慢性精神分裂症病患之求變階段與尼古丁貼片減菸之治療結果

Abstract

目的: 檢視使用尼古丁貼片之精神分裂症患者其求變階段與戒菸與減菸結果的關係。 方法: 作者藉由Prochaska及其同儕(1991)提出的「求變階段」的概念，驗証戒菸意願與後續吸菸行為的關係。本研究納入150位慢性精神分裂症患者。受試者被隨機分配到不同尼古丁劑量的組別: 低劑量組(20.8毫克)或是高劑量組(31.2毫克)。進到研究前，受試者按照其戒菸的意願被分類為高意願組(準備期)、中度意願組(考慮期)及低意願組(不考慮期)。在進入研究前及進入研究後的兩個月，研究者會評估受試者的吸菸行為、求變階段與正性及負性症狀量表。預定測量的結果:八週內吸菸量下降超過百分之二十五及百分之五十的個案百分率及七日戒菸點盛行率。本研究將使用羅吉斯迴歸方程模式檢視求變階段與上述三種結果的關係。在模型中，將調整以下變數: 年齡、尼古丁依賴程度、進入研究前的每日吸菸量、抗精神病劑的種類、尼古丁貼片的劑量、負性症狀及錐體外徑路症候群症狀的程度。 結果: 百分二十五的減菸率為36% (54/150)，百分之五十的減菸率為16.7 % (25/150)，七日戒菸點盛行率為0.6% (1/150)。對於百分二十五減菸率而言，準備期、考慮期及不考慮期減菸成功的比例為55.6%, 38.2% and 25.9% (趨勢檢定為顯著，p = 0.02)。求變階段的考慮期相對於不考慮期的勝算比為5.1 (95%信賴區間為1.7-15.6，p = 0.004); 決定期對於不考慮期的勝算比為16.3 (95%信賴區間為2.7-100，p = 0.002)。對於百分之五十減菸率而言，與不考慮期相比，考慮期及決定期之勝算比分別為4 (95%信賴區間為1.03-15，p = 0.044)及3 (95%信賴區間為0.4-22.6，p = 0.29)。 結論: 求變階段在慢性分裂症患者之尼古丁貼片的減菸結果具有預測力。本研究的發現強調:若目前的戒菸經費有限，治療的對象應該首先考慮高意願戒菸的病患(例如: 準備期及考慮期)。對於低意願戒菸的病人(例如:不考慮期)，藉由認知行為治療或動機式晤談在進行藥物戒菸療程前及療程中提昇其求變階段，應該有利於強化其減菸及戒菸效果。

ABSTRACT Objectives. To examine the association between the stages of change and the outcomes of smoking-cessation along with reduction among schizophrenic patients receiving transdermal nicotine patches. Methods. The authors were willing to attest the value of readiness to change smoking behaviors by using the concept of stages of change proposed by Prochaska et al. (1991). This study enrolled 150 chronic schizophrenic patients who were randomly assigned to different dose of NRT ( 20.8mg or 31.2mg). At baseline, participants were categorized into 3 stages: preparation, contemplation and precontemplation based on readiness to change smoking behaviors. Stages of change, smoking behaviors, scores of psychopathology and measures of smoking reduction were assessed at baseline and reassessed at 2-months post-baseline. Outcomes measures: daily cigarettes consumption more than 25% along with 50% after 8-week and 7-day point prevalence of abstinence. Logistic regression model was used to analyze the association between the stages of change and outcomes with adjustments for other confounding factors. Results. Stages of change was predictive of 25% smoking-reduction outcomes. Contemplators were more likely to reduce 25% cigarettes amount than precontemplators (OR = 5.1, 95% CI = 1.7-15.6, p = 0.004); preparators were more likely to reduce 25% cigarettes amount than precontemplators (OR = 16.3, 95% CI = 2.7-100, p = 0.002). Contemplators were more likely to reduce 50% cigarettes amount than precontemplators (OR = 4, 95% CI = 1.03-15., p = 0.044); preparators were more likely to reduce 50% cigarettes amount than precontemplators (OR = 3, 95% CI = 0.4-22.6, p = 0.29). Conclusions. Stages of change is a predictor of smoking-reduction outcomes among chronic schizophrenic patients with NRT. For precontemplators, boosting them with cognitive behavioral therapy and motivational enhancement to the stages of contemplation and preparation before and during NRT program is critical to maximize the smoking-reduction effects. Key words: transtheoretical model (TTM), stages of change, smoking cessation, smoking reduction, schizophrenia, nicotine-replacement therapy (NRT)