Preparando el escenario para dejar de fumar en el paciente con Trastorno Bipolar: intervención breve en la práctica clínica

Fernando Sarramea, Maria José Jaen-Moreno, Vicent Balanzá-Martínez, Maria Isabel Osuna, José Ángel Alcalá, Francisco Javier Montiel, Cristina Gómez, María Dolores Sánchez, Ana Belén Rico, Justa Redondo-Écija, Susana Gil, Francisca Valdivia, Javier Caballero-Villarraso, Luis Gutiérrez-Rojas

Resumen


El consumo de tabaco es el principal factor prevenible de mortalidad en pacientes con trastorno bipolar (TB), y las posibles soluciones se encuentran bloqueadas por prejuicios acerca del deseo, posibilidades y riesgos al dejar el consumo de tabaco en estos pacientes. En 8 Centros de Salud Mental se reclutaron consecutivamente pacientes con TB. Los fumadores fueron evaluados antes y después de una intervención breve basada en las 3 As y clasificados según los “estadios de cambio” (EC) y su “disposición para el cambio” (DC). Mediante una regresión lineal múltiple se analizó la evolución del DC y su efecto sobre otras variables independientes (tratamiento farmacológico, historias de síntomas psicóticos, presencia de síntomas de ansiedad, deseo de abandono, capacidad auto-percibida y la percepción subjetiva de funcionamiento cognitivo). Se incluyeron 212 pacientes con TB estabilizados, los fumadores activos (n=101; 47.6%) pasaron a la fase de intervención, y un 80.2% la completaron. Basalmente, 75.2% consideraban la idea de dejar de fumar, después de la intervención breve, el 30.9% de los pacientes progresó en su EC. Se observó un incremento significativo del nivel de DC (53.3 vs 59.3, P=0.019). La autopercepción del rendimiento cognitivo (β=-0.35;P=0.002), el deseo de abandono (β=0.32;P=0.008), la autopercepción de la capacidad para dejar de fumar (β=-0.30;P=0.012), la edad del paciente (β=-0.72;P=0.004), la edad de inicio del tabaquismo (β=0.48;P=0.022) y los años fumando (β=0.48;P=0.025) fueron los factores que influyeron significativamente en la posibilidad de cambio tras la intervención breve. Los fumadores con TB consideran la idea de dejar de fumar y una intervención breve desarrollada en el marco de la atención a la salud mental diaria, mejoraría el nivel de preparación. La disfunción neurocognitiva asociada con el TB podría limitar la disposición de los pacientes a dejar de fumar.

Palabras clave


Trastorno bipolar; Tabaco; Abandono tabaquismo; Intervención breve; Disposición para el cambio

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Referencias


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DOI: https://doi.org/10.20882/adicciones.1006

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