Impact of an Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic Smokers: A Prospective 12-Month Pilot Study Varenicline for Smoking Cessation in Schizophrenia: Safety and Effectiveness in a 12-Week Open-Label Trial Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia Smoking history and motivation to quit in smokers with schizophrenia in a smoking cessation program A randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of varenicline for smoking cessation in patients with schizophrenia or schizoaffective disorder. Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. Neuropsychological deficits are associated with smoking cessation treatment failure in patients with schizophrenia Varenicline Treatment of Concurrent Alcohol and Nicotine Dependence in Schizophrenia: A Randomized, Placebo-Controlled Pilot Trial Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial Two-year follow-up of a smoking cessation trial in patients with schizophrenia: increased rates of smoking cessation and reduction. A Double-blind Placebo-Controlled Trial of Bupropion Sustained-Release for Smoking Cessation in Schizophrenia Counseling and exercise intervention for smoking reduction in patients with schizophrenia: a feasibility study. A placebo controlled trial of bupropion for smoking cessation in schizophrenia Social predictors of cessation treatment use among smokers with serious mental illness. Identifying effective behavioural components of Intervention and Comparison group support provided in SMOKing cEssation (IC-SMOKE) interventions: a systematic review protocol Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment. Modeling nicotine regulation: A review of studies in smokers with mental health conditions. Smoking Cessation and Reduction in Schizophrenia (SCARIS) with e-cigarette: study protocol for a randomized control trial A double-blind randomized clinical trial of different doses of transdermal nicotine patch for smoking reduction and cessation in long-term hospitalized schizophrenic patients Mortality in schizophrenia: clinical and serological predictors. Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence.
Background : Cigarette smoking is a tough addiction to break . This dependence is the most common dual diagnosis for individuals with schizophrenia . Currently three effective drugs are approved for smoking cessation : nicotine replacement therapy ( NRT ) , varenicline and bupropion . However , some serious side effects of varenicline have been reported , including depression , suicidal thoughts , and suicide . The use of bupropion also has side effects . It should not be used by people who have epilepsy or any condition that lowers the seizure threshold , nor by people who take a specific class of drugs called monoamine oxidase inhibitors . Hence , there are pharmacodynamic reason to believe they could precipitate or exacerbate psychosis . For its capacity to deliver nicotine and provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures , electronic-cigarettes may reduce nicotine withdrawal symptoms without serious side effects . Our recent work with ECs in healthy smokers not intending to quit consistently show surprisingly high success rates . We hypothesised that these positive findings could be replicated in difficult patients with schizophrenia This tool may help smokers with schizophrenia remain abstinent during their quitting attempts or to reduce cigarette consumption . Efficacy and safety of these devices in long-term smoking cessation and /or smoking reduction studies have never been investigated for this special population . Methods : In this study we monitored possible modifications in smoking habits of 14 smokers ( not intending to quit ) with schizophrenia experimenting with the “ Categoria ” e-Cigarette  with a focus on smoking reduction and smoking abstinence . Study participants were invited to attend six study visits : at baseline , week-4 , week-8 , week-12 week-24 and week 52 . Product use , number of cigarettes smoked , carbon monoxide in exhaled breath ( eCO ) and positive and negative symptoms of schizophrenia levels were measured at each visit . Smoking reduction and abstinence rates were calculated . Adverse events were also review ed . Results : Sustained 50 % reduction in the number of cig/day at week-52 was shown in 7/14 ( 50 % ) participants ; their median of 30 cig/day decreasing significantly to 15 cig/day ( p = 0.018 ) . Sustained smoking abstinence at week-52 was observed in 2/14 ( 14.3 % ) participants . Combined sustained 50 % reduction and smoking abstinence was shown in 9/14 ( 64.3 % ) participants . Nausea was observed in 2/14 ( 14.4 % ) of participants , throat irritation in 2/14 ( 14.4 % ) of participants , headache in 2/14 ( 14.4 % ) of participants , and dry cough in 4/14 ( 28.6 % ) of participants . However , these adverse events diminished substantially by week-24 . Overall , one to two cartridges/day were used throughout the study . Positive and negative symptoms of schizophrenia are not increased after smoking reduction/cessation in patients using e-cigarettes . Conclusions : We have shown for the first time that the use of e-cigarette substantially decreased cigarette consumption without causing significant side effects in chronic schizophrenic patients who smoke not intending to quit . This was achieved without negative impacts on the symptoms of schizophrenia as assessed by SAPS and SANS symptoms scales Objective : Varenicline was approved by the FDA in 2006 . In 2009 , based largely on case reports , the FDA issued a warning of possible adverse neuropsychiatric effects including depression and suicidal thoughts and behavior for varenicline and bupropion . Prospect i ve trials of varenicline have not reported increased incidence of psychiatric adverse events other than sleep disturbance , but smokers with major mental illness have been excluded from large prospect i ve trials of varenicline to date . We sought to evaluate the effect of a st and ard open-label 12-week varenicline trial on prospect ively assessed safety and smoking outcomes in adults with stable , treated schizophrenia spectrum disorder and nicotine dependence . Methods : One-hundred twelve stable out patients who smoked 10 or more cigarettes/day participated in a 12-week open-label smoking cessation trial of varenicline and weekly group cognitive behavioral therapy . Participants took varenicline for 4 weeks before attempting cessation . Trained raters collected safety and smoking outcome data weekly . Results : Participants demonstrated improved psychotic symptoms , depressive symptoms , and nicotine withdrawal symptoms from baseline to week 12 or early termination . At the end of 12 weeks ’ open-label treatment , the 14- and 28-day continuous abstinence rates were 47.3 % and 34 % , respectively . Expired carbon monoxide declined significantly during treatment in those who did not achieve abstinence . Conclusions : This prospect i ve study suggests that varenicline may be well tolerated and effective for smoking cessation in combination with group cognitive behavioral therapy in stable out patients with schizophrenia , a group with high rates of smoking and smoking-attributable morbidity and mortality . This clinical trial is registered at www . clinical trials.gov as trial # NCT00621777 Rationale Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions . Objectives This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia . Methods Using a double-blind , placebo-controlled , between-groups design , 57 non-treatment-seeking participants were r and omized to receive 300 mg/day bupropion or placebo . One week later , participants were r and omized to a contingency management ( CM ) intervention in which reductions in urinary cotinine levels were reinforced , or a non-contingent reinforcement ( NR ) condition in which session attendance was reinforced , regardless of cotinine level . Over the 22-day study period , participants visited the laboratory approximately three times per week to provide urine sample s for analysis of cotinine levels , to give breath sample s for analysis of carbon monoxide ( CO ) levels , and to report number of cigarettes smoked per day , nicotine withdrawal symptoms , cigarette craving , and psychiatric symptoms . Results Cotinine and CO levels significantly decreased during the study period in participants r and omized to the CM condition , but not the NR condition . Bupropion did not reduce cotinine levels or increase the efficacy of CM . Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups . Conclusions The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia OBJECTIVE The present study sought to better underst and the relationships among smoking history , motivation to change , and smoking cessation outcomes in people with schizophrenia who smoke . METHOD We examined smoking and quit history , negative consequences due to smoking , readiness to change , smoking temptation , and confidence to quit in a sample of people diagnosed with schizophrenia or schizoaffective disorder according to DSM-IV criteria who were participating in a larger r and omized trial of bupropion SR and a psychoeducational intervention for smoking cessation .  Data were collected from June 2003 to May 2005 . RESULTS At baseline , participants reported high levels of nicotine dependence and daily smoking , as well as multiple recent and lifetime quit attempts that were generally brief in nature . Participants were most concerned about the health effects of smoking and endorsed reasons for smoking related to coping with negative affect and boredom . Most participants reported wanting to quit smoking , but the sample generally reported low levels of confidence in their ability to quit . During the course of participation in the intervention , self-efficacy to quit increased while temptation to smoke decreased ; however readiness to quit remained unchanged . CONCLUSION Smoking cessation programs for people with schizophrenia should focus on teaching coping skills for negative affect , boredom , and specific " high risk situations " for smoking in addition to education , medication , or nicotine replacement therapy . Further , cessation efforts may benefit from directly addressing low self-efficacy for quitting , rather than readiness for change alone , among people with schizophrenia OBJECTIVE Effective smoking cessation treatments are needed for patients with schizophrenia , who , compared with the general population , have high rates of cigarette smoking and more difficulty quitting . We evaluated the safety and efficacy of varenicline for smoking cessation in out patients with stable schizophrenia or schizoaffective disorder . METHOD In this 12-week , r and omized , double-blind , multicenter trial ( May 8 , 2008 , to April 1 , 2010 ) , 127 smokers ( ≥ 15 cigarettes/d ) with DSM-IV-confirmed schizophrenia or schizoaffective disorder received varenicline or placebo ( 2:1 ratio ) . The primary outcome was safety and tolerability of varenicline  assessed by adverse events frequency and changes in ratings on the Positive and Negative Syndrome Scale and other psychiatric scales from baseline to 24 weeks . Abstinence was defined as no smoking 7 days prior to weeks 12 and 24 , verified by carbon monoxide level . RESULTS Eighty-four participants received varenicline ; 43 , placebo . At 12 weeks ( end of treatment ) , 16/84 varenicline-treated patients ( 19.0 % ) met smoking cessation criteria versus 2/43 ( 4.7 % ) for placebo ( P = .046 ) . At 24 weeks , 10/84 ( 11.9 % ) varenicline-treated and 1/43 ( 2.3 % ) placebo-treated patients , respectively , met abstinence criteria ( P = .090 ) . Total adverse event rates were similar between groups , with no significant changes in symptoms of schizophrenia or in mood and anxiety ratings . Rates of suicidal ideation adverse events were 6.0 % ( varenicline ) and 7.0 % ( placebo ) ( P = 1.0 ) . There was 1 suicide attempt by a varenicline patient with a lifetime history of similar attempts and no completed suicides . CONCLUSIONS Varenicline was well tolerated , with no evidence of exacerbation of symptoms , and was associated with significantly higher smoking cessation rates versus placebo at 12 weeks . Our findings suggest varenicline is a suitable smoking cessation therapy for patients with schizophrenia or schizoaffective disorder . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00644969 OBJECTIVE Schizophrenic patients have high rates of cigarette smoking .  The authors compared the outcomes of two group psychotherapy programs for smoking cessation in patients with schizophrenia or schizoaffective disorder who were also treated with the nicotine transdermal patch and with either atypical or typical antipsychotic medications . METHOD Forty-five subjects were r and omly assigned to 1 ) the group therapy program of the American Lung Association ( N=17 ) or 2 )  a specialized group therapy program for smokers with schizophrenia ( N=28 ) that emphasized motivational enhancement , relapse prevention , social skills training , and psychoeducation . All subjects participated in 10 weeks of treatment with the nicotine transdermal patch ( 21 mg/day ) and 10 weekly group therapy sessions and continued to receive their pre study atypical ( N=18 ) or typical ( N=27 ) antipsychotic medications . Outcome variables included treatment retention , rate of smoking abstinence , and expired-breath carbon monoxide level . RESULTS Smoking abstinence rates did not differ in the two group therapy programs . However , atypical antipsychotic agents , in combination with the nicotine transdermal patch , significantly enhanced the rate of smoking cessation ( 55.6 % in the atypical agent group versus 22.2 % in the typical group ) , which was reflected by a significant effect of atypical versus typical agents on carbon monoxide levels . Risperidone and olanzapine were associated with the highest quit rates . CONCLUSIONS The results suggest that 1 ) smoking cessation rates with the nicotine transdermal patch are modest in schizophrenia , 2 ) specialized group therapy for schizophrenic patients is not significantly different from American Lung Association group therapy in its effect on smoking cessation , and 3 ) atypical agents may be superior to typical agents in combination with the nicotine transdermal patch for smoking cessation in schizophrenia Abstract Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. ( Lasser et al. 2000 ) . This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that : ( 1 ) they smoke at two to three times the rate of the general population ; ( 2 ) cessation interventions for this population are understudied ; ( 3 ) most cessation studies exclude persons with serious mental illness ; and ( 4 ) cessation results in public health care savings and disposable income savings for clients . This study included a large number of persons with serious mental illness ( N = 181 ) who were r and omly assigned to one of three groups : contingent reinforcement ( CR ) , CR plus nicotine patch ( 21 mg , CR+NRT ) for 16 weeks , and a minimal intervention , self-quit control group . These participants were followed for 36 weeks . CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide ( CO ) . Quit rates , as measured by expired CO , were higher and discordant with saliva cotinine quit rates . Cotinine showed lower quit rates and small differences between intervention and control partici pants at weeks 20 and 36 . There was , however , evidence of reduced smoking and importantly , no evidence of psychiatric exacerbation The purpose of this study was to determine the effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia . This was a longitudinal study and sixty-eight schizophrenic patients were assigned to 8 weeks of a nicotine-patch therapy program or a control group . The generalized estimating equation analysis revealed that there were significant reductions in the subjects ' nicotine dependence ( Fagerstrom Tolerance Question naire ) , the number of cigarettes per day , and CO levels over an 8-week period of nicotine-patch therapy and 3-month follow-up . The point-prevalence rates of abstinence from smoking were an abstinence of 26.9 % at 8 weeks and 26.9 % at a 3-month follow-up . At the 3-month follow-up , the rate of continuous smoking abstinence in the nicotine-patch group was 23.1 % Schizophrenics have deficits in neuropsychological performance , some of which are modified by cigarette smoking . These patients also have high rates of smoking and resistance to smoking cessation interventions . We examined whether the presence of neuropsychological deficits prior to smoking cessation treatment was associated with smoking cessation treatment failure in schizophrenic as compared to non-psychiatric control smokers . Neuropsychological assessment s were performed prior to treatment with pharmacological agents during the course of placebo-controlled trials in schizophrenic and non-psychiatric control smokers , and included the  Wisconsin Card Sorting Test ( WCST ) , a Visuospatial Working Memory ( VSWM ) task , the Stroop Color Word Test ( SCWT ) and the Continuous Performance Test ( CPT ) .  In schizophrenics ( n=32 ) , subjects who had greater deficits in VSWM and WCST performance were significantly less likely to quit smoking , but this association was not observed in controls ( n=40 ) . Differences between quitters and non-quitters were not likely related to atypical antipsychotic treatment or differences in depressive symptoms . No associations between baseline performance on CPT or SCWT and quit status were found in either group . These preliminary data suggest that in schizophrenics , neuropsychological deficits are associated with smoking cessation treatment failure Abstract Alcohol and nicotine dependence are common in schizophrenia .  Varenicline is effective in smoking cessation and has also been shown to decrease alcohol consumption in smokers . The present pilot study assessed the safety and effectiveness of varenicline for treatment of concurrent nicotine and alcohol dependence in schizophrenia . Out patients with schizophrenia or schizoaffective disorder and concurrent alcohol and nicotine dependence were enrolled in this 8-week , double-blind , r and omized , placebo-controlled trial . Alcohol use and smoking were assessed using self-report ( Timeline Follow-Back ) and biological measures . Adverse events were recorded . Changes in the number of st and ard drinks per week and cigarettes per week were compared in the 2 groups . Because of safety concerns or loss to follow-up , of 55 patients enrolled , only 10 started study medication , 5 each on varenicline and placebo .  Gastrointestinal adverse effects , such as severe abdominal pain , limited study completion to only 4 subjects . Number of st and ard alcoholic drinks consumed per week decreased by [ mean ( SD ) ] 16.6 ( 20.1 ) in the varenicline group and by 2.4 ( 27.4 ) in the placebo group . Mean ( SD ) number of cigarettes smoked per week decreased by 66 ( 65 ) in the varenicline group and by 47 ( 77 ) in the placebo group . Varenicline treatment of concurrent alcohol and nicotine dependence in schizophrenia may be problematic because of safety concerns limiting recruitment and poor tolerability ( gastrointestinal adverse effects ) limiting retention . There was no increased number of serious neuropsychiatric adverse events in the varenicline group . Based on this small sample , concurrent alcohol and nicotine dependence in schizophrenia may present special obstacles to successful treatment with varenicline Introduction : The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime . A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing st and ard treatment compared to smokers with no mental illness . We sought to determine if combination extended treatment ( COMB-EXT ) and home visits ( HV ) would lead to improved outcomes in smokers with schizophrenia . Methods : Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV , COMB-EXT without HV , or treatment as usual ( TAU ) ( r and om assignment ) . COMB-EXT consisted of group cognitive-behavioral therapy ( CBT ) , bupropion , nicotine patch , and nicotine lozenge , which were initiated within 2 weeks and continued for 26 weekly visits . HV consisted of biweekly visits to the home with assessment of secondh and smoke ( SHS ) exposure and brief behavioral therapy with participants and others in the home environment . TAU consisted of group CBT plus serial single or combination medication trials as per st and ard care . Results : Smokers with schizophrenia who received COMB-EXT ( with or without HV ) had greater reductions in cigarettes per day than those treated with TAU ( both ps < .01 ) . In addition , 7-day point prevalence abstinence rates for the three groups were 45 % , 20 % , and 8 % , respectively , which was significantly higher for COMB-EXT plus HV than TAU ( & khgr;2(1 ) = 4.8 , p = .03 ) . Groups did not differ significantly in the number of adverse events , and HV were easily scheduled . Conclusion : COMB-EXT improves outcomes for smokers with schizophrenia . HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population . Implication s : The clear benefit found here of rapidly initiated , combination , extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia . Furthermore , HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence , indicating that this intervention may be worthy of future research BACKGROUND Long-term success rates of smoking cessation programs for patients with schizophrenia are unknown . This study , conducted between June 2001 and November 2002 , evaluated the rate of smoking cessation and reduction in patients with schizophrenia ( DSM-IV ) 2 years after they had participated in a smoking cessation study in order to determine whether subjects who significantly reduced smoking during the original trial resumed their previous level of smoking at 2 years . METHOD Two years following a double-blind placebo-controlled trial of bupropion sustained release , 150 mg/day , added to cognitive-behavioral therapy for smoking cessation in patients with schizophrenia , subjects were interviewed , medical charts were review ed , and carbon monoxide in expired air was measured . RESULTS Seventeen of 18 subjects completed the follow-up assessment . More subjects were abstinent ( 22 % [ N = 4 ] ) at the 2-year follow-up than were abstinent at the end of the trial ( 6 % [ N = 1 ] ) . Subjects who achieved significant smoking reduction during the trial were more likely to be abstinent at 2 years ( 4/7 ) than those who did not significantly reduce smoking during the trial ( 0/11 ) ( chi(2 ) = 8.1 , p < .005 ) . Most subjects who achieved > or = 50 % reduction in smoking at the end of the trial maintained at least that level of reduction at 2 years . Smoking reduction during the treatment intervention was correlated with smoking reduction at follow-up ( r = 0.60 , p = .01 ) . CONCLUSION The results from this naturalistic study suggest that behavior changes achieved in smoking cessation programs for patients with schizophrenia may be durable and may predict future smoking behavior . We conclude that further investigation into the relationship between smoking reduction and future smoking cessation in special population s is indicated Abstract : The objective of this study was to examine the efficacy of bupropion for smoking cessation in patients with schizophrenia . Adults with schizophrenia who smoked more than 10 cigarettes per day and wished to try to quit smoking were recruited from community mental health centers , enrolled in a 12-week group cognitive behavioral therapy intervention , and r and omly assigned to receive either bupropion sustained-release 300 mg/d or identical placebo .  Fifty-three adults , 25 on bupropion and 28 on placebo  , were r and omized , completed at least 1 postbaseline assessment and were included in the analysis . The primary outcome measures were 7-day point prevalence abstinence in the week after the quit date ( week 4 ) and at the end of the intervention ( week 12 ) . Subjects in the bupropion group were significantly more likely to be abstinent for the week after the quit date ( 36 % [ 9/25 ] vs. 7 % [ 2/28 ] , P = 0.016 ) and at end of the intervention ( 16 % [ 4/25 ] vs. 0 % , P = 0.043 ) . Subjects in the bupropion group also had a higher rate of 4-week continuous abstinence ( weeks 8 - 12 ) ( 16 % [ 4/25 ] vs. 0 % , P = 0.043 ) and a longer duration of abstinence ( 4.2 [ 3.2 ] weeks vs. 1.8 [ 0.96 ] weeks , t = 2.30 , P = 0.037 ) . The effect of bupropion did not persist after discontinuation of treatment . Subjects in the bupropion group had no worsening of clinical symptoms and had a trend toward improvement in depressive and negative symptoms . We conclude that bupropion does not worsen clinical symptoms of schizophrenia and is modestly effective for smoking cessation  in patients with schizophrenia . The relapse rate is high after treatment discontinuation Smoking cessation is possible for individuals with schizophrenia but the relapse rate is high . It is necessary to develop more flexible approaches to help these patients . The aim of this study was to examine the feasibility of an intervention approach that integrates counseling and exercise for participants with schizophrenia or schizoaffective disorder . A single group prospect i ve design was used in this study . A sample of in patients with schizophrenia or schizoaffective disorder participated in a program called " oxygen group " , a program combining five sessions of smoking reduction counseling and three sessions of moderate intensity exercise over an 8-week period  . Tobacco consumption , motivation , carbon monoxide level , anxiety and depression , smoking self-efficacy , nicotine dependence and waist circumference were measured pre- and post-intervention . Participants reported their satisfaction with the study characteristics after completion of the intervention . Smoking consumption and CO level were assessed at 6-week post-intervention follow-up . Twelve individuals ( mean age 45.7±10.8years ) were recruited . Participant attendance was 81.3 % . There were no dropouts . Significant decreases were found for tobacco consumption ( P=.04 ) and CO rate ( P=.003 ) at the end of the intervention and were maintained at 6-week follow-up . Compared to baseline levels , there were no changes in depression and anxiety . Smoking cessation motivation increased significantly . This intervention appears feasible and acceptable to patients with schizophrenia and there were promising findings regarding smoking reduction . Larger trials to test the intervention are warranted BACKGROUND Schizophrenic patients have high rates of cigarette smoking compared with the general population . We compared sustained-release ( SR ) bupropion with placebo for smoking cessation in patients with schizophrenic disorders . We also examined how antipsychotic class predicts smoking cessation outcomes with bupropion . METHODS Thirty-two subjects meeting DSM-IV criteria for schizophrenia or schizoaffective disorder and nicotine dependence were r and omized to bupropion SR ( BUP , 300 mg/day ) or placebo ( PLA ) . Outcomes included treatment retention , smoking abstinence rates , expired breath carbon monoxide ( CO ) levels , psychotic symptoms , and medication side effects . RESULTS Bupropion significantly increased trial endpoint 7-day point prevalence smoking abstinence rates compared with placebo [ BUP , 8/16 ( 50.0 % ) , PLA , 2/16 ( 12.5 % ) ; chi(2 ) = 5.24 , df = 1 , p < .05 ] , and reduced CO levels during the trial [ Medication x Time interaction ; Z = 3.09 , p < .01 ] . Positive schizophrenia symptoms were not altered by BUP , but negative symptoms were significantly reduced . Atypical antipsychotic drug treatment enhanced smoking cessation responses to BUP . Major side effects were dry mouth , gastrointestinal symptoms , headache , and insomnia . CONCLUSIONS Our results suggest that 1 ) BUP enhances smoking abstinence rates compared with PLA in nicotine-dependent schizophrenic smokers ; 2 ) BUP is well-tolerated and safe for use in these patients ; and 3 ) atypical antipsychotics may enhance smoking cessation outcomes with BUP OBJECTIVE Social factors play an important role in quitting smoking in the general population , but relatively little is known about social influences on smoking cessation efforts among individuals with serious mental illness who suffer disproportionately high rates of smoking . This study examined social factors as predictors of using  smoking cessation treatment  among adults with serious mental illness . METHODS We conducted a secondary analysis of data from a r and omized study comparing two versions of a motivational decision support system for smoking cessation treatment including 124 smokers with schizophrenia or severe mood disorders .  Hierarchical logistic regression with blocked entry of theoretically linked predictor variables was used to model two types of social influences ( explicit and implicit ) as predictors of using cessation group therapy or smoking cessation medication . RESULTS Approximately 31 % of participants initiated  smoking cessation treatment during the 2-month follow-up . Hierarchical logistic regression analyses revealed that over and above demographic and personal factors , implicit social influences ( others ' approval of treatment ) significantly predicted use of smoking cessation medication , while explicit social influences ( smoking with others ) significantly predicted use of  cessation group therapy . CONCLUSIONS For people with serious mental illness , social factors appear to influence use of smoking cessation treatment above and beyond personal factors and may be specific to the type of treatment . These data support the need to further explore the role of social factors as potential leverage points for engagement in smoking cessation treatments in this population Background Systematic review s of behaviour change interventions for  smoking cessation  vary in scope , quality , and applicability . The current review aims to generate more accurate and useful findings by ( 1 ) a detailed analysis of intervention elements that change behaviour ( i.e. behaviour change techniques ( BCTs ) ) and potential moderators of behaviour change ( i.e. other intervention and sample characteristics ) and ( 2 ) assessing and controlling for variability in support provided to comparison groups in smoking cessation trials . Methods A systematic review will be conducted of r and omized controlled trials of behaviour change interventions for smoking cessation in adults ( with or without pharmacological support ) , with a minimum follow-up of 6 months , published after 1995 . Eligible articles will be identified through the Cochrane Tobacco Addiction Group Specialized Register . Study authors will be asked for detailed descriptions of smoking cessation support provided to intervention and comparison groups . All data will be independently coded by two research ers . The BCT taxonomy v1 ( tailored to smoking cessation interventions ) and template for intervention description and replication criteria will be used to code intervention characteristics . Data collection will further include sample and trial characteristics and outcome data ( smoking cessation rates ) . Multilevel mixed-effects meta-regression models will be used to examine which BCTs and /or BCT clusters delivered to intervention and comparison groups explain smoking cessation rates in treatment arms ( and effect sizes ) and what key moderators of behaviour change are . Predicted effect sizes of each intervention will be computed assuming all interventions are compared against comparison groups receiving the same levels of behavioural support ( i.e. low , medium , and high levels ) . Multi-disciplinary advisory board members ( policymakers , health care providers , and (ex-)smokers ) will provide strategic input throughout the project to ensure the review ’s applicability to policy and practice . Discussion By capturing BCTs in intervention and comparison groups , this systematic review will provide more accurate estimates of the effectiveness of smoking cessation interventions , the most promising BCTs and /or BCT clusters associated with smoking cessation rates in intervention and comparison arms , and important moderators of behaviour change . The results could set new st and ards for conducting meta-analyses of behaviour change interventions and improve research , service delivery , and training in the area of smoking cessation . Systematic review registration PROSPERO AIMS To underst and the relations among anxiety disorders and tobacco dependence , withdrawal symptoms , response to smoking cessation pharmacotherapy and ability to quit smoking . DESIGN R and omized placebo-controlled clinical trial . Participants received six 10-minute individual counseling sessions and either : placebo , bupropion SR , nicotine patch , nicotine lozenge , bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge . SETTING Two urban research sites . PARTICIPANTS Data were collected from 1504 daily smokers ( > 9 cigarettes per day ) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use . MEASUREMENTS Participants completed baseline assessment s , the Composite International Diagnostic Interview and ecological momentary assessment s for 2 weeks . FINDINGS A structured clinical interview identified participants who ever met criteria for a panic attack ( n = 455 ) , social anxiety ( n = 199 ) or generalized anxiety disorder ( n = 99 ) , and those who qualified for no anxiety diagnosis ( n = 891 ) . Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms . Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect . Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies . CONCLUSIONS Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke , elevated withdrawal , lack of response to pharmacotherapy and impaired ability to quit smoking . These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses Smokers with mental health conditions ( MHCs ) lose approximately 15 years of life relative to non-smokers without MHCs , of which two-thirds are attributable to smoking . The Food and Drug Administration ( FDA ) recently announced a new regulatory strategy for tobacco that includes a reduction in the nicotine content of cigarettes sold in the US to a minimally-addictive level . This action could improve cessation rates in smokers with MHCs by reducing their dependence on nicotine . However , nicotine reduction also could have unintended negative consequences in smokers with MHCs . Thus , it is important to conduct r and omized controlled trials to investigate the potential effects of nicotine reduction in smokers with MHCs . Several studies of the acute or extended effects of nicotine reduction in smokers with emotional disorders or serious mental illness have been recently completed or are underway . Studies to date indicate that when smokers with MHCs are switched , under r and omized , double-blind conditions , to cigarettes with very low nicotine content , they reduce their cigarette intake , with minimal or no effects on withdrawal , psychiatric symptoms , or compensatory smoking . However , some deleterious effects of nicotine reduction on cognitive performance measures in smokers with schizophrenia have been observed , which are offset by providing concurrent nicotine replacement . We review these studies and provide suggestions for potentially increasing the effectiveness of a  nicotine reduction strategy  for reducing smoking in people with MHCs . The research described was conducted in the United States in 2010 - 2018 Background It is well established in studies across several countries that tobacco smoking is more prevalent among schizophrenic patients than the general population . Electronic cigarettes are becoming increasingly popular with smokers worldwide . To date there are no large r and omized trials of electronic cigarettes in schizophrenic smokers . A well- design ed trial is needed to compare efficacy and safety of these products in this special population . Methods / Design Intervention : We have design ed a r and omized controlled trial investigating the efficacy and safety of electronic cigarette . The trial will take the form of a prospect i ve 12-month r and omized clinical study to evaluate smoking reduction , smoking abstinence and adverse events in schizophrenic smokers not intending to quit . We will also monitor quality of life , neurocognitive functioning and measure participants ’ perception and satisfaction of the product . Outcome measures : A ≥50 % reduction in the number of cigarettes/day from baseline , will be calculated at each study visit ( “ reducers ” ) . Abstinence from smoking will be calculated at each study visit ( “ quitters ” ) . Smokers who leave the study protocol before its completion and will carry out the Early Termination Visit or who will not satisfy the criteria of “ reducers ” and “ quitters ” will be defined “ non responders”.Statistical analysis : The differences of continuous variables between the three groups will be evaluated with the Kruskal-Wallis Test , followed by the Dunn multiple comparison test . The differences between the three groups for normally distributed data will be evaluated with ANOVA test one way , followed by the Newman-Keuls multiple comparison test . The normality of the distribution will be evaluated with the Kolmogorov-Smirnov test . Any correlations between the variables under evaluation will be assessed by Spearman r correlation . To compare qualitative data will be used the Chi-square test . Discussion The main strengths of the SCARIS study are the following : it ’s the first large RCT on schizophrenic patient , involving in and outpatient , evaluating the effect of a three-arm study design , and a long term of follow-up (52-weeks).The goal is to propose an effective intervention to reduce the risk of tobacco smoking , as a complementary tool to treat tobacco addiction in schizophrenia . Trial registration Clinical Trials.gov , NCT01979796 There have been many studies of smoking cessation using nicotine replacement therapy ( NRT ) with schizophrenic patients , but none exploring the smoking-reduction effects of varying doses of NRT in long-stay patients with schizophrenia . This study aim ed to examine the effect of different doses of the nicotine transdermal patch on smoking-reduction and cessation outcomes in long-term hospitalized schizophrenic patients . A total of 184 subjects participated in a r and omized , controlled , double-blind 8-week clinical trial . Participants were r and omized into two groups using two different doses of NRT : a high-dose NRT group ( 31.2 mg for the first 4 weeks , then 20.8 mg for 4 weeks , n = 92 ) or a low-dose NRT group ( 20.8 mg for 8 weeks , n = 92 ) . The 7-day point prevalence of abstinence was 2.7 % ( 5/184 ) . Participants in the low-dose NRT group reduced smoking by 3.1 more cigarettes on average than those in the high-dose group ( p = 0.005 ) . However , a repeated measures analysis of variance revealed that the main effect of changes in the number of cigarettes smoked , comparing the two types of treatment across periods , was not significant ( p = 0.35 , partial eta square = 0.018 ) . In summary , among a cohort of chronic institutionalized schizophrenic patients , smoking cessation and reduction outcomes were not correlated with NRT dose , and the cessation rate was much lower than rates in similar studies . It indicates that long-term hospitalized schizophrenic patients have more difficulties with quitting smoking . More effective integrative smoking cessation programs should be addressed for these patients Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes . Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication . The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation . We prospect ively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample  from which antibodies to human herpes viruses and Toxoplasma gondii were measured . Mortality was determined with data from the National Death Index following a period of up to 11 years . We examined the role of demographic , serological , and clinical factors on mortality . A total of 25 ( 5 % ) of 517 persons  died of natural causes . The st and ardized mortality ratio was 2.80 ( 95 % CI 0.89 , 6.38 ) . After adjusting for age and gender , mortality from natural causes was predicted in separate models by cigarette smoking ( relative risk [ RR ] = 4.66 , P = .0029 ) ; lower cognitive score ( RR = 0.96 , P = .013 ) ; level of antibodies to Epstein-Barr virus ( RR = 1.22 , P = .0041 ) and to Herpes Simplex virus type 1 ( RR = 1.19 , P = .030 ) ; immunologic disease ( RR = 3.14 , P = .044 ) ; and genitourinary disease ( RR = 2.70 ; P = .035 ) . Because cigarette smoking confers an almost 5-fold risk of mortality , smoking cessation is an urgent priority . Having an elevated level of antibodies to Epstein-Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes INTRODUCTION Smoking prevalence remains high in some vulnerable groups , including those who misuse substances , have a mental illness , are homeless , or are involved with the criminal justice system .  E-cigarette use is increasing and may support smoking cessation/reduction . METHODS Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups . Data bases search ed were MEDLINE , EMBASE , PsychINFO , CINAHL , ASSIA , ProQuest Dissertations and Theses , and Open Grey . Narrative synthesis of quantitative data and thematic synthesis of qualitative data . RESULTS 2628 records and 46 full texts were screened ; 9 studies were identified for inclusion . Due to low quality of evidence , it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable population s. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy . Four studies suggested significant smoking reduction ; however , three were uncontrolled and had sample sizes below 30 . A prospect i ve cohort study found no differences between e-cigarette users and nonusers . No significant adverse events and minimal side effects were identified . Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceptions of effectiveness for cessation/reduction ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . CONCLUSION Further research is needed to identify the most appropriate device types for practicality and safety , level of support required in e-cigarette interventions , and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups . IMPLICATION S Smoking prevalence among people with mental illness , substance misuse , homelessness , or criminal justice system involvement remains high . E-cigarettes could support cessation . This systematic review found limited quantitative evidence assessing effectiveness . No serious adverse events were identified . Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceived effectiveness ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . Further research should consider appropriate devices for practicality and safety , concurrent support , and comparison with best practice smoking cessation support
Overall , nicotine replacement therapy , bupropion , and varenicline have all proven their effectiveness at either promoting smoking abstinence or a significant reduction in cigarette use
Smoking cessation is a chronic issue surrounding individuals with schizophrenia .
It is estimated that up to 90 % of patients diagnosed with schizophrenia smoke cigarettes .
The purpose of this article is to provide a non systematic review of the efficacy of  smoking cessation interventions as well as to explore the potential neuropsychiatric adverse effects of these agents in patients with schizophrenia .