Mental Health Service, VA San Diego Healthcare System, San Diego, CA, USA.
Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA.
Nicotine Tob Res. 2021 Aug 29;23(10):1646-1655. doi: 10.1093/ntr/ntab056.
Psychiatric and substance use disorders represent barriers to smoking cessation. We sought to identify correlates of psychiatric comorbidity (CM; 2 diagnoses) and multimorbidity (MM; 3+ diagnoses) among smokers attempting to quit and to evaluate whether these conditions predicted neuropsychiatric adverse events (NPSAEs), treatment adherence, or cessation efficacy (CE).
Data were collected from November 2011 to January 2015 across sixteen countries and reflect the psychiatric cohort of the EAGLES trial. Participants were randomly assigned to receive varenicline, bupropion, nicotine replacement therapy, or placebo for 12 weeks and were followed for an additional 12 weeks posttreatment. NPSAE outcomes reflected 16 moderate-to-severe neuropsychiatric symptom categories, and CE outcomes included continuous abstinence at weeks 9-12 and 9-24.
Of the 4103 participants included, 36.2% were diagnosed with multiple psychiatric conditions (20.9% CM, 15.3% MM). Psychiatric CM and MM were associated with several baseline factors, including male gender, nonwhite race or ethnicity, more previous quit attempts, and more severe mental health symptoms. The incidence of moderate-to-severe NPSAEs was significantly higher (p < .01) in participants with MM (11.9%) than those with CM (5.1%) or primary diagnosis only (4.6%). There were no significant (ps > .05) main effects or interactions with treatment condition for diagnostic grouping on treatment adherence or CE outcomes.
While having multiple psychiatric diagnoses increased risk of developing moderate-to-severe NPSAEs during a quit attempt, neither CM nor MM were associated with treatment adherence or odds of quitting. These findings reassure providers to advise smokers with multiple stable psychiatric conditions to consider using Food and Drug Administration (FDA)-approved medications when trying to quit.
Psychiatric MM may be associated with development of NPSAEs when smokers make a medication-assisted quit attempt, but it does not appear to be differentially associated with medication compliance or efficacy. Prescribing healthcare professionals are encouraged to not only promote use of FDA-approved pharmacotherapies by smokers with complex psychiatric presentations, but also to closely monitor such smokers for neuropsychiatric side effects that may be related to their mental health conditions.
NCT #: NCT01456936.
精神和物质使用障碍是戒烟的障碍。我们试图确定试图戒烟的吸烟者的精神共病（2 种诊断）和多种疾病（3 种及以上诊断）的相关因素，并评估这些情况是否预测神经精神不良事件（NPSAEs）、治疗依从性或戒烟效果（CE）。
数据于 2011 年 11 月至 2015 年 1 月在 16 个国家收集，反映了 EAGLES 试验的精神病队列。参与者被随机分配接受伐伦克林、安非他酮、尼古丁替代疗法或安慰剂治疗 12 周，并在治疗后再随访 12 周。NPSAE 结果反映了 16 种中度至重度神经精神症状类别，CE 结果包括第 9-12 周和第 9-24 周连续戒烟。
在纳入的 4103 名参与者中，36.2%被诊断患有多种精神疾病（20.9%的 CM，15.3%的 MM）。精神科 CM 和 MM 与多种基线因素相关，包括男性性别、非白种人或种族、更多的既往戒烟尝试和更严重的心理健康症状。患有多种疾病（MM）的参与者发生中度至重度 NPSAEs 的发生率明显更高（p<.01）（11.9%），而患有 CM（5.1%）或原发性诊断的参与者发生率较低（4.6%）。治疗组对治疗依从性或 CE 结果的诊断分组没有显著的（p>.05）主效应或相互作用。
虽然患有多种精神诊断会增加在戒烟尝试中发生中度至重度 NPSAEs 的风险，但 CM 或 MM 均与治疗依从性或戒烟几率无关。这些发现使提供者放心，建议患有多种稳定精神疾病的吸烟者在尝试戒烟时考虑使用食品和药物管理局（FDA）批准的药物。
当吸烟者尝试药物辅助戒烟时，精神科多种疾病可能与 NPSAEs 的发展相关，但它似乎与药物依从性或疗效无差异相关。鼓励处方医疗保健专业人员不仅要促进有复杂精神表现的吸烟者使用 FDA 批准的药物治疗，还要密切监测这些吸烟者可能与心理健康状况相关的神经精神副作用。
NCT #: NCT01456936.
