Skip to main content
SpringerLink
Log in

Smoking improves divided attention in schizophrenia

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Rationale

Smoking is highly prevalent in schizophrenia, and there is evidence for beneficial effects on neurocognition. Smoking is therefore hypothesized a self-medication in schizophrenia. Although much effort is devoted to characterize those cognitive domains that potentially benefit from smoking, divided attention has not yet been investigated.

Objectives

The aim of this study was to analyze the interactional effects of diagnosis of schizophrenia and smoking history on divided attention.

Methods

We investigated behavioral measures of divided attention in a sample of 48 schizophrenic patients and 48 controls (24 current smokers and non-smokers each) carefully matched for age, sex, education, verbal IQ, and smoking status with general linear models.

Results

Most important within the scope of this study, significant interactions were found for valid reactions and errors of omission: Performance substantially increased in smoking schizophrenic patients, but not in controls. Further, these interactions were modified by sex, driven by female schizophrenic patients who showed a significant behavioral advantage of smokers over non-smokers, other than male schizophrenic patients or healthy controls who did not express this sex-specific pattern.

Conclusions

Results suggest a positive effect of smoking history on divided attention in schizophrenic patients. This study provides first evidence that the complex attention domain of divided attention is improved by smoking, which further substantiates the self-medication hypothesis of smoking in schizophrenia, although this has been shown mainly for sustained and selective attention. Gender-specific effects on cognition need to be further investigated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Andreasen NC, Pressler M, Nopoulos P, Miller D, Ho BC (2010) Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biol Psychiatry 67(3):255–262

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Avila MT, Sherr JD, Hong E, Myers CS, Thaker GK (2003) Effects of nicotine on leading saccades during smooth pursuit eye movements in smokers and nonsmokers with schizophrenia. Neuropsychopharmacology 28(12):2184–2191

    PubMed  CAS  Google Scholar 

  • Barr RS, Culhane MA, Jubelt LE, Mufti RS, Dyer MA, Weiss AP, Deckersbach T, Kelly JF, Freudenreich O, Goff DC, Evins AE (2008) The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology 33(3):480–490

    Article  PubMed  CAS  Google Scholar 

  • Chambers RA, Krystal JH, Self DW (2001) A neurobiological basis for substance abuse comorbidity in schizophrenia. Biol Psychiatry 50(2):71–83

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Coull JT, Frith CD, Dolan RJ, Frackowiak RS, Grasby PM (1997) The neural correlates of the noradrenergic modulation of human attention, arousal and learning. Eur J Neurosci 9(3):589–598

    Article  PubMed  CAS  Google Scholar 

  • Depatie L, O'Driscoll GA, Holahan AL, Atkinson V, Thavundayil JX, Kin NN, Lal S (2002) Nicotine and behavioral markers of risk for schizophrenia: a double-blind, placebo-controlled, cross-over study. Neuropsychopharmacology 27(6):1056–1070

    Article  PubMed  CAS  Google Scholar 

  • Ernst M, Heishman SJ, Spurgeon L, London ED (2001) Smoking history and nicotine effects on cognitive performance. Neuropsychopharmacology 25(3):313–319

    Article  PubMed  CAS  Google Scholar 

  • George TP, Vessicchio JC, Termine A, Sahady DM, Head CA, Pepper WT, Kosten TR, Wexler BE (2002) Effects of smoking abstinence on visuospatial working memory function in schizophrenia. Neuropsychopharmacology 26(1):75–85

    Article  PubMed  Google Scholar 

  • Goldstein JM, Seidman LJ, Goodman JM, Koren D, Lee H, Weintraub S, Tsuang MT (1998) Are there sex differences in neuropsychological functions among patients with schizophrenia? Am J Psychiatry 155(10):1358–1364

    PubMed  CAS  Google Scholar 

  • Hahn B, Ross TJ, Wolkenberg FA, Shakleya DM, Huestis MA, Stein EA (2009) Performance effects of nicotine during selective attention, divided attention, and simple stimulus detection: an fMRI study. Cereb Cortex 19(9):1990–2000

    Article  PubMed  PubMed Central  Google Scholar 

  • Hahn C, Hahn E, Dettling M, Gunturkun O, Ta TM, Neuhaus AH (2012) Effects of smoking history on selective attention in schizophrenia. Neuropharmacology 62(4):1897–1902

    Article  PubMed  CAS  Google Scholar 

  • Harris JG, Kongs S, Allensworth D, Martin L, Tregellas J, Sullivan B, Zerbe G, Freedman R (2004) Effects of nicotine on cognitive deficits in schizophrenia. Neuropsychopharmacology 29(7):1378–1385

    Article  PubMed  CAS  Google Scholar 

  • Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991) The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 86(9):1119–1127

    Article  PubMed  CAS  Google Scholar 

  • Imperato A, Mulas A, Di Chiara G (1986) Nicotine preferentially stimulates dopamine release in the limbic system of freely moving rats. Eur J Pharmacol 132(2–3):337–338

    Article  PubMed  CAS  Google Scholar 

  • Jacobs E, D'Esposito M (2011) Estrogen shapes dopamine-dependent cognitive processes: implications for women's health. J Neurosci 31(14):5286–5293

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Jacobsen LK, D'Souza DC, Mencl WE, Pugh KR, Skudlarski P, Krystal JH (2004) Nicotine effects on brain function and functional connectivity in schizophrenia. Biol Psychiatry 55(8):850–858

    Article  PubMed  CAS  Google Scholar 

  • Jacobsen LK, Krystal JH, Mencl WE, Westerveld M, Frost SJ, Pugh KR (2005) Effects of smoking and smoking abstinence on cognition in adolescent tobacco smokers. Biol Psychiatry 57(1):56–66

    Article  PubMed  Google Scholar 

  • Lawrence NS, Ross TJ, Stein EA (2002) Cognitive mechanisms of nicotine on visual attention. Neuron 36(3):539–548

    Article  PubMed  CAS  Google Scholar 

  • Lehrl S, Triebig G, Fischer B (1995) Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence. Acta Neurol Scand 91(5):335–345

    Article  PubMed  CAS  Google Scholar 

  • Leonard S, Mexal S, Freedman R (2007) Smoking, genetics and schizophrenia: evidence for self medication. J Dual Diagn 3(3–4):43–59

    Article  PubMed  PubMed Central  Google Scholar 

  • Lu Y, Wang SS, Reynolds P, Chang ET, Ma H, Sullivan-Halley J, Clarke CA, Bernstein L (2011) Cigarette smoking, passive smoking, and non-Hodgkin lymphoma risk: evidence from the California teachers study. Am J Epidemiol 174(5):563–573

    Article  PubMed  PubMed Central  Google Scholar 

  • Neuhaus AH, Opgen-Rhein C, Urbanek C, Gross M, Hahn E, Ta TM, Koehler S, Dettling M (2009) Spatiotemporal mapping of sex differences during attentional processing. Hum Brain Mapp 30(9):2997–3008

    Article  PubMed  Google Scholar 

  • Newhouse PA, Potter A, Singh A (2004) Effects of nicotinic stimulation on cognitive performance. Curr Opin Pharmacol 4(1):36–46

    Article  PubMed  CAS  Google Scholar 

  • Palomero-Gallagher N, Vogt BA, Schleicher A, Mayberg HS, Zilles K (2009) Receptor architecture of human cingulate cortex: evaluation of the four-region neurobiological model. Hum Brain Mapp 30(8):2336–2355

    Article  PubMed  Google Scholar 

  • Rezvani AH, Levin ED (2001) Cognitive effects of nicotine. Biol Psychiatry 49(3):258–267

    Article  PubMed  CAS  Google Scholar 

  • Roesch-Ely D, Hornberger E, Weiland S, Hornstein C, Parzer P, Thomas C, Weisbrod M (2009) Do sex differences affect prefrontal cortex associated cognition in schizophrenia? Schizophr Res 107(2–3):255–261

    Article  PubMed  Google Scholar 

  • Sacco KA, Termine A, Seyal A, Dudas MM, Vessicchio JC, Krishnan-Sarin S, Jatlow PI, Wexler BE, George TP (2005) Effects of cigarette smoking on spatial working memory and attentional deficits in schizophrenia: involvement of nicotinic receptor mechanisms. Arch Gen Psychiatry 62(6):649–659

    Article  PubMed  Google Scholar 

  • Sacher J, Okon-Singer H, Villringer A (2013) Evidence from neuroimaging for the role of the menstrual cycle in the interplay of emotion and cognition. Front Hum Neurosci 7:374

    Article  PubMed  PubMed Central  Google Scholar 

  • Segarra R, Zabala A, Eguiluz JI, Ojeda N, Elizagarate E, Sanchez P, Ballesteros J, Gutierrez M (2011) Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis. Eur Arch Psychiatry Clin Neurosci 261(4):241–250

    Article  PubMed  Google Scholar 

  • Shen C, Popescu FC, Hahn E, Ta TT, Dettling M, Neuhaus AH (2013) Neurocognitive pattern analysis reveals classificatory hierarchy of attention deficits in schizophrenia. Schizophr Bull

  • Smith RC, Singh A, Infante M, Khandat A, Kloos A (2002) Effects of cigarette smoking and nicotine nasal spray on psychiatric symptoms and cognition in schizophrenia. Neuropsychopharmacology 27(3):479–497

    Article  PubMed  CAS  Google Scholar 

  • Stein EA, Pankiewicz J, Harsch HH, Cho JK, Fuller SA, Hoffmann RG, Hawkins M, Rao SM, Bandettini PA, Bloom AS (1998) Nicotine-induced limbic cortical activation in the human brain: a functional MRI study. Am J Psychiatry 155(8):1009–1015

    PubMed  CAS  Google Scholar 

  • Uban KA, Rummel J, Floresco SB, Galea LA (2012) Estradiol modulates effort-based decision making in female rats. Neuropsychopharmacology 37(2):390–401

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Vijayraghavan S, Wang M, Birnbaum SG, Williams GV, Arnsten AF (2007) Inverted-U dopamine D1 receptor actions on prefrontal neurons engaged in working memory. Nat Neurosci 10(3):376–384

    Article  PubMed  CAS  Google Scholar 

  • Vohn R, Fimm B, Weber J, Schnitker R, Thron A, Spijkers W, Willmes K, Sturm W (2007) Management of attentional resources in within-modal and cross-modal divided attention tasks: An fMRI study. Hum Brain Mapp 28(12):1267–1275

    Article  PubMed  Google Scholar 

  • Winterer G (2010) Why do patients with schizophrenia smoke? Curr Opin Psychiatry 23(2):112–119

    Article  PubMed  Google Scholar 

  • Zimmermann P, Fimm B (1992) Testbatterie zur Aufmerksamkeitsprüfung (tap). Psytest, Freiburg

    Google Scholar 

Download references

Acknowledgments

We would like to thank all participants of this study for contributing their time and effort. This study is part of the doctoral thesis of Elnaz Goudarzi.

Conflict of interest

There is no conflict of interest for any of the authors.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Charité University Medicine, Campus Benjamin Franklin, Eschenallee 3, 14050, Berlin, Germany

    Eike Ahlers, Eric Hahn, Thi Minh Tam Ta, Elnaz Goudarzi, Michael Dettling & Andres H. Neuhaus

Authors
  1. Eike Ahlers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thi Minh Tam Ta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elnaz Goudarzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Dettling
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andres H. Neuhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eike Ahlers.

Additional information

Eike Ahlers and Eric Hahn contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahlers, E., Hahn, E., Ta, T.M.T. et al. Smoking improves divided attention in schizophrenia. Psychopharmacology 231, 3871–3877 (2014). https://doi.org/10.1007/s00213-014-3525-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-014-3525-2

Keywords

Search

Navigation