• continuous smoking reduction (50 % reduction in weekly expired air carbon monoxide (CO) measurements compared to baseline and self report) [ Time Frame: end of treatment ] [ Designated as safety issue: No ]
• continuous tobacco abstinence (weekly expired CO measurements less than 9 ppm and self report) [ Time Frame: end of treatment ] [ Designated as safety issue: No ]
• psychotic symptoms [ Time Frame: continuous and end of treatment ] [ Designated as safety issue: No ]
• negative side effects [ Time Frame: continuous ] [ Designated as safety issue: Yes ]
• negative and depressive symptoms compared to baseline at the end of the 3-month treatment and 3-month follow-up phases [ Time Frame: continuous and end of treatment ] [ Designated as safety issue: No ]
• measures of attention and memory while attempting to quit smoking [ Time Frame: end of treatment ] [ Designated as safety issue: No ]
• health-related quality at the end of the 3-month treatment and 3-month follow-up phases [ Time Frame: continuous and end of treatment ] [ Designated as safety issue: No ]
• weight gain at the end of the 3-month treatment and 3-month follow-up phases [ Time Frame: continuous and end of treatment ] [ Designated as safety issue: No ]

• continuous smoking reduction (50 % reduction in weekly expired air carbon monoxide (CO) measurements compared to baseline and self report)
• continuous tobacco abstinence (weekly expired CO measurements less than 9 ppm and self report)
• psychotic symptoms
• negative side effects
• negative and depressive symptoms compared to baseline at the end of the 3-month treatment and 3-month follow-up phases
• measures of attention and memory while attempting to quit smoking
• health-related quality at the end of the 3-month treatment and 3-month follow-up phases
• weight gain at the end of the 3-month treatment and 3-month follow-up phases

Many individuals with schizophrenia smoke cigarettes. Individuals in the schizophrenic population often find it difficult to quit smoking. The purpose of this trial is to determine the safety and effectiveness of bupropion in treating individuals with schizophrenia who smoke.

Schizophrenia affects 1 % of the population. Among individuals with schizophrenia, between 74 and 92 % smoke cigarettes regularly. Heavy smoking represents a significant and neglected public health problem for people with schizophrenia; smoking cessation treatment is often overlooked as part of the psychiatric care for such individuals.

The most effective treatment for smoking cessation described to date is sustained release (SR) bupropion. Past research suggests that SR bupropion may be especially effective in individuals with depressive symptoms, including individuals with schizophrenia. The purpose of this trial is to evaluate the safety and efficacy of SR bupropion, when combined with cognitive behavioral therapy (CBT), in individuals with schizophrenia.

This trial will last 12 weeks. Participants will be randomly assigned to receive SR bupropion or placebo. All participants will receive weekly CBT. Participants will be followed for 3 months following completion of the 12-week treatment session.

• Tobacco-Use Disorder
• Schizophrenia
• Psychotic Disorders

• Drug: bupropion SR
• Behavioral: Cognitive Behavioral Group Therapy
• Drug: nicotine replacement therapy

• Experimental: Experiment group received 300 mgs of bupropion, in addition to weekly CBT and nicotine replacement therapy
• Placebo Comparator: Placebo group received placebo, in addition to weekly CBT and nicotine replacement therapy

Inclusion Criteria:

• Meets DSM-IV criteria for schizophrenia or schizoaffective disorder
• Receiving a stable dose of antipsychotic medication for at least 1 month prior to study entry
• Smokes at least 10 cigarettes per day
• Wishes to stop smoking
• Attended last three scheduled clinic visits, prior to study entry

Exclusion Criteria:

• Significant medical or neurologic illness
• History of severe head injury with loss of consciousness
• Treated with monoamine oxidase inhibitors or carbamazepine in the 14 days prior to study entry
• Taking clozapine at doses greater than 500 mg/d without an anticonvulsant
• Currently undergoing an acute exacerbation of psychotic symptoms
• Current or history of bulimia or anorexia
• Current excessive water intake
• Recent history of mania
• Known allergy or hypersensitivity to bupropion
• Current substance abuse other than tobacco, nicotine replacement treatment, or smokeless tobacco
• Currently receiving treatment with bupropion
• Pregnant or breastfeeding