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Advocates Call for Treating Tobacco Dependence in Psychiatric Patients 

Smoking cessation services should be integrated into substance use disorder treatment programs, according to David Kalman, MD, Department of Psychiatry, University of Massachusetts, and colleagues, in their recent review of tobacco dependency among patients who sought treatment for alcoholism.1

"Clearly there exist many barriers to simultaneous treatment of tobacco dependence and other substance use disorders," the investigators observe. "However, most alcoholics in treatment are concerned about their smoking and the preponderance of evidence indicates that trying to quit during substance use disorder treatment does not interfere with sobriety and, in fact, appears to be associated with better alcohol and other drug use outcomes." Kalman and colleagues are among a growing number of clinicians and researchers calling for the recognition of (and interventions for) tobacco dependence as a common comorbidity with other substance use and psychiatric disorders.

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Smoking mums have 'problem kids' 

Smoking during pregnancy significantly increases the risk of having a child with behavioural problems, according to UK and US researchers.

Writing in the Journal of Epidemiology and Community Health, they say the problems can be evident in children as young as three years old.

They believe smoking in pregnancy may damage the developing structure of the baby's brain.

One expert said it was another strong reason for mothers to give up smoking.

The researchers from the universities of York, Hull and Illinois looked at more than 14,000 mother and child pairs who were taking part in the Millennium Cohort Study.

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• Smoking while pregnant linked to behavioural problems in children  

Smoking during pregnancy significantly increases the risk of having a child with behavioural problems, according to research published today. Disturbances can manifest themselves in children as young as three years old, the study in the Journal of Epidemiology and Community Health claims.

The findings are based on more than 14,000 mother-and-child pairs drawn from the millennium cohort study, a population-based study of children born between 2000 and 2001 whose families are receiving child benefit.

The research was carried out by Professor Kate Pickett, at the department of health sciences at Hull York medical school, University of York.

Mothers, who were categorised as light or heavy smokers, depending on how many cigarettes they smoked every day during pregnancy, were asked to score their children's behaviour.

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Clinical Trials Update: Nov. 2, 2009: * Smoking Cessation and Depression  

This study is for people who are depressed and want to quit smoking. Participants will receive nicotine patches and counseling.

The research site is in Houston, Texas.

More information

Please see http://www.clinicalconnection.com/clinical_trials/condition/smoking.aspx.

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A Developmental Twin Study of Church Attendance and Alcohol and Nicotine Consumption: A Model for Analyzing the Changing Impact of Genes and Environment  

Conclusions: As individuals mature, they increasingly shape their own social environment in large part as a result of their genetically influenced temperament. When individuals are younger and living at home, frequent church attendance reflects a range of familial and social-environmental influences that reduce levels of substance use. In adulthood, by contrast, high levels of church attendance largely index genetically influenced temperamental factors that are protective against substance use. Using genetically informative designs such as twin studies, it is possible to show that the causes of the relationship between social risk factors and substance use can change dramatically over development.

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Genes may explain why churchgoers are teetotalers 

Churchgoers have been found to have lower rates of drinking and smoking than those who spend their Sundays elsewhere. Now a new study suggests that for adults, it may not be church attendance itself that explains much of the phenomenon. It might be genes.

The study, which included nearly 1,800 adult male twins, found that in adolescence, the relationship between church attendance and lower rates of drinking and smoking appeared largely a matter of "shared" environment -- those factors influencing both members of a twin pair.

That is, teenagers who attended church regularly were more likely to want to follow their parents' wishes and conform to community expectations.

By adulthood, however, those environmental influences had faded, the researchers found. Instead, genes seemed to account for the relationship between church-going and lesser alcohol and nicotine use. . . .

SOURCE: American Journal of Psychiatry, October 2009.

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Smoking predicts suicidality in BD patients 

Current cigarette smoking is a predictor for current and 9-month suicidal ideation and behavior in bipolar disorder (BD) patients, suggest US study results.

Studies have shown that BD patients are four times as likely to have nicotine dependence than the general population. Furthermore, cigarette smoking in BD individuals has been associated with suicidal behavior, although the precise relationship between the two remains unclear.

To investigate, Michael Ostacher (Harvard Medical School, Boston, Massachusetts) and colleagues examined the association between smoking, suicidality, and prospective suicide attempts in 116 BD patients over a 9-month period.

In total, 27% of patients were smokers who showed significantly higher rates of lifetime substance abuse disorders (61% vs 33%), were younger (37.3 vs 46.7 years), and had an earlier age of BD onset (14.4 vs 18.4 years) compared with non-smokers.

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• Mothers' smoking causes newborn discomfort 

French researchers say they have tied maternal smoking to an increased risk of discomfort in newborns.

The study, published in Biological Psychiatry, suggests significantly more discomfort among newborns of smoking mothers may be related to having less monoamine oxidase A an enzyme, which degrades chemicals involved in brain message-sending.

Monoamine oxidase A activity was reduced both in the pregnant smokers and in their newborns when the researchers tested for blood biomarkers of monoamine oxidase A activity in smoking and non-smoking pregnant women and in the cord blood of their newborns.

Smoke exposure-induced low monoamine oxidase A activity in the womb may affect fetus brain neurotransmission and create potential vulnerabilities to behavioral disorders later in life,

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At Evanston park, a turf war between mentally ill patients and parents who live nearby 

A small Evanston park offers a place to relax for men and women who live at a nearby mental health center, but it is off-limits for some parents worried about cigarette smoke and uncomfortable encounters.

Grey Park's playground -- with its teeter-totters and tot lot -- sits virtually unused these days. . . .

Some have suggested eliminating the playground to focus more on drawing adults into the park. They also have discussed designating a smoking area and upgrading the dilapidated community garden. . . .

Tossi said Albany Care, a 417-bed facility, has smoking rooms. If the city ever bans smoking in the park, he said he would try to ensure that residents complied. But smoking, he said, is important to some who live at the center, and he can't stop them.

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• Addressing smoking beliefs may help schizophrenia patients to quit 

Challenging positive expectations and providing information on the negative consequences of smoking increase the motivation of schizophrenia and schizoaffective patients to quit smoking, conclude US investigators.

It has been shown in a number of different populations that smoking expectations, in terms of both positive expectations of smoking and the negative health consequences, are associated with intention to quit and predict smoking cessation success. However, while smoking has been widely studied in schizophrenia, the links between smoking expectancies and understanding and intention to quit have not been investigated.

Jennifer Tidey, from Brown University in Providence, Rhode Island, and colleagues studied 46 smokers with schizophrenia, 35 smokers with schizoaffective disorder, and 71 smokers without psychiatric illness, all of whom were heavy smokers. . . .

The team concludes in the journal Schizophrenia Research: "The results of this study support the importance of focusing on the expected pros and cons of smoking in motivation interviewing and other cognitive behavioral interventions for tobacco dependence in people with schizophrenia and schizoaffective disorder."

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• Maternal Smoking May Increase Newborns' Discomfort 

A new research study being published in the October 15th issue of Biological Psychiatry suggests that maternal smoking may increase the level of distress of newborns.

Studies have consistently found that prenatal cigarette smoke exposure is associated with increased rates of behavior problems, irritability, attention-deficit/hyperactivity disorder, the risk of violent offenses, conduct disorder, adolescent onset of drug dependence, and the risk for criminal arrest in offspring. This study adds another potential negative outcome to the list of reasons for mothers to stop smoking while pregnant.

Most of the effects of tobacco either during pregnancy or on postnatal outcomes are attributed to nicotine. However, smoking is associated with reduced monoamine oxidase A (MAO-A) activity, enzymes that degrade brain neurotransmitters in smokers. Prenatal smoke exposure-induced low MAO-A activity in fetal life may dysregulate brain neurotransmission, creating a potential vulnerability to develop behavioral disorders later in life. This dysregulation can occur with or without interaction with nicotine's effect on the developing brain.

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• Smoking Keeps Its Grip on Urban Poor  

A full 42 percent of people in Milwaukee's poorest neighborhoods smoke -- more than twice the national U.S. average -- sacrificing $9 on a pack of cigarettes even while most of the households reported earning less than $15,000 a year.

Even more troubling is the fact that a large number of these low-income smokers hold beliefs that make them less likely to quit, according to ongoing research from the University of Wisconsin-Madison.

Over the past 40 years or so, the overall smoking rate in the United States has decreased to about 20 percent, but those gains have taken place largely among people with resources, namely money and education, said Bruce Christiansen, an associate scientist with the University of Wisconsin Center for Tobacco Research and Intervention in Madison, who is one of the researchers on what's known as the "ZIP Code" project.

"With public health, we got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans. "Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people."

That select group includes people with mental health issues, which, according to the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA), smoke 44 percent of all cigarettes.

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[W]e got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough. Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people.
Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans.

• Doctors should ask mentally ill to stop smoking, new report says 

Smoking addiction treatment should be included in the care plans for mentally ill patients with tobacco dependence.

Based on the new study, clinical psychologist and lead author Brian Hitsman, of Northwestern University Feinberg School of Medicine, recommended an integrated care model to help mental health patients quit smoking. The method, combining drugs and psychological therapy, addresses the tobacco dependence of mentally ill smokers.

The review review appeared in a recent issue of the Canadian Journal of Psychiatry.

In this Q&A, Hitsman explained his recommended smoking cessation method and why mental health care professionals should consider it.

Q: Why did you decide to focus on the mentally ill for this tobacco addiction review?

A: Smokers with mental illness have been underserved when it comes to tobacco dependence treatments both clinically as well as in the tobacco addiction research field. They just haven’t gotten the attention. The thinking has been that they can’t quit and that if you get them in your clinical trial they won’t show up so what’s tended to happen is that this population has been excluded from treatments.

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Cigarettes Have Calming Effect on Brain Metabolism  

LITTLE FALLS, N.J., April 24 -- Brain scans have revealed that nicotine does indeed have a calming effect, something smokers have claimed for years.

A small study found that nicotine administered via a patch was associated with a reduced tendency to retaliate against an opponent during a game, Jean Gehricke, M.D., of the University of California Irvine, and colleagues reported online in Behavioral and Brain Functions.

Those who held back also showed changes in brain metabolism. Dr. Gehricke said length of retaliation was "associated with changes in brain metabolism in response to nicotine in brain areas responsible for orienting, planning, and processing of emotional stimuli."

The findings support the idea that people with an angry disposition are more susceptible to nicotine's effects and are therefore more likely to become addicted to cigarettes, the researchers said. . . .

Primary source: Behavioral and Brain Functions Source reference: Gehricke JG, et al "Nicotine-induced brain metabolism associated with anger provocation" Behav Brain Func 2009; DOI: 10.1186/1744-9081-5-19.

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Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database (Full Text) 

Main findings

We found no clear evidence of an increased risk of self harm associated with varenicline compared with other smoking cessation products, although the limited study power means we cannot rule out either a halving or a twofold increase in risk. Analysis of those patients prescribed varenicline suggested that they were likely to be at lower risk of self harm than those prescribed nicotine replacement products—they had lower levels of past psychiatric consultation and previous self harm.

Nevertheless, controlling for these factors in multivariable models did not alter our conclusions.Wefound no evidence that varenicline increased the incidence of suicidal thoughts. However, associations with suicidal thoughts should be treated with caution as they are under-recorded in the General Practice Research Database (GPRD). Varenicline was associated with a reduced risk of treated depression, as indexed by initiation of antidepressant therapy. . . .

Conclusion

We found no clear evidence of an increased risk of self harm, suicidal thoughts, or depression in people prescribed varenicline compared with those prescribed other smoking cessation products. In view of increasing concerns about the possible increased risk of suicide associated with these drugs and their increasing popularity, further investigation of their effect on suicide risk is required in other databases and through secondary analysis of all adverse event reporting in relevant clinical trials. Any such risk must be balanced against the likely long term health benefits of smoking cessation and the robust evidence of the effectiveness of varenicline as an aid to smoking cessation.

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