Tobacco use and impulsivity in people with mental illness: A systematic review

A 55-year-old man with a history of schizophrenia and heavy tobacco use presents to the emergency department with psychotic symptoms. Nursing staff report he has been increasingly restless and irritable since admission. He has not had access to cigarettes for over 12 hours. His chart notes a high Fagerström Test for Nicotine Dependence (FTND) score.

Which of the following may be a clinically justified management strategy?

A 29-year-old woman with bipolar II disorder is seen for routine psychiatric follow-up. She reports occasional mood swings and self-harming behavior. She mentions a history of smoking but does not identify it as a current concern.

What would be an appropriate clinical step to better understand her risk profile?

A 38-year-old man with schizophrenia is admitted to a psychiatric inpatient unit. He smokes heavily and has a history of repeated hospitalizations and one prior suicide attempt. On intake, he is in nicotine withdrawal and scores high on both the FTND and the Overt Aggression Scale (OAS).

Based on current evidence, which of the following best describes the role of tobacco smoking in patients with schizophrenia?

A 44-year-old woman with a history of major depressive disorder (MDD) reports difficulty maintaining abstinence from cigarettes despite multiple quit attempts. She expresses a strong interest in quitting but shares that smoking helps relieve her depressive symptoms. She also describes herself as impulsive, and her clinical history includes elevated baseline depressive symptoms and emotional reactivity.

Which of the following is the most appropriate to suggest?

A 28-year-old man presents to a psychiatric clinic with ongoing difficulties in managing his behavior. He reports frequently interrupting conversations, acting on urges without considering consequences, and engaging in risky activities like speeding and gambling. He also describes feeling overwhelmed by emotions and sometimes making impulsive decisions in those moments. On further assessment, he performs poorly on the Go/No-Go Task and reports high scores on the Barratt Impulsiveness Scale.

Which of the following best reflects the multidimensional nature of impulsivity as seen in this patient?