Smoking reduction and cessation for people with schizophrenia Identify smokers
1 Many people with schizophrenia smoke and smoke heavily, resulting in significant
Royal Australian College of General Practitioners
health and lifestyle problems. Smoking reduction and cessation is complicated
because smoking may alleviate some of their psychiatric symptoms and lessen the
side-effects of some antipsychotics. Assess readiness to quit (stage-of-change cycle)
2 Motivation to quit can be increased by discussing the specific costs of smoking
(such as health and lifestyle issues) for that person and the benefits of quitting, as
well as acknowledging the difficulties associated with quitting. A smoking history,
including any past quit attempts, is useful. Assess risks of smoking reduction and cessation Precipitation or exacerbation of psychotic symptoms
It is important to know the usual signs of relapse in that person. Development of clinical depression
Be aware of past history or family history of depression.
Smoking alters liver metabolism of some antipsychotic medications. Write an individual plan
4 If thepatient is psychiatrically stable and wishes to commence smoking reduction
and cessation, a written plan using the Guidelines available at
www.health.vic.gov.au/mentalhealth/publications/smoke is important, as people
with schizophrenia may have cognitive deficits. Use nicotine replacement
5 Nicotine withdrawal symptoms usually occur and can by very distressing. Use of
nicotine replacement therapy has been shown to increase successful cessation.
At present, bupropion (Zyban) should only be used with extreme caution in this
group because it carries the risk of provoking psychosis or seizures. Recommend group support
Involvement with a specialised group program (for example, a SANE SmokeFree
6 Program) will increase reduction in smoking and quit rates, as well as assisting in
7 Frequentreview initially after quitting is very important, especially with respect to
mental state and medication. The person should be seen 1 to 3 days after quitting
and then weekly for one month, and then monthly for six months. Congratulate on any progress
Smokers, on average, take 5-7 attempts before they successfully cease.
8 Itis important to give credit for any gains made. Smoking reduction and cessation for people with schizophrenia Bob’s story
Bob has schizophrenia, is 39 years old and has been trying to quit smoking, on
and off, for the last five years. He is in regular contact with a GP and
community health service. He has trouble with dizziness and is worried about
weight gain if he quits (he has a family history of diabetes). A year ago, he took
part in a SANE SmokeFree Program with support from his GP and psychiatrist.
He now hasn't smoked for two months, with help from nicotine gum. (He put
on nearly 2 kg in the first few weeks after giving up, but is now exercising more
and is only 0.5 kg above his starting weight.) He tells everyone how great he
feels, and how much money he is saving, now that he has finally quit.
People with schizophrenia can quit smoking, but they may need some extra
support and time. You can help by using these Guidelines to move your patient
In Australia, tobacco smoking is the largest single preventable cause of death
and disease. One in two lifetime smokers will die from diseases caused by
tobacco, and half of these deaths will occur in middle age. SANE SmokeFree Zone
Smoking rates in people with schizophrenia are up to three times those of the
general population. People with schizophrenia die younger, even when factors
related to their illness (such as suicide) are taken into account. They also have
increased morbidity – rates of cardiovascular and respiratory disease are up to
three times higher than age-matched controls.
General practitioners see about 80% of this population each year and are in a
unique position to improve their quality of life. The management principles
SANE SmokeFree Kit
outlined on the front of this sheet are most effectively used in conjunction with
the full Guidelines: Smoking reduction and cessation for people with schizophrenia:Guidelines for general practitioners (see Resources for details).
Contact your local mental health or community health service for more
information about support for people wishing to quit.
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Agents Classified by the IARC Monographs , Volumes 1–103 Acetaldehyde associated with consumption of alcoholic 000313-67-7 (NB: Overall evaluation upgraded to Group 1 based on 000313-67-7 Aristolochic acid, plants containing 007440-38-2 Arsenic and inorganic arsenic compounds 001332-21-4 013768-00-8 Asbestos (all forms, including actinolite, amosite, 012172-73-5 anthophyllite, chrysot