Smoking and mental health - NCSCT

Mental disorders 1
Similar to many common chronic disorders, dementia has mixed genetic and
environmental risk factors. Several genetic abnormalities have been found for the
rare early onset dementias and one gene, apolipoprotein E, has been found to
affect risk of the more common late-onset forms. 61 The main environmental risk
factors are those that influence vascular risk, such as high blood pressure, diabetes,
high cholesterol, obesity, lack of exercise, poor quality diet and smoking, all of
which have been established to be risk factors not only for vascular dementia but
also for Alzheimer’s disease. 62 Dementia is also associated with lower levels of
education, although the mechanism of this association is not clearly understood.
Gender is not a risk factor for dementia but because of longer female longevity
there tend to be more women with dementia in any given population. Other
putative risk factors include head injury, heavy alcohol use and depression.
1.9 Mental health services
Most people with mental disorders in the UK who seek healthcare for their
symptoms are treated in primary care, 63 although patients may present with
symptoms such as fatigue and poor appetite that are not recognised as symptoms
of an underlying mental disorder; as a result, as many as half of all cases of
common mental disorder are undetected by the general practitioner (GP). 63 In
the 2007 Adult Psychiatric Morbidity Survey, only a third of people with
common mental disorders assessed as severe enough to require treatment had
used a healthcare service for their emotional difficulties, most commonly their
GP. 4 In primary care, common mental disorders may be treated by psychological
therapy services, which usually offer cognitive–behavioural therapy, or
medication such as antidepressants.
Severe cases and rarer illnesses in the UK tend to be referred to secondary care
mental health services – in 2010–11, 2.8% of adults in England used hospital or
community mental health services. 64 Mental health services are based
predominantly in the community, in multidisciplinary community mental health
teams. Such teams usually include a consultant psychiatrist, psychiatric nurses, a
psychologist and social workers. There are also specialised teams in the
community, eg crisis resolution teams that focus on intensive home treatment to
avoid hospitalisation, early intervention teams for young people presenting with
psychotic symptoms, rehabilitation teams, and assertive outreach teams for
people with severe and chronic disorders (usually psychotic disorders) who need
care but are reluctant to engage with services. Inpatient services are used
predominantly for acute presentations that cannot be managed in the
community, and patients with chronic severe illness are typically now cared for in
supported accommodation rather than the large asylums of the past. The overall
provision of NHS acute psychiatric beds for adults and elderly people is 4.3 per
10,000 of the total population, 65 with provision for people aged over 65 roughly
double that for working age adults in relation to their population numbers.
© Royal College of Physicians 2013 11