Monday, April 15, 2019

Smoking Cessation Program Tailored to Patients With SMI Reduces Smoking, Improves Health

A smoking cessation intervention tailored to people with severe mental illness (SMI) such as schizophrenia can lead to reduced smoking and improved physical health in the short term, reports a study published in Lancet Psychiatry.

Compared with patients with SMI who received standard smoking cessation treatment, patients who received the tailored intervention that combined behavioral and pharmacological therapy were more than twice as likely to have successfully quit smoking at six months. These improvements, however, were maintained by only 15% of the patients at the 12-month mark.

“The results of the SCIMITAR+ [Smoking Cessation Intervention for Severe Mental Illness] trial will be helpful in informing clinical practice, since we have shown that quitting can be achieved for people who use mental health services just as it can for the general population of smokers,” wrote Simon Gilbody, D.Phil., of the University of York and colleagues. “Clinicians should therefore ask all of their patients about smoking status and offer referrals to effective smoking cessation services.”

The study included 526 adults with SMI (which included schizophrenia, schizoaffective disorder, and bipolar disorder) who smoked at least five cigarettes a day. All study participants expressed an interest in reducing or quitting smoking. The participants were randomly assigned to receive usual care (access to smoking cessation medications and a telephone helpline) or a tailored cessation intervention for 12 months. The tailored intervention included cessation medications and behavioral therapy adapted to meet the needs of people with SMI; these adaptations included providing assessments and nicotine replacement before setting a quit date, providing home visits, and providing additional face-to-face support following smoking relapse.

The tailored intervention was well received; 234 of the 265 participants (88%) assigned to the intervention attended at least one therapeutic session over 12 months, with an average attendance of 6.4 sessions. After six months, 14% of the participants in the intervention group had successfully quit (which was confirmed with a carbon monoxide breath test) compared with 6% of participants in the usual care group. At 12 months, the participants in the intervention group maintained a higher quit rate compared with usual care (15% versus 10%), though the difference was no longer statistically significant.

“This finding is in line with research in the general population that shows that long-term cessation of smoking is difficult to achieve and remains a challenge in treatment for nicotine dependence in any population,” Gilbody and colleagues wrote.

Among secondary assessments, physical health scores were higher in the intervention group compared with the usual care group after six months, though this improvement also disappeared after 12 months. There were no differences in depression or anxiety scores between the two groups at either six or 12 months, which the authors noted as supportive evidence that smoking cessation interventions are not detrimental to mental health.

For related information, see the Psychiatric News article “Schizophrenia Patients Show Cognitive Improvements After Smoking Cessation.”

(Image: iStock/Sezeryadigar)


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