Estudio descriptivo del consumo tabáquico en pacientes con diagnóstico de primer episodio psicótico

Abstract

Introduction: Schizophrenia is a serious mental disorder with significant cognitive dysfunction. A first psychotic episode (FEP) consists of the abrupt or gradual onset of a set of psychotic symptoms for the first time in life. In patients diagnosed with schizophrenia, medical comorbidity with other pathologies is common, as is a consequent lower life expectancy. The main natural causes of mortality result from respiratory, cardiovascular, cerebrovascular diseases, and neoplasms, with lung cancer being the most frequent. Half of the years of life lost are due to tobacco consumption, which is the most common substance abuse disorder. Smoking rates are directly associated with the degree of pathology and functionality. To explain the relationship between schizophrenia and high smoking rates, studies suggest that consumption is considered a combination of various biological and psychosocial factors. Objectives: to descriptively evaluate tobacco consumption among patients presenting with a first psychotic episode. Materials and methods: observational study conducted within the ITPCan Program, part of the Psychiatry Service at HUMV. 206 participants (99 smokers and 107 non-smokers) with a confirmed diagnosis of FEP within the schizophrenia spectrum disorder. Validated questionnaires and scales administered by trained clinical specialists. Descriptive univariate analysis of the clinical and analytical variables studied was used. Pearson's Chi-Square test, Student's T-test, one-way ANOVA was used. Statistical analyses were performed using the SPSS. All statistical tests were two-tailed, and significance was determined at the 0.05 level. Results and discussion: Among patients with psychosis who were born abroad, there was a lower proportion of smokers (82 vs. 77; p = 0.04). A higher number of cannabis users was observed in the group of smokers compared to non-smokers (45.4% vs. 9.3%, p < 0.001). Being a smoker at the onset of the psychotic episode is significantly associated with the use of other substances (p < 0.001). Regarding risk perception, smokers perceived a lower risk of tobacco use as well as cannabis use (p < 0.05). Longitudinal Differences (3 Months) Smokers showed smaller decreases in all clinical scales, with statistically significant for the PANSS general scale (-14.92 vs. 10.73, p= 0.051). Conclusion: Tobacco interacts with a wide range of psychotropic medications increasing the metabolism of several psychotropic drugs and reducing their plasma concentrations and clinical effectiveness. DUP tends to be longer in smokers compared to non-smokers. Smokers with FEP have a higher prevalence of cannabis and other substance use, as well as earlier and more intense use. There is an interaction between nicotine and THC and -OH, which can enhance the pleasurable effects of these substances and have significant implications for clinical management. These patients have a lower perception of the risk associated with substance use. Smoking rates are related to the severity of the pathology.