Balance: Schizophrenia, Smoking Cessation, and Health
Medication management of patients on clozapine is impacted when individuals start or stop cigarette smoking. A reduction in cigarette smoking or smoking cessation increases clozapine plasma concentration by approximately 50%.3,15Individuals who start smoking will reduce the level of clozapine in plasma concentration, which may present with increase symptoms or therapeutic failure. Assessing smoking habits should be a part of every office visits, especially when a patient has been hospitalized or in a crisis unit.
Smoking cessation should be a part of health prevention for all patients. Mental health professionals influence lifestyle behaviors and reducing health consequences. The initial intervention to consider is the implementation of a ban on smoking in treatment facilities, community health clinics, and places where patients seek care to promote wellness. The benefits of a tobacco-free campus policy will heighten awareness and open the door to thinking about quitting.
Education plays a tremendous role in health and habits. Implementation of an atmosphere to promote elimination of secondhand smoke. Providing patients with information regarding established and funded programs like, 1-800-QUIT-NOW or www.smokefree.gov to help patients stop smoking. Some agencies may be able to provide counseling, support groups or self-help groups to offer an opportunity for patients to support each other. Develop an opportunity to work with other programs and community resources to promote smoking cessation.
Individuals diagnosed with schizophrenia have a greater than 10-year risk of developing cardiovascular disease compared to the general population. Antipsychotic medications influence weight gain and can lead to adverse consequences of diabetes. Cigarette smoking is a preventable cause of mortality and morbidity. Schizophrenia places individuals at higher risk for premature death and a lifetime prevalence of smoking has a cumulative effect on the potential outcome.
Healthcare providers should continue to target strategies to help individuals to stop smoking. Mental health professionals should engage patients so that they understand the influence of smoking on antipsychotic medications. Clozapine used for the treatment of resistant schizophrenia is influenced by smoking. Orchestrating a smoking cessation plan must be collaborative with the dosing of the clozapine for treatment-resistant schizophrenia to treat the symptoms and provide for the most optimal patient outcomes.
Irene Talarico, DNP, APRN, PMHNP-BC, is a graduate of Jacksonville University, Florida.
1. American Psychiatric Association. Diagnostics and Statistical Manual of Mental Health Disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013.
2. Dube N. OLR Research Report: Cigarette smoking and schizophrenia. Connecticut General Assembly website. www.cga.ct.gov/2012/rpt.2012-R-0402.htm. Published September 13, 2012. Accessed August 7, 2019.
3. Domino FJ, Baldor RA, Golding J, Stephens MB. The 5-Minute Clinical Consultant. 25th ed. Philadelphia, PA: Wolters Kluwter; 2017.
4. Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P.T. 2014;39(9):638-645.
5. Stahl S. Stahl’s Essential Psychopharmacology Neuroscientific Basics and Practical Application. 4th ed. New York, NY: Cambridge University Press; 2013.
6. Jentsch JD, Roth RH. The neuropsychopharmacology of phencyclidine: from NMDA receptor hypofunction to the dopamine hypothesis of schizophrenia. Neuropsychopharmacology. 1999;20(3):201-225.
7. Furth KE, Mastwal S, Wang KH, Buonanno A, Vullhorst D. Dopamine, cognitive function, and gamma oscillations: role of D4 receptors. Front Cell Neurosci. 2013;7:102.
8. Centers for Medicare & Medicaid Services. National Health Expenditure Projections 2018-2027. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf. Accessed August 8, 2019.
9. Dazzan P, Morgan KD, Orr K, et al. Different effect of typical and atypical antipsychotics on grey matter in first episode psychosis: the AESOP study. Neuropsychopharmacology, 2005;30(4):765-774.
10. Warnez S, Alessi-Severini S. Clozapine: A review of clinical practice guidelines and prescribing trends. BMC Psychiatry. 2014;14(103):1-5.
This article originally appeared on Clinical Advisor