What is the role of pharmacotherapy in tobacco cessation in patients with schizophrenia?
Notice bibliographique
Résumé
Tobacco use is the leading preventable cause of death and disease in our society, and the prevalence of smoking in individuals with schizophrenia is significantly higher than in the general population (up to 88; v. 20%). Additionally, the risk of cancer in individuals with schizophrenia is increased. In patients with weight gain and diabetes associated with atypical antipsychotic drug use, the risk of cardiovascular death may be further increased. Forced abstinence from nicotine is associated with significant adverse outcomes and is contraindicated in this population. Nicotine replacement therapy (NRT) should be routinely offered to individuals who wish to quit smoking. NRT appears to be both safe and indeed imperative for successful outcomes in tobacco cessation treatment of patients with schizophrenia. The combination of nicotine transdermal patches and nicotine polacrilex gum is advised. Although patients are generally discouraged from smoking while using NRT, cautiously allowing this practice appears to keep them engaged in the process, and the dangers may be overrated. Care should, however, be exercised in the dosing protocol of NRT, assuring adequate nicotinic receptor saturation, with the possibility of cautiously exceeding labelled indications (dose and duration) for heavy smokers. Bupropion is thought to be safe and effective in individuals with schizophrenia and, with adequate blood pressure monitoring, could be combined with NRT. Higher doses of bupropion should be used with caution because of the quite frequent existence of a genetic polymorphism for cytochrome P450 2B6 (CYP2B6). Slow metabolizers of bupropion may have high circulating blood levels, further lowering the seizure threshold when combined with clozapine, necessitating adequate seizure prophylaxis (e.g., divalproex sodium). The use of clozapine (to ameliorate mesolimbic dopaminergic dysregulation) has been associated with a reduction in smoking, whereas the use of typical antipsychotics has been associated with increases in smoking behaviour. The combined use of NRT and atypical antipsychotics appears to be superior to typical antipsychotics combined with NRT in smoking cessation trials in combination with psychosocial interventions. Polynuclear aromatic hydrocarbons in cigarette smoke induce cytochrome P450 1A2 (CYP1A2), which is partially responsible for the metabolism of clozapine, olanzapine and quetiapine. Smoking cessation may interfere with metabolism in that CYP1A2 induction may be reversed, leading to increased bioavailability and higher (and even toxic) plasma levels of clozapine and olanzapine. Neither nicotine (metabolized by CYP2A6) nor bupropion (metabolized by CYP2B6) is expected to alter the pharmacokinetics of each other or of the atypical antipsychotics. Individuals with schizophrenia and tobacco dependence should be offered intensive multimodal treatment, including NRT at adequate doses of optimal duration and, in selected individuals, bupropion. Caution should be exercised to avoid the development of toxic levels of olanzapine or clozapine in patients who quit smoking or manage to reduce their consumption (below 10 cigarettes/d). Pharmacologic and nonpharmacologic interventions, including advocacy for a smoke-free environment, should form part of an intensive multimodal treatment plan, with special attention to compliance. Charl Els, MB ChB, MMed (Psych) Department of Psychiatry University of Alberta Edmonton, Alta.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».