Smoking and mental illness. An update for psychiatrists

Abstract

Objective: We aimed to review research on smoking and mental illness and provide evidence-based guidelines for psychiatrists to help smoking patients quit.

Method: We undertook a narrative review of the literature with a special focus on the Australian context.

Results: Although one in three people with mental illness smoke tobacco, smoking is often neglected in psychiatric practice. Smoking is a significant contributor to the health gap between people with mental illness and the general population. Smokers with mental illness are motivated to quit and are able to do so, albeit with lower quit rates. Quitting can lead to substantial improvements in mental wellbeing and physical health and does not exacerbate pre-existing mental illness. Psychiatrists should advise all smokers to quit and provide counselling, medication and support, based on the 5As framework. Approved pharmacotherapy - nicotine replacement therapy, varenicline and bupropion - is recommended for nicotine-dependent smokers. Smoking induces the metabolism of certain psychotropic drugs such as clozapine and olanzapine and dose reductions may be necessary after cessation.

Conclusions: Psychiatrists have a duty of care to identify the smoking status of their patients and to provide evidence-based support to quit.

Keywords: mental health; mental illness; nicotine dependence; psychiatry; smoking.