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Available from: Marc Steinberg, Dec 30, 2014
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    • "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). "
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    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
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    • "addition to the costs for the health systems, the individual costs for the mental health patient also have to be considered: a study found that in the USA patients suffering from schizophrenia spent a median of US$142.50 (range $57.15–$319.13) per month on cigarettes, corresponding to 27.4% of the median monthly income of this population, the majority of whom were receiving public assistance [268]. The motivation to quit is as high among psychiatric patients as in the general population [2] [78] [233] [235], and the distribution of the stages of motivation to quit smoking in psychiatric samples, as measured by the stages of change model [229], parallels that for the general population [112]. "
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    ABSTRACT: Tobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.
    European Psychiatry 01/2014; 29(2). DOI:10.1016/j.eurpsy.2013.11.002 · 3.44 Impact Factor
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    • "Another area for potential research is in examining the psychiatric hospitals that have been successful in developing and enforcing smoke-free policies and the alternatives to smoke breaks integrated into the daily programming and activities. Finally, people with mental illness tend to be dependent on limited, fixed incomes, and cigarettes can take up 27 percent to 36 percent of their monthly budget (Mechanic, Bilder, & McAlpine, 2002; Steinberg, Williams, & Ziedonis, 2004). Although many of the focus group participants stated that they did not find it challenging to pay for cigarettes, further research should examine the financial, health, and social implications of quitting for people with mental illness. "
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    ABSTRACT: Even as the rate of smoking in the U.S. population overall has decreased dramatically during the last four decades, people with mental illness continue to use tobacco at alarmingly high rates. In the last two years, national initiatives have developed to address smoking within this population, yet there has not been an attempt to understand the perspectives of people with mental illness themselves regarding the role tobacco plays in their lives. This grounded theory study, based on focus group interviews with 26 individuals with various smoking statuses receiving outpatient mental health services, attempted to develop a theory to understand this high prevalence from the perspectives of people with mental illness. The article explores the experiences ofpeople with mental illness related to never smoking, smoking, and quitting; the role of tobacco use for people with mental illness; the other forces that promote or discourage tobacco use; and the tensions and complexities in understanding the "problem" of tobacco use in this population. It concludes by highlighting directions for future research, policy considerations, and the important role social workers can play in addressing this significant cause of health disparities.
    Health & social work 02/2011; 36(1):19-32. DOI:10.1093/hsw/36.1.19 · 0.94 Impact Factor
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