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Mohan P, Chatterjee K, Sinha S, Saini R, Sharma A, Waikole S. Smoking blunts sertraline response in depression: A prospective observational cohort study. Med J Armed Forces India 2024; 80:145-152. [PMID: 38525466 PMCID: PMC10954491 DOI: 10.1016/j.mjafi.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022] Open
Abstract
Background Smoking is common in patients of depression and is known to affect response to antidepressants. This study was undertaken to evaluate the effect of smoking on the antidepressant effect of sertraline. Method Patients with depression were divided into smoker and nonsmoker cohorts and followed up for 8 weeks. Serum sertraline levels were estimated using the high-performance liquid chromatography system. Response to treatment was evaluated with the Hamilton Depression Rating Scale (HAM-D). Results Serum sertraline levels did not differ between smokers and nonsmokers at 4 and 8 weeks. Nonsmokers responded better to sertraline than smokers after 8 weeks. Adverse drug reaction profile did not vary between the two groups and was not impacted by serum sertraline levels. Nonsmokers showed a greater fall in the HAM-D score than smokers. Conclusion This study found depression among smokers to be less responsive to sertraline. This was not explained by serum sertraline levels. Treatment of depression in smokers with sertraline might require higher doses and duration, with more frequent reviews.
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Affiliation(s)
- Prafull Mohan
- Classified Specialist (Pharmacology) & Commanding Officer, 421 Field Hospital, C/o 99 APO, India
| | - Kaushik Chatterjee
- Professor & Head, Department of Psychiatry, Armed Forces Medical College, Pune, India
| | - Sharmila Sinha
- Professor & Head, Department of Pharmacology, Armed Forces Medical College, Pune, India
| | - R.K. Saini
- Senior Adviser (Psychiatry), Command Hospital (Eastern Command), Kolkata, India
| | - A.K. Sharma
- Ex-Professor & Head, Department of Pharmacology, Armed Forces Medical College, Pune, India
| | - Suraj Waikole
- Resident, Department of Pharmacology, Armed Forces Medical College, Pune, India
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2
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Dean B, Duce J, Li QX, Masters CL, Scarr E. Lower levels of soluble β-amyloid precursor protein, but not β-amyloid, in the frontal cortex in schizophrenia. Psychiatry Res 2024; 331:115656. [PMID: 38071879 DOI: 10.1016/j.psychres.2023.115656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/02/2024]
Abstract
We identified a sub-group (25%) of people with schizophrenia (muscarinic receptor deficit schizophrenia (MRDS)) that are characterised because of markedly lower levels of cortical muscarinic M1 receptors (CHRM1) compared to most people with the disorder (non-MRDS). Notably, bioinformatic analyses of our cortical gene expression data shows a disturbance in the homeostasis of a biochemical pathway that regulates levels of CHRM1. A step in this pathway is the processing of β-amyloid precursor protein (APP) and therefore we postulated there would be altered levels of APP in the frontal cortex from people with MRDS. Here we measure levels of CHRM1 using [3H]pirenzepine binding, soluble APP (sAPP) using Western blotting and amyloid beta peptides (Aβ1-40 and Aβ1-42) using ELISA in the frontal cortex (Brodmann's area 6: BA 6; MRDS = 14, non-MRDS = 14, controls = 14). We confirmed the MRDS cohort in this study had the expected low levels of [3H]pirenzepine binding. In addition, we showed that people with schizophrenia, independent of their sub-group status, had lower levels of sAPP compared to controls but did not have altered levels of Aβ1-40 or Aβ1-42. In conclusion, whilst changes in sAPP are not restricted to MRDS our data could indicate a role of APP, which is important in axonal and synaptic pruning, in the molecular pathology of the syndrome of schizophrenia.
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Affiliation(s)
- Brian Dean
- The Florey, Parkville, Victoria, Australia; The University of Melbourne of Melbourne Florey Department of Neuroscience and Mental Health, Parkville, Victoria, Australia.
| | - James Duce
- MSD Discovery Centre, 120 Moorgate, London, UK
| | - Qiao-Xin Li
- The Florey, Parkville, Victoria, Australia; The University of Melbourne of Melbourne Florey Department of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Colin L Masters
- The Florey, Parkville, Victoria, Australia; The University of Melbourne of Melbourne Florey Department of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Elizabeth Scarr
- The Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
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3
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Vallés AS, Barrantes FJ. Nicotinic Acetylcholine Receptor Dysfunction in Addiction and in Some Neurodegenerative and Neuropsychiatric Diseases. Cells 2023; 12:2051. [PMID: 37626860 PMCID: PMC10453526 DOI: 10.3390/cells12162051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
The cholinergic system plays an essential role in brain development, physiology, and pathophysiology. Herein, we review how specific alterations in this system, through genetic mutations or abnormal receptor function, can lead to aberrant neural circuitry that triggers disease. The review focuses on the nicotinic acetylcholine receptor (nAChR) and its role in addiction and in neurodegenerative and neuropsychiatric diseases and epilepsy. Cholinergic dysfunction is associated with inflammatory processes mainly through the involvement of α7 nAChRs expressed in brain and in peripheral immune cells. Evidence suggests that these neuroinflammatory processes trigger and aggravate pathological states. We discuss the preclinical evidence demonstrating the therapeutic potential of nAChR ligands in Alzheimer disease, Parkinson disease, schizophrenia spectrum disorders, and in autosomal dominant sleep-related hypermotor epilepsy. PubMed and Google Scholar bibliographic databases were searched with the keywords indicated below.
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Affiliation(s)
- Ana Sofía Vallés
- Bahía Blanca Institute of Biochemical Research (UNS-CONICET), Bahía Blanca 8000, Argentina;
| | - Francisco J. Barrantes
- Biomedical Research Institute (BIOMED), Faculty of Medical Sciences, Pontifical Catholic University of Argentina—National Scientific and Technical Research Council, Av. Alicia Moreau de Justo 1600, Buenos Aires C1107AFF, Argentina
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Al-Soufi L, Costas J. Genetic susceptibility for schizophrenia after adjustment by genetic susceptibility for smoking: implications in identification of risk genes and genetic correlation with related traits. Psychol Med 2023; 53:1-11. [PMID: 36876478 DOI: 10.1017/s0033291723000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Prevalence of smoking in schizophrenia (SCZ) is larger than in general population. Genetic studies provided some evidence of a causal effect of smoking on SCZ. We aim to characterize the genetic susceptibility to SCZ affected by genetic susceptibility to smoking. METHODS Multi-trait-based conditional and joint analysis was applied to the largest European SCZ genome-wide association studies (GWAS) to remove genetic effects on SCZ driven by smoking, estimated by generalized summary data-based Mendelian randomization. Enrichment analysis was performed to compare original v. conditional GWAS. Change in genetic correlation between SCZ and relevant traits after conditioning was assessed. Colocalization analysis was performed to identify specific loci confirming general findings. RESULTS Conditional analysis identified 19 new risk loci for SCZ and 42 lost loci whose association with SCZ may be partially driven by smoking. These results were strengthened by colocalization analysis. Enrichment analysis indicated a higher association of differentially expressed genes at prenatal brain stages after conditioning. Genetic correlation of SCZ with substance use and dependence, attention deficit-hyperactivity disorder, and several externalizing traits significantly changed after conditioning. Colocalization of association signal between SCZ and these traits was identified for some of the lost loci, such as CHRNA2, CUL3, and PCDH7. CONCLUSIONS Our approach led to identification of potential new SCZ loci, loci partially associated to SCZ through smoking, and a shared genetic susceptibility between SCZ and smoking behavior related to externalizing phenotypes. Application of this approach to other psychiatric disorders and substances may lead to a better understanding of the role of substances on mental health.
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Affiliation(s)
- Laila Al-Soufi
- Psychiatric Genetics group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Spain
- Department of Zoology, Genetics and Physical Anthropology, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Javier Costas
- Psychiatric Genetics group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Spain
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
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5
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Kanniah G, Kumar R. A selective literature review exploring the role of the nicotinic system in schizophrenia. Gen Psychiatr 2023; 36:e100756. [PMID: 36937093 PMCID: PMC10016241 DOI: 10.1136/gpsych-2022-100756] [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] [Received: 01/20/2022] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
Nicotine use is more prevalent in patients with psychiatric disorders, especially those diagnosed with psychotic illnesses. Previously, this higher prevalence has been partially attributed to the potential ameliorative effects of nicotine on symptom severity and cognitive impairment. Some healthcare professionals and patients perceive there is a beneficial effect of nicotine on mental health. Emerging data show that the harm associated with nicotine in the population of patients with mental health conditions outweighs any potential benefit. This paper will review the evidence surrounding the nicotinic system and schizophrenia, with a focus on any causality between nicotine and psychosis.
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Affiliation(s)
- Guna Kanniah
- Mental Health and Addictions Services, Waikato DHB, Waikato Hospital, Hamilton, New Zealand
| | - Rishi Kumar
- Department of General Medicine, Middlemore Hospital, Auckland, New Zealand
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Rognli EB, Bramness JG, von Soest T. Smoking in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, antidepressants and anxiolytics. Psychol Med 2022; 52:3241-3250. [PMID: 33583454 PMCID: PMC9693672 DOI: 10.1017/s0033291720005401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Whether smoking should be regarded as a risk factor for mental disorders remains unresolved. Prescribed psychotropic drugs can be used as indications for mental disorders. We investigated how smoking was prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS Information about smoking, including the Fagerström Test for Nicotine Dependence, and relevant confounders, were obtained from the population-based Young in Norway Study (N = 2602), with four data collection waves between 1992 and 2006. These survey data were linked with information on prescriptions for psychotropic drugs from the comprehensive, nationwide Norwegian Prescription Database from 2007 to 2015. RESULTS Daily smoking with high dependence in 2006 at age 28.5 (s.d. = 2.0) was associated with filling prescriptions of antipsychotics (OR, 6.57, 95% CI 2.19-19.70, p = 0.001), mood stabilizers (OR, 7.11, 95% CI 2.51-20.15, p < 0.001) and antidepressants (OR, 1.91, 95% CI 1.13-3.23, p = 0.016) 1-9 years later. Associations remained significant after adjustment for a variety of potential confounders measured before the assessment of smoking, including sociodemographic background, conduct problems, cannabis use, mental distress, and previous prescriptions for psychotropic medications. The association between smoking and prescription of anxiolytics was weaker and more unstable. CONCLUSIONS In this study of young adults, daily smoking with high dependence was associated with later prescriptions of antipsychotics, mood stabilizers and antidepressants, indicating smoking as a risk factor for mental disorders treated with these drugs.
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Affiliation(s)
- Eline Borger Rognli
- Section for Clinical Addiction Research, Department on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian Institute of Public Health, Oslo, Norway
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
- Norwegian Social Research (NOVA), OsloMet – Oslo Metropolitan University, Oslo, Norway
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Spasova V, Mehmood S, Minhas A, Azhar R, Anand S, Abdelaal S, Sham S, Chauhan TM, Dragas D. Impact of Nicotine on Cognition in Patients With Schizophrenia: A Narrative Review. Cureus 2022; 14:e24306. [PMID: 35475247 PMCID: PMC9020415 DOI: 10.7759/cureus.24306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/20/2022] [Indexed: 12/24/2022] Open
Abstract
Nicotine is the psychoactive component given tobacco has several main components and acts as an agonist for nicotinic acetylcholine receptors (nAChRs) in the nervous system. Although the ligand-gated cation channels known as nAChRs are found throughout the nervous system and body, this review focuses on neuronal nAChRs. Individuals with psychiatric diseases such as schizophrenia, comorbid substance use disorders, attention-deficit hyperactivity disorder, major depression, and bipolar disorder have increased rates of smoking. These psychiatric disorders are associated with various cognitive deficits, including working memory, deficits in attention, and response inhibition functions. The cognitive-enhancing effects of nicotine may be particularly relevant predictors of smoking initiation and continuation in this comorbid population. Individuals with schizophrenia make up a significant proportion of smokers. Literature suggests that patients smoke to alleviate cognitive deficiencies due to the stimulating effects of nicotine. This narrative review examines the role of nicotine on cognition in schizophrenia.
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Sabe M, Pillinger T, Kaiser S, Chen C, Taipale H, Tanskanen A, Tiihonen J, Leucht S, Correll CU, Solmi M. Half a century of research on antipsychotics and schizophrenia: A scientometric study of hotspots, nodes, bursts, and trends. Neurosci Biobehav Rev 2022; 136:104608. [PMID: 35303594 DOI: 10.1016/j.neubiorev.2022.104608] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
Changes over 50 years of research on antipsychotics in schizophrenia have occurred. A scientometric synthesis of such changes over time and a measure of researchers' networks and scientific productivity is currently lacking. We searched Web of Science Core Collection from inception until November 5, 2021, using the appropriate key. Our primary objective was to conduct systematic mapping with CiteSpace to show how clusters of keywords have evolved over time and obtain clusters' structure and credibility. Our secondary objective was to measure research network performance (countries, institutions, and authors) using CiteSpace, VOSviewer, and Bibliometrix. We included 32,240 studies published between 1955 and 2021. The co-cited reference network identified 25 clusters with a well-structured network (Q=0.8166) and highly credible clustering (S=0.91). The main trends of research were: 1) antipsychotic efficacy; 2) cognition in schizophrenia; 3) side effects of antipsychotics. Last five years research trends were: 'ultra-resistance schizophrenia' (S=0.925), 'efficacy/dose-response' (S=0.775), 'evidence-synthesis' (S=0.737), 'real-world effectiveness' (S=0.794), 'cannabidiol' (S=0.989), and 'gut microbiome' (S=0.842). These results can inform funding agencies and research groups' future directions.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
| | - Toby Pillinger
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College of London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, USA
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; University of Eastern Finland, School of Pharmacy, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christoph U Correll
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Ottawa
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Al‐Soufi L, Martorell L, Moltó M, González‐Peñas J, García‐Portilla MP, Arrojo M, Rivero O, Gutiérrez‐Zotes A, Nácher J, Muntané G, Paz E, Páramo M, Bobes J, Arango C, Sanjuan J, Vilella E, Costas J. A polygenic approach to the association between smoking and schizophrenia. Addict Biol 2022; 27:e13104. [PMID: 34779080 DOI: 10.1111/adb.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
Smoking prevalence in schizophrenia is considerably larger than in general population, playing an important role in early mortality. We compared the polygenic contribution to smoking in schizophrenic patients and controls to assess if genetic factors may explain the different prevalence. Polygenic risk scores (PRSs) for smoking initiation and four genetically correlated traits were calculated in 1108 schizophrenic patients (64.4% smokers) and 1584 controls (31.1% smokers). PRSs for smoking initiation, educational attainment, body mass index and age at first birth were associated with smoking in patients and controls, explaining a similar percentage of variance in both groups. Attention-deficit hyperactivity disorder (ADHD) PRS was associated with smoking only in schizophrenia. This association remained significant after adjustment by psychiatric cross-disorder PRS. A PRS combining all the traits was more explanative than smoking initiation PRS alone, indicating that genetic susceptibility to the other traits plays an additional role in smoking behaviour. Smoking initiation PRS was also associated with schizophrenia in the whole sample, but the significance was lost after adjustment for smoking status. This same pattern was observed in the analysis of specific SNPs at the CHRNA5-CHRNA3-CHRNB4 cluster associated with both traits. Overall, the results indicate that the same genetic factors are involved in smoking susceptibility in schizophrenia and in general population and are compatible with smoking acting, directly or indirectly, as a risk factor for schizophrenia that contributes to the high prevalence of smoking in these patients. The contrasting results for ADHD PRS may be related to higher ADHD symptomatology in schizophrenic patients.
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Affiliation(s)
- Laila Al‐Soufi
- Psychiatric Genetics Group Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Department of Zoology, Genetics and Physical Anthropology Universidade de Santiago de Compostela (USC) Santiago de Compostela Spain
| | - Lourdes Martorell
- Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Universitat Rovira i Virgili (URV) Reus Spain
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
| | - M.Dolores Moltó
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- INCLIVA Biomedical Research Institute Fundación Investigación Hospital Clínico de Valencia Valencia Spain
- Department of Genetics Universitat de València Valencia Spain
| | - Javier González‐Peñas
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - Ma Paz García‐Portilla
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- Department of Psychiatry, Universidad de Oviedo; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA); Servicio de Salud del Principado de Asturias (SESPA) Oviedo Spain
| | - Manuel Arrojo
- Psychiatric Genetics Group Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela Servizo Galego de Saúde (SERGAS) Santiago de Compostela Spain
| | - Olga Rivero
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- INCLIVA Biomedical Research Institute Fundación Investigación Hospital Clínico de Valencia Valencia Spain
- Department of Genetics Universitat de València Valencia Spain
| | - Alfonso Gutiérrez‐Zotes
- Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Universitat Rovira i Virgili (URV) Reus Spain
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
| | - Juan Nácher
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- INCLIVA Biomedical Research Institute Fundación Investigación Hospital Clínico de Valencia Valencia Spain
- Department of Cell Biology, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED) Universitat de València Valencia Spain
| | - Gerard Muntané
- Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Universitat Rovira i Virgili (URV) Reus Spain
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
| | - Eduardo Paz
- Psychiatric Genetics Group Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela Servizo Galego de Saúde (SERGAS) Santiago de Compostela Spain
| | - Mario Páramo
- Psychiatric Genetics Group Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela Servizo Galego de Saúde (SERGAS) Santiago de Compostela Spain
| | - Julio Bobes
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- Department of Psychiatry, Universidad de Oviedo; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA); Servicio de Salud del Principado de Asturias (SESPA) Oviedo Spain
| | - Celso Arango
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - Julio Sanjuan
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
- INCLIVA Biomedical Research Institute Fundación Investigación Hospital Clínico de Valencia Valencia Spain
- Department of Psychiatric, School of Medicine Universitat de València Valencia Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Universitat Rovira i Virgili (URV) Reus Spain
- Spanish Mental Health Research Network (CIBERSAM) Madrid Spain
| | - Javier Costas
- Psychiatric Genetics Group Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Servizo Galego de Saúde (SERGAS) Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) Santiago de Compostela Spain
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10
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Altered Dynamic Functional Connectivity of Cuneus in Schizophrenia Patients: A Resting-State fMRI Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112311392] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: Schizophrenia (SZ) is a functional mental condition that has a significant impact on patients’ social lives. As a result, accurate diagnosis of SZ has attracted researchers’ interest. Based on previous research, resting-state functional magnetic resonance imaging (rsfMRI) reported neural alterations in SZ. In this study, we attempted to investigate if dynamic functional connectivity (dFC) could reveal changes in temporal interactions between SZ patients and healthy controls (HC) beyond static functional connectivity (sFC) in the cuneus, using the publicly available COBRE dataset. Methods: Sliding windows were applied to 72 SZ patients’ and 74 healthy controls’ (HC) rsfMRI data to generate temporal correlation maps and, finally, evaluate mean strength (dFC-Str), variability (dFC-SD and ALFF) in each window, and the dwelling time. The difference in functional connectivity (FC) of the cuneus between two groups was compared using a two-sample t-test. Results: Our findings demonstrated decreased mean strength connectivity between the cuneus and calcarine, the cuneus and lingual gyrus, and between the cuneus and middle temporal gyrus (TPOmid) in subjects with SZ. Moreover, no difference was detected in variability (standard deviation and the amplitude of low-frequency fluctuation), the dwelling times of all states, or static functional connectivity (sFC) between the groups. Conclusions: Our verdict suggest that dynamic functional connectivity analyses may play crucial roles in unveiling abnormal patterns that would be obscured in static functional connectivity, providing promising impetus for understanding schizophrenia disease.
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Caroff SN, Gutman AR, Northrop J, Leong SH, Berkowitz RM, Campbell EC. Effect of Varenicline on Tardive Dyskinesia: A Pilot Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:355-360. [PMID: 33888664 PMCID: PMC8077061 DOI: 10.9758/cpn.2021.19.2.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023]
Abstract
Objective Although evidence implicates striatal cholinergic impairment as a mechanism underlying tardive dyskinesia, trials of nonspecific cholinergic agents have been inconclusive. As a partial agonist at specific nicotinic receptor subtypes, varenicline reduces drug-induced dyskinesias in animal models suggesting promise as a treatment for tardive dyskinesia. Methods Three schizophrenia patients with tardive dyskinesia who were smokers underwent an open trial of varenicline. After a 2-week baseline, subjects received varenicline 1 mg twice daily. Changes from baseline on the Abnormal Involuntary Movement Scale were measured after a 4-week varenicline stabilization period, and 6 weeks after the smoking quit date in one patient. Results Varenicline had no effect on mean Abnormal Involuntary Movement Scale scores after 4 weeks. Although smoking decreased after 4 weeks on varenicline and diminished further in one patient after 10 weeks, this also appeared to have no effect on ratings of tardive dyskinesia. Conclusion In contrast to animal models, no significant change in tardive dyskinesia occurred in response to varenicline replacement in three schizophrenia patients. Further investigations of cholinergic mechanisms in tardive dyskinesia are worthwhile as agents for specific cholinergic targets become available for treatment. In addition, treatment trials of tardive dyskinesia should control for smoking status, while patients on antipsychotics receiving nicotine replacement therapies for smoking should be studied further for changes in movement.
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Affiliation(s)
- Stanley N Caroff
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alisa R Gutman
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - John Northrop
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Shirley H Leong
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rosalind M Berkowitz
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - E Cabrina Campbell
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Roles of the Functional Interaction between Brain Cholinergic and Dopaminergic Systems in the Pathogenesis and Treatment of Schizophrenia and Parkinson's Disease. Int J Mol Sci 2021; 22:ijms22094299. [PMID: 33919025 PMCID: PMC8122651 DOI: 10.3390/ijms22094299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022] Open
Abstract
Most physiologic processes in the brain and related diseases involve more than one neurotransmitter system. Thus, elucidation of the interaction between different neurotransmitter systems could allow for better therapeutic approaches to the treatments of related diseases. Dopaminergic (DAergic) and cholinergic neurotransmitter system regulate various brain functions that include cognition, movement, emotion, etc. This review focuses on the interaction between the brain DAergic and cholinergic systems with respect to the pathogenesis and treatment of schizophrenia and Parkinson’s disease (PD). We first discussed the selection of motor plans at the level of basal ganglia, the major DAergic and cholinergic pathways in the brain, and the receptor subtypes involved in the interaction between the two signaling systems. Next, the roles of each signaling system were discussed in the context of the negative symptoms of schizophrenia, with a focus on the α7 nicotinic cholinergic receptor and the dopamine D1 receptor in the prefrontal cortex. In addition, the roles of the nicotinic and dopamine receptors were discussed in the context of regulation of striatal cholinergic interneurons, which play crucial roles in the degeneration of nigrostriatal DAergic neurons and the development of L-DOPA-induced dyskinesia in PD patients. Finally, we discussed the general mechanisms of nicotine-induced protection of DAergic neurons.
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13
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Komatsu H, Watanabe E, Fukuchi M. Psychiatric Neural Networks and Precision Therapeutics by Machine Learning. Biomedicines 2021; 9:403. [PMID: 33917863 PMCID: PMC8068267 DOI: 10.3390/biomedicines9040403] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
Learning and environmental adaptation increase the likelihood of survival and improve the quality of life. However, it is often difficult to judge optimal behaviors in real life due to highly complex social dynamics and environment. Consequentially, many different brain regions and neuronal circuits are involved in decision-making. Many neurobiological studies on decision-making show that behaviors are chosen through coordination among multiple neural network systems, each implementing a distinct set of computational algorithms. Although these processes are commonly abnormal in neurological and psychiatric disorders, the underlying causes remain incompletely elucidated. Machine learning approaches with multidimensional data sets have the potential to not only pathologically redefine mental illnesses but also better improve therapeutic outcomes than DSM/ICD diagnoses. Furthermore, measurable endophenotypes could allow for early disease detection, prognosis, and optimal treatment regime for individuals. In this review, decision-making in real life and psychiatric disorders and the applications of machine learning in brain imaging studies on psychiatric disorders are summarized, and considerations for the future clinical translation are outlined. This review also aims to introduce clinicians, scientists, and engineers to the opportunities and challenges in bringing artificial intelligence into psychiatric practice.
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Affiliation(s)
- Hidetoshi Komatsu
- Medical Affairs, Kyowa Pharmaceutical Industry Co., Ltd., Osaka 530-0005, Japan
- Department of Biological Science, Graduate School of Science, Nagoya University, Nagoya City 464-8602, Japan
| | - Emi Watanabe
- Interactive Group, Accenture Japan Ltd., Tokyo 108-0073, Japan;
| | - Mamoru Fukuchi
- Laboratory of Molecular Neuroscience, Faculty of Pharmacy, Takasaki University of Health and Welfare, Gunma 370-0033, Japan;
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14
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Khan TA, Hussain S, Ikram A, Mahmood S, Riaz H, Jamil A, Amin A, Haider YG, Sandhu M, Mushtaq A, Barbui C, Johnson CF, Godman B. Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications. Hosp Pract (1995) 2020; 48:145-160. [PMID: 32343632 DOI: 10.1080/21548331.2020.1762366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. METHODS Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. RESULTS 57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. CONCLUSIONS There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.
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Affiliation(s)
- Tanveer Ahmed Khan
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Shahzad Hussain
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Aamer Ikram
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Sidra Mahmood
- Department of Pharmacy, Quaid-e-Azam University , Islamabad, Pakistan
| | - Humayun Riaz
- Department of Pharmaceutics, Rashid Latif College of Pharmacy , Lahore, Pakistan
| | - Ayesha Jamil
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | - Amina Amin
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | | | - Marva Sandhu
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Atifa Mushtaq
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona , Verona, Italy
| | - Chris F Johnson
- Pharmacy Services, National Health Service Greater Glasgow and Clyde (NHS GGC) , Glasgow, UK
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden.,Department of Pharmacoepidemiolgy, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK.,Health Economics Centre, Liverpool University , Liverpool, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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Cannabinoid receptor CNR1 expression and DNA methylation in human prefrontal cortex, hippocampus and caudate in brain development and schizophrenia. Transl Psychiatry 2020; 10:158. [PMID: 32433545 PMCID: PMC7237456 DOI: 10.1038/s41398-020-0832-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
Beyond being one the most widely used psychoactive drugs in the world, cannabis has been identified as an environmental risk factor for psychosis. Though the relationship between cannabis use and psychiatric disorders remains controversial, consistent association between early adolescent cannabis use and the subsequent risk of psychosis suggested adolescence may be a particularly vulnerable period. Previous findings on gene by environment interactions indicated that cannabis use may only increase the risk for psychosis in the subjects who have a specific genetic vulnerability. The type 1 cannabinoid receptor (CB1), encoded by the CNR1 gene, is a key component of the endocannabinoid system. As the primary endocannabinoid receptor in the brain, CB1 is the main molecular target of the endocannabinoid ligand, as well as tetrahydrocannabinol (THC), the principal psychoactive ingredient of cannabis. In this study, we have examined mRNA expression and DNA methylation of CNR1 in human prefrontal cortex (PFC), hippocampus, and caudate samples. The expression of CNR1 is higher in fetal PFC and hippocampus, then drops down dramatically after birth. The lifespan trajectory of CNR1 expression in the DLPFC differentially correlated with age by allelic variation at rs4680, a functional polymorphism in the COMT gene. Compared with COMT methionine158 carriers, Caucasian carriers of the COMT valine158 allele have a stronger negative correlation between the expression of CNR1 in DLPFC and age. In contrast, the methylation level of cg02498983, which is negatively correlated with the expression of CNR1 in PFC, showed the strongest positive correlation with age in PFC of Caucasian carriers of COMT valine158. Additionally, we have observed decreased mRNA expression of CNR1 in the DLPFC of patients with schizophrenia. Further analysis revealed a positive eQTL SNP, rs806368, which predicted the expression of a novel transcript of CNR1 in human DLPFC, hippocampus and caudate. This SNP has been associated with addiction and other psychiatric disorders. THC or ethanol are each significantly associated with dysregulated expression of CNR1 in the PFC of patients with affective disorder, and the expression of CNR1 is significantly upregulated in the PFC of schizophrenia patients who completed suicide. Our results support previous studies that have implicated the endocannabinoid system in the pathology of schizophrenia and provided additional insight into the mechanism of increasing risk for schizophrenia in the adolescent cannabis users.
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16
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Strand JE, Nybäck H. Tobacco use in schizophrenia: a study of cotinine concentrations in the saliva of patients and controls. Eur Psychiatry 2020; 20:50-4. [PMID: 15642444 DOI: 10.1016/j.eurpsy.2004.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2001] [Revised: 08/16/2004] [Accepted: 08/23/2004] [Indexed: 10/26/2022] Open
Abstract
AbstractNicotine has been proposed to provide anxiety relief, oral gratification and self-medication of psychotic symptoms in psychiatric patients. In order to investigate the relations between psychopathology and tobacco use we measured the concentration of cotinine, the major metabolite of nicotine, in the saliva of psychiatric patients and healthy volunteers. In a sample of 42 schizophrenic patients we correlated smoking status, cotinine levels, symptom profiles (PANSS), and neuroleptic side effects (Simpson–Angus). Despite reporting the same amount of cigarettes consumed per day the saliva concentration of cotinine was significantly higher in patients with schizophrenia than in the controls. There were no significant differences in clinical characteristics between smoking and non-smoking schizophrenic patients, but smokers tended to be on higher drug doses. High cotinine concentrations correlated significantly with the negative symptoms Passive withdrawal and Social avoidance. The results indicate that the schizophrenic patients smoke cigarettes more intensely than other patients and healthy subjects. The correlation between high cotinine levels and negative symptomatology may reflect an attempt by schizophrenic patients to overcome the emotional withdrawal and thus the results may lend support to a self-medication hypothesis.
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Affiliation(s)
- Jan-Erik Strand
- Department of Psychiatry, Vasa Central Hospital, Vasa, Finland
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17
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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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19
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Hassanzadah M, Bitar AH, Khanfar NM, Khasawneh FT, Lutfy K, Shankar GS. A retrospective cohort study of the prevalence of anxiety and agitation in schizophrenic smokers and the unmet needs of smoking cessation programs. Medicine (Baltimore) 2019; 98:e17375. [PMID: 31577741 PMCID: PMC6783193 DOI: 10.1097/md.0000000000017375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Achieving abstinence in schizophrenic smokers using a combination of medications and cognitive behavioral therapy is feasible; however, abstinence rates are significantly lower compared to the general population and studies are scanty. Additionally, maintaining sustained abstinence and preventing relapse is a major limiting factor and represents key tasks in managing tobacco dependence in schizophrenic patients. Several theories have been postulated to explain the higher tendency of tobacco use among schizophrenic individuals. Schizophrenic patients may use nicotine as a "self-medication" strategy to improve negative symptoms of schizophrenia. However, studies suggest that although nicotine may act as an anxiolytic acutely, chronic use of nicotine may lead to increased anxiety with the possibility of increased catecholamines, which is confirmed with the prevalence of tachycardia and hypertension in smokers in general. On this basis, the main objective of our present study was to assess anxiety in schizophrenic smoking and nonsmoking patients by comparing the number of anxiety and agitation episodes and evaluating the amount of antianxiety/antiagitation medication used by each group. A separate objective was to document the unmet needs of smoking cessation programs in treating schizophrenic patients. Consequently, in the present retrospective cohort study, it was observed that schizophrenic smokers tend to have higher anxiety episodes and utilize as-needed medications at a higher frequency compared to nonsmokers for the relief of anxiety and agitation symptoms. Further research is warranted to examine these results on a larger scale.
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Affiliation(s)
| | - Adib H Bitar
- Aurora Charter Oak Behavioral Healthcare, Covina, CA
| | - Nile M Khanfar
- College of Pharmacy, Nova Southeastern University, Palm Beach, FL
| | - Fadi T Khasawneh
- School of Pharmacy, The University of Texas at El Paso, El Paso, TX
| | - Kabirullah Lutfy
- College of Pharmacy, Western University of Health Sciences, Pomona, CA
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Abela AR, Li Z, Lê AD, Fletcher PJ. Clozapine reduces nicotine self-administration, blunts reinstatement of nicotine-seeking but increases responding for food. Addict Biol 2019; 24:565-576. [PMID: 29575323 DOI: 10.1111/adb.12619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/19/2018] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Abstract
People with schizophrenia display significantly higher rates of smoking than the general population, which may be due to an interaction between nicotine and antipsychotic medication. While the conventional antipsychotic drug haloperidol sometimes increases cigarette smoking in patients with schizophrenia, there is some evidence suggesting that clozapine, an atypical antipsychotic drug, may reduce nicotine use in these patients. However, the effects of antipsychotic drugs like clozapine on aspects of nicotine self-administration and reinstatement have not been systematically examined. In the current study, we assessed the effect of clozapine on nicotine self-administration under fixed ratio and progressive ratio schedules of reinforcement, as well as reinstatement of nicotine-seeking following a period of abstinence. To determine the specificity of its effect on nicotine reward, we also tested the effect of clozapine on responding for food reinforcement under fixed ratio and progressive ratio schedules. For comparison, we also examined the effects of haloperidol, a first-generation antipsychotic drug, under some of the same behavioral conditions as clozapine. We show that clozapine inhibits nicotine self-administration and reinstatement of nicotine-seeking but also increases the amount of effort that rats will exert for food reward. In contrast, haloperidol at a wide range of doses attenuated responding for nicotine and food reward, suggestive of a non-specific reduction in reinforcer efficacy. These results show the potential utility of clozapine as a smoking cessation treatment for patients with schizophrenia, in addition to its antipsychotic properties.
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Affiliation(s)
- Andrew R. Abela
- Centre for Addiction and Mental HealthPreclinical Research and Campbell Family Mental Health Research Institute Toronto ON Canada
- Department of PsychiatryUniversity of Toronto Toronto ON Canada
| | - Zhaoxia Li
- Centre for Addiction and Mental HealthPreclinical Research and Campbell Family Mental Health Research Institute Toronto ON Canada
| | - Anh D. Lê
- Centre for Addiction and Mental HealthPreclinical Research and Campbell Family Mental Health Research Institute Toronto ON Canada
- Department Pharmacology and ToxicologyUniversity of Toronto Toronto ON Canada
| | - Paul J. Fletcher
- Centre for Addiction and Mental HealthPreclinical Research and Campbell Family Mental Health Research Institute Toronto ON Canada
- Department Pharmacology and ToxicologyUniversity of Toronto Toronto ON Canada
- Department of PsychiatryUniversity of Toronto Toronto ON Canada
- Department of PsychologyUniversity of Toronto Toronto ON Canada
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21
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Quigley H, MacCabe JH. The relationship between nicotine and psychosis. Ther Adv Psychopharmacol 2019; 9:2045125319859969. [PMID: 31308936 PMCID: PMC6604123 DOI: 10.1177/2045125319859969] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/15/2019] [Indexed: 01/20/2023] Open
Abstract
Cigarette smoking is strongly associated with psychotic disorders such as schizophrenia. For several decades it was assumed that the relationship could be explained by reverse causation; that smoking was secondary to the illness itself, either through self-medication or a process of institutionalization, or was entirely explained by confounding by cannabis use or social factors. However, studies have exposed that such hypotheses cannot fully explain the association, and more recently a bidirectional relationship has been proposed wherein cigarette smoking may be causally related to risk of psychosis, possibly via a shared genetic liability to smoking and psychosis. We review the evidence for these candidate explanations, using findings from the latest epidemiological, neuroimaging, genetic and preclinical work.
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Affiliation(s)
- Harriet Quigley
- Department of Psychosis Studies, Institute of
Psychiatry, Psychology and Neuroscience, Kings College London, SE5 8AF,
Denmark Hill, London, UK
| | - James H. MacCabe
- Department of Psychosis Studies, Institute of
Psychiatry, Psychology and Neuroscience, Kings College London, London,
UK
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22
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Huang H, Dong M, Zhang L, Zhong BL, Ng CH, Ungvari GS, Yuan Z, Meng X, Xiang YT. Psychopathology and extrapyramidal side effects in smoking and non-smoking patients with schizophrenia: Systematic review and meta-analysis of comparative studies. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:476-482. [PMID: 30794823 DOI: 10.1016/j.pnpbp.2019.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022]
Abstract
The association between smoking and psychopathology and extrapyramidal side effects (EPSE) in schizophrenia has been controversial. This systematic review and meta-analysis compared psychopathology and EPSE between smoking and non-smoking schizophrenia patients. The PubMed, EMBASE, PsycINFO, Cochrane Library, and Web of Science databases were independently and systematically searched by two researchers to identify relevant articles. Standardized mean differences (SMDs) and their 95% confidence intervals (CI) were calculated with random effect models. Subgroup and meta-regression analyses were performed to explore sources of heterogeneity. The systematic review and meta-analysis included 29 studies that compared psychotic, depressive and anxiety symptoms and EPSE between smoking (n = 3591) and non-smoking schizophrenia patients (n = 2980). Smoking patients had significantly more severe positive symptoms (24 studies; SMD = 0.33, 95% CI: 0.16 to 0.50, P < 0.001), but less severe EPSE (7 studies; SMD = -0.20, 95% CI: -0.38 to -0.02, P = 0. 03). No significant group differences in negative, depressive and anxiety symptoms were found. In conclusion, this systematic review and meta-analysis found that smoking schizophrenia patients had more severe positive symptoms but less severe EPSE than non-smoking patients.
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Affiliation(s)
- Hui Huang
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Dong
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, the Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
| | - Bao-Liang Zhong
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Zhen Yuan
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Xiangfei Meng
- Department of Psychiatry, McGill University and the Douglas Mental Health University Institute, Montreal, Canada
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Abstract
SUMMARYTobacco smoking among people with mental illnesses can be explained by biological, psychological and social factors. The prevalence of smoking in people diagnosed with schizophrenia is higher than in people with other mental disorders and in the general population. This article explores three current hypotheses that explain this higher prevalence of smoking in schizophrenia. The first, the self-medication hypothesis, is increasingly countered by a growing body of evidence indicating that smokers experience more severe symptoms of schizophrenia. Numerous researchers have already identified smoking as a possible risk factor for the development of schizophrenia, which is the second hypothesis. The third hypothesis (shared genetic vulnerability) identifies certain genes that confer vulnerability for both schizophrenia and nicotine dependence. Understanding the reasons behind the higher prevalence of smoking among people with schizophrenia is vital in planning effective primary, secondary and tertiary smoking prevention for these individuals.LEARNING OBJECTIVESAt the end of this article, readers will be able to:
•understand the self-medication hypothesis in relation to tobacco smoking by people with schizophrenia•understand the role of tobacco smoking as a possible risk factor for causation of schizophrenia•understand the role of shared genetic vulnerability in the causation of both schizophrenia and nicotine dependence.
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Lally J, Spaducci G, Gardner-Sood P, Atakan Z, Greenwood K, Di Forti M, Ismail K, Murphy KC, Smith S, McNeill A, Murray RM, Gaughran F. Tobacco smoking and nicotine dependence in first episode and established psychosis. Asian J Psychiatr 2019; 43:125-131. [PMID: 31132542 DOI: 10.1016/j.ajp.2019.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 01/08/2023]
Abstract
AIM People with psychotic disorders have increased premature mortality in comparison with the general population, with high rates of cigarette use a contributing factor. We aimed to describe the prevalence of cigarette use and nicotine dependence (ND) in first episode psychosis (FEP), and established psychosis; and to investigate associations between clinical symptoms and ND. METHODOLOGY Smoking and clinical data were collected from two cohorts: 181 people with FEP recruited as part of the Physical Health and Substance Use Measures in First Onset Psychosis (PUMP) study and from 432 people with established psychosis recruited as part of the Improving physical health and reducing substance use in psychosis randomised controlled trial (IMPaCT RCT). RESULTS The prevalence of cigarette smoking was 78% in FEP and 62% in established psychosis. Forty nine percent (n = 60) of smokers in the FEP cohort and 69% (n = 183) of smokers with established psychosis were highly nicotine dependent. Being a highly nicotine dependent smoker was significantly associated with higher PANSS positive symptom scores (F = 5.480 p = 0.004), and with decreased scores on the Rosenberg self-esteem scale (F = 3.261, p = 0.039) in established psychosis. There was no diagnostic specificity identified in relation to smoking or ND in both groups. CONCLUSION High rates of cigarette usage and nicotine dependence are problems from the early stages of psychosis. ND is higher in people with established psychosis. Smoking cessation strategies as part of comprehensive management of psychotic disorders at every stage require further development and evaluation.
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Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; St Vincent's Hospital Fairview, Dublin, Ireland.
| | - Gilda Spaducci
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK.
| | | | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, School of Psychology, University of Sussex, Brighton, UK.
| | - Marta Di Forti
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Khalida Ismail
- Psychological Medicine Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Denmark Hill, London, UK.
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK; Forensic Intensive Care Service, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy.
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, Reader, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK.
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25
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Mallet J, Le Strat Y, Schürhoff F, Mazer N, Portalier C, Andrianarisoa M, Aouizerate B, Berna F, Brunel L, Capdevielle D, Chereau I, D'Amato T, Dubreucq J, Faget C, Gabayet F, Honciuc RM, Lançon C, Llorca PM, Misdrahi D, Rey R, Roux P, Schandrin A, Urbach M, Vidailhet P, Fond G, Dubertret C. Tobacco smoking is associated with antipsychotic medication, physical aggressiveness, and alcohol use disorder in schizophrenia: results from the FACE-SZ national cohort. Eur Arch Psychiatry Clin Neurosci 2019; 269:449-457. [PMID: 29396753 DOI: 10.1007/s00406-018-0873-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022]
Abstract
Tobacco smoking is common in schizophrenia and is one of the main causes of premature mortality in this disorder. Little is known about clinical correlates and treatments associated with tobacco smoking in patients with schizophrenia. Still, a better characterization of these patients is necessary, in a personalized care approach. Aggressiveness and childhood trauma have been associated with tobacco smoking in general population, but this association has never been explored in schizophrenia. Our study examines the clinical and therapeutic characteristics of tobacco smoking in schizophrenia. 474 stabilized patients (mean age = 32.2; 75.7% male gender; smokers n = 207, 54.6%) were consecutively included in the network of the FondaMental Expert centers for Schizophrenia and assessed with valid scales. Current tobacco status was self-declared. Aggressiveness was self-reported with Buss-Perry Aggressiveness Questionnaire and Childhood Trauma with Childhood Trauma Questionnaire. Ongoing treatment was reported. In univariate analysis, tobacco smoking was associated with lower education level (p < 0.01), positive syndrome (p < 0.01), higher physical aggressiveness (p < 0.001), alcohol dependence (p < 0.001), and First Generation Antipsychotics (FGAs) use (p = 0.018). In a multivariate model, tobacco smoking remained associated with physical aggressiveness (p < 0.05), current alcohol dependence (p < 0.01) and FGA use (p < 0.05). No association was observed with childhood trauma history, mood disorder, suicidal behavior, psychotic symptom, global functioning or medication adherence. Patients with tobacco use present clinical and therapeutic specificities, questioning the neurobiological links between tobacco and schizophrenia. They could represent a specific phenotype, with specific clinical and therapeutic specificities that may involve interactions between cholinergic-nicotinic system and dopaminergic system. Further longitudinal studies are needed to confirm the potential efficacy of second generation antipsychotics (SGAs) on tobacco use in schizophrenia and to develop effective strategies for tobacco cessation in this population.
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Affiliation(s)
- J Mallet
- Fondation FondaMental, Créteil, France. .,AP-HP, Paris, France. .,Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France. .,Inserm U894, Paris, France. .,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France.
| | - Y Le Strat
- Fondation FondaMental, Créteil, France.,AP-HP, Paris, France.,Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Inserm U894, Paris, France.,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France.,INSERM U955, Équipe de Psychiatrie Translationnelle, Créteil, France.,Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - N Mazer
- Fondation FondaMental, Créteil, France.,AP-HP, Paris, France.,Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Inserm U894, Paris, France.,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France
| | - C Portalier
- Fondation FondaMental, Créteil, France.,AP-HP, Paris, France.,Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Inserm U894, Paris, France.,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France
| | - M Andrianarisoa
- Fondation FondaMental, Créteil, France.,INSERM U955, Équipe de Psychiatrie Translationnelle, Créteil, France.,Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, 33076, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Bordeaux Sleep Clinique, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Research Unit, 33000, Bordeaux, France.,Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, 33000, Bordeaux, France
| | - F Berna
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - L Brunel
- Fondation FondaMental, Créteil, France.,INSERM U955, Équipe de Psychiatrie Translationnelle, Créteil, France.,Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France.,Pôle Psychiatrie Universitaire, CHU Sainte-Marguerite, 13274, Marseille Cedex 09, France
| | - F Gabayet
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - R M Honciuc
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - C Lançon
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle Universitaire de Psychiatrie, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, 33076, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,CNRS UMR 5287-INCIA, Bordeaux, France
| | - R Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - P Roux
- Fondation FondaMental, Créteil, France.,Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - M Urbach
- Fondation FondaMental, Créteil, France.,Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - G Fond
- Fondation FondaMental, Créteil, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Paris, France.,Department of Psychiatry, Service de Psychiatrie et d'Addictologie, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Inserm U894, Paris, France.,Sorbonne Paris Cité, Faculté de Médecine, Université Paris Diderot, Paris, France
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26
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Strauss GP, Chapman HC, Keller WR, Koenig JI, Gold JM, Carpenter WT, Buchanan RW. Endogenous oxytocin levels are associated with impaired social cognition and neurocognition in schizophrenia. J Psychiatr Res 2019; 112:38-43. [PMID: 30849617 DOI: 10.1016/j.jpsychires.2019.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 01/20/2023]
Abstract
Intranasal administration of the neuropeptide oxytocin (OT) has yielded inconsistent effects on social cognition and general cognition in individuals with schizophrenia (SZ). Few studies have examined whether endogenous peripheral OT levels are also associated with social and general cognition in SZ. The current study examined whether plasma OT levels are associated with performance on a higher-order social cognition measure (i.e., a task that requires inferential processes and knowledge not directly presented in social stimuli), as well as domains of general cognition. Participants included 30 individuals with SZ and 21 demographically matched healthy controls (CN). The MATRICS Consensus Cognitive Battery was administered to assess neuropsychological impairment in relation to 7 domains (processing speed, attention/vigilance, working memory, verbal learning, visual learning, reasoning/problem solving, and social cognition). Plasma OT levels were measured via radioimmunoassay. SZ had significantly lower endogenous OT levels and poorer MCCB performance on all 7 domains than CN. In CN and SZ, lower endogenous OT was associated with poorer social cognition. In SZ, lower endogenous OT was also associated with poorer processing speed and working memory. The significant association between OT and social cognition in both CN and SZ highlights the importance of endogenous OT levels as a biological predictor of social cognition, irrespective of clinical status. Significant associations between plasma OT and general neurocognition may reflect either an anxiolytic effect of plasma OT that results in better neurocognitive performance, or OT's action on dopamine and enhancement of dopamine tone that results in improved cognition.
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Affiliation(s)
| | | | - William R Keller
- Dartmouth College Geisel School of Medicine, Department of Psychiatry, USA
| | - James I Koenig
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center, USA
| | - James M Gold
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center, USA
| | - William T Carpenter
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center, USA
| | - Robert W Buchanan
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center, USA
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27
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Flitter AS, Lubitz SF, Ziedonis D, Stevens N, Leone FT, Mandell D, Kimberly J, Lopez O, Beidas RS, Schnoll RA. A Cluster-Randomized Clinical Trial Testing the Effectiveness of the Addressing Tobacco Through Organizational Change Model for Improving the Treatment of Tobacco Use in Community Mental Health Care: Preliminary Study Feasibility and Baseline Findings. Nicotine Tob Res 2019; 21:559-567. [PMID: 30388273 PMCID: PMC6468132 DOI: 10.1093/ntr/nty239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION People with mental illness are more likely to smoke and less likely to receive tobacco treatment than the general population. The Addressing Tobacco Through Organizational Change (ATTOC) approach supports organizational change to increase tobacco treatment in this population. We describe preliminary study feasibility and baseline behaviors and attitudes among clients and staff regarding tobacco treatment, and assesse correlates of treatment of smoking. METHODS Preliminary accrual, engagement, and baseline data are reported from a cluster-randomized trial comparing ATTOC to usual care. Feasibility, thus far, was the rate of site and participant accrual and engagement (eg, participants remaining in the trial). Correlates of assessing smoking, advising cessation, and providing treatment were assessed. RESULTS Site and participant accrual is 80% (8/10) and 86% (456/533), and engagement is 100% and 82%. "Staff asking about smoking" was reported by 63% of clients and 38% of staff; "staff advising cessation" was reported by 57% of clients and 46% of staff; staff report "assisting clients with any medication" at most 22% of the time, whereas at most 18% of clients report receiving a cessation medication; 59% of clients want tobacco treatment, but 36% of staff think that it is part of their job. "Staff assisting with medications" is related to more training, believing treating smoking is part of their job, and believing patients are concerned about smoking (ps < .05). CONCLUSIONS This trial of training in tobacco treatment within mental health care is feasible thus far; self-reported rates of tobacco treatment are low and associated with clinician attitudes and barriers. IMPLICATIONS Evaluation of ways to help address tobacco use treatment in community mental health care is feasible and needed, including the use of technical assistance and training guided by an organizational change approach.
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Affiliation(s)
- Alex S Flitter
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Su Fen Lubitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Douglas Ziedonis
- Department of Psychiatry, University of California, San Diego, CA
| | - Nathaniel Stevens
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Frank T Leone
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - John Kimberly
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA
| | - Oscar Lopez
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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28
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Antipsychotics and cardiovascular risk: A case/non-case study. Psychiatry Res 2018; 270:341-347. [PMID: 30292087 DOI: 10.1016/j.psychres.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022]
Abstract
Severe mental disorders have been reported to be associated with an increased cardiovascular risk. To measure the potential risk excess as compared, not with the baseline cardiovascular risk for the general population, but with the cardiovascular risk associated with drug iatrogenia. 197 reported cases of cardiovascular adverse reaction to antipsychotic drugs as compared to the reported cases of this type of adverse reactions to drugs other than antipsychotics entered in the Spanish Pharmacovigilance System database (FEDRA) (1995-2018) in an observational case/non-case study. Risk estimates of association were reporting odds ratio (ROR), and, chi-square test (χ2). Overall disproportionality for the whole drug class was found [ROR 2.3 (95% CI 2.0-2.7)], χ2 = 127.07]. When the two types of antipsychotics (typical and atypical) were analysed separately, we also found statistically significant disproportionality, and this disproportionality is similar between both groups, with disproportionality measures around 2.30, with the confidence intervals not including the 1. The disproportionality observed suggests a risk excess that might be greater than expected, which holds particularly true for torsade de pointes, sudden death and cardiac arrhythmias in patients treated with any of the two types of antipsychotics. There was no significant risk for ischaemic heart disease.
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29
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Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients. Schizophr Res 2018; 199:367-373. [PMID: 29486959 DOI: 10.1016/j.schres.2018.02.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine. METHODS Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. RESULTS Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of individuals, cardio-metabolic risk factors were untreated or under-treated. CONCLUSIONS Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.
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30
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Hunter A, Murray R, Asher L, Leonardi-Bee J. The Effects of Tobacco Smoking, and Prenatal Tobacco Smoke Exposure, on Risk of Schizophrenia: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2018; 22:3-10. [DOI: 10.1093/ntr/nty160] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background
The association between cigarette smoking and schizophrenia is well established. However, up to 90% of people with schizophrenia begin smoking before the onset of their illness; thus, smoking could be an independent risk factor for schizophrenia. Prenatal exposure to maternal cigarette smoke is also associated with psychiatric problems in adolescence. Therefore, our aim was to undertake a systematic review and meta-analysis to explore the effect of smoking, and prenatal smoke exposure, on risk of schizophrenia.
Method
We systematically searched Medline, EMBASE, PsychInfo, Maternity and Infant Care, and Web of Science (from inception to February 2018) to identify comparative observational studies of the risk of schizophrenia in relation to smoking status. Measures of relative risk (RR) were pooled in a meta-analysis with 95% confidence intervals (CI), using random effects model.
Results
Twelve studies (9 cohort, 3 case-control) were included. Odds ratios (OR) and hazard ratios (HR) were pooled together to estimate pooled relative risks and estimates combined in a meta-analysis on an assumption of constant risk over time. Smokers had a significantly increased risk of schizophrenia compared with nonsmokers (RR = 1.99, 95% CI = 1.10% to 3.61%, I2 = 97%, 5 studies). Exposure to prenatal smoke increased the risk of schizophrenia by 29% (95% CI = 1.10% to 1.51%, I2 = 71%, 7 studies). Sensitivity analyses identified no significant differences between the results from studies reporting OR and hazard ratio.
Conclusions
Our findings suggest smoking, and prenatal smoke exposure, may be an independent risk factor for schizophrenia. Care should be taken when inferring causation, given the observational nature of the studies.
Implications
In this meta-analysis of 12 studies, smokers had a significantly increased risk of schizophrenia compared with nonsmokers. Exposure to prenatal tobacco smoke also increased the risk of schizophrenia by 29% compared with those with no exposure to prenatal tobacco smoke. Our findings suggest that smoking, and prenatal tobacco smoke exposure, may be independent risk factors for schizophrenia. These results may have important public health implications for decreasing the incidence of schizophrenia. The possibility of a causal link between smoking and schizophrenia warrants further investigation.
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Affiliation(s)
- Abby Hunter
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Rachael Murray
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Laura Asher
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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31
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Kadra G, Stewart R, Shetty H, MacCabe JH, Chang C, Taylor D, Hayes RD. Long-term antipsychotic polypharmacy prescribing in secondary mental health care and the risk of mortality. Acta Psychiatr Scand 2018; 138:123-132. [PMID: 29845597 PMCID: PMC6099447 DOI: 10.1111/acps.12906] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the association between long-term antipsychotic polypharmacy use and mortality; and determine whether this risk varies by cause of death and antipsychotic dose. METHODS Using data from a large anonymised mental healthcare database, we identified all adult patients with serious mental illness (SMI) who had been prescribed a single antipsychotic or polypharmacy, for six or more months between 2007 and 2014. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical factors and smoking, to examine the association between APP use and the risk of death. RESULTS We identified 10 945 adults with SMI who had been prescribed long-term antipsychotic monotherapy (76.9%) or APP (23.1%). Patients on long-term APP had a small elevated risk of mortality, which was significant in some but not all models. The adjusted hazard ratios for death from natural and unnatural causes associated with APP were 1.2 (0.9-1.4, P = 0.111) and 1.1 (0.7-1.9, P = 0.619) respectively. The strengths of the associations between APP and mortality outcomes were similar after further adjusting for % BNF antipsychotic dose (P = 0.031) or olanzapine equivalence (P = 0.088). CONCLUSION The findings suggest that the effect of long-term APP on mortality is not clear-cut, with limited evidence to indicate an association, even after controlling for the effect of dose.
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Affiliation(s)
- G. Kadra
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - R. Stewart
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - H. Shetty
- South London and Maudsley NHS Foundation TrustLondonUK
| | - J. H. MacCabe
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - C.‐K. Chang
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - D. Taylor
- South London and Maudsley NHS Foundation TrustLondonUK
| | - R. D. Hayes
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Reeves LE, Gaudiano BA, Metrik J, Guzman Holst C, Morena A, Sydnor VJ, Weinstock LM, Epstein-Lubow G. Comorbid Cannabis and Tobacco Use Disorders in Hospitalized Patients with Psychotic-Spectrum Disorders. J Dual Diagn 2018; 14:171-180. [PMID: 30265850 DOI: 10.1080/15504263.2018.1470359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Individuals with psychotic-spectrum disorders use tobacco and cannabis at higher rates than the general population and individuals with other psychiatric disorders, which may contribute to increased rates of medical problems and mortality. The present study examined whether individuals with psychosis and comorbid tobacco and/or cannabis use disorders exhibit differing clinical characteristics in terms of their sociodemographic, mental health, substance use, physical health, and medication use patterns. Elucidation of these profiles, and determining their relative severity, has important implications for treatment, including offering more targeted interventions based on type of comorbidity pattern. METHODS We examined the electronic medical records of 829 patients with psychotic-spectrum disorders admitted to a psychiatric hospital and categorized them as having: (1) cannabis use disorder (CUD); (2) tobacco use disorder (TUD); (3) comorbid cannabis and tobacco use disorders (CUD + TUD); or (4) neither disorder (no CUD/TUD). Multinomial logistic regression was used to compare the aforementioned groups on multiple variables controlling for age and sex. RESULTS Alcohol and stimulant use disorder diagnoses were each related to higher odds of having a CUD and CUD + TUD, relative to no CUD/TUD. Stimulant and polysubstance use disorder diagnoses were each related to higher odds of having a TUD compared to no CUD/TUD. Greater number of prescribed psychotropic medications was related to higher odds of a TUD compared to no CUD/TUD. CONCLUSIONS Although several differences between groups were accounted for by age of cannabis versus tobacco users, findings point to the importance of considering comorbid alcohol and substance use disorders among those with psychosis and CUD/TUD, as these comorbidities have important implications for screening and treatment selection during and following acute hospitalization.
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Affiliation(s)
- Lauren E Reeves
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA.,b Warren Alpert Medical School of Brown University , Department of Psychiatry and Human Behavior , Providence , Rhode Island , USA
| | - Brandon A Gaudiano
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA.,b Warren Alpert Medical School of Brown University , Department of Psychiatry and Human Behavior , Providence , Rhode Island , USA
| | - Jane Metrik
- c Providence Veterans Administration Medical Center , Providence , Rhode Island , USA.,d Center for Alcohol and Addiction Studies , Brown University, School of Public Health , Providence , Rhode Island , USA
| | - Carolina Guzman Holst
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA.,b Warren Alpert Medical School of Brown University , Department of Psychiatry and Human Behavior , Providence , Rhode Island , USA
| | - Alexandra Morena
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA
| | - Valerie J Sydnor
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA.,b Warren Alpert Medical School of Brown University , Department of Psychiatry and Human Behavior , Providence , Rhode Island , USA
| | - Lauren M Weinstock
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA.,b Warren Alpert Medical School of Brown University , Department of Psychiatry and Human Behavior , Providence , Rhode Island , USA
| | - Gary Epstein-Lubow
- a Butler Hospital, Psychosocial Research Program, Providence , Rhode Island , USA.,b Warren Alpert Medical School of Brown University , Department of Psychiatry and Human Behavior , Providence , Rhode Island , USA
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Al Risi K, Al Maqbali M, Asiri WA, Al Sinawi H. Rate of Tobacco Smoking Among Psychiatric Outpatients Attending a Tertiary Care Hospital in Oman:
A Cross-sectional Study. Oman Med J 2018; 33:224-228. [PMID: 29896330 DOI: 10.5001/omj.2018.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Tobacco smoking is the single most avoidable cause of morbidity and mortality around the world. Patients with psychiatric disorders tend to smoke tobacco at a higher rate than the general population, with significant adverse health consequences. This study aimed to determine the rate of tobacco smoking among psychiatric outpatients attending Sultan Qaboos University Hospital, a tertiary care hospital in Muscat, Oman. Methods We conducted a cross-sectional study among psychiatric outpatients attending a psychiatric clinic from 1 January to 1 August 2017. The patients' demographic information, history of smoking, previous hospitalizations, and the number of and specific psychotropics used during treatment was documented. The degree of dependence on tobacco smoking was measured using the Fagerstrom test for nicotine dependence. Results A total of 272 patients were included in this study. The overall rate of smoking among psychiatric patients was 13.6%. Patients with schizophrenia had the highest rate of smoking (22.2%), followed by those with bipolar (13.1%), and anxiety disorders (11.1%). Patients who smoked tobacco were more likely to be admitted to the psychiatric ward than non-smokers (p < 0.050). Conclusions Tobacco smoking is common among psychiatric patients, a finding consistent with similar studies conducted in different parts of the world. Assessment of smoking status and its associated adverse health associations among patients with mental disorders is of paramount importance.
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Affiliation(s)
- Khalid Al Risi
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | | | | | - Hamed Al Sinawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Aguocha C, Uwakwe R, Olose E, Amadi K, Onyeama G, Duru C. Clinical implication of smoking among patients with schizophrenia at a Tertiary Institution in South East Nigeria. Afr Health Sci 2018; 18:102-110. [PMID: 29977263 PMCID: PMC6016984 DOI: 10.4314/ahs.v18i1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The chronic and debilitating nature of schizophrenia creates a disease with marked clinical and economic consequences. Smoking in schizophrenia appears to be associated with increased psychopathology and disability. Objective The aim of this study was to determine if cigarette smoking in schizophrenia is associated with increased disability and psychopathology. Materials and methods This was a cross-sectional descriptive study in which 367 out-patients with International Classification of Diseases (ICD) 10 diagnosis of schizophrenia were recruited. Socio-demographic questionnaire, Present State Examination (PSE) 10, Positive And Negative Syndrome Scale (PANSS) and World Health Organization Disability Assessment Schedule (WHODAS) were administered. Data was analyzed using a software package SPSS version 15. Results There was no significant difference in the mean PANSS scores of smokers and non-smokers. Current smoking was associated with increased disability (F=5.39, p=0.02). Total PANSS score significantly predicted disability F(3,71=5.60, p=0.002, R2=0.19). There was no significant association between positive or negative symptoms and being a smoker or non-smoker. Conclusion The results of this study revealed that smoking in Nigerian schizophrenia patients is associated with significant disability. Measures should be put in place to discourage cigarette smoking among Nigerian patients with schizophrenia.
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Affiliation(s)
- Chinyere Aguocha
- Imo state university Teaching Hospital, Orlu, imo state, Nigeria, Department of Medicine; Imo state university , owerri, imo state, Nigeria, Department of Medicine
| | - Richard Uwakwe
- Nnamdi Azikiwe University Teaching Hospital, Mental Health
| | - Emmanuel Olose
- Department of Psychiatry, University Of Calabar, Cross Rivers, Nigeria
| | - Kennedy Amadi
- University of Nigeria, Department of Psychological Medicine
| | | | - Chukwuma Duru
- Imo State University Teaching Hospital, Orlu, Nigeria., Community Medicine
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Nordon C, Bovagnet T, Belger M, Jimenez J, Olivares R, Chevrou-Severac H, Verdoux H, Haro JM, Abenhaim L, Karcher H. Trial exclusion criteria and their impact on the estimation of antipsychotic drugs effect: A case study using the SOHO database. Schizophr Res 2018; 193:146-153. [PMID: 28712965 DOI: 10.1016/j.schres.2017.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/05/2017] [Accepted: 07/09/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the impact upon estimation of drug effect as a result of applying exclusion criteria in randomized-controlled trials (RCT) measuring the efficacy of antipsychotics (AP) in schizophrenia. METHODS Three characteristics which may act as effect-modifiers of AP, while also common exclusion criteria in RCTs, were identified through literature review: schizophrenia duration, substance use disorder and poor adherence. The SOHO cohort was used to estimate the effect of initiating antipsychotic drugs "A", "B" or "C" (pooled) upon symptom evolution at 3months from baseline (CGI-S scale). "Estimated effectiveness" and "estimated efficacy" were drawn from the "SOHO" and "RCT-like" (patients with none of the above-listed exclusion criteria) samples, respectively. Effect-modification and impact of each exclusion criterion on AP effect estimates were explored using non-adjusted statistics. RESULTS The "SOHO sample" included 8250 patients initiating drug A, B or C at baseline, whose AP "estimated effectiveness" was ΔCGI-S=-0.78 (95% CI=-0.80, -0.76). The "RCT-like" sub-sample included 5348 (65%) patients whose AP "estimated efficacy" was ΔCGI-S=-0.73 (95% CI=-0.75, -0.70). Patients with short illness duration (≤3years since first AP; n=2436) experienced significant symptom improvement (ΔCGI-S=-0.89; 95%CI=-0.93, -0.85) compared to patients with duration >3years (mean ΔCGI-S=-0.73; 95%CI=-0.76, -0.71). Excluding patients with short illness duration led to a change in AP effect estimates but this was not the case for substance use disorder or poor adherence. CONCLUSION Using certain exclusion criteria in RCTs may impact the drug's effect estimate, particularly when exclusion criteria are AP effect-modifiers representing frequent characteristics among patients with schizophrenia.
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Affiliation(s)
| | | | - Mark Belger
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, United Kingdom
| | - Javier Jimenez
- Medical Evidence and Observational Research, AstraZeneca, 1 Medimmune way, Gaithersburg, MD, United States
| | - Robert Olivares
- Global HEOR, Sanofi, 1 Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Helene Chevrou-Severac
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Glattpark-Opfikon, Zurich, Switzerland
| | - Helene Verdoux
- Univ. Bordeaux 2 and INSERM U1219, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
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Abstract
It has been recognised for many years that patients with psychiatric illnesses, especially schizophrenia, smoke to excess. However, recently there has been a resurgence of interest in the high prevalence of nicotine addiction in patients with schizophrenia. It has become increasingly clear that heavy cigarette smoking is intimately associated with the schizophrenic illness and that this may have implications for the underlying neurobiology of schizophrenia.
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Abstract
Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.
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McDonald C, Sheppard N. Smoking in chronic psychiatric illness: is it worth it? PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.20.9.533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The prevalence of smoking is higher among chronic psychiatric patients than the general population, in spite of their lower income. The purpose of this study was to calculate the percentage of income these patients spend on smoking and to discuss the relationship between smoking and chronic psychiatric disorders, in particular schizophrenia. Ninety-six smokers were included in the study. The mean percentage expenditure on smoking was 294% of income. We discuss why chronic psychiatric patients smoke so much, why they should not, and what factors may encourage them to quit.
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Bhavsar V, Jauhar S, Murray RM, Hotopf M, Hatch SL, McNeill A, Boydell J, MacCabe JH. Tobacco smoking is associated with psychotic experiences in the general population of South London. Psychol Med 2018; 48:123-131. [PMID: 28655360 DOI: 10.1017/s0033291717001556] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between cigarette smoking and psychosis remains unexplained, but could relate to causal effects in both directions, confounding by socioeconomic factors, such as ethnicity, or use of other substances, including cannabis. Few studies have evaluated the association between cigarettes and psychotic experiences (PEs) in diverse, inner-city populations, or relationships with number of cigarettes consumed. METHODS We assessed associations and dose-response relationships between cigarette smoking and PEs in a cross-sectional survey of household residents (n = 1680) in South East London, using logistic regression to adjust for cannabis use, other illicit substances, and socioeconomic factors, including ethnicity. RESULTS We found association between any PEs and daily cigarette smoking, which remained following adjustment for age, gender, ethnicity, cannabis and use of illicit stimulant drugs (fully adjusted odds ratio 1.47, 95% confidence interval 1.01-2.15). Fully adjusted estimates for the association, and with number of PEs, increased with number of cigarettes smoked daily, implying a dose-response effect (p = 0.001 and <0.001, respectively). Odds of reporting any PEs in ex-smokers were similar to never-smokers. CONCLUSIONS In this diverse epidemiological sample, association between smoking and PEs was not explained by confounders such as cannabis or illicit drugs. Daily cigarette consumption showed a dose-response relationship with the odds of reporting PEs, and of reporting a greater number of PEs. There was no difference in odds of reporting PEs between ex-smokers and never-smokers, raising the possibility that the increase in PEs associated with smoking may be reversible.
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Affiliation(s)
- V Bhavsar
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - S Jauhar
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - R M Murray
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - M Hotopf
- Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - S L Hatch
- Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - A McNeill
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience and UK Centre for Tobacco and Alcohol Studies, King's College London,London
| | - J Boydell
- Cornwall Partnership Foundation NHS Trust,Cornwall
| | - J H MacCabe
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
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Mallet J, Le Strat Y, Schürhoff F, Mazer N, Portalier C, Andrianarisoa M, Aouizerate B, Berna F, Brunel L, Capdevielle D, Chereau I, D'Amato T, Denizot H, Dubreucq J, Faget C, Gabayet F, Lançon C, Llorca PM, Misdrahi D, Rey R, Roux P, Schandrin A, Urbach M, Vidailhet P, Fond G, Dubertret C. Cigarette smoking and schizophrenia: a specific clinical and therapeutic profile? Results from the FACE-Schizophrenia cohort. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:332-339. [PMID: 28663115 DOI: 10.1016/j.pnpbp.2017.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/17/2017] [Accepted: 06/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tobacco use is common in patients with schizophrenia (SZ) but little is known on the role of tobacco in the physiopathology or on the course of the disease. Only few studies embrace an extensive examination of clinical and therapeutic characteristics in stabilized patients. The objective of the present study was to determine the prevalence of tobacco smoking in stabilized SZ outpatients and the clinical and treatment characteristics associated with daily tobacco use in a large community-dwelling sample of patients. METHODS Three-hundred-and-sixty-one patients were included in the network of the FondaMental Expert Centers for Schizophrenia. Current tobacco status was self-declared. RESULTS 53.7% were smokers. Mean age at tobacco onset was 17.2years old. In multivariate analyses, after adjustment for confounding factors, positive symptoms and mean daily antipsychotic dose were associated with a higher frequency of tobacco use (OR=1.06 95%IC[1.02-1.12], for positive symptoms, OR=1.1, 95%IC[1.02-1.18] for daily antipsychotic dose). Education level, negative symptoms, anticholinergic agents, clozapine or aripiprazole administration were independently associated with a lower frequency of tobacco use (respectively OR=0.87, 95%IC [0.79, 0.95], OR=0.95, 95%IC[0.91-0.98], OR=0.41, 95%IC[0.22-0.76], OR=0.56, 95%IC=[0.32, 0.99] and OR=0.49, 95%IC [0.26-0.91]). CONCLUSION The prevalence of current tobacco smoking in a French community-dwelling SZ patients is higher that observed in the general population. Patients with tobacco use present clinical and therapeutic specificities that may involve interaction between cholinergic-nicotinic and dopaminergic systems. The present study suggests that some therapeutics may improve daily smoking behavior in smokers. These results should be confirmed in longitudinal studies.
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Affiliation(s)
- J Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France.
| | - Y Le Strat
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - N Mazer
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - C Portalier
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - M Andrianarisoa
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; Bordeaux Sleep Clinique, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Research Unit, 33000 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - L Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon,Université Claude Bernard Lyon 1, Equipe PSlYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - H Denizot
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France; Pôle psychiatrie universitaire, CHU Sainte-Marguerite, F-13274 Marseille Cedex 09, France
| | - F Gabayet
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Lançon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle universitaire de psychiatrie, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; CNRS UMR 5287-INCIA, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon,Université Claude Bernard Lyon 1, Equipe PSlYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - P Roux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - G Fond
- Fondation FondaMental, Créteil, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
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Inhibitory deficits in prepulse inhibition, sensory gating, and antisaccade eye movement in schizotypy. Int J Psychophysiol 2017; 114:47-54. [DOI: 10.1016/j.ijpsycho.2017.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022]
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Lange B, Mueller JK, Leweke FM, Bumb JM. How gender affects the pharmacotherapeutic approach to treating psychosis - a systematic review. Expert Opin Pharmacother 2017; 18:351-362. [PMID: 28129701 DOI: 10.1080/14656566.2017.1288722] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The effectiveness, effective dosages and side effect profiles of antipsychotic medication differ significantly between the sexes. Areas covered: We present a systematic review of gender-differences in the treatment of psychosis focusing on randomized, controlled trials and meta-analyses. Expert opinion: Despite many years of research, the database on gender-differences affecting the pharmacotherapeutic approach to treating psychosis is insufficient. Currently, the US National Institute of Health encouraged the enrolment of female participants in federally supported phase III clinical trials to increase the data available of female patients. Emerging evidence points to a superior antipsychotic response in women, with men requiring higher dosages. In general, women metabolize drugs differently, resulting in side effects occuring more frequently when compared to men. In any case, women require electrocardiograms or bone density scans as well as diabetes and cardiovascular workups when treated with antipsychotics. Dose adjustments during the menstrual cycle (e.g. to raise antipsychotic doses premenstrually) should be considered. First-generation antipsychotics, drugs that are known to prolong QTc interval and increase prolactin levels should be avoided in postmenopausal female patients. Furthermore, the effects of antipsychotics during pregnancy and breastfeeding have been investigated insufficiently, and more research is urgently needed.
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Affiliation(s)
- Bettina Lange
- a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - Juliane K Mueller
- a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - F Markus Leweke
- a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - J Malte Bumb
- b Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health , Medical Faculty Mannheim/Heidelberg University , Mannheim , Germany
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Grossman M, Bowie CR, Lepage M, Malla AK, Joober R, Iyer SN. Smoking status and its relationship to demographic and clinical characteristics in first episode psychosis. J Psychiatr Res 2017; 85:83-90. [PMID: 27863280 DOI: 10.1016/j.jpsychires.2016.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/15/2016] [Accepted: 10/26/2016] [Indexed: 02/08/2023]
Abstract
Elevated rates of cigarette smoking are observed prior to the onset of psychosis and remain stable early in the illness. Cannabis use frequently co-occurs with cigarette smoking and is independently associated with distinct clinical outcomes. However, past research has not controlled for cannabis use in cigarette smokers with first episode psychosis (FEP), limiting conclusions on the unique relationship of cigarette smoking to the demographic and clinical profiles of these patients. The present study therefore aimed to: (1) Determine the prevalence and patterns of cigarette smoking and its co-use with cannabis in FEP, and (2) Examine the demographic, clinical, cognitive, and functional characteristics associated with cigarette smoking status, after adjusting for frequency of cannabis use. Patients entering specialized treatment for FEP (N = 140) were divided into groups according to their current smoking status: 66 non-smokers (0 cigarettes/day), 47 light/moderate smokers (1-19 cigarettes/day; M = 9.81, SD = 3.93), and 27 heavy smokers (≥20 cigarettes/day; M = 26.39, SD = 6.31). The prevalence of cigarette smoking was 53% and smoking status was highly associated with frequency of cannabis use. After adjusting for cannabis use, significant between-group differences emerged. Heavy smokers were older at program entry and had a later age of onset of psychosis than light/moderate and non-smokers. Non-smokers had more education, better neurocognitive performance, and higher levels of functioning than light/moderate and heavy smokers. Prospective, longitudinal studies are needed to better understand the clinical significance of tobacco use and factors that contribute to the initiation and continuation of smoking behaviours in FEP.
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Affiliation(s)
- Michael Grossman
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
| | - Christopher R Bowie
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada.
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; ACCESS Open Minds (A Pan-Canadian Youth Mental Health Network), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada.
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada.
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; ACCESS Open Minds (A Pan-Canadian Youth Mental Health Network), Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada.
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Oliveira P, Ribeiro J, Donato H, Madeira N. Smoking and antidepressants pharmacokinetics: a systematic review. Ann Gen Psychiatry 2017; 16:17. [PMID: 28286537 PMCID: PMC5340025 DOI: 10.1186/s12991-017-0140-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/24/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective. METHODS We present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies. RESULTS Twenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers. CONCLUSIONS There is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.
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Affiliation(s)
- Pedro Oliveira
- Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
| | - Joana Ribeiro
- Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
| | - Helena Donato
- Documentation Department, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Nuno Madeira
- Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
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Lee EE, Eyler LT, Wolkowitz OM, Martin AS, Reuter C, Kraemer H, Jeste DV. Elevated plasma F2-isoprostane levels in schizophrenia. Schizophr Res 2016; 176:320-326. [PMID: 27318521 PMCID: PMC5026902 DOI: 10.1016/j.schres.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Schizophrenia is one of the most disabling psychiatric disorders with increased morbidity and mortality. Both schizophrenia and oxidative stress have been associated with accelerated aging. Previous studies found increased oxidative stress in individuals with schizophrenia, though only one study measured F2-isoprostanes and did so in urine. To our knowledge, the present study is the first to assess plasma F2-isoprostane levels, the putative gold standard measure of systemic oxidative stress in vivo, in schizophrenia. METHODS We compared plasma F2-isoprostane levels in 134 stable outpatients with schizophrenia and 120 age- and gender-matched healthy comparison (HC) subjects. Sociodemographic and clinical data were collected in both groups. RESULTS Plasma F2-isoprostane levels were significantly higher in the schizophrenia group than in the HC group. Women had higher F2-isoprostane levels compared to men, and those with higher body mass index (BMI) had higher levels, within each group. F2-isoprostane levels correlated with BMI, physical functioning, and medical comorbidity but not with severity of psychopathology or executive function. Linear models showed significant effects of diagnosis, gender, and BMI on F2-isoprostane levels, but no interactions. DISCUSSION Our finding of increased oxidative stress in schizophrenia is consistent with reports of increased morbidity and mortality as well as accelerated aging in schizophrenia. The significant associations between F2-isoprostane levels and both gender and BMI warrant further study.
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Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego
| | | | - Averria Sirkin Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Chase Reuter
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Helena Kraemer
- Department of Psychiatry, Stanford University, Palo Alto
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States,Center for Healthy Aging, University of California, San Diego, La Jolla, CA, United States,Department of Neurosciences, University of California, San Diego
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Jeon DW, Shim JC, Kong BG, Moon JJ, Seo YS, Kim SJ, Oh MK, Jung DU. Adjunctive varenicline treatment for smoking reduction in patients with schizophrenia: A randomized double-blind placebo-controlled trial. Schizophr Res 2016; 176:206-211. [PMID: 27543252 DOI: 10.1016/j.schres.2016.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Smoking is more common among patients with schizophrenia than it is in the general population. Varenicline, a partial and full agonist at the α4β2 and α7 nicotine acetylcholine receptors, respectively, has been shown to be an effective anti-smoking treatment. This study examined the effects of varenicline treatment on smoking reduction in patients with schizophrenia. METHODS Sixty smokers with schizophrenia were recruited and randomized to receive either varenicline or placebo. Smoking behavior was assessed with the Minnesota Nicotine Withdrawal Scale (mNWS), Brief Questionnaire of Smoking Urge (QSU-brief), and Modified Cigarette Evaluation Questionnaire (mCEQ). Exhaled carbon monoxide was also measured to assess smoking dependency and status. Data were analyzed with the two-tailed Student's t-test, χ(2) test, and repeated measures ANOVA. RESULTS During the 8-week study, there was a significant time×group interaction, which showed that smoking decreased over time in the varenicline group. Expired CO levels also decreased in the varenicline group, showing a significant time effect, group effect, and time×group interaction. Total mCEQ scores decreased in the varenicline group, demonstrating a significant time×group interaction. Among the five domains of the mCEQ, the smoking satisfaction, psychological reward, and enjoyment of respiratory tract sensation domains showed significant time×group interactions in the varenicline group. The QSU-brief and mNWS demonstrated a significant time effect, but not significant time×group interactions. Adjunctive varenicline treatment with antipsychotics was generally well-tolerated and safe. CONCLUSIONS Varenicline showed significant efficacy in reducing smoking in people with schizophrenia.
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Affiliation(s)
- Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Joo-Cheol Shim
- Shim Joo Cheol Psychiatry Clinic, Busan, Republic of Korea.
| | - Bo-Geum Kong
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Young-Soo Seo
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea.
| | - Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Min-Kyung Oh
- Department of Clinical Pharmacology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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The challenge of reducing smoking in people with serious mental illness. THE LANCET RESPIRATORY MEDICINE 2016; 4:835-844. [DOI: 10.1016/s2213-2600(16)30228-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 12/28/2022]
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48
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Nadalin S, Buretić-Tomljanović A, Rebić J, Pleša I, Šendula Jengić V. An association between the PPARα-L162V polymorphism and nicotine dependency among patients with schizophrenia. Compr Psychiatry 2016; 70:118-24. [PMID: 27624431 DOI: 10.1016/j.comppsych.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/25/2016] [Accepted: 07/06/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Patients with schizophrenia are more likely to be smokers than the general population, which makes them an interesting group with which to study the etiology of nicotine dependency. We studied the prevalence of a gene variant of peroxisome proliferator-activated receptor alpha (PPARα) in schizophrenia, together with nicotine dependency, to investigate whether the PPARα-L162V polymorphism (rs1800206) influences nicotine dependency in schizophrenia. Given evidence suggesting that smoking influences the severity of schizophrenia, together with our recent data linking the PPARα-L162V polymorphism to clinical manifestations of schizophrenia (in the Croatian population), we hypothesized that interactions between the two (smoking and the PPARα-L162V polymorphism) might contribute to disease onset and scores for the Positive and Negative Syndrome Scale. To the best of our knowledge, this is the first study to investigate the possible associations between the PPARα gene and nicotine dependency. PATIENTS AND METHODS Genotyping was performed for 267 chronically ill schizophrenia patients (males/females: 140/127) by polymerase chain reaction. RESULTS A significant excess of PPARα-L162V genotypes and PPARα-162V alleles were detected among female smokers in comparison to female nonsmokers (18.2% vs. 2.0%, and 9.1% vs. 1.0%, p<0.01, respectively). We also revealed a significant PPARα genotype-smoking interaction that predicted positive symptom severity among male patients (F=4.43, p<0.05). These data indicated that the PPARα-L162V heterozygous genotype, depending on smoking status, might be of relevance as either protective, or a risk factor, for the severity of positive symptoms. No interaction between the PPARα-L162V polymorphism and smoking for the time of onset of schizophrenia was detected (p>0.05, respectively). CONCLUSION We demonstrated two significant yet weak effects. The first showed an effect of the PPARα-L162V polymorphism on the risk of nicotine dependency. The second linked the PPARα genotype-smoking interaction to positive symptoms severity among schizophrenia patients; both effects manifested in a gender-specific fashion.
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Affiliation(s)
- Sergej Nadalin
- Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.
| | - Alena Buretić-Tomljanović
- Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Jelena Rebić
- Psychiatry Clinic, Clinical Hospital Center Rijeka, Cambierieva 15, 51000 Rijeka, Croatia
| | - Ivana Pleša
- Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
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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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Synthesis and biological activities of indolizine derivatives as alpha-7 nAChR agonists. Eur J Med Chem 2016; 115:94-108. [PMID: 26994846 DOI: 10.1016/j.ejmech.2016.03.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/16/2022]
Abstract
Human α7 nicotinic acetylcholine receptor (nAChR) is a promising therapeutic target for the treatment of schizophrenia accompanied with cognitive impairment. Herein, we report the synthesis and agonistic activities of a series of indolizine derivatives targeting to α7 nAChR. The results show that all synthesized compounds have affinity to α7 nAChR and some give strong agonistic activity, particularly most active agonists show higher potency than control EVP-6124. The docking and structure-activity relationship studies provide insights to develop more potent novel α7 nAChR agonists.
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