Skip to main content Accessibility help
×
Home

Smoking by people with mental illness and benefits of smoke-free mental health services

  • Jonathan Campion, Ken Checinski, Jo Nurse and Ann McNeill

Abstract

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Smoking by people with mental illness and benefits of smoke-free mental health services
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Smoking by people with mental illness and benefits of smoke-free mental health services
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Smoking by people with mental illness and benefits of smoke-free mental health services
      Available formats
      ×

Copyright

References

Hide All
Adler, L. E., Hoffer, L. D., Wiser, A. et al (1993) Normalization of auditory physiology by cigarette smoking in schizophrenic patients. American Journal of Psychiatry, 150, 18561861.
Aguilar, M. C., Gurpegui, M., Diaz, F. J. et al (2005) Nicotine dependence and symptoms in schizophrenia. Naturalistic study of complex interactions. British Journal of Psychiatry, 186, 215221.
American Psychiatric Association (1995) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). APA.
Baker, A., Richmond, R., Haile, M. et al (2006) A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. American Journal of Psychiatry, 163, 19341942.
Barnes, M., Lawford, B. R., Burton, S. C. et al (2006) Smoking and schizophrenia: is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use? Australian and New Zealand Journal of Psychiatry, 40, 575580.
Bauld, L., Ferguson, J., Kerr, A. et al (2007) Moving towards smoke-free mental health services. Mental Health Review Journal, 12, 1824.
Bazire, S. (2003) Psychotropic Drug Directory 2003/2004 . Fivepin
Benowitz, N. L. (1998) Nicotine Safety and Toxicity. Oxford University Press.
Breslau, N. & Klein, D. F. (1999) Smoking and panic attacks: an epidemiological investigation. Archives of General Psychiatry, 56, 11411197.
Breslau, N., Novak, S. P. & Kessler, R. C. (2004) Psychiatric disorders and stages of smoking. Biological Psychiatry, 55, 6976.
Brown, S., Barraclough, B. & Inskip, H. (2000) Causes of the excess mortality of schizophrenia. British Journal of Psychiatry, 177, 212217.
Campion, J., McNeill, A. & Checinski, K. M. (2006) Exempting mental health units from smoke-free laws. BMJ, 333, 407408.
Campion, J., Checinski, K. & Nurse, J. (2008a) Review of smoking cessation treatments for people with mental illness. Advances in Psychiatric Treatment, 14, 208216.
Campion, J., Lawn, S., Brownlie, A. et al (2008b) Implementing smoke-free policies in mental health units: learning from unsuccessful experience. Australasian Psychiatry, 16, 9297.
Chambers, R. A., Krystal, J. H. & Self, D. W. (2001) A neurobiological basis for substance abuse comorbidity in schizophrenia. Biological Psychiatry, 50, 7183.
Cohen, S. & Lichtenstein, E. (1990) Perceived stress, quitting smoking and smoking relapse. Health Psychology, 9, 466478.
Cooke, A. (1991) Maintaining a smoke-free psychiatric ward. Dimensions in Health Service, 68, 1415.
Coultard, M., Farrell, M., Singleton, N. et al (2000) Tobacco, Alcohol and Drug Use and Mental Health. UK Department of Health.
Cuijpers, P., Smit, F., ten Have, M. et al (2007) Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study. Addiction, 102, 13031309.
Dalack, G. W. & Meador-Woodruff, J. H. (1996) Smoking, smoking withdrawal and schizophrenia: case reports and a review of the literature. American Journal Psychiatry, 155, 14901501.
Dawe, S., Gerada, C., Russell, M. A. H. et al (1995) Nicotine intake in smokers increases following a single dose of haloperidol. Psychopharmacology, 117, 110115.
Department of Health (2005) Consultation on The Smokefree Elements of the Health Improvement and Protection Bill. Department of Health.
Department of Health (2006) Smoke-free Premises and Vehicles. Consultation on Proposed Regulations to be Made under the Powers in the Health Bill. TSO (The Stationery Office).
Dierker, L. C., Avenevoli, S., Stolar, M. et al (2002) Smoking and depression: an examination of mechanisms of comorbidity. American Journal Psychiatry, 159, 947–531.
Doll, R., Peto, R., Boreham, J. et al (2004) Mortality in relation to smoking: 50 years' observation on male British doctors. BMJ, 328, 745.
el-Guebaly, N., Cathcart, J., Currie, S. et al (2002) Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatric Services, 53, 16171622.
Farrell, M., Howes, S., Bebbington, P. et al (2001) Nicotine, alcohol and drug dependence and psychiatric morbidity. Results of a national household survey. British Journal Psychiatry, 179, 432437.
Federal Trade Commission (2007) Cigarette Report for 2004 and 2005. US Federal Trade Commission.
Fichtenberg, C. M. & Glantz, S. A. (2002) Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ, 325, 188.
Forchuk, C., Norman, R., Malla, A. et al (2002) Schizophrenia and the motivation for smoking. Perspectives on Psychiatric Care, 38(2), 4149.
Ford, D., Vua, H. & Anthony, J. (2002) Marijuana use and cessation of tobacco smoking in adults from a community sample. Drug and Alcohol Dependence, 67, 243248.
Foulds, J. G. K., Steinberg, M. B., Richardson, D. et al (2006) Factors associated with quitting smoking at a tobacco dependence treatment clinic. American Journal of Health Behavior, 30, 400412.
Fu, S., McFall, M., Saxon, A. et al (2007) Post-traumatic stress disorder and smoking: a systematic review. Nicotine and Tobacco Research, 9, 10711084.
George, T. P., Sernyak, M. J., Ziedonis, D. M. et al (1995) Effects of clozapine on smoking in chronic schizophrenic outpatients. Journal of Clinical Psychiatry, 56, 344346.
George, T. P., Ziedonis, D. M., Feingold, A. et al (2000) Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. American Journal Psychiatry, 157, 18351842.
Goddard, E. (2008) Smoking and Drinking among Adults, 2006. General Household Survey 2006. Office for National Statistics.
Goff, D. C., Henderson, D. C. & Amico, E. (1992) Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. American Journal Psychiatry, 149, 11911194.
Goodman, E. & Capitman, J. (2000) Depressive symptoms and cigarette smoking among teens. Paediatrics, 106, 748755.
Gotti, C., Fornasari, D. & Clementi, F. (1997) Human neuronal nicotinic receptors. Progress in Neurobiology, 53, 199237.
Harris, G. T., Parle, D. & Gagne, J. (2007) Effects of a tobacco ban on long-term psychiatric patients. Journal of Behavioral Health Services and Research, 34, 4355.
Haukkala, A., Uutela, A., Vartiainen, E. et al (2000) Depression and smoking cessation: the role of motivation and self efficacy. Addictive Behaviour, 25, 311316.
Haustein, K. O., Haffner, S. & Woodcock, B. G. (2002) A review of the pharmacological and psychopharmacological aspects of smoking and smoking cessation in psychiatric patients. International Journal of Clinical Pharmacology and Therapeutics, 40, 404418.
Hempel, A. G., Kownacki, R., Malin, D. H. et al (2002) Effect of a total smoking ban in a maximum security psychiatric hospital. Behavioral Science and the Law, 20, 507522.
Hennekens, C. H., Hennekens, A. R., Hollar, D. et al (2005) Schizophrenia and increased risks of cardiovascular disease. American Heart Journal, 150, 11151121.
Hughes, J. R. (1999) Co-morbidity and smoking. Nicotine and Tobacco Research, 1, S149S152.
Hughes, J. R. (2007a) Effects of abstinence from tobacco: etiology, animal models, epidemiology, and significance: a subjective review. Nicotine and Tobacco Research, 9, 329339.
Hughes, J. R. (2007b) Effects of abstinence from tobacco: valid symptoms and time course. Nicotine and Tobacco Research, 9, 315327.
Hughes, J. R. (2007c) Depression during tobacco abstinence. Nicotine and Tobacco Research, 9, 443446.
Jamrozik, K. (2005) Estimate of deaths attributable to passive smoking among adults: database analysis. BMJ, 330, 812.
Jochelson, J. & Majrowski, B. (2006) Clearing the Air. Debating Smoke-Free Policies in Psychiatric Units. King's Fund.
John, U., Meyer, C., Rumpf, H. J. et al (2004) Smoking, nicotine dependence and psychiatric comorbidity – a population-based study including smoking cessation after three years. Drug and Alcohol Dependence, 76, 287295.
Johnson, J. G., Cohen, P., Pine, D. S. et al (2000) Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. JAMA, 284, 23482351.
Joukamaa, M., Heliövaara, M., Knekt, P. et al (2001) Mental disorders and cause-specific mortality. British Journal Psychiatry, 179, 498502.
Kavanagh, D. J., McGrath, J., Saunders, J. B. et al (2002) Substance misuse in patients with schizophrenia: epidemiology and management. Drugs, 62, 743755.
Kelly, C. & McCreadie, R. G. (1999) Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. American Journal Psychiatry, 156, 17511757.
Kelly, C. & McCreadie, R. (2000) Cigarette smoking and schizophrenia. Advances in Psychiatric Treatment, 6, 327331.
Kendler, K. S., Neale, M. C., Maclean, C. J. et al (1993) Smoking and major depression: a causal analysis. Archives of General Psychiatry, 50, 3643.
Khalil, A. A., Steyn, S. & Castagnoli, N. (2000) Isolation and characterization of a monoamine oxidase inhibitor from tobacco leaves. Chemical Research in Toxicology, 13, 3135.
Kitabayashi, Y., Narumoto, J., Shibata, K. et al (2006) Effect of institutional smoking prohibition on Japanese inpatients with chronic schizophrenia. Nihon Arukoru Yakubutsu Igakkai Zasshi, 41, 128133.
Klimek, V., Zhu, M.-Y. & Dilley, G. (2001) Effects of long-term cigarette smoking on the locus coerulus. Archives of General Psychiatry, 58, 821827.
Klungsoyr, O., Nygard, J. F., Sorensen, T. et al (2006) Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study. American Journal of Epidemiology, 163, 421432.
Kumari, V. & Postma, P. (2005) Nicotine use in schizophrenia: the self medication hypothesis. Neuroscience and Biobehavioural Reviews, 29, 10211034.
Lawn, S. & Pols, R. (2003) Nicotine withdrawal: pathway to aggression and assault in the locked psychiatric ward? Australasian Psychiatry, 1, 199203.
Lawn, S. & Pols, R. (2005) Smoking bans in psychiatric settings? A review of the research. Australian and New Zealand Journal of Psychiatry, 39, 866–855.
Lawn, S. J., Pols, R. G. & Barber, J. G. (2002) Smoking and quitting: a qualitative study with community-living psychiatric clients. Social Science and Medicine, 54, 93104.
Leavell, N. R., Muggli, M. E., Hurt, R. D. et al (2006) Blowing smoke: British American Tobacco's air filtration scheme. BMJ, 332, 227229.
Leonard, S., Adler, L. E., Benhammou, K. et al (2001) Smoking and mental illness. Pharmacology, Biochemistry and Behavior, 70, 561570.
Malone, K. M., Waternaux, C., Haas, G. L. et al (2003) Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders. American Journal Psychiatry, 160, 773779.
Martini, S., Wagner, F. A. & Anthony, J. C. (2002) The association of tobacco smoking and depression in adolescence: evidence from the United States. Substance Use and Misuse, 37, 18531867.
McEvoy, J. P., Freudenreich, O. & Wilson, W. H. (1999) Smoking and therapeutic response to clozapine in patients with schizophrenia. Biological Psychiatry, 46, 125.
McNally, L., Oyefeso, A., Annan, J. et al (2006) A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care. Journal of Public Health, 28, 192196.
McNeill, A. & Owen, L. (2005) Guidance for Smokefree Hospital Trusts. Health Development Agency.
Miller, N. & Gold, M. (1998) Comorbid cigarette and alcohol addiction: epidemiology and treatment. Journal of Addictive Disorders, 17, 5566.
Mino, Y., Shigemi, J., Otsu, T. et al (2000) Does smoking cessation improve mental health? Psychiatry and Clinical Neurosciences, 54, 169172.
Minzenberg, M. J., Poole, J. H., Benton, C. et al (2004). Association of anticholinergic load with impairment of complex attention and memory in schizophrenia. American Journal of Psychiatry, 161, 116124.
Mykletun, A., Overland, S., Aarø, L.E. et al (2008) Smoking in relation to anxiety and depression: Evidence from a large population survey. The HUNT study. European Psychiatry, 23, 7784.
Nurse, J. & Campion, J. (2006) Mental health and well-being in the South East. Care Services Improvement Partnership.
O'Hara, P., Connett, J. E., Lee, W. W. et al (1998) Early and late weight gain following smoking cessation in the Lung Health Study. American Journal of Epidemiology, 148, 821830.
Parrott, A.C. (2006) Nicotine psychobiology: how chronic-dose prospective studies can illuminate some of the theoretical issues from acute-dose research. Psychopharmacology (Berlin), 184, 567576.
Patten, C. A., Bruce, B. K., Hurt, R. D. et al (1995) Effects of a smokefree policy on an inpatient psychiatric unit. Tobacco Control, 4, 373379.
Patton, G. C., Carlin, J. B., Coffey, C. et al (1998) Depression, anxiety and smoking initiation: a prospective study over 3 years. American Journal of Public Health, 88, 15181522.
Peto, R., Darby, S., Deo, H. et al (2000) Smoking, smoking cessation, and ling cancer in the UK since 1950: combination of national statistics with two case control studies. BMJ, 321, 323329.
Phelan, M., Stradins, L. & Morrison, S. (2001) Physical health of people with severe mental illness. BMJ, 322, 443444.
Prochaska, J., Hall, S. & Bero, L. (2008) Tobacco use among individuals with schizophrenia: what role has the tobacco industry played? Schizophrenia Bulletin, 28 Mar.
Punnoose, S. & Belgamwar, M. R. (2006) Nicotine for schizophrenia. Cochrane Database of Systematic Reviews, issue 1 (DOI: 10.1002/14651858). John Wiley & Sons.
Reiger, D. A., Meyers, J. K., Kramer, M. et al (1984) The NIMH Epidemiologic Catchment Area program. Historical epidemiology of comorbidity, context, major objectives, and study population characteristics. Archives of General Psychiatry, 41, 934941.
Roy, K., Parker, G., Mitchell, P. et al (2001) Depression and smoking: examining correlates in a subset of depressed patients. Australian and New Zealand Journal of Psychiatry, 35, 329335.
Royal College of Physicians (2000) Nicotine Addiction in Britain. Royal College of Physicians of London.
Scientific Committee on Tobacco and Health (2004) Secondhand Smoke: Review of Evidence since 1998. Update of Evidence on Health Effects of Secondhand Smoke. Department of Health.
Schall, U. S., Pries, E., Katta, T. et al (1996) Pharmacokinetic and pharmacodynamic interactions in an outpatient maintenance therapy of intravenous heroin users with levomethadone. Addiction Biology, 1, 105113.
Smith, M. J. (2006) Risks of ‘passivity smoking’. BMJ, 11 September (http://bmj.com/cgi/eletters/333/7565/407#141586).
Smith, C. M., Pristach, C. A. & Cartagena, M. (1999) Obligatory cessation of smoking by psychiatric inpatients. Psychiatric Services, 50, 9194.
Sonntag, H., Wittchen, H. U., Hofler, M. et al (2000) Are social fears and DSM–IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults? European Psychiatry, 15, 6774.
Spring, S., Pingitore, R. & McChargue, D. E. (2003) Reward value of cigarette smoking for comparably heavy smoking schizophrenic, depressed and nonpatient smokers. American Journal of Psychiatry, 160, 316322.
Stubbs, J., Haw, C. & Garner, L. (2004) Survey of staff attitudes to smoking in a large psychiatric hospital. Psychiatric Bulletin, 28, 204207.
Sullivan, M. A. & Covey, L. S. (2002) Nicotine dependence: the role for antidepressants and anxiolytics. Current Opinion in Investigational Drugs, 3, 262271.
Taylor, T., Lader, D., Bryant, A. et al (2006) Smoking-related Behaviour and Attitudes, 2005. Office for National Statistics (http://www.statistics.gov.uk/downloads/theme_health/Smoking2005.pdf).
Wade, D., Harrigan, S., Edwards, J. et al (2006) Course of substance misuse and daily tobacco use in first-episode psychosis. Schizophrenia Research, 81, 145150.
Wanless, D. (2004) Securing Good Health for the Whole Population. TSO (The Stationery Office).
Watkins, S. S., Koob, G. F. & Markou, A. (2000) Neural mechanisms underlying nicotine addiction: acute positive reinforcement and withdrawal. Nicotine and Tobacco Research, 2, 1937.
West, R. & Hajek, P. (1997) What happens to anxiety levels on giving up smoking? American Journal Psychiatry, 154, 15891592.
West, R. & Jarvis, M. (2005) Tobacco smoking and mental disorder. Italian Journal of Psychiatry and Behavioural Science, 15, 1017.
Whincup, P. H., Gilg, J. A., Emberson, J. R. et al (2004) Passive smoking and risk of coronary heart disease and stroke: a prospective study with cotinine measurement. BMJ, 329, 200205.
Wilhelm, K., Arnold, K., Niven, H. et al (2004) Grey lungs and blue moods: smoking cessation in the context of lifetime depression history. Australian and New Zealand Journal of Psychiatry, 38, 896905.
Wilhelm, K., Mitchell, P., Slade, T. et al (2003) Prevalence and correlates of DSM–IV major depression in an Australian national survey. Journal of Affective Disorders, 75, 155162.
Williams, J. M. & Ziedonis, D. M. (2004) Addressing tobacco among individuals with a mental illness or an addiction. Addictive Behaviours, 29, 10671083.
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO.
World Health Organization (2006) Tobacco: Deadly in any Form or Disguise (http://www.who.int/tobacco/communications/events/wntd/2006/Tfi_Rapport.pdf).
Wu, L. T. & Anthony, J. C. (1999) Tobacco smoking and depressed mood in late childhood and early adolescence. American Journal of Public Health, 89, 18371840.
Zammit, S., Allebeck, P., Dalman, C. et al (2003) Investigating the association between cigarette smoking and schizophrenia in a cohort study. American Journal Psychiatry, 160, 22162221.
Ziedonis, D. M., Kosten, T. R., Glazer, W. M. et al (1994) Nicotine dependence and schizophrenia. Hospital Community Psychiatry, 45, 204206.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Smoking by people with mental illness and benefits of smoke-free mental health services

  • Jonathan Campion, Ken Checinski, Jo Nurse and Ann McNeill
Submit a response

eLetters

Smoking ban and Clozapine level !

Mohammed Ashir, SpR
23 July 2008

The smoking ban implemented this July will affect psychiatric in-patients of whom 74% are smokers (Meltzer, 1996). Plasma concentrations ofcertain psychotropics are known to be affected by smoking status. Smokersare usually prescribed higher doses compared to non-smokers and abrupt smoking cessation will lead to high plasma concentrations and potentially more side-effects.

Clozapine plasma concentrations can rise 1.5 times in 2–4 weeks following smoking cessation (de Leon, 2004) and in some instances 50-70% within 2-4 days. If baseline plasma concentrations are higher – particularly over 1mg\L - the plasma concentration may rise dramatically due to non linear kinetics. If patients smoking more than 7-12 cigarettes per day while taking clozapine decide to quit the dose may need to be reduced by 50 % ( Haslemo et al 2006).

Although patients may not quit during an admission their access to cigarettes may be limited depending on leave status or other practicalities e.g. availability of staff to escort them off the ward. The“PRN” prescription of Nicotine Replacement Therapy, although strictly speaking off license, may help cravings but NRT has NO effect on clozapineplasma concentration.

All patients should be informed that in-patient settings are now smoke-free and we need to clarify and record smoking status on admission. Clinicians will need to monitor clozapine plasma concentrations in smokersclosely during admissions and shortly after discharge. All UK assays are performed at the Toxicology Unit, Kings College Hospital, London and electronic access to results is possible after registration. (pathologyi.t@kch.nhs.uk). Savings made by clozapine dose reductions will mitigate the additional costs incurred!

Dr Mohammed Ashir, Specialist Registrar in Psychiatry, Tomswood Rehabilitation Unit, Whipps Cross Hospital, E11 1NR, mohammed.ashir@nelmht.nhs.uk.

Dr Louise Petterson, Consultant in Rehabilitation Psychiatry, Goodmays Hospital, London.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *