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Letter to the Editor   |    
Tobacco Use and Cataracts in Patients With Schizophrenia
JONATHAN FOULDS, Ph.D.; JILL WILLIAMS, M.D.
Am J Psychiatry 2005;162:1028-1028. doi:10.1176/appi.ajp.162.5.1028

To the Editor: We read with great interest the recent report by Stephen R. Marder, M.D., and coauthors on the physical health monitoring of patients with schizophrenia (1). We agree with those authors’ concerns that "the health needs of people with schizophrenia…are not adequately addressed by clinicians in specialty mental health programs or in primary care settings." However, we were perplexed to find that tobacco smoking was not considered in the review process, and no recommendations for monitoring and intervening on tobacco smoking were made in the report. There is a real risk that this report may worsen rather than improve the health of people with schizophrenia by advising clinicians to monitor and intervene on factors that have relatively small impact on their patients’ health while ignoring the main causes (substance use generally and tobacco use in particular).

Most of the excess mortality in schizophrenia is directly attributable to cigarette smoking (2). There is also an indirect effect of tobacco use on health through the high proportion of total income that people with schizophrenia spend on tobacco (27%) (3). Mental health professionals rarely assess their patients’ tobacco use (4), despite the existence of effective treatments (57).

We hope that those responsible for the care of people with schizophrenia will strive to improve the physical health of their patients but will target their efforts appropriately to the main causes of ill health and premature death rather than focusing on the side effects of psychotropic medications. Among the most important things clinicians can do for the health of people with schizophrenia is the proper assessment and treatment of nicotine dependence (8).

Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, Kane JM, Lieberman JA, Schooler NR, Covell N, Stroup S, Weissman EM, Wirshing DA, Hall CS, Pogach L, Pi-Sunyer X, Bigger JT Jr, Friedman A, Kleinberg D, Yevich SJ, Davis B, Shon S: Physical health monitoring of patients with schizophrenia. Am J Psychiatry  2004; 161:1334–1349
[PubMed]
[CrossRef]
 
Brown S, Inskip H, Barraclough B: Causes of the excess mortality of schizophrenia. Br J Psychiatry  2000; 177:212–217
[PubMed]
[CrossRef]
 
Steinberg ML, Williams JM, Ziedonis DM: Financial implications of cigarette smoking among individuals with schizophrenia. Tob Control  2004; 13:206
[CrossRef]
 
Phillips KM, Brandon TH: Do psychologists adhere to the clinical practice guidelines for tobacco cessation? a survey of practitioners. Prof Psychol Res Pr  2004; 35:281–285
[CrossRef]
 
George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkel J, Rounsaville BJ, Kosten TR: Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry  2000; 157:1835–1842
[PubMed]
[CrossRef]
 
Fiore MC, Bailey WC, Cohen SJ: Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, Md, US Department of Health and Human Services, Public Health Service, June 2000
 
Williams J, Ziedonis DM, Foulds J: Nicotine nasal spray in the combination treatment of tobacco dependence in schizophrenia: a case series. Psychiatr Serv  2004; 55:1064–1066
[PubMed]
[CrossRef]
 
Krejci J, Foulds J: Engaging patients in tobacco dependence treatment: assessment and motivational techniques. Psychiatr Annals  2003; 33:436–444
 
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References

Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, Kane JM, Lieberman JA, Schooler NR, Covell N, Stroup S, Weissman EM, Wirshing DA, Hall CS, Pogach L, Pi-Sunyer X, Bigger JT Jr, Friedman A, Kleinberg D, Yevich SJ, Davis B, Shon S: Physical health monitoring of patients with schizophrenia. Am J Psychiatry  2004; 161:1334–1349
[PubMed]
[CrossRef]
 
Brown S, Inskip H, Barraclough B: Causes of the excess mortality of schizophrenia. Br J Psychiatry  2000; 177:212–217
[PubMed]
[CrossRef]
 
Steinberg ML, Williams JM, Ziedonis DM: Financial implications of cigarette smoking among individuals with schizophrenia. Tob Control  2004; 13:206
[CrossRef]
 
Phillips KM, Brandon TH: Do psychologists adhere to the clinical practice guidelines for tobacco cessation? a survey of practitioners. Prof Psychol Res Pr  2004; 35:281–285
[CrossRef]
 
George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkel J, Rounsaville BJ, Kosten TR: Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry  2000; 157:1835–1842
[PubMed]
[CrossRef]
 
Fiore MC, Bailey WC, Cohen SJ: Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, Md, US Department of Health and Human Services, Public Health Service, June 2000
 
Williams J, Ziedonis DM, Foulds J: Nicotine nasal spray in the combination treatment of tobacco dependence in schizophrenia: a case series. Psychiatr Serv  2004; 55:1064–1066
[PubMed]
[CrossRef]
 
Krejci J, Foulds J: Engaging patients in tobacco dependence treatment: assessment and motivational techniques. Psychiatr Annals  2003; 33:436–444
 
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Tobacco use and cataracts in patients with schizophrenia. Am J Psychiatry 2005;162(5):1028-9; author reply 1029.
Tobacco use and cataracts in patients with schizophrenia. Am J Psychiatry 2005;162(5):1028; author reply 1029.