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Smoking has no place in psychiatric hospitals

  • Faouzi Dib Alam (a1)
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Abstract
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Ryabik, B. M., Lippman, S. B. & Mount, R. (1994) Implementation of a smoking ban on a locked psychiatric unit. General Hospital Psychiatry, 16, 200204.
Smith, C. M., Pristach, C. A. & Cartagena, M. (1999) Obligation cessation of smoking by psychiatric inpatients. Psychiatric Services, 50, 9194.
Velasco, J., Eells, T. D., Anderson, R., et al (1996) A two year follow up on the effects of smoking ban in an inpatient psychiatric service. Psychiatric Services, 47, 869871.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Smoking has no place in psychiatric hospitals

  • Faouzi Dib Alam (a1)
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eLetters

Smoking ban: some unaddressed issues

Ravi Nahata, Staff Grade Psychiatrist
02 May 2007

Sir:We read Alam’s letter with interest. Apart from the issue of further impinging upon the freedom of detained patients that a smoking ban would entail (particularly for those on high levels of observation or in ‘intensive care’), there is evidence of serious psychopathology resulting from nicotine abstinence. Covey, et.al (1997). Found that 30% of people suffering from major depression who stop smoking relapse within 12 weeks of cessation negating the three day follow-up study quoted by Alam. Furthermore, polycyclic hydrocarbon compounds contained in tobacco smoke are well known inducers of 1A2, a specific isoform of the cytochrome P450 enzyme complex responsible for the metabolism of several widely used psychotropic medications such as clozapine, olanzapine and amitriptylline. There are well documented and highly significant interactions involving smoking with medications which could well predispose to worsening toxicity following smoking cessation or relapse upon restarting smoking after discharge or relaxation of restrictions. Smoking cessation has also been linked to the emergence of antipsychotic induced akathisia.

Lastly quite why allowing smoking on psychiatric wards adds to the stigmatization of mental illness is not made clear by the author when psychiatric wards are already, for the most part, separate from general hospital wards and involve compulsory treatment which is not a part of general medicine or surgery. These are not trivial issues, and whilst notquestioning the adverse general health implications of smoking, should be further considered before embarking upon an in-patient smoking ban which, in the long term, will have little or no impact on smoking behaviour upon discharge.

References

Covey, Lirio S, Glassman, Alexander H, Stetner, Fay. Major depression following smoking cessation. The American Journal of Psychiatry. Washington: Feb 1997.Vol.154, Iss. 2; pg. 263, 3 pgs.
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