A Rational Choice

By D.J.Jaffe, from: NYT Opinions/Letters


To the Editor:

Contrary to Dr. Mender's assertion ('Mentally Ill, Too, Get Hooked on Smoking,' letter, Aug. 22nd), individuals with schizophrenia who smoke do not do so because they have poor judgment or because they have been encouraged by institutional rules.

They smoke because nicotine stimulates the subcortial brain reward mechanisms and the prefrontal cortex, which may be hypoactive in schizophrenia. In addition, for individuals with schizophrenia, nicotine may also improve concentration, and reduce anxiety, positive and negative symptoms and symptoms of movement disorder.

Individuals with schizophrenia who smoke are, from where they sit, making what could be considered a very rational decision. For these reasons, the joint Commission on Accreditation of Health Care Organizations, the New York State Legislature, and the New York City Council have all included provisions that would allow individuals with neurobiological disorders who smoke to continue to smoke in discrete areas, even when hospitalized.

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