Abstract
<title>Abstract</title> <p>Background: The nicotine consumption rate is disproportionately high among individuals with psychotic disorders, with prevalence rates of 70–80% in schizophrenia. This study aimed to compare the severity of psychotic symptoms between nicotine-dependent and non-smoking patients with psychotic disorders and to investigate the relationship between nicotine dependence intensity and symptom severity. Methods: A case-control study was conducted on 52 male patients diagnosed with psychosis (DSM-IV via SCID-I) at governmental mental health hospital, Egypt. Patients were divided into a case group (n = 26, nicotine-dependent) and a control group (n = 26, non-smokers). Assessments included the Positive and Negative Syndrome Scale (PANSS), Structured Clinical Interview for DSM-IV (SCID-I), and the Fagerström Test for Cigarette Dependence (FTCD). Results: The PANSS positive scale was significantly higher in smokers (24.23 ± 4.91) than non-smokers (21.0 ± 5.08, p = 0.024), while the negative scale (p = 0.006), general psychopathology (p = 0.026), and composite scale (p = 0.047) were higher in non-smokers. SCID-I total score was significantly higher in smokers (33.85 ± 3.33 vs. 26.15 ± 2.69, p < 0.001). Strong positive correlations were found between FTCD and PANSS composite scale (r = 0.787, p < 0.001) and SCID-IV total score (r = 0.835, p < 0.001). Conclusions: Nicotine dependence was associated with increased positive psychotic symptoms and higher SCID-I symptom burden. The intensity of nicotine dependence showed the strongest correlation with symptom severity, suggesting tobacco use may exacerbate certain dimensions of psychosis.</p>