Structured Intervention for Smoking Cessation in Inpatients with Psychotic Disorders: Clinical Protocol and Implementation Perspectives
DOI:
https://doi.org/10.51338/rppsm.659Keywords:
Mental Disorders, Smoking Cessation, Substance Withdrawal SyndromeAbstract
Introduction: Smoking continues to be one of the main preventable causes of morbidity and mortality, with an aggravated impact in populations with severe mental disorders. Among individuals with psychotic disorders, the prevalence of smoking is significantly higher than in the general population, and is often justified by the relief of negative and cognitive symptoms. Smoking cessation in this group is therefore particularly challenging, but a clinical priority. We aimed to develop and implement a structured smoking cessation protocol aimed at patients admitted in an unit specialising in the treatment of patients with psychotic disorders, promoting improved overall health and contributing to psychiatric rehabilitation.
Methods: The protocol is based on a multi-professional approach, integrating structured clinical assessment, brief psychotherapeutic interventions and individualised pharmacological therapy. Validated psychometric instruments are used, with longitudinal assessment at different times up to 12 months after the start of the intervention.
Results: Implementing the protocol will improve smoking cessation rates, reduce psychiatric symptomatology and prevent relapse. Improvements in quality of life, control of antipsychotic medication and physical health indicators are also expected.
Conclusion: Integrating smoking cessation into psychiatric hospitalisation is a strategic therapeutic opportunity. Protocols such as the one proposed could be replicated in other clinical units, contributing to a more holistic approach to severe mental illness.
Downloads
References
McClave AK, McKnight-Eily LR, Davis SP, Dube SR. Smoking characteristics of adults with selected lifetime mental illnesses: results from the 2007 National Health Interview Survey. Am J Public Health. 2010;100:2464-72. doi: 10.2105/AJPH.2009.188136.
Tsoi DT, Porwal M, Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database Syst Rev. 2013;2013:CD007253. doi: 10.1002/14651858.CD007253.pub3.
Nunes E. Programa-tipo de atuação em cessação tabágica: Circular Normativa Nº: 26/DSPPS. Lisboa: Direcção-Geral da Saúde; 2007.
Rollemberg EV, Pires TO, Cintra MM, Correa MC, Aguiar LL, Silva DF. Abordagem Terapêutica Para Cessação do Tabagismo em Esquizofrênicos: Uma Revisão de Literatura. Rev Med Saude Brasilia 2017; 6:359-371.
Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2023: CD006103. doi: 10.1002/14651858.CD006103.pub9.
Banham L, Gilbody S. Smoking cessation in severe mental illness: what works? Addiction. 2010;105:1176-89. doi:10.1111/j.1360-0443.2010.02946.x
Rollemberg EV, Pires TO, Cintra MM, Correa MC, Aguiar LL, Silva DO. Therapeutic Approach to Cessation of Smoking in Schizophrenics: A Literature Review. Rev Med Saude Brasilia 2017; 6:359-371.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;3281519. doi: 10.1136/bmj.38142.554479.AE.
Instituto Nacional de Câncer José Alencar Gomes da Silva/Ministério da Saúde. Protocolo Clínico E Diretrizes Terapêuticas Dependência À Nicotina: Divisão de Controle do Tabagismo/Coordenação de
Baker A, Richmond R, Haile M, et al. A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. Am J Psychiatry. 2006;163:1934-42. doi:10.1176/ajp.2006.163.11.1934.
Pinho S, Rocha V, Vieira-Coelho MA. Effectiveness of multimodal interventions focused on smoking cessation in patients with schizophrenia: A systematic review. Schizophrenia Res. 2021:145-53. https://doi.org/10.1016/j.schres.2021.03.012.
Rigotti NA, Benowitz NL, Prochaska J, Leischow S, Nides M, Blumenstein B, et al. Cytisinicline for Smoking Cessation: A Randomized Clinical Trial. JAMA. 2023;330:152-60. doi:10.1001/jama.2023.10042.
Ofori S, Lu C, Olasupo OO, Dennis BB, Fairbairn N, Devereaux PJ, Mbuagbaw L. Cytisine for smoking cessation: A systematic review and meta-analysis. Drug Alcohol Depend. 2023:110936. doi:10.1016/j.drugalcdep.2023.110936.
Prochaska JO, Di Clemente CC. Transtheoretical therapy: towards a more integrative model of change. Psychotherapy.1982;19:276-288.
Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public Health. Annu Rev Public Health. 2017;38:165-85. doi:10.1146/annurev-publhealth-031816-044618.
Zanello A, Berthoud L, Ventura J, Merlo MC. The Brief Psychiatric Rating Scale (version 4.0) factorial structure and its sensitivity in the treatment of outpatients with unipolar depression. Psychiatry Res. 2013;210:626-33. doi:10.1016/j.psychres.2013.07.001.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA, et al. The Audit alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Inter Med. 1998, 16: 1789-95.
Araujo RB, Oliveira MS, Duarte Moraes JF, Pedroso RS, Port F, Tanori de Castro MG. Validation of the Brazilian version of Questionnaire of Smoking Urges- Brief. Arch Clin Psychiatry. 2007;34. doi: 10.1590/S0101-60832007000400002.
Etter J. A self-administered questionnaire to measure cigarette withdrawal symptoms: the Cigarette Withdrawal Scale. Nicotine Tob Res. 2005;7:47-57. doi: 10.1080/14622200412331328501.
Welsch SK, Smith SS, Wetter DW, Jorenby DE, Fiore MC, Baker TB. Development and validation of the Wisconsin Smoking Withdrawal Scale. Exp Clin Psychopharmacol. 1999;7:354-61. doi: 10.1037//1064-1297.7.4.354.
Pereira dos Santos JD, Silveira DV, Oliveira DF, Caiaffa WT. Instruments used to evaluate smoking habits: a systematic review. Cien Saude Coletiva, 2011;16:4707-20. doi: 10.1590/S1413-81232011001300020.
Issa JS. A new nicotine dependence score and a new scale assessing patient comfort during smoking cessation treatment. J Bras Pneumol. 2012;38:761-5. https://doi.org/10.1590/S1806-37132012000600012.
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998; 28:551-8.
