Smoking in schizophrenia: cognitive impact of nicotine and relationship to smoking motivators

Smoking prevalence in schizophrenia is significantly elevated relative to other clinical and to non-clinical groups. The cognitive self-medication hypothesis attributes this to the beneficial effects of nicotine on illness-related cognitive deficits. Significant effects of nicotine have been observed on visual spatial working memory (VSWM), sustained attention (Continuous Performance Test — Identical Pairs; CPT-IP) and prepulse inhibition (PPI). It remains unclear whether these neurophysiological and neurocognitive effects of nicotine influence self-reported smoking motivation.To explore the relationship between nicotine effects on cognition and self-reported smoking motivation in schizophrenia and non-psychiatric control smokers, the impact of smoking abstinence and reinstatement was examined across three cognitive indices (VSWM, CPT-IP, PPI) and compared to self-reported smoking motivation (Modified Reasons for Smoking Scale revised to include ‘cognitive motivators’). Cognitive function was assessed after ‘typical’ smoking and overnight abstinence. Schizophrenia smokers (but not controls) demonstrated significantly less error on the VSWM task in the smoking relative to abstinent condition. Control (but not schizophrenia) smokers, showed evidence of CPT-IP improvement in the smoking relative to abstinent condition. The overall profile of smoking motivation was comparable between groups. However, significant relationships between subjective and objective indices of smoking related cognitive change were observed for controls.Differential effects of nicotine on cognition have been hypothesised to influence the pattern and persistence of smoking in schizophrenia. These preliminary findings indicate that evidence for such effects is apparent even in small samples — particularly for VSWM. This is the first study to show that neurocognitive effects of smoking may influence self-reported smoking motivation.