Alcohol Consumption Special Therapeutic Situations

only฀in฀evidence฀in฀non-schizophrenics฀ [178] .฀Basically,฀smoking฀cessation฀is฀easier฀for฀ psychiatric฀ patients,฀ the฀ more฀ actively฀ they฀ cooperate฀ and฀ the฀ more฀ independent฀ their฀ behaviour฀is.฀Accordingly,฀ex-smokers฀with฀mental฀illnesses฀have฀lower฀Brief฀Psychiatric฀ Rating฀Scale฀BPRS฀scores฀than฀smokers฀ [179] .฀The฀analysis฀of฀data฀on฀4,411฀respondents฀ aged฀from฀15฀to฀54฀years฀demonstrated฀that฀smokers฀with฀any฀history฀of฀mental฀illness฀had฀ a฀self-reported฀quit฀rate฀of฀37.1,฀and฀smokers฀with฀past-month฀mental฀illness฀had฀a฀self- reported฀quit฀rate฀of฀30.5฀compared฀with฀smokers฀without฀mental฀illness฀42.5.฀The฀ ORs฀for฀current฀and฀lifetime฀smoking฀in฀respondents฀with฀mental฀illness฀in฀the฀past฀month฀ vs.฀respondents฀without฀mental฀illness,฀adjusted฀for฀age,฀sex฀and฀region฀of฀the฀country,฀ were฀2.7฀2.3–3.1฀vs.฀2.7฀2.4–3.2.฀Persons฀with฀a฀mental฀disorder฀in฀the฀past฀month฀ consumed฀ approximately฀ 44.3฀ of฀ cigarettes฀ smoked฀ by฀ this฀ nationally฀ representative฀ sample฀ [180] .฀In฀treatment฀with฀nicotine฀patches,฀the฀smoking฀withdrawal฀results฀for฀208฀ psychiatric฀outpatients฀were฀no฀worse฀than฀for฀non-patients฀ [181] .฀Patients฀treated฀with฀ antidepressants฀and฀neuroleptics฀consume฀more฀cigarettes฀than฀patients฀not฀treated฀with฀ these฀substances.฀Clearly,฀the฀anticholinergic฀effect฀of฀these฀medicines฀is฀also฀at฀least฀atten- uated฀by฀increased฀nicotine฀administration,฀or฀else฀increased฀cigarette฀consumption฀accel- erates฀the฀hepatic฀metabolism฀of฀neuroleptics,฀thus฀reducing฀the฀unwanted฀effects. A฀no-smoking฀policy฀in฀psychiatric฀clinics,฀with฀the฀attendant฀withdrawal฀symptoms,฀ does฀not฀have฀a฀negative฀effect฀on฀mental฀illnesses฀ [182] .฀Another฀compromise฀method฀is฀to฀ put฀restrictions฀on฀the฀smokers฀in฀these฀clinics,฀although฀this฀does฀not฀encourage฀them฀to฀stop฀ smoking฀ [183] .฀It฀is฀certainly฀no฀easy฀matter฀to฀enforce฀a฀no-smoking฀policy฀in฀a฀psychiatric฀ clinic,฀although฀no฀threatening฀consequences฀result฀for฀the฀patients.฀What฀does฀make฀sense฀ is฀to฀couple฀smoking฀prohibition฀with฀NRT฀to฀facilitate฀smoking฀cessation฀ [183] .

11.5.5.1 Organic Depression

Co-morbidity฀of฀psychiatric฀illnesses,฀especially฀depression,฀in฀conjunction฀with฀the฀use฀of฀ illicit฀drugs,฀is฀more฀common฀than฀was฀previously฀assumed฀ [184,฀185] .฀This฀also฀applies฀ for฀nicotine฀dependence฀in฀the฀form฀of฀cigarette฀smoking. Of฀a฀group฀of฀120฀chronic฀smokers,฀62.3฀were฀mentally฀ill฀mood,฀anxiety,฀or฀sub- stance฀abuse฀disorders.฀Although฀these฀smokers฀were฀more฀“stressed”฀at฀the฀time฀of฀treat- ment฀high฀levels฀of฀nicotine฀dependence,฀depressive฀mood,฀they฀achieved฀the฀same฀level฀ of฀cessation฀success฀as฀the฀non-patients฀ [186] ,฀so฀that฀it฀was฀not฀possible฀to฀establish฀an฀ association฀between฀smoking฀cessation฀and฀mental฀illness. An฀existing฀depression฀diminishes฀the฀success฀of฀smoking฀cessation฀compared฀with฀ persons฀not฀suffering฀from฀this฀condition฀ [187] .฀According฀to฀a฀large฀Finnish฀study฀ [188] ,฀ the฀motivation฀for฀smoking฀cessation฀is฀reportedly฀stronger฀in฀depressive฀patients,฀suggest- ing฀ a฀ large฀ pool฀ of฀ depressive฀ smokers.฀ Depressive฀ symptoms฀ that฀ occur฀ during฀ with- drawal฀are฀of฀decisive฀signiicance฀in฀terms฀of฀relapses฀and฀should฀therefore฀be฀treated฀ concurrently฀ [189] .฀Concurrent฀depression฀was฀the฀indication฀for฀smoking฀cessation฀ther- apy฀in฀elderly฀women฀ [190] .฀In฀these฀patients,฀it฀proved฀possible฀to฀control฀smoking฀absti- nence฀relatively฀arbitrarily฀by฀means฀of฀monetary฀rewards฀set฀for฀various฀time฀periods฀ [191] .฀Subsequently,฀however,฀the฀relapse฀rate฀was฀not฀determined฀by฀the฀duration฀of฀absti- nence฀but฀rather฀by฀psychopathological฀criteria฀only.