6. SMOKING AND SCHIZOPHRENIA: STILL A BURNING PROBLEM

Abstract

The prevalence of tobacco use in schizophrenia is 3x that of the general population and the disparity is growing. Persons with schizophrenia die on average 10-15 years earlier than those in the general population and smoking is the largest preventable cause of this premature mortality. Understanding the association between smoking and schizophrenia is a high priority as is the development of more effective smoking cessation strategies for this population. In this symposium, we examine epidemiological aspects of smoking and schizophrenia. We also examine novel smoking cessation interventions that have been recently developed for persons with schizophrenia. While we typically consider the effects of cigarette smoking in persons with schizophrenia, there is new evidence that smoking may play a causal role in the development of psychosis. In the first presentation, Dr. Robin Murray presents data showing that daily tobacco use is associated with an increased risk of psychotic illness and also that smoking is associated with an earlier age at onset of psychotic illness. Data were drawn from a systematic review of the literature including studies with an overall sample of almost 300,000 persons and from two case control studies of persons with a first episode of psychosis. Tobacco smoking was significantly more common in the patient groups even after adjusting for cannabis use. Plausible biological explanations add weight to the causal hypothesis. In the second presentation, Dr. Faith Dickerson turns to the adverse effects of cigarette smoking in schizophrenia. Data are drawn from two cohorts looking at the cross sectional association between tobacco use and cognitive functioning and suicide attempts; a third and longitudinal cohort examined the association between smoking at baseline and subsequent natural cause morality. Smoking was significantly and inversely associated with total cognitive score and also with a history of suicide attempts. In the third cohort, smoking at baseline was the strongest predictor of subsequent natural cause mortality in a multivariate model including other demographic and clinical variables. These data contradict the notion that smoking is “self medication” for persons with schizophrenia. In the third presentation, Dr. Mary Brunette describes the results of a randomized trial with schizophrenia smokers comparing two brief web-based motivational interventions for smoking cessation adapted for people with cognitive impairments. Nearly 40% of the sample reported quit attempts at the 6-month follow-up though only 4% had verified abstinence. Brief web-based treatments can motivate schizophrenia smokers to use cessation treatments. In the final presentation, Dr. Gail Daumit describes an ongoing trial testing an 18-month intervention delivered in community mental health centers to smokers with serious mental illness who are interested in quitting. The intervention involves group and individual smoking cessation and weight management counseling, smoking cessation pharmacotherapy, and exercise. The intervention aims to promote smoking abstinence, improved physical activity, and weight control. Baseline results will be presented.The discussion will be led by Dr. Eden Evins, a leading expert in smoking cessation treatments for persons with schizophrenia.