http://jppbr.
DOI: 10.
21776/ub.
eISSN: 2723-083X pISSN: 2723-0821 Journal of Psychiatry Psychology and Behavioral Research Vol.
No.
September 2023
JPPBR
CHRONIC SMOKING AND PORNOGRAPHIC ADDICTION IN
SCHIZOPHRENIA PATIENT WITH URBAN LIVING: CASE
REPORT
Gumilar Fardhani Ami Putra1.
Zain Budi Syulthoni2.
Zuhrotun Ulya3 Correspondence: gumilarfardhani@student.
1Department of Anatomy Faculty of Medicine Institut Teknologi Sepuluh Nopember.
Surabaya.
Indonesia.
2Department pf Psychiatry Faculty of Medicine Institut Teknologi Sepuluh Nopember.
Surabaya.
Indonesia.
3Department of Psychiatry Faculty of Medicine Brawijaya University.
Malang.
Indonesia
REVIEW
OPEN ACCESS
ABSTRACT
Introduction Ae Urban living, chronic smoking is a risk factor in schizophrenia.
Pornographic addiction is also a potential risk factor of schizophrenia considering its neurobiological pathways.
Schizophrenia is one of the most dangerous mental illness contributing to 2,8% years lived with disability.
Considering many people with urban living, chronic smoking, and pornographic consumption, relation of these risk factors to schizophrenia is demonstrated in this case report.
Methods Ae Presented the case of the patient, 39 years old with psychotic symptoms was found to be born and lived most of his life in urban area, smoking since junior high school, and often consumed pornographic contents since senior high school.
Data were taken from psychiatric interviews, general, and mental status examinations in psychiatric clinics, then a literature review was carried out.
Results Ae People who born, and live through their live longer in a larger city, have more risk of Schizophrenia.
Patient was known to be born in one of the biggest city in Indonesia, before moved out to another urban area in different countries in last two years.
Crave with chronic smoking and pornographic addiction become one of contraproductive conduct source which arise difficulty in patientAos side to take an health life style with the risk of poor prognosis and mental health deterioration.
Discuss Ae People who born and live longer in urban areas such as cities are in increased risk of schizophrenia due to social status awareness and fast paced life induce brain stress.
Chronic smoking is a risk factor of schizophrenia due to the effect of nicotine on dopamine levels.
Pornographic addiction is a potential risk factor due to addiction pathway effect on dopamine threshold.
Conclusion Ae Urban living, chronic smoking, and pornographic addiction are risk factors associated with schizophrenia found in this case Epidemiologic and pathophysiological mechanisms behind these risk factors are an interesting view for physician dealing with schizophrenia patients.
Awareness of social status and fast paced life in urban lifestyle, pathways of nicotine in dopamine dysregulation, and dopamine-related impairment in addiction are the neurobiological mechanisms behind these risk factors which a physician needs to be aware Keywords: schizophrenia, urban living, chronic smoking, pornographic addiction.
Article History:
Received: May 26, 2021 Accepted: December 25, 2021 Published: September 30, 2023 Cite this as: Putra.
Syulthoni.
Ulya.
Chronic Smoking and Pornographic Addiction in Schizophrenia Patient with Urban Living: Case Report.
Journal of Psychiatry Psychology and Behavioral Research.
:22-25.
Psychosis is the main feature of schizophrenia spectrum Defined broadly as loss of ego boundaries or impairment in perception of reality, psychosis also interferes with an individual ability to do daily activities.
Current definition of psychosis requires presence of hallucinations or delusions without insight that him or herself are having illness .
ack of insigh.
Hallucination defined as perceptions occurring without any external stimuli, and delusion defined as beliefs maintained strongly, even with inevitable, contradicting evidence present.
INTRODUCTION
Schizophrenia is one of the most dangerous mental illness.
Systematic reviews show relatively high prevalence of schizophrenia but relatively low incidence because of its early adult onset and chronic duration.
Globally, schizophrenia contributed to 2,8% years lived with disability.
Schizophrenia is more common in men, and is occurring at earlier age in men than women.
Genetic and various environmental factors, such as social isolation also play an important role in Urban living and chronic smoking have been associated with prevalence of schizophrenia.
Urban living, whether it is a place of birth, or a place of living has been associated with increasing prevalence of schizophrenia.
Chronic smoking, by its direct and indirect neurobiological pathway is also associated with increasing prevalence of schizophrenia.
Various psychosocial factors and neurobiological mechanism interact within each other, causing the effect of chronic smoking and urban living in schizophrenia.
3Ae5 Pornography content consumption had been studied in its relation with psychosocial disorders.
Depression, and psychosomatic symptoms are two of the common psychosocial-related symptoms associated with excessive pornography consumption.
Previous study also relate pornography addiction to other forms of addiction, such as substance use addiction and sex addiction.
The relation between these addictions and psychosocial disorders may be related to stages of addiction and its neurobiology, which will be discussed later in this case report.
METHOD
Presented the case of the patient, 39 years old with psychotic symptoms was found to be born and lived most of his life in urban area, smoking since junior high school, and often consumed pornographic contents since senior high school.
Data were taken from psychiatric interviews, general, and mental status examinations in psychiatric clinics, then a literature review was carried out.
This case report was approval and permitted by Rumah Sakit Universitas Brawijaya, patient and his families.
Ethical clearance was permitted by Ethical Team in Faculty of Medicine Brawijaya University (No.
135/EC/KEPK/07/2.
CASE REPORT
A 39 years old man visited Psychiatry Clinic with his uncle.
Patient came with complaints of talking by himself and getting confused sometimes.
As portrayed by his uncle, he also sometimes getting angry by himself.
The patient first became aware of his symptoms at the age of 19.
At first, patient symptoms consist of talking by himself and getting confused, then symptoms progressively got worse by him getting angry by himself, then tried to stab his mother at the age of 37.
Since his birth and until adolescent age, patient didnAot have any particular event that led to his current condition.
Patient was known to be born in one of the biggest city in Indonesia, before moved out to another urban area in different countries in last two years.
Patient is an introverted person since his childhood.
Patient started smoking since junior high school, and have been smoking around 1 box .
of cigarettes per day until time of interview.
In senior high school, patient and his close friends often watched pornographic contents via compact disc (CD).
It was around second grade of senior high school that his first symptoms appear.
Patient was sometimes seen talking by himself and getting confused.
Worsening of patientAos symptoms happened when he was at the age of 23.
Going in and out of jobs because of his symptoms, this was the first time that patient was getting angry by himself.
Because of patientAos symptoms, he was forced to leave from his job, and his family admitted him to alternative medicine for three weeks.
The patient never attended any medical facility, hence no treatment with antipsychotics or any other drugs.
PatientAos condition never reached normal state, constantly talking by himself, even getting angry by himself few times each week.
There is no particularly bad relationship by patient with any member of his family.
His father had cardiovascular disease, and died when the patient was 30 years of age.
Worsening of the patientAos psychiatric condition happened again when the patient was at 38 years old.
At that time, patient attempted to stab his mother with a knife, and interfered by his younger brother.
The patient then left his house and became a homeless person.
The patient said that he had to feed himself by asking other people for food, and slept at public places such as mosque.
Social services finally found the patient after went missing for almost a year, and admitted in Mental Health Hospital.
The patient undergoes one and a half months of intrahospital therapy.
Patient admitted out with risperidone and clozapine treatment.
Physical examination showed normal vital signs and generalist Mental status showed appearance that was appropriate for age, cooperative person with normal psychomotor Mood and affect were normal and coherent.
Flow of thought was coherent with no particularly abnormal content.
Patient had visual and olfactory hallucinations when he was in Mental Health Hospital.
Mental status examination also showed that patient had difficulty in concentration.
The patientAos surveillance degree is grade 4 .
atient understands that he is sick but does not know wh.
RESULT
Some of the difficulties in handling this case that patient does not have insight into his mental disorder, denying about the needed of therapeutical process, worsening mental condition as the treatment process delayed as part of lack therapeutical adherence, and lack of care by his caregiver.
One of the habits which arise in community and patientAos caregiver is medication can be hold when the patient become agitated, got some violation behavior .
n this case such as stabbing her mothe.
, and had no continuity.
Initial treatment observations revealed that patientAos agitation, anger and confusion become decreased gradually, but still had some concern problem such as chronic smoking and pornographic addiction.
Patient beliefs about his urgency that he need to do both .
moking and watching porn video, masturbate, et.
to reduce his restless.
When this behavior had not fullfil, the patient will get more sound in his ears such as.
AuHai you stupid moron! Just go ahead with your last habit, try to do that, it is easy for you to stab your old mom until she died, why take a bother for just some cigarette? Porn is a must.
Ay, patient also take some note about increasing thougth of echo and thougth of withdrawal every night.
Unemployment condition made patient felt insecure, more stressed due to inability in financial problem.
People who born, and live through their live longer in a larger city, have more risk of Schizophrenia.
Patient was known to be born in one of the biggest city in Indonesia, before moved out to another urban area in different countries in last two years.
Crave with chronic smoking and pornographic addiction become one of contraproductive conduct source which arise difficulty in patientAos side to take an health life style with the risk of poor prognosis and mental health deterioration.
DISCUSS
Patient is a 39 years old men with introvert personality and excessive pornography content consumption.
Studies showed higher men to women ratio of schizophrenia, with a 1.
4 to 1 ratio, as well as higher prevalence found in people who born in People who born, and live through their live longer in a larger city, have more risk of Schizophrenia.
Patient was known to be born in one of the biggest city in Indonesia, before moved out to another urban area in different countries in last two years.
There were many studies evaluating association between urbanicity of oneAos life with psychosis.
Factors evaluated in urbanicity are place of birth and how long an individual live in urban areas.
People born in urban city and live longer in an urban city are more likely to have schizophrenia.
3,4,7
Neurobiological mechanism contributing to this phenomenon is not fully understood yet.
Theories suggest that constant stress due to social status awareness, and fast paced life in urban city may result in dysregulation of hypothalamuspituitary-adrenal axis.
This cause sensitization of mesolimbic dopamine pathway, contributing to higher risk of Urban living also associated with anterior cingulate cortex (ACC) in the brain.
ACC, which modulates negative emotion and stress response, is specifically activated in individuals exposed to unstable social status, and living in the city.
8Ae10 Chronic smoking had been associated to schizophrenia by few Although smoking in schizophrenia is associated with lots of factors such as psychosocial .
tress, depression, and social affiliatio.
, neurobiological mechanism of smoking and schizophrenia also contributes to the relation between smoking and schizophrenia.
Nicotine is one of the substances.
Nicotine is known to increase dopamine level in the prefrontal region of the brain.
Nicotine achieves this effect by binding with glutamate receptor to enhance and stimulate glutamate activity, which in turn enhances dopaminergic activity directly.
Nicotine also bind to GABA receptor, in chronic setting, this will desensitize GABA receptor and dampen dopaminergic inhibition, indirectly enhancing dopaminergic activity.
Considering neurobiological consequences of nicotine, cessation of smoking in patient with schizophrenia is very Despite global efforts to decrease cigarette use, few studies showed that schizophrenia patients smoke frequently.
Studies showed that at least 50% of schizophrenia patient who smoked cigarettes were more than three times as likely to smoke compared to individual without psychiatric disorders.
Schizophrenia patients known to consume greater quantities, smoke more frequently, and have greater dependency to nicotine compared to normal individual.
These epidemiological findings, combined with the knowledge of nicotineAos neurobiological effect on schizophrenia, may lead to prevention and treatment challenge in schizophrenia 11Ae15 Relation between pornographic addiction and schizophrenia may be associated with its dopamine-related neurobiological Pathophysiology of schizophrenia related to dopamine pathway is not yet confirmed.
But, various evidences, including efficacy of dopamine receptor antagonists to treat acute symptoms of schizophrenia, and the proof that increase of extracellular dopamine by amphetamines lead to stimulation of psychosis, support this theory.
Initial theory of dopamine related pathway in schizophrenia proposed that increased dopamine level lead to psychosis, causing overactivity of the mesolimbic system, while more recent theories proposed dysfunction of presynaptic dopamine as the main neurobiological pathway to psychosis.
16Ae18 Neurobiology of pornographic addiction is similar to other Addiction is a neurobiological shift from impulsive actions through positive reinforcement to compulsive actions through negative reinforcement.
This shift leads to addiction cycle, known as three stages of addictive cycle, which are binge/intoxication, withdrawal/negative preoccupation/anticipation.
These stages are related to mesolimbic dopamine pathway consists of ventral tegmental area (VTA) and nucleus accumbens (NAc.
This pathway then connects with amygdala, frontal cortex, and hippocampus to form the integrated circuits commonly called as the reward The binge or intoxication stage is when addiction .
rugs, sex, pornographic consumption, et.
activate the reward system.
Different forms of addiction activate reward system through different mechanisms, but the end result is similar, increase of dopamine in NAcc.
This phenomenon results in positive reinforcement of the behavior that started the reinforcement at the first place.
This stage of behavior and positive reinforcement results in neuroplastic changes.
Continued release of dopamine increases dynorphin, which decreases dopaminergic function in reward system.
This increases reward dopaminergic threshold, resulting in increase of 19,20 In the second stage or withdrawal/negative affect, dopamine had lost its increment, resulting in activation of extended amygdala, which induces negative emotional state and brain This leads to decreased sensitivity to reward system and also increase to dopamine tolerance.
The third stage or preoccupation/anticipation described as expansion of neuroplastic impairments.
Rather than just the mesocortical dopamine, impairments also expand to other regions of prefrontal cortex, resulting in impairment of motivation, selfcontrol, and other cognitive functions.
19Ae22 Although some of neurobiological mechanisms above are not yet confirmed, such as dopamine pathway in schizophrenia, and specific pornographic addiction in dopamine-related impairment, epidemiological evidences are strong enough that we should consider them in schizophrenia patient.
Lack of confirmation of these specific mechanisms should be studied further in future researches.
CONCLUSION
Urban living, chronic smoking, and pornographic addiction are risk factors associated with schizophrenia found in this case Epidemiologic and pathophysiological mechanisms behind these risk factors are an interesting view for physician dealing with schizophrenia patients.
Awareness of social status and fast paced life in urban lifestyle, pathways of nicotine in dopamine dysregulation, and dopamine-related impairment in addiction are the neurobiological mechanisms behind these risk factors which a physician needs to be aware of.
REFERENCES