Tobacco use in first-episode psychosis, a multinational EU-GEI study

BACKGROUND

Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis.

METHODS

The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use.

RESULTS

After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use.

CONCLUSIONS

Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.

Family Conflict and the Use of Conventional and Electronic Cigarettes in Adolescence: the Role of Impulsivity Traits

Adolescents’ use of tobacco is a worldwide problem due to the negative consequences on their physical and psychosocial development. One contextual variable related to tobacco use is family conflict. Previous research has suggested that the relationship between family conflict and tobacco use could be mediated by personality traits. The aim of this study is to examine the direct and indirect effects of family conflict on tobacco use (conventional and electronic cigarettes) through specific impulsivity constructs. The sample comprised 879 adolescents (56.4% male; M(SD)age = 14.25 (1.88) years). Multiple mediational analysis showed that there was no significant direct effect between family conflict and tobacco use; however, an indirect effect was found between family conflict and conventional cigarette use through sensation seeking and premeditation. With electronic cigarettes, a significant indirect effect was found via sensation seeking. These findings have implications in terms of prevention and treatment of tobacco use during adolescence.

Clinical symptoms and personality traits predict subpopulations of treatment-seeking substance users

BACKGROUND

The heterogeneity of treatment-seeking substance users represents a challenge, as most studies include participants having problems with specific substances or merge polysubstance users into the same category without considering differences between profiles. Considering the inconsistent literature on predictors of treatment outcomes, this study aimed to identify subpopulations of individuals with substance use disorders (SUDs) and analyze the association among class membership, previous relapses, and treatment retention.

METHODS

The study recruited a total of 159 participants (mean age = 40.60, SD = 8.70; 85.5% males) from two treatment facilities (outpatient daycare and inpatient residential centers). The baseline assessment gathered lifetime and current substance use, and personality and psychopathology measures. The study performed a latent class analysis to identify subpopulations of substance users and explored predictors of class membership using a multinomial regression analysis.

RESULTS

The study found six different classes of substance users based on their diagnosis and pattern of substance use: class 1 (6.92% of participants): individuals with cannabis as primary substance, alcohol/cocaine as secondary substance and additional use of stimulants or other drugs; class 2 (30.82%): cocaine as primary substance, alcohol as secondary and additional cannabis use; class 3 (20.13%): alcohol as primary substance, cocaine as secondary and additional cannabis use; class 4 (17.61%): cocaine as primary substance, cannabis as secondary and additional alcohol/other drugs use; class 5 (16.35%): alcohol as primary and cannabis as secondary substance; class 6 (8.18%): heroin as primary substance, cocaine as secondary and additional alcohol use. Several traits and clinical symptoms predicted distinct class memberships. Participants pertaining to class 6 presented the highest number of relapses (M = 2.54, SD = 1.56).

CONCLUSIONS

These results have several clinical implications. Belonging to class 6 was associated with a greater number of previous relapses. Also, specific psychopathological symptoms and personality traits may impact SUD treatment response, which may help clinicians to guide initial assessment and treatment allocation.

Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis

BACKGROUND

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

METHODS

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

RESULTS

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively).

CONCLUSIONS

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

Effects of nicotine abstinence on clinical symptoms. Study at 3 and 6-months follow-up of outpatients with schizophrenia

Introduction

Tobacco use has been associated with more excitement and agitation symptoms, greater severity of global psychopathology as measured by the Clinical General Impression (CGI) Scale, and psychotic symptoms in patients with schizophrenia.

Aim

To assess the effects of nicotine abstinence versus nicotine maintenance on the clinical symptoms of a sample of outpatients smokers diagnosed with schizophrenia.

Methods

Sample: 81 outpatients with schizophrenia [72.8% males; mean age (SD) = 43.35 (8.82)] currently smoking tobacco [no. of cigarettes (SD) = 27.96 (12.29)]. Desing: non-randomized, open-label, 6-month follow-up and multi-center study conducted at 3 sites in Spain (Oviedo, Santiago de Compostela and Orense). Instruments: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression for Schizophrenia (CGI-SCH), Hamilton Depression Rating Scale (HDRS). Antropometric measures: Body mass index (BMI) and waist circumference. Vital sings: heart rate. Procedure: Patients were assigned to 2 conditions:

– control group = patients continuing their tobacco use;

– experimental group = patients participated in vareniclina or nicotine patches treatment for smoking cessation.

Patients were evaluated at baseline (all patients smoking) and after 3 and 6 months.

Results

No significant differences (P>.05) were found between groups at baseline evaluation. Likewise, there were no significant differences between smokers and non-smokers after treatment (3 and 6 months follow-up) in their clinical symptomatology (according to PANSS, HDRS and CGI-SCH), anthropometric measures and heart rate.

Conclusions

No significant differences were found in the clinical symptoms after a period of nicotine abstinence. Therefore, clinicians should motivate and help their patients to quit smoking (CIBERSAM - FIS PI11/01891).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Suicide attempts and suicide ideation in adolescents: SDQ scores in the Spanish sample of “saving and empowering young lives in Europe” (SEYLE) project

Introduction

Behaviour disorders in adolescents are a risk factor associated with suicidal behavior.

Aim

To examine the distribution of the Strengths and Difficulties Questionnaire (SDQ) scores in the Spanish sample of adolescents from the “Saving and Empowering Young Lives in Europe” (SEYLE) project and study the differences according to the gender and the relationship with both suicide attempts (SA) and suicidal ideation (SI).

Method

875 pupils from 12 secondary schools sited in Asturias (Spain) [50.7% males; mean age (SD) =14.5 (0.72)] were assessed through the SDQ and Paykel Suicide Scale (PSS).

Results

No significant differences were found in the SDQ total score by gender, but were found (p< 0.001) in some subscales as emotional symptoms (t=-6.769) (women scoring higher), hyperactivity (t=3.283) and prosocial (t=5.260) (men scoring higher). Regarding PSS, 3.1% tried to take their life during past six months. No significant differences were found in SA by gender but were found (p< 0.050) for the thought that life not worth (t=-3.597), women scoring higher, and about wish to be dead (t=-2.630), men scoring higher. Previous SA were significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=25,528), hyperactivity (X2=13,572) and behaviour disorders (X2=7,505). SI was significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=31,077), behaviour disorders (X2=33,011), peer problems (X2=35,161) and prosocial behavior (X2=17,978).

Conclusion

SA and SI were related with difficulties (SDQ criteria), mainly on emotional symptoms and behaviour disorders. Prevention strategies in high risk groups are likely to become increasingly important.

Differences Observed by ASI-6 among users of Alcohol, Cocaine and Opiates

Aim:

To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).

Conclusions:

Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.

Sociodemographic Profile and Clinical Data of Suicide Attempters from the Emergency Room of the Central Hospital of Asturias (Northern Spain)

Objectives:

i.

Method:

1,633 suicide attempters who attended the Emergency Room of the University Central Hospital of Asturias during the period 2003-2005 were included in the study. Evaluation of these patients was made using the WHO/Euro Multicentre Study Protocol. Psychiatric diagnoses were made following ICD-10 criteria.

Results:

Sociodemographic data: mean age (SD) = 38.66 (15.13); females: 62%; single: 39.8%; living with their family: 83.8%; lowest educational level: 67%; economically inactive: 33.8%. More prevalent psychiatric diagnoses were affective disorders (24.1%) and anxiety disorders (21.6%). Previous SA were present in 49.2% and 40% repeat the attempt during the monitoring period. Severity of the attempt (lethality of method and intentionality) was related with repetition of the behaviour during the monitoring period (p = 0.001). More frequent methods were overdose (74.8%) followed by cutting (18.5%).

Conclusions:

SA was more prevalent in a single woman with age between 30 and 50 years who suffering for affective or anxiety disorders. Many of the patients repeat the suicidal behaviour and this was related to the severity of the attempt. Individuals appear to use the methods that are available to them to attempt suicide.

Physical Health of Patients with Drug use Disorders

Aim:

To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).

Conclusions:

Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.