[Tobacco use and smoking cessation in the psychiatric patient]

Smoking is far more prevalent among psychiatric patients than with healthy individuals. Particularly patients with substance-related disorders and schizophrenia often are addicted smokers. This is of great importance, as heavy smoking is clearly accompanied by a higher morbidity and mortality. Up to now there is no convincing explanation for the high prevalence of smoking. Numerous studies point to the fact that smoking is practised as a form of self-medication by psychiatric patients. The influences on cerebral dopaminergic or cholinergic transmission or even psychopharmacological treatment may reinforce smoking behaviour. Efforts to reduce the frequency of smoking in case of psychiatric patients have mostly proved fruitless. Prevention strategies as well as smoking cessation therapies seldom achieve success due to the poor motivation. Besides that smoking cessation often is complicated due to the simultaneous psychopharmacological treatment. The latest investigations, however, confirm the efficacy of cessation strategies, also in case of schizophrenia, mood or substance related disorders. Intensive behavioural treatment strategies as well as high dose nicotine replacement achieve encouraging long-term abstinence rates. Nicotine replacement by patch, gum or nasal spray might be a kind of causal treatment, assuming biological mechanisms to be responsible for heavy smoking.