51
|
Kozak K, Lowe DJE, George TP. Effects of Tobacco Smoking Status on Verbal Learning and Memory in Patients With Schizophrenia and Non-Psychiatric Controls. Am J Addict 2019; 28:503-511. [PMID: 31291035 DOI: 10.1111/ajad.12903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/03/2019] [Accepted: 04/20/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with schizophrenia have higher rates of tobacco smoking compared to the general population. Moreover, these patients have deficits in cognition, including verbal learning and memory. However, it is not clear whether smoking status alters verbal learning and memory in schizophrenia. We examined the effects of smoking abstinence and reinstatement on verbal learning and memory in people with schizophrenia and nonpsychiatric controls and other cognitive domains as exploratory. METHODS Smoking participants (N = 28; 14 schizophrenia smokers; 14 nonpsychiatric smokers) were studied under smoking satiated, overnight abstinence and smoking reinstatement conditions. Nonsmokers ( n = 30; 15 schizophrenia nonsmokers; 15 nonpsychiatric nonsmokers) were also studied. A comprehensive cognitive battery was administered including verbal learning and memory using the Hopkins Verbal Learning Test-Revised (HVLT-R). RESULTS A 2 (diagnosis) × 2 (smoking status) repeated measures analysis of variance with time (session) as the within-subjects factor and diagnosis and smoking status as the between-subject factors was performed for HVLT-R and other cognitive outcomes. Smoking abstinence produced a decline in verbal memory of the HVLT discrimination index in smokers with schizophrenia that was partially revised by reinstatement, although trends for other HVLT measures were not statistically significant. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Acute cigarette smoking and abstinence may selectively alter verbal learning and memory deficits in smokers with schizophrenia compared to nonpsychiatric smoking controls and nonsmokers, but additional studies are needed to confirm the preliminary findings in this small sample. (Am J Addict 2019;00:1-9).
Collapse
Affiliation(s)
- Karolina Kozak
- Institute of Medical Sciences (IMS), University of Toronto, Toronto, Canada.,Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Darby J E Lowe
- Institute of Medical Sciences (IMS), University of Toronto, Toronto, Canada.,Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Tony P George
- Institute of Medical Sciences (IMS), University of Toronto, Toronto, Canada.,Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
52
|
Effects of the Nicotinic Partial Agonist Varenicline on Smoking Lapse Behaviour in Schizophrenia. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
53
|
Evins AE, Benowitz NL, West R, Russ C, McRae T, Lawrence D, Krishen A, St. Aubin L, Maravic MC, Anthenelli RM. Neuropsychiatric Safety and Efficacy of Varenicline, Bupropion, and Nicotine Patch in Smokers With Psychotic, Anxiety, and Mood Disorders in the EAGLES Trial. J Clin Psychopharmacol 2019; 39:108-116. [PMID: 30811371 PMCID: PMC6488024 DOI: 10.1097/jcp.0000000000001015] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuropsychiatric safety and relative efficacy of varenicline, bupropion, and transdermal nicotine patch (NRT) in those with psychiatric disorders are of interest. METHODS We performed secondary analyses of safety and efficacy outcomes by psychiatric diagnosis in EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study), a 12-week, randomized, double-blind, triple-dummy, placebo- and active (NRT)-controlled trial of varenicline and bupropion with 12-week follow-up, in a subset population, n = 4092, with a primary psychotic (n = 390), anxiety (n = 792), or mood (n = 2910) disorder. Primary end-point parameters were incidence of prespecified moderate and severe neuropsychiatric adverse events (NPSAEs) and weeks 9 to 12 continuous abstinence rates (9-12CAR). RESULTS The observed NPSAE incidence across treatments was 5.1% to 6.3% in those with a psychotic disorder, 4.6% to 8.0% in those with an anxiety disorder, and 4.6% to 6.8% in those with a mood disorder. Neither varenicline nor bupropion was associated with significantly increased NPSAEs relative to NRT or placebo in the psychiatric cohort or any psychiatric diagnostic subcohort. There was a significant effect of treatment on 9-12CAR (P < 0.0001) and no significant treatment-by-diagnostic subcohort interaction (P = 0.24). Abstinence rates with varenicline were superior to bupropion, NRT, and placebo, and abstinence with bupropion and NRT was superior to placebo. Within-diagnostic subcohort comparisons of treatment efficacy yielded estimated odds ratios for 9-12CAR versus placebo of greater than 3.00 for varenicline, greater than 1.90 for bupropion, and greater than 1.80 for NRT for all diagnostic groups. CONCLUSIONS Varenicline, bupropion, and nicotine patch are well tolerated and effective in adults with psychotic, anxiety, and mood disorders. The relative effectiveness of varenicline, bupropion, and NRT versus placebo did not vary across psychiatric diagnoses.
Collapse
Affiliation(s)
- A. Eden Evins
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Neal L. Benowitz
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Robert West
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Cristina Russ
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Thomas McRae
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - David Lawrence
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Alok Krishen
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Lisa St. Aubin
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Melissa Culhane Maravic
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| | - Robert M. Anthenelli
- Harvard Medical School and Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA (AE Evins
, MC Maravic ); University of California
Department of Medicine, San Francisco, California, USA (NL Benowitz ); University College
Department of Behavioural Science and Health, London, UK (R West ); Pfizer, New York, New
York, USA (L St. Aubin , T McRae , D Lawrence
, C Russ ); PAREXEL International on behalf of
GSK, Research Triangle Park, North Carolina, USA (A Krishen ); Harvard Medical School and
Massachusetts General Hospital Division of Biostatistics, Boston, Massachusetts, USA );
Department of Psychiatry, University of California, San Diego, California, USA (RM Anthenelli
)
| |
Collapse
|
54
|
Smith CA, McNeill A, Kock L, Shahab L. Exploring mental health professionals' practice in relation to smoke-free policy within a mental health trust: a qualitative study using the COM-B model of behaviour. BMC Psychiatry 2019; 19:54. [PMID: 30717722 PMCID: PMC6360690 DOI: 10.1186/s12888-019-2029-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/16/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Smoking has played a significant role in the historical culture of mental healthcare settings. Mental health professionals (MHPs) often hold dismissive attitudes regarding the importance of smoking cessation in the context of mental healthcare. In 2007, English mental health inpatient buildings were required by law to become smoke-free, and healthcare trusts have more recently begun to implement comprehensive policies (i.e. smoke-free grounds and buildings) and staff training in response to national guidance. It is therefore important to explore MHPs practice around smoking, smoking cessation, and smoke-free policy adherence. This study aimed to explore these issues by using the COM-B (capability, opportunity, motivation, behaviour) model to systematically identify barriers to, and facilitators for, MHPs addressing smoking with their patients. METHODS Five focus groups with a total of 36 MHPs were conducted between March and August 2017. MHPs were recruited from one of the largest mental health trusts in Europe. Discussions were guided by a semi-structured guide. Responses were audio recorded, transcribed and coded using thematic analysis and the COM-B framework. RESULTS Addressing smoking with patients was undermined by MHPs' 1) psychological capability to recall training content, misunderstand the potential benefits of addressing patient smoking and harm reduction approaches; 2) physical opportunity in terms of time constraints, and easy accessibility of tobacco in the community; 3) social opportunity in terms of increased cultural value of tobacco following inpatient smoke-free policy implementation, and lack of support from colleagues to enforce the smoke-free policy; 4) automatic motivation, including intrinsic biases regarding patients abilities and motivations to quit, and 5) reflective motivation, including perceived job role and decision making processes related to addressing behaviours deemed more important than smoking. The main facilitating factors identified were MHPs' having opportunity in the form of patients asking directly for support, and MHPs having access to resources such as stop smoking services and spirometers. CONCLUSION Multiple barriers were identified across all key domains of the COM-B framework that undermine MHPs' practice regarding smoking cessation. Few facilitators were identified which may have implications for future smoke-free policy and clinical practice.
Collapse
Affiliation(s)
- Charlie Albert Smith
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Ann McNeill
- National Addiction Centre, King’s College London, 4 Windsor Walk, London, SE5 8BB UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, NG5 1PB UK
| | - Loren Kock
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| |
Collapse
|
55
|
Komiyama M, Takahashi Y, Tateno H, Mori M, Nagayoshi N, Yonehara H, Nakasa N, Haruki Y, Hasegawa K. Support for Patients Who Have Difficulty Quitting Smoking: A Review. Intern Med 2019; 58:317-320. [PMID: 30210111 PMCID: PMC6395133 DOI: 10.2169/internalmedicine.1111-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Smoking cessation plays a crucial role in reducing preventable morbidity and mortality. However, some smokers find smoking cessation difficult, despite receiving treatment. This includes heavy smokers with chronic obstructive pulmonary disease, smokers with a psychiatric disorder, and female and underage smokers. This review article describes smoking cessation approaches for patients who find it difficult to quit smoking.
Collapse
Affiliation(s)
- Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yuko Takahashi
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Hiroki Tateno
- Department of Internal Medicine, Saitama City Hospital, Japan
| | - Masahiro Mori
- Department of Surgery, National Hospital Organization Chiba Medical Center, Japan
| | | | | | - Naoko Nakasa
- Health Support Center, Matsue Memorial Hospital, Japan
| | - Yuko Haruki
- Health Support Center, Matsue Memorial Hospital, Japan
| | - Koji Hasegawa
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| |
Collapse
|
56
|
Lucatch AM, Lowe DJE, Clark RC, Kozak K, George TP. Neurobiological Determinants of Tobacco Smoking in Schizophrenia. Front Psychiatry 2018; 9:672. [PMID: 30574101 PMCID: PMC6291492 DOI: 10.3389/fpsyt.2018.00672] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose of review: To provide an overview of the underlying neurobiology of tobacco smoking in schizophrenia, and implications for treatment of this comorbidity. Recent findings: Explanations for heavy tobacco smoking in schizophrenia include pro-cognitive effects of nicotine, and remediation of the underlying pathophysiology of schizophrenia. Nicotine may ameliorate neurochemical deficits through nicotine acetylcholine receptors (nAChRs) located on the dopamine, glutamate, and GABA neurons. Neurophysiological indices including electroencephalography, electromyography, and smooth pursuit eye movement (SPEM) paradigms may be biomarkers for underlying neuronal imbalances that contribute to the specific risk of tobacco smoking initiation, maintenance, and difficulty quitting within schizophrenia. Moreover, several social factors including socioeconomic factors and permissive smoking culture in mental health facilities, may contribute to the smoking behaviors (initiation, maintenance, and inability to quit smoking) within this disorder. Summary: Tobacco smoking may alleviate specific symptoms associated with schizophrenia. Understanding the neurobiological underpinnings and psychosocial determinants of this comorbidity may better explain these potential beneficial effects, while also providing important insights into effective treatments for smoking cessation.
Collapse
Affiliation(s)
- Aliya M. Lucatch
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Darby J. E. Lowe
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Rachel C. Clark
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Karolina Kozak
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Division and Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
57
|
Tidey JW, Davis DR, Miller ME, Pericot-Valverde I, Denlinger-Apte RL, Gaalema DE. Modeling nicotine regulation: A review of studies in smokers with mental health conditions. Prev Med 2018; 117:30-37. [PMID: 30343684 PMCID: PMC7467778 DOI: 10.1016/j.ypmed.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 01/02/2023]
Abstract
Smokers with mental health conditions (MHCs) lose approximately 15 years of life relative to non-smokers without MHCs, of which two-thirds are attributable to smoking. The Food and Drug Administration (FDA) recently announced a new regulatory strategy for tobacco that includes a reduction in the nicotine content of cigarettes sold in the US to a minimally-addictive level. This action could improve cessation rates in smokers with MHCs by reducing their dependence on nicotine. However, nicotine reduction also could have unintended negative consequences in smokers with MHCs. Thus, it is important to conduct randomized controlled trials to investigate the potential effects of nicotine reduction in smokers with MHCs. Several studies of the acute or extended effects of nicotine reduction in smokers with emotional disorders or serious mental illness have been recently completed or are underway. Studies to date indicate that when smokers with MHCs are switched, under randomized, double-blind conditions, to cigarettes with very low nicotine content, they reduce their cigarette intake, with minimal or no effects on withdrawal, psychiatric symptoms, or compensatory smoking. However, some deleterious effects of nicotine reduction on cognitive performance measures in smokers with schizophrenia have been observed, which are offset by providing concurrent nicotine replacement. We review these studies and provide suggestions for potentially increasing the effectiveness of a nicotine reduction strategy for reducing smoking in people with MHCs. The research described was conducted in the United States in 2010-2018.
Collapse
Affiliation(s)
- Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, USA.
| | | | - Mollie E Miller
- Department of Behavioral and Social Sciences, Brown University, USA
| | | | | | | |
Collapse
|
58
|
Hidese S, Matsuo J, Ishida I, Hiraishi M, Teraishi T, Ota M, Hattori K, Kunugi H. Association between lower estimated premorbid intelligence quotient and smoking behavior in patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 15:7-13. [PMID: 30310770 PMCID: PMC6176847 DOI: 10.1016/j.scog.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/26/2018] [Accepted: 09/30/2018] [Indexed: 12/18/2022]
Abstract
Aim We aimed to investigate the involvement of premorbid intelligence quotient in higher prevalence of smoking in patients with schizophrenia. Methods Participants included 190 patients with schizophrenia (mean ± standard deviation age: 37.7 ± 10.8 years; 88 males and 102 females) and 312 healthy individuals (mean ± standard deviation age: 38.1 ± 13.8; 166 males and 146 females), matched for age, sex, and ethnicity (Japanese). Premorbid intelligence quotient was estimated using the Japanese Adult Reading Test and distress symptoms were assessed using the Hopkins Symptom Check List. Current smoking information was collected according to self-declarations. Results As expected, the smoking rate was higher, while mean education level and Japanese Adult Reading Test scores were significantly lower, in patients with schizophrenia than in healthy individuals (p < 0.01). The mean education level and Japanese Adult Reading Test scores were significantly lower in the smoker group than in the non-smoker group in both patients and healthy individuals (p < 0.05). In the patient group alone, Hopkins Symptom Check List subscale and total scores were significantly higher in the smoker group than in the non-smoker group (p < 0.05). A multivariate regression analysis showed that the Japanese Adult Reading Test score was a significant and negative predictor for smoking (p < 0.001, odds ratio = 0.97; 95% confidence interval: 0.96–0.99). Conclusion Our results suggest that lower estimated premorbid intelligence quotient is an important variable in elucidating smoking behavior in humans and may be associated with higher prevalence of smoking in patients with schizophrenia. Lower premorbid intelligence quotient (IQ) was observed in patients with schizophrenia who were smokers. Lower education level was observed in patients with schizophrenia who were smokers. Lower premorbid IQ and education level were also seen in smokers in the healthy group. Distress symptoms were higher in smokers with schizophrenia. In total, premorbid IQ was a negative predictor for smoking.
Collapse
Key Words
- ANCOVA, Analysis of covariance
- CI, Confidence interval
- Distress symptom
- Education level
- HSCL, Hopkins Symptom Check List
- IQ, Intelligence quotient
- JART, Japanese Adult Reading Test
- MANCOVA, Multivariate analysis of covariance
- NART, National Adult Reading Test
- OR, Odds ratio
- PANSS, Positive and Negative Syndrome Scale
- PSQI, Pittsburgh Sleep Quality Index
- Premorbid intelligence quotient
- Schizophrenia
- Smoking
Collapse
Affiliation(s)
- Shinsuke Hidese
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Moeko Hiraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| |
Collapse
|
59
|
Bakhshaie J, Rogers AH, Kauffman BY, Fasteau M, Buckner JD, Schmidt NB, Zvolensky MJ. Situational fears: Association with negative affect-related smoking cognition among treatment seeking smokers. Addict Behav 2018; 85:158-163. [PMID: 29907345 PMCID: PMC6460920 DOI: 10.1016/j.addbeh.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/15/2018] [Accepted: 06/07/2018] [Indexed: 01/18/2023]
Abstract
Despite the consistent clinically-significant relation between smoking and anxiety and its disorders, there is limited understanding of how specific fears relate to smoking processes. To isolate therapeutic targets for smoking-anxiety treatment development, there is a need to identify the underlying situational fears most related to smoking processes. Thus, the present study examined the association between interoceptive, agoraphobic, and social fears in terms of clinically significant negative affect-related smoking cognitions including negative affect reduction expectancies, coping motives, and perceived internal barriers to cessation. Participants were 469 treatment seeking smokers (48.2% female, Mage = 36.59, SD = 13.58) enrolled in a smoking cessation trial and completed baseline measures of smoking cognitions and situational fears. Results indicated that the there was a significant effect for social fears, relative to interoceptive and agoraphobic fears, for each of the studied clinically relevant smoking variables. Overall, this study offers initial empirical evidence that social fears are significantly and consistently related to several clinically-significant types of smoking cognition.
Collapse
Affiliation(s)
- Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, Houston, TX, United States
| | | | - Julia D Buckner
- Department of Psychology, Louisiana State University, LA, United States
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| |
Collapse
|
60
|
Brunette MF, Ferron JC, Robinson D, Coletti D, Geiger P, Devitt T, Klodnick V, Gottlieb J, Xie H, Greene MA, Ziedonis D, Drake RE, McHugo GJ. Brief Web-Based Interventions for Young Adult Smokers With Severe Mental Illnesses: A Randomized, Controlled Pilot Study. Nicotine Tob Res 2018; 20:1206-1214. [PMID: 29059417 PMCID: PMC6121912 DOI: 10.1093/ntr/ntx190] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/22/2017] [Indexed: 11/14/2022]
Abstract
Significance About 50% of young adults with schizophrenia, bipolar disorder, and other severe mental illnesses smoke tobacco, but few studies have evaluated interventions for this group. Methods We conducted a randomized pilot study among 58 young adult smokers with severe mental illnesses comparing a brief interactive web-based motivational tool, Let's Talk About Smoking, to computerized standard education from the National Cancer Institute. An additional 23 subjects received minimal tobacco assessment at baseline and no intervention, providing a comparison condition for naturalistic cessation behavior. All participants (total n = 81) were assessed for smoking and breath carbon monoxide at baseline and 14 weeks and had access to standard cessation treatments. Results The 81 participants were stable outpatients ages 18-30 (mean 24.8 years): 43.2% were diagnosed with schizophrenia-spectrum disorders, the remainder with severe mood and anxiety disorders. They smoked 14.6 ± 10.2 cigarettes per day. All participants completed their assigned intervention; 83.4% of Let's Talk About Smoking users and 71.4% of standard education users rated their intervention "good" or "very good." At 14 weeks, less than 15% of participants in all conditions had used additional cessation treatment. Let's Talk About Smoking users were more likely to have biologically verified abstinence at 14 weeks than standard education users (14.8% vs. 0%; X2 = 3.7, p = .05). None of the participants in the naturalistic comparison condition were abstinent at 14 weeks. Conclusions Interactive, web-based motivational interventions are feasible and promising for smoking cessation among young smokers with severe mental illnesses. Such interventions warrant further study among this group of smokers. Implications Young adult smokers with severe mental illnesses are a vulnerable population that, without intervention, goes on to experience disparate morbidity and mortality. Brief, easily disseminable interventions are needed to facilitate cessation in this group. This pilot research indicates that brief, technology-delivered, motivational interventions that are tailored for this group may be able to activate a significant number to quit without additional cessation intervention.
Collapse
Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| | - Joelle C Ferron
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| | | | - Daniel Coletti
- Department of Psychiatry, Hillside Hospital, New York, NY
| | - Pamela Geiger
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| | - Timothy Devitt
- Departments of Clinical Operations and Research, Thresholds, Inc, Chicago, IL
| | - Vanessa Klodnick
- Departments of Clinical Operations and Research, Thresholds, Inc, Chicago, IL
| | | | - Haiyi Xie
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| | - Mary Ann Greene
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts, Worchester, MA
| | - Robert E Drake
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| | - Gregory J McHugo
- Geisel School of Medicine at Dartmouth, and Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH
| |
Collapse
|
61
|
Pericot-Valverde I, Elliott RJ, Miller ME, Tidey JW, Gaalema DE. Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis. Addict Behav 2018; 84:238-247. [PMID: 29753221 PMCID: PMC7285418 DOI: 10.1016/j.addbeh.2018.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/18/2018] [Accepted: 04/30/2018] [Indexed: 12/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) and tobacco use are prevalent conditions that co-occur at striking rates in the US. Previous reviews examined prevalence and factors associated with cigarette smoking among individuals with PTSD but have not been summarized since 2007. Moreover, none explored rates and factors associated with the use of other tobacco products. This study aimed to systematically review the most recent literature examining the comorbidity of PTSD and tobacco use to provide prevalence rates, as well as summarize the literature exploring other factors associated with tobacco use among individuals with PTSD. Studies were identified using a systematic search of keywords related to tobacco use and PTSD within the following databases: PubMed, PsycINFO, Web of Knowledge, CINAHL, PsycARTICLES, and Cochrane Clinical Trials Library. The studies included in this review (N = 66) showed that the prevalence of current use of tobacco products in individuals with PTSD was 24.0% and the rate of PTSD among users of tobacco products was 20.2%. Additionally, results demonstrated that individuals with PTSD present with high levels of nicotine dependence and heavy use of tobacco products, as well as underscore the importance of negative emotional states as a contributing factor to tobacco use among individuals with PTSD. It is imperative that future studies continue monitoring tobacco use among individuals with PTSD while also assessing factors identified as having a prominent role in tobacco use among individuals with PTSD. These findings also demonstrate the need for more innovative approaches to reduce the pervasive tobacco use among individuals with PTSD.
Collapse
Affiliation(s)
- Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States
| |
Collapse
|
62
|
Abstract
PURPOSE OF REVIEW Mental and addictive disorders commonly co-occur with medical comorbidities, resulting in poor health and functioning, and premature mortality. This review provides an overview of the intertwined causal pathways and shared risk factors that lead to comorbidity. Additionally, this review examines the strategies to prevent the onset of and to effectively manage chronic medical conditions among people with mental and addictive disorders. RECENT FINDINGS Recent research provides further evidence for the shared genetic and biological, behavioral, and environmental risk factors for comorbidity. Additionally, there is evidence of effective approaches for screening, self-management, and treatment of medical conditions among people with mental disorders. There are promising health system models of integrated care, but additional research is needed to fully establish their effectiveness. A combination of public health and clinical approaches are needed to better understand and address comorbidity between mental and addictive disorders and chronic medical conditions.
Collapse
Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Ave, Atlanta, GA, 30322, USA.
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
63
|
Abstract
Objectives Poor mental health is associated with increased cigarette smoking, yet whether this extends to alternative tobacco product use remains unknown. Methods Wave 1 data from the Population Assessment of Tobacco and Health study assessed relationships between self-perceived mental health (SPMH) and prevalence of and motives for tobacco use among US adults (N = 32,320). Results Fair/poor SPMH, as compared to good/excellent SPMH, was associated with increased current cigarette (AOR = 2.91, 95% CI = 2.64, 3.20), e-cigarette (AOR = 1.35, 95% CI = 1.20, 1.53), cigarillo (AOR = 1.38, 95% CI = 1.22, 1.56), filtered cigar (AOR = 1.43, 95% CI = 1.21, 1.70), and smokeless tobacco (AOR = 1.17, 95% CI = 1.01, 1.36), but not traditional cigar use (AOR = 1.04, 95% CI = 0.90, 1.20). Whereas most motives for tobacco use were similar across SPMH rating, those with fair/poor SPMH, as compared to good/excellent SPMH, were more likely to report using traditional cigars due to affordability (AOR = 1.56, 95% CI = 1.23, 1.98) and e-cigarettes (AOR = 1.43, 95% CI = 1.15, 1.79) and smokeless tobacco (AOR = 1.84, 95% CI = 1.19, 2.83) due to appealing advertising. Conclusions Although individuals with poor SPMH are more likely to use alternative tobacco products than those with better SPMH, most motives for use are strikingly similar. These findings highlight the importance of continual monitoring of tobacco use trends among vulnerable populations.
Collapse
|
64
|
Bullen C, Verbiest M, Galea-Singer S, Kurdziel T, Laking G, Newcombe D, Parag V, Walker N. The effectiveness and safety of combining varenicline with nicotine e-cigarettes for smoking cessation in people with mental illnesses and addictions: study protocol for a randomised-controlled trial. BMC Public Health 2018; 18:596. [PMID: 29728074 PMCID: PMC5935940 DOI: 10.1186/s12889-018-5351-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background Smoking rates are higher in New Zealand (NZ) adults with mental illnesses and alcohol and other drug (AOD) addictions, compared to the overall population. Quit attempts using “gold standard” smoking cessation treatments often fail in people with these conditions, so more flexible treatment regimens that adapt to a person’s responsiveness to treatment are worth investigating. The STATUS trial aims to evaluate the effectiveness and safety of combining varenicline with nicotine e-cigarettes for smoking cessation among varenicline non-responders in treatment for mental health illnesses and/or AOD addictions. Methods This is a pragmatic two-arm, open-label, randomised trial. Participants will be daily smokers using mental health and/or addiction services in Auckland, aged ≥18 years, motivated to quit smoking, and eligible to access varenicline through the NZ special authority process. After 2 weeks of using varenicline plus behavioural support, participants who have not reduced their daily smoking by ≥50% will be randomised (1:1) to either 10 weeks of continued varenicline use or 10 weeks of varenicline plus an 18 mg/mL nicotine e-cigarette. All participants will receive weekly withdrawal-orientated behavioural support calls for 6 weeks post-randomisation. The primary outcome is self-reported biochemically-verified (exhaled carbon monoxide) continuous abstinence at 24 weeks post-randomisation. Secondary outcomes, measured at six, 12 and 24 weeks post-randomisation include: self-reported continuous abstinence, 7-day point prevalence abstinence, smoking reduction, time to relapse, cross-over, use of other smoking cessation support, serious adverse events, treatment adherence, compliance, acceptability, dual use, continuation of treatment use, mental illness symptoms and AOD use, health-related quality of life, and cost-analysis. A sample size of 338 will confer 80% power (p = 0.05) to detect a 15% absolute difference between the varenicline alone and varenicline plus e-cigarette groups. Discussion People with mental illness and/or AOD addictions are just as motivated as others to quit smoking, but are less likely to succeed. Adapting smoking cessation medication after a lack of responsiveness in the first 2 weeks of initial treatment in this priority population by adding a nicotine e-cigarette may be one way to increase long-term quit rates. Trial Registration Australian NZ Clinical Trial Registry: ACTRN12616001355460 (29 September 2016). Electronic supplementary material The online version of this article (10.1186/s12889-018-5351-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. .,Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Marjolein Verbiest
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Susanna Galea-Singer
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Community Alcohol & Drug Services, Waitemata District Health Board, Pitman House, 50 Carrington Road, Point Chevalier, Auckland, 1003, New Zealand
| | - Tomasz Kurdziel
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - George Laking
- School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - David Newcombe
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Department of Social and Community Health, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| |
Collapse
|
65
|
Public versus internal conceptions of addiction: An analysis of internal Philip Morris documents. PLoS Med 2018; 15:e1002562. [PMID: 29715300 PMCID: PMC5929514 DOI: 10.1371/journal.pmed.1002562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/28/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tobacco addiction is a complex, multicomponent phenomenon stemming from nicotine's pharmacology and the user's biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine's addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement. METHODS AND FINDINGS We analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris's move from public denial to public affirmation of nicotine's addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government's filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine's (IoM's) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris's public statements reinforce the idea that nicotine's pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis. CONCLUSIONS Philip Morris's research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine's pharmacology, the industry's continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.
Collapse
|
66
|
Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020254. [PMID: 30720772 PMCID: PMC5858323 DOI: 10.3390/ijerph15020254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/28/2022]
Abstract
(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18⁻29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.
Collapse
|
67
|
Keinänen J, Mantere O, Markkula N, Partti K, Perälä J, Saarni SI, Härkänen T, Suvisaari J. Mortality in people with psychotic disorders in Finland: A population-based 13-year follow-up study. Schizophr Res 2018; 192:113-118. [PMID: 28499768 DOI: 10.1016/j.schres.2017.04.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/21/2017] [Accepted: 04/30/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.
Collapse
Affiliation(s)
- Jaakko Keinänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Outi Mantere
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC H4H 1R3, Canada.
| | - Niina Markkula
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago, Chile.
| | - Krista Partti
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; University of Helsinki, Doctoral Program in Clinical Research, P.O. Box 700, FIN-00029 HUS, Finland.
| | - Jonna Perälä
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Samuli I Saarni
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Turku University Hospital and the University of Turku, P.O. Box 52, FIN-20521, Turku, Finland.
| | - Tommi Härkänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Health Monitoring Unit, P.O. Box 30, FIN-00271, Helsinki, Finland.
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland.
| |
Collapse
|
68
|
Okoli CTC, Otachi JK, Manuel A, Woods M. A cross-sectional analysis of factors associated with the intention to engage in tobacco treatment among inpatients in a state psychiatric hospital. J Psychiatr Ment Health Nurs 2018; 25:14-25. [PMID: 28976063 DOI: 10.1111/jpm.12435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: People admitted to psychiatric facilities have high rates of tobacco use and hospitalizations present an opportunity for patients to have conversations about tobacco use treatment. Clinicians may believe that people with mental illnesses are not interested in quitting or that they do not understand the importance of treatment. Positive attitudes towards tobacco treatment, viewing that participating in treatment is normal care, and feeling that one is quite able to participate in such treatment predicts intentions to participate in treatment, which, in turn, predicts actual participation. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Psychiatric patients who use tobacco use report poor prior involvement with tobacco treatment. Positive attitudes towards, encouraging opinions of other people about, and having a sense of control over taking part in tobacco treatment increases plans to engage in treatment. Having a sense of control in taking part in tobacco treatment is strongly associated with prior experiences with evidence-based treatment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Because psychiatric hospitalizations are an opportunity for addressing tobacco use and treatment, clinicians should be prepared to support willing patients, especially those with prior substance use histories. Support should include providing them with information regarding tobacco treatment options during their hospital stay and ways that they can continue to receive care after discharge. Clinicians should be promoters of pro-tobacco treatment attitudes and supporting patients' sense of control over participating in treatment during hospitalization. ABSTRACT Introduction Hospitalized tobacco users with mental illnesses (MI) may face several barriers to stopping smoking. However, motivational factors that affect the intention to engage in tobacco treatment have been shown to predict actual engagement. Aim To use the Theory of Planned Behavior to assess intentions to and prior experiences of engaging in evidence-based tobacco treatment among hospitalized individuals with MI. Method A cross-sectional survey was conducted among 115 patients in a state psychiatric hospital. Multivariate analyses were used to examine associations with the intentions and prior experiences of engaging in tobacco treatment. Results After controlling for demographic and smoking history, attitudes, subjective norms and perceived behavioural control towards engaging in tobacco treatment were significantly associated with intentions towards treatment engagement. Only higher scores on perceived behavioural control and lower education levels were associated with reported prior experiences of tobacco treatment. Discussion The low prior treatment engagement scores, but relatively higher intention to engage scores among participants suggests the need for deliberate support for evidence-based tobacco treatment during psychiatric hospitalizations. Implications for practice Clinician training in tobacco treatment can promote self-efficacy to engage patients while supporting patients' control so that tobacco treatment is an expected component of psychiatric care.
Collapse
Affiliation(s)
- C T C Okoli
- University of Kentucky College of Nursing, Lexington, KY, USA
| | - J K Otachi
- University of Kentucky Center of Health Services Research, Lexington, KY, USA
| | - A Manuel
- Eastern State Hospital, Lexington, KY, USA
| | - M Woods
- Eastern State Hospital, Lexington, KY, USA
| |
Collapse
|
69
|
García-Portilla MP, Bobes J. Smoking cessation programs for persons with schizophrenia: An urgent unmet need. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 9:181-184. [PMID: 27969002 DOI: 10.1016/j.rpsm.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 01/19/2023]
Affiliation(s)
- María Paz García-Portilla
- Área de Psiquiatría y Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, Asturias, España
| | - Julio Bobes
- Área de Psiquiatría y Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, Asturias, España.
| |
Collapse
|
70
|
Liu H, Luo Q, Du W, Li X, Zhang Z, Yu R, Chen X, Meng H, Du L. Cigarette smoking and schizophrenia independently and reversibly altered intrinsic brain activity. Brain Imaging Behav 2018; 12:1457-1465. [DOI: 10.1007/s11682-017-9806-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
71
|
Okoli CTC, Wiggins A, Fallin-Bennett A, Rayens MK. A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community-based mental health and addictions treatment settings. J Psychiatr Ment Health Nurs 2017. [PMID: 28635015 DOI: 10.1111/jpm.12408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Persons with different mental illnesses smoke for reasons based on their particular diagnosis. As compared to those without, persons with mental illnesses are less able to quit smoking when using smoking cessation medications. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper shows that there may be differences in the ability to quit smoking between persons with different mental illness diagnoses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Clinicians should be aware that persons with anxiety disorders may find it more difficult to quit smoking as compared to those with other mental illnesses. Clinicians should be aware that of all medications, varenicline seems to help those with mood disorders to quit the best. Clinicians should be aware that persons with psychotic disorders likely need longer treatment durations for smoking cessation as compared to persons with other mental illnesses. ABSTRACT Introduction Individuals with mental illnesses (MI) have diagnosis-specific reasons for smoking and achieve low smoking cessation when using cessation medications. Aim To assess differences in smoking cessation outcomes by MI diagnosis and cessation medications in outpatient mental health and addictions treatment settings in Vancouver, Canada. Method This is a retrospective analysis of tobacco treatment outcomes from 539 participants. The programme consists of cessation pharmacotherapy with 8 to 12 weeks of behavioural counselling and 12 weeks of support group. Smoking cessation was verified by expired carbon monoxide levels. Generalized estimating equations models assessed differences in cessation by type of medication in both total and stratified samples. Results There were no significant differences in cessation by pharmacotherapy in the total sample. Individuals with a mood disorder were two times more likely to achieve cessation as compared to those with an anxiety disorder. Among individuals with mood disorders, receiving varenicline alone resulted in three times the likelihood of cessation as compared to receiving single NRT. Discussion The differences in outcomes by MI diagnosis suggest the need for more diagnosis-specific approaches to optimize cessation. Implications for Practice Compared with other diagnoses, persons with anxiety disorders may have a greater challenge quitting and those with a psychotic disorder may require longer treatment durations.
Collapse
Affiliation(s)
- C T C Okoli
- University of Kentucky College of Nursing, Lexington, KY, USA
| | - A Wiggins
- University of Kentucky College of Nursing, Lexington, KY, USA
| | | | - M K Rayens
- University of Kentucky College of Nursing, Lexington, KY, USA
| |
Collapse
|
72
|
Higgins ST, Heil SH, Sigmon SC, Tidey JW, Gaalema DE, Hughes JR, Stitzer ML, Durand H, Bunn JY, Priest JS, Arger CA, Miller ME, Bergeria CL, Davis DR, Streck JM, Reed DD, Skelly JM, Tursi L. Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction. JAMA Psychiatry 2017; 74:1056-1064. [PMID: 28832876 PMCID: PMC5710465 DOI: 10.1001/jamapsychiatry.2017.2355] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States. OBJECTIVE To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content. DESIGN, SETTING, AND PARTICIPANTS A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016. INTERVENTIONS After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions. MAIN OUTCOMES AND MEASURES Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale. RESULTS Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η2 = 0.008; dose-by-time interaction, P = .002). CONCLUSIONS AND RELEVANCE Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.
Collapse
Affiliation(s)
- Stephen T. Higgins
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Sarah H. Heil
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Stacey C. Sigmon
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Diann E. Gaalema
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - John R. Hughes
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Maxine L. Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hanna Durand
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Janice Y. Bunn
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Jeff S. Priest
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Christopher A. Arger
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Cecilia L. Bergeria
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Danielle R. Davis
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Joanna M. Streck
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Derek D. Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence
| | - Joan M. Skelly
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Lauren Tursi
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| |
Collapse
|
73
|
Crockford D, Addington D. Canadian Schizophrenia Guidelines: Schizophrenia and Other Psychotic Disorders with Coexisting Substance Use Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:624-634. [PMID: 28886671 PMCID: PMC5593250 DOI: 10.1177/0706743717720196] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Persons with schizophrenia and other psychotic disorders frequently have coexisting substance use disorders that require modifications to treatment approaches for best outcomes. The objectives of this review were to identify evidence-based practices best practices that improve outcomes for individuals with schizophrenia and substance used disorders. METHOD We reviewed guidelines that were published in the last 5 years and that included systematic reviews or meta-analyses. Most of our recommendations came from 2 publications from the National Institute for Health and Care Excellence (NICE): the 2011 guidance titled Coexisting Severe Mental Illness (Psychosis) and Substance Misuse: Assessment and Management in Healthcare Settings and the 2014 guidance titled Psychosis and Schizophrenia in Adults: Prevention and Management. We placed these recommendations into the Canadian context to create this guideline. RESULTS Evidence supports the inclusion of individuals with coexisting substance use disorders in first-episode psychosis programs. The programs should integrate psychosis and substance use treatments, emphasizing ongoing monitoring of both substance use and patterns and symptoms. The best outcomes are achieved with combined use of antipsychotic medications and addiction-based psychosocial interventions. However, limited evidence is available to recommend using one antipsychotic medication over another or one psychosocial intervention over another for persons with schizophrenia and other psychotic disorders with coexisting substance use disorders. CONCLUSIONS Treating persons who have schizophrenia and other psychotic disorders with coexisting substance use disorders can present clinical challenges, but modifications in practice can help engage and retain people in treatment, where significant improvements over time can be expected.
Collapse
Affiliation(s)
- David Crockford
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary
| | - Donald Addington
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary
| |
Collapse
|
74
|
Chen LS, Baker T, Brownson RC, Carney RM, Jorenby D, Hartz S, Smock N, Johnson M, Ziedonis D, Bierut LJ. Smoking Cessation and Electronic Cigarettes in Community Mental Health Centers: Patient and Provider Perspectives. Community Ment Health J 2017; 53:695-702. [PMID: 27900650 PMCID: PMC5449258 DOI: 10.1007/s10597-016-0065-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 11/22/2016] [Indexed: 01/15/2023]
Abstract
Little is known about patients' electronic cigarette use, interest in and use of smoking cessation treatments, and providers' attitude towards such treatment. We assessed patients (N = 231) and providers (45 psychiatrists, 97 case workers) in four Community Mental Health Centers. Interestingly, 50% of smokers reported interest in using electronic cigarettes to quit smoking, and 22% reported current use. While 82% of smokers reported wanting to quit or reduce smoking, 91% of psychiatrists and 84% of case workers reported that patients were not interested in quitting as the lead barrier, limiting the provision of cessation interventions. Providers' assumption of low patient interest in treatment may account for the low rate of smoking cessation treatment. In contrast, patients report interest and active use of electronic cigarettes to quit smoking. This study highlights the need for interventions targeting different phases of smoking cessation in these patients suffering disproportionately from tobacco dependence.
Collapse
Affiliation(s)
- Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA.
- BJC Behavioral Health, BJC Healthcare, St. Louis, MO, USA.
| | - Timothy Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Douglas Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sarah Hartz
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Mark Johnson
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
- BJC Behavioral Health, BJC Healthcare, St. Louis, MO, USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| |
Collapse
|
75
|
Galéra C, Salla J, Montagni I, Hanne-Poujade S, Salamon R, Grondin O, Guichard E, Bouvard MP, Tzourio C, Michel G. Stress, attention deficit hyperactivity disorder (ADHD) symptoms and tobacco smoking: The i-Share study. Eur Psychiatry 2017; 45:221-226. [PMID: 28957791 DOI: 10.1016/j.eurpsy.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The contribution of mental health to the risk of smoking is increasingly acknowledged but still insufficiently studied during the key period of student life. In particular, the simultaneous action of stress and Attention Deficit Hyperactivity Disorder (ADHD) symptoms on the risk of smoking remains poorly understood. AIMS To assess the effects of stress and ADHD symptoms on tobacco smoking. METHOD Multivariate modeling was conducted on the French i-Share study (n=8110, median age 20.3 years, 74.8% females, 32.9% regular/occasional smokers) to evaluate the associations between stress, ADHD symptoms and tobacco smoking, adjusting for potential family/socio-demographic confounders. RESULTS Students with high levels of stress were more likely to smoke>10 cigarettes/day (adjusted odds ratio (aOR): 1.48, 95% CI: 1.12-1.96) than those with low levels of stress. Students with high levels of ADHD symptoms were more likely to smoke>10 cigarettes/day (aOR: 2.08, 95% CI: 1.58-2.75) than those with low levels of ADHD symptoms. CONCLUSIONS Stress and ADHD contribute independently to the risk of smoking. Interventions targeting each condition are likely to reduce the burden of tobacco use in students.
Collapse
Affiliation(s)
- C Galéra
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France; Centre hospitalier Perrens, 33076 Bordeaux, France.
| | - J Salla
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| | - I Montagni
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| | - S Hanne-Poujade
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| | - R Salamon
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| | - O Grondin
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| | - E Guichard
- Inserm CIC1415, CHRU de Tours, 37044 Tours, France
| | - M P Bouvard
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; Centre hospitalier Perrens, 33076 Bordeaux, France
| | - C Tzourio
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| | - G Michel
- UMR1219, université de Bordeaux, 33000 Bordeaux, France; UMR1219, Inserm, HEALTHY Team, 33000 Bordeaux, France
| |
Collapse
|
76
|
Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Koivisto M, Melartin T, Suominen K, Näätänen P, Heikkinen M, Oksanen J, Isometsä E. Psychoactive substance use in specialized psychiatric care patients. Int J Psychiatry Med 2017; 52:399-415. [PMID: 29179661 DOI: 10.1177/0091217417738937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.
Collapse
Affiliation(s)
- Boris Karpov
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grigori Joffe
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Aaltonen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- 2 Department of Mental Health and Substance Abuse Services, 3837 Terveyden ja hyvinvoinnin laitos , National Institute for Health and Welfare, Helsinki, Finland
| | - Ilya Baryshnikov
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maaria Koivisto
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tarja Melartin
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Suominen
- 3 Department of Social Services and Health Care, 3834 Helsingin Kaupunki , Helsinki, Finland
| | - Petri Näätänen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti Heikkinen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Oksanen
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Mental Health and Substance Abuse Services, 3837 Terveyden ja hyvinvoinnin laitos , National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Isometsä
- 1 Department of Psychiatry, 159841 HYKS sairaanhoitopiiri , University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Mental Health and Substance Abuse Services, 3837 Terveyden ja hyvinvoinnin laitos , National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
77
|
Wilson A, Guillaumier A, George J, Denham A, Bonevski B. A systematic narrative review of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups (2010-2017). Expert Rev Respir Med 2017; 11:617-630. [PMID: 28608758 DOI: 10.1080/17476348.2017.1340836] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tobacco remains the key modifiable risk factor for the development of a number of diseases, including cardiovascular disease, cerebrovascular disease, lower respiratory infections, chronic obstructive pulmonary disease, tuberculosis and cancer. Among priority populations, smoking prevalence remains high, smokers tend to relapse more often and earlier and fewer are able to sustain quit attempts. This systematic review provides an update on the literature. Areas covered: Twenty-four randomized controlled trials published from 2010-2017, in English language, were identified after searching on Medline, Ovid, Embase and PsycINFO databases. Studies reported on the effectiveness of smoking cessation interventions among six disadvantaged groups known to have high smoking rates: (i) homeless, (ii) prisoners, (iii) indigenous populations, (iv) at-risk youth, (v) people with low income, and (vi) those with a mental illness. Narrative review and assessment of methodological quality of included papers was undertaken. Expert commentary: There is a growing evidence base of methodologically robust studies evaluating a variety of behavioural smoking cessation interventions for priority populations. Multi-component interventions and those examining behavioural interventions incorporating mindfulness training, financial incentives, motivational interviewing and extended telephone-delivered counseling may be effective in the short-term, particularly for smokers on low incomes and people with a mental illness.
Collapse
Affiliation(s)
- Amanda Wilson
- a School of Nursing and Midwifery, Faculty of Health and Medicine , University of Newcastle , Callaghan , NSW , USA
| | - Ashleigh Guillaumier
- b School of Medicine and Public Health, Faculty of Health and Medicine , University of Newcastle & Hunter Medical Research Institute , Waratah , NSW , USA
| | - Johnson George
- c Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , USA
| | - Alexandra Denham
- d School of Medicine and Public Health, Faculty of Health and Medicine , University of Newcastle & Hunter Medical Research Institute , Waratah , NSW , USA
| | - Billie Bonevski
- e School of Medicine and Public Health, Faculty of Health and Medicine , University of Newcastle & Hunter Medical Research Institute , Waratah , NSW , USA
| |
Collapse
|
78
|
Van Schayck OCP, Williams S, Barchilon V, Baxter N, Jawad M, Katsaounou PA, Kirenga BJ, Panaitescu C, Tsiligianni IG, Zwar N, Ostrem A. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. NPJ Prim Care Respir Med 2017; 27:38. [PMID: 28600490 PMCID: PMC5466643 DOI: 10.1038/s41533-017-0039-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/29/2017] [Accepted: 05/09/2017] [Indexed: 11/12/2022] Open
Abstract
Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it recognises that clinical decisions should be tailored to the individual's circumstances and attitudes and be influenced by the availability and affordability of drugs and specialist services. Finally it argues that the role of the International Primary Care Respiratory Group is to improve the confidence as well as the competence of primary care and, therefore, makes recommendations about clinical education and evaluation. We also advocate for an update to the WHO Model List of Essential Medicines to optimise each primary-care intervention. This International Primary Care Respiratory Group statement has been endorsed by the Member Organisations of World Organization of Family Doctors Europe.
Collapse
Affiliation(s)
- O C P Van Schayck
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - S Williams
- International Primary Care Respiratory Group, Aberdeen, UK
| | - V Barchilon
- Andalusian Health Service (SAS), Tobacco group of GRAP (Primary Care Respiratory Group), Andalusia, Spain
| | - N Baxter
- International Primary Care Respiratory Group, Aberdeen, UK
- Southwark Clinical Commissioning Group, London, UK
| | - M Jawad
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - P A Katsaounou
- Pulmonary Medicine, Medical School, National and Kapodistran University of Athens, Evaggelismos Hospital, Athens, Greece
| | - B J Kirenga
- Lung Institute and Division of Pulmonary Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - C Panaitescu
- Family Medicine Solo Practice, RespiRo- Romanian Primary Care Respiratory Group, Bucharest, Romania
| | - I G Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - N Zwar
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - A Ostrem
- General Practitioner, Gransdalen Legesenter, Oslo, Norway
| |
Collapse
|
79
|
Stepankova L, Kralikova E, Zvolska K, Pankova A, Ovesna P, Blaha M, Brose LS. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up. Ann Behav Med 2017; 51:454-463. [PMID: 28035641 PMCID: PMC5440483 DOI: 10.1007/s12160-016-9869-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Smoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms. PURPOSE The aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression. METHODS Observational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: N = 3775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck's Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: N = 835 patients abstinent at 1 year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance. RESULTS Rate of abstinence was lower for patients with mild (32.5%, OR = 0.68; 95% CI: 0.54 to 0.87, p = 0.002) and moderate/severe depression (25.8%; OR = 0.57, 95% CI: 0.45 to 0.74, p < 0.001) compared with patients without depression (40.5%). Across abstinent patients, the majority with baseline depression reported lower depression levels at follow-up. Overall mean (SD) BDI-II scores improved from 9.2 (8.6) to 5.3 (6.1); t(834) = 14.6, p < 0.001. There were significant main effects of time (F(1832) = 880.8, p < 0.001, partial η2 = 0.51) and baseline depression level (F(2832) = 666.4, p < 0.001, partial η2 = 0.62) on follow-up depression and a significant depression * time interaction (F(2832) = 296.5, p < 0.001, partial η2 = 0.42). CONCLUSIONS In this effective smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1 year later. Patients abstinent from smoking experienced considerable improvement in depression.
Collapse
Affiliation(s)
- Lenka Stepankova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
| | - Eva Kralikova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Studničkova 7, 128 00 Praha 2, Czech Republic
| | - Kamila Zvolska
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
| | - Alexandra Pankova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Studničkova 7, 128 00 Praha 2, Czech Republic
| | - Petra Ovesna
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
| | - Milan Blaha
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
| | - Leonie S Brose
- Psychology and Neuroscience, King’s College London, UK and UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, UK
| |
Collapse
|
80
|
Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs 2017; 31:471-481. [PMID: 28550660 PMCID: PMC5646360 DOI: 10.1007/s40263-017-0438-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Premature mortality due to cardiovascular disease in those with schizophrenia is the largest lifespan disparity in the US and is growing; adults in the US with schizophrenia die, on average, 28 years earlier than those in the general population. The rate of smoking prevalence among individuals with schizophrenia is estimated to be from 64 to 79%. Smokers with schizophrenia have historically been excluded from most large nicotine-dependence treatment studies. However, converging evidence indicates that a majority of smokers with schizophrenia want to quit smoking, and that available pharmacotherapeutic smoking cessation aids are well tolerated by this population of smokers and are effective when combined with behavioral treatment. The aim of this review is to present updated evidence for safety and efficacy of smoking cessation interventions for those with schizophrenia spectrum illness. We also highlight implications of the very low abstinence rates for smokers with schizophrenia who receive placebo plus behavioral treatment in randomized trials, and review treatment approaches to address the high rate of rapid relapse observed upon pharmacologic treatment discontinuation in this population. Recommendations for monitoring for treatment-emergent nicotine withdrawal symptoms, side effects, and effects of cessation on antipsychotic medication are also provided. Smokers with schizophrenia spectrum disorders should be encouraged to quit smoking and should receive varenicline, bupropion with or without nicotine replacement therapy (NRT), or NRT, all in combination with behavioral treatment for at least 12 weeks. Maintenance pharmacotherapy may reduce relapse and improve sustained abstinence rates. Controlled trials in smokers with schizophrenia consistently show no greater rate of neuropsychiatric adverse events with pharmacotherapeutic cessation aids than with placebo.
Collapse
Affiliation(s)
- Corinne Cather
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA.
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Gladys N Pachas
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
| | - Kristina M Cieslak
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
81
|
Tobacco Use Disorder Among Patients With Smoking-related Chronic Medical Disease: Association With Comorbid Substance Use Disorders. J Addict Med 2017; 11:293-299. [PMID: 28368906 DOI: 10.1097/adm.0000000000000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Very little is known of the behavioral vulnerabilities of patients diagnosed with smoking-related chronic medical illness who continue to smoke, potentially worsening morbidity and mortality risks. This study explores the association of tobacco use disorder (TUD) among those with smoking-related chronic medical illnesses with other substance use disorders (SUDs) and risk factors. METHODS Among veterans with smoking-related chronic medical illnesses identified from the National Veterans Health Administration administrative records from fiscal year 2012, we compared the characteristics of those with a diagnosis of TUD (International Classification of Diseases, 9th edition code 305.xx; n = 519,918), and those without such a diagnosis (n = 2,691,840). Using multiple logistic regression, we further explored the independent association of factors associated with TUD. RESULTS SUD prevalence was markedly higher among those with TUD (24.9% vs 5.44%), including alcohol use disorder (20.4% vs 4.3%) and drug use disorder (13.5% vs 2.6%), compared with nonsmokers. On multiple logistic regression analyses, alcohol use disorder (odds ratio [OR] 2.94, 95% confidence interval [CI] 2.90-2.97) and drug use disorder (OR 1.97, 95% CI 1.94-1.99) were independently associated with current TUD diagnosis. Having any single SUD was associated with considerably high odds of having TUD (OR 3.32, 95% CI 3.29-2.36), and having multiple SUDs with even further increased risk (OR 4.09, 95% CI 4.02-4.16). CONCLUSIONS A substantial proportion of people with TUD diagnosis despite concurrent smoking-related medical illnesses are also likely to have other comorbid SUDs, complicating efforts at smoking cessation, and requiring a broader approach than standard nicotine-dependence interventions.
Collapse
|
82
|
Brunette MF, Feiron JC, Aschbrenner K, Colctti D, Devitt T, Greene MA, Harrington A, MoHugo GC, Pratt S, Robinson D, Williams J, Xie H. Characteristics and Predictors of Intention to use Cessation Treatment among Smokers with Schizophrenia: Young Adults Compared to Older Adults. JOURNAL OF SUBSTANCE ABUSE AND ALCOHOLISM 2017; 5:1055. [PMID: 29881770 PMCID: PMC5988490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Over half of young adults with schizophrenia smoke. Quitting before age 30 could prevent some of the disparate morbidity and mortality due to smoking-related diseases. However, little research has addressed smoking in this group nor evaluated strategies to help young adults with schizophrenia quit smoking. METHODS We compared demographic and smoking-related characteristics of young adults and those over 30 years of age among 184 smokers with schizophrenia. With a series of regression models, we assessed whether age, gender, smoking characteristics, social norms, attitudes, and perceived behavioral control predicted intention to quit smoking and to use cessation treatments. RESULTS Young adults had smoked for fewer years, had lower nicotine dependence, and had lower breath carbon monoxide levels than those over 30, yet awareness of the harms of smoking and readiness to quit were similar between groups. Attitudes about smoking, attitudes about cessation treatment, social norms for cessation treatment, and perceived behavioral control for cessation treatment significantly predicted intention to use cessation treatment. Age was not a predictor of intention to quit, nor to use cessation treatment. CONCLUSIONS Young adults with schizophrenia are amenable to smoking cessation intervention. Increasing awareness of the safety, efficacy and access to cessation treatments among smokers with schizophrenia and also among those in their social network may improve use of effective cessation treatment. These strategies may enhance the standard educational approach (increasing awareness of harms). Research is needed to evaluate such intervention strategies in smokers with schizophrenia of all ages.
Collapse
Affiliation(s)
- Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Joelle C. Feiron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | | | | | - Mary Ann Greene
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Amy Harrington
- Department of Psychiatry, University of Massachusetts, USA
| | - Gregory C. MoHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Samh Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | | | - Jill Williams
- Rutgcrs University-Robert Wood Johnson Medical School, USA
| | - Haiyi Xie
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| |
Collapse
|
83
|
Hefner K, Valentine G, Sofuoglu M. Electronic cigarettes and mental illness: Reviewing the evidence for help and harm among those with psychiatric and substance use disorders. Am J Addict 2017; 26:306-315. [DOI: 10.1111/ajad.12504] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/22/2016] [Accepted: 01/14/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kathryn Hefner
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Gerald Valentine
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Mehmet Sofuoglu
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| |
Collapse
|
84
|
Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
Collapse
Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
85
|
Molas S, DeGroot SR, Zhao-Shea R, Tapper AR. Anxiety and Nicotine Dependence: Emerging Role of the Habenulo-Interpeduncular Axis. Trends Pharmacol Sci 2017; 38:169-180. [PMID: 27890353 PMCID: PMC5258775 DOI: 10.1016/j.tips.2016.11.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
While innovative modern neuroscience approaches have aided in discerning brain circuitry underlying negative emotional behaviors including fear and anxiety responses, how these circuits are recruited in normal and pathological conditions remains poorly understood. Recently, genetic tools that selectively manipulate single neuronal populations have uncovered an understudied circuit, the medial habenula (mHb)-interpeduncular (IPN) axis, that modulates basal negative emotional responses. Interestingly, the mHb-IPN pathway also represents an essential circuit that signals heightened anxiety induced by nicotine withdrawal. Insights into how this circuit interconnects with regions more classically associated with anxiety, and how chronic nicotine exposure induces neuroadaptations resulting in an anxiogenic state, may thereby provide novel strategies and molecular targets for therapies that facilitate smoking cessation, as well as for anxiety relief.
Collapse
Affiliation(s)
- Susanna Molas
- Brudnick Neuropsychiatric Research Institute, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Steven R DeGroot
- Brudnick Neuropsychiatric Research Institute, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA; Graduate Program in Neuroscience, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rubing Zhao-Shea
- Brudnick Neuropsychiatric Research Institute, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Andrew R Tapper
- Brudnick Neuropsychiatric Research Institute, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| |
Collapse
|
86
|
Daly OE. Physical illness in those with mental illness: psychiatric services need to change focus. Br J Psychiatry 2017; 210:1-2. [PMID: 28052889 DOI: 10.1192/bjp.bp.116.182915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 08/09/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022]
Abstract
Those with mental illness die prematurely. One reason may be that psychiatrists are overly concerned with risk, focusing too much on this aspect of practice and neglecting the physical health needs of our patients. We need to reconsider how we approach our patients and their needs.
Collapse
Affiliation(s)
- Oscar Eunan Daly
- Oscar Eunan Daly, MB, FRCPsych, Seraphic Clinic, 7 John Mitchel Place, Newry, Co. Down, BT34 2BP, Northern Ireland, UK.
| |
Collapse
|
87
|
Dos Santos APC, Lazzari TK, Silva DR. Health-Related Quality of Life, Depression and Anxiety in Hospitalized Patients with Tuberculosis. Tuberc Respir Dis (Seoul) 2016; 80:69-76. [PMID: 28119749 PMCID: PMC5256348 DOI: 10.4046/trd.2017.80.1.69] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/21/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022] Open
Abstract
Background Much of the attention of tuberculosis (TB) programs is focused on outcomes of microbiological cure and mortality, and health related quality of life (HRQL) is undervalued. Also, TB patients have a significantly higher risk of developing depression and anxiety compared with those in the general population. We intend to evaluate the HRQL and the prevalence of symptoms of depression and anxiety in hospitalized patients with TB. Methods Cross-sectional study in a tertiary care hospital in Brazil. Adult patients with pulmonary TB that were hospitalized during the study period were identified and invited to participate. HRQL was measured using the Medical Outcomes Study Short Form-36 (SF-36) version 2. Hospital Anxiety and Depression Scale (HADS) was used to record symptoms of anxiety and depression. Results Eighty-six patients were included in the analysis. The mean age of all patients was 44.6±15.4 years, 69.8% were male, and 53.5% were white. Thirty-two patients (37.2%) were human immunodeficiency virus positive. Twenty-seven patients (31.4%) met study criteria for depression (HADS depression score ≥11) and 33 (38.4%) had anxiety (HADS anxiety score ≥11). Scores on all domains of SF-36 were significantly lower than the Brazilian norm scores (p<0.001). Conclusion The present study shows that TB patients may have a poor HRQL. Additionally, we found a possible high prevalence of depression and anxiety in this population. Health care workers should be aware of these psychological disorders to enable a better management of these patients. The treatment of these comorbidities may be associated with better TB outcomes.
Collapse
Affiliation(s)
- Ana Paula Ceré Dos Santos
- Graduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tássia Kirchmann Lazzari
- Graduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Denise Rossato Silva
- Graduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Pulmonology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
88
|
Spears CA, Jones DM, Weaver SR, Pechacek TF, Eriksen MP. Use of Electronic Nicotine Delivery Systems among Adults with Mental Health Conditions, 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:E10. [PMID: 28025560 PMCID: PMC5295261 DOI: 10.3390/ijerph14010010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 01/02/2023]
Abstract
Adults with mental health conditions (MHC) are especially likely to smoke and experience tobacco-related health disparities. Individuals with MHC may also use electronic nicotine delivery devices (ENDS) at disproportionately high rates. However, there is a relative dearth of knowledge regarding ENDS use among individuals with MHC. In a large representative sample of U.S. adults (n = 6051), associations between self-reported MHC diagnoses and ENDS use and susceptibility were examined, stratified by smoking status. Participants with MHC were approximately 1.5 times more likely to have used ENDS in their lifetime and almost twice as likely to currently use ENDS as those without MHC. MHC status was most strongly linked to higher ENDS use among former smokers, and former smokers with MHC were more likely to report using ENDS during past smoking quit attempts than those without MHC. Among participants who had not tried ENDS, former smokers with MHC were especially susceptible to future ENDS use. The potential advantage of ENDS for cessation purposes should be balanced with the risk of attracting former smokers with MHC to ENDS.
Collapse
Affiliation(s)
- Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Dina M Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Scott R Weaver
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Terry F Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| |
Collapse
|
89
|
Dervaux A, Laqueille X. Tabagisme et comorbidités psychiatriques. Presse Med 2016; 45:1133-1140. [DOI: 10.1016/j.lpm.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/08/2016] [Indexed: 01/17/2023] Open
|
90
|
Meurk C, Ford P, Sharma R, Fitzgerald L, Gartner C. Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111166. [PMID: 27886046 PMCID: PMC5129376 DOI: 10.3390/ijerph13111166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
Aims and Background: People living with mental disorders experience a disproportionately higher burden of tobacco-related disease than the general population. Long-term substitution with less harmful nicotine products could reduce the tobacco-related harm among this population. This study investigated the views and preferences of people with mental health disorders about different nicotine products and their use as long-term substitutes for cigarettes. Methods: Semi-structured focus group discussion followed by a brief questionnaire. The discussion transcripts were analysed for content and themes and quantitative data summarised with descriptive statistics. Results: Twenty-nine participants took part in four focus groups. Vaping devices were the most acceptable nicotine products discussed; however preferences for nicotine products were individual and varied along aesthetic, pragmatic, sensory and symbolic dimensions. The concept of tobacco harm reduction was unfamiliar to participants, however they generally agreed with the logic of replacing cigarettes with less harmful nicotine products. Barriers to activating tobacco harm reduction included the symbolism of smoking and quitting; the importance placed on health; the consumer appeal of alternatives; and cost implications. Discussion and Conclusions: Engaging this population in tobacco harm reduction options will require communication that challenges black and white thinking (a conceptual framework in which smoking cigarettes or quitting all nicotine are the only legitimate options) as in practice this serves to support the continuance of smoking. Consumers should be encouraged to trial a range of nicotine products to find the most acceptable alternative to smoking that reduces health harms. Providing incentives to switch to nicotine products could help overcome barriers to using less harmful nicotine products among mental health consumers.
Collapse
Affiliation(s)
- Carla Meurk
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD 4018, Australia.
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia.
| | - Ratika Sharma
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Lisa Fitzgerald
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Coral Gartner
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4006, Australia.
| |
Collapse
|
91
|
Tidey JW. A behavioral economic perspective on smoking persistence in serious mental illness. Prev Med 2016; 92:31-35. [PMID: 27196141 PMCID: PMC5085837 DOI: 10.1016/j.ypmed.2016.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/05/2016] [Accepted: 05/15/2016] [Indexed: 01/17/2023]
Abstract
Serious mental illness (SMI) is associated with disproportionately high rates of cigarette smoking. The identification of factors that contribute to persistent smoking in people with SMI may lead to the development and adoption of tobacco control policies and treatment approaches that help these smokers quit. This commentary examines factors underlying smoking persistence in people with SMI from the perspective of behavioral economics, a discipline that applies economic principles to understanding drug abuse and dependence. Studies, conducted in the Northeastern US within the past 30years, that compare the reinforcing effects of nicotine and the costs of smoking in smokers with and without schizophrenia and depression are discussed, and interventions that may reduce the reinforcing efficacy of nicotine and increase the costs of smoking in people with SMI are described.
Collapse
Affiliation(s)
- Jennifer W Tidey
- Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University, Providence, RI 02912, United States.
| |
Collapse
|
92
|
Reid RD, Pritchard G, Walker K, Aitken D, Mullen KA, Pipe AL. Managing smoking cessation. CMAJ 2016; 188:E484-E492. [PMID: 27698200 DOI: 10.1503/cmaj.151510] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont.
| | - Gillian Pritchard
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Kathryn Walker
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Debbie Aitken
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| |
Collapse
|
93
|
Jeon DW, Shim JC, Kong BG, Moon JJ, Seo YS, Kim SJ, Oh MK, Jung DU. Adjunctive varenicline treatment for smoking reduction in patients with schizophrenia: A randomized double-blind placebo-controlled trial. Schizophr Res 2016; 176:206-211. [PMID: 27543252 DOI: 10.1016/j.schres.2016.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Smoking is more common among patients with schizophrenia than it is in the general population. Varenicline, a partial and full agonist at the α4β2 and α7 nicotine acetylcholine receptors, respectively, has been shown to be an effective anti-smoking treatment. This study examined the effects of varenicline treatment on smoking reduction in patients with schizophrenia. METHODS Sixty smokers with schizophrenia were recruited and randomized to receive either varenicline or placebo. Smoking behavior was assessed with the Minnesota Nicotine Withdrawal Scale (mNWS), Brief Questionnaire of Smoking Urge (QSU-brief), and Modified Cigarette Evaluation Questionnaire (mCEQ). Exhaled carbon monoxide was also measured to assess smoking dependency and status. Data were analyzed with the two-tailed Student's t-test, χ(2) test, and repeated measures ANOVA. RESULTS During the 8-week study, there was a significant time×group interaction, which showed that smoking decreased over time in the varenicline group. Expired CO levels also decreased in the varenicline group, showing a significant time effect, group effect, and time×group interaction. Total mCEQ scores decreased in the varenicline group, demonstrating a significant time×group interaction. Among the five domains of the mCEQ, the smoking satisfaction, psychological reward, and enjoyment of respiratory tract sensation domains showed significant time×group interactions in the varenicline group. The QSU-brief and mNWS demonstrated a significant time effect, but not significant time×group interactions. Adjunctive varenicline treatment with antipsychotics was generally well-tolerated and safe. CONCLUSIONS Varenicline showed significant efficacy in reducing smoking in people with schizophrenia.
Collapse
Affiliation(s)
- Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Joo-Cheol Shim
- Shim Joo Cheol Psychiatry Clinic, Busan, Republic of Korea.
| | - Bo-Geum Kong
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Young-Soo Seo
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea.
| | - Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Min-Kyung Oh
- Department of Clinical Pharmacology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| |
Collapse
|
94
|
The challenge of reducing smoking in people with serious mental illness. THE LANCET RESPIRATORY MEDICINE 2016; 4:835-844. [DOI: 10.1016/s2213-2600(16)30228-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 12/28/2022]
|
95
|
Donny EC, Walker N, Hatsukami D, Bullen C. Reducing the nicotine content of combusted tobacco products sold in New Zealand. Tob Control 2016; 26:e37-e42. [DOI: 10.1136/tobaccocontrol-2016-053186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 11/04/2022]
|
96
|
Brody AL, Zorick T, Hubert R, Hellemann GS, Balali S, Kawasaki SS, Garcia LY, Enoki R, Abraham P, Young P, McCreary C. Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial. Nicotine Tob Res 2016; 19:68-76. [PMID: 27613888 DOI: 10.1093/ntr/ntw190] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/18/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime. A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing standard treatment compared to smokers with no mental illness. We sought to determine if combination extended treatment (COMB-EXT) and home visits (HV) would lead to improved outcomes in smokers with schizophrenia. METHODS Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV, COMB-EXT without HV, or treatment as usual (TAU) (random assignment). COMB-EXT consisted of group cognitive-behavioral therapy (CBT), bupropion, nicotine patch, and nicotine lozenge, which were initiated within 2 weeks and continued for 26 weekly visits. HV consisted of biweekly visits to the home with assessment of secondhand smoke (SHS) exposure and brief behavioral therapy with participants and others in the home environment. TAU consisted of group CBT plus serial single or combination medication trials as per standard care. RESULTS Smokers with schizophrenia who received COMB-EXT (with or without HV) had greater reductions in cigarettes per day than those treated with TAU (both ps < .01). In addition, 7-day point prevalence abstinence rates for the three groups were 45%, 20%, and 8%, respectively, which was significantly higher for COMB-EXT plus HV than TAU (χ2(1) = 4.8, p = .03). Groups did not differ significantly in the number of adverse events, and HV were easily scheduled. CONCLUSION COMB-EXT improves outcomes for smokers with schizophrenia. HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population. IMPLICATIONS The clear benefit found here of rapidly initiated, combination, extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia. Furthermore, HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence, indicating that this intervention may be worthy of future research.
Collapse
Affiliation(s)
- Arthur L Brody
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA; .,Department of Psychiatry, University of California at San Diego, San Diego, CA
| | - Todd Zorick
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Robert Hubert
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Gerhard S Hellemann
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Shabnam Balali
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Sarah S Kawasaki
- Department of Primary Care, Health Care for the Homeless, Baltimore, MD
| | - Lizette Y Garcia
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Ryutaro Enoki
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Paul Abraham
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Paulina Young
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Charles McCreary
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| |
Collapse
|
97
|
Cooper SJ, Reynolds GP, Barnes T, England E, Haddad PM, Heald A, Holt R, Lingford-Hughes A, Osborn D, McGowan O, Patel MX, Paton C, Reid P, Shiers D, Smith J. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol 2016; 30:717-48. [PMID: 27147592 DOI: 10.1177/0269881116645254] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.
Collapse
Affiliation(s)
- Stephen J Cooper
- Professor of Psychiatry (Emeritus), Queen's University Belfast, UK Clinical Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Gavin P Reynolds
- Professor (Emeritus), Queen's University Belfast, UK Honorary Professor of Neuroscience, Sheffield Hallam University, Sheffield, UK
| | | | - Tre Barnes
- Professor of Psychiatry, The Centre for Mental Health, Imperial College London, London, UK
| | - E England
- General Practitioner, Laurie Pike Health Centre, Birmingham, UK
| | - P M Haddad
- Honorary Clinical Professor of Psychiatry, University of Manchester, Manchester, UK Consultant Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - A Heald
- Consultant Physician, Leighton and Macclesfield Hospitals, Cheshire, UK Research Fellow, University of Manchester, Manchester, UK
| | - Rig Holt
- Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - A Lingford-Hughes
- Professor of Addiction Biology, Imperial College, London, UK Consultant Psychiatrist, CNWL NHS Foundation Trust, London, UK
| | - D Osborn
- Professor of Psychiatric Epidemiology and Honorary Consultant Psychiatrist, Division of Psychiatry UCL, London, UK
| | - O McGowan
- Trainee in Psychiatry, Hairmyres Hospital, Glasgow, UK
| | - M X Patel
- Honorary Senior Lecturer, King's College London, IOPPN, Department of Psychosis Studies PO68, London, UK
| | - C Paton
- Chief Pharmacist, Oxleas NHS Foundation Trust, Dartford, UK Joint-Head, Prescribing Observatory for Mental Health, CCQI, Royal College of Psychiatrists, London, UK
| | - P Reid
- Policy Manager, Rethink Mental Illness, London, UK
| | - D Shiers
- Primary Care Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - J Smith
- Professor of Early Intervention and Psychosis, University of Worcester, Worcester, UK
| |
Collapse
|
98
|
Price JH, Khubchandani J, Price JA, Whaley C, Bowman S. Reducing Premature Mortality in the Mentally Ill Through Health Promotion Programs. Health Promot Pract 2016; 17:617-22. [DOI: 10.1177/1524839916656146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nearly half of the U.S. adult population will have a major mental illness during their lifetimes. At any point in time, almost a fifth of all American adults have a serious mental illness (SMI). Too many in our society do not understand mental illnesses, placing the blame for the illness on those with the illness, resulting in isolation, marginalization, or incarceration of individuals with SMIs. They may experience stigma, inadequate and delayed health and mental health care, and major socioeconomic disadvantages. They may struggle with activities of daily living, lose many of their resources, and spiral down into poverty. The disadvantages and decreased ability to function experienced by individuals with SMIs lead to increased unhealthy behaviors, reduced participation in wellness-related activities, and premature morbidity and mortality. The general and physical health of individuals with SMIs poses greater challenges from both practice and research standpoints. However, health educators are poised uniquely to provide health promotion programs, conduct research, and advocate for the health and well-being of individuals with SMIs. In this review, we summarize the challenges and opportunities for health promotion in individuals with SMIs.
Collapse
Affiliation(s)
| | | | | | - Cathy Whaley
- Northeast Indiana Area Health Education Center, Muncie, IN, USA
| | | |
Collapse
|
99
|
Tedeschi GJ, Cummins SE, Anderson CM, Anthenelli RM, Zhuang YL, Zhu SH. Smokers with Self-Reported Mental Health Conditions: A Case for Screening in the Context of Tobacco Cessation Services. PLoS One 2016; 11:e0159127. [PMID: 27391334 PMCID: PMC4938618 DOI: 10.1371/journal.pone.0159127] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/28/2016] [Indexed: 01/30/2023] Open
Abstract
Background People with mental health conditions (MHC) smoke at high rates and many die prematurely from smoking-related illnesses. Smoking cessation programs, however, generally do not screen for MHC. This study examined the utility of MHC screening in a large tobacco quitline to determine whether self-reported MHC predicts service utilization and quitting behaviors. Methods & Findings A brief set of question on MHC was embedded in the routine intake of a state quitline, and 125,261 smokers calling from June 2012 to September 2015 were asked the questions. Quit attempt rate and 6-month success rate were analyzed for a random subset of participants. Overall, 52.2% of smokers reported at least one MHC. Demographic patterns like gender or ethnic difference in self-reported MHC were similar to that in the general population. Depression disorder was reported most often (38.6%), followed by anxiety disorder (33.8%), bipolar disorder (17.0%), drug/alcohol abuse (11.9%), and schizophrenia (7.9%). Among those reporting any MHC, about two-thirds reported more than 1 MHC. Smokers with MHC received more counseling than smokers with no MHC. Quit attempt rates were high for all three groups (>70%). The probability of relapse was greater for those with more than one MHC than for those with one MHC (p<0.005), which in turn was greater than those with no MHC (p < .01). The six-month prolonged abstinence rates for the three conditions were, 21.8%, 28.6%, and 33.7%, respectively. The main limitation of this study is the use of a non-validated self-report question to assess MHC, even though it appears to be useful for predicting quitting behavior. Conclusions Smokers with MHC actively seek treatment to quit. Smoking cessation services can use a brief set of questions to screen for MHC to help identify smokers in need of more intensive treatment to quit smoking.
Collapse
Affiliation(s)
- Gary J. Tedeschi
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Sharon E. Cummins
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Christopher M. Anderson
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Robert M. Anthenelli
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California San Diego, La Jolla, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| |
Collapse
|
100
|
Li DJ, Tseng PT, Chen YW, Wu CK, Lin PY. Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants: A Meta-Analysis Following the PRISMA Guidelines. Medicine (Baltimore) 2016; 95:e3165. [PMID: 27043678 PMCID: PMC4998539 DOI: 10.1097/md.0000000000003165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought. The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis. Electronic search through PubMed and ClinicalTrials.gov was performed. The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials. All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis. Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants. We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small. Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other antidepressants as previously thought, which should serve to remind clinicians of the risk of phase shifting when prescribing bupropion to BD patients regardless of the suggestions of current clinical practice guidelines.
Collapse
Affiliation(s)
- Dian-Jeng Li
- From the Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (D-JL), Kaohsiung; Department of Psychiatry (P-TT, C-KW), Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home; Department of Neurology (Y-WC), E-Da Hospital; Department of Psychiatry (P-YL), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; and Institute for Translational Research in Biomedical Sciences (P-YL), Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|