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Update in smoking and mental illness: a primary care perspective
- Author:
- LASSER Karen E.
- Journal article citation:
- Journal of Dual Diagnosis, 5(2), April 2009, pp.191-196.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The 1991-92 National Comorbidity Survey (NCS) found that 41% of people with a mental illness in the previous month were current smokers, that people with mental illness were twice as likely to smoke as those without, and that heavy smoking was rare in people without mental illness. People with a current mental illness smoked 44% of all cigarettes in the USA, and the paper briefly explores explanations of why smoking rates, and thus smoking-related death rates, are so high in this population. Data from the NCS indicate that those with mental illness are able to stop smoking, though the rates are lower than in the general population, and the author argues that they should be included in clinical trials of smoking cessation medications.
Smoking and depression: a co-morbidity
- Authors:
- BERLIN Ivan, COVEY Lirio S., GLASSMAN Alexander H.
- Journal article citation:
- Journal of Dual Diagnosis, 5(2), April 2009, pp.149-158.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This literature review, based on searches of PubMed for a ten year period, shows that depression (defined as depressive mood, major depressive disorder or negative affect) increases the risk of smoking, and vice versa. The relationship between depression and smoking cessation is less clear, with some clinical and epidemiological studies concluding that depression has an impact on the ability to quit and others showing no such association. Research has also strongly suggested that commonality in genetic and environmental factors underlies the co-morbidity of smoking and depression, although the specific mechanisms have yet to be identified. The authors conclude that the relationship between depression and smoking is firmly established and that reciprocal relationships between the two are strongly suggested although requiring further investigation.
Genotype effects of CHRNA7, CNR1 and COMT in schizophrenia: interactions with tobacco and cannabis use
- Authors:
- ZAMMIT Stanley, et al
- Journal article citation:
- British Journal of Psychiatry, 191(11), November 2007, pp.402-407.
- Publisher:
- Cambridge University Press
Genetic variations might modify associations between schizophrenia and cannabis or tobacco use. The aim was to examine whether variants within the cannabinoid receptor (CNR1) and 7 nicotinic receptor (CHRNA7) genes are associated with schizophrenia, and whether these effects vary according to cannabis or tobacco use. The study also examined a putative interaction between cannabis and Val158Met within the catechol-O-methyltransferase gene (COMT). Genotype effects of CHRNA7 and CNR1 were studied in a case–control sample of 750 individuals with schizophrenia and 688 controls, with interactions for these genes studied in small subsamples. A case-only design of 493 of the schizophrenia group was used to examine interactions between cannabis use and COMT. There was no evidence of association between schizophrenia and CNR1 or CHRNA7 genotypes, or of interactions between tobacco use and CHRNA7, or cannabis use and CNR1 or COMT genotypes. Neither CNR1 nor CHRNA7 variation appears to alter the risk of schizophrenia. Furthermore, the results do not support the presence of different effects of cannabis use on schizophrenia according to variation within COMT.
Substance abuse and psychiatric dual disorders: focus on tobacco
- Authors:
- GOLD Mark S., FROST-PINEDA Kimberley
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.15-35.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Smoking is a leading cause of morbidity and is the single most important preventable cause of mortality in the United States. The link between tobacco smoking and lung cancer, heart disease, stroke, chronic lung disease, other cancers, and other medical diseases is now generally accepted. The link between tobacco and psychiatric diseases has become a focus for recent epidemiological studies, which have even led to the suggestion that in the differential diagnosis of "smoker" highest on the list are depression, alcohol dependence, and schizophrenia. Less is known about the role of second hand tobacco exposure, either in utero or during childhood, in the risk of dual disorders. Here the authors explore the issue of substance abuse and psychiatric dual disorders, prenatal and early childhood Second Hand Smoke (SHS) exposure and the relationship to the genesis of these dual disorders. They describe a novel method of detecting SHS exposure and the public health implications of this development. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Dual diagnosis: discovery of a critical role for environmental exposure
- Author:
- GOLD Mark S.
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.5-13.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
It is estimated that 10 million persons in the United States have at least one mental disorder and at least one substance-related disorder in any given year. Dual disorders are common in psychiatry, but misdiagnosis may be even more common. Drug and alcohol testing should be expanded from routine use in the Olympics and intercollegiate athletics to psychiatric diagnosis of drug intoxication, dependence, and withdrawal states. Major Depression is co-morbid with opiate addiction, alcohol dependency, tobacco smoking, and many other substance abuse disorders. Drug use induces adaptations in brain systems associated with mood and motivation. The acute rewarding effects of drugs change the mesolimbic dopaminergic system. Cessation of drug self-administration induces dysphoria and anhedonia as a result of changes in monoamine levels in brain reward circuits; opposite to the effects that occur after the administration of drugs of abuse. While most models for dual disorders assume compulsive or volitional use or self administration, we have been interested in second-hand exposure which was common in the past among flight attendants and occurs today between smoking parent and child. We expand the concept from parent-to-child environmental tobacco toxicity to a workplace toxicity hypothesis for anesthesiologists. Such a hypothesis can explain the high rates of depression, workplace and social distress, drug abuse, and drug addiction among anesthesiologists. While co-occurring disorders have been the focus of epidemiological studies and twin and genetic studies, the role of exposure to potent drugs of abuse in the intra-uterine, home, and workplace environment has been neglected. We have demonstrated the unequivocal presence of fentanyl and other potent drugs of abuse in the air that anesthesiologists breathe in the operating room. Drug exposure sensitizes the brain. When sensitization is coupled with the stress of operating room, employment may produce the pattern of co-occurring disorders seen in anesthesiologists but not psychiatrists. Prevention is the goal in environmental or toxicity-related illness. After diagnosis, treatment for dual disorders should be vigorous with remission of all disorders in mind. For anesthesiologists, limiting toxic environmental exposure may prevent both drug and affective disorders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Factors associated with smoking and smoking cessation among primary care patients with depression: a naturalistic cohort study
- Authors:
- GILCHRIST Gail, et al
- Journal article citation:
- Advances in Dual Diagnosis, 8(1), 2015, pp.18-28.
- Publisher:
- Emerald
Purpose: People with a history of depression are more likely to smoke and less likely to achieve abstinence from smoking long term. The purpose of this paper is to understand the factors associated with smoking and smoking cessation among patients with depression. Design/methodology/approach: This paper reports on smoking prevalence and cessation in a cohort of 789 primary care attendees with depressive symptoms (Centre for Epidemiologic Studies Depression Scale score of=16) recruited from 30 randomly selected Primary Care Practices in Victoria, Australia in 2005. Findings: At baseline, 32 per cent of participants smoked. Smokers were more likely to be male, unmarried, receive government benefits, have difficulty managing on available income, have emphysema, a chronic illness, poor self-rated health, to have more severe depressive and anxiety symptoms, to be taking anti-depressants, to be hazardous drinkers, to report suicidal ideation and to have experienced childhood physical or sexual abuse. At 12 months, 20 participants reported quitting. Females and people with good or better self-rated health were significantly more likely to have quit, while people with a chronic illness or suicidal ideation were less likely to quit. Smoking cessation was not associated with increases in depression or anxiety symptoms. Only six participants remained quit over four years. Practical implications: Rates of smoking were high, and long-term cessation was low among primary care patients with depressive symptoms. Primary care physicians should provide additional monitoring and support to assist smokers with depression quit and remain quit. Originality/value: This is the first naturalistic study of smoking patterns among primary care attendees with depressive symptoms. (Publisher abstract)
Using a multidisciplinary approach for pregnant women with nicotine dependence and co-occurring disorders
- Authors:
- LUNDQUIST Rebecca S., et al
- Journal article citation:
- Journal of Dual Diagnosis, 8(2), April 2012, pp.158-167.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
While smoking prevalence among pregnant women has been declining, pregnant women with co-occurring disorders struggle with smoking cessation not only because they are managing their psychiatric and substance-related conditions but also because they are at greater risk for a number of psychosocial stressors. In addition, substance abuse and psychiatric treatment for pregnant women is often fragmented and uncoordinated, resulting in poor health outcomes for mother and baby. This article demonstrates the potential for multidisciplinary treatment providers and community members to work together toward successfully meeting the complex needs of pregnant women with co-occurring disorders. Following the case presentation, it outlines the ways in which patients and their psychiatric and substance abuse treatment providers can work together as a team. In addition, it outlines an organisational change model to systematically address tobacco use in clinical settings that serve these patients. The article suggests that even small efforts to coordinate care can have large payoffs in terms of outcomes for mothers and their babies.
Exercise and counseling for smoking cessation in smokers with depressive symptoms: a randomized controlled pilot trial
- Authors:
- BERNARD Paquito, et al
- Journal article citation:
- Journal of Dual Diagnosis, 11(3-4), 2015, pp.205-216.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: Despite various strategies to help smokers with depressive disorders to quit, the smoking relapse rate remains high. The purpose of this pilot study was to estimate the effects of adding an exercise and counseling intervention to standard smoking cessation treatment for smokers with depressive disorders. We hypothesized that the exercise and counseling intervention would lead to improved abstinence, reduced depressive symptoms, and increased physical activity. Methods: Seventy smokers with current depressive disorders were randomly assigned to standard smoking cessation treatment plus exercise and counseling (n = 35) or standard treatment plus a time-to-contact control intervention on health education (n = 35). Both programs involved 10 sessions over 8 weeks. The primary outcome was continuous abstinence since the quit date and was measured at week 8 (end of the intervention) and again at 12-, 24-, and 52-week follow-ups. Results: Nearly 60% of participants were female (n = 41), 38 (52.3%) were single, 37 (52.9%) had education beyond high school, and 32 (45.7%) met criteria for major depressive disorder or dysthymia. Participants in the two treatment conditions differed at baseline only in marital status (χ2 = 4.28, df = 1, p =.04); and smoking abstinence self-efficacy, t(66) = -2.04, p =.04). The dropout rate did not differ significantly between groups and participants attended 82% and 75% of the intervention and control sessions, respectively. Intention-to-treat analysis showed that, at 12 weeks after the beginning of the intervention, continuous abstinence did not vary significantly between the intervention and control groups: 48.5% versus 28.5%, respectively, ORadj = 0.40, 95% CI [0.12–1.29], p =.12. There were no group differences in depressive symptoms, but the intervention group did outperform the control group on the 6-minute walking test (Mint = 624.84, SD = 8.17, vs. Mcon = 594.13, SD = 8.96, p =.015) and perceived physical control (Mint = 2.84, SD = 0.16, vs. Mcon = 2.27, SD = 0.18, p =.028). The sample was not large enough to ensure adequate statistical power. Conclusions: This finding, while preliminary, suggests that an exercise and counseling intervention may yield better results than health education in improving smoking abstinence. This study is registered at www.clinincaltrials.gov under # NCT01401569. (Publisher abstract)
Psychiatric morbidity and substance use in young people aged 13-15 years: results from the Child and Adolescent Survey of Mental Health
- Authors:
- BOYS A., et al
- Journal article citation:
- British Journal of Psychiatry, 182(6), June 2003, pp.509-517.
- Publisher:
- Cambridge University Press
Psychoactive substance use is strongly associated with psychiatric morbidity in both adults and adolescents. Data from 2624 adolescents aged 13-15 years were drawn from a national mental health survey of children. The relationship between psychiatric morbidity and smoking, drinking and cannabis use was examined by logistic regression analyses. Having a psychiatric disorder was associated with an increased risk of substance use. Greater involvement with any one substance increased the risk of other substance use. Analyses of the interactions between smoking, drinking and cannabis use indicated that the relationship between substance use and psychiatric morbidity was primarily explained by regular smoking and (to a lesser extent) regular cannabis use. In this sample, links between substance use and psychiatric disorders were primarily accounted for by smoking. The strong relationship is likely to be due to a combination of underlying individual constitutional factors and drug-specific effects resulting from consumption over the period of adolescent development and growth.