Tabaquismo y enfermedad psiquiátrica enmascarada

Abstract

Introduction

In order to achieve an adequate case management with patients who smoke, we must study the habit and make a correct diagnosis. Respiratory, cardiovascular and psychiatric comorbidities should also be taken into account.

Case report

We present the case of a 53-year old male patient who was an active smoker of 70 packs/year index. He had previously unsuccessfully attempted to quite smoking. Fagerstrom and Glover-Nilsson tests showed low physical (2 points) and psychosocial and behavioral dependence (9 points), respectively, whereas the Richmond test showed a moderate dependence (7 points). After an initial minimum approach, treatment was initiated with varenicline. At week 12 of treatment, he reported work-related insomnia (this had also appeared in the previous attempts to quit the habit, and ceased with habit restoration) that did not respond to lorazepam. He was admitted in Psychiatry and was diagnosed with «adjustment disorder with mixed anxiety and depressed mood». After an 8-month treatment with mirtazapine, the insomnia abated with no smoking relapse.

Comment

In this insomnia should be regarded as a symptom of cigarette withdrawal, a varenicline side effect or a psychiatric symptom. Furthermore, smoking is not only very common among psychiatric patients, and it can mask underlying psychiatric disease in a supposedly non-psychiatric population. We must, therefore, make careful assessments and a correct use of the existing diagnostic tests and drugs currently used for smoking cessation.