Two-year follow-up of a smoking cessation trial in patients with schizophrenia: increased rates of smoking cessation and reduction. Counseling and exercise intervention for smoking reduction in patients with schizophrenia: a feasibility study. Smoking history and motivation to quit in smokers with schizophrenia in a smoking cessation program A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses Impact of an Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic Smokers: A Prospective 12-Month Pilot Study A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. Nonmedication Smoking Reduction Program for Inpatients With Chronic Schizophrenia: A Randomized Control Design Study Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial Acute feasibility and safety of a smoking reduction strategy for smokers with schizophrenia. Smoking Cessation and Reduction in Schizophrenia (SCARIS) with e-cigarette: study protocol for a randomized control trial Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia Smoking Cessation in Individuals With Serious Mental Illness: A Randomized Controlled Trial of Two Psychosocial Interventions Effects of sustained-release bupropion and supportive group therapy on cigarette consumption in patients with schizophrenia. A randomised controlled trial linking mental health inpatients to community smoking cessation supports: A study protocol
BACKGROUND Long-term success rates of smoking cessation programs for patients with schizophrenia are unknown . This study , conducted between June 2001 and November 2002 , evaluated the rate of smoking cessation and reduction in patients with schizophrenia ( DSM-IV ) 2 years after they had participated in a smoking cessation study in order to determine whether subjects who significantly reduced smoking during the original trial resumed their previous level of smoking at 2 years . METHOD Two years following a double-blind placebo-controlled trial of bupropion sustained release , 150 mg/day , added to cognitive-behavioral therapy for smoking cessation in patients with schizophrenia , subjects were interviewed , medical charts were review ed , and carbon monoxide in expired air was measured . RESULTS Seventeen of 18 subjects completed the follow-up assessment . More subjects were abstinent ( 22 % [ N = 4 ] ) at the 2-year follow-up than were abstinent at the end of the trial ( 6 % [ N = 1 ] ) . Subjects who achieved significant smoking reduction during the trial were more likely to be abstinent at 2 years ( 4/7 ) than those who did not significantly reduce smoking during the trial ( 0/11 ) ( chi(2 ) = 8.1 , p < .005 ) . Most subjects who achieved > or = 50 % reduction in smoking at the end of the trial maintained at least that level of reduction at 2 years . Smoking reduction during the treatment intervention was correlated with smoking reduction at follow-up ( r = 0.60 , p = .01 ) . CONCLUSION The results from this naturalistic study suggest that behavior changes achieved in smoking cessation programs for patients with schizophrenia may be durable and may predict future smoking behavior . We conclude that further investigation into the relationship between smoking reduction and future smoking cessation in special population s is indicated Smoking cessation is possible for individuals with schizophrenia but the relapse rate is high . It is necessary to develop more flexible approaches to help these patients . The aim of this study was to examine the feasibility of an intervention approach that integrates counseling and exercise for participants with schizophrenia or schizoaffective disorder . A single group prospect i ve design was used in this study . A sample of in patients with schizophrenia or schizoaffective disorder participated in a program called " oxygen group " , a program combining five sessions of smoking reduction counseling and three sessions of moderate intensity exercise over an 8-week period  . Tobacco consumption , motivation , carbon monoxide level , anxiety and depression , smoking self-efficacy , nicotine dependence and waist circumference were measured pre- and post-intervention . Participants reported their satisfaction with the study characteristics after completion of the intervention . Smoking consumption and CO level were assessed at 6-week post-intervention follow-up . Twelve individuals ( mean age 45.7±10.8years ) were recruited . Participant attendance was 81.3 % . There were no dropouts . Significant decreases were found for tobacco consumption ( P=.04 ) and CO rate ( P=.003 ) at the end of the intervention and were maintained at 6-week follow-up . Compared to baseline levels , there were no changes in depression and anxiety . Smoking cessation motivation increased significantly . This intervention appears feasible and acceptable to patients with schizophrenia and there were promising findings regarding smoking reduction . Larger trials to test the intervention are warranted OBJECTIVE The present study sought to better underst and the relationships among smoking history , motivation to change , and smoking cessation outcomes in people with schizophrenia who smoke . METHOD We examined smoking and quit history , negative consequences due to smoking , readiness to change , smoking temptation , and confidence to quit in a sample of people diagnosed with schizophrenia or schizoaffective disorder according to DSM-IV criteria who were participating in a larger r and omized trial of bupropion SR and a psychoeducational intervention for smoking cessation .  Data were collected from June 2003 to May 2005 . RESULTS At baseline , participants reported high levels of nicotine dependence and daily smoking , as well as multiple recent and lifetime quit attempts that were generally brief in nature . Participants were most concerned about the health effects of smoking and endorsed reasons for smoking related to coping with negative affect and boredom . Most participants reported wanting to quit smoking , but the sample generally reported low levels of confidence in their ability to quit . During the course of participation in the intervention , self-efficacy to quit increased while temptation to smoke decreased ; however readiness to quit remained unchanged . CONCLUSION Smoking cessation programs for people with schizophrenia should focus on teaching coping skills for negative affect , boredom , and specific " high risk situations " for smoking in addition to education , medication , or nicotine replacement therapy . Further , cessation efforts may benefit from directly addressing low self-efficacy for quitting , rather than readiness for change alone , among people with schizophrenia Abstract Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. ( Lasser et al. 2000 ) . This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that : ( 1 ) they smoke at two to three times the rate of the general population ; ( 2 ) cessation interventions for this population are understudied ; ( 3 ) most cessation studies exclude persons with serious mental illness ; and ( 4 ) cessation results in public health care savings and disposable income savings for clients . This study included a large number of persons with serious mental illness ( N = 181 ) who were r and omly assigned to one of three groups : contingent reinforcement ( CR ) , CR plus nicotine patch ( 21 mg , CR+NRT ) for 16 weeks , and a minimal intervention , self-quit control group . These participants were followed for 36 weeks . CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide ( CO ) . Quit rates , as measured by expired CO , were higher and discordant with saliva cotinine quit rates . Cotinine showed lower quit rates and small differences between intervention and control partici pants at weeks 20 and 36 . There was , however , evidence of reduced smoking and importantly , no evidence of psychiatric exacerbation Background : Cigarette smoking is a tough addiction to break . This dependence is the most common dual diagnosis for individuals with schizophrenia . Currently three effective drugs are approved for smoking cessation : nicotine replacement therapy ( NRT ) , varenicline and bupropion . However , some serious side effects of varenicline have been reported , including depression , suicidal thoughts , and suicide . The use of bupropion also has side effects . It should not be used by people who have epilepsy or any condition that lowers the seizure threshold , nor by people who take a specific class of drugs called monoamine oxidase inhibitors . Hence , there are pharmacodynamic reason to believe they could precipitate or exacerbate psychosis . For its capacity to deliver nicotine and provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures , electronic-cigarettes may reduce nicotine withdrawal symptoms without serious side effects . Our recent work with ECs in healthy smokers not intending to quit consistently show surprisingly high success rates . We hypothesised that these positive findings could be replicated in difficult patients with schizophrenia This tool may help smokers with schizophrenia remain abstinent during their quitting attempts or to reduce cigarette consumption . Efficacy and safety of these devices in long-term smoking cessation and /or smoking reduction studies have never been investigated for this special population . Methods : In this study we monitored possible modifications in smoking habits of 14 smokers ( not intending to quit ) with schizophrenia experimenting with the “ Categoria ” e-Cigarette  with a focus on smoking reduction and smoking abstinence . Study participants were invited to attend six study visits : at baseline , week-4 , week-8 , week-12 week-24 and week 52 . Product use , number of cigarettes smoked , carbon monoxide in exhaled breath ( eCO ) and positive and negative symptoms of schizophrenia levels were measured at each visit . Smoking reduction and abstinence rates were calculated . Adverse events were also review ed . Results : Sustained 50 % reduction in the number of cig/day at week-52 was shown in 7/14 ( 50 % ) participants ; their median of 30 cig/day decreasing significantly to 15 cig/day ( p = 0.018 ) . Sustained smoking abstinence at week-52 was observed in 2/14 ( 14.3 % ) participants . Combined sustained 50 % reduction and smoking abstinence was shown in 9/14 ( 64.3 % ) participants . Nausea was observed in 2/14 ( 14.4 % ) of participants , throat irritation in 2/14 ( 14.4 % ) of participants , headache in 2/14 ( 14.4 % ) of participants , and dry cough in 4/14 ( 28.6 % ) of participants . However , these adverse events diminished substantially by week-24 . Overall , one to two cartridges/day were used throughout the study . Positive and negative symptoms of schizophrenia are not increased after smoking reduction/cessation in patients using e-cigarettes . Conclusions : We have shown for the first time that the use of e-cigarette substantially decreased cigarette consumption without causing significant side effects in chronic schizophrenic patients who smoke not intending to quit . This was achieved without negative impacts on the symptoms of schizophrenia as assessed by SAPS and SANS symptoms scales OBJECTIVE Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs , few studies have investigated the efficacy of smoking cessation interventions among this group . The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone . METHOD The authors recruited 298 regular smokers with a psychotic disorder residing in the community and r and omly assigned them to a routine care comparison condition ( N=151 ) or an eight-session , individually administered smoking cessation intervention ( N=147 ) , which consisted of nicotine replacement therapy , motivational interviewing , and cognitive behavior therapy . Outcome variables included continuous and point-prevalence abstinence rates , smoking reduction status , and changes in symptoms and functioning . RESULTS While there were no overall differences between the treatment group and comparison group in abstinence rates , a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions ( point-prevalence rates : 3 months , 30.0 % versus 6.0 % ; 6 months , 18.6 % versus 4.0 % ; and 12 months , 18.6 % versus 6.6 % ) . Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months ( 21.4 % versus 4.0 % ) . There was a strong dose-response relationship between treatment session attendance and smoking reduction status , with one-half of those who completed the intervention program achieving a 50 % or greater reduction in daily cigarette consumption across the follow-ups , relative to less than one-fifth of the comparison subjects . There was no evidence of any associated deterioration in symptoms or functioning . CONCLUSIONS These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder . Further development of more efficacious interventions is required for those who do not respond to existing interventions Abstract People with schizophrenia are more likely to smoke , and to smoke more frequently , than those without schizophrenia . Furthermore , in patients smoke even more frequently compared with those living in the community . In light of this , we implemented and assessed a smoking reduction intervention using a wide array of behavioral group techniques and methods in chronic hospitalized schizophrenic clients . Using a controlled design , we r and omly assigned chronic schizophrenic clients to either a five-session smoking reduction intervention ( n = 35 ) or a waiting list ( WL ; n = 18 ) . We assessed self-reported smoking behavior , clinical status ( Positive and Negative Syndrome Scale , Hamilton Rating Scale for Depression ; Clinical Global Impression Scale for Psychosis ) , subjective quality of life ( Quality of Life Enjoyment and Satisfaction Question naire – abbreviated version ) , and weight before and 3 months after the intervention . The intervention successfully reduced the number of cigarettes smoked compared with nonintervention . No clinical worsening or weight gain was observed . Behavioral group – oriented smoking reduction interventions can significantly reduce smoking behavior in hospitalized chronic clients with schizophrenia Compared to the general population , smokers with schizophrenia ( SCZ ) have reduced success in quitting smoking with usual approaches . This study tested two manualized behavioral counseling approaches-Treatment of Addiction to Nicotine in Schizophrenia ( TANS ) or Medication Management (MM)-for  smokers who were motivated to quit .  Individual counseling sessions were provided by mental health clinicians in mental health setting s , along with nicotine patch . The two treatments varied in intensity and frequency of sessions . Eighty-seven subjects were r and omized and attended at least one treatment session . Twenty-one percent ( n = 18 ) of participants had continuous abstinence at 12 weeks after the target quit date , which was not significantly different between conditions ( 15.6 % TANS vs. 26.2 % MM , chi(2 ) = 1.50 , p = .221 ) . Smokers in both groups significantly reduced smoking as measured by cigarettes per day and expired carbon monoxide . Findings support that mental health clinicians can be trained to effectively help smokers with SCZ maintain tobacco abstinence The purpose of this study was to determine the effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia . This was a longitudinal study and sixty-eight schizophrenic patients were assigned to 8 weeks of a nicotine-patch therapy program or a control group . The generalized estimating equation analysis revealed that there were significant reductions in the subjects ' nicotine dependence ( Fagerstrom Tolerance Question naire ) , the number of cigarettes per day , and CO levels over an 8-week period of nicotine-patch therapy and 3-month follow-up . The point-prevalence rates of abstinence from smoking were an abstinence of 26.9 % at 8 weeks and 26.9 % at a 3-month follow-up . At the 3-month follow-up , the rate of continuous smoking abstinence in the nicotine-patch group was 23.1 % OBJECTIVE Schizophrenic patients have high rates of cigarette smoking .  The authors compared the outcomes of two group psychotherapy programs for smoking cessation in patients with schizophrenia or schizoaffective disorder who were also treated with the nicotine transdermal patch and with either atypical or typical antipsychotic medications . METHOD Forty-five subjects were r and omly assigned to 1 ) the group therapy program of the American Lung Association ( N=17 ) or 2 )  a specialized group therapy program for smokers with schizophrenia ( N=28 ) that emphasized motivational enhancement , relapse prevention , social skills training , and psychoeducation . All subjects participated in 10 weeks of treatment with the nicotine transdermal patch ( 21 mg/day ) and 10 weekly group therapy sessions and continued to receive their pre study atypical ( N=18 ) or typical ( N=27 ) antipsychotic medications . Outcome variables included treatment retention , rate of smoking abstinence , and expired-breath carbon monoxide level . RESULTS Smoking abstinence rates did not differ in the two group therapy programs . However , atypical antipsychotic agents , in combination with the nicotine transdermal patch , significantly enhanced the rate of smoking cessation ( 55.6 % in the atypical agent group versus 22.2 % in the typical group ) , which was reflected by a significant effect of atypical versus typical agents on carbon monoxide levels . Risperidone and olanzapine were associated with the highest quit rates . CONCLUSIONS The results suggest that 1 ) smoking cessation rates with the nicotine transdermal patch are modest in schizophrenia , 2 ) specialized group therapy for schizophrenic patients is not significantly different from American Lung Association group therapy in its effect on smoking cessation , and 3 ) atypical agents may be superior to typical agents in combination with the nicotine transdermal patch for smoking cessation in schizophrenia Introduction : The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime . A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing st and ard treatment compared to smokers with no mental illness . We sought to determine if combination extended treatment ( COMB-EXT ) and home visits ( HV ) would lead to improved outcomes in smokers with schizophrenia . Methods : Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV , COMB-EXT without HV , or treatment as usual ( TAU ) ( r and om assignment ) . COMB-EXT consisted of group cognitive-behavioral therapy ( CBT ) , bupropion , nicotine patch , and nicotine lozenge , which were initiated within 2 weeks and continued for 26 weekly visits . HV consisted of biweekly visits to the home with assessment of secondh and smoke ( SHS ) exposure and brief behavioral therapy with participants and others in the home environment . TAU consisted of group CBT plus serial single or combination medication trials as per st and ard care . Results : Smokers with schizophrenia who received COMB-EXT ( with or without HV ) had greater reductions in cigarettes per day than those treated with TAU ( both ps < .01 ) . In addition , 7-day point prevalence abstinence rates for the three groups were 45 % , 20 % , and 8 % , respectively , which was significantly higher for COMB-EXT plus HV than TAU ( & khgr;2(1 ) = 4.8 , p = .03 ) . Groups did not differ significantly in the number of adverse events , and HV were easily scheduled . Conclusion : COMB-EXT improves outcomes for smokers with schizophrenia . HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population . Implication s : The clear benefit found here of rapidly initiated , combination , extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia . Furthermore , HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence , indicating that this intervention may be worthy of future research The authors examined whether smoking while wearing a transdermal nicotine patch over 32 h was well-tolerated and led to smoking suppression in heavy smokers with schizophrenia . In a crossover design , 10 male veteran smokers with schizophrenia were admitted for two brief inpatient stays to smoke while wearing a transdermal nicotine or placebo patch .  Carbon monoxide in expired air , self-reported cigarettes per day , nicotine plasma levels , and psychiatric ratings were measured . Nicotine levels increased during active patch treatment , without evidence of nicotine toxicity . Psychiatric symptoms , carbon monoxide and cigarettes per day did not change , although eight subjects had a decrease in expired carbon monoxide on the active patch . Dyskinesias showed a small , but significant , increase during smoking plus active patch . The heaviest smokers ( identified by placebo phase nicotine plasma level or CO level above group median ; n = 5 ) had a statistically significant decrease in expired carbon monoxide of at least 20 % . Smoking while wearing the nicotine patch over 32 h was well tolerated . Significant decreases in carbon monoxide smoking indices were seen for the heaviest smokers . These findings suggest further investigation of a smoking reduction intervention in this population Background It is well established in studies across several countries that tobacco smoking is more prevalent among schizophrenic patients than the general population . Electronic cigarettes are becoming increasingly popular with smokers worldwide . To date there are no large r and omized trials of electronic cigarettes in schizophrenic smokers . A well- design ed trial is needed to compare efficacy and safety of these products in this special population . Methods / Design Intervention : We have design ed a r and omized controlled trial investigating the efficacy and safety of electronic cigarette . The trial will take the form of a prospect i ve 12-month r and omized clinical study to evaluate smoking reduction , smoking abstinence and adverse events in schizophrenic smokers not intending to quit . We will also monitor quality of life , neurocognitive functioning and measure participants ’ perception and satisfaction of the product . Outcome measures : A ≥50 % reduction in the number of cigarettes/day from baseline , will be calculated at each study visit ( “ reducers ” ) . Abstinence from smoking will be calculated at each study visit ( “ quitters ” ) . Smokers who leave the study protocol before its completion and will carry out the Early Termination Visit or who will not satisfy the criteria of “ reducers ” and “ quitters ” will be defined “ non responders”.Statistical analysis : The differences of continuous variables between the three groups will be evaluated with the Kruskal-Wallis Test , followed by the Dunn multiple comparison test . The differences between the three groups for normally distributed data will be evaluated with ANOVA test one way , followed by the Newman-Keuls multiple comparison test . The normality of the distribution will be evaluated with the Kolmogorov-Smirnov test . Any correlations between the variables under evaluation will be assessed by Spearman r correlation . To compare qualitative data will be used the Chi-square test . Discussion The main strengths of the SCARIS study are the following : it ’s the first large RCT on schizophrenic patient , involving in and outpatient , evaluating the effect of a three-arm study design , and a long term of follow-up (52-weeks).The goal is to propose an effective intervention to reduce the risk of tobacco smoking , as a complementary tool to treat tobacco addiction in schizophrenia . Trial registration Clinical Trials.gov , NCT01979796 Rationale Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions . Objectives This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia . Methods Using a double-blind , placebo-controlled , between-groups design , 57 non-treatment-seeking participants were r and omized to receive 300 mg/day bupropion or placebo . One week later , participants were r and omized to a contingency management ( CM ) intervention in which reductions in urinary cotinine levels were reinforced , or a non-contingent reinforcement ( NR ) condition in which session attendance was reinforced , regardless of cotinine level . Over the 22-day study period , participants visited the laboratory approximately three times per week to provide urine sample s for analysis of cotinine levels , to give breath sample s for analysis of carbon monoxide ( CO ) levels , and to report number of cigarettes smoked per day , nicotine withdrawal symptoms , cigarette craving , and psychiatric symptoms . Results Cotinine and CO levels significantly decreased during the study period in participants r and omized to the CM condition , but not the NR condition . Bupropion did not reduce cotinine levels or increase the efficacy of CM . Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups . Conclusions The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia Objective : Smoking among individuals with serious mental illness is a critical public health problem . Although guidelines recommend bupropion for these smokers , many do not want to use medications for smoking cessation , express ambivalence about identifying a “ quit date , ” and do not have access to behavioral smoking cessation services integrated with mental health care . Methods : Individuals with serious mental illness who smoked 10 or more cigarettes per day ( N = 178 ) were r and omized to either a multifaceted behavioral group intervention or a supportive group intervention , both of which were integrated within outpatient mental health services at three VA medical centers . Participants attended twice-weekly meetings for 12 weeks , provided information on their smoking at each meeting , and completed baseline and post-treatment assessment s conducted by an assessor who was blind to condition . Primary outcomes collected at post-treatment included 1-week abstinence , number of cigarettes smoked per day during the last week , and number of quit attempts during the treatment period . Outcomes examined for a subset of participants who attended at least one intervention meeting ( n = 152 ) included smoking abstinence for 1- , 2- , and 4-week blocks during the treatment period . Analyses conducted on those participants who attended three or more intervention meetings ( n = 127 ) included time to 50 % reduction in the number of cigarettes smoked and time to first quit attempt . Results : Sixteen participants achieved abstinence ( 11.8 % ) , smoking quantity was significantly reduced ( baseline M = 15.2 , SD = 9.8 to post-treatment M = 7.5 , SD = 7.7 , p < .0001 ) , and most reported making a quit attempt ( n = 88 , 72.7 % ) . There were no differences by study condition on any abstinence or reduction outcomes . Significant reductions in number of cigarettes smoked generally took place within the first two weeks ; however , these reductions did not often translate into abstinence . Conclusions : Many participants reduced their smoking and sample d quitting during the study . Implementing smoking cessation services in mental health treatment setting s is feasible and , if delivered in line with best practice s , either a behavioral or a supportive approach can be helpful . Future research should examine ways to facilitate the transition from reduction to abstinence . This study was part of a clinical trial registered as NCT # 00960375 at www . clinical trials.gov OBJECTIVE The study examined the efficacy , tolerability , and safety of supportive group psychotherapy and adjunctive sustained-release bupropion for nicotine addiction in patients with schizophrenia . METHOD Eight patients participated in a 14-week open-label trial . End expired breath carbon monoxide level , symptom levels , neuropsychological performance , and suppression of the P50 event-related potential were measured before and after the 14-week trial . RESULTS Patients showed a decrease in carbon monoxide levels that was not associated with any worsening in symptom , neuropsychological , or P50 suppression measures . CONCLUSIONS Use of sustained-release bupropion in combination with supportive group therapy may help patients with schizophrenia decrease their cigarette consumption Background Mental health in patients smoke at higher rates than the general population and are disproportionately affected by tobacco dependence . Despite the advent of smoke free policies within mental health hospitals , limited systems are in place to support a cessation attempt post hospitalisation , and international evidence suggests that most smokers return to pre-admission smoking levels following discharge . This protocol describes a r and omised controlled trial that will test the feasibility , acceptability and efficacy of linking inpatient smoking care with ongoing community cessation support for smokers with a mental illness . Methods / Design This study will be conducted as a r and omised controlled trial . 200 smokers with an acute mental illness will be recruited from a large inpatient mental health facility . Participants will complete a baseline survey and will be r and omised to either a multimodal smoking cessation intervention or provided with hospital smoking care only . R and omisation will be stratified by diagnosis ( psychotic , non-psychotic ) . Intervention participants will be provided with a brief motivational interview in the inpatient setting and options of ongoing smoking cessation support post discharge : nicotine replacement therapy ( NRT ) ; referral to Quitline ; smoking cessation groups ; and fortnightly telephone support . Outcome data , including cigarettes smoked per day , quit attempts , and self-reported 7-day point prevalence abstinence ( vali date d by exhaled carbon monoxide ) , will be collected via blind interview at one week , two months , four months and six months post discharge . Process information will also be collected , including the use of cessation supports and cost of the intervention . Discussion This study will provide comprehensive data on the potential of an integrated , multimodal smoking cessation intervention for persons with an acute mental illness , linking inpatient with community cessation support . Trial Registration Australian and New Zeal and Clinical Trials Registry ANZTCN :
Overall , nicotine replacement therapy , bupropion , and varenicline have all proven their effectiveness at either promoting smoking abstinence or a significant reduction in cigarette use
Smoking cessation is a chronic issue surrounding individuals with schizophrenia .
It is estimated that up to 90 % of patients diagnosed with schizophrenia smoke cigarettes .
The purpose of this article is to provide a non systematic review of the efficacy of  smoking cessation interventions as well as to explore the potential neuropsychiatric adverse effects of these agents in patients with schizophrenia .