| Abstract: | This thesis aims to understand the current perspectives on the subject tobaccoism and psychiatric comorbidades, to investigate the evaluation of the effectiveness of the treatment of the nicotine dependence and variable related with the ceasing process to smoke, as well as verifying the index of fallen again between the individuals that search the recovery. In the first study a not systematic revision of literature was carried through. The upheavals of mood, upheavals of anxiety, schizophrenia had been studied, other upheavals for psychoactive substance use beyond other psychiatric upheavals that had been also identified in literature as related to the tobaccoism. It is argued hypothesis of the use of the nicotine as self-medication in the mental upheavals. Possible contributions of the knowledge for the clinical interventions in the treatment of the tobaccoism are presented. In as the study a random longitudinal clinical assay was carried through carried through to evaluate the treatment effectiveness, the sample was chosen by convenience formed for dependent patients of nicotine who had looked clinic treatment in a general hospital. The instruments used for dependence of the nicotine were the Fagerström Test will be Nicotine Dependence (FTND), for the motivation for change were used the University scale of Rhode Island Change Assessment Scale (URICA), for the psychiatric comorbidades Escale International Neuropsychiatric Interview (MINI), and finally, were used a standardized questionnaire, half-structuralized for evaluation of demographic data, history of tobaccoism, social support, attempts to stop, main organic problems attributed to the tobaccoism. Two forms of treatment for the tobaccoism had been evaluated. A treatment of intensive minimum intervention (group has controlled) and a program of treatment of group psycotherapy (experimental group).The two modalities of treatment had been compared and associates with the variable, history, motivation for change, degree of addition, demographic psychiatric and characteristic comorbities. 181 patients had been enclosed in the study, 93 in the group intervention and 88 in the group have controlled. The majority (63%) was of the feminine sex and 57% had between 31 and 50 years of age, without differences between the groups. 56% were married or lived with friend- 14% lived alone. Significant difference was observed (p=0, 002) enters the groups for the changeable school level. One observed that almost 60% had started to smoke until the 15 years and 66% had started to smoke regularly until the 18 years, approximately three rooms of the citizens they smoked 20 or more cigarettes per day and had looked treatment without indication. The group intervention presented more upheavals in comorbities (53%) of what the group has controlled (36%), predominating the upheavals of mood in both groups - 38% versus 25%, respectively. The levels of dependence of the nicotine thus had been distributed: it has led: 35%; moderate: high 42% and: 23%. How much to the motivation for change, 13% of the sample were in the period of training of daily pay-contemplation, 33% in the period of training of contemplation, 50% in the period of training of action and 3%. As conclusion of these data we can observe that the reason of prevalences was of 2,33, that is, 80% of the patients of the group intervention were abstinentes against 34% of the group has controlled, what it allows esteem an effectiveness at this moment of 57%. To the 90 days, this reason went up for 3,22, implying in an effectiveness of the treatment of 69%; to the end of the study, 180 days after the beginning, this reason went up for 4,72, being able itself to attribute to the carried through treatment a 79% effectiveness. The purpose of the third study was to investigate factors associates to the fallen again one, as the social demographic characteristics, the motivational periods of training and the degree of dependence to the nicotine. The citizens had been enclosed for convenience from services of treatment to the tobaccoism in Porto Alegre and Pelotas between 2005 and 2006. To evaluate the dependence of the nicotine it was used scales Fagerström Test will be Nicotine Dependence (FTND) and the motivation to abandon the habit to smoke was evaluated by scale URICA. The psychiatric comorbities had been surveyed by scale MINI and were used a standardized questionnaire, for demographic data, history of tobaccoism, social support, attempts to stop and main organic problems attributed to the tobaccoism. 181 patients, the majority (63%) of the feminine sex had been enclosed, and 57% had between 31 and 50 years of age. Approximately 60% initiated to smoke until the 15 years of age and 66% smoked regularly to the 18 years. Most smoked 20 or more cigarettes per day and had looked treatment without medical indication. It had the predominance of mood upheavals as comorbities. The levels of dependence of the nicotine thus had been distributed: it has taken 35%, moderate high 42% and 23%. How much to the motivation to abandon the habit to smoke, 13% of the sample were in the period of training of daily paycontemplation, 33% in the period of training of contemplation, 50% in the period of training of action and 3% in the maintenance. Six months after the high one of the treatments, the fallen again one to the tobaccoism was of 69%, and the main factors associates had been low the school level, the absence of story of physical symptoms when stopping to smoke and the reference to the family and social group as motivation source.
Esta tese visa entender as perspectivas atuais sobre o tema tabagismo e comorbidades psiquiátricas, investigar a avaliação da efetividade do tratamento da dependência de nicotina e variáveis relacionadas com o processo de cessação de fumar, assim como verificar o índice de recaídas entre os indivíduos que buscam a recuperação. No primeiro estudo foi realizada uma revisão não sistemática de literatura. Foram estudados os transtornos de humor, transtornos de ansiedade, esquizofrenia, outros transtornos por uso de substância psicoativa além outros transtornos psiquiátricos que também foram identificados na literatura como relacionados ao tabagismo. Discute-se a hipótese do uso da nicotina como automedicação nos transtornos mentais. São apresentadas possíveis contribuições dos conhecimentos para as intervenções clínicas no tratamento do tabagismo. No segundo estudo foi realizado um ensaio clínico longitudinal randomizado realizado para avaliar a efetividade de tratamento, a amostra foi escolhida por conveniência formada por pacientes dependentes de nicotina que procuraram tratamento ambulatorial em um hospital geral. Os instrumentos utilizados para dependência da nicotina foi o Fagerström Test for Nicotine Dependence (FTND), para a motivação para mudança foi utilizada a escala University of Rhode Island Change Assessment Scale (URICA), para as comorbidades psiquiátricas a Escala International Neuropsychiatric Interview (MINI), e por fim, foi utilizado um questionário padronizado, semi-estruturado para avaliação de dados demográficos, história de tabagismo, apoio social, tentativas de parar, principais problemas orgânicos atribuídos ao tabagismo. Foram avaliadas duas formas de tratamento para o tabagismo. Um tratamento de intervenção mínima intensiva (grupo controle) e um programa de tratamento de psicoterapia grupal (grupo experimental). As duas modalidades de tratamento foram comparadas e associadas às variáveis, nicotina utilizou-se a escala Fagerström Test for Nicotine Dependence (FTND) e a motivação para abandonar o hábito de fumar foi avaliada pela escala URICA. As comorbidades psiquiátricas foram aferidas pela escala MINI e foi utilizado um questionário padronizado, para dados demográficos, história de tabagismo, apoio social, tentativas de parar e principais problemas orgânicos atribuídos ao tabagismo. Foram incluídos 181 pacientes, a maioria (63%) do sexo feminino, e 57% tinham entre 31 e 50 anos de idade. Aproximadamente 60% iniciou a fumar até os 15 anos de idade e 66% fumavam regularmente aos 18 anos. A maior parte fumava 20 ou mais cigarros por dia e procuraram tratamento sem indicação médica. Houve a predominância de transtornos de humor como comorbidade. Os níveis de dependência da nicotina foram assim distribuídos: leve 35%, moderado 42% e alto 23%. Quanto à motivação para abandonar o hábito de fumar, 13% da amostra estava no estágio de pré-contemplação, 33% no estágio de contemplação, 50% no estágio de ação e 3% na manutenção. Seis meses após a alta dos tratamentos, a recaída ao tabagismo foi de 69%, e os principais fatores associados foram a baixa escolaridade, a ausência de relato de sintomas físicos ao parar de fumar e a referência à família e grupo social como fonte de motivação. |
