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Smoking and Mental Health a Joint Report by the Royal College of Physicians and the Royal College of Psychiatrists

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Smoking and Mental Health a Joint Report by the Royal College of Physicians and the Royal College of Psychiatrists PDF not for circulation Smoking and mental health A joint report by the Royal College of Physicians and the Royal College of Psychiatrists Endorsed by: 0450_PUBS_S&MH_jacket_322x234mm.indd 2 11/03/2013 15:42 Smoking & mental health Prelims 11/3/13 3:59 pm Page ii Acknowledgments The Tobacco Advisory Group acknowledges with thanks contributions to the production of this report by staff and students at the UK Centre for Tobacco Control Studies (www.ukctcs.org), which is supported by core funding from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, Medical Research Council and Department of Health under the auspices of the UK Clinical Research Collaboration. We thank Cancer Research UK for additional funding to support the systematic reviews and new data analyses, and EPIC for providing THIN data. We also thank Kapka Nilan for help in preparing bibliographies, and Joanna Reid and Urooj Asif Akhtar of the RCP Corporate Communications and Publishing team, for the production of this report. The Royal College of Physicians The Royal College of Physicians plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in over 30 medical specialties with education, training and support throughout their careers. As an independent charity representing more than 28,000 fellows and members worldwide, we advise and work with government, patients, allied healthcare professionals and the public to improve health and healthcare. The Royal College of Psychiatrists The Royal College of Psychiatrists is an independent charity that represents over 16,000 members worldwide. It exists to set standards and promote excellence in psychiatry and mental healthcare; to lead, represent and support psychiatrists; and to work with mental healthcare service users, carers and their organisations in achieving these aims. Citation for this document Royal College of Physicians, Royal College of Psychiatrists. Smoking and mental health. London: RCP, 2013. Royal College of Psychiatrists Council Report CR178. Copyright All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Copyright © Royal College of Physicians 2013 ISBN 978 1 86016 508 5 eISBN 978 1 86016 509 2 Royal College of Physicians Royal College of Psychiatrists 11 St Andrews Place 17 Belgrave Square Regent’s Park London SW1X 8PG London NW1 4LE www.rcpsych.ac.uk www.rcplondon.ac.uk Registered Charity No 228636 Registered Charity No 210508 Typeset by Cambrian Typesetters, Camberley, Surrey Printed by The Lavenham Press Limited, Suffolk Smoking & mental health Prelims 7/3/13 10:36 am Page iii Contents Members of the Tobacco Advisory Group x Contributors xi Foreword xiv 1 Mental disorders 1 1.1 What is a mental disorder? 1 1.2 Occurrence and associations of mental disorder 2 1.3 Common mental disorders 3 1.4 Other non-psychotic disorders 3 1.4.1 Obsessive–compulsive disorder 3 1.4.2 Post-traumatic stress disorder 4 1.4.3 Eating disorders 4 1.4.4 Somatisation disorder 5 1.5 Psychotic disorders 6 1.5.1 Schizophrenia 6 1.5.2 Bipolar disorder 7 1.6 Personality disorder 7 1.7 Childhood disorders 8 1.7.1 Attention deficit hyperactivity disorder 8 1.7.2 Conduct disorders 9 1.8 Dementia 10 1.9 Mental health services 11 1.10 Summary 12 2 Smoking among people with mental disorders 16 2.1 Introduction 16 2.2 Data and methods 16 2.2.1 Health Survey for England 16 2.2.2 Adult Psychiatric Morbidity Survey 17 2.2.3 The Health Improvement Network 19 2.3 Smoking prevalence 21 2.3.1 HSE 21 2.3.2 APMS 22 2.3.3 THIN 23 © Royal College of Physicians 2013 iii Smoking & mental health Prelims 7/3/13 10:36 am Page iv Smoking and mental health 2.4 Population estimates 25 2.5 Variations in smoking prevalence among those with mental disorder by age, sex and socioeconomic status 27 2.6 Strength of addiction 27 2.7 Association between cigarette consumption and mental disorders 29 2.8 Proportion of cigarettes smoked by people with a mental disorder 29 2.9 Quitting behaviour 29 2.10 Delivery of smoking cessation interventions 33 2.11 Supplementary APMS survey data on special populations 35 2.12 Summary 35 3 Neurobiological and behavioural mechanisms linking smoking and mental disorders 38 3.1 Mechanisms of nicotine addiction 38 3.2 Models of association and sources of evidence 39 3.2.1 Genetic evidence 40 3.2.2 Animal models 40 3.2.3 Social and psychosocial mechanisms 41 3.3 Depression and anxiety 41 3.3.1 Evidence from genetic studies 42 3.3.2 Evidence from animal studies 42 3.3.3 Evidence from human studies 44 3.4 Schizophrenia 46 3.4.1 Evidence from genetic studies 46 3.4.2 Evidence from animal studies 47 3.4.3 Evidence from human studies 47 3.5 Attention deficit hyperactivity disorder 48 3.5.1 Evidence from genetic studies 48 3.5.2 Evidence from animal studies 49 3.5.3 Evidence from human studies 50 3.6 Smoking and dementia 51 3.7 Future studies 52 3.8 Summary 52 4 Epidemiology of the association between smoking and mental disorders 63 4.1 Introduction 63 4.2 Search methods 63 4.3 Smoking and onset of any mental disorder 64 4.4 Smoking and developmental and emotional disorders 65 4.4.1 Composite measures of behavioural and emotional disorders 65 4.4.2 Internalising and externalising problems 66 iv © Royal College of Physicians 2013 Smoking & mental health Prelims 7/3/13 10:36 am Page v Contents 4.4.3 Attention deficit hyperactivity disorder 66 4.4.4 Oppositional defiant disorder 67 4.4.5 Conduct disorder 67 4.5 Smoking and bipolar disorder 68 4.6 Smoking and schizophrenia 69 4.7 Smoking and anxiety disorders 70 4.8 Smoking and eating disorders 70 4.9 Smoking and depression 71 4.9.1 Smoking and onset of depression 71 4.9.2 Depression and onset of smoking 72 4.10 Smoking and dementia 75 4.11 Smoking and increased mortality and morbidity among people with mental disorders 76 4.12 Summary 76 Appendix to Chapter 4 (Tables A1–7) is available online at www.rcplondon.ac.uk/publications/smoking-and-mental-health 5 Smoking cessation interventions for individuals with mental disorders 84 5.1 General considerations 84 5.2 Cessation interventions for severe mental illness 85 5.2.1 Behavioural support 85 5.2.2 Nicotine replacement therapy 86 5.2.3 Bupropion 87 5.2.4 Varenicline 87 5.2.5 Cautions on use of bupropion and varenicline 88 5.3 Cutting down on smoking, and other harm reduction strategies 89 5.3.1 Behavioural interventions 89 5.3.2 Nicotine replacement therapy 90 5.3.3 Bupropion 90 5.3.4 Varenicline 90 5.4 Is it safe for people with SMI to give up smoking? 90 5.4.1 Adverse events relating to smoking cessation interventions 91 5.4.2 Effects of smoking cessation on mental health symptoms 91 5.4.3 Weight gain 92 5.4.4 Interactions with treatment for mental disorders 92 5.4.5 Interactions with caffeine 95 5.4.6 Nicotine withdrawal symptoms 95 5.4.7 Effects of antipsychotic medication on smoking cessation 95 © Royal College of Physicians 2013 v Smoking & mental health Prelims 7/3/13 10:36 am Page vi Smoking and mental health 5.5 Provision of smoking cessation and tobacco dependence treatment for smokers with mental disorders in the UK 96 5.5.1 Primary care 96 5.5.2 Specialist mental health settings (secondary care) 97 5.5.3 Child and adolescent mental health services 98 5.5.4 NHS stop smoking services 99 5.5.5 Enhancing service provision for smokers with mental disorders 100 5.6 Experience of attempts to introduce comprehensive smoking cessation support in mental health settings: UK case studies 100 5.6.1 London, UK 100 5.6.2 Nottingham, UK 101 5.6.3 Implications for practice 103 5.7 Summary 103 6 Population strategies to prevent smoking in mental disorders 111 6.1 Introduction 111 6.2 General population strategies 111 6.2.1 Smoke-free legislation 111 6.2.2 Mass media campaigns 112 6.2.3 Health warnings 112 6.2.4 Ending tobacco advertising, promotion and sponsorship 113 6.2.5 Price increases 113 6.2.6 Illicit tobacco 114 6.2.7 Minimum legal age for cigarette purchase 114 6.2.8 Smoking cessation services 114 6.2.9 Preventing smoking uptake through school-based interventions 115 6.2.10 Harm reduction 115 6.3 Population strategies and smoking prevention in mental health 116 6.3.1 Smoke-free policies in mental health treatment settings 116 6.3.2 Media campaigns 119 6.3.3 Health warnings, advertising and sponsorship 119 6.3.4 Price and illicit supply 119 6.3.5 Minimum legal age of purchase 120 6.3.6 NHS stop smoking services 120 6.3.7 Harm reduction strategies 120 6.3.8 School-based interventions 120 6.4 Factors perpetuating smoking in mental health settings 121 6.4.1 A smoking culture 121 6.4.2 Staff beliefs and attitudes 121 vi © Royal College of Physicians 2013 Smoking & mental health Prelims 7/3/13 10:36 am Page vii Contents 6.4.3 Staff knowledge 122 6.4.4 Staff smoking 122 6.4.5 Systems, targets, and resources 123 6.5 Summary 124 7 Smoking and mental disorders: special circumstances 130 7.1 Forensic psychiatric inpatient services 130 7.1.1 Introduction 130 7.1.2 Smoking prevalence in forensic psychiatric services 131 7.1.3 Smoking cessation support within forensic psychiatric services 131 7.1.4 Smoke-free policies in forensic psychiatric
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