Increasing diagnosis of nicotine dependence in adolescent mental health patients

Objective: The aim of this study was to investigate the routine recording p atterns of patients' smoking by clinical staff of an adolescent mental heal th service over a 3-year period. Method: A systematic examination of the clinical files of all patients who underwent an initial assessment or reassessment at the Youth Specialty Serv ice (Mental Health; YSS) over a 2-month period (1 April-31 May) was carried out in 1996, 1997 and 1998. A range of data were collected including: demo graphics; diagnoses; amount of total information recorded and history of ni cotine dependence. Results: A stable historical record of cigarette smoking in the region of 3 0-40% across the 3 years sampled was found, but the rate of formal diagnosi s of nicotine dependence rose from 3.6% in 1996 to 26.3% in 1998. This rise was in the context of relative stability over this time period of: size of reports and relevant sections (alcohol and drug history, cigarette smoking history); three other key diagnoses, major depression, conduct disorder an d alcohol dependence; and demographic data. The rise in rate of diagnosis p roceeded specific discussion within the clinical team about nicotine depend ence. Conclusions: Adolescent mental health settings are a key venus to address h eavy and potentially chronic cigarette smoking, but nicotine dependence has been traditionally a neglected diagnosis in mental health patients. The ra te of diagnosis is likely to rise when specific discussion is undertaken wi thin clinical teams.