"There was some evidence of small reductions in the number of cigarettes smoked for patients assigned to ziprasidone as compared with those on perphenazine or risperidone. Substance abuse among patients with schizophrenia has been found to be associated with a number of serious impacts and higher risks for poor outcome and poor overall response to pharmacologic treatment (Dixon, 1999; Goff et al., 2005; Keltner and Grant, 2006; Kerfoot et al., 2011; McCloughen, 2003; Steinberg et al., 2004). Unlike the present study, a number of case studies or observational studies that relied on small samples or used retrospective designs have reported benefits for SGAs compared with first-generation agents in the treatment of comorbid substance abuse (Green, 2005; Swanson et al., 2007); however, most of the published reports were limited to examination of a single drug (Rubio et al., 2006; Smelson et al., 2002, 2004; Tsuang et al., 2002), with limited information on quetiapine or aripiprazole (Brown et al., 2002; Potvin et al., 2008; Zhornitsky et al., 2011). "
[Show abstract][Hide abstract] ABSTRACT: No large-scale randomized trial has compared the effect of different second-generation antipsychotic drugs and any first-generation drug on alcohol, drug and nicotine use in patients with schizophrenia. The Clinical Antipsychotic Trial of Intervention Effectiveness study randomly assigned 1432 patients formally diagnosed with schizophrenia to four second-generation antipsychotic drugs (olanzapine, risperidone quetiapine, and ziprasidone) and one first-generation antipsychotic (perphenazine) and followed them for up to 18 months. Secondary outcome data documented cigarettes smoked in the past week and alcohol and drug use severity ratings. At baseline, 61% of patients smoked, 35% used alcohol, and 23% used illicit drugs. Although there were significant effects of time showing reduction in substance use over the 18 months (all p < 0.0001), this study found no evidence that any antipsychotic was robustly superior to any other in a secondary analysis of data on substance use outcomes from a large 18-month randomized schizophrenia trial.
The Journal of nervous and mental disease 06/2015; 203(7). DOI:10.1097/NMD.0000000000000317 · 1.69 Impact Factor
"It is well established in studies across several countries that tobacco smoking is more prevalent among schizophrenic patients than the general population . For example, in the US, 80% or more of schizophrenic patients smoke, compared to approximately 20% of the general population . An increased rate of smoking among subjects with schizophrenia contributes to multiple negative health effects, including higher rates of coronary heart disease, hypertension, respiratory disease and lung cancer than in the general population . "
[Show abstract][Hide abstract] ABSTRACT: It is well established in studies across several countries that tobacco smoking is more prevalent among schizophrenic patients than the general population. Electronic cigarettes are becoming increasingly popular with smokers worldwide. To date there are no large randomized trials of electronic cigarettes in schizophrenic smokers. A well-designed trial is needed to compare efficacy and safety of these products in this special population.Methods/design: Intervention: We have designed a randomized controlled trial investigating the efficacy and safety of electronic cigarette. The trial will take the form of a prospective 12-month randomized clinical study to evaluate smoking reduction, smoking abstinence and adverse events in schizophrenic smokers not intending to quit. We will also monitor quality of life, neurocognitive functioning and measure participants' perception and satisfaction of the product.Outcome measures: A >=50% reduction in the number of cigarettes/day from baseline, will be calculated at each study visit ("reducers"). Abstinence from smoking will be calculated at each study visit ("quitters"). Smokers who leave the study protocol before its completion and will carry out the Early Termination Visit or who will not satisfy the criteria of "reducers" and "quitters" will be defined "non responders".Statistical analysis: The differences of continuous variables between the three groups will be evaluated with the Kruskal-Wallis Test, followed by the Dunn multiple comparison test. The differences between the three groups for normally distributed data will be evaluated with ANOVA test one way, followed by the Newman-Keuls multiple comparison test. The normality of the distribution will be evaluated with the Kolmogorov-Smirnov test. Any correlations between the variables under evaluation will be assessed by Spearman r correlation. To compare qualitative data will be used the Chi-square test.
The main strengths of the SCARIS study are the following: it's the first large RCT on schizophrenic patient, involving in and outpatient, evaluating the effect of a three-arm study design, and a long term of follow-up (52-weeks).The goal is to propose an effective intervention to reduce the risk of tobacco smoking, as a complementary tool to treat tobacco addiction in schizophrenia.Trial registration: NCT01979796.
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