Concurrent Alcohol and Tobacco Dependence
Anti-psychotic drugs linked to diabetes

How—and why—to help psychiatric patients stop smoking

Smoking_cigarette Did you know that almost half (44%) of the cigarettes smoked in the United States are smoked by people with a psychiatric disorder? It makes it  true with a flip of a coin to say that "you have to be nuts or an addict to smoke".

There are a lot of myths in the behavioral health field about why providers can't or shouldn't address their patient's smoking. While every patient and situation is different, these myths are not born out upon further investigation.

The clinical practice guideline for treating nicotine dependence promulgated by the U.S. Public Health Serice asks health care providers to routinely use the 5 "A"s in their patient encounters: Ask, Advise, Assess, Assist, and Arrange.

There are many treatment options available these days including nicotine replacement therapy, NRT, antidepressants, behavioral counseling, motivational interviewing, group support, and patient education.

430,000 Americans die every year from tobacco related illnesses. Successful  behavioral health treatment that results in a patient dying from tobacco induced heart attack, or cancer reminds me of the old cynical saying that "The surgery was a success, but the patient died."

Use the five "A"s with your patients from now on. You may save lives.

Link: How—and why—to help psychiatric patients stop smoking.



herapeutic phlebotomy for hereditary hemochromatosis is relatively safe and presumably efficacious when offered before cirrhosis develops, so screening primary care patients is of substantial interest. PURPOSE: To conduct a systematic review of the evidence on 1) the prevalence of the disease in primary care, 2) the risk for morbid or fatal complications for untreated patients, 3) the diagnostic usefulness of transferrin saturation and serum ferritin level in identifying early disease, 4) the efficacy of early treatment, and 5) whether the benefits of screening outweigh the risks. DATA SOURCES: MEDLINE search from 1966 through April 2004, complemented by reference review of identified original studies and review articles published in English. STUDY SELECTION: PubMed Clinical Queries filters search of prognosis, diagnosis, etiology, or treatment were used depending on the question. Two authors reviewed all titles and abstracts. DATA EXTRACTION: Two investigators independently reviewed extracted data. DATA SYNTHESIS: The prevalence of hereditary hemochromatosis was 1 in 169 patients to 1 in 556 patients (n = 3 studies). Uncontrolled, prospective studies of genetic homozygous patients did not consistently identify a link to overt hereditary hemochromatosis. A serum ferritin level less than 1000 microg/L was predictive of absence of cirrhosis. Six studies demonstrated reduced survival in patients with cirrhosis. Diagnostic studies varied with respect to case definition. No blinded, independent comparisons of screening tests with the gold standard (biopsy or results of quantitative phlebotomy) or randomized, controlled trials of phlebotomy were identified. Cost-effectiveness analysis was limited by lack of prospective data on the natural history of the disease. LIMITATIONS: Varied case definition and lack of prospective cohort studies or randomized trials. CONCLUSIONS: The available evidence does not demonstrate that benefits outweigh the risks and costs of screening for hemochromatosis.

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