We are living in an era of implementing complete smoking cessation in all closed areas, following the example of the USA and other countries in the European Union. We appear more tolerant in our mentally ill in-patients, especially the ones suffering from long-term schizophrenia, where smoking is accepted and even encouraged. We tried to investigate the effect of smoking in these patients. We performed an in depth literature research of medical databases and web search engines containing relevant articles, opinions and arguments. It has been shown from a lot of different studies that the proportion of persons with mental health problems who smoke is considerably higher compared to the general population. 51% of individuals with diagnosis of schizophrenia and 50% of those with bipolar affective disorder smoke more than 20 cigarettes per day against 8% of the general population who smoke the same amount. In another study from the USA , it was calculated that 45% of all cigarettes smoked in one month, were consumed by individuals with diagnosis of mental disorder or substance abuse. Smokers that suffer from schizophrenia present more positive symptoms, although clinical observation and research confirmed data show a positive effect in extrapyramidal symptoms and other side effects of medication. For other parameters such as attention, cognitive function and impulsivity, research is non conclusive and with contradictory results. Rates of premature death are higher for persons with mental illnesses compared with the general population, even if we don’t include suicides. Much of these deaths are attributed to cardiovascular and respiratory problems and smoking is considered to be a major contributor to these illnesses. Substances found in cigarette’s tar act as enhancers of P450 liver enzymes, increasing the metabolism of certain of antipsychotic medication, including clozapine, fluphenazine, haloperidol and olanzapine. This leads to higher required doses of medication. Smoking adds a big economical burden upon the smoker, who, as an individual with mental illness, is likely to have low income and should be directed to cover other real life necessities that could improve the overall quality of life. People who are heavy smokers find difficult to participate in certain activities or attend places where smoking is not allowed. This contributes further to their social exclusion. This habit should be treated as an addiction. Currently a lot of different treatments both pharmacological and non-pharmacological are available, which can be combined with promising results.

Key words: Smoking, nicotine, mental illness, schizophrenia, bipolar disorder, psychopathology.

C. Tsopelas, K. Kardaras, V. Kontaxakis (page 306) - Full article