Evaluation of Tobacco Treatment Strategies for Inpatient Psychiatry

摘要 本研究的总体目标是确定治疗烟草依赖的有效策略， 患有严重精神疾病的成年吸烟者住院治疗。尼古丁依赖是最普遍的物质 精神病患者中的滥用障碍，这一群体占美国人口的44%至46%， 烟草市场16，17.就花费的美元而言，这相当于每年烟草销售额390亿美元18。而 许多试验已经确定了戒烟干预对住院医疗人员的有效性。 病人，很少有研究针对急性精神病住院设置19。美国精神病学 协会的烟草治疗指南确定精神病住院治疗是一个理想的机会， 促进戒烟1.患有精神疾病的人戒烟率较低，可能缺乏动力 并准备在不久的将来退出比一般人群20 -22。因此，足够的强度，多- 需要针对尼古丁的生理和行为方面的成分干预 在戒烟过程的各个准备阶段，帮助吸烟者23。 使用三组相加设计，拟定的随机临床试验（N=1100）旨在评价 在急性精神病住院患者中开始不同强度的戒烟治疗。的 Prochaska博士的K23指导职业发展奖的基础上，并寻求确定：（i） 在学术精神病医院中看到的初步成功是否可以在更大的， 从社区医院招募更多样化的患者人群;以及（ii）如果更广泛和密集 临床医生提供的治疗可以超越我们目前的最佳实践。这三组是： (1)戒烟护理（N=150），包括简短的戒烟建议、戒烟指南和尼古丁 在住院期间提供替代品; (2)简短治疗（N=475）增加了一个基于阶段的手册，计算机提供的阶段定制的个性化 住院期间的反馈和简短的戒烟咨询会议，并在第3个月重复， 6，并在住院后获得12周的尼古丁替代; (3)扩展治疗（N=475）建立在我们目前的简短治疗，并提供12个额外的 使用个体化、咨询师提供的激励性药物进行24周尼古丁替代（共24周） 和认知行为停止治疗 我们假设，延长治疗将优于短期治疗，两个治疗组 在产生戒烟尝试和最终戒烟方面比常规护理更有效。 次要目标将模拟治疗条件的成本效益;检查调节剂， 治疗结果的介导因素;并前瞻性地检查吸烟、精神疾病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.