SMOKING IN MENTAL DISORDERS – BETWEEN THE RIGHT TO HEALTH AND A PUBLIC HEALTH PROBLEM
Abstract:
There is an association between smoking and many mental illnesses. Smoking prevalence in
all patients with psychiatric pathology is between 35% and 54%. The prevalence of smoking among
patients with schizophrenia is between 74% and 92%, much higher than the one between 22% and 30%
concerning the general population. Male patients with schizophrenia are at increased risk for smoking.
Smoking is implicated in the pathogenesis of many diseases and it is responsible for 90% of lung cancer
deaths, 75% of those in chronic bronchitis and emphysema and around 25% of those involving
cardiovascular diseases. Tobacco is a strong inducer of cytochrome P450 enzyme, the metabolizing
pathway for many antipsychotics. This leads to decreased levels in plasma concentrations of
antipsychotic agents. Higher doses of antipsychotic agents are administered to smoking patients with
schizophrenia to achieve similar therapeutic effects as in non-smoking patients with schizophrenia. The
higher the doses of antipsychotic agents administered, the greater the risk of adverse events. In case of
sudden smoking cessation, the plasma concentrations of antipsychotic agents may exceed the therapeutic
range and may cause side effects. Thus, there is an added risk of adverse reactions to antipsychotics to
the general health risk of smoking. Patients with schizophrenia smoke because nicotine improves the
cognitive symptoms of the disease. Smoking is a habit for patients with schizophrenia and sometimes this
activity is the only source of pleasure. Smoking-related concessions are motivating factors that increase
compliance in patients with schizophrenia. It is well known that compliance rates are low for this
category of patients. It would be preferable to try phasing out smoking in patients with schizophrenia, as
well as in any other patient.
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