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It is difficult for mentally impaired people to quit smoking, but they can if proper treatment is administered, like the well-orchestrated campaigns that have proved effective in assisting cancer patients undergoing hospital treatment to kick the habit.

These and other examples were reported at an annual scientific meeting of the Japan Medical-Dental Association for Tobacco Control in Wakayama in February.

Atsuko Kawai, director of the Koutokukai Total Health Center in Nanyo, Yamagata Prefecture, explained the effectiveness of the program to help the mentally impaired quit smoking in her presentation at the meeting.

“When they smoke, some portion of their psychotropic medication metabolizes faster, necessitating more drugs and making side effects more likely. Smokers are more than twice as likely to suffer depression,” she said.

“There is a lot to be said for mentally impaired people quitting smoking. When we mention a way to easily quit smoking and our readiness to offer support, unexpectedly large numbers of mentally impaired people want to kick the habit,” she added.

Kawai polled mentally impaired people at Koutokukai Sato Hospital and found only 27 percent had no interest in giving up smoking, while 30 percent were receptive to the idea.

Although treatment to stop smoking was less successful for the mentally impaired than for other patients, one-third of those who underwent the program remained nonsmokers more than one year later, she said.

Since many mentally impaired people live on or close to the poverty line, those who spring for cigarettes often do so in lieu of buying food. The number of mentally impaired people visiting hospitals for economic reasons is increasing, Kawai said.

But depression can be made worse by quitting smoking.

“It is necessary to determine whether the subject’s symptoms are stable before promoting the treatment,” said Kawai. In addition to cognitive behavioral therapy, frequent consultations and the use of adjunctive agents as an aid to no smoking are also required, she said.

Support from families is also helpful, as is talking to patients and encouraging them during their medical examinations, she said.

One problem, however, is that psychiatrists have a particularly high smoking rate. It has been common for both doctors and patients to smoke in examination rooms. But the antismoking movement is gradually spreading even to psychiatric hospitals.

More than a dozen such hospitals across the country now ban smoking. Nanzan Hospital in Itoman, Okinawa, has reduced to zero the rate of smoking among inpatients and employees.

Support for inpatients is also important. The Osaka Medical Center for Cancer and Cardiovascular Diseases issued its “Stop-smoking support clinical pass” in 2005 as part of an antismoking campaign.

On the day the hospitalization date is decided, on the check-in day and upon discharge, patients are advised by nurses that their treatment will be more effective and the posttreatment process improved if they don’t light up.

The clinical pass makes it twice as easy to quit smoking, Masahiro Tanaka, a doctor at the research division of the Osaka Medical Center, claimed at the annual meeting.

The clinical pass has influenced the entire hospital. Smoking is not allowed on the premises, but there are still inpatients who go out to the street and smoke.

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