Lighting Up: Why do Schizophrenia Patients Smoke?

By Gary Goldman

Brain normalcy is something most people take for granted.

Waking up in the morning, pouring a cup of coffee, looking at a calendar to plan the day – these are all simple routines that require us to perceive the world in a linear continuum in which the pieces of our lives fit together. 

But people with mental illnesses like schizophrenia do not often perceive their world in that fashion. Too many times, they perceive simple gestures like a “Good morning” greeting as a threat, or somehow containing a hidden agenda. They do not enter the day or see the world the way most people do, which leads to many seeking treatment, usually involving pharmaceutical medications.

But these medications often come at a price, according to Dr. Laxminarayan Bhat, PhD, founder, president and chief executive officer of Reviva Pharmaceuticals (NASDAQ: RVPH), a clinical-stage pharmaceutical company that discovers, develops and seeks to commercialize therapeutics for diseases like Schizophrenia.

“The side effects of the primary medications being prescribed to schizophrenia patients can be severe,” Dr. Bhat said. “Mood swings, weight gain, even hormonal changes leading to  enlargement of breasts in male patients have been known to occur. As a consequence of the side effects, coupled with the symptoms of the disease itself, many patients have a tendency to self-medicate. And that’s where circumstances can become quite dangerous.”

Nicotine, alcohol, cocaine, cannabis, and even harder illegal drugs can be attractive to schizophrenia patients, as they might be more biologically vulnerable to the rewarding temporary effects of illicit drug use, according to a 2003 study from the Université de Montréal, Clinique Cormier-Lafontaine. According to AddictionCenter.com,. an estimated 50 percent of individuals suffering from schizophrenia have a history of substance abuse.

In fact, people with schizophrenia smoke up to three times more than the general population and more than most psychiatric populations, based on reports from Brainfacts, a public information initiative of The Kavli Foundation, the Gatsby Charitable Foundation, and the Society for Neuroscience – global nonprofit organizations dedicated to advancing brain research.

“Schizophrenia patients who smoke also have higher levels of nicotine in their bodies because they tend to extract more nicotine per cigarette than other smokers,” Brainfacts reports.“Schizophrenia and addiction, or substance use disorder (SUD), can often co-occur., and their unique smoking behaviors have led scientists to believe that nicotine, the addicting substance in tobacco, may represent a form of self-medication, normalizing some central nervous system deficits involved in the disorder.”

The report also says nicotine and its brain receptors—proteins on the surface of cells that receive chemical messages—are keys to understanding the links between smoking and schizophrenia. Already, research has revealed that:

Finally, the Brainfacts report concluded that receiving nicotine through a skin patch reversed the cognitive slowing associated with haloperidol, a common drug for schizophrenia. 

“Nicotine may improve lack of motivation and indifference in this population as well,” the report stated. “However, it remains unclear if nicotine minimizes hallucinations and delusions, and some studies have reported that people with schizophrenia who quit smoking did not experience worsening of their symptoms.”

While the scientific community still seems split on the connection between smoking and schizophrenia patients, Dr. Bhat is convinced.

“Cognitive ability in schizophrenia patients actually gets a short boost from nicotine,” Dr. Bhat added. “That boost is incredibly short-lived, barely lasting the amount of time it takes to smoke the cigarette, but it’s a few minutes of normalcy that schizophrenia patients rarely get to enjoy.“