Is pharmacotherapy safe for patients with psychiatric comorbidity
{"Image DocumentName": "Is pharmacotherapy safe for patients with psychiatric comorbidity", "Image ImageDescription": "Is pharmacotherapy safe for patients with psychiatric comorbidity? (cont) Patients with a history of major depression who quit may be 7 times more likely to have a recurrence of major depression than people who continue to smoke Current smokers have higher rates of anxiety disorders & may find it more difficult to remain abstinent. Evidence suggests that anxiolytics are not effective smoking cessation aids Quitting may affect the pharmacokinetics of psychiatric medications (eg anti-psychotic medications) Monitor actions or side effects of psychiatric medications in smokers attempting abstinence. Mental health patients demonstrate a preference for nicotine inhaler over the transdermal patch. SPEAKERS NOTES: A recent follow-up study of 76 participants with a history of major depression (excluding bipolar disorders) who stopped smoking found they were seven times more likely to have a recurrence of major depression than people who continued to smoke. Risk of depression did not generally arise immediately after cessation but was distributed across the entire study period of six months (Glassman et al 2001). The National Survey of Mental Health and Wellbeing found that current smokers also have higher rates of anxiety disorders and, as with depression, anxious persons may find it more difficult to remain abstinent. Evidence suggests that anxiolytics are not effective smoking cessation aids (Degenhardt & Hall 2001). Current smokers were significantly more likely to screen positively for psychosis and this finding is in accord with the high rates of tobacco smoking observed in clinical samples of persons with psychotic illness, particularly schizophrenia. Studies indicate that 70% or more of schizophrenia patients smoke (Jorm 1999). It has been suggested that nicotine may be used to self-medicate some psychotic symptoms and evidence suggests that persons with psychosis smoke more heavily and use higher tar cigarettes. Although psychiatric comorbidity places smokers at increased risk for relapse, such smokers can be helped by smoking cessation treatments. Stopping smoking may affect the pharmacokinetics of certain psychiatric medications (e.g. anti-psychotic medications), therefore clinicians may wish to monitor closely the actions or side effects of psychiatric medications in smokers attempting abstinence (Fiore et al 2000). A recent study of 55 patients hospitalised in a smoke-free ward demonstrated a definite preference for the nicotine inhaler over the transdermal patch (D\u2019Mello et al 2001). (See Page 16 of \u2018Guide for the management of nicotine dependent inpatients\u2019)", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}