Many pages of The Carlat Report have been devoted to how we cause our patients to become obese with some of the medications we prescribe. In this article, we review ways in which we can atone for our sins.

Too many of our patients smoke, especially those with schizophrenia. Amazingly, the best estimate is that 85% of patients with schizophrenia are regular smokers (Am J Psychiatry 1986; 143:993-997). While we may not have a whole lot of time during our sessions to discuss smoking, it’s still helpful to tuck away some smoking cessation tools in your arsenal.

Dr. Guttmacher, as the Chief of Psychiatry at a large state hospital (the Rochester Psychiatric Center), you have a wealth of experience caring for the chronically mentally ill. I know you have been giving quite a bit of thought lately to medical issues that psychiatrists may be missing in this population.

Archeological evidence suggests that tobacco grew in the Americas as long ago as 6000 B.C., and that the custom of smoking it began with the Mayans, sometime around 1000 B.C. The first European to smoke is thought to be Rodrigo de Jerez, who, with Christopher Columbus, observed the custom in Cuba in 1493.