Boumaza S, Lebain P, Brazo P
Établissement public de santé mentale, 15ter, rue Saint-Ouen, 14012 Caen, France.
Service de psychiatrie, CHU de Caen, avenue de la Côte de Nacre, CS 30001, 14033 Caen cedex 9, France.
Encephale. 2015 Jun;41 Suppl 1:S1-6. doi: 10.1016/j.encep.2014.10.017. Epub 2014 Dec 16.
Tobacco smoking is the main cause of death among mentally ill persons. Since February 2007, smoking has been strictly forbidden in French covered and closed psychiatric wards. The fear of an increased violence risk induced by tobacco withdrawal is one of the most frequent arguments invoked against this tobacco ban. According to the literature, it seems that the implementation of this ban does not imply such a risk. All these studies compared inpatients' violence risk before and after the tobacco ban in a same psychiatric ward.
We aimed to analyse the strict tobacco withdrawal consequences on the violence risk in a retrospective study including patients hospitalised in a psychiatric intensive care unit of the university hospital of Caen during the same period.
We compared clinical and demographic data and the violence risk between the smoker group (strict tobacco withdrawal with proposed tobacco substitution) and the non-smoker group (control group). In order to evaluate the violence risk, we used three indicators: a standardised scale (the Bröset Violence Checklist) and two assessments specific to the psychiatric intensive care setting ("the preventing risk protocol" and the "seclusion time"). The clinical and demographic data were compared using the Khi2 test, Fisher test and Mann-Whitney test, and the three violence risk indicators were compared with the Mann-Whitney test. Firstly, comparisons were conducted in the total population, and secondly (in order to eliminate a bias of tobacco substitution) in the subgroup directly hospitalised in the psychiatric intensive care setting. Finally, we analysed in the smoker group the statistical correlation between tobacco smoking intensity and violence risk intensity using a regression test.
A population of 72 patients (50 male) was included; 45 were smokers (62.5%) and 27 non-smokers. No statistically significant differences were found in clinical and demographic data between smoker and non-smoker groups in the whole population, as well as in the subgroup directly hospitalised in the psychiatric intensive care setting. Whatever the violence risk indicators, no statistically significant difference was found between the smoker group and the non-smoker group in the total population, as well as the subgroup directly hospitalised in the psychiatric intensive care setting. Moreover, no correlation was found between the tobacco smoking intensity and the violence risk intensity in the smoker group.
Strict tobacco withdrawal does not appear to constitute a violence risk factor in psychiatric intensive care unit inpatients. However, further studies are needed to confirm these results. They should be prospective and they should take into account larger samples including patients hospitalised in non-intensive care psychiatric wards.
吸烟是精神疾病患者死亡的主要原因。自2007年2月起，法国有顶篷的封闭式精神科病房内严禁吸烟。担心戒烟会增加暴力风险是反对这项禁烟令最常提及的理由之一。根据文献，这项禁令的实施似乎并不意味着存在这样的风险。所有这些研究都比较了同一精神科病房禁烟前后住院患者的暴力风险。
我们旨在通过一项回顾性研究分析严格戒烟对暴力风险的影响，该研究纳入了同一时期在卡昂大学医院精神科重症监护病房住院的患者。
我们比较了吸烟者组（严格戒烟并建议替代烟草）和非吸烟者组（对照组）的临床和人口统计学数据以及暴力风险。为了评估暴力风险，我们使用了三个指标：一个标准化量表（布罗泽特暴力清单）和两个针对精神科重症监护环境的评估（“预防风险方案”和“隔离时间”）。使用卡方检验、费舍尔检验和曼-惠特尼检验比较临床和人口统计学数据，并使用曼-惠特尼检验比较三个暴力风险指标。首先，在总体人群中进行比较，其次（为了消除烟草替代偏差）在直接入住精神科重症监护病房的亚组中进行比较。最后，我们在吸烟者组中使用回归检验分析吸烟强度与暴力风险强度之间的统计相关性。
纳入了72名患者（50名男性）；45名是吸烟者（62.5%），27名是非吸烟者。在总体人群以及直接入住精神科重症监护病房的亚组中，吸烟者组和非吸烟者组在临床和人口统计学数据上均未发现统计学上的显著差异。无论使用何种暴力风险指标，在总体人群以及直接入住精神科重症监护病房的亚组中，吸烟者组和非吸烟者组之间均未发现统计学上的显著差异。此外，在吸烟者组中未发现吸烟强度与暴力风险强度之间存在相关性。
严格戒烟似乎并非精神科重症监护病房住院患者的暴力风险因素。然而，需要进一步的研究来证实这些结果。这些研究应该是前瞻性的，并且应该纳入更大的样本，包括在非重症监护精神科病房住院的患者。
