Tobacco and Psychosis: not quite a smoking gun | Hacker News Reader

Tobacco and Psychosis: not quite a smoking gun

anp.sagepub.com

26 pointsDanBC37 comments

Wait: if tobacco use were actually the cause of psychosis, wouldn't we expect to see a dramatic reduction in the prevalence of psychosis in the United States, given that the smoking rate in the US has declined by over fifty percent in recent decades?

As far as I know, there has been no such decline.

What we have seen is a large increase in the incidence of depression, and tobacco has been persuasively shown to have antidepressant effects. Nicotine is, of course, a powerful stimulant, and tobacco also contains monoamine oxidase inhibitors (which also have antidepressant effects).

I wonder if there is any correlation with the obesity epidemic as well, since nicotine's appetite suppression is also well documented.

Good question.

Grab your white jumpsuit and fire up a heater.

Is it the effect of nicotine itself or, like it seems to be the case with addictive properties, a combination of nicotine and other agents present in the cigarette smoke?

I ask because I've been using pure nicotine as a cognitive stimulation agent for some time and I haven't noticed any effect on weight or appetite (INB4 I know, n=1, etc.).

It seems nicotine itself is believed to be an appetite suppressant, although the even the evidence for weight loss from smoking is sketchier than I realised. At least, so I surmise from skimming the relevant Wikipedia article: https://en.wikipedia.org/wiki/Cigarette_smoking_for_weight_l....

Hypothesis: All mind-altering substances precipitate the onset of, and worsen the symptoms of schizophrenia. The strength of the effect depends on interactions between the substance and brain systems we do not yet adequately understand.

There may be nothing special about nicotine except that it is psychoactive. We will need to learn a whole lot more about the brain before we can figure out why nicotine might have a more profound effect than, for example, caffeine.

Some stream of consciousness writing: I would add to that that the body, brain, mind are in part pressure-based systems and normally if all systems are functioning and energy is flowing as it needs to - then pressure in one or multiple areas won't rise, however if those energies aren't flowing for whatever possible causes - then problems can occur and worsen over time as the brain has its natural systems that will keep evolving and applying pressure; if "you" understand Qi (chi) and how energy can become stagnant in the body, this may be easier to comprehend -- stagnant energy, blocks or buildups, in my experience leads to actual pain sensations in the body, and a simple acupuncture session can help alleviate or eliminate the pains (until perhaps the energy buildsup again); this doesn't necessarily mean it will reduce the baseline of existing causes, that would require more work.

And here we find direct evidence of the effects of over-consumption of cannabis.

I laughed. No, just a very vague, disconnected, unreferenced part to a much bigger construct that I'll eventually have time to write out - so it will at least appear a little more grounded in reality, and science.

President Obama, Carl Sagan, all of your favorite musicians, etc, etc, etc.

Have what? Over consumed cannabis? Probably not.

Qi does not exist.

So, that's your theory?

Can you prove that? There is evidence to the contrary.

The Wikipedia article for it shows only skepticism regarding it, with no professional sources arguing for its existence.

https://en.wikipedia.org/wiki/Qi#Scientific_view

Could you show the evidence to the contrary?

Also, potentially beneficial effects of acupuncture do not imply anything about the existence of qi.

Depends on what you mean by existence? Detectable by modern instrumentation? What if Qi is an extremely useful system of mental organization, allowing practitioners to fine-tune their own body's operation. There is plenty of evidence that this is possible (see mindfullness / trancendental meditation) which have concrete isomorphisms (so to speak) to the concept of Qi.

Qi doesn't exist the same way that software doesn't exist. It's an abstraction that labels an emergent phenomenon. Software is made up if zeros and ones which actually don't exist but are labels we give to certain states of organized matter and energy. The same goes for Qi. It's the perception of a composite of the various aspects of a body's state as well as mental awareness of that state, such as relaxation in a specific part of the body. It's more detailed than explained here, but that's the jist.

Qi is neither necessary nor sufficient to explain or describe any physical, emotional, cognitive, social or "spiritual" phenomena. It is certainly not emergent (nor is software). To paraphrase Dawkins, you already don't believe in homunculi, aether, or many other previous attempts to explain our experience of being ourselves. Qi is just another thing to not believe, try it.

> Qi is neither necessary nor sufficient to explain or describe any physical, emotional, cognitive, social or "spiritual" phenomena

Care to be more specific? How do the terms "necessary" and "sufficient" come into play? It's not a binary "all" or "nothing" distinction. If something helps you even a little bit, then it's valuable. An easy to grasp model of your body's state can help you maintain awareness of that state, and thus improve it.

Also, what do homunculi, aether, etc have to do with Qi? Qi is a useful abstraction. I've never claimed that it exists as an objective property of the universe.

Hi there.

Sure --

"Necessary" and "sufficient" are technical terms: https://en.wikipedia.org/wiki/Necessity_and_sufficiency

You described Qi as "the perception of a composite of the various aspects of a body's state as well as mental awareness of that state". I'm saying Qi is neither necessary nor sufficient to perceive these things.

Similarly, I could say "Aether carries the mental awareness of my body's state". Or "Tiny homuncli exist in my brain, and it's the job of one of them to make me aware of my body's state". These things are neither necessary nor sufficient to explain awareness of ones own body. Consequently they could detract from explanations that may be genuinely useful.

It seems difficult to point to exactly what Qi is, and how it's different from similarly vague postulations.

Whether your idea of Qi helps you or not wasn't mentioned in your previous comment, so I wasn't responding to that.

If Qi is simply an "abstraction" then we can call it whatever we want. Why call it Qi?

If Qi is not "an objective property of the universe" is it entirely a subjective property of whoever believes in it? If that's the case, I'd struggle to understand how "useful" it is.

Certainly, I can see that things like self-awareness, relaxation, mindfulness, stillness and so on are "useful". They can be potent, restorative, healthful, etc, and we can demonstrate those effects through experiment. Unfortunately concepts like Qi tend to unravel in the light of experiment because they are so indefinable. Or more accurately: the definition constantly seems to shift.

Not everything is definable, of course. I have no issue with finding beauty, wonder and awe in life. In fact -- that's probably one important element in living well.

Ultimately I don't particularly mind if you believe in something called Qi, although I find it odd, and I hope you have a happy life :)

This sort of thing is taught to school children in China, but completely foreign to Western audiences. We might test if these associations vary across cultures. Might Chinese people smoke more yet have a lower incidence of psychosis?

You also have to look at the person's beginning state of health - all aspects of their health, not just physical and some general overview of emotional/mental state. Perhaps knowing the differences of how they approach health-concerns is important as well - even looking at their diet.

I don't know of any tests that would adequately determine the holistic health of someone. You have to define what health means as well.

Psychological flexibility is a term that may come into the mainstream more in the future - the ability for the mind to be more fluid between states; all-or-nothing thinking vs. "I'm happy and sad [at the same time]."

Perhaps psychoactives lead to expanding the capabilities of ones' mind, expanding ones' ability to think, creating new connections - which includes opening up their creativity. If there is some block, whether it is a coping mechanism or other, then what happens when a coping mechanism in a brain that's been developing further for a decade or longer with that mechanism in place - and then you change the environment suddenly? Whatever that coping mechanism was helping you cope with is all of the sudden potentially broken or removed -- what will happen to the rest of the systems and pathways? Many systems will potentially all of a sudden experience something they never have experienced before - perhaps with schizophrenia being on the extreme side of fluidity of mental energy being more rigid - so certain systems shutdown and become rigid and which would be on a spectrum of rigidness of course.

Neural pathways will have a normal rate of connecting throughout the brain, all of the sudden changing that will cause unexpected connections. Some of those connections could have been missing because of the coping mechanisms that were in place. Most coping mechanisms protect from perceived emotional pain or physical pain and are learned because "I did X and felt Y - so I will no longer do X [or keep it in my awareness, e.g. conditioning]" - which where the understanding could be wrong. This would put a person more in all-or-nothing thinking instead of a fluid state that having more than 1 possibility in your mind would allow for.

Perhaps it is certain thinking structures are learned as rigid then this will evolve into problems, and depending on which and how many structures are more rigid will determine what issues they will have and how severe they impact behaviour. It could be genetic for what thinking structures are possible or it could a coping mechanism from whatever situation occurred. Autism for example can be seen as a developmental delay or block, and depending where one is at on the spectrum, different therapies can have a substantial impact on unlocking the developmental block and allowing the child/person to continue their natural development evolution.

If I were to make a completely blind guess, I'd say it may be the case that drugs which affect dopamine or dopamine receptors directly or indirectly can have some causal or exacerbatory effect on psychotic disorders like schizophrenia.

Lots of different stimulant and psychedelic drugs affect dopamine in some way.

Uh, all mind-altering substances? Including the ones they use to treat schizophrenia?

Seems pretty unlikely.

Nicotine is a powerful anti-psychotic. This has been known for many years and was one of reasons doctors used to prescribe smoking to patients. Most schizophrenics use it for that effect; the idea it causes it is somewhat ludicrous.

They didn't address the confounding variable that these disorders are caused by dopaminergic issues, which are present even before becoming floridly psychotic. High levels of dopamine = low levels of arousal, so the slight elevation caused by tobacco smoking is probably pretty appealing.

Only first person experience, here, but I can say antipsychotics (which are dopamine-receptor antagonists... hence the "thorazine shuffle") cause these bouts of sedation that are made much less uncomfortable by simply having a smoke.

The hydrocarbons in cigarette smoke interact with the anti-psychotics - it's well known that people who smoke need to take larger doses of their meds.

But wait a second. An easy counter argument to the theory is that smoking has significantly decreased all over the Western world. So, if the number of schizophrenics hasn't decreased proportionally, then tobacco smoking can't be a major factor.

Agreed, with the caveat that mental illness diagnosis has become more common over the past century. (Though I'm not sure whether people have become more willing, in the past couple of decades, to diagnose schizophrenia specifically.)

Here is a paper that really exemplifies Paul Graham's Write Like You Talk article, which is currently on the FP. I wish these articles were written for the public and were at least somewhat easy to digest.

It's not even writing like you talk in this case. As an example:

"This study examined smoking in first episode psychosis in order to minimize the any confounding effect of self-medication."

Is there an editor in the house? It gets worse:

"The results were that worldwide, 59% people with first episode psychosis use are regular tobacco users, that people with first episode psychosis have a six-fold greater probability of being smokers than the general population and that smoking initiation occurs on average 5.3 years before the onset of psychosis."

I'll give researchers the benefit of the doubt that these types of mistakes could be related to English as a second, third, or fourth language. Maybe they happened as part of a bad translation? However, these were researchers from South Wales and Australia. As a result I wonder how many mistakes they made in their research. If you produce research which is worth publishing, get an editor.

from South Wales

New South Wales is a state of Australia, fyi.

It's a shame you got downvoted, because you make a good point. This article doesn't have to use as much jargon as it does; it doesn't have to use English in the confusing way it does.

I want MH trusts to go smoke free. That involves me telling people why that's a good idea, and that would be much easier for me to do if articles like this were written in plainer English.

Some jargon would still need to be used. For example they're talking about psychosis and first episodes of psychosis so that needs to stay.

Thanks. I smoke and I found the title and subject matter interesting. I am not a genius but am perfectly capable of understanding the article. It is just mentally taxing trying to wade through a sentence structure that seems aimed at a goal of obfuscating knowledge and proving the writer is intelligent rather than disclosing the information in a terse digestible way. Below, someone pointed out that there are many grammatical errors as well. I have thought a lot more about long form articles in publications like the New Yorker and NYT, etc. While often criticized for over simplifications and lack of understanding of subject matter, they often present articles in a way casually interested parties will understand. I don't have a problem with the jargon, large/obscure word use (to the extent it is reasonable) or otherwise employing tactics to get the point across. It is just that, as someone casually interested (not an academic looking for citations) I don't really know what to do with this sentence: > Cannabis use almost always predates psychosis, is associated with an earlier age at onset (Donoghue et al., 2014; Myles et al., 2012b) and heavier and more potent cannabis users have an increased risk of developing psychosis (Di Forti et al., 2009) and do so at an earlier age than people smoking milder cannabis (Di Forti et al., 2014). I wish they would just use superscripts for citations, as a significant portion of that sentence is citations. If academics would just edit the papers, dump them into Tufte CSS or LaTEX with sitations as footnotes or sidenotes and adapt a style human beings could digest without collapsing to rest from the boredom and dull overly-complex structure I think they may find a readership base that exceeds the single digits it currently has. Do you know of a place with interesting articles written for non-academics? I think that would be a cool thing and sure it exists? Cheers.

> Researchers have often overlooked the obvious – that almost all cannabis users also smoke tobacco

Is that obvious? Out of the people in my life that smoke pot, less than half smoke cigarettes.

This is my experience too- the overlap isn`t that pronounced at all. All the pot smokers I know don`t smoke cigarettes, don`t like cigarettes, and while they`ll light up a joint in their own home, ask cigarette smokers to do their tobacco smoking outdoors

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