A Patch for Agitation in Smoking Schizophrenia Patients

Adding nicotine patches to usual treatment reduces agitation in newly admitted patients with schizophrenia who smoke.

Many patients with schizophrenia smoke cigarettes, but many treatment facilities now ban smoking. Schizophrenia patients who smoke face this additional stressor when admitted to smoke-free hospitals. This double-blind, randomized, controlled trial of nicotine replacement therapy involved 40 adult smokers with schizophrenia and at least some agitation who were admitted to a smoke-free psychiatric emergency unit.

The patients received nicotine (21 mg) or placebo patches plus their ongoing antipsychotic medications or newly administered oral or intramuscular olanzapine (5 or 10 mg) or intramuscular haloperidol (5 mg). Compared with placebo, nicotine was associated with 33% less agitation at 4 hours and 23% less agitation at 24 hours. The intervention showed a dose–response curve inversely related to the degree of nicotine dependence. The difference in agitation between nicotine replacement and placebo was stronger in patients with who smoked less than in those who smoked more.

Comment: Patients who smoked more might have had a smaller response to the nicotine patch because the 21-mg dose was insufficient; higher doses might be more effective for them. Future research may yield a more sophisticated understanding of such dose–response relationships and may explore potential drug–drug interactions between nicotine and various antipsychotics. The authors conjecture that nicotine might reduce aggression even in nonsmoking patients, but this hypothesis has yet to be clinically tested.

Joel Yager, MD

Published in Journal Watch Psychiatry February 18, 2011

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