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Information for Health Professionals: Smoking and Mental Health While the relationship between smoking and mental health is at times complex, the evidence shows that people with a mental health problem do want to quit and can do so safely. The current rate of smoking in the Australian population is just less than 17%,1 yet for people with a mental health problem the rate is about 32%.2 In some cases, such as for people with schizophrenia, the rate is up to 62%.* The impact of this is that people with a mental health problem will experience a disproportionate level of health, financial and social burden. Health professionals have a key role to play in supporting people with mental health problems reduce and For many the reasons are the same as for anybody else – they tried it in adolescence and it is Support: Continued support and encouragement addictive. Other risk factors for smoking - limited to anybody who is making a quit attempt is very education, low-income, unemployment, adverse important. It is often assumed that quitting childhood experiences, having friends or family smoking is too difficult for people with a mental who smoke - are more common among people health problem and that they are not interested. Yet research tells us that just like anybody else, people with a mental health problem want to “I am very interested in quitting but at the address their smoking.4,5 It may take a longer same time it’s such a friend to me that’s been amount of time and people with a mental health problem may need more intensive support, but having a mental health problem is not an obstacle There are other reasons for smoking that relate “[As a smoker] I feel like an outcast and if not to the nature of mental health but to the you’ve got a mental disorder, that’s quite cultures in which people with a mental health problem are subjected - such as the smoking personally than you’re average person.” culture within the mental health sector. There are a number of myths and assumptions surrounding smoking and mental health. A Quit Smoking Advice: Making a quit attempt common and widely held belief is that smoking requires proper planning. There are a number of can help ease the symptoms of a range of mental strategies people use to quit smoking and most people do so without any clinical intervention.3 If a schizophrenia, for example improving some person does use nicotine replacement therapies people’s ability to focus and perform tasks helping (NRT), such as patches or lozenges, or other non- to correct some of the organisational deficits nicotine medications, Zyban (Bupropion) and experienced by people with schizophrenia. While Champix (Varenicline), it is important to check that this may be biological y plausible, the evidence for this theory is not strongly supported; the risks of correctly. The most common problem with using smoking far outweigh any perceived benefits of pharmacotherapies is incorrect use which can smoking, and the ‘benefits’ or improved focus may lead people to mistake nicotine withdrawal simply be due to relieving nicotine withdrawal pharmacotherapies. There are a number of Information for Health Professionals: Smoking & Mental Health contraindications with Zyban and Champix for Monitor Changes in Mental Health: There is little people with mental health problems therefore evidence to suggest that people with a mental some caution and close monitoring of their use health problem will experience a relapse in their mental health – some people with a history of depression can experience a relapse, others will Pharmacotherapies are not a substitute for not.9 A number of nicotine withdrawal symptoms counselling or other support interventions and are like sadness, anger, anxiety, depression, in fact more effective when coupled with individual irritability, restlessness and poor concentration can be confused with symptoms of a mental health problem, but often subside after about two “I quit smoking 2 months ago and feel fine weeks.8 This range of withdrawal symptoms is about it and my health is going well, even my normal for anybody giving up smoking and is not medication has had to be reduced. I’ve also necessarily a symptom of a relapse in a mental been saving money that I would be spending “I was spending $70 a week and then I got sick of it. Now I just spend my money on DVD’s or anything else but cigarettes.” Medication Review: It is important that any person who has either reduced or quit smoking and is taking any psychiatric medications undergo a medication review. The SANE guidelines for General Practitioners recommends closely Smoke and Mirrors: A review of the literature on Smoking can affect the dosage of a number of psychiatric medications; some may need to be by Mark Ragg and Dr. Tanya Ahmed (2008). increased, some may need to be decreased and for others there is a variable or unknown effect.3 Some of these medications include clozapine, ing_tobacco/tacklingtobacco/downloads/Smoke_mirror fluphenazine, decanoate, haloperidol and For more information and other information sheets go to: ƒ Cancer Council NSW, Tackling Tobacco Program – ƒ The Mental Health Coordinating Council, breathe easy project – This information sheet was developed by the Cancer Council NSW and the as part of the Tackling Tobacco Program, 2009. 1 Australian Institute of Health and Welfare. (2007) National Drug Strategy Household Survey: First results. Drug Statistics Series Number 20. Cat. No. PHE 98. Canberra: AIHW. 2 Australian Bureau of Statistics. (2006) Mental Health in Australia: A Snapshot, 2004-05. cat. no. 4824.0.55.001. Canberra: ABS * This figure is an average smoking rate for people with schizophrenia taken from studies across 20 countries. 3 Ragg, M. and Ahmed, T. (2008). Smoke and Mirrors: A review of the literature on smoking and mental illness. Tackling Tobacco Program Research Series No. 1. Sydney: Cancer Council NSW. 4 Moeller-Saxone, K., Tobias, G. & Helyer, K. (2005) Expanding choices for smokers with a mental illness: smoking rates, desire to change and program implementation in a day program. New 5 Baker, A., Richmond, R., Haile, M., Lewin, T.J., Carr, V.J., Taylor, R.L., Constable, P.M, Jansons, S., Wilhelm, K. and Moeller-Saxone, K. (2007). Characteristics of smokers with a psychotic disorder and implications for smoking interventions. Psychiatry Research, 150(2): 141-152. 6 Campion J, Checinski, K. and Nurse, J. 2008. Review of smoking cessation treatments for people with mental illness, Advances in Psychiatric Treatment, 14: 208–216. 7 Strasser, M. (2001) Smoking Reduction and Cessation for people with Schizophrenia: Guidelines for General Practitioners. SANE Australia and University of Melbourne. 8 Zwar N, Richmond R, Borland R, Stillman S, Cunningham M, Litt J. (2004) Smoking cessation guidelines for Australian general practice: practice handbook. Canberra: Commonwealth Dept of Health and Ageing. 9 el-Guebaly, N., Cathcart, J., Currie, S.R., Brown, D. & Gloster, S. (2002) Smoking Cessation Approaches for Person with Mental Illness or Addictive Disorders. Psychiatric Services, 53: 1166-1170. Information for Health Professionals: Smoking & Mental Health


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