Liam Davenport

April 11, 2016

FLORENCE, Italy — e-Cigarettes may help reduce tobacco smoking among individuals with serious mental illness as well as the harm associated with cigarette smoking in this patient population, results of a new pilot study indicate.

In a poster presented here at the Schizophrenia International Research Society (SIRS) 2016 Biennial Meeting, researchers from King's College London and the London South Bank University, United Kingdom, found that the use of e-cigarettes for 6 weeks led to significant reductions in tobacco use and in expired carbon monoxide levels.

The researchers concluded that e-cigarettes may be "useful in supporting smoking reduction/cessation in patients with serious mental illness" without exacerbating their psychopathologic symptoms.

Noting that previous studies have indicated that e-cigarettes may be effective for reducing harm among individuals with serious mental illness, the researchers recruited 36 smokers from a community mental health service in South London.

The participants were aged 18 to 70 years and had been diagnosed with schizophrenia, bipolar disorder, or schizoaffective or schizophreniform disorders. They were given free e-cigarettes (King Bold brand, 4.5% nicotine) for 6 weeks and were encouraged to use the e-cigarettes instead of their conventional cigarettes.

Patients were assessed weekly for 12 weeks, and then again at 12 weeks. Use of conventional cigarettes and e-cigarettes was recorded in a weekly diary, and expired carbon monoxide and peak exploratory flow rates were collected.

In addition, the acceptability of e-cigarettes was assessed using a visual analogue scale and the e-Cig Intention to Continue questionnaire. Any adverse effects were recorded. The Positive and Negative Syndrome Scale (PANSS) was administered on a weekly basis to assess psychotic symptoms.

The results indicated that there was a significant reduction in the average number of cigarettes smoked per day between baseline and week 10 (P < .001). There was also a significant reduction in the use of e-cigarettes during follow-up (P = .001).

The team also found that there was a significant reduction in expired carbon monoxide levels between baseline and week 6 (P = .021). There was, however, no significant changed in peak flow rates between baseline and follow-up (P > .05).

By week 6, 44% of the patients stated that they wanted to reduce their cigarette use and to continue to use e-cigarettes. Interestingly, 41% of patients felt that the e-cigarettes tasted nothing at all like a tobacco cigarette, as measured on the visual analogue scale.

There were no significant changes in scores on the positive, negative, or general subscales of the PANSS.

Lead investigator Lauren Hickling, Institute of Psychiatry, Psychology and Neuroscience, King's College London, who presented the poster, pointed out that in their study, they used a first- generation e-cigarette and that they would "expect similar results, possibly slightly better" with the latest-generation devices.

Lauren Hickling

She told Medscape Medical News that the reason they chose an older e-cigarette was partly "because a lot of our users were new to electronic cigarettes, so these can be disposed of and don't need recharging or refilling, so it's a lot easier in that respect."

She also noted, "To avoid bias, this is the only one that's not owned by a tobacco company, so we're not funding them at all."

Hickling pointed out that with second- and third-generation e-cigarettes, levels of nicotine can be adjusted, and the "nicotine hit" increased or decreased. e-Cigarettes may therefore "be better at reducing and helping people to quit smoking."

She added that the change in peak flow levels in their study was "erring towards the trend level," and so with further study, they may see a significant change, particularly when using second- and third-generation e-cigarettes.

Funding for the study was provided by the Maudsley Charity. The investigators report no relevant financial relationships.

Schizophrenia International Research Society (SIRS) 2016 Biennial Meeting: Poster M53, presented April 4, 2016.

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