Indeed, Sean Hannity has interviewed investigative reporter Sara Carter of the web site Circa who cites several concrete insider intelligence sources confirming the listening in. Moreover, there are those prominently reported details, from The New York Times e.
Causes[ edit ] A number of theories have been proposed to explain increased rates of smoking among people with schizophrenia. Psychological and social theories[ edit ] Several psychological and social explanations have been proposed.
The earliest explanations were based on psychoanalytic theory. Research has found that this explanation alone cannot account for the extreme amount of smoking among people with schizophrenia.
This hypothesis proposed that anxiety as a symptom of schizophrenia may contribute to smoking. Research on this hypothesis notes that people with schizophrenia often cannot cope with problems in constructive ways, so use of smoking as a psychological tool may result in a vicious cycle of more and more smoking.
The cognitive effects hypothesis suggests that nicotine has positive effects on cognition, so smoking is used to improve neurocognitive dysfunction.
However, people with schizophrenia smoke at higher rates and for longer periods than other groups that experience both institutionalization and boredom. Atypical antipsychotics may work against smoking cessationas symptoms of smoking cessation such as irritable mood, mental dulling, and increased appetite overlap with Ethical issues schizophrenia effects of atypical antipsychotics.
Some also argue that smoking works to reduce the side effects of antipsychotics. However, research shows no association between smoking and antipsychotic use after controlling for schizophrenia. However, both people with schizophrenia and the general population experience this effect, so it cannot fully explain increased smoking in people with schizophrenia.
Studies including personal perspectives find that people with schizophrenia generally start smoking for the same reasons as the general population, including social pressures and cultural and socioeconomic factors.
People with schizophrenia who are current smokers also cite similar reasons for smoking as people without schizophrenia, primarily relaxation, force of habit, and settling nerves. The major themes found in studies of personal perspectives are habit and routine, socialization, relaxation, and addiction to nicotine.
It is argued that smoking provides structure and activity, both of which may be lacking in the lives of those with serious mental illness. This finding implies that the association is not solely social or cultural, but rather has a strong biological component.
Nicotine increases release of dopamine, so it is hypothesized that smoking helps correct dopamine deficiency in the prefrontal cortex and thus relieve negative symptoms.
One theory argues that the beneficial effects of nicotine on negative symptoms outweigh possible exacerbation of positive symptoms. Another theory is based on animal models showing that chronic nicotine use eventually results in a reduction in dopamine, thus alleviating positive symptoms.
However, human studies show conflicting results, including some studies that show that smokers with schizophrenia have the most positive symptoms and a reduction in negative symptoms. Studies show increased numbers of exposed nicotinic receptors, which could explain the pathology of both smoking and schizophrenia.
However, others argue that the increase in nicotinic receptors is a result of persistent heavy smoking, rather than schizophrenia. Nicotine may help improve auditory gating, the ability to screen out intrusive environmental sounds.
This may help improve attention spans and reduce auditory hallucinations, allowing people with schizophrenia to perceive the environment more effectively and engage in smoother motor functions. However, research shows this effect alone cannot account for increased smoking rates.
One well-documented consequence is the increase in premature death among people with schizophrenia. Ten-year coronary heart disease risk is significantly elevated in people with schizophrenia, as well as diabetes and hypertension.
Smoking results in faster metabolism of antipsychotics, which results in smokers being prescribed higher doses. Studies are unclear as to whether changes in smoking are caused by changes in symptoms, side effects of medication, or primary effects of medication.
One major impact is financial, as people with schizophrenia have been found to spend a disproportionate amount of their income on cigarettes.
Some argue that this results in further social impacts as people with schizophrenia are then unable to spend money on entertainment and social events that would promote well-being, or may even be unable to afford housing or nutrition. Research based on internal industry documents shows a concerted effort by the industry to promote belief that people with schizophrenia need to smoke and that it is dangerous for them to quit.
Such promotion includes monitoring or supporting research that endorsed the idea that people with schizophrenia are uniquely immune to the health consequences of smoking since proved false and that tobacco is needed for people with schizophrenia to self-medicate.
The industry also provided cigarettes to hospital wards and supported efforts to block hospital-based smoking bans. Although this does not discredit the effects of nicotine in schizophrenia, it is argued that the efforts of the tobacco industry slowed the decline in smoking prevalence in people with schizophrenia as well as the development of clinical policies to promote smoking cessation.
Historically, mental health providers have overlooked smoking in schizophrenia, based on the rationale that patients with serious mental illness already suffer from significant stress and disability and as such should be allowed to engage in smoking as an activity that is pleasurable, albeit destructive.
There is also historical precedent of mental health providers, particularly in patient settings, to use cigarettes as a way to manipulate patient behavior, such as rewarding good behavior with cigarettes or withholding cigarettes to encourage medication compliance. However, research showing that eliminating even one risk factor for disease can significantly improve long-term health outcomes has resulted in the dominant view among clinicians opposing smoking.
However, all studies have shown a reduction in smoking, though not necessarily elimination. Evidence has been found to support the use of sustained-release bupropionnicotine replacement therapyatypical antipsychoticsand cognitive-behavioral therapy.
Better outcomes are seen when two or more cessation strategies are employed, as well as for patients using atypical antipsychotics rather than typical antipsychotics.
There is also no evidence for an increase in positive symptoms or side effects following smoking cessation, while there is evidence for a decrease in negative symptoms.Ketamine, sold under the brand name Ketalar among others, is a medication mainly used for starting and maintaining anesthesia.
It induces a trance-like state while providing pain relief, sedation, and memory loss. Other uses include for chronic pain and for sedation in intensive care. Heart function, breathing, and airway reflexes generally remain functional during its effects.
Here, an additional ethical question to consider is what effect would telling or not telling a patient that he or she may develop schizophrenia have on the patient/psychiatrist relationship. This would be the question that Havens would give paramount importance. Support Groups > Family Education: The Ethics Of Psychosis: Written by Cannonier (diagnosed with schizophrenia) I have been heavily involved in recent discussions about schizophrenia induced psychosis and the medical treatment for it.
Given that physical restraints cause adverse effects to patients and nurses, their wide and frequent use has resulted in various clinical and ethical controversies in mental health services. Current Opinion in Pharmacology. The Current Opinion journals were developed out of the recognition that it is increasingly difficult for specialists to keep up to date with the expanding volume of information published in their subject.
5. Prodromal Schizophrenia. Perhaps the most difficult ethical question raised in regard to the treatment of patients with schizophrenia over the last decade is if or when a psychiatrist should tell a patient that he or she is at an increased risk of developing schizophrenia.