of subsequent schizophrenia (potential protective factor) Self-medication Hypothesis: Contradictory evidence regarding effects on positive and negative symptoms Smoking decreases blood serum levels of antipsychotics Smokers often prescribed higher doses of antipsychotics No randomised clinical trials support self-medication hypothesis The neurotransmitter effects of smoking: Initial Mechanism: Nicotine crosses blood-brain barrier within seconds of inhalation Binds to nicotinic cholinergic receptors Neurotransmitters Nicotine causes release of: Noradrenaline Serotonin Dopamine Acetylcholine GABA Glutamate Key Receptor Effects: Causes up-regulation of nicotinic receptors Notable as this contrasts with typical down-regulation seen with most neurotransmitter receptors when exposed to agonists MAO-B Effects: Smoking inhibits monoamine oxidase B (MAO-B) MAO-B normally catabolizes dopamine, serotonin, and noradrenaline Smokers have lower brain MAO-B levels Levels return to normal after quitting MAO-B inhibition increases dopamine, making smoking rewarding Specific Mental Health Links: Depression: Neurochemical abnormalities in locus cerulus similar to antidepressant effects MAO inhibitor effects might provide antidepressant action Schizophrenia: Nicotine especially reinforcing due to stimulation of: Subcortical reward system Prefrontal cortex (both hypofunctional in schizophrenia) Dopamine release in mesolimbic reward centres may overcome anhedonia in both schizophrenia and depression Noradrenergic effects may increase attentiveness and improve repetitive task performance Specific Mental Health Links Depression: Neurochemical abnormalities in locus cerulus similar to antidepressant effects MAO inhibitor effects might provide antidepressant action Schizophrenia: Nicotine especially reinforcing due to stimulation of: Subcortical reward system Prefrontal cortex (both hypofunctional in schizophrenia) Dopamine release in mesolimbic reward centres may overcome anhedonia in both schizophrenia and depression Noradrenergic effects may increase attentiveness and improve repetitive task performance More e vidence-based sources Summary of evidence Public Health England: Reports significantly higher smoking prevalence and associated health risks among people with mental health conditions

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