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Gao Z, Xiu M, Liu J, Wu F, Zhang X. Smoking, Symptoms Improvement, and Total Antioxidant Capacity in Patients with Drug-naive First-episode Schizophrenia: A Prospective Cohort Study. Curr Neuropharmacol 2024; 22:1733-1741. [PMID: 37859307 DOI: 10.2174/1570159x22666231019105328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/08/2023] [Accepted: 04/26/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND It has been hypothesized that smoking is associated with the severity of negative symptoms. Until now, no studies have investigated whether the impact of smoking on negative symptoms is dependent on antioxidants. This study was designed to evaluate the effect of smoking on therapeutic response and total antioxidants capacity (TAOC) in antipsychotic-naïve first-episode (ANFE) patients. METHODS The severity of the patient's symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). A total of 237 ANFE patients were recruited and treated with risperidone (oral tablets, 4-6 mg/day twice a day) for 12 weeks. PANSS was assessed at baseline and a 12-week follow-up. Plasma TAOC levels were also assayed at baseline and week 12. RESULTS Relative to nonsmokers with ANFE SZ, smokers had higher PANSS negative subscores. There was no significant difference in TAOC changes after 12 weeks of treatment with risperidone between smokers and non-smokers. However, we found greater improvement in negative symptoms in smokers compared to non-smokers. Further analysis in smokers with SZ demonstrated that improvements in negative symptoms were not associated with changes in TAOC. CONCLUSION Our study suggested that smoking affected the severity of baseline negative symptoms and further contributed to their reduction after risperidone treatment. However, improvement in negative symptoms was not dependent on the changes in TAOC.
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Affiliation(s)
- Zhiyong Gao
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China
| | - Meihong Xiu
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Jiahong Liu
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiangyang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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2
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Rajalu BM, Jayarajan D, Muliyala KP, Sharma P, Gandhi S, Chand PK. Effectiveness of personalized tobacco cessation intervention package among patients with schizophrenia and related psychotic disorders - A two-group experimental study. Asian J Psychiatr 2023; 81:103447. [PMID: 36652840 DOI: 10.1016/j.ajp.2023.103447] [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: 10/14/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Persons with schizophrenia and related psychotic disorders (PwS) smoke more, and have twice the rate of mortality, with 10-25 years lower life expectancy than the general population. Evidence-based tobacco cessation interventions would help in quitting. AIM To evaluate the effectiveness of a personalized tobacco cessation intervention package for patients attending the outpatient psychiatry department. METHODS The study adopted a two-group experimental design in PwS, using a simple randomization method. Eligible participants were randomly allocated to either the intervention group (n = 85) receiving the intervention package or the control group (n = 85) receiving brief advice to stop tobacco. The study outcomes were measured at baseline, 1, 3, and 6 months. SPSS 23 was used for data analysis. Intention-to-treat analysis was used to manage missing data. The p-value of < 0.05 is considered statistically significant. RESULTS At 6 months, there was a significant difference (p < 0.001) in 7 days point-prevalence abstinence (28 % vs 10.8 %), reduction of tobacco by at least 50 % (62.4 % vs 40.9 %) with an attrition rate of 15.3 % vs 30.5 % in intervention and control group respectively. Reduction in nicotine dependence and tobacco craving, an increase in motivation level, quit attempts and clinical improvement favored the intervention group. 16.5 % of participants expressed interest in pharmacotherapy for tobacco cessation, 3.5 % were referred to a specialized tobacco cessation center, two control group participants were hospitalized for drug default, and withdrawal symptoms reported were mild. CONCLUSION Implementing a tobacco cessation intervention based on the stage of motivation aids in abstinence and reduction of tobacco use in PwS.
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Affiliation(s)
| | - Deepak Jayarajan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Priyamvada Sharma
- Centre for Addiction Medicine, Department of Clinical Pharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Prabhat Kumar Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
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3
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Selby P, Vojtila L, Ashfaq I, Dragonetti R, Melamed OC, Carriere R, LaChance L, Kohut SA, Hahn M, Mulsant BH. Technology-enabled collaborative care for youth with early psychosis: A protocol for a feasibility study to improve physical health behaviours. Early Interv Psychiatry 2021; 15:828-836. [PMID: 32748501 DOI: 10.1111/eip.13018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022]
Abstract
AIM Individuals with psychotic disorders have poorer health outcomes and die earlier due to cardiovascular diseases when compared to healthy populations. Contributing factors include low levels of physical activity, poor nutrition and tobacco smoking. Currently, patients navigate a fragmented health-care system to seek physical and mental health services, often without access to evidence-based health promotion interventions, especially in non-academic settings or rural areas, increasing client barriers at the individual and provider level. To address these gaps, we wish to test the feasibility and impact of a Technology-Enabled Collaborative Care for Youth (TECC-Y) model to improve healthy behaviours among youth with early psychosis. The model addresses geographical barriers and maldistribution of physical and mental health care. METHODS A randomized controlled trial, including youth (ages of 16-29) with early psychosis (diagnosed in the past 5 years) residing in Ontario, Canada. Our primary outcome is client engagement. Secondary outcomes include smoking status, physical health and nutrition. Participants are randomly assigned to either a health coach supervised by a virtual care team, or a self-directed learning group (e-platform with psychoeducational materials). Assessments are conducted at baseline, 6, 12 and 24 weeks. RESULTS This paper presents the protocol of the study. Recruitment commenced in August 2018. This study was registered on 16 July 2018 on clinicaltrials.gov (Registry ID: NCT03610087). CONCLUSIONS TECC-Y will determine if a technology-based collaborative care model engages youth with early psychosis, and whether this will be associated with changes in smoking, physical health and nutrition.
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Affiliation(s)
- Peter Selby
- Addictions Research Program, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lenka Vojtila
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Osnat C Melamed
- Department of Family and Community Medicine, Toronto, Canada.,Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rebecca Carriere
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Trillium Health Partners, Mississauga, Canada
| | - Laura LaChance
- St. Mary's Hospital Centre, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Sara Ahola Kohut
- Department of Psychiatry, University of Toronto, Toronto, Canada.,IBD Centre, Toronto, Canada.,SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Margaret Hahn
- Department of Psychiatry, Institute of Medical Science, Toronto, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada.,Mental Health and Metabolism Clinic, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Geriatric Psychiatry, University of Toronto, Toronto, Canada
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4
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Buck JM, O'Neill HC, Stitzel JA. The Intergenerational Transmission of Developmental Nicotine Exposure-Induced Neurodevelopmental Disorder-Like Phenotypes is Modulated by the Chrna5 D397N Polymorphism in Adolescent Mice. Behav Genet 2021; 51:665-684. [PMID: 34159514 DOI: 10.1007/s10519-021-10071-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022]
Abstract
Maternal tobacco smoking during pregnancy constitutes developmental nicotine exposure (DNE) and is associated with nicotine dependence and neurodevelopmental disorders in both children and grandchildren as well as animal models thereof. Genetic variants such as the CHRNA5 single nucleotide polymorphism (SNP) rs16969968, which leads to an aspartic acid to asparagine substitution at amino acid position 398 (D398N) in the alpha-5 nicotinic acetylcholine receptor subunit, can also confer risk for nicotine dependence and neurodevelopmental disorders in the absence of DNE. However, the degrees to which, the consequences of maternal smoking on offspring outcomes are influenced by genetic variants and interactions therewith are not well understood. Addressing this void in the literature, the present study utilizes a DNE mouse model engineered to possess the equivalent of the human D398N SNP in CHRNA5 (D397N SNP in mice) to assess how the N397 risk allele impacts the induction and intergenerational transmission of a range of neurodevelopmental disorder-related behavioral phenotypes in first- and second-generation DNE offspring. Results reveal that offspring possessing the N397 variant in the absence of DNE as well as DNE offspring and grand offspring possessing theD397 variant exhibit analogous neurodevelopmental disorder-like phenotypes including hyperactivity, risk-taking behaviors, aberrant rhythmicity of activity, and enhanced nicotine consumption. DNE amplified these behavioral anomalies in first-generation N397 progeny, but the severity of DNE-evoked behavioral perturbations did not significantly differ between first-generation D397 and N397 DNE mice for any measure. Remarkably, the behavioral profiles of second-generation N397 DNE progeny closely resembled DNE-naive D397 mice, suggesting that the N397 variant may protect against the intergenerational transmission of DNE-induced neurodevelopmental disorder-like behaviors.
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Affiliation(s)
- Jordan M Buck
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th Street, Boulder, CO, 80309-0447, USA
- Department of Integrative Physiology, University of Colorado, Boulder, USA
| | - Heidi C O'Neill
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th Street, Boulder, CO, 80309-0447, USA
| | - Jerry A Stitzel
- Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th Street, Boulder, CO, 80309-0447, USA.
- Department of Integrative Physiology, University of Colorado, Boulder, USA.
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5
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Caponnetto P, Polosa R. Approved and emerging smoking cessation treatments for people with schizophrenia spectrum disorders: A narrative review. Health Psychol Res 2020; 8:9237. [PMID: 33123649 PMCID: PMC7588850 DOI: 10.4081/hpr.2020.9237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/15/2020] [Indexed: 11/22/2022] Open
Abstract
This review focuses on smoking cessation treatments for people with schizophrenia spectrum disorders. It concludes with comments on the significance of the research and why it constitutes an original contribution. We searched PubMed (National Library of Medicine), and PsycINFO (Ovid) (2006-2020) for studies on schizophrenic disorder (schizophrenia or psychotic or psychosis or severe mental illness) and smoking cessation treatment (smoking cessation treatment or varenicline or tobacco cessation or reduction or bupropion or NRT or behavioral treatment or e-cigarette). Studies found evidence suggesting that pharmacotherapy combined with behavioural therapy for smoking cessation is effective amongst smokers with schizophrenia spectrum disorders, although more long-term research is required. This review summarised and critically reviewed also studies on vaping as a smoking cessation strategy for smokers with schizophrenia spectrum disorders and evidence suggests that they may effective as smoking cessation tool and may be less harmful alternatives to combustible cigarette smoking. Consequently, e-cigarettes could be considered as an applicable instrument for Tobacco Harm Reduction (THR) and smoking cessation. Overall, there are very few studies of e-cigarettes for smoking cessation in patients with schizophrenia and these studies are very small. They have promising results, but more research is needed.
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6
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Caponnetto P, Polosa R, Robson D, Bauld L. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res 2020; 8:9042. [PMID: 32510003 PMCID: PMC7267811 DOI: 10.4081/hpr.2020.9042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco & Alcohol Studies, Nottingham, UK
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7
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Kilicaslan EE, Karakilic M, Erol A. The Relationship between 10 Years Risk of Cardiovascular Disease and Schizophrenia Symptoms: Preliminary Results. Psychiatry Investig 2019; 16:933-939. [PMID: 31801314 PMCID: PMC6933131 DOI: 10.30773/pi.2019.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Previous research shows that patients with schizophrenia have increased cardiovascular disease risk than general population. Increased cardiovascular risk in schizophrenia patients have been associated with many reasons such as antipsychotic drugs, genetic predisposition, andlifestyle. In this study, we aimed to investigate the relationship between the risk of heart disease and schizophrenia symptomatology. METHODS The 10-year cardiovascular risk was assessed by the Framingham Risk Score (FRS) in 103 patients with schizophrenia and in 39 healthy controls. Sociodemographic characteristics, age at schizophrenia onset, duration of illness, number of hospitalizations, the course of the disease and antipsychotic medications were recorded. Patients' symptoms were evaluated via The Scale for the Assessment of Negative Symptoms (SANS), The Scale for the Assessment of Positive Symptoms (SAPS), and Calgary Depression Scale for Schizophrenia (CDSS). RESULTS Ten-year cardiovascular risk was 5.16% inpatients with schizophrenia, and 3.02% in control group (p=0.030). No significant correlation was found between FRS scores, SANS, SAPS, and CDSS scores. However, FRS scores were significantly correlated with age, number of hospitalizations and duration of disease (r=0.300, 0.261, 0.252, respectively). Moreover FRS scores were higher (p=0.008) and high-density lipoprotein (HDL) levels were lower (p=0.048) in patients using multiple antipsychotics. CONCLUSION Our findings suggest a relationship between the risk of cardiovascular disease and the duration and overall severity of schizophrenia and also highlights the role of antipsychotics in this relationship.
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Affiliation(s)
- Esin Evren Kilicaslan
- Department of Psychiatry, Atatürk Education and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Merve Karakilic
- Department of Psychiatry, Atatürk Education and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Almila Erol
- Department of Psychiatry, Atatürk Education and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey
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8
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Underner M, Perriot J, Brousse G, de Chazeron I, Schmitt A, Peiffer G, Harika-Germaneau G, Jaafari N. Arrêt et réduction du tabac chez le patient souffrant de schizophrénie. L'ENCEPHALE 2019; 45:345-356. [PMID: 31153585 DOI: 10.1016/j.encep.2019.04.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023]
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9
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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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10
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Keller-Hamilton B, Moe AM, Breitborde NJK, Lee A, Ferketich AK. Reasons for smoking and barriers to cessation among adults with serious mental illness: A qualitative study. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1462-1475. [PMID: 31102293 DOI: 10.1002/jcop.22197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
AIMS Most research into reasons for smoking among adults with serious mental illness (SMI) has focused on reasons related to SMI symptoms. The current study reports reasons for smoking and barriers to cessation that are both related and unrelated to SMI symptoms among adults with SMI. METHODS Four focus groups were conducted among current smokers receiving outpatient care for a psychotic disorder in 2017 (N = 24). Participants were asked why they currently smoke and their barriers to quitting smoking. RESULTS Smoking as a coping mechanism and to self-medicate SMI symptoms were reasons for current smoking and barriers to cessation. Avoidance of other unhealthy behaviors, routine, and enjoyment emerged as reasons for smoking and barriers to cessation that were unrelated to mental illness. CONCLUSION Consideration of factors that are both related and unrelated to SMI symptoms in smoking cessation interventions and brief cessation counseling may improve cessation success in this population.
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Affiliation(s)
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, Ohio
- Department of Psychology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio
| | - Angela Lee
- College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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11
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Yuen JWY, Kim DD, Procyshyn RM, White RF, Honer WG, Barr AM. Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review. Front Neurosci 2018; 12:203. [PMID: 29670504 PMCID: PMC5893810 DOI: 10.3389/fnins.2018.00203] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/14/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and has minimal risk for extrapyramidal symptoms. Therapeutic benefits, however, are accompanied by a myriad of cardiometabolic side-effects. The specific reasons for clozapine's high propensity to cause adverse cardiometabolic events remain unknown, but it is believed that autonomic dysfunction may play a role in many of these. Objective: This systematic review summarizes the literature on autonomic dysfunction and related cardiovascular side effects associated with clozapine treatment. Method: A search of the EMBASE, MEDLINE, and EBM Cochrane databases was conducted using the search terms antipsychotic agents, antipsychotic drug*, antipsychotic*, schizophrenia, schizophren*, psychos*, psychotic*, mental ill*, mental disorder*, neuroleptic*, cardiovascular*, cardiovascular diseases, clozapine*, clozaril*, autonomic*, sympathetic*, catecholamine*, norepinephrine, noradrenaline, epinephrine, adrenaline. Results: The search yielded 37 studies that were reviewed, of which only 16 studies have used interventions to manage cardiovascular side effects. Side effects reported in the studies include myocarditis, orthostatic hypotension and tachycardia. These were attributed to sympathetic hyperactivity, decreased vagal contribution, blockade of cholinergic and adrenergic receptors, reduced heart rate variability and elevated catecholamines with clozapine use. Autonomic neuropathy was identified by monitoring blood pressure and heart rate changes in response to stimuli and by spectral analysis of heart rate variability. Metoprolol, lorazepam, atenolol, propranolol, amlodipine, vasopressin and norepinephrine infusion were used to treat tachycardia and fluctuations in blood pressure, yet results were limited to case reports. Conclusion: The results indicate there is a lack of clinical studies investigating autonomic dysfunction and a limited use of interventions to manage cardiovascular side effects associated with clozapine. As there is often no alternative treatment for refractory schizophrenia, the current review highlights the need for better designed studies, use of autonomic tests for prevention of cardiovascular disease and development of novel interventions for clozapine-induced side effects.
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Affiliation(s)
- Jessica W Y Yuen
- Faculty of Medicine and Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, Faculty of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, Faculty of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, Faculty of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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12
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Fletcher PJ, Li Z, Coen KM, Lê AD. Acquisition of nicotine self-administration in amphetamine and phencyclidine models of schizophrenia: A role for stress? Schizophr Res 2018; 194:98-106. [PMID: 28318841 DOI: 10.1016/j.schres.2017.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/25/2017] [Accepted: 02/27/2017] [Indexed: 01/07/2023]
Abstract
Nicotine use and dependence is very high in patients with schizophrenia. One possible reason is that altered dopamine or glutamate activity in schizophrenia enhances the reinforcing effectiveness of nicotine. We used animal models to test the hypothesis that a hyperdopaminergic state (induced by repeated intermittent injections of amphetamine) or altered glutamate function (subchronic injection of phencyclidine, PCP) facilitates spontaneous acquisition of nicotine self-administration in rats. In Experiment 1 animals in an amphetamine-induced sensitized state (AISS) did not differ from saline-injected controls in their acquisition and maintenance of nicotine self-administration. This effect was replicated in experiment 2, but it was also found that AISS rats and saline-injected controls showed higher rates of nicotine self-administration compared to uninjected controls. This difference was maintained across several fixed ratio and progressive ratio schedules of reinforcement. In Experiment 3 PCP treated rats and their saline-injected controls did not differ in nicotine self-administration. However, both groups showed consistently increased responding for nicotine on FR and PR schedules compared to an uninjected control group. Injection-stress appeared to influence the outcomes of these experiments in two ways. Firstly, injection stress potentially masked the impact of the AISS and PCP treatment on nicotine self-administration. Secondly, injection stress itself may have been sufficient to induce plastic changes in dopamine and glutamate systems, and these changes enhanced the acquisition and maintenance of nicotine self-administration. Further investigation is needed into the role of stress in the development of nicotine use and dependence, in the aetiology of schizophrenia and in their co-morbidity.
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Affiliation(s)
- Paul J Fletcher
- Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Dept. Psychiatry, University of Toronto, Toronto, ON, Canada; Dept. Psychology, University of Toronto, Toronto, ON, Canada.
| | - Zhaoxia Li
- Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Kathleen M Coen
- Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Anh D Lê
- Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Dept. Psychiatry, University of Toronto, Toronto, ON, Canada; Dept. Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
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13
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Waterhouse U, Brennan KA, Ellenbroek BA. Nicotine self-administration reverses cognitive deficits in a rat model for schizophrenia. Addict Biol 2018; 23:620-630. [PMID: 28497655 DOI: 10.1111/adb.12517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/02/2017] [Accepted: 03/22/2017] [Indexed: 01/18/2023]
Abstract
High comorbidity between schizophrenia and tobacco addiction has been well established. Explanatory theories include nicotine as a cognitive enhancer ameliorating symptoms of schizophrenia and underlying shared substrates increasing susceptibility to addiction in these individuals. To test these non-mutually exclusive theories, the maternal immune activation (MIA) model was utilized. To this end, pregnant Sprague Dawley rats were subcutaneously injected with a bacterial endotoxin, lipopolysaccharide (0.5 mg/kg), on gestation days 10 and 11. Selective attention and working memory in adult male offspring were subsequently assessed using the latent inhibition and delayed non-matching to sample paradigms both before and after nicotine or saline self-administration. MIA led to deficits in both latent inhibition and delayed non-matching to sample in male offspring. Further, these animals showed a small but significantly increased responding for nicotine during self-administration acquisition, although there was no difference in dose-response effect or in progressive ratio testing. However, nicotine, but not saline self-administration, significantly ameliorated the cognitive deficits induced by MIA. While the male offspring of mothers prenatally exposed to lipopolysaccharide was only slightly more sensitive to the reinforcing effects of nicotine, after self-administration, the MIA-induced cognitive deficits significantly improved. These data lend support for the self-medication hypothesis of schizophrenia.
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Affiliation(s)
- Uta Waterhouse
- School of Psychology; Victoria University of Wellington; Wellington New Zealand
| | | | - Bart A. Ellenbroek
- School of Psychology; Victoria University of Wellington; Wellington New Zealand
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14
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Šagud M, Vuksan-Ćusa B, Jakšić N, Mihaljević-Peleš A, Živković M, Vlatković S, Prgić T, Marčinko D, Wang W. Nicotine dependence in Croatian male inpatients with schizophrenia. BMC Psychiatry 2018; 18:18. [PMID: 29357830 PMCID: PMC5778660 DOI: 10.1186/s12888-018-1606-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with schizophrenia have the highest known rates of cigarette smoking, but less is known about their smoking behavior and the differences across geographical regions, including Croatia. The aim of this study was to compare patterns of nicotine dependence between patients with schizophrenia and healthy individuals, and to determine the relationship between clinical presentation and the severity of smoking. METHODS This cross-sectional study included 182 recently hospitalized male inpatients and 280 healthy males, who were daily smokers. All participants have fulfilled the Fagerstrom Test for Nicotine Dependence (FTND). Patients were also evaluated by the Positive and Negative Syndrome Scale (PANSS). RESULTS Patients had higher FTND total score (p = 0.010), smoked their first cigarette earlier in the morning (p = 0.000), consumed higher number of cigarettes (p = 0.000), while healthy subjects had more difficulties to refrain from smoking in places where it is forbidden (p = 0.000) and smoked more even when they were sick (p = 0.000). While severe dependence was more prevalent in the patient group, light dependence was more frequent in control subjects (p = 0.04). Smoking behavior was not associated with either PANSS total score or any of its subscales and items. CONCLUSIONS Smokers with schizophrenia differ from healthy smokers in both smoking behavior and level of dependence. Longitudinal studies are needed to shed more light on the complex relationship between smoking and psychopathology in schizophrenia.
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Affiliation(s)
- Marina Šagud
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Bjanka Vuksan-Ćusa
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
- School of Medicine, University of Osijek, Osijek, Croatia
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Nenad Jakšić
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Alma Mihaljević-Peleš
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | | | | | - Tea Prgić
- Department of Psychiatry, General Hospital Vinkovci, Vinkovci, Croatia
| | - Darko Marčinko
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Psychiatry, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry, Zhejiang University College of Medicine, Hangzhou, China
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15
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Stramecki F, Kotowicz KD, Piotrowski P, Frydecka D, Rymaszewska J, Beszłej JA, Samochowiec J, Jabłoński M, Wroński M, Moustafa AA, Misiak B. Assessment of the Association Between Cigarette Smoking and Cognitive Performance in Patients With Schizophrenia-Spectrum Disorders: A Case-Control Study. Front Psychiatry 2018; 9:642. [PMID: 30559684 PMCID: PMC6287108 DOI: 10.3389/fpsyt.2018.00642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/15/2018] [Indexed: 12/21/2022] Open
Abstract
The prevalence of cigarette smoking is significantly higher in patients with schizophrenia compared to the general population. Schizophrenia is also characterized by cognitive impairments that can be detected in the premorbid phase of illness. However, studies addressing the association between cigarette smoking and cognition in patients with psychosis have provided mixed findings. Therefore, the aim of this study was to assess the relationship between tobacco smoking and cognitive performance in patients with schizophrenia. In this case-control study, we recruited 67 inpatients with schizophrenia (34 cigarette smokers) and 62 healthy controls (30 cigarette smokers) at two clinical sites (Wroclaw and Szczecin, Poland). Cognitive performance was examined using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Smoking dependence was determined using the Fagerström Test for Nicotine Dependence (FTND) and the pack-year index. Results show that, after adjustment for potential confounders, smokers with schizophrenia presented significantly lower scores on delayed memory tests compared to non-smokers with schizophrenia (F = 11.07, p = 0.002). In healthy controls, after adjustment for age, sex, and education level, smokers had significantly lower scores in immediate memory (47.1 ± 6.4 vs. 52.0 ± 4.0, F = 11.64, p = 0.001), visuospatial/constructional functions (34.8 ± 3.8 vs. 37.7 ± 1.8, F = 12.86, p = 0.001) and global cognition (177.0 ± 15.7 vs. 191.2 ± 14.0, F = 12.63, p = 0.001) compared to non-smokers. There were no significant correlations between FTND scores or pack-year index and cognitive performance neither in patient nor control group. Our results show that cigarette smoking is related to worse delayed memory performance in schizophrenia patients as well as deficits of immediate memory, visuospatial/constructional functions, and global cognition in controls. Longitudinal studies are required to establish causal interference between smoking and cognition in patients with schizophrenia.
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Affiliation(s)
- Filip Stramecki
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Kamila D Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Jabłoński
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Michał Wroński
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW, Australia.,Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Błazej Misiak
- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland
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16
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Rey R, D'Amato T, Boyer L, Brunel L, Aouizerate B, Berna F, Capdevielle D, Chereau I, Chesnoy-Servanin G, Denizot H, Dorey JM, Dubertret C, Dubreucq J, Faget C, Gabayet F, Lancon C, Mallet J, Misdrahi D, Passerieux C, Schandrin A, Schürhoff F, Urbach M, Vidailhet P, Llorca PM, Fond G. Nicotine dependence is associated with depression and childhood trauma in smokers with schizophrenia: results from the FACE-SZ dataset. Eur Arch Psychiatry Clin Neurosci 2017; 267:567-577. [PMID: 28389889 DOI: 10.1007/s00406-017-0779-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/06/2017] [Indexed: 12/27/2022]
Abstract
In a perspective of personalized care for smoking cessation, a better clinical characterization of smokers with schizophrenia (SZ) is needed. The objective of this study was to determine the clinical characteristics of SZ smokers with severe nicotine (NIC) dependence. 240 stabilized community-dwelling SZ smokers (mean age = 31.9 years, 80.4% male gender) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia and assessed with validated scales. Severe NIC dependence was defined by a Fagerstrom questionnaire score ≥ 7. Depression was defined by a Calgary score ≥ 6. Childhood trauma was self-reported by the Childhood Trauma Questionnaire score (CTQ). Ongoing psychotropic treatment was recorded. Severe NIC dependence was identified in 83 subjects (34.6%), depression in 60 (26.3%). 44 (22.3%) subjects were treated by antidepressants. In a multivariate model, severe NIC dependence remained associated with depression (OR = 3.2, p = 0.006), male gender (OR = 4.5, p = 0.009) and more slightly with childhood trauma (OR = 1.03, p = 0.044), independently of socio-demographic characteristics, psychotic symptoms severity, psychotropic treatments and alcohol disorder. NIC dependence was independently and strongly associated with, respectively, depression and male gender in schizophrenia, and only slightly with history of childhood trauma. Based on these results, the care of both nicotine dependence and depression should be evaluated for an effective smoking cessation intervention in schizophrenia.
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Affiliation(s)
- Romain Rey
- Fondation FondaMental, Créteil, France.
- INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France.
| | - Thierry D'Amato
- Fondation FondaMental, Créteil, France
- INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France
- Pôle Psychiatrie Universitaire, CHU Sainte-Marguerite, F-13274, Marseille cedex 09, France
| | - Lore 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, 40 rue de Mesly, F-94010, Créteil, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France, Université de Bordeaux, Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000, Bordeaux, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - Gabrielle Chesnoy-Servanin
- Fondation FondaMental, Créteil, France
- INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - Hélène Denizot
- Fondation FondaMental, Créteil, France
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - Jean-Michel Dorey
- Fondation FondaMental, Créteil, France
- INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France
- Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Catherine Faget
- Fondation FondaMental, Créteil, France
- Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - Franck Gabayet
- Fondation FondaMental, Créteil, France
- Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France
- Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France, Université de Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Christine Passerieux
- 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
| | - Aurélie Schandrin
- Fondation FondaMental, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Franck 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, 40 rue de Mesly, F-94010, Créteil, France
| | - Mathieu 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
| | - Pierre Vidailhet
- Fondation FondaMental, Créteil, France
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France
- Clinique Jeanne D'Arc-Hôpital Privé Parisien, Saint Mandé, F94000, France, CHU Carémeau, Nîmes, F30000, France
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Smucny J, Tregellas JR. Targeting neuronal dysfunction in schizophrenia with nicotine: Evidence from neurophysiology to neuroimaging. J Psychopharmacol 2017; 31:801-811. [PMID: 28441884 PMCID: PMC5963521 DOI: 10.1177/0269881117705071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with schizophrenia self-administer nicotine at rates higher than is self-administered for any other psychiatric illness. Although the reasons are unclear, one hypothesis suggests that nicotine is a form of 'self-medication' in order to restore normal levels of nicotinic signaling and target abnormalities in neuronal function associated with cognitive processes. This brief review discusses evidence from neurophysiological and neuroimaging studies in schizophrenia patients that nicotinic agonists may effectively target dysfunctional neuronal circuits in the illness. Evidence suggests that nicotine significantly modulates a number of these circuits, although relatively few studies have used modern neuroimaging techniques (e.g. functional magnetic resonance imaging (fMRI)) to examine the effects of nicotinic drugs on disease-related neurobiology. The neuronal effects of nicotine and other nicotinic agonists in schizophrenia remain a priority for psychiatry research.
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason R Tregellas
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Research Service, Denver VA Medical Center, Denver, CO, USA
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18
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Clark V, Baker A, Lewin T, Richmond R, Kay-Lambkin F, Filia S, Castle D, Williams J, Todd J. Self-Reported Reasons for Smoking: Predicting Abstinence and Implications for Smoking Cessation Treatments Among Those With a Psychotic Disorder. J Dual Diagn 2017; 13:6-14. [PMID: 27982748 DOI: 10.1080/15504263.2016.1271489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES People living with a psychotic illness have higher rates of cigarette smoking and face unique barriers to quitting compared to the general population. We examined whether self-reported reasons for smoking are useful predictors of successful quit attempts among people with psychosis. METHODS As part of a randomized controlled trial addressing smoking and cardiovascular disease risk behaviors among people with psychosis, self-reported reasons for smoking were assessed at baseline (n = 235), 15 weeks (n = 151), and 12 months (n = 139). Three factors from the Reasons for Smoking Questionnaire (Coping, Physiological, and Stimulation/Activation) were entered into a model to predict short- and long-term abstinence. The relationship between these factors and mental health symptoms were also assessed. RESULTS Participants scoring higher on the Stimulation/Activation factor (control of weight, enjoyment, concentration, and "peps me up") at baseline were just less than half as likely to be abstinent at 15 weeks. Female participants were five times more likely to abstinent at 15 weeks, and those with a higher global functioning at baseline were 5% more likely to be abstinent. There was a positive correlation between changes over time in the Stimulation/Activation factor from baseline to 12-month follow-up and the Brief Psychiatric Rating Scale total score at 12-month follow-up. This indicates that increasingly higher endorsement of the factor was associated with more psychological symptoms. There was also a negative correlation between the change over time in the Stimulation/Activation factor and global functioning at 12 months, indicating that increasingly higher endorsement of the factor led to lower global assessment of functioning. CONCLUSIONS The Stimulation/Activation factor may be particularly important to assess and address among smokers with psychosis. It is recommended that further research use the Reasons for Smoking Questionnaire among smokers with psychosis as a clinical tool to identify specific quit barriers. Further research into why females have higher smoking cessation rates in the short term and relapse prevention interventions seem worthy of further investigation.
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Affiliation(s)
- Vanessa Clark
- a School of Medicine and Public Health , University of Newcastle , New South Wales , Australia
| | - Amanda Baker
- a School of Medicine and Public Health , University of Newcastle , New South Wales , Australia.,b NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre , University of Newcastle , New South Wales , Australia
| | - Terry Lewin
- c Priority Research Centre for Brain and Mental Health , University of Newcastle , New South Wales , Australia
| | - Robyn Richmond
- d School of Public Health and Community Medicine , University of New South Wales , Australia
| | - Frances Kay-Lambkin
- b NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre , University of Newcastle , New South Wales , Australia.,c Priority Research Centre for Brain and Mental Health , University of Newcastle , New South Wales , Australia
| | - Sacha Filia
- e Central Clinical School , Monash University , The Alfred Hospital, Victoria , Australia
| | - David Castle
- f St. Vincent's Hospital Melbourne , Victoria, Australia.,g The University of Melbourne , Victoria , Australia.,h Faculty of Health Sciences , Australian Catholic University , Victoria , Australia
| | - Jill Williams
- i Division of Addiction Psychiatry , Rutgers-Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Juanita Todd
- j School of Psychology , University of Newcastle , New South Wales , Australia
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19
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Kourakos M, Kalokairinou A, Zyga S, Koukia E. Views and Attitudes of Patients in Mental Facilities Regarding Smoking. Glob J Health Sci 2016; 8:54508. [PMID: 27045414 PMCID: PMC5016352 DOI: 10.5539/gjhs.v8n8p228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/23/2015] [Accepted: 11/19/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Smoking rates amongst people with a mental health disorder are significantly higher than in the general population and there is growing evidence to show a strong association between smoking and mental health disorders. The aim of the present study was to investigate views and attitudes of mental patients regarding smoking. MATERIAL & METHODS The sample is composed of 356 patients treated in the Attica Psychiatric Hospital (a.k.a. "Dafni") as well as in other Units affiliated with the Hospital. The 'Smoking in psychiatric hospitals-a survey of patients' views' questionnaire was used in the form of semi-structured interviews. The PASW 18 (SPSS Inc.) package was used for the statistical analysis and statistical significance was set to p= 0.05. RESULTS Overall, 40% of the participants were in-patients, the rest being treated in other settings, the average length of hospital stay was 4.4 years, and the most common diagnosis (61.5.%) was schizophrenia (F20, according to ICD-10), while almost all of the participants (97.5%) were smokers. Most patients (58.8%) said they had had a hard time trying to quit smoking although they had sufficient information and encouragement (≈90%); they also reported that watching the staff smoking did not affect them inasmuch as watching other patients smoking (41 % vs 54.8%). 75.5% of the patients felt that they had no particular difficulty to quit smoking. Men smoked significantly more cigarettes per day compared to females (36.70 vs 30.82, p=0.002). There were no significant differences among males and females regarding previous attempts to quit smoking. Information gathered from such studies should be taken into account when designing systematic smoking management plans in mental institutions. CONCLUSION Although almost all mental patients smoke, they seem to be receptive to quitting smoking, since two thirds of them have already tried to quit, but one-third of the patients find smoking a little or not at all dangerous.
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Affiliation(s)
- Michael Kourakos
- Department of Nursing, National and Kapodistrian University of Athens, Greece.
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20
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Wang CK, Xu MS, Ross CJ, Lo R, Procyshyn RM, Vila-Rodriguez F, White RF, Honer WG, Barr AM. Development of a cost-efficient novel method for rapid, concurrent genotyping of five common single nucleotide polymorphisms of the brain derived neurotrophic factor (BDNF) gene by tetra-primer amplification refractory mutation system. Int J Methods Psychiatr Res 2015; 24:235-44. [PMID: 26118823 PMCID: PMC6878560 DOI: 10.1002/mpr.1475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/30/2014] [Accepted: 02/23/2015] [Indexed: 01/08/2023] Open
Abstract
Brain derived neurotrophic factor (BDNF) is a molecular trophic factor that plays a key role in neuronal survival and plasticity. Single nucleotide polymorphisms (SNPs) of the BDNF gene have been associated with specific phenotypic traits in a large number of neuropsychiatric disorders and the response to psychotherapeutic medications in patient populations. Nevertheless, due to study differences and occasionally contrasting findings, substantial further research is required to understand in better detail the association between specific BDNF SNPs and these psychiatric disorders. While considerable progress has been made recently in developing advanced genotyping platforms of SNPs, many high-throughput probe- or array-based detection methods currently available are limited by high costs, slow processing times or access to advanced instrumentation. The polymerase chain reaction (PCR)-based, tetra-primer amplification refractory mutation system (T-ARMS) method is a potential alternative technique for detecting SNP genotypes efficiently, quickly, easily, and cheaply. As a tool in psychopathology research, T-ARMS was shown to be capable of detecting five common SNPs in the BDNF gene (rs6265, rs988748, rs11030104, 11757G/C and rs7103411), which are all SNPs with previously demonstrated clinical relevance to schizophrenia and depression. The present technique therefore represents a suitable protocol for many research laboratories to study the genetic correlates of BDNF in psychiatric disorders. Copyright Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Cathy K Wang
- Department of Pharmacology, University of British Columbia, Vancouver, Canada
| | - Michael S Xu
- Department of Pharmacology, University of British Columbia, Vancouver, Canada
| | - Colin J Ross
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Ryan Lo
- Department of Pharmacology, University of British Columbia, Vancouver, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health & Addictions Research Institute, Vancouver, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health & Addictions Research Institute, Vancouver, Canada
| | - Randall F White
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health & Addictions Research Institute, Vancouver, Canada
| | - Alasdair M Barr
- Department of Pharmacology, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health & Addictions Research Institute, Vancouver, Canada
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21
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Adequacy of help received among individuals with severe mental disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 41:302-16. [PMID: 23334467 DOI: 10.1007/s10488-013-0466-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Using multiple linear regression analyses and a new assessment measure, this exploratory study identifies variables associated with help adequacy of 352 individuals with severe mental disorder. Help adequacy is higher with tobacco use, psychological distress domain, having a caregiver, help form services, being older, and lower with number of needs; accommodation, food, childcare and involvement in treatment decisions domains; number of suicide attempts, legal problems in previous year, and drugs problem. Results confirm the importance of a better collaboration with relatives, healthcare and social service providers to provide more adequate and satisfactory services for severe mental disorders individuals.
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Gates J, Killackey E, Phillips L, Álvarez-Jiménez M. Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis. Lancet Psychiatry 2015; 2:726-742. [PMID: 26249304 DOI: 10.1016/s2215-0366(15)00213-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/30/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility.
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Affiliation(s)
- Jesse Gates
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Mario Álvarez-Jiménez
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Sundgren E, Hallqvist J, Fredriksson L. Health for smokers with schizophrenia – a struggle to maintain a dignified life. Disabil Rehabil 2015; 38:416-22. [DOI: 10.3109/09638288.2015.1044033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Whitney Z, Boyda HN, Procyshyn RM, Elbe D, Black T, Eslami A, Barr AM. Therapeutic drug levels of second generation antipsychotics in youth: a systematic review. J Child Adolesc Psychopharmacol 2015; 25:234-45. [PMID: 25803501 DOI: 10.1089/cap.2014.0044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In children and adolescents, the prevalence rate of mental illness is claimed to be as high as 10-20%. Effective pharmacological treatments are available for use in children, adolescents, and adults; however, most of what is known about the effects of these treatments has been confirmed in clinical studies involving adults only. Second generation antipsychotic drugs (SGAs) are the most common class of antipsychotic medication used in pediatric populations, and these drugs are increasingly being used for disorders other than psychosis. Many SGAs are routinely used in pediatric care, and the vast majority of use in this population is off label. Children, adolescents, and adults differ in age, weight, height, and metabolism, which may lead to pharmacokinetic differences in how drugs ultimately affect target tissues. The aim of this review is to summarize and evaluate the literature that investigated blood plasma levels of SGAs in youth. METHODS Plasma levels were assessed in relation to their administered dose, indication, and therapeutic range (if known). Studies were limited to those evaluating oral administration only. A systematic electronic database search for peer-reviewed articles published between 2000 and 2013 was conducted. Twenty-one articles were included in the review. Additional articles for discussion were also included throughout the article. RESULTS The only SGA that may require routine therapeutic drug monitoring (TDM) in youth given the current body of research is clozapine. Highly variable results were seen in studies of aripiprazole, olanzapine, and risperidone, indicating that more research is needed on plasma levels with these drugs. Quetiapine maintained a similar profile to that found in adults, with no dosage adjustments or indications of TDM. CONCLUSION TDM may be indicated in any circumstance in which cytochrome P450 inhibitors or inducers are coprescribed. Further research is required for establishing a sounder safety profile for SGA use in the pediatric population.
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Affiliation(s)
- Zachary Whitney
- 1 Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia , Vancouver, British Columbia, Canada
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Manzella F, Maloney SE, Taylor GT. Smoking in schizophrenic patients: A critique of the self-medication hypothesis. World J Psychiatry 2015; 5:35-46. [PMID: 25815253 PMCID: PMC4369547 DOI: 10.5498/wjp.v5.i1.35] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/27/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
A common remark among laypeople, and notably also among mental health workers, is that individuals with mental illnesses use drugs as self-medication to allay clinical symptoms and the side effects of drug treatments. Roots of the self-medication concept in psychiatry date back at least to the 1980s. Observations that rates of smokers in schizophrenic patients are multiple times the rates for regular smoking in the general population, as well as those with other disorders, proved particularly tempting for a self-medication explanation. Additional evidence came from experiments with animal models exposed to nicotine and the identification of neurobiological mechanisms suggesting self-medication with smoking is a plausible idea. More recently, results from studies comparing smoking and non-smoking schizophrenic patients have led to the questioning of the self-medication hypothesis. Closer examination of the literature points to the possibility that smoking is less beneficial on schizophrenic symptomology than generally assumed while clearly increasing the risk of cancer and other smoking-related diseases responsible for early mortality. It is a good time to examine the evidence for the self-medication concept as it relates to smoking. Our approach is to focus on data addressing direct or implied predictions of the hypothesis in schizophrenic smokers.
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26
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Rowe AR, Mercer L, Casetti V, Sendt KV, Giaroli G, Shergill SS, Tracy DK. Dementia praecox redux: a systematic review of the nicotinic receptor as a target for cognitive symptoms of schizophrenia. J Psychopharmacol 2015; 29:197-211. [PMID: 25567553 DOI: 10.1177/0269881114564096] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most individuals with schizophrenia suffer some cognitive dysfunction: such deficits are predictive of longer-term functioning; and current dopamine-blocking antipsychotics have made little impact on this domain. There is a pressing need to develop novel pharmacological agents to tackle this insidious but most disabling of problems. The acetylcholinergic system is involved in cognitive and attentional processing, and its metabotropic and nicotinic receptors are widespread throughout the brain. Deficits in acetylcholinergic functioning occur in schizophrenia, and high rates of tobacco smoking have been posited to represent a form of self-medication. The nicotinic acetylcholine receptor (nAChR) has emerged as a putative target to improve cognitive deficits in schizophrenia, and this study systematically reviewed the emerging data. Nineteen studies were identified, covering three compound classes: agonists at the α7 and α 4β2 nAChRs, and positive allosteric modulators. Overall data are underwhelming: some studies showed significant improvements in cognition but as many studies had negative findings. It remains unclear if this represents drug limitations or nascent study methodology problems. The literature is particularly hindered by variability in inclusion of smokers, generally small sample sizes, and a lack of consensus on cognitive test batteries. Future work should evaluate longer-term outcomes, and, particularly, the effects of concomitant cognitive training.
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Affiliation(s)
- Arann R Rowe
- The Institute of Psychiatry, King's College London, London, UK
| | - Louise Mercer
- The Institute of Psychiatry, King's College London, London, UK
| | - Valentina Casetti
- The Institute of Psychiatry, King's College London, London, UK Oxleas NHS Foundation Trust, London, UK
| | | | | | - Sukhwinder S Shergill
- The Institute of Psychiatry, King's College London, London, UK South London and Maudsley NHS Foundation Trust, London, UK
| | - Derek K Tracy
- The Institute of Psychiatry, King's College London, London, UK Oxleas NHS Foundation Trust, London, UK
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27
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Beck AK, Baker AL, Todd J. Smoking in schizophrenia: cognitive impact of nicotine and relationship to smoking motivators. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:26-32. [PMID: 29379758 PMCID: PMC5779288 DOI: 10.1016/j.scog.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 10/31/2022]
Abstract
Smoking prevalence in schizophrenia is significantly elevated relative to other clinical and to non-clinical groups. The cognitive self-medication hypothesis attributes this to the beneficial effects of nicotine on illness-related cognitive deficits. Significant effects of nicotine have been observed on visual spatial working memory (VSWM), sustained attention (Continuous Performance Test - Identical Pairs; CPT-IP) and prepulse inhibition (PPI). It remains unclear whether these neurophysiological and neurocognitive effects of nicotine influence self-reported smoking motivation. To explore the relationship between nicotine effects on cognition and self-reported smoking motivation in schizophrenia and non-psychiatric control smokers, the impact of smoking abstinence and reinstatement was examined across three cognitive indices (VSWM, CPT-IP, PPI) and compared to self-reported smoking motivation (Modified Reasons for Smoking Scale revised to include 'cognitive motivators'). Cognitive function was assessed after 'typical' smoking and overnight abstinence. Schizophrenia smokers (but not controls) demonstrated significantly less error on the VSWM task in the smoking relative to abstinent condition. Control (but not schizophrenia) smokers, showed evidence of CPT-IP improvement in the smoking relative to abstinent condition. The overall profile of smoking motivation was comparable between groups. However, significant relationships between subjective and objective indices of smoking related cognitive change were observed for controls. Differential effects of nicotine on cognition have been hypothesised to influence the pattern and persistence of smoking in schizophrenia. These preliminary findings indicate that evidence for such effects is apparent even in small samples - particularly for VSWM. This is the first study to show that neurocognitive effects of smoking may influence self-reported smoking motivation.
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Affiliation(s)
- Alison K Beck
- School of Psychology, University of Newcastle, Callaghan, 2280, NSW, Australia.,Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW, Australia
| | - Amanda L Baker
- Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW, Australia.,School of Medicine & Public Health, University of Newcastle, Callaghan, 2280, NSW, Australia
| | - Juanita Todd
- School of Psychology, University of Newcastle, Callaghan, 2280, NSW, Australia.,Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW, Australia
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Wu C, Yuen J, Boyda HN, Procyshyn RM, Wang CK, Asiri YI, Pang CCY, Honer WG, Barr AM. An evaluation of the effects of the novel antipsychotic drug lurasidone on glucose tolerance and insulin resistance: a comparison with olanzapine. PLoS One 2014; 9:e107116. [PMID: 25254366 PMCID: PMC4177840 DOI: 10.1371/journal.pone.0107116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022] Open
Abstract
Over the past two decades, there has been a notable rise in the use of antipsychotic drugs, as they are used to treat an increasing number of neuropsychiatric disorders. This rise has been led predominantly by greater use of the second generation antipsychotic (SGA) drugs, which have a low incidence of neurological side-effects. However, many SGAs cause metabolic dysregulation, including glucose intolerance and insulin resistance, thus increasing the risk of cardiometabolic disorders. The metabolic effects of the novel SGA lurasidone, which was approved by the Food and Drug Administration in 2010, remain largely unknown. As rodent models accurately predict the metabolic effects of SGAs in humans, the aim of the present study was to use sophisticated animal models of glucose tolerance and insulin resistance to measure the metabolic effects of lurasidone. In parallel, we compared the SGA olanzapine, which has established metabolic effects. Adult female rats were treated with vehicle, lurasidone (0.2, 0.8 or 2.0 mg/kg, s.c.) or olanzapine (10.0 mg/kg, s.c.) and subjected to the glucose tolerance test (GTT). Separate groups of rats were treated with vehicle, lurasidone (0.2, 0.8 or 2.0 mg/kg, s.c.) or olanzapine (1.5 and 15 mg/kg, s.c.) and tested for insulin resistance with the hyperinsulinemic-euglycemic clamp (HIEC). Compared to vehicle treated animals, lurasidone caused mild glucose intolerance in the GTT with a single dose, but there was no effect on insulin resistance in the GTT, measured by HOMA-IR. The HIEC also confirmed no effect of lurasidone on insulin resistance. In contrast, olanzapine demonstrated dose-dependent and potent glucose intolerance, and insulin resistance in both tests. Thus, in preclinical models, lurasidone demonstrates mild metabolic liability compared to existing SGAs such as olanzapine. However, confirmation of these effects in humans with equivalent tests should be confirmed.
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Affiliation(s)
- Claire Wu
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Yuen
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heidi N. Boyda
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
| | - Cathy K. Wang
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yahya I. Asiri
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine C. Y. Pang
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M. Barr
- Department of Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
- * E-mail:
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29
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Leung JY, Pang CC, Procyshyn RM, Barr AM. Cardiovascular effects of acute treatment with the antipsychotic drug olanzapine in rats. Vascul Pharmacol 2014; 62:143-9. [DOI: 10.1016/j.vph.2014.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/30/2014] [Accepted: 06/08/2014] [Indexed: 12/01/2022]
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30
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Filia SL, Baker AL, Gurvich CT, Richmond R, Lewin TJ, Kulkarni J. Gender differences in characteristics and outcomes of smokers diagnosed with psychosis participating in a smoking cessation intervention. Psychiatry Res 2014; 215:586-93. [PMID: 24485064 DOI: 10.1016/j.psychres.2014.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 11/16/2013] [Accepted: 01/01/2014] [Indexed: 11/26/2022]
Abstract
While research has identified gender differences in characteristics and outcomes of smokers in the general population, no studies have examined this among smokers with psychosis. This study aimed to explore gender differences among 298 smokers with psychosis (schizophrenia, schizoaffective and bipolar affective disorder) participating in a smoking intervention study. Results revealed a general lack of gender differences on a range of variables for smokers with psychosis including reasons for smoking/quitting, readiness and motivation to quit, use of nicotine replacement therapy, and smoking outcomes including point prevalence or continuous abstinence, and there were no significant predictors of smoking reduction status according to gender at any of the follow-up time-points. The current study did find that female smokers with psychosis were significantly more likely than males to report that they smoked to prevent weight gain. Furthermore, the females reported significantly more reasons for quitting smoking and were more likely to be driven by extrinsic motivators to quit such as immediate reinforcement and social influence, compared to the male smokers with psychosis. Clinical implications include specifically focussing on weight issues and enhancing intrinsic motivation to quit smoking for female smokers with psychosis; and strengthening reasons for quitting among males with psychosis.
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Affiliation(s)
- Sacha L Filia
- Monash Alfred Psychiatry research centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Prahran, VIC 3181, Australia.
| | - Amanda L Baker
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Caroline T Gurvich
- Monash Alfred Psychiatry research centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Prahran, VIC 3181, Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Terry J Lewin
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry research centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Prahran, VIC 3181, Australia
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Wijesundera H, Hanwella R, de Silva VA. Antipsychotic medication and tobacco use among outpatients with schizophrenia: a cross-sectional study. Ann Gen Psychiatry 2014; 13:7. [PMID: 24642279 PMCID: PMC3995423 DOI: 10.1186/1744-859x-13-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies have shown that the prevalence of smoking in schizophrenia is higher than in the general population. Biological, psychological and social factors influence smoking in patients with schizophrenia. METHODS The study was carried out in psychiatry outpatient clinics in a tertiary care hospital in Sri Lanka. Every third patient was selected using systematic sampling from patients diagnosed with schizophrenia according to ICD-10 clinical criteria. Smoking behaviours were assessed using self-reports. Severity of illness was assessed using Brief Psychiatric Rating Scale (BPRS). Fagerstrom Test for Nicotine Dependence assessed level of dependence. Readiness to Change Questionnaire assessed motivation to change smoking behaviour. RESULTS The sample consisted of 306 patients with schizophrenia. Mean age was 38.93 years (SD 10.98). There were 148 males (48.4%). Mean duration of illness was 12.63 years (SD 8.38). Current medication was oral atypical antipsychotics 103, clozapine 136, oral typicals 29 and depot typicals 38. Prevalence of tobacco use among males was 30.41% (95% CI 22.91 to 37.90) and among females 1.90% (95% CI -0.25 to 4.05). Prevalence of current smoking among males was 20.27% (95% CI 13.72 to 26.82). None of the females smoked. Prevalence of smokeless tobacco use among males was 10.14 (95% CI 5.22 to 15.05) and among females 1.90 (95% CI -0.03 to 4.05). When patients treated with clozapine were excluded from the analysis, prevalence of tobacco use was 41.6% among males and 3.2% among females and prevalence of smoking was 29.9% among males. Prevalence of tobacco use was lowest in patients treated with clozapine 18.31 (95% CI 9.09 to 27.53) and highest in those treated with depot antipsychotics 47.83 (95% CI 25.74 to 69.91). CONCLUSIONS Prevalence of smoking was less than in many countries. This is influenced by prevalence in the general population and low affordability. Risk of tobacco use was significantly less among patients treated with clozapine.
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Affiliation(s)
- Hiranya Wijesundera
- University Psychiatry Unit, National Hospital of Sri Lanka, Colombo 08, Sri Lanka
| | - Raveen Hanwella
- Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka
| | - Varuni A de Silva
- Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka
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Fredrikson DH, Boyda HN, Tse L, Whitney Z, Pattison MA, Ott FJ, Hansen L, Barr AM. Improving metabolic and cardiovascular health at an early psychosis intervention program in vancouver, Canada. Front Psychiatry 2014; 5:105. [PMID: 25249985 PMCID: PMC4155777 DOI: 10.3389/fpsyt.2014.00105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022] Open
Abstract
Psychotic disorders most commonly appear during the late teenage years and early adulthood. A focused and rapid clinical response by an integrated health team can help to improve the quality of life of the patient, leading to a better long-term prognosis. The Vancouver Coastal Health early psychosis intervention program covers a catchment area of approximately 800,000 people in the cities of Vancouver and Richmond, Canada. The program provides a multidisciplinary approach to supporting patients under the age of 30 who have recently experienced first-break psychosis. The program addresses the needs of the treatment environment, medication, and psychological therapies. A critical part of this support includes a program to specifically improve patients' physical health. Physical health needs are addressed through a two-pronged, parallel approach. Patients receive routine metabolic health assessments during their first year in the program, where standard metabolic parameters are recorded. Based on the results of clinical interviews and laboratory tests, specific actionable interventions are recommended. The second key strategy is a program that promotes healthy lifestyle goal development. Patients work closely with occupational therapists to develop goals to improve cardiometabolic health. These programs are supported by an active research environment, where patients are able to engage in studies with a focus on improving their physical health. These studies include a longitudinal evaluation of the effects of integrated health coaching on maintaining cardiometabolic health in patients recently admitted to the program, as well as a clinical study that evaluates the effects of low versus higher metabolic risk antipsychotic drugs on central adiposity. An additional pharmacogenomic study is helping to identify genetic variants that may predict cardiometabolic changes following treatment with antipsychotic drugs.
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Affiliation(s)
- Diane H Fredrikson
- Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada ; Early Psychosis Intervention Program, Vancouver Coastal Health , Vancouver, BC , Canada
| | - Heidi N Boyda
- Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Lurdes Tse
- Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Zachary Whitney
- Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Mark A Pattison
- Early Psychosis Intervention Program, Vancouver Coastal Health , Vancouver, BC , Canada
| | - Fred J Ott
- Early Psychosis Intervention Program, Vancouver Coastal Health , Vancouver, BC , Canada
| | - Laura Hansen
- Early Psychosis Intervention Program, Vancouver Coastal Health , Vancouver, BC , Canada
| | - Alasdair M Barr
- Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
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Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”? ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/251048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Linton D, Procyshyn RM, Elbe D, Lee LHN, Barr AM. A retrospective study of antipsychotic drug switching in a pediatric population. BMC Psychiatry 2013; 13:248. [PMID: 24103197 PMCID: PMC3851439 DOI: 10.1186/1471-244x-13-248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 10/03/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Antipsychotic drugs can be used to help treat a wide variety of psychiatric disorders. However, specific antipsychotic drugs for any particular patient may need to be changed for a number of different reasons, including a lack of therapeutic efficacy and / or intolerance to medication side-effects. Drug switching may occur through a limited number of established patterns. The nature of these changes is not well characterized in youth, despite their frequent occurrence. METHODS A retrospective analysis of antipsychotic drug switches was conducted on patients who had been admitted as inpatients to a tertiary care child and adolescent psychiatric institute. PharmaNet (a large, central administrative database) records of all medications prescribed in the 52 weeks prior to admission, and then between admission and discharge, were analyzed for switching patterns. Additional data regarding diagnoses were obtained from medical chart review. RESULTS Patients represented a diagnostically heterogeneous population, and almost all antipsychotic drugs were administered off-label. In the one year prior to and during admission to the hospital, a total of 31 out of 139 patients switched antipsychotic drugs. The frequency of switching increased closer to the time of admission, and the proportional rate of switching was even higher during hospital stay. The most common switch was from risperidone to quetiapine. Our analysis identified three main patterns of drug switching, all occurring with similar frequency: titrated drug switches, abrupt drug switches and concurrent drug administration. CONCLUSIONS The present study indicates that antipsychotic drug switching in youth may be relatively common, particularly in the year prior to hospitalization. No specific manner of drug switching predominates. This study also demonstrates the feasibility of using large administrative databases to characterise switching patterns in youth.
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Affiliation(s)
- David Linton
- British Columbia Mental Health and Addictions Services Research Institute, 938 W 28th Avenue, Vancouver, BC V5Z 4H4, Canada.
| | - Ric M Procyshyn
- British Columbia Mental Health and Addictions Services Research Institute, 938 W 28th Avenue, Vancouver, BC V5Z 4H4, Canada,Department of Psychiatry, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Dean Elbe
- British Columbia Mental Health and Addictions Services Research Institute, 938 W 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Lik Hang N Lee
- British Columbia Mental Health and Addictions Services Research Institute, 938 W 28th Avenue, Vancouver, BC V5Z 4H4, Canada,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Alasdair M Barr
- British Columbia Mental Health and Addictions Services Research Institute, 938 W 28th Avenue, Vancouver, BC V5Z 4H4, Canada,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver V6T 1Z3, Canada
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Rabin RA, Giddens JL, George TP. Relationship between tobacco and cannabis use status in outpatients with schizophrenia. Am J Addict 2013; 23:170-5. [PMID: 25187052 DOI: 10.1111/j.1521-0391.2013.12084.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/26/2013] [Accepted: 04/28/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE While high prevalence of tobacco and cannabis use are well established in schizophrenia, reports on their co-morbid use is limited. We explored the links between tobacco and cannabis use in an outpatient population meeting DSM-IV criteria for schizophrenia. METHODS Cigarette smoking behaviors were assessed in an outpaitent population with schizophrenia (N=54) with current (n=18), former (n=24), and no lifetime cannabis dependence (n=12). RESULTS We found significant differences in cigarettes per day (CPD) across groups: current dependent patients smoked less CPD than patients with former dependence and those with no history of dependence; former dependent patients smoked significantly less than patients with no history of cannabis dependence. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Preliminary results support an effect of cannabis use status on tobacco consumption. In the absence of cannabis, patients may increase cigarette smoking, suggesting state-dependent effects of cannabis on tobacco. Prospective designs should further examine this relationship between cannabis and tobacco in schizophrenia versus non-psychiatric controls.
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Affiliation(s)
- Rachel A Rabin
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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Hsu JH, Chien IC, Lin CH, Chou YJ, Chou P. Increased Risk of Chronic Obstructive Pulmonary Disease in Patients with Schizophrenia: A Population-Based Study. PSYCHOSOMATICS 2013. [DOI: 10.1016/j.psym.2012.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Do atypical antipsychotics really enhance smoking reduction more than typical ones?: the effects of antipsychotics on smoking reduction in patients with schizophrenia. J Clin Psychopharmacol 2013; 33:319-28. [PMID: 23609378 DOI: 10.1097/jcp.0b013e31828b2575] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Whether atypical antipsychotics (AAs) can enhance smoking reduction in schizophrenic patients remains controversial because of methodological limitations in existing studies. This study explored whether certain types of antipsychotics predict smoking reduction in schizophrenic patients. Three hundred eight smoking, predominantly male schizophrenic patients (271/308 [88.9%]) participated in an 8-week open-label study with antismoking medications (high-dose, low-dose nicotine transdermal patch and bupropion). Antipsychotics were classified into (1) typical antipsychotics (TAs) and (2) AAs, including multiacting receptor-targeted antipsychotics (clozapine, olanzapine, and quetiapine), serotonin-dopamine antagonists (risperidone), D2/D3 receptor antagonists (amisulpride), and partial dopamine receptor agonists (aripiprazole). A general linear model was used to explore whether types of antipsychotic predict changes in the number of cigarettes smoked per day (CPD) and the score of the Fagerstrom Test for Nicotine Dependence (FTND) while controlling for confounding factors. The type of antipsychotic (TAs or AAs) was not significantly associated with smoking cessation (n = 21; χ = 1.8; df = 4; P = 0.77). Regarding smoking reduction, the type of antipsychotic was significantly predictive of a change in the CPD (P = 0.027; partial eta square = 0.055) and FTND scores (P = 0.002; partial eta square = 0.073). The 95% confidence intervals of the estimated means of change in the CPD and FTND scores did not contain zero only among subjects on TAs or clozapine.These findings suggest that TAs and clozapine enhance smoking reduction compared with nonclozapine atypical antipsychotics in schizophrenic patients. The mechanisms underlying the effects of various antipsychotics on smoking reduction remain unclear and warrant future study.
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Nejad AB, Ebdrup BH, Glenthøj BY, Siebner HR. Brain connectivity studies in schizophrenia: unravelling the effects of antipsychotics. Curr Neuropharmacol 2013; 10:219-30. [PMID: 23449679 PMCID: PMC3468876 DOI: 10.2174/157015912803217305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/27/2012] [Accepted: 07/05/2012] [Indexed: 11/22/2022] Open
Abstract
Impaired brain connectivity is a hallmark of schizophrenia brain dysfunction. However, the effect of drug treatment and challenges on the dysconnectivity of functional networks in schizophrenia is an understudied area. In this review, we provide an overview of functional magnetic resonance imaging studies examining dysconnectivity in schizophrenia and discuss the few studies which have also attempted to probe connectivity changes with antipsychotic drug treatment. We conclude with a discussion of possible avenues for further investigation.
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Affiliation(s)
- Ayna B Nejad
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark ; Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Psychiatric Center Glostrup, Denmark
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Stewart DW, Vinci C, Adams CE, Cohen AS, Copeland AL. Smoking topography and outcome expectancies among individuals with schizotypy. Psychiatry Res 2013; 205:205-12. [PMID: 23261186 PMCID: PMC3760683 DOI: 10.1016/j.psychres.2012.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 11/12/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022]
Abstract
Compared to smokers in the general population, smokers with schizophrenia smoke more cigarettes per day and have higher nicotine dependence and biochemical indicators of nicotine intake. They also have more intense smoking topography and greater positive smoking expectancies. Little is known about the relationship between smoking and schizotypy, defined as the personality organization reflecting a vulnerability to schizophrenia-spectrum pathology. This study assessed schizotypy symptoms, smoking characteristics and behaviors, and smoking expectancies in young adults with psychometrically defined schizotypy and demographically matched controls without schizotypy. Smokers with schizotypy had higher nicotine dependence and smoked more cigarettes per week compared to control smokers. They were also more likely to endorse greater positive consequences (i.e., improved state enhancement, stimulation, social facilitation, taste/sensorimotor manipulation, reduced negative affect and boredom) and fewer negative consequences of smoking. Smokers with schizotypy and control smokers did not differ on smoking topography or carbon monoxide levels. This is the first known study to investigate relationships between these smoking-related variables in smokers with schizotypy. Individuals with schizotypy possessed certain smoking-related characteristics and smoking expectancies similar to those with schizophrenia. This offers preliminary insight into unique smoking-related factors among individuals with schizotypy and highlights the importance of continued research in this area.
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Affiliation(s)
- Diana W Stewart
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research-Unit 1440, P.O. Box 301402, Houston, TX 77230-1402, USA.
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Boyda HN, Procyshyn RM, Pang CCY, Hawkes E, Wong D, Jin CH, Honer WG, Barr AM. Metabolic side-effects of the novel second-generation antipsychotic drugs asenapine and iloperidone: a comparison with olanzapine. PLoS One 2013; 8:e53459. [PMID: 23326434 PMCID: PMC3541274 DOI: 10.1371/journal.pone.0053459] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/30/2012] [Indexed: 12/20/2022] Open
Abstract
Background The second generation antipsychotic (SGA) drugs are widely used in psychiatry due to their clinical efficacy and low incidence of neurological side-effects. However, many drugs in this class cause deleterious metabolic side-effects. Animal models accurately predict metabolic side-effects for SGAs with known clinical metabolic liability. We therefore used preclinical models to evaluate the metabolic side-effects of glucose intolerance and insulin resistance with the novel SGAs asenapine and iloperidone for the first time. Olanzapine was used as a comparator. Methods Adults female rats were treated with asenapine (0.01, 0.05, 0.1, 0.5, 1.0 mg/kg), iloperidone (0.03, 0.5, 1.0, 5.0, 10.0 mg/kg) or olanzapine (0.1, 0.5, 1.5, 5.0, 10.0 mg/kg) and subjected to the glucose tolerance test (GTT). Separate groups of rats were treated with asenapine (0.1 and 1.0 mg/kg), iloperidone (1.0 and 10 mg/kg) or olanzapine (1.5 and 15 mg/kg) and tested for insulin resistance with the hyperinsulinemic-euglycemic clamp (HIEC). Results Asenapine showed no metabolic effects at any dose in either test. Iloperidone caused large and significant glucose intolerance with the three highest doses in the GTT, and insulin resistance with both doses in the HIEC. Olanzapine caused significant glucose intolerance with the three highest doses in the GTT, and insulin resistance with the higher dose in the HIEC. Conclusions In preclinical models, asenapine shows negligible metabolic liability. By contrast, iloperidone exhibits substantial metabolic liability, comparable to olanzapine. These results emphasize the need for appropriate metabolic testing in patients treated with novel SGAs where current clinical data do not exist.
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Affiliation(s)
- Heidi N. Boyda
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Addictions Services, British Columbia Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
| | - Catherine C. Y. Pang
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Hawkes
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Wong
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chen Helen Jin
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Addictions Services, British Columbia Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Addictions Services, British Columbia Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
- * E-mail:
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de Beaurepaire R, Rat P, Beauverie P, Houery M, Niel P, Castéra S, Dagorne O, Espaze R, Giroult P, Mahuzier G, Matheron I, Padovani P, Poisson N, Richier JP, Rocher J, Ruetsh O, Touzeau D, Visinoni A, Molimard R. Is smoking linked to positive symptoms in acutely ill psychiatric patients? Nord J Psychiatry 2012; 66:225-31. [PMID: 21905972 DOI: 10.3109/08039488.2011.610468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The self-medication hypothesis is commonly put forward to explain the high prevalence of smoking in psychiatric patients. However, studies supporting the self-medication hypothesis have most often been carried out on chronic patients stabilized by antipsychotics. AIM Given that antipsychotics tend to erase psychiatric symptoms, the present study was undertaken on acutely ill patients usually receiving no medications, or on whom medications are ineffective. METHODS Participants were 492 consecutively hospitalized patients. They were evaluated the day of their hospitalization with the Brief Psychiatric Rating Scale (BPRS, 18 items). Urinary cotinine and creatinine were measured the morning following their hospitalization. The urinary cotinine/creatinine ratio and the cotinine/creatinine/number of cigarettes smoked per day ratio (nicotine extraction index) were calculated for each patient. RESULTS The positive symptoms subscale of the BPRS significantly correlated with smoking, whereas other BPRS subscales did not. In patients with mood disorder, the nicotine extraction index correlated with the positive symptoms, activation and hostility subscales, but not with the negative symptoms subscale. Analyses of individual BPRS items using the cotinine/creatinine ratio measure showed that smoking is positively associated with "unusual thought content" and "grandiosity" items and negatively associated with "guilt feeling", "depressed mood" and "motor retardation". Analyses of individual BPRS items using the nicotine extraction index showed a positive association only with "unusual thought content" and "grandiosity" items. Patients with schizophrenia extract more nicotine from cigarettes than other patients. CONCLUSION In acutely ill psychiatric patients, smoking is linked with positive symptoms and not with negative symptoms.
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Affiliation(s)
- Renaud de Beaurepaire
- Groupe Hospitalier Paul-Guiraud, 54, avenue de la République, 94806 Villejuif, France.
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Cardiovascular side-effects of antipsychotic drugs: The role of the autonomic nervous system. Pharmacol Ther 2012; 135:113-22. [DOI: 10.1016/j.pharmthera.2012.04.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/08/2012] [Indexed: 01/27/2023]
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Thornton LK, Baker AL, Johnson MP, Lewin TJ. Attitudes and perceptions towards substances among people with mental disorders: a systematic review. Acta Psychiatr Scand 2012; 126:87-105. [PMID: 22486607 DOI: 10.1111/j.1600-0447.2012.01861.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop effective interventions for people with coexisting mental disorders (MD) and substance use, it may be beneficial to understand their attitudes and perceptions of substances. METHOD A systematic literature search regarding attitudes and perceptions towards tobacco, alcohol or cannabis among people with MD was conducted. Studies' methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS Twenty-one papers were included in the review and found to have generally low methodological quality. Papers investigated reasons for substance use, substance use expectancies, substances' perceived effects and reasons for quitting. People with psychotic disorders reported using substances primarily for relaxation and pleasure. Among people with mood disorders, alcohol was used primarily for social motives and tobacco for negative affect reduction. CONCLUSION For substance use interventions among people with MD to be more effective, it may be necessary to tailor interventions specifically for this population and customize by substance type. Gaps in the literature regarding attitudes and perceptions towards substance use among people with MD were identified, which future research should aim to address. These include designing and conducting methodologically rigorous research, investigating perceived harmfulness and knowledge of substances, and broadening recruitment of participants to include people with MD other than psychosis.
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Affiliation(s)
- L K Thornton
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia.
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Vancampfort D, Correll CU, Scheewe TW, Probst M, De Herdt A, Knapen J, De Hert M. Progressive muscle relaxation in persons with schizophrenia: a systematic review of randomized controlled trials. Clin Rehabil 2012; 27:291-8. [DOI: 10.1177/0269215512455531] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this systematic review was to assess the effectiveness of progressive muscle relaxation on psychological distress and anxiety symptoms and on response/remission for people with schizophrenia. Methods: Randomized controlled trials were considered if they investigated progressive muscle relaxation in patients with schizophrenia. EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL, PEDro and Cochrane Library were searched. The selection of studies, data extraction and quality assessment were performed independently by two reviewers. Results: Three randomized controlled trials involving 146 patients met the inclusion criteria. Progressive muscle relaxation can acutely reduce state anxiety and psychological distress and improve subjective well-being. No studies investigated the evidence for progressive muscle relaxation as an add-on treatment for general psychopathology and for positive or negative symptoms. Also, no studies assessed the value of progressive muscle relaxation in longer-term treatment and for relapse prevention. There were no data to draw any conclusions about progressive muscle relaxation in comparison with other treatment modalities. None of the studies encountered adverse events. Dose-response relationships could not be determined. Conclusion: Progressive muscle relaxation might be a useful add-on treatment to reduce state anxiety and psychological distress and improve subjective well-being in persons with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium
- Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Heverlee, Belgium
| | - Christoph U Correll
- The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas W Scheewe
- Department of Psychiatry, University Medical Centre, Utrecht, The Netherlands
| | - Michel Probst
- University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium
- Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Heverlee, Belgium
| | - Amber De Herdt
- Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Heverlee, Belgium
| | - Jan Knapen
- University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium
- Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Heverlee, Belgium
| | - Marc De Hert
- University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium
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Kelly DL, Raley HG, Lo S, Wright K, Liu F, McMahon RP, Moolchan ET, Feldman S, Richardson CM, Wehring HJ, Heishman SJ. Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophr Bull 2012; 38:543-51. [PMID: 21041835 PMCID: PMC3330003 DOI: 10.1093/schbul/sbq124] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). METHODS Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. RESULTS There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 ± 5.4 vs 15.6 ± 5.5 y, P = .44), number of cigarettes daily (17.9 ± 11.6 vs 17.0 ± 7.9, P = 0.51), or in breath CO (28.0 ± 14.5 vs 22.9 ± 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). CONCLUSIONS This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.
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Affiliation(s)
- Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228,To whom correspondence should be addressed; tel: 410-402-6860, fax: 410-402-6038, e-mail:
| | - Heather G. Raley
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Suzanne Lo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Katherine Wright
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | | | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Charles M. Richardson
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Stephen J. Heishman
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Aubin HJ, Rollema H, Svensson TH, Winterer G. Smoking, quitting, and psychiatric disease: A review. Neurosci Biobehav Rev 2012; 36:271-84. [DOI: 10.1016/j.neubiorev.2011.06.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 11/25/2022]
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A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development. Dev Psychopathol 2011; 23:725-76. [DOI: 10.1017/s0954579411000289] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractThe allostatic load (AL) model represents an interdisciplinary approach to comprehensively conceptualize and quantify chronic stress in relation to pathologies throughout the life cycle. This article first reviews the AL model, followed by interactions among early adversity, genetics, environmental toxins, as well as distinctions among sex, gender, and sex hormones as integral antecedents of AL. We next explore perspectives on severe mental illness, dementia, and caregiving as unique human models of AL that merit future investigations in the field of developmental psychopathology. A complimenting transdisciplinary perspective is applied throughout, whereby we argue that the AL model goes beyond traditional stress–disease theories toward the advancement of person-centered research and practice that promote not only physical health but also mental health.
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An analysis of nicotine conditioned place conditioning in early postweanling and adolescent rats neonatally treated with quinpirole. Behav Brain Res 2011; 220:254-61. [DOI: 10.1016/j.bbr.2011.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 02/01/2011] [Accepted: 02/02/2011] [Indexed: 11/18/2022]
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Filia SL, Baker AL, Richmond R, Castle DJ, Kay-Lambkin FJ, Sakrouge R, Gurvich CT, de Castella AR, Taylor R, Kulkarni J. Health behaviour risk factors for coronary heart disease (CHD) in smokers with a psychotic disorder: baseline results. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/17523281.2011.555088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Persons with severe and persistent mental illnesses, e.g. schizophrenia spectrum disorders and bipolar disorder, smoke at a much higher rate than the general population. Treatment options for schizophrenia spectrum disorders and bipolar disorder often include the first-generation (typical) and second-generation (atypical) antipsychotics, which have been shown to be effective in treating both psychotic and mood symptoms. This article reviews studies examining the relationship between antipsychotic medication and cigarette smoking. These studies suggest that in persons with schizophrenia and schizoaffective disorder, typical antipsychotics may increase basal smoking and decrease people's ability to stop smoking, whereas atypical antipsychotics decrease basal smoking and promote smoking cessation. However, we found that the data available were generally of moderate quality and from small studies, and that there were conflicting findings. The review also critically assesses a number of potential mechanisms for this effect: the use of smoking as a form of self-medication for the side effects of antipsychotics, the effect of antipsychotics on smoking-related cues and the effect of antipsychotics on the appreciation of the economic cost of smoking behaviour. Gaps in the research are noted and recommendations for further study are included. More study of this important issue is needed to clarify the effect of antipsychotics on smoking behaviours.
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Affiliation(s)
- Annette M Matthews
- Research and Development Service, Portland VA Medical Center, Portland, Oregon, USA.
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