Tobacco Use and Cataracts in Patients With Schizophrenia

To the Editor: We read with great interest the recent report by Stephen R. Marder, M.D., and coauthors on the physical health monitoring of patients with schizophrenia (1). We agree with those authors’ concerns that “the health needs of people with schizophrenia…are not adequately addressed by clinicians in specialty mental health programs or in primary care settings.” However, we were perplexed to find that tobacco smoking was not considered in the review process, and no recommendations for monitoring and intervening on tobacco smoking were made in the report. There is a real risk that this report may worsen rather than improve the health of people with schizophrenia by advising clinicians to monitor and intervene on factors that have relatively small impact on their patients’ health while ignoring the main causes (substance use generally and tobacco use in particular).

Most of the excess mortality in schizophrenia is directly attributable to cigarette smoking (2). There is also an indirect effect of tobacco use on health through the high proportion of total income that people with schizophrenia spend on tobacco (27%) (3). Mental health professionals rarely assess their patients’ tobacco use (4), despite the existence of effective treatments (5–7).

We hope that those responsible for the care of people with schizophrenia will strive to improve the physical health of their patients but will target their efforts appropriately to the main causes of ill health and premature death rather than focusing on the side effects of psychotropic medications. Among the most important things clinicians can do for the health of people with schizophrenia is the proper assessment and treatment of nicotine dependence (8).