Tobacco smoking and nicotine dependence in first episode and established psychosis
Tobacco smoking and nicotine dependence in first episode and established psychosis
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DOI：
10.1016/j.ajp.2019.05.002
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发表时间：
2019-06-01
影响因子：
9.5
通讯作者：
Gaughran, Fiona
中科院分区：
文献类型：
--
作者：
Lally, John;Spaducci, Gilda;Gaughran, Fiona
目的：与一般人群相比，精神病患者的过早死亡率增加，高吸烟率是一个促成因素。我们的目的是描述香烟使用和尼古丁依赖（ND）在首发精神病（FEP）和确诊精神病中的患病率；并调查临床症状与ND之间的关系。方法：吸烟和临床数据从两个队列中收集：181名FEP患者作为首次发病精神病的身体健康和物质使用测量（PUMP）研究的一部分招募，以及432名确诊精神病患者作为改善身体健康和减少精神病药物使用随机对照试验（IMPaCT RCT）的一部分招募。结果：FEP患者吸烟的患病率为78%，确诊精神病患者为62%。FEP队列中49% （n = 60）的吸烟者和69% （n = 183）的确诊精神病吸烟者高度依赖尼古丁。高度尼古丁依赖吸烟者与较高的PANSS阳性症状得分显著相关（F = 5.480 p = 0.004），与已确诊精神病的Rosenberg自尊量表得分降低（F = 3.261, p = 0.039）显著相关。两组均未发现与吸烟或ND相关的诊断特异性。结论：高吸烟率和尼古丁依赖是精神病早期存在的问题。ND在已确诊精神病患者中更高。戒烟策略作为精神疾病每一阶段综合管理的一部分，需要进一步发展和评估。
Aim: People with psychotic disorders have increased premature mortality in comparison with the general population, with high rates of cigarette use a contributing factor. We aimed to describe the prevalence of cigarette use and nicotine dependence (ND) in first episode psychosis (FEP), and established psychosis; and to investigate associations between clinical symptoms and ND.Methodology: Smoking and clinical data were collected from two cohorts: 181 people with FEP recruited as part of the Physical Health and Substance Use Measures in First Onset Psychosis (PUMP) study and from 432 people with established psychosis recruited as part of the Improving physical health and reducing substance use in psychosis randomised controlled trial (IMPaCT RCT).Results: The prevalence of cigarette smoking was 78% in FEP and 62% in established psychosis. Forty nine percent (n = 60) of smokers in the FEP cohort and 69% (n = 183) of smokers with established psychosis were highly nicotine dependent. Being a highly nicotine dependent smoker was significantly associated with higher PANSS positive symptom scores (F = 5.480 p = 0.004), and with decreased scores on the Rosenberg self-esteem scale (F = 3.261, p = 0.039) in established psychosis. There was no diagnostic specificity identified in relation to smoking or ND in both groups.Conclusion: High rates of cigarette usage and nicotine dependence are problems from the early stages of psychosis. ND is higher in people with established psychosis. Smoking cessation strategies as part of comprehensive management of psychotic disorders at every stage require further development and evaluation.