FACTORS ASSOCIATED with TOBACCO USE - PowerPoint PPT Presentation

Loading...

PPT – FACTORS ASSOCIATED with TOBACCO USE PowerPoint presentation | free to view - id: 85ef82-YTI4Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

FACTORS ASSOCIATED with TOBACCO USE

Description:

In their analysis of prospective data from the National Longitudinal Study of Adolescent ... To whom do psychiatrists offer smoking-cessation counseling? Am J ... – PowerPoint PPT presentation

Number of Views:55
Avg rating:3.0/5.0
Slides: 37
Provided by: Kymbe8
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: FACTORS ASSOCIATED with TOBACCO USE


1
FACTORS ASSOCIATED with TOBACCO USE MENTAL
ILLNESS
2
WHY do INDIVIDUALS with MENTAL ILLNESS SMOKE?
Smoking in adolescence is associated with
psychiatric disorders in adulthood, including
panic disorder, GAD and agoraphobia, depression
and suicidal behavior, substance use disorders,
and schizophrenia (Breslau et al., 2004 Weiser
et al., 2004 Goodman, 2000 Johnson et al., 2000)
MENTAL ILLNESS
SMOKING
Active psychiatric disorders are associated with
daily smoking and progression to nicotine
dependence (Breslau et al., 2004).
3
FACTORS ASSOCIATED with TOBACCO USE in the
MENTALLY ILL
Psychological/Behavioral Conditioning effects
Coping tool Social interactions
Boredom
Biologic Pharmacologic Genetic
predisposition Alleviation of
withdrawal Pleasure effects
Weight control
Tobacco Use
Systemic Treatment Use of cigarettes for
reinforcement Failure to treat
4
NEUROCHEMICAL and RELATED EFFECTS of NICOTINE
N I C O T I N E
? Pleasure, reward ? Arousal, appetite
suppression ? Arousal, cognitive enhancement ?
Learning, memory enhancement ? Reduction of
anxiety and tension ? Reduction of anxiety and
tension ? Mood modulation, appetite suppr.
  • Dopamine
  • Norepinephrine
  • Acetylcholine
  • Glutamate
  • ?-Endorphin
  • GABA
  • Serotonin

Benowitz. Nicotine Tobacco Research
19991(suppl)S159S163.
5
BIOLOGY of NICOTINE ADDICTION ROLE of DOPAMINE
Nicotine addiction
Nicotine stimulates dopamine release
is not just a bad habit.
Discontinuation leads to withdrawal symptoms.
Benowitz. (2008). Clin Pharmacol Ther 83531541.
6
DOPAMINE REWARD PATHWAY
Prefrontal cortex
Dopamine release
Stimulation of nicotine receptors
Nucleus accumbens
Ventral tegmental area
Nicotine enters brain
Amygdala
7
CHRONIC ADMINISTRATION of NICOTINE EFFECTS on
the BRAIN
Perry et al. J Pharmacol Exp Ther
199928915451552.
8
acetylcholine
nicotine
Chronic Smoking Effects
nicotine receptor
pit
Source S.M. Stahl (2000). Essential
Psychopharmacology
9
acetylcholine
nicotine
State of Nicotine Withdrawal
nicotine receptor
Source S.M. Stahl (2000). Essential
Psychopharmacology
10
NICOTINE ADDICTION CYCLE
Reprinted with permission. Benowitz. Med Clin N
Am 19922415437.
11
NICOTINE WITHDRAWAL EFFECTS
  • Dysphoric or depressed mood
  • Insomnia and fatigue
  • Irritability/frustration/anger
  • Anxiety or nervousness
  • Difficulty concentrating
  • Impaired task performance
  • Increased appetite/weight gain
  • Restlessness and impatience
  • Cravings

Most symptoms peak 2448 hr after quitting and
subside within 24 weeks.
Refer to Withdrawal Symptoms Info Sheet
American Psychiatric Association. (1994). DSM-IV.
Hughes et al. (1991). Arch Gen Psychiatry
485259. Hughes Hatsukami. (1998). Tob Control
79293.
Not considered a withdrawal symptom by DSM-IV
criteria.
12
GENETIC EFFECTS on NICOTINE METABOLISM
4.4
0.4
9.8
Nornicotine
Nicotine-1'- N-oxide
Nicotine
Nicotine
Nicotine glucuronide
  1. CYP2A6
  2. Aldehyde oxidase

4.2
80
Trans-3'- hydroxycotinine
Trans-3'- hydroxycotinine
Cotinine
Cotinine
13.0
33.6
Trans-3'- hydroxycotinine glucuronide
Cotinine glucuronide
12.6
Norcotinine
7.4
Cotinine- N-oxide
2.0
Reprinted with permission, Benowitz et al., 1994.
2.4
13
WHAT is ADDICTION?
  • Compulsive drug use, without medical purpose, in
    the face of negative consequences
  • Alan I. Leshner, Ph.D.
  • Former Director, National Institute on Drug Abuse
  • National Institutes of Health

14
MODEL of ADDICTION
Positive Reinforcement
Impulse control disorders
tension / arousal
regret / guilt / self-reproach
impulsive acts
TIME
Pleasure / relief / gratification
Compulsive disorders
anxiety / stress
obsessions
repetitive behaviors
relief of anxiety / relief of stress
Negative Reinforcement
Source GF Koob et al. (2004) Neuroscience and
Biobehavioral Reviews
15
DSM-IV TOBACCO USE DISORDERS
  • Nicotine Withdrawal
  • Daily use of nicotine
  • Abrupt cessation/reduction followed within 24 hrs
    by 4
  • Depressed mood
  • Insomnia
  • Irritability
  • Anxiety
  • Difficulty concentrating
  • Decreased HR
  • Increased appetite
  • Clinically significant impairment
  • Not due to GMC
  • Nicotine Dependence
  • Maladaptive pattern of use with significant
    impairment manifested by 3 in 12-mos
  • Tolerance
  • Withdrawal
  • ? Use
  • Unsuccessful efforts to stop
  • Time investment
  • Loss of important activities
  • Continued use despite knowledge of physical or
    psychological problems

16
SYSTEMIC and TREATMENT FACTORS
17
(No Transcript)
18
PSYCHIATRISTS in PRACTICE (Himelhoch Daumit,
2003)
  • 1992-96 Natl Ambulatory Medical Care Survey
  • 23 of psychiatric visits dropped from analysis
    because patient smoking status unknown
  • For patients identified as smokers (N1610)
  • Cessation counseling offered at 12 of visits
  • Nicotine Dependence not diagnosed at any visit
  • Nicotine replacement therapy never prescribed

19
2005 AAMC PRACTICE SURVEY 801 PSYCHIATRISTS
  • 62 Ask about tobacco
  • 44 Assess readiness to quit
  • 62 Advise cessation
  • Assist
  • NRT (23), other Rx (20)
  • Cessation materials (13)
  • 14 Arrange follow up
  • 11 Refer to others

Psychiatrists the least likely to address tobacco
use with their patients relative to other
specialties (family medicine, internal medicine,
OB/GYN)
20
PSYCHIATRY RESIDENTS (N105) ENGAGEMENT in the
5-As
Source Prochaska, Fromont et al., 2005 Acad
Psychiatry
21
2008 American Psychiatric Nurses Association
Survey
  • 85 Ask about tobacco
  • 61 Refer patients for tobacco cessation
  • Only 29 of respondents agencies offer tobacco
    cessation treatment

22
Legacy Tobacco Documents
  • Digital online library
  • 10 million documents (50 million pages) from
    the major tobacco companies
  • Related to their advertising, manufacturing,
    marketing, sales, and scientific research
    activities

http//legacy.library.ucsf.edu
23
Tobacco Documents
Department of Health, Education, and
Welfare National Institute of Mental
Health Washington, DC August 4, 1980
I am writing to request a donation of cigarettes
for long-term psychiatric patientsbecause of
recent changes in the DHHS regulations, Saint
Elizabeth Hospital can no longer purchase
cigarettes for them.
I am therefore requesting a donation of
approximately 5,000 cigarettes a week (8 per day
for each of the 100 patients without funds).
24
TOBACCO INDUSTRYS INTERESTS
  • 1950s-1980s Beliefs that patients with
    schizophrenia, who smoke at high rates, immune to
    cancer

Prochaska, Hall Bero (2008). Schizophrenia
Bulletin
25
TOBACCO INDUSTRYS INTERESTS
  • 1960s1970s TI funded research on psychosomatic
    causes of cancer
  • Proposed those who denied or repressed grief were
    more likely to develop cancer than those who
    expressed emotion
  • longterm schizophrenics, outwardly calm, have
    no capacity for the repression of significant
    emotional events and no need to contain emotional
    conflict.
  • Ultimately came under scrutiny for its
    scientific integrity

Prochaska, Hall Bero (2008). Schizophrenia
Bulletin
26
TOBACCO INDUSTRYS INTERESTS
  • 1964 1997 TI denied funding of 2 proposals to
    examine high rates of cancer in smokers with
    mental illness
  • 1964 proposal denied in principle but referred
    to the study group on the psychophysiological
    aspects of smoking, for working over.
  • Questioned whether some other kind of use could
    profitably be made of his data collection
    methods.

Prochaska, Hall Bero (2008). Schizophrenia
Bulletin
27
(No Transcript)
28
Tobacco industry documents indicate the author
received funding from CTR and PM from at least
1977-1994 and contributed to papers conceived by
PM
29
HOSPITAL SMOKING BANS
JCAHO ultimately yielded to massive pressure
from mental patients and their families, relaxing
a policy that called on hospitals to ban
smoking.
30
LD 463 - An Act to Exempt Substance Abuse and
Psychiatric Patients from the Prohibition against
Smoking in Hospitals
31
(No Transcript)
32
Source Legacy Tobacco Documents
33
RJ Reynolds Project Sub Culture Urban Marketing
34
(No Transcript)
35
(No Transcript)
36
CONTRIBUTING FACTORS SUMMARY
  • Tobacco products are effective delivery systems
    for the highly addictive drug nicotine.
  • Nicotine activates the dopamine reward pathway in
    the brain, which reinforces continued tobacco
    use.
  • Nicotine dependence and withdrawal are DSM-IV
    psychiatric disorders.
  • Tobacco dependence involves biological,
    psychological, social, systemic and treatment
    factors requiring a long-term multifaceted
    treatment approach.
About PowerShow.com