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Mental health: smoking, treatment and going smoke free
Eden Evins, Director, Addiction Research Program, Massachusetts General Hospital & Assistant Professor of Psychiatry, Harvard Medical School, Boston, USA
Abstract
Smokers with major mental illness want to, can, and should be encouraged to quit smoking. People with psychiatric illness such as schizophrenia smoke with greater prevalence, have a higher level of dependence, and are less likely to quit smoking on a given try than smokers in the general population. That said, standard behavioral and pharmacologic treatments with few modifications are moderately effective for smoking cessation in smokers with psychiatric illness. These will be discussed. Treaters should be aware of several special considerations. Nicotine withdrawal symptoms are similar to symptoms that preceed psychotic decompensation. Thus patients should be educated in detail that they can expect withdrawal symptoms such as anxiety, irritability and insomnia, and informed that these are time limited. Second, smoking increases metabolism of many medications, including psychotropic medications, and many patients will need to reduce their dose of antipsychotic or antidepressant medication when they quit smoking in order to avoid adverse effects of increased serum medication concentrations. Third, whether smokers with a history of major depressive disorder are at increased risk of a depressive episode in the year following smoking cessation remains controversial. Finally, relapse rates are especially high following discontinuation of nicotine dependence treatment, and nicotine may reduce some cognitive dysfunction associated with illnesses such as schizophrenia. Strategies for prevention of relapse to smoking following brief abstinence will be discussed.
Biography
Eden Evins, MD, MPH is an Assistant Professor of Psychiatry at Harvard Medical School and Director of the Massachusetts General Hospital Center for Addiction Medicine and Addiction Research Program. She is also a member of the Schizophrenia Program and the Depression Clinical and Research Program of the Massachusetts General Hospital where she directs smoking cessation studies and clinical programs.
Dr. Evins earned her undergraduate degree at University of Virginia in Charlottesville, VA, and her medical degree at the Medical University of South Carolina in Charleston. She completed her residency in adult psychiatry at the Harvard Longwood Psychiatry Residency Training Program in Boston, where she was also Chief Resident. She conducted a molecular biology fellowship at McLean Hospital and a second fellowship in schizophrenia research at the Massachusetts General Hospital with Dr. Donald Goff. She received a Masters in Public Health in Clinical Effectiveness at the Harvard School of Public Health. Her research interests include pharmacotherapy for dual disorders of major mental illness and addiction, negative symptoms in schizophrenia, treatment for cognitive dysfunction in schizophrenia. She is an expert in treatment of nicotine addiction in patients with schizophrenia. She has authored book chapters, reviews and articles that have been published in prestigious scientific journals, such as American Journal of Psychiatry, Journal of Clinical Psychiatry, Journal of Clinical Psychopharmacology, Journal of Neural Transmission, and Biological Psychiatry.
Dr. Evins has received NIMH NCDEU Young Investigator Award, a NIDA career development award, the Massachusetts Department of Public Health Tobacco Control Young Investigator Award, and has twice received the National Alliance for Research on Schizophrenia and Depression Young Investigator Award. Dr. Evins is currently a PI on three NIDA research awards to study novel treatments for smoking cessation and prevention of relapse to smoking.
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