INTRODUCTION: Individuals with schizophrenia spectrum disorders (SSDs) record elevated rates of smoking, which is often attributed to their effort to self-medicate cognitive and attentional symptoms of their illness. Empirical evidence for this hypothesis is conflicting, however. In this study, we aimed to test predictions derived from the cognitive self-medication hypothesis. We predicted that cigarette smoking status and extent would predict the attentional performance of participants with SSDs. Simultaneously, we wished to address methodological gaps in previous research. We measured distinct attentional components and made adjustments for the effects of other, attention-modulation variables. METHODS: Sixty-one smokers (82.0% males, 26.73 ± 6.05 years) and 61 non-smokers (50.8% males, 27.10 ± 7.90 years) with recent-onset SSDs completed an X-type Continuous Performance Test, which was used to derive impulsivity and inattention component scores. Relationships between the two component scores and cigarette smoking status and extent were assessed using hierarchical regression. Effects of estimated premorbid intellectual functioning and antipsychotic medication dosage were held constant. RESULTS: Smokers had significantly higher inattention component scores than non-smokers when covariates were controlled (p = 0.026). Impulsivity remained unaffected by smoking status (p = 0.971). Cigarette smoking extent, i.e., the number of cigarettes smoked per day, was not associated with either inattention (p = 0.414) or impulsivity (p = 0.079). CONCLUSION: Models of smoking-related attentional changes can benefit from the inclusion of sample-specific component scores and attention-modulating covariates. Under these conditions, smokers with SSDs can show a partial attentional benefit. However, the limited scope of this benefit suggests that the cognitive self-medication hypothesis requires further testing or reconsidering.

Department of Psychiatry 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia

Department of Psychology Faculty of Arts Charles University Prague Czechia

Department of Psychology Faculty of Social Studies Masaryk University Brno Czechia

National Institute of Mental Health Klecany Czechia

Zobrazit více v PubMed

Adler L. E., Hoffer L. D., Wiser A., Freedman R. (1993). Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Am. J. Psychiatry 150, 1856–1861. doi: 10.1176/ajp.150.12.1856, PMID: PubMed DOI

American Psychiatric Association . (1994). Diagnostic and statistical manual of mental disorders, fourth edition (DSM–IV), Washington, DC: American Psychiatric Association.

Amoretti S., Cabrera B., Torrent C., Bonnín C. D. M., Mezquida G., Garriga M., et al. . (2019). Cognitive reserve assessment scale in health (CRASH): its validity and reliability. J. Clin. Med. 8:586. doi: 10.3390/jcm8050586, PMID: PubMed DOI PMC

Barr R. S., Culhane M. A., Jubelt L. E., Mufti R. S., Dyer M. A., Weiss A. P., et al. . (2008). The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology 33, 480–490. doi: 10.1038/sj.npp.1301423, PMID: PubMed DOI

Beck A. K., Baker A. L., Todd J. (2015). Smoking in schizophrenia: cognitive impact of nicotine and relationship to smoking motivators. Schizophr. Res. Cogn. 2, 26–32. doi: 10.1016/j.scog.2014.12.001, PMID: PubMed DOI PMC

Benowitz N. L. (2009). Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu. Rev. Pharmacol. Toxicol. 49, 57–71. doi: 10.1146/ANNUREV.PHARMTOX.48.113006.094742, PMID: PubMed DOI PMC

Chapman S., Ragg M., McGeechan K. (2009). Citation bias in reported smoking prevalence in people with schizophrenia. Aust. New Zeal. J. Psychiatry 43, 277–282. doi: 10.1080/00048670802653372, PMID: PubMed DOI

Conners C. K. (2000). Conners’ Continuous Performance Test II: Computer Program for Windows Technical Guide and Software Manual. Toronto: Multi-Health Systems Inc.

Conners C. K. (2014). Conners Continuous Performance Test 3rd. Toronto: Multi-Health Systems Inc.

Cornblatt B. A., Risch N. J., Faris G., Friedman D., Erlenmeyer-Kimling L. (1988). The continuous performance test, identical pairs version (CPT-IP): new findings about sustained attention in normal families. Psychiatry Res. 26, 223–238. doi: 10.1016/0165-1781(88)90076-5, PMID: PubMed DOI

Dekker T. E. G., van der Heijden H. S., Schirmbeck F., van Amelsvoort T., Bartels-Velthuis A. A., Simons C. J. P., et al. . (2021). The association between smoking behaviour, social cognition and social functioning in patients with a non-affective psychotic disorder: A prospective follow-up study. Schizophr. Res. Cogn.. 26:100206. doi: 10.1016/J.SCOG.2021.100206 PubMed DOI PMC

D’Souza M. S., Markou A. (2012). Schizophrenia and tobacco smoking comorbidity: NAChR agonists in the treatment of schizophrenia-associated cognitive deficits. Neuropharmacology 62, 1564–1573. doi: 10.1016/j.neuropharm.2011.01.044, PMID: PubMed DOI PMC

Egeland J., Kovalik-Gran I. (2010a). Measuring several aspects of attention in one test. The factor structure of Conners’s continuous performance test. J. Atten. Disord. 13, 339–346. doi: 10.1177/1087054708323019 PubMed DOI

Egeland J., Kovalik-Gran I. (2010b). Validity of the factor structure of Conners’ CPT. J. Atten. Disord. 13, 347–357. doi: 10.1177/1087054709332477, PMID: PubMed DOI

Erdodi L. A., Pelletier C. L., Roth R. M. (2018). Elevations on select Conners’ CPT-II scales indicate noncredible responding in adults with traumatic brain injury. Appl. Neuropsychol. Adult 25, 19–28. doi: 10.1080/23279095.2016.1232262, PMID: PubMed DOI

Fernandes T. M. P., de Andrade M. J. O., Santana J. B., Nogueira R. M. T. B. L., dos Santos N. A. (2018). Tobacco use decreases visual sensitivity in schizophrenia. Front. Psychol. 9:288. doi: 10.3389/FPSYG.2018.00288/BIBTEX, PMID: PubMed DOI PMC

Fernandes T. P., Shaqiri A., Brand A., Nogueira R. L., Herzog M. H., Roinishvili M., et al. . (2019). Schizophrenia patients using atypical medication perform better in visual tasks than patients using typical medication. Psychiatry Res. 275, 31–38. doi: 10.1016/J.PSYCHRES.2019.03.008, PMID: PubMed DOI

Gardner D. M., Murphy A. L., O’Donnell H., Centorrino F., Baldessarini R. J. (2010). International consensus study of antipsychotic dosing. Am. J. Psychiatry 167, 686–693. doi: 10.1176/appi.ajp.2009.09060802, PMID: PubMed DOI

Guy W. (1976). ECDEU Assessment Manual for Psychopharmacology. Rockville: US Department of Heath, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration.

Hahn C., Hahn E., Dettling M., Güntürkün O., Tam Ta T. M., Neuhaus A. H. (2012). Effects of smoking history on selective attention in schizophrenia. Neuropharmacology 62, 1897–1902. doi: 10.1016/j.neuropharm.2011.12.032, PMID: PubMed DOI

Hájková M., Knížková K., Siroňová A., Keřková B., Jonáš J., Šustová P., et al. . (2021). Cannabis use and cognitive performance in patients with first episode schizophrenia spectrum disorder. Cogn. Neuropsychiatry 26, 257–272. doi: 10.1080/13546805.2021.1924649, PMID: PubMed DOI

Hennekens C. H. (2007). Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. J. Clin. Psychiatry 68, 4–7. doi: 10.4088/JCP.0507e12, PMID: PubMed DOI

Herrero P., Contador I., Stern Y., Fernández-Calvo B., Sánchez A., Ramos F. (2020). Influence of cognitive reserve in schizophrenia: a systematic review. Neurosci. Biobehav. Rev. 108, 149–159. doi: 10.1016/j.neubiorev.2019.10.019, PMID: PubMed DOI

Hickling L. M., Perez-Iglesias R., Ortiz-García de la Foz V., Balanzá-Martínez V., McGuire P., Crespo-Facorro B., et al. . (2018). Tobacco smoking and its association with cognition in first episode psychosis patients. Schizophr. Res. 192, 269–273. doi: 10.1016/j.schres.2017.04.018, PMID: PubMed DOI

Hidese S., Matsuo J., Ishida I., Hiraishi M., Teraishi T., Ota M., et al. . (2019). Association between lower estimated premorbid intelligence quotient and smoking behavior in patients with schizophrenia. Schizophr. Res. Cogn. 15, 7–13. doi: 10.1016/J.SCOG.2018.09.003, PMID: PubMed DOI PMC

Hori H., Noguchi H., Hashimoto R., Nakabayashi T., Omori M., Takahashi S., et al. . (2006). Antipsychotic medication and cognitive function in schizophrenia. Schizophr. Res. 86, 138–146. doi: 10.1016/j.schres.2006.05.004 PubMed DOI

Huisman M., Kunst A. E., Mackenbach J. P. (2005). Inequalities in the prevalence of smoking in the European Union: comparing education and income. Prev. Med. (Baltim). 40, 756–764. doi: 10.1016/j.ypmed.2004.09.022, PMID: PubMed DOI

Kay S. R., Fiszbein A., Opler L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr. Bull. 13, 261–276. doi: 10.1093/schbul/13.2.261 PubMed DOI

Kagabo R., Gordon A. J., Okuyemi K. (2020). Smoking cessation in inpatient psychiatry treatment facilities: A review. Addict. Behav. Reports. 11:100255. doi: 10.1016/J.ABREP.2020.100255 PubMed DOI PMC

Kelly D. L., McMahon R. P., Wehring H. J., Liu F., Mackowick K. M., Boggs D. L., et al. . (2011). Cigarette smoking and mortality risk in people with schizophrenia. Schizophr. Bull. 37, 832–838. doi: 10.1093/schbul/sbp152, PMID: PubMed DOI PMC

Kumari V., Soni W., Sharma T. (2001). Influence of cigarette smoking on prepulse inhibition of the acoustic startle response in schizophrenia. Hum. Psychopharmacol. 16, 321–326. doi: 10.1002/hup.286, PMID: PubMed DOI

Lezak M. D., Howieson D. B., Bigler E. D., Tranel D. (2012). Neuropsychological Assessment. 5th Edn. Oxford University Press.

MacKenzie N. E., Kowalchuk C., Agarwal S. M., Costa-Dookhan K. A., Caravaggio F., Gerretsen P., et al. . (2018). Antipsychotics, metabolic adverse effects, and cognitive function in schizophrenia. Front. Psych. 9:622. doi: 10.3389/fpsyt.2018.00622, PMID: PubMed DOI PMC

Manzella F., Maloney S. E., Taylor G. T. (2015). Smoking in schizophrenic patients: a critique of the self-medication hypothesis. World J. Psychiatry 5, 35–46. doi: 10.5498/wjp.v5.i1.35, PMID: PubMed DOI PMC

Matarazzo J. D., Herman D. O. (1984). Relationship of education and IQ in the WAIS--R standardization sample. J. Consult. Clin. Psychol. 52, 631–634. doi: 10.1037/0022-006X.52.4.631 DOI

McGurk S. R., Twamley E. W., Sitzer D. I., McHugo G. J., Mueser K. T. (2007). A meta-analysis of cognitive remediation in schizophrenia. Am. J. Psychiatry 164, 1791–1802. doi: 10.1176/appi.ajp.2007.07060906, PMID: PubMed DOI PMC

Mueser K. T., Deavers F., Penn D. L., Cassisi J. E. (2013). Psychosocial treatments for schizophrenia. Annu. Rev. Clin. Psychol. 9, 465–497. doi: 10.1146/annurev-clinpsy-050212-185620 PubMed DOI

Nelson H. E., Willison J. (1991). National Adult Reading Test (NART) Nfer-Nelson Windsor.

Nuechterlein K. H., Subotnik K. L., Turner L. R., Ventura J., Becker D. R., Drake R. E. (2008). Individual placement and support for individuals with recent-onset schizophrenia: integrating supported education and supported employment. Psychiatr. Rehabil. J. 31, 340–349. doi: 10.2975/31.4.2008.340.349, PMID: PubMed DOI

Riala K., Hakko H., Isohanni M., Pouta A., Räsänen P. (2005). Is initiation of smoking associated with the prodromal phase of schizophrenia? J. Psychiatry Neurosci. 30, 26–32. PubMed PMC

Riccio C. A., Reynolds C. R., Lowe P., Moore J. J. (2002). The continuous performance test: a window on the neural substrates for attention? Arch. Clin. Neuropsychol. 17, 235–272. doi: 10.1016/S0887-6177(01)00111-1, PMID: PubMed DOI

Rodriguez M., Knížková K., Keřková B., Siroňová A., Šustová P., Jonáš J., et al. . (2022). The relationships between cognitive reserve, cognitive functioning and quality of life in first-episode schizophrenia spectrum disorders. Psychiatry Res. 310:114479. doi: 10.1016/J.PSYCHRES.2022.114479, PMID: PubMed DOI

Rodriguez M., Zaytseva Y., Cvrčková A., Dvořaček B., Dorazilová A., Jonáš J., et al. . (2019). Cognitive profiles and functional connectivity in first-episode schizophrenia spectrum disorders - linking behavioral and neuronal data. Front. Psychol. 10:689. doi: 10.3389/fpsyg.2019.00689, PMID: PubMed DOI PMC

Roth M., Hong L. E., McMahon R. P., Fuller R. L. (2013). Comparison of the effectiveness of Conners’ CPT and the CPT-identical pairs at distinguishing between smokers and nonsmokers with schizophrenia. Schizophr. Res. 148, 29–33. doi: 10.1016/j.schres.2013.06.012, PMID: PubMed DOI PMC

Ryan J. J., Sattler J. M., Lopez S. J. (2000). Age effects on Wechsler adult intelligence scale-III subtests. Arch. Clin. Neuropsychol. 15, 311–317. doi: 10.1016/S0887-6177(99)00019-0, PMID: PubMed DOI

Segarra R., Zabala A., Eguíluz J. I., Ojeda N., Elizagarate E., Sánchez P., et al. . (2011). Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis. Eur. Arch. Psychiatry Clin. Neurosci. 261, 241–250. doi: 10.1007/s00406-010-0146-6, PMID: PubMed DOI

Setién-Suero E., Ayesa-Arriola R., Peña J., Crespo-Facorro B., Ojeda N. (2022). Longitudinal effects of cannabis use on attentional processes in patients with first episode of psychosis. Schizophr. Res. 244, 71–80. doi: 10.1016/J.SCHRES.2022.05.011, PMID: PubMed DOI

Stern Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. J. Int. Neuropsychol. Soc. 8, 448–460. doi: 10.7916/D8TQ7D3P, PMID: PubMed DOI

Vaňurová I. (2000). Prevalence kouření v souboru pacientů s 1. epizodou schizofrenie. Česká a Slov. Psychiatr. 96, 402–405.

Vermeulen J., Schirmbeck F., Blankers M., van Tricht M., van den Brink W., de Haan L., et al. . (2019). Smoking, symptoms, and quality of life in patients with psychosis, siblings, and healthy controls: A prospective, longitudinal cohort study. The Lancet Psychiatry. 6 25–34. doi: 10.1016/S2215-0366(18)30424-3 PubMed DOI

Wang D. M., Xia L. Y., Zhou H. X., Tian Y., Dai Q. L., Xiu M. H., et al. . (2023). Smoking affects the association between cognitive impairment and P50 inhibition defects in patients with chronic schizophrenia: a case-control study. Asian J. Psychiatr. 79:103391. doi: 10.1016/J.AJP.2022.103391, PMID: PubMed DOI

Wechsler D. (1997). Wechsler Adult Intelligence Scale. 3rd Edn. The Psychological Association.

Wing V. C., Bacher I., Sacco K. A., George T. P. (2011). Neuropsychological performance in patients with schizophrenia and controls as a function of cigarette smoking status. Psychiatry Res. 188, 320–326. doi: 10.1016/j.psychres.2011.05.037, PMID: PubMed DOI PMC

Winterer G. (2010). Why do patients with schizophrenia smoke? Curr. Opin. Psychiatry 23, 112–119. doi: 10.1097/YCO.0b013e3283366643, PMID: PubMed DOI

Wykes T., Huddy V., Cellard C., McGurk S. R., Czobor P. (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am. J. Psychiatry 168, 472–485. doi: 10.1176/appi.ajp.2010.10060855, PMID: PubMed DOI

Zabala A., Eguiluz J. I., Segarra R., Enjuto S., Ezcurra J., Pinto A. G., et al. . (2009). Cognitive performance and cigarette smoking in first-episode psychosis. Eur. Arch. Psychiatry Clin. Neurosci. 259, 65–71. doi: 10.1007/s00406-008-0835-6, PMID: PubMed DOI

Zeng L. N., Zong Q. Q., Zhang L., Feng Y., Ng C. H., Ungvari G. S., et al. . (2020). Worldwide prevalence of smoking cessation in schizophrenia patients: A meta-analysis of comparative and observational studies. Asian J. Psychiatr. 54:102190. doi: 10.1016/J.AJP.2020.102190 PubMed DOI

Ziedonis D., Hitsman B., Beckham J. C., Zvolensky M., Adler L. E., Audrain-Mcgovern J., et al. . (2008). Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine Tob. Res. 10, 1691–1715. doi: 10.1080/14622200802443569 PubMed DOI