Cigarette Smoking Associated With Psychotic Experiences in Adolescents, Study Finds

Smoking tobacco is associated with psychotic experiences in adolescents, according to a study published in the Journal of the American Academy of Child & Adolescent Psychiatry.

In the study, Wikus Barkhuizen, M.Sc., of the Centre for Brain and Cognitive Development at the University of London and colleagues analyzed smoking frequency in 3,787 adolescent pairs of twins, with a mean age of roughly 16 years. The adolescents fell into three categories: nonsmokers who had never smoked a cigarette, occasional smokers who had smoked fewer than 50 cigarettes in their lifetimes, and regular smokers who had smoked 50 or more cigarettes in their lifetimes. The researchers used the Specific Psychotic Experiences Questionnaire to assess the adolescents for three positive psychotic experiences (paranoia, hallucinations, and grandiosity), two negative psychotic experiences (self-reported anhedonia and negative symptoms reported by the adolescents’ parents), and cognitive disorganization.

The researchers found that scores for psychotic experiences differed significantly across the three groups. Occasional smokers scored higher than nonsmokers on paranoia, hallucinations, and cognitive disorganization and lower on anhedonia, with no significant differences on grandiosity and parent-rated negative symptoms. Regular smokers scored higher than nonsmokers on paranoia, hallucinations, cognitive disorganization, grandiosity, and parent-rated negative symptoms, but not on anhedonia. Regular smokers scored higher than occasional smokers on all the conditions examined. These results remained after adjusting for variables including sex, age, ethnicity, socioeconomic status, prenatal maternal smoking, cannabis use, sleep disturbances, and stressful life events.

In a secondary analysis, the researchers tested whether shared genetic influences underlie adolescent psychotic experiences and smoking by comparing identical twins and same-sex fraternal twins. They found that the correlations between smoking and paranoia, hallucinations, and cognitive disorganization were higher for identical twins than fraternal twins, suggesting that psychotic experiences “co-occur largely due to shared genetic influences,” Barkhuizen and colleagues wrote.

“Our results suggest that some of the same genetic factors that influence tobacco use in adolescents also influence PE [psychotic experiences],” they added.

For related information, see the Psychiatric News article “FDA’s ‘Real Cost’ Campaign Cuts Cigarette Smoking by Teens.”

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Sleep Disorders May Be Missed in Patients With Psychosis

Sleep disorders appear to be common in patients with psychosis, but few appear to be receiving sleep assessments or treatment for such disorders, suggests a report in Schizophrenia Bulletin.

“Taking sleep disorders in psychosis seriously may have important benefits,” Sarah Reeve, D.Phil., of the University of Oxford and colleagues wrote. “Recent manipulation studies have demonstrated that simulating insomnia increases psychotic experiences, and, conversely, treating insomnia reduces psychotic experiences. … [B]y improving sleep it may be possible to improve psychosis, representing an exciting new treatment target.”

For the study, Reeve and colleagues recruited patients aged 18 to 30 who had received a diagnosis of nonaffective psychotic disorder and outpatient clinical services. The researchers used the Diagnostic Interview for Sleep Patterns and Disorders (DISP) and information obtained from sleep diaries and wrist-based activity monitoring devices to assess the presence of sleep disorders in these patients. If the patient met criteria for diagnosis or positive screen for a sleep disorder, they were then asked whether they had ever discussed the issue with a medical professional and whether they received treatment for the disorder.

Of the 60 patients included in the study, 48 (80%) received a positive screen or diagnosis for at least one sleep disorder. The most common sleep diagnoses were insomnia (n=30, 50%) and nightmare disorder (n=29, 48.3%), but as the authors noted, “there was a broad range of sleep issues presenting in this group and comorbidity was high, with an average of 3.3 sleep disorders per patient.”

Patients with at least one sleep disorder reported more severe paranoia, hallucinations, depression, and anxiety compared with those who did not report a sleep disorder (as assessed by Specific Psychotic Experiences Questionnaire and Depression Anxiety and Stress Scale). The researchers found that over half of the sleep disorders had been discussed with a clinician but almost three-quarters had received no treatment.

“Diagnostic systems such as DSM-5 recommend that sleep problems should be assessed and treated irrespective of other psychiatric comorbidities. This does not appear to be happening in psychosis services,” Reeve and colleagues wrote. “[I]ndependent of any relationship with psychotic experiences, our view is that the assessment and treatment of sleep disorders among those with psychosis merits greater clinical attention.”

For related information, see the Psychiatric News article “Brains of People With Insomnia Stay More Active During Sleep.”

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Clinicians Develop New Rating Scale for Perimenopausal Depression

Key differences in depressive symptoms that arise during perimenopause (the period immediately before menopause) suggest that perimenopausal depression may be a distinct subtype of depression, but scales to measure or monitor symptoms of perimenopausal depression are lacking. A report published yesterday in Translational Psychiatry describes the development and validation of a questionnaire that clinicians or patients can use to rate the severity of perimenopausal depression symptoms.

“Having a reliable tool to aid in the diagnosis of perimenopausal depression is very important in research of this relatively neglected area of women’s health,” wrote Jayashiri Kulkarni, M.D., and colleagues at Monash University in Melbourne, Australia. “Clinically, it is very important to accurately detect and diagnose perimenopausal depression as early as possible to enable more specific treatments, such as hormone treatment strategies.”

Kulkarni and colleagues conducted an extensive literature review and relied on clinical observation and focus groups (including perimenopausal women and clinicians) to identify key perimenopausal depression symptom areas. From this research, they created a 12-item questionnaire, called the Meno-D, which asked patients to rate the severity of the following symptoms on a scale of 0 to 4: anxiety, concentration, energy, irritability, isolation, memory, paranoia, self-esteem, sexual interest, sleep, somatic symptoms, and weight changes.

The Meno-D was then administered to 93 women experiencing symptoms of perimenopausal depression, 82 of whom completed the questionnaire. While the women varied significantly in their total Meno-D scores, despite all having perimenopausal depression, they generally had above average scores related to somatic (somatic symptoms and weight), cognitive (memory and concentration), self (self-esteem, paranoia, isolation, and anxiety), sleep (sleep disturbances and irritability), and/or sexual (sexual interest and energy) symptoms.

“Previous studies have reported that women experiencing perimenopausal depression complain about physical symptoms more than cognitive ones, which are not typically included in previous scales assessing for major depressive disorder,” Kulkarni and colleagues wrote. “This may explain why perimenopausal depression is often overlooked or left undiagnosed.”

They concluded, “The Meno-D will support a growing research field, interfacing both psychiatry and endocrinology, which indicates that perimenopausal depression is a unique subtype of depression requiring a different management approach.”

To read more about this topic, see the Psychiatric News article “Discontinuing Hormone Therapy May Increase Risk of Depression in Some Women.”

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Teens Who Regularly Use Marijuana May Be at Greater Risk of Paranoia, Hallucinations

Adolescents who regularly use marijuana may be more likely to experience subclinical paranoia and hallucinations, even after sustained abstinence from the drug, a study published this week in AJP in Advance reports.

Several studies have suggested that marijuana use, particularly during adolescence, is related to acute psychotic episodes and future psychotic disorders, but little is known about whether adolescents who regularly use the drug over several years exhibit a systematic increase in their subclinical psychotic symptoms that persists during periods of sustained abstinence.

Researchers from University of Pittsburgh Medical Center and Arizona State University, Phoenix, analyzed data from a sample of 1,009 adolescent boys from Pittsburgh who self-reported annually on the number of days they used marijuana in the past year and experiences of subclinical psychotic symptoms (e.g., feelings of paranoia, hallucinations, bizarre thinking) from age 13 to 18. The teens also annually reported on the number of days they used alcohol, tobacco, and other illicit drugs.

As expected, substance use increased from age 13 to 18. By the last assessment, 270 participants reported having used marijuana weekly, 325 had used alcohol weekly, 377 had used tobacco daily, and 134 had used other illicit drugs at least once. For each year the participants engaged in weekly marijuana use, their expected level of subsequent subclinical psychotic symptoms rose by 21% and their expected odds of experiencing subsequent subclinical paranoia or hallucinations rose by 133% and 92%, respectively.

Additional analysis revealed that even when adolescents stopped using marijuana for one year, the effect of prior weekly marijuana use on total subclinical psychotic symptoms, paranoia, and hallucinations persisted. For each additional year adolescents engaged in weekly marijuana use, their expected number of total subclinical psychotic symptoms rose by 29% during subsequent periods of year-long abstinence, and their expected odds of experiencing paranoia and hallucinations rose by 112% and 158%, respectively.

“[T]he most concerning finding is that the effect of prior weekly marijuana use persists even after adolescents have stopped using for one year,” the researchers wrote.

While the authors acknowledged future studies are needed to determine whether the findings hold for girls and adults living in geographically diverse locales and whether the effect of regular adolescent marijuana use on subclinical psychotic symptoms persists into adulthood, they concluded, “Given the recent proliferation of marijuana legalization across the country, it will be important to enact preventive policies and programs to keep adolescents from engaging in regular marijuana use, as chronic use seem to increase their risk of developing persistent subclinical psychotic symptoms.”

For related information, see the Psychiatric News article “Research Identifies Gene Linked to Cannabis-Induced Psychosis.”

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