By Andrew Holtz
ANN ARBOR, MI, Jun 19 (Reuters Health) - Researchers are having a difficult
time trying to help people with schizophrenia reduce their high rates of
cigarette smoking, while still offering them the apparent benefits of nicotine.
Many physicians and mental health professionals simply accept the sky-high
smoking rate in their patients, which is thought to be as high as 90%, according
to a presentation by Dr. Gregory W. Dalack at a University of Michigan Tobacco
Research Network seminar, "Tobacco's Future."
"Basically it was that stigma of, 'Well, you know, they are already ill, why
are you going to deprive them from this behavior that gives them some pleasure?"
Dalack said. "In my mind that's part of the stigma of chronic mental illness, to
say, 'Well, we shouldn't worry about their risk of heart disease or lung
cancer.'"
Dalack pointed out that very few smokers with schizophrenia quit smoking,
perhaps in part because nicotine seems to offer benefits to them, such as
improving their ability to filter sounds and track moving targets. So Dalack and
his colleagues at the University of Michigan, in Ann Arbor, put 15 schizophrenic
patients on a daily schedule of 22-mg dose nicotine patches, while allowing them
to continue smoking at will. Despite the added nicotine, he said that carbon
monoxide measurements indicated that the patients did not cut back on their
smoking.
"In preliminary data from a study that is still ongoing, we are repeating
this with patients who've been through the first study, having them wear two
patches a day," Dalack reported. But even the double dose has not suppressed
patients' smoking, he said. "We really want to pursue this, because it may mean
they just don't regulate their reward system or their smoking behavior in quite
the same way as I would have expected in non-psychiatrically ill smokers."
The lack of a nicotine "rush" from patches may also help explain the
intervention's failure. University of Michigan psychiatry and pharmacy professor
Dr. Sally Guthrie and colleagues measured arterial blood levels of nicotine in
smokers using a nasal spray or puffing on a cigarette. Guthrie said that the
nasal sprays offered only about one third the nicotine dose that cigarettes
provided in the first 3 minutes after a puff.
"The bottom line here is that the speed with which the nicotine gets into
the system, even when we use the spray, is nowhere near what we get when we are
giving someone the tobacco version," she said. The inability so far to replicate
a cigarette's nicotine burst remains a serious challenge to designers of smoking
cessation aids, according to Guthrie.
