How—and why—to help psychiatric patients stop smoking

On the morning of his TQD, Mr. J is to apply the first 21-mg transdermal nicotine patch. He is told not to smoke that day and to apply a new patch daily. The psychiatrist also tells him he will most likely remain on that dosage for 4 weeks. Then the patch strength will be reduced in 7-mg aliquots every 2 to 4 weeks, depending on his progress. The psychiatrist also provides him with educational materials on how to quit successfully.

Follow-up. Recognizing that most relapses occur in the first few days of quitting, the psychiatrist sets Mr. J’s first follow-up appointment for the day after his TQD to assess:

• whether he has smoked and number of cigarettes smoked per day
  
• presence and severity of withdrawal symptoms
  
• onset of psychiatric symptoms
  
• treatment adherence
  
• how he is handling high-risk situations and urges to smoke
  
• medication side effects.⁶
  

Another follow-up visit is set for 1 week later, and weekly telephone appointments are scheduled for the rest of the month, with a face-to-face appointment set 1 month after his quit date.

Related resources

• American Psychiatric Association. Practice guideline for the treatment of patients with nicotine dependence. Am J Psychiatry 1996; 53(153[suppl]): 1-31.
  
• Fiore MC, Bailey WC, Cohen SJ, et.al. Treating tobacco use and dependence. Clinical practice guideline. Rockville, MD: U.S. Public Health Service, 2000. https://www.ahcpr.gov/path/tobacco.htm. Accessed Dec. 13, 2004.
  

Drug brand names

• Amantadine • Symmetrel
  
• Bupropion • Wellbutrin SR, Zyban
  
• Clonidine • Catapres
  
• Nicotine nasal spray • Nicotrol NS
  
• Nicotine polacrilex • Nicorette
  
• Nicotine replacement patch • Nicoderm CQ, Nicotrol, others
  
• Nicotine vapor inhaler • Nicotrol Inhaler
  
• Nortriptyline •Aventyl, Pamelor
  

Disclosure

Dr. Anthenelli receives grant/research support from Sanofi-Aventis and Ortho-McNeil Pharmaceuticals and is a consultant and speaker for Sanofi-Aventis.

Acknowledgments

The author would like to thank Reene Cantwell for technical assistance in preparing this manuscript. This work was supported by grants R01 AA13307 and R01 AA13957 from the National Institute on Alcohol Abuse and Alcoholism and by the Department of Veterans Affairs.