Stop Turning a Blind Eye: Tobacco Smoking Among Egyptian Patients With Schizophrenia

Heavy metal concentrations and clinical symptoms in patients diagnosed with schizophrenia related to cigarette smoking

In our study, blood concentrations of lead (Pb), arsenic (As), and cadmium (Cd) and urine concentrations of thallium (Tl) were measured together with related symptoms of heavy metal poisoning in cigarette smoking volunteers diagnosed with schizophrenia, in cigarette smokers not diagnosed with schizophrenia, and in the control group of non-smokers and not diagnosed with schizophrenia volunteers. Our study was performed on 171 volunteers divided into the following subgroups: patients diagnosed with schizophrenia with at least 1 year of continuous cigarette smoking experience (56 participants), cigarette smokers not diagnosed with schizophrenia with at least one year of continuous smoking experience (58), and control group (not diagnosed with schizophrenia and non-smoking volunteers) (57). Smoking durations of cigarette smokers diagnosed with schizophrenia and cigarette smokers not diagnosed with schizophrenia are not similar (p = 0.431). Blood Pb, As, and Cd concentrations and urine Tl concentrations were the highest in the subgroup of cigarette smokers not diagnosed with schizophrenia, followed by the subgroup of cigarette smokers diagnosed with schizophrenia, and the control group. Only blood Pb concentrations were significantly higher (probability value p < 0.05) in the group of cigarette smokers not diagnosed with schizophrenia (5.16 μg/dL), comparing to the group of cigarette smokers diagnosed with schizophrenia (3.83 μg/dL) and to the control group (3.43 μg/dL). Blood Cd and As concentrations and urine Tl concentrations were significantly higher (p < 0.05) in cigarette smokers not diagnosed with schizophrenia than in the control group. The results revealed a statistically significant positive correlation (p < 0.001) in the cigarette smokers in the schizophrenia diagnosed group between blood Pb, blood As, and urine Tl concentrations and the duration of cigarette smoking.

Support and attitudes of Qatar mental health professionals to a proposed mental health inpatient smoking ban: Results of a cross-sectional survey

WHAT IS KNOWN ON THE SUBJECT?: Smoking is more common among people with serious mental illness, and it contributes to a reduced life expectancy. Several Western countries have successfully introduced smoke-free policies in inpatient mental health units. There is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We surveyed mental health professionals working in Qatar's main mental health service to determine support for and attitudes towards a proposed total smoking ban in psychiatric wards. Most staff who completed the survey supported an inpatient smoking ban. However, further analysis, both quantitative and qualitative, showed markedly ambivalent attitudes, that is staff simultaneously held attitudes that supported and opposed a smoking ban. Professionals who did not support a ban were more likely to have not received smoking cessation training in the last 5 years, to be a psychiatrist rather than a nurse or allied mental health professional, to be current smokers and to be a Middle Eastern and North African national. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further staff training is necessary to achieve more consistent attitudes that support a total smoking ban and increase the likelihood of successful implementation. The attitudes in this study showed similarities and differences to those reported for mental health professionals in Western countries. This highlights that local research is necessary to help shape training and successfully implement smoke-free policies. ABSTRACT: Introduction Despite the fact that patients with serious mental illness (SMI) have high rates of smoking and an increased standardized mortality, there is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. Aim To assess support for, and attitudes towards, a proposed total smoking ban in psychiatric wards among mental health clinicians in Qatar. Method Cross-sectional survey of mental health professionals working in Qatar's primary mental health service. Results The response rate was 68% (353/520). Support for a ban was assessed with a single-item question; 73% of respondents supported a ban with opposition significantly (p < .05) associated with being a current smoker, a Middle Eastern and North African (MENA) national, a psychiatrist versus a mental health nurse or allied health professional and not receiving smoking cessation training in the last 5 years. A 21-item questionnaire assessed attitudes to a total smoking ban. It showed marked ambivalence with multiple linear regression identifying MENA nationality, male gender and current smoking status as independent variables influencing attitudes. The most strongly held attitude supporting a ban was concern about passive smoking and against a ban was concern it may increase patient agitation. Qualitative data confirmed ambivalent views. Discussion The results show similarities and differences to research from other countries suggesting that cultural factors influence some attitudes to smoke-free policies. Implications for Practice Staff support and smoking cessation education are necessary to achieve more consistent staff attitudes to support smoke-free policies.

Indicadores hospitalarios y comportamiento de pacientes internados en hospital psiquiátrico que adoptó la prohibición de fumar

Resumen Objetivo: comparar indicadores de internación, alta, costo con medicamentos y comportamientos de los pacientes antes y después de la prohibición del tabaquismo en un hospital psiquiátrico. Método: estudio ecológico, longitudinal y retrospectivo realizado en un hospital psiquiátrico. Fueron obtenidos datos secundarios, a partir de consulta a las fichas médicas, referentes a 2.142 internaciones. Fue aplicado el test de medianas para comparación de las variables antes y después de la prohibición. Resultados: con la implementación de la prohibición el porcentaje de ocupación de las camas fue reducido en las unidades masculinas de trastornos mentales (88,8% para 48,4%) y de dependencia química (94,4% para 42,8%). La media de días de internación fue reducida en la unidad masculina de dependencia química (13,5 para 12,6) en comparación con la unidad femenina (14,7 para 19,5). Los costos con psicofármacos y expectorantes, las agresiones verbales/físicas y las contenciones físicas/químicas fueron reducidas. Conclusión: la prohibición de fumar alteró los indicadores hospitalarios, redujo costos y mejoró el comportamiento de los pacientes, contrariando el mito de que esta resulta en hostilidad. Se espera que este estudio contribuya para que los enfermeros revisen sus creencias relacionadas con la prohibición del tabaquismo, considerando los resultados positivos para las relaciones interpersonales y para la administración de los servicios de salud mental, que fueron obtenidos.

Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban

Abstract Objective: to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital. Method: ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban. Results: after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints. Conclusion: the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.

Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban

OBJECTIVE

to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital.

METHOD

ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban.

RESULTS

after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints.

CONCLUSION

the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.

Effects of Smoking Status on Remission and Metabolic and Cognitive Outcomes in Schizophrenia Patients Treated with Clozapine

BACKGROUND

Even though clozapine is the recommended last-resort antipsychotic, many patients fail to respond and show treatment-refractory psychotic symptoms. Smoking has been suggested as a possible risk factor for poor clozapine response, hampering remission and negatively impacting somatic outcomes.

METHODS

Our aim was to test whether smoking status is associated with remission rates and other symptomatic and somatic outcomes. We therefore assessed remission rates according to The Remission in Schizophrenia Working Group (RSWG) criteria, and metabolic and cognitive outcomes among patients with schizophrenia-spectrum disorders treated with clozapine for at least 6 months. For analyses, we grouped our cohort into 3 groups according to clozapine treatment duration (6 months, 2 years, 5 years).

RESULTS

One hundred five patients were included in our analyses and grouped according to their clozapine treatment duration. In the 6-months analyses, patients who smoked were significantly more likely to be younger of age (p=0.002) despite on average shorter duration of clozapine treatment (p=0.041) and significantly more likely to be treated with mood-stabilizing co-medication (p=0.030) compared to nonsmokers. Remission rates (p=0.490), as well as a set of metabolic and cognitive variables did not differ between the 2 groups. A related pattern could be observed for the 2- and 5-years analyses.

CONCLUSIONS

Smoking behavior among clozapine-treated schizophrenia patients might delineate a cohort with an earlier onset of the disease. Nevertheless, most findings comparing disease-specific and clinical outcomes among smokers and nonsmokers were negative. Further research is needed to identify strategies to overcome insufficient remission rates in this patient group.

Causes of premature mortality in schizophrenia: a review of literature published in 2018

PURPOSE OF REVIEW

The current review examines the recent literature on the causes of premature mortality in schizophrenia.

RECENT FINDINGS

People with schizophrenia have higher premature mortality rates compared with the general population. Suicides and accidents account for a nontrivial part of the excess mortality, but the largest part is attributable to natural causes of death. Five major causes have been identified: first, adverse effects of medication; second, suboptimal lifestyle; third, somatic comorbidity; fourth, suboptimal treatment of somatic disorders; and fifth, accelerated ageing/genetic explanations. The positive aspect is that people with schizophrenia have increasing life expectancy, at least in high-income countries, and this development seems to largely follow the increase in the general population. Especially mortality rates from unnatural causes appear to have a positive impact. Nevertheless, despite more than 100 years of research and progress, the excess mortality in persons with schizophrenia remains unacceptably high, with no prospects of reaching the level in the general population.

SUMMARY

The excess mortality in schizophrenia has received much focus. Future studies should explore the reasons for the high rates of natural causes of death, while aiming to disentangle the complex interplay between medication, lifestyle, comorbidity, treatment of somatic disorders, and genetic effects.