RESUMEN
OBJECTIVE: We aimed to review research on smoking and mental illness and provide evidence-based guidelines for psychiatrists to help smoking patients quit. METHOD: 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.
Asunto(s)
Psiquiatría , Cese del Hábito de Fumar/métodos , Fumar/terapia , Interacciones Farmacológicas , Humanos , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Guías de Práctica Clínica como Asunto , Psicotrópicos/farmacocinética , Psicotrópicos/uso terapéutico , Fumar/tratamiento farmacológico , Fumar/epidemiología , Tabaquismo/tratamiento farmacológico , Tabaquismo/terapiaRESUMEN
BACKGROUND: Widespread reports of high stress levels and mental health problems among university student populations indicate the use of interventions to facilitate stress reduction and support student resilience and wellbeing. There is growing evidence that regular mindfulness practice may confer positive health benefits and reduced stress levels. OBJECTIVES: The aim of this pilot project was to explore the impact of a seven-week stress management and mindfulness program as a learning support and stress reduction method for nursing and midwifery students. SETTING: The program was conducted at a large regional university in Australia. PARTICIPANTS: Fourteen first-year undergraduate nursing and midwifery students agreed to attend the program and to participate in a follow-up focus group. METHOD AND DESIGN: A descriptive qualitative design was utilised to examine the impact of the program. A semi-structured focus group interview was conducted with a thematic analysis undertaken of the transcript and process notes. RESULTS: Ten students completed the research component of this project by participating in the focus group interview. Three main themes capture the participants' experience: attending to self, attending to others and attending to program related challenges. Data indicate a positive impact on sleep, concentration, clarity of thought and a reduction in negative cognitions. Participants also identified challenges related to timetabling, program structure and venue. CONCLUSIONS: Overall, this pilot program enhanced the participants' sense of well-being. Despite the challenges, benefits were identified on a personal and professional level. Valuable feedback was provided that will be used to further develop and expand stress management and mindfulness programs offered to students attending this university.
Asunto(s)
Bachillerato en Enfermería , Retroalimentación , Atención Plena/educación , Estrés Psicológico , Estudiantes de Enfermería/psicología , Adulto , Australia , Femenino , Grupos Focales , Humanos , Persona de Mediana Edad , Partería/educación , Investigación en Educación de Enfermería , Proyectos Piloto , Investigación Cualitativa , Adulto JovenRESUMEN
OBJECTIVE: To determine the prevalence of hyponatraemia associated with selective serotonin reuptake inhibitor (SSRI) and venlafaxine use in elderly patients compared to that in elderly patients not prescribed these drugs, while controlling for age, sex, depression status and illnesses or prescribed medications also associated with hyponatraemia. Design and setting Retrospective controlled analysis in a 36-bed inpatient unit for elderly psychiatric patients in Melbourne. PATIENTS: Inpatients (199) with a mean age of 74.2 years of whom 74 were prescribed an SSRI or venlafaxine. RESULTS: Patients on SSRIs or venlafaxine were 5.6 times as likely as patients not so treated to have hyponatraemia. Thirty-nine percent of patients on an SSRI or venlafaxine had hyponatraemia compared with 10% of controls. Ten of the 14 patients on venlafaxine were hyponatraemic. Controlling for thiazide status did not reduce the odds of these patients having hyponatraemia and taking an SSRI or venlafaxine was still strongly associated with hyponatraemia after also controlling for age, sex, and depression status, consumption of other drugs potentially causative of hyponatraemia and medical illness severity (Odds Ratio (OR) 3.5, p = 0.008). CONCLUSIONS: SSRI and venlafaxine use is strongly associated with the presence of hyponatraemia in a population of elderly psychiatric inpatients and the association is not due to confounding by age, sex, depression status, medical illness severity or consumption of other drugs. Elderly patients on SSRIs or venlfaxine should have sodium levels checked before and after commencement of antidepressant treatment.