Baker Amanda, Richmond Robyn, Haile Melanie, Lewin Terry J, Carr Vaughan J, Taylor Rachel L, Jansons Sylvia, Wilhelm Kay
Centre for Mental Health Studies, University of Newcastle, University Dr., Callaghan, NSW 2308, Australia.
Am J Psychiatry. 2006 Nov;163(11):1934-42. doi: 10.1176/ajp.2006.163.11.1934.
Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs, few studies have investigated the efficacy of smoking cessation interventions among this group. The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone.
The authors recruited 298 regular smokers with a psychotic disorder residing in the community and randomly assigned them to a routine care comparison condition (N=151) or an eight-session, individually administered smoking cessation intervention (N=147), which consisted of nicotine replacement therapy, motivational interviewing, and cognitive behavior therapy. Outcome variables included continuous and point-prevalence abstinence rates, smoking reduction status, and changes in symptoms and functioning.
While there were no overall differences between the treatment group and comparison group in abstinence rates, a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions (point-prevalence rates: 3 months, 30.0% versus 6.0%; 6 months, 18.6% versus 4.0%; and 12 months, 18.6% versus 6.6%). Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months (21.4% versus 4.0%). There was a strong dose-response relationship between treatment session attendance and smoking reduction status, with one-half of those who completed the intervention program achieving a 50% or greater reduction in daily cigarette consumption across the follow-ups, relative to less than one-fifth of the comparison subjects. There was no evidence of any associated deterioration in symptoms or functioning.
These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder. Further development of more efficacious interventions is required for those who do not respond to existing interventions.
尽管患有精神疾病的个体吸烟率极高，且存在相关的经济和健康成本，但很少有研究调查该群体戒烟干预措施的效果。本研究的目的是比较针对患有精神疾病的人群的综合心理和尼古丁替代疗法干预与单纯常规护理的效果。
作者招募了298名居住在社区的患有精神疾病的经常吸烟者，并将他们随机分配到常规护理对照组（N = 151）或为期八节的个体戒烟干预组（N = 147），后者包括尼古丁替代疗法、动机性访谈和认知行为疗法。结果变量包括持续和点流行率戒烟率、吸烟减少状况以及症状和功能的变化。
虽然治疗组和对照组在戒烟率上没有总体差异，但在每次随访时，完成所有治疗疗程的吸烟者中戒烟的比例显著更高（点流行率：3个月时，30.0% 对6.0%；6个月时，18.6% 对4.0%；12个月时，18.6% 对6.6%）。完成所有治疗疗程的吸烟者在3个月时也更有可能实现持续戒烟（21.4% 对4.0%）。治疗疗程的参与程度与吸烟减少状况之间存在强烈的剂量反应关系，完成干预计划的人中，有一半在随访期间每日香烟消费量减少了50%或更多，而对照组中这一比例不到五分之一。没有证据表明症状或功能有任何相关恶化。
这些发现证明了尼古丁替代疗法加动机性访谈/认知行为疗法戒烟干预对患有精神疾病的个体的效用。对于对现有干预措施无反应的人，需要进一步开发更有效的干预措施。
