Smoking is the top cause of death among lifestyle habits and continues to affect more than one billion people around the world. The current gold standard for smoking cessation is a combination of pharmacological and behavioural approaches. In March 2017, the National Addictions Management Service, Singapore, initiated a smoking cessation programme that combined the pharmacological treatment options of either nicotine replacement therapy, bupropion or varenicline with individual counselling to achieve optimal results. Treatment is customised to the individual based on demographics, individual preferences, cost considerations, and history of chronic medical or psychiatric ailments. After more than 1.5 years of running this programme, we share the lessons learnt.

Introduction: Assertive Community Treatment (ACT) was introduced in the 1970s as a comprehensive and assertive approach to community-based case management of patients with chronic and serious mental illness. Launched in Singapore in 2003, the Assertive Community Management (ACM) was modelled after the ACT, but with the main difference of 24 hour availability for the latter only. In line with the move towards de-institutionalisation of psychiatric patients, ACM was introduced to provide a mobile community-based multidisciplinary team approach to manage patients with severe chronic psychiatric illness. This article aims to evaluate and provide an update on this service programme in Singapore following an earlier study by Fam Johnson in 2007. Materials and Methods: A naturalistic and retrospective study was conducted. One hundred and fifty-five patients recruited into ACM from 1 September 2008 to 1 September 2009 and had completed 1 year of ACM were included in our study. Outcomes were defined as number of admissions (NOA) and length of stay (LOS) one year before and one year following induction into the programme. Baseline socio-demographic factors were also investigated to see if they predicted outcome with ACM. Results: The mean NOA was 1.9 pre-ACM and 0.6 post-ACM, with mean reduction in NOA of 1.3 (P <0.01). The mean LOS was 72.2 days pre-ACM and 17.1 days post ACM, mean reduction in LOS 55.1 days (P <0.01). In addition, it was found that gender, diagnoses and ethnicity were not predictive of the outcome measures of NOA or LOS. Conclusion: ACM in Singapore had been well established since its inception and continued to show effectiveness in reducing inpatient hospitalisation among the chronically mentally ill. Key words: Assertive Community Treatment, Community Psychiatry, Length of stay, Number of admission, Global assessment of functioning

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Introduction:Codeine Induced Psychotic Disorder is a poorly characterized illness but is increasingly being reported amongst cough mixture abusers. A study done in Hong Kong found that substance induced psychotic disorder is the most common psychiatric diagnosis amongst cough mixture abusers.Objectives/Aims:We aim to describe the clinical characteristics of patients referred to our National Addictions Management Service with a diagnosis of Substance Induced Psychotic Disorder secondary to Codeine cough syrup use.Methods:A retrospective audit of clinical records was done for patients seen at our National Addictions Management Service from Apr 2007 to Mar 2013 with a diagnosis of Substance Induced Psychotic Disorder secondary to codeine use. Patients with a prior primary psychotic disorder diagnosis were excluded from the study.Results:11 patients (9 male, 2 female) out of a total of 48 patients with substance induced psychotic disorder had used codeine cough syrup. 4 of the patients had concomitantly used other substances as well. The age range of the patients was 28-45 yrs with a mean of 37.3 yrs. The duration of hospitalization during their psychotic episode ranged from 4-38 days with a mean of 13.5 days. 10 out of 11 patients were started on antipsychotics at baseline. At the end of a one year follow up period, two patients had their diagnosis revised to that of schizophrenia.Conclusions:Codeine Induced Psychotic disorder is increasingly being seen amongst codeine abusers and more research is needed to better characterize this condition and determine the biological mechanisms behind it.