Presentation on theme: "Physical health and sever mental illness"— Presentation transcript:
1 Physical health and sever mental illness Prepared by:Mr. mutasem naser allahContinue presentation
2 Why do people with SMI experience physical health problem Factor related to having SMIHealth behaviour of people with SMIAdverse effect of psychotropic medication on health
3 Factor related to having SMI 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 schizophreniaAlso socio-economic of having mental disorder such as poverty , poor housing ,reduce social networks , lack of employment , social stigma
4 Health behavior of people with SMI The most common increase morbidity and mortality rate in people with SMI their habits :-Rate of smokingPoor housinglack of ExerciseSubstance abuseUnsafe sexual practice
5 cont(2003) comprehensive survey of 102 service users with schizophrenia identified that :-70% were smoker86% of female over weight70% of male were over weight53 % had raised cholesterolAll of these are related to their behavior
6 Smoking and sever mental illness 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 populationIn UK prevalence smoke rate 74% in cigarettes a day
7 Causes of high rate of smoking NeurobiologicalPsychologicalBehaviorCultural
8 contNicotine alleviate certain psychiatric symptoms as negative symptoms , cognitive dysfunction, side effect of antipsychotic medicationDopamine factorIncrease dopamine release through inhaling nicotine may reduce negative symptoms and improve attention and selective processing of information that usually impaired in people with schizophrenia
9 Psychosocial and behavior factor Many epidemiological studies founed:-People with schizophrenia smoke out of habits routineFor relaxationWay of making social contactFor pleasureThey believe they are addicted
10 Mental health cultureSmoking 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 medicationIt is improved mood and reduce anxiety
11 Why Do People With Mental Illness Smoke 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.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 .
12 ContNicotine 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
13 Nicotine Dependence among Seriously Mentally Ill (SMI) 75% of SMI are tobacco dependent (22% general population)85% in schizophrenia% of people with addiction disorders smoke
14 Impact smoking in people with SMI who take medication 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
15 contThe plasma concentration of clozapen increase dramatically in pt following abrupt smoking cessation leading to toxicity
16 Nicotine replacementBegin NRT on the quit date, (apply patches the night before)Use a dose that controls the withdrawal symptomsNRT provides levels of nicotine well below smokingPrescribe in blocks of two weeksArrange follow up to provide supportUse a full dose for 6 to 8 weeks then reduce the dose gradually over 4 weeks.
17 Nurse can do to help client Explore the good thing and not so good thing about smoking and not so good thing and good thing about stoppingPsychological support need to make successful quiet and prevent relapseHealth education information can be provided in balance , non judgmental waySupporting with pharmacological NRT
18 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 difficultiesReview the need for pharmacotherapy.Refer to a quit line and/or an active call back programme
19 ARRANGE follow up Offer a follow up appointment within 7 days Affirm success when you next see the patientReinforce successful quitting: positive feedback helps sustain smoking cessation.Don’t talk about ‘failure’, ‘relapse’ is very commonHelp the patient work out ‘what went wrong this time’ and how they prevent a relapse next time.
20 Nurse can do 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.
21 Barriers to Successful Cessation Provider inattention/pessimismCo-dependency and mental illnessMental health staff smokeHistoric attitudes about smoking in mental health communityNo coverage for cessation drugsImproper use of the drugs
22 ADVISE on coping strategies Drinking alcohol is strongly associated with relapseInform friends and family and ask for supportConsider writing a ‘contract’ with a quit dateRemoval of cigarettes from home, car and workplace;Give practical advice about coping with Withdrawal symptoms occur mostly during the first two weeksRelapse after this time relates to cues or distressing events.Remind patients of the health benefits of quitting
23 Potential Obstacles Lack of motivation Effects of medication Lack of moneyBoredomMental health cultureAttitudes and beliefs of health staff
24 Our aimOur aim is to improve the physical health of mental health service users byEngaging people in activities that reduce their risks of illnessRemoving obstacles
25 Why do people with SMI experience physical health problem Adverse effect of psychotropic medication on health:-Both Antipsychotic drug make weigh gainSome antipsychotic drug make excessive salivation like clozapen and olanzepen…..
26 Baseline before or at start drug initiation Weigh and high and body mass index should be recordedPersonnel and family history of obesity and diabetesFast blood glucose after one month for clozapen and olanzepenReduce energy and fat intakeIncrease fiber and fruit and vegetables intakeIncrease physical activity to 20 min aday
27 Medication impact of sexual interest In medicated people the effect of medication on number of neurotransmitter will interfere with sexual functionAll 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
28 contThe drug rely on dopamine antagonist to provide their antipsychotic effect and removed the brake on prolactine secretion leading to hyperprolactinRaised in prolactine level will occur decrease in testosterone hormones in both men and women leading to sexual dysfunctionHyperprolactin side effect of both typical and atypical antipsychotic drugRoutine blood test can be take for prolactine level
29 Thank you for attention mutasem naser allah Mr.