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Smoking, psychiatric illness and the brain.

Tobacco smoking remains a leading cause of mortality and morbidity despite recent declines in prevalence. In 2012, global prevalence rates for tobacco smoking were estimated to be 31% for men and 6% for women.1 Rates of smoking are markedly higher among people with psychiatric illness than in the general population, estimated at being 2–5 times higher in patients with several disorders, including schizophrenia, mood disorders, anxiety disorders, attentiondeficit/hyperactivity disorder (ADHD), binge eating disorder, bulimia and substance use disorders.2–5 The aim of this editorial is to emphasize the importance of smoking as a factor that should regularly be considered as a potential confound in neurobiological studies of psychiatric illnesses. Smoking can be regarded as playing at least several roles in relation to psychiatric illness — as a causal factor contributing to psychiatric disorders, as an agent causing brain changes on its own that may interact with psychiatric pathophysiology, or as a modulator of effects of psychotropic medications. In each of these roles, smoking may impact the course of psychiatric illness and brain function.