Depressive, anxious, withdrawal symptoms, and craving as possible predictors of abstinence maintenance in smokers attending a 12-week quitting program

BACKGROUND INFORMATION: Depressive, anxious, withdrawal symptoms, and craving might affect differently the probability to maintain abstinence after quitting smoking. OBJECTIVE: The objective of this study was to assess depressive, anxious, nicotine withdrawal symptoms, and craving in a sample of smokers attending a smoking cessation program over a period of 12 weeks. METHODS: A naturalistic study was conducted in which 78 smokers were consecutively recruited for a 12 week evaluation program. Socio-demographic data and clinical information were collected, rating scales were used to assess anxious and depressive symptoms, nicotine dependence, withdrawal symptoms, and craving. RESULTS: Of the 78 recruited smokers, 17 remained abstinent and 61 reverted to smoking during the period of 12 weeks. The probability of maintaining abstinence was increased when low depressive symptoms or low craving occurred during the cessation program. CONCLUSION: The present results strengthen the importance of assessing depressive symptoms and craving over the follow-up of a physician-assisted smoking cessation program to detect abstaining smokers at risk to relapse

Nicotine dependence and psychological distress: outcomes and clinical implications in smoking cessation

Nicotine dependence is characteristically a chronic and relapsing disease. Although 75%–85% of smokers would like to quit, and one-third make at least three serious lifetime attempts, less than 50% of smokers succeed in stopping before the age of 60. Relevant and complex factors contributing to sustained cigarette consumption, and strongly implicated in the clinical management of smokers, are the level of nicotine dependence and psychological distress. In this review of the literature, these two factors will be examined in detail to show how they may affect smoking cessation outcome and to encourage clinicians to assess patients so they can offer tailored support in quitting smoking

Biological Challenge Procedures Used to Study Co-occurring Nicotine Dependence and Panic Disorder

A wide array of biological challenge procedures – including carbon dioxide inhalation, hyperventilation, and breath holding – have been used to model panic in laboratory settings. Originally used to study developmental processes in panic disorder (PD), these procedures, along with nicotine patch administration and self-administered smoking, have recently been applied to help understand the etiology of co-occurring nicotine dependence and PD. The goals of the present paper are to review studies that have employed biological challenges to study the comorbid condition, identify the advantages and limitations of the various procedures, describe desirable outcome measures for use in biological challenges, and present recommendations for future challenge studies in this field. We argue that biological challenges, though in need of standardization, are useful for studying the development, maintenance, prevention, and treatment of comorbid nicotine dependence and PD

Clinimetric properties of the 21-item Depression, Anxiety and Stress Scales (DASS-21)

Background: The Depression, Anxiety and Stress Scale-21 (DASS-21) is a widely used patient-reported outcome measure. While psychometric properties of the DASS-21 have been studied, insufficient attention has been devoted to the assessment of its clinimetric properties. This study verified the clinimetric properties of the Italian version of the DASS-21 according to Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria. Methods: This is a cross-sectional study involving 951 university students from April to September 2020. Participants were asked to fill in the DASS-21 via an online survey. Participation was voluntary. Item Response Theory (IRT) models were used to test dimensionality, scalability, and sensitivity of DASS-21. Results: IRT analyses showed that the DASS-21 total score was a multidimensional measure of psychological distress. Fit to the Rasch model was achieved after excluding five misfitting items and adjusting the sample size, resulting in a 16-item version of the DASS-21. The 16-item version entailed the clinimetric property of sensitivity but included inter-correlated items. Brief versions of the DASS-21 subscales of depression, anxiety, and stress, which did not include locally dependent items, fitted the Rasch model expectations, and had an acceptable unidimensionality and scalability, were identified. Conclusion: The 16-item version of the DASS-21 may be used as an overall indicator of dysthymia and should be supplemented with the brief versions of the depression, anxiety, and stress subscales, which were found to be valid clinimetric indices

Mental Pain as a Transdiagnostic Patient-Reported Outcome Measure

Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies