November 4, 2013

Addiction goes hand in hand with other mental illnesses. People with psychiatric conditions smoke at twice to four times the rate of the general population, and they are estimated to purchase nearly half of all cigarettes sold in this country. Yet physicians have tended to ignore the smoking behavior of their psychiatric patients.

Image of hand holding cigarette with caption "It's drug addiction"

A new study published in the Journal of Psychiatric Research reveals the mortality toll caused by the elevated smoking rates in psychiatric patients. The study used death certificate data and hospital records for individuals over 35 who had been hospitalized for a psychiatric illness in California between 1990 and 2005 to calculate standardized mortality ratios for diseases causally linked to tobacco use. Markedly increased mortality from respiratory or cardiovascular diseases (although not cancers) was found in this population. There were 145% more deaths from tobacco-related diseases in people with schizophrenia than would be expected in the general population; 57% more deaths in people with bipolar disorder; and 95% more deaths in people with depression.

This translates into considerably shorter life expectancy for people with mental illnesses. A 2011 study in England and published in PLOS One found that men with schizophrenia lost on average 14.6 years of life, and that women with schizoaffective disorders lost 17.5 years of life—losses likely attributable in part to smoking.

In the past, clinicians have tended not to address smoking in psychiatric patients, among other things because of a belief that nicotine functioned as a form of self-medication, improving cognitive function or mood or counteracting some of the adverse effects of psychiatric medications. Recent research (such as a new NIDA-funded study in Biological Psychiatry) is casting doubt on the validity of these beliefs. Regardless, the deadly consequences of smoking in patients with mental illnesses require us to pay greater attention to this addictive disorder as a serious comorbidity in these populations and to much more aggressively treat it.

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