Tobacco smoking is associated with antipsychotic medication, physical aggressiveness, and alcohol use disorder in schizophrenia: results from the FACE-SZ national cohort

Eur Arch Psychiatry Clin Neurosci. 2019 Jun;269(4):449-457. doi: 10.1007/s00406-018-0873-7. Epub 2018 Feb 2.


Tobacco smoking is common in schizophrenia and is one of the main causes of premature mortality in this disorder. Little is known about clinical correlates and treatments associated with tobacco smoking in patients with schizophrenia. Still, a better characterization of these patients is necessary, in a personalized care approach. Aggressiveness and childhood trauma have been associated with tobacco smoking in general population, but this association has never been explored in schizophrenia. Our study examines the clinical and therapeutic characteristics of tobacco smoking in schizophrenia. 474 stabilized patients (mean age = 32.2; 75.7% male gender; smokers n = 207, 54.6%) were consecutively included in the network of the FondaMental Expert centers for Schizophrenia and assessed with valid scales. Current tobacco status was self-declared. Aggressiveness was self-reported with Buss-Perry Aggressiveness Questionnaire and Childhood Trauma with Childhood Trauma Questionnaire. Ongoing treatment was reported. In univariate analysis, tobacco smoking was associated with lower education level (p < 0.01), positive syndrome (p < 0.01), higher physical aggressiveness (p < 0.001), alcohol dependence (p < 0.001), and First Generation Antipsychotics (FGAs) use (p = 0.018). In a multivariate model, tobacco smoking remained associated with physical aggressiveness (p < 0.05), current alcohol dependence (p < 0.01) and FGA use (p < 0.05). No association was observed with childhood trauma history, mood disorder, suicidal behavior, psychotic symptom, global functioning or medication adherence. Patients with tobacco use present clinical and therapeutic specificities, questioning the neurobiological links between tobacco and schizophrenia. They could represent a specific phenotype, with specific clinical and therapeutic specificities that may involve interactions between cholinergic-nicotinic system and dopaminergic system. Further longitudinal studies are needed to confirm the potential efficacy of second generation antipsychotics (SGAs) on tobacco use in schizophrenia and to develop effective strategies for tobacco cessation in this population.

Keywords: Aggressiveness; Alcohol dependence; Antipsychotics; Childhood trauma; Schizophrenia; Tobacco smoking.

MeSH terms

  • Adult
  • Adult Survivors of Child Adverse Events
  • Adverse Childhood Experiences*
  • Aggression / physiology*
  • Alcoholism / epidemiology
  • Alcoholism / physiopathology*
  • Antipsychotic Agents / therapeutic use
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / physiopathology*
  • Schizophrenia / drug therapy
  • Schizophrenia / epidemiology
  • Schizophrenia / physiopathology*
  • Tobacco Smoking / epidemiology
  • Tobacco Smoking / physiopathology*
  • Young Adult


  • Antipsychotic Agents