An editorial in the January 2006 issue of the Psychiatric Bulletin reviews the evidence for the effectiveness of gene-based smoking cessation packages, and asks whether they are appropriate for psychiatric patients.
It is well known that the prevalence of smoking among psychiatric patients is far higher than in the general public (70% v. 30%). Smoking in schizophrenia and depression is thought in part to be an attempt to self-medicate symptoms of the illness.
There is also preliminary evidence to support a relationship between eating disorders and smoking, with smoking being used to control weight.
As clinicians working with patients with such high smoking rates, psychiatrists have a duty of care to protect them from the harmful effects of tobacco smoke. This involves informing patients of the best treatment available, and directing them to the appropriate services.
The mainstays of current smoking cessation treatment are nicotine replacement therapy (patches, gum, inhalers, lozenges and spray) and bupropion (Zyban), although behavioural support is also effective.
Gene-based tests for smoking cessation are currently marketed privately to smokers via the internet to help inform them whether they carry gene variants predisposing them to nicotine addiction. The results are given with a personally tailored plan to stop smoking, including medication, behavioural changes and alternative therapies.
Should psychiatric patients be advised to purchase gene-based tests? There are several issues to be considered: