title: Smoking and mental illness. An update for psychiatrists.
abstract: OBJECTIVE
  We aimed to review research on smoking and mental illness and provide evidence-based guidelines for psychiatrists to help smoking patients quit.
  
  
  METHODS
  We undertook a narrative review of the literature with a special focus on the Australian context.
  
  
  RESULTS
  Although one in three people with mental illness smoke tobacco, smoking is often neglected in psychiatric practice. Smoking is a significant contributor to the health gap between people with mental illness and the general population. Smokers with mental illness are motivated to quit and are able to do so, albeit with lower quit rates. Quitting can lead to substantial improvements in mental wellbeing and physical health and does not exacerbate pre-existing mental illness. Psychiatrists should advise all smokers to quit and provide counselling, medication and support, based on the 5As framework. Approved pharmacotherapy - nicotine replacement therapy, varenicline and bupropion - is recommended for nicotine-dependent smokers. Smoking induces the metabolism of certain psychotropic drugs such as clozapine and olanzapine and dose reductions may be necessary after cessation.
  
  
  CONCLUSIONS
  Psychiatrists have a duty of care to identify the smoking status of their patients and to provide evidence-based support to quit.
authors.affiliation: Tobacco Treatment Specialist, The Sydney Clinic, Sydney, NSW, Australia mendel@bigpond.net.au.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Mendelsohn
authors.affiliation: Consultant Psychiatrist, Melbourne Health and Bendigo Health Services, Melbourne, NSW, Australia.
authors.forename: Dianne P
authors.initials: DP
authors.lastname: Kirby
authors.affiliation: Chair of Psychiatry, St. Vincent's Hospital MelbourneThe University of Melbourne; Adjunct Professor, Faculty of Health Sciences, Australian Catholic University, Melbourne, NSW, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Castle
mesh_terms: D004347:Drug Interactions; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011570:Psychiatry; D011619:Psychotropic Drugs / Q000493:pharmacokinetics / Q000627:therapeutic use; D012907:Smoking / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000628:therapy
chemical_list: D011619:Psychotropic Drugs
keywords: mental health; mental illness; nicotine dependence; psychiatry; smoking