In the EAGLES trial, the participants were motivated individuals who had on average 3 past quit attempts. Research suggests that even patients who have a serious mental illness can be motivated to quit (Box).6-9
Box
Mental illness and motivation to quit smoking
In the past, clinicians may have believed that many individuals with mental illness typically weren’t motivated to quit smoking. We now know this is not the case and that such patients’ motivation is similar to that of the general population, and the reasons driving their desire are the same—health concerns and social influences.6 Even individuals with serious mental illness such as schizophrenia who have a long history of tobacco use are highly motivated and persistent in their attempts to quit.7,8 The prevalence of future “readiness to quit” among individuals diagnosed with schizophrenia and depression ranges from 21% to 49%, which is similar to that among the general population (26% to 41%). Evidence also suggests that motivation translates into successful quitting, with quit rates of up to 22% for people with mental illness who use a combination of psychosocial and pharmacological interventions.9
3. What is the patient’s mental health status? What is the patient’s psychiatric diagnosis and how clinically stable is he or she? What is his or her suicide risk? Consider using the Columbia Suicide Severity Rating Scale (C-SSRS).10
In the EAGLES trial, the psychiatric cohort included only patients who had been clinically stable for the past 6 months and had received the same medication regimen for at least the past 3 months, with no expected changes for 12 weeks. Patients with certain diagnoses were excluded (eg, delusional disorder, schizophreniform disorder, impulse control disorders), and only 1% had a personality disorder, which increases mood lability and likelihood of suicidality behavior.
Continue to: Does the patient have another comorbid substance use disorder?