Smoking and schizophrenia: Prevalence, mechanisms and implications for treatment

Clinical Schizophrenia and Related Psychoses

Volumn 2, Issue 1, 2008, Pages 70-78

  Cather, Corinne ^a   Barr, Ruth S ^a   Evins, A Eden ^a  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Attention; Cognition; Cognitive behavioral therapy; Nicotine; Pharmacotherapy; Schizophrenia; Smoking; Smoking cessation

Indexed keywords

AMFEBUTAMONE; CHOLINERGIC RECEPTOR; CLOZAPINE; CYTOCHROME P450 1A2; HALOPERIDOL; NEUROLEPTIC AGENT; NICOTINE; NICOTINE DERIVATIVE; NICOTINE GUM; NICOTINE PATCH; OLANZAPINE; PLACEBO; RISPERIDONE; VARENICLINE;

ADAPTIVE BEHAVIOR; ATTENTION DISTURBANCE; CIGARETTE SMOKING; COGNITIVE DEFECT; COGNITIVE THERAPY; DRUG BLOOD LEVEL; DRUG DOSE TITRATION; DRUG METABOLISM; DRUG SAFETY; DRUG WITHDRAWAL; ENZYME INDUCTION; HUMAN; INDIVIDUALIZATION; MENTAL DISEASE; NAUSEA; NEUROBIOLOGY; NICOTINE REPLACEMENT THERAPY; NONHUMAN; PARKINSONISM; PATIENT CARE; PREVALENCE; RELAPSE; REVIEW; SCHIZOPHRENIA; SINGLE DRUG DOSE; SMOKING CESSATION; SMOKING HABIT; TARDIVE DYSKINESIA; TOBACCO DEPENDENCE; TREATMENT DURATION; TREATMENT OUTCOME; UNITED STATES; WITHDRAWAL SYNDROME;

EID: 42549130984     PISSN: 19351232     EISSN: None     Source Type: Journal    
DOI: 10.3371/CSRP.2.1.5     Document Type: Review

References (112)

1. Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and economic costs - United States, 1995-1999. MMWR Morb Mortal Wkly Rep 2002;51(14):300-303.
2. U.S. Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411. 1989.
3. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270(18):2207-2212.
4. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004;328(7455):1519.
5. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: A population-based prevalence study. JAMA 2000;284(20):2606-2610.
6. U.S. Department of Health and Human Services. The health benefits of smoking cessation. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 90-8416. 1990.
7. Nunn-Thompson CL, Simon PA. Pharmacotherapy for smoking cessation. Clin Pharm 1989;8(10):710-720.
8. Hughes JR. Prevalence of smoking among psychiatric outpatients. Am J Psychiatry 1986;143(8):993-997.
9. Meltzer H, Gill B, Petticrew M, Hinds K. OPCS surveys of psychiatric morbidity report 3: economic activity and social functioning of adults with psychiatric disorders. London: HMSO; 1995.
10. de Leon J, Dadvand M, Canuso C, White AO, Stanilla JK, Simpson GM. Schizophrenia and smoking: an epidemiological survey in a state hospital. Am J Psychiatry 1995;152(3):453-455.
11. de Leon J, Diaz FJ, Rogers T, Browne D, Dinsmore L. Initiation of daily smoking and nicotine dependence in schizophrenia and mood disorders. Schizophr Res 2002;56(1-2):47-54.
12. McDonald C. Cigarette smoking in patients with schizophrenia. Br J Psychiatry 2000;176:596-597.
13. McCreadie RG, Kelly C. Patients with schizophrenia who smoke. Private disaster, public resource. Br J Psychiatry 2000;176:109.
14. Olincy A, Young DA, Freedman R. Increased levels of the nicotine metabolite cotinine in schizophrenic smokers compared to other smokers. Biol Psychiatry 1997;42(1):1-5.
15. Strand JE, Nyback H. Tobacco use in schizophrenia: a study of cotinine concentrations in the saliva of patients and controls. Eur Psychiatry 2005;20(1):50-54.
16. Bozikas VP, Niopas I, Kafantari A, Kanaze FI, Gabrieli C, Melissidis P, et al. No increased levels of the nicotine metabolite cotinine in smokers with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2005;29(1):1-6.
17. Brown S, Inskip H, Barraclough B. Causes of the excess mortality of schizophrenia. Br J Psychiatry 2000;177:212-217.
18. Joukamaa M, Heliovaara M, Knekt P, Aromaa A, Raitasalo R, Lehtinen V. Mental disorders and cause-specific mortality. Br J Psychiatry 2001;179:498-502.
19. Goff DC, Cather C, Evins AE, Henderson DC, Freudenreich O, Copeland PM, et al. Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. J Clin Psychiatry 2005;66(2):183-194.
20. Sudders M. Massachusetts Department of Mental Health mortality report 2000. Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Mental Health; 2002.
21. Enger C, Weatherby L, Reynolds RF, Glasser DB, Walker AM. Serious cardiovascular events and mortality among patients with schizophrenia. J Nerv Ment Dis 2004;192(1):19-27.
22. Curkendall SM, Mo J, Glasser DB, Rose Stang M, Jones JK. Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry 2004;65(5):715-720.
23. Mortensen PB, Juel K. Mortality and causes of death in schizophrenic patients in Denmark. Acta Psychiatr Scand 1990;81(4):372-377.
24. Tsuang MT, Perkins K, Simpson JC. Physical diseases in schizophrenia and affective disorder. J Clin Psychiatry 1983;44(2):42-46.
25. Saku M, Tokudome S, Ikeda M, Kono S, Makimoto K, Uchimura H, et al. Mortality in psychiatric patients, with a specific focus on cancer mortality associated with schizophrenia. Int J Epidemiol 1995;24(2):366-372.
26. McEvoy JP, Freudenreich O, Levin ED, Rose JE. Haloperidol increases smoking in patients with schizophrenia. Psychopharmacology (Berl) 1995;119(1):124-126.
27. Dawe S, Gerada C, Russell MA, Gray JA. Nicotine intake in smokers increases following a single dose of haloperidol. Psychopharmacology (Berl) 1995;117(1):110-115.
28. Miller DD, Kelly MW, Perry PJ, Coryell WH. The influence of cigarette smoking on haloperidol pharmacokinetics. Biol Psychiatry 1990;28(6):529-531.
29. Goff DC, Henderson DC, Amico E. Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry 1992;149(9):1189-1194.
30. Jusko WJ. Role of tobacco smoking in pharmacokinetics. J Pharmacokinet Biopharm 1978;6(1):7-39.
31. Menza MA, Grossman N, Van Horn M, Cody R, Forman N. Smoking and movement disorders in psychiatric patients. Biol Psychiatry 1991;30(2):109-115.
32. Chong SA, Choo HL. Smoking among Chinese patients with schizophrenia. Aust N Z J Psychiatry 1996;30(3):350-353.
33. Salokangas RK, Saarijarvi S, Taiminen T, Lehto H, Niemi H, Ahola V, et al. Effect of smoking on neuroleptics in schizophrenia. Schizophr Res 1997;23(1):55-60.
34. Levin ED, Wilson W, Rose JE, McEvoy J. Nicotine-haloperidol interactions and cognitive performance in schizophrenics. Neuropsychopharmacology 1996;15(5):429-436.
35. Rezvani AH, Levin ED. Nicotine-antipsychotic drug interactions and attentional performance in female rats. Eur J Pharmacol 2004;486(2):175-182.
36. McEvoy JP, Brown S. Smoking in first-episode patients with schizophrenia. Am J Psychiatry 1999;156(7):1120-1121.
37. Durany N, Zochling R, Boissl KW, Paulus W, Ransmayr G, Tatschner T, et al. Human post-mortem striatal alpha4beta2 nicotinic acetylcholine receptor density in schizophrenia and Parkinson's syndrome. Neurosci Lett 2000;287(2):109-112.
38. Freedman R, Hall M, Adler LE, Leonard S. Evidence in postmortem brain tissue for decreased numbers of hippocampal nicotinic receptors in schizophrenia. Biol Psychiatry 1995;38(1):22-33.
39. Breese CR, Lee MJ, Adams CE, Sullivan B, Logel J, Gillen KM. et al. Abnormal regulation of high affinity nicotinic receptors in subjects with schizophrenia. Neuropsychopharmacology 2000;23(4):351-364.
40. Leonard S, Gault J, Hopkins J, Logel J, Vianzon R, Short M, et al. Association of promoter variants in the alpha7 nicotinic acetylcholine receptor subunit gene with an inhibitory deficit found in schizophrenia. Arch Gen Psychiatry 2002;59(12):1085-1096.
41. Griffith JM, O'Neill JE, Petty F, Garver D, Young D, Freedman R. Nicotinic receptor desensitization and sensory gating deficits in schizophrenia. Biol Psychiatry 1998;44(2):98-106.
42. Adler LE, Hoffer LD, Wiser A, Freedman R. Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Am J Psychiatry 1993;150(12):1856-1861.
43. Adler LE, Hoffer LJ, Griffith J, Waldo MC, Freedman R. Normalization by nicotine of deficient auditory sensory gating in the relatives of schizophrenics. Biol Psychiatry 1992;32(7):607-616.
44. Avila MT, Sherr JD, Hong E, Myers CS, Thaker GK. Effects of nicotine on leading saccades during smooth pursuit eye movements in smokers and nonsmokers with schizophrenia. Neuropsychopharmacology 2003;28(12):2184-2191.
45. Olincy A, Johnson LL, Ross RG. Differential effects of cigarette smoking on performance of a smooth pursuit and a saccadic eye movement task in schizophrenia. Psychiatry Res 2003;117(3):223-236.
46. Adler LE, Olincy A, Waldo M, Harris JG, Griffith J, Stevens K, et al. Schizophrenia, sensory gating, and nicotinic receptors. Schizophr Bull 1998;24(2):189-202.
47. Tregellas JR, Tanabe JL, Miller DE, Ross RG, Olincy A, Freedman R. Neurobiology of smooth pursuit eye movement deficits in schizophrenia: an fMRI study. Am J Psychiatry 2004;161(2):315-321.
48. Tregellas JR, Tanabe JL, Martin LF, Freedman R. FMRI of response to nicotine during a smooth pursuit eye movement task in schizophrenia. Am J Psychiatry 2005;162(2):391-393.
49. Jacobsen LK, D'Souza DC, Mencl WE, Pugh KR, Skudlarski P, Krystal JH. Nicotine effects on brain function and functional connectivity in schizophrenia. Biol Psychiatry 2004;55(8):850-858.
50. Lawrence NS, Ross TJ, Stein EA. Cognitive mechanisms of nicotine on visual attention. Neuron 2002;36(3):539-548.
51. Goff DC, Evins AE. Negative symptoms in schizophrenia: neurobiological models and treatment response. Harv Rev Psychiatry 1998;6(2):59-77.
52. Levin E, Icenogle L, Farzad A. Ketanserin attenuates nicotine-induced working memory improvement in rats. Pharmacol Biochem Behav 2005;82(2):289-292.
53. Tizabi Y, Mastropaolo J, Park CH, Riggs RL, Powell D, Rosse RB, et al. Both nicotine and mecamylamine block dizocilpine-induced explosive jumping behavior in mice: psychiatric implications. Psychopharmacology (Berl) 1998;140(2):202-205.
54. Spielewoy C, Markou A. Strain-specificity in nicotine attenuation of phencyclidine-induced disruption of prepulse inhibition in mice: relevance to smoking in schizophrenia patients. Behav Genet 2004;34(3):343-354.
55. Vidal C. Nicotine potentiation of glutamatergic synapses in the prefrontal cortex: New insight into the analysis of the role of nicotinic receptors in cognitive functions. Drug Dev Res 1994;31:120-126.
56. McGehee DS, Heath MJ, Gelber S, Devay P, Role LW. Nicotine enhancement of fast excitatory synaptic transmission in the CNS by presynaptic receptors. Science 1995;269(5231):1692-1696.
57. Clarke PB, Pert A. Autoradiographic evidence for nicotine receptors on nigrostriatal and mesolimbic dopaminergic neurons. Brain Research 1985;348(2):355-358.
58. Balfour DJ. Neural mechanisms underlying nicotine dependence. Addiction 1994;89(11):1419-1423.
59. Harris JG, Kongs S, Allensworth D, Martin L, Tregellas J, Sullivan B, et al. Effects of nicotine on cognitive deficits in schizophrenia. Neuropsychopharmacology 2004;29(7):1378-1385.
60. Barr RS, Culhane MA, Jubelt LE, Mufti RS, Dyer MA, Weiss AP, et al. The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology 2007 Apr 18; Epub ahead of print.
61. Smith RC, Singh A, Infante M, Khandat A, Kloos A. Effects of cigarette smoking and nicotine nasal spray on psychiatric symptoms and cognition in schizophrenia. Neuropsychopharmacology 2002;27(3):479-497.
62. Myers CS, Rabies O, Kakoyannis AN, Sherr JD, Avila MT, Blaxton TA, et al. Nicotine improves delayed recognition in schizophrenic patients. Psychopharmacology (Berl) 2004;174(3):334-340.
63. Levin ED, Briggs SJ, Christopher NC, Rose JE. Persistence of chronic nicotine-induced cognitive facilitation. Behav Neural Biol 1992;58(2):152-158.
64. White HK, Levin ED. Four-week nicotine skin patch treatment effects on cognitive performance in Alzheimer's disease. Psychopharmacology (Berl) 1999;143(2):158-165.
65. Levin ED, Conners CK, Silva D, Canu W, March J. Effects of chronic nicotine and methylphenidate in adults with attention deficit/ hyperactivity disorder. Exp Clin Psychopharmacol 2001;9(1):83-90.
66. Levin ED, Conners CK, Sparrow E, Hinton SC, Erhardt D, Meck WH, et al. Nicotine effects on adults with attention-deficit/hyperactivity disorder. Psychopharmacology (Berl) 1996;123(1):55-63.
67. White HK, Levin ED. Chronic transdermal nicotine patch treatment effects on cognitive performance in age-associated memory impairment. Psychopharmacology (Berl) 2004;171(4):465-471.
68. Rezvani AH, Levin ED. Nicotinic-glutamatergic interactions and attentional performance on an operant visual signal detection task in female rats. Eur J Pharmacol 2003;465(1-2):83-90.
69. Hernandez CM, Terry AV Jr. Repeated nicotine exposure in rats: effects on memory function, cholinergic markers and nerve growth factor. Neuroscience 2005;130(4):997-1012.
70. Chung YC, Li Z, Dai J, Meltzer HY, Ichikawa J. Clozapine increases both acetylcholine and dopamine release in rat ventral hippocampus: role of 5-HT1A receptor agonism. Brain Res 2004;1023(1):54-63.
71. Adler LE, Olincy A, Cawthra EM, McRae KA, Harris JG, Nagamoto HT, et al. Varied effects of atypical neuroleptics on P50 auditory gating in schizophrenia patients. Am J Psychiatry 2004;161(10):1822-1828.
72. Simosky JK, Stevens KE, Freedman R. Nicotinic agonists and psychosis. Curr Drug Targets CNS Neurol Disord 2002;1(2):149-162.
73. McEvoy J, Freudenreich O, McGee M, VanderZwaag C, Levin E, Rose J. Clozapine decreases smoking in patients with chronic schizophrenia. Biol Psychiatry 1995;37(8):550-552.
74. George TP, Sernyak MJ, Ziedonis DM, Woods SW. Effects of clozapine on smoking in chronic schizophrenic outpatients. J Clin Psychiatry 1995;56(8):344-346.
75. McEvoy JP, Freudenreich O, Wilson WH. Smoking and therapeutic response to clozapine in patients with schizophrenia. Biol Psychiatry 1999;46(1):125-129.
76. Addy NA, Pocivavsek A, Levin ED. Reversal of clozapine effects on working memory in rats with fimbria-fornix lesions. Neuropsychopharmacology 2005;30(6):1121-1127.
77. George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkel J, et al. Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry 2000;157(11):1835-1842.
78. Lader D, Meltzer H. Smoking related behaviour and attitudes, 2001. London: Office for National Statistics, Department of Health; 2001.
79. Evins AE, Cather C, Rigotti NA, Freudenreich O, Henderson DC, Olm-Shipman CM, et al. Two-year follow up of a smoking cessation trial in patients with schizophrenia: increased rates of smoking cessation and reduction. J Clin Psychiatry 2004;65(3):307-311.
80. Addington J, el-Guebaly N, Addington D, Hodgins D. Readiness to stop smoking in schizophrenia. Can J Psychiatry 1997;42(1):49-52.
81. Ziedonis DM, George TP. Schizophrenia and nicotine use: report of a pilot smoking cessation program and review of neurobiological and clinical issues. Schizophr Bull 1997;23(2):247-254.
82. Sullivan MA. Patterns of nicotine use among schizophrenic and schizoaffective outpatients. In: Society for Research on Nicotine and Tobacco. Proceedings of the 4th Annual Scientific Conference; 1998; New Orleans, LA; 1998. p. A1.
83. Evins AE, Tisdale T. Bupropion and smoking cessation. Am J Psychiatry 1999;156(5):798-799.
84. Weiner E, Ball MP, Summerfelt A, Gold J, Buchanan RW. Effects of sustained-release bupropion and supportive group therapy on cigarette consumption in patients with schizophrenia. Am J Psychiatry 2001;158(4):635-637.
85. Evins AE, Mays VK, Rigotti NA, Tisdale T, Cather C, Goff DC. A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia. Nicotine Tob Res 2001;3(4):397-403.
86. George TP, Vessicchio JC, Termine A, Bregartner TA, Feingold A, Rounsaville BJ, et al. A placebo controlled trial of bupropion for smoking cessation in schizophrenia. Biol Psychiatry 2002;52(1):53-61.
87. Addington J, el-Guebaly N, Campbell W, Hodgins DC, Addington D. Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry 1998;155(7):974-976.
88. Williams JM, Ziedonis DM, Foulds J. A case series of nicotine nasal spray in the treatment of tobacco dependence among patients with schizophrenia. Psychiatr Serv 2004;55(9):1064-1066.
89. Evins AE, Cather C, Deckersbach T, Freudenreich O, Culhane MA, Olm-Shipman CM, et al. A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. J Clin Psychopharmacol 2005;25(3):218-225.
90. Baker A, Richmond R, Haile M, Lewin TJ, Carr VJ, Taylor RL, et al. A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. Am J Psychiatry 2006;163(11):1934-1942.
91. Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999;340(9):685-691.
92. Saxon AJ, Baer JS, Davis TM, Sloan KL, Malte CA, Fitzgibbons K, et al. Smoking cessation treatment among dually diagnosed individuals: preliminary evaluation of different pharmacotherapies. Nicotine Tob Res 2003;5(4):589-596.
93. Fagerstrom KO, Schneider NG, Lunell E. Effectiveness of nicotine patch and nicotine gum as individual versus combined treatments for tobacco withdrawal symptoms. Psychopharmacology (Berl) 1993;111(3):271-277.
94. Blondal T, Gudmundsson LJ, Olafsdottir I, Gustavsson G, Westin A. Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow-up. BMJ 1999;318(7):285-288.
95. Kornitzer M, Boutsen M, Dramaix M, Thijs J, Gustavsson G. Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. Prev Med 1995;24(1):41-47.
96. Evins AE, Cather C, Culhane MA, Birnbaum A, Horowitz J, Hsieh E, et al. A 12-week double-blind, placebo-controlled study of bupropion sr added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia. J Clin Psychopharmacol 2007;27(4):380-386.
97. Hurt RD, Sachs DP, Glover ED, Offord KP, Johnston JA, Dale LC, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997;337(17):1195-1202.
98. Hall SM, Humfleet GL, Reus VI, Munoz RF, Hartz DT, Maude-Griffin R. Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 2002;59(10):930-936.
99. Hays JT, Hurt RD, Rigotti NA, Niaura R, Gonzales D, Duncan MJ, et al. Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. a randomized, controlled trial. Ann Intern Med 2001;135(6):423-433.
100. Durcan MJ, Deener G, White J, Johnston JA, Gonzales D, Niaura R, et al. The effect of bupropion sustained-release on cigarette craving after smoking cessation. Clin Ther 2002;24(4):540-551.
101. Hall SM, Humfleet GL, Reus VI, Munoz RF, Cullen J. Extended nortriptyline and psychological treatment for cigarette smoking. Am J Psychiatry 2004;161(11):2100-2107.
102. Rollema H, Chambers LK, Coe JW, Glowa J, Hurst RS, Lebel LA, et al. Pharmacological profile of the alpha4beta2 nicotinic acetylcholine receptor partial agonist varenicline, an effective smoking cessation aid. Neuropsychopharmacology 2007;52(3):985-994.
103. Coe JW, Brooks PR, Vetelino MG, Wirtz MC, Arnold EP, Huang J, et al. Varenicline: an alpha4beta2 nicotinic receptor partial agonist for smoking cessation. J Med Chem 2005;48:3474-3477.
104. Mihalak KB, Carroll FI, Luetje CW. Varenicline is a partial agonist at alpha4beta2 and a full agonist at alpha7 neuronal nicotinic receptors. Mol Pharmacol 2006;70(3):801-805.
105. Oncken C, Gonzales D, Nides M, Rennard S, Watsky E, Billing CB, et al. Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation. Arch Intern Med 2006;166(15):1571-1577.
106. Nides M, Oncken C, Gonzales D, Rennard S, Watsky EJ, Anziano R, et al. Smoking cessation with varenicline, a selective alpha4beta2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up. Arch Intern Med 2006;166(15):1561-1568.
107. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA 2006;296(1):47-55.
108. Jorenby D, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation. JAMA 2006;296(1):56-63.
109. Tonstad S, Tonnesen P, Hajek P, Williams KE, Billing CB, Reeves KR. Effect of maintenance therapy with varenicline on smoking cessation. JAMA 2006;296(1):64-71.
110. Williams KE, Reeves KR, Billing CB Jr, Pennington AM, Gong J. A double-blind study evaluating the long-term safety of varenicline for smoking cessation. Curr Med Res Opin 2007;23(4):793-801.
111. Freedman R. Exacerbation of schizophrenia by varenicline. Am J Psychiatry 2007;164(8):1269.
112. Evins AE, Goff DC. J Clin Psychiatry. In press 2007.