Smoking and beyond in schizophrenia patients

Schizophrenia patients have approximately 20% shorter life period compared to normal population. They generally lose more than 25 years of normal life span. There are many risk factors regarding shorter life expectancy in schizophrenia patients including metabolic syndrome and medicines. One of the important risk factors causing early death issue in patients with schizophrenia is smoking cigarettes. Comorbid nicotine dependence is very common among schizophrenia patients showing prevalence rates of %60 - %80 which is 2-4 folds higher than in the general population. Also they smoke “harder” with significantly higher plasma nicotine levels, more puffs per cigarette, shorter puff intervals, and larger puff volumes. Smoking habit may be the result of self medication for negative symptoms or cognitive deficits in schizophrenia. There is clear evidence that cigarette smoking increase mortality risk in patients with schizophrenia. However patients have lower appreciation for health risks of smoking. Up to date many study results have found modest efficacy of bupropion, varenicline, nicotine replacement therapy, cognitive-behavioral therapy and psychosocial interventions. Bupropion or varenicline treatment combined with nicotine replacement treatment may be effective especially in the first 6-months of treatment compared to placebo in schizophrenia patients, but treatment effect generally decreases with time. Therefore new treatment strategies to stop smoking in patients with schizophrenia are needed to be developed.