Discussion The current systematic review provides convincing evidence of high rates of tobacco use in first-episode psychosis, being in agreement, in fact, with the prior knowledge from previous studies.3 A meta-analysis of worldwide studies suggests that smoking begins before the first referral for treatment38 and two prospective cohort studies have indicated that smoking may begin before the onset of psychosis.39,40 Regarding the first topic, tobacco smoking as a potential risk factor for first-episode psychosis, it was observed that, in spite of the percentage of patients aged 20 years or older who smoked being greater than the percentage of teenaged patients, suggesting that a percentage of them started to smoke after the onset of the illness, in general the mean age of starting to smoke was significantly earlier than the age of functional decline and the onset of psychosis
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This work was supported by Science and Technology Plan Project of Dali Prefecture Branch of Yunnan Tobacco Company (2022530000241035, DLYC2023001, 2015YN20, 2024530000241012)
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