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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.
    Full-text · Article · Jun 2015 · The Journal of nervous and mental disease
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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.
    Full-text · Article · Jan 2014 · European Psychiatry
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    • "In addition, the relationship between alcohol and substance abuse and smoking in people with mental illness is well known (Koola et al., 2012; Sara et al., 2012). Smokers endure financial hardship, often resulting in a lack of food and other necessities (Steinberg et al., 2004). "
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    ABSTRACT: Objective: This study aimed to identify factors associated with the high rates of smoking amongst people with psychosis living in a disadvantaged region in Adelaide, South Australia. Methods: Data were collected from 402 people with psychosis, aged 18-64 years, who lived in the northern suburbs of Adelaide. This area is disadvantaged on many measures of socioeconomic well-being and people living in this region have higher rates of smoking compared to the general Australian population. We hypothesised that whilst tobacco use by people with psychosis living in this region was primarily associated with mental illness, factors related to social disadvantage also contributed to the high rates of smoking. Results: Approximately 74% of men and 71% of women with psychotic disorders living in the northern suburbs of Adelaide were current smokers. Factors such as unemployment, lower levels of education and receiving government welfare, factors known to be associated with smoking in the general population, were more prevalent in the northern region. Smokers with psychosis were less likely to participate in recreational programs and physical activity, and more likely to use illicit substances and be a victim of crime. They had poorer health and financial outcomes than non-smokers. There were some gender differences: for men with psychosis, employment and having a post-school qualification decreased the risk of smoking while cannabis use increased the risk; for women with psychosis, a diagnosis of alcohol abuse/dependence, using cannabis and being sedentary were risk factors for smoking, while attending recreational programs reduced this risk. Conclusion: Smoking rates were strikingly high in both men and women, and particularly high in women when compared with previous research. Our study shows that the risk of smoking is increased by factors related to the social disadvantage of living in the northern Adelaide region. Smoking cessation interventions for people with mental illness should take into account the social context, and also address relevant comorbidities such as drug and alcohol disorders.
    Full-text · Article · Jun 2013 · Australian and New Zealand Journal of Psychiatry
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