CLINICAL HANDBOOK OF SCHIZOPHRENIA

41. Medical Comorbidity 433Counseling regarding risk reduction is an essential component in reducing the likelihoodof becoming infected or of transmitting viral infections. Several risk reduction programsuse 8–12 sessions of group and individual cognitive-behavioral therapy. However,brief, individually tailored counseling may be more feasible and still be effective. In threesessions, the newly developed STIRR model (Screen, Test, Immunize, Reduce Risk, andRefer) intervention developed by Rosenberg and colleagues (2004) provides education,risk assessment, risk reduction counseling, screening, pre- and posttest counseling, vaccinationagainst hepatitis A and B, treatment referrals, and follow-up.Individuals infected with HIV, HBV, or HCV should be referred promptly to specialistmedical care. Although no cure is available, appropriate medical care can slow diseaseprogression. Chronic infections with either type of hepatitis can cause cirrhosis or cancerof the liver (this is particularly common in hepatitis C). Because HCV infection oftencauses no symptoms for the first two decades, it is frequently diagnosed and referred tomedical care late in the disease process. Therefore, liver damage is typically present whensymptoms appear. When diagnosed with hepatitis, it is vital to stop consuming alcoholand other substances that can be toxic to the liver, including certain medications.Given the complexity of HIV and hepatitis treatments, efforts to support personswith schizophrenia continually in managing their illness and to follow treatment regimensare particularly helpful.SmokingSmoking cessation is an important goal for all persons with schizophrenia. For those whoalso have diabetes, hypertension, heart disease, or COPD, it is absolutely essential to quitsmoking. Although smoking has decreased in the general population, it is still commonamong persons with serious mental illnesses, including schizophrenia. Research on nicotinereceptors of the brain suggests that individuals with schizophrenia may have an increasedbiological risk for tobacco use and nicotine dependence. Lifestyle, social, and environmentalfactors also contribute to high rates of tobacco use. For sustainable smoking cessation,it is important to address how the “void” of a cigarette habit may be filled withother useful activities.Formal smoking cessation programs designed for persons with schizophrenia may benecessary in achieving successful and sustained recovery from nicotine dependence. Alongwith cognitive-behavioral treatment, smoking cessation programs for schizophrenia generallyinclude bupropion and/or nicotine replacement therapy. Long-term replacement withnicotine may be useful to prevent relapse. It is important to be aware that the process of quittingcan affect psychiatric symptoms and increase the risk for relapse. In addition, plasmalevels of antipsychotic medications sometimes increase when smoking is discontinued.Antipsychotic MedicationsAntipsychotic medications are associated with a wide range of potential physical side effectsand health risks. The newer (atypical), or “second-generation,” antipsychotics havefewer nervous system side effects and have been promoted as being potentially more effectivethan the older “conventional,” or “first-generation,” antipsychotic medications,such as Haldol and Prolixin. However, as a group, it is not clear that atypicalantipsychotics are more effective than first-generation antipsychotics. Furthermore, thesemedications carry a new and different set of potential health risks that have raised concernamong consumers and providers (e.g., weight gain and elevated blood sugar). Atypicalantipsychotics have been associated with an increased risk of developing metabolicsyndrome, characterized by a combination of metabolic risk factors, including abdominal