Gemma Nieva

The alternative five-factor model of personality, nicotine dependence and relapse after treatment for smoking cessation.

Personality is one of several factors that have been related to the initiation, maintenance and cessation of smoking. This paper aims to analyze the relationship between the alternative five-factor model of personality (AFFM), nicotine dependence (ND), nicotine use (NU) and cessation after twelve months of a cognitive-behavioral therapy combined with medication. In this prospective study, a sample of 103 smokers who were taking part in a workplace smoking cessation intervention, answered the Zuckerman-Kuhlman Personality Questionnaire. ND and NU were measured with the Fagerström Test for the Nicotine Dependence (FTND) and the number of cigarettes smoked per day (CPD), respectively. Tobacco cessation was self-reported at twelve months follow-up and biologically confirmed. Results varied according to gender. In men, low scores on Sociability predicted high ND and large number of CPD. In addition, low scores on Sensation Seeking and high scores on Impulsivity predicted also a high smoking rate at baseline. No personality traits were found to explain ND in women, but high Impulsivity-Sensation Seeking and General Activity predicted high CPD. Predictors of cessation also differed by gender. Apart from FTND level, high levels on Impulsivity predicted relapse in males. In women, high levels on Sociability predicted relapse. This model correctly classified two thirds of abstainers and relapsers for men and three fourths for women at 12months. Furthermore an interaction between personality and gender was observed. The AFFM appears to have a substantial power for predicting cessation. Personality assessment when beginning treatment for smoking cessation could allow incorporating strategies to improve outcomes.

Smoke-free policies in psychiatric services: identification of unmet needs

Introduction Smoke-free policies have been extended to enclosed workplaces in many countries; however, smoking continues to be commonly allowed on psychiatric premises. The aim of this study was to describe tobacco control strategies undertaken in psychiatric inpatient services and day centres in Spain. Methods This cross-sectional survey included all psychiatric service centres that offered public services in Catalonia, Spain (n=192). Managers responded to a questionnaire of 24 items that covered four dimensions, including clinical intervention, staff training and commitment, smoking area management and communication of smoke-free policies. Results A total of 186 managers (96.9%) completed the questionnaire. Results showed low tobacco control in psychiatric services: 41.0% usually intervened in patient tobacco use, 34.1% had interventional pharmacotherapy available and 38.9% had indoor smoking areas. Day centres showed the lowest implementation of tobacco control measures. Out of 186 managers, 47.3% stated that the staff had insufficient knowledge on smoking cessation interventions. Conclusions The former Spanish partial law has not been sufficiently successful in promoting tobacco control in psychiatric services. There is room for improvement in tobacco control policies, specifically in smoking interventions, staff training and resource availability.

Evaluación de la intervención mínima en tabaquismo en el ámbito hospitalario

Fundamento y objetivo Dado que la Organizacion Mundial de la Salud (OMS) recomienda incluir de forma sistematica en el trabajo clinico asistencial la intervencion minima sistematizada en tabaquismo, el objetivo principal de este articulo es averiguar en que medida dicha intervencion forma parte de la practica habitual de los profesionales sanitarios que trabajan en unidades de hospitalizacion de un hospital general de Barcelona y, en segundo lugar, determinar la prevalencia de fumadores en 5 unidades. Pacientes y metodo Dicha intervencion se evaluo a traves de un cuestionario administrado a los pacientes ingresados en el momento del alta y de los informes de alta. Resultados El 18,8% de los pacientes eran fumadores. Aunque la mayoria de los informes (72,9%) incluia la situacion relativa al tabaco, menos de una tercera parte de los pacientes (30,8%) recordaba que se les hubiera preguntado al respecto durante el ingreso. El consejo, la ayuda o la derivacion para un seguimiento fueron la excepcion. Conclusiones Cabe deducir que el tabaco sigue sin ser una prioridad a nivel hospitalario. Para lograr que la intervencion minima sistematizada que propone la OMS constituya la regla y no la excepcion, se plantea la necesidad de sensibilizar, informar y formar en intervencion minima al personal sanitario que trabaja en los hospitales.

Safety of Varenicline for Smoking Cessation in Psychiatric and Addicts Patients.

ABSTRACT The safety of varenicline in the treatment of tobacco dependence has been questioned, in psychiatric patients. However, most published studies have not included psychiatric patients. Objective: Assess the safety of varenicline for smoking cessation in patients with psychiatric disorders. Methods: This is a prospective, longitudinal, multicenter study. The sample is composed of three groups (patients with psychotic disorder, patients with alcohol dependence disorder and patients addicts in methadone maintenance treatment). Patients were recruited consecutively between September 2008 and June 2009 from 11 centers. All patients received a standardized smoking cessation program with varenicline and psychological support. Adverse events of the drug were monitored at weeks 1, 2, 4, 6, 8, and 12 of treatment. Bivariate analysis has been used. Results: None of the 90 patients included, presented a serious adverse event. The most frequent adverse effect was dry mouth (28.9%), followed by the presence of flatulence (27.8%), abnormal dreams (27.8%), and nausea (22%), especially between weeks 2 and 6 of treatment. None of the patients referred intense suicidal ideation, although two referred to moderate suicidal ideation, which was solved in one case and in the other, treatment was discontinued. Four participants (4.4%) abandoned treatment because of gastrointestinal symptoms. The initial dose of varenicline was reduced in 25% of patients during the study. Conclusions: Gastrointestinal adverse events are the most incident in this sample of psychiatric patients and no exacerbation of psychiatric symptoms was detected, thus indicating a good safety record for varenicline use for smoking cessation in psychiatric patients.

Cigarette dependence and depressive symptoms as predictors of smoking status at five-year follow-up after a workplace smoking cessation program

Workplace smoking cessation interventions increase quit rates compared to no treatment or minimal interventions. However, most studies report data up to one year. This study aims to evaluate long-term effects of a worksite smoking cessation intervention based on cognitive behavioral cessation groups combined with first-line medications, and determine to what extent cigarette dependence (FTCD) and depressive symptoms may influence results at five-year follow-up. Participants were invited to answer a short survey five years after starting the program. A total of 90.4% (n=227) of those who had attended at least one treatment session and were alive, completed the survey. At the five-year follow-up, 29.5% participants reported continuous abstinence. Low scores in the FTCD and low depressive symptoms at baseline predicted continuous abstinence. Three out of four continuous abstainers at twelve months remained abstinent at the five-year follow-up. The study shows that workplace smoking cessation interventions have long-term effects and supports the traditional one-year follow-up period to assess smoking cessation.