title: Nicotine Withdrawal, Relapse of Mental Illness, or Medication Side-Effect? Implementing a Monitoring Tool for People With Mental Illness Into Quitline Counseling.
abstract: BACKGROUND
  Smokers with mental illness and their health care providers are often concerned that smoking cessation will worsen mental health. Smokers with mental illness tend to be more nicotine-dependent and experience more severe symptoms of nicotine withdrawal, some of which are difficult to distinguish from psychiatric symptoms. In addition, smoking cessation can increase the blood levels and hence side effects of some psychotropic medications. Improved monitoring of nicotine withdrawal and medication side effects may help distinguish temporary withdrawal symptoms from psychiatric symptoms and facilitate targeted treatment to help smokers with mental illness manage the acute phase of nicotine withdrawal.
  
  
  OBJECTIVE
  The aim of this research was to examine the acceptability and feasibility to quitline counselors of implementing structured assessments of nicotine withdrawal and common medication side effects in people with mental illness who are quitting smoking using a telephone smoking cessation service.
  
  
  METHODS
  Monitoring involves administering (once pre-cessation and at each contact post-cessation) (1) the Minnesota Nicotine Withdrawal Scale, assessing eight symptoms: anger, anxiety, depression, cravings, difficulty concentrating, increased appetite, insomnia, and restlessness and (2) an adverse side effects checklist of 5 to 10 symptoms, for example, dry mouth and increased thirst. Following a 1-day update training in mental health, quitline counselors were asked to offer these assessments to callers disclosing mental illness in addition to usual counseling. Group interviews with counselors were conducted 2 months later to examine implementation barriers and benefits.
  
  
  RESULTS
  Barriers included awkwardness in integrating a new structured practice into counseling, difficulty in limiting some callers to only the content of new items, and initial anxieties about how to respond to changes in some symptoms. Benefits included the ability to provide objective feedback on changes in symptoms, as this identified early benefits of quitting, provided reassurance for clients, and provided an opportunity for early intervention where symptoms worsened.
  
  
  CONCLUSIONS
  Structured monitoring of withdrawal symptoms and medication side effects was able to be integrated into the quitline's counseling and was valued by counselors and clients. Given evidence of its benefits in this limited pilot study, we recommend it be considered for larger-scale adoption by quitlines.
authors.affiliation: a Cancer Council Victoria , Melbourne , Australia.|b Centre for Health Policy, School of Population and Global Health, University of Melbourne , Australia.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Segan
authors.affiliation: c School of Medicine and Public Health, University of Newcastle , Callaghan , Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Baker
authors.affiliation: c School of Medicine and Public Health, University of Newcastle , Callaghan , Australia.|d IMPACT SRC, Faculty of Health, Deakin University , Geelong , Australia.
authors.forename: Alyna
authors.initials: A
authors.lastname: Turner
authors.affiliation: e Priority Division of Addiction Psychiatry, Rutgers-Robert Wood Johnson Medical School , New Brunswick , NJ.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Williams
mesh_terms: D001291:Attitude of Health Personnel; D003376:Counseling / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D015277:Hotlines; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D014029:Tobacco Use Disorder / Q000150:complications / Q000628:therapy*
keywords: Smoking cessation; medication side effects; mental illness; nicotine withdrawal; quitline; telephone counseling