What is it about?

Many people, including some psychiatrists, seem to think that tobacco smoking helps people with schizophrenia, a serious mental illness, to control their symptoms or to reduce the side effects of the medications they take. This is called the 'self-medication hypothesis'. This could be the reason why people with schizophrenia smoke much more than people without mental illnesses. They seem to smoke more than people with other mental illnesses, too. However, this article tell us this is probably not the case. It also reveals how the tobacco industry worked in a very crafty way to make us believe that that it is the case. The authors examine the possibility that the genes of certain people are such that these genes predispose them to develop tobacco smoking as well as schizophrenia later in life. So, neither tobacco smoking causes schizophrenia, nor schizophrenia causes tobacco smoking, just that both happen because of same problematic genes. This is called the 'shared genetic vulnerability hypothesis'. The authors reject this hypothesis as well. The most important finding the authors bring to our notice through this article is that the tobacco smoke may actually "cause" schizophrenia. If you put it in scientific terms, tobacco smoking seems to increase our vulnerability to develop schizophrenia. Few powerful research studies are highlighted and analysed by the authors to strongly suggest this hypothesis. If tobacco smoke is a causative factor for schizophrenia, then what needs to happen is to get people with schizophrenia to quit smoking. And, perhaps more importantly, to urge young people not to smoke if they do not want to increase their risk of developing schizophrenia.

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Why is it important?

Many psychiatrists and other mental health specialists seem to accept the 'self-medication' hypothesis uncritically. It has been there for so long, well sponsored by the deceitful tobacco industry. It is time to break the shackles and put your biases away and take a fresh, critical, scientific look at the connection between tobacco smoking and schizophrenia. The association between the two is so strong that we should have done this long ago.

Perspectives

Dr. Diyanath Samarasinghe brought to my attention the fact that there are well-designed scientific studies that suggest tobacco smoke is a major risk factor for development of schizophrenia. I felt that this is going to cause a paradigm shift. Then I contacted Dr. Amila Isuru, who was very much interested in this, and that was the beginning of this paper three years ago. So, what you read is our work of three long years, the beginning of a paradigm shift in the way we look at tobacco smoking and schizophrenia.

Dr. Mahesh Rajasuriya
University of Colombo

Read the Original

This page is a summary of: Tobacco smoking and schizophrenia: re-examining the evidence, BJPsych Advances, June 2019, Royal College of Psychiatrists,
DOI: 10.1192/bja.2019.33.
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