Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESCigarette Smoking and Psychiatric Comorbidity in Children and Adolescents
Section snippets
Adult Studies
At least two reports indicate that, in a small sample of smokers and nonsmokers with attention-deficit/ hyperactivity disorder (ADHD), a nicotine transdermal patch improved the Clinical Global Impression scores and caused increased vigor, reduction in reaction time on the Continuous Performance Test, and improved accuracy of time estimation (Conners et al., 1996;Levin et al., 1996). Pomerleau and colleagues (1995) found that adults with ADHD are more likely to smoke and may have a harder time
ODD/CD AND SMOKING
Evidence from studies involving genetic and epidemiological approaches in both community and psychiatric samples indicates a strong link between disruptive behavior disorders and cigarette smoking. Cigarette smoking in subjects with oppositional defiant disorder (ODD)/CD may represent a general pattern of defiant behaviors or individuals with CD may have an increased vulnerability to the development of nicotine dependence (Donovan et al., 1988;Jessor and Jessor, 1977). Pomerleau and colleagues
SMOKING AND MOOD DISORDERS
Major depression is the mood disorder most consistently and robustly associated with cigarette smoking.
Adult Studies
Research on anxiety disorders and nicotine dependence in adults is limited, although most studies exploring mood disorders assess or query about anxiety symptoms or disorders. Despite systematic assessment of anxiety symptoms, there is a dearth of research focused specifically on anxiety disorders and comorbid nicotine dependence. Breslau and colleagues (1991) used the National Institute of Mental Health Diagnostic Interview Schedule (Robins et al., 1981) to investigate the OR of major
Adult Studies
Not surprisingly, early tobacco use increases the risk of developing nicotine dependence (Breslau et al., 1993). Cigarette smoking has also been associated with increased odds of alcohol and drug use in several reports (Black et al., 1999;Burling and Ziff, 1988;Golding et al., 1983;Henningfield et al., 1990;Hughes and Frances, 1995;Joseph et al., 1990;Kao et al., 2000;Revell et al., 1985;Torabi et al., 1993). Several reports indicate that smokers are more likely to drink alcohol than
POSSIBLE MECHANISMS FOR THE LINK BETWEEN SMOKING AND PSYCHIATRIC DISORDERS
The exact mechanism of the comorbidity between smoking and psychiatric disorders is not known. The comorbidity may be explained by the combination of one or more of the following factors: chance, common vulnerability to both psychiatric disorders and smoking (familial/genetic or environmental), self-medication, and common neurobiological alterations. For example, a yet unidentified substance in cigarette smoke inhibits brain monoamine oxidase (MAO) A activity by an average of 28% in the various
SUMMARY AND CLINICAL IMPLICATIONS
Many psychiatric disorders are highly comorbid with cigarette smoking in adolescents. Most studies have examined the relationship between loosely defined “regular” cigarette smoking and psychiatric disorders, whereas the emerging evidence indicates that DSM-IV based diagnosis of nicotine dependence is even more robustly associated with psychiatric comorbidity (Breslau, 1995;Dierker et al., 2001).
In clinical settings, it is important to assess adolescent smokers for psychiatric disorders and to
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Financial support for this project was provided by the career development K12 award, grant DA00357-01, given jointly from the AACAP and NIDA to Dr. Upadhyaya.
Reprint requests to Dr. Upadhyaya, 2N IOP, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425.
DOI: 10.1097/01.CHI.0000024845.60748.8F