Tobacco Smoking and Bipolar Disorder
J Clin Psychiatry 1998;59(5):225-228
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: We sought to determine whether
tobacco smoking is associated with bipolar
Method: This case-control study carried out in
Alava, in the north of Spain, included patients with a DSM-III-R
diagnosis of bipolar disorder type I (N=51) and a representative
sample of the normal population (N=517). Smoking history of
bipolar patients was assessed with the Fagerstrom Test for
Nicotine Dependence and was verified by family members of the
Results: The frequencies of ever smoking and
current daily smoking were, respectively, 63% (32/51) and 51%
(26/51) for the bipolar patients and 45% (235/517) and 33%
(169/517) for the control group (respective odds ratios [ORs] and
95% confidence intervals [CIs] were OR=2.0, 95% CI=1.1 to 3.8 and
OR=2.1, 95% CI=1.2 to 4.0). The differences were significant
(p=.03 and p=.042, respectively) for bipolar versus control
males. Bipolar disorder (in both genders) was also significantly
associated (OR=4.4, 95% CI=1.7 to 11.9, p=.0015) with heavy
smoking (more than 1 pack per day).
Conclusion: Despite its small sample size, this
study suggests that smoking may be more prevalent in bipolar
patients than in the normal population. Since most patients
started to smoke before the onset of illness, vulnerability to
bipolar illness may make subjects vulnerable to become tobacco