Smoking and psychiatric illness: Mechanisms and interventions

Smoking is far more prevalent among psychiatric patients than with healthy individuals. Particularly patients with substance-related disorders and sch izophrenia often are addicted smokers. This is of great importance, as heav y smoking is clearly accompanied by a higher morbidity and mortality. Up to now there is no convincing explanation for the high prevalence of smoking. Numerous studies point to the fact that smoking is practised as a form of self-medication by psychiatric patients. The influences on cerebral dopamin ergic or cholinergic transmission or even psychopharmacological treatment m ay reinforce smoking behaviour. Efforts to reduce the frequency of smoking in case of psychiatric patients have mostly proved fruitless. Prevention st rategies as well as smoking cessation therapies seldom achieve success due to the poor motivation, Besides that smoking cessation often is complicated due to the simultaneous psychopharmacological treatment. The latest invest igations, however, confirm the efficacy of cessation strategies, also in ca se of schizophrenia, mood or substance related disorders. Intensive behavio ural treatment strategies as well as high dose nicotine replacement achieve encouraging long-term abstinence rates. Nicotine replacement by patch, gum or nasal spray might be a kind of causal treatment, assuming biological me chanisms to be responsible for heavy smoking.