对烟草依赖的心理干预ppt课件.pptVIP

GIM Primary Care Conference Presentation October 25, 2006;Disclosure Statement;Learning Objectives;Case Studies;Case Studies;Case Studies: Smoking History;Progress: Dramatic Decrease in Adult Smoking Prevalence Over 40 Years ; 20.9%; 400,000 deaths per year nationally (8000 in WI) 2,000 children and adolescents become regular smokers each day $75 billion in added healthcare costs $80 billion in lost productivity Low rates of clinical assistance with quitting;2003 Wisconsin Tobacco Survey;Disproportionate Smoking Rates ;Tobacco Dependence and Mental Illness;(Source: Lasser et al., JAMA. 2000;284:2606-2610); % Current Past 30 Days Smoking Quit Rate, % No Mental Illness 23 43 Major Depression 45 26 Nonaffective Psychosis 45 0 Gen. Anxiety Disorder 55 29 Alcohol Abuse or Dependence 56 17 Bipolar Disorder 61 26 Drug Abuse or Dependence 68 22;(Adapted from Lasser et al., 2000);Tobacco Dependence and Mental Illness;U.S. Public Health Service Clinical Practice Guideline Michael C. Fiore, MD, MPH Panel Chair Published June, 2000 Evidence-based 50 meta-analyses of 6000 articles (1975-1999);Putting the 5 A’s into PRACTICE: ASK – ADVISE – ASSESS – ASSIST- ARRANGE;The Guideline recommends the use of FDA-approved pharmacotherapy, except when contraindicated First-line medications: Bupropion SR, nicotine patch, nicotine gum, nicotine inhaler, nicotine nasal spray Second-line medications: Clonidine, nortriptyline (Although not available when the 2000 Guideline was developed, consider OTC nicotine lozenge, varenicline);The Guideline recommends that ALL smokers trying to quit should be offered cessation medication except for special circumstances: - medical contraindications - smoke 10 cigarettes/day - pregnant/breastfeeding - adolescent smokers;Guideline Recommendations for Smokers With Psychiatric Comorbidities;General Recommendations for Depressed Smokers ;General Recommendations for Dep