Evaluation of Tobacco Treatment Strategies for Inpatient Psychiatry

摘要 这项研究的总体目标是找出治疗烟草依赖的有效策略 成年吸烟者因严重的精神疾病住院。尼古丁依赖是最普遍的物质 精神病患者中的虐待障碍，这一群体在美国的比例高达44%至46% 烟草市场16，17.就花费的美元而言，这相当于每年390亿美元的烟草销售额18。而当 许多试验已经确定了戒烟干预对住院医生的有效性 患者方面，很少有研究针对急性精神病住院患者19。《美国精神病学》 协会的烟草治疗指南将精神科住院确定为 促进戒烟1.患有精神疾病的人戒烟率较低，也可能缺乏动力 而准备在不久的将来辞职的人比一般人多20-22人。因此，足够强烈，多- 需要针对尼古丁的生理和行为方面的成分干预 在戒烟过程中，在戒烟的所有阶段对吸烟者进行依赖和协助。 采用三组相加设计，建议的随机临床试验(N=1100)旨在评估 不同强度的戒烟治疗在急性精神科住院患者中开始。这个 该提案以普罗查斯卡博士的K23指导职业发展奖为基础，旨在确定：(I) 在以学术为基础的精神病院看到的最初成功是否可以在更大和更大的 从社区医院招募更多样化的患者群体；以及(Ii)如果更广泛和更密集 临床医生提供的治疗可以超越我们目前的最佳实践。这三个小组是： (1)常规护理(N=150)，包括简短的戒烟建议、戒烟指南和尼古丁 住院期间提供的更换； (2)简单治疗(N=475)增加了基于阶段的手册，计算机交付的阶段定制的个性化 住院期间的反馈和短暂的戒烟咨询会议，并在3个月和3个月重复 6，并在住院后获得12周的尼古丁替代； (3)延长治疗(N=475)是在我们目前的短期治疗的基础上发展起来的，并提供了12个额外的治疗 为期数周的尼古丁替代疗法(共24周)，辅导员提供个性化的激励疗法 并手动进行认知行为戒断治疗。 我们假设延长治疗的效果将优于短期治疗，并且两个治疗组 在戒烟尝试和最终戒烟方面将比通常的护理更有效。 二级目标将对治疗条件的成本效益进行建模；审查主持人和 治疗结果的中介因素；并前瞻性地检查吸烟、精神变化和精神疾病之间的关系 健康功能，以及随着时间的推移使用其他物质。

ABSTRACT The overall goal of this research is to identify efficacious strategies for treating tobacco dependence among adult smokers hospitalized with severe mental illness. Nicotine dependence is the most prevalent substance abuse disorder among psychiatric patients, a group that accounts for a staggering 44% to 46% of the US tobacco market16, 17. In terms of dollars spent, this equates to $39 billion in annual tobacco sales18. While numerous trials have established the effectiveness of smoking cessation interventions for hospitalized medical patients, little research has targeted the acute psychiatric inpatient setting19. The American Psychiatric Association's tobacco treatment guidelines identify psychiatric hospitalization as an ideal opportunity for promoting smoking cessation1. Individuals with mental illness have lower quit rates and may be less motivated and prepared to quit in the near future than the general population20-22. Thus, sufficiently intense, multi- component interventions are needed that address both the physiological and behavioral aspects of nicotine dependence and assist smokers at all stages of readiness through the quitting process23. Using a three group additive design, the proposed randomized clinical trial (N=1100) aims to evaluate tobacco cessation treatments of varying intensities initiated in the acute psychiatric inpatient setting. The proposal builds upon Dr. Prochaska's K23 mentored career development award and seeks to determine: (i) whether the initial successes seen in an academic-based psychiatric hospital can be replicated in a larger and more diverse patient population recruited from a community hospital; and (ii) if more extended and intensive clinician-delivered treatment can outperform our current best practices. The three groups are: (1) Usual Care (N=150) consisting of brief cessation advice, a quit smoking guide, and nicotine replacement provided during hospitalization; (2) Brief Treatment (N=475) adds a stage-based manual, computer-delivered stage-tailored individualized feedback and brief cessation counseling sessions during hospitalization and repeated at months 3 and 6, and access to 12 weeks of nicotine replacement following hospitalization; (3) Extended Treatment (N=475) builds upon our current brief treatment and provides 12 additional weeks of nicotine replacement (24 weeks total) with individualized, counselor-delivered motivational and manualized cognitive behavioral cessation treatment. We hypothesize that the extended treatment will outperform the brief treatment, and that both treatment groups will be more effective than usual care in producing quit attempts and ultimately abstinence from cigarettes. Secondary aims will model the cost-effectiveness of the treatment conditions; examine moderators and mediators of treatment outcomes; and prospectively examine the relation between changes in smoking, mental health functioning, and use of other substances over time.