Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia

Objective: Schizophrenic patients have high rates of cigarette smoking. The authors compared the outcomes of two group psychotherapy programs for smok ing cessation in patients with schizophrenia or schizoaffective disorder wh o were also treated with the nicotine transdermal patch and with either aty pical or typical antipsychotic medications. Method: Forty-five subjects were randomly assigned to 1) the group therapy program of the American Lung Association (N=17) or 2) a specialized group t herapy program for smokers with schizophrenia (N=28) that emphasized motiva tional enhancement, relapse prevention, social skills training, and psychoe ducation. All subjects participated in 10 weeks of treatment with the nicot ine transdermal patch (21 mg/day) and 10 weekly group therapy sessions and continued to receive their prestudy atypical (N=18) or typical (N=27) antip sychotic medications. Outcome variables included treatment retention, rate of smoking abstinence, and expired-breath carbon monoxide level. Results: Smoking abstinence rates did not differ in the two group therapy p rograms. However, atypical antipsychotic agents, in combination with the ni cotine transdermal patch, significantly enhanced the rate of smoking cessat ion (55.6% in the atypical agent group versus 22.2% in the typical group), which was reflected by a significant effect of atypical versus typical agen ts on carbon monoxide levels. Risperidone and olanzapine were associated wi th the highest quit rates. Conclusions: The results suggest that I)smoking cessation rates with the ni cotine transdermal patch are modest in schizophrenia, 2) specialized group therapy for schizophrenic patients is not significantly different from Amer ican Lung Association group therapy in its effect on smoking cessation, and 3) atypical agents may be superior to typical agents in combination with t he nicotine transdermal patch for smoking cessation in schizophrenia.