托吡酯终止抑郁发作患者吸烟效果1年期追踪观察

目的：评价托吡酯戒烟治疗的远期疗效。方法：99例抑郁发作患者分为托吡酯治疗组和对照组。两组用抗抑郁药物基础上接受小组教育。托吡酯治疗组同时口服托吡酯25～200 mg?d-1 8周。两组患者住院治疗3月，随诊1年。观察第12周末、第6月末及第12月末不同时点戒烟成功率(吸烟量≤1支?d-1)，评定汉密顿抑郁量表（HAMD）、焦虑状态/特性询问表（STAI）、可视性渴求强度测评表，以呼气一氧化碳浓度验证吸烟情况。结果：治疗后12月内两组各时间点戒烟成功率、渴求强度得分、CO呼出量、HAMD总分、STAI总分治疗组均低于对照组(P＜0.01)。治疗期间两组均无严重不良事件发生。结论：托吡酯的戒烟疗效肯定，远期疗效可靠，不良反应轻。     

托吡酯终止抑郁发作患者吸烟效果1年期追踪观察

目的：评价托吡酯戒烟治疗的远期疗效。方法：99例抑郁发作患者分为托吡酯治疗组和对照组。两组用抗抑郁药物基础上接受小组教育。托吡酯治疗组同时口服托吡酯25～200 mg?d-1 8周。两组患者住院治疗3月，随诊1年。观察第12周末、第6月末及第12月末不同时点戒烟成功率(吸烟量≤1支?d-1)，评定汉密顿抑郁量表（HAMD）、焦虑状态/特性询问表（STAI）、可视性渴求强度测评表，以呼气一氧化碳浓度验证吸烟情况。结果：治疗后12月内两组各时间点戒烟成功率、渴求强度得分、CO呼出量、HAMD总分、STAI总分治疗组均低于对照组(P＜0.01)。治疗期间两组均无严重不良事件发生。结论：托吡酯的戒烟疗效肯定，远期疗效可靠，不良反应轻。     

托吡酯终止抑郁发作患者吸烟效果1年期追踪观察

目的：评价托吡酯戒烟治疗的远期疗效。方法：99例抑郁发作患者分为托吡酯治疗组和对照组。两组用抗抑郁药物基础上接受小组教育。托吡酯治疗组同时口服托吡酯25～200 mg?d-1 8周。两组患者住院治疗3月,随诊1年。观察第12周末、第6月末及第12月末不同时点戒烟成功率(吸烟量≤1支?d-1),评定汉密顿抑郁量表（HAMD）、焦虑状态/特性询问表（STAI）、可视性渴求强度测评表,以呼气一氧化碳浓度验证吸烟情况。结果：治疗后12月内两组各时间点戒烟成功率、渴求强度得分、CO呼出量、HAMD总分、STAI总分治疗组均低于对照组(P＜0.01)。治疗期间两组均无严重不良事件发生。结论：托吡酯的戒烟疗效肯定,远期疗效可靠,不良反应轻。     

托吡酯终止抑郁发作患者吸烟效果1年期追踪观察

目的：评价托吡酯戒烟治疗的远期疗效。方法：99例抑郁发作患者分为托吡酯治疗组和对照组。两组用抗抑郁药物基础上接受小组教育。托吡酯治疗组同时口服托吡酯25～200 mg?d-1 8周。两组患者住院治疗3月，随诊1年。观察第12周末、第6月末及第12月末不同时点戒烟成功率(吸烟量≤1支?d-1)，评定汉密顿抑郁量表（HAMD）、焦虑状态/特性询问表（STAI）、可视性渴求强度测评表，以呼气一氧化碳浓度验证吸烟情况。结果：治疗后12月内两组各时间点戒烟成功率、渴求强度得分、CO呼出量、HAMD总分、STAI总分治疗组均低于对照组(P＜0.01)。治疗期间两组均无严重不良事件发生。结论：托吡酯的戒烟疗效肯定，远期疗效可靠，不良反应轻。     

托吡酯终止抑郁症病人吸烟效果的对照试验

目的评价托吡酯戒烟治疗的有效性。方法99例抑郁症病人,分为托吡酯治疗组和对照组,治疗组50例[男性49例,女性1例,年龄(34±s9)岁],对照组49例[男性47例,女性2例,年龄(33±8)岁]。2组病人在用文拉法辛、米氮平和氟西汀等抗抑郁药物基础上接受认知行为治疗,托吡酯治疗组同时口服托吡酯200 mg·d~(-1);疗程12wk。观察治疗期间不同时点戒烟成功率(吸烟量≤1支·d~(-1)),评定汉密顿抑郁量表(HAMD)、焦虑状态/特性询问表(STAI)、可视性渴求强度测评表;以呼气一氧化碳浓度验证吸烟情况。结果治疗后,治疗组和对照组戒烟成功率分别为52%和18%,2组差异具有非常显著意义(P<0.01);治疗组渴求强度得分(2.1±1.0)分、CO呼出量(6.6±1.6)×10~(-6)、HAMD (3.1±1.7)分、STAI(44±5)分,均低于对照剂组(4.0±1.8)分,(12±4)×10~(-6),(7.2±1.7)分, (49±10)分,差异有非常显著意义(P<0.01)。治疗组不良反应轻微可耐受。结论托吡酯在12 wk内的戒烟疗效优于对照,不良反应轻,适用于抑郁症戒烟治疗。     

托吡酯致剥脱性皮炎1例

1临床资料患者,男,18岁。2003年因反复发作性意识丧失伴四肢抽搐在我院确诊为癫痫,予丙戊酸钠(VPA)0.2 g,po,tid。治疗后癫痫发作频率明显减少,1年发作1～2次。近半年来,患者服药间断,癫痫发作频率明显增加,每月发作5～6次。予VPA0.4 g,po,tid,1月后患者癫痫发作频率无明显减少。复诊后加用托吡酯(TPM)(妥泰,25 mg/片,西安杨     

托吡酯治疗小儿癫痫临床观察

目的:探讨托吡酯治疗小儿原发性癫痫发作的疗效及不良反应。方法:应用托吡酯进行治疗,以自身前后发作频率变化进行对照的开放性研究。结果:本组46例患者均观察3月以上,控制发作26例(56.5%),显效4例(8.7%),有效8例(17.4%),无效8例(17.4%),总有效率82.6%。不良反应13人,发生率为28.3%,多呈一过性。结论:托吡酯治疗小儿癫痫疗效显著,不良反应轻而少、安全性高,可单用治疗。     

托吡酯致红细胞减少一例

患者男,11岁,体重48 kg.2009年12月15日,因癫(癎)发作来我院就诊,给予丙戊酸钠片(山东仁和堂药业有限公司,批号20090425)0.2 g,3次/d口服治疗.1个月后家长擅自停药,诱发癫(癎)大发作,再次就诊,继续给予丙戊酸钠片口服治疗,剂量改为0.4 g,3次/d,继续观察.服药2个月后,于2010年5月3日查肝功能正常,血常规:WBC 7.6×109/L,RBC 4.54×1012/L,PLT 122×1012/L.     

托吡酯单药和添加治疗癫痫发作的疗效观察

目的：观察及评价托吡酯对各型癫痫发作的疗效及安全性。方法：采用开放性自身对照试验的方法对确诊的44例癫痫患者采用托吡酯单药治疗、127例癫痫患者采用添加托吡酯治疗，经8周加量期和12周稳定期后进行评价。结果：单药治疗纪及添加治疗组癫痫发作完全控制率分别为45．54％和34.65％；对各型癫痫发作的总有效率：单纯部分性发作分别为70．59％和64．86％；复杂部分性发作分别为70．00％和67．11％；部分发作继发全面性发作分别为88．24％和76．32％；全面性发作分别为85.71％和75．00％。各型癫痫发作的疗效差异无显著性。不良反应为轻至中度，耐受性良好。结论：托吡酯对各种类型癫痫发作均有效，口服安全．可以单药治疗或添加治疗。     

托吡酯单用或添加治疗癫痫发作

目的 :研究托吡酯单用或添加治疗癫痫病人的疗效、副作用。方法 :1 43例入组病人填写 4wk发作的逐日志 ,完成后分为 2组 (Ⅰ组 1 0 1例为随访的癫痫病人 ,Ⅱ组 42例为新诊断的癫痫病人 ) ,Ⅰ组病人除原用的抗癫痫药物外加用托吡酯 ,按每周 2 5mg递增 ,无效则加至 2 0 0mg·d-1,分 2次服 ,4wk后原用抗癫痫药开始减量 ,至停用。Ⅱ组单用托吡酯 ,剂量同Ⅰ组。定期随访 ,以用药mo 6时发作减少 5 0 %以上为有效 ,观察疗效及副作用。结果 :Ⅰ组随访病人 1 0 1例 ,其中 80例完成试验 ,有效5 7例 ;Ⅱ组新诊断癫痫病人 42例 ,其中 3 2例完成全部试验 ,有效 2 9例。全组病人中有 41例出现不同程度的副作用。结论 :托吡酯对癫痫病人的发作有良好的疗效 ,副作用轻微 ,多数不需处理。     

Role of the general practitioner in smoking cessation

This paper reflects on the role of general practitioners in smoking cessation and suggests initiatives to enhance general practice as a setting for effective smoking cessation services. This paper is one of a series of reflections on key issues in smoking cessation. In this article we highlight the extent that general practitioners (GPs) have contact with the population, evidence for effectiveness of GP advice, barriers to greater involvement and suggested future directions. General practice has an extensive population reach, with the majority of smokers seeing a GP at least once per year. Although there is level 1 evidence of the effectiveness of smoking cessation advice from general practitioners, there are substantial barriers to this advice being incorporated routinely into primary care consultations. Initiatives to overcome these barriers are education in smoking cessation for GPs and other key practice staff; teaching of medical students about tobacco and cessation techniques, clinical practice guidelines; support for guideline implementation; access to pharmacotherapies; and development of referral models. We believe the way forward for the role of the GPs is to develop the practice as a primary care service for providing smoking cessation advice. This will require education relevant to the needs of a range of health professionals, provision of and support for the implementation of clinical practice guidelines, access for patients to smoking cessation pharmacotherapies and integration with other cessation services such as quitlines. [Zwar NA, Richmond RL. Role of the general practitioner in smoking cessation. Drug Alcohol Rev 2006;25:21-26]     

Improving efficiency of initial tests for efficacy in smoking cessation drug discovery

Introduction: One obstacle to rapid development of new smoking cessation medications is the inefficient early clinical evaluation of the efficacy of novel drugs, which inform us as to whether or not to proceed with the greater expense and time of more formal clinical trials. The vast majority of novel drugs fail to show efficacy for cessation only after substantial resources have been spent and, thus, are largely wasted.

Areas covered: The author reviews the general limitations in the current typical procedures for initial tests of cessation efficacy in novel drugs. Small, randomized clinical trials often have good validity but may have practical limitations in achieving adequate statistical power to test novel versus placebo treatment conditions. Lab tests of acute drug effects on abstinence symptoms, during brief enforced cessation periods, are practical but have limited clinical predictive validity.

Expert opinion: Initial efficacy testing may be more efficient if done using innovative crossover designs that evaluate brief ‘practice’ quit periods for both active and placebo treatments within the same smokers, recruiting those high in quit motivation. Because this approach would require far fewer subjects and a shorter duration of testing, results could be obtained more rapidly and inexpensively to indicate that a novel drug may, or may not, be sufficiently efficacious as to warrant the greater costs and time of formal randomized clinical trials.     

Effectiveness of pharmacological or psychological interventions for smoking cessation in smokers with major depression or depressive symptoms: A systematic review of the literature

Background: Smokers with major depressive disorder (MDD) or depressive symptoms (DS) represent a subgroup in need of attention, since they have specific clinical features and prognosis. Methods: A systematic review of the literature (Cochrane, MEDLINE, ScienceDirect, Web of Science databases from inception to June 2017) of randomized clinical trials assessing the effectiveness of pharmacological, psychological, or combined interventions for smoking cessation in subjects with current or past MDD/DS without medical or comorbid psychiatric disorder(s) was run following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twenty-seven studies met the inclusion criteria. Nicotine, varenicline, and staged-care intervention were more effective in smokers with current MDD; nicotine and fluoxetine plus nicotine were more effective in smokers with DS; naltrexone and nicotine plus fluoxetine were more effective in smokers with severe current DS. Cognitive-behavioral therapy and cognitive and behavioral cessation and relapse prevention skills training were superior to placebo in smokers with past MDD. Conclusions: More research is needed into effectively addressing smoking in people with concurrent mental disorder. Data currently available need to be confirmed in randomized trials aimed at replicating the results and disentangling the effects of each therapeutic ingredient when a combination therapy is proposed. Studies on tolerability of treatments are warranted, as well as those aimed at identifying factors of vulnerability to adverse effects.     

Insomnia symptoms as a risk factor for cessation failure following smoking cessation treatment

Insomnia symptoms are associated with smoking and may interfere with smoking cessation. Specifically, studies have shown that smoking-related sleep problems are associated with long-term smoking relapse, and longer sleep duration is associated with successful smoking cessation. However, it is currently unclear whether pre- or post-quit insomnia symptoms are associated with smoking cessation outcomes. As such, the current study aimed to extend previous findings by using a measure of insomnia symptoms as a predictor of smoking cessation failure by Month 3 following smoking cessation treatment. Additionally, we examined whether post-quit insomnia symptoms predicted cessation outcomes. Results indicated that pre-, but not post-quit insomnia, predicted smoking cessation failure by 3-month post-cessation, after covarying for depressive symptoms, anxiety sensitivity, alcohol use disorder severity, treatment condition, and number of cigarettes per day. These findings add to the literature on insomnia symptoms as a risk factor for difficulties with smoking cessation, and suggest it may be a worthy clinical target for smoking populations who are interested in quitting smoking.     

Varenicline for smoking cessation intervention in chronic obstructive pulmonary disease

Introduction: In smoking-related chronic obstructive pulmonary disease (COPD), smoking cessation was previously demonstrated to reduce lung function decline and disease morbidity if it resulted in a sustained tobacco abstinence. Varenicline is a newer pharmacologic therapeutic agent able to reduce withdrawal symptoms in smokers, and this makes it particularly valuable in inducing abstinence in patients with significant addiction.

Areas covered: This paper discusses the results of a randomized, placebo-controlled study evaluating the effects of a smoking cessation intervention including varenicline in patients with COPD.

Expert opinion: Varenicline can be an appropriate aid to maintaining smoking abstinence in patients with COPD and heavier nicotine addiction, and the documentation of the long-term effects of a smoking cessation intervention that includes this pharmacologic therapeutic agent is necessary.