Background and Hypothesis The high co-occurrence of tobacco smoking in patients with schizophrenia spectrum disorders (SSD) poses a serious health concern, linked to increased mortality and worse clinical outcomes. The mechanisms underlying this co-occurrence are not fully understood. Study Design Addressing the need for a comprehensive overview of the impact of tobacco use on SSD neurobiology, we conducted a systematic review of neuroimaging studies (including structural, functional, and neurochemical magnetic resonance imaging studies) that investigate the association between chronic tobacco smoking and brain alterations in patients with SSD. Study Results Eight structural and fourteen functional studies were included. Structural studies show widespread independent and additive reductions in gray matter in relation to smoking and SSD. The majority of functional studies suggest that smoking might be associated with improvements in connectivity deficits linked to SSD. However, the limited number of and high amount of cross-sectional studies, and high between-studies sample overlap prevent a conclusive determination of the nature and extent of the impact of smoking on brain functioning in patients with SSD. Overall, functional results imply a distinct neurobiological mechanism for tobacco addiction in patients with SSD, possibly attributed to differences at the nicotinic acetylcholine receptor level. Conclusions Our findings highlight the need for more longitudinal and exposure-dependent studies to differentiate between inherent neurobiological differences and the (long-term) effects of smoking in SSD, and to unravel the complex interaction between smoking and schizophrenia at various disease stages. This could inform more effective strategies addressing smoking susceptibility in SSD, potentially improving clinical outcomes.

中文翻译：

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长期吸烟与精神分裂症大脑改变之间的关联：磁共振成像研究的系统回顾


背景和假设 精神分裂症谱系障碍 (SSD) 患者吸烟的高并发性造成了严重的健康问题，与死亡率增加和临床结果恶化有关。这种同时发生的机制尚不完全清楚。研究设计 为了满足全面概述烟草使用对 SSD 神经生物学影响的需要，我们对神经影像学研究（包括结构、功能和神经化学磁共振成像研究）进行了系统回顾，这些研究调查了慢性吸烟与大脑之间的关联SSD患者的改变。研究结果 包括八项结构研究和十四项功能研究。结构研究表明，与吸烟和 SSD 相关的灰质存在广泛的独立和加性减少。大多数功能性研究表明，吸烟可能与 SSD 相关连接缺陷的改善有关。然而，横断面研究的数量和数量有限，以及研究间样本的高度重叠，阻碍了吸烟对 SSD 患者大脑功能影响的性质和程度的结论性确定。总体而言，功能结果表明 SSD 患者烟草成瘾存在独特的神经生物学机制，可能归因于烟碱乙酰胆碱受体水平的差异。结论 我们的研究结果强调需要进行更多的纵向和暴露依赖性研究，以区分 SSD 中固有的神经生物学差异和吸烟的（长期）影响，并揭示不同疾病阶段吸烟与精神分裂症之间复杂的相互作用。 这可以为解决 SSD 吸烟易感性问题提供更有效的策略，从而有可能改善临床结果。