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TOBACCO AND SCHIZOPHRENIA

TOBACCO AND SCHIZOPHRENIA. Mini Lecture 3 Module: Tobacco and Mental Health. Objectives of the Mini Lecture. GOAL OF MINI LECTURE: Provide students with knowledge on the association between tobacco and schizophrenia. LEARNING OBJECTIVES Students will be able to:

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TOBACCO AND SCHIZOPHRENIA

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  1. TOBACCO AND SCHIZOPHRENIA Mini Lecture 3 Module: Tobacco and Mental Health

  2. Objectives of the Mini Lecture GOAL OF MINI LECTURE: Provide students with knowledge on the association between tobacco and schizophrenia. LEARNING OBJECTIVES Students will be able to: • Describe the burden of schizophrenia, and its association with other chronic diseases • Illustrate the biological, psychological and social factors associated with tobacco use in schizophrenia patients • Discuss how cessation can be addressed in clinical management of schizophrenia patients.

  3. Contents Core Slides Optional Slides Tobacco Use and Schizophrenia: The Biological Factor Smoking and Anti-psychotic Treatments Cessation Medication in Schizophrenia Patients • The Burden of Schizophrenia • Schizophrenia and Chronic Diseases • Smoking in Schizophrenia Patients • Tobacco Use and Schizophrenia • Tobacco Addiction in Schizophrenia: Treatment • Tobacco Dependence and Schizophrenia: Treatment

  4. CORE SLIDES Tobacco and Schizophrenia Mini Lecture 3 Module: Tobacco and Mental Health

  5. The Burden of Schizophrenia • Schizophrenia is one of the most common psychiatric illnesses being treated. Patients can exhibit positive and negative psychotic symptoms leading to social and occupational dysfunction for at least 6 months.1 • Global burden of schizophrenia: • Median incidence: 15.2 per 100,000 population • Median prevalence: 460 per 100,000 population • Median lifetime morbidity risk: 720 per 100,000 population • Median standardized mortality ratio of all causes: 2.62 1. Ziedonis et al. 2008; 2.Eaton et al. 2008

  6. Schizophrenia and Chronic Diseases Schizophrenia patients have poorer health care, higher burden of non-communicable disease (NCD) risk factors, and more NCD premature deaths than the general population. • Schizophrenia patients have a 20% shorter life expectancy.1 • Common NCD risk factors in schizophrenic: smoking, obesity and dyslipidemia, hypertension, insulin resistance, diabetes, sedentary life style, poor nutrition.2 • 2/3 of schizophrenia patients died of CVD vs. half of general population.1 • High burden of respiratory diseases due to smoking. 1. Hennekens et al. 2005; 2. Ziedonis et al. 2008

  7. Smoking in Schizophrenia Patients Results from 42 studies in 18 countries showed that: • Smoking in schizophrenia patients is six times more common than in the general population (prevalence 70–85%). • More common in male patients (OR 7.2 in male vs. 3.3 in female). • 50% smoked more than 25 cigarettes per day. • Schizophrenia patients typically puff more and deeper when they smoke, thus they have a higher level of nicotine and cotinine. • Quitting rate: 9% in schizophrenia patients vs. 14-49% in general population. de Leon and Diaz 2005

  8. Tobacco Use and Schizophrenia There is a complex interaction between biological, psychological, and social factors in the association between tobacco use and schizophrenia. • Biological factors: nicotine improves sensory gating and visuospatial working memory. • Psychological factors: patients use tobacco and its perceived positive effects for self-treatment. • Social factors: cigarettes used in social exchange and as form of bonding—main barrier in promoting smoking cessation in mental health institutions. Ziedonis et al. 2008

  9. Tobacco Addiction inSchizophrenia: Treatment • Cessation is better achieved in patients with higher motivation to quit and a lower level of tobacco dependence. • Combination of psychosocial treatment improves chances that patients will quit.1 • The polycyclic aromatic hydrocarbons (PAHs) in cigarettes affect the metabolism of antipsychotic drugs; therefore, medication has to be closely monitored during and after quitting.2 1. Fagerstrom and Aubin 2009; 2. Ziedonis et al. 2008

  10. 1 Tobacco Dependence and Schizophrenia Treatment • Typical antipsychotic (e.g., haloperidol) increases smoking. • Atypical antipsychotic (e.g., clozapine) reduces smoking significantly in heavy smokers.1,2 • Clozapine is the only atypical antipsychotic that has 5HT3 receptor antagonist activity and can improve P50 gating. • Alpha-7 nicotine receptor (α7) agonist agent (e.g., DMXB-A) improves memory, P50 response, and attention. α7-agonist is more potent and has slower decreasing response than nicotine.2 1. San et al. 2007; 2. Ziedonis et al. 2008

  11. OPTIONAL SLIDES Tobacco and Schizophrenia Mini Lecture 3 Module: Tobacco and Mental Health

  12. Tobacco Use and Schizophrenia:The Biological Factor • Nicotine improved deficit in auditory sensory gating, led to better filter of distracting stimuli and better focus of attention, and ultimately improved cognitive function. • Nicotine improved visuospatial working memory and led to better visualization of relative positions of items. • Improvement of visuospatial working memory is related to prefrontal cortical dopamine activity. Activation of the anterior cingulated and bilateral thalamus improves visuospatial working memory. Ziedonis et al., 2008

  13. Smoking andAnti-psychotic Treatments • Schizophrenia patients who smoke experience less extra- pyramidal symptoms and other antipsychotic drug side-effects  misuse of nicotine as self-medication. • Polycyclic aromatic hydrocarbons (PAHs) in tobacco smoke can induce P450 1A2 isoenzyme, and affect the metabolism of antipsychotic medications (olanzapine, clozapine, haloperidol, and fluphenazine).1 • Induced P450 1A2 isoenzyme leads to lower blood levels of antipsychotic medications among smokers. • Increased antipsychotic side effects therefore should be monitored during smoking cessation treatment.2 1. Green 2005; 2.Ziedonis et al. 2008

  14. Cessation Medication in Schizophrenia Patients • Combination of atypical schizophrenia treatments and nicotine dependence treatments • Buproprion: help reducing smoking and expired air CO • Nicotine patch: safe, well-tolerated, shorter long-term abstinence than expected • Nicotine nasal spray: short-term reduction in schizophrenia symptoms and impaired cognition1,2 • There is very limited data about the effects of smoking cessation treatment in schizophrenic patients. 1. Fagerstrom and Aubin 2009; 2. Ziedonis et al. 2008

  15. The most important health message a doctor can give to patients is to quit smoking.

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