Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

Mental disorders; Smoking cessation; TelephoneMalalties mentals; Deixar de fumar; TelèfonEnfermedades mentales; Dejar de fumar; TeléfonoBACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System

Vareniclina en el tratamiento del tabaquismo: efi cacia y seguridad en población general, psiquiátrica y drogodependiente

Desde el año 2006 la vareniclina se está utilizando como tratamiento de primera elección para dejar de fumar. La mayoría de estudios publicados sobre efi cacia y seguridad de este producto se han hecho sobre muestras de fumadores sanos. El presente trabajo es una revisión de estudios publicados que aportan datos sobre efi cacia y seguridad de vareniclina en tres tipos de población: población general, psiquiátrica y drogodependiente. En población general se presentan los resultados sobre efi cacia en comparación a placebo, Terapia Sustitutiva de Nicotina y Bupropion. Se valoran los estudios relacionados con la seguridad que tratan sobre los efectos adversos psiquiátricos de la medicación. En población psiquiátrica y población drogodependiente se valoran las conclusiones de los pocos estudios relacionados con el tema. Se concluye que la efi cacia y la seguridad de vareniclina en población general están confi rmadas. Destaca la escasez de estudios controlados realizados con población psiquiátrica y drogodependiente. Se recomienda monitorizar bien los pacientes psiquiátricos y drogodependientes que tomen este fármaco.Varenicline has been used as a fi rst-line treatment for smoking cessation since 2006, but most studies to date on its effi cacy and safety have been conducted in samples of healthy smokers. This paper reviews published studies about the effi cacy and safety of varenicline in three types of population: the general population, psychiatric patients and drug addicts. In the general population we present the results of effi cacy of varenicline compared to placebo, nicotine replacement therapy and bupropion. Results about neuropsychiatric adverse events are also presented. In psychiatric patients and drug-dependent population we present the conclusions of the few studies on the topic. Our fi ndings confi rmed the effi cacy of varenicline in the general population and emphasize the paucity of controlled studies in psychiatric and drug addict populations. We thus recommend that treatment should be monitored in these latter populations

Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients: A one-year follow-up

Introduction: Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders. Methods: This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables. Results: The probability of abstinence at one year was 0.225 (95% CI: 0.143- 0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098- 0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01). Conclusions: The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients

Anchor Side Chains of Short Peptide Fragments Trigger Ligand-Exchange of Class II MHC Molecules

Class II MHC molecules display peptides on the cell surface for the surveillance by CD4+ T cells. To ensure that these ligands accurately reflect the content of the intracellular MHC loading compartment, a complex processing pathway has evolved that delivers only stable peptide/MHC complexes to the surface. As additional safeguard, MHC molecules quickly acquire a ‘non-receptive’ state once they have lost their ligand. Here we show now that amino acid side chains of short peptides can bypass these safety mechanisms by triggering the reversible ligand-exchange. The catalytic activity of dipeptides such as Tyr-Arg was stereo-specific and could be enhanced by modifications addressing the conserved H-bond network near the P1 pocket of the MHC molecule. It affected both antigen-loading and ligand-release and strictly correlated with reported anchor preferences of P1, the specific target site for the catalytic side chain of the dipeptide. The effect was evident also in CD4+ T cell assays, where the allele-selective influence of the dipeptides translated into increased sensitivities of the antigen-specific immune response. Molecular dynamic calculations support the hypothesis that occupation of P1 prevents the ‘closure’ of the empty peptide binding site into the non-receptive state. During antigen-processing and -presentation P1 may therefore function as important “sensor” for peptide-load. While it regulates maturation and trafficking of the complex, on the cell surface, short protein fragments present in blood or lymph could utilize this mechanism to alter the ligand composition on antigen presenting cells in a catalytic way

Characteristics of patients admitted to a detoxification unit interested in tobacco cessation

Introduction The prevalence of tobacco use is high in patients with other addictions. Morbidity and mortality associated with smoking are often higher than those produced by the “principal” drug. The Tobacco Detoxification-Mental Health Program (PDT-SM) is carried out in a smoke-free-inpatient detoxification unit of a general hospital. The intervention begins during hospitalization and continues for patients who wish maintain cessation after discharge. The purposes of the intervention are to increase awareness of tobacco risk, reinforce motivation for cessation and guarantee the continuity of smoking cessation in an outpatient setting. Methods Population: smokers admitted for inpatient detoxification of other substance (October 2013-December 2017). At admission, data regarding smoking history and carbon monoxide (CO) in exhaled breath is obtained. Nicotine substitution is offered. During the hospitalization, weekly motivational group is carried out. Interested patients are referred to an outpatient specialized facility. They continue a free pharmacological and psychological treatment for one year. Results 166 patients were interested (14,5% of all smokers admitted), 66.3% men, mean age 46.5 years (SD 10). Patients with alcohol (46.4%) and cocaine (17.5%) addiction were the most interested. Depressive Disorder (18.1%) was the principal comorbidity. Average age of onset of tobacco use was 16 years old. 62% had prior quit attempts. Average number of cigarettes was 26.2 (SD 11.3), mean Fagerström test 6,9 (SD 2,1). 94% patients accepted nicotine substitution and assisted to group therapy. The level of CO decreased from an average of 19.3ppm (admission) to 1.8ppm (discharge). Conclusions The results highlight that motivational interventions during admission in a detoxification unit could be effective to increase the awareness of tobacco risks, the self-efficacy of patients, and more important to promote quit-attempts in a very severe and resistant to treat patients. Funding The Catalan Network of Smokefree Hospitals is partially funded by the Government of Catalonia through the Public Health Agency of Catalonia (contract SA-2017-N111)

To quit smoking successfully: Former smoker's testimonies sharing knowledge to promote quitting tobacco

Introduction Quitting tobacco is a complex procedure which involves other factors than those strictly medical, such as: personal, emotional, social... Smokers need encouraging messages to make the final decision to quit. At this point, the active participation of the pacients themselves in their own health is changing the perspective of the medical attention provided so far. This is why sharing ex-smokers successful experiences could change the way of managing these patients. We are designed a website, www.historiesdexfumadors.cat, where former smokers experiences can be posted, so that they can be a role model that inspires other smokers to choose the same path. Afterwards, the effect of these recommendations would be evaluated. Methods Promotion of the website within health professionals, social media and social networks. Collection of former smokers stories. Revision of the content and post of the stories with a score scale. Reward the best story to promote participation. Results In 18 months the website has received 30 stories of former smokers, and 343 visits had read and evaluated them. Conclusions The use of this website is low due to the dependence of publicity of such services. An increase of visibility and knowledge about this tool is needed in order to evaluate the impact of this iniciative later on. Also, an assessment of the contest's impact among the participants is required. Funding Not funded

Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients : A one-year follow-up

Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders. This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables. The probability of abstinence at one year was 0.225 (95% CI: 0.143-0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098-0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01). The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients

¿Por qué y cómo tener en cuenta al cannabis en nuestros pacientes fumadores?

EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic

Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients: A one-year follow-up

Introduction: Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders. Methods: This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables. Results: The probability of abstinence at one year was 0.225 (95% CI: 0.143- 0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098- 0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01). Conclusions: The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients

Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients: A one-year follow-up

Introduction: Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders. Methods: This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables. Results: The probability of abstinence at one year was 0.225 (95% CI: 0.143- 0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098- 0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01). Conclusions: The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients