Some epidemiological studies indicate that obesity, osteoporosis, and cigarette smoke are common problems in people with intellectual disabilities, for which it would be necessary to improve the detection, management, and prevention. It is not clear however if these problems are more frequent in those that are mentally disabled than the general population. In fact, the results of several searches are not concordant.
The data obtained from the questionnaires filled out a few years ago, by more than a thousand people with mild intellectual disabilities living in England, indicated that those who do not utilize the services for the disabled are more likely to smoke tobacco and to be exposed to some social factors with negative impacts on health, such as material difficulties, social isolation and low participation in the community life.
In a population of people with intellectual disabilities, the number of smokers is particularly high among those who suffer from a psychiatric disorder, especially depression or psychosis.
Most clinicians believe that, generally in the population of intellectually disabled, smoking and mental disorders are inextricably linked and therefore the elimination of tobacco dependence is particularly difficult to achieve in those with psychiatric disorders.
The devastating consequences of tobacco use in smokers with mental disorders are easily available in medical literature. They include a significantly increased risk of developing cancer, lung diseases and cardiovascular diseases; also many of these people die 25 years before the average population.
Smoking also complicates psychiatric treatments. Some components of cigarettes accelerate the metabolism of many antidepressants and antipsychotics, resulting in a significant reduction in blood levels and therapeutic effect. Among people affected with schizophrenia, epidemiological studies have revealed that for those who smoke there is a higher hospitalization rate, higher doses of medication used, and the presence of more severe symptoms than in non-smokers.
Although the particular mechanism is not known, the use of tobacco is also one of the strongest predictors of future suicidal behavior.
Recent French neuroradiological research has confirmed that smoking is associated with a significant reduction of dopamine transporters (DAT) in all the brain circuits that utilize this neurotransmitter, including those for regulating mood.
The managing of smoking among people with intellectual disabilities and mental health problems has helped to overcome many socio-cultural obstacles. This includes, for example, correcting some false beliefs that tobacco is used as a self medication for these types of disorders.
Nicotine is a substance with a powerful tonic and is able to temporarily improve focus and attention regardless of the mental state of the smoker, but it is ineffective as a drug or as an adjunct for the treatment of all mental disorders. On the contrary, there is data on its pathogenic potential, direct or as a cofactor, as well as the effects from other substances released from cigarette smoke.
Another misconception is that smoking, perceived to have distal effects, is the last thing to worry about in patients with severe cognitive deficits and/or acute psychiatric symptoms. However, these people are more likely to die of diseases resulting from tobacco rather than from the consequences of psychiatric disorders.
We can also reasonably conclude that those who suffer from intellectual disorders are not able to easily quit smoking. In this case, increasing evidence shows that smokers with mental disabilities have a greater difficulty in quitting smoking than those smokers without any negative implications on mental functioning.
Smoking in people with intellectual disabilities and mental health problem appears to be a medical emergency. Some European countries are planning to adopt, as early as next year, new standards for the treatment of smoking addiction. It is hoped that in Italy, the health care providers, policy makers and promoters of mental health are getting involved in the coordination of the effort to improve access to evidence-based treatment programs.
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