Health Psychology Research / HPR / Volume 8 / Issue 2 / DOI: 10.4081/​hpr.2020.9237
GENERAL

Approved and emerging smoking cessation treatments for people  with schizophrenia spectrum disorders: A narrative review

Pasquale Caponnetto1,2,3,4* Riccardo Polosa1,2,3
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1 Centro per la Prevenzione e Cura del Tabagismo (CPCT), University Hospital Vittorio Emanuele, University of Catania, Italy
2 Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Italy
3 Department of Clinical and Experimental Medicine, University of Catania, Italy
4 Faculty of Health Sciences and Sport, University of Stirling, UK
Submitted: 9 July 2020 | Accepted: 15 August 2020 | Published: 5 October 2020
© 2020 by the Author(s). Licensee Health Psychology Research, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract

This review focuses on smoking cessation treatments for peo ple with schizophrenia spectrum disorders. It concludes with com ments on the significance of the research and why it constitutes an original contribution. We searched PubMed (National Library of Medicine), and PsycINFO (Ovid) (2006-2020) for studies on schizophrenic disorder (schizophrenia or psychotic or psychosis or severe mental illness) and smoking cessation treatment (smok ing cessation treatment or varenicline or tobacco cessation or reduction or bupropion or NRT or behavioral treatment or e-ciga rette). Studies found evidence suggesting that pharmacotherapy combined with behavioural therapy for smoking cessation is effective amongst smokers with schizophrenia spectrum disorders, although more long-term research is required. This review sum marised and critically reviewed also studies on vaping as a smok ing cessation strategy for smokers with schizophrenia spectrum disorders and evidence suggests that they may effective as smok ing cessation tool and may be less harmful alternatives to com bustible cigarette smoking. Consequently, e-cigarettes could be considered as an applicable instrument for Tobacco Harm Reduction (THR) and smoking cessation. Overall, there are very few studies of e-cigarettes for smoking cessation in patients with schizophrenia and these studies are very small. They have promis ing results, but more research is needed. 

Keywords
smoking cessation treatments
schizophrenia spectrum dis orders
review
References

1. Addington, J., el-Guebaly, N., Addington, D., & Hodgins, D. (1997). Readiness to stop smoking in schizophrenia. The Canadian Journal of Psychiatry/La Revue canadienne de psychiatrie 42(1), 49-52.
2. Addington, J., el-Guebaly, N., Campbell, W., Hodgins, D. C., & Addington, D. (1998). Smoking cessation treatment for patients with schizophrenia. The American Journal of Psichiatry, 155(7), 974-976.
3. Anthenelli, R. M., Benowitz, N. L., West, R., St Aubin, L., McRae, T., Lawrence, D., Asher, J., Russ, C., krishen, A., & Evins A. E. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. The Lancet, 387(10037), 2507-2520.
4. Baker, A., Richmond, R., Haile, M., Lewin, T. J., Carr, V. J., Taylor, R. L., et al. (2006). A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. The American Journal of Psychiatry, 163 (11), 1934-42.
5. Baker, A., Richmond, R., Haile, M., Lewin, T. J., Carr, V. J., Taylor, R. L., et al. (2007). Characteristics of smokers with a psychotic disorder and implications for smoking interventions. Psychiatry Research,150(2), 141–152.
6. Barr, A. M., Procyshyn, R. M., Hui, P., Johnson, J. L., & Honer, W. G. (2008). Self-reported motivation to smoke in schizophrenia is related to antipsychotic drug treatment. Schizophrenia Research, 100(1-3), 252–260.
7. Bennett, M. E., Wilson, A. L., Genderson, M., & Saperstein, A. M. (2013). Smoking cessation in people with schizophrenia. Current Drug Abuse Reviews, 6(3), 180-90.
8. Brown, C. H., Medoff, D., Dickerson, F. B., Fang, L. J., Lucksted, A., Goldberg, R. W., Dixon, L. B. (2015). Factors influencing implementation of smoking cessation treatment within community mental health centers. Journal of dual diagnosis, 11(2), 145–150.
9. Briskman, I., Bar, G., Boaz, M., & Shargorodsky, M. (2012). Impact of Co-Morbid Mental Illness on the Diagnosis and Management of Patients Hospitalized for Medical Conditions in a General Hospital. The International Journal of Psychiatry in Medicine, 43(4), 339–348.
10. Caponnetto, P., Auditore, R., Russo, C., Cappello G. C., & Polosa, R. (2013). Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study. International Journal of Environmental Research and Public Health, 10(2), 446-61.
11. Caponnetto, P., Polosa, R., Auditore, R., Minutolo, G., Signorelli, M., Maglia, M., et al. (2014). Smoking Cessation and Reduction in Schizophrenia (SCARIS) with e-cigarette: study protocol for a randomized control trial. Trials, 15(1), 88.
12. Cather, C., Dyer, M. A., Burrell, H. A., Hoeppner B., Goff, D. C., & Evins, A. E. (2013). An open trial of relapse prevention therapy for smokers with schizophrenia. Journal of Dual Diagnosis, 9(1), 87-93.
13. Cather, C., Pachas, G.N., Cieslak, K.M., Evins, A.E. (2017). Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs, 31, 471.
14. Chen, L. S., Baker, T., Brownson, R. C., Carney, R. M., Jorenby, D., Hartz, S., et al. (2016). Smoking Cessation and Electronic Cigarettes in Community MentalHealth Centers: Patient and Provider Perspectives.Community Ment Health, 53(6), 695-702. 
15. Chou, K. R., Chen, R., Lee, J. F., Ku, C. H., & Lu, R. B. (2004). The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. International Journal of Nursing Studies, 41(3), 321-30.
16. Dickerson, F., Stallings, C., Origoni, A. E., Vaughan, C., Khushalani, S., Schroeder, J., Yolken, R. H. (2013). Cigarette smoking among persons with schizophrenia or bipolar disorder in routine clinical settings, 1999–2011. Psychiatric services, 64(1), 44–50.
17. Dixon, L., Medoff, D. R., Wohlheiter, K., Goldberg, C., Kreyenbuhl, R., Adams, J., et al. (2007). Correlates of severity of smoking among persons with severe mental illness. American Journal on Addiction, 16(2), 101–110.
18. D’Souza, M. S., & Markou, A. (2012). Schizophrenia and tobacco smoking comorbidity: nAChR agonists in the treatment of schizophrenia-associated cognitive deficits. Neuropharmacology, 62(3), 1564-1573.
19. D’Souza, D. C., Esterlis, I., Carbuto, M., Krasenics, M., Seibyl, J., Bois, F., et al. (2012). Lower β2*-nicotinic acetylcholine receptor availability in smokers with schizophrenia. The American Journal of Psychiatry, 169(3), 326-34.
20. Duffy, S. A., Kilbourne, A. M., Austin, K. L., Dalack, G. W., Woltmann, E. M., Waxmonsky, J., & Noonan, D. (2012). Risk of smoking and receipt of cessation services among veterans with mental disorders. Psychiatric services (Washington, D.C.), 63(4), 325–332. 
21. Esterlis, I., Bois, F., Pittman, B., Picciotto, M. R., Shearer, L., Anticevic, A., et al. (2013). In vivo evidence for B2 nicotinic acetylcholine receptor subunit upregulation in smokers as compared with nonsmokers with schizophrenia. Biological Psychiatry, 76(6), 495-502.
22. Evins, A. E., Cather, C., Deckersbach, T., Freudenreich, O., Culhane, M. A., Olm-Shipman, C. M., Henderson, D. C., Shoenfeld, D. A., Goff, D. C., Rigotti, N. A. (2005). A double-blind placebo controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. Journal of Clinical Psychopharmacology, 25(3), 218-25.
23. Evins, A. E., Cather, C., Pratt, S. A., Pachas, G. N., Hoeppner, S. S., Goff, D. C., Achtyens, E. D., Ayer, D., Shoenfeld, D.A. (2014). Maintenance treatment with varenicline for smoking cessation in patients with schizophrenia and bipolar disorder: a randomized clinical trial. JAMA, 311(2), 145-54.
24. George, T.P, Ziedonis, D.M., Feingold, A., Pepper, W.T., Satterburg, C.A., Winkel, J., et al. (2000). Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry, 157, 1835–1842.
25. George, T.P., Vessicchio, J.C., Termine, A., Bregartner, T.A., Feingold, A., Rounsaville, B.J., et al. (2002). A placebo-controlled trial of bupropion for smoking cessation in schizophrenia. Biological Psychiatry, 52, 53–61.
26. Goldberg, J. O. (2010). Successful Change in Tobacco Use in Schizophrenia. Journal of the American Psychiatric Nurses Association, 16(1), 30–35.
27. Hickling L.M., Perez-Iglesias R., McNeill A., Dawkins L., Moxham J., Ruffell T., et al. (2018). A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness. Psychological Medicine, 1–8
28. Horst, W. D., Klein, M. W., Williams, D., & Werder, S. F. (2005). Extended use of nicotine replacement therapy to maintain smoking cessation in persons with schizophrenia. Neuropsychiatric disease and treatment, 1(4), 349-355.
29. Johnson, J. L., Moffat, B., & Malchy, L. (2010). In the shadow of a new smoke free policy: A discourse analysis of health care providers' engagement in tobacco control in community mental health. International Journal of Mental Health Systems, 4(1), 23.
30. Kelly, D. L., McMahon, R. P., Wehring, H. J., Liu, F., Mackowick, K. M., Boggs, D. L., et al. (2011). Cigarette smoking and mortality risk in people with schizophrenia. Schizophrenia Bulletin, 37(4), 832-838.
31. Kelly, D. L., Raley, H. G., Lo, S., Wright, K., Liu, F., McMahon, R. P., Heishman, S. J. (2012). Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophrenia bulletin, 38(3), 543–551. 
32. Kishi, T., & Iwata, N. (2015). Varenicline for smoking cessation in people with schizophrenia: systematic review and meta-analysis. European archives of psychiatry and clinical neuroscience, 265(3), 259-268.
33. Knowles, S., Planner, C., Bradshaw, T., Peckham, E., Man, M-S., & Gilbody, S. (2016). Making the journey with me: a qualitative study of experiences of a bespoke mental health smoking cessation intervention for service users with serious mental illness. BMC Psychiatry, 16:193.
34. McCloughen, A. (2003). The association between schizophrenia and cigarette smoking: a review of the literature and implications for mental health nursing practice. International journal of mental health nursing, 12(2), 119-129.
35. Mexal, S., Berger, R., Logel, J., Ross, R. G., Freedman, R., & Leonard, S. (2010). Differential regulation of α7 nicotinic receptor gene (CHRNA7) expression in schizophrenic smokers. Journal of molecular neuroscience, 40(1-2), 185-195.
36. Miller, B. J., Wang, A., Wong, J., Paletta, N., & Buckley, P. F. (2017). E-cigarette use in schizophrenia: prevalence and attitudes. Annals of Clinical Psychiatry, 29(1), 4-10.
37. Owen, M. J., Sawa, A., & Mortensen, P.B. (2016). Schizophrenia. Lancet, 388, 86-97.
38. Peckham, E., Brabyn, S., Cook, L., Tew, G., & Gilbody, S. (2017). Smoking cessation in severe mentalill health: whatworks? anupdatedsystematic review and meta-analysis. BMC psychiatry, 17(1), 252.
39. Pratt, S. I., Sargent, J., Daniels, L., Santos, M. M., & Brunette, M. (2016). Appeal of electronic cigarettes in smokers with serious mental illness. Addictive behaviors, 59, 30-34.
40. Prochaska, J. J. (2011). Smoking and mental illness-breaking the link. New England Journal of Medicine, 365 (3), 196-198.
41. Purcell, S. M., Moran, J. L., Fromer, M., Ruderfer, D., Solovieff, N., & Roussos, P., O’Dushlaine, C., Chambert, K., Bergen, S. E., Kähler, A., Duncan, L., stahl, E., Genovese, G., Fernández, E., O Collins, M., Komiyama, N. H., Choudhary, J. S., Magnusson, P. K. E., Banks, E., Shakir, K., garimella, K., Fennel, T., DePristo, M., Grant, S. G. M., Haggarty, S. J., Gabriel, S., Scolnick, E. M., Lander, E. S., Hultman, C. M., Sullivan, P. F., McCarroll , S. A., Skiar P. (2014). A polygenic burden of rare disruptive mutations in schizophrenia. Nature, 506 (7487), 185-90.
42. Rae, J., Pettey D., Aubry, T., Stol, J. (2015) Factors Affecting Smoking Cessation Efforts of People with Severe Mental Illness: A Qualitative Study. Journal of Dual Diagnosis, 11(1), 42-49.
43. Ratschen, E., Britton, J., Doody, G. A., Leonardi-Bee, J., & McNeill, A. (2009). Tobacco dependence, treatment and smoke-free policies: a survey of mental health professionals' knowledge and attitudes. General hospital psychiatry, 31(6), 576-582.
44. Riley, B. P., Makoff, A., Mogudi-Carter, M., Jenkins, T., Williamson, R., Collier, D., Murray, R. (2000). Haplotype transmission disequilibrium and evidence for linkage of the CHRNA7 gene region to schizophrenia in Southern African Bantu families. American journal of medical genetics, 96 (2), 196-201.
45. Roberts, E., Evins, A. E., McNeill, A., & Robson, D. (2016). Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with seriousmentalillness: a systematic review and network meta-analysis. Addiction, 111(4), 599-612.
46. Sharma, R., Wigginton, B., Meurk, C., Ford, P., & Gartner, C. E. (2017). Motivations and limitations associated with lapin among people with mental illness: A qualitative analysis of Reddit discussions. International journal of environmental research and public health, 14 (1), 7.
47. Tidey, J. W., Rohsenow, D. J., Kaplan, G. B., & Swift, R. M. (2005). Cigarette smoking to pography in smokers with schizophrenia and matched non-psychiatric controls. Drug and Alcohol Dependence,80 (2), 259-265.
48. Trainor, K., & Leavey, G. (2017). Barriers and facilitators to smoking cessation among people with severe mental illness: a critical appraisal of qualitative studies. Nicotine Tob Res, 19(1),14–23.
49. Tsoi, D. T., Porwal, M., & Webster, A. C. (2013). Interventions for smoking cessation and reduction in individuals with schizophrenia. The Cochrane Database of Systematic Reviews, 2.
50. Weiner, E., Buchholtz, A., Coffay, A., Liu, F., McMahon, R. P., Buchanan, R. W., Kelly, D. L. (2011). Varenicline for smoking cessation in people with schizophrenia: a double-blind randomized pilot study. Schizophrenia research, 129(1), 94-95.
51. Williams, J. M., Steinberg, M. L., Zimmermann, M. H., Gandhi, K. K., Stipelman, B., Budsock, P. D., et al. (2010). Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. Journal of substance abuse treatment, 38(4), 384-393.
52. Yann, S. & Marina, R. (2008). Genetics of nicotinic acetylcholine receptors: Relevance to nicotine addiction. Biochemical Pharmacology,75, 323–333.

Conflict of interest
The authors declare they have no competing interests.
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