A 51-Year-Old Woman With Bipolar Disorder Who Wants to Quit Smoking

Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 02/2009; 301(5):522-31. DOI: 10.1001/jama.2008.982
Source: PubMed


Smoking among patients with mental illness is a major and underappreciated public health problem. The case of Ms G, a 51-year-old woman with bipolar disorder who wishes to quit smoking, illustrates the importance and feasibility of smoking cessation in patients with psychiatric disorders. Persons with chronic mental illness and/or substance abuse constitute 22% of the US population yet are estimated to consume 44% of cigarettes. As many as 200,000 of the 435,000 annual deaths related to smoking in the United States are estimated to occur in this population. On average, patients with mental illness die 25 years earlier than the general population, and smoking is a major contributor to these premature deaths. In the past, mental health clinicians have tended not to address smoking cessation with their patients, but increasing evidence suggests that such reticence is unwarranted, as smoking cessation in this population is feasible. The approach to cessation should include standard interventions of counseling and pharmacotherapy, for which substantial evidence of efficacy exists in patients with and without mental illness. If patients with mental illness are to achieve wellness, smoking cessation must be an integral component of their treatment regimen.

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    • "With respect to mental health, there is strong evidence of a close association between smoking and mental disorders. Smoking prevalences of patients with major depression (40–60%), anxiety disorders (19.2–56%) and alcohol abuse (43–80%) are greatly increased as compared to 19.8% in the general population (Lasser et al., 2000; Schroeder, 2009). Adults with depression are more likely to be lifetime smokers and they smoke more than persons without depression (Taylor et al., 2011). "
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    ABSTRACT: BACKGROUND: Exposition to tobacco smoke is among the major modifiable risk factors in the general population. There is strong evidence for a close association between smoking exposure and mental disorders. METHODS: Cross-sectional associations of different conditions of smoking status (former, current, and second hand smoking (SHS)) with indicators of mental distress were analyzed in a sample of N=5000 participants (aged 35-74 years) of the population-based survey "Gutenberg Health Study". RESULTS: In the general population clinically significant depression (OR 1.59, 95%CI 1.17-2.17) and a previous diagnosis of depression (OR 1.50, 95%CI 1.16-1.94) were associated with current smoking. Each cigarette per day was associated with a 3% increase for the likelihood of clinically significant depression. We did not find a decreased prevalence for current first and second hand exposure in persons with established cardiovascular or lung disease. In this subgroup mental distress was strongly associated with SHS at home. LIMITATIONS: Main limitations of the study pertain to the reliance on self-report of distress and smoking status and the cross-sectional nature of the data. CONCLUSIONS: Despite public health efforts, smoke exposure is still alarmingly high in the general population, especially in persons with mental distress and with established cardiovascular or lung disease. In the management of persons with chronic cardiovascular and lung disease, enquiry of the medical history should include exposure to SHS at home and offer special counseling.
    Full-text · Article · Oct 2012 · Journal of Affective Disorders
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    • "Anecdotally, it was of interest to note that in conducting in-person screening of potential subjects for the varenicline trial (Wu et al., 2012), many of the psychiatrists and family physicians who we contacted about their patients' participation noted that they were not convinced about the safety of smoking cessation in their patients with bipolar disorder, nor in the use of the smoking cessation agents for these patients. A Clinical Case Conference in the Journal of the American Medical Association highlighted the public health importance of the need to develop evidence-based treatments to address tobacco dependence in smokers with bipolar and other mental illness (Schroeder, 2009). "
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    ABSTRACT: Tobacco smoking is common in people with bipolar disorder, and rates of smoking cessation are lower than in the general population. A literature review found eleven clinical research publications on bipolar disorder and tobacco, including only one smoking cessation pharmacotherapy trial. This article will review these findings and discuss possible reasons for the high rates of tobacco addiction among persons with bipolar disorder, as well as specific vulnerability factors that may contribute to tobacco treatment failure. An approach to the clinical assessment and treatment of tobacco dependence is described for this sub-group of smokers. Finally, recommendations are made for planning future treatment studies in persons with bipolar disorder and nicotine dependence.
    Full-text · Article · Apr 2012 · Journal of Dual Diagnosis
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    • "Approximately 4 million persons in the U.S. received addiction treatment in 2008 (Substance Abuse and Mental Health Services Administration, 2009), and most of those were smokers (Schroeder and Morris, 2009). As addiction treatment systems work to address tobacco dependence, they will need improved measurement tools to evaluate their efforts. "
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    ABSTRACT: Addiction treatment programs are increasingly working to address prevalent and comorbid tobacco dependence in their service populations. However at present there are few published measurement tools, with known psychometric properties, that can be used to assess client-level constructs related to tobacco dependence in addiction treatment settings. Following on previous work that developed a staff-level survey instrument, this report describes the development and measurement characteristics of the smoking knowledge, attitudes and services (S-KAS) for use with clients in addiction treatment settings. 250 clients enrolled in residential drug abuse treatment programs were surveyed. Summary statistics were used to characterize both the participants and their responses, and exploratory factor analysis (EFA) was used to examine the underlying factor structure. Examination of the rotated factor pattern indicated that the latent structure was formed by one knowledge factor, one attitude factor, and two "service" factors reflecting program services and clinician services related to tobacco dependence. Standardized Cronbach's alpha coefficients for the four scales were, respectively, .57, .75, .82 and .82. The proposed scales have reasonably good psychometric characteristics, although the knowledge scale leaves room for improvement, and will allow researchers to quantify client knowledge, attitudes and services regarding tobacco dependence treatment. Researchers, program administrators, and clinicians may find the S-KAS useful in changing organizational culture and clinical practices related to tobacco addiction, help in program evaluation studies, and in tracking and improving client motivation.
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