Neuroleptics and smoking

[clubcard]

Could I ask, what % of people on neuroleptics also smoke? I'm married to someone who worked with schizophrenic people (the ones who would escape from the wards, forgo medication and so on). Some fascinating people. One character 'purple Ronnie' deserves a whole book dedicated to his regular jaunts and conviction that he didn't need medication. I can certainly UNDERSTAND why people would wish to forego the 'liquid cosh'.

Of the smokers, I presume that nicotine temporarily reduces the nasty effects of the meds. If you could take 1 pill a day which gave you the 'just smoked' feeling, would it be of benefit to you?

Many thanks for reading.

 

[Kittycat5]

I am not sure of all people, but remember reading something like 50% of schizophrenics use tobacco. It is of concern because tobacco smoke may induce quicker metabolism of certain neuroleptics (clozapine comes to mind) and patients may not be getting full benefits of the therapy.

Maybe I am reading your post wrong but I think the use of tobacco in schizophrenics has to do with them trying to self medicate stimulus input and/or not being able to comprehend the negative aspects not that neuroleptics are a replacement for smokingm

 

[Burnt Offerings]

Yes the number of schizophrenics who smoke is high, considerably higher than the general population. I'll copy a bit from a psychopharmacology textbook I own:

"Goff et al. (1992) studied schizophrenic outpatients and found that 74% smoked compared to the national average of approximately 30%. Between 80 and 90% of a group of institutionalized schizophrenic inpatients were found to smoke (Matherson and O'Shea 1984). There is no known reason for the high rate of nicotine use by schizophrenic patients. Some have speculated that the dopamine-augmenting effect of nicotine may counterbalance a relative dopamine deficiency that exists in schizophrenic patients (Glassman 1993). However, nicotine-induced changes in other neurotransmitters (e.g., serotonin) (Benwell and Balfour 1982) may help to explain why so many schizophrenic patients smoke."

The textbook was published in 1998 though so I don't know what the latest data on it is.

 

[clubcard]

I've heard of higher figures, on wards (like 90%+), can anyone help out with figures on that one.

I'm wondering if a large part of the higher morbidity (people on neuroleptics live, on average, 10 years less than the general population).

The reason is simple, research in another area threw up long-acting, orally active ligands that bind to the same sub-receptors as nicotine. I'm sure this would result in people eschewing tobacco BUT although the research didn't suggest that animal models required increasing doses, I'm very sceptical about such results as they are often skewed to get the next stage of funding. If not, it would produce the same effects as tobacco (again, animal studies) i.e. physical relaxation and mental focus (one colleague swore to me that nicotine was THE ONLY smart drug...) in the general population BUT a reduction of the mental side-effects in people on neuroleptics.

It's a patentable idea but if people wouldn't use it or continue smoking while on it, it would be a failure. So the simple question is 'do you smoke because you like it OR because it reduces side-effects?'

If it reduces morbidity by a noticeable amount and, more importantly, doesn't lead to patients dying in a particularly distressing manner, it's good. I would only patent so that someone seeking a fortune couldn't do so. I would license it to non-profit organizations. That way, I'm not betraying my education, faith and personal morals.

 

[herbavore]

There is the dopamine and then there is also the "centering" effect of lighting and smoking a cigarette. I heard an ethnobotanist give a talk about tobacco last summer and the traditional uses were often a way to center and ground the user(s) to the very deliberate act of smoking. For someone dealing with a racing mind this can be useful.