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      Nicotine dependence in Croatian male inpatients with schizophrenia

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          Patients with schizophrenia have the highest known rates of cigarette smoking, but less is known about their smoking behavior and the differences across geographical regions, including Croatia.

          The aim of this study was to compare patterns of nicotine dependence between patients with schizophrenia and healthy individuals, and to determine the relationship between clinical presentation and the severity of smoking.


          This cross-sectional study included 182 recently hospitalized male inpatients and 280 healthy males, who were daily smokers. All participants have fulfilled the Fagerstrom Test for Nicotine Dependence (FTND). Patients were also evaluated by the Positive and Negative Syndrome Scale (PANSS).


          Patients had higher FTND total score ( p = 0.010), smoked their first cigarette earlier in the morning ( p = 0.000), consumed higher number of cigarettes ( p = 0.000), while healthy subjects had more difficulties to refrain from smoking in places where it is forbidden ( p = 0.000) and smoked more even when they were sick ( p = 0.000). While severe dependence was more prevalent in the patient group, light dependence was more frequent in control subjects ( p = 0.04). Smoking behavior was not associated with either PANSS total score or any of its subscales and items.


          Smokers with schizophrenia differ from healthy smokers in both smoking behavior and level of dependence. Longitudinal studies are needed to shed more light on the complex relationship between smoking and psychopathology in schizophrenia.

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          Most cited references 46

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          The positive and negative syndrome scale (PANSS) for schizophrenia.

          The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
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            A comparison of the Fagerström Test for Nicotine Dependence and smoking prevalence across countries.

            To examine the correlation between the Fagerström Test for Nicotine Dependence (FTND) score and smoking prevalence across countries. Cross-sectional study. Fifteen studies from 13 countries with FTND score data. Samples of smokers were identified through systematic literature searches, web queries and colleagues. Smokers were considered representative of their country's smoking population if they were drawn from population-based sources, were not seeking smoking cessation treatment and did not have significant comorbidities. Smoking prevalence data were derived from the study itself or the country's population rate of daily smoking for the study year. A Pearson correlation coefficient was used to examine the direction and magnitude of the correlation between FTND score and smoking prevalence across countries. FTND scores ranged from 2.8 to 4.6. Smokers in Germany and Norway had the lowest FTND scores, while smokers in Sweden and the United States had the highest FTND scores. The prevalence of daily smoking in these countries was very different: 37% and 30% in Germany and Norway, 19% and 16% in the United States and Sweden, respectively. An inverse correlation towards higher FTND scores in countries with lower smoking prevalence was found (r=-0.73, P=0.001). Current smokers had higher FTND scores than former smokers. The significant inverse correlation between FTND score and smoking prevalence across countries and higher FTND score among current smokers supports the idea that remaining smokers may be hardening. Less dependent smokers may quit more easily and remaining dependent smokers may need more intensive treatment.
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              Tobacco smoking among people living with a psychotic illness: the second Australian Survey of Psychosis.

              The aims of this study were to (a) describe patterns of tobacco smoking among Australians living with a psychotic illness and (b) explore the association between smoking and measures of psychopathology, psychiatric history, psychosocial functioning, physical health, substance use and demographic characteristics. Data were from 1812 participants in the 2010 Australian Survey of High Impact Psychosis. Participants were aged 18-64 years and resided in seven mental health catchment sites across five states of Australia. Bivariate statistics were used to compare smokers with non-smokers on the measures of interest, and to compare ICD-10 diagnostic categories on measures of smoking prevalence, nicotine addiction and quitting history. Multivariate logistic regression was used to test whether (a) demographics and psychiatric history were associated with having ever smoked and (b) whether symptoms and psychosocial functioning were independently associated with current smoking, after controlling for demographics, psychiatric history and substance use. The prevalence of current tobacco smoking was 66.6% (72% of men and 59% of women); lifetime prevalence was 81%. In univariate analyses, individuals with a diagnosis of schizophrenia or schizoaffective disorder were most likely to be smoking tobacco (70%) and were more nicotine dependent. Smokers reported worse perceived physical health, lower body mass index and waist circumference, and more lifetime medical conditions. A younger age of illness onset, male gender and low education were associated with having ever smoked. Associations with current smoking included low education, male gender, no formal employment, worse negative symptoms, higher daily caffeine consumption, and alcohol dependence and substance abuse/dependence. The prevalence of tobacco smoking is high amongst people with a psychotic disorder, and is associated with adverse mental health symptoms as well as high rates of other substance use, poorer subjective physical health, and a higher risk of the many known health consequences of smoking.

                Author and article information

                0038512388386 ,
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                22 January 2018
                22 January 2018
                : 18
                [1 ]ISNI 0000 0001 0657 4636, GRID grid.4808.4, School of Medicine, , University of Zagreb, ; Zagreb, Croatia
                [2 ]ISNI 0000 0004 0397 9648, GRID grid.412688.1, Department of Psychiatry, , University Hospital Center Zagreb, ; Kišpatićeva 12, 10 000 Zagreb, Croatia
                [3 ]ISNI 0000 0001 1015 399X, GRID grid.412680.9, School of Medicine, , University of Osijek, ; Osijek, Croatia
                [4 ]ISNI 0000 0001 0741 1142, GRID grid.413034.1, School of Medicine, , University of Mostar, ; Mostar, Bosnia and Herzegovina
                [5 ]Psychiatric Clinic Vrapče, Zagreb, Croatia
                [6 ]Department of Psychiatry, General Hospital Vinkovci, Vinkovci, Croatia
                [7 ]ISNI 0000 0000 8744 8924, GRID grid.268505.c, Department of Clinical Psychology and Psychiatry, , Zhejiang University College of Medicine, ; Hangzhou, China
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef, Sveučilište u Zagrebu;
                Award ID: BM1.45
                Research Article
                Custom metadata
                © The Author(s) 2018

                Clinical Psychology & Psychiatry

                ftnd, schizophrenia, smoking behavior, nicotine dependence


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