Preparando el escenario para dejar de fumar en el paciente con Trastorno Bipolar: intervención breve en la práctica clínica
DOI:
https://doi.org/10.20882/adicciones.1006Palabras clave:
Trastorno bipolar, Tabaco, Abandono tabaquismo, Intervención breve, Disposición para el cambioResumen
El consumo de tabaco es el principal factor prevenible de mortalidad en pacientes con trastorno bipolar (TB), y las posibles soluciones se encuentran bloqueadas por prejuicios acerca del deseo, posibilidades y riesgos al dejar el consumo de tabaco en estos pacientes. En 8 Centros de Salud Mental se reclutaron consecutivamente pacientes con TB. Los fumadores fueron evaluados antes y después de una intervención breve basada en las 3 As y clasificados según los “estadios de cambio” (EC) y su “disposición para el cambio” (DC). Mediante una regresión lineal múltiple se analizó la evolución del DC y su efecto sobre otras variables independientes (tratamiento farmacológico, historias de síntomas psicóticos, presencia de síntomas de ansiedad, deseo de abandono, capacidad auto-percibida y la percepción subjetiva de funcionamiento cognitivo). Se incluyeron 212 pacientes con TB estabilizados, los fumadores activos (n=101; 47.6%) pasaron a la fase de intervención, y un 80.2% la completaron. Basalmente, 75.2% consideraban la idea de dejar de fumar, después de la intervención breve, el 30.9% de los pacientes progresó en su EC. Se observó un incremento significativo del nivel de DC (53.3 vs 59.3, P=0.019). La autopercepción del rendimiento cognitivo (β=-0.35;P=0.002), el deseo de abandono (β=0.32;P=0.008), la autopercepción de la capacidad para dejar de fumar (β=-0.30;P=0.012), la edad del paciente (β=-0.72;P=0.004), la edad de inicio del tabaquismo (β=0.48;P=0.022) y los años fumando (β=0.48;P=0.025) fueron los factores que influyeron significativamente en la posibilidad de cambio tras la intervención breve. Los fumadores con TB consideran la idea de dejar de fumar y una intervención breve desarrollada en el marco de la atención a la salud mental diaria, mejoraría el nivel de preparación. La disfunción neurocognitiva asociada con el TB podría limitar la disposición de los pacientes a dejar de fumar.Citas
Aharonovich, E., Brooks, A. C., Nunes, E .V. y Hasin, D. S. (2008). Cognitive deficits in marijuana users: Effects on motivational enhancement therapy plus cognitive behavioral therapy treatment outcome. Drug and Alcohol Dependence, 95, 279-283. doi:10.1016/j.drugalcdep.2008.01.009.
Al-Halabí, S., Fernández-Artamendi, S., Díaz-Mesa, E.M., García-Álvarez, L., Flórez, G., Martínez-Santamaría, E.,… Bobes J. (2016). Tobacco and cognitive performance in schizophrenia patients: the design of the COGNICO study. Adicciones, 29, 6-12. doi:10.20882/adicciones.724.
Almadana Pacheco, V., Gómez-Bastero Fernández, A.P., Valido Morales, A., Luque Crespo, E., Monserrat, S. y Montemayor Rubio, T. (2017). Anxiety, depression and tobacco abstinence. Adicciones, 29, 233-244. doi:10.20882/adicciones.761.
Anthenelli, R. M., Benowitz, N. L., West, R., St Aubin, L., McRae, T., Lawrence, D.,… Evins, A.E. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet, 387, 2507-2520. doi:10.1016/S0140-6736(16)30272-0.
Ashare, R.L., Falcone, M. y Lerman, C. (2014). Cognitive function during nicotine withdrawal: Implications for nicotine dependence treatment. Neuropharmacology, 76 Pt B, 581-591. doi:10.1016/j.neuropharm.2013.04.034.
Balanzá-Martínez, V., Crespo-Facorro, B., González-Pinto, A. y Vieta, E. (2015). Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates. Frontiers in Physiology, 6, 108. doi:10.3389/fphys.2015.00108.
Baune, B.T. y Malhi, G.S. (2015). A review on the impact of cognitive dysfunction on social, occupational, and general functional outcomes in bipolar disorder. Bipolar Disorders, 17 (Suppl 2), 41-55. doi:10.1111/bdi.12341.
Biener, L. y Abrams, D.B. (1991). The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychology, 10, 360-365.
Borland, R., Yong, H.H., Balmford, J., Cooper, J., Cummings, K.M., O’Connor, R.J.,… Fong, G.T. (2010). Motivational factors predict quit attempts but not maintenance of smoking cessation: findings from the International Tobacco Control Four country project. Nicotine and Tobacco Research, 12 Suppl, S4-11. doi:10.1093/ntr/ntq050.
Callaghan, R.C., Veldhuizen, S., Jeysingh, T., Orlan, C., Graham, C., Kakouris, G.,… Gatley, J. (2014). Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. Journal of Psychiatry Research, 48, 102-110. doi:10.1016/j.jpsychires.2013.09.014.
Cazard, F. y Ferreri, F. (2013). Bipolar disorders and comorbid anxiety: prognostic impact and therapeutic challenges. Encephale 39, 66-74. doi:10.1016/j.encep.2012.04.005.
Ceccarini, M., Borrello, M., Pietrabissa, G., Manzoni, G.M. y Castelnuovo, G. Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments. Frontiers in Psychology, 6, 511. doi:10.3389/fpsyg.2015.00511.
Chengappa, K.N., Perkins, K.A., Brar, J.S., Schlicht, P.J., Turkin, S.R,… George, T.P. (2014). Varenicline for smoking cessation in bipolar disorder: a randomized, double-blind, placebo-controlled study. Journal Clinical of Psychiatry, 75, 765-772. doi:10.4088/JCP.13m08756.
Chou, K., Chen, H.K., Hung, C.H., Chen, T.T., Chen, C.M. y Wu, B.J. (2015). Readiness to quit as a predictor for outcomes of smoking-reduction programme with transdermal nicotine patch or bupropion in a sample of 308 patients with schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 265, 249-257. doi:10.1007/s00406-014-0515-7.
CIE-10., 1992. Trastornos mentales y del comportamiento, descripciones clínicas y pautas para el diagnóstico. Madrid: Meditor.
de Leon, J., Diaz, F.J., Aguilar, M.C., Jurado, D. y Gurpegui, M. (2006). Does smoking reduce akathisia? Testing a narrow version of the self-medication hypothesis. Schizophrenia Research, 86, 256-268. doi:10.1016/j.schres.2006.05.009.
Diaz, F.J., James, D., Botts, S., Maw, L., Susce, M.T. y de Leon, J. (2009). Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression. Bipolar Disorders, 11, 154-165. doi:10.1111/j.1399-5618.2009.00664.x.
DiClemente, C.C., Prochaska, J.O., Fairhurst, S.K., Velicer, W.F., Velasquez M.M. y Rossi, J.S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295–304.
DiClemente, C.C. y Prochascka, J.O. (1998). Toward a comprehensive, transtheoretical model of change: stages of change and addictive behavior. In: Miller WR, Heather N, eds. Treating Addictive Behaviors. 2nd ed. New York, Plenum. Pp: 3-24.
DiClemente, C.C., Schlundt, D. y Gemmell, L. (2004). Readiness and stages of change in addiction treatment. American Journal on Addictions, 13, 103-119. doi:10.1080/10550490490435777.
DiClemente, C.C., Delahanty, J.C., Kofeldt, M.G., Dixon, L., Goldberg, R. y Lucksted, A. (2011). Stage movement following a 5A’s intervention in tobacco dependent individuals with serious mental illness (SMI). Addictive Behaviour, 36, 261-264. doi:10.1016/j.addbeh.2010.11.002.
Etter, M. y Etter, J.F. (2004). Alcohol consumption and the CAGE test in outpatients with schizophrenia or schizoaffective disorder and in the general population. Schizophrenia Bulletin, 30, 947-956.
Evins, A.E., Cather, C. y Laffer, A. (2015). Treatment of tobacco use disorders in smokers with serious mental illness; toward clinical best practices. Harvard Review of Psychiatry, 23, 90-98. doi:10.1097/HRP.0000000000000063.
Fagerström, K.O. (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviour, 3, 235-241.
Fiore, M. y Panel, G. (2008). Treating tobacco use and dependence: 2008 update. Rockville MD: Department of Health and Human Services.
García-Portilla, M.P., Saiz, P.A., Benabarre, A., Florez, G., Bascaran, M.T., Díaz, E.M.,… Bobes, J. (2010). Impact of substance use on the physical health of patients with bipolar disorder. Acta Psychiatrica Scandinavica, 121, 437-445. doi:10.1111/j.1600-0447.2009.01498.x.
García-Portilla, M.P., García–Álvarez, L., Sarramea, F., Galvan, G., Díaz-Mesa, E., Bobes-Bascaran, T.,… Bobes, J. (2016). It is feasible and effective to help patients with severe mental disorders to quit smoking: an ecological pragmatic clinical trial with transdermal nicotine partches and varenicline. Schizophrenia Research, 176, 272-280. doi:10.1016/j.schres.2016.05.011.
George, T.P., Wu, B.S. y Weinberger, A.H. (2012). A review of smoking cessation in bipolar disorder: implications for future research. Journal of Dual Diagnosis, 8, 126–130. doi:10.1080/15504263.2012.671717.
Goes, F.S. (2015). The importance of anxiety states in bipolar disorder. Current Psychiatry Reports, 17, 3. doi:10.1007/s11920-014-0540-2.
Gómez-Peña, M., Penelo, E., Granero, R., Fernández-Aranda, F., Alvarez-Moya, E., Santamaría, J.J.,… Jiménez-Murcia, S. (2011). Motivation to change and pathological gambling: analysis of the relationship with clinical and psychopathological variables. British Journal of Clinical Psychology, 50, 196-210. doi:10.1348/014466510X511006.
Gonzalez-Pinto, A., Gutierrez, M., Ezcurra, J., Aizpuru, F., Mosquera, F., López, P. y de Leon, J. (1998). Tobacco smoking and bipolar disorder. Journal of Clinical Psychiatry, 59, 225-228.
Gutiérrez-Rojas, L., Gurpegui, M., Ayuso-Mateos, J.L., Gutiérrez-Ariza, J.A., Ruiz-Veguilla, M. y Jurado, D. (2008). Quality of life in bipolar disorder patients: a comparison with a general population sample. Bipolar Disorders, 10, 625-634. doi:10.1111/j.1399-5618.2008.00604.x.
Gwaltney, C.J., Metrik, J., Kahler, C.W. y Shiffman, S. (2009). Self-efficacy and smoking cessation: a meta-analysis. Psychol. Addictive Behaviour, 23, 56-66. doi:10.1037/a0013529.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50-55.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56-62.
Heatherton, T.F., Kozlowski, L.T., Frecjer, R.C. y Fageström, K.O. (1991). The Fageström Test for Nicotine Dependence: A revision of the Fageström Tolerance Questionnaire. British Journal of Addiction, 86, 1119-1127.
Heffner, J.L., Strawn, J.R., DelBello, M.P., Strakowski, S.M. y Anthenelli, R.M. (2011). The co-ocurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations. Bipolar Disorders, 13, 439-453. doi:10.1111/j.1399-5618.2011.00943.x.
Jackson, J.G., Diaz, F.J., Lopez, L. y de Leon, J. (2015). A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disorders, 17, 575-597. doi:10.1111/bdi.12319.
Japuntich, S.J., Leventhal, A.M., Piper, M.E., Bolt, D.M., Roberts, L.J., Fiore, M.C. y Baker, T.B. (2011). Smoker characteristics and smoking-cessation milestones. American Journal of Preventive Medicine, 40, 286-294. doi:10.1016/j.amepre.2010.11.016.
Kruger, J., O’Halloran, A., Rosenthal, A.C., Babb, S.D. y Fiore, M.C. (2016). Receipt of evidence-based brief cessation interventions by health professionals and use of cessation assisted treatments among current adult cigarette-only smokers: National Adult Tobacco Survey, 2009-2010. BMC Public Health, 16, 141. doi:10.1186/s12889-016-2798-2.
Marín Romero, B., Gil Roales-Nieto, J. y Moreno San Pedro, E. (2017). Self-quitting in a Spanish sample. An exploratory study. Adicciones, 29, 210-212. doi:10.20882/adicciones.925.
Miller, W.R. (2011). Motivational factors in addictive behaviors. In: Miller WR and Carroll KM, (Eds). Rethinking substance abuse: What the science shows and what we should do about it. New York: Guilford Press, pp. 134-152.
Miskowiak, K.W., Petersen, J.Z., Ott, C.V., Knorr, U., Kessing, L.V., Gallagher, P. y Robinson, L. (2016). Predictors of the discrepancy between objective and subjective cognition in bipolar disorder: a novel methodology. Acta Psychiatrica Scandinavica, 134, 511-521.
Moss, T.G., Sacco, K.A., Allen, T.M., Weinberger, A.H., Vessicchio, J.C. y George, T.P. (2009). Prefrontal cognitive dysfunction is associated with tobacco dependence treatment failure in smokers with schizophrenia. Drug and Alcohol Dependence, 104, 94-99. doi:10.1111/acps.12649.
Prochaska, J.O. y DiClemente, C.C. (1983). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
Prochaska, J.J., Reyes, R.S., Schroeder, S.A., Daniels, A.S., Doederlein, A. y Bergeson, B. (2011). An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder. Bipolar Disorders, 13, 466–473. doi:10.1111/j.1399-5618.2011.00944.x.
Rhodes, J.D. y Hawk, L.W. JR. (2016). Smoke and mirrors: The overnight abstinence paradigm as an index of disrupted cognitive function. Psychopharmacology, (Berl). 233, 1395-1404. doi:10.1007/s00213-016-4227-8.
Rice, V.H. y Stead, L.F. (2008). Nursing interventions for smoking cessation. Cochrane Database Systematic Review, CD001188. doi:10.1002/14651858.CD001188.pub3.
Rosa, A.R., Mercadé, C., Sánchez-Moreno, J., Solé, B., Mar Bonnin, C.D., Torrent, C.,… Martinez-Aran, A. (2013). Validity and reliability of a rating scale on subjective cognitive deficits in bipolar disorder (COBRA). Journal of Affective Disorders, 150, 29-36. doi:10.1016/j.jad.2013.02.022.
Rüther, T., Bobes, J., De Hert, M., Svensson, T.H., Mann, K., Batra, A.,… Möller, H.J. (2014). EPA guidance on tobacco dependence and strategies for smoking cessation in people with mental illness. European Psychiatry, 29, 65-82. doi:10.1016/j.eurpsy.2013.11.002.
Schroeder, S.A. (2014). Even more illness caused by smoking than previously estimated. JAMA Internal Medicine, 174, 1928-1929. doi:10.1001/jamainternmed.2014.4297.
Sharma, A. y Szatkowski, L. (2014). Characteristics of smokers who have never tried to quit: evidence from the British Opinions and Lifestyle Survey. BMC Public Health, 14, 346. doi:10.1186/1471-2458-14-346.
Siru, R., Hulse, G.K. y Tait, R.J. (2009). Assessing motivation to quit smoking in people with mental illness: a review. Addiction, 104, 719-733. doi:10.1111/j.1360-0443.2009.02545.x.
Tidey, J.W. y Miller, M.E. (2015). Smoking cessation and reduction in people with chronic mental illness. BMJ, 351, h4065. doi:10.1136/bmj.h4065.
Torrent, C., Bonnin, C del M., Martínez-Arán, A., Valle, J., Amann, B.L., González-Pinto, A.,… Vieta, E. (2013). Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. American Journal of Psychiatry, 170, 852-859. doi:10.1176/appi.ajp.2012.12070971.
Vieta, E., Popovic, D., Rosa, A.R., Solé, B., Grande, I., Frey, B.N.,… Kapczinski, F. (2013). The clinical implications of cognitive impairment and allostatic load in bipolar disorder. European Psychiatry, 28, 21-29. doi:10.1016/j.eurpsy.2011.11.007.
Weinberger, A.H., Krishnan-Sarin, S., Mazure, C.M. y McKee, S.A. (2008). Relationship of perceived risks of smoking cessation to symptoms of withdrawal, craving, and depression during short-term smoking abstinence. Addictive Behaviour, 33, 960-963. doi:10.1016/j.addbeh.2008.02.013.
West. R., McNeill, A. y Raw, M. (2000). Smoking cessation guidelines for health professionals: an update. Health Education Authority. Thorax, 55, 987-999. doi:10.1016/j.eurpsy.2011.11.007.
West, R., Raw, M., McNeill, A., Stead, L., Aveyard, P., Bitton, J.,… Borland, R. (2015). Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 110, 1388-1403. doi:10.1111/add.12998.
Wu, B.S., Weinberger, A.H., Mancuso, E., Wing, V.C., Haji-Khamneh, B., Levinson, A.J. y George, T.P. (2012). A Preliminary Feasibility Study of Varenicline for Smoking Cessation in Bipolar Disorder. Journal of Dual Diagnosis, 8, 131-132. doi:10.1080/15504263.2012.671067.
Young, R.C., Biggs, J.T., Ziegler, V.E. y Meyer, D.A. (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429-435.
Zolnierek, K.B. y Dimatteo, M.R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical Care, 47, 826-834. doi:10.1097/MLR.0b013e31819a5acc.
