AUTHOR=Schirmbeck Frederike , van der Ven Els , Boyette Lindy-Lou , McGuire Philip , Valmaggia Lucia R. , Kempton Matthew J. , van der Gaag Mark , Riecher-Rössler Anita , Barrantes-Vidal Neus , Nelson Barnaby , Krebs Marie-Odile , Ruhrmann Stephan , Sachs Gabriele , Rutten Bart P. F. , Nordentoft Merete ,  EU-GEI High Risk Study Group , de Haan Lieuwe , Vermeulen Jentien M. , Calem Maria , Tognin Stefania , Modinos Gemma , Pisani Sara , Hedges Emily P. , Velthorst Eva , Kraan Tamar C. , van Dam Daniella S. , Burger Nadine , Politis Athena , Goodall Joanne , Borgwardt Stefan , Studerus Erich , Gadelha Ary , Brietzke Elisa , Asevedo Graccielle , Asevedo Elson , Zugman Andre , Domínguez-Martínez Tecelli , Monsonet Manel , Hinojosa Lidia , Cristóbal Paula , Kwapil Thomas R. , Kazes Mathilde , Daban Claire , Bourgin Julie , Gay Olivier , Mam-Lam-Fook Célia , Nordholm Dorte , Randers Lasse , Krakauer Kristine , Birkedal Glenthøj Louise , Gebhard Dominika , Arnhold Julia , Klosterkötter Joachim , Lasser Iris , Winklbaur Bernadette , Delespaul Philippe A. 

TITLE=Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes

JOURNAL=Frontiers in Psychiatry

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.869023

DOI=10.3389/fpsyt.2022.869023

ISSN=1664-0640

ABSTRACT=<sec><title>Objective</title><p>People at ultra-high risk (UHR) for psychosis have a high prevalence of tobacco smoking, and rates are even higher among the subgroup that later develop a psychotic disorder. However, the longitudinal relationship between the course of tobacco smoking and clinical outcomes in UHR subjects is unknown.</p></sec><sec><title>Methods</title><p>We investigated associations between tobacco smoking and clinical outcomes in a prospective study of UHR individuals (<italic>n</italic> = 324). Latent class mixed model analyses were used to identify trajectories of smoking severity. Mixed effects models were applied to investigate associations between smoking trajectory class and the course of attenuated psychotic symptoms (APS) and affective symptoms, as assessed using the CAARMS.</p></sec><sec><title>Results</title><p>We identified four different classes of smoking trajectory: (i) Persistently High (<italic>n</italic> = 110), (ii) Decreasing (<italic>n</italic> = 29), (iii) Persistently Low (<italic>n</italic> = 165) and (iv) Increasing (<italic>n</italic> = 20). At two-year follow-up, there had been a greater increase in APS in the Persistently High class than for both the Persistently Low (ES = 9.77, SE = 4.87, <italic>p</italic> = 0.046) and Decreasing (ES = 18.18, SE = 7.61, <italic>p</italic> = 0.018) classes. There were no differences between smoking classes in the incidence of psychosis. There was a greater reduction in the severity of emotional disturbance and general symptoms in the Decreasing class than in the High (ES = −10.40, SE = 3.41, <italic>p</italic> = 0.003; ES = −22.36, SE = 10.07, <italic>p</italic> = 0.027), Increasing (ES = −11.35, SE = 4.55, <italic>p</italic> = 0.014; ES = −25.58, SE = 13.17, <italic>p</italic> = 0.050) and Low (ES = −11.38, SE = 3.29, <italic>p</italic> = 0.001; ES = −27.55, SE = 9.78, <italic>p</italic> = 0.005) classes, respectively.</p></sec><sec><title>Conclusions</title><p>These findings suggests that in UHR subjects persistent tobacco smoking is associated with an unfavorable course of psychotic symptoms, whereas decrease in the number of cigarettes smoked is associated with improvement in affective symptoms. Future research into smoking cessation interventions in the early stages of psychoses is required to shine light on the potential of modifying smoking behavior and its relation to clinical outcomes.</p></sec>