6.7Clinical populations

Last updated: January 2018

Suggested citation: Christensen, D. 6.7 Clinical populations. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from http://www.tobaccoinaustralia.org.au/chapter-6-addiction/6-7-clinical-populations

Smoking tobacco is closely related to the development and incidence of various psychiatric disorders.1 Daily tobacco use is associated with an increased likelihood of psychiatric disorders and an early onset of psychiatric illnesses;2 for example, there are very high rates of smoking among people with schizophrenia.3 These associations also appear to have some intergenerational effects. For example, some evidence suggests there is a relationship between maternal smoking and increased risk for ADHD.4  

Smoking also appears to be associated with cognitive decline in dementia disorders and the development of Alzheimer disease.5 One study found that when images of brain structures of healthy elderly subjects were compared to images of Alzheimer patients, both healthy smokers and mildly cognitively impaired Alzheimer patients had smaller basal forebrain volumes,6 a measure of brain region size that is a predecessor and predictor of Alzheimer’s disease.7

However, there is also evidence to suggest that nicotine can result in improved clinical outcomes for ADHD smokers and non-smokers.8 Similarly, epidemiological studies have indicated a link between smoking and a decreased incidence of Parkinson’s disease,9 which is correlated with smoking intensity and duration.10 Researchers suggest a possible explanation is that nicotine activates nAChRs which protects the dopaminergic integrity and neuronal pathways against degenerative Parkinsonian toxicities10 — see Chapter 3, Section 3.28.2 for further information.  


Relevant news and research

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1. Prochaska JJ. Smoking and mental illness--breaking the link. New England Journal of Medicine, 2011; 365(3):196–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21774707

2. Gurillo P, Jauhar S, Murray R, and MacCabe J. Does tobacco use cause psychosis? Systematic review and meta-analysis. The Lancet: Psychiatry, 2015; 2:718–25. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698800/

3. Jiang J, See Y, Subramaniam M, and Lee J. Investigation of cigarette smoking among male schizophrenia patients. PLoS ONE, 2013; 8:e71343. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23977021

4. Sciberras E, Mulraney M, Silva D, and Coghill D. Prenatal risk factors and the etiology of adhd-review of existing evidence. Current Psychiatry Reports, 2017; 19(1):1. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28091799

5. Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, et al. Epidemiologic studies of modifiable factors associated with cognition and dementia: Systematic review and meta-analysis. BMC Public Health, 2014; 14(643):643. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24962204

6. Durazzo T, Insel P, and Weiner M. The Alzheimer disease neuroimaging initiative. Greater regional brain atrophy rate in healthy elderly subjects with a history of cigarette smoking. Alzheimer’s & Dementia, 2012; 8:513–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23102121

7. Schmitz T and Spreng N. The Alzheimer’s disease neuroimaging initiative. Basal forebrain degeneration precedes and predicts the cortical spread of Alzheimer’s pathology. Nature Communications, 2016; 7(13249). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27811848

8. Levin ED, Conners CK, Sparrow E, Hinton SC, Erhardt D, et al. Nicotine effects on adults with attention-deficit/hyperactivity disorder. Psychopharmacology (Berl), 1996; 123(1):55–63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8741955

9. Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, and Mandel J. Epidemiology and etiology of Parkinson's disease: A review of the evidence. European Journal of Epidemiology, 2011; 26 Suppl 1:S1–58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21626386

10. Quik M, Perez X, and Bordia T. Nicotine as a potential neuroprotective agent for Parkinson’s disease. Movement Disorders, 2012; 27:947–57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22693036