How to treat nicotine dependence in smokers with schizophrenia

	Tweet

Improve patients’ health, help them kick addiction with this practical approach.

Mr. V, age 49, has stable but symptomatic schizophrenia and a 33-year cigarette smoking history. He is very concerned because his primary care physician told him he has 2 serious smoking-related health problems: diabetes and hypertension. He tried a smoking cessation program for the general public, but it was a poor fit because of his schizophrenia symptoms.

Despite adhering to his medications (ziprasidone, 20 mg hs; perphenazine, 8 mg hs; lorazepam, 1 mg hs; zonisamide, 200 mg/d, and benztropine mesylate, 2 mg hs), Mr. V has residual auditory hallucinations, paranoid ideation, and impaired concentration and attention. He smokes approximately 1.5 packs per day, particularly when very ill, to alleviate chronic boredom, and to diminish distress from the hallucinations. All of his friends smoke, and they do not support his attempts to quit.

Obstacles to smoking cessation for schizophrenia patients

Smokers with schizophrenia are more nicotine-dependent, more likely to become medically ill, and less likely to receive help in quitting, compared with the general population. They:

• begin smoking at a higher rate before diagnosis or treatment for schizophrenia, compared with persons who do not go on to develop the disorder
  
• smoke each cigarette more intensely, extracting more nicotine per cigarette
  
• have higher rates of smoking-related illness and medical morbidity
  
• are much less likely to receive physician advice to quit smoking.

Many persons with severe mental illness are misinformed about the risks and benefits of smoking vs nicotine dependence treatment. They often fear and overestimate the medical risks of nicotine replacement therapies. Many believe smoking relieves depression and anxiety, whereas nicotine actually is anxiogenic. Nicotine may improve some aspects of cognitive dysfunction in schizophrenia, which could be a disincentive for patients to quit smoking.

This article reviews these empiric studies and suggests practical ways for clinicians to create smoking cessation and relapse prevention plans for individuals with schizophrenia.

Successfully treating nicotine dependence can seem a formidable challenge in patients with schizophrenia:

• 72% to 90% smoke cigarettes, compared with 21% of the general population
  
• They tend to smoke heavily, spending about one-third of their incomes on cigarettes.
  
• Their negative symptoms (such as apathy), positive symptoms (such as disorganized thinking), and cognitive impairment can reduce motivation to quit and adhere to a smoking cessation strategy.
  
• Sociologic and physiologic aspects of schizophrenia reinforce their smoking habit

Even so, smokers with schizophrenia can be highly motivated and persistent in attempting to quit. Promising results have been reported in trials when psychopharmacologic treatments are combined with cognitive and behavioral interventions.

Jennifer D. Gottlieb, PhD
Schizophrenia clinical and research program, Massachusetts General Hospital, Instructor in psychiatry, Harvard Medical School

A. Eden Evins, MD, MPH
Schizophrenia and depression clinical and research programs Director, Center for Addiction Medicine and addiction research program, Massachusetts General Hospital, Assistant professor of psychiatry Harvard Medical School

Full text

RELATED STORIES:
Potential new approach to treat cognitive impairments in schizophrenia   Cold Sore Virus May Contribute to Cognitive and Brain Abnormalities in Schizophrenia   Empirical evaluation of language disorder in schizophrenia   Glutamate: Too much of a good thing in schizophrenia?   Study finds cancer is the second most frequent cause of death in individuals with schizophrenia   Researchers find a partially shared genetic profile between schizophrenia and bipolar disorder   The Use of Depot Medications in the Treatment of Schizophrenia   “Schizophrenia” should be dropped, say experts   Risk of Malignancy in Patients With Schizophrenia or Bipolar Disorder: study   Sex and gender in schizophrenia   Scientists propose new direction in the search for genetic causes of schizophrenia   Diet And Schizophrenia: The Link Is More Important Than You Think   The future of schizophrenia   Sexual dysfunction in schizophrenia: focus on recent evidence   No link seen between flu outbreak, schizophrenia

Comments

[ + Post Your Own ]

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

There are no comments for this entry yet. [ + Comment here + ]