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Hersi M, Beck A, Hamel C, Esmaeilisaraji L, Pussegoda K, Austin B, Ahmadzai N, Pratt M, Thuku M, Yazdi F, Bennett A, Shaver N, Vyas N, Skidmore B, Hutton B, Manuel D, Morrow M, Pakhale S, Presseau J, Shea BJ, Little J, Moher D, Stevens A. Effectiveness of smoking cessation interventions among adults: an overview of systematic reviews. Syst Rev 2024; 13:179. [PMID: 38997788 PMCID: PMC11242003 DOI: 10.1186/s13643-024-02570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older. METHODS We searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another. RESULTS A total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John's wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John's wort, SAMe). CONCLUSION Results suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099691.
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Affiliation(s)
- Mona Hersi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Andrew Beck
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Leila Esmaeilisaraji
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Kusala Pussegoda
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Bradley Austin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nadera Ahmadzai
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Misty Pratt
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Micere Thuku
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Alexandria Bennett
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Nicole Shaver
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Niyati Vyas
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Otolaryngology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Matt Morrow
- Patient Representative, British Columbia, Vancouver, Canada
| | - Smita Pakhale
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley J Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
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Healthy choices, healthy changes: A randomized trial of incentives to promote healthy eating and exercise in people with schizophrenia and other serious mental illnesses. Schizophr Res 2023; 255:1-8. [PMID: 36933290 DOI: 10.1016/j.schres.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION People with schizophrenia and other serious mental illnesses (SMI) represent a concerning health disparity population, with 10-30 fewer years of life compared to the general population, mainly from high rates of cardiovascular disease (CVD). Preventing CVD is possible with exercise and diet interventions, but only 50 % of participants in clinical trials achieve reduction in CVD risk. This study assessed whether cash incentives improved weight loss, cardiovascular endurance, and/or mortality risk when added to one of four healthy lifestyle programs (gym membership, Weight Watchers membership, the InSHAPE program, InSHAPE + Weight Watchers). METHODS From 2012 to 2015, 1348 overweight or obese adults with SMI enrolled in a study using equipoise stratified randomization. Participants were randomly assigned to intervention, then to cash incentives, or not, for participation (gym and/or Weight Watchers), with baseline and quarterly assessments for 12 months. We examined effects of the interventions, key covariates, and incentives, using generalized linear models. RESULTS Main effects of randomization to receive cash incentives was not significant for any outcome; whereas total amount of incentives was significantly associated with all three primary outcomes (weight loss, cardiovascular endurance, mortality risk), mainly for participants in the InSHAPE+WW group who received additional cash incentives. CONCLUSIONS Incentives may be effective at preventing CVD and improving health outcomes for people with SMI, especially in the context of intensive support for healthy lifestyle behaviors. Policy changes are required to increase access to healthy lifestyle programming and more research is needed to establish the optimal amount of incentives for people with SMI. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02515981.
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Evins AE, Cather C, Maravic MC, Reyering S, Pachas GN, Thorndike AN, Levy DE, Fung V, Fischer MA, Schnitzer K, Pratt S, Fetters MD, Deeb B, Potter K, Schoenfeld DA. A Pragmatic Cluster-Randomized Trial of Provider Education and Community Health Worker Support for Tobacco Cessation. Psychiatr Serv 2022; 74:365-373. [PMID: 36349498 DOI: 10.1176/appi.ps.20220187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Individuals with serious mental illness have a high prevalence of tobacco use disorder and related early mortality but underutilize smoking cessation medication. The authors determined whether clinician-delivered education to primary care providers regarding safety, efficacy, and importance of cessation medication (provider education [PE]) alone or combined with community health worker (CHW) support would increase tobacco abstinence in this population, compared with usual care. METHODS All adult current tobacco smokers receiving psychiatric rehabilitation for serious mental illness through two community agencies in Greater Boston were eligible, regardless of readiness to quit smoking. Primary care clinics were cluster randomized to PE or usual care, with a nested, participant-level randomization to CHW or no CHW in PE-assigned clinics. The primary outcome was blindly assessed, biochemically verified tobacco abstinence at year 2. RESULTS Overall, 1,010 eligible participants were enrolled. PE was delivered to providers in 53 of 55 assigned clinics; 220 of 336 CHW-assigned participants consented to CHW support. Year 2 abstinence rates were significantly higher among participants assigned to PE+CHW versus usual care (12% vs. 5%; adjusted odds ratio [AOR]=2.40, 95% confidence interval [CI]=1.20-4.79) or PE alone (12% vs. 7%; AOR=1.84, 95% CI=1.04-3.24). No effect of PE alone on abstinence was detected. Compared with participants assigned to usual care, those assigned to PE+CHW had greater odds of varenicline use (OR=2.77, 95% CI=1.61-4.75), which was associated with higher year 2 abstinence (OR=1.97, 95% CI=1.16-3.33). CONCLUSIONS Combined PE and CHW tobacco cessation support increased tobacco abstinence rates among adults with serious mental illness.
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Affiliation(s)
- A Eden Evins
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Corinne Cather
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Melissa Culhane Maravic
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sally Reyering
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Gladys N Pachas
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Anne N Thorndike
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Douglas E Levy
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Vicki Fung
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael A Fischer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kristina Schnitzer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sarah Pratt
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael D Fetters
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Bianca Deeb
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kevin Potter
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - David A Schoenfeld
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
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Shang X, Guo K, E. F, Deng X, Wang Y, Wang Z, Wu Y, Xu M, Yang C, Li X, Yang K. Pharmacological interventions on smoking cessation: A systematic review and network meta-analysis. Front Pharmacol 2022; 13:1012433. [PMID: 36353488 PMCID: PMC9638092 DOI: 10.3389/fphar.2022.1012433] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
Objective: A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of pharmacological interventions on smoking cessation. Methods: English databases were searched to obtain randomized controlled trials reporting the effect of pharmacological interventions on smoking cessation. The risk of bias for the included trials was assessed using Cochrane Handbook tool. Stata 15.1 software was used to perform network meta-analysis, and GRADE approach was used to assess the evidence credibility on the effects of different interventions on smoking cessation. Results: A total of 159 studies involving 60,285 smokers were included in the network meta-analysis. The analysis involved 15 interventions and which yielded 105 pairs of comparisons. Network meta-analysis showed that varenicline was more helpful for smoking cessation than other monotherapies, such as nicotine replacement therapy [Odds Ratio (OR) = 1.42, 95% confidence interval (CI) (1.16, 1.73)] and bupropion [OR = 1.52, 95% CI (1.22, 1.89)]. Furthermore, combined interventions were superior to monotherapy in achieving smoking cessation, such as varenicline plus bupropion over bupropion [OR = 2.00, 95% CI (1.11, 3.61)], varenicline plus nicotine replacement therapy over nicotine replacement therapy [OR = 1.84, 95% CI (1.07, 3.18)], and nicotine replacement therapy plus mecamylamine over naltrexone [OR = 6.29, 95% CI (1.59, 24.90)]. Finally, the surface under the cumulative ranking curve value indicated that nicotine replacement therapy plus mecamylamine had the greatest probability of becoming the best intervention. Conclusion: Most pharmacological interventions demonstrated a benefit in smoking cessation compared with placebo, whether monotherapy or combination therapy. Moreover, confirmed evidence suggested that some combination treatments, such as varenicline plus bupropion and nicotine replacement therapy plus mecamylamine have a higher probability of being the best smoking cessation in
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Affiliation(s)
- Xue Shang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kangle Guo
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - Fenfen E.
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xinxin Deng
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yongsheng Wang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Ziyi Wang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yanan Wu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Meng Xu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Chaoqun Yang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Xiuxia Li, ; Kehu Yang,
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Xiuxia Li, ; Kehu Yang,
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Effectiveness of multimodal interventions focused on smoking cessation in patients with schizophrenia: A systematic review. Schizophr Res 2021; 231:145-153. [PMID: 33857662 DOI: 10.1016/j.schres.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking is a significant risk factor for mortality and morbidity among patients with schizophrenia. OBJECTIVE To clarify the effectiveness of multimodal smoking cessation interventions in adult smokers diagnosed with schizophrenia. METHODS A systematic review was conducted according to PRISMA guidelines. Relevant electronic databases were searched for clinical trials that combined pharmacological and non-pharmacological smoking cessation interventions for patients with schizophrenia, published up to October 2020. Primary outcomes were smoking abstinence and smoking reduction. Secondary outcomes consisted in psychiatric symptoms. RESULTS A final sample of nine articles was obtained from a total of 208 studies. All studies reported higher biochemically validated smoking reduction rates after treatment. However, the majority of the studies reported low smoking abstinence rates, which progressively decreased over time. Multimodal interventions did not worsen psychiatric symptoms. CONCLUSION Evidence suggests that multimodal smoking cessation interventions for individuals diagnosed with schizophrenia should be recommended by clinicians, as they showed to be effective in reducing smoking without worsening psychiatric symptoms. Further studies are needed to understand how interventions can become more effective in helping patients achieve long-term smoking abstinence.
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Peckham E, Arundel C, Bailey D, Crosland S, Fairhurst C, Heron P, Hewitt C, Li J, Parrott S, Bradshaw T, Horspool M, Hughes E, Hughes T, Ker S, Leahy M, McCloud T, Osborn D, Reilly J, Steare T, Ballantyne E, Bidwell P, Bonner S, Brennan D, Callen T, Carey A, Colbeck C, Coton D, Donaldson E, Evans K, Herlihy H, Khan W, Nyathi L, Nyamadzawo E, Oldknow H, Phiri P, Rathod S, Rea J, Romain-Hooper CB, Smith K, Stribling A, Vickers C, Gilbody S. A bespoke smoking cessation service compared with treatment as usual for people with severe mental ill health: the SCIMITAR+ RCT. Health Technol Assess 2020; 23:1-116. [PMID: 31549622 DOI: 10.3310/hta23500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a high prevalence of smoking among people with severe mental ill health (SMI). Helping people with SMI to quit smoking could improve their health and longevity, and reduce health inequalities. However, those with SMI are less likely to access and engage with routine smoking cessation services than the general population. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual stop smoking services for people with SMI. DESIGN A pragmatic, two-arm, individually randomised controlled trial. SETTING Primary care and secondary care mental health services in England. PARTICIPANTS Smokers aged ≥ 18 years with SMI who would like to cut down on or quit smoking. INTERVENTIONS A BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual care. MAIN OUTCOME MEASURES The primary outcome was self-reported, CO-verified smoking cessation at 12 months. Smoking-related secondary outcomes were self-reported smoking cessation, the number of cigarettes smoked per day, the Fagerström Test for Nicotine Dependence and the Motivation to Quit questionnaire. Other secondary outcomes were Patient Health Questionnaire-9 items, Generalised Anxiety Disorder Assessment-7 items and 12-Item Short-Form Health Survey, to assess mental health and body mass index measured at 6 and 12 months post randomisation. RESULTS The trial randomised 526 people (265 to the intervention group, 261 to the usual-care group) aged 19 to 72 years (mean 46 years). About 60% of participants were male. Participants smoked between 3 and 100 cigarettes per day (mean 25 cigarettes per day) at baseline. The intervention group had a higher rate of exhaled CO-verified smoking cessation at 6 and 12 months than the usual-care group [adjusted odds ratio (OR) 12 months: 1.6, 95% confidence interval (CI) 0.9 to 2.8; adjusted OR 6 months: 2.4, 95% CI 1.2 to 4.7]. This was not statistically significant at 12 months (p = 0.12) but was statistically significant at 6 months (p = 0.01). In total, 111 serious adverse events were reported (69 in the BSC group and 42 in the usual-care group); the majority were unplanned hospitalisations due to a deterioration in mental health (n = 98). The intervention is likely (57%) to be less costly but more effective than usual care; however, this result was not necessarily associated with participants' smoking status. LIMITATIONS Follow-up was not blind to treatment allocation. However, the primary outcome included a biochemically verified end point, less susceptible to observer biases. Some participants experienced difficulties in accessing nicotine replacement therapy because of changes in service provision. Efforts were made to help participants access nicotine replacement therapy, but this may have affected participants' quit attempt. CONCLUSIONS People with SMI who received the intervention were more likely to have stopped smoking at 6 months. Although more people who received the intervention had stopped smoking at 12 months, this was not statistically significant. FUTURE WORK Further research is needed to establish how quitting can be sustained among people with SMI. TRIAL REGISTRATION Current Controlled Trials ISRCTN72955454. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | - Paul Heron
- Department of Health Sciences, University of York, York, UK
| | | | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Tim Bradshaw
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Michelle Horspool
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | | | - Tom Hughes
- Research and Development, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Suzy Ker
- North East York Community Mental Health Team, Tees, Esk and Wear Valleys NHS Foundation Trust, York, UK
| | - Moira Leahy
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Tayla McCloud
- Division of Psychiatry, University College London, London, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK
| | - Joseph Reilly
- North East York Community Mental Health Team, Tees, Esk and Wear Valleys NHS Foundation Trust, York, UK
| | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | - Emma Ballantyne
- Research and Development, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Polly Bidwell
- Research and Development, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Susan Bonner
- Research and Development, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton on Tees, UK
| | - Diane Brennan
- Research and Development, Lincolnshire Partnership NHS Foundation Trust, Sleaford, UK
| | - Tracy Callen
- Research and Development, Solent NHS Trust, Portsmouth, UK
| | - Alex Carey
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Charlotte Colbeck
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Debbie Coton
- Research and Development, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Emma Donaldson
- Research and Development, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Kimberley Evans
- Research and Development, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Hannah Herlihy
- Research and Development, Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
| | - Wajid Khan
- Research and Development, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Lizwi Nyathi
- Research and Development, Lincolnshire Partnership NHS Foundation Trust, Sleaford, UK
| | - Elizabeth Nyamadzawo
- Research and Development, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Helen Oldknow
- Research and Development, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Peter Phiri
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Jamie Rea
- Research and Development, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Kaye Smith
- Research and Development, Solent NHS Trust, Portsmouth, UK
| | - Alison Stribling
- Research and Development, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carinna Vickers
- Research and Development, Somerset Partnership NHS Foundation Trust, South Petherton, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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7
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Ho RKS, Lee GMT, Fok PWY, Chan HCH, Ching JKW. Characteristics of Chinese smokers with psychotic disorders
and their predictors on smoking cessation in Hong Kong. Tob Prev Cessat 2020; 6:7. [PMID: 32548344 PMCID: PMC7291916 DOI: 10.18332/tpc/115030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Raymond K. S. Ho
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Gina M. T. Lee
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Patrick W. Y. Fok
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Helen C. H. Chan
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
| | - Joe K. W. Ching
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Tsuen Wan, Hong Kong
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8
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Bonfioli E, Mazzi MA, Berti L, Burti L. Physical health promotion in patients with functional psychoses receiving community psychiatric services: Results of the PHYSICO-DSM-VR study. Schizophr Res 2018; 193:406-411. [PMID: 28709772 DOI: 10.1016/j.schres.2017.06.017] [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] [Received: 11/09/2016] [Revised: 05/30/2017] [Accepted: 06/10/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Psychotic patients have poorer health behaviours, including poor diets and sedentary lifestyles increasing their risk for obesity, diabetes, hypertension, and dyslipidaemia, and tend to have a shorter life expectancy as compared to nonpsychiatric populations. Lifestyle intervention programmes that target modifiable risk factors in such patients have produced uneven results. The objective was to evaluate the efficacy of a package of health promotion strategies to improve diet and physical exercise in psychotic patients. Our hypothesis was that a pre- to post-treatment improvement in physical activity and dietary habits would occur in the group receiving intervention. METHOD This randomised controlled trial was carried out in four psychiatric services. The intervention included psychoeducation sessions on diet and physical activity and regular participation in walking groups (experimental group). The control group received routine treatment. The primary outcome was an improvement of at least one World Health Organization recommendation on diet and exercise. RESULTS Of a total of 326 subjects recruited, 169 were randomly assigned to the experimental group and 157 to the control group. An improvement in one or more World Health Organization criteria over baseline was observed in 25.4% of experimental group subjects and in 12.2% of control group subjects (odds ratio 2.46, 95% confidence interval 1.22-4.97; p=0.01). CONCLUSIONS A statistically significant proportion of the sample achieved post-treatment improvement in lifestyle habits, especially as regarded increased physical activity. A post-intervention reduction in lifestyle variability was also noted. Interventions directly addressing dietary habits may be desirable in psychotic patients.
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Affiliation(s)
- Elena Bonfioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Loretta Berti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Lorenzo Burti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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9
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Mitchell AJ, Delaffon V, Lord O. Let's get physical: improving the medical care of people with severe mental illness. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.111.009068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThere is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.
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10
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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11
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Das S, Prochaska JJ. Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders. Expert Rev Respir Med 2017; 11:841-850. [PMID: 28756728 PMCID: PMC5790168 DOI: 10.1080/17476348.2017.1361823] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.
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Affiliation(s)
- Smita Das
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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12
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Wu BJ, Lan TH. Predictors of smoking reduction outcomes in a sample of 287 patients with schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2017; 267:63-72. [PMID: 26310877 DOI: 10.1007/s00406-015-0636-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/11/2015] [Indexed: 12/28/2022]
Abstract
Many studies have investigated whether a type of antipsychotics or type of adjuvant is associated with smoking reduction in patients with schizophrenia. However, there has been no study exploring a comprehensive range of factors related to smoking reduction in schizophrenia patients. We analyzed a dataset of 287 smoking patients with schizophrenia who participated in an 8-week open-label study with high- (n = 90) or low-dose nicotine dermal patches (n = 132) or bupropion (n = 65). A logistic regression model and a linear mixed model were used to explore factors associated with the outcomes of smoking cessation and reduction, i.e., the number of cigarettes smoked and the level of nicotine dependence. The total cessation rate was 6.3 % (18/287). There were no significant predictors of cessation. The time effect of reduction was significant during the program (p = 0.001). Type of antipsychotics (p = 0.018), readiness to quit (p = 0.014), baseline number of cigarettes smoked per day (p = 0.001), and nicotine dependence level (p = 0.001) were significantly associated with smoking reduction. Patients on first-generation antipsychotics (n = 129) or clozapine (n = 70) reduced their smoking more than those on non-clozapine second-generation antipsychotics (n = 74). Patients in the preparation stage (n = 97) or in the contemplation (n = 70) reduced their smoking more than those in the precontemplation stage (n = 120). The mechanisms of tobacco addiction need to be better understood for further development of effective cessation programs in patients with schizophrenia.
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Affiliation(s)
- Bo-Jian Wu
- Department of Psychiatry, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsuo-Hung Lan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Center for Neuropsychiatric Research, NHRI, Miaoli, Taiwan. .,Department of Psychiatry, Taichung Veterans General Hospital, 160, Sec.3, Chung-Kang Rd, Taichung, 40705, Taiwan.
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13
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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.
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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.
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Osborn D, Burton A, Walters K, Nazareth I, Heinkel S, Atkins L, Blackburn R, Holt R, Hunter R, King M, Marston L, Michie S, Morris R, Morris S, Omar R, Peveler R, Pinfold V, Zomer E, Barnes T, Craig T, Gilbert H, Grey B, Johnston C, Leibowitz J, Petersen I, Stevenson F, Hardy S, Robinson V. Evaluating the clinical and cost effectiveness of a behaviour change intervention for lowering cardiovascular disease risk for people with severe mental illnesses in primary care (PRIMROSE study): study protocol for a cluster randomised controlled trial. Trials 2016; 17:80. [PMID: 26868949 PMCID: PMC4751703 DOI: 10.1186/s13063-016-1176-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/15/2016] [Indexed: 12/24/2022] Open
Abstract
Background People with severe mental illnesses die up to 20 years earlier than the general population, with cardiovascular disease being the leading cause of death. National guidelines recommend that the physical care of people with severe mental illnesses should be the responsibility of primary care; however, little is known about effective interventions to lower cardiovascular disease risk in this population and setting. Following extensive peer review, funding was secured from the United Kingdom National Institute for Health Research (NIHR) to deliver the proposed study. The aim of the trial is to test the effectiveness of a behavioural intervention to lower cardiovascular disease risk in people with severe mental illnesses in United Kingdom General Practices. Methods/Design The study is a cluster randomised controlled trial in 70 GP practices for people with severe mental illnesses, aged 30 to 75 years old, with elevated cardiovascular disease risk factors. The trial will compare the effectiveness of a behavioural intervention designed to lower cardiovascular disease risk and delivered by a practice nurse or healthcare assistant, with standard care offered in General Practice. A total of 350 people will be recruited and followed up at 6 and 12 months. The primary outcome is total cholesterol level at the 12-month follow-up and secondary outcomes include blood pressure, body mass index, waist circumference, smoking status, quality of life, adherence to treatments and services and behavioural measures for diet, physical activity and alcohol use. An economic evaluation will be carried out to determine the cost effectiveness of the intervention compared with standard care. Discussion The results of this pragmatic trial will provide evidence on the clinical and cost effectiveness of the intervention on lowering total cholesterol and addressing multiple cardiovascular disease risk factors in people with severe mental illnesses in GP Practices. Trial registration Current Controlled Trials ISRCTN13762819. Date of Registration: 25 February 2013. Date and Version Number: 27 August 2014 Version 5.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. .,Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Alexandra Burton
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Kate Walters
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Irwin Nazareth
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Samira Heinkel
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Lou Atkins
- Division of Psychology and Language Sciences, Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Ruth Blackburn
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, University Rd, Southampton, SO17 1BJ, UK.
| | - Racheal Hunter
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Michael King
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Louise Marston
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Susan Michie
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, University Rd, Southampton, SO17 1BJ, UK.
| | - Richard Morris
- UCL Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Steve Morris
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Rumana Omar
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Robert Peveler
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, University Rd, Southampton, SO17 1BJ, UK.
| | - Vanessa Pinfold
- The McPin Foundation, 32-36 Loman Street, London, SE1 0EH, UK.
| | - Ella Zomer
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Thomas Barnes
- Department of Medicine, Faculty of Medicine, Imperial College London, Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Tom Craig
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Hazel Gilbert
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Ben Grey
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Claire Johnston
- Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Judy Leibowitz
- Camden and Islington NHS Foundation Trust, 4th Floor, East Wing, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Irene Petersen
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Fiona Stevenson
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Sheila Hardy
- University of Northampton, Berrywood Hospital, Berrywood Drive, Upton, Northampton, NN5 6UD, UK.
| | - Vanessa Robinson
- Rethink Mental Illness, 89 Albert Embankment, London, SE1 7TP, UK.
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review. Schizophr Bull 2016; 42. [PMID: 26221050 PMCID: PMC4681556 DOI: 10.1093/schbul/sbv101] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
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Affiliation(s)
- Emma E. McGinty
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;,*To whom correspondence should be addressed; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, US; tel: 410-614-4018, e-mail:
| | - Julia Baller
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Gail L. Daumit
- Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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Peckham E, Man MS, Mitchell N, Li J, Becque T, Knowles S, Bradshaw T, Planner C, Parrott S, Michie S, Shepherd C, Gilbody S. Smoking Cessation Intervention for severe Mental Ill Health Trial (SCIMITAR): a pilot randomised control trial of the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation service. Health Technol Assess 2015; 19:1-148, v-vi. [PMID: 25827850 DOI: 10.3310/hta19250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a high prevalence of smoking among people who experience severe mental ill health (SMI). Helping people with disorders such as bipolar illness and schizophrenia to quit smoking would help improve their health, increase longevity and also reduce health inequalities. Around half of people with SMI who smoke express an interest in cutting down or quitting smoking. There is limited evidence that smoking cessation can be achieved for people with SMI. Those with SMI rarely access routine NHS smoking cessation services. This suggests the need to develop and evaluate a behavioural support and medication package tailored to the needs of people with SMI. OBJECTIVE The objective in this project was to conduct a pilot trial to establish acceptability of the intervention and to ensure the feasibility of recruitment, randomisation and follow-up. We also sought preliminary estimates of effect size in order to design a fully powered trial of clinical effectiveness and cost-effectiveness. The pilot should inform a fully powered trial to compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual general practitioner (GP) care for people with SMI. DESIGN A pilot pragmatic two-arm individually randomised controlled trial (RCT). Simple randomisation was used following a computer-generated random number sequence. Participants and practitioners were not blinded to allocation. SETTING Primary care and secondary care mental health services in England. PARTICIPANTS Smokers aged > 18 years with a severe mental illness who would like to cut down or quit smoking. INTERVENTIONS A BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual GP care. MAIN OUTCOME MEASURES The primary outcome was carbon monoxide-verified smoking cessation at 12 months. Smoking-related secondary outcomes were reduction of number of cigarettes smoked, Fagerstrom test of nicotine dependence and motivation to quit (MTQ). Other secondary outcomes were Patient Health Questionnaire-9 items and Short Form Questionnaire-12 items to assess whether there were improvements or deterioration in mental health and quality of life. We also measured body mass index to assess whether or not smoking cessation was associated with weight gain. These were measured at 1, 6 and 12 months post randomisation. RESULTS The trial recruited 97 people aged 19-73 years who smoked between 5 and 60 cigarettes per day (mean 25 cigarettes). Participants were recruited from four mental health trusts and 45 GP surgeries. Forty-six people were randomised to the BSC intervention and 51 people were randomised to usual GP care. The odds of quitting at 12 months was higher in the BSC intervention (36% vs. 23%) but did not reach statistical significance (odds ratio 2.9; 95% confidence interval 0.8% to 10.5%). At 3 and 6 months there was no evidence of difference in self-reported smoking cessation. There was a non-significant reduction in the number of cigarettes smoked and nicotine dependence. MTQ and number of quit attempts all increased in the BSC group compared with usual care. There was no difference in terms of quality of life at any time point, but there was evidence of an increase in depression scores at 12 months for the BSC group. There were no serious adverse events thought likely to be related to the trial interventions. The pilot economic analysis demonstrated that it was feasible to carry out a full economic analysis. CONCLUSIONS It was possible to recruit people with SMI from primary and secondary care to a trial of a smoking cessation intervention based around behavioural support and medication. The overall direction of effect was a positive trend in relation to biochemically verified smoking cessation and it was feasible to obtain follow-up in a substantial proportion of participants. A definitive trial of a bespoke cessation intervention has been prioritised by the National Institute for Health Research (NIHR) and the SCIMITAR pilot trial forms a template for a fully powered RCT to examine clinical effectiveness and cost-effectiveness. TRIAL REGISTRATION Current Controlled Trials ISRCTN79497236. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment, Vol. 19, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Mei-See Man
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Taeko Becque
- Department of Health Sciences, University of York, York, UK
| | - Sarah Knowles
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Tim Bradshaw
- The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Claire Planner
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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Paul C, Wolfenden L, Tzelepis F, Yoong S, Bowman J, Wye P, Sherwood E, Rose S, Wiggers J. Nicotine replacement therapy as a smoking cessation aid among disadvantaged smokers: What answers do we need? Drug Alcohol Rev 2015; 35:785-789. [PMID: 26661119 DOI: 10.1111/dar.12362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/03/2015] [Accepted: 10/06/2015] [Indexed: 11/30/2022]
Abstract
In Australia and New Zealand, population groups who experience social disadvantage smoke at much higher rates than the general population. As there are limited data specific to these groups regarding the success of nicotine replacement therapy for smoking cessation, this commentary will provide an overview of the relevant international literature supplemented with observational data relevant to the policy contexts in Australia and New Zealand. [Paul C, Wolfenden L, Tzelepis F, Yoong S, Bowman J, Wye P, Sherwood E, Rose S, Wiggers J. Nicotine replacement therapy as a smoking cessation aid among disadvantaged smokers: What answers do we need? Drug Alcohol Rev 2016;35:785-789].
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Affiliation(s)
- Christine Paul
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia
| | - Luke Wolfenden
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Newcastle, Australia
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Newcastle, Australia
| | - Serene Yoong
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Newcastle, Australia
| | - Jenny Bowman
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia
| | - Paula Wye
- Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Newcastle, Australia
| | - Emma Sherwood
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia
| | - Shiho Rose
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia
| | - John Wiggers
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, HMRI Building, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Newcastle, Australia
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Burton A, Osborn D, Atkins L, Michie S, Gray B, Stevenson F, Gilbert H, Walters K. Lowering Cardiovascular Disease Risk for People with Severe Mental Illnesses in Primary Care: A Focus Group Study. PLoS One 2015; 10:e0136603. [PMID: 26317516 PMCID: PMC4552729 DOI: 10.1371/journal.pone.0136603] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/06/2015] [Indexed: 11/26/2022] Open
Abstract
Background People with severe mental illnesses die early from cardiovascular disease. Evidence is lacking regarding effective primary care based interventions to tackle this problem. Aim To identify current procedures for, barriers to, and facilitators of the delivery of primary care based interventions for lowering cardiovascular risk for people with severe mental illnesses. Method 75 GPs, practice nurses, service users, community mental health staff and carers in UK GP practice or community mental health settings were interviewed in 14 focus groups which were audio-recorded, transcribed and analysed using Framework Analysis. Results Five barriers to delivering primary care based interventions for lowering cardiovascular risk in people with severe mental illnesses were identified by the groups: negative perceptions of people with severe mental illnesses amongst some health professionals, difficulties accessing GP and community-based services, difficulties in managing a healthy lifestyle, not attending appointments, and a lack of awareness of increased cardiovascular risk in people with severe mental illnesses by some health professionals. Identified facilitators included involving supportive others, improving patient engagement with services, continuity of care, providing positive feedback in consultations and goal setting. Conclusion We identified a range of factors which can be incorporated in to the design, delivery and evaluation of services to reduce cardiovascular risk for people with severe mental illnesses in primary care. The next step is determining the clinical and cost effectiveness of primary care based interventions for lowering cardiovascular risk in people with severe mental illnesses, and evaluating the most important components of such interventions.
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Affiliation(s)
- Alexandra Burton
- Epidemiology and Applied Clinical Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
- * E-mail: (AB); (DO)
| | - David Osborn
- Epidemiology and Applied Clinical Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
- * E-mail: (AB); (DO)
| | - Lou Atkins
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Susan Michie
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Ben Gray
- The McPin Foundation, London, United Kingdom
| | - Fiona Stevenson
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Hazel Gilbert
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Kate Walters
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, United Kingdom
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Gilbody S, Peckham E, Man MS, Mitchell N, Li J, Becque T, Hewitt C, Knowles S, Bradshaw T, Planner C, Parrott S, Michie S, Shepherd C. Bespoke smoking cessation for people with severe mental ill health (SCIMITAR): a pilot randomised controlled trial. Lancet Psychiatry 2015; 2:395-402. [PMID: 26360283 DOI: 10.1016/s2215-0366(15)00091-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/12/2015] [Accepted: 02/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with severe mental ill health are three times more likely to smoke but typically do not access conventional smoking cessation services, contributing to widening health inequalities and reduced life expectancy. We aimed to pilot an intervention targeted at smokers with severe mental ill health and to test methods of recruitment, randomisation, and follow up before implementing a full trial. METHODS The Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR) is a pilot randomised controlled trial of a smoking cessation strategy designed specifically for people with severe mental ill health, to be delivered by mental health nurses and consisting of behavioural support and drugs, compared with a conventional smoking cessation service (ie, usual care). Adults (aged 18 years or older) with bipolar disorder or schizophrenia, who were current smokers, were recruited from NHS primary care and mental health settings in the UK (York, Scarborough, Hull, and Manchester). Eligible participants were randomly allocated to either usual care (control group) or usual care plus the bespoke smoking cessation strategy (intervention group). Randomisation was done via a central telephone system, with computer-generated random numbers. We could not mask participants, family doctors, and researchers to the treatment allocation. Our primary outcome was smoking status at 12 months, verified by carbon monoxide measurements or self-report. Only participants who provided an exhaled CO measurement or self-reported their smoking status at 12 months were included in the primary analysis. The trial is registered at ISRCTN.com, number ISRCTN79497236. FINDINGS Of 97 people recruited to the pilot study, 51 were randomly allocated to the control group and 46 were assigned to the intervention group. Participants engaged well with the bespoke smoking cessation strategy, but no individuals assigned to usual care accessed NHS smoking cessation services. At 12 months, 35 (69%) controls and 33 (72%) people assigned to the intervention group provided a CO measurement or self-reported their smoking status. Smoking cessation was highest among individuals who received the bespoke intervention (12/33 [36%] vs 8/35 [23%]; adjusted odds ratio 2·9, 95% CI 0·8-10·5). INTERPRETATION We have shown the feasibility of recruiting and randomising people with severe mental ill health in a trial of this nature. The level of engagement with a bespoke smoking cessation strategy was higher than with a conventional approach. The effectiveness and safety of a smoking cessation programme designed particularly for people with severe mental ill health should be tested in a fully powered randomised controlled trial. FUNDING National Institute of Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences, University of York, York, UK.
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Mei-See Man
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Taeko Becque
- Department of Health Sciences, University of York, York, UK
| | | | - Sarah Knowles
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Claire Planner
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Guo SE, Wang AL, Shu BC. Self-efficacy in providing smoking-cessation services among psychiatric nurses in central and southern Taiwan: an exploratory study. Int J Ment Health Nurs 2015; 24:158-68. [PMID: 25582504 DOI: 10.1111/inm.12119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Smoking by psychiatric patients remains prevalent. The purpose of this cross-sectional study was to understand the influence of self-efficacy and its correlates among psychiatric nurses when providing smoking-cessation services (SCS). A convenience sample of 193 nurses from psychiatric institutions was obtained. Surveys were conducted using self-report measures regarding SCS provided by psychiatric nurses. The survey questions focused on self-efficacy, attitude, practical experience, and smoke-free policies, and their implementation in the workplace. The participants reported low self-efficacy for providing SCS in their self-assessment, as demonstrated by their scores of 55.3 ± 20.4, on a scale of 0 (low confidence) to 100 (high confidence). Using multiple linear regressions, statistically-significant, relevant factors included perceived provider-related barriers in providing SCS, environmental tobacco smoke exposure, the nurse's attitude towards a patient smoking, and the nurse's frequency and practical experience in providing SCS. The correlates of this self-efficacy can serve as a reference for in-service curriculum planning of SCS by psychiatric nurses. In addition, policies to limit exposure to second-hand tobacco smoke should be explored.
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Affiliation(s)
- Su-Er Guo
- Chronic Diseases and Health Promotion Research Center and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Chiayi, Taiwan
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21
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Steinberg ML, Williams JM, Stahl NF, Budsock PD, Cooperman NA. An Adaptation of Motivational Interviewing Increases Quit Attempts in Smokers With Serious Mental Illness. Nicotine Tob Res 2015; 18:243-50. [PMID: 25744954 DOI: 10.1093/ntr/ntv043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokers with serious mental illness (SMI) have a high smoking prevalence and a low quit rate. Motivational interviewing (MI) is an empirically supported approach for addressing substance use disorders and may motivate smokers with SMI to quit. METHODS We randomized smokers (N = 98) with SMI to receive a single 45-minute session of (1) MI with personalized feedback or (2) interactive education. We hypothesized that participants receiving the MI intervention would be more likely to follow-up on a referral for tobacco dependence treatment, to make a quit attempt, and to quit smoking than those receiving the interactive educational intervention. RESULTS Smokers receiving an MI intervention were significantly more likely to make a quit attempt by the 1-month follow-up (34.7% vs. 14.3%; OR = 4.39 [95% CI = 1.44 to 13.34], P = .009); however, these quit attempts did not translate into abstinence. In addition, 32.7% of those receiving MI followed-up on a referral for tobacco dependence treatment (vs. 20.4% receiving interactive education; OR = 2.02 [95% CI = 0.76 to 3.55], P = .157). MI Treatment Integrity Code ratings indicated that the interventions were easily distinguishable from each other and that MI was delivered with proficiency. Despite the intervention's brevity, participants reported high levels of therapeutic alliance with their therapist. CONCLUSIONS A brief adaptation of MI with personalized feedback appears to be a promising approach for increasing quit attempts in smokers with SMI, but future research is required to determine how to best help smokers with SMI to attain sustained abstinence.
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Affiliation(s)
- Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jill M Williams
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Naomi F Stahl
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Prochaska JJ, Hall SE, Delucchi K, Hall SM. Efficacy of initiating tobacco dependence treatment in inpatient psychiatry: a randomized controlled trial. Am J Public Health 2014; 104:1557-65. [PMID: 23948001 PMCID: PMC4103208 DOI: 10.2105/ajph.2013.301403] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the efficacy of a motivational tobacco cessation treatment combined with nicotine replacement relative to usual care initiated in inpatient psychiatry. METHODS We randomized participants (n = 224; 79% recruitment rate) recruited from a locked acute psychiatry unit with a 100% smoking ban to intervention or usual care. Prior to hospitalization, participants averaged 19 (SD = 12) cigarettes per day; only 16% intended to quit smoking in the next 30 days. Results. Verified smoking 7-day point prevalence abstinence was significantly higher for intervention than usual care at month 3 (13.9% vs 3.2%), 6 (14.4% vs 6.5%), 12 (19.4% vs 10.9%), and 18 (20.0% vs 7.7%; odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.22, 8.14; P = .018; retention > 80%). Psychiatric measures did not predict abstinence; measures of motivation and tobacco dependence did. The usual care group had a significantly greater likelihood than the intervention group of psychiatric rehospitalization (adjusted OR = 1.92; 95% CI = 1.06, 3.49). CONCLUSIONS The findings support initiation of motivationally tailored tobacco cessation treatment during acute psychiatric hospitalization. Psychiatric severity did not moderate treatment efficacy, and cessation treatment appeared to decrease rehospitalization risk, perhaps by providing broader therapeutic benefit.
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Affiliation(s)
- Judith J Prochaska
- At the time of the study, the authors were with the Department of Psychiatry, University of California, San Francisco
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Abstract
Tobacco smoking is a contributory factor in the death of 50% of individuals who are regular or heavy smokers (The Office of Tobacco Control Ireland defines a regular smoker as someone who smokes 11-20 per day and a heavy smoker as someone who smokes 21 or more cigarettes per day). The World Health Organisation (WHO) regards tobacco smoking as the leading preventable cause of death worldwide. In Ireland, approximately 750,000 people smoke tobacco regularly (23.5% of the population) with 7,000 Irish people dying annually from smoking-related causes. Although there are no exact figures for prevalence rates of smoking in individuals with mental illness in Ireland, international studies unequivocally state that the prevalence of smoking is significantly higher in those with mental illness, with greater nicotine intake and increased prevalence of nicotine dependence also reported. Furthermore people with mental illness experience greater withdrawal symptoms and have lower cessation rates when attempting to stop smoking compared to the general population.
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Rüther T, Bobes J, De Hert M, Svensson T, Mann K, Batra A, Gorwood P, Möller H. EPA Guidance on Tobacco Dependence and Strategies for Smoking Cessation in People with Mental Illness. Eur Psychiatry 2014; 29:65-82. [DOI: 10.1016/j.eurpsy.2013.11.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 11/13/2013] [Accepted: 11/13/2013] [Indexed: 12/16/2022] Open
Abstract
AbstractTobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.
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Prochaska JJ, Fromont SC, Delucchi K, Young-Wolff KC, Benowitz NL, Hall S, Bonas T, Hall SM. Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change. Health Psychol 2014; 33:1518-29. [PMID: 24467257 DOI: 10.1037/a0035164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. METHOD Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. RESULTS Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. CONCLUSION Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | | | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco
| | - Kelly C Young-Wolff
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California-San Francisco
| | - Stephen Hall
- Department of Psychiatry, University of California-San Francisco
| | | | - Sharon M Hall
- Department of Psychiatry, University of California-San Francisco
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Okoli CTC, Khara M. Smoking cessation outcomes and predictors among individuals with co-occurring substance use and/or psychiatric disorders. J Dual Diagn 2014; 10:9-18. [PMID: 25392058 DOI: 10.1080/15504263.2013.866860] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. METHODS Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. RESULTS Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. CONCLUSIONS Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.
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Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”? ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/251048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Minichino A, Bersani FS, Calò WK, Spagnoli F, Francesconi M, Vicinanza R, Delle Chiaie R, Biondi M. Smoking behaviour and mental health disorders--mutual influences and implications for therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4790-811. [PMID: 24157506 PMCID: PMC3823321 DOI: 10.3390/ijerph10104790] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 12/27/2022]
Abstract
Tobacco use is strongly associated with a variety of psychiatric disorders. Smokers are more likely than non-smokers to meet current criteria for mental health conditions, such as mood disorders, anxiety disorders and psychosis. Evidence also suggest that smokers with psychiatric disorders may have more difficulty quitting, offering at least a partial explanation for why smoking rates are higher in this population. The mechanisms linking mental health conditions and cigarette smoking are complex and likely differ across each of the various disorders. The most commonly held view is that patients with mental health conditions smoke in an effort to regulate the symptoms associated with their disorder. However some recent evidence suggests that quitting smoking may actually improve mental health symptoms. This is particularly true if the tobacco cessation intervention is integrated into the context of ongoing mental health treatment. In this paper we reviewed and summarized the most relevant knowledge about the relationship between tobacco use and dependence and psychiatric disorders. We also reviewed the most effective smoking cessation strategies available for patients with psychiatric comorbidity and the impact of smoking behavior on psychiatric medication.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
| | - Francesco Saverio Bersani
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
| | - Wanda Katharina Calò
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
| | - Francesco Spagnoli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
| | - Roberto Vicinanza
- Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University, Rome 00185, Italy; E-Mail:
| | - Roberto Delle Chiaie
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, Italy; E-Mails: (F.S.B.); (W.K.C.); (F.S.); (M.F.); (R.D.C.); (M.B.)
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Killackey E, Alvarez-Jimenez M, Allott K, Bendall S, McGorry P. Community rehabilitation and psychosocial interventions for psychotic disorders in youth. Child Adolesc Psychiatr Clin N Am 2013; 22:745-58. [PMID: 24012084 DOI: 10.1016/j.chc.2013.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
During recovery, young people with psychosis need attention paid not only to their psychotic symptoms but also to the areas of functioning that restrict their capacity to live a fulfilled life in the community. Despite improvements in medications and psychological therapies, people with psychosis still have poor outcomes in functional domains such as vocation, physical health, housing, and imprisonment. This article reviews 2 of these areas: vocational functioning and physical health. It examines the extent of each of these issues, provides guidance as to what evidence there exists on which to base interventions, and describes such evidence.
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Affiliation(s)
- Eóin Killackey
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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A group based smoking cessation pilot programme for community mental health clients in Sydney. J Smok Cessat 2013. [DOI: 10.1017/jsc.2013.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: This article describes the process and evaluation of a smoking cessation support programme for mental health clients in Sydney.Aim: The objective of the study was to assess a group-based smoking cessation support model for community mental health clients.Methods: Two community mental health services participated; 29 clients received free NRT products and weekly education for 12 weeks on: effects of smoking, nicotine dependence, NRT use, withdrawal process and the benefits of quitting. Evaluation included face-to-face interviews, telephone or postal survey using a semi-structured questionnaire.Results: The baseline (n = 29) and follow-up (n = 14) surveys showed reduction in the number of cigarettes (30 to 21) smoked a day (55% vs. 36%). At one month 47% (n = 19) were confident about stopping smoking permanently whereas 19% (n = 14) reported the same after six months. Participants reported concerns of health effects, illness, physical symptoms (77% n = 27) and financial cost (93% n = 27) were the motivating factors in quitting. None of the findings was statistically significant.Conclusions: Community based interventions to address the rate of smoking in this group is needed. Financial and health benefits can be used as motivating factors, and integration of smoking cessation assistance in treatment and rehabilitation of mental health consumers would be useful.
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Outcomes of a tobacco treatment programme for individuals with severe and persistent mental illness attending a community mental health team. J Smok Cessat 2013. [DOI: 10.1017/jsc.2013.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Individuals with severe and persistent mental illnesses have a greater prevalence of smoking than the general population and are disproportionately affected by tobacco-related morbidity and mortality. Evidence-based tobacco treatment can aid such populations in their efforts at smoking cessation. Few studies have examined the effectiveness of tobacco treatment programmes within Mental Health and Addictions Services in Canada.Aims: This study examines outcomes from an evidence-based tobacco treatment programme provided within community mental health services in Vancouver, Canada.Methods: A retrospective chart review was conducted of 134 participants (from June 2010 to February 2012). Information on demographics, tobacco use and cessation history, substance use history, psychiatric disorder diagnosis, expired carbon monoxide level, and duration of treatment in the programme were obtained. Programme completion and smoking cessation/reduction were examined.Results: Sixty-seven per cent completed the programme. Of those who completed, 26.7% were abstinent at the end-of-treatment and 50% (of those not achieving abstinence) reduced their consumption to at least 50% of their baseline cigarette consumption. Predictors of smoking cessation included having a social support for smoking cessation and lower nicotine dependence at baseline.Conclusions: Evidence-based tobacco treatment within community mental health services is well received by individuals with severe and persistent mental illness. Such treatment can aid in their efforts towards smoking cessation. Future studies may need to assess factors that can enhance the integration of tobacco treatment within mental health services while providing tailored treatment that addresses the unique needs of smokers who have severe and persistent mental illness.
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Stewart GB, Mengersen K, Meader N. Potential uses of Bayesian networks as tools for synthesis of systematic reviews of complex interventions. Res Synth Methods 2013; 5:1-12. [PMID: 26054022 DOI: 10.1002/jrsm.1087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 11/09/2022]
Abstract
Bayesian networks (BNs) are tools for representing expert knowledge or evidence. They are especially useful for synthesising evidence or belief concerning a complex intervention, assessing the sensitivity of outcomes to different situations or contextual frameworks and framing decision problems that involve alternative types of intervention. Bayesian networks are useful extensions to logic maps when initiating a review or to facilitate synthesis and bridge the gap between evidence acquisition and decision-making. Formal elicitation techniques allow development of BNs on the basis of expert opinion. Such applications are useful alternatives to 'empty' reviews, which identify knowledge gaps but fail to support decision-making. Where review evidence exists, it can inform the development of a BN. We illustrate the construction of a BN using a motivating example that demonstrates how BNs can ensure coherence, transparently structure the problem addressed by a complex intervention and assess sensitivity to context, all of which are critical components of robust reviews of complex interventions. We suggest that BNs should be utilised to routinely synthesise reviews of complex interventions or empty reviews where decisions must be made despite poor evidence.
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Affiliation(s)
- G B Stewart
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - K Mengersen
- Department of Statistical Science, Science and Engineering Faculty, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001, Australia
| | - N Meader
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
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Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 2013:CD009329. [PMID: 23728690 PMCID: PMC8406789 DOI: 10.1002/14651858.cd009329.pub2] [Citation(s) in RCA: 573] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Smoking is the leading preventable cause of illness and premature death worldwide. Some medications have been proven to help people to quit, with three licensed for this purpose in Europe and the USA: nicotine replacement therapy (NRT), bupropion, and varenicline. Cytisine (a treatment pharmacologically similar to varenicline) is also licensed for use in Russia and some of the former socialist economy countries. Other therapies, including nortriptyline, have also been tested for effectiveness. OBJECTIVES How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long-term abstinence (six months or longer)? How do the remaining treatments compare with placebo in achieving long-term abstinence? How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits? METHODS The overview is restricted to Cochrane reviews, all of which include randomised trials. Participants are usually adult smokers, but we exclude reviews of smoking cessation for pregnant women and in particular disease groups or specific settings. We cover nicotine replacement therapy (NRT), antidepressants (bupropion and nortriptyline), nicotine receptor partial agonists (varenicline and cytisine), anxiolytics, selective type 1 cannabinoid receptor antagonists (rimonabant), clonidine, lobeline, dianicline, mecamylamine, Nicobrevin, opioid antagonists, nicotine vaccines, and silver acetate. Our outcome for benefit is continuous or prolonged abstinence at least six months from the start of treatment. Our outcome for harms is the incidence of serious adverse events associated with each of the treatments. We searched the Cochrane Database of Systematic Reviews (CDSR) in The Cochrane Library, for any reviews with 'smoking' in the title, abstract or keyword fields. The last search was conducted in November 2012. We assessed methodological quality using a revised version of the AMSTAR scale. For NRT, bupropion and varenicline we conducted network meta-analyses, comparing each with the others and with placebo for benefit, and varenicline and bupropion for risks of serious adverse events. MAIN RESULTS We identified 12 treatment-specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (odds ratios (OR) 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head-to-head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96). Varenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46). Cytisine (a nicotine receptor partial agonist) returned positive findings (risk ratio (RR) 3.98; 95% CI 2.01 to 7.87), without significant adverse events or SAEs. Across the 82 included and excluded bupropion trials, our estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. SAE meta-analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta-analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56). Nortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose-dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. AUTHORS' CONCLUSIONS NRT, bupropion, varenicline and cytisine have been shown to improve the chances of quitting. Combination NRT and varenicline are equally effective as quitting aids. Nortriptyline also improves the chances of quitting. On current evidence, none of the treatments appear to have an incidence of adverse events that would mitigate their use. Further research is warranted into the safety of varenicline and into cytisine's potential as an effective and affordable treatment, but not into the efficacy and safety of NRT.
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Affiliation(s)
- Kate Cahill
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Noto C, Gadelha A, Belangero SI, Spindola LM, Rocha NP, de Miranda AS, Teixeira AL, Cardoso Smith MA, de Jesus Mari J, Bressan RA, Brietzke E. Circulating levels of sTNFR1 as a marker of severe clinical course in schizophrenia. J Psychiatr Res 2013; 47:467-71. [PMID: 23360651 DOI: 10.1016/j.jpsychires.2012.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/15/2012] [Accepted: 12/20/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND Schizophrenia (SZ) has been associated with an imbalance in the inflammatory cytokine TNF-α. The objectives of this study were to compare TNF-α and its soluble receptors' serum levels in individuals with SZ with the levels found in a group of healthy volunteers and to investigate the possible association between these biomarkers and the dimensions and severity of symptoms, clinical outcomes and response to treatment in patients with SZ. METHODS Fifty-four chronically medicated SZ outpatients and 118 healthy controls were included in the study. TNF-α levels were measured by Cytometric Bead Assay (CBA), and serum levels of soluble tumor necrosis factor receptor 1 (sTNFR1) and soluble tumor necrosis factor receptor 2 (sTNFR2) were measured by ELISA. RESULTS sTNFR1 and sTNFR2 were significantly elevated in patients with SZ as compared to the healthy control group. In the group of individuals with SZ, the levels of both types of soluble TNF receptors showed a negative correlation with global functioning. sTNFR1 levels were higher in the treatment-resistant patients as compared to the non-treatment-resistant patients and the controls. sTNFR1 levels were also heightened in patients with SZ and concomitant depression. CONCLUSION Our findings reinforce that SZ is associated with an inflammatory profile and suggest that sTNFR1 is a marker of a treatment-resistance and severe clinical course in SZ.
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Affiliation(s)
- Cristiano Noto
- Program of Schizophrenia (PROESQ), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
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Howard LM, Bekele D, Rowe M, Demilew J, Bewley S, Marteau TM. Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study. BJOG 2013; 120:362-70. [PMID: 23167511 PMCID: PMC3638317 DOI: 10.1111/1471-0528.12059] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether 1) pregnant smokers with mental disorders are less likely to accept referrals to smoking cessation services compared with pregnant smokers without disorders; 2) they experience specific barriers to smoking cessation. DESIGN Cohort study supplemented by cross-sectional survey and nested qualitative study. SETTING Three maternity services, London, UK. POPULATION Pregnant smokers with and without mental disorders. METHODS Case notes were examined on a cohort of 400 consecutive pregnant smokers; data were triangulated with routinely collected data on 845 pregnant smokers at two other sites; 27 pregnant smokers were interviewed using qualitative methods. MAIN OUTCOME MEASURES Acceptance of referral to smoking cessation services; perceived barriers to quitting. RESULTS Pregnant smokers with a mental disorder recorded by midwives were one-quarter of the cohort (97, 23%), were more likely to accept referral to smoking cessation services (69% versus 56%, adjusted odds ratio 1.70, 95% confidence interval 1.03-2.79), but more likely to still smoke at delivery (69% versus 56%, adjusted odds ratio 2.63, 95% confidence interval 1.41-4.92). Discussion about smoking was documented in 7.7% of subsequent antenatal visits in women with or without mental disorders. Pregnant smokers with diagnosed mental disorders reported that they and health practitioners did not prioritise smoking advice because of concern about adversely impacting mental health. CONCLUSIONS Pregnant women with mental disorders appear more motivated, yet find it more difficult, to stop smoking. Prioritisation of mental health over smoking may therefore lead to increasing health inequality for this group. Research into effective smoking cessation interventions is required for those with mental disorders.
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Affiliation(s)
- L M Howard
- PO31 Institute of Psychiatry, King's College London, London, UK.
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Garner S, Docherty M, Somner J, Sharma T, Choudhury M, Clarke M, Littlejohns P. Reducing ineffective practice: Challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy 2013; 18:6-12. [DOI: 10.1258/jhsrp.2012.012044] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: Despite international agreement that stopping low value practices will increase efficiency, identifying them is difficult and controversial. Opponents of centralized lists of low value practices stress that the actual problem is inappropriate low value use, and better targeting and implementation of treatment thresholds is needed. Our objective was to use Cochrane Reviews to identify low value practices to support local disinvestment decisions. Methods: New or updated reviews were included if the authors concluded that the uncertain effectiveness of an intervention meant it should only be used in research, or that it was ineffective or harmful and should not be used. The reviews go through a production and quality assurance process, and are published as ‘Cochrane Quality and Productivity topics’ through the NHS Evidence website ( http://www.library.nhs.uk/qipp/ ). Results: Over a six-month period, 65 Cochrane reviews were processed by the National Institute for Health and Clinical Excellence (NICE). Of these, 28 identified potentially low value practices in the UK context. This was primarily due to a lack of randomized evidence of effectiveness, rather than robust evidence of a lack of effectiveness, or evidence of harm. Conclusions: Identifying low-value health care practices for local disinvestment (total or partial) is both practically and politically challenging, yet it is necessary to manage health budgets. This project identified that Cochrane Reviews can potentially identify low value health care practices. However, each review has to be reinterpreted for the UK context and additional analysis has to be undertaken to facilitate local implementation. Recommendations to improve the usability of systematic reviews are made.
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Affiliation(s)
- Sarah Garner
- National Institute for Health and Clinical Excellence, London
| | - Mary Docherty
- Institute of Psychiatry, King's College London, London
| | - John Somner
- The Vision & Eye Research Unit, Anglia Ruskin University, Cambridge
| | - Tarang Sharma
- National Institute for Health and Clinical Excellence, London
| | - Moni Choudhury
- National Institute for Health and Clinical Excellence, London
| | - Mike Clarke
- Queen's University Belfast, County Antrim, UK
| | - Peter Littlejohns
- Division of Health and Social Research, King's College London, London, UK
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Cather C, Dyer MA, Burrell HA, Hoeppner B, Goff DC, Evins AE. An Open Trial of Relapse Prevention Therapy for Smokers With Schizophrenia. J Dual Diagn 2013; 9:87-93. [PMID: 23750123 PMCID: PMC3671354 DOI: 10.1080/15504263.2012.749559] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Following successful smoking cessation, smokers with schizophrenia are vulnerable to relapse shortly after treatment discontinuation. Our objective was to assess the feasibility and effectiveness of a 12-month relapse prevention intervention in recently abstinent smokers with schizophrenia. METHOD Adult outpatient smokers with schizophrenia received weekly cognitive behavioral therapy groups, bupropion slow release, transdermal nicotine patch, and nicotine gum or lozenge for three months. Subjects with seven-day point prevalence abstinence at month 3 received an additional 12 months (months 4-15) of therapy with bupropion, transdermal nicotine patch, and nicotine gum/lozenge in conjunction with relapse prevention-based cognitive behavioral therapy groups that were held weekly in month 4, biweekly in months 5-6, and monthly in months 7-15. RESULTS Seventeen of 41 participants (41.5%) attained biochemically verified self-report of seven-day point prevalence abstinence at the end of three months of treatment and entered relapse prevention treatment. There was an 81% attendance rate at relapse prevention groups. At the end of the 12-month relapse prevention phase (month 15 overall), 11 of 17 (64.7%) demonstrated biochemically verified seven-day point prevalence abstinence, and 10 of 17 (58.8%) reported four-week continuous abstinence. Almost one quarter of the sample (23.5%) demonstrated long-term prolonged abstinence through the end of the trial. There were no clinically detected cases of psychiatric symptom exacerbation. One participant, who was managed as an outpatient, self-reported psychiatric symptom exacerbation in the interim period between study visits. CONCLUSIONS Extended duration smoking cessation treatment is well-tolerated and may improve smoking outcomes for recently abstinent smokers with schizophrenia. Controlled trials are warranted.
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Affiliation(s)
- Corinne Cather
- Schizophrenia Program, Massachusetts General Hospital and Harvard Medical School ; Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School ; Department of Psychiatry of the Massachusetts General Hospital and Harvard Medical School
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Apollonio D, Philipps R, Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance abuse. Cochrane Database Syst Rev 2012; 12:1-10. [PMID: 23833567 PMCID: PMC3698983 DOI: 10.1002/14651858.cd010274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of tobacco cessation therapy offered concurrently with treatment for drug and alcohol addiction.
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Affiliation(s)
- Dorie Apollonio
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Rose Philipps
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Lisa Bero
- Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2012:CD010078. [PMID: 22972148 DOI: 10.1002/14651858.cd010078] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking in pregnancy is a substantial public health problem. When used by non-pregnant smokers, pharmacotherapies [nicotine replacement therapy (NRT), bupropion and varenicline] are effective treatments for smoking cessation, however, their efficacy and safety in pregnancy remains unknown. OBJECTIVES To determine the efficacy and safety of smoking cessation pharmacotherapies, including NRT, varenicline and bupropion (or any other medications) when used to support smoking cessation in pregnancy. SEARCH METHODS We searched the Pregnancy and Childbirth Group's Trials Register (5 March 2012), checked references of retrieved studies and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) with designs that permit the independent effects of any type of NRT (e.g. patch, gum etc.) or any other pharmacotherapy on smoking cessation to be ascertained were eligible for inclusion. Trials must provide very similar (ideally identical) levels of behavioural support or cognitive behaviour therapy (CBT) to participants in active drug and comparator trial arms.The following RCT designs are considered acceptable.Placebo RCTs: any form of NRT or other pharmacotherapy, with or without behavioural support/CBT, or brief advice compared with placebo NRT and additional support of similar intensity.RCTs providing a comparison between i) behavioural support/CBT or brief advice and ii) any form of NRT or other pharmacotherapy added to behavioural support of similar (ideally identical) intensity.Parallel- or cluster-randomised design trials are eligible for inclusion. However, quasi-randomised, cross-over and within-participant designs are not eligible for inclusion due to the potential biases associated with these designs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias and extracted data. Two assessors independently extracted data and cross checked individual outcomes of this process to ensure accuracy. The primary efficacy outcome was smoking cessation in later pregnancy (in all but one trial, at or around delivery); safety was assessed by seven birth outcomes that indicated neonatal well being and we also collated data on adherence. MAIN RESULTS Six trials of NRT enrolling 1745 pregnant smokers were included; we found no trials of varenicline or bupropion. No statistically significant difference was seen for smoking cessation in later pregnancy after using NRT as compared to control (risk ratio (RR) 1.33, 95% confidence interval (CI) 0.93 to 1.91, six studies, 1745 women). Subgroup analysis comparing placebo-RCTs with those which did not use placebos found that efficacy estimates for cessation varied with trial design (placebo RCTs, RR 1.20, 95% CI 0.93 to 1.56, four studies, 1524 women; non-placebo RCTs, RR 7.81, 95% CI 1.51 to 40.35, two studies, 221 women; P value for random-effects subgroup interaction test = 0.03). There were no statistically significant differences in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care or neonatal death between NRT or control groups. AUTHORS' CONCLUSIONS Nicotine replacement therapy is the only pharmacotherapy for smoking cessation that has been tested in RCTs conducted in pregnancy. There is insufficient evidence to determine whether or not NRT is effective or safe when used to promote smoking cessation in pregnancy or to determine whether or not using NRT has positive or negative impacts on birth outcomes. Further research evidence of efficacy and safety is needed, ideally from placebo-controlled RCTs that investigate higher doses of NRT than were tested in the included studies.
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Affiliation(s)
- Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK.
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Carr VJ, Whiteford H, Groves A, McGorry P, Shepherd AM. Policy and service development implications of the second Australian National Survey of High Impact Psychosis (SHIP). Aust N Z J Psychiatry 2012; 46:708-18. [PMID: 22563037 DOI: 10.1177/0004867412446488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We consider insights from the second Australian National Survey of High Impact Psychosis (2010) in order to identify the key policy and service development implications. METHOD The Survey of High Impact Psychosis (SHIP) provides an updated description of the experiences of people living with psychosis in Australia. We discuss the SHIP survey participants' greatest challenges for the future in light of the strength of existing literature, highlighting prospective opportunities for policy and service planning. RESULTS Targets for future policy development and service initiatives are informed by the survey participants' leading challenges: financial difficulties, social isolation, lack of employment, physical and mental ill health, accommodation, and access to services. CONCLUSIONS Many of the areas of need identified by survey participants are supported by quality research that may be more widely translated into effective services. For areas of need where the evidence is lacking, more clinical research is urgently needed. A targeted approach is vital to secure necessary investment in the wider dissemination of efficacious interventions and their systematic evaluation in ordinary clinical practice, enabled by both research investment and active integration of the research effort within ordinary clinical settings.
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Affiliation(s)
- Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Lingford-Hughes AR, Welch S, Peters L, Nutt DJ. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 2012; 26:899-952. [PMID: 22628390 DOI: 10.1177/0269881112444324] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
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Kelly DL, Raley HG, Lo S, Wright K, Liu F, McMahon RP, Moolchan ET, Feldman S, Richardson CM, Wehring HJ, Heishman SJ. Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophr Bull 2012; 38:543-51. [PMID: 21041835 PMCID: PMC3330003 DOI: 10.1093/schbul/sbq124] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). METHODS Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. RESULTS There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 ± 5.4 vs 15.6 ± 5.5 y, P = .44), number of cigarettes daily (17.9 ± 11.6 vs 17.0 ± 7.9, P = 0.51), or in breath CO (28.0 ± 14.5 vs 22.9 ± 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). CONCLUSIONS This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.
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Affiliation(s)
- Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228,To whom correspondence should be addressed; tel: 410-402-6860, fax: 410-402-6038, e-mail:
| | - Heather G. Raley
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Suzanne Lo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Katherine Wright
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | | | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Charles M. Richardson
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Stephen J. Heishman
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Khanna P, Clifton A, Banks D, Tosh G. Smoking cessation advice for people with serious mental illness. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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de Leon J, Diaz FJ. Genetics of schizophrenia and smoking: an approach to studying their comorbidity based on epidemiological findings. Hum Genet 2011; 131:877-901. [PMID: 22190153 DOI: 10.1007/s00439-011-1122-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/27/2011] [Indexed: 01/10/2023]
Abstract
The association between schizophrenia and tobacco smoking has been described in more than 1,000 articles, many with inadequate methodology. The studies on this association can focus on: (1) current smoking, ever smoking or smoking cessation; (2) non-psychiatric controls or controls with severe mental illness (e.g., bipolar disorder); and (3) higher smoking frequency or greater usage in smokers. The association with the most potential for genetic studies is that between ever daily smoking and schizophrenia; it may reflect a shared genetic vulnerability. To reduce the number of false-positive genes, we propose a three-stage approach derived from epidemiological knowledge. In the first stage, only genetic variations associated with ever daily smoking that are simultaneously significant within the non-psychiatric controls, the bipolar disorder controls and the schizophrenia cases will be selected. Only those genetic variations that are simultaneously significant in the three hypothesis tests will be tested in the second stage, where the prevalence of the genes must be significantly higher in schizophrenia than in bipolar disorder, and significantly higher in bipolar disorder than in controls. The genes simultaneously significant in the second stage will be included in a third stage where the gene variations must be significantly more frequent in schizophrenia patients who did not start smoking daily until their 20s (late start) versus those who had an early start. Any genetic approach to psychiatric disorders may fail if attention is not given to comorbidity and epidemiological studies that suggest which comorbidities are likely to be explained by genetics and which are not. Our approach, which examines the results of epidemiological studies on comorbidities and then looks for genes that simultaneously satisfy epidemiologically suggested sets of hypotheses, may also apply to the study of other major illnesses.
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Affiliation(s)
- Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA.
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Reavley NJ, Yap MBH, Wright A, Jorm AF. Actions taken by young people to deal with mental disorders: findings from an Australian national survey of youth. Early Interv Psychiatry 2011; 5:335-42. [PMID: 21951823 DOI: 10.1111/j.1751-7893.2011.00292.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The study examined actions taken by young people to deal with mental disorders and the factors associated with help-seeking and self-help behaviours. METHODS Participants in a 2006 national survey of Australian youth (aged 12-25 years) were contacted 2 years later and participated in telephone interviews based on a vignette of one of the following disorders: depression, depression with alcohol misuse, social phobia and psychosis. Personal experiences of these disorders and subsequent self-help and help-seeking behaviours were examined. RESULTS Of the 2005 participants interviewed, 275 (14%) reported experiencing a mental disorder since January 2007, most commonly depression. The most frequent sources of help were family (77%) and close friends (73%). General practitioners (GPs) were consulted by 53% of respondents. The most frequent self-help behaviours were physical activity (70%) and getting up early and out in the sunlight (46%). Beliefs about the helpfulness of interventions at baseline were compared with actual use in the following 2 years. Interventions ranked higher for beliefs about helpfulness than actual use mainly included consulting health professionals and cutting down on substance use. Interventions ranked higher for actual use than beliefs typically included lifestyle interventions but also included consulting GPs. CONCLUSIONS Young people with mental health problems are more likely to seek help from close friends and family and to use self-help interventions than to access professional help, although over half of survey respondents had visited a GP. Help seeking tended to be better predicted by intentions to seek help than by beliefs about the helpfulness of interventions.
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Affiliation(s)
- Nicola J Reavley
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia.
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Cahill K, Lancaster T, Perera R. Pharmacological interventions for smoking cessation: an overview of reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Heffner JL, Strawn JR, DelBello MP, Strakowski SM, Anthenelli RM. The co-occurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations. Bipolar Disord 2011; 13:439-53. [PMID: 22017214 PMCID: PMC3729285 DOI: 10.1111/j.1399-5618.2011.00943.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Despite recent advances in understanding the causes and treatment of nicotine dependence among individuals with psychiatric disorders, smoking among individuals with bipolar disorder (BD) has received little attention. The goal of this review is to synthesize the literature on the epidemiology, consequences, and treatment of smoking and nicotine dependence among individuals with BD and to delineate a future research agenda. METHODS We conducted a PubMed search of English-language articles using the search terms bipolar disorder, mania, tobacco, nicotine, and smoking, followed by a manual search of the literature cited in the identified articles. Articles were chosen by the authors on the basis of their relevance to the topic areas covered in this selective review. RESULTS Adults with BD are two to three times more likely to have started smoking and, on the basis of epidemiological data, may be less likely to initiate and/or maintain smoking abstinence than individuals without psychiatric disorders. Smoking cessation is achievable for individuals with BD, but challenges such as chronic mood dysregulation, high prevalence of alcohol and drug use, more severe nicotine dependence, and limited social support can make quitting more difficult. Effective treatments for tobacco cessation are available, but no controlled trials in smokers with BD have been conducted. CONCLUSIONS Cigarette smoking is a prevalent and devastating addiction among individuals with BD and should be addressed by mental health providers. Additional research on the mechanisms of, and optimal treatment for, smoking and nicotine dependence in this population is desperately needed.
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Affiliation(s)
- Jaimee L. Heffner
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Melissa P. DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Robert M. Anthenelli
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
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Collins SE, Witkiewitz K, Kirouac M, Marlatt GA. Preventing Relapse Following Smoking Cessation. CURRENT CARDIOVASCULAR RISK REPORTS 2010; 4:421-428. [PMID: 26550097 PMCID: PMC4636196 DOI: 10.1007/s12170-010-0124-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cigarette smoking is the leading cause of preventable deaths worldwide. Long-term smoking cessation can drastically reduce people's risk for developing smoking-related disease. The research literature points to a need for clearer operationalization and differentiation between smoking cessation and relapse prevention interventions and outcomes. That said, extensive meta-analyses and research studies have indicated that there are various efficacious smoking interventions that can both support smoking cessation and relapse prevention efforts. Specifically, behavioral treatments, relapse prevention psychotherapy, pharmacologic interventions, motivational enhancement, smoking reduction to quit, brief advice, alternative intervention modes (telephone, Internet, computer), self-help, and tailored treatments can help prepare smokers for longer-term abstinence. Although these methods vary on reach, they are relatively efficacious, particularly in combined formats.
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Affiliation(s)
- Susan E Collins
- Addictive Behaviors Research Center, University of Washington, Box 351629, Seattle, WA 98195, USA
| | - Katie Witkiewitz
- Department of Psychology, Washington State University - Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686, USA
| | - Megan Kirouac
- Addictive Behaviors Research Center, University of Washington, Box 351629, Seattle, WA 98195, USA
| | - G Alan Marlatt
- Addictive Behaviors Research Center, University of Washington, Box 351629, Seattle, WA 98195, USA
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