Effectiveness of smoking cessation in patients with psychiatric disease

Background: Smoking cessation treatment is considered to be less effective in patients with psychiatric diseases. Aim: To evaluate the smoking cessation rate in patients with psychiatric diseases, compare the effectiveness between the different treatment modalities and demonstrate the discrepancies from other patients. Methods: From a total number of 609 active smokers; 52 with psychiatric diseases (most distinctive concomitant condition was depression) were prospectively evaluated between 2004 and 2010. Each patient answers the same questionnaire including smoking status and medical background. Nicotine dependence and CO levels were evaluated. Smoking cessation program was administered individually according to the guidelines and all of the patients were followed at least l year. Results: There was no difference between the groups in; age, baseline Fagerstrom nicotine addiction score, exhaled carbon monoxide level and treatment protocols. However, total amount of smoked tobacco (27,8±21pack-year) and cigarette consumption per day (21±10) was higher in patients with psychiatric diseases (p=0.001 for all). The cessation rates with or without psychiatric diseases are respectively 44,2% and 55,6%. Effectiveness of treatment modalities are 44,4% for nicotine replacement treatment (NRT), 75% for bupropion, 25% for varenicline and 33,3% for behavioral treatment without pharmacotherapy in psychiatric diseases. Conclusion: According to our results, one year smoking cessation success was lower in psychiatric diseases. Pharmacotherapy is superior to pure behavioral treatment. Bupropion and varenicline seems to more effective than NRT at relapse rates.