A review of the effects of nicotine on schizophrenia and antipsychotic medications

Psychiatr Serv. 1999 Oct;50(10):1346-50. doi: 10.1176/ps.50.10.1346.


Objective: Research on the impact of nicotine on schizophrenia and antipsychotic medications was reviewed to determine ways to improve treatment planning for patients with schizophrenia who smoke and to evaluate smoking cessation programs for this population.

Methods: All major research databases were searched. The review focuses on reports published since 1990.

Results: Smoking improves processing of auditory stimuli (sensory gating) by patients with schizophrenia and may lessen negative symptoms by increasing dopamine in the nucleus accumbens and the prefrontal and frontal cortex. Use of traditional antipsychotics may result in patients' smoking more, whereas patients taking atypical antipsychotics may smoke less. Patients who smoke metabolize antipsychotics faster than nonsmoking patients. Smoking cessation programs for outpatients with schizophrenia report a success rate of about 12 percent after six months. No studies of cessation programs for chronically ill inpatients with schizophrenia have been published. Several hospitals have implemented smoking bans with equivocal results.

Conclusions: Nicotine affects both schizophrenia and antipsychotic medications. Neurobiological and psychosocial factors reinforce the high use of nicotine by patients with schizophrenia

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / metabolism*
  • Antipsychotic Agents / therapeutic use*
  • Auditory Perception / drug effects
  • Chlorpromazine / metabolism*
  • Chlorpromazine / therapeutic use*
  • Chronic Disease
  • Clozapine / metabolism*
  • Clozapine / therapeutic use*
  • Databases as Topic
  • Dopamine / metabolism
  • Dose-Response Relationship, Drug
  • Frontal Lobe / drug effects
  • Frontal Lobe / metabolism
  • Humans
  • Nicotine / pharmacology*
  • Nucleus Accumbens / drug effects
  • Nucleus Accumbens / metabolism
  • Prefrontal Cortex / drug effects
  • Prefrontal Cortex / metabolism
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Severity of Illness Index
  • Smoking Cessation


  • Antipsychotic Agents
  • Nicotine
  • Clozapine
  • Chlorpromazine
  • Dopamine