Staff representations and tobacco-related practices in a psychiatric hospital with an indoor smoking ban.

The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses (Spearman r = 0.38, P < 0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues.

Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital.

OBJECTIVE: To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland. METHODS: In 2003, smoking was allowed everywhere in psychiatric units. In 2004, smoking was prohibited everywhere except in smoking rooms. In 2006, smoking rooms were removed and smoking was totally prohibited indoors. Patients and staff were surveyed in 2003 (n=106), 2004 (n=108), 2005 (n=119) and 2006 (n=134). RESULTS: Exposure to environmental tobacco smoke (ETS) decreased after the partial ban and further decreased after the total ban. Among patients, after the total ban, more smokers attempted to quit smoking (18%) relative to before the total ban (2%, odds ratio=10.1, p=0.01). More smokers said that hospital staff gave them nicotine replacement products after the total ban (52%), compared with before (13%, odds ratio=7.6, p<0.001). Many participants (55%) commented that the total ban was too strict, and most (64%) preferred the partial ban. CONCLUSIONS: The partial ban decreased exposure to ETS and the total ban further improved the situation and increased the proportion of smokers who attempted to quit smoking and received nicotine medications. The total ban was loosely enforced and was overall acceptable, but most participants preferred a partial ban.

[Prevalence and characteristics of neuroleptic association in a patient cohort with psychotic disorders]. / Prévalence et caractéristiques de l'association de neuroleptiques chez une cohorte de patients souffrant de troubles psychotiques.

OBJECTIVES: Combined antipsychotic drugs are often prescribed, despite a lack of objective supporting data. Therefore, it is especially important to determine the scope of this practice and to better understand the characteristics of affected patients to identify which associations to study first. METHOD: We studied patients with psychotic disorders followed for at least 1 year at an outpatient psychiatric clinic in Geneva (n = 253). We collected data on prescriptions given at baseline and during that period, as well as sociodemographic and clinical data. RESULTS: During the follow-up period, 36% of patients were prescribed a neuroleptic. These patients differ by negative changing characteristics: less activity, financial assistance, nursing home placement, and numerous admissions with earlier onset of disorder. Three-quarters of patients did not change treatment during that period. Treatment stability is associated with treatment compliance and lack of hospital admission during the follow-up period. CONCLUSION: Without any scientific substantiation, patients with negative changing characteristics are often prescribed neuroleptics. Such treatment options are likely relatively inefficient strategies. Moreover, this practice risks further complicating patients who are already characterized by negative elements.