Smoking and mental health - NCSCT

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Smoking and mental health anticipate difficulty quitting smoking, and historically much less likely to succeed in any quit attempt. > Over the course of a year, smokers with mental disorders are more likely to receive advice from their GP to quit smoking, and be prescribed cessation medications, but this reflects the increased frequency of their consultations. Overall, only a minority receive cessation pharmacotherapy. Neurobiological and behavioural mechanisms linking smoking and mental disorders > Although smoking, and high levels of dependence on smoking, are both more common in people with mental disorders, the mechanisms underlying these associations are uncertain. > There is some evidence of common genetic determinants of both smoking and specific mental disorders, particularly depression and schizophrenia. > Experimental evidence suggests that nicotine can relieve symptoms of anxiety, depression, schizophrenia and attention deficit hyperactivity disorder (ADHD), although nicotine withdrawal symptoms may then exacerbate symptoms of mental disorders. > People with some mental disorders may use nicotine to ameliorate symptoms such as depression or anxiety (the self-medication model). > However, the symptoms of mental disorders can be confused with or exacerbated by those of nicotine withdrawal, hence resulting in false attribution of relief to effects on mental disorders. > The effects of constituents of tobacco and tobacco smoke other than nicotine on mood and cognition remain unclear. > The association between smoking and mental disorders is therefore complex and further work is needed to help improve understanding. Epidemiology of the association between smoking and mental disorders > Current smoking is associated with an increased risk of onset of depression, including postnatal depression, and people with depression are more likely to become smokers. > Current smoking is associated with an increased risk of onset of anxiety disorders, and people with anxiety disorders are more likely to take up smoking. > Former smokers are not at an increased risk of subsequent onset of depression. > Adolescents with eating disorders are more likely to become smokers. 196 © Royal College of Physicians 2013
Key conclusions and recommendations 11 > There is some evidence that people with behavioural disorders, particularly ADHD and conduct disorder, are more likely to become smokers, but no evidence that smoking increases the risk of onset of these conditions. > There is a strong association between smoking and schizophrenia in crosssectional studies, but longitudinal evidence on the temporal relationship is mixed. > Adolescents with bipolar disorder may be more likely to become heavy smokers. > Smoking is associated with an increased risk of dementia. > People with mental disorders appear to have higher risks of cardiovascular disease and stroke (after accounting for the effects of smoking); however, there is no consistent evidence regarding an increased risk of cancer. Smoking cessation interventions for individuals with mental disorders > Smoking cessation interventions that combine behavioural support with cessation pharmacotherapy, and are effective in the general population, are also likely to be effective in people with mental disorders. > Nicotine replacement therapy (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 the tobacco harm reduction guidance of the National Institute for Health and Clinical Excellence (NICE)) to support smoking abstinence in secondary care or other smokefree 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 © Royal College of Physicians 2013 197
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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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6 Population strategies to prevent
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Population strategies to prevent sm
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Smoking and mental health - NCSCT

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