慢性精神分裂症男性患者维持吸烟原因的现况调查

摘要

目的：分析慢性精神分裂症男性患者维持吸烟行为的原因。方法：收集符合美国精神障碍与统计手册第4版（DSM-IV）于精神分裂症的分类诊断标准，病程5年以上，近3个月服抗精神病药物剂量未变化的男性吸烟患者188例，同时纳入61名自愿参加本研究的健康男性吸烟者作为对照组。采用阳性和阴性症状量表（PANSS）评定患者的临床精神病理症状，Fagerstrom 尼古丁依赖量表（FTND）评定患者烟草的依赖程度，RUSSELL 吸烟动机问卷（SMQ）评估患者组及对照组的吸烟原因。结果：RUSSELL 吸烟问卷调查结果显示，慢性精神分裂症男性吸烟患者药理维度的镇静一项的得分低于健康对照组外[3（0，9）vs.6（0，9），P ＜0.001]，其他各分量表得分与对照组差异均无统计学意义；患者组中的重度依赖者少于健康对照组（2.7％vs.8.2％，P ＜0.05）。患者组 FTND 总分与目前服用的抗精神病药剂量（氯丙嗪当量）呈正相关（r ＝0.22，P ＜0.01）。多因素逐步线性回归分析显示患者组的 RUSSELL 总分（β＝0.22）、自动（β＝0.27）及镇静分（β＝0.37）均低于对照组（均 P ＜0.001）。结论：慢性精神分裂症男性吸烟患者与普通吸烟人群相比，对镇静的需求较少、更少重度吸烟者以及吸烟动机较小，可能与住院患者吸烟受限制有关。%Objective:To explore the causes of the maintenance of smoking behaviors in male patient with chronic schizophrenia.Methods:Totally 188 male,smoking patients with chronic schizophrenia,meeting with the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-IV),above 5-year course of disease,taken a steady dosage of antipsychotics for 3 months,and 61 healthy smoking men were collected according to the voluntary principles.The psychopathologic symptoms and the dependence of cigarette of all patients were as- sessed with the Positive and Negative Syndrome Scale (PANSS)and the Fagerstrom Test for Nicotine Dependence (FTND),the Russell's Smoking Motivation Questionnaire (SMQ)was used to investigate the causes for maintai-ning behaviors of smoking in patients and healthy controls respectively.Results:The sedative item scores of SMQ were lower in patient group than in the controls [3 (0,9)vs.6 (0,9),P <0.001],and other scores of subscales had no significant difference compared with control.Heavy dependence happened in patient group slightly less than health controls (2.7%vs.8.2%,P <0.05).The total scores of FTND were positively correlated with the doses of antipsychotics (chlorpromazine equivalent)(r =0.22,P <0.01).The scores of total (β=0.22),automatic (β=0.27)and sedative (β=0.37)items in patient group were less than controls (Ps <0.001)by multi-factors step-wise Linear regression analysis.Conclusion:Compared with general smokers,lower need for sedation,less heavy dependence and motivation in smoking patients might be correlated with the strict management for inpatients smok-ing,social-psychological factors and culture background in China.