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KMID : 1231220150060020078
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Journal of the Korean Society for Research on Nicotine and Tobacco
2015 Volume.6 No. 2 p.78 ~ p.85
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Treatment of Tobacco Use Disorders in People with Mental Illness
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Na Eui-Hyeon
Roh Sung-Won
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Abstract
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People with mental illness have higher smoking prevalence, and less success in stopping smoking compared with the general population. Furthermore, smoking-related medical illness may be the leading cause of death in smokers with mental illness. Though smokers with mental illness have been excluded from most of large clinical trials for tobacco use disorder, there is a growing evidence to guide clinicians in assisting their patients with mental illness to quit smoking. The objective of this review is to summarize the evidence on efficacy and safety of smoking cessation treatments for individuals with psychiatric disorders. Smokers with schizophrenia should receive varenicline or bupropion with or without nicotine replacement therapy (NRT) in combination with psychosocial intervention. Although more research is needed, preliminary evidence suggests that varenicline in combination with behavioral treatment is efficacious and well tolerated for smoking cessation for people with bipolar disorder and depressive disorder. In the treatment of smokers with posttraumatic stress disorder, bupropion and NRT have an effect on increasing smoking cessation rate. However, treatment efficacy of NRT or bupropion is limited in patients with alcohol use disorder. Controlled trials have found no evidence that in individuals with mental illness, the use of pharmacotherapeutic cessation worsens psychiatric symptoms or increases the rate of psychiatric adverse events. Converging evidence indicates that a majority of smokers with mental illness want to quit smoking and that available pharmacotherapies combined with behavioral treatment are both effective for, and well tolerated by, these patients.
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KEYWORD
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Tobacco use disorder, Mental illness, Schizophrenia, Bipolar disorder, Depressive disorder, Anxiety disorder, Substance use disorder, Smoking cessation, Pharmacotherapy, Behavioral treatment
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