Transcript Why do people with SMI experience physical health problem

Physical health and sever
mental illness
Prepared by:
Mr. mutasem naser allah
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Why do people with SMI experience physical
health problem
Factor
related to having SMI
Health behaviour of people with SMI
Adverse effect of psychotropic medication on health
Factor related to having SMI
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The people with schizophrenia are less likely to
spontaneously report physical symptoms .
Because they may be unaware of physical
problem because of cognitive deficit associated
with the schizophrenia
Also socio-economic of having mental
disorder such as poverty , poor housing ,reduce
social networks , lack of employment , social
stigma
Health behavior of people with SMI
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The most common increase morbidity and
mortality rate in people with SMI their habits :Rate of smoking
Poor housing
lack of Exercise
Substance abuse
Unsafe sexual practice
cont
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(2003) comprehensive survey of 102 service
users with schizophrenia identified that :70% were smoker
86% of female over weight
70% of male were over weight
53 % had raised cholesterol
All of these are related to their behavior
Smoking and sever mental illness
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Many epidemiological studies have assessed rate
of smoking in people with schizophrenia ,
bipolar disorder range 585 to 88% up to 3 time
higher than general population
In UK prevalence smoke rate 74% in 2002 25
cigarettes a day
Causes of high rate of smoking
Neurobiological
Psychological
Behavior
Cultural
cont
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Nicotine alleviate certain psychiatric symptoms
as negative symptoms , cognitive dysfunction,
side effect of antipsychotic medication
Dopamine factor
Increase dopamine release through inhaling
nicotine may reduce negative symptoms and
improve attention and selective processing of
information that usually impaired in people with
schizophrenia
Psychosocial and behavior factor
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Many epidemiological studies founed:People with schizophrenia smoke out of habits
routine
For relaxation
Way of making social contact
For pleasure
They believe they are addicted
Mental health culture
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Smoking is ingrained in culture of psychiatric so
the most wrong to encourage to stop smoking ,
because you well increase violent behavior
because that means self medication
It is improved mood and reduce anxiety
Why Do People With Mental Illness
Smoke
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Nicotine increases alertness. This may enhance
concentration, thinking and learning. This may be a
benefit to people with schizophrenia whose illness
or medication leads to cognitive problems.
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Nicotine can help relaxation, and it can also reduce
negative feelings such as anxiety, tension and anger.
So smoking may help people with mental illness
deal with stressful situations.
For pleasure and because they believe they are
addicted .
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Cont
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Nicotine may reduce positive symptoms, such as
hallucinations for a short period.
There is some evidence to suggest that smoking is
associated with reduced levels of antipsychotic induced
Parkinsonism.
Smoking can help to relieve boredom and provide a
framework for the day.
Smoking can improve social interaction, something that
may be of particular benefit to people with negative
symptoms
Nicotine Dependence among
Seriously Mentally Ill (SMI)
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75% of SMI are tobacco dependent (22%
general population)
 85% in schizophrenia
60 - 95% of people with addiction disorders
smoke
Impact smoking in people with SMI
who take medication
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Cytochrome p450 metabolism some drug like
antipsychotic antidepressant .
Polycyclic hydrocarbon in tobacco induced this
inzyme and increase metabolism and therefore
lower the plasma concentration of these
medication so the smoker often need more
medication compared with non smoker
cont
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The plasma concentration of clozapen increase
dramatically in pt following abrupt smoking
cessation leading to toxicity
Nicotine replacement
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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 client
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Explore the good thing and not so good thing
about smoking and not so good thing and good
thing about stopping
Psychological support need to make successful
quiet and prevent relapse
Health education information can be provided
in balance , non judgmental way
Supporting with pharmacological NRT
ASSIST the quit attempt
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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
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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 do
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Decrease number of smokers in every setting.
Increase the number of smokers advancing
toward quitting.
Increase the number of smokers who have been
given advise to quit.
Barriers to Successful Cessation
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Provider inattention/pessimism
Co-dependency and mental illness
Mental health staff smoke
Historic attitudes about smoking in mental
health community
No coverage for cessation drugs
Improper use of the drugs
ADVISE on coping strategies
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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 Obstacles
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Lack of motivation
Effects of medication
Lack of money
Boredom
Mental health culture
Attitudes and beliefs of health staff
Our aim
Our aim is to improve the physical health of
mental health service users by
 Engaging people in activities that reduce their
risks of illness
 Removing obstacles
Why do people with SMI experience physical health
problem
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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 drug
initiation
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Weigh and high and body mass index should be
recorded
Personnel and family history of obesity and
diabetes
Fast blood glucose after one month for clozapen
and olanzepen
Reduce energy and fat intake
Increase fiber and fruit and vegetables intake
Increase physical activity to 20 min aday
Medication impact of sexual interest
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In medicated people the effect of medication on
number of neurotransmitter will interfere with
sexual function
All antipsychotic are dopamine antagonist
except airpirazol dopamine involve in sexual
arousal and orgasm .so blocking dopamine may
contribute to reduce libido and disturbance in
orgasm
cont
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The drug rely on dopamine antagonist to provide their
antipsychotic effect and removed the brake on
prolactine secretion leading to hyperprolactin
Raised in prolactine level will occur decrease in
testosterone hormones in both men and women
leading to sexual dysfunction
Hyperprolactin side effect of both typical and atypical
antipsychotic drug
Routine blood test can be take for prolactine level
Thank you for attention
Mr. mutasem naser allah