Middle East Current Psychiatry

ASSOCIATION BETWEEN COGNITIVE DYSFUNCTION AND NICOTINE

DEPENDENCE IN SCHIZOPHRENIA
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Full Title: ASSOCIATION BETWEEN COGNITIVE DYSFUNCTION AND NICOTINE

DEPENDENCE IN SCHIZOPHRENIA

Article Type: Research

Funding Information:

Abstract: Background: This study aims to determine the relationship between impaired cognitive
function and the degree of nicotine dependence in schizophrenia. In this context,
the study was carried out with analytic, cross-sectional, and relational design. In the
study, 39 outpatient schizophrenia patients of West Java Provincial Mental Hospital
and Hasan Sadikin Hospital were assessed using Rey Auditory Verbal Learning Test
(RAVLT) instrument, Digit Span, and Trail Making Test. Nicotine dependence using the
Fagerstrom questionnaire.
Results: Most schizophrenia patients have a high/very high degree of nicotine
dependence. There is a weak negative linear correlation between nicotine dependence
and cognitive function on the TMT A instrument (r = -0.295, p = 0.034) and TMT B (r =
-0.393, p = 0.007), there is no correlation between nicotine dependence with RAVLT 1,
2, 3, and recall. There is no correlation between nicotine dependence and cognitive
function on the Digit Span Forward (r = 0.233, p = 0.215) and Digit Span Backward (r =
0.216, p = 0.251) instruments.
Conclusion: Most schizophrenia patients have a high or very high degree of nicotine
dependence. The higher the degree of nicotine dependence, the lower the cognitive
function in the aspect of psychomotor speed and executive function in schizophrenia
patients. There is no relationship between the degree of nicotine dependence and
cognitive function, in the aspect of direct verbal memory and working memory in
schizophrenia patients. There is no relationship between the degree of nicotine
dependence with cognitive function in the aspects of short-term memory, working
memory, and long-term memory in schizophrenia patients.
Keywords: cognitive dysfunction, nicotine dependence, schizophrenia

Corresponding Author: Gensya Prangomo, M.D.

Padjadjaran University: Universitas Padjadjaran
INDONESIA

Corresponding Author Secondary

Information:

Corresponding Author's Institution: Padjadjaran University: Universitas Padjadjaran

Corresponding Author's Secondary

Institution:

First Author: Gensya Prangomo, M.D.

First Author Secondary Information:

Order of Authors: Gensya Prangomo, M.D.

Santi Andayani, MD

Tuti Kurnianingsih, MD

Order of Authors Secondary Information:

Opposed Reviewers:

Additional Information:

Question Response

<b>Is this study a clinical No

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by the World Health Organisation as ‘any
research study that prospectively assigns
human participants or groups of humans
to one or more health-related
interventions to evaluate the effects on
health outcomes’.</i>

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1
2 Association Between Cognitive Dysfunction and Nicotine Dependence In
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5 Schizophrenia
6
7 Abstract
8
9 Background: This study aims to determine the relationship between impaired cognitive
10
11 function and the degree of nicotine dependence in schizophrenia. In this context,
12
13 the study was carried out with analytic, cross-sectional, and relational design. In the study,
14
15 39 outpatient schizophrenia patients of West Java Provincial Mental Hospital and Hasan
16 Sadikin Hospital were assessed using Rey Auditory Verbal Learning Test (RAVLT)
17
18 instrument, Digit Span, and Trail Making Test. Nicotine dependence using the Fagerstrom
19
20 questionnaire.
21
22 Results: Most schizophrenia patients have a high/very high degree of nicotine dependence.
23
24 There is a weak negative linear correlation between nicotine dependence and cognitive
25
26
function on the TMT A instrument (r = -0.295, p = 0.034) and TMT B (r = -0.393, p =
27 0.007), there is no correlation between nicotine dependence with RAVLT 1, 2, 3, and recall.
28
29 There is no correlation between nicotine dependence and cognitive function on the Digit
30
31 Span Forward (r = 0.233, p = 0.215) and Digit Span Backward (r = 0.216, p = 0.251)
32
33 instruments.
34
35 Conclusion: Most schizophrenia patients have a high or very high degree of nicotine
36
37
dependence. The higher the degree of nicotine dependence, the lower the cognitive function
38 in the aspect of psychomotor speed and executive function in schizophrenia patients. There
39
40 is no relationship between the degree of nicotine dependence and cognitive function, in the
41
42 aspect of direct verbal memory and working memory in schizophrenia patients. There is no
43
44 relationship between the degree of nicotine dependence with cognitive function in the
45
46 aspects of short-term memory, working memory, and long-term memory in schizophrenia
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48
patients.
49 Keywords: cognitive dysfunction, nicotine dependence, schizophrenia
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51
52
53 Introduction
54
55 Schizophrenia is a serious mental illness with a wide range of etiologies, clinical
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57 manifestations, treatment outcomes, and disease progression. The signs and symptoms of
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schizophrenia include alterations in perception, emotion, cognition, thought, and behavior
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2 [2, 24]. In 2016, one of the top 15 global leading causes of disability was the incidence of
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4 schizophrenia [6]. According to the Indonesian Basic Health Research (Riskesdas) 2018,
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6 the Province of West Java has a schizophrenia prevalence of 4.97 per mile (22,489 persons),
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8 while the estimated prevalence of schizophrenia in Indonesia is 1.8 per 1000 inhabitants
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10 [16].
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12
Significant cognitive dysfunction affects 73–98% of people with schizophrenia.
13 Cognitive function includes working memory, verbal and visual learning, problem-solving,
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15 attention, processing speed, and social cognition. Attention, working memory, and
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17 executive function are three areas of the brain that are frequently compromised in people
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19 with schizophrenia [2, 24]. Compared to the normal population, those with schizophrenia
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21 smoke more frequently. More than 60% of individuals with schizophrenia smoke, and
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35.5% of them smoke 20 or more cigarettes a day. Patients with schizophrenia may smoke
24 for unknown reasons. Numerous research on the subject have demonstrated that smoking
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26 is soothing, can improve or damage cognition, may be an etiological component in
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28 schizophrenia, and can lead to nicotine dependence due to genetic and environmental
29
30 variables. Smoking can interact with the pharmacokinetics of antipsychotic medications,
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32 which can lessen the efficacy of these drugs [26].
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Donde et al.'s systematic review research demonstrates that acute nicotine use can
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35 enhance cognitive function, however this study's limitation is the high degree of
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37 heterogeneity in the papers they gathered and the lack of quantitative analysis, as in studies
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39 using meta-analysis [11]. According to other studies, smoking is linked to poorer cognitive
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41 performance [7, 13]. According to a meta-analysis study, smokers had higher
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43 neurocognitive impairment, including problems with short-term memory, concentration,
44 impulsivity, adaptability, and intelligence [30, 32]. The author wanted to investigate the
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46 link between cognitive dysfunction and nicotine dependency in schizophrenia patients
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48 because earlier studies had produced conflicting findings.
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50
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52 Methods and materials
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54 Purpose and design of the research
55 In this analytical cross-sectional study, it was aimed to determine the correlation between
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57 cognitive dysfunction and nicotine dependence in schizophrenia patients.
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2 Place and date of the research
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4 The research was conducted with men schizophrenia patients who undergo outpatient
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6 treatment at the Psychiatric Clinic of the West Java Psychiatric Hospital and the Psychiatric
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8 Clinic of Dr. Hasan Sadikin General Hospital. The data of the study were collected between
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10 March and April 2023.
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12 Procedure and participants
13 All men schizophrenia patients diagnosed based on the Diagnostic and Statistical of Mental
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15 Disorder-5 (DSM-5), met the inclusion criteria, and volunteered to participate in the study
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17 were included in the study.
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19 The inclusion criteria of the study are being a man with the age of 18-45, under-
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21 treatment of antipsychotic drug, cigarette smoking, and speaking Indonesian language.
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23
Whereas the exclusion criteria are patients with intellectual disability (based on DSM-5),
24 metabolic syndrome, a neurological disorder (e.g. epilepsy, delirium, dementia, stroke, and
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26 post-stroke) that affects cognitive function, infective disorder, autoimmune disorder,
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28 allergic disorder, use anti-inflammatory drugs and have substance and/or alcohol abuse.
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30 Data collection tools
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32 Personal information form
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The personal information form created by the researcher was aimed to determine some
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35 personal characteristics of the participants. The form consists of questions such as age,
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37 education level, occupation, monthly income, marital status, use of anti-psychotic drug, and
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39 duration of the illness.
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41 Nicotine Dependence Test
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43 Nicotine dependence was evaluated as an independent variable in the study. This variable
44 was evaluated by the Fagerstrom Tolerance Questionnaire test which has been validated by
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46 Purba V.T from HKBP Nommensen Medan University, North Sumatra [23].
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48 Cognitive Function Test
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50 In this study, the Trail Making Test A & B (TMT A & TMT B); Rey Auditory Verbal
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52 Learning Test 1, 2, 3, recall (RAVLT 1, RAVLT 2, RAVLT 3, RAVLT recall); and Digit
53
54 Span Forward & Backward (DSF & DSB) were utilized as assessments of the cognitive
55 function of schizophrenia patients. The TMT test is used to measure motor visual
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57 processing ability and mental flexibility. The RAVLT test evaluates a wide diversity of
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59 functions: short-term auditory-verbal memory, rate of learning, learning strategies,
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2 retroactive, and proactive interference, presence of confabulation of confusion in memory
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4 processes, retention of information, and differences between learning and retrieval. The
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6 DSF test measures the ability of short-term working memory to repeat a sequence of
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8 numbers presented in the same order, while the DSB test measures the ability of short-term
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10 working memory to repeat a sequence of numbers in reverse.
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13 Data analysis
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15 Analytical studies were performed with the SPSS 25 (Statistical Program in Social
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17 Sciences) program. By using the correlation model (Pearson test if the data is distributed
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19 normally, and Spearman test if the data is not distributed normally), the relationship
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21 between cognitive dysfunction and nicotine dependence was provided. The significance
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23
level was 0.05.
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25
26 Results
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28 This study had 39 participants. The individuals ranged in age from 20 to 45 years, with a
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30 median age of 38. A majority of subjects (41.0%) had completed high school, half of the
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32 participants (64.1%) did not work, majority of subjects (64.1% and 35.9%, respectively)
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had no income or an income of less than $5 million. The percentage of participants who
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35 were married and divorced, respectively, was 15.4% and 5.1%, whereas the majority of
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37 subjects (79.5%) were single. The majority of participants (64.1%) received clozapine to
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39 treat their schizophrenia, and the majority (61.5%) also took trihexyphenidyl. The duration
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41 of schizophrenia lasted for a median of 14 months and a maximum of 22 months (Table 1).
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43 Table 1. Subject characteristics and distribution of nicotine dependence level
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45 Characteristic n (%) Median (Range)
46 Age (year) 38 (20 – 45)
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48 Education level
49 Elementary school 7 (17.9)
50 Junior high school 11 (28.2)
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Senior high school 16 (41.0)
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53 University 5 (12.8)
54 Employment status
55 No 25 (64.1)
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57 Yes 14 (35.9)
58 Monthly income
59 No income 25 (64.1)
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3 Characteristic n (%) Median (Range)
4 <5 million IDR 14 (35.9)
5
6 Marital status
7 Not married 31 (79.5)
8 Married 6 (15.4)
9 Divorced 2 (5.1)
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11 Pharmacotherapy
12 Typical antipsychotic
13 Chlorpromazine 5 (12.8)
14
Trifluoperazine 2 (5.1)
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16 Haloperidol 17 (43.6)
17 Atypical antipsychotic
18 Olanzapine 4 (10.5)
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20 Risperidone 15 (38.5)
21 Clozapine 25 (64.1)
22 Quetiapine 1 (2.6)
23 2 (5.1)
Diazepam
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25 Clobazam 2 (5.1)
26 Triheksifenidil 24 (61.5)
27 Duration of illness (month) 14 (1 – 22)
28
Nicotine dependence level (Fagerstrom) 4 (1 – 6)
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30 Low 13 (33.3
31 Moderate 7 (17.9)
32 High/very high 19 (48.7)
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35
Table 2 shows working and monthly income have a positive correlation coefficient
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37 with nicotine dependence which is statistically significant (p=0.049). This suggests that
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39 patients who work or have more income tend to have higher nicotine dependence. Duration
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41 of illness also has a positive and significant correlation coefficient with nicotine
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43 dependence (p=0.031), indicating that patients with a longer duration of schizophrenia tend
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45 to have higher nicotine dependence. Meanwhile, the relationship between subject
46 characteristics and cognitive function tests with a significant positive correlation is
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48 education level (on the DSB test with r=0.384, p=0.008), marital status (on the RAVLT 2
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50 test with r=0.385, p=0.008; and RAVLT test 3 with r=0.289, p=0.037), as well as the use
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52 of quetiapine (in the RAVLT 2 test with r=0.373, p=0.019); while the variables that had a
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54 significant negative correlation were the use of antipsychotic drugs i.e clozapine (on the
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56 DSF test with r=-0.380, p=0.017), lorazepam (on the DSB test with r=-0.358, p=0.025),
57 and risperidone (on the DSB test TMT B with r=-0.435, p=0.006).
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23 Table 2. Association of subject characteristics with nicotine dependence and cognitive function test on the schizophrenic patient
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25 Fagerstrom DSF DSB TMT A TMT B RAVLT 1 RAVLT 2 RAVLT 3 RAVLT recall
26 Characteristic
27 r P r p r p r p r p r p r p r p r p
28
29
Age 0.244 0.067 -0.042 0.400 0.259 0.056 -0.174 0.145 -0.091 0.292 -0.161 0.163 -0.243 0.068 -0.136 0.205 0.007 0.484
30 Education level 0.129 0.217 0.138 0.202 0.384 0.008* -0.361 0.121 -0.182 0.133 0.129 0.218 0.150 0.181 0.099 0.275 0.090 0.477
31 Working status 0.268 0.049* -0.024 0.886 0.195 0.233 -0.175 0.288 -0.276 0.089 0.029 0.860 0.072 0.662 0.160 0.331 0.050 0.762
32 Monthly income 0.268 0.049* -0.024 0.886 0.195 0.233 -0.175 0.288 -0.276 0.089 0.029 0.860 0.072 0.662 0.160 0.331 0.050 0.762
33
34 Marital status 0.150 0.461 0.209 0.101 0.157 0.170 0.105 0.263 0.181 0.135 0.223 0.086 0.385 0.008* 0.289 0.037* 0.167 0.155
35 Pharmacotherapy
36 Typical antipsychotic
37
Chlorpromazine 0.111 0.250 -0.142 0.387 0.041 0.805 0.118 0.476 0.006 0.971 -0.056 0.733 0.190 0.246 -0.021 0.897 0.114 0.489
38
39 Trifluoperazine 0.169 0.152 -0.187 0.255 0.046 0.782 -0.066 0.688 0.122 0.458 -0.095 0.567 -0.072 0.662 0.265 0.103 -0.014 0.931
40 Haloperidol 0.055 0.371 0.132 0.424 -0.130 0.429 0.068 0.682 0.185 0.260 -0.183 0.265 0.083 0.615 -0.162 0.324 -0.214 0.190
41 Atypical antipsychotic
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43 Risperidone -0.123 0.228 -0.123 0.457 0.037 0.825 -0.081 0.622 -0.435 0.006* -0.085 0.607 -0.098 0.554 -0.008 0.963 -0.070 0.671
44 Clozapine 0.063 0.352 -0.380 0.017* -0.002 0.988 0.110 0.504 0.050 0.764 0.049 0.769 -0.083 0.616 -0.160 0.331 -0.132 0.422
45 Olanzapine 0.113 0.247 0.185 0.260 -0.01 0.953 -0.137 0.405 0.198 0.228 0.082 0.618 0.015 0.926 0.081 0.623 -0.019 0.908
46 -0.236 0.074 0.220 0.178 0.105 0.524
Quetiapine -0.028 0.866 -0.075 0.649 0.230 0.160 0.373 0.019* 0.283 0.081 0.194 0.238
47
48 Diazepam -0.061 0.355 -0.061 0.711 0.151 0.36 -0.200 0.223 -0.138 0.404 0.268 0.098 -0.017 0.918 -0.119 0.472 0.143 0.384
49 Clobazam -0.061 0.355 0.315 0.05 -0.164 0.318 -0.026 0.874 -0.059 0.719 -0.095 0.567 -0.127 0.440 -0.119 0.472 -0.080 0.627
50 Lorazepam 0.067 0.343 0.072 0.663 -0.358 0.025* 0.192 0.243 -0.018 0.913 0.157 0.34 0.174 0.290 0.283 0.081 0.194 0.238
51
Triheksifenidil 0.230 0.080 -0.048 0.771 -0.037 0.825 -0.059 0.721 0.026 0.876 -0.186 0.258 -0.192 0.240 -0.210 0.200 -0.092 0.577
52
53 Duration of illness 0.302 0.031* 0.017 0.458 0.185 0.130 -0.066 0.344 -0.013 0.468 0.011 0.473 -0.172 0.148 -0.168 0.154 0.009 0.477
54 Notes: Correlation analysis with Spearman’s rank correlation coefficient
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23 Table 3. Correlation of cognitive function with nicotine dependence level and number of cigarettes in schizophrenic patients
24
25 Nicotine Dependence Level Number of Cigarettes
Median
26 Cognitive Test n (%)
(IQR) Low Moderate High
27 r p r p
(n=13) (n=7) (n=19)
28
29 TMT A (mins) 53.1 (37.0 – 72.1)
30 <78 32 (82.1) 10 (76.9) 7 (100) 15 (78.9) -0.295 0.034* -0.313* 0.026
31 ≥78 7 (17.9) 3 (23.1) 0 (0) 4 (21.1)
32
TMT B (mins) 108.0 (61.1 – 162)
33
34 <273 36 (92.3) 12 (92.3) 6 (85.7) 18 (94.7) -0.393 0.007* -0.354* 0.013
35 ≥273 3 (7.7) 1 (7.7) 1 (14.3) 1 (5.3)
36 RAVLT 1 4 (3 – 6)
37
38 ≥7 (normal) 5 (12.8) 1 (7.7) 0 (0) 4 (21.1) 0.045 0.393 0.043 0.397
39 <7 (deficit) 34 (87.2) 12 (92.3) 7 (100) 15 (78.9)
40 RAVLT 2 5 (4 – 7)
41
≥9 (normal) 3 (7.7) 1 (7.7) 0 (0) 2 (10.5) -0.026 0.437 -0.023 0.445
42
43 <9 (deficit) 36 (92.3) 12 (92.3) 7 (100) 17 (89.5)
44 RAVLT 3 5 (3 – 8)
45 ≥11 (normal) 1 (2.6) 0 (0) 0 (0) 1 (5.3) 0.150 0.181 0.168 0.153
46
<11 (deficit) 38 (97.4) 13 (100) 7 (100) 18 (94.7)
47
48 RAVLT Recall 4 (3 – 7)
49 ≥9 (normal) 4 (10.3) 0 (0) 1 (14.3) 3 (15.8) -0.031 0.426 -0.032 0.422
50 <9 (deficit) 35 (89.7) 13 (100) 6 (85.7) 16 (84.2)
51
52 DSF 5 (4 – 5)
53 ≥5 (normal) 25 (64.1) 7 (53.8) 3 (42.9) 15 (78.9) 0.216 0.251 0.283 0.053
54 <5 (deficit) 14 (35.9) 6 (46.2) 4 (57.1) 4 (21.1)
55
DSB 3 (3 – 4)
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57 ≥5 (normal) 2 (5.1) 0 (0) 1 (14.3) 1 (5.3) 0.233 0.215 0.293 0.057
58 <5 (deficit) 37 (94.9) 13 (100) 6 (85.7) 18 (94.7)
59 Notes: Correlation analysis with Spearman’s rank correlation coefficient
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2 Based on Table 3, there is a weak negative linear correlation between nicotine
3
4 dependence and cognitive function on the TMT A (r= -0.295, p=0.034) and TMT B (r=-
5
6 0.393, p=0.007) instruments, the higher level of nicotine dependence affects the lower
7
8 result of TMT A and TMT B. These results are consistent with the negative correlation of
9
10 the number of cigarettes with cognitive function in TMT A (r=-0.313, p=0.026) and TMT
11
12
B (r=-0.354, p=0.013).
13
14
15 Discussion
16
17 Based on Table 2, it is known that employment, monthly income, and duration of
18
19 illness are the aspects of schizophrenia patients that have a weak correlation with nicotine
20
21 dependency. These findings are consistent with previous research by Isuru et al., which
22
23
found that patients with schizophrenia had a number of psychosocial risk factors, such as a
24 lack of education, poor income, and unemployment, that lead to smoking addiction [12, 15].
25
26 According to studies by Holm et al., as many as 24% of people with schizophrenia were
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28 employed three years prior to diagnosis. However, employment rates started to decline
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30 shortly after the initial diagnosis. Only 10% of people with schizophrenia are still in the
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32 workforce five years later. Protective factors associated with employment after diagnosis
33
were a high level of education, older age at first diagnosis, marital status, absence of
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35 substance abuse, and a low number of previous hospitalizations [14].
36
37 Table 2 shows that education, marital status, and pharmacotherapy (clozapine,
38
39 lorazepam, and risperidone) are the factors that significantly affect cognitive function.
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41 Marital status was demonstrated to be a protective factor by Dickinson et al. Results from
42
43 multiple earlier research show that schizophrenia patients' gender has a direct impact on
44 quality of life and interacts with marital status; singles, particularly men, report more
45
46 cognitive impairment [9, 28]. Additionally, some data point to a relationship between
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48 married status and certain schizophrenia symptoms according to gender. Men who had been
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50 married before exhibited the most symptoms, whereas men who were still married
51
52 exhibited the fewest symptoms, according to research by Walker et al [29].
53
54 According to MacKenzie et al., the impact of antipsychotic medications on cognitive
55 performance is still debatable. In the past, it was believed that the so-called "first-
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57 generation" class of anti-psychotics had negative or even counterproductive effects on
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59 cognitive performance. The "second generation" of anti-psychotics, on the other hand,
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2 raises hopes that these more recent medications would enhance cognitive performance.
3
4 Numerous studies have demonstrated that using this unusual medication to treat
5
6 schizophrenia patients can enhance cognitive performance. For instance, clozapine has
7
8 demonstrated significant increases in verbal fluency and attention, with only minor gains
9
10 in executive function and delayed recollection. In terms of working memory, executive
11
12
function, attention, and delayed recall, risperidone demonstrated only modest gains. It has
13 been demonstrated that quetiapine enhances verbal short-term memory and overall
14
15 cognitive performance in the early phases of treatment [19]. Long-term use of
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17 benzodiazepines, including lorazepam, is known to impair verbal learning, processing
18
19 speed, and visuospatial ability, among other cognitive functions [27].
20
21 In this investigation, it was discovered that all patients with schizophrenia had
22
23
cognitive impairment. Cognitive impairment is one of the main symptoms of schizophrenia,
24 according to Bowie et al [5]. In various areas, including attention, working memory, verbal
25
26 learning and memory, and executive function, there are moderate to severe deficiencies [1,
27
28 20]. According to research by Talreja et al [28], patients with schizophrenia frequently
29
30 experience lasting cognitive abnormalities. Patients who had been ill for more than two
31
32 years and who lived in metropolitan areas exhibited increased cognitive impairment,
33
according to a correlation with sociodemographic characteristics. Language and cognitive
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35 difficulties are common in male patients [28].
36
37 In this study, the Fagerstrom test revealed that all patients with schizophrenia exhibit
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39 varied degrees of nicotine dependence. Numerous studies have indicated that schizophrenia
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41 is a significant risk factor for smoking addiction, and people with the disorder may continue
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43 to smoke due to a stronger reinforcing impact and to alleviate some of the symptoms [4, 10,
44 18, 25]. In comparison to patients with bipolar illness, those with schizophrenia were found
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46 to smoke twice as often [8].
47
48 A unique neural mechanism underlying the high prevalence of nicotine dependency
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50 in schizophrenia was discovered by Ding et al. The default mode network (DMN) and the
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52 dorsal attention network (DAN), two resting-state networks located in the right parieto-
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54 occipital area, were found to have a relationship with changes in nicotine usage. More
55 specifically, larger levels of daily tobacco use were linked to the DMN's extension into
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57 areas ordinarily inhabited by the DAN in healthy controls. Only subjects with schizophrenia
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59 showed a connection between smoking and this topography. Prior research has noted
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2 individual variances in network topography. Recently, behavioral and cognitive traits have
3
4 been linked to this topographical variance [10, 31]. Based on research by Beck et al.
5
6 mentioning the “cognitive self-medication” hypothesis, smokers with schizophrenia are
7
8 likely to report higher levels of cognitive motivators for smoking and, furthermore, are
9
10 likely to demonstrate a stronger impact of nicotine on functioning. The basic addiction
11
12
theory states that due to the inherent parallels between the neurobiologies of addiction and
13 schizophrenia, addiction is regarded as a primary sign of schizophrenic illness. There is
14
15 proof that smoking causes schizophrenia because of a biological mechanism (addiction
16
17 susceptibility) unrelated to a person's level of consciousness [3].
18
19 Based on the findings of the TMT A and TMT B tests, it was determined from this
20
21 study that there was a relationship between nicotine dependency and cognitive performance
22
23
in schizophrenic patients (p<0.05) with a negative correlation in TMT A and TMT B. Based
24 on the TMT B test and digit span backward, research by Moss et al. revealed that
25
26 schizophrenia patients who smoke had worse cognitive performance [21]. According to
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28 Depp et al., compared to smokers who have given up or have never smoked, schizophrenia
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30 patients who are continuously smoking today have worse composite cognitive function and
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32 worse functional results [8]. McCutcheon et al. also mentioned that in the long term,
33
smoking in schizophrenia is associated with worse cognitive performance and increases the
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35 risk of cognitive decline in old age. In addition, smoking cessation appears to improve
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37 cognition in schizophrenia [17]
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39 Following the TMT A and TMT B instruments used in this study, there was a
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41 significant negative correlation between the number of cigarettes smoked and cognitive
42
43 function. This means that as more cigarettes were smoked, the TMT A and TMT B tests
44 would produce results more quickly, counteracting the idea that smoking would lower
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46 cognitive function. This finding contrasts with research by Ekramulla et al., which found a
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48 statistically significant positive correlation between TMT-A and the number of packs of
49
50 cigarettes consumed annually (r = 0.781, p=0.0001) and between TMT-B and that quantity
51
52 (r = 0.851, p=0.0001). The study demonstrates that TMT-A and TMT-B completion times
53
54 increase with annual cigarette consumption. This suggests that smokers who consume more
55 cigarettes each year have serious cognitive impairments, which makes it take them longer
56
57 to complete TMT-A and TMT-B. The fact that this study did not collect information on
58
59 past smoking history may be the cause of these conflicting outcomes. These findings are
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2 crucial since chronic smokers (those who have smoked for at least 10 years) are known to
3
4 experience the harmful effects of smoking on cognitive function [22].
5
6
7
8 Limitations
9
10 The limitation of this study is a small sample, no control over schizophrenia severity, type
11
12
of antipsychotic given, duration from onset of smoking, and duration of patients suffering
13 from schizophrenia. This study also did not control for the severity of extrapyramidal side
14
15 effects that may be related to cognitive dysfunction.
16
17
18
19 Conclusions
20
21 According to the study's findings, the majority of patients with schizophrenia exhibit high
22
23
or extremely high levels of nicotine dependency. In schizophrenic patients, cognitive
24 performance in the areas of psychomotor speed and executive function declines with
25
26 increasing nicotine use. Moreover, there is no correlation between nicotine dependency and
27
28 cognitive performance in terms of working memory, direct verbal memory, short-term
29
30 memory, and long-term memory.
31
32
33
34
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