Although cigarette smoking is declining in the general population, this is
not the case among individuals with schizophrenia, among whom the smoking rate
is 70 percent to 88 percent.
Despite these extremely high rates of smoking, little research has been
conducted on ways to get schizophrenia patients to quit. In a study by Amanda
Baker, Ph.D., an associate professor at the Center for Mental Health Studies
at the University of Newcastle in Australia, and coworkers,
motivational/cognitive behavioral therapy (CBT) sessions combined with
nicotine replacement therapy were found to be "encouraging" and
The team reported their findings in the November American Journal of
Baker and her colleagues recruited 298 individuals with a psychotic
disorder who were smoking at least 15 cigarettes a day and wanted to stop
smoking. Half were assigned to routine care and half to a smoking-cessation
program. Those allocated to the program were counseled in eight individual
weekly sessions about how to stop smoking and were given cognitive strategies
to assist them in doing so. In the last four of the eight sessions, subjects
were given nicotine patches to wear as well. The researchers then tracked the
subjects' smoking outcomes during the following year.
There were no significant differences between the treatment group and the
control group in continuous-abstinence rates or in point-prevalence-abstinence
rates, measured at three, six, and 12 months. However, a significantly higher
proportion of smokers who completed all treatment sessions were found
to have stopped smoking at three, six, and 12 months. (At three months, the
difference was 30 percent versus 6 percent for the control group; at six
months, 19 percent versus 4 percent; and at 12 months, 19 percent versus 7
Moreover, 44 percent of intervention participants who completed all
treatment sessions had reduced their smoking by at least 50 percent at 12
months, compared with only 17 percent of controls—a highly significant
difference that particularly impressed her, Baker told Psychiatric
"This is a neglected area," Jose de Leon, M.D., a University of
Kentucky psychiatrist with a special interest in smoking and schizophrenia,
said in an interview. "The authors should be complimented for completing
this large study.... [However,] the important outcome in this study was the
smoking-cessation rate, defined as continuous abstinence after 12 months. In
the intervention group it was 3.4 percent. This is a very low number, better
than the 0.7 percent rate in controls, but not significantly better. [Thus,]
we need new and better interventions for smoking cessation in severely
mentally ill patients."
In an editorial accompanying the study report, Sherry Leonard, Ph.D., and
Catherine Adams, Ph.D., professors of psychiatry at the University of
Colorado, agreed. Indeed, a nicotinic receptor agonist such as DMXB-A [3-2,4
dimethoxybenzylidene anabaseine] might "provide a better adjuvant
treatment for smoking cessation than the nicotine patch," they
They explained that for schizophrenia patients, smoking may represent a
form of self-medication—an attempt to treat an underlying biological
deficit. Schizophrenia patients are known to have a fewer-than-normal number
of nicotinic receptors, the brain's first line of response to nicotine in
cigarettes. This inadequate number of nicotinic receptors may be the
biological deficit that patients try to correct by smoking. Thus, if
schizophrenia patients were given a drug, such as DMXB-A, that enhances the
activity of nicotinic receptors, they might not feel a need to smoke, the
Leonard and Adams, in fact, conjectured that giving DMXB-A to schizophrenia
patients might fill two purposes—not just reduce patients' urge to
smoke, but also lessen their sensory deficits and improve their cognition. The
reason is that in a recent phase 1 trial in which Leonard participated, DMXB-A
was found to both improve cognition and decrease symptoms in schizophrenia
subjects (Psychiatric News, July 21).
A phase-2 trial testing the value of DMXB-A to schizophrenia subjects'
mental well-being is now under way, Leonard told Psychiatric News."
We will then begin a study [of DMXB-A] in schizophrenia smokers,"
The study was funded by Australia's National Health and Medical Research
Council, Rotary, and Community Health and Tuberculosis Australia. Nicotine
replacement therapy was provided free by GlaxoSmithKline.
"A Randomized Controlled Trial of a Smoking Cessation
Intervention Among People With a Psychotic Disorder" is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/11/1934>.▪