Nicotine dependence and psychosis in Bipolar disorder and Schizoaffective disorder, Bipolar type

Patients with Bipolar disorder smoke more than the general population. Smoking negatively impacts mortality and clinical course in Bipolar disorder patients. Prior studies have shown contradictory results regarding the impact of psychosis on smoking behavior in Bipolar disorder. We analyzed a large sample of Bipolar disorder and Schizoaffective disorder, Bipolar Type patients and predicted those with a history of psychosis would be more likely to be nicotine dependent. Data from subjects and controls were collected from the Genomic Psychiatry Cohort (GPC). Subjects were diagnosed with Bipolar disorder without psychosis (N=610), Bipolar disorder with psychosis (N=1544). Participants were classified with or without nicotine dependence. Diagnostic groups were compared to controls (N=10065) using logistic regression. Among smokers (N=6157), those with Bipolar disorder had an increased risk of nicotine dependence (OR=2.5; P<0.0001). Patients with Bipolar disorder with psychosis were more likely to be dependent than Bipolar disorder patients without psychosis (OR=1.3; P=0.03). Schizoaffective disorder, Bipolar Type patients had more risk of nicotine dependence when compared to Bipolar disorder patients with or without psychosis (OR=1.2; P=0.02). Bipolar disorder patients experiencing more severity of psychosis have more risk of nicotine dependence.