Motivations for smoking in hospitalized patients

SUMMARY OBJECTIVE: To investigate the profile of motivations for smoking among inpatients at a hospital in southern Brazil. METHODS: A survey study involving hospitalized smokers. The Modified Reasons for Smoking Scale (MRFSS) and its domains were analyzed according to gender and dependence degree. RESULTS: The sample consisted of 85 adults (mean age 53 years), low schooling/family income, and well-adjusted in terms of gender (male= 52.9%) and clinical (48%) or surgical (47%) specialty. Most were in Action as the motivational stage (68%), with elevated smoking exposure (median = 39 years/packs) and dependence degree of nicotine (56.4%). The highest domains of the MRFSS were: Smoking Pleasure (4.34 ± 1.2), Relaxation/Tension Reduction (4.24 ± 1.2) and Dependence (3.8±1.4). Significantly, women presented higher scores, in domain Relaxation/Tension Reduction (4.7±0.9). In those with elevated nicotine dependence, higher scores were observed in the Automatism/Habit and Stimulation domains. CONCLUSIONS: Smoking Pleasure and Relaxation/Tension Reduction, especially in women and Automatism, in those more dependents, are factors that should be more highlighted in future strategies for smoking cessation in inpatients.

Smoking, Preparing the Patient with a Severe Mental Disorder for Change

IntroductionSmoking is a serious health problem for people with mental illness like the bipolar disorder patients. The developmental of motivational tools such as brief intervention it is necessary in the context of community care.ObjectivesEvaluating the change in motivational stage after brief intervention and evaluating the clinical and smoking factors in relation with this.MethodsTwo hundred and twenty patients diagnosed with bipolar disorder (according DSM-5 criteria) that were in the euthymic phase (defined as less than 7 points in YMRS and 10 points in HDRS) and attended the community care centers of three provinces of Andalusia (Spain). Patients who consumed in the last month qualified for the level of motivation for change (measured by URICA scale).ResultsAfter brief intervention the 29.3% of the smoking patients change in their motivational stage. The results of the multivariate analysis showed three factors in relation with dificultar the progression of the evolution of motivation to change. The high punctuation in Hamilton anxiety scale (OR = 0.53; IC95%, P = 0.002), the high puntuation in the Fageström scale (OR = 0.56, IC95%, P = 0.01), and have high autoperception of the capacity of change (OR = 0.52; IC95%, P = 0.002).ConclusionsThe anxiety (measure with Hamilton anxiety scale) plus factors in relation with smoking, like the puntuation in Fagestrom scale and the autoperception of the capacity of change decrease the possibilities to change.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Motivational stage of change in young patients undergoing day treatment for eating disorders

Background: The objective was to determine whether motivation to change is significantly altered over the course of partial hospitalization in children and adolescents with eating disorders (EDs). Method: This study was a retrospective chart review of 30 sets of adolescents and their parents who completed the Motivational Stage of Change for Adolescents Recovering from an Eating Disorder (MSCARED) at both intake and discharge from partial hospitalization. The main outcome variables included change in stage of change (SOC) for patients and their parents. Secondary outcomes included correlations between SOC and other baseline variables, as well as changes in SOC and psychological test scores. Results: The SOC was significantly higher at discharge than at intake in both the patients and parents, but the two groups were not in agreement at discharge. The change in the SOC was correlated with change in Children’s Eating Attitudes Test scores. Assessment of decisional balance showed correlations with SOC. Age, change in weight, and psychiatric diagnoses did not correlate with initial SOC. Conclusion: The MSCARED may be a useful tool for monitoring young ED patients’ psychological improvements with day treatment. Initial SOC is not predictive of treatment outcomes.

Response to an unsolicited intervention offer to persons aged ≥ 75 years after screening positive for depressive symptoms: a qualitative study

ABSTRACTBackground: Screening can increase detection of clinically relevant depressive symptoms, but screen-positive persons are not necessarily willing to accept a subsequent unsolicited treatment offer. Our objective was to explore limiting and motivating factors in accepting an offer to join a “coping with depression” course, and perceived needs among persons aged ≥75 years who screened positive for depressive symptoms in general practice.Methods: In a randomized controlled trial, in which 101 persons who had screened positive for depressive symptoms were offered a “coping with depression” course, a sample of 23 persons were interviewed, of whom five (22%) accepted the treatment offer. Interview transcripts were coded independently by two researchers.Results: All five individuals who accepted a place on the course felt depressed and/or lonely and had positive expectations about the course. The main reasons for declining to join the course were: not feeling depressed, or having negative thoughts about the course effect, concerns about group participation, or about being too old to change and learn new things. Although perceived needs to relieve depressive symptoms largely matched the elements of the course, most of those who had been screened were not (yet) prepared to accept an intervention offer. Many expressed the need to discuss this treatment decision with their general practitioner.Conclusions: Although the unsolicited treatment offer closely matched the perceived needs of people screening positive for depressive symptoms, only those who combined feelings of being depressed or lonely with positive expectations about the offered course accepted it. Treatment should perhaps be more individually tailored to the patient's motivational stage towards change, a process in which general practitioners can play an important role.