الفهرس 
An Overview on Nicotine DependenceOnly 14 pages are availabe for public view
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Abstract
The nicotine consumption rate is high in the mentally ill and seems to remain high over the last years, in contrast to the decline of smoking prevalence observed in the general population. A recent study has found that prevalence of smoking in adults with any mental disorder was 36.1%, compared to 21.4% in individuals without any mental disorder, but rose significantly (even four to five times higher than the healthy population) in severe or psychotic disorders such as schizophrenia, bipolar disorder, schizoaffective disorder, Posttraumatic Stress Disorder, and substance use disorder (Gogos et al., 2019).
Worldwide statistics have shown that smoking contributes significantly to mortality, with nicotine being more addictive than alcohol, marijuana, or cocaine. Compared to the general healthy population, the prevalence of smoking is found to be much higher among people with psychotic disorders and, among those suffering from schizophrenia, the occurrence of smoking and nicotine dependence is higher than that of both the general population and those with other mental illnesses. Schizophrenic patients who smoke tend to have higher frequency of heavy smoking, with rates ranging from 60% to as high as 80% (Yee et al., 2015).
In addition, they are less likely to quit smoking. Hence, it is not surprising that smokers with psychiatric disorders suffer higher rates of morbidity and mortality secondary to smoking related illnesses. Smoking is the leading preventable cause of morbidity and premature mortality. Cigarette smoking is strongly associated with psychotic disorders such as schizophrenia (Zhang et al., 2012).
For several decades it was assumed that the relationship could be explained by reverse causation; that smoking was secondary to the illness itself, either through self-medication or a process of institutionalization, or was entirely explained by confounding by cannabis use or social factors. However, studies have exposed that such hypotheses cannot fully explain the association, and more recently a bidirectional relationship has been proposed wherein cigarette smoking may be causally related to risk of psychosis, possibly via a shared genetic liability to smoking and psychosis (Quigley and MacCabe, 2019).
Psychosis arises from difficulties establishing what is real and what is not, and is characterized by disordered thinking and speech, hallucinations and delusions, so-called positive psychotic symptoms or experiences. A psychotic disorder constitutes more persistent and pervasive psychotic symptoms, typically alongside a number of other deficits. One of the most severe psychotic disorders is schizophrenia. It has long been acknowledged that there is a strong relationship between cigarette smoking and psychotic disorders. More recently, smoking has also been found to be associated with psychotic experiences in the general population (Bhavsar et al., 2018).
Rates of cigarette smoking in individuals with psychotic disorders are 2–3 times greater than those without. Moreover, tobacco smokers with psychotic disorders display patterns of heavy smoking, severe nicotine dependence and are less likely to quit than nonsmokers. There is an increased risk of tobacco-related morbidity and excess mortality in this population, constituting a major contributor to health inequalities (Jones et al., 2018).
Aim and objectives:
The aim of the study was to compare the severity of psychotic symptoms in both groups of patients with psychotic disorders (who have nicotine dependence and patients who don’t smoke), and to investigate the relation between the intensity of nicotine dependence and the severity of psychotic symptoms in the case group (patients with psychotic disorders who are nicotine dependent).
Subjects and methods:
This was a case control analytical study conducted on 52 patients diagnosed with psychosis according to the DSM-IV diagnostic criteria (via SCID-I) who were admitted at Al Khanka Mental Hospital before July 2019 at Al Khanka Mental Hospital, Egypt.
from each patient the following data had been collected upon admission
A predesigned clinical sheet including the sociodemographic data
Psychometric assessment: Structured Clinical Interview for DSM-IV Axis I Disorders - Clinician Version (SCID I-CV), Positive and Negative Syndrome Scale (PANSS), and The Fagerstrom Test for Cigarette Dependence (FTCD)
Statistical Analysis:
Collected data were recorded then presented and analyzed statistically using SPSS version 20 (SPSS Inc. Chicago, IL, U.S.A).
The main findings of the study revealed that:
Among the studied cases; the mean age 34.46 (±9.57 SD) and range (20-50) years, there were 4 (15.4%) single, 14 (53.8%) married, 5 (19.2%) widower and 3 (11.5%) divorced, there were 9 (34.6%) primary educated, 9 (34.6%) secondary educated and 5 (19.5%) university graduate, and 2 (7.7%) not working and there were 14 (53.8%) urban residents and 12(46.2%) rural residents.
In the control group; the mean age 35.85 (±8.7 SD) and range (20-50) years, there were 7 (26.9%) single, 13 (50%) married, 3 (11.5%) widower and 3 (11.5%) divorced, there were 6 (23.1%) primary educated, 11 (42.3%) secondary educated and 6 (23.1%) university graduate, there were 1 (3.8%) not working and there were 9 (34.6%) urban residents and 17 (65.4%) rural residents.
Among the studied cases 20 (76.9) are on traditional antipsychotics, 10 (38.5) are taking antipsychotic twice daily,15 (57.7) diagnosed Schizophrenia and 18 (69.2) are psychotic for 2 years.
In the control group 18 (69.2) are on traditional antipsychotics, 10 (38.5) are taking antipsychotic once daily, 16 (61.5) diagnosed Schizophrenia and 15 (57.7) are psychotic for 2 years.
regarding case group using Fagerström severity index scale there is 19 (73.1%) cigarettes smokers, 7 (26.9%) shisha smokers,17 (65.4%) smoking more than 3 times, 9 (34.6%) smoking for less than 2 years, 9 (34.6%) smoking for more than 5 years and according to cause of smoking in 11 (42.3%) was habit, 4 (15.4%) was bearship, 11(42.3%) was curiosity.
Among the cases 10 (38.5%) with age between 20-30 and 10 (38.5%) with age between 41-50 years while in control group 10 (38.5%) with age between 41-50, in the cases 14 (53.8%) married while in control group 13 (50%) married, in the cases 9 (34.6%) primary educated and 9 (34.6%) secondary educated while in control group 11 (42.3%) secondary educated, in the cases 10 (38.5%) professional while in control group 11 (42.3%) professional and in the cases 14 (53.8%) urban residents while in control group 17 (65.4%) rural residents. So, there is no statistically significant difference between cases and controls as regards age, marital status, education, occupation and residence
Among the studied cases 20 (76.9) are on traditional antipsychotics while in control group 18 (69.2) are on traditional antipsychotics, in the studied cases 10 (38.5) are taking antipsychotic twice daily while in control group 10 (38.5) are taking antipsychotic once daily, in the studied cases 15 (57.7) diagnosed Schizophrenia while in control group 16 (61.5) diagnosed Schizophrenia and in the studied cases 18 (69.2) are psychotic for 2 years while in control group 15 (57.7) are psychotic for 2 years. So, there is statistically significant difference between cases and controls as regards Dose of antipsychotics. And there is no statistically significant difference between cases and controls as regards Type of antipsychotics, SCID I results for psychosis spectrum and Duration of psychosis
There is 19 (73.1%) cigarettes smokers, 7 (26.9%) shisha smokers, 1 (3.8%) smoking once a day, 4 (15.4%) smoking twice a day, 4 (15.4%) smoking 3 times, 17 (65.4%) smoking more than 3 times, 9 (34.6%) smoking for less than 2 years, 8 (30.8%) smoking for 2-5 years, 9 (34.6%) smoking for more than 5 years, according to cause of smoking in 11 (42.3%) was habit, 4 (15.4%) was bear ship, 11(42.3%) was curiosity and mean of Fagerström Test for Cigarette Dependence 5.81 ( ± 2.0 SD).
the positive scale are higher in cases than the control group while in the negative scale, general psychopathology scale and composite scale the control group are higher than the cases. So, there is statistically significant difference between cases and controls groups as regards positive scale, negative scale, general psychopathology and composite scale.
There was strong positive correlation between frequency of smoking with presence of positive and negative symptoms and number of symptoms listed by DSM-IV in cases group with significance.
There is correlation between duration of smoking with presence of positive and negative symptoms and number of symptoms listed by DSM-IV in cases group.
There is strong positive correlation between Fagerström Test for Cigarette Dependence with presence of positive and negative symptoms and number of symptoms listed by DSM-IV in cases group with high significance.
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.