Cather Corinne, Pachas Gladys N, Cieslak Kristina M, Evins A Eden
Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA.
Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
CNS Drugs. 2017 Jun;31(6):471-481. doi: 10.1007/s40263-017-0438-8.
Premature mortality due to cardiovascular disease in those with schizophrenia is the largest lifespan disparity in the US and is growing; adults in the US with schizophrenia die, on average, 28 years earlier than those in the general population. The rate of smoking prevalence among individuals with schizophrenia is estimated to be from 64 to 79%. Smokers with schizophrenia have historically been excluded from most large nicotine-dependence treatment studies. However, converging evidence indicates that a majority of smokers with schizophrenia want to quit smoking, and that available pharmacotherapeutic smoking cessation aids are well tolerated by this population of smokers and are effective when combined with behavioral treatment. The aim of this review is to present updated evidence for safety and efficacy of smoking cessation interventions for those with schizophrenia spectrum illness. We also highlight implications of the very low abstinence rates for smokers with schizophrenia who receive placebo plus behavioral treatment in randomized trials, and review treatment approaches to address the high rate of rapid relapse observed upon pharmacologic treatment discontinuation in this population. Recommendations for monitoring for treatment-emergent nicotine withdrawal symptoms, side effects, and effects of cessation on antipsychotic medication are also provided. Smokers with schizophrenia spectrum disorders should be encouraged to quit smoking and should receive varenicline, bupropion with or without nicotine replacement therapy (NRT), or NRT, all in combination with behavioral treatment for at least 12 weeks. Maintenance pharmacotherapy may reduce relapse and improve sustained abstinence rates. Controlled trials in smokers with schizophrenia consistently show no greater rate of neuropsychiatric adverse events with pharmacotherapeutic cessation aids than with placebo.
在美国，精神分裂症患者因心血管疾病导致的过早死亡是最大的寿命差距，且这一差距正在扩大；美国成年精神分裂症患者的平均死亡年龄比普通人群早28年。据估计，精神分裂症患者的吸烟率在64%至79%之间。历史上，大多数大型尼古丁依赖治疗研究都将精神分裂症吸烟者排除在外。然而，越来越多的证据表明，大多数精神分裂症吸烟者想要戒烟，而且现有的药物戒烟辅助手段在这群吸烟者中耐受性良好，与行为治疗相结合时也很有效。本综述的目的是为精神分裂症谱系疾病患者的戒烟干预措施的安全性和有效性提供最新证据。我们还强调了在随机试验中接受安慰剂加行为治疗的精神分裂症吸烟者极低的戒烟率的影响，并回顾了针对该人群停药后观察到的高快速复发率的治疗方法。还提供了关于监测治疗中出现的尼古丁戒断症状、副作用以及戒烟对抗精神病药物影响的建议。应鼓励患有精神分裂症谱系障碍的吸烟者戒烟，并应接受伐尼克兰、有或没有尼古丁替代疗法（NRT）的安非他酮或NRT，所有这些都与行为治疗相结合，持续至少12周。维持性药物治疗可能会减少复发并提高持续戒烟率。对精神分裂症吸烟者进行的对照试验一致表明，与安慰剂相比，药物戒烟辅助手段导致的神经精神不良事件发生率并不更高。
