Complex cases and tobacco

In addictology, complex cases can take various forms across different specialties, with no official nomenclature to define them. In psychiatry, particularly among schizophrenic patients, the interactions between medication-based treatments, tobacco use, and clinical status are significant. When failing to achieve smoking cessation goals, the alternative approach is to opt for risk and harm reduction. Given this multifactorial complexity, motivational approaches and the patient/caregiver alliance remain key elements in treatment management. The presented clinical case illustrates the interaction that can take place between smoking cessation and medication-based treatment for a patient on clozapine, reminding us of the necessity for regular clinical and pharmacological monitoring related to cytochrome P450.