The disease, which occurs between the ages of 21 and 27 on average, also poses a high risk for suicide, as 1 in 3 of schizophrenia patients are reported to attempt suicide.

Although the chronic illness, called schizophrenia, progresses with the loss of the ability to interpret reality in individuals, it can progress with various conditions such as changes in speech, thought disorders, and loss of perception.

The disease, which occurs on average at the age of 21 in men and at the age of 27 in women, also poses a high risk for suicide because it is known that 1 in 3 of schizophrenia patients attempted suicide and 10% of the attempts were successful.

Although typical and atypical antipsychotic drugs are used in the treatment of the negative and positive symptoms (signs) of the disease, the 3rd generation antipsychotic drug called clozapine is used in the treatment of the disease, but setting the therapeutic (therapeutic) window of clozapine and keeping the symptoms under control is another area of ‚Äč‚Äčexpertise.

Although cigarette consumption is quite common in patients with schizophrenia, intensive use of tobacco and tobacco products reduces the negative symptoms of the disease (It is obvious that the CYP1A2 microsomal enzyme system activity increases in smoking patients (Bozikas et al.2004). Ziedonis et al. (1994) reported that smoking patients needed an average of 590 mg / day chlorpromazine equivalent, whereas non-smokers needed an average of 375 mg / day chlorpromazine equivalent. Therefore, it should be kept in mind that drug doses may need to be adjusted in patients who smoke. It is thought that it changes dopamine release in the mesolimbic pathways, stimulates glutaminergic neurons in the prefrontal cortex, thus increasing glutamate and dopamine activity in the basal ganglia (Wise and Gardner 2002). It has been suggested that it reduces symptoms, but can also increase positive symptoms. Partly in line with this view, it is observed that atypical antipsychotics, which are considered more effective on negative symptoms, are more effective in quitting smoking than typical antipsychotics (McEvoy et al. 1999). Nicotine stimulates the reward mechanisms in the brain with the increased dopaminergic transmission it creates in the mesolimbic pathway, which includes the nucleus accum-bens and ventral tegmental area (Corrigall et al. 1992). ), but tobacco use also significantly affects the plasma concentration of clozapine.

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Polycyclic aromatic hydrocarbons found in tobacco products also induce (stimulate) hepatic cytochrome P450 (CYP1A2) enzymes, so the therapeutic dose of clozapine is affected by the use of these products.

Tobacco and tobacco products
While it is stated that the proportion of tobacco use among schizophrenia patients in the United States is 90%, schizophrenia patients spend approximately 27% of their income on tobacco products and consume approximately 20 to 40 cigarettes a day, so the life span of schizophrenia patients is 15 to 20 years longer than those without schizophrenia. Although stated to be rare, cardiovascular diseases alone constitute one of the leading causes of death for schizophrenia patients.

Nicotine-Clozapine dilemma
Nicotine mimics the effects of the neurotransmitter acetylcholine and binds to specialized acetylcholine receptors called nicotinic receptors. Clozapine is used to prevent suicidal behaviors in treatment-resistant schizophrenia cases, but it is preferred in cases with violent behavior and aggressive behaviors accompanying psychosis. It should also be noted that clozapine is degraded by the CYP1A2 enzyme and its oral bioavailability is between 60 and 70%, with a half-life of approximately 14 hours.

Although it is known that the use of tobacco products increases clonidine metabolism by CYP1A2 and the dose should almost double to reach the same plasma concentration (compared to non-smokers), schizophrenia patients using tobacco products show more hallucinations and delusion-like symptoms in acute episodes It is known that there is an increase in hospitalization (hospitalization) rates.

In addition to all these, it should be noted that individuals who use typical antipsychotic drugs such as haloperidol, chlorpromazine, thioridazine are more prone to smoking than individuals who use atypical antipsychotics such as clozapine, risperidone and olanzapine. In other words, switching from typical antipsychotic use to atypical antipsychotic use can be considered as another factor that reduces smoking.


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