Prochaska Judith J, Gill Patricia, Hall Sharon M
Department of Psychiatry, University of California-San Francisco, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143-0984, USA.
Psychiatr Serv. 2004 Nov;55(11):1265-70. doi: 10.1176/appi.ps.55.11.1265.
Despite high rates of tobacco use among psychiatric patients, such patients are one of the least studied groups of smokers, and little is known about their access to cessation treatment. This study examined delivery of tobacco cessation services in a smoke-free inpatient psychiatric setting.
Medical records of 250 psychiatric inpatients who were admitted from 1998 to 2001 were randomly selected and systematically reviewed.
A total of 105 patients (42 percent) were identified as current smokers; the mean+/-SD number of cigarettes that they smoked per day was 21+/-15. Smokers evidenced statistically greater agitation and irritability compared with nonsmokers. None of the smokers received a diagnosis of nicotine dependence or withdrawal, and smoking status was not included in treatment planning for any patient. Nicotine replacement therapy was prescribed for 59 smokers (56 percent); of these patients, 54 (92 percent) used it. Smokers who were not given a prescription for nicotine replacement therapy were more than twice as likely as nonsmokers and smokers who were given a prescription for this therapy to be discharged from the hospital against medical advice. Only one smoker was encouraged to quit smoking, referred for cessation treatment, or provided with nicotine replacement therapy on discharge.
Psychiatric inpatients smoke at high rates, yet interventions to treat this deadly addiction are rare. Furthermore, nicotine withdrawal left unaddressed may compromise psychiatric care.
尽管精神病患者中烟草使用率很高，但这类患者却是研究最少的吸烟群体之一，对于他们获得戒烟治疗的情况知之甚少。本研究调查了无烟精神病住院环境中戒烟服务的提供情况。
随机抽取并系统回顾了1998年至2001年收治的250名精神病住院患者的病历。
共有105名患者（42%）被确定为当前吸烟者；他们每天吸烟的平均数量±标准差为21±15支。与不吸烟者相比，吸烟者在统计学上表现出更大的激动和易怒情绪。没有一名吸烟者被诊断为尼古丁依赖或戒断，并且任何患者的治疗计划中都未包括吸烟状况。59名吸烟者（56%）被开了尼古丁替代疗法的处方；在这些患者中，54名（92%）使用了该疗法。未被开尼古丁替代疗法处方的吸烟者违背医嘱出院的可能性是不吸烟者以及被开此疗法处方的吸烟者的两倍多。只有一名吸烟者在出院时被鼓励戒烟、被转介接受戒烟治疗或获得尼古丁替代疗法。
精神病住院患者吸烟率很高，但治疗这种致命成瘾行为的干预措施却很少。此外，未得到解决的尼古丁戒断问题可能会影响精神病护理。
