Cigarette smoking, manifest anxiety and somatic symptoms

Relationship satisfaction determines the association between Epstein-Barr virus latency and somatic symptoms after the loss of a spouse

The loss of a spouse is associated with a host of negative health outcomes. While bereaved individuals commonly report somatic symptoms, no investigations exist of the association between reactivation of latent Epstein-Barr virus (EBV) and somatic symptoms among this population. Further, how an individual perceives the quality of their lost relationship in retrospect may impact loss outcomes. Among 99 bereaved spouses, elevated EBV antibody titers were associated with somatic symptoms for those who retrospectively reported high or mean levels of relationship satisfaction (RS), but not among those less satisfied. Further, higher RS was associated with greater grief symptoms. This study identifies higher retrospective RS as a possible risk factor for negative physical and mental health outcomes during bereavement.

Cigarette smoking in subjects maintained with methadone or buprenorphine: The role of psychiatric symptoms and psychological distress

OBJECTIVE

The relationship between cigarette smoking, psychiatric symptoms/psychological distress in subjects maintained with methadone or buprenorphine was studied.

METHODS

1049 subjects with a diagnosis of heroin use disorder were enrolled. The Symptom Checklist-90-Revised (SCL-90-R) and the General Health Questionnaire-12 (GHQ-12) were administered. The analyses were run in the whole sample and stratified for substitution therapies.

RESULTS

In the whole sample as well as among subjects maintained with methadone, the number of cigarettes smoked daily was associated with SCL-90-R Global score (whole sample: p = 0.001; ΔR² = 0.012; subjects maintained with methadone: p ≤ 0.001; ΔR² = 0.019) and with GHQ-12 (whole sample: p = 0.001; ΔR² = 0.013; subjects maintained with methadone: p = 0.01; ΔR² = 0.010) while among subjects maintained with buprenorphine, the number of cigarettes smoked daily was associated with SCL-90-R Global score (p = 0.05; ΔR² = 0.020).

CONCLUSION

Psychiatric symptoms were associated with the number of cigarettes smoked daily among subjects maintained with methadone and among those maintained with buprenorphine, thus deserving clinical attention.

Tobacco-Free Cigarette Smoke Exposure Induces Anxiety and Panic-Related Behaviours in Male Wistar Rats

Smokers, who generally present with lung damage, are more anxious than non-smokers and have an associated augmented risk of panic. Considering that lung damage signals specific neural pathways that are related to affective responses, the aim of the present study was to evaluate the influence of pulmonary injury on anxiety and panic-like behaviours in animals exposed to cigarette smoke with and without tobacco. Male Wistar rats were divided into the following groups: a control group (CG); a regular cigarette group (RC); and a tobacco-free cigarette (TFC) group. Animals were exposed to twelve cigarettes per day for eight consecutive days. The animals were then exposed to an elevated T-maze and an open field. The RC and TFC groups presented increases in inflammatory cell inflow, antioxidant enzyme activity, and TBARS levels, and a decrease in the GSH/GSSG ratio was observed in the TFC group. Exposure to RC smoke reduced anxiety and panic-related behaviours. On the other hand, TFC induced anxiety and panic-related behaviours. Thus, our results contradict the concept that nicotine is solely accountable for shifted behavioural patterns caused by smoking, in that exposure to TFC smoke causes anxiety and panic-related behaviours.

Applying the tripartite model of anxiety and depression to cigarette smoking: an integrative review

INTRODUCTION

Research on the relationship between emotional disorders and smoking often characterizes anxiety and depression at the broad syndrome level. Because of the complex concordance and discordance across and within anxiety and depressive symptoms, research using this approach may be limited. Watson and Clark developed the tripartite model of anxiety and depression, which identifies negative affect (NA), anhedonia and low positive affect (PA), and anxious arousal (AA) as traits that characterize the underlying heterogeneity in emotional symptoms. An emerging literature has examined the relation between the affective constructs in the tripartite model and smoking; however, these findings have not been summarized and integrated. The aim of this report reviews the literature on the association between tripartite affective dimensions (anhedonia and low PA, NA, and AA) and smoking variables (smoking status, heaviness, chronicity, dependence, cessation, craving/urge).

METHODS

Qualitative summarization and integration of findings.

RESULTS

All three dimensions were consistently associated with smoking status but demonstrated mixed or no relationship with smoking heaviness, chronicity, and dependence. Low PA and anhedonia consistently associated with craving and relapse, even in studies that controlled for other dimensions. Emotional disturbance on multiple dimensions (e.g., low PA + high NA) was associated with disproportionate increases in smoking risk in several studies.

CONCLUSIONS

Tripartite dimensions may each have differential effects on smoking. Anhedonic and low PA individuals (especially those with concurrent NA or AA) may be a high-risk group worthy of targeting for interventions. Continued research of the affective dimensions linked with smoking could inform the etiology of tobacco dependence and lead to more effective smoking interventions that target affect.

Negative affectivity in smokers applying to smoking cessation clinics: a case-control study

OBJECTIVE

The objective of this study was to assess whether subjects applying to smoking cessation clinics display a higher level of affective symptoms than smokers recruited from the general population.

METHODS

The study was conducted according to a cross-sectional, case-control design. Cases were smokers applying to public smoking cessation clinics for the first time and controls were smokers recruited from the general population. Socio-demographic data and clinical information were collected. Self- (Hospital Anxiety Depression Scale, Beck Depression Inventory, State-Trait Anxiety Inventory) and hetero-administered (Montgomery Asberg Depression Rating Scale, Hamilton Anxiety scale) rating scales were used to assess anxious and depressive symptoms. Nicotine dependence was measured via a self-administered questionnaire (Fagerström Tolerance Questionnaire).

RESULTS

Sixty-eight cases were recruited, individually matched, and compared to controls. Overall, cases had significantly higher scores than controls when the rating scales assessing anxious and depressive symptoms were evaluated.

CONCLUSIONS

Smokers applying to smoking cessation clinics for the first time have a higher level of negative affectivity than smokers from the general population. An evaluation of the level of negative affectivity could be introduced into clinical practice to have a complete assessment of the patient. We propose adding psychological or pharmacological support to complement the smoking cessation program.

Compulsive behavior in tobacco users

Addictions have been associated with compulsive behaviors, which serve to reduce emotional distress. Tobacco use has been associated with increased adverse moods such as anxiety. Nicotine has established anxiolytic effects through modulation of central neurotransmitters, including monoamines. Both obsessive-compulsive behaviors and tobacco use have both been associated with dysfunction in orbitofrontal-subcortical circuits. This study demonstrated greater intensity of compulsive behaviors (as measured by the Yale-Brown Obsessive Compulsive Scale [Y-BOCS]) in tobacco users compared to nonusers, which was not due to demographic influences or use of other psychoactive drugs. Both the frequency of tobacco use and level of overall emotional distress correlated positively with the severity of compulsive symptoms. The results are consistent with tobacco use as a form of self-medicating compulsive symptoms, likely through monoamine modulation of orbitofrontal-subcortical circuits.

Trait anxiety and nicotine dependence in adolescents: a report from the DANDY study

The Revised Children's Manifest Anxiety Scale (RCMAS) and the Hooked on Nicotine Checklist (HONC) were used to measure trait anxiety and tobacco dependence in a population of 581 adolescents. Smokers demonstrated higher mean RCMAS scores (9.3, S.D.=6.5) than nonsmokers did (7.4, S.D.=6.2, t=-3.7, P<.001). Participants with symptoms of tobacco dependence had higher RCMAS scores (mean=11.6, S.D.=6.0, n=115) than did the participants without symptoms (mean=7.8, S.D.=6.0, n=177, t=-5.3, P<.001). Scores on the RCMAS and the HONC correlated positively (n=292, r=.32, P<.001). Participants who had felt relaxed in response to their first exposure to nicotine were also more likely to develop dependence and to report that stress caused cravings or a need to smoke. Trait anxiety and relaxation in response to the first dose of nicotine were unrelated and appear to be independent risk factors for the development of nicotine dependence and a reliance on tobacco to cope with stress.

Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking

This transdisciplinary review of the literature addresses the questions, Do stress and negative affect (NA) promote smoking? and Does smoking genuinely relieve stress and NA? Drawing on both human and animal literatures, the authors examine these questions across three developmental stages of smoking--initiation, maintenance, and relapse. Methodological and conceptual distinctions relating to within- and between-subjects levels of analyses are emphasized throughout the review. Potential mechanisms underlying links between stress and NA and smoking are also reviewed. Relative to direct-effect explanations, the authors argue that contextual mediator-moderator approaches hold greater potential for elucidating complex associations between NA and stress and smoking. The authors conclude with recommendations for research initiatives that draw on more sophisticated theories and methodologies.

Panic disorder and cigarette smoking behavior

Smoking has been discussed both as a risk factor for panic disorder and as a contributing factor to elevated cardiovascular risk in panic disorder patients. Smoking habits and their association with panic disorder were studied in a sample of 102 panic disorder patients. Both for female and for male patients, rates of smokers and of exsmokers were substantially higher than in the general population. However, a surprisingly high number of patients had succeeded in reducing or quitting cigarette smoking because of their panic disorder, although they experienced little benefit in regard to panic symptoms from doing so. We conclude that the motivation for changing smoking habits is high in this population with elevated smoking prevalence and should be taken into consideration by therapists.

Factors influencing smoking cessation in patients with coronary artery disease

The purpose of this paper is to review the sociodemographic, clinical, and psychological characteristics suggested as being predictors of difficulty with smoking cessation in patients with coronary artery disease. These characteristics include age, gender, socioeconomic status, social support, intensity of smoking, severity of coronary artery disease, anxiety, depression, hostility/anger/aggression, and health locus of control. In addition, nicotine addiction is discussed as a factor which may further compound this problem. Consideration of these factors in relation to the patient with coronary artery disease may assist in the delivery of an optimal and individualized intervention program to facilitate sustained smoking cessation. A brief overview of intervention strategies is provided.

Depressive, not anxiety, symptoms are associated with current cigarette smoking among university internal medical patients

To investigate the relationship between symptoms of anxiety and current cigarette smoking, the authors conducted a cross-sectional survey of internal medicine outpatients. The participants completed a questionnaire that contained the Sheehan Patient-Rated Anxiety Scale, as well as several demographic, substance use, and medical questions. Of the 471 persons asked to participate, 370 (78.5%) agreed. The current smokers scored statistically higher on the anxiety scale than the nonsmokers (P = 0.009). For a subset of depressive questions, the smokers scored higher than the nonsmokers (P = 0.005). When subjected to univariate and multivariate analyses, only the depressive symptoms (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.34-1.43) and amount of caffeine intake (OR = 1.84, 95% CI = 1.28-2.650) were significantly related to current smoking. The authors conclude that among patients attending a university's internal medicine clinic, current depressive symptoms and amount of caffeine intake were significantly related to current cigarette use. Symptoms of anxiety were not related to current cigarette smoking.

Caffeine and nicotine: a review of their joint use and possible interactive effects in tobacco withdrawal

There is a strong, significant relationship between coffee consumption and smoking. In six epidemiological studies reviewed and analyzed here, 86.4% of smokers consumed coffee versus 77.2% of nonsmokers. Exsmokers use more coffee than nonsmokers but somewhat less than smokers. Seventeen experimental studies suggest that the pharmacologic effect of caffeine in coffee may be partially but not totally responsible for the relationship. Conditioning, a reciprocal interaction (caffeine intake increases anxiety/arousal--nicotine decreases it), or joint effect of a third variable (e.g., stress, alcohol) may account for the relationship. In abstinent smokers, blood caffeine levels increase and remain elevated for as long as 6 months. These higher caffeine plasma levels may be sufficient to produce caffeine toxicity syndrome. A review of 86 studies of nicotine withdrawal, caffeine withdrawal, and caffeine toxicity suggests that the symptoms are similar enough to be confused, and that reported nicotine withdrawal symptoms may be a mixture of nicotine withdrawal and caffeine toxicity.

Smoking in patients with panic disorder

We compared smoking prevalence in 217 patients with panic disorder with that in 217 age- and sex-matched control subjects who were obtained by telephone survey from the same neighborhoods. Data were obtained for current smoking habits and smoking status at either the onset of illness (patients) or 10 years previously (control subjects). Patients had been ill for 10.6 (SD = 10.0) years. Female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% vs. 35%). The current smoking prevalence for female patients was also significantly higher than that of control subjects (40% vs. 25%). Male smoking rates did not differ between patients and control subjects. Caffeine use did not appear to explain these findings. These data suggest a link between smoking behavior and panic disorder in women.