Currently, there are many interventions that have been tried to counter the major public health burdens of smoking either in general populations or in patients with mental illnesses, but this issue is not addressed more vigorously in patients with mental illness as in the general population. Despite having very high prevalence’s of smoking in mental illness, particularly in the schizophrenic populations, this population often excluded from studies while applying and examining different strategies to counter this unmet health problem. Though we have observed successful regimens for smoking cessation in general populaces that have developed a significant decline in smoking prevalence. For example, within general populations there is fair evidence that different combined therapies (e.g. triple regimen therapy) may also improve quitting rates and longer durations of treatments may also prove as successful outcomes (Steinberg & Greenhaus, 2009; Smith & McCarthy 2009, Piper ME, Smith SS 2009).
Yet there is not any evidence-based data which could explain such examples of triple regimen therapy amongst patients of schizophrenia. The efficacy, safety and tolerability of bupropion in schizophrenia populations could be more effective by adding other adjunctive therapies in that either group support, or NRT, there must be standardized assessment parameters to evaluate efficacy of various combinations that have been previously applied. Relapse rates and maintaining abstinence for longer durations are difficult components of the smoking cessation treatment plans in this population. So, studies should be examined for longer durations and subjects should be treated for longer durations, which could improve overall outcomes by decreasing relapse rates, Though we have little evidence that Varenciline could be effective to prevent replase (Cahill et al., 2012), but future studies are needed to study varneicline particularly in this aspect.
Since Cognition dysfunction is one of major problem & has an important role in functional outcome of illness, couple of studies (Patterson et al., 2009; Smith et al., 2009) reviewed in this paper in those authors explained advantageous effect of Varenicline on cognition improvement, But there is need of further studies to evaluate any potential role of Varenicline on some or global improvement as well as cognitive measures are reflected in functional improvements in daily life. Since Varenicline has black box warnings and there are certain case reports, which explain possible risks by its use, at the same time there are many evidence-based studies, which claim its efficacy and safe use. Thus, it is very critical to identify reliable predictors of good response or worsening of symptoms in order to minimize or maximize its efficacy and use, similarly these must be proper assessment (e.g. system, questionnaire, structured program) to assess suicidal ideations. These assessment types should also be considered for use in future studies similar to what William JM et al. did in a study (Williams, 2012). Craving is an important factor in smoking, so newly emerging TMS treatment has shown good results for addressing this issue.
There is a study (Wing, Bacher, Wu et al., 2012) by Wing et al., which has encouraging results and thus calls for further research to be done on larger scales . Early deaths, short life span due to cardiovascular components or any other metabolic factor, should alert clinicians to increase the frequency of follow-up for these patients. Also, there should be a focus on preventing initial cardio-metabolic risks because subsequent reduction in this risk is more difficult to achieve, either through behavioral or pharmacologic interventions. Considering these facts and ignorance at the level of primary care health physicians, this issue should be addressed at the primary care level by regular assessments of the following factors: fasting glucose, body mass index, fasting triglycerides, fasting cholesterol, waist, high-density lipoprotein/low-density lipoprotein, blood pressure and symptoms of diabetes. In terms of interventions, most guidelines recommended advice on physical activity, diet, psycho-education of the patient, treatment of lipid abnormalities, treatment of diabetes, referral for advice and treatments, psycho-education of the family and smoking cessation advice.
Steinberg ML et al. did the first study, which examined the relationship between task persistence and smoking cessation outcome in smokers with schizophrenia. Task persistence may make important contributions to smoking cessation successful. This will be exhibited by indicating that the contribution of task persistence to smoking cessation is similar for smokers with schizophrenia and non-psychiatric smokers, which too, warrants more in-depth consideration on larger scales (Steinberg et al., 2012).
Journal Reference: Saeed, A., et al. (2015). Nicotine Addiction in Schizophrenia, Availability of Better Treatment Options as are in General Population. International Journal of Emergency Mental Health and Human Resilience, 17(1), 156-166.