RESUMO
Objective: Global tobacco control efforts in both prevention and treatment have advanced to levels never imagined 20 years ago. This review examines the relationship between mental illness and tobacco use, with particular focus on the role of psychiatrists in the treatment of tobacco dependence. Methods: The literature search utilised MEDLINE, Embase and PsychINFO databases using the terms psychiatry, psychiatrist, smoking cessation, tobacco use disorder and tobacco dependence treatment. A manual search of all references from relevant scientific articles obtained was also conducted. Finally, further material sourced included all major guidelines for smoking cessation or tobacco dependence treatment from the United States, United Kingdom, Canada, Australia and New Zealand. Results: Psychiatry has ignored tobacco dependence and its treatment resulting in multiple missed opportunities in improving the health and well-being of smokers with mental illness. Improvement in the training and knowledge of psychiatrists and those in the mental health sector will be the most effective activity to rectify this situation. Conclusion: Psychiatry must recognise tobacco dependence as equally important as the primary mental illness and to treat accordingly. A significant change in the training of future psychiatrists, introducing or implementing smoke free mental health services, changes in the management of caring for the mentally ill, and the introduction of tobacco treatment specialists within the mental health system is needed if psychiatry is serious about confronting this problem.
RESUMO
Cigarette smoking is motivated primarily by a desire for nicotine. Nicotine provides direct effects such as pleasure, stimulation, and stress relief, and it also reverses the unpleasant symptoms of nicotine withdrawal. Most smokers try to quit smoking but find it difficult because of nicotine addiction. Both behavioral counseling and and pharmacotherapy increase the cessation rates, and the effects of these interventions are generally additive. Recent guidelines for smoking cessation recommend that all smokers trying to quit should be offered pharmacotherapy. Two classes of medications have been approved for smoking cessation: nicotine replacement medications and bupropion, which was originally marketed as an antidepressant drug. The choice of medications should be individualized-based on the patient's preference,tolerance of adverse effects, and smoking habits.The combination nicotine replacement therapy-a patch plus short acing formulations such as gum or troche is increasingly prescribed to patients with severe addiction. All types of smoking cessation medications, if used properly, double the smoking cessation rate compared with placebo treatment. Some data suggest that the combination and extended duration of pharmacotherapies may offer some advantages, especially in dependent smokers, but these results have been inconclusive. The optimal combinations of medications for tobacco dependence treatment are not yet determined, and few studies have evaluated the effects of more complex combinations.