101
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Morrison KN, Naegle MA. An Evidence-based Protocol for Smoking Cessation for Persons with Psychotic Disorders. J Addict Nurs 2010. [DOI: 10.3109/10884602.2010.481505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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102
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Wang CY, Xiang YT, Weng YZ, Bo QJ, Chiu HFK, Chan SSM, Lee EHM, Ungvari GS. Cigarette smoking in patients with schizophrenia in China: prospective, multicentre study. Aust N Z J Psychiatry 2010; 44:456-62. [PMID: 20397788 DOI: 10.3109/00048670903493348] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to explore the rate of cigarette smoking and its sociodemographic and clinical characteristics in Chinese schizophrenia patients. METHODS In a multicentre, randomized, controlled, longitudinal study, 374 clinically stable patients with schizophrenia were interviewed at entry using standardized assessment instruments, and followed up for 1-2 years. RESULTS The rate of cigarette smoking was 13.9% in the whole sample, and 26.2% in men and 3.5% in women. On univariate analysis, male sex, unemployment, alcohol consumption, older age, older age at onset, longer duration of illness, more frequent admissions, more severe hostility-excitement at entry and less deterioration in hostility-excitement over the study period were significantly associated with cigarette smoking. On multivariate analysis, male sex, unemployment, alcohol consumption, more frequent admissions, less severe positive and negative symptoms at entry, smaller decline in negative symptoms and more deterioration in disorganized thoughts over the study period were independently associated with cigarette smoking. CONCLUSION The rate of cigarette smoking in Chinese schizophrenia patients is considerably lower than most figures reported in the Western literature.
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Affiliation(s)
- Chuan-Yue Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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103
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Williams JM, Steinberg ML, Zimmermann MH, Gandhi KK, Stipelman B, Budsock PD, Ziedonis DM. Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. J Subst Abuse Treat 2010; 38:384-93. [PMID: 20363089 DOI: 10.1016/j.jsat.2010.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 02/04/2010] [Accepted: 03/09/2010] [Indexed: 11/18/2022]
Abstract
Compared to the general population, smokers with schizophrenia (SCZ) have reduced success in quitting smoking with usual approaches. This study tested two manualized behavioral counseling approaches-Treatment of Addiction to Nicotine in Schizophrenia (TANS) or Medication Management (MM)-for smokers who were motivated to quit. Individual counseling sessions were provided by mental health clinicians in mental health settings, along with nicotine patch. The two treatments varied in intensity and frequency of sessions. Eighty-seven subjects were randomized and attended at least one treatment session. Twenty-one percent (n = 18) of participants had continuous abstinence at 12 weeks after the target quit date, which was not significantly different between conditions (15.6% TANS vs. 26.2% MM, chi(2) = 1.50, p = .221). Smokers in both groups significantly reduced smoking as measured by cigarettes per day and expired carbon monoxide. Findings support that mental health clinicians can be trained to effectively help smokers with SCZ maintain tobacco abstinence.
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Affiliation(s)
- Jill M Williams
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-2008, USA.
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104
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Lin HC, Chen YH, Lee HC, Lin HC. Increased risk of acute myocardial infarction after acute episode of schizophrenia: 6 year follow-up study. Aust N Z J Psychiatry 2010; 44:273-9. [PMID: 20050720 DOI: 10.3109/00048670903487209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to estimate the risk of acute myocardial infarction (AMI) among patients who received a first hospital diagnosis of schizophrenia during a 6 year follow-up period. METHOD Data from the Taiwan National Health Insurance Research Database were used. The study cohort consisted of 7353 patients who were hospitalized with a principal diagnosis of schizophrenia in 2000. The comparison cohort were 22 059 enrollees randomly selected matched with the study group in terms of gender and age. Each patient was tracked from their index hospitalization in 2000 until the end of 2006 to identify whether or not an AMI had occurred during the follow-up period. Cox proportional hazard regressions were performed to compute the adjusted 6 year survival rate, following adjustment for possible confounding variables. RESULTS A total of 130 patients suffered AMI during the 6 year follow-up period, including 30 from the study cohort (0.41% of the schizophrenia patients), and 100 (0.45%) from the comparison cohort. But after censoring those patients who died from non-AMI causes and adjusting for potential confounding factors, the risk of AMI occurrence during the 6 year follow-up period was 1.83-fold greater for schizophrenia patients (95% confidence interval 5 1.62-2.05) than for patients in the comparison cohort. CONCLUSION Schizophrenia patients had a higher risk of AMI compared to patients in the comparison cohort. The present study draws attention to the need for clinicians to more actively monitor and treat schizophrenia patients with well-recognized risk factors associated with AMI.
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Affiliation(s)
- Hung-Chuan Lin
- Department of Psychiatry, PoJen General Hospital, Taipei, Taiwan
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105
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Abstract
PURPOSE OF REVIEW Among the mentally ill, smoking prevalence is highest in patients with schizophrenia ( approximately 70-80%). This can impose a significant financial burden on patients, not to speak of increased smoking-related morbidity and mortality. Therefore, it is critical for clinicians to understand why patients with schizophrenia smoke in order to adapt treatment schemes. Understanding the reasons may also help to develop new drugs that target the nicotinic system in the brain as well as smoking cessation programs that are specifically designed for this particular patient population. RECENT FINDINGS So far, several reasons have been identified which are believed to explain tobacco consumption in patients with schizophrenia. Originally, it was widely believed that patients with schizophrenia smoke to increase hepatic clearance and to restore the dopamine blockade of certain antipsychotic drugs to diminish their side effects. However, more recently it became obvious that cigarette smoking may also be reinforcing for patients because it improves psychiatric symptoms, most notably negative and cognitive symptoms. The underlying molecular mechanisms of these nicotine effects are currently under intensive investigation. SUMMARY Heavy smoking in schizophrenia cannot simply be viewed as a 'bad habit'. Rather, self-medication of clinical symptoms and side effects of antipsychotic drugs appear to play a major role.
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106
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Dixon LB, Medoff D, Goldberg R, Lucksted A, Kreyenbuhl J, DiClemente C, Potts W, Leith J, Brown C, Adams C, Afful J. Is implementation of the 5 A's of smoking cessation at community mental health centers effective for reduction of smoking by patients with serious mental illness? Am J Addict 2010; 18:386-92. [PMID: 19874158 DOI: 10.3109/10550490903077747] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We tested whether implementing the "5 A's" (Ask, Advise, Assess, Assist, Arrange) at six mental health centers reduces smoking among persons with serious mental illness. One hundred and fifty six patients were evaluated just before initiating the 5 A's and after six and 12 months. A delayed control condition evaluated 148 patients six months before 5 A's implementation, just before and then after six months. Six months of the 5 A's produced no effect. Modest cessation and reduction benefits were noted after 12 months. Implementing the 5 A's at community mental health centers may have modest benefit after twelve months.
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Affiliation(s)
- Lisa B Dixon
- University of Maryland School of Medicine, Department of Psychiatry, Division of Services Research, 737 W Lombard St. Room 520, Baltimore, MD 21201, USA.
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107
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Abstract
BACKGROUND Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help smokers to a make a successful attempt to quit. OBJECTIVES To determine the effects of motivational interviewing in promoting smoking cessation. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with terms (motivational OR motivation OR motivating OR motivate OR behavi* OR motivat*) and (interview* OR session* OR counsel* OR practi*) in the title or abstract, or as keywords. Date of the most recent search: April 2009. SELECTION CRITERIA Randomized controlled trials in which motivational interviewing or its variants were offered to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were treated as continuing smokers. We performed meta-analysis using a fixed-effect Mantel-Haenszel model. MAIN RESULTS We identified 14 studies published between 1997 and 2008, involving over 10,000 smokers. Trials were conducted in one to four sessions, with the duration of each session ranging from 15 to 45 minutes. All but two of the trials used supportive telephone contacts, and supplemented the counselling with self-help materials. MI was generally compared with brief advice or usual care in the trials. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (RR 1.27; 95% CI 1.14 to 1.42). Subgroup analyses suggested that MI was effective when delivered by primary care physicians (RR 3.49; 95% CI 1.53 to 7.94) and by counsellors (RR 1.27; 95% CI 1.12 to 1.43), and when it was conducted in longer sessions (more than 20 minutes per session) (RR 1.31; 95% CI 1.16 to 1.49). Multiple session treatments may be slightly more effective than single sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls.There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing.Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports. AUTHORS' CONCLUSIONS Motivational interviewing may assist smokers to quit. However, the results should be interpreted with caution due to variations in study quality, treatment fidelity and the possibility of publication or selective reporting bias.
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Affiliation(s)
- Douglas Tc Lai
- Professional Development and Quality Assurance, Department of Health, 1/F Main Block, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd, Chai Wan, Hong Kong
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Buchanan RW, Kreyenbuhl J, Kelly DL, Noel JM, Boggs DL, Fischer BA, Himelhoch S, Fang B, Peterson E, Aquino PR, Keller W. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2010; 36:71-93. [PMID: 19955390 PMCID: PMC2800144 DOI: 10.1093/schbul/sbp116] [Citation(s) in RCA: 618] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.
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Affiliation(s)
- Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228,To whom correspondence should be addressed; tel: 410-402-7876, fax: 410-402-7198, e-mail:
| | - Julie Kreyenbuhl
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD,VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Jason M. Noel
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Douglas L. Boggs
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Bernard A. Fischer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
| | - Seth Himelhoch
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Beverly Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Eunice Peterson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Patrick R. Aquino
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - William Keller
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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Abstract
The high rates of tobacco use among individuals with schizophrenia are well documented, but there has been less attention paid to identifying what are the special needs for this population. In fact, there have even been suggestions from early work that standard interventions and approaches might be adequate. In contrast, based on more than a decade of experience supporting change smoking behavior among people with schizophrenia, three key factors were identified as unique considerations that are associated with success. The first factor involves readiness to change; smokers with schizophrenia are rarely given opportunities to even try to quit unlike their counterparts in the general population and therefore have not benefited from the self-efficacy aspects of attempt experiences. The second factor is medication and symptom monitoring; there are special needs for nurses and medical staff to monitor symptoms (including schizophrenia symptoms and mood symptoms), medication dosage and side-effects, during the period when individuals with schizophrenia are changing (reducing) their tobacco use, particularly when nicotine replacement therapy is being implemented. Finally, the third factor is peer and caregiver support; the use of peer assistants in group-based programs and the teaching of nurses and other professional casegivers as well as family members about their role as supports can make an important difference in tipping the balance toward successful change and toward maintenance of change over time.
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Affiliation(s)
- Joel O Goldberg
- York University, Toronto, and McMaster University, Hamilton, Ontario, Canada,
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110
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Abstract
Around 50% of patients with schizophrenia develop a co-occurring substance use disorder involving alcohol or illicit substances at some time during their lives. The comorbid substance abuse will markedly affect the course of illness of schizophrenia. In this article, the authors review the epidemiology, theories of causation, effect on the course of illness, and treatment of co-occurring schizophrenia and substance use disorder.
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Affiliation(s)
- Janice Lybrand
- Department of Psychiatry, Philadelphia VA Medical Center, Philadelphia, PA 19104, USA.
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111
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Predictors of abstinence and changes in psychiatric symptoms in a pooled sample of smokers with schizophrenia receiving combination pharmacotherapy and behavioral therapy for smoking cessation. J Clin Psychopharmacol 2009; 29:601-3. [PMID: 19910728 PMCID: PMC3675444 DOI: 10.1097/jcp.0b013e3181bfd0b4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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112
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WILLIAMS JILLM, ZIEDONIS DOUGLASM, VREELAND BETTY, SPEELMAN-EDWARDS NANCY, ZECHNER MICHELLER, WILLIAMS MARKT, RAHIM RAQUEL, KARIMI LINDA, MOLNAR MARGARET, EILERS ROBERT. A Wellness Approach to Addressing Tobacco in Mental Health Settings: Learning About Healthy Living. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2009. [DOI: 10.1080/15487760903248580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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113
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Brown S, Smith E. Can a brief health promotion intervention delivered by mental health key workers improve clients' physical health: A randomized controlled trial. J Ment Health 2009. [DOI: 10.3109/09638230802522460] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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114
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Morisano D, Bacher I, Audrain-McGovern J, George TP. Mechanisms underlying the comorbidity of tobacco use in mental health and addictive disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:356-67. [PMID: 19527556 DOI: 10.1177/070674370905400603] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We discuss potential explanations for the high prevalence of tobacco use and tobacco dependence (TD) in people with mental health and addictive (MHA) disorders. The biopsychosocial basis for this comorbidity is presented, integrating evidence from epidemiologic and clinical studies. We also review evidence that suggests a shared vulnerability related to biological, genetic, and environmental factors may be the most parsimonious mechanism to explain the association between TD and MHA disorders. Finally, we review the examples of various MHA disorders that are associated with TD, and suggest avenues for new investigation that could aid in the development of rationale and more effective treatments for tobacco and MHA disorder comorbidities.
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Affiliation(s)
- Dominique Morisano
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario
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115
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Hitsman B, Moss TG, Montoya ID, George TP. Treatment of tobacco dependence in mental health and addictive disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:368-78. [PMID: 19527557 PMCID: PMC3632078 DOI: 10.1177/070674370905400604] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
People with mental health and addictive (MHA) disorders smoke at high rates and require tobacco treatment as a part of their comprehensive psychiatric care. Psychiatric care providers often do not address tobacco use among people with mental illness, possibly owing to the belief that their patients will not be able to quit successfully or that even short-term abstinence will adversely influence psychiatric status. Progress in the development of treatments has been slow in part because smokers with current MHA disorders have been excluded from most smoking cessation trials. There are several smoking cessation treatment options, including psychological and pharmacological interventions, that should be offered to people with an MHA disorder who smoke. Building motivation and readiness to quit smoking is a major challenge, and therefore motivational interventions are essential. We review the treatment options for people with tobacco dependence and MHA disorders, offer recommendations on tobacco assessment and tailored treatment strategies, and provide suggestions for future research. Treatment efficacy could be enhanced through promoting smoking reduction as an initial treatment goal, extending duration of treatment, and delivering it within an integrated care model that also aims to reduce the availability of tobacco in MHA treatment settings and in the community.
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Affiliation(s)
- Brian Hitsman
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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116
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Baker A, Ivers RG, Bowman J, Butler T, Kay-Lambkin FJ, Wye P, Walsh RA, Pulver LJ, Richmond R, Belcher J, Wilhelm K, Wodak A. Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention. Drug Alcohol Rev 2009; 25:85-96. [PMID: 16492581 DOI: 10.1080/09595230500459552] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.
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Affiliation(s)
- Amanda Baker
- Centre for Mental Health Studies, University of Newcastle, Callaghan, and Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia.
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117
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Abstract
BACKGROUND People with mental health (MH) disorders smoke at higher rates, are more nicotine-dependent and suffer greater morbidity and mortality from smoking-related illnesses than the general population. Helping these people to quit smoking is a public health priority; however, many MH professionals assume that those with mental illness are not motivated to quit. OBJECTIVES To use predetermined criteria to identify, review critically and evaluate empirically all English language, peer-reviewed data on motivation to quit smoking in MH populations. METHODS A systematic search was conducted and key data on subject characteristics, measures of motivation and other variables abstracted. chi(2) analyses were used to compare motivation between MH and general populations, between in-patients and out-patients and between people with depression and people with psychotic disorders. RESULTS Evidence suggests that people with MH disorders are as motivated to quit smoking as the general population, although those with psychotic disorders may be less motivated than individuals with depression. Although readiness to cease smoking was assessed in 14 studies, only two evaluated motivation to quit smoking in in-patient populations. CONCLUSIONS People with MH disorders are motivated to quit smoking, although more research is needed looking at in-patient populations. The commonly held false belief that people with MH disorders are not motivated to cease smoking means that opportunities to encourage smoking cessation among this disenfranchised group are being missed.
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Affiliation(s)
- Ranita Siru
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, QE II Medical Centre, Nedlands, WA, Australia
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118
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Purvis TL, Mambourg SE, Balvanz TM, Magallon HE, Pham RH. Safety and effectiveness of varenicline in a veteran population with a high prevalence of mental illness. Ann Pharmacother 2009; 43:862-7. [PMID: 19383936 DOI: 10.1345/aph.1l661] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Varenicline is a selective nicotinic receptor partial agonist used to aid in the process of smoking cessation. Research on varenicline's approval for marketing demonstrated that after 12 weeks of treatment, at least 44% of patients successfully quit smoking and, on average, 13% of individuals discontinued therapy due to an adverse drug event (ADE). Growing postmarketing data linked varenicline to an increase in neuropsychiatric symptoms. OBJECTIVE To evaluate the safety profile, specifically psychiatric symptoms, and effectiveness of varenicline in a veteran population and to determine whether there is an association among specific baseline demographics and success rate. METHODS The study was a retrospective review of a prospective performance measure involving veterans initiated on varenicline. Patients were contacted via telephone throughout treatment and at week 12 for effectiveness follow-up. Smoking history was obtained and medication counseling was provided. The primary endpoint was tobacco cessation between weeks 9 and 12 of therapy. Varenicline's safety profile and discontinuation rates due to ADEs were also analyzed. RESULTS Of the 50 patients included in the study, 30% (n = 15) successfully quit smoking and 70% (n = 35) failed therapy (lack of effectiveness, n = 22; intolerability, n = 13). Prevalence of underlying mental illness in the success group (4/15; 27%) versus failure group (20/35; 57%) was statistically significant (p < 0.001). All patients who discontinued therapy due to an increase in mood and behavioral changes (n = 4) had an underlying psychiatric illness. The study results demonstrate a lower success rate and a higher incidence of discontinuation due to an ADE in our veteran population compared with premarketing data. An inverse association was shown between psychiatric disorders and success. CONCLUSIONS Cautious treatment initiation and close monitoring of veterans initiated on varenicline are warranted. Furthermore, the results from this study demonstrate the need for prospective effectiveness trials to determine the clinical significance of the results.
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Affiliation(s)
- Tara L Purvis
- Western Missouri Mental Health Center, Kansas City, MO 64108, USA.
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119
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Effects of Topiramate on Smoking in Patients with Schizoaffective Disorder, Bipolar Type: Response to Khazaal and Zullino. J Clin Psychopharmacol 2009; 29:193-194. [PMID: 25506116 PMCID: PMC4263249 DOI: 10.1097/jcp.0b013e31819c57d4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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120
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Fusar-Poli P, De Marco L, Cavallin F, Bertorello A, Nicolasi M, Politi P. Lifestyles and cardiovascular risk in individuals with functional psychoses. Perspect Psychiatr Care 2009; 45:87-99. [PMID: 19366419 DOI: 10.1111/j.1744-6163.2009.00202.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aims to examine known determinants of cardiovascular risk in Italian patients with functional psychoses. DESIGN AND METHODS A cross-sectional study design was used to examine cardiovascular risk factors and lifestyle behaviors of 123 individuals with functional psychosis and compare clinically relevant data with those of the general Italian population. FINDINGS A significant proportion of patients manifested frank hypertension (6.9%), hypercholesterolemia (20.5%), diabetes (6.5%), or a body mass index of more than 30 (20.3%). Many also smoked (63.0%) or ingested alcohol every day (26.0%), did not eat fruits or vegetables (8.0%), or did not exercise on a daily basis (34.0%). PRACTICE IMPLICATIONS Patients with psychosis manifest significant rates of potentially reversible risk factors for cardiovascular diseases. Mental health nurses should advocate for and implement well-resourced counseling programs to reduce the prevalence of smoking and metabolic syndrome in mental health populations.
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Affiliation(s)
- Paolo Fusar-Poli
- Department of Psychobehavioural Health Sciences, University of Pavia, Pavia, Italy.
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121
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Conway JLC. Exogenous nicotine normalises sensory gating in schizophrenia; therapeutic implications. Med Hypotheses 2009; 73:259-62. [PMID: 19328631 DOI: 10.1016/j.mehy.2009.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 02/16/2009] [Accepted: 02/18/2009] [Indexed: 10/21/2022]
Abstract
There is a current popular recognition that cigarette smoking is deleterious to health. Although this is very clearly the case for physical health, the situation regarding mental health is, however, rather more complicated. This piece concentrates on the role of smoking in schizophrenia: it is important to consider why schizophrenia, exceptionally amongst the severe and enduring mental illnesses, is associated with increased cigarette consumption. People who suffer from schizophrenia consequently have a greater risk of the complications to physical health caused by this addiction and clearly, it is important to understand why this occurs. Numerous investigators have found that both neuroleptic-naive, first-onset schizophrenics, together with chronic sufferers of the illness, consume more cigarettes and extract a greater amount of nicotine from them. Researchers have further determined that there is deficient endogenous central nicotinic neurotransmission in schizophrenia, which causes a disruption of sensory gating. This disrupted sensory gating is a reasonable explanation for the delusional misinterpretation of consequent cerebral events. This is the principal reason for the markedly increased rate of cigarette smoking in people with schizophrenia: tobacco cigarette smoking represents an attempt at self-medication in schizophrenia, because the additional nicotine so provided alleviates the hypofunctional sensory gating seen in this illness. Nicotine has been proposed to alleviate negative symptoms. The hypothesis here proposes that as nicotine alleviates positive symptoms, it consequently also - ultimately - prevents negative symptoms caused by the apoptotic effects of excitotoxicity. It would be worthwhile to investigate the therapeutic effects, if any, of additional exogenous nicotine delivered in a less toxic form than cigarettes.
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Affiliation(s)
- J L C Conway
- MRC SGDP Centre, Institute of Psychiatry, Denmark Hill, London SE5 8AF, United Kingdom.
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122
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Ferron JC, Alterman AI, McHugo GJ, Brunette MF, Drake RE. A review of research on smoking cessation interventions for adults with schizophrenia spectrum disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17523280802593327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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123
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Abstract
BACKGROUND There is a close relationship between tobacco smoking and psychiatric disorders, and a higher proportion of individuals with mental health conditions smoke compared with the general population. Due to the increased smoking prevalence in this population, patients with psychiatric conditions are at greater risk of smoking-related morbidity and mortality and experience detrimental effects on their quality of life. However, while the majority of individuals with a history of mental health conditions appreciate that smoking is detrimental to their health, they are less likely to quit smoking and have a lower success rate during quit attempts compared with the general population. SCOPE Peer-reviewed articles were identified from PubMed using the inclusive date-range of 1990 - October 2008 and the search terms; depression, mental health, psychiatric disorders, schizophrenia, and smoking cessation. Articles were selected from the search results to provide a general overview of some of the main issues for smokers with psychiatric disorders in general and specifically, those with schizophrenia and depression. The evidence from smoking cessation trials within these populations was also reviewed. FINDINGS Nicotine has some positive effects on symptoms of psychiatric disorders and it has been proposed that patients with mental health conditions may smoke as a form of self-medication. Further, several studies have shown that some symptoms of psychiatric disorders may be exacerbated by nicotine withdrawal. Therefore, attempts to quit smoking pose additional problems to patients with mental health problems. CONCLUSION Traditional programmes for smoking cessation may not always be suitable for psychiatric patients due to their neuropsychological profile. Preliminary evidence suggests that more flexible, open-ended, combination approaches of pharmacotherapy and counselling may be more successful. In addition, identification and treatment of nicotine addiction remains very low in patients with mental health conditions and far more needs to be done to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems.
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Affiliation(s)
- Karl Fagerström
- Smokers Information Centre, Fagerström Consulting AB, Helsingborg, Sweden.
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124
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Abstract
BACKGROUND A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions were proposed to help prevent relapse. OBJECTIVES To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register in August 2008 for studies mentioning relapse prevention or maintenance in title, abstracts or keywords. SELECTION CRITERIA Randomized or quasi-randomized controlled trials of relapse prevention interventions with a minimum follow up of six months. We included smokers who quit on their own, or were undergoing enforced abstinence, or who were participating in treatment programmes. We included trials that compared relapse prevention interventions to a no intervention control, or that compared a cessation programme with additional relapse prevention components to a cessation programme alone. DATA COLLECTION AND ANALYSIS Studies were screened and data extracted by one author and checked by a second. Disagreements were resolved by discussion or referral to a third author. MAIN RESULTS Fifty-four studies met inclusion criteria, but were heterogeneous in terms of populations and interventions. We considered 36 studies that randomized abstainers separately from studies that randomized participants prior to their quit date.Looking at studies of behavioural interventions which randomised abstainers, we detected no benefit of brief and 'skills-based' relapse prevention methods for women who had quit smoking due to pregnancy, or for smokers undergoing a period of enforced abstinence during hospitalisation or military training. We also failed to detect significant effects of behavioural interventions in trials in unselected groups of smokers who had quit on their own or with a formal programme. Amongst trials randomising smokers prior to their quit date and evaluating the effect of additional relapse prevention components we also found no evidence of benefit of behavioural interventions in any subgroup. Overall, providing training in skills thought to be needed for relapse avoidance did not reduce relapse, but most studies did not use experimental designs best suited to the task, and had limited power to detect expected small differences between interventions. For pharmacological interventions, extended treatment with varenicline significantly reduced relapse in one trial (risk ratio 1.18, 95% confidence interval 1.03 to 1.36). Pooling of five studies of extended treatment with bupropion failed to detect a significant effect (risk ratio 1.17; 95% confidence interval 0.99 to 1.39). Two small trials of oral nicotine replacement treatment (NRT) failed to detect an effect but treatment compliance was low and in two other trials of oral NRT randomizing short-term abstainers there was a significant effect of intervention. AUTHORS' CONCLUSIONS At the moment there is insufficient evidence to support the use of any specific behavioural intervention for helping smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focusing on identifying and resolving tempting situations, as most studies were concerned with these. There is little research available regarding other behavioural approaches. Extended treatment with varenicline may prevent relapse. Extended treatment with bupropion is unlikely to have a clinically important effect. Studies of extended treatment with nicotine replacement are needed.
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Affiliation(s)
- Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Turner Street, London, UK, E1 2AD
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125
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Borras L, Mohr S, Brandt PY, Gillieron C, Eytan A, Huguelet P. Influence of spirituality and religiousness on smoking among patients with schizophrenia or schizo-affective disorder in Switzerland. Int J Soc Psychiatry 2008; 54:539-49. [PMID: 18974192 DOI: 10.1177/0020764008091424] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The rates of cigarette smoking among patients with schizophrenia are two to four times the rates observed in the community. Spirituality and religiousness have been shown to be associated with lower smoking rates in the general population. AIMS This study assessed the role of religion in cigarette smoking among patients with schizophrenia or schizo-affective disorder. METHODS Some 115 stabilized outpatients from Geneva's public psychiatric facilities were included. Interviews were conducted to investigate spiritual and religious beliefs, religious practices and religious coping. Cigarette smoking was assessed through interviews and medical records. RESULTS Some 58% of patients were smokers. Two-thirds of the total sample considered spirituality as very important or essential in their every day life. Religiosity was negatively associated with tobacco use: there were more current smokers without religious affiliation than non-smokers (p < 0.05). For non-smokers, the support of their faith community was significantly more important and they reported more frequent group religious practices than smokers ( p < 0.05). This relation persisted after controlling for demographic confounders (gender, age, ethnicity, education, civil status). CONCLUSION In patients with schizophrenia, religion and spirituality seem to be related to smoking behaviour. Similar results were previously found in the general population. These results underscore the need for a systematic exploration of religious issues in the care of smokers with schizophrenia.
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Affiliation(s)
- Laurence Borras
- University Hospital of Geneva, Department of Psychiatry, Division of Adult Psychiatry, Geneva, Switzerland.
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126
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127
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Green MA, Hawranik PG. Smoke-free policies in the psychiatric population on the ward and beyond: A discussion paper. Int J Nurs Stud 2008; 45:1543-9. [DOI: 10.1016/j.ijnurstu.2007.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 11/30/2007] [Accepted: 12/28/2007] [Indexed: 11/16/2022]
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128
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Kisely S, Campbell LA. Use of smoking cessation therapies in individuals with psychiatric illness : an update for prescribers. CNS Drugs 2008; 22:263-73. [PMID: 18336057 DOI: 10.2165/00023210-200822040-00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Individuals with mental illness are particularly disadvantaged by their use of tobacco, spending as much as 40% of their income on cigarettes. They also have increased mortality from cardiovascular and respiratory disorders. The most effective interventions to help psychiatric patients stop smoking are similar to those that are effective in the general population. These include psychological treatments, nicotine replacement therapy (NRT), bupropion and nortriptyline, at least in the short term. Most studies agree that these gains can be achieved in the absence of significant adverse effects in terms of psychological morbidity. Effects diminish over time, but these findings also apply to the general population. The best long-term results have come from extended prescription and psychological interventions, and apply equally to patients with and without a history of psychiatric disorder, such as major depression. In spite of this, clinicians are not fully exploiting opportunities to help psychiatric patients stop smoking. It is not possible to plan a programme to help individuals stop smoking in mental health settings unless factors such as demographics, diagnosis and concurrent medication are taken into account.
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Affiliation(s)
- Stephen Kisely
- Departments of Psychiatry, Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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129
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Survey of clinician attitudes toward smoking cessation for psychiatric and substance abusing clients. J Addict Dis 2008; 27:55-63. [PMID: 18551888 DOI: 10.1300/j069v27n01_06] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current study examined mental health clinician attitudes regarding smoking cessation for psychiatric and substance abusing patients. Participants included n = 15 never smokers, n = 12 former smokers, and n = 7 current smokers. There was a trend (p = 0.08) for current smokers as compared to former and never smokers to be less likely to encourage their clients to stop smoking. Overall, clinicians strongly agreed that an individual's motivation is the most important determinant of success in quitting. Clinicians were concerned that smoking cessation would initiate a relapse to substance abuse. We suggest that mental health clinicians can be instrumental in providing information, encouragement, and opportunities for their patients to attempt smoking cessation.
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130
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Yoshimura R, Kakihara S, Umene-Nakano W, Sugita A, Hori H, Ueda N, Nakamura J. Acute risperidone treatment did not increase daily cigarette consumption or plasma levels of cotinine and caffeine: a pilot study. Hum Psychopharmacol 2008; 23:327-32. [PMID: 18273830 DOI: 10.1002/hup.928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Excessive cigarette smoking and caffeine intake are often seen in schizophrenic patients being treated with antipsychotic drugs, particularly typical antipsychotic drugs. Using nicotine and caffeine sometimes influences psychotic symptoms in these patients. Clozapine is the only antipsychotic drug reported to reduce the amount of cigarette smoking, however, still remains controversial of its efficacy. In the present study, we examined the effect of acute risperidone treatment on the amount of cigarette smoking and plasma levels of cotinine and caffeine in schizophrenic patients. Treatment with risperidone for 4 weeks did not increase daily cigarette consumption or plasma levels of cotinine and caffeine. The results suggest that acute risperidone treatment does not promote the intake of nicotine and caffeine at least by 4 weeks in schizophrenic patients.
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Affiliation(s)
- Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatansihi-ku, Kitakyushu, Fukuoka, Japan.
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131
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Tidey JW, Rohsenow DJ, Kaplan GB, Swift RM, Adolfo AB. Effects of smoking abstinence, smoking cues and nicotine replacement in smokers with schizophrenia and controls. Nicotine Tob Res 2008; 10:1047-56. [PMID: 18584468 PMCID: PMC2952171 DOI: 10.1080/14622200802097373] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The mechanisms underlying the low smoking cessation rates among smokers with schizophrenia (SS) are unknown. In this laboratory study, we compared the responses of 21 SS and 21 non-psychiatric controls (CS) to manipulations of 5-hour smoking abstinence, transdermal nicotine replacement (0 mg, 21 mg and 42 mg), and in vivo smoking cues. Results indicate that SS were more sensitive than CS to the effects of acute abstinence on carbon monoxide (CO) boost, but not more sensitive to the effects of abstinence on urge levels or withdrawal symptoms. SS and CS did not differ in urge response to in vivo smoking cues, but SS were less consistent in their reactions. These findings suggest that heightened sensitivity to the effects of abstinence on smoke intake may partially account for the low cessation rates experienced by SS, but other potential mechanisms should be explored using behavioral laboratory models.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA.
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132
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George TP, Vessicchio JC, Sacco KA, Weinberger AH, Dudas MM, Allen TM, Creeden CL, Potenza MN, Feingold A, Jatlow PI. A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia. Biol Psychiatry 2008; 63:1092-6. [PMID: 18096137 PMCID: PMC2693008 DOI: 10.1016/j.biopsych.2007.11.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 11/01/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Individuals with schizophrenia smoke at higher rates (58%-88%) than the general population (approximately 22%), and have difficulty quitting. We determined whether the combination of sustained-release (SR) bupropion (BUP) with the transdermal nicotine patch (TNP) was well-tolerated and superior to placebo (PLO)+TNP for smoking cessation in schizophrenia. METHODS A 10-week, double-blind, placebo-controlled trial of BUP (300 mg/day) in combination with TNP (21 mg/24h) for 58 outpatient smokers with schizophrenia was conducted. Primary outcome measures were continuous smoking abstinence in the last 4 weeks of the trial (Days 43-70) and 7-day point prevalence abstinence at 6 months post-target quit date (TQD) (week 26). RESULTS Smokers assigned to the BUP+TNP group (n = 29) were more likely to achieve continuous smoking abstinence (8/29, 27.6%) than the PLO+TNP group (n = 29, 1/29, 3.4%) [Fisher's Exact Test, p < .05]; at 6-months post-TQD, 4/29 (13.8%) versus 0/29 (0.0%) achieved 7-day point prevalence smoking abstinence (p = .11). Neither bupropion SR nor smoking abstinence significantly altered the positive or negative symptoms of schizophrenia. The combination was well-tolerated in smokers with schizophrenia. CONCLUSIONS Combination therapy with bupropion SR+TNP versus placebo+TNP is well-tolerated and significantly improved short-term smoking abstinence in smokers with schizophrenia.
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Affiliation(s)
- Tony P George
- Centre for Addiction and Mental Health, Faculty of Medicine, University of Toronto, Ontario, Canada.
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133
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Currie SR, Karltyn J, Lussier D, de Denus E, Brown D, El-Guebaly N. Outcome from a community-based smoking cessation program for persons with serious mental illness. Community Ment Health J 2008; 44:187-94. [PMID: 18049896 DOI: 10.1007/s10597-007-9113-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 10/24/2007] [Indexed: 01/18/2023]
Abstract
Six and 12-month outcomes are reported on 79 mentally ill persons attending either a 4- or 8-session community-based smoking cessation group. Quit rates at post, 3-, 6-, and 12-month follow-ups were 16, 19, 16, and 19%, respectively, with no significant effect of program length. These success rates are comparable to outcomes reported following group-based treatment with mentally healthy smokers. The majority of quitters used nicotine replacement therapy. Psychotropic medication dosages did not vary over time in quitters or non-quitters. No reductions in smoking were observed among non-quitters. Quitting smoking had no untoward effects on symptoms of mental illness or general functioning.
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Affiliation(s)
- Shawn R Currie
- Department of Psychiatry, Mental Health Information and Evaluation Unit, Calgary Health Region, Mental Health and Psychiatric Services, 206, 301-14th Street NW, Calgary, AB, Canada, T2N 2A1.
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134
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Cather C, Barr R, Evins A. Smoking and Schizophrenia: Prevalence, Mechanisms and Implications for Treatment. ACTA ACUST UNITED AC 2008. [DOI: 10.3371/csrp.2.1.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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135
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Barr AM, Procyshyn RM, Hui P, Johnson JL, Honer WG. Self-reported motivation to smoke in schizophrenia is related to antipsychotic drug treatment. Schizophr Res 2008; 100:252-60. [PMID: 18178062 DOI: 10.1016/j.schres.2007.11.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 11/18/2007] [Accepted: 11/19/2007] [Indexed: 12/15/2022]
Abstract
PURPOSE The prevalence of smoking in schizophrenia has reliably been reported as being higher than for any other psychiatric disorder. While a number of theories have been proposed to account for such high rates of smoking, little is known about the subjective motivation for why schizophrenia patients smoke in comparison with those without the disease. OBJECTIVES The aim of the present study was to evaluate and compare smoking motivation in control subjects and schizophrenia patients, and determine if factors such as type of medication or access to cigarettes could contribute to self-reported motivation for smoking. METHODS We assessed motivation to smoke in 61 schizophrenia inpatients and 33 non-psychiatric health worker controls at a tertiary care psychiatric facility in a cross-sectional study. Nicotine dependency and smoking behavior were evaluated using the Fagerstrom Test for Nicotine Dependence and a validated questionnaire that assesses motivation for smoking along seven different dimensions. RESULTS Schizophrenia patients reported a stronger motivation to smoke than controls for reasons related to pleasure from the act of smoking, as well as a need for psychomotor stimulation. Scores on both these factors were significantly associated with daily antipsychotic drug dose. The sedative and anxiolytic effects of smoking were related to anticholinergic load of psychiatric medications. CONCLUSION The findings highlight important differences in self-reported motivation to smoke between schizophrenia patients and normals. Antipsychotic drugs may also influence aspects of motivation to smoke.
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Affiliation(s)
- Alasdair M Barr
- Faculty of Medicine, Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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136
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Abstract
Although patients with have low motivations to quit smoking, smoking cessation treatment can be effective for these patients. Patients schizophrenia who achieve significant smoking reduction during a treatment intervention can at least maintain that level of reduction at 2 years. Cigarette smoking by patients with frequently goes unaddressed, contributing to excess mortality in this population. Behavioural interventions improve smoking cessation in schizophrenia patients. Nicotine replacement can substantially reduce withdrawal symptoms. Bupropion enhances smoking abstinence rates. Bupropion is well-tolerated and safe for use in schizophrenia patients: bupropion does not worsen clinical symptoms of schizophrenia. Atypical antipsychotics may reduce smoking consumption in schizophrenia patients, in particular clozapine. Atypical antipsychotic medication, in combination with the nicotine transdermal patch, significantly enhance the rate of smoking cessation. Interactions between smoking and antipsychotic medication - Smoking increases the metabolism of the antipsychotic medications by inducing the cytochrome P450 1A2 isoform. Smoking lowers the blood levels of typical or atypical antipsychotic medication, in particular haloperidol, chlorpromazine, olanzapine and clozapine. -Abstinence can increase many psychotropics' blood levels. Accordingly, smoking appears to reduce neuroleptic-induced parkinsonism. In contrast, smoking is a risk factor for tardive dyskinesia, independent of neuroleptic exposure.
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Affiliation(s)
- A Dervaux
- Psychiatre des hôpitaux, Service d'Addictologie Moreau-de-Tours, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris
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137
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Abstract
The development of medications for the treatment of nicotine dependence in patients with schizophrenia is a public health priority due to its high prevalence rates, devastating medical consequences, and difficulty to treat. It has been hypothesized that the high prevalence of nicotine dependence among patients with schizophrenia may be due to a shared neurobiological vulnerability. This shared vulnerability has been evidenced in reports showing that nicotine improves neuropsychological deficits associated with schizophrenia such as in the P50 evoked auditory potentials, spatial working memory, and attention. The common pathophysiologic pathways of smoking and schizophrenia may serve as the basis for the pharmacological evaluation of medications for the treatment of these concurrent disorders. Currently, little research of medications for the treatment of this comorbidity has been conducted. Studies have evaluated the efficacy of smoking cessation medications in patients with schizophrenia. These include the nicotine replacement therapy (patch, nasal spray) and sustained release bupropion. Others have evaluated the anti-smoking effect of medications (e.g., clozapine, haloperidol) used for the treatment of schizophrenia. In both cases, the results have not been conclusive. Newer smoking cessation approaches such as varenicline, selegiline, rimonabant, and nicotine vaccine, among others, have yet to be tested in this population. The purpose of this article is to review the results of the studies conducted to date and propose some potential pharmacotherapies based on the current knowledge of the pathophysiology of both disorders.
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138
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Abstract
Substance use disorder is the most frequent and clinically significant comorbidity among schizophrenia patients today. All schizophrenia patients should be assessed and monitored carefully regarding their substance use. Those with any regular use of alcohol or other drugs should be considered at risk for multiple adverse effects. As therapies for co-occurring substance use disorders have evolved over the past 20 years, medication management, psychosocial interventions, and rehabilitation models have increasingly emphasized the integration of mental health and substance abuse treatments, attention to group and residential interventions, matching interventions to stage of treatment, comprehensiveness, and long-term perspectives on recovery. Clinicians should understand the implications of each of these principles of care.
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139
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Kisely SR, Wise M, Preston N, Malmgren S, Shannon P. A group intervention to reduce smoking in individuals with psychiatric disorder: brief report of a pilot study. Aust N Z J Public Health 2007; 27:61-3. [PMID: 14705269 DOI: 10.1111/j.1467-842x.2003.tb00381.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate a group intervention to help individuals with psychiatric disorder stop smoking. METHOD A waitlist-treatment crossover design. Outcome measures included smoking cessation, motivation to stop, the Fagerstrom Test for Nicotine Dependence (FTND), urinary cotinine and psychiatric symptoms on the General Health Questionnaire. RESULTS 38 subjects participated, of whom 19 completed the waitlist and intervention phases. There were no significant differences between subjects and dropouts. During the waitlist period there were no significant changes in tobacco use. At the end of the intervention, almost a quarter had stopped smoking, (z = -2.24, p = 0.02). Subjects also showed significant improvements on state of change, FTND score and urinary cotinine levels. These improvements were maintained at three-month follow-up (n = 10). Psychiatric morbidity showed no change. CONCLUSIONS It is possible to reduce smoking in individuals with psychiatric disorder. IMPLICATIONS Larger randomised controlled trials are indicated to determine the relative contributions of nicotine replacement, bupropion and group interventions to smoking cessation in this population.
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Affiliation(s)
- Stephen R Kisely
- Primary Care Mental Health Unit, University of Western Australia.
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140
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Palomo T, Kostrzewa RM, Beninger RJ, Archer T. Treatment consideration and manifest complexity in comorbid neuropsychiatric disorders. Neurotox Res 2007; 12:43-60. [PMID: 17513199 DOI: 10.1007/bf03033900] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Psychiatric disorders may co-occur in the same individual. These include, for example, substance abuse or obsessive-compulsive disorder with schizophrenia, and movement disorders or epilepsy with affective dysfunctional states. Medications may produce iatrogenic effects, for example cognitive impairments that co-occur with the residual symptoms of the primary disorder being treated. The observation of comorbid disorders in some cases may reflect diagnostic overlap. Impulsivity, impulsiveness or impulsive behaviour is implicated in a range of diagnostic conditions including substance abuse, affective disorder and obsessive-compulsive disorder. These observations suggest a need to re-evaluate established diagnostic criteria and disorder definitions, focusing instead on symptoms and symptom-profiles.
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Affiliation(s)
- Tomas Palomo
- Psychiatry Service, 12 de Octubre, University Hospital, Madrid 28041, Spain
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141
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Abstract
Coronary heart disease (CHD) is a major cause of mortality in people who have schizophrenia, and it is caused by many factors relating to lifestyle choices, antipsychotic treatment, and other medical comorbidities. This article focuses on modifiable risk factors such as cigarette smoking, diabetes, hyperlipidemia, hypertension, and the metabolic syndrome, all of which occur more frequently in patients who have schizophrenia than in the general population. Although treatment of risk factors for CHD is still far from ideal, all attempts should be made to strive for wellness to improve patients' long-term outcomes.
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142
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Ratto LRC, Menezes PR, Gulinelli A. Prevalence of tobacco use in individuals with severe mental illnesses, São Paulo, Brazil. Rev Saude Publica 2007; 41:510-6. [PMID: 17589747 DOI: 10.1590/s0034-89102006005000039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 03/03/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To analyze the prevalence of cigarette smoking in individuals with severe mental illnesses in a large urban centre of a middle income country. METHODS: Cross-sectional study carried out in São Paulo. The sample (N=192) comprised individuals diagnosed with severe mental illnesses who had contact with public psychiatric care services from September to November 1997 and were aged between 18 and 65 years. Prevalence of daily tobacco smoking in the 12 months previous to the interview and characteristics associated were studied. RESULTS: Out of 192 subjects with severe mental illnesses interviewed, 115 (59.9%; 95% CI: 52.6%; 66.9%) reported smoking cigarettes on a daily basis. Male gender, marital status separated or widowed, irregular use of neuroleptic drugs and history of ten or more psychiatric admissions were independently associated with cigarette smoking. CONCLUSIONS: The prevalence of cigarette smoking in the present sample was higher than that found in the general Brazilian population. Mental care services should implement non-smoking policies and mental health providers need to help patients with severe mental illness who want to quit smoking.
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Affiliation(s)
- Lilian R C Ratto
- Centro de Atenção Integrada à Saúde Mental, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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143
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Evins AE, Cather C, Culhane MA, Birnbaum A, Horowitz J, Hsieh E, Freudenreich O, Henderson DC, Schoenfeld DA, Rigotti NA, Goff DC. A 12-week double-blind, placebo-controlled study of bupropion sr added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia. J Clin Psychopharmacol 2007; 27:380-6. [PMID: 17632223 DOI: 10.1097/01.jcp.0b013e3180ca86fa] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The objective of this study was to examine whether there is a benefit of adding bupropion SR to high-dose combination nicotine replacement therapy (NRT) and weekly group cognitive behavioral therapy (CBT) for smoking reduction or cessation in schizophrenia. Fifty-one adult smokers with schizophrenia were randomly assigned to a 12-week trial of bupropion SR 300 mg/d or placebo added to transdermal nicotine patch, nicotine polacrilex gum, and CBT. The treatment goal was smoking cessation. The primary outcome measure was biochemically confirmed 7-day point-prevalence of 50% to 100% smoking reduction at week 12. Secondary outcomes were biochemically confirmed tobacco abstinence and change from baseline in expired air carbon monoxide (CO) and psychiatric symptoms. Subjects on bupropion + NRT had a greater rate of 50% to 100% smoking reduction at weeks 12 (60% vs. 31%; P = 0.036) and 24, a lower expired air CO in the treatment and follow-up periods, (F = 13.8; P < 0.001) and a greater continuous abstinence rate at week 8, before NRT taper, (52% vs. 19%; P = 0.014). However, relapse rates in subjects on bupropion + dual NRT were 31% during NRT taper (weeks 8-12) and 77% at the 12-month follow-up. Abstinence rates did not differ by treatment group at weeks 12 (36% vs. 19%), 24 (20% vs. 8%), or 52 (12% vs. 8%). Because abstinence rates were high during treatment with combination pharmacotherapy and relapse rates were very high during taper and after discontinuation of treatment, study of longer term treatment with combination pharmacotherapy and CBT for sustained abstinence is warranted in those who attain initial abstinence with this intervention.
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Affiliation(s)
- A Eden Evins
- Schizophrenia Program, Massachusetts General Hospital, Boston, MA 02144, USA.
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Olivier D, Lubman DI, Fraser R. Tobacco smoking within psychiatric inpatient settings: biopsychosocial perspective. Aust N Z J Psychiatry 2007; 41:572-80. [PMID: 17558619 DOI: 10.1080/00048670701392809] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tobacco smoking remains a neglected issue within general psychiatry despite high rates of associated morbidity and mortality. While there has been a coordinated community campaign to reduce tobacco smoking within the general population, mental health facilities have been reluctant to adopt such regulatory controls, and rarely target smoking prevention or treatment. This paper summarizes and discusses evidence relating to the clinical impact of tobacco smoking within inpatient psychiatric settings. A selective review of psychiatric and psychological research on smoking within inpatient settings was conducted, with a particular focus on the influence of smoking on the physical and mental health, pharmacotherapy, and social interactions of patients during their inpatient stay. Patients frequently alter their smoking habits during inpatient treatment, which can affect both their presentation and pharmacotherapeutic management. Smoking also appears to play a central role in social interactions on the ward, with staff frequently using cigarettes to reinforce certain behaviours. Despite current guidelines, mental health professionals rarely address nicotine use among their patients. Nevertheless, programmes that assist patients to quit during an inpatient stay have been shown to be both efficacious and cost-effective. Strategies that address staff concerns and assist in the implementation of effective smoking bans on psychiatric units are also available. Cessation should be a key component of inpatient treatment planning because this setting provides a safe and timely opportunity to help patients quit. A flowchart of interventions that could be incorporated within standard inpatient settings is proposed.
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Affiliation(s)
- David Olivier
- ORYGEN Youth Health, Melbourne, Victoria, Australia.
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145
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Green AI, Noordsy DL, Brunette MF, O'Keefe C. Substance abuse and schizophrenia: pharmacotherapeutic intervention. J Subst Abuse Treat 2007; 34:61-71. [PMID: 17574793 PMCID: PMC2930488 DOI: 10.1016/j.jsat.2007.01.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 01/08/2007] [Accepted: 01/20/2007] [Indexed: 11/20/2022]
Abstract
Substance use disorder is common in patients with schizophrenia and dramatically worsens their outcome. The typical antipsychotic medications, introduced more than 50 years ago, are effective for the treatment of psychosis but may have only limited efficacy in patients with these co-occurring disorders because patients continue to use substances while taking them. In preliminary studies, however, several of the atypical antipsychotic medications have shown promise for reducing alcohol and drug use in patients with schizophrenia. A neurobiological formulation is discussed, suggesting that the use of substances in patients with schizophrenia may be based on a dysfunction within the dopamine-mediated brain reward circuitry and that clozapine, in particular, may potentially ameliorate this dysfunction and lessen the desire for substance use. Medications for the treatment of alcohol use disorders, such as disulfiram, naltrexone, and acamprosate, as well as other adjunctive medications, may also be useful. Further studies are required to establish a solid evidence base of best practices for the use of medications in these patients.
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Affiliation(s)
- Alan I Green
- Department of Psychiatry, Dartmouth Medical School, Lebanon, NH 03756, USA.
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146
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Abstract
Neurotensin (NT) is a neuropeptide that, for decades, has been implicated in the biology of schizophrenia. It is closely associated with, and is thought to modulate, dopaminergic and other neurotransmitter systems involved in the pathophysiology of various neuropsychiatric diseases, including schizophrenia. This review outlines the neurochemistry and function of the NT system and the data implicating its role in schizophrenia. The data suggest that NT receptor agonists have the potential to be used as novel therapeutic agents for the treatment of schizophrenia, with the added benefits of (i) not causing weight gain, an adverse effect that is problematic with some of the currently used atypical antipsychotic drugs; and (ii) helping patients to stop smoking, a behaviour that is highly prevalent in those with schizophrenia.
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Affiliation(s)
- Mona Boules
- Neuropsychopharmacology Laboratory, Mayo Foundation for Medical Education and Research, Mayo Clinic Jacksonville, Florida 32224, USA.
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147
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Weinberger AH, Sacco KA, Creeden CL, Vessicchio JC, Jatlow PI, George TP. Effects of acute abstinence, reinstatement, and mecamylamine on biochemical and behavioral measures of cigarette smoking in schizophrenia. Schizophr Res 2007; 91:217-25. [PMID: 17293085 PMCID: PMC1913717 DOI: 10.1016/j.schres.2006.12.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 12/01/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Schizophrenics have higher rates of smoking than the general population, and more difficulty with smoking cessation. However, there has been little study of differences between schizophrenics and controls with respect to biochemical and behavioral indices of smoking. We compared smokers with schizophrenia (SS; n=27) and control smokers (CS; n=26) on smoking and psychiatric outcomes at baseline, during acute smoking abstinence and reinstatement, and with pre-treatment using the nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine (MEC) in a human laboratory setting. METHODS Biochemical (e.g., plasma nicotine) and behavioral (e.g., craving, withdrawal) outcomes were assessed at baseline, after overnight abstinence, and after smoking reinstatement during three consecutive test weeks. Each week, participants received one of three doses of MEC (0.0, 5.0, or 10.0 mg/dayx3 days) in a randomized, counterbalanced manner. RESULTS Compared to CS, SS displayed similar levels of craving and withdrawal, but higher plasma nicotine and cotinine levels, and cotinine/CPD ratio. During reinstatement, SS consumed significantly more cigarettes than CS, but MEC did not significantly alter indices of smoking, psychiatric symptoms, or cigarette consumption during reinstatement. CONCLUSIONS 1) The reinforcing effects of smoking may be increased in SS versus CS after overnight abstinence; 2) the lack of effects of nAChR antagonism may suggest that non-nicotinic components of cigarettes may contribute to the behavioral effects of smoking in both SS and CS; and 3) consistent with previous studies, SS may exhibit higher baseline levels of nicotine and cotinine, and greater extraction of nicotine per cigarette than CS.
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Affiliation(s)
- Andrea H Weinberger
- Program for Research on Smokers with Mental Illness (PRISM), Yale University School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
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148
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Edmonds N, Bremner J. Improving access to stop smoking support for people with mental health problems. JOURNAL OF PUBLIC MENTAL HEALTH 2007. [DOI: 10.1108/17465729200700003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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149
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Abstract
Substance use disorder (SUD) occurs commonly in patients with schizophrenia and is associated with a poor outcome. Despite this common co-morbid occurrence (and its negative impact on the course of schizophrenia), there have been very few studies assessing pharmacological strategies for optimal treatment of these patients. A number of theories have been advanced to help explain the high rate of substance use disorder in patients with schizophrenia. Our group has suggested that the brain reward circuit dysfunction model, which may incorporate aspects of all of these models, may help direct research aimed at developing new pharmacological treatments for patients with schizophrenia and co-occurring SUD. Although typical antipsychotic medications appear to be of limited value in these patients, emerging, but preliminary, data suggest that the atypical antipsychotics, particularly clozapine, may be particularly helpful. The role of adjunctive medications, such as those medications that have recently been shown to be useful for the treatment of alcoholism, may have a role in the treatment of these patients, although only naltrexone has, thusfar, been carefully tested in these comorbid patients. Further studies are indicated to assess the role of novel pharmacologic treatment strategies for these patients. Ultimately, any medication given to these patients will need to be prescribed within psychosocial treatment programs aimed at assisting these patients in limiting and ultimately ceasing substance use.
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Affiliation(s)
- Alan I Green
- Department of Psychiatry, Dartmouth Medical School/DHMC, One Medical Center Drive, Lebanon, NH 03756-0001, USA.
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Gurpegui M, Martínez-Ortega JM, Jurado D, Aguilar MC, Diaz FJ, de Leon J. Subjective effects and the main reason for smoking in outpatients with schizophrenia: a case-control study. Compr Psychiatry 2007; 48:186-91. [PMID: 17292710 DOI: 10.1016/j.comppsych.2006.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This study examines in daily smokers (1) subjective effects and main reason for smoking after controlling for nicotine dependence level in 100 controls and 173 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, schizophrenia and (2) the association of specific subjective effects and schizophrenia symptoms. The subjective effects and the main reason for smoking were studied using a questionnaire and the schizophrenia symptoms with the Positive and Negative Syndrome Scale. Proportions were compared by odds ratios controlling for the effects of sex, age, education, and level of nicotine dependence by logistic regression. Schizophrenia was strongly associated with subjective effects of cheerfulness, agility, alertness, concentration, and calmness. In patients with schizophrenia, a cheerfulness effect was associated with higher depressive symptoms; a calming effect, with higher anxiety symptoms; and a sociability effect, with lower negative symptoms. Compared with controls, desire for calmness as the main reason for smoking was more frequent in patients with schizophrenia. These survey data call for confirmation through experimental studies and may help in the design of more focused smoking cessation programs for these patients.
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Affiliation(s)
- Manuel Gurpegui
- Department of Psychiatry and Institute of Neurosciences, University of Granada Medical School, Av. Madrid 11, E-18071 Granada, Spain.
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