they might hesitate before recommending someone with schizophrenia to stop smoking (depending on the circumstances), but they certainly did NOT recommend them to start smoking.
Sure, but nobody was actually saying that they
should take up smoking. The links to symptom abatement and nicotine are just in the data, so they round out an understanding of why people smoke, rather than just saying "it's bad!!! stop it!!!" which is the general population attitude, and is what I was referring to originally. The point about "recommend them to start smoking" is kind of a red herring here.
I was checking the current recommendations in medscape (which is my general medicine go-to guide btw. Poor man's Up to Date insofar it's actually free, but not really any worse), and I found an interesting tidbit
Smoking tobacco products induces the liver enzyme CYP1A2 (though nicotine patches, nicotine inhalers, and chewing tobacco do not); this enzyme metabolizes a number of antipsychotic drugs, so that, for example, patients who stop smoking while being treated with clozapine or olanzapine often experience increased antipsychotic levels; a patient who has stopped smoking may have a variety of complaints, and checking drug levels can help determine their etiology
That's a strong confusing factor for smoking cessation and schizophrenia (and mind you, I think withdrawal alone is likely a strong confusing factor by itself.
Also, more relevantly: I looked up the NICE guidelines for schizophrenia, and, sure enough, they DO NOT recommend to smoke, and they DO recommend smoking cessation.
But those recommendations might not take into account the research that's going on, much of which was only actually conducted in the last 3-4 years, while the correlational data goes back further than that. Remember it wasn't that long ago that the official medical advice was to prevent babies having peanuts as long as possible, to prevent allergies, and now it's to give them peanuts as early as possible, to prevent allergies. This 180 degree change in peanut allergy advice for babies happened in the USA about 18 months ago.
https://edition.cnn.com/2017/01/05/health/peanuts-allergy-prevention-guidelines/index.htmlHowever, if you kept up with the literature, it's was quite well established that there was a link some time around 15-20 years ago. The point here
isn't that they should have changed the advice to say "eat more peanuts early" as soon as preliminary data showed a link, it's that the previous orthodox medical advice
wasn't based on any actual data to start with. So, there was literally zero data supporting the medical establishment's orthodox treatment
whatsoever, yet they've demanded that competing ideas fulfill a "burden of proof". That's just pure confirmation bias. The original advice didn't in fact have
any data to support it, so the alternate idea should have been accepted on "preponderance of evidence" around 15 years ago, because the old advice should have been thrown out already, on the basis that it was pure guesswork/opinion and not based on any medical research.
How this relates to the current debate is that many people and organizations hold a "nicotine is always bad" attitude to a near-religious level of zeal, much more strongly than the "avoid peanuts for babies" thing: and we all saw how hard it was to change
that wrong advice. So there's strong confirmation bias against any study showing any positive correlations for nicotine.
And of course, none of that is to condone "smoking" or "taking up smoking" it's just to point out the potential that people are self-medicating and the research showing that nicotine has valid therapeutic uses. Alternate delivery methods such as vaping might shift the balance between harm/good to the point that there is data showing that doctors
should be recommending vaping to some people, especially if they're already smokers and they're schizophrenic. The only reason to stick against that no matter the evidence is an ingrained prejudice that "nicotine = bad/evil".