nicotine-related disorders answers obtained from dsm-iv-tr and the ajp supplement of august, 2006,...
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Nicotine-related disorders
Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on
substance abuseAs of 1Sep08.
Percentage of population
Q. Percentage of population that smokes?
Percentage of population
Ans. DSM-IV has 30%. Right answer is probably closer to 21% today. The slow decrease per year has ceased and the percentage has become constant in the past few years.
Survey instrument
Q. What is the name of the survey instrument used to measure level of smoking addiction
Survey instrument
Ans. Fagerstrom Tolerance Questionnaire.
Other mental illness
Q. Of individual with a mental illness, what percentage smoke?
Other mental illness
Ans. 55 to 90%, with the 90% pertaining to people with schizophrenia.
Withdrawal
Q. List the 8 DSM signs of nicotine withdrawal.
Withdrawal
Ans. 1] sad2] insomnia3] irritable4] anxious5] can’t concentrate6] restless7] decrease pulse8] increased appetite
Lab findings
Q. What are the sleep and chemical lab findings during withdrawal?
Lab findings
Ans. During withdrawal:
EEG slowing
Decrease catecholamine level
Decrease cortisol level
REM changes
Neuropsychological testing impairments
Decreased metabolic rate
First line medications
Q. Besides nicotine replacement meds, what other meds are regarded as a first line option?
First line medications
Ans.
Bupropion.
Varenicline
Bupropion dosing
Q. What is the typical bupropion dosing schedule?
Bupropion dosing
Ans. Begin with 150 mg SR 7 days before quit date, then 150 mg bid SR 2 days before stop date.
Varenicline dosing
Q. What is typical varenicline dosing?
Varenicline
Ans. Varies somewhat, of course, but the following is typical:
0.5 mg/d x 3 days
0.5 mg/d x 4 days
Dc smoking on 7th day
1 mg/d x 12 weeks
Can go to 2 mg/d
Combination
Q. Can you prescribe varenicline and bupropion in the same pt?
Combination
Ans. Can use both.
Nicotine replacements
Q. Nicotine replacements come in what forms?
Nicotine replacements
Ans.
-- patch
-- gum
-- lozenge
-- nasal spray
-- inhaler
Combinations
Q. Any advantage to combining meds?
Combinations
Ans. Yes, may improve results, including two nicotine replacement meds, in addition to prescribing both nicotine replacement and bupropion and varenicline.
Best results
Q. Very generally, best results are achieved with?
Best results
Ans. Combine meds with psychosocial approach.
Second-line agents
Q. Besides nicotine replacement, varenicline, and bupropion, what other two meds are used?
Second-line meds
Ans.
Nortriptyline
Clonidine
Nortriptyline dosing
Q. Typical dosing schedule for nortriptyline?
Nortriptyline dosing
Ans. Start at 25 mg/d 10 – 14 days before quit day, and increase to 75 mg/d by the quit day.
Clonidine dosing
Q. What is typical clonidine dosing?
Clonidine dosing
Ans. 0.1 to 0.4 mg/d on quit day for 2 to 6 weeks.
FDA
Q. Has the FDA approved any meds?
FDA
Ans.
Nicotine replacement meds
Bupropion
Varenicline
Acupuncture
Q. Status of acupuncture?
Acupuncture
Ans. Not been proven to be effective.
Psychosocial formats
Q. Four general psychosocial approaches are?
Psychosocial formats
Ans.
-- individual
-- group
-- telephone
-- self-help
Psychosocial approaches
Q. Regardless of format, what four psychosocial approaches have value?
Psychosocial approaches
Ans.
-- motivational enhancement therapy
-- behavior therapies
-- CBT
-- social supports
Behavior therapy
Q. What does behavior therapy consists of?
Behavior therapy
Ans.
-- contingency management
-- cue exposure
-- “rapid smoking” aversion
12-step-oriented groups
Q. Has 12-step-oriented groups been effective?
12-step-oriented groups
Ans. Have not been shown to be effective.
Hypnosis
Q. Hypnosis effectiveness in this disorder?
Hypnosis
Ans. Has not been shown to be effective.
Stop date
Q. As part of the psychosocial approach, is abrupt cessation or gradual cessation preferred?
Stop use
Ans. Once date is set to cease, better that cessation be abrupt.
Caffeine use
Q. Advice as to caffeine use after stop date begins.
Caffeine use
Ans. Best to avoid.
Alcohol use
Q. After stop date has begun, advice as to alcohol use?
Alcohol use
Ans. Best to avoid.