Waxmonsky Jeanette A, Thomas Marshall R, Miklowitz David J, Allen Michael H, Wisniewski Stephen R, Zhang Hongwei, Ostacher Michael J, Fossey Mark D
Department of Psychiatry, University of Colorado Health Sciences Center, Denver, CO 80220, USA.
Gen Hosp Psychiatry. 2005 Sep-Oct;27(5):321-8. doi: 10.1016/j.genhosppsych.2005.05.003.
Only a few small descriptive studies have examined the prevalence and correlates of tobacco use among bipolar patients. We predicted that poorly controlled manic, depressed and mixed states, and the presence of psychotic symptoms, would be associated with a greater prevalence of smoking among patients with bipolar disorder.
We examined the prevalence of smoking in a cross-sectional sample of 1904 patients with bipolar disorder enrolled in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) database. We also examined the relationship between smoking and other factors including: bipolar subtype, current clinical status, illness severity (e.g., number of prior mood episodes), age of bipolar onset, gender, education, socioeconomic status, and concurrent substance use.
At STEP-BD program entry, 31.2% of patients reported that they were smokers. Patients who were male, less educated, and/or had lower income were more likely to be smokers (P<.01). Additionally, patients with rapid cycling, comorbid psychiatric disorders, and/or substance abuse, and those experiencing a current episode of illness were more likely to be smokers (P<.0001). More lifetime depressive and manic episodes as well as greater severity of depressive and manic symptoms were associated with smoking (P<.001). Use of atypical antipsychotic medications was more prevalent among smokers (P=.04).
Clinical and demographic variables are associated with smoking in this sample of bipolar patients. Longitudinal analyses are needed to determine how mood and bipolar symptoms interact with smoking over the episodic course of bipolar disorder. Additional studies should focus on whether controlling bipolar symptoms is associated with cessation of smoking.
仅有少数小型描述性研究探讨了双相情感障碍患者中烟草使用的患病率及其相关因素。我们预测，双相情感障碍患者中，躁狂、抑郁和混合状态控制不佳以及存在精神病性症状与吸烟患病率较高有关。
我们在国立精神卫生研究所双相情感障碍系统治疗强化项目（STEP - BD）数据库中纳入的1904例双相情感障碍患者的横断面样本中，研究了吸烟的患病率。我们还研究了吸烟与其他因素之间的关系，这些因素包括：双相情感障碍亚型、当前临床状态、疾病严重程度（如既往情绪发作次数）、双相情感障碍起病年龄、性别、教育程度、社会经济地位以及并发物质使用情况。
在进入STEP - BD项目时，31.2%的患者报告称自己是吸烟者。男性、受教育程度较低和/或收入较低的患者更有可能是吸烟者（P<0.01）。此外，快速循环型、合并精神障碍和/或物质滥用的患者以及当前正经历疾病发作的患者更有可能是吸烟者（P<0.0001）。更多的终生抑郁和躁狂发作次数以及更严重程度的抑郁和躁狂症状与吸烟有关（P<0.001）。非典型抗精神病药物的使用在吸烟者中更为普遍（P = 0.04）。
在这个双相情感障碍患者样本中临床和人口统计学变量与吸烟有关。需要进行纵向分析以确定在双相情感障碍的发作过程中情绪和双相情感障碍症状如何与吸烟相互作用。进一步的研究应关注控制双相情感障碍症状是否与戒烟有关。
