BackgroundThere is an increased risk of premature death in people with severe mental illness (SMI). Respiratory disorders and cardiovascular disease are leading causes of increased mortality rates in these patients, and tobacco consumption remains the most preventable risk factor involved. Developing new tools to motivate patients towards cessation of smoking is a high priority. Information on the motivational value of giving the lung age and prevention opportunities is unknown in this high-risk population.Methods/designThis article describes in detail a protocol developed to evaluate an intensive motivational tool, based on the individual risks of pulmonary damage and prevention opportunities. It is designed as a randomized, 12-month, follow-up, multicenter study. A minimum of 204 smokers will be included, aged 40 years and older, all of whom are patients diagnosed with either schizophrenia or bipolar disorder (BD). Chronic obstructive pulmonary disease (COPD) will be evaluated using spirometry, and the diagnosis will then be validated by a pneumologist and the lung age estimated. Based on this value, a motivational message about prevention will be issued for the intervention group, which will be reinforced by individualized text messages over a period of 3 months.The efficacy of the method and the pulmonary damage variables will be evaluated: smoking cessation at the end of follow-up will be confirmed by cooximetry, and the COPD diagnosis and the severity of the staging for disease will be assessed.DiscussionIn the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking.Trial registrationClinicalTrials.gov, ID: NCT03583203. Registered on 11 July 2018.Trial status: recruitment.

BackgroundThis study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention.MethodA multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention.ResultsThe study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group.ConclusionIn this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.

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.

IntroductionThe efficacy of electroconvulsive therapy (ECT) in the treatment of depressive episodes is well established, and so is reflected in the major guides.ObjectivesDescription of a clinical case of a patient diagnosed with major depressive episode with psychotic symptoms and obsessive compulsive disorder prevalence of compulsive acts that do not respond to drug treatment but to electroconvulsive therapy.MethodsPresentation and review of a case.ResultsA 55-year-old woman diagnosed with recurrent depressive disorder with worsening in the last 4 years.Clinical depressive Sadness, spontaneous crying in the form of access, apathy, isolation and clinofilia desires, complaints mnemonic deficits and complete anhedonia. Obsessional symptoms compulsive as more repetitive behaviors of obsessive ideas, which repeats incessantly despite checking, that does not prepare or calm. The patient has not responded to any pharmacological strategy, despite using full doses and combinations of antidepressant, but euthymics more antipsychotics (sertraline, fluoxetine, reboxetine, venlafaxine, bupropion, lithium, valproic acid, lamotrigine, risperidone, quetiapine, trifluoperazine, clotiapine). For this reason, it was decided to start treatment with ECT, progressively responds in each session, after 8 sessions the patient is euthymic, it has resumed normal activities, no obsessive or psychotic symptoms.ConclusionsIt is important to know that it is a safe technique that would save not only an economic cost, if not a personal emotional cost. It is noteworthy that more than 50% of depressed patients who respond to a course of ECT, fall between 6 and 12 months despite receiving adequate pharmacological treatment then so we will have to closely monitor the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.