University of Kentucky College of Nursing, Lexington, KY 40536, USA.
University of Kentucky College of Medicine, Lexington, KY, USA.
Addict Behav. 2018 Oct;85:131-138. doi: 10.1016/j.addbeh.2018.06.005. Epub 2018 Jun 7.
Psychiatric patients have high tobacco use prevalence, dependence, and withdrawal severity. A tobacco-free psychiatric hospitalization necessitates the management of nicotine withdrawal (NW) for tobacco using patients. NW management often requires the provision of approved nicotine replacement therapy (NRT) to patients, which may also motivate tobacco users towards cessation. However, few studies have examined the associations between providing NRT, motivation to quit, and NW among psychiatric patients.
OBJECTIVE(S): To examine the associations between providing NRT at admission and motivation to quit smoking and severity of NW symptoms.
A retrospective review of the medical records of 255 tobacco using patients on whom NW was assessed during their hospital stay. The time when NRT was provided (i.e., at admission vs. not provided vs. on the unit), motivation to quit smoking, and 8-item Minnesota Nicotine Withdrawal Scale were assessed.
The primary NW symptom was 'craving' (65.1%); reporting of 'anxiety' varied by psychiatric diagnosis. Providing NRT at admission was not associated with motivation to quit. Patients receiving NRT on the unit (i.e., delayed receipt) had significantly higher NW than those who received NRT at admission. In multivariate analyses, receiving NRT on the unit was significantly associated with greater NW severity (β = .19, p = .002).
Among psychiatric patients, providing NRT at admission is associated with greater severity of NW. The provision of NRT for NW management may be considered as standard practice during tobacco-free psychiatric stays. Future studies may consider the effect of other tobacco treatment medications (such as varenicline, bupropion) on managing NW.
精神科患者的吸烟率、依赖率和戒断严重程度都很高。要实现精神病院的全面禁烟，就必须管理使用烟草的患者的尼古丁戒断（Nicotine Withdrawal，NW）症状。NW 管理通常需要为患者提供经过批准的尼古丁替代疗法（Nicotine Replacement Therapy，NRT），这也可能促使吸烟者戒烟。然而，很少有研究探讨为精神科患者提供 NRT、戒烟动机与 NW 之间的关系。
探讨入院时提供 NRT 与戒烟动机和 NW 症状严重程度之间的关系。
回顾性分析了 255 名使用烟草的患者的病历，这些患者在住院期间接受了 NW 评估。评估入院时是否提供 NRT（即提供、未提供或在病房提供）、戒烟动机以及 8 项明尼苏达州尼古丁戒断量表（Minnesota Nicotine Withdrawal Scale）。
主要的 NW 症状是“渴望”（65.1%）；不同的精神科诊断报告的“焦虑”情况不同。入院时提供 NRT 与戒烟动机无关。在病房内（即延迟提供）接受 NRT 的患者的 NW 严重程度明显高于入院时接受 NRT 的患者。多变量分析显示，在病房内接受 NRT 与 NW 严重程度显著相关（β=0.19，p=0.002）。
在精神科患者中，入院时提供 NRT 与 NW 严重程度增加有关。在全面禁烟的精神科住院期间，为 NW 管理提供 NRT 可被视为标准做法。未来的研究可能会考虑其他烟草治疗药物（如伐尼克兰、安非他酮）对 NW 管理的影响。
