Electronic Letters to:
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eLetters: Electronic letters published:
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wake up call
- Indermeet sawhney (11 March 2005)
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Smoking in a long stay psychiatric rehabilitation centre
- Reza Kiani, Mohammed Abbas, SHO in Psychiatry, Lincolnshire Partnership NHS Trust (13 September 2005)
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Indermeet sawhney, specialist registrar,oxfordshire LD NHS Trust
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inder.sawhney{at}oldt.nhs.uk Indermeet sawhney
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The article on lifestyle and physical health in schizophrenia is a brilliant write up which indeed is an eye opener.We psychiatrists have a major contribution towards the deterioration of the physical health of patients through the prescribing of antipsychotic medication.We cannot and should not absolve ourselves of the responsibility towards their physical care when we are in actual fact,the culprits.The dependency on other health professionals to look into it is not acceptable.The dichotomy between physical and mental health shoud be done away with and we must adopt a more holistic approach. Guidelines should be in place in every trust when patients are prescribed antipsychotics.Basalweight,bloodpressure,fasting glucose levels,lipid profile and prolactin levels should be done on initiation of treatment with antipsychotics and monitored religiously thereafter.The detrimental and sinister effects of the medication have been hidhlighted in the article.It is high time we become proactive and initiate some safe guard measures in our routine clinical practise.It is indeed a wake up call !!! |
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Reza Kiani, SHO in Psychiatry , Mohammed Abbas, SHO in Psychiatry, Lincolnshire Partnership NHS Trust
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reza.kiani{at}lpt.nhs.uk Reza Kiani, et al.
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We read with interest the comprehensive article “Lifestyle and physical health in schizophrenia’’ by Connolly & Kelly (2005). Physical health problems in chronic mental illnesses are recognised causes of morbidity and mortality (Brown et al, 1999). Previous studies have reported a very high prevalence rate of smoking (75-92%) in patients with psychotic disorders (Kelly et al, 2000). In a survey of 2 long stay psychiatric rehabilitation wards in Lincoln, 31 Patients (males/females= 21/10, Mean age= 43 years, SD: 10, with an 87% diagnosis of schizophrenia) were asked to complete the short version of Fagerstrom questionnaire. This is a short but highly reliable and valid questionnaire, which has been used universally to measure levels of nicotine dependency. The higher a person scores in the test, the more likely he or she will be dependent and benefit from nicotine replacement therapy (Heatherton et al, 1991). Our survey showed that 77.4% of the patients were smokers, with more than half either highly or very highly dependent on nicotine (11.5% very highly dependent, 42% highly dependent, 11.5 % moderately and 12.4% mildly dependent). Only 7 patients out of 31(22.6%) were non smokers. The survey also indicated that about two thirds (62%) were overweight and one third were suffering from co morbid physical illnesses such as diabetes, asthma and thyroid disorder. Reducing smoking rates in patients with schizophrenia together with better management of physical illness are suggested strategies to reduce high mortality rates (Cormac et al, 2005). Mental health professionals with the help of primary care services, by delivering a shared care model, can thus effectively address the problem of unhealthy life styles in people with mental illness. Sport facilities should be offered to engage patients in physical activities. Dietary advice by a hospital nutritionist and provision of a healthy diet would be extremely useful in improving the physical health of the long stay patients. In addition, nicotine dependency can be tackled effectively through liaison with primary care teams, who offer education, support and nicotine replacement therapy. References 1- Brown S, Birtwistle J (1999) ‘The unhealthy lifestyle of people with schizophrenia’. Psychological Medicine, 29, 697–701. 2- Kelly C, McCreadie R (2000) ‘Cigarette smoking and schizophrenia’. Advances in Psychiatric Treatment, 6, 327–332. 3- Cormac M, Ferriter R (2005) ‘Physical health and health risk factors in a population of long-stay psychiatric patients’. Psychiatric Bulletin, 29(1): 18 – 20. 4- Heatherton TF, Fagerstrom KO (1991) ‘The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire’. British Journal of Addiction, 86: 1119-1127. 5- Connolly M, Kelly C (2005) ‘Lifestyle and physical health in schizophrenia’. Advances in Psychiatric Treatment, 11, 125-132. |
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