As, I had a short 4-day trip to the mental hospital I can attest, almost all of the smoked. Low blood sugar and high caffeine consumption are also common among mental patients. Personally I think there is a link here.

Low blood sugar and high caffeine intake are also characteristic of many active alcoholics and other addicts.

Nice job breaking it down…

Not mentioned is the supposed release of seratonin during repetitive motions (i.e, hand to mouth). As someone who has spent time on both sides of the desk, smoking, chewing gum, rubbing your forearm… any of these would usually bring a small amount of comfort. And when you’re waiting for the meds to work, a small amount of comfort is as good as all the comfort in the world…

I don’t know how psychiatric clinics and hospitals could consider no-smoking policies for their patients- it’s so obvious it’s self medication, and most psych patients will tell you quite unequivocally how it makes them feel/not feel. I think most ordinary human beings in the community eventually smoke to self-medicate, even if they started for a dare as a teenager. At the psychiatric hospital and general hospital psych wards here in South Australia there are smoking areas and rooms especially for patients, which I think is a humane provision. However, patients tell me that they feel discriminated against and almost “criminalised” because they must smoke in special places, instead of in their own living rooms or bedrooms as many can do at home. They say that having their smoking stigmatised makes it more difficult for them to recover from their psychotic episodes which have brought them into hospital- so what can be done? They don’t want to stop smoking- the behaviours involved are habitual and serve multiple purposes for them; they need the nicotine (whatever it does to their brains, lungs, blood vessels); some feel smoking is a part of their core self image. On the other hand, many of these mentally ill people live in group accommodation with other unemployed and disabled people- they have very low incomes/pensions, yet they spend a terrific amount on tobacco/cigarettes- many supported accommodation hostels actually make rollie cigarettes in vast numbers for the residents- or residents are employed to roll them- just to save a little money. It seems to me we have to study the role of nicotine and smoking behaviour more thoroughly to see if it is possible to humanely divorce mentally ill people from their habits without destroying any remaining capacity for wellness.

Amen to that. I do think that smoking areas in clinics are a workable compromise that both patients and staff should learn to accept. It’s not stigmatizing smoking so much as accomodating those who are allergic to or discomfited by cigarette smoke. What stigmatizes smoking and adds to the recovery burden of patients is a blanket ban on smoking on the premises, no exceptions allowed. That might work in an office building, but presents added health dimensions in a hospital for the mentally ill.

Something is missing here, and that is social interaction. In closed environments, and especially those with people whose ability to communicate may be compromised by illness or medication, there are very few ways of making or maintaining friendships. I have seen cigarettes used as gift exchange between patients in mental hospitals – not just for the chemical effect, which I do not doubt, but also because the physical offering and accepting of cigarettes provides a non-verbal way of establishing a relationship.

It’s worth noting that people in these institutions may have no other gift to give; even the gift of time may be deeply compromised if people are unable to pay attention, sit quietly, or have enough concentration to focus on a chain of conversation. Simply saying “Want a cigarette? Thank you” may be the only meaningful communication they have with fellow patients.

One useful thing I took from this article. If you are one of those poor souls who is under an assisted outpatient treatment order then you are being medicated against your will. Antipsychotics are dangerous brain, gland and nervous system damaging drugs that are standard issue now for people with bipolar and schizophrenia.

It’s good to know that smoking can severely diminish the effects of antipsychotics. If I was under an AOT order the first thing I would do is pretend that the sedation and stupidity inducing effects of the antipsychotic were much worse then they were in order to be put on a low dose. Then I would start smoking again and I would smoke all day in the hope I could feel my old self again and have my faculties, memory, artistic inspiration and cerebration back.

Nicotine is not the only pharmacologically active substance in tobacco smoke. Carbon monoxide is something that should be considered too. CO does have cross-talk with many heme containing proteins that are the receptors for nitric oxide. The EC50 for NO on sGC is ~ 10 nM/L, less than a ppb by wt. Enough CO ia inhaled during smoking to significantly populate heme proteins with CO.

Very interesting article.
The primary reason I believe patients smoke is as a form of comfort and stress relief.
When you feel overwhelmed by the psychosis you are going through, smoking is the one thing that can connect you to the mundane, ordinary world that you have become so disconnected from. It is a physical process and you also view it as a ‘normal’ activity. It helps you to feel that you are not so much different to anyone else, and it also helps provide structure to your day…(lack of structure being one of the root caues of schizophrenia I think). If you have a mental routine where you know where and when you are going to smoke, this provides a little more structure and routine – important elements in surviving any period of time in the mental health system. While smoking is obviously unhealthy, I don’t believe that patients should be denied access to them simply because they are under mental health care. If they have not gone voluntarily, the removal of cigarettes will probably cause alot of mental distress. Even voluntary patients should be permitted to smoke. When you are in the depths of psychosis, unhealthy as it might be, it is still an important lifeline. I don’t smoke at all now, but back in 1999 when I was very poorly, it would have been unthinkable to be denied a cigarette at one of the lowest points of my life.

When I was on haloperidol and rendered into a state of complete zombification,there was only one tiny window in the day when I felt like the happy, alive person I was before the onset of my psychotic episode and the ensuing forced medication.It was when I smoked my first cigarette of the day. Even though it was 30 years ago, and I was only on the drug for 3 months, that memory of my brief moment of happiness each morning is still as vivid as if it were yesterday. .

This was a big issue when I was working in the California State Hospital system as an advocate. One other reason there’s so much smoking is because state hospital life is totally restrictive. Smoking a cigarette is one of the few activities patients can engage in in private that has a somewhat meditative quality. Listening to music — another cherished activity — is another. An interesting study, imo, would be to look at smoking rates of patients IN THE SAME HOSPITAL with schizophrenia and non-schizophrenia diagnoses and see if there’s a difference.

It’s long been of interest to me that there exists such an obvious link between tobacco smoking and serious mental illness, yet there has never – to my knowledge – been any suspicion of there being a causal link between tobacco use and the illness.

During the recent cannabis and mental health scare great play was made of the claim that cannabis altered the dopeamine balance in the brain and for a while this was suggested as a possible causal mechanism., yet this was never mentioned in respect of tobacco.

Whilst it’s important of course to remmeber that a correlation of use of a particular substance and metnal illness doesn’t imply a causal role, the correlation betwen tobacco use and mental illness is far greater than any such correlation for cannabis.

Is there any research which looks at the rates of severe mental illness amongst young people who started smoking as young teenagers? I’m not aware of any but it would be interesting to see if psychosis rates are higher amongst young smokers than non-smokers.

Its well known that before anti-psychotics nicotine was a treatment for psychosis and schizophrenia. If the mentally ill respond so well to it, why don’t they combine nicotine with therapy? There are other ways to get nicotine. I have a brother who is schizophrenic, and when he was well he hated smokers. He now smokes as much as he can. Its sad. I wouldn’t even think of asking him to quit. Obviously he sees a benefit. Can’t the health care community see the benefit and make this healthier?

It’s not a terribly popular idea, but I think that schizophrenics and the alzheimer’s-prone elderly might benefit from the use of nicotine patches as maintenance medicine.

This sounds like a population which could really benefit from e-cigarettes.