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Tobacco and first-episode psychosis : a systematic review
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O primeiro episódio psicótico é uma síndrome variável que se define pela presença de sintomas positivos e negativos com uma duração contínua mínima de uma semana. Tipicamente tem início na adolescência e idade adulta jovem. A prevalência do uso de tabaco em doentes com primeiro episódio psicótico é marcadamente elevada, cerca de 59%, superior comparativamente à da população em geral. A maioria dos estudos existentes atualmente refere-se a doentes com doença psicótica crónica. Desta forma, tem-se manifestado interesse em entender a origem concreta da relação entre o tabaco e o primeiro episódio psicótico. Esta revisão sistemática reuniu os estudos publicados até março de 2018, através da pesquisa nas bases de dados Pubmed e Web of Knowledge, sobre a relação referida de forma a estudar três tópicos principais que poderão contribuir para a associação entre o tabaco e o primeiro episódio psicótico: 1)Tabaco como fator de risco do primeiro episódio psicótico; 2)A exposição à nicotina, através do tabaco, como comportamento de auto-medicação, e 3)Tabaco como marcador de gravidade da doença. Foram incluídos dez artigos originais, dos quais: um estudou o primeiro tópico acima referido; quatro estudaram o segundo; e os restantes cinco estudaram a terceira hipótese. Esta revisão permite concluir que a relação entre o tabaco e o primeiro episódio psicótico é inegável, e, apesar de ser dificil de alcançar a verdadeira génese da mesma, houve uma tendência para mostrar uma maior contribuição da hipótese “Tabaco como fator de risco do primeiro episódio psicótico” em relação à hipótese “A exposição à nicotina, através do tabaco, como comportamento de auto-medicação”. A última hipótese “Tabaco como marcador de gravidade da doença” foi aquela que mais foi corroborada, com quatro dos cinco estudos incluídos neste tópico a apoiar esta hipótese. Num dos estudos, sugere-se que a fraca adesão à medicação possa ser um fator causal que medeia a associação entre o tabaco e uma maior severidade da doença. Constatou-se, desta forma, que, apesar de serem necessários mais estudos sobre estas associações, no caso de serem totalmente provadas, poderão ter uma utilidade clínica muito vantajosa, primeiramente, numa perspetiva de prevenção e ainda no estadiamento da doença.
The first episode psychosis is a variable syndrome defined by the presence of positive and negative symptoms with a continuous duration of at least one week. Typically it begins in adolescence or young adulthood. The prevalence of tobacco use in patients with first episode psychosis is markedly high, about 59%, higher than in the general population. Most of the existing studies currently refer to patients with chronic psychotic disorders. Thus, there has been crescent interest in understanding the concrete origin of the relationship between tobacco and the first psychotic episode. This systematic review reunites the studies published until March 2018, through a search in Pubmed and Web of Knowledge databases, in order to study three main aims that could contribute to the existence of the relationship between tobacco and first psychotic episode: 1)Tobacco smoking as a potential risk factor to first episode psychosis; 2)Nicotine use in the form of tobacco smoking in first episode psychosis: the self-medication hypothesis; and 3)Tobacco use as a marker of greater illness severity in first episode psychosis. Ten original articles were included, of which: one studied the first topic mentioned above; four studied the second; and the remaining five studied the third hypothesis. This review concludes that the relationship between tobacco and the first psychotic episode is undeniable, and, in spite of being difficult to reach the nature of this association, there was a trend towards a greater contribution of the hypothesis “Tobacco smoking as a potential risk factor to first episode psychosis” comparative to the “Nicotine use in the form of tobacco smoking in first episode psychosis: the self-medication hypotheses”. The last hypothesis "Tobacco as a marker of disease severity" was the one that was most corroborated, with four of the five studies included in this topic supporting this hypothesis. In one study, it is suggested that poor adherence to medication may be a causal factor that mediates the association between smoking and increased severity of the disease. It was found that, although further studies on this associations are necessary, if fully tested, it may be very useful in clinical practice, primarily in a view of prevention and also in the staging of the disease.
The first episode psychosis is a variable syndrome defined by the presence of positive and negative symptoms with a continuous duration of at least one week. Typically it begins in adolescence or young adulthood. The prevalence of tobacco use in patients with first episode psychosis is markedly high, about 59%, higher than in the general population. Most of the existing studies currently refer to patients with chronic psychotic disorders. Thus, there has been crescent interest in understanding the concrete origin of the relationship between tobacco and the first psychotic episode. This systematic review reunites the studies published until March 2018, through a search in Pubmed and Web of Knowledge databases, in order to study three main aims that could contribute to the existence of the relationship between tobacco and first psychotic episode: 1)Tobacco smoking as a potential risk factor to first episode psychosis; 2)Nicotine use in the form of tobacco smoking in first episode psychosis: the self-medication hypothesis; and 3)Tobacco use as a marker of greater illness severity in first episode psychosis. Ten original articles were included, of which: one studied the first topic mentioned above; four studied the second; and the remaining five studied the third hypothesis. This review concludes that the relationship between tobacco and the first psychotic episode is undeniable, and, in spite of being difficult to reach the nature of this association, there was a trend towards a greater contribution of the hypothesis “Tobacco smoking as a potential risk factor to first episode psychosis” comparative to the “Nicotine use in the form of tobacco smoking in first episode psychosis: the self-medication hypotheses”. The last hypothesis "Tobacco as a marker of disease severity" was the one that was most corroborated, with four of the five studies included in this topic supporting this hypothesis. In one study, it is suggested that poor adherence to medication may be a causal factor that mediates the association between smoking and increased severity of the disease. It was found that, although further studies on this associations are necessary, if fully tested, it may be very useful in clinical practice, primarily in a view of prevention and also in the staging of the disease.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Primeiro episódio psicótico Tabaco Nicotina Psiquiatria