Gaps and challenges: WHO treatment recommendations for tobacco cessation and management of substance use disorders in people with severe mental illness

• DOI: 10.1186/s12888-020-02623-y
• Publication Date: 2020-05-14T13:10:14Z
• Authors: Jayati Das-Munshi; Maya Semrau; Corrado Barbui; Neerja Chowdhary; Petra C. Gronholm; Kavitha Kolappa; Dzmitry Krupchanka; Tarun Dua; Graham Thornicroft
• Keywords: Nicotine replacement therapy; Varenicline; Bupropion

People with severe mental disorders (SMD) experience premature mortality mostly from preventable physical causes. The World Health Organization (WHO) have recently produced guidelines on the management of health conditions in SMD. This paper presents evidence which led to recommendations for tobacco cessation and substance use Scoping reviews informed 2 PICO (Population Intervention, Comparator, Outcome) questions relating Systematic searches identification systematic relevant address these questions. Retrieved was assessed using GRADE methodology, informing development guidelines. One thousand four hundred thirty-four records were identified through SMD cessation, 4 included tables 18 narrative synthesis. For disorders, 4268 identified, studies 16 who should be offered combined pharmacological (Varenicline, Bupropion or Nicotine Replacement Therapy) non-pharmacological interventions such as tailored directive supportive behavioural interventions. people (drug and/or alcohol), considered accordance WHO mhGAP Prescribers note potential drug-drug interactions. Recommendation conditional based low/very low certainty a scarcity low- middle-income settings. These mark an important step towards addressing dearth high-quality LMIC settings must inform future research agenda. Guidelines: https://www.who.int/mental_health/evidence/guidelines_physical_health_and_severe_mental_disorders/en https://www.who.int/publications-detail/mhgap-intervention-guide%2D%2D-version-2.0