Loreto Aline Rodrigues, Carvalho Carlos Felipe Cavalcanti, Frallonardo Fernanda Piotto, Ismael Flavia, Andrade Arthur Guerra de, Castaldelli-Maia João Maurício
a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.
b Clima Clinic , São Paulo , SP , Brazil.
J Dual Diagn. 2017 Oct-Dec;13(4):238-246. doi: 10.1080/15504263.2017.1328149. Epub 2017 May 10.
The aim of this study was to investigate smoking treatment effectiveness and retention in a population with and without mental disorders (MD). Participants received cognitive behavioral therapy (CBT) plus nicotine patch alone or in combination with other medications (i.e., gum, bupropion, or nortriptyline) for smoking cessation treatment in a Brazilian Psychosocial Care Center unit (CAPS), taking into account sociodemographics and smoking profile covariates.
The study involved comparison of treatment success (seven-day point prevalence abstinence at the end of the treatment) and retention (presence of the individual in all of the four medical consultations and six group sessions) in two subsamples of patients with MD (n = 267) and without MD (n = 397) who were included in a six-week treatment provided by a CAPS from 2007 to 2013. The treatment protocol comprised group CBT and pharmacotherapy (nicotine patches, nicotine gums, and bupropion and nortriptyline available, prescribed by psychiatrists).
Within patients with MD, CBT plus nicotine patch plus bupropion (aOR = 2.00, 95% CI [1.14, 3.50], p = .015) and CBT plus nicotine patch plus gum (aOR = 2.10, 95% CI [1.04, 4.23], p = .036) were associated with treatment success. Within patients without MD, female gender (aOR = 0.60, 95% CI [0.37, 0.95], p = .031) and lower Heaviness of Smoking Index score (aOR = 0.80, 95% CI [0.65, 0.99], p = .048) were associated with treatment success. No variable was associated with dropout or retention within patients with or without MD.
Our findings support the use of CBT plus nicotine patch plus bupropion as well as CBT plus nicotine patch plus gum in samples with high rates of medical, psychiatric, and addiction disorders. These findings support those of previous studies in the general population. Pharmacological treatment associated with group CBT based on cognitive-behavioral concepts and combined with ongoing MD treatment seems to be the best option for smoking cessation treatment among patients with MD. Units that deal with patients with MD, such as CAPS in Brazil, should be encouraged to treat smoking addiction in this population. Future studies should investigate retention rates in other samples of patients with MD.
本研究旨在调查有精神障碍（MD）和无精神障碍人群的吸烟治疗效果及治疗依从性。参与者在巴西社会心理护理中心（CAPS）接受认知行为疗法（CBT）加尼古丁贴片单独治疗或与其他药物（即口香糖、安非他酮或去甲替林）联合治疗以戒烟，同时考虑社会人口统计学和吸烟特征协变量。
该研究比较了2007年至2013年期间由CAPS提供的为期六周治疗中，MD患者亚组（n = 267）和无MD患者亚组（n = 397）的治疗成功率（治疗结束时七天点患病率戒烟）和治疗依从性（个体参加所有四次医疗咨询和六次小组会议）。治疗方案包括团体CBT和药物治疗（尼古丁贴片、尼古丁口香糖、安非他酮和去甲替林，由精神科医生处方）。
在MD患者中，CBT加尼古丁贴片加安非他酮（校正优势比[aOR]=2.00，95%可信区间[CI][1.14, 3.50]，p = 0.015）和CBT加尼古丁贴片加口香糖（aOR = 2.10，95% CI[1.04, 4.23]，p = 0.036）与治疗成功相关。在无MD患者中，女性（aOR = 0.60，95% CI[0.37, 0.95]，p = 0.031）和较低的吸烟严重指数得分（aOR = 0.80，95% CI[0.65, 0.99]，p = 0.048）与治疗成功相关。没有变量与MD患者或无MD患者的退出或治疗依从性相关。
我们的研究结果支持在患有医学、精神和成瘾性疾病比例较高的样本中使用CBT加尼古丁贴片加安非他酮以及CBT加尼古丁贴片加口香糖。这些结果支持了先前在普通人群中的研究结果。基于认知行为概念的团体CBT相关的药物治疗并结合正在进行的MD治疗似乎是MD患者戒烟治疗的最佳选择。应鼓励像巴西的CAPS这样处理MD患者的单位治疗该人群中的吸烟成瘾问题。未来的研究应调查其他MD患者样本中的治疗依从率。
