SUMMARYTobacco smoking among people with mental illnesses can be explained by biological, psychological and social factors. The prevalence of smoking in people diagnosed with schizophrenia is higher than in people with other mental disorders and in the general population. This article explores three current hypotheses that explain this higher prevalence of smoking in schizophrenia. The first, the self-medication hypothesis, is increasingly countered by a growing body of evidence indicating that smokers experience more severe symptoms of schizophrenia. Numerous researchers have already identified smoking as a possible risk factor for the development of schizophrenia, which is the second hypothesis. The third hypothesis (shared genetic vulnerability) identifies certain genes that confer vulnerability for both schizophrenia and nicotine dependence. Understanding the reasons behind the higher prevalence of smoking among people with schizophrenia is vital in planning effective primary, secondary and tertiary smoking prevention for these individuals.LEARNING OBJECTIVESAt the end of this article, readers will be able to: •understand the self-medication hypothesis in relation to tobacco smoking by people with schizophrenia•understand the role of tobacco smoking as a possible risk factor for causation of schizophrenia•understand the role of shared genetic vulnerability in the causation of both schizophrenia and nicotine dependence.

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Background:Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with a lifetime prevalence of 1.9%–3.0% in the general population. It is an easily missed diagnosis. Although several paper-based tools have been developed, none are culturally validated for Sri Lankans to screen for OCD at field level.Aims:This study aimed to translate and assess the validity and reliability of obsessive-compulsive inventory-revised scale (OCI-R) for Sri Lankan adults.Setting and Design:This study was a case–control study.Materials and Methods:This was conducted among 89 OCD patients and 89 controls recruited from the National Hospital of Sri Lanka to assess the criterion validity of OCI-R (an 18-item tool on common OCD symptoms using six subscales), by applying it and the gold standard (clinical diagnosis made by two independent consultant psychiatrists) to the same patient simultaneously. Before this, the tool was translated into local language (Sinhala) by bilingual experts and two psychiatrists using the forward-backward translation method. Receiver operating characteristics (ROC) curve was drawn to determine the cutoff value to identify OCD in Sri Lanka.Results:The translated tool demonstrated the following: sensitivity 84.4%, specificity 85.6%, positive predictive value 85.4%, negative predictive value 84.6%, and positive and negative likelihood ratios of 5.86 and 0.18, respectively. The cutoff value for diagnosing OCD was 21 according to the ROC curve. Internal consistency (Cronbach's alpha reliability coefficient) of all six domains and the total scale showed values exceeding Nunnally's criteria of 0.7.Conclusions:Sinhala version of the OCI-R scale was identified as a valid and reliable screening instrument to be applied in Sri Lankan adults.

ConclusionsPharmacological methods seem to focus on managing withdrawal, and hold little promise in managing or preventing relapses, except varenicline. Despite heavy emphasis placed on NRT, nortriptyline seems to be safer, cheaper and equally effective. Brief advice given by doctors is as effective as NRT.Which non-pharmacological method work best with regards to relapse prevention is yet to be determined. Psychiatrists may use MI or personalised psychoeducation with or without nortriptyline, NRT, bupropion or varenicline. Clonidine is reserved as a second line intervention for inpatients. NRT may also be useful for temporary withdrawal of tobacco use for heavy smokers who are unwilling to quit. E-cigarettes are not to be recommended. Further research on unassisted cessation, safer interventions such as simple advice, and the role of tobacco and pharmaceutical industries is needed. New treatment guidance, better informed by evidence, is warranted.