Smoking and mental illness. An update for psychiatrists

Abstract

Objective:

We aimed to review research on smoking and mental illness and provide evidence-based guidelines for psychiatrists to help smoking patients quit.

Method:

We undertook a narrative review of the literature with a special focus on the Australian context.

Results:

Although one in three people with mental illness smoke tobacco, smoking is often neglected in psychiatric practice. Smoking is a significant contributor to the health gap between people with mental illness and the general population. Smokers with mental illness are motivated to quit and are able to do so, albeit with lower quit rates. Quitting can lead to substantial improvements in mental wellbeing and physical health and does not exacerbate pre-existing mental illness. Psychiatrists should advise all smokers to quit and provide counselling, medication and support, based on the 5As framework. Approved pharmacotherapy – nicotine replacement therapy, varenicline and bupropion – is recommended for nicotine-dependent smokers. Smoking induces the metabolism of certain psychotropic drugs such as clozapine and olanzapine and dose reductions may be necessary after cessation.

Conclusions:

Psychiatrists have a duty of care to identify the smoking status of their patients and to provide evidence-based support to quit.

Keywords

smoking nicotine dependence psychiatry mental health mental illness

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References

Williams

Steinberg

Griffiths

. Smokers with behavioral health comorbidity should be designated a tobacco use disparity group. Am J Public Health 2013; 103: 1549–1555.

Prochaska

JJ.

Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction?

Drug Alcohol Depend 2010; 110: 177–182.

Ragg

Gordon

Ahmed

. The impact of smoking cessation on schizophrenia and major depression. Australas Psychiatry 2013; 21: 238–245.

Banham

Gilbody

Smoking cessation in severe mental illness: What works?

Addiction 2010; 105: 1176–1189.

Taylor

McNeill

Girling

. Change in mental health after smoking cessation: Systematic review and meta-analysis. BMJ 2014; 348: g1151.

Australian Bureau of Statistics. National survey of mental health and wellbeing: summary of results, 2007. Cat. No. 4326.0. Canberra: ABS, 2008.

Cooper

Mancuso

Borland

. Tobacco smoking among people living with a psychotic illness: The second Australian Survey of Psychosis. Aust N Z J Psychiatry 2012; 46: 851–863.

Lawrence

Hancock

Kisely

The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: Retrospective analysis of population based registers. BMJ 2013; 346: f2539.

Hurt

Offord

Croghan

. Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort. JAMA 1996; 275: 1097–1103.

10.

Benowitz

NL.

Nicotine addiction. N Engl J Med 2010; 362: 2295–2303.

11.

Aubin

Rollema

Svensson

. Smoking, quitting, and psychiatric disease: A review. Neurosci Biobehav Rev 2012; 36: 271–284.

12.

Yaworski

Robinson

Sareen

. The relation between nicotine dependence and suicide attempts in the general population. Can J Psychiatry 2011; 56: 161–170.

13.

Prochaska

Delucchi

Hall

SM.

A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. J Consult Clin Psychol 2004; 72: 1144–1156.

14.

Zwar

Richmond

Borland

. Supporting smoking cessation: A guide for health professionals. Melbourne: The Royal Australian College of General Practitioners, 2014.

15.

Lai

Cahill

Qin

. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010; 1: CD006936.

16.

Lancaster

Stead

LF.

Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev 2005; 2: CD001292.

17.

Brewer

Mallik

Babuscio

. Mindfulness training for smoking cessation: Results from a randomized controlled trial. Drug Alcohol Depend 2011; 119: 72–80.

18.

Cahill

Stevens

Perera

. Pharmacological interventions for smoking cessation: An overview and network meta-analysis. Cochrane Database Syst Rev 2013; 5: CD009329.

19.

Stead

Perera

Bullen

. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012; 11: CD000146.

20.

Hughes

Stead

Hartmann-Boyce

. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2014; 1: CD000031.

21.

Cahill

Stead

Lancaster

Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2012; 4: CD006103.

22.

Bittoun

A combination nicotine replacement (NRT) algorithm for hard-to-treat smokers. J Smoking Cess 2006; 1: 3–6.

23.

Stead

Lancaster

Interventions to reduce harm from continued tobacco use. Cochrane Database Syst Rev 2007; 3: CD005231.

24.

Mendelsohn

Optimising nicotine replacement therapy in clinical practice. Aust Fam Physician 2013; 42: 305–309.

25.

Gibbons

Mann

JJ.

Varenicline, smoking cessation, and neuropsychiatric adverse events. Am J Psychiatry 2013; 170: 1460–1467.

26.

Anthenelli

Morris

Ramey

. Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial. Ann Intern Med 2013; 159: 390–400.

27.

Williams

Anthenelli

Morris

. A randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of varenicline for smoking cessation in patients with schizophrenia or schizoaffective disorder. J Clin Psychiatry 2012; 73: 654–660.

28.

Zyban SR Prescribing Information . GlaxoSmithKline Australia. Last amended 19 July 2014.

29.

Zevin

Benowitz

NL.

Drug interactions with tobacco smoking. An update. Clin Pharmacokinet 1999; 36: 425–438.

30.

Faber

Fuhr

Time response of cytochrome P450 1A2 activity on cessation of heavy smoking. Clin Pharmacol Ther 2004; 76: 178–184.

31.

Haslemo

Eikeseth

Tanum

. The effect of variable cigarette consumption on the interaction with clozapine and olanzapine. Eur J Clin Pharmacol 2006; 62: 1049–1053.

32.

Tsuda

Saruwatari

Yasui-Furukori

Meta-analysis: The effects of smoking on the disposition of two commonly used antipsychotic agents, olanzapine and clozapine. BMJ Open 2014; 4: e004216.

33.

Desai

Seabolt

Jann

MW.

Smoking in patients receiving psychotropic medications: A pharmacokinetic perspective. CNS Drugs 2001; 15: 469–494.

34.

Knadler

Lobo

Chappell

. Duloxetine: Clinical pharmacokinetics and drug interactions. Clin Pharmacokinet 2011; 50: 281–294.

35.

Lind

Reis

Bengtsson

. Steady-state concentrations of mirtazapine, N-desmethylmirtazapine, 8-hydroxymirtazapine and their enantiomers in relation to cytochrome P450 2D6 genotype, age and smoking behaviour. Clin Pharmacokinet 2009; 48: 63–70.