Smoking in a long-stay psychiatric rehabilitation centre

We read with interest the comprehensive article on lifestyle and physical health in schizophrenia by Connolly & Kelly (2005). Physical health problems in chronic mental illness are recognised causes of morbidity and mortality (Brown et al, 1999). Previous studies have reported a very high prevalence of smoking (75–92%) in people with psychotic disorders (Kelly & McCreadie, 2000).

In a survey of two long-stay psychiatric rehabilitation wards in Lincoln, 31 patients (21 men, 10 women; mean age = 43 years; s.d. = 10; 27/31 with a diagnosis of schizophrenia) were asked to complete the short version of Fagerstrom questionnaire (Heatherton et al, 1991). This is a highly reliable and valid questionnaire widely used to measure levels of nicotine dependence. The higher the score, the greater the likelihood of dependence and of benefit from nicotine replacement therapy.

Of the 31 participants, 24 (77.4%) were smokers, more than half of whom were either highly or very highly dependent on nicotine (11.5% very highly dependent, 42% highly dependent, 11.5 % moderately and 12.4% mildly dependent). About two-thirds (62%) of the participants were overweight and one-third had comorbid physical illnesses such as diabetes, asthma or thyroid disorder.

Reducing smoking rates in people with schizophrenia, together with better management of physical illness, are suggested strategies to reduce high mortality rates (Cormac et al, 2005). By adopting a shared care model, mental health professionals with the help of primary care services could effectively address the problem of unhealthy life styles in people with mental illness.

Sports facilities should be available to engage patients in physical activities. Dietary advice by a hospital nutritionist and provision of a healthy diet would be extremely useful in improving the physical health of the long-stay patients. In addition, nicotine dependence can be tackled through liaison with primary care teams offering education, support and nicotine replacement therapy.