Smoking and mental health - NCSCT

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Smoking and mental health of a 50% reduction in consumption by a ratio of 2.62 (95% CI 1.76–3.93) at 4 months and 1.75 (95% CI 1.15–2.66) at 13 months. 30 5.3.2 Nicotine replacement therapy In a study of 10 participants with schizophrenia, Dalack and Meador-Woodruff 54 reported modest but non-significant reductions in mean expired CO after shortterm use of NRT. 5.3.3 Bupropion Two studies have reported significant reductions in mean CO levels and numbers of cigarettes smoked at up to 3 months after receiving group therapy plus bupropion, relative to group therapy alone. 36,37 Another reported significant reductions in mean serum cotinine levels during, but not after, treatment. 35 A study using bupropion with NRT reported a significant increase in the likelihood of achieving self-reported 7-day smoking reduction of 50% or more, and CO reduction of 40% or more after 3 months (RR 1.95; 95% CI 1.01–3.77), although not at earlier endpoints. 38 5.3.4 Varenicline Evidence on the effectiveness of varenicline for smoking reduction is scarce, and to our knowledge is limited to an uncontrolled before and after study in 14 men with schizophrenia or schizoaffective disorder, most of whom did not express strong motivation to stop smoking. This study reported a non-significant reduction in the average number of cigarettes smoked per day, from 36.5 to 12.5, when treated with varenicline (mean, p = 0.12). 44 Significant reductions were also observed in expired CO (from a mean of 9 ppm (parts per million) before to 5 ppm after) and plasma cotinine levels (from 239 ng/mL before to 130 ng/mL after). 5.4 Is it safe for people with SMI to give up smoking? Many mental health professionals are concerned that smoking cessation may impact adversely on mental health, and this perception can pose a barrier to the implementation of smoking cessation interventions in mental health settings. 18,20,22,56 This is a serious concern which, if grounded in fact, might add some legitimacy to continued use of tobacco in this population. We summarise the evidence on adverse events, psychological wellbeing and other consequences of smoking cessation in people with SMI in the following sections. 90 © Royal College of Physicians 2013
Smoking cessation interventions for individuals with mental disorders 5 5.4.1 Adverse events relating to smoking cessation interventions Evidence on adverse events occurring in the context of stopping smoking aided by different pharmacological regimens suggests that, overall, smoking cessation interventions in people with mental disorders are well tolerated and safe. Of four studies in people with schizophrenia exploring adverse events with bupropion alone or in combination with NRT in people with schizophrenia, two used the Systematic Assessment For Treatment Emergent Effects (SAFTEE), 35,36 and two recorded events descriptively. 38,39 In placebo-controlled studies of bupropion, no adverse events were reported in the smallest, involving 18 participants, 35 whereas a study involving 53 participants reported three adverse events requiring trial withdrawal: one a probable medication allergy, and two cases of suicidal ideation (trial group not clear). 36 A study of 51 patients with schizophrenia using bupropion or placebo in addition to NRT 38 reported four trial withdrawals due to medication side effects, two in the intervention group, whereas a similar study by George et al 39 reported three serious adverse events described as psychotic decompensation, two of which occurred in the placebo group. Adverse events relating to the concurrent use of NRT while smoking were assessed in a study of smoking reduction; 54 none were reported. For varenicline, the available evidence 27,41,45 suggests that the medication is well tolerated in participants with schizophrenia, schizoaffective disorders and major depression, with no differences in the occurrence of adverse events detected between the respective intervention and placebo groups; however, side effects in the form of nausea and insomnia are common, as is the case with this drug in the general population. A study conducted in the military health service in the USA showed that there does not appear to be an increase in neuropsychiatric hospitalisations with varenicline compared with NRT patch over 30 or 60 days after drug initiation. 57 5.4.2 Effects of smoking cessation on mental health symptoms Studies using validated symptom scales to ascertain whether psychiatric symptoms change during cessation interventions generally suggest that smoking cessation has no negative impact on psychiatric symptoms in people with schizophrenia, and that there may in fact be benefits in relation to depression and anxiety, eg in patients with schizophrenia receiving cessation interventions significantly lower scores have been reported on the Beck Depression Index II (BDI-II), Short Form 12 (SF-12) and State Trait Anxiety Inventory (STAI), 30 reduced Brief Psychiatric Rating Scale (BPRS) general score, 35 improved Positive and Negative Symptoms Scale (PANSS) scores, 36 and lower Barnes Akathisia Scale and Simpson Angus Scale (SAS) scores for extrapyramidal side effects, 38 and a greater decrease in PANSS score (negative symptoms). 39 A recent study of © Royal College of Physicians 2013 91
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Smoking among people with mental di
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The economic cost of smoking in peo
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Ethical and legal aspects 9 pose co
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Ethical and legal aspects 9 less an
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Ethical and legal aspects 9 patient
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10 Summary and conclusions 10.1 Smo
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Summary and conclusions 10 10.4 Smo
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Summary and conclusions 10 although
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11 Key conclusions and recommendati
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Key conclusions and recommendations
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