Physical health and Physical health and sever mental illnesssever mental illness

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Mr. mutasem naser allahMr. mutasem naser allah

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Why do people with SMI experience Why do people with SMI experience physical health problemphysical health problem

Factor related to having SMIHealth behaviour of people with SMIAdverse effect of psychotropic medication on health

Factor related to having SMI

The people with schizophrenia are less The people with schizophrenia are less likely to spontaneously report physical likely to spontaneously report physical symptoms . symptoms .

Because they may be unaware of physical Because they may be unaware of physical problem because of cognitive deficit problem because of cognitive deficit associatedassociated with the schizophreniawith the schizophrenia

Also socio-economic of having mental Also socio-economic of having mental disorderdisorder such as poverty , poor such as poverty , poor housing ,reduce social networks , lack of housing ,reduce social networks , lack of employment , social stigma employment , social stigma

Health behavior of people Health behavior of people with SMIwith SMI

The most common increase The most common increase morbidity and mortality rate in morbidity and mortality rate in people with SMI their habits :-people with SMI their habits :-

Rate of smoking Rate of smoking Poor housingPoor housing lack of Exercise lack of Exercise Substance abuse Substance abuse Unsafe sexual practice Unsafe sexual practice

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(2003) comprehensive survey of 102 (2003) comprehensive survey of 102 service users with schizophrenia service users with schizophrenia identified that :- identified that :-

70% were smoker 70% were smoker 86% of female over weight 86% of female over weight 70% of male were over weight 70% of male were over weight 53 % had raised cholesterol 53 % had raised cholesterol All of these are related to their All of these are related to their

behavior behavior

Smoking and sever mental Smoking and sever mental illnessillness

Many epidemiological studies have Many epidemiological studies have assessed rate of smoking in people assessed rate of smoking in people with schizophrenia , bipolar disorder with schizophrenia , bipolar disorder range 585 to 88% up to 3 time range 585 to 88% up to 3 time higher than general population higher than general population

In UK prevalence smoke rate 74% in In UK prevalence smoke rate 74% in 2002 25 cigarettes a day 2002 25 cigarettes a day

Causes of high rate of Causes of high rate of smokingsmoking

Neurobiological Psychological

Behavior Cultural

contcont Nicotine alleviate certain psychiatric Nicotine alleviate certain psychiatric

symptoms as negative symptoms , symptoms as negative symptoms , cognitive dysfunction, side effect of cognitive dysfunction, side effect of antipsychotic medicationantipsychotic medication

Dopamine factor Dopamine factor Increase dopamine release through Increase dopamine release through

inhaling nicotine may reduce negative inhaling nicotine may reduce negative symptomssymptoms and improve attention and selective processing of information that usually impaired in people with schizophrenia

Psychosocial and Psychosocial and behavior factorbehavior factor

Many epidemiological studies Many epidemiological studies founed:-founed:-

People with schizophrenia smoke out People with schizophrenia smoke out of habits routine of habits routine

For relaxationFor relaxation Way of making social contact Way of making social contact For pleasure For pleasure They believe they are addicted They believe they are addicted

Mental health cultureMental health culture

Smoking is ingrained in culture of Smoking is ingrained in culture of psychiatric so the most wrong to psychiatric so the most wrong to encourage to stop smoking , because encourage to stop smoking , because you well increase violent behavior you well increase violent behavior because that means self medication because that means self medication

It is improved mood and reduce It is improved mood and reduce anxiety anxiety

Why Do People With Mental Illness Why Do People With Mental Illness SmokeSmoke

Nicotine increases alertness. This may enhance Nicotine increases alertness. This may enhance concentration, thinking and learning. This may be concentration, thinking and learning. This may be a benefit to people with schizophrenia whose a benefit to people with schizophrenia whose illness or medication leads to cognitive problems. illness or medication leads to cognitive problems.

Nicotine can help relaxation, and it can also Nicotine can help relaxation, and it can also reduce negative feelings such as anxiety, tension reduce negative feelings such as anxiety, tension and anger. So smoking may help people with and anger. So smoking may help people with mental illness deal with stressful situations. mental illness deal with stressful situations.

For pleasure and because they believe they are For pleasure and because they believe they are addicted .addicted .

ContCont Nicotine may reduce positive symptoms, Nicotine may reduce positive symptoms,

such as hallucinations for a short period. such as hallucinations for a short period. There is some evidence to suggest that There is some evidence to suggest that

smoking is associated with reduced levels smoking is associated with reduced levels of antipsychotic induced Parkinsonism. of antipsychotic induced Parkinsonism.

Smoking can help to relieve boredom and Smoking can help to relieve boredom and provide a framework for the day. provide a framework for the day.

Smoking can improve social interaction, Smoking can improve social interaction, something that may be of particular something that may be of particular benefit to people with negative symptoms benefit to people with negative symptoms

Nicotine Dependence Nicotine Dependence among Seriously Mentally among Seriously Mentally

Ill (SMI)Ill (SMI)

75% of SMI are tobacco dependent 75% of SMI are tobacco dependent (22% general population)(22% general population) 85% in schizophrenia85% in schizophrenia

60 - 95% of people with addiction 60 - 95% of people with addiction disorders smokedisorders smoke

Impact smoking in people Impact smoking in people with SMI who take with SMI who take

medicationmedication Cytochrome p450 metabolism some Cytochrome p450 metabolism some

drug like antipsychotic antidepressant .drug like antipsychotic antidepressant . Polycyclic hydrocarbon in tobacco Polycyclic hydrocarbon in tobacco

induced this inzyme and increase induced this inzyme and increase metabolism and therefore lower the metabolism and therefore lower the plasma concentration of these plasma concentration of these medication so the smoker often need medication so the smoker often need more medication compared with non more medication compared with non smokersmoker

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The plasma concentration of The plasma concentration of clozapen clozapen increase dramatically in pt following abrupt smoking cessation leading to toxicity

Nicotine replacementNicotine replacement

Begin NRT on the quit date, (apply patches the night before)

Use a dose that controls the withdrawal symptoms

NRT provides levels of nicotine well below smoking

Prescribe in blocks of two weeks Arrange follow up to provide support Use a full dose for 6 to 8 weeks then

reduce the dose gradually over 4 weeks.

Nurse can do to help Nurse can do to help clientclient

Explore the good thing and not so good Explore the good thing and not so good thing about smoking and not so good thing about smoking and not so good thing and good thing about stopping thing and good thing about stopping

Psychological support need to make Psychological support need to make successful quiet and prevent relapse successful quiet and prevent relapse

Health education information can be Health education information can be provided in balance , non judgmental provided in balance , non judgmental way way

Supporting with pharmacological NRTSupporting with pharmacological NRT

ASSIST the quit attempt

Provide assistance in developing a quit plan;

Help a patient to set a quit date; Offer self-help material; Explore potential barriers and

difficulties Review the need for pharmacotherapy. Refer to a quit line and/or an active call

back programme

ARRANGE follow up

Offer a follow up appointment within 7 days Affirm success when you next see the

patient Reinforce successful quitting: positive

feedback helps sustain smoking cessation. Don’t talk about ‘failure’, ‘relapse’ is very

common Help the patient work out ‘what went wrong

this time’ and how they prevent a relapse next time.

Nurse can doNurse can do

Decrease number of smokers in Decrease number of smokers in every settingevery setting..

Increase the number of smokers Increase the number of smokers advancing toward quitting.advancing toward quitting.

Increase the number of smokers who Increase the number of smokers who have been given advise to quit.have been given advise to quit.

Barriers to Successful Barriers to Successful CessationCessation

Provider inattention/pessimismProvider inattention/pessimism Co-dependency and mental illnessCo-dependency and mental illness Mental health staff smokeMental health staff smoke Historic attitudes about smoking in Historic attitudes about smoking in

mental health communitymental health community No coverage for cessation drugsNo coverage for cessation drugs Improper use of the drugsImproper use of the drugs

ADVISE on coping strategies

Drinking alcohol is strongly associated with relapse Inform friends and family and ask for support Consider writing a ‘contract’ with a quit date Removal of cigarettes from home, car and

workplace; Give practical advice about coping with Withdrawal

symptoms occur mostly during the first two weeks Relapse after this time relates to cues or

distressing events. Remind patients of the health benefits of quitting

Potential ObstaclesPotential Obstacles

Lack of motivationLack of motivation Effects of medicationEffects of medication Lack of moneyLack of money BoredomBoredom Mental health cultureMental health culture Attitudes and beliefs of health staffAttitudes and beliefs of health staff

Our aimOur aim

Our aim is to improve the physical Our aim is to improve the physical health of mental health service users health of mental health service users byby

Engaging people in activities that Engaging people in activities that reduce their risks of illnessreduce their risks of illness

Removing obstaclesRemoving obstacles

Why do people with SMI experience Why do people with SMI experience physical health problemphysical health problem

Adverse effect of psychotropic medication on health:-

Both Antipsychotic drug make weigh gain

Some antipsychotic drug make excessive salivation like clozapen and olanzepen…..

Baseline before or at start Baseline before or at start drug initiationdrug initiation

Weigh and high and body mass index Weigh and high and body mass index should be recordedshould be recorded

Personnel and family history of obesity Personnel and family history of obesity and diabetes and diabetes

Fast blood glucose after one month for Fast blood glucose after one month for clozapen and olanzepen clozapen and olanzepen

Reduce energy and fat intake Reduce energy and fat intake Increase fiber and fruit and vegetables Increase fiber and fruit and vegetables

intakeintake Increase physical activity to 20 min adayIncrease physical activity to 20 min aday

Medication impact of Medication impact of sexual interestsexual interest

In medicated people the effect of In medicated people the effect of medication on number of medication on number of neurotransmitter will interfere with neurotransmitter will interfere with sexual functionsexual function

All antipsychotic are dopamine All antipsychotic are dopamine antagonist except airpirazol dopamine antagonist except airpirazol dopamine involve in sexual arousal and orgasm .so involve in sexual arousal and orgasm .so blocking dopamine may contribute to blocking dopamine may contribute to reduce libido and disturbance in orgasm reduce libido and disturbance in orgasm

contcont

The drug rely on dopamine antagonist to The drug rely on dopamine antagonist to provide their antipsychotic effect and removed provide their antipsychotic effect and removed the brake on prolactine secretion leading to the brake on prolactine secretion leading to hyperprolactinhyperprolactin

Raised in prolactine level will occur decrease Raised in prolactine level will occur decrease in testosterone hormones in both men and in testosterone hormones in both men and women leading to sexual dysfunction women leading to sexual dysfunction

Hyperprolactin side effect of both typical and Hyperprolactin side effect of both typical and atypical antipsychotic drug atypical antipsychotic drug

Routine blood test can be take for prolactine Routine blood test can be take for prolactine level level

Thank you for attentionThank you for attention

mutasem naser allahmutasem naser allah MrMr . .