smokers psychiatric patients have a strong dependence to nicotine difficult to eradicate
XVI National Congress of Psychiatry, Bilbao
-60% of patients in therapy of smoking cessation in the Psychiatric Hospital of Ãlava did not quit.
-many patients consume tobacco to self-medicate because the effect of nicotine could reduce some of the symptoms of schizophrenia.
Bilbao, September of 2012. Psychiatric patients who consume tobacco make it significantly. This strong dependence causes that smoking dehabituacion therapies unable to eradicate the consumption of this type of substance in many cases.
These conclusions are extracted from the Symposium smoking, nicotine, and psychosis: improving the present ” held at the 15th National Congress of Psychiatry in Bilbao that has been played by Dr. Manuel Gurpegui, Professor in Psychiatry at the University of Granada; Dr. Javier Ballesteros, and the Professor of the University of the Basque country (UPV/EHU), specialized in epidemiology. Likewise, the table of experts has counted on the presence of Edorta Elizagárate, head of the unit of refractory psychosis of the University Hospital of Alava (HUA).
At the Symposium, which has been moderated by the doctor in medicine and surgery and Professor of Pharmacology of the University of the Basque country, Javier Meana, there have been several studies that has been revealed a strong association between nicotine and mental illness.
The first of the works presented corresponds to a study in the Psychiatric Hospital of Alava, involving 25 smokers with an average of 44 years old. The object of the study was to evaluate the response of these subjects front a three-month smoking cessation program.
The study is part of a project coordinated by the area of Psychiatry of the University of Oviedo and directed by Dr. Julio Bobes and Dr. Garcia Portilla, consisting of three studies conducted in Asturias, Alava, and Jaén.
Dr. Elizagárate, with respect to the study of Alava, explained that the average consumption of cigarettes per day per patient was 28. As for the results, the expert explained that 12% of patients (3 of the total of 25) got a complete withdrawal; 60% (15/25) continued smoking as normal; and 28% (7 of 25) reduced their consumption by half.
In this context, Dr. Elizagárate stressed that the treatment of smoking on clinical populations with severe mental illness is a requirement and a duty for these patients ” and stated, in addition, that these improved and better adapted programs should implement until antipsychotics tomorrow’s better not only psychiatric symptoms, but also our most serious patients nicotine dependence ”.
For his part, Manuel Gurpegui said that the prevalence of smoking (every day) among patients with schizophrenia is, in various countries of the world, about twice that in the general population, where there is smoking more and have a stronger nicotine dependence ”.
He also indicated that intense smoking is associated with a worse prognosis in the course of schizophrenia and that tobacco can be used by patients to self-medicate because the effect of nicotine could reduce some of the symptoms of the disease, to correct neurochemical defect and side-effects of antipsychotic medication.
Doctor Ballesteros, on the other hand, pointed out that cognitive disorders (memory, attention, planning and troubleshooting problems) occur in the development of schizophrenia.
These alterations are of poor prognosis in the effectiveness of treatments and the psychosocial rehabilitation for the sick. This would be useful to have treatments that decrease the cognitive disorders or increase these functions ”, said.
Treatment
Ballesteros, said, in this line, basic laboratory studies have shown that improving the performance of a brain neurotransmitter (acetylcholine), which is strongly related to cognition, improves.
Can increase the action of the neurotransmitter by blocking the enzyme that degrades it (acetylcholinesterase, which is the main drugs antidemencia action), or enhancing the action of brain receptors through nicotine or similar drugs (agonists). The present evidence to date on the effectiveness of these drugs is inadequate and of low methodological quality. While the potential of this type of treatment is great (and there are several drugs from different companies in study), today the evidence on their effectiveness is small, and further studies are needed to assess its real effectiveness ”, has concluded.
