全部 标题 作者
关键词 摘要

Impact of an Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic Smokers: A Prospective 12-Month Pilot Study

DOI: 10.3390/ijerph10020446

Keywords: smoking cessation, smoking reduction, electronic cigarette, electronic nicotine delivery device, schizophrenia

Full-Text   Cite this paper   Add to My Lib


Background: Cigarette smoking is a tough addiction to break. This dependence is the most common dual diagnosis for individuals with schizophrenia. Currently three effective drugs are approved for smoking cessation: nicotine replacement therapy (NRT), varenicline and bupropion. However, some serious side effects of varenicline have been reported, including depression, suicidal thoughts, and suicide. The use of bupropion also has side effects. It should not be used by people who have epilepsy or any condition that lowers the seizure threshold, nor by people who take a specific class of drugs called monoamine oxidase inhibitors. Hence, there are pharmacodynamic reason to believe they could precipitate or exacerbate psychosis. For its capacity to deliver nicotine and provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures, electronic-cigarettes may reduce nicotine withdrawal symptoms without serious side effects. Our recent work with ECs in healthy smokers not intending to quit consistently show surprisingly high success rates. We hypothesised that these positive findings could be replicated in difficult patients with schizophrenia This tool may help smokers with schizophrenia remain abstinent during their quitting attempts or to reduce cigarette consumption. Efficacy and safety of these devices in long-term smoking cessation and/or smoking reduction studies have never been investigated for this special population. Methods: In this study we monitored possible modifications in smoking habits of 14 smokers (not intending to quit) with schizophrenia experimenting with the “Categoria” e-Cigarette with a focus on smoking reduction and smoking abstinence. Study participants were invited to attend six study visits: at baseline, week-4, week-8, week-12 week-24 and week 52. Product use, number of cigarettes smoked, carbon monoxide in exhaled breath (eCO) and positive and negative symptoms of schizophrenia levels were measured at each visit. Smoking reduction and abstinence rates were calculated. Adverse events were also reviewed. Results: Sustained 50% reduction in the number of cig/day at week-52 was shown in 7/14 (50%) participants; their median of 30 cig/day decreasing significantly to 15 cig/day ( p = 0.018). Sustained smoking abstinence at week-52 was observed in 2/14 (14.3%) participants. Combined sustained 50% reduction and smoking abstinence was shown in 9/14 (64.3%) participants. Nausea was observed in 2/14 (14.4%) of participants, throat irritation in 2/14 (14.4%) of participants, headache


[1]  de Leon, J.; Diaz, F.J. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr. Res. 2005, 76, 1351–1357.
[2]  Keltner, N.L.; Grant, J.S. Smoke, smoke, smoke that cigarette. Perspect. Psychiatr. Care 2006, 42, 256–261, doi:10.1111/j.1744-6163.2006.00085.x.
[3]  Glassman, A.H. Cigarette smoking: Implications for psychiatric illness. Am. J. Psychiatry 1993, 150, 546–553.
[4]  Kelly, C.; McCreadie, R.G. Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotlad. Am. J. Psychiatry 1999, 156, 1751–1757.
[5]  Addington, J. Group treatment for smoking cessation among persons with schizophrenia. Psychiatr. Services 1998, 49, 925–928.
[6]  Brown, S.; Inskip, H.; Barraclough, B. Causes of the excess mortality of schizophrenia. Brit. J. Psychiat. 2000, 177, 212–217, doi:10.1192/bjp.177.3.212.
[7]  United States Public Health Service. Office of the Surgeon General; Office on Smoking and Health. In The Health Benefits of Smoking Cessation; United States Public Health Service. Office on Smoking and Health: Atlanta, GA, USA, 1990.
[8]  Lightwood, J.M.; Glantz, S.A. Short-term economic and health benefits of smoking cessation: Myocardial infarction and stroke. Circulation 1997, 96, 1089–1096, doi:10.1161/01.CIR.96.4.1089.
[9]  Casella, G.; Caponnetto, P.; Polosa, R. Therapeutic advances in the treatment of nicotine addiction: Present and future. Ther. Adv. Chronic Dis. 2010, 1, 95–106, doi:10.1177/2040622310374896.
[10]  George, T.P.; Ziedonis, D.M.; Feingold, A.; Pepper, W.T.; Satterburg, C.A.; Winkel, J.; Rounsaville, B.J.; Kosten, T.R. Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Amer. J. Psychiat. 2006, 157, 1835–1842.
[11]  Aubin, H.J.; Rollema, H.; Svensson, T.H.; Winterer, G. Smoking, quitting, and psychiatric disease: A review. Neurosci. Biobehav. Rev. 2012, 36, 271–284, doi:10.1016/j.neubiorev.2011.06.007.
[12]  Polosa, R.; Benowitz, N.L. Treatment of nicotine addiction: Present therapeutic options and pipeline developments. Trends Pharmacol. Sci. 2011, 32, 281–289, doi:10.1016/j.tips.2010.12.008.
[13]  Hon, L. A Non-Smokable Electronic Spray Cigarette. Canada Patent CA 2518174, 6 September 2005.
[14]  Zezima, K. Cigarettes without smoke or regulation. New York Times 2009.
[15]  Etter, J.F. Electronic cigarettes: A survey of users. BMC Public Health 2010, 10, 231, doi:10.1186/1471-2458-10-231.
[16]  Vansickel, A.R.; Cobb, C.O.; Weaver, M.F.; Eissenberg, T.E. A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: Nicotine delivery profile and cardiovascular and subjective effects. Cancer Epidemiol. Biomarkers Prev. 2010, 19, 1945–1953, doi:10.1158/1055-9965.EPI-10-0288.
[17]  Polosa, R.; Caponnetto, P.; Morjaria, J.B.; Papale, G.; Campagna, D.; Russo, C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: A prospective 6-month pilot study. BMC Public Health 2011, 11, 786, doi:10.1186/1471-2458-11-786.
[18]  Caponnetto, P. The Efficacy and Safety of an Electronic Cigarette (ECLAT) Study: A Prospective 12 Month Randomized Control Design Study. In XIV Annual Meeting of the SRNT Europe, Helsinki, Finland, 30 August–2 September 2012.
[19]  World Health Organisation. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines; World Health Organisation: Geneva, Switzerland, 1992.
[20]  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; American Psychiatric Association: Washington, DC, USA, 2000.
[21]  First, M.B.; Spitzer, R.L.; Gibbon, M.; Williams, J.B.W. Structured Clinical Interview for DSM-IV-TR Axis I Disorders—Research Version (SCID-1); Columbia University: New York, NY, USA, 2002.
[22]  Fagerstrom, K.O.; Schneider, N.G. Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. J. Behav. Med. 1989, 12, 159–182.
[23]  Andreasen, N.C. The Scale for Assessment of Negative Symptoms (SANS)The University of Iowa, Iowa City, IA, USA, 1983.
[24]  Andreasen, N.C. The Scale for Assessment of Positive Symptoms (SAPS)The University of Iowa, Iowa City, IA, USA, 1984.
[25]  Classificazione ed Etichettatura Delle Miscele Contenute Nelle Cartucce Denominate “Categoria”. 2010. Available online: www.liaf-onlus.org/public/allegati/categoria1b.pdf (accessed on 31 December 2011).
[26]  Bolliger, C.T.; Zellweger, J.P.; Danielsson, T.; van Biljon, X.; Robidou, A.; Westin, A.; Perruchoud, A.P.; Sawe, U. Smoking reduction with oral nicotine inhalers: Double blind, randomised clinical trial of efficacy and safety. BMJ 2000, 321, 329–333.
[27]  SPSS, Statistical Package for the Social Sciences (SPSS) for Windows, Version 17.0, SPSS, Chicago, IL, USA, 2008.
[28]  Dalack, G.W.; Becks, L.; Hill, E.; Pomerleau, O.F.; Meador-Woodruff, J.H. Nicotine withdrawal and psychiatric symptoms in cigarette smokers with schizophrenia. Neuropsychopharmacology 1999, 21, 195–202, doi:10.1016/S0893-133X(98)00121-3.
[29]  Evins, A.E.; Mays, V.K.; Rigotti, N.A.; Tisdale, T.; Cather, C.; Goff, D.C. A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia. Nicotine Tob. Res. 2001, 3, 397–403, doi:10.1080/14622200110073920.
[30]  Dalack, G.W.; Meador-Woodruff, J.H. Acute feasibility and safety of a smoking reduction strategy for smokers with schizophrenia. Nicotine Tob. Res. 1999, 1, 53–57, doi:10.1080/14622299050011151.
[31]  Adler, L.E.; Hoffer, L.D.; Wiser, A.; Freedman, R. Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Amer. J. Psychiat. 1993, 150, 1856–1861.
[32]  George, T.P.; Vessicchio, J.C.; Termine, A.; Sahady, D.M.; Head, C.A.; Pepper, W.T.; Kosten, T.R.; Wexler, B.E. Effects of smoking abstinence on visuospatial working memory function in schizophrenia. Neuropsychopharmacology 2002, 26, 75–85, doi:10.1016/S0893-133X(01)00296-2.
[33]  Levin, E.D.; Wilson, W.; Rose, J.E.; McEvoy, J. Nicotine-haloperidol interactions and cognitive performance in schizophrenics. Neuropsychopharmacology 1996, 15, 429–436, doi:10.1016/S0893-133X(96)00018-8.
[34]  Decina, P.; Caracci, G.; Sandik, R.; Berman, W.; Mukherjee, S.; Scapicchio, P. Cigarette smoking and neuroleptic-induced parkinsonism. Biol. Psychiat. 1990, 28, 502–508.
[35]  McEvoy, J.P.; Freudenreich, O.; Levin, E.D.; Rose, J.E. Haloperidol increases smoking in patients with schizophrenia. Psychopharmacology 1995, 119, 124–216, doi:10.1007/BF02246063.
[36]  de Leon, J. Smoking and vulnerability for schizophrenia. Schizophrenia Bull. 1996, 22, 405–409, doi:10.1093/schbul/22.3.405.
[37]  Stassen, H.H.; Bridler, R.; Hagele, S.; Hergersberg, M.; Mehmann, B.; Schinzel, A.; Weisbrod, M.; Scharfetter, C. Schizophrenia and smoking: Evidence for a common neurobiological basis? Am. J. Med. Genet. 2000, 96, 173–177, doi:10.1002/(SICI)1096-8628(20000403)96:2<173::AID-AJMG10>3.0.CO;2-U.
[38]  Griffith, J.M.; O’Neill, J.E.; Petty, F.; Garver, D.; Young, D.; Freedman, R. Nicotinic receptor desensitization and sensory gating deficits in schizophrenia. Biol. Psychiat. 1998, 44, 98–106, doi:10.1016/S0006-3223(97)00362-4.
[39]  Caponnetto, P.; Cibella, F.; Mancuso, S.; Campagna, D.; Arcidiacono, G.; Polosa, R. Effect of a nicotine free inhalator as part of a smoking cessation program. ERJ 2011, 38, 1005–1011.
[40]  Wieslander, G.; Norback, D.; Lindgren, T. Experimental exposure to propylene glycol mist in aviation emergency training: Acute ocular and respiratory effects. Occup. Environ. Med. 2001, 58, 649–655, doi:10.1136/oem.58.10.649.
[41]  Varughese, S.; Teschke, K.; Brauer, M.; Chow, Y.; van Netten, C.; Kennedy, S.M. Effects of theatrical smokes and fogs on respiratory health in the entertainment industry. Am. J. Ind. Med. 2005, 47, 411–418, doi:10.1002/ajim.20151.
[42]  Fagerstrom, K.O.; Hughes, J.R.; Rasmussen, T.; Callas, P.W. Randomised trial investigating effect of a novel nicotine delivery device (Eclipse) and a nicotine oral inhaler on smoking behaviour, nicotine and carbon monoxide exposure, and motivation to quit. Tob. Control 2000, 9, 327–333, doi:10.1136/tc.9.3.327.
[43]  McNeill, A. Harm reduction. BMJ 2004, 328, 885–887.
[44]  Bolliger, C.T.; Zellweger, J.P.; Danielsson, T.; van Biljon, X.; Robidou, A.; Westin, A.; Perruchoud, A.P.; Sawe, U. Influence of long-term smoking reduction on health risk markers and quality of life. Nicotine Tob. Res. 2002, 4, 433–439, doi:10.1080/1462220021000018380.
[45]  Hatsukami, D.K.; Kotlyar, M.; Allen, S.; Jensen, J.; Li, S.; Le, C.; Murphy, S. Effects of cigarette reduction on cardiovascular risk factors and subjective measures. Chest 2005, 128, 2528–2537, doi:10.1378/chest.128.4.2528.
[46]  Godtfredsen, N.S.; Prescott, E.; Osler, M. Effect of smoking reduction on lung cancer risk. JAMA 2005, 294, 1505–1510, doi:10.1001/jama.294.12.1505.
[47]  Hughes, J.R.; Carpenter, M.J. The feasibility of smoking reduction: An update. Addiction 2005, 100, 1074–1089, doi:10.1111/j.1360-0443.2005.01174.x.
[48]  Wennike, P.; Danielsson, T.; Landfeldt, B.; Westin, A.; Tonnesen, P. Smoking reduction promotes smoking cessation: Results from a double blind, randomized, placebo-controlled trial of nicotine gumwith 2-year follow-up. Addiction 2003, 98, 1395–1402, doi:10.1046/j.1360-0443.2003.00489.x.
[49]  Rennard, S.I.; Glover, E.D.; Leischow, S.; Daughton, D.M.; Glover, P.N.; Muramoto, M.; Franzon, M.; Danielsson, T.; Landfeldt, B.; Westin, A. Efficacy of the nicotine inhaler in smoking reduction: A double-blind, randomized trial. Nicotine Tob. Res. 2006, 8, 555–654.
[50]  Walker, N.; Bullen, C.; McRobbie, H. Reduced-nicotine content cigarettes: Is there potential to aid smoking cessation? Nicotine Tob. Res. 2009, 11, 1274–1279, doi:10.1093/ntr/ntp147.
[51]  Williams, J.M.; Anthenelli, R.M.; Morris, C.D.; Treadow, J.; Thompson, J.R.; Yunis, C.; George, T.P. A randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of varenicline for smoking cessation in patients with schizophrenia or schizoaffective disorder. J. Clin. Psychiat. 2012, 73, 654–660, doi:10.4088/JCP.11m07522.


comments powered by Disqus