Background: Psychotic disorders (e.g., Schizophrenia, schizoaffetive disorder) are associated with a higher smoking prevalence (relative to other psychiatric disorders) and smoking attributable mortality. Until recently, little has been done to address the disproportionate smoking in this population. The objectives of our study are to: 1) describe the characteristics of smokers with a history of psychiatric disorders (i.e., none, psychotic, and depressive/anxiety) and 2) examine smoking cessation/reduction outcomes by history of psychiatric disorders.

Methods: Retrospective analyses were conducted from charts of 982 participants accessing a tailored, evidence-based, tobacco treatment program within mental health and addictions services in Vancouver, Canada. Demographics, tobacco use and cessation attempt history, nicotine dependence, importance and confidence in quitting smoking, expired carbon monoxide (expCO) level, history of polysubstance use, and total visits to the program were obtained. Main outcomes were: a) 7-day prevalence of smoking abstinence verified by expCO and b) a 50% reduction in baseline cigarette consumption verified by expCO (for those who did not achieve abstinence).

Results: As compared to individuals with no psychiatric disorder, those with psychotic disorders were more likely to have initiated smoking later, report lower importance and confidence in quitting, smoke a greater number of cigarettes per day, and be more nicotine dependent. Among program completers (n=543), 35.7% of individuals with a psychotic disorder achieved smoking cessation (as compared to no psychiatric disorder =45.6% vs. depressive/anxiety disorder=39.6%, p=.350). Similarly, 59.3% of individuals with a psychotic disorder achieved smoking reduction (as compared to no psychiatric disorder=74.1% vs. vs. depressive/anxiety=67.3%, p=.370) among those who did not achieve abstinence at the end of treatment (n=244). In multivariate analysis, significant predictors of successful smoking cessation were: a) having a greater number of visits to the program among individuals without a psychiatric disorders, b) having a lower baseline expCO level among individuals with psychotic disorder, and c) a greater number of visits to the program and a greater length of abstinence at the last quit attempt among individuals with depressive/anxiety disorders.

Conclusion: Individuals with a history of psychotic disorders are able to achieve smoking cessation when provided evidence-based treatment. However, tailored approaches specific to the needs of individuals with psychotic disorders may be warranted to enhance cessation outcomes. Hence, future studies may be required to further understand how to tailor treatment outcomes and modify existing treatment approaches to optimize outcomes among individuals with a history of psychotic disorders and other psychiatric disorders.

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A presentation at the Asian Pacific Conference on Tobacco or Health in Chiba, Japan.