A double-blind randomized clinical trial of different doses of transdermal nicotine patch for smoking reduction and cessation in long-term hospitalized schizophrenic patients

Original Paper


There have been many studies of smoking cessation using nicotine replacement therapy (NRT) with schizophrenic patients, but none exploring the smoking-reduction effects of varying doses of NRT in long-stay patients with schizophrenia. This study aimed to examine the effect of different doses of the nicotine transdermal patch on smoking-reduction and cessation outcomes in long-term hospitalized schizophrenic patients. A total of 184 subjects participated in a randomized, controlled, double-blind 8-week clinical trial. Participants were randomized into two groups using two different doses of NRT: a high-dose NRT group (31.2 mg for the first 4 weeks, then 20.8 mg for 4 weeks, n = 92) or a low-dose NRT group (20.8 mg for 8 weeks, n = 92). The 7-day point prevalence of abstinence was 2.7 % (5/184). Participants in the low-dose NRT group reduced smoking by 3.1 more cigarettes on average than those in the high-dose group (p = 0.005). However, a repeated measures analysis of variance revealed that the main effect of changes in the number of cigarettes smoked, comparing the two types of treatment across periods, was not significant (p = 0.35, partial eta square = 0.018). In summary, among a cohort of chronic institutionalized schizophrenic patients, smoking cessation and reduction outcomes were not correlated with NRT dose, and the cessation rate was much lower than rates in similar studies. It indicates that long-term hospitalized schizophrenic patients have more difficulties with quitting smoking. More effective integrative smoking cessation programs should be addressed for these patients.


Schizophrenia Nicotine replacement therapy Smoking cessation Smoking reduction Long-term hospitalization 


  1. 1.
    Beratis S, Katrivanou A, Gourzis P (2001) Factors affecting smoking in schizophrenia. Compr Psychiatry 42(5):393–402PubMedCrossRefGoogle Scholar
  2. 2.
    Combs DR, Advokat C (2000) Antipsychotic medication and smoking prevalence in acutely hospitalized patients with chronic schizophrenia. Schizophr Res 46(2–3):129–137PubMedCrossRefGoogle Scholar
  3. 3.
    Diwan A, Castine M, Pomerleau CS, Meador-Woodruff JH, Dalack GW (1998) Differential prevalence of cigarette smoking in patients with schizophrenic vs mood disorders. Schizophr Res 33(1–2):113–118PubMedCrossRefGoogle Scholar
  4. 4.
    Herran A, de Santiago A, Sandoya M, Fernandez MJ, Diez-Manrique JF, Vazquez-Barquero JL (2000) Determinants of smoking behaviour in outpatients with schizophrenia. Schizophr Res 41(2):373–381PubMedCrossRefGoogle Scholar
  5. 5.
    McCreadie RG, Scottish Comorbidity Study G (2002) Use of drugs, alcohol and tobacco by people with schizophrenia: case-control study. Br J Psychiatry 181:321–325PubMedCrossRefGoogle Scholar
  6. 6.
    Zabala A, Eguiluz JI, Segarra R, Enjuto S, Ezcurra J, Gonzalez Pinto A, Gutierrez M (2009) Cognitive performance and cigarette smoking in first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 259(2):65–71PubMedCrossRefGoogle Scholar
  7. 7.
    Dalack GW, Meador-Woodruff JH (1996) Smoking, smoking withdrawal and schizophrenia: case reports and a review of the literature. [Review] [45 refs]. Schizophr Res 22(2):133–141PubMedCrossRefGoogle Scholar
  8. 8.
    Leonard S, Adler LE, Benhammou K, Berger R, Breese CR, Drebing C, Gault J, Lee MJ, Logel J, Olincy A, Ross RG, Stevens K, Sullivan B, Vianzon R, Virnich DE, Waldo M, Walton K, Freedman R (2001) Smoking and mental illness. Pharmacol Biochem Behav 70(4):561–570PubMedCrossRefGoogle Scholar
  9. 9.
    Lyon ER (1999) A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatr Serv 50(10):1346–1350PubMedGoogle Scholar
  10. 10.
    Bradshaw T, Lovell K, Harris N (2005) Healthy living interventions and schizophrenia: a systematic review. J Adv Nurs 49(6):634–654PubMedCrossRefGoogle Scholar
  11. 11.
    Corrigall WA (1991) Understanding brain mechanisms in nicotine reinforcement. Br J Addict 86(5):507–510PubMedCrossRefGoogle Scholar
  12. 12.
    Imperato A, Mulas A, Di Chiara G (1986) Nicotine preferentially stimulates dopamine release in the limbic system of freely moving rats. Eur J Pharmacol 132(2–3):337–338PubMedCrossRefGoogle Scholar
  13. 13.
    Mereu G, Yoon KW, Boi V, Gessa GL, Naes L, Westfall TC (1987) Preferential stimulation of ventral tegmental area dopaminergic neurons by nicotine. Eur J Pharmacol 141(3):395–399PubMedCrossRefGoogle Scholar
  14. 14.
    Farnam CR (1999) Zyban: a new aid to smoking cessation treatment–will it work for psychiatric patients? J Psychosoc Nurs Ment Health Serv 37(2):36–42 (quiz 43–34)Google Scholar
  15. 15.
    Ziedonis DM, George TP (1997) Schizophrenia and nicotine use: report of a pilot smoking cessation program and review of neurobiological and clinical issues. Schizophr Bull 23(2):247–254PubMedCrossRefGoogle Scholar
  16. 16.
    Addington J, el-Guebaly N, Campbell W, Hodgins DC, Addington D (1998) Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry 155(7):974–976PubMedGoogle Scholar
  17. 17.
    Chou KR, Chen R, Lee JF, Ku CH, Lu RB (2004) The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. Int J Nurs Stud 41(3):321–330PubMedCrossRefGoogle Scholar
  18. 18.
    George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkel J, Rounsaville BJ, Kosten TR (2000) Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry 157(11):1835–1842PubMedCrossRefGoogle Scholar
  19. 19.
    Fredrickson PA, Hurt RD, Lee GM, Wingender L, Croghan IT, Lauger G, Gomez-Dahl L, Offord KP (1995) High dose transdermal nicotine therapy for heavy smokers: safety, tolerability and measurement of nicotine and cotinine levels. Psychopharmacology 122(3):215–222PubMedCrossRefGoogle Scholar
  20. 20.
    Hurt RD, Dale LC, Fredrickson PA, Caldwell CC, Lee GA, Offord KP, Lauger GG, Marusic Z, Neese LW, Lundberg TG (1994) Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up. One-year outcome and percentage of nicotine replacement. JAMA 271(8):595–600PubMedCrossRefGoogle Scholar
  21. 21.
    Bohadana A, Nilsson F, Rasmussen T, Martinet Y (2000) Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 160(20):3128–3134PubMedCrossRefGoogle Scholar
  22. 22.
    Gardner DM, Murphy AL, O’Donnell H, Centorrino F, Baldessarini RJ (2010) International consensus study of antipsychotic dosing. Am J Psychiatry 167(6):686–693PubMedCrossRefGoogle Scholar
  23. 23.
    Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47(9):1102–1114PubMedCrossRefGoogle Scholar
  24. 24.
    Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991) The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 86(9):1119–1127PubMedCrossRefGoogle Scholar
  25. 25.
    Huang CL, Lin HH, Wang HH (2006) Psychometric evaluation of the Chinese version of the Fagerstrom Tolerance Questionnaire as a measure of cigarette dependence. J Adv Nurs 55(5):596–603PubMedCrossRefGoogle Scholar
  26. 26.
    Cheng JJ, Ho H, Chang CJ, Lan SY, Hwu HG (1996) Positive and negative syndrome scale (PANSS): establishment and reliability study of a Mandarin Chinese language version. Taiwan J psychiatry 10:251–258Google Scholar
  27. 27.
    Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13(2):261–276PubMedCrossRefGoogle Scholar
  28. 28.
    Simpson G, Kunz-Bartholini E (1968) Relationship of individual tolerance, behavior and phenothiazine produced extrapyramidal system disturbance. Dis Nerv Syst 29(4):269–274PubMedGoogle Scholar
  29. 29.
    Cohen S, Lichtenstein E, Prochaska JO, Rossi JS, Gritz ER, Carr CR, Orleans CT, Schoenbach VJ, Biener L, Abrams D et al (1989) Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves. Am Psychol 44(11):1355–1365PubMedCrossRefGoogle Scholar
  30. 30.
    Blondal T, Gudmundsson LJ, Olafsdottir I, Gustavsson G, Westin A (1999) Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up. [see comment] [erratum appears in BMJ 1999 Mar 20;318(7186):764]. BMJ 318 (7179):285–288Google Scholar
  31. 31.
    Baker A, Richmond R, Haile M, Lewin TJ, Carr VJ, Taylor RL, Jansons S, Wilhelm K (2006) A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. Am J Psychiatry 163(11):1934–1942PubMedCrossRefGoogle Scholar
  32. 32.
    George TP, Vessicchio JC, Sacco KA, Weinberger AH, Dudas MM, Allen TM, Creeden CL, Potenza MN, Feingold A, Jatlow PI (2008) A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia. Biol Psychiatry 63(11):1092–1096PubMedCrossRefGoogle Scholar
  33. 33.
    Liao DL, Yang JY, Lee SM, Chen H, Tsai SJ (2002) Smoking in chronic schizophrenic inpatients in Taiwan. Neuropsychobiology 45(4):172–175PubMedCrossRefGoogle Scholar
  34. 34.
    Evins AE, Cather C, Rigotti NA, Freudenreich O, Henderson DC, Olm-Shipman CM, Goff DC (2004) Two-year follow-up of a smoking cessation trial in patients with schizophrenia: increased rates of smoking cessation and reduction. J Clin Psychiatry 65(3):307–311PubMedCrossRefGoogle Scholar
  35. 35.
    Addington J (1998) Group treatment for smoking cessation among persons with schizophrenia. Psychiatr Serv 49(7):925–928PubMedGoogle Scholar
  36. 36.
    Hall SM, Humfleet GL, Reus VI, Munoz RF, Cullen J (2004) Extended nortriptyline and psychological treatment for cigarette smoking. Am J Psychiatry 161(11):2100–2107PubMedCrossRefGoogle Scholar
  37. 37.
    Carrao JL, Moreira LB, Fuchs FD (2007) The efficacy of the combination of sertraline with buspirone for smoking cessation. A randomized clinical trial in nondepressed smokers. Eur Arch Psychiatry Clin Neurosci 257(7):383–388PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of PsychiatryYuli HospitalYuli, HualienTaiwan
  2. 2.Department of HealthYuli HospitalYuli, HualienTaiwan
  3. 3.Department of Psychiatry, School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  4. 4.Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan

Personalised recommendations