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Dean B, Haroutunian V, Scarr E. Lower levels of cortical [ 3H]pirenzepine binding to postmortem tissue defines a sub-group of older people with schizophrenia with less severe cognitive deficits. Schizophr Res 2023; 255:274-282. [PMID: 37079947 DOI: 10.1016/j.schres.2023.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 04/22/2023]
Abstract
Multiple lines of evidence argue for lower levels of cortical muscarinic M1 receptors (CHRM1) in people with schizophrenia which is possibly due to a sub-group within the disorder who have a marked loss of CHRM1 (muscarinic receptor deficit sub-group (MRDS)). In this study we sought to determine if the lower levels of CHRM1 was apparent in older people with schizophrenia and whether the loss of CHRM1 was associated with symptom severity by measuring levels of cortical [3H]pirenzepine binding to CHRM1 from 56 people with schizophrenia and 43 controls. Compared to controls (173 ± 6.3 fmol / mg protein), there were lower levels of cortical [3H]pirenzepine binding in the people with schizophrenia (mean ± SEM: 153 ± 6.0 fmol / mg protein; p = 0.02; Cohen's d = - 0.46). [3H]pirenzepine binding in the people with schizophrenia, but not controls, was not normally distributed and best fitted a two-population solution. The nadir of binding separating the two groups of people with schizophrenia was 121 fmol / mg protein and levels of [3H]pirenzepine binding below this value had a 90.7 % specificity for the disorder. Compared to controls, the score from the Clinical Dementia Rating Scale (CDR) did not differ significantly in MRDS but were significantly higher in the sub-group with normal radioligand binding. Positive and Negative Syndrome Scale scores did not differ between the two sub-groups with schizophrenia. Our current study replicates and earlier finding showing a MRDS within schizophrenia and, for the first time, suggest this sub-group have less severe cognitive deficits others with schizophrenia.
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Affiliation(s)
- Brian Dean
- The Synaptic Biology and Cognition Laboratory, The Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia; Florey Department of Neuroscience and Mental Health, the University of Melbourne, Parkville, Victoria, Australia.
| | - Vahram Haroutunian
- Departments of Psychiatry and Neuroscience, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Mental Illness Research, Education and Clinical Centers, JJ Peters VA Medical Center, Bronx, NY, USA
| | - Elizabeth Scarr
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
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2
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Terry AV, Jones K, Bertrand D. Nicotinic acetylcholine receptors in neurological and psychiatric diseases. Pharmacol Res 2023; 191:106764. [PMID: 37044234 DOI: 10.1016/j.phrs.2023.106764] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
Neuronal nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels that are widely distributed both pre- and post-synaptically in the mammalian brain. By modulating cation flux across cell membranes, neuronal nAChRs regulate neuronal excitability and the release of a variety of neurotransmitters to influence multiple physiologic and behavioral processes including synaptic plasticity, motor function, attention, learning and memory. Abnormalities of neuronal nAChRs have been implicated in the pathophysiology of neurologic disorders including Alzheimer's disease, Parkinson's disease, epilepsy, and Tourette´s syndrome, as well as psychiatric disorders including schizophrenia, depression, and anxiety. The potential role of nAChRs in a particular illness may be indicated by alterations in the expression of nAChRs in relevant brain regions, genetic variability in the genes encoding for nAChR subunit proteins, and/or clinical or preclinical observations where specific ligands showed a therapeutic effect. Over the past 25 years, extensive preclinical and some early clinical evidence suggested that ligands at nAChRs might have therapeutic potential for neurologic and psychiatric disorders. However, to date the only approved indications for nAChR ligands are smoking cessation and the treatment of dry eye disease. It has been argued that progress in nAChR drug discovery has been limited by translational gaps between the preclinical models and the human disease as well as unresolved questions regarding the pharmacological goal (i.e., agonism, antagonism or receptor desensitization) depending on the disease.
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Affiliation(s)
- Alvin V Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Augusta, Georgia, 30912.
| | - Keri Jones
- Educational Innovation Institute, Medical College of Georgia at Augusta University, Augusta, Georgia, 30912
| | - Daniel Bertrand
- HiQScreen Sàrl, 6, rte de Compois, 1222 Vésenaz, Geneva, Switzerland
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Davies K, Courtney RJ, Summersby-Mitchell M, Morell R, Briggs N, Lappin JM. A systematic review of factors associated with sustained smoking abstinence in people experiencing severe mental illness following participation in a smoking intervention. Aust N Z J Psychiatry 2023; 57:489-510. [PMID: 36744432 DOI: 10.1177/00048674221147206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE People experiencing severe mental illness report higher rates of tobacco smoking than the general population, while rates of quitting and sustaining abstinence are considerably lower. This systematic review aimed to identify factors associated with sustained abstinence in people experiencing severe mental illness following a smoking intervention. METHOD Searches were conducted in PubMed, PsycInfo, Scopus, Embase, Emcare, CINAHL and Cochrane Library from the inception of the e-databases until June 2022. Selection criteria included randomised and non-randomised studies of smoking cessation interventions in which most of the participants were experiencing severe mental illness, and reported a follow-up of 3 months or longer. From an initial 1498 unique retrieved records, 26 references were included detailing 17 smoking cessation intervention studies and 3 relapse prevention intervention studies. Risk of bias was assessed using the RoB2 tool for randomised study designs and the ROBINS-I tool for non-randomised designs. RESULTS Participation in smoking interventions was associated with higher odds of abstinence in the medium-term, but not long-term follow-ups. There was insufficient evidence that any other factors impact sustained abstinence. Most studies were considered to have some risk of bias, largely due to insufficient availability of analysis plans. CONCLUSION Despite an abundance of studies investigating smoking cessation in smokers experiencing severe mental illness, there is limited knowledge on the factors associated with staying quit. The inclusion of people experiencing severe mental illness in large-scale randomised control trials, in which predictors of sustained abstinence are measured in the medium and long term are needed to address this important question.
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Affiliation(s)
- Kimberley Davies
- Discipline of Psychiatry & Mental Health, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Rachel Morell
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Julia M Lappin
- Discipline of Psychiatry & Mental Health, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
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Li Z, Wang S, Chen Y, Wu X, Gu Y, Lang X, Wu F, Zhang XY. Smoking Affects the Patterns of Metabolic Disorders and Metabolic Syndrome in Patients With First-Episode Drug-Naive Schizophrenia: A Large Sample Study Based on the Chinese Han Population. Int J Neuropsychopharmacol 2021; 24:798-807. [PMID: 34153098 PMCID: PMC8538889 DOI: 10.1093/ijnp/pyab038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/22/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Although metabolic disorders and smoking are common in schizophrenia, few studies have investigated the effects of smoking on metabolic disorders or metabolic syndrome (MetS) in schizophrenia patients, especially in first-episode drug-naïve (FEDN) patients. We sought to investigate the differences in metabolic disorders and MetS between smoking and nonsmoking FEDN schizophrenia patients. METHODS A total of 428 FEDN schizophrenia patients and 435 controls were recruited. Blood pressure, waist circumference, body mass index (BMI), lipid profiles, and glucose metabolism were measured. The psychopathology was evaluated by Positive and Negative Syndrome Scale. RESULTS FEDN schizophrenia patients had a higher smoking rate than controls (23.8% vs 14.0%, P < .001). After adjusting for confounding variables, the prevalence of MetS, overweight, hypertension, hypertriglyceridemia, elevated insulin, and insulin resistance in smoking patients was higher than those in nonsmoking patients, while overweight and hypertension were higher in the smoking controls than in nonsmoking controls (all P < .05). In smoking patients, triglyceridemia, high-density lipoprotein cholesterol, and fasting blood glucose were the main contributing components to MetS, while in nonsmoking patients, waist circumference, systolic blood pressure, triglyceridemia, high-density lipoprotein cholesterol, and fasting blood glucose were the main contributing components to MetS. In smoking patients, BMI and homeostatic model assessment for insulin resistance were associated factors of MetS (both P < .05). In nonsmoking patients, sex, BMI, insulin, and homeostatic model assessment for insulin resistance were associated factors of MetS (all P < .05). CONCLUSIONS Our study indicates that smoking schizophrenia patients have a higher prevalence of MetS and metabolic disorders than nonsmoking patients. Moreover, smoking and nonsmoking patients have different contributing components and associated factors for MetS.
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Affiliation(s)
- Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuning Wang
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Yuping Chen
- Department of Neurosurgery, Shanghai Changhai Hospital, Shanghai, China
| | - Xi Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yinjun Gu
- Jinshan Mental Health Center, Shanghai, China
| | - Xiaoe Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Fengchun Wu
- Department of Neurosurgery, Shanghai Changhai Hospital, Shanghai, China
- Correspondence: Fengchun Wu, Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China ()
| | - Xiang Yang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Xiang Yang Zhang, Institute of Psychology, Chinese Academy of Sciences, Beijing, China ()
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Peterson RE, Bigdeli TB, Ripke S, Bacanu SA, Gejman PV, Levinson DF, Li QS, Rujescu D, Rietschel M, Weinberger DR, Straub RE, Walters JTR, Owen MJ, O'Donovan MC, Mowry BJ, Ophoff RA, Andreassen OA, Esko T, Petryshen TL, Kendler KS, Fanous AH. Genome-wide analyses of smoking behaviors in schizophrenia: Findings from the Psychiatric Genomics Consortium. J Psychiatr Res 2021; 137:215-224. [PMID: 33691233 PMCID: PMC8096167 DOI: 10.1016/j.jpsychires.2021.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022]
Abstract
While 17% of US adults use tobacco regularly, smoking rates among persons with schizophrenia are upwards of 60%. Research supports a shared etiological basis for smoking and schizophrenia, including findings from genome-wide association studies (GWAS). However, few studies have directly tested whether the same or distinct genetic variants also influence smoking behavior among schizophrenia cases. Using data from the Psychiatric Genomics Consortium (PGC) study of schizophrenia (35476 cases, 46839 controls), we estimated genetic correlations between these traits and tested whether polygenic risk scores (PRS) constructed from the results of smoking behaviors GWAS were associated with schizophrenia risk or smoking behaviors among schizophrenia cases. Results indicated significant genetic correlations of schizophrenia with smoking initiation (rg = 0.159; P = 5.05 × 10-10), cigarettes-smoked-per-day (rg = 0.094; P = 0.006), and age-of-onset of smoking (rg = 0.10; P = 0.009). Comparing smoking behaviors among schizophrenia cases to the general population, we observe positive genetic correlations for smoking initiation (rg = 0.624, P = 0.002) and cigarettes-smoked-per-day (rg = 0.689, P = 0.120). Similarly, TAG-based PRS for smoking initiation and cigarettes-smoked-per-day were significantly associated with smoking initiation (P = 3.49 × 10-5) and cigarettes-smoked-per-day (P = 0.007) among schizophrenia cases. We performed the first GWAS of smoking behavior among schizophrenia cases and identified a novel association with cigarettes-smoked-per-day upstream of the TMEM106B gene on chromosome 7p21.3 (rs148253479, P = 3.18 × 10-8, n = 3520). Results provide evidence of a partially shared genetic basis for schizophrenia and smoking behaviors. Additionally, genetic risk factors for smoking behaviors were largely shared across schizophrenia and non-schizophrenia populations. Future research should address mechanisms underlying these associations to aid both schizophrenia and smoking treatment and prevention efforts.
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Affiliation(s)
- Roseann E Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - Tim B Bigdeli
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Stephan Ripke
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA; Dept. of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin 10117, Germany
| | - Silviu-Alin Bacanu
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Pablo V Gejman
- Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem, Evanston, IL, USA; Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Douglas F Levinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Qingqin S Li
- Neuroscience Therapeutic Area, Janssen Research and Development, LLC, Raritan, NJ, USA
| | - Dan Rujescu
- Department of Psychiatry, University of Halle, Halle, Germany; Department of Psychiatry, University of Munich, Munich, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Baltimore, MD, USA; Departments of Psychiatry, Neurology, Neuroscience and Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Bryan J Mowry
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia; Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Roel A Ophoff
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Ole A Andreassen
- NORMENT Centre and KG Jebsen Centre for Neurodevelopmental disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tõnu Esko
- Estonian Genome Center, University of Tartu, Tartu, Estonia; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA; Department of Genetics, Harvard Medical School, Boston, MA, USA; Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tracey L Petryshen
- Center for Human Genetic Research and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Ayman H Fanous
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, NY, USA; VA New York Harbor Healthcare System, Brooklyn, NY, USA.
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Dondé C, Brunelin J, Mondino M, Cellard C, Rolland B, Haesebaert F. The effects of acute nicotine administration on cognitive and early sensory processes in schizophrenia: a systematic review. Neurosci Biobehav Rev 2020; 118:121-133. [PMID: 32739422 DOI: 10.1016/j.neubiorev.2020.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/18/2020] [Accepted: 07/25/2020] [Indexed: 12/01/2022]
Abstract
Nicotine use, which is mostly done through smoking tobacco, is among the most burdensome comorbidities of schizophrenia. However, the ways in which nicotine affects the cognitive and early sensory alterations found in this illness are still debated. After conducting a systematic literature search, 29 studies were selected. These studies involve individuals with schizophrenia who underwent cognitive and/or early sensory function assessments after acute nicotine administration and include 560 schizophrenia subjects and 346 non-schizophrenia controls. The findings highlight that a single dose of nicotine can improve a range of cognitive functions in schizophrenia subjects, such as attention, working memory, and executive functions, with attention being the most responsive domain. In addition, nicotine can modulate early detection of changes in the sensory environment at both the auditory and visual levels. Nevertheless, effects vary strongly depending on the type of neuropsychological assessment and nicotine intake conditions used in each study. The current findings suggest the need to consider a potential decrease of cognitive and early sensory performance when patients with schizophrenia quit smoking.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, F-38000 Grenoble, France; Psychiatry Department, CHU Grenoble Alpes, F-38000 Grenoble, France.
| | - Jérôme Brunelin
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | - Marine Mondino
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | | | - Benjamin Rolland
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | - Frédéric Haesebaert
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
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7
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Dean B, Pavey G, Scarr E. Higher levels of α7 nicotinic receptors, but not choline acetyltransferase, in the dorsolateral prefrontal cortex from a sub-group of patients with schizophrenia. Schizophr Res 2020; 222:283-290. [PMID: 32507381 DOI: 10.1016/j.schres.2020.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/16/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
It has been suggested the study of sub-groups within the syndrome of schizophrenia will assist in elucidating the complex pathophysiology of the syndrome. Hence, we have studied a number of cholinergic markers in the cortex from a sub-group of subjects with schizophrenia that have a marked decrease in levels of muscarinic M1 receptors (MRDS). The displacement of [3H]NMS by cortical extracts was used to measure tissue anticholinergic load, [125I]α bungarotoxin binding was used to measure levels of the α7 nicotinic receptor (CHRNA7) and western blotting was used to measure levels of choline acetyltransferase (ChAT) 68 and 82 as well as synaptosome nerve-associated protein 25 (SNAP25). In comparing schizophrenia, MRDS and non-MRDS to controls, there were no differences in levels of ChAT 68 or 82, SNAP 25 or cholinergic load in BA 9. However, levels of CHRNA7 were higher in BA 9, but not BA 6 or 44, from subjects with MRDS. These data argue that there is no change in cholinergic innovation (measured using ChAT), presynaptic neurons (measured using SNAP25) or cholinergic load in schizophrenia, MRDS or non-MRDS. However, increased levels of CHRNA7 may be contributing to a breakdown in cholinergic homeostasis in BA 9, but not BA 6 or 44, in subjects with MRDS.
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Affiliation(s)
- Brian Dean
- The Molecular Psychiatry Laboratory, The Florey Institute for Neuroscience and Mental Health, Victoria, Australia; The Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia.
| | - Geoffrey Pavey
- The Molecular Psychiatry Laboratory, The Florey Institute for Neuroscience and Mental Health, Victoria, Australia
| | - Elizabeth Scarr
- The Molecular Psychiatry Laboratory, The Florey Institute for Neuroscience and Mental Health, Victoria, Australia; Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia
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8
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Does the degree of smoking effect the severity of tardive dyskinesia? A longitudinal clinical trial. Eur Psychiatry 2020; 24:33-40. [DOI: 10.1016/j.eurpsy.2008.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/27/2008] [Accepted: 07/13/2008] [Indexed: 11/30/2022] Open
Abstract
AbstractBackgroundTardive dyskinesia (TD) is a movement disorder observed after chronic neuroleptic treatment. Smoking is presumed to increase the prevalence of TD. The question of a cause-effect-relationship between smoking and TD, however, remains to be answered. Purpose of this study was to examine the correlation between the degree of smoking and the severity of TD with respect to differences caused by medication.MethodWe examined 60 patients suffering from schizophrenia and TD. We compared a clozapine-treated group with a group treated with typical neuroleptics. Movement disorders were assessed using the Abnormal-Involuntary-Movement-Scale and the technical device digital image processing, providing rater independent information on perioral movements.ResultsWe found a strong correlation (.80 < r < .90, always p < .0001) between the degree of smoking and severity of TD. Repeated measurements revealed a positive correlation between changes in cigarette consumption and changes of the severity of TD (p < .0001). Analyses of covariance indicated a significant group-effect with a lower severity of TD in the clozapine-group compared to the typical-neuroleptics-group (p = .010). Interaction-analyses indicated a higher impact of smoking on the severity of TD in the typical-neuroleptics-group compared to the clozapine-group (p = .033).ConclusionConcerning a possible cause-effect-relationship between smoking and TD, smoking is more of a general health hazard than neuroleptic exposure in terms of TD.
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Salokangas RKR, Honkonen T, Stengård E, Koivisto AM, Hietala J. Cigarette smoking in long-term schizophrenia. Eur Psychiatry 2020; 21:219-23. [PMID: 16360309 DOI: 10.1016/j.eurpsy.2005.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 07/24/2005] [Indexed: 11/22/2022] Open
Abstract
AbstractPurposeCigarette smoking is a great health problem and prevalent among subjects with schizophrenia. Our aim was to investigate the prevalence and associations of cigarette smoking in patients with long-term schizophrenia.MethodsSeven hundred and sixty schizophrenia patients were interviewed and their cigarette smoking was recorded.ResultsSmoking was more prevalent men than in women patients. In logistic regression analysis, male gender, duration of illness (DUI) from 10 to 19 years, being divorced or separated, lower education and high daily doses of neuroleptics (DDN) associated significantly with regular smoking. Heavy smoking associated, in men, with hospital treatment.ConclusionsIn schizophrenia patients, smoking is associated with long DUI, high DDN and institutional care. Interventions for cessation and/or reduction of cigarette smoking should be a part of the treatment for patients with schizophrenia.
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Affiliation(s)
- R K R Salokangas
- Department of Psychiatry, University of Turku Psychiatric Clinic, Turku University Central Hospital, 20520 Turku, Finland.
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10
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Terry AV, Callahan PM. α7 nicotinic acetylcholine receptors as therapeutic targets in schizophrenia: Update on animal and clinical studies and strategies for the future. Neuropharmacology 2020; 170:108053. [PMID: 32188568 DOI: 10.1016/j.neuropharm.2020.108053] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
Schizophrenia is a devastating mental illness and its effective treatment is among the most challenging issues in psychiatry. The symptoms of schizophrenia are heterogeneous ranging from positive symptoms (e.g., delusions, hallucinations) to negative symptoms (e.g., anhedonia, social withdrawal) to cognitive dysfunction. Antipsychotics are effective at ameliorating positive symptoms in some patients; however, they are not reliably effective at improving the negative symptoms or cognitive impairments. The inability to address the cognitive impairments is a particular concern since they have the greatest long-term impact on functional outcomes. While decades of research have been devoted to the development of pro-cognitive agents for schizophrenia, to date, no drug has been approved for clinical use. Converging behavioral, neurobiological, and genetic evidence led to the identification of the α7-nicotinic acetylcholine receptor (α7-nAChR) as a therapeutic target several years ago and there is now extensive preclinical evidence that α7-nAChR ligands have pro-cognitive effects and other properties that should be beneficial to schizophrenia patients. However, like the other pro-cognitive strategies, no α7-nAChR ligand has been approved for clinical use in schizophrenia thus far. In this review, several topics are discussed that may impact the success of α7-nAChR ligands as pro-cognitive agents for schizophrenia including the translational value of the animal models used, clinical trial design limitations, confounding effects of polypharmacy, dose-effect relationships, and chronic versus intermittent dosing considerations. Determining the most optimal pharmacologic strategy at α7-nAChRs: agonist, positive allosteric modulator, or potentially even receptor antagonist is also discussed. article is part of the special issue on 'Contemporary Advances in Nicotine Neuropharmacology'.
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Affiliation(s)
- Alvin V Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, 30912, Georgia; Small Animal Behavior Core, Medical College of Georgia, Augusta University, Augusta, 30912, Georgia.
| | - Patrick M Callahan
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, 30912, Georgia; Small Animal Behavior Core, Medical College of Georgia, Augusta University, Augusta, 30912, Georgia
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11
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Tregellas JR, Wylie KP. Alpha7 Nicotinic Receptors as Therapeutic Targets in Schizophrenia. Nicotine Tob Res 2019; 21:349-356. [PMID: 30137618 DOI: 10.1093/ntr/nty034] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/09/2018] [Indexed: 12/12/2022]
Abstract
While current treatments for schizophrenia often provide much relief for positive symptoms such as hallucinations, other symptoms, particularly cognitive deficits, persist and contribute to substantial suffering and reduced quality of life for patients. In searching for novel therapeutic avenues to treat cognitive deficits in schizophrenia, recent work is exploring nicotinic receptor neurobiology. Supported by a large body of evidence, with contributions from studies of smoking behaviors, genetics, receptor distribution and function, animal models and nicotinic effects on illness symptoms, the alpha7 nicotinic receptor has emerged as a potential therapeutic target. Despite promise in early clinical trials, however, no drug targeting nicotinic systems has succeeded in larger phase 3 trials. Following a brief review of nicotinic receptor biology and the evidence that has led to pursuit of alpha7 nicotinic agonism as a therapeutic strategy, this review will provide an update on the status of recent trials, discuss potential issues that may have contributed to negative outcomes, and point to new directions and promising advances in developing alpha7 nicotinic receptor-based treatment for cognitive symptoms in schizophrenia. IMPLICATIONS By examining alpha7 nicotinic receptor biology and recent efforts to target the receptor in clinical trials, it is hoped that investigators will be motivated to explore novel, promising directions focusing on the receptor as a strategy to treat cognitive symptoms in schizophrenia.
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Affiliation(s)
- Jason R Tregellas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO.,Research Service, Denver VA Medical Center, Denver, CO
| | - Korey P Wylie
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO.,Research Service, Denver VA Medical Center, Denver, CO
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12
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Pearsall R, Smith DJ, Geddes JR. Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: a systematic review and meta-analysis of randomised trials. BMJ Open 2019; 9:e027389. [PMID: 31784428 PMCID: PMC6924825 DOI: 10.1136/bmjopen-2018-027389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Smoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness. METHOD A systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration's tool for assessing the risk of bias. RESULTS Twenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low. CONCLUSION The new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.
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Affiliation(s)
- Robert Pearsall
- Department of Psychiatry, Monklands Hospital, Airdrie, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
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13
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Li Y, Hou CL, Ma XR, Zang Y, Jia FJ, Lai KYC, Ungvari GS, Ng CH, Cai MY, Xiang YT. Nicotine dependence in community-dwelling Chinese patients with schizophrenia. Gen Psychiatr 2019; 32:e100014. [PMID: 31179421 PMCID: PMC6551433 DOI: 10.1136/gpsych-2018-100014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/16/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022] Open
Abstract
Background Smoking is a serious public health problem. Patients with schizophrenia usually have a higher prevalence of smoking than the general population, but the level of nicotine dependence is seldom studied, especially for patients living in the communities. Aims This study aimed to examine the level of nicotine dependence in Chinese community-dwelling patients with schizophrenia and explored its associated sociodemographic and clinical factors. Methods A total of 621 patients with schizophrenia treated in the primary care centres of Guangzhou were consecutively recruited. The level of nicotine dependence was assessed with the Chinese version of the Fagerström Test for Nicotine Dependence (FTND). Results 148 patients with schizophrenia were current smokers, and the mean (SD) score of FTND was 5.06 (2.55) for all the current smokers. The prevalence of nicotine addiction was 48.0% (95% CI: 40.0%-56.0%) in patients with current smoking. The patients with schizophrenia had a significantly higher level of nicotine dependence than the Chinese general population. Multiple linear regression analysis revealed that male gender, being unemployed, having a family history of psychiatric disorders, having major medical conditions, first illness episode and less severe positive symptoms were significantly associated with a higher level of nicotine dependence. Conclusion Community-dwelling patients with schizophrenia in China, especially male patients, had a higher level of nicotine dependence than the general population.
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Affiliation(s)
- Yan Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin-Rong Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kelly Y C Lai
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Mei-Ying Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
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14
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Waterhouse U, Brennan KA, Ellenbroek BA. Nicotine self-administration reverses cognitive deficits in a rat model for schizophrenia. Addict Biol 2018; 23:620-630. [PMID: 28497655 DOI: 10.1111/adb.12517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/02/2017] [Accepted: 03/22/2017] [Indexed: 01/18/2023]
Abstract
High comorbidity between schizophrenia and tobacco addiction has been well established. Explanatory theories include nicotine as a cognitive enhancer ameliorating symptoms of schizophrenia and underlying shared substrates increasing susceptibility to addiction in these individuals. To test these non-mutually exclusive theories, the maternal immune activation (MIA) model was utilized. To this end, pregnant Sprague Dawley rats were subcutaneously injected with a bacterial endotoxin, lipopolysaccharide (0.5 mg/kg), on gestation days 10 and 11. Selective attention and working memory in adult male offspring were subsequently assessed using the latent inhibition and delayed non-matching to sample paradigms both before and after nicotine or saline self-administration. MIA led to deficits in both latent inhibition and delayed non-matching to sample in male offspring. Further, these animals showed a small but significantly increased responding for nicotine during self-administration acquisition, although there was no difference in dose-response effect or in progressive ratio testing. However, nicotine, but not saline self-administration, significantly ameliorated the cognitive deficits induced by MIA. While the male offspring of mothers prenatally exposed to lipopolysaccharide was only slightly more sensitive to the reinforcing effects of nicotine, after self-administration, the MIA-induced cognitive deficits significantly improved. These data lend support for the self-medication hypothesis of schizophrenia.
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Affiliation(s)
- Uta Waterhouse
- School of Psychology; Victoria University of Wellington; Wellington New Zealand
| | | | - Bart A. Ellenbroek
- School of Psychology; Victoria University of Wellington; Wellington New Zealand
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15
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Analyzing the genes related to nicotine addiction or schizophrenia via a pathway and network based approach. Sci Rep 2018; 8:2894. [PMID: 29440730 PMCID: PMC5811491 DOI: 10.1038/s41598-018-21297-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/31/2018] [Indexed: 01/02/2023] Open
Abstract
The prevalence of tobacco use in people with schizophrenia is much higher than in general population, which indicates a close relationship between nicotine addiction and schizophrenia. However, the molecular mechanism underlying the high comorbidity of tobacco smoking and schizophrenia remains largely unclear. In this study, we conducted a pathway and network analysis on the genes potentially associated with nicotine addiction or schizophrenia to reveal the functional feature of these genes and their interactions. Of the 276 genes associated with nicotine addiction and 331 genes associated with schizophrenia, 52 genes were shared. From these genes, 12 significantly enriched pathways associated with both diseases were identified. These pathways included those related to synapse function and signaling transduction, and drug addiction. Further, we constructed a nicotine addiction-specific and schizophrenia-specific sub-network, identifying 11 novel candidate genes potentially associated with the two diseases. Finally, we built a schematic molecular network for nicotine addiction and schizophrenia based on the results of pathway and network analysis, providing a systematic view to understand the relationship between these two disorders. Our results illustrated that the biological processes underlying the comorbidity of nicotine addiction and schizophrenia was complex, and was likely induced by the dysfunction of multiple molecules and pathways.
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16
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García-Portilla MP, Bobes J. Smoking cessation programs for persons with schizophrenia: An urgent unmet need. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 9:181-184. [PMID: 27969002 DOI: 10.1016/j.rpsm.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 01/19/2023]
Affiliation(s)
- María Paz García-Portilla
- Área de Psiquiatría y Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, Asturias, España
| | - Julio Bobes
- Área de Psiquiatría y Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, Asturias, España.
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17
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Miyauchi M, Kishida I, Suda A, Shiraishi Y, Fujibayashi M, Taguri M, Ishii C, Ishii N, Moritani T, Hirayasu Y. Long term effects of smoking cessation in hospitalized schizophrenia patients. BMC Psychiatry 2017; 17:87. [PMID: 28270120 PMCID: PMC5341461 DOI: 10.1186/s12888-017-1250-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of smoking in patients with schizophrenia is higher than that in the general population and is an important medical issue. Short-term smoking cessation tends to worsen psychiatric symptoms in patients with schizophrenia but decreases sympathetic nervous system activity and improves plasma cholesterol levels in healthy people. Few studies have assessed the long-term effects of smoking cessation in patients with schizophrenia. METHODS Subjects were 70 Japanese patients with schizophrenia (38 smokers, 32 non-smokers). We compared the following clinical parameters between the two groups at baseline (before smoking cessation) and in each group separately between baseline and at three years after smoking cessation: autonomic nervous system activity, plasma cholesterol levels, body weight, drug therapy, and Global Assessment of Functioning scores. We also compared the mean changes in clinical parameters throughout this study between the groups at both time points. Autonomic nervous system activity was assessed by power spectral analysis of heart rate variability. RESULTS Parasympathetic nervous system activity and the doses of antiparkinsonian drugs in smokers were significantly higher than those in non-smokers at baseline. Smoking cessation was associated with significantly decreased sympathetic nervous system activity and decreased doses of antipsychotics and antiparkinsonian drugs at three years after smoking cessation. However, there was no significant difference in the mean change in clinical factors scores, except for Global Assessment of Functioning scores, between smokers and non-smokers at three years after smoking cessation. CONCLUSIONS Our results suggest that smoking reduces both autonomic nervous system activity and the effectiveness of drug therapy with antipsychotics and antiparkinsonian drugs in patients with schizophrenia, but that both factors could be ameliorated over the long term by smoking cessation. Taken together with the findings of previous studies, smoking cessation in patients with schizophrenia has many long-term positive physiological effects.
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Affiliation(s)
- Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. .,Fujisawa Hospital, 383 Kotsuka, Fujisawa, Kanagawa, 251-8530, Japan.
| | - Ikuko Kishida
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Akira Suda
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yohko Shiraishi
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,0000 0004 1767 0473grid.470126.6Clinical Laboratory Department, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Mami Fujibayashi
- 0000 0001 0454 7765grid.412493.9The Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, Osaka 572-8508 Japan
| | - Masataka Taguri
- 0000 0001 1033 6139grid.268441.dDepartment of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotsuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotsuka, Fujisawa, Kanagawa 251-8530 Japan
| | - Toshio Moritani
- 0000 0001 0674 6688grid.258798.9Faculty of General Education, Kyoto Sangyo University, Kamo-motoyama, Kita-Ku, Kyoto, 606-8555 Japan
| | - Yoshio Hirayasu
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
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18
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Wolfe RM, Reeves LE, Gibson LE, Cooper S, Ellman LM. Attenuated Positive Psychotic Symptoms in Relation to Cigarette Smoking in a Nonclinical Population. Nicotine Tob Res 2016; 19:124-128. [PMID: 27651478 DOI: 10.1093/ntr/ntw240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explored the association between cigarette smoking and attenuated positive psychotic symptoms in a young adult nonclinical sample. METHODS Undergraduates (N = 930), aged 18-35 years (26.3% male), completed a battery of self-report measures assessing subthreshold psychotic symptoms, cigarette smoking behavior/dependence, and drug use. RESULTS Individuals endorsing a greater number of attenuated positive psychotic symptoms were more likely to be smokers. Exploratory analyses indicated that the odds of being a smoker were two times greater for those at potential higher risk for psychosis compared with individuals at lower risk. Results were consistent after adjusting for sex and other drug use. CONCLUSIONS In line with findings from psychotic populations, results suggest that attenuated positive psychotic symptoms, particularly those endorsed as distressing in a nonclinical, undergraduate population, are related to cigarette smoking. IMPLICATIONS Even in nonclinical, undergraduate populations, subthreshold psychotic symptoms are related to cigarette smoking, and cigarette smokers are twice as likely to be considered at potentially higher risk for psychosis compared with noncigarette smokers. In summary, there may be a threshold whereby psychotic symptoms confer increased risk for nicotine consumption, with endorsement of a greater number of distressing subthreshold psychotic symptoms increasing the likelihood of cigarette use.
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Affiliation(s)
- Rebecca M Wolfe
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Reeves
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Gibson
- Department of Psychology, Temple University, Philadelphia, PA
| | - Shanna Cooper
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
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19
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Parikh V, Kutlu MG, Gould TJ. nAChR dysfunction as a common substrate for schizophrenia and comorbid nicotine addiction: Current trends and perspectives. Schizophr Res 2016; 171:1-15. [PMID: 26803692 PMCID: PMC4762752 DOI: 10.1016/j.schres.2016.01.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/07/2016] [Accepted: 01/10/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The prevalence of tobacco use in the population with schizophrenia is enormously high. Moreover, nicotine dependence is found to be associated with symptom severity and poor outcome in patients with schizophrenia. The neurobiological mechanisms that explain schizophrenia-nicotine dependence comorbidity are not known. This study systematically reviews the evidence highlighting the contribution of nicotinic acetylcholine receptors (nAChRs) to nicotine abuse in schizophrenia. METHODS Electronic data bases (Medline, Google Scholar, and Web of Science) were searched using the selected key words that match the aims set forth for this review. A total of 276 articles were used for the qualitative synthesis of this review. RESULTS Substantial evidence from preclinical and clinical studies indicated that dysregulation of α7 and β2-subunit containing nAChRs account for the cognitive and affective symptoms of schizophrenia and nicotine use may represent a strategy to remediate these symptoms. Additionally, recent meta-analyses proposed that early tobacco use may itself increase the risk of developing schizophrenia. Genetic studies demonstrating that nAChR dysfunction that may act as a shared vulnerability factor for comorbid tobacco dependence and schizophrenia were found to support this view. The development of nAChR modulators was considered an effective therapeutic strategy to ameliorate psychiatric symptoms and to promote smoking cessation in schizophrenia patients. CONCLUSIONS The relationship between schizophrenia and smoking is complex. While the debate for the self-medication versus addiction vulnerability hypothesis continues, it is widely accepted that a dysfunction in the central nAChRs represent a common substrate for various symptoms of schizophrenia and comorbid nicotine dependence.
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Affiliation(s)
- Vinay Parikh
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA 19112, United States.
| | - Munir Gunes Kutlu
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA 19112, United States
| | - Thomas J Gould
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA 19112, United States
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20
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Deng H, Wang J, Zhang X, Ma M, Domingo C, Sun H, Kosten T. Smoking reduction and quality of life in chronic patients with schizophrenia in a Chinese population--A pilot study. Am J Addict 2016; 25:86-90. [PMID: 26824336 DOI: 10.1111/ajad.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Tobacco use is a significant public health issue on a global scale. Prevalence of daily tobacco smoking for men in China is much higher than in the United States. Although prevailing literature suggests a negative relationship between smoking and quality of life, this pilot study sought to evaluate whether smoking reduction/cessation impacted on the perception of quality of life in an in-patient population in China. METHODS Twenty Chinese patients meeting DSM-IV criteria for schizophrenia were recruited from Beijing Hui-Long-Guan Hospital, an in-patient facility in Beijing, China, for participation in this 4-week study. Seventeen participants with schizophrenia completed the study and were included in the final analysis. Cigarette consumption was recorded daily and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) was completed at baseline and at week 4. The relationships between smoking and perceived quality of life were evaluated using correlations between changes in WHOQOL-BREF and changes in cigarettes consumed as measured from baseline to week 4. RESULTS We found an increase in perceived quality of life in the social relationships domain with increased cigarette consumption in contrast to a decrease in this domain with decreased consumption. However, decreased cigarette consumption was associated with an increase in the psychological domain compared to the social domain. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These associations suggest a need for interventions to improve the social relationship perceptions with any successful reduction in cigarette consumption among Chinese schizophrenics in order to match their perceived psychological improvement.
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Affiliation(s)
- Huiqiong Deng
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, Houston, Texas
| | - Jia Wang
- Baylor College of Medicine, Houston, Texas
| | - Xiangyang Zhang
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, Houston, Texas
| | - Mengying Ma
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Coreen Domingo
- Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Hongqiang Sun
- Peking University Sixth Hospital/Institute of Mental Health and National Clinical Research Center for Mental Disorders, Beijing, China.,Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Thomas Kosten
- Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
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21
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Misiak B, Kiejna A, Frydecka D. Assessment of cigarette smoking status with respect to symptomatic manifestation in first-episode schizophrenia patients. Compr Psychiatry 2015; 58:146-51. [PMID: 25595518 DOI: 10.1016/j.comppsych.2014.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE It has been repeatedly found that cigarette smoking may influence schizophrenia psychopathology. However, little is known about the relationship between nicotine consumption and symptomatic manifestation of first-episode schizophrenia (FES). METHOD We recruited 109 minimally medicated FES patients. Cigarette smoking was assessed using the Fagerström test for nicotine dependence (FTND) and pack-year index. Psychopathology on the day of recruitment was examined using the Positive and Negative Syndrome Scale (PANSS). RESULTS Smokers had significantly lower severity of negative and depressive symptoms in comparison with non-smokers. Patients with severe nicotine dependence had significantly later age of psychosis onset in comparison with those with mild nicotine dependence and non-smokers. Significantly lower severity of negative and depressive symptoms was also observed in patients with severe nicotine dependence in comparison with non-smokers. The associations between the severity of nicotine dependence and scores of negative and depressive symptoms as well as age of psychosis onset remained significant after co-varying for gender, education, duration of untreated psychosis (DUP) and measures of antipsychotic treatment. CONCLUSION Our results indicate that cigarette smoking might be associated with less severe negative and depressive symptoms as well as delayed age of psychosis onset. However, longitudinal studies are required to indicate the direction of causality.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
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22
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Gupta T, Mittal VA. Nicotine usage is associated with elevated processing speed, spatial working memory, and visual learning performance in youth at ultrahigh-risk for psychosis. Psychiatry Res 2014; 220:687-90. [PMID: 25190344 PMCID: PMC4252748 DOI: 10.1016/j.psychres.2014.07.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 06/26/2014] [Accepted: 07/28/2014] [Indexed: 01/03/2023]
Abstract
Research has stressed a link between nicotine and cognition in schizophrenia but this has not been examined in youth at ultrahigh-risk (UHR) for psychosis. A total of 35 UHR and 32 control participants were assessed for naturalistic nicotine-use and administered a cognitive battery. Smoking was reported more frequently in the UHR group (46%) than controls (22%). Frequent smoking was associated with elevated cognitive performance in the UHR group, highlighting a need for experimental investigations.
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Affiliation(s)
- Tina Gupta
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1905 Colorado Avenue, CB 345 UCB, Boulder, CO 80309-0345, United States.
| | - Vijay A Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1905 Colorado Avenue, CB 345 UCB, Boulder, CO 80309-0345, United States; Center for Neuroscience, University of Colorado Boulder, 1905 Colorado Avenue, Boulder, CO 80309-0345, United States
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23
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Young-Wolff KC, Hickman NJ, Kim R, Gali K, Prochaska JJ. Correlates and prevalence of menthol cigarette use among adults with serious mental illness. Nicotine Tob Res 2014; 17:285-91. [PMID: 25190706 DOI: 10.1093/ntr/ntu141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION With a focus on protecting vulnerable groups from initiating and continuing tobacco use, the FDA has been considering the regulation of menthol in cigarettes. Using a large sample of adult smokers with serious mental illness (SMI) in the San Francisco Bay Area, we examined demographic and clinical correlates of menthol use, and we compared the prevalence of menthol use among our study participants to that of adult smokers in the general population in California. METHODS Adult smokers with SMI (N = 1,042) were recruited from 7 acute inpatient psychiatric units in the San Francisco Bay Area. Demographic, tobacco, and clinical correlates of menthol use were examined with bivariate and multivariate logistic regression analyses, and prevalence of menthol use was compared within racial/ethnic groups to California population estimates from the 2008-2011 National Survey on Drug Use and Health. RESULTS A sample majority (57%) reported smoking menthol cigarettes. Multivariate logistic regression analyses indicated that adult smokers with SMI who were younger, who had racial/ethnic minority status, who had fewer perceived interpersonal problems, and who had greater psychotic symptoms also had a significantly greater likelihood of menthol use. Smokers with SMI had a higher prevalence of menthol use relative to the general population in California overall (24%). CONCLUSIONS Individuals with SMI-particularly those who are younger, have racial/ethnic minority status, and have been diagnosed with a psychotic disorder-are vulnerable to menthol cigarette use. FDA regulation of menthol may prevent initiation and may encourage cessation among smokers with SMI.
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Affiliation(s)
- Kelly C Young-Wolff
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - Norval J Hickman
- Tobacco-Related Disease Research Program, Office of Research and Graduate Studies, University of California Office of the President, Oakland, CA
| | - Romina Kim
- Michigan State University College of Human Medicine, East Lansing, MI
| | - Kathleen Gali
- Social Cognitive Sciences Graduate Group, School of Social Sciences Humanities and Arts, University of California, Merced, CA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA;
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Knott V, Impey D, Philippe T, Smith D, Choueiry J, de la Salle S, Dort H. Modulation of auditory deviance detection by acute nicotine is baseline and deviant dependent in healthy nonsmokers: a mismatch negativity study. Hum Psychopharmacol 2014; 29:446-58. [PMID: 25196041 DOI: 10.1002/hup.2418] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/19/2014] [Accepted: 05/19/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Cognitive enhancement resulting from nicotinic acetylcholine receptor stimulation may be evidenced by increased efficiency of the auditory-frontal cortex network of auditory discrimination, which is impaired in schizophrenia, a cognitive disorder associated with excessive tobacco use. Investigating automatic (preattentive) detection of acoustic change with the mismatch negativity (MMN) brain event-related potential in response to nicotine in individuals with varying baseline levels of auditory discrimination may provide useful insight into the cholinergic regulation of this neural network and its potential amelioration with novel nicotinic agents. METHODS Sixty healthy, non-smoking male volunteers were presented with an 'optimal' multi-feature MMN paradigm in a randomized, placebo controlled double-blind design with 6 mg of nicotine gum. RESULTS Participants with low, medium, and high baseline amplitudes responded differently to nicotine (vs. placebo), and nicotine response was feature specific. Whereas MMN in individuals with high amplitudes was diminished by nicotine, MMN increased in those with low amplitudes. Nicotine effects were not shown in medium amplitude participants. CONCLUSIONS These findings provide preliminary support for the role of nicotinic neurotransmission in sensory memory processing of auditory change and suggest that nicotinic receptor modulation can both enhance and diminish change detection, depending on baseline MMN and its eliciting stimulus feature.
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Affiliation(s)
- Verner Knott
- University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Neuroscience Program, Department of Cellular and Molecular Medicine, University of Ottawa, Ontario, Canada
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Ong KY, Muhd Ramli ER, Che Ismail H. Factors associated with sexual dysfunction among schizophrenia men with nicotine dependency and non-smoking schizophrenia men. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/17523281.2014.940370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bot M, Vink J, Milaneschi Y, Smit JH, Kluft C, Neuteboom J, Penninx B. Plasma cotinine levels in cigarette smokers: impact of mental health and other correlates. Eur Addict Res 2014; 20:183-91. [PMID: 24481322 DOI: 10.1159/000356809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We examined in cigarette smokers whether cotinine was associated with depressive and/or anxiety disorders. METHODS Data were derived from 1,026 smoking adults with and without depressive and/or anxiety disorders participating in the Netherlands Study of Depression and Anxiety (NESDA). Depressive and anxiety disorders were ascertained with the DSM-IV Composite International Diagnostic Interview. Cigarette consumption was inquired about during an interview. Cotinine was assessed in plasma. RESULTS Currently depressed and/or anxious smokers (n=692) reported smoking a higher number of cigarettes per day (CPD) than smokers with a remitted disorder (n=190) and smokers with no lifetime disorder (n=144). After controlling for CPD and other covariates, depressed and/or anxious smokers had lower cotinine levels compared to smokers with no lifetime disorder (B=-56.0, p=0.001). In the full regression model, CPD was positively associated with cotinine levels, whereas current depression and/or anxiety and high body mass index were inversely associated with cotinine. CONCLUSION After considering CPD, the presence of current depressive and/or anxiety disorders was associated with lower cotinine levels, which may point to a different smoking topography or a faster cotinine metabolism in individuals with affective disorders. The latter could help to explain the higher number of cigarettes smoked and poorer cessation rates among depressed or anxious patients.
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Affiliation(s)
- Mariska Bot
- Department of Psychiatry, EMGO Institute of Health and Care Research, Neuroscience Campus Amsterdam, VU University Medical Center, and GGZinGeest, Amsterdam, The Netherlands
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Socio-demographic and clinical characteristics of heavy and non-heavy smokers among schizophrenia inpatients in a Chinese Han population. Psychopharmacology (Berl) 2014; 231:305-14. [PMID: 23963531 DOI: 10.1007/s00213-013-3239-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Despite higher smoking rates in schizophrenia, few studies have explored the clinical-demographic correlates of different amounts of smoking exposure. Little is known about the association between smoking severity and clinical phenotypes in Chinese patients with schizophrenia. MATERIALS AND METHODS We investigated differences between heavy (≥1 pack/day) and non-heavy (<1 pack/day) smoking in 550 male inpatients with schizophrenia using clinician-administered questionnaires and the Fagerstrom Test for Nicotine Dependence. They also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS), as well as were assayed with laboratory tests and an electrocardiogram. RESULTS Heavy smoking prevalence was approximately 31 %. Compared to the non-heavy smokers, the heavy smokers were younger, more with paranoid subtype but less with disorganized subtype schizophrenia, smoked at an earlier age, fewer getting clozapine or all atypical antipsychotics together, and were taking larger doses of antipsychotic drugs. The heavy smokers scored significantly lower on the PANSS negative symptom subscore and total score, and also on the SAES and AIMS scores than the non-heavy smokers. In addition, heavy smokers displayed longer rate-corrected electrocardiographic QT intervals, but without any significant differences in other laboratory tests. CONCLUSION Our results suggest several clinical or demographic differences between the heavy and non-heavy smoking patients with schizophrenia in a Chinese population. Heavy smoking remains a general health risk for schizophrenia.
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Garcia-Portilla MP, Garcia-Alvarez L, Saiz PA, Diaz-Mesa E, Galvan G, Sarramea F, Garcia-Blanco J, Elizagarate E, Bobes J. Effectiveness of a multi-component Smoking Cessation Support Programme (McSCSP) for patients with severe mental disorders: study design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:373-89. [PMID: 24368428 PMCID: PMC3924449 DOI: 10.3390/ijerph110100373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 11/24/2022]
Abstract
Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4–12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrolment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.
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Affiliation(s)
- Maria Paz Garcia-Portilla
- Departmento de Psiquiatría, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (M.P.G.-P.); (J.B.)
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (L.G.-A.); (E.D.-M.)
| | - Leticia Garcia-Alvarez
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (L.G.-A.); (E.D.-M.)
| | - Pilar Alejandra Saiz
- Departmento de Psiquiatría, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (M.P.G.-P.); (J.B.)
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (L.G.-A.); (E.D.-M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +34-985-103-552; Fax: +34-985-103-553
| | - Eva Diaz-Mesa
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (L.G.-A.); (E.D.-M.)
| | - Gonzalo Galvan
- Universidad Nacional de la Patagonia Austral, Puerto San Julián, 9310 Santa Cruz, Argentina; E-Mail:
- Instituto Interuniversitario de Postgrado en Salud, Santa Rosa, 6300 La Pampa, Argentina
| | - Fernando Sarramea
- Complejo Hospitalario de Jaén, Equipo de Salud Mental de Andújar, 23740 Jaén, Spain; E-Mails: (F.S.); (J.G.-B.)
| | - Josefa Garcia-Blanco
- Complejo Hospitalario de Jaén, Equipo de Salud Mental de Andújar, 23740 Jaén, Spain; E-Mails: (F.S.); (J.G.-B.)
| | - Edorta Elizagarate
- Unidad de Psicosis Refractarias, Hospital Psiquiátrico de Álava, 01006 Vitoria, Spain; E-Mail:
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Universidad del País Vasco, 48940 Leioa-Bizkaia, Spain
| | - Julio Bobes
- Departmento de Psiquiatría, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (M.P.G.-P.); (J.B.)
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Universidad de Oviedo, 33006 Oviedo, Spain; E-Mails: (L.G.-A.); (E.D.-M.)
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Allostatic load as a tool for monitoring physiological dysregulations and comorbidities in patients with severe mental illnesses. Harv Rev Psychiatry 2013; 21:296-313. [PMID: 24201821 DOI: 10.1097/hrp.0000000000000012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe mental illnesses like schizophrenia and bipolar disorder are disabling, chronic conditions that are often accompanied by medical comorbidities. In this theoretical article, we review the allostatic load model representing the "wear and tear" that chronic stress exacts on the brain and body. We propose an innovative way of monitoring physical and psychiatric comorbidities by integrating the allostatic load model into clinical practice. By interpreting peripheral biomarkers differently, medical professionals can calculate a simple, count-based, allostatic load index known to predict diverse stress-related pathologies. In addition to screening for comorbidities, allostatic load indices can be used to monitor the effects of pharmacological and psychosocial interventions. This framework can also be used to generate a dialogue between patient and practitioner to promote preventive and proactive approaches to health care.
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Investigation of cigarette smoking among male schizophrenia patients. PLoS One 2013; 8:e71343. [PMID: 23977021 PMCID: PMC3744579 DOI: 10.1371/journal.pone.0071343] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 07/01/2013] [Indexed: 12/25/2022] Open
Abstract
Male schizophrenia patients are known to have a heavier smoking pattern compared with the general population. However, the mechanism for this association is not known, though hypothesis that smoking could alleviate symptomatology of schizophrenia and reduce side effects of antipsychotics has been suggested. The aims of this study were to validate the heavier smoking pattern among male schizophrenia patients and to investigate the possible mechanisms for the association. To enhance the reliability of the study, we recruited two large independent samples with 604 and 535 male Chinese schizophrenia patients, and compared their smoking pattern with that of 535 healthy male controls recruited from general population. Validated multiple indicators and multiple causes structure equation model and regression models were used to investigate the association of smoking with factors of schizophrenia symptomatology and with the usage of antipsychotics and their extra-pyramidal side effects (EPS). Schizophrenia patients had significantly heavier smoking pattern compared with healthy controls in our sample (42.4% vs. 16.8%, p<0.001 for current smoking prevalence; 23.5% vs. 43.3%, p<0.001 for smoking cessation rate; 24.5% vs. 3.0%, p<0.001 for heavy smoker proportion). Their smoking status was also found to be consistently and significantly associated with reduced negative factor scores for schizophrenia symptomatology (β = −0.123, p = 0.051 for sample-A; β = −0.103, p = 0.035 for sample-B; β = −0.082, p = 0.017 for the combined sample). However, no significant association was found between smoking and antipsychotics usage or risk of EPS. These results support that smoking is associated with improved negative symptoms, which could account for the heavier smoking pattern among schizophrenia patients.
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Zhang XY, Chen DC, Xiu MH, Haile CN, He SC, Luo X, Zuo L, Rosenheck R, Kosten TA, Kosten TR. Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case-control study. Psychol Med 2013; 43:1651-1660. [PMID: 23149169 DOI: 10.1017/s0033291712002590] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although patients with chronic schizophrenia have substantially higher smoking rates than either the general population or patients with other mental illnesses, drug-naive patients with a first episode of schizophrenia have received little systemic study. This study examined smoking rates, the association between smoking and symptom severity and cognitive function in Chinese first-episode schizophrenia (FES) patients using cross-sectional and case-control designs. METHOD Two hundred and forty-four drug-naive FES patients and 256 healthy controls matched for gender, age and education completed the Fagerström Test for Nicotine Dependence (FTND) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients were also rated on the Positive and Negative Symptom Scale (PANSS). RESULTS The rate and quantity of smoking were not significantly higher among FES patients compared to the general population. Among patients, smokers scored higher than non-smokers on the total PANSS and the positive symptom subscale scores. There were no significant associations between cognitive function and smoking in either FES patients or healthy controls. CONCLUSIONS In contrast to studies in patients with chronic schizophrenia, drug-naive FES patients did not smoke more frequently than the general population. Furthermore, patients with psychotic disorders who smoked did not exhibit significant cognitive differences compared with those who did not smoke. However, smoking may have other detrimental effects on physical and mental health, for example on positive symptoms.
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Affiliation(s)
- X Y Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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Beebe LH, Parker CR. Descriptions and correlates of salivary cotinine in individuals with schizophrenia spectrum disorders. J Psychosoc Nurs Ment Health Serv 2013; 51:33-8. [PMID: 23758225 DOI: 10.3928/02793695-20130603-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/26/2013] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to describe the procedure and results of salivary cotinine testing and to examine correlations between cotinine levels, self-reported smoking behavior, and other demographic variables in outpatients with schizophrenia spectrum disorders (SSDs). Twenty-one participants completed salivary cotinine measures. Sixteen reported smoking cigarettes (mean = 1.2 packs per day; SD = 0.8; range = 0.25 to 3.0) for a mean of 27.4 years (SD = 16.3 years, range = 1 to 46 years). Age was significantly positively correlated with self-report of packs smoked per day (r = 0.52; p = 0.04) and years smoked (r = 0.63; p = 0.02). There was no clear pattern of relationship between salivary cotinine level and self-reported smoking behavior. This pilot study adds to a small body of literature describing salivary cotinine measures in individuals with SSDs, yet further investigation is warranted to definitively determine the utility of this objective measure of nicotine use.
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Stewart DW, Vinci C, Adams CE, Cohen AS, Copeland AL. Smoking topography and outcome expectancies among individuals with schizotypy. Psychiatry Res 2013; 205:205-12. [PMID: 23261186 PMCID: PMC3760683 DOI: 10.1016/j.psychres.2012.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 11/12/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022]
Abstract
Compared to smokers in the general population, smokers with schizophrenia smoke more cigarettes per day and have higher nicotine dependence and biochemical indicators of nicotine intake. They also have more intense smoking topography and greater positive smoking expectancies. Little is known about the relationship between smoking and schizotypy, defined as the personality organization reflecting a vulnerability to schizophrenia-spectrum pathology. This study assessed schizotypy symptoms, smoking characteristics and behaviors, and smoking expectancies in young adults with psychometrically defined schizotypy and demographically matched controls without schizotypy. Smokers with schizotypy had higher nicotine dependence and smoked more cigarettes per week compared to control smokers. They were also more likely to endorse greater positive consequences (i.e., improved state enhancement, stimulation, social facilitation, taste/sensorimotor manipulation, reduced negative affect and boredom) and fewer negative consequences of smoking. Smokers with schizotypy and control smokers did not differ on smoking topography or carbon monoxide levels. This is the first known study to investigate relationships between these smoking-related variables in smokers with schizotypy. Individuals with schizotypy possessed certain smoking-related characteristics and smoking expectancies similar to those with schizophrenia. This offers preliminary insight into unique smoking-related factors among individuals with schizotypy and highlights the importance of continued research in this area.
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Affiliation(s)
- Diana W Stewart
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research-Unit 1440, P.O. Box 301402, Houston, TX 77230-1402, USA.
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de Beaurepaire R, Rat P, Beauverie P, Houery M, Niel P, Castéra S, Dagorne O, Espaze R, Giroult P, Mahuzier G, Matheron I, Padovani P, Poisson N, Richier JP, Rocher J, Ruetsh O, Touzeau D, Visinoni A, Molimard R. Is smoking linked to positive symptoms in acutely ill psychiatric patients? Nord J Psychiatry 2012; 66:225-31. [PMID: 21905972 DOI: 10.3109/08039488.2011.610468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The self-medication hypothesis is commonly put forward to explain the high prevalence of smoking in psychiatric patients. However, studies supporting the self-medication hypothesis have most often been carried out on chronic patients stabilized by antipsychotics. AIM Given that antipsychotics tend to erase psychiatric symptoms, the present study was undertaken on acutely ill patients usually receiving no medications, or on whom medications are ineffective. METHODS Participants were 492 consecutively hospitalized patients. They were evaluated the day of their hospitalization with the Brief Psychiatric Rating Scale (BPRS, 18 items). Urinary cotinine and creatinine were measured the morning following their hospitalization. The urinary cotinine/creatinine ratio and the cotinine/creatinine/number of cigarettes smoked per day ratio (nicotine extraction index) were calculated for each patient. RESULTS The positive symptoms subscale of the BPRS significantly correlated with smoking, whereas other BPRS subscales did not. In patients with mood disorder, the nicotine extraction index correlated with the positive symptoms, activation and hostility subscales, but not with the negative symptoms subscale. Analyses of individual BPRS items using the cotinine/creatinine ratio measure showed that smoking is positively associated with "unusual thought content" and "grandiosity" items and negatively associated with "guilt feeling", "depressed mood" and "motor retardation". Analyses of individual BPRS items using the nicotine extraction index showed a positive association only with "unusual thought content" and "grandiosity" items. Patients with schizophrenia extract more nicotine from cigarettes than other patients. CONCLUSION In acutely ill psychiatric patients, smoking is linked with positive symptoms and not with negative symptoms.
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Affiliation(s)
- Renaud de Beaurepaire
- Groupe Hospitalier Paul-Guiraud, 54, avenue de la République, 94806 Villejuif, France.
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Wehring HJ, Liu F, McMahon RP, Mackowick KM, Love RC, Dixon L, Kelly DL. Clinical characteristics of heavy and non-heavy smokers with schizophrenia. Schizophr Res 2012; 138:285-9. [PMID: 22578720 PMCID: PMC4062915 DOI: 10.1016/j.schres.2012.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 03/16/2012] [Accepted: 03/21/2012] [Indexed: 01/09/2023]
Abstract
Up to 50-90% of persons with schizophrenia smoke cigarettes. Limited data and theories suggest persons with schizophrenia may smoke for different reasons than persons without schizophrenia, making smoking cessation interventions particularly challenging in this population. Although health consequences of smoking are widely known, less information is available regarding characteristics of different amounts of smoking exposure in this population. This study was performed to investigate differences between heavy (≥ 1 pack per day) and non-heavy (<1 pack per day) smoking in patients with schizophrenia. Data from 745 patients, mean age 41.3+/-12.6 years, were drawn from a population of smokers admitted to State of Maryland inpatient mental health facilities (1994-2000). Records were reviewed to obtain demographic information, diagnosis, medication, smoking and substance use. 43% of patients were characterized as heavy smokers. Heavy and non-heavy groups did not differ in age, GAF, weight, or BMI. No differences were found in race, gender or antipsychotic treatments. However, patients smoking ≥ 1 packs per day were more likely to use other substances such as alcohol (χ(2)=6.67, df=1, p=0.01), cocaine (χ(2)=6.66, df=1, p=0.01), and other substances (χ(2)=9.95, df=1, p=0.003) compared to non-heavy smokers. No differences in cannabis or heroin use were found by smoking category. Controlling for age, race, sex and BMI, heavy smokers had higher total cholesterol (190.7(51.6)mg/dL) compared to non-heavy smokers (178.2 (43.0)mg/dL, p=0.03), but no differences were found in glucose or blood pressure. Heavy smoking may be a particular health risk in schizophrenia and significant efforts for smoking cessation or reduction are needed.
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Affiliation(s)
- Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Kristen M. Mackowick
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Raymond C. Love
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Lisa Dixon
- Division of Services Research, University of Maryland School of Medicine, Baltimore, MD
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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Zhang XY, Chen DC, Xiu MH, Haile CN, Sun H, Lu L, Kosten TA, Kosten TR. Cigarette smoking and cognitive function in Chinese male schizophrenia: a case-control study. PLoS One 2012; 7:e36563. [PMID: 22570726 PMCID: PMC3343009 DOI: 10.1371/journal.pone.0036563] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/06/2012] [Indexed: 11/27/2022] Open
Abstract
Schizophrenic patients have higher smoking rates than the general population. Studies show that smoking may be a form of self-medication in an attempt to alleviate cognitive deficits in schizophrenic patients of European background. This study examined the relationships between smoking and cognitive deficits in Chinese schizophrenic patients, which have previously received little systemic study. We recruited 580 male chronic patients meeting DSM-IV criteria for schizophrenia and 175 male control subjects who were matched on age and education. The subjects completed a detailed cigarette smoking questionnaire, the Fagerstrom Test for Nicotine Dependence (FTND), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS). All five RBANS subscales except for the Visuospatial/Constructional index showed significantly lower cognitive performance for schizophrenics than normal controls. The schizophrenic smokers scored lower than the schizophrenic non-smokers on the RBANS total score and the Visuospatial/Constructional and Immediate Memory indices. Similarly, the control smokers scored lower than the control non-smokers on the RBANS total score and the Immediate Memory index . Also, the schizophrenic smokers consistently performed the poorest on the cognitive domains of the RBANS. Among the schizophrenic patients, smokers displayed significantly fewer negative symptoms than non-smokers. Using multivariate regression analysis the following variables were independently associated with the RBANS total score: years of education, PANSS negative symptom score, age at schizophrenia onset, and number of hospitalizations. Our results show that smoking is associated with significant cognitive impairment in both schizophrenic patients and normal controls, but the smokers with schizophrenia had a reduced level of negative symptoms, suggesting that the benefits of smoking for those with schizophrenia may be limited to certain aspects of a given clinical phenotype.
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Affiliation(s)
- Xiang Yang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America
- Beijing HuiLongGuan Hospital, Peking University, Beijing, People's Republic of China
| | - Da Chun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, People's Republic of China
| | - Mei Hong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, People's Republic of China
| | - Colin N. Haile
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America
| | - Hongqiang Sun
- Beijing HuiLongGuan Hospital, Peking University, Beijing, People's Republic of China
- The National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- The National Institute on Drug Dependence, Peking University, Beijing, China
| | - Therese A. Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America
| | - Thomas R. Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America
- Beijing HuiLongGuan Hospital, Peking University, Beijing, People's Republic of China
- * E-mail:
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Fisher DJ, Grant B, Smith DM, Borracci G, Labelle A, Knott VJ. Nicotine and the hallucinating brain: effects on mismatch negativity (MMN) in schizophrenia. Psychiatry Res 2012; 196:181-7. [PMID: 22425471 DOI: 10.1016/j.psychres.2012.01.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 01/23/2012] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
Elevated smoking rates have been noted in schizophrenia, and it has been hypothetically attributed to nicotine's ameliorating abnormal brain processes in this illness. There is some preliminary evidence that nicotine may alter pre-attentive auditory change detection, as indexed by the EEG-derived mismatch negativity (MMN), but no previous study has examined what role auditory verbal hallucinations (AVH) may have on these effects. The objective of this study was to examine MMN-indexed acoustic change detection in schizophrenia (SZ) following nicotine administration and elucidate its association with AVH. Using a modified multi-feature paradigm, MMNs to duration, frequency and intensity deviants were recorded in 12 schizophrenia outpatients (SZ) with persistent AVHs following nicotine (6mg) and placebo administration. Electrical activity was recorded from 32 scalp electrodes; MMN amplitudes and latencies for each deviant were compared between treatments and were correlated with trait (PSYRATS) and state measures of AVH severity and Positive and Negative Syndrome Scale (PANSS) ratings. Nicotine administration resulted in a shortened latency for intensity MMN. Additionally, nicotine-related change in MMN amplitude was correlated with nicotine-related change in subjective measures of hallucinatory state. In summary, nicotine did not affect MMN amplitudes in schizophrenia patients with persistent AVHs, however this study reports accelerated auditory change detection to intensity deviants with nicotine in this group. Additionally, nicotine appeared to induce a generalized activation of the auditory cortex in schizophrenia, resulting in a concurrent increase in intensity MMN amplitude and subjective clarity of AVHs.
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Affiliation(s)
- Derek J Fisher
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
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D’Souza DC, Esterlis I, Carbuto M, Krasenics M, Seibyl J, Bois F, Pittman B, Ranganathan M, Cosgrove K, Staley J. Lower ß2*-nicotinic acetylcholine receptor availability in smokers with schizophrenia. Am J Psychiatry 2012; 169:326-34. [PMID: 22193533 PMCID: PMC3881431 DOI: 10.1176/appi.ajp.2011.11020189] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a strong association between cigarette smoking and schizophrenia. Nicotine's actions in the brain are mediated through nicotinic acetylcholine receptors. Those containing α(4) and β(2) subunits are the most abundant ones in the brain, have the highest affinity for nicotine, and are critical in mediating nicotine's reinforcing properties. Healthy tobacco smokers have significantly higher levels of β(2)*-nicotinic acetylcholine receptors than do nonsmokers. However, in postmortem studies, smokers with schizophrenia do not show these higher levels. The purpose of this study was to measure β(2)*-nicotinic acetylcholine receptors in vivo and to relate levels to concurrent behavioral measures of smoking and schizophrenia. METHOD By using single-photon emission computed tomography with the β(2)*-nicotinic acetylcholine receptor agonist radiotracer [(123)I]5-IA-85380, the availability of receptors was measured in smokers with schizophrenia (11 men) and matched comparison smokers after 1 week of confirmed smoking abstinence. RESULTS Smokers with schizophrenia showed significantly lower (21%-26%) β(2)*-nicotinic acetylcholine receptor availability relative to comparison smokers in the frontal cortex, parietal cortex, and thalamus (in descending order). There was a specific and robust negative correlation between regional β(2)*-nicotinic acetylcholine receptor availability and negative symptoms. CONCLUSIONS These are the first in vivo findings of lower β(2)*-nicotinic acetylcholine receptor availability in smokers with schizophrenia. The relationship between β(2)*-nicotinic acetylcholine receptor availability and negative symptoms may explain the high rates of smoking in schizophrenia and the relationship between smoking and negative symptoms. Findings support the development of medications targeting the β(2)*-nicotinic acetylcholine receptor system for the treatment of negative symptoms.
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Affiliation(s)
- Deepak Cyril D’Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michelle Carbuto
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Maegan Krasenics
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John Seibyl
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Institute for Neurodegenerative Disorders, New Haven, T 06510, USA
| | - Frederic Bois
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Pittman
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kelly Cosgrove
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Julie Staley
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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de Leon J, Diaz FJ. Genetics of schizophrenia and smoking: an approach to studying their comorbidity based on epidemiological findings. Hum Genet 2011; 131:877-901. [PMID: 22190153 DOI: 10.1007/s00439-011-1122-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/27/2011] [Indexed: 01/10/2023]
Abstract
The association between schizophrenia and tobacco smoking has been described in more than 1,000 articles, many with inadequate methodology. The studies on this association can focus on: (1) current smoking, ever smoking or smoking cessation; (2) non-psychiatric controls or controls with severe mental illness (e.g., bipolar disorder); and (3) higher smoking frequency or greater usage in smokers. The association with the most potential for genetic studies is that between ever daily smoking and schizophrenia; it may reflect a shared genetic vulnerability. To reduce the number of false-positive genes, we propose a three-stage approach derived from epidemiological knowledge. In the first stage, only genetic variations associated with ever daily smoking that are simultaneously significant within the non-psychiatric controls, the bipolar disorder controls and the schizophrenia cases will be selected. Only those genetic variations that are simultaneously significant in the three hypothesis tests will be tested in the second stage, where the prevalence of the genes must be significantly higher in schizophrenia than in bipolar disorder, and significantly higher in bipolar disorder than in controls. The genes simultaneously significant in the second stage will be included in a third stage where the gene variations must be significantly more frequent in schizophrenia patients who did not start smoking daily until their 20s (late start) versus those who had an early start. Any genetic approach to psychiatric disorders may fail if attention is not given to comorbidity and epidemiological studies that suggest which comorbidities are likely to be explained by genetics and which are not. Our approach, which examines the results of epidemiological studies on comorbidities and then looks for genes that simultaneously satisfy epidemiologically suggested sets of hypotheses, may also apply to the study of other major illnesses.
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Affiliation(s)
- Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA.
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Chen XS, Li CB, Smith RC, Xiao ZP, Wang JJ. Differential sensory gating functions between smokers and non-smokers among drug-naive first episode schizophrenic patients. Psychiatry Res 2011; 188:327-33. [PMID: 21216472 DOI: 10.1016/j.psychres.2010.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 11/19/2010] [Accepted: 12/05/2010] [Indexed: 01/03/2023]
Abstract
Although an acute effect of cigarette smoking and nicotine on sensory gating of schizophrenias has been investigated in published papers, the chronic effect of cigarette smoking on this phenomenon has not yet been reported. We report the effects of chronic cigarette smoking, without new acute exposure before testing, on sensory gating using the P50 auditory evoked potential in a group of drug-naive first episode schizophrenic smokers and healthy smokers. Sensory gating was evaluated using auditory P50 suppression elicited using the conditioning (S1)-testing (S2) paradigm. Fifty six male drug-naive first episode schizophrenic patients were compared to 41 healthy male controls. Patients were classified into subgroups of current smokers (n=18) and non-smokers (n=38) to explore the effects of smoking on sensory gating. All subjects did not smoke a cigarette for at least 1h prior to testing. Schizophrenic patients showed an increased S2 amplitude and a poorer sensory gating as measured by both S2/S1 ratio and S1-S2 difference of P50 amplitude, as compared to healthy controls. However, smokers showed an increased S1 amplitude and better sensory gating than did non-smokers both in schizophrenia patients and healthy controls. Our findings support a sensory gating deficit among first episode schizophrenic patients. However, it was less pronounced among schizophrenic patients who were current cigarette smokers, suggesting a positive effect of chronic cigarette smoking on ameliorating this sensory gating deficit in schizophrenia. Our findings of the present study present new evidence supporting the self-medication hypothesis of self-medication by cigarette smoking in schizophrenia to possibly ameliorate pre-existing functional deficits.
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Affiliation(s)
- Xing-shi Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
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Meszaros ZS, Dimmock JA, Ploutz-Snyder RJ, Abdul-Malak Y, Leontieva L, Canfield K, Batki SL. Predictors of smoking severity in patients with schizophrenia and alcohol use disorders. Am J Addict 2011; 20:462-7. [PMID: 21838846 DOI: 10.1111/j.1521-0391.2011.00150.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goal of the present study was to identify predictors of smoking severity in patients with schizophrenia and co-occurring alcohol use disorders (AUD). Our hypothesis was that negative symptoms of schizophrenia, severity of depression, male gender, drinking severity, and recreational drug use were associated with increased smoking. Clinical data, including demographic variables, alcohol and substance use severity, psychiatric medications, severity of depression, positive and negative symptoms of schizophrenia were analyzed in a cohort of 90 patients with schizophrenia or schizoaffective disorder and AUD. Eighty-eight percent of participants were smokers, they smoked an average of 15 cigarettes/day. Zero-inflated negative binomial (ZINB) regression analyses demonstrated that alcohol use severity, gender, and severity of negative symptoms were not predictive of the number of cigarettes smoked. Smoking severity was positively related to Caucasian race, psychosis severity (Positive and Negative Syndrome Scale [PANSS] general score), and medications (conventional antipsychotics). Subjects who used recreational drugs smoked less. In summary, severe, treatment resistant schizophrenia, and conventional antipsychotic treatment is associated with heavy smoking in patients with schizophrenia and AUD regardless of gender or alcohol use.
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Coyle JT, Balu D, Benneyworth M, Basu A, Roseman A. Beyond the dopamine receptor: novel therapeutic targets for treating schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20954431 PMCID: PMC3181979 DOI: 10.31887/dcns.2010.12.3/jcoyle] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
All current drugs approved to treat schizophrenia appear to exert their antipsychotic effects through blocking the dopamine D2 receptor. Recent meta-analyses and comparative efficacy studies indicate marginal differences in efficacy of newer atypical antipsychotics and the older drugs, and little effects on negative and cognitive symptoms. This review integrates findings from postmortem, imaging, and drug-challenge studies to elucidate a corticolimbic “pathologic circuit” in schizophrenia that may be particularly relevant to the negative symptoms and cognitive impairments of schizophrenia. Potential sites for pharmacologic intervention targeting glutatatergic, GABAergic, and cholinergic neurotransmission to treat these symptoms of schizophrenia are discussed.
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Affiliation(s)
- Joseph T Coyle
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA.
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Stewart DW, Cohen AS, Copeland AL. Cigarette smoking across the schizotypy spectrum. Psychiatry Res 2010; 179:113-5. [PMID: 20483483 DOI: 10.1016/j.psychres.2010.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 03/26/2010] [Accepted: 04/25/2010] [Indexed: 12/15/2022]
Abstract
This study examined relationships between schizotypy symptom dimensions and smoking. Individuals with schizotypy (n=81) were twice as likely to smoke as individuals in a normative reference group (n=303). Among those with schizotypy, smokers reported more severe disorganization and less severe negative schizotypal symptoms. These findings offer insight into mechanisms underlying smoking in schizotypal individuals and suggest areas for further research.
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Affiliation(s)
- Diana W Stewart
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
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Affiliation(s)
- John A Stapleton
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
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Williams JM, Gandhi KK, Lu SE, Kumar S, Shen J, Foulds J, Kipen H, Benowitz NL. Higher nicotine levels in schizophrenia compared with controls after smoking a single cigarette. Nicotine Tob Res 2010; 12:855-9. [PMID: 20584771 DOI: 10.1093/ntr/ntq102] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The increase in blood nicotine after smoking a single cigarette is nicotine boost. We hypothesized that smokers with schizophrenia (SCZ) have a greater nicotine boost than controls without this disorder. METHODS Twenty-one subjects (11 SCZ and 10 controls, CON) had repeated venous blood sampling before, during, and after smoking a single cigarette after 12-hr abstinence to measure nicotine concentrations. Blood samples were drawn at baseline (before smoking) and 1, 2, 4, 6, 8, 10, 20, 30, 60, 90, and 120 min after the first puff. Groups were similar in baseline characteristics, including gender and level of dependence, and all smoked 20-30 cigarettes/day. Area under the serum nicotine concentration-time curve (AUC(20)) was calculated for time up to 20 min after the start of smoking. RESULTS The mean difference in AUC(20) was significantly greater for SCZ versus CON (135.4 ng-min/ml; 95% CI = 0.45-283.80). The shape of the nicotine concentration-time curve for SCZ was significantly different compared with controls (p < .01). Nicotine boost in the first 4 min of smoking was higher in SCZ versus CON (25.2 vs. 11.1 ng/ml, p < .01) with no difference in the total time spent smoking. DISCUSSION This technique improves on methods, which draw only two blood specimens to assess nicotine intake. Understanding how nicotine boost differs in SCZ from CON may explain high levels of addiction and low success in cessation in smokers with SCZ.
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Affiliation(s)
- Jill M Williams
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-2008, USA.
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Williams JM, Steinberg ML, Zimmermann MH, Gandhi KK, Stipelman B, Budsock PD, Ziedonis DM. Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. J Subst Abuse Treat 2010; 38:384-93. [PMID: 20363089 DOI: 10.1016/j.jsat.2010.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 02/04/2010] [Accepted: 03/09/2010] [Indexed: 11/18/2022]
Abstract
Compared to the general population, smokers with schizophrenia (SCZ) have reduced success in quitting smoking with usual approaches. This study tested two manualized behavioral counseling approaches-Treatment of Addiction to Nicotine in Schizophrenia (TANS) or Medication Management (MM)-for smokers who were motivated to quit. Individual counseling sessions were provided by mental health clinicians in mental health settings, along with nicotine patch. The two treatments varied in intensity and frequency of sessions. Eighty-seven subjects were randomized and attended at least one treatment session. Twenty-one percent (n = 18) of participants had continuous abstinence at 12 weeks after the target quit date, which was not significantly different between conditions (15.6% TANS vs. 26.2% MM, chi(2) = 1.50, p = .221). Smokers in both groups significantly reduced smoking as measured by cigarettes per day and expired carbon monoxide. Findings support that mental health clinicians can be trained to effectively help smokers with SCZ maintain tobacco abstinence.
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Affiliation(s)
- Jill M Williams
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-2008, USA.
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Tidey JW, Rohsenow DJ. Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schizophr Res 2009; 115:310-6. [PMID: 19836210 PMCID: PMC2795352 DOI: 10.1016/j.schres.2009.09.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 11/16/2022]
Abstract
Cigarette smoking expectancies are systematically related to intention to quit smoking in adult smokers without psychiatric illness, but little is known about these relationships in smokers with serious mental illness. In this study, we compared positive and negative smoking expectancies, and examined relationships between expectancies and intention to quit smoking, in smokers with schizophrenia (n=46), smokers with schizoaffective disorder (n=35), and smokers without psychiatric illness (n=71). In all three groups, reduction of negative affect was rated as the most important smoking expectancy and intention to quit smoking was systematically related to concerns about the health effects and social consequences of smoking. Compared to the other groups of smokers, those with schizoaffective disorder were more concerned with social expectancies and with the immediate negative physical effects of smoking. Results of this study suggest that challenging positive smoking expectancies and providing more tailored information about the negative consequences of smoking might increase motivation to quit smoking in smokers with schizophrenia and schizoaffective disorder, as has been found with non-psychiatric smokers.
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Affiliation(s)
- Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA,Corresponding author: Jennifer W. Tidey, Ph.D., Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912 USA. Telephone: 401-863-6418, Fax: 401-863-6697,
| | - Damaris J. Rohsenow
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA,Providence Veterans Affairs Medical Center, Providence, RI, USA
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Dome P, Lazary J, Kalapos MP, Rihmer Z. Smoking, nicotine and neuropsychiatric disorders. Neurosci Biobehav Rev 2009; 34:295-342. [PMID: 19665479 DOI: 10.1016/j.neubiorev.2009.07.013] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/23/2009] [Accepted: 07/30/2009] [Indexed: 12/20/2022]
Abstract
Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.
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Affiliation(s)
- Peter Dome
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary.
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Presynaptic type III neuregulin 1 is required for sustained enhancement of hippocampal transmission by nicotine and for axonal targeting of alpha7 nicotinic acetylcholine receptors. J Neurosci 2008; 28:9111-6. [PMID: 18784291 DOI: 10.1523/jneurosci.0381-08.2008] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Both the neuregulin 1 (Nrg1) and alpha7 nicotinic acetylcholine receptor (alpha7*nAChRs) genes have been linked to schizophrenia and associated sensory-motor gating deficits. The prominence of nicotine addiction in schizophrenic patients is reflected in the normalization of gating deficits by nicotine self-administration. To assess the role of presynaptic type III Nrg1 at hippocampal-accumbens synapses, an important relay in sensory-motor gating, we developed a specialized preparation of chimeric circuits in vitro. Synaptic relays from Nrg1(tm1Lwr) heterozygote ventral hippocampal slices to wild-type (WT) nucleus accumbens neurons (1) lack a sustained, alpha7*nAChRs-mediated phase of synaptic potentiation seen in comparable WT/WT circuits and (2) are deficient in targeting alpha7*nAChRs to presynaptic sites. Thus, selective alteration of the level of presynaptic type III Nrg1 dramatically affects the modulation of glutamatergic transmission at ventral hippocampal to nucleus accumbens synapses.
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Levander S, Eberhard J, Lindström E. Nicotine use and its correlates in patients with psychosis. Acta Psychiatr Scand Suppl 2008:27-32. [PMID: 17953523 DOI: 10.1111/j.1600-0447.2007.01085.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine nicotine use and its correlates among psychotic patients. METHOD Longitudinal naturalistic study of 176 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders, and treated with risperidone at study entry. Levels of nicotine use (smoking, snuffing) were measured along with other relevant ratings and measurements (symptoms, drug treatment, side effects, weight, cognitive functions and outcome) at baseline and once yearly for 5 years. RESULTS Nicotine use was twice as common as in the general population. Only few nicotine users had started after onset of psychoses. We could not find any differences among nicotine users and non-users in diagnosis, symptoms, side effects, weight, cognitive functions, personality and outcome, cross-sectionally and longitudinally, ruling against the 'self-medication' hypothesis. CONCLUSION A parsimonious interpretation of the findings is that patients suffering from psychosis fail to desist from nicotine rather than experience significant positive effects of the usage.
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Affiliation(s)
- S Levander
- Department of Health and Society, Malmö University, Malmö, Sweden
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