Physical health and sever mental illness Prepared by: Mr. mutasem naser allah Continue presentation

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 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 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 (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 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 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 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 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 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 .

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

Nicotine 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 client 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 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 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.

Barriers to Successful Cessation 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 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 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 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 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 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 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 mutasem naser allah Mr.