Tobacco smoking in Egyptian schizophrenia patients with and without obsessive - compulsive symptoms

Background: Nicotine dependence is common in schizophrenia patients but rare in patients with obsessive-compulsive disorder. Little is known, however, about smoking in schizophrenia patients with obsessive-compulsive symptoms (OCS) especially in a developing country, such as Egypt, that has the highest rate of tobacco consumption in the Middle East and North Africa. Objectives: To test a hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without-OCS. Results: Out of 87 consecutive schizophrenia patients attending a psychiatric out-patients clinic in Egypt, 34 patients (39\%) had significant OCS, and a smoking rate (85.3\%) not significantly lower than that of patients without-OCS (90.6\%). Patients were reclassified by their Fagerstrom's scores into 3 groups of nicotine dependence: mild (37 patients), high (21 patients) and very high (29 patients). There were no differences between these groups in terms of YBOCS scores (F=0.324;p=0.724). When comparing PANSS scores of patients, with and without-OCS, those of the former group were higher on the positive symptoms (mean= 24.2 versus 20.8; p=0.002), and anxiety/depression (mean= 10.8 versus 10.1 ;p=0.03) but lower on the negative symptoms (mean= 15.0 versus 19.4; p=0.000), disorganized thoughts (mean= 14.5 versus 17.5;p=0.002), and uncontrolled hostility/excitement) (mean=7.5 versus 9.5; p=0.002). However, there was no significant between-group difference in the total PANSS scores. Conclusions: The high and equal rates of smoking in patients with-, and without-OCS, and the lack of difference between YBOCS scores of mild, high and very high nicotine dependence groups undermined our initial hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without them. Nevertheless, the finding of a distinctive PANSS scores, may support a suggestion that OCS in schizophrenia represent a distinct subtype or dimension. (c) 2007 Elsevier B.V. All rights reserved.