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Use of Smoking Cessation Therapies in Individuals with Psychiatric Illness

An Update for Prescribers

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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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References

  1. Lasser K, Boyd JW, Woolhandler S, et al. Smoking and mental illness: a population-based prevalence study. JAMA 2000; 284(20): 2606–10

    Article  PubMed  CAS  Google Scholar 

  2. SANE. Cessation of smoking in long term psychiatric patients. Melbourne (VIC): SANE, 1997

    Google Scholar 

  3. Grant BF, Hasin DS, Chou SP, et al. Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2004 Nov; 61(11): 1107–15

    Article  PubMed  Google Scholar 

  4. Farrell M, Howes S, Bebbington P, et al. Nicotine, alcohol and drug dependence and psychiatric comorbidity: results of a national household survey. Br J Psychiatry 2001 Nov; 179: 432–7

    Article  PubMed  CAS  Google Scholar 

  5. Glassman AH. Cigarette smoking: implications for psychiatric illness. Am J Psychiatry 1993; 150: 546–53

    PubMed  CAS  Google Scholar 

  6. Kisely S, Preston N, Shannon P. Smoking in mental health settings: a pilot study. Health Promot J Austr 2000; 10: 60–2

    Google Scholar 

  7. Hughes JR. Possible effects of smoke-free inpatient units on psychiatric diagnosis and treatment. J Clin Psychiatry 1993; 54: 109–14

    PubMed  CAS  Google Scholar 

  8. Hall S, Muñoz R, Reus V. Smoking cessation, depression and dysphoria. NIDA Res Monogr 1991; 105: 312–3

    Google Scholar 

  9. Jorm AF, Rodgers B, Jacomb PA, et al. Smoking and mental health: results from a community survey. Med J Aust 1999; 170: 74–7

    PubMed  CAS  Google Scholar 

  10. Thorndike FP, Wernicke R, Pearlman MY, et al. Nicotine dependence, PTSD symptoms, and depression proneness among male and female smokers. Addict Behav 2006 Feb; 31(2): 223–31

    Article  PubMed  Google Scholar 

  11. Breslau N, Klein DF. Smoking and panic attacks: an epidemiologic investigation. Arch Gen Psychiatry 1999; 56: 1141–7

    Article  PubMed  CAS  Google Scholar 

  12. Wilhem K. The relevance of smoking and nicotine to clinical psychiatry. Australasian Psychiatry 1998; 6: 130–2

    Article  Google Scholar 

  13. American Psychiatric Association. Practice guideline for the treatment of patients with nicotine dependence. Am J Psychiatry 1996; 153(10 Suppl.): 1–31

    Google Scholar 

  14. George T, Sernyak M, Woods S. Effects of clozapine on smoking in chronic schizophrenic patients. J Clin Psychiatry 1995; 56: 344–6

    PubMed  CAS  Google Scholar 

  15. Prochaska JJ, Gill P, Hall SM. Treatment of tobacco use in an inpatient psychiatric setting. Psychiatr Serv 2004 Nov; 55(11): 1265–70

    Article  PubMed  Google Scholar 

  16. Himelhoch S, Daumit G. To whom do psychiatrists offer smoking-cessation counseling? Am J Psychiatry 2003 Dec; 160(12): 2228–30

    Article  PubMed  Google Scholar 

  17. McFall M, Saxon AJ, Thompson CE, et al. Improving the rates of quitting smoking for veterans with posttraumatic stress disorder. Am J Psychiatry 2005; 162: 1311–9

    Article  PubMed  Google Scholar 

  18. Hall SM, Humfleet GL, Reus VI, et al. Extended nortriptyline and psychological treatment for cigarette smoking. Am J Psychiatry 2004; 161: 2100–7

    Article  PubMed  Google Scholar 

  19. Rigotti NA. Clinical practice: treatment of tobacco use and dependence. N Engl J Med 2002; 346(7): 506–12

    Article  PubMed  Google Scholar 

  20. Fiore MC, Hatsukami DK, Baker TB. Effective tobacco dependence treatment. JAMA 2002; 288(14): 1768–71

    Article  PubMed  Google Scholar 

  21. Glassman AH. Psychiatry and cigarettes. Arch Gen Psychiatry 1998; 55: 692–3

    Article  PubMed  CAS  Google Scholar 

  22. Hall S, Reus VI, Munoz RF, et al. Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 1998; 55: 683–9

    Article  PubMed  CAS  Google Scholar 

  23. Dale LC, Hurt RD, Offord KP, et al. High-dose nicotine patch therapy: percentage of replacement and smoking cessation. JAMA 1995; 274(17): 1353–8

    Article  PubMed  CAS  Google Scholar 

  24. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340(9): 685–91

    Article  PubMed  CAS  Google Scholar 

  25. Keating GM, Siddiqui MAA. Varenicline: a review of its use as an aid to smoking cessation therapy. CNS Drugs 2006; 20(11): 945–60

    Article  PubMed  CAS  Google Scholar 

  26. Covey LS, Glassman AH, Stetner F, et al. A randomized trial of sertraline as a cessation aid for smokers with a history of major depression. Am J Psychiatry 2002; 159: 1731–7

    Article  PubMed  Google Scholar 

  27. Killen JD, Fortmann SP, Schatzberg AF, et al. Nicotine patch and paroxetine for smoking cessation. J Consult Clin Psychol 2000; 68(5): 883–9

    Article  PubMed  CAS  Google Scholar 

  28. Robinson MD, Pettice YL, Smith WA, et al. Buspirone effect on tobacco withdrawal symptoms: a randomized placebo-controlled trial. J Am Board Fam Pract 1992; 5(1): 1–9

    PubMed  CAS  Google Scholar 

  29. Lancaster T, Stead L, Silagy C, et al. Effectiveness of interventions to help people stop smoking: findings from the Cochrane library. BMJ 2000; 321: 355–8

    Article  PubMed  CAS  Google Scholar 

  30. El-Guebaly N, Cathcart J, Currie S, et al. Smoking cessation approaches for persons with mental illness or addictive disorders. Psychiatr Serv 2002; 53: 1166–70

    Article  PubMed  Google Scholar 

  31. Berlin I, Covey LS. Pre-cessation depressive mood predicts failure to quit smoking: the role of coping and personality traits. Addiction 2006; 101(12): 1814–21

    Article  PubMed  Google Scholar 

  32. Evins AE, Cather C, Rigotti NA, et al. Two-year follow-up of a smoking cessation trial in patients with schizophrenia: increased rates of smoking cessation and reduction. J Clin Psychiatry 2004; 65(3): 307–11

    Article  PubMed  Google Scholar 

  33. Evins AE, Cather C, Deckersbach T, et al. A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. J Clin Psychopharmacol 2005; 25(3): 218–25

    Article  PubMed  CAS  Google Scholar 

  34. Evins AE, Cather C, Culhane MA, et al. 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(4): 380–6

    Article  PubMed  CAS  Google Scholar 

  35. George TP, Vessicchio JC, Termine A, et al. A placebo controlled trial of bupropion for smoking cessation in schizophrenia. Biol Psychiatry 2002; 52: 53–61

    Article  PubMed  CAS  Google Scholar 

  36. Hall SM, Humfleet GL, Reus VI, et al. Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 2002; 59: 930–6

    Article  PubMed  CAS  Google Scholar 

  37. Hall SM, Tsoh JY, Prochaska JJ, et al. Treatment for cigarette smoking among depressed mental health outpatients: a randomized clinical trial. Am J Pub Health 2006; 96: 1808–14

    Article  Google Scholar 

  38. Kisely S, Wise M, Preston N, et al. A group intervention to reduce smoking in individuals with psychiatric disorder. Aust N Z J Public Health 2003; 27: 61–6

    Article  PubMed  Google Scholar 

  39. Saules KK, Schuh LM, Arfken CL, et al. Double-blind placebo-controlled trial of fluoxetine in smoking cessation treatment including nicotine patch and cognitive-behavioral group therapy. Am J Addict 2004; 13(5): 438–46

    Article  PubMed  Google Scholar 

  40. Swan GE, Jack LM, Curry S, et al. Bupropion SR and counseling for smoking cessation in actual practice: predictors of outcome. Nicotine Tob Res 2003; 5(6): 911–21

    Article  PubMed  CAS  Google Scholar 

  41. Ranney L, Melvin C, Lux L, et al. Systematic review: smoking cessation intervention strategies for adults and adults in special populations. Ann Intern Med 2006; 145(11): 845–56

    PubMed  Google Scholar 

  42. Brown RA, Kahler CW, Niaura R, et al. Cognitive-behavioral treatment for depression in smoking cessation. J Consult Clin Psychol 2001 Jun; 69(3): 471–80

    Article  PubMed  CAS  Google Scholar 

  43. Kinnunen T, Doherty K, Militello FS, et al. Depression and smoking cessation: characteristics of depressed smokers and effects of nicotine replacement. J Consult Clin Psychol 1996; 64: 791–8

    Article  PubMed  CAS  Google Scholar 

  44. Hall SM, Sees KL, Muñoz FR, et al. Mood management and nicotine gum in smoking treatment: a therapeutic contact and placebo-controlled study. J Consult Clin Psychol 1996; 64: 1003–9

    Article  PubMed  CAS  Google Scholar 

  45. Hayford KE, Patten CA, Rummans TA, et al. Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 1999 Feb; 174: 173–8

    Article  PubMed  CAS  Google Scholar 

  46. Chengappa KN, Kambhampati RK, Perkins K, et al. Bupropion sustained release as a smoking cessation treatment in remitted depressed patients maintained on treatment with selective serotonin reuptake inhibitor antidepressants. J Clin Psychiatry 2001; 62(7): 503–8

    Article  PubMed  CAS  Google Scholar 

  47. Cox LS, Patten CA, Niaura RS, et al. Efficacy of bupropion for relapse prevention in smokers with and without a past history of major depression. J Gen Intern Med 2004; 19(8): 828–34

    Article  PubMed  Google Scholar 

  48. Hitsman B, Pingitore R, Spring B, et al. Antidepressant pharmacotherapy helps some cigarette smokers more than others. J Consult Clin Psychol 1999; 67(4): 547–54

    Article  PubMed  CAS  Google Scholar 

  49. Cinciripini P, Wetter D, Fouladi R, et al. The effects of depressed mood on smoking cessation: mediation by postcessation self-efficacy. J Consult Clin Psychol 2003; 71(2): 292–301

    Article  PubMed  Google Scholar 

  50. Heatherton TP, Kozlowski LT, Frecker RC, et al. The Fager-strom test for nicotine dependence: a revision of the Fager-strom tolerance questionnaire. Br J Addict 1991; 86: 1119–27

    Article  PubMed  CAS  Google Scholar 

  51. Hartman N, Leong GB, Glynn SM, et al. Transdermal nicotine and smoking behavior in psychiatric patients. Am J Psychiatry 1991 Mar; 148(3): 374–5

    PubMed  CAS  Google Scholar 

  52. Weiner E, Ball MP, Summerfelt A, et al. Effects of sustained-release bupropion and supportive group therapy on cigarette consumption in patients with schizophrenia. Am J Psychiatry 2001; 158: 635–7

    Article  PubMed  CAS  Google Scholar 

  53. Evins AE, Mays VK, Rigotti NA, et al. A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia. Nicotine Tob Res 2001 Nov; 3(4): 397–403

    Article  PubMed  CAS  Google Scholar 

  54. George TP, Ziedonis DM, Feingold A, et al. Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry 2000; 157: 1835–42

    Article  PubMed  CAS  Google Scholar 

  55. Addington J, el-Guebaly N, Campbell W, et al. Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry 1998; 155: 974–6

    PubMed  CAS  Google Scholar 

  56. Hughes JR, Goldstein MG, Hurt RD, et al. Recent advances in the pharmacotherapy of smoking. JAMA 1999; 281(1): 72–6

    Article  PubMed  CAS  Google Scholar 

  57. Addington J. Group treatment for smoking cessation among persons with schizophrenia. Psychiatr Serv 1998; 49: 925–8

    PubMed  CAS  Google Scholar 

  58. Lawn S, Pols R. Smoking bans in psychiatric inpatient settings: a review of the research. Aust N Z J Psychiatry 2005 Oct; 39(10): 866–85

    Article  PubMed  Google Scholar 

  59. Drake RE, Mercer-McFadden C, Mueser KT, et al. Treatment of substance abuse in patients with severe mental illness: a review of recent research. Schizophr Bull 1998; 24(4): 589–608

    Article  PubMed  CAS  Google Scholar 

  60. Drake RE, Mueser KT. Psychosocial approaches to dual diagnosis. Schizophr Bull 2000; 26(1): 105–18

    Article  PubMed  CAS  Google Scholar 

  61. Covey LS, Glassman AH, Stetner F. Depression and depressive symptoms in smoking cessation. Compr Psychiatry 1990 Jul–Aug; 31(4): 350–4

    Article  PubMed  CAS  Google Scholar 

  62. Tsoh JY, Humfleet GL, Muñoz RF, et al. Development of major depression after treatment for smoking cessation. Am J Psychiatry 2000; 157: 368–74

    Article  PubMed  CAS  Google Scholar 

  63. Hughes JR. Depression during tobacco abstinence. Nicotine Tob Res 2007; 9(4): 443–6

    Article  PubMed  Google Scholar 

  64. Prochaska JJ, Hall SM, Tsoh JY, et al. Treating tobacco dependence in clinically depressed smokers: effect of smoking cessation on mental health functioning. Am J Public Health. Epub 2008 Jan 30

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Departments of Psychiatry, Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

    Stephen Kisely & Leslie Anne Campbell

  2. School of Medicine, Griffith University, University Drive, Room 2, 15d Building LO3, Logan Campus, Meadowbrook, Queensland, 4131, Australia

    Stephen Kisely

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Correspondence to Stephen Kisely.

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Kisely, S., Campbell, L.A. Use of Smoking Cessation Therapies in Individuals with Psychiatric Illness. CNS Drugs 22, 263–273 (2008). https://doi.org/10.2165/00023210-200822040-00001

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