Psychological Medicine

Original Articles

Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case-control study

X. Y. Zhanga1a2 c1 , D. C. Chena2 , M. H. Xiua2 , C. N. Hailea1, S. C. Hea3, X. Luoa4, L. Zuoa4, R. Rosenhecka4, T. A. Kostena1 and T. R. Kostena1 c1

a1 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA

a2 Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China

a3 Department of Psychology, Peking University, Beijing, China

a4 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA


Background Although patients with chronic schizophrenia have substantially higher smoking rates than either the general population or patients with other mental illnesses, drug-naive patients with a first episode of schizophrenia have received little systemic study. This study examined smoking rates, the association between smoking and symptom severity and cognitive function in Chinese first-episode schizophrenia (FES) patients using cross-sectional and case-control designs.

Method Two hundred and forty-four drug-naive FES patients and 256 healthy controls matched for gender, age and education completed the Fagerström Test for Nicotine Dependence (FTND) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients were also rated on the Positive and Negative Symptom Scale (PANSS).

Results The rate and quantity of smoking were not significantly higher among FES patients compared to the general population. Among patients, smokers scored higher than non-smokers on the total PANSS and the positive symptom subscale scores. There were no significant associations between cognitive function and smoking in either FES patients or healthy controls.

Conclusions In contrast to studies in patients with chronic schizophrenia, drug-naive FES patients did not smoke more frequently than the general population. Furthermore, patients with psychotic disorders who smoked did not exhibit significant cognitive differences compared with those who did not smoke. However, smoking may have other detrimental effects on physical and mental health, for example on positive symptoms.

(Received May 24 2012)

(Revised September 30 2012)

(Accepted October 16 2012)

(Online publication November 13 2012)

Key words

  • Cognition;
  • first episode;
  • nicotine;
  • psychopathology;
  • schizophrenia;
  • smoking


c1 Author for correspondence: X. Y. Zhang, M.D., Ph.D., VA Medical Center, Research Building 109, Room 130, 2002 Holcombe Boulevard, Houston, TX 77030, USA. (Email: [X. Y. Zhang] (Email: [T. R. Kosten]


  These authors contributed equally to this work.