Current smoking is associated with worse cognitive and adaptive functioning in serious mental illness

Acta Psychiatr Scand. 2015 May;131(5):333-41. doi: 10.1111/acps.12380. Epub 2015 Jan 5.


Objective: Cigarette smoking is highly prevalent among people with bipolar disorder or schizophrenia. Few studies have examined whether smoking history is associated with adaptive functioning among individuals diagnosed with these serious mental illnesses.

Method: In a large relatively homogenous cohort of patients with either bipolar disorder (n=363) or schizophrenia (n=400), we investigated the association between cigarette smoking status, intensity, and cumulative exposure and performance on a comprehensive battery of neurocognitive, functional capacity, and informant-rated functional measures. The associations were adjusted for variation in sociodemographic indicators, psychopathologic symptoms, and substance use.

Results: There was an average of 12 pack years of smoking across the sample. People with schizophrenia reported double the rate of current smoking compared to patients with bipolar disorder. Adjusting for demographic covariates, current smokers had worse composite cognitive functioning and poorer functional outcome than past or never smokers. There were no significant differences between never and past smokers, and these effects were evident in both bipolar disorder and schizophrenia.

Conclusion: Current smokers with either schizophrenia or bipolar disorder evidence worse cognitive and adaptive functioning functional outcome, even when demographic covariates are considered.

Keywords: Bipolar Disorder; Cognition; Neuropsychology; Nicotine; Psychosis; Schizophrenia.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Bipolar Disorder* / complications
  • Bipolar Disorder* / diagnosis
  • Bipolar Disorder* / psychology
  • Cognition*
  • Cross-Sectional Studies
  • Executive Function*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Schizophrenia* / complications
  • Schizophrenia* / diagnosis
  • Schizophrenic Psychology*
  • Self Report
  • Smoking / psychology
  • Social Adjustment
  • Tobacco Use Disorder* / complications
  • Tobacco Use Disorder* / diagnosis
  • Tobacco Use Disorder* / psychology
  • United States