Interventions for smoking cessation and reduction in individuals with schizophrenia

 

Abstract

Background

Patients with schizophrenia smoke more heavily than the general population and this contributes to their higher morbidity and mortality from smoking-related illnesses. It remains unclear what interventions can help them to quit or reduce smoking.

Objectives

To evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia.

Search methods

We searched the Cochrane Tobacco Addiction Group Specialized Register and electronic databases including MEDLINE, EMBASE and PsycINFO from inception to April 2010.

Selection criteria

We included randomized trials for smoking cessation or reduction, comparing any pharmacological or non-pharmacological intervention with placebo or with another therapeutic control in adult smokers with schizophrenia or schizoaffective disorder.

Data collection and analysis

Two reviewers independently assessed the eligibility and quality of trials and extracted data. Outcome measures included smoking abstinence, reduction in the amount smoked and any change in mental state. We extracted abstinence and reduction data at the end of treatment and at least six months after the intervention. We used the most rigorous definition of abstinence or reduction and biochemically validated data where available. Any reported adverse events were noted. Where appropriate, we pooled data using a random effects model.

Main results

We included 21 trials (11 trials of smoking cessation; four trials of smoking reduction; one trial for relapse prevention; five trials reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta-analysis showed that smoking cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, N=340; risk ratio [RR] 2.84; 95% confidence interval [CI] 1.61 to 4.99) and after six months (five trials, N=214, RR 2.78; 95% CI 1.02 to 7.58). Expired carbon monoxide (CO) level and the number of cigarettes smoked daily were significantly lower with bupropion at the end of therapy but not after six months.  There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo group. There was no report of major adverse event such as seizures with bupropion.

Contingent reinforcement (CR) with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits are maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including nicotine replacement therapy (NRT)) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking.

Authors' conclusions

Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardising their mental state. Bupropion may also reduce the amount these patients smoke. CR may help this group of patients to quit and reduce smoking. We failed to find convincing evidence that other interventions have a beneficial effect on smoking behaviour in schizophrenia.

 

Plain language summary

Are there any effective interventions to help individuals with schizophrenia to quit or to reduce smoking?

People with schizophrenia are, very often, heavy smokers. It is uncertain whether treatments that have been shown to help other groups of people to quit smoking are also effective for people with schizophrenia. In this review, we found that bupropion (an antidepressant medication previously shown to be effective for smoking cessation) helps patients with schizophrenia to quit or to reduce smoking. The effect was clear at the end of the treatment and it may also be maintained after six months. Patients who used bupropion in the trials did not experience any major adverse effect and their mental state was stable during the treatment. Smokers with schizophrenia who receive money as a reward for quitting may have a higher rate of stopping smoking whilst they get payments. However, there is no evidence that they will remain abstinent after the reward stops. There was too little evidence to show whether other treatments like nicotine replacement therapy and psychosocial interventions are helpful.

 

摘要

背景

針對精神分裂病患戒菸及減少抽菸的介入措施

患有精神分裂症的病患，通常比常人抽菸抽得更凶，這會造成其吸菸相關病症所引起的發病率及死亡率上升。目前仍不清楚，介入措施是否能幫助他們戒菸或減少抽菸。

目標

評估各種針對精神病患尼古丁依賴的治療的好處及壞處。

搜尋策略

我們搜尋了the Cochrane Tobacco Addiction Group Specialized Register以及MEDLINE、EMBASE和PsycINFO等電子資源，搜尋截止於2010年4月。

選擇標準

我們收錄了針對有吸菸的成人精神病患或情感性精神分裂病患，以任何藥理學或非藥理學的介入措施和安未劑或其他治療方式比較，討論戒菸及減少抽菸的隨機對照試驗。

資料收集與分析

2未回顧作者分別評估是雁的品質及可用性，並擷取數據。結果量測包括戒菸、菸癮的降低極精神狀態的轉變。我們分別在治療結束以及實施介入措施6個月後，擷取戒菸及減少抽菸的數據。我們套用最嚴謹的戒菸或減少抽菸的定義，並取得生化確效數據。所有有回報的不良反應都會紀錄。在適合的部分，會利用隨機效果模式匯集數據。

主要結論

我們收錄了21篇試驗 (11篇針對戒菸做討論；4篇討論減少抽菸；1篇討論煙癮復發的預防；5篇回報其它目的的介入措施的菸癮相關結果) 。7篇試驗以bupropion和安慰劑做比較；整合分析結果顯示，比起安慰劑，使用bupropion在治療結束後 (seven trials, N = 340; risk ratio [RR] 2.84; 95% confidence interval [CI] 1.61 to 4.99) 及治療結束後6個月 (five trials, N = 214, RR 2.78; 95% CI 1.02 to 7.58) 的戒菸率顯著較高。使用bupropion，在治療結束後，呼氣的一氧化碳濃度及每日抽菸數量也有顯著減少。使用bupropion及安慰劑的組別間，在正向、負向症狀及憂鬱症狀方面，沒有顯著差距。沒有任何關於主要不良反應，例如bupropion引發的痙攣的發生。利用金錢作為隨音強化 (CR) 可能可以增加精神分裂病患的戒菸率以及吸菸減少率。然而，目前仍不確定這樣的作法是否能使病患長期禁菸。目前缺乏關於以其它藥物療法 (包括尼古丁替態療法 (NRT)) ，及精神社會介入措施，能幫助精神病患戒菸或減少抽菸的證據。

作者結論

Bupropion可以提升精神病患的戒菸率，且不會對病患的精神狀況造成危害。Bupropion可能可以減少這些病患的抽菸數量。CR可以幫助這些病患戒菸或減少吸菸。我們無法找到關於其它介入措施，對精神病患的抽菸行為有幫助的可靠證據。

翻譯人

本摘要由朱奕蓁翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

目前有沒有幫助精神分裂病患戒菸或減少吸菸的有效介入措施呢 患有精神分裂症的人，通常都有很重的菸癮。目前仍不確定現有的戒菸措施，對於幫助精神分裂病患是否有效。在本篇回顧中，我們發現bupropion (一種可以戒菸的抗憂鬱藥物) 可以幫助精神分裂病患戒菸或減少抽菸。在治療結束後，戒菸效果很顯著，而且可以維持6個月。試驗中使用bupropion的病患都沒有發生不良反應，且治療過程中精神狀態都很穩定。以金錢作為戒菸獎賞的病患，在有獎賞的期間有很高的戒菸率。但目前沒有證據，能證明他們在停止獎勵後不會繼續抽菸。目前所擁有的證據太少，以致於無法判斷像尼古丁替代療法等其它治療，以及精神社會介入措施是否有效。