1 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
2 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2018 Mar;52(3):239-252. doi: 10.1177/0004867417714336. Epub 2017 Jun 14.
People living with psychotic disorders (schizophrenia spectrum and bipolar disorders) have high rates of cardiovascular disease risk behaviours, including smoking, physical inactivity and poor diet. We report cardiovascular disease risk, smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm randomised controlled trial among smokers with psychotic disorders.
Participants ( N = 235) drawn from three sites were randomised to receive nicotine replacement therapy plus (1) a Healthy Lifestyles intervention delivered over approximately 9 months or (2) a largely telephone-delivered intervention (designed to control for nicotine replacement therapy provision, session frequency and other monitoring). The primary outcome variables were 10-year cardiovascular disease risk and smoking status, while the secondary outcomes included weekly physical activity, unhealthy eating, waist circumference, psychiatric symptomatology, depression and global functioning.
Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions, with no significant differences between conditions. One-quarter (25.5%) of participants reported reducing cigarettes per day by 50% or more at multiple post-treatment assessments; however, few (8.9%) managed to sustain this across the majority of time points. Changes in other health behaviours or lifestyle factors were modest; however, significant improvements in depression and global functioning were detected over time in both conditions. Participants experiencing worse 'social discomfort' at baseline (e.g. anxiety, mania, poor self-esteem and social disability) had on average significantly worse global functioning, lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference.
Although the telephone-delivered intervention was designed as a comparison condition, it achieved excellent retention and comparable outcomes. Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders. Discomfort in social situations may also be a useful target for future health interventions, addressing confidence and social skills, and promoting social networks that reduce inactivity.
患有精神病障碍（精神分裂症谱系和双相情感障碍）的人患心血管疾病风险行为的比率较高，包括吸烟、身体活动不足和不良饮食。我们报告了在招募患有精神病障碍的吸烟者参加一项为期 36 个月的双臂随机对照试验后 36 个月内的心血管疾病风险、戒烟和其他风险行为结果。
从三个地点招募的参与者（n=235）被随机分配接受尼古丁替代疗法加（1）大约 9 个月的健康生活方式干预或（2）主要通过电话提供的干预（旨在控制尼古丁替代疗法的提供、会议频率和其他监测）。主要结局变量是 10 年心血管疾病风险和吸烟状况，而次要结局包括每周身体活动、不健康饮食、腰围、精神病症状、抑郁和总体功能。
在 36 个月的随访期间，两种干预条件下的心血管疾病风险和吸烟均显著降低，且条件之间无显著差异。四分之一（25.5%）的参与者报告在多次治疗后评估中每天减少 50%或更多的香烟；然而，很少有人（8.9%）能够在大多数时间点维持这种状态。其他健康行为或生活方式因素的变化不大；然而，在两种情况下，抑郁和总体功能随着时间的推移都有显著改善。在基线时经历更严重“社交不适”（如焦虑、躁狂、自尊心差和社会残疾）的参与者平均而言，总体功能更差，12 项简短健康调查身体量表得分更低，腰围更大。
尽管电话提供的干预措施被设计为对照条件，但它实现了极好的保留率和可比的结果。电话提供的戒烟支持可能有助于降低精神病障碍患者的吸烟率。社交场合的不适也可能是未来健康干预的一个有用目标，解决信心和社交技能问题，并促进减少不活动的社交网络。
