{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:12:18Z","timestamp":1791378738880,"version":"4.3.2"},"reference-count":50,"publisher":"MedWorks Media","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychopharmacol Bull"],"abstract":"<jats:p>Objective: To estimate the association between tobacco use and the prevalence of psychotropic medication use and prescribed dosage among inpatients and outpatients with severe mental disorders treated at a neuropsychiatric hospital. Methods: Observational, cross-sectional, analytical study conducted on May 3, 2023. Smoking status and prescribed psychotropic medications were recorded for all hospitalized patients and community-based outpatients. Dosages were reported in mg\/day, defined daily doses (DDD), and for antipsychotics as chlorpromazine equivalents (CPZeq). Bivariate and multivariate analyses were performed. Results: Tobacco use data were collected from 325 out of 425 total patients (71.7% male, mean age [SD]: 51.4 [14.4] years, 56% inpatients, 70.2% with schizophrenia and related psychosis). The prevalence of smoking was 72.3%, with differences by gender (78.1% in males vs. 57.8% in females, p &lt; 0.001), and decreased with age (18\u201339 years: 86.1%; 40\u201359 years: 71.7%; \u2a7e 60 years: 63.2%; p = 0.01). Mean dosages of antipsychotics, clozapine, and olanzapine measured in CPZeq were higher in smokers than in non-smokers by 35.4%, 37.1%, and 33.3%, respectively. After adjusting for confounding factors, smoking was associated with a 21.8% higher dosage of antipsychotics (95% CI: 0.4%\u201343.2%; p = 0.046), equivalent to an additional 132.2 mg\/day (24.2\u2013240.1; p = 0.017) of clozapine and 5.4 mg\/day (1.2\u20139.6; p = 0.012) of olanzapine. The average dosage of sedatives\/hypnotics was 45.5% higher among smokers (13.6%\u201389.5%; p = 0.008). Conclusion: A high prevalence of smoking was found among patients with severe mental disorders, associated with higher average dosages of sedatives\/ hypnotics and antipsychotics, particularly clozapine and olanzapine. Psychopharmacology Bulletin. 2026;56(1):48\u201363.<\/jats:p>","DOI":"10.64719\/pb.15417","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:38:16Z","timestamp":1767976696000},"page":"48-63","source":"Crossref","is-referenced-by-count":0,"title":["Differences in the Prevalence of Use and Dosage of Psychotropic Drugs by Smoking Status in Inpatient and Outpatient: An Observational, Analytical, Cross-Sectional Study"],"prefix":"10.64719","volume":"56","author":[{"given":"Pedro Damian","family":"Gargoloff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00edn A.","family":"Urtasun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Riveros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iv\u00e1n Omar Moreno","family":"Frade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00edn","family":"Ca\u00f1\u00e1s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54175","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"de Leon J, Diaz FJ. 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Effects of a complete smoking ban on inpatients at an intermediate to long-term psychiatric facility. Community Ment Health J. 2013;49(2):193\u2013198. doi: 10.1007\/s10597-012-9532-z.","DOI":"10.1007\/s10597-012-9532-z"},{"key":"ref5","unstructured":"Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3(2):A42."},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Prochaska JJ, Das S, Young-Wolff KC. Smoking, mental illness, and public health. Annu Rev Public Health. 2017;38:165\u2013185. doi: 10.1146\/annurev-publhealth-031816-044618.","DOI":"10.1146\/annurev-publhealth-031816-044618"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Callaghan RC, Veldhuizen S, Jeysingh T et al. Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. J Psychiatr Res. 2014;48(1):102\u2013110. doi: 10.1016\/j.jpsychires.2013.09.014.","DOI":"10.1016\/j.jpsychires.2013.09.014"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Reeves S, Bertrand J, Obee SJ, Hunter S, Howard R, Flanagan RJ. A population pharmacokinetic model to guide clozapine dose selection, based on age, sex, ethnicity, body weight and smoking status. Br J Clin Pharmacol. 2024;90(1):135\u2013145. doi: 10.1111\/bcp.15691.","DOI":"10.1111\/bcp.15691"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Flanagan RJ, Hunter S, Obee SJ, Reeves S. Clozapine: dose, sex, ethnicity, smoking habit, age, body weight, and plasma clozapine and N - desmethylclozapine (Norclozapine) concentrations in clinical practice. J Clin Psychopharmacol. 2023;43(2):131. doi: 10.1097\/JCP.0000000000001653.","DOI":"10.1097\/JCP.0000000000001653"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Zang YN, Dong F, Li AN et al. The impact of smoking, sex, infection, and comedication administration on oral olanzapine: a population pharmacokinetic model in Chinese psychiatric patients. Eur J Drug Metab Pharmacokinet. 2021;46(3):353\u2013371. doi: 10.1007\/s13318-021-00673-5.","DOI":"10.1007\/s13318-021-00673-5"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Tsuda Y, Saruwatari J, Yasui-Furukori N. Meta-analysis: the effects of smoking on the disposition of two commonly used antipsychotic agents, olanzapine and clozapine. BMJ Open. 2014;4(3):e004216. doi: 10.1136\/bmjopen-2013-004216.","DOI":"10.1136\/bmjopen-2013-004216"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Barrangou-Poueys-Darlas M, Guerlais M, Laforgue EJ et al. CYP1A2 and tobacco interaction: a major pharmacokinetic challenge during smoking cessation. Drug Metab Rev. 2021;53(1):30\u201344. doi: 10.1080\/03602532.2020.1859528.","DOI":"10.1080\/03602532.2020.1859528"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Nguyen C, Mondoloni S, Le Borgne T et al. Nicotine inhibits the VTA-to-amygdala dopamine pathway to promote anxiety. Neuron. 2021;109(16):2604\u20132615.e9. doi: 10.1016\/j.neuron.2021.06.013.","DOI":"10.1016\/j.neuron.2021.06.013"},{"key":"ref14","unstructured":"Campion J, Shiers D, Britton J, Gilbody S, Bradshaw T. Primary care guidance on smoking and mental disorders\u20142014 Update. [Published online 2014]; https:\/\/www.rcpsych.ac.uk\/docs\/default-source\/improving-care\/better-mh-policy\/policy\/primary-care-guidance-on-smoking-and-mental-disorders-2014-update.pdf."},{"key":"ref15","unstructured":"Taylor DM, Barnes TR, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 15th. Wiley-Blackwell; 2025."},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Corrales A, Vilapri\u00f1o Duprat M, Benavente Pinto C et al. Argentine consensus on the diagnosis and therapeutics of treatment resistant schizophrenia. Vertex B Aires Argent. 2021;XXXII(154):49\u201385. doi: 10.53680\/vertex.v32i154.119.","DOI":"10.53680\/vertex.v32i154.119"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Gargoloff PD, Urtasun MA, Riveros R, Ruiz V, Ca\u00f1\u00e1s M. Patrones de prescripci\u00f3n de psicof\u00e1rmacos en usuarios internados y en atenci\u00f3n ambulatoria comunitaria en el hospital neuropsiqui\u00e1trico \u201cDr. Alejandro Korn\u201d, La Plata, Argentina. Estudio de corte transversal. Vertex B Aires Argent. 2025;36(167, ene.mar.):6\u201316. doi: 10.53680\/vertex.v36i167.796.","DOI":"10.53680\/vertex.v36i167.796"},{"key":"ref18","unstructured":"WHO collaborating centre for drug statistics methodology. 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Am J Health Syst Pharm.. 2007;64(18):1917\u20131921. doi: 10.2146\/ajhp060414.","DOI":"10.2146\/ajhp060414"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Haslemo T, Eikeseth PH, Tanum L, Molden E, Refsum H. The effect of variable cigarette consumption on the interaction with clozapine and olanzapine. Eur J Clin Pharmacol. 2006;62(12):1049\u20131053. doi: 10.1007\/s00228-006-0209-9.","DOI":"10.1007\/s00228-006-0209-9"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Desai HD, Seabolt J, Jann MW. Smoking in patients receiving psychotropic medications: a pharmacokinetic perspective. CNS Drugs. 2001;15(6):469\u2013494. doi: 10.2165\/00023210-200115060-00005.","DOI":"10.2165\/00023210-200115060-00005"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Brody AL, Mandelkern MA, Olmstead RE et al. Ventral striatal dopamine release in response to smoking a regular vs a denicotinized cigarette. Neuropsychopharmacol. 2009;34(2):282\u2013289. doi: 10.1038\/npp.2008.87.","DOI":"10.1038\/npp.2008.87"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Lee J, Salloum RG, Lindstrom K, Kathryn McHugh R. Benzodiazepine misuse and cigarette smoking status in US adults: Results from the National Survey on Drug Use and Health, 2015\u20132018. Addict Behav. 2021;123:107058. doi: 10.1016\/j.addbeh.2021.107058.","DOI":"10.1016\/j.addbeh.2021.107058"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Ostroumov A, Wittenberg RE, Kimmey BA et al. Acute nicotine exposure alters ventral tegmental area inhibitory transmission and promotes diazepam consumption. eNeuro. 2020;7(2):ENEURO.0348-19.2020. doi: 10.1523\/ENEURO.0348-19.2020.","DOI":"10.1523\/ENEURO.0348-19.2020"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"McArdle CJ, Arnone AA, Heaney CF, Raab-Graham KF. A paradoxical switch: the implications of excitatory GABAergic signaling in neurological disorders. Front Psychiatry. 2023;14:1296527. doi: 10.3389\/fpsyt.2023.1296527.","DOI":"10.3389\/fpsyt.2023.1296527"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Uliana DL, Lisboa JRF, Gomes FV, Grace AA. The excitatory-inhibitory balance as a target for the development of novel drugs to treat schizophrenia. Biochem Pharmacol. 2024;228:116298. doi: 10.1016\/j.bcp.2024.116298.","DOI":"10.1016\/j.bcp.2024.116298"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Coyle JT. The GABA-glutamate connection in schizophrenia: which is the proximate cause? Biochem Pharmacol. 2004;68(8):1507\u20131514. doi: 10.1016\/j.bcp.2004.07.034.","DOI":"10.1016\/j.bcp.2004.07.034"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Stahl SM. Stahl\u2019s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 5th. Cambridge University Press; 2021.","DOI":"10.1017\/9781108975292"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Kleinman RA, Barnett BS. Smoking cessation as a priority for psychiatrists. JAMA Psychiatry. 2024;81(10):951\u2013952. doi: 10.1001\/jamapsychiatry.2024.2162.","DOI":"10.1001\/jamapsychiatry.2024.2162"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Dome P, Lazary J, Kalapos MP, Rihmer Z. Smoking, nicotine and neuropsychiatric disorders. Neurosci Biobehav Rev. 2010;34(3):295\u2013342. doi: 10.1016\/j.neubiorev.2009.07.013.","DOI":"10.1016\/j.neubiorev.2009.07.013"},{"key":"ref42","unstructured":"NICE. Tobacco: preventing uptake, promoting quitting and treating dependence. [Published online 2021]; [Accessed May 28, 2025]; https:\/\/www.nice.org.uk\/guidance\/ng209."},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Alghzawi H, Trinkoff A, Zhu S, Storr C. 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