Effects of Nicotine and Smoking on Clinical and Cognitive Deficits Associated With Schizophrenia

Several cross-sectional studies have examined the effects of cigarette smoking on psychotic symptoms in schizophrenic patients (Goff et al. 1992 Hall et al. 1995 Ziedonis et al. 1994). Goff and colleagues found that schizophrenic smokers had higher Brief Psychiatric Rating Scale (BPRS) total scores than schizophrenic nonsmokers, and higher subscale scores for both positive and negative symptoms. Ziedonis and colleagues found increased positive symptom scores and reduced negative symptom scores...

Pharmacology of Nicotine and Tobacco Relevance to Schizophrenia

There has been an increasing understanding of the neurobiology of both schizophrenia and nicotine addiction in the past 20 years. For the purposes of this discussion, nicotine is assumed to be the active ingredient in tobacco and cigarette smoking that exerts psychopharmacological effects, though other components of tobacco smoke may also be active in this respect (Fowler et al. 1996a, 1996b). There are three possible reasons for the high comorbidity rates of nicotine addiction in schizophrenia...

Obesity in Schizophrenia

In the pre-antipsychotic era, Kraepelin noted that some patients with schizophrenia exhibited bizarre eating habits, and not uncommonly were obese. The taking of food fluctuates from complete refusal to the greatest voracity. The body weight usually falls at first often to a considerable degree. . . . L ater, on the contrary we see the weight not infrequently rise quickly in the most extraordinary way, so that the patients in a short time acquire an uncommonly well-nourished turgid appearance...

Conventional Antipsychotic Agents Diabetes and Glucose Intolerance

Conventional antipsychotic agents, which have primarily antidopaminer-gic activity, may alter glucose-insulin homeostasis (Hagg et al. 1998). In particular, the low-potency phenothiazines may induce diabetes mellitus or aggravate existing diabetes mellitus (Hagg et al. 1998 Haupt and Newcomer 2001). Because of this finding, chlorpromazine has been used to prevent hypoglycemia in patients with malignant insulinoma. Furthermore, chlorpromazine has been shown to induce hyperglycemia in healthy...

The Epidemic of Obesity

Obesity and its related sequelae represent a growing epidemic in the United States. Overweight is defined by the World Health Organization as a body mass index (BMI) of 25.0-29.9 kg m2, and obesity as BMI > 30 kg m2. Recent data estimate that more than 50 of U.S. adults are overweight, with 31 of men and 35 of women considered obese, or at least 20 above their ideal body weight (Yanovski and Yanovski 1999). Results of the 1999 National Health and Nutrition Examination Survey (NHANES),...

Cancer

Increased and decreased prevalence rates for different types of cancer among schizophrenic populations have been reported in the literature. Comparisons are made more difficult because some studies focus on death rates and others focus on disease rates. In general, compared with the overall population, there seems to be a pattern of lower rates of lung cancer and higher rates of digestive and breast cancers among schizophrenic populations (Schoos and Cohen 2003). The apparent lower prevalence...

Pharmacological Treatment of Obesity in Schizophrenia

The literature thus far suggests that some of the novel antipsychotic medications cause less weight gain than others thus it may be possible to switch patients on agents associated with the most weight gain to those with lower weight gain liability (Allison et al. 1999a Wirshing et al. 1999) however, prior to switching, it is important to recall that the most difficult symptoms to control are those of psychosis. A switch of antipsychotic medication makes sense particularly if the patient is...

Cocaine and Amphetamines

Cocaine is derived from the coca plant, native to South America, and is typically insufflated nasally (snorted), smoked (in the form of freebase or crack), or injected intravenously. Amphetamines are analogues of naturally occurring ephedrine and have been abused in various forms since their original synthesis in 1887. Currently, -methamphetamine (crystal meth, meth) is the most popular form of amphetamine abused, and in some areas of the country, such as the West Coast, abuse of...

Diabetes and Glucose Intolerance in Schizophrenic Patients in the Preantipsychotic

Early reports dating back to the 1920s, before the use of antipsychotic agents, suggest that individuals with schizophrenia and other psychotic dis orders exhibited an elevated risk for developing glucose intolerance or diabetes mellitus (Braceland et al. 1945 Brambilla et al. 1976 Haupt and Newcomer 2001 Marinow 1971 Schwartz and Munoz 1968 Waitzkin 1966a, 1966b). Specifically, the reports indicate a pattern of insulin resistance in schizophrenic patients independent of adverse medication...

Prostate and Testes

Prolactin normally stimulates cell growth in the prostate gland probably through direct as well as through androgen-mediated mechanisms , although it is unclear what impact hyperprolactinemia may have on the prostate gland in humans. In animal studies high prolactin results in prostate gland inflammation and abnormal cell growth Reiter et al. 1999 . In men benign prostatic hypertrophy is associated with increased prolactin in some but not all studies Saroff et al. 1980 . Prolactin levels...

Mechanisms by Which the Atypical Antipsychotic Agents May Cause Diabetes Mellitus

There are a number of ways in which the atypical antipsychotic medications could lead to hyperglycemia and diabetes mellitus. As discussed earlier in this chapter, decreased sensitivity increased resistance to insulin and decreased insulin secretion as a result of decreased beta cell function are involved in the development of type II diabetes mellitus. A few controlled studies suggest that the atypical antipsychotic medications affect insulin resistance rather than causing a primary defect in...

Patterns of Substance Abuse Among Persons With Schizophrenia

Overall, it is clear that substance use disorders in persons diagnosed with schizophrenia occur more frequently than in the general population however, there is little evidence to suggest that persons with schizophrenia abuse substances for different reasons than the general population. Specifically, the literature demonstrates that patients with schizophrenia do not differentially choose to abuse specific drugs to ameliorate specific psychic states e.g., anhedonia . Multiple studies also...