Smoking and mental health - NCSCT

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Smoking and mental health > NRT is effective in people with mental disorders, but is likely to be required in high doses, for longer durations and with more intensive behavioural support than in the general population of smokers. > Bupropion and varenicline are both effective in people with mental disorders, but should be used with appropriate supervision and monitoring; further research on their use in this population is an urgent priority. > Smoking cessation does not exacerbate symptoms of mental disorders, and improves symptoms in the longer term. > However, symptoms of nicotine withdrawal are easily confused with those of underlying mental disorder, and should be treated with NRT or other cessation therapy. > Smoking cessation reduces the metabolism of some drugs, such as clozapine, used to treat mental disorder, necessitating prompt reduction in doses of affected drugs at the time of quitting, and increases in the event of relapse. > Smokers who do not want to quit smoking, or else feel unable to make a quit attempt, should be encouraged to cut down on smoking, and to use NRT or other nicotine-containing devices (in line with NICE tobacco harm reduction guidance) to support smoking abstinence in secondary care or other smoke-free settings, and promote the likelihood of future quit attempts. > All primary and secondary care services should record smoking status and provide effective cessation or harm reduction interventions as a central, systematic component of care delivery. Where access to community-based services is limited, as, for example, in secondary care settings, services should be provided in-house. > As many people with mental disorders are managed by both primary and secondary care, provision of smoking cessation support in primary and secondary care settings requires coordination to ensure consistency. > Further research is urgently required to improve the design and content of cessation and harm reduction interventions in mental health settings, and to maximise access to and delivery of evidence-based support. References 1 Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2007;(4):CD006103. 2 Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007;(1):CD000031. 3 Lancaster T, Stead LF. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2004;(4):CD000165. 4 Lancaster T, Perera R, Stead LF. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2006;(2):CD001292. 5 Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation [online]. Cochrane Database of Systematic Reviews 2005;(2):CD001292. 104 © Royal College of Physicians 2013
Smoking cessation interventions for individuals with mental disorders 5 6 Lancaster T, Stead LF. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2005;(2):CD001007. 7 Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2005;(3):CD001118. 8 Lancaster T, Hajek P, Stead LF, West R, Jarvis MJ. Prevention of relapse after quitting smoking a systematic review of trials. Archives of Internal Medicine 2006;166:828–35. 9 Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2004;(3):CD000146. 10 Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation (Review). Cochrane Database of Systematic Reviews 2007;(3):CD002850. 11 Stead LF, Perera R, Bullen C. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2008;(1):CD000146. 12 National Institute for Health and Clinical Excellence. NICE Public Health Guidance 10: Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. London: NICE, 2008. 13 National Institute of Clinical Excellence. Brief interventions and referral for smoking cessation in primary care and other settings: NICE public health intervention guidance. London: NICE, 2006. 14 McManus S, Meltzer H, Campion J. Cigarette smoking and mental health in England. Data from the Adult Psychiatric Morbidity Survey 2007. London: National Centre for Social Research, 2010. 15 Rigotti NA, Clair C, Munafo MR, Stead LF. Interventions for smoking cessation in hospitalised patients (Review). Cochrane Database of Systematic Reviews 2012;(5):CD001837. 16 Chong SA, Ong YY, Subramaniam M, et al. An assessment of the understanding and motivations of patients with schizophrenia about participating in a clinical trial. Contemporary Clinical Trials 2009;30:446–50. 17 Gierisch J, Bastian L, Calhoun P, McDuffie J, Williams J. Smoking cessation interventions for patients with depression: a systematic review and meta-analysis. Journal of General Internal Medicine 2012;27:351–60. 18 Lawn S. Systematic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites. International Journal of Social Psychiatry 2004;39:866–85. 19 Lawn S, Pols R. Smoking bans in psychiatric in-patient settings? A review of the research. Australian and New Zealand Journal of Psychiatry 2005;39:855–66. 20 Lawn S, Condon J. Psychiatric nurses’ ethical stance on cigarette smoking by patients: Determinants and dilemmas in their role in supporting cerssation. International Journal of Mental Health 2006;15(111):118. 21 Prochaska JJ. Smoking and mental illness: breaking the link. New England Journal of Medicine 2011;365:196–8. 22 Ratschen E, Britton J, McNeill A. The smoking culture in psychiatry: time for change. British Journal of Psychiatry 2011;198:6–7. 23 Williams JM, Ziedonis D. Addressing tobacco among individuals with a mental illness or an addiction. Addictive Behaviour 2004;29:1067–80. 24 Banham L, Gilbody S. Smoking cessation in severe mental illness: what works? Addiction 2010;105:1176–89. 25 Tsoi DT, Porwal M, Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2010;(6):CD007253. © Royal College of Physicians 2013 105
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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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