Department of Psychiatry, Monklands Hospital, Airdrie, UK.
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
BMJ Open. 2019 Nov 28;9(11):e027389. doi: 10.1136/bmjopen-2018-027389.
Smoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness.
A systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration's tool for assessing the risk of bias.
Twenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low.
The new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.
在患有严重精神疾病的人群中吸烟是一个主要的公共卫生问题，导致了相当程度的发病率和死亡率。本综述的目的是系统地评估有助于患有严重精神疾病的人群戒烟的方法的疗效。
对比较严重精神疾病患者使用药物和行为干预戒烟的随机对照试验进行系统评价和荟萃分析。检索了截止到 2018 年 7 月的电子数据库。我们使用 Cochrane 协作组的偏倚风险评估工具。
确定了 28 项随机对照试验。在 3 个月时（风险比 (RR) 3.56，95%置信区间 1.82 至 6.96，p=0.0002）和 6 个月时（RR 3.69，95%置信区间 1.08 至 12.60，p=0.04），伐伦克林增加了戒烟的可能性。在 3 个月时（RR 3.96，95%置信区间 1.86 至 8.40，p=0.0003），安非他酮有效，尤其是 300mg/天的剂量，但在 6 个月时没有效果（RR 2.22，95%置信区间 0.52 至 9.47，p=0.28）。在一项小型研究中，尼古丁治疗在增加 3 个月的戒烟率方面被证明是有效的。与尼古丁替代疗法联合使用安非他酮比单独使用效果更好。行为和定制干预措施总体上没有带来明显的益处。发现副作用较低。
本综述的新信息是伐伦克林在 3 个月和 6 个月时戒烟的有效性，以及没有证据支持使用安非他酮和尼古丁产品来维持 3 个月以上的持续戒断。总的来说，在这一人群中，研究相对较少。
