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Zhang Q, Wen C. The risk profile of electronic nicotine delivery systems, compared to traditional cigarettes, on oral disease: a review. Front Public Health 2023; 11:1146949. [PMID: 37255760 PMCID: PMC10226679 DOI: 10.3389/fpubh.2023.1146949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/14/2023] [Indexed: 06/01/2023] Open
Abstract
The use of electronic nicotine delivery systems (ENDS) has exploded, especially among teenagers and new smokers, amid widespread awareness of the dangers of traditional tobacco and restrictions on smoking. However, the risk effects of ENDS on physical health, especially oral health, are still ambiguous. The purpose of this study was to review the available evidence on risks of ENDS on oral health, and compares the differences between ENDS and traditional cigarettes. For heavy smokers, transferring the addiction of tobacco to ENDS can be less harmful to periodontal condition and physical health but is not completely without risk. The components of ENDS vapor have cytotoxic, genotoxic, and carcinogenic properties, and its usage may be associated with a wide range of oral health sequelae. The chemicals in ENDS increase the susceptibility to tooth decay, increase the risk of periodontal disease, peri-implant, and oral mucosal lesions. Nicotine aerosols from ENDS can be a potential risk factor for oral cancer due to the presence of carcinogenic components. Compared to smoking traditional cigarettes, the harm associated with ENDS use may be underestimated due to the reduced ability to control vaping behavior, ease of ENDS access, fewer vaping area restrictions, and better taste. Currently, the available evidence suggests that ENDS may be a safer alternative to traditional tobacco products. Though most oral symptoms experienced by ENDS users are relatively mild and temporary compared to traditional cigarettes, the dangers of ENDS still exist. However, further research with longer follow-up periods is required to establish the long-term safety of ENDS.
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Affiliation(s)
- Qing Zhang
- Department of Nosocomial Infection Control, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Cai Wen
- Department of Oral Implantology, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of VIP Dental Service, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China
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2
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Hobkirk AL, Houser KR, Hoglen B, Bitzer ZT, Fendrich A, Bordner CR, Foulds J, Wang J, Mukherjee D, Yingst JM, Karunanayaka P, Goel R, Richie JP, Elias RJ, Yang QX. Evidence from an fMRI study that dessert-flavored e-cigarettes engage taste-related, but not smoking-related, brain circuitry for female daily smokers. Exp Clin Psychopharmacol 2022; 30:947-958. [PMID: 34110883 PMCID: PMC8660928 DOI: 10.1037/pha0000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Regulations limiting the sale of flavored e-cigarette products are controversial for their potential to interfere with e-cigarette use as a cessation aid in addition to curbing youth use. Limited research suggests that flavor might enhance the addictive potential of e-cigarettes; however, the acute effects of flavored aerosols on brain function among humans have not been assessed. The present study aimed to isolate and compare the neural substrates of flavored and unflavored e-cigarette aerosols on brain function among nine female daily smokers. Participants inhaled aerosolized e-liquid with 36 mg/mL of nicotine with and without a strawberry-vanilla flavor while undergoing functional magnetic resonance imaging. We used general linear modeling to compare whole-brain mean neural activation and seed-to-voxel task-based functional connectivity between the flavored and unflavored inhalation runs. Contrary to our hypothesis, the flavored aerosol was associated with weaker activation than the unflavored aerosol in the brain stem and bilateral parietal-temporal-occipital region of the cortex. Instead, the flavor engaged taste-related brain regions while suppressing activation of the neural circuits typically engaged during smoking and nicotine administration. Alternatively, functional connectivity between subcortical dopaminergic brain seeds and cortical brain regions involved in motivation and reward salience were stronger during the flavored compared to unflavored aerosol run. The findings suggest that fruity and dessert-flavored e-cigarettes may dampen the reward experience of aerosol inhalation for smokers who initiate e-cigarette use by inhibiting activation of dopaminergic brain circuits. These preliminary findings may have implications for understanding how regulations on flavored e-cigarettes might impact their use as cessation aids. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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3
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Ringin E, Cropley V, Zalesky A, Bruggemann J, Sundram S, Weickert CS, Weickert TW, Bousman CA, Pantelis C, Van Rheenen TE. The impact of smoking status on cognition and brain morphology in schizophrenia spectrum disorders. Psychol Med 2022; 52:3097-3115. [PMID: 33443010 DOI: 10.1017/s0033291720005152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cigarette smoking is associated with worse cognition and decreased cortical volume and thickness in healthy cohorts. Chronic cigarette smoking is prevalent in schizophrenia spectrum disorders (SSD), but the effects of smoking status on the brain and cognition in SSD are not clear. This study aimed to understand whether cognitive performance and brain morphology differed between smoking and non-smoking individuals with SSD compared to healthy controls. METHODS Data were obtained from the Australian Schizophrenia Research Bank. Cognitive functioning was measured in 299 controls and 455 SSD patients. Cortical volume, thickness and surface area data were analysed from T1-weighted structural scans obtained in a subset of the sample (n = 82 controls, n = 201 SSD). Associations between smoking status (cigarette smoker/non-smoker), cognition and brain morphology were tested using analyses of covariance, including diagnosis as a moderator. RESULTS No smoking by diagnosis interactions were evident, and no significant differences were revealed between smokers and non-smokers across any of the variables measured, with the exception of a significantly thinner left posterior cingulate in smokers compared to non-smokers. Several main effects of smoking in the cognitive, volume and thickness analyses were initially significant but did not survive false discovery rate (FDR) correction. CONCLUSIONS Despite the general absence of significant FDR-corrected findings, trend-level effects suggest the possibility that subtle smoking-related effects exist but were not uncovered due to low statistical power. An investigation of this topic is encouraged to confirm and expand on our findings.
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Affiliation(s)
- Elysha Ringin
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Jason Bruggemann
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
| | - Suresh Sundram
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Australia
- Mental Health Program, Monash Health, Clayton, Victoria, Australia
| | - Cynthia Shannon Weickert
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York 13210, USA
| | - Thomas W Weickert
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- School of Psychiatry, University of New South Wales, New South Wales, Australia
- Neuroscience Research Australia, New South Wales, Australia
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York 13210, USA
| | - Chad A Bousman
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
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Caponnetto P, DiPiazza J, Kim J, Maglia M, Polosa R. A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes. Nicotine Tob Res 2021; 23:1113-1122. [PMID: 33723598 PMCID: PMC8186418 DOI: 10.1093/ntr/ntab005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/18/2021] [Indexed: 01/14/2023]
Abstract
Introduction An estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population. Aims and Methods This study aimed to assess the feasibility of using a new-generation high strength nicotine e-cigarette to modify smoking behavior in individuals with schizophrenia spectrum disorders who smoke cigarettes. A single-arm pilot study was conducted with 40 adults with schizophrenia spectrum disorders who smoked and did not intend to reduce or quit smoking. Participants were given a 12-week supply of a JUUL e-cigarette loaded with a 5% nicotine pod. The primary outcome was smoking cessation at week 12. Additional outcomes included: smoking reduction, continuous abstinence at week 24, adoption rate, adherence to the e-cigarette, feasibility, acceptability, and subjective effects. Results Sixteen (40%) participants quit by the end of 12 weeks. For the whole sample, we observed an overall, sustained 50% reduction in smoking or smoking abstinence in 37/40 (92.5%) of participants and an overall 75% reduction in median cigarettes per day from 25 to six was observed by the end of the 12 weeks (p < .001). Conclusions A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking. Further research with a larger sample and a comparator group is needed. The results provide useful information and direction to augment the existing body of knowledge on smoking cessation for people with schizophrenia spectrum disorders. Implications Considering that most people with schizophrenia spectrum disorders continue smoking, alternative and efficient interventions to reduce or prevent morbidity and mortality are urgently needed. This study showed that adults who smoke and were not motivated to quit, when provided a new-generation e-cigarette with high nicotine content, demonstrated substantially decreased cigarette consumption without causing significant side effects. Although not specifically measured in this study, nicotine absorption in new-generation devices has been shown to be consistently superior compared with the first generation of e-cigarette devices, and this may help explain the lower quit rates in studies using earlier generation devices.
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Affiliation(s)
- Pasquale Caponnetto
- Department of Educational Science, University of Catania, Catania, Italy.,Faculty of Health Science and Sport, University of Stirling, Stirling, UK
| | - Jennifer DiPiazza
- Hunter Bellevue School of Nursing, Hunter College-City University of New York, New York, NY, USA
| | - Jason Kim
- Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY, USA
| | - Marilena Maglia
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "G.Rodolico-S. Marco", Università di Catania, Catania, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Abstract
JUUL is a popular electronic cigarette (e-cig) that is capable of delivering nicotine similarly to a cigarette. While known to deliver high doses of nicotine, there is little systematic evidence to show how the nicotine delivery of JUUL translates to user dependence. Purpose: The purpose of the study was to evaluate self-reported dependence of JUUL users and examine the relationship of dependence to user behaviors. Methods: Current JUUL users were recruited via Amazon Mechanical Turk to complete an online survey about their use of JUUL. Participants were asked to complete the Penn State Electronic Cigarette Dependence Index (PSECDI) and to answer questions about their use patterns and other tobacco use. Means and frequencies were used to describe the sample. A linear regression model was used to predict user dependence. Results: Participants (n = 76) were 65.4% male with a mean age of 31.9 (SD = 8.3) years. The mean PSECDI score was 7.8 (SD = 4.2) and ranged from no (15.8%) to high (14.5%) dependence. Overall predictors of a greater PSECDI score included reporting ever stealth vaping (β = 2.8, p < .01) and reporting greater use days in the past 30 (β = 3.5, p < .01). Conclusions: On average, JUUL users reported low to medium nicotine dependence on the PSECDI. JUUL user dependence may be more similar to e-cig user dependence than cigarette smoker dependence. These preliminary findings should be followed up in studies of larger samples of Juul users, collecting multiple measures of dependence, as well as biomarkers of nicotine intake (e.g. cotinine).
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Affiliation(s)
- Jessica Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Center for Research on Tobacco and Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Center for Research on Tobacco and Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Center for Research on Tobacco and Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
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6
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Evins AE, West R, Benowitz NL, Russ C, Lawrence D, McRae T, Maravic MC, Heffner JL, Anthenelli RM. Efficacy and Safety of Pharmacotherapeutic Smoking Cessation Aids in Schizophrenia Spectrum Disorders: Subgroup Analysis of EAGLES. Psychiatr Serv 2021; 72:7-15. [PMID: 33138708 DOI: 10.1176/appi.ps.202000032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of varenicline, bupropion, and nicotine replacement therapy (NRT) among smokers with schizophrenia spectrum disorders in post hoc analyses of Evaluating Adverse Events in a Global Smoking Cessation Study data. METHODS Smokers with schizophrenia spectrum disorder (N=390) and without a psychiatric illness (control group, N=4,028) were randomly assigned to receive varenicline, bupropion, NRT patch, or placebo for 12 weeks. Outcomes included abstinence rates during treatment and follow-up, number needed to treat (NNT) for abstinence, incidence of neuropsychiatric adverse events (NPSAEs), and temporal relationship between NPSAEs and abstinence status. RESULTS Smokers with schizophrenia smoked more and had greater dependence and fewer prior trials of cessation pharmacotherapy at baseline. At each time point, smokers with schizophrenia assigned to varenicline had significantly greater odds of abstinence compared with their matched placebo group, with NNT comparable to the control group. Bupropion and NRT increased odds of abstinence; confidence intervals (CIs) included 1 for some comparisons, and NNT for smokers with schizophrenia was greater than for the control group. No treatment was associated with significantly more NPSAEs, compared with placebo, in either cohort. The estimated NPSAE rate was 5% (95% CI=3.0-7.7) for smokers with schizophrenia and 1% (95% CI=0.6-2.1) for the control group. Over one-third of NPSAEs occurred during partial or full abstinence, suggesting a multifactorial nature. CONCLUSIONS For smokers with schizophrenia, varenicline led to significantly higher abstinence rates, and NNT was comparable to the control group. A significant proportion of NPSAEs occurred during early abstinence. No treatment significantly increased NPSAE prevalence.
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Affiliation(s)
- A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Robert West
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Neal L Benowitz
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Cristina Russ
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - David Lawrence
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Thomas McRae
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Melissa Culhane Maravic
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Jaimee L Heffner
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Robert M Anthenelli
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
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7
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Caponnetto P, Polosa R. A qualitative study of the views about smoking, licensed cessation aids and e-cigarettes in people with schizophrenia spectrum disorders. J Addict Dis 2020; 39:152-165. [PMID: 33043838 DOI: 10.1080/10550887.2020.1826097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Smoking prevalence remains high among people with a mental health condition compared to those without. Understanding people's motivation to quit and their views of smoking cessation support may help to develop future interventions. We conducted a qualitative study to explore the perceptions of 30 people with schizophrenia spectrum disorders who were current smokers, about smoking traditional cigarettes, the appeal of licensed medicines and e-cigarettes for smoking cessation or smoking reduction. The experiences of participants who were motivated to quit were compared with those who were not motivated to quit. Findings suggest traditional cigarettes were pleasurable and licensed cessation aids and e-cigarettes unappealing to participants who were unmotivated to quit. Whereas nicotine replacement products and e-cigarettes may be an appealing smoking cessation or reduction strategy for those motivated to quit. There is a need to find ways of making traditional cigarettes less appealing and alternative less harmful nicotine products (licensed and unlicensed) more appealing and accessible to this group of high risk smokers.
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Affiliation(s)
- Pasquale Caponnetto
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.,Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-S. Marco," University of Catania, Catania, Italy.,Department of Educational Sciences, University of Catania, Catania, Italy.,Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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8
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Kamens HM, Silva CP, Nye RT, Miller CN, Singh N, Sipko J, Trushin N, Sun D, Branstetter SA, Muscat JE, Richie JP, Foulds J. Pharmacokinetic Profile of Spectrum Reduced Nicotine Cigarettes. Nicotine Tob Res 2020; 22:273-279. [PMID: 30892637 DOI: 10.1093/ntr/ntz045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Spectrum research cigarettes have been developed with varying nicotine content for use in studies evaluating the effects of a regulatory policy reducing the permissible nicotine content in cigarettes. This study aimed to characterize the nicotine pharmacokinetic profile of Spectrum cigarettes. METHODS Twelve daily smokers attended four sessions and had blood nicotine, exhaled carbon monoxide, and subjective effects measured before and after smoking either a single cigarette of their preferred brand or high (10.9 mg/cigarette), medium (3.2 mg/cigarette), or low (0.2 mg/cigarette) nicotine content Spectrum research cigarettes, in a double-blind design with order counterbalanced. RESULTS The boost in blood nicotine concentration was dose-dependent, with a boost of 0.3, 3.9, and 17.3 ng/mL for low-, medium-, and high-nicotine content Spectrum cigarettes. The high dose Spectrum had a similar nicotine boost to the "preferred brand" cigarettes (19 ng/mL). Subjects took longer puffs on the low nicotine cigarettes, but smoked these cigarettes faster than other cigarette types. High nicotine Spectrum cigarettes reduced the urge to smoke more than other cigarette types. CONCLUSIONS This study shows that Spectrum research cigarettes produce blood nicotine absorption in a dose-dependent manner, and therefore, are appropriate for use in studies of nicotine reduction in cigarettes. IMPLICATIONS This is the first study to determine the pharmacokinetic profile of Spectrum reduced nicotine content research cigarettes following an overnight abstinence. These data could provide evidence to regulatory agencies about the effects of reduced nicotine cigarettes when considering regulations on tobacco reduction.
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Affiliation(s)
- Helen M Kamens
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA.,Penn State Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Constanza P Silva
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Russell T Nye
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Carley N Miller
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Nayantara Singh
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Joseph Sipko
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA
| | - Neil Trushin
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA
| | - Dongxiao Sun
- Department of Pharmacology, Pennsylvania State University, Hershey, PA.,Penn State Mass Spectrometry Core Facility, Pennsylvania State University, Hershey, PA
| | - Steven A Branstetter
- Biobehavioral Health Department, Pennsylvania State University, University Park, PA.,Penn State Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Joshua E Muscat
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.,Department of Public Health Sciences, Pennsylvania State University, Hershey, PA
| | - John P Richie
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.,Department of Public Health Sciences, Pennsylvania State University, Hershey, PA.,Department of Pharmacology, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.,Department of Public Health Sciences, Pennsylvania State University, Hershey, PA.,Department of Psychiatry, Pennsylvania State University, Hershey, PA
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9
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Dondé C, Brunelin J, Mondino M, Cellard C, Rolland B, Haesebaert F. The effects of acute nicotine administration on cognitive and early sensory processes in schizophrenia: a systematic review. Neurosci Biobehav Rev 2020; 118:121-133. [PMID: 32739422 DOI: 10.1016/j.neubiorev.2020.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/18/2020] [Accepted: 07/25/2020] [Indexed: 12/01/2022]
Abstract
Nicotine use, which is mostly done through smoking tobacco, is among the most burdensome comorbidities of schizophrenia. However, the ways in which nicotine affects the cognitive and early sensory alterations found in this illness are still debated. After conducting a systematic literature search, 29 studies were selected. These studies involve individuals with schizophrenia who underwent cognitive and/or early sensory function assessments after acute nicotine administration and include 560 schizophrenia subjects and 346 non-schizophrenia controls. The findings highlight that a single dose of nicotine can improve a range of cognitive functions in schizophrenia subjects, such as attention, working memory, and executive functions, with attention being the most responsive domain. In addition, nicotine can modulate early detection of changes in the sensory environment at both the auditory and visual levels. Nevertheless, effects vary strongly depending on the type of neuropsychological assessment and nicotine intake conditions used in each study. The current findings suggest the need to consider a potential decrease of cognitive and early sensory performance when patients with schizophrenia quit smoking.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, F-38000 Grenoble, France; Psychiatry Department, CHU Grenoble Alpes, F-38000 Grenoble, France.
| | - Jérôme Brunelin
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | - Marine Mondino
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | | | - Benjamin Rolland
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | - Frédéric Haesebaert
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France; University Lyon 1, Villeurbanne, F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
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10
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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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11
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Silverstein SM, Fradkin SI, Demmin DL. Schizophrenia and the retina: Towards a 2020 perspective. Schizophr Res 2020; 219:84-94. [PMID: 31708400 PMCID: PMC7202990 DOI: 10.1016/j.schres.2019.09.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Differences between people with schizophrenia and psychiatrically healthy controls have been consistently demonstrated on measures of retinal function such as electroretinography (ERG), and measures of retinal structure such as optical coherence tomography (OCT). Since our 2015 review of this literature, multiple new studies have been published using these techniques. At the same time, the accumulation of data has highlighted the "fault lines" in these fields, suggesting methodological considerations that need greater attention in future studies. METHODS We reviewed studies of ERG and OCT in schizophrenia, as well as data from studies whose findings are relevant to interpreting these papers, such as those on effects of the following on ERG and OCT data: comorbid medical conditions that are over-represented in schizophrenia, smoking, antipsychotic medication, substance abuse, sex and gender, obesity, attention, motivation, and influences of brain activity on retinal function. RESULTS Recent ERG and OCT studies continue to support the hypothesis of retinal structural and functional abnormalities in schizophrenia, and suggest that these are relevant to understanding broader aspects of pathophysiology, neurodevelopment, and neurodegeneration in this disorder. However, there are differences in findings which suggest that the effects of multiple variables on ERG and OCT data need further clarification. CONCLUSIONS The retina, as the only component of the CNS that can be imaged directly in live humans, has potential to clarify important aspects of schizophrenia. With greater attention to specific methodological issues, the true potential of ERG and OCT as biomarkers for important clinical phenomena in schizophrenia should become apparent.
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Affiliation(s)
- Steven M Silverstein
- Rutgers University Behavioral Health Care, United States; Rutgers University, Robert Wood Johnson Medical School, Departments of Psychiatry and Ophthalmology, United States.
| | | | - Docia L Demmin
- Rutgers University, Department of Psychology, United States.
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12
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Abstract
BACKGROUND Differences between people with schizophrenia and psychiatrically healthy controls have been consistently demonstrated on measures of retinal function such as electroretinography (ERG), and measures of retinal structure such as optical coherence tomography (OCT). Since our 2015 review of this literature, multiple new studies have been published using these techniques. At the same time, the accumulation of data has highlighted the "fault lines" in these fields, suggesting methodological considerations that need greater attention in future studies. METHODS We reviewed studies of ERG and OCT in schizophrenia, as well as data from studies whose findings are relevant to interpreting these papers, such as those on effects of the following on ERG and OCT data: comorbid medical conditions that are over-represented in schizophrenia, smoking, antipsychotic medication, substance abuse, sex and gender, obesity, attention, motivation, and influences of brain activity on retinal function. RESULTS Recent ERG and OCT studies continue to support the hypothesis of retinal structural and functional abnormalities in schizophrenia, and suggest that these are relevant to understanding broader aspects of pathophysiology, neurodevelopment, and neurodegeneration in this disorder. However, there are differences in findings which suggest that the effects of multiple variables on ERG and OCT data need further clarification. CONCLUSIONS The retina, as the only component of the CNS that can be imaged directly in live humans, has potential to clarify important aspects of schizophrenia. With greater attention to specific methodological issues, the true potential of ERG and OCT as biomarkers for important clinical phenomena in schizophrenia should become apparent.
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13
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Yingst JM, Foulds J, Veldheer S, Hrabovsky S, Trushin N, Eissenberg TT, Williams J, Richie JP, Nichols TT, Wilson SJ, Hobkirk AL. Nicotine absorption during electronic cigarette use among regular users. PLoS One 2019; 14:e0220300. [PMID: 31344110 PMCID: PMC6657878 DOI: 10.1371/journal.pone.0220300] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The capability of electronic cigarette devices (e-cigs) to deliver nicotine is key to their potential to replace combustible cigarettes. We compared nicotine delivery and subjective effects associated with the use of two classes of e-cigarettes and cigarettes. METHODS 14 e-cigarette users were instructed to vape their own e-cigarette device every 20 seconds for 10 minutes while blood was drawn at 1, 2, 4, 6, 8, 10,12, and 15 minutes after initiating vaping. Users rated withdrawal symptoms and side effects before and after vaping. E-cigarette devices were classified as first-generation (same size as cigarette, no activation button) or advanced (larger than cigarette with an activation button). Separately, 10 cigarette smokers completed a similar protocol. Fisher's Exact Test and two-sided t-tests were used as appropriate to determine differences in outcomes between first-generation e-cigarette users, advanced e-cigarette users, and smokers. RESULTS Compared to first-generation devices, advanced devices were associated with greater serum nicotine Cmax (ng/ml) (11.5 v. 2.8, p = 0.0231) and greater nicotine boost (ng/ml) (10.8 v. 1.8, p = 0.0177). Overall, e-cigarettes users experienced a significant reduction in withdrawal and craving, although there were no significant differences between users of first-generation and advanced devices. Comparing e-cigarettes overall to cigarettes, cigarettes were associated with greater Cmax (25.9 v. 9.0, p = 0.0043) and greater nicotine boost (21.0 v. 8.2, p = 0.0128). CONCLUSIONS Advanced e-cigarettes delivered significantly more nicotine than first-generation devices but less than combustible cigarettes. Overall, e-cigarette use was associated with a reduction in withdrawal and craving with no reported side effects. The wide variation in nicotine absorption from different e-cigarette devices should be considered in studies of e-cigarettes for smoking cessation.
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Affiliation(s)
- Jessica M. Yingst
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Jonathan Foulds
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Susan Veldheer
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Shari Hrabovsky
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Neil Trushin
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Thomas T. Eissenberg
- Department of Psychology, Center for the Study on Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Jill Williams
- Division of Addiction Psychiatry, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America
| | - John P. Richie
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Travis T. Nichols
- Department of Psychology, Pennsylvania State University, University Park, PA, United States of America
| | - Stephen J. Wilson
- Department of Psychology, Pennsylvania State University, University Park, PA, United States of America
| | - Andrea L. Hobkirk
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
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Caponnetto P, DiPiazza J, Signorelli M, Maglia M, Polosa R. Existing and emerging smoking cessation options for people with schizophrenia spectrum disorders. J Addict Dis 2018; 37:279-290. [PMID: 31906833 DOI: 10.1080/10550887.2019.1679063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tobacco cigarette addiction is a deeply entrenched behavior among people with Schizophrenia Spectrum Disorders, and consequently these individuals die an average of 25 years earlier than the general population. The aim of this review was to evaluate the state-of-the-science focused on cessation and reduction interventions for people with SSD. We searched peer-reviewed articles from medline, psycinfo, web of science, scopus, and cochrane library, about cessation interventions for people with SSD. The search was carried out by combining an exhaustive list of terms denoting schizophrenic disorder and smoking cessation treatment. The review search period was limited from January 2000-November 2018, 260 studies were identified and a total of 24 of studies were included in the final review. This review demonstrates the vulnerability of smokers with SSD and underscores the need for research in these areas with large enough sample sizes to detect treatment effects: 1) outcomes using and comparing standard treatments 2) long-term cessation/reduction outcomes 3) flexible treatment options 4) more research to develop the evidence-base for e-cigarettes intervention.
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Affiliation(s)
- Pasquale Caponnetto
- Dipartimento di Medicina clinica e sperimentale, Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy.,Faculty of Health Science and Sports, University of Stirling, Stirling, Scotland
| | - Jennifer DiPiazza
- Hunter Bellevue School of Nursing, Hunter College-City University of New York, New York, NY, USA
| | - Maria Signorelli
- Dipartimento di Medicina clinica e sperimentale, Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy
| | - Marilena Maglia
- Dipartimento di Medicina clinica e sperimentale, Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy
| | - Riccardo Polosa
- Dipartimento di Medicina clinica e sperimentale, Center of Excellence for the Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy
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15
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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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16
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Ahmed S, Virani S, Kotapati VP, Bachu R, Adnan M, Khan AM, Zubair A, Begum G, Kumar J, Qureshi M, Ahmed R. Efficacy and Safety of Varenicline for Smoking Cessation in Schizophrenia: A Meta-Analysis. Front Psychiatry 2018; 9:428. [PMID: 30283363 PMCID: PMC6156523 DOI: 10.3389/fpsyt.2018.00428] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023] Open
Abstract
Objective: Smoking represents a major public health problem among patients with schizophrenia. To this end, some studies have investigated the efficacy of varenicline for facilitating smoking cessation in schizophrenia patients. The present review seeks to synthesize the results of these studies as well as document the reported side effects of using this medication. Methods: An electronic search was performed using five major databases: PubMed, Scopus, EMBASE, Web of Science, and Cochrane Library. Included in the current analysis were randomized clinical trials (RCTs) that have investigated the effect of varenicline in promoting smoking cessation in patients with schizophrenia. Risk of bias among included RCTs was assessed using the Cochrane Collaboration's quality assessment tool. Results: Among the 828 screened articles, only four RCTs, which involved 239 participants, were eligible for meta-analysis. In patients with schizophrenia, varenicline treatment when compared to placebo significantly reduced the number of cigarettes consumed per day [SMD (95% CI) = 0.89(0.57-1.22)] and expired carbon monoxide levels [SMD (95% CI) = 0.50 (0.06-0.94)] respectively. Conclusion: Despite a limited number of studies included in the meta-analysis, our results suggest that varenicline is an effective and safe drug to assist smoking cessation in patients with schizophrenia. Future large-scale well-designed RCTs are required to validate these findings.
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Affiliation(s)
- Saeed Ahmed
- Nassau University Medical Center, East Meadow, NY, United States
| | - Sanya Virani
- Maimonides Medical Center, New York, NY, United States
| | | | - Ramya Bachu
- Zucker Hillside Hospital, New York, NY, United States
| | - Mahwish Adnan
- Department of Cognitive Behavioral Science, McMaster University, Hamilton, ON, Canada
| | - Ali M Khan
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Aarij Zubair
- St. John's University, New York, NY, United States
| | - Gulshan Begum
- Manhattan Psychiatric Center, New York, NY, United States
| | | | - Mustafa Qureshi
- Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Rizwan Ahmed
- Liaquat National Medical College, Karachi, Pakistan
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17
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Silva ACD, Vargas LS, Lucchese R, Calixto BDS, Guimarães RA, Vera I, Castro PAD, Pagotto V, Fernandes IL. Patterns of tobacco consumption among residents of a rural settlement: a cross-sectional study. Rev Saude Publica 2017; 51:100. [PMID: 29166444 PMCID: PMC5697925 DOI: 10.11606/s1518-8787.2017051006781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/02/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Investigate patterns and factors associated with tobacco consumption among residents of a rural settlement. METHODS A cross-sectional study conducted between September and November 2014, with 172 residents of a rural settlement in the Midwest region of Brazil. We analyzed as dependent variables tobacco consumption at some point in life; current tobacco consumption; tobacco abuse; and the high risk of nicotine dependence, with sociodemographic variables associated with tobacco use, and we applied the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and Self-Reporting Questionnaire (SRQ-20). RESULTS The prevalence of tobacco use in life, current use, tobacco abuse, and high risk of nicotine dependence were 62.2%, 20.9%, 59.8%, and 10.3%, respectively. Advanced age, low education level, evangelical religion, marijuana use, hypnotic or sedative consumption, and male gender were factors associated with smoking patterns in the settlers. CONCLUSIONS There was a high prevalence of smoking patterns, evidencing the need for public policies on tobacco prevention and control in this population.
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Affiliation(s)
| | - Lorena Silva Vargas
- Secretaria Municipal de Saúde de Catalão. Programa Municipal de Controle do Tabagismo. Catalão, GO, Brasil
| | - Roselma Lucchese
- Universidade Federal de Goiás. Departamento de Enfermagem. Catalão, GO, Brasil
| | | | | | - Ivania Vera
- Universidade Federal de Goiás. Departamento de Enfermagem. Catalão, GO, Brasil
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18
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Rüther T, Hagedorn D, Schiela K, Schettgen T, Osiander-Fuchs H, Schober W. Nicotine delivery efficiency of first- and second-generation e-cigarettes and its impact on relief of craving during the acute phase of use. Int J Hyg Environ Health 2017; 221:191-198. [PMID: 29129555 DOI: 10.1016/j.ijheh.2017.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022]
Abstract
Knowledge about the change in blood nicotine concentrations during the first five minutes (acute phase) of e-cigarette vaping is important to determine whether the used product has a dependence potential or may be an efficient nicotine replacement product. To address this issue, we monitored blood nicotine levels during the acute phase in volunteers using disposable cigalikes (CLs) and a tank model (TM) and compared them with blood nicotine levels in subjects using a tobacco cigarette (TC). In parallel, heart rate changes were continually measured and withdrawal symptoms and craving were assessed with the Questionnaire on Smoking Urges before and immediately after the vaping/smoking sessions. Additionally, at the end of each session negative health effects were rated on a visual analog scale. After five minutes of e-cigarette or TC use, the mean nicotine plasma concentrations were as follows: CLs, 5.5ng/ml; TM, 9.3ng/ml; TC, 17.1ng/ml. Nicotine levels increased significantly faster in the first 4min of consuming a TC than with the CLs and the TM. The highest rate of increase in nicotine concentration was found with the TC (6.8ng/ml) and TM (2.3ng/ml) between the 1st and 2nd minute, whereas the CLs showed comparatively small changes in the amount delivered over the five minutes. Withdrawal and craving for smoking decreased with the TM by the same amount as with the TC, even though less nicotine was delivered to the blood and considerably fewer side effects occurred. The heart rate of TM users was also markedly lower than that of the TC users. Unlike CLs, TM e-cigarettes represent an effective source of nicotine and might be used as an alternative nicotine replacement product to aid smoking cessation. However, nicotine plasma levels observed in TM users after short-time vaping have also the potential to produce and sustain nicotine addiction.
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Affiliation(s)
- Tobias Rüther
- Department of Psychiatry, Ludwig-Maximilians-Universität, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Dieter Hagedorn
- Department of Psychiatry, Ludwig-Maximilians-Universität, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Konstantin Schiela
- Department of Psychiatry, Ludwig-Maximilians-Universität, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Thomas Schettgen
- Institute for Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Helga Osiander-Fuchs
- Bavarian Health and Food Safety Authority, Department of Cosmetics and Tobacco Products, Veterinärstrasse 2, 85764 Oberschleissheim, Germany
| | - Wolfgang Schober
- Bavarian Health and Food Safety Authority, Department of Chemical Safety and Toxicology, Pfarrstrasse 3, 80538 Munich, Germany.
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Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs 2017; 31:471-481. [PMID: 28550660 PMCID: PMC5646360 DOI: 10.1007/s40263-017-0438-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Premature mortality due to cardiovascular disease in those with schizophrenia is the largest lifespan disparity in the US and is growing; adults in the US with schizophrenia die, on average, 28 years earlier than those in the general population. The rate of smoking prevalence among individuals with schizophrenia is estimated to be from 64 to 79%. Smokers with schizophrenia have historically been excluded from most large nicotine-dependence treatment studies. However, converging evidence indicates that a majority of smokers with schizophrenia want to quit smoking, and that available pharmacotherapeutic smoking cessation aids are well tolerated by this population of smokers and are effective when combined with behavioral treatment. The aim of this review is to present updated evidence for safety and efficacy of smoking cessation interventions for those with schizophrenia spectrum illness. We also highlight implications of the very low abstinence rates for smokers with schizophrenia who receive placebo plus behavioral treatment in randomized trials, and review treatment approaches to address the high rate of rapid relapse observed upon pharmacologic treatment discontinuation in this population. Recommendations for monitoring for treatment-emergent nicotine withdrawal symptoms, side effects, and effects of cessation on antipsychotic medication are also provided. Smokers with schizophrenia spectrum disorders should be encouraged to quit smoking and should receive varenicline, bupropion with or without nicotine replacement therapy (NRT), or NRT, all in combination with behavioral treatment for at least 12 weeks. Maintenance pharmacotherapy may reduce relapse and improve sustained abstinence rates. Controlled trials in smokers with schizophrenia consistently show no greater rate of neuropsychiatric adverse events with pharmacotherapeutic cessation aids than with placebo.
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Affiliation(s)
- Corinne Cather
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA.
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Gladys N Pachas
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
| | - Kristina M Cieslak
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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21
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Abstract
OBJECTIVE To characterize vaping behavior and nicotine intake during ad libitum e-cigarette access. METHODS Thirteen adult e-cigarette users had 90 minutes of videotaped ad libitum access to their usual e-cigarette. Plasma nicotine was measured before and every 15 minutes after the first puff; subjective effects were measured before and after the session. RESULTS Average puff duration and interpuff interval were 3.5±1.4 seconds (±SD) and 118±141 seconds, respectively. 12% of puffs were unclustered puffs while 43%, 28%, and 17% were clustered in groups of 2-5, 6-10, and >10 puffs, respectively. On average, 4.0±3.3 mg of nicotine was inhaled; the maximum plasma nicotine concentration (Cmax) was 12.8±8.5 ng/mL. Among the 8 tank users, number of puffs was positively correlated with amount of nicotine inhaled, Cmax, and area under the plasma nicotine concentration-time curve (AUC0→90min) while interpuff interval was negatively correlated with Cmax and AUC0→90. CONCLUSION Vaping patterns differ from cigarette smoking. Plasma nicotine levels were consistent with intermittent dosing of nicotine from e-cigarettes compared to the more bolus dosing from cigarettes. Differences in delivery patterns and peak levels of nicotine achieved could influence the addictiveness of e-cigarettes compared to conventional cigarettes.
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22
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Wolfe RM, Reeves LE, Gibson LE, Cooper S, Ellman LM. Attenuated Positive Psychotic Symptoms in Relation to Cigarette Smoking in a Nonclinical Population. Nicotine Tob Res 2016; 19:124-128. [PMID: 27651478 DOI: 10.1093/ntr/ntw240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explored the association between cigarette smoking and attenuated positive psychotic symptoms in a young adult nonclinical sample. METHODS Undergraduates (N = 930), aged 18-35 years (26.3% male), completed a battery of self-report measures assessing subthreshold psychotic symptoms, cigarette smoking behavior/dependence, and drug use. RESULTS Individuals endorsing a greater number of attenuated positive psychotic symptoms were more likely to be smokers. Exploratory analyses indicated that the odds of being a smoker were two times greater for those at potential higher risk for psychosis compared with individuals at lower risk. Results were consistent after adjusting for sex and other drug use. CONCLUSIONS In line with findings from psychotic populations, results suggest that attenuated positive psychotic symptoms, particularly those endorsed as distressing in a nonclinical, undergraduate population, are related to cigarette smoking. IMPLICATIONS Even in nonclinical, undergraduate populations, subthreshold psychotic symptoms are related to cigarette smoking, and cigarette smokers are twice as likely to be considered at potentially higher risk for psychosis compared with noncigarette smokers. In summary, there may be a threshold whereby psychotic symptoms confer increased risk for nicotine consumption, with endorsement of a greater number of distressing subthreshold psychotic symptoms increasing the likelihood of cigarette use.
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Affiliation(s)
- Rebecca M Wolfe
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Reeves
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Gibson
- Department of Psychology, Temple University, Philadelphia, PA
| | - Shanna Cooper
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
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Potvin S, Lungu O, Lipp O, Lalonde P, Zaharieva V, Stip E, Melun JP, Mendrek A. Increased ventro-medial prefrontal activations in schizophrenia smokers during cigarette cravings. Schizophr Res 2016; 173:30-6. [PMID: 27005897 DOI: 10.1016/j.schres.2016.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Highly prevalent in schizophrenia, tobacco smoking substantially increases the risk of cardiac-related death. Compared to the general population, tobacco smoking cessation rates are lower in schizophrenia. Unfortunately, the reasons for these low cessation rates remain poorly understood. Recently, it has been shown that tobacco cravings are increased in schizophrenia smokers compared to smokers with no comorbid psychiatric disorder. In view of these results, we sought to examine - for the first time - the neurophysiologic responses elicited by cigarette cues in schizophrenia smokers. We hypothesized that cigarettes cues would elicit increased activations in brain regions involved in drug cravings in schizophrenia smokers relative to control smokers. METHODS Smokers with (n=18) and without (n=24) schizophrenia (DSM-IV criteria) were scanned using functional magnetic resonance imaging (fMRI) while viewing appetitive cigarette images. RESULTS Schizophrenia smokers and smokers with no psychiatric comorbidity did not differ in subjective cravings in response to appetitive smoking cues. However, in schizophrenia smokers relative to control smokers, we found that appetitive cigarette cues triggered increased activations of the bilateral ventro-medial prefrontal cortex, a core region of the brain reward system. Moreover, a negative correlation was observed between cigarette cravings and activations of the right ventro-medial prefrontal cortex in schizophrenia smokers. DISCUSSION The current results highlight a key role of the brain reward system in cigarette craving in schizophrenia, and suggest that the neurophysiologic mechanisms involved in the regulation of cue-induced cigarette craving are impaired in this population.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada; Department of Psychiatry, University of Montreal, Montreal, Canada.
| | - Ovidiu Lungu
- Department of Psychiatry, University of Montreal, Montreal, Canada; Institut de Gériatrie de l'Université de Montréal, Montreal, Canada; Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, Montreal, Canada
| | - Olivier Lipp
- Department of Psychiatry, University of Montreal, Montreal, Canada; Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Pierre Lalonde
- Department of Psychiatry, University of Montreal, Montreal, Canada; Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Vessela Zaharieva
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
| | - Emmanuel Stip
- Department of Psychiatry, University of Montreal, Montreal, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Jean-Pierre Melun
- Department of Psychiatry, University of Montreal, Montreal, Canada; Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Adrianna Mendrek
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada; Department of Psychology, Bishop's University, Lennoxville, Canada
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St. Helen G, Havel C, Dempsey D, Jacob P, Benowitz NL. Nicotine delivery, retention and pharmacokinetics from various electronic cigarettes. Addiction 2016; 111:535-44. [PMID: 26430813 PMCID: PMC4749433 DOI: 10.1111/add.13183] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/28/2015] [Accepted: 09/18/2015] [Indexed: 12/28/2022]
Abstract
AIMS To measure the systemic retention of nicotine, propylene glycol (PG) and vegetable glycerin (VG) in electronic cigarette (e-cigarette) users, and assess the abuse liability of e-cigarettes by characterizing nicotine pharmacokinetics. DESIGN E-cigarette users recruited over the internet participated in a 1-day research ward study. Subjects took 15 puffs from their usual brand of e-cigarette. Exhaled breath was trapped in gas-washing bottles and blood was sampled before and several times after use. SETTING San Francisco, California, USA. PARTICIPANTS Thirteen healthy, experienced adult e-cigarette users (six females and seven males). MEASUREMENTS Plasma nicotine was analyzed by gas chromatography-mass spectrometry (GC-MS/MS) and nicotine, VG and PG in e-liquids and gas traps were analyzed by LC-MS/MS. Heart rate changes and subjective effects were assessed. FINDINGS E-cigarettes delivered an average of 1.33 (0.87-1.79) mg [mean and 95% confidence interval (CI)] of nicotine, and 93.8% of the inhaled dose, 1.22 (0.80-1.66) was systemically retained. Average maximum plasma nicotine concentration (Cmax ) was 8.4 (5.4-11.5) ng/ml and time of maximal concentration (Tmax ) was 2-5 minutes. One participant had Tmax of 30 minutes. 84.4% and 91.7% of VG and PG, respectively, was systemically retained. Heart rate increased by an average of 8.0 beats per minute after 5 minutes. Withdrawal and urge to smoke decreased and the e-cigarettes were described as satisfying. CONCLUSIONS E-cigarettes can deliver levels of nicotine that are comparable to or higher than typical tobacco cigarettes, with similar systemic retention. Although the average maximum plasma nicotine concentration in experienced e-cigarette users appears to be generally lower than what has been reported from tobacco cigarette use, the shape of the pharmacokinetic curve is similar, suggesting addictive potential.
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Affiliation(s)
- Gideon St. Helen
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA,Center for Tobacco Control Research and Education, University of California, San Francisco, CA,UCSF Tobacco Center of Regulatory Sciences (TCORS), University of California, San Francisco, CA,Corresponding Author: Gideon St. Helen, Ph.D., Assistant Professor, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, Box 1220, San Francisco, California 94143-1220, Tel (415) 206-2687, Fax (415) 206-4956,
| | - Christopher Havel
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA
| | - Delia Dempsey
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA
| | - Peyton Jacob
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA,Center for Tobacco Control Research and Education, University of California, San Francisco, CA,UCSF Tobacco Center of Regulatory Sciences (TCORS), University of California, San Francisco, CA
| | - Neal L. Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA,Center for Tobacco Control Research and Education, University of California, San Francisco, CA,UCSF Tobacco Center of Regulatory Sciences (TCORS), University of California, San Francisco, CA,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA
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25
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Besson M, Forget B. Cognitive Dysfunction, Affective States, and Vulnerability to Nicotine Addiction: A Multifactorial Perspective. Front Psychiatry 2016; 7:160. [PMID: 27708591 PMCID: PMC5030478 DOI: 10.3389/fpsyt.2016.00160] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 09/06/2016] [Indexed: 11/17/2022] Open
Abstract
Although smoking prevalence has declined in recent years, certain subpopulations continue to smoke at disproportionately high rates and show resistance to cessation treatments. Individuals showing cognitive and affective impairments, including emotional distress and deficits in attention, memory, and inhibitory control, particularly in the context of psychiatric conditions, such as attention-deficit hyperactivity disorder, schizophrenia, and mood disorders, are at higher risk for tobacco addiction. Nicotine has been shown to improve cognitive and emotional processing in some conditions, including during tobacco abstinence. Self-medication of cognitive deficits or negative affect has been proposed to underlie high rates of tobacco smoking among people with psychiatric disorders. However, pre-existing cognitive and mood disorders may also influence the development and maintenance of nicotine dependence, by biasing nicotine-induced alterations in information processing and associative learning, decision-making, and inhibitory control. Here, we discuss the potential forms of contribution of cognitive and affective deficits to nicotine addiction-related processes, by reviewing major clinical and preclinical studies investigating either the procognitive and therapeutic action of nicotine or the putative primary role of cognitive and emotional impairments in addiction-like features.
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Affiliation(s)
- Morgane Besson
- Unité de Neurobiologie Intégrative des Systèmes Cholinergiques, Department of Neuroscience, CNRS UMR 3571, Institut Pasteur , Paris , France
| | - Benoît Forget
- Unité de Neurobiologie Intégrative des Systèmes Cholinergiques, Department of Neuroscience, CNRS UMR 3571, Institut Pasteur , Paris , France
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26
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Li Y, Hou CL, Ma XR, Zang Y, Jia FJ, Zhong BL, Lin YQ, Chiu HFK, Ungvari GS, Himelhoch S, Cao XL, Cai MY, Lai KYC, Xiang YT. Smoking and its associations with sociodemographic and clinical characteristics and quality of life in patients with schizophrenia treated in primary care in China. Gen Hosp Psychiatry 2016; 38:79-83. [PMID: 26633862 DOI: 10.1016/j.genhosppsych.2015.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated smoking rates in this population. This study investigated the rate of smoking and its associations with sociodemographic and clinical characteristics and quality of life (QOL) in patients with schizophrenia treated in primary care in China. METHODS This was a cross-sectional, community-based survey. A total of 621 schizophrenia patients were recruited from 22 primary care services in Guangzhou, China, in 2013. Patients' sociodemographic and clinical characteristics, smoking status, and QOL were recorded. RESULTS The frequency of current smoking was 23.8% in the whole sample; 41.5% for men and 2.5% for women. Multiple logistic regression analysis revealed that male gender, married status, alcohol use, older age at onset, fewer major medical conditions, lower education level and more hospitalizations were independently associated with current smoking. CONCLUSION The frequency of smoking in Chinese schizophrenia patients treated by primary care physicians is lower than most figures reported from Western and Chinese psychiatric settings.
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Affiliation(s)
- Yan Li
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Xin-Rong Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China.
| | - Bao-Liang Zhong
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yong-Qiang Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Helen F K Chiu
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Seth Himelhoch
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xiao-Lan Cao
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Mei-Ying Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
| | - Kelly Y C Lai
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China.
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27
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Smucny J, Olincy A, Rojas DC, Tregellas JR. Neuronal effects of nicotine during auditory selective attention in schizophrenia. Hum Brain Mapp 2015; 37:410-21. [PMID: 26518728 DOI: 10.1002/hbm.23040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/29/2015] [Accepted: 10/18/2015] [Indexed: 12/11/2022] Open
Abstract
Although nicotine has been shown to improve attention deficits in schizophrenia, the neurobiological mechanisms underlying this effect are poorly understood. We hypothesized that nicotine would modulate attention-associated neuronal response in schizophrenia patients in the ventral parietal cortex (VPC), hippocampus, and anterior cingulate based on previous findings in control subjects. To test this hypothesis, the present study examined response in these regions in a cohort of nonsmoking patients and healthy control subjects using an auditory selective attention task with environmental noise distractors during placebo and nicotine administration. In agreement with our hypothesis, significant diagnosis (Control vs. Patient) X drug (Placebo vs. Nicotine) interactions were observed in the VPC and hippocampus. The interaction was driven by task-associated hyperactivity in patients (relative to healthy controls) during placebo administration, and decreased hyperactivity in patients after nicotine administration (relative to placebo). No significant interaction was observed in the anterior cingulate. Task-associated hyperactivity of the VPC predicted poor task performance in patients during placebo. Poor task performance also predicted symptoms in patients as measured by the Brief Psychiatric Rating Scale. These results are the first to suggest that nicotine may modulate brain activity in a selective attention-dependent manner in schizophrenia.
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Affiliation(s)
- Jason Smucny
- Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ann Olincy
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Research Service, Denver VA Medical Center, Denver, Colorado
| | - Donald C Rojas
- Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Jason R Tregellas
- Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Research Service, Denver VA Medical Center, Denver, Colorado
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28
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Jørgensen KN, Psychol C, Skjærvø I, Mørch-Johnsen L, Haukvik UK, Lange EH, Melle I, Andreassen OA, Agartz I. Cigarette smoking is associated with thinner cingulate and insular cortices in patients with severe mental illness. J Psychiatry Neurosci 2015; 40:241-9. [PMID: 25672482 PMCID: PMC4478057 DOI: 10.1503/jpn.140163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/07/2014] [Accepted: 11/28/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) studies show reduced cortical thickness in patients with schizophrenia and bipolar disorder. These subtle brain abnormalities may provide insight into illness mechanisms. However, environmental and lifestyle-related factors, such as cigarette smoking, may contribute to brain structure changes. Cigarette smoking is highly prevalent in patients with severe mental illness. In nonpsychiatric samples, smoking has been associated with reduced thickness in the anterior (ACC) and posterior cingulate cortices, the insular cortex (INS), the dorsolateral prefrontal cortex and the orbitofrontal cortex. METHODS We examined MRI scans from patients with schizophrenia, other psychotic disorders or bipolar disorder and healthy controls using FreeSurfer. RESULTS We included 506 patients (49% smokers) and 237 controls (20% smokers) in our study. We found reduced cortical thickness in the left rostral ACC and the left INS in smoking patients compared with nonsmoking patients, but this difference was not found among healthy controls. No dose-response relationship was found between amount of smoking and cortical thickness in these regions. Among patients, maps of thickness along the whole cortical surface revealed reduced insular thickness but no effects in other regions. Among healthy controls, similar analyses revealed increased age-related cortical thinning in the left occipital lobe among smokers compared with nonsmokers. LIMITATIONS The causal direction could not be determined owing to the cross-sectional design and lack of detailed data on smoking addiction and smoking history. CONCLUSION The effect of cigarette smoking should be considered in MRI studies of patients with severe mental illness.
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Affiliation(s)
- Kjetil Nordbø Jørgensen
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
| | | | | | - Lynn Mørch-Johnsen
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
| | - Unn Kristin Haukvik
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
| | - Elisabeth Heffermehl Lange
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
| | - Ingrid Melle
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
| | - Ole Andreas Andreassen
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, (Jørgensen, Skjærvø, Mørch-Johnsen, Haukvik, Lange, Agartz); NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Jørgensen, Mørch-Johnsen, Haukvik, Lange, Melle, Andreassen, Agartz); the Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo (Skjærvø); and the Division of Mental Health and Addiction, Oslo University Hospital (Melle, Andreassen), Oslo, Norway
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Koszowski B, Viray LC, Stanfill SB, Lisko JG, Rosenberry ZR, Potts JL, Pickworth WB. Nicotine delivery and pharmacologic response from Verve, an oral nicotine delivery product. Pharmacol Biochem Behav 2015; 136:1-6. [PMID: 26096037 DOI: 10.1016/j.pbb.2015.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
Verve, an oral nicotine delivery product (ONDP), was introduced by Nu Mark (Altria Client Group, Richmond VA) for smokers to use in places where smoking is prohibited. This study assessed the effect of this ONDP on plasma nicotine levels, heart rate, product satisfaction, and ability to suppress smoking urge and cigarette cravings. Thirteen daily cigarette smokers [8 men and 5 women; average age 33.4years] attended two laboratory sessions, one occurred after overnight tobacco abstinence. Plasma samples were collected before and after ONDP use and measured for nicotine. In non-abstinent smokers, mean plasma nicotine levels increased from 18.3 to 21.0ng/mL. In abstinent smokers, average nicotine levels increased from 3.1 to 4.5ng/mL. After overnight tobacco abstinence, ONDP use significantly (p<0.01) increased heart rate from 69beats per minute (bpm) to 75bpm; while urge to smoke decreased significantly (p<0.01) from a score of 8.6 to 4.9. Participants indicated moderate product satisfaction that was not changed by tobacco abstinence. Analysis of unused ONDP revealed total nicotine levels of 1.68±0.09mg/disc. Spent ONDP discs were also analyzed to determine % nicotine liberated during chewing; results were 80% in the non-abstinent and 82% in the abstinent conditions (ns). Our study results indicate that ONDP use can increase plasma nicotine levels and heart rate and reduce cigarette cravings in abstinent smokers.
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Affiliation(s)
- Bartosz Koszowski
- Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Lauren C Viray
- Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Stephen B Stanfill
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, United States
| | - Joseph G Lisko
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, United States
| | - Zach R Rosenberry
- Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Jennifer L Potts
- Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States
| | - Wallace B Pickworth
- Battelle Public Health Center for Tobacco Research, Baltimore, MD, United States.
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Potvin S, Tikàsz A, Dinh-Williams LLA, Bourque J, Mendrek A. Cigarette Cravings, Impulsivity, and the Brain. Front Psychiatry 2015; 6:125. [PMID: 26441686 PMCID: PMC4562259 DOI: 10.3389/fpsyt.2015.00125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/26/2015] [Indexed: 12/28/2022] Open
Abstract
Craving is a core feature of tobacco use disorder as well as a significant predictor of smoking relapse. Studies have shown that appetitive smoking-related stimuli (e.g., someone smoking) trigger significant cravings in smokers impede their self-control capacities and promote drug seeking behavior. In this review, we begin by an overview of functional magnetic resonance imaging (fMRI) studies investigating the neural correlates of smokers to appetitive smoking cues. The literature reveals a complex and vastly distributed neuronal network underlying smokers' craving response that recruits regions involved in self-referential processing, planning/regulatory processes, emotional responding, attentional biases, and automatic conducts. We then selectively review important factors contributing to the heterogeneity of results that significantly limit the implications of these findings, namely between- (abstinence, smoking expectancies, and self-regulation) and within-studies factors (severity of smoking dependence, sex-differences, motivation to quit, and genetic factors). Remarkably, we found that little to no attention has been devoted to examine the influence of personality traits on the neural correlates of cigarette cravings in fMRI studies. Impulsivity has been linked with craving and relapse in substance and tobacco use, which prompted our research team to examine the influence of impulsivity on cigarette cravings in an fMRI study. We found that the influence of impulsivity on cigarette cravings was mediated by fronto-cingulate mechanisms. Given the high prevalence of cigarette smoking in several psychiatric disorders that are characterized by significant levels of impulsivity, we conclude by identifying psychiatric patients as a target population whose tobacco-smoking habits deserve further behavioral and neuro-imaging investigation.
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Affiliation(s)
- Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | - Andràs Tikàsz
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | | | - Josiane Bourque
- Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada ; Centre de Recherche de l'Hôpital Sainte-Justine , Montreal, QC , Canada
| | - Adrianna Mendrek
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychology, Bishop's University , Lennoxville, QC , Canada
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31
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Donny EC, Hatsukami DK, Benowitz NL, Sved AF, Tidey JW, Cassidy RN. Reduced nicotine product standards for combustible tobacco: building an empirical basis for effective regulation. Prev Med 2014; 68:17-22. [PMID: 24967958 PMCID: PMC4253911 DOI: 10.1016/j.ypmed.2014.06.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/21/2014] [Accepted: 06/15/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Both the Tobacco Control Act in the U.S. and Article 9 of the Framework Convention on Tobacco Control enable governments to directly address the addictiveness of combustible tobacco by reducing nicotine through product standards. Although nicotine may have some harmful effects, the detrimental health effects of smoked tobacco are primarily due to non-nicotine constituents. Hence, the health effects of nicotine reduction would likely be determined by changes in behavior that result in changes in smoke exposure. METHODS Herein, we review the current evidence on nicotine reduction and discuss some of the challenges in establishing the empirical basis for regulatory decisions. RESULTS To date, research suggests that very low nicotine content cigarettes produce a desirable set of outcomes, including reduced exposure to nicotine, reduced smoking, and reduced dependence, without significant safety concerns. However, much is still unknown, including the effects of gradual versus abrupt changes in nicotine content, effects in vulnerable populations, and impact on youth. DISCUSSION A coordinated effort must be made to provide the best possible scientific basis for regulatory decisions. The outcome of this effort may provide the foundation for a novel approach to tobacco control that dramatically reduces the devastating health consequences of smoked tobacco.
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Affiliation(s)
- Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Dorothy K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55414, USA
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alan F Sved
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Jennifer W Tidey
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Rachel N Cassidy
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI 02912, USA
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32
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Bot M, Vink J, Milaneschi Y, Smit JH, Kluft C, Neuteboom J, Penninx B. Plasma cotinine levels in cigarette smokers: impact of mental health and other correlates. Eur Addict Res 2014; 20:183-91. [PMID: 24481322 DOI: 10.1159/000356809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We examined in cigarette smokers whether cotinine was associated with depressive and/or anxiety disorders. METHODS Data were derived from 1,026 smoking adults with and without depressive and/or anxiety disorders participating in the Netherlands Study of Depression and Anxiety (NESDA). Depressive and anxiety disorders were ascertained with the DSM-IV Composite International Diagnostic Interview. Cigarette consumption was inquired about during an interview. Cotinine was assessed in plasma. RESULTS Currently depressed and/or anxious smokers (n=692) reported smoking a higher number of cigarettes per day (CPD) than smokers with a remitted disorder (n=190) and smokers with no lifetime disorder (n=144). After controlling for CPD and other covariates, depressed and/or anxious smokers had lower cotinine levels compared to smokers with no lifetime disorder (B=-56.0, p=0.001). In the full regression model, CPD was positively associated with cotinine levels, whereas current depression and/or anxiety and high body mass index were inversely associated with cotinine. CONCLUSION After considering CPD, the presence of current depressive and/or anxiety disorders was associated with lower cotinine levels, which may point to a different smoking topography or a faster cotinine metabolism in individuals with affective disorders. The latter could help to explain the higher number of cigarettes smoked and poorer cessation rates among depressed or anxious patients.
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Affiliation(s)
- Mariska Bot
- Department of Psychiatry, EMGO Institute of Health and Care Research, Neuroscience Campus Amsterdam, VU University Medical Center, and GGZinGeest, Amsterdam, The Netherlands
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Socio-demographic and clinical characteristics of heavy and non-heavy smokers among schizophrenia inpatients in a Chinese Han population. Psychopharmacology (Berl) 2014; 231:305-14. [PMID: 23963531 DOI: 10.1007/s00213-013-3239-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Despite higher smoking rates in schizophrenia, few studies have explored the clinical-demographic correlates of different amounts of smoking exposure. Little is known about the association between smoking severity and clinical phenotypes in Chinese patients with schizophrenia. MATERIALS AND METHODS We investigated differences between heavy (≥1 pack/day) and non-heavy (<1 pack/day) smoking in 550 male inpatients with schizophrenia using clinician-administered questionnaires and the Fagerstrom Test for Nicotine Dependence. They also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS), as well as were assayed with laboratory tests and an electrocardiogram. RESULTS Heavy smoking prevalence was approximately 31 %. Compared to the non-heavy smokers, the heavy smokers were younger, more with paranoid subtype but less with disorganized subtype schizophrenia, smoked at an earlier age, fewer getting clozapine or all atypical antipsychotics together, and were taking larger doses of antipsychotic drugs. The heavy smokers scored significantly lower on the PANSS negative symptom subscore and total score, and also on the SAES and AIMS scores than the non-heavy smokers. In addition, heavy smokers displayed longer rate-corrected electrocardiographic QT intervals, but without any significant differences in other laboratory tests. CONCLUSION Our results suggest several clinical or demographic differences between the heavy and non-heavy smoking patients with schizophrenia in a Chinese population. Heavy smoking remains a general health risk for schizophrenia.
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Hahn B, Harvey AN, Concheiro-Guisan M, Huestis MA, Holcomb HH, Gold JM. A test of the cognitive self-medication hypothesis of tobacco smoking in schizophrenia. Biol Psychiatry 2013; 74:436-43. [PMID: 23660272 PMCID: PMC3755590 DOI: 10.1016/j.biopsych.2013.03.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 02/22/2013] [Accepted: 03/15/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heavier tobacco smoking among people with schizophrenia (SCZ) has been suggested to reflect self-medication of cognitive deficits. The idea that cognitive-enhancing effects of nicotine are a primary motivator of tobacco consumption in SCZ and that abstinence would deprive SCZ of such beneficial effects might explain hesitation among providers to pursue smoking cessation in SCZ. This study tested predictions of the cognitive self-medication hypothesis. METHODS In three counterbalanced sessions, 17 SCZ and 17 healthy control subjects (HCS), all smokers, were tested under ad libitum smoking or 3.5 hours after abstaining and receiving a nicotine (14 mg/24 hours) or placebo patch. RESULTS Attention task performance was improved by transdermal nicotine relative to placebo, with intermediate performance by ad libitum smoking. These effects were of similar size in SCZ and HCS and did not reflect remediation of functions disproportionately impaired in SCZ. Although more SCZ reported that the need to concentrate influenced their smoking, this was not reflected by the actual behavior of these patients. Self-reported ability to concentrate changed with nicotine status in HCS but not SCZ, suggesting insensitivity of SCZ to nicotine-derived performance benefits. Nicotine plasma concentrations after ad libitum smoking were not associated with performance benefits but instead with the propensity to experience nicotine withdrawal upon abstinence. This association was seen selectively in SCZ, suggesting a possible reason for heavier smoking. CONCLUSIONS These findings suggest that subjective or objective attentional benefits are unlikely the primary driving force of tobacco consumption in SCZ and should not discourage providers from supporting quit attempts.
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Affiliation(s)
- Britta Hahn
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA.
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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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Stachowiak MK, Kucinski A, Curl R, Syposs C, Yang Y, Narla S, Terranova C, Prokop D, Klejbor I, Bencherif M, Birkaya B, Corso T, Parikh A, Tzanakakis ES, Wersinger S, Stachowiak EK. Schizophrenia: a neurodevelopmental disorder--integrative genomic hypothesis and therapeutic implications from a transgenic mouse model. Schizophr Res 2013; 143:367-76. [PMID: 23231877 DOI: 10.1016/j.schres.2012.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/02/2012] [Accepted: 11/06/2012] [Indexed: 12/14/2022]
Abstract
Schizophrenia is a neurodevelopmental disorder featuring complex aberrations in the structure, wiring, and chemistry of multiple neuronal systems. The abnormal developmental trajectory of the brain appears to be established during gestation, long before clinical symptoms of the disease appear in early adult life. Many genes are associated with schizophrenia, however, altered expression of no one gene has been shown to be present in a majority of schizophrenia patients. How does altered expression of such a variety of genes lead to the complex set of abnormalities observed in the schizophrenic brain? We hypothesize that the protein products of these genes converge on common neurodevelopmental pathways that affect the development of multiple neural circuits and neurotransmitter systems. One such neurodevelopmental pathway is Integrative Nuclear FGFR1 Signaling (INFS). INFS integrates diverse neurogenic signals that direct the postmitotic development of embryonic stem cells, neural progenitors and immature neurons, by direct gene reprogramming. Additionally, FGFR1 and its partner proteins link multiple upstream pathways in which schizophrenia-linked genes are known to function and interact directly with those genes. A th-fgfr1(tk-) transgenic mouse with impaired FGF receptor signaling establishes a number of important characteristics that mimic human schizophrenia - a neurodevelopmental origin, anatomical abnormalities at birth, a delayed onset of behavioral symptoms, deficits across multiple domains of the disorder and symptom improvement with typical and atypical antipsychotics, 5-HT antagonists, and nicotinic receptor agonists. Our research suggests that altered FGF receptor signaling plays a central role in the developmental abnormalities underlying schizophrenia and that nicotinic agonists are an effective class of compounds for the treatment of schizophrenia.
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Affiliation(s)
- M K Stachowiak
- Molecular and Structural Neurobiology & Gene Therapy Program, Department of Pathology and Anatomical Sciences, Western New York Stem Cell Culture and Analysis Center, SUNY, Buffalo, NY, USA.
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Cather C, Dyer MA, Burrell HA, Hoeppner B, Goff DC, Evins AE. An Open Trial of Relapse Prevention Therapy for Smokers With Schizophrenia. J Dual Diagn 2013; 9:87-93. [PMID: 23750123 PMCID: PMC3671354 DOI: 10.1080/15504263.2012.749559] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Following successful smoking cessation, smokers with schizophrenia are vulnerable to relapse shortly after treatment discontinuation. Our objective was to assess the feasibility and effectiveness of a 12-month relapse prevention intervention in recently abstinent smokers with schizophrenia. METHOD Adult outpatient smokers with schizophrenia received weekly cognitive behavioral therapy groups, bupropion slow release, transdermal nicotine patch, and nicotine gum or lozenge for three months. Subjects with seven-day point prevalence abstinence at month 3 received an additional 12 months (months 4-15) of therapy with bupropion, transdermal nicotine patch, and nicotine gum/lozenge in conjunction with relapse prevention-based cognitive behavioral therapy groups that were held weekly in month 4, biweekly in months 5-6, and monthly in months 7-15. RESULTS Seventeen of 41 participants (41.5%) attained biochemically verified self-report of seven-day point prevalence abstinence at the end of three months of treatment and entered relapse prevention treatment. There was an 81% attendance rate at relapse prevention groups. At the end of the 12-month relapse prevention phase (month 15 overall), 11 of 17 (64.7%) demonstrated biochemically verified seven-day point prevalence abstinence, and 10 of 17 (58.8%) reported four-week continuous abstinence. Almost one quarter of the sample (23.5%) demonstrated long-term prolonged abstinence through the end of the trial. There were no clinically detected cases of psychiatric symptom exacerbation. One participant, who was managed as an outpatient, self-reported psychiatric symptom exacerbation in the interim period between study visits. CONCLUSIONS Extended duration smoking cessation treatment is well-tolerated and may improve smoking outcomes for recently abstinent smokers with schizophrenia. Controlled trials are warranted.
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Affiliation(s)
- Corinne Cather
- Schizophrenia Program, Massachusetts General Hospital and Harvard Medical School ; Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School ; Department of Psychiatry of the Massachusetts General Hospital and Harvard Medical School
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Moran LV, Sampath H, Stein EA, Hong LE. Insular and anterior cingulate circuits in smokers with schizophrenia. Schizophr Res 2012; 142:223-9. [PMID: 23021898 PMCID: PMC3502674 DOI: 10.1016/j.schres.2012.08.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/20/2012] [Accepted: 08/28/2012] [Indexed: 11/25/2022]
Abstract
Schizophrenia (SZ) is associated with high rates of smoking. We previously found that resting state functional connectivity (rsFC) between the dorsal anterior cingulate (dACC) and striatum is independently associated with nicotine addiction and psychiatric illness. Since the insula is implicated in nicotine dependence, we hypothesized that SZ smokers will have greater dysfunction in smoking-related insular and dACC circuits than normal control smokers (NC) independent of smoking severity, consistent with an inherent disease-related weakening of smoking-related circuits. Nicotine challenge was used to demonstrate that decreased rsFC in identified circuits reflects addiction trait and is not affected by pharmacological state. Twenty-four NC smokers and 20 smokers with SZ matched on nicotine addiction severity participated in a resting state fMRI study and were scanned during two separate sessions while receiving a placebo or nicotine patch, in a randomized, cross-over design. Using individualized, anatomically defined anterior and posterior insula and dACC as regions of interest (ROI), whole brain rsFC was performed using each ROI as a seed. Significant negative correlations between smoking severity and rsFC between insula, dACC and striatum were found for both groups. Furthermore, smokers with SZ demonstrated additive reductions in circuit strength between the dACC and insula compared to NC smokers independent of smoking severity. Nicotine challenge did not significantly alter rsFC in insula-dACC-striatal circuits. Reduced rsFC strength between the insula, dACC and striatum is associated with nicotine addiction severity in both non-psychiatrically ill and in SZ smokers. Decreased insula-dACC rsFC may index overlapping circuitry associated with smoking and SZ.
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Affiliation(s)
- Lauren V. Moran
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland,Correspondence to: Dr. Moran, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228,
| | - Hemalatha Sampath
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elliot A. Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, Maryland
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Steinberg ML, Williams JM, Gandhi KK, Foulds J, Epstein EE, Brandon TH. Task persistence predicts smoking cessation in smokers with and without schizophrenia. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:850-8. [PMID: 22642860 PMCID: PMC3605732 DOI: 10.1037/a0028375] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Smokers attempting to quit should benefit from persisting in cognitive and behavioral coping in order to achieve and maintain abstinence. Task persistence, which describes the act of persisting in a difficult or effortful task, is likely to be required in the face of distressing smoking cues, urges to smoke, or other nicotine withdrawal symptoms. This study examined whether task persistence (also called distress tolerance) could prospectively predict smoking cessation in a mixed sample of smokers with and without schizophrenia. Smokers with schizophrenia or schizoaffective disorder (n = 71) and nonpsychiatric smokers (n = 78) seeking treatment at state-funded tobacco dependence treatment clinics completed tests of task persistence before their target quit date, and then provided tobacco use data over the 6 months after their quit date. Findings from generalized estimating equations support the hypothesis that task persistence as measured by a mirror-tracing task predicts smoking cessation while controlling for important covariates such as psychiatric diagnosis, nicotine dependence, and confidence in ability to quit. These findings add to the literature by corroborating reports suggesting that task persistence may make important contributions to smoking cessation success, and by indicating that the contribution of task persistence to smoking cessation is similar for smokers with schizophrenia and nonpsychiatric smokers. These results suggest that efforts to target task persistence in smoking cessation counseling protocols may be warranted.
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Affiliation(s)
- Marc L Steinberg
- Department of Psychiatry, Robert Wood Johnson Medical School, 317 George Street, Suite 105, New Brunswick, NJ 08901, USA.
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Williams JM, Gandhi KK, Lu SE, Steinberg ML, Benowitz NL. Nicotine intake and smoking topography in smokers with bipolar disorder. Bipolar Disord 2012; 14:618-27. [PMID: 22938167 PMCID: PMC3641517 DOI: 10.1111/j.1399-5618.2012.01047.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cigarette smoking behavior in bipolar disorder (BPD), including the effects of mood-stabilizing medications, has not been well characterized. METHODS We compared serum nicotine, nicotine metabolite levels, and smoking topography in 75 smokers with BPD to 86 control smokers (CON). For some comparisons, an additional control group of 75 smokers with schizophrenia (SCZ) were included. RESULTS There were no differences between the BPD and CON groups in baseline smoking characteristics or serum nicotine or cotinine levels. Fifty-one smokers with BPD (68.9%) were taking one of the following mood stabilizers: valproic acid, lamotrigine, carbamazepine, oxcarbazepine, lithium, or topiramate. The 3-hydroxycotinine-to-cotinine ratio, a marker of cytochrome P450 2A6 (CYP2A6) metabolic activity, was significantly higher in BPD versus CON and versus SCZ (0.68 versus 0.49 versus 0.54; p =0.002). The difference between groups, however, was no longer significant when the analysis was repeated with those taking hepatic enzyme-inducing drugs (carbamazepine, oxcarbazepine, and topiramate) included as a covariate. The time between puffs, or interpuff interval (IPI), was shorter in BPD versus CON by an average of 3.0sec (p<0.05), although this was no longer significant when we removed smokers from the analysis of those taking hepatic enzyme inducers. CONCLUSIONS Smokers with BPD are not different from CON on most measures of nicotine intake and smoking topography. We found an increased rate of nicotine metabolism in smokers taking mood stabilizers that are hepatic enzyme inducers, including carbamazepine, oxcarbazepine, and topiramate. Smokers with rapid nicotine metabolism might be expected to smoke more intensely to compensate for the more rapid disappearance of nicotine from the blood and brain, and may have more difficulty in quitting smoking, although this requires further study.
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Affiliation(s)
- Jill M Williams
- University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-2008, USA.
| | - Kunal K Gandhi
- UMDNJ–School of Public Health, New Brunswick, NJ,GlaxoSmithKline
| | - Shou-En Lu
- University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School, New Brunswick, NJ,UMDNJ–School of Public Health, New Brunswick, NJ
| | - Marc L Steinberg
- University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School, New Brunswick, NJ,UMDNJ–School of Public Health, New Brunswick, NJ
| | - Neal L Benowitz
- University of California at San Francisco, San Francisco, CA, USA
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de Leon J, Diaz FJ. Genetics of schizophrenia and smoking: an approach to studying their comorbidity based on epidemiological findings. Hum Genet 2012; 131:877-901. [PMID: 22190153 PMCID: PMC3536540 DOI: 10.1007/s00439-011-1122-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/27/2011] [Indexed: 01/10/2023]
Abstract
The association between schizophrenia and tobacco smoking has been described in more than 1,000 articles, many with inadequate methodology. The studies on this association can focus on: (1) current smoking, ever smoking or smoking cessation; (2) non-psychiatric controls or controls with severe mental illness (e.g., bipolar disorder); and (3) higher smoking frequency or greater usage in smokers. The association with the most potential for genetic studies is that between ever daily smoking and schizophrenia; it may reflect a shared genetic vulnerability. To reduce the number of false-positive genes, we propose a three-stage approach derived from epidemiological knowledge. In the first stage, only genetic variations associated with ever daily smoking that are simultaneously significant within the non-psychiatric controls, the bipolar disorder controls and the schizophrenia cases will be selected. Only those genetic variations that are simultaneously significant in the three hypothesis tests will be tested in the second stage, where the prevalence of the genes must be significantly higher in schizophrenia than in bipolar disorder, and significantly higher in bipolar disorder than in controls. The genes simultaneously significant in the second stage will be included in a third stage where the gene variations must be significantly more frequent in schizophrenia patients who did not start smoking daily until their 20s (late start) versus those who had an early start. Any genetic approach to psychiatric disorders may fail if attention is not given to comorbidity and epidemiological studies that suggest which comorbidities are likely to be explained by genetics and which are not. Our approach, which examines the results of epidemiological studies on comorbidities and then looks for genes that simultaneously satisfy epidemiologically suggested sets of hypotheses, may also apply to the study of other major illnesses.
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Affiliation(s)
- Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA.
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Balaraman S, Winzer-Serhan UH, Miranda RC. Opposing actions of ethanol and nicotine on microRNAs are mediated by nicotinic acetylcholine receptors in fetal cerebral cortical-derived neural progenitor cells. Alcohol Clin Exp Res 2012; 36:1669-77. [PMID: 22458409 DOI: 10.1111/j.1530-0277.2012.01793.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/17/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ethanol (EtOH) and nicotine are often co-abused. However, their combined effects on fetal neural development, particularly on fetal neural stem cells (NSCs), which generate most neurons of the adult brain during the second trimester of pregnancy, are poorly understood. We previously showed that EtOH influenced NSC maturation in part, by suppressing the expression of specific microRNAs (miRNAs). Here, we tested in fetal NSCs the extent to which EtOH and nicotine coregulated known EtOH-sensitive (miR-9, miR-21, miR-153, and miR-335), a nicotine-sensitive miRNA (miR-140-3p), and mRNAs for nicotinic acetylcholine receptor (nAChR) subunits. Additionally, we tested the extent to which these effects were nAChR dependent. METHODS Gestational day 12.5 mouse fetal murine cerebral cortical-derived neurosphere cultures were exposed to EtOH, nicotine, and mecamylamine, a noncompetitive nAChR antagonist, individually or in combination, for short (24 hour) and long (5 day) periods, to mimic exposure during the in vivo period of neurogenesis. Levels of miRNAs, miRNA-regulated transcripts, and nAChR subunit mRNAs were assessed by quantitative reverse transcription polymerase chain reaction. RESULTS EtOH suppressed the expression of known EtOH-sensitive miRNAs and miR-140-3p, while nicotine at concentrations attained by cigarette smokers induced a dose-related increase in these miRNAs. Nicotine's effect was blocked by EtOH and by mecamylamine. Finally, EtOH decreased the expression of nAChR subunit mRNAs and, like mecamylamine, prevented the nicotine-associated increase in α4 and β2 nAChR transcripts. CONCLUSIONS EtOH and nicotine exert mutually antagonistic, nAChR-mediated effects on teratogen-sensitive miRNAs in fetal NSCs. These data suggest that concurrent exposure to EtOH and nicotine disrupts miRNA regulatory networks that are important for NSC maturation.
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Affiliation(s)
- Sridevi Balaraman
- Department of Neuroscience and Experimental Therapeutics , College of Medicine, Texas A&M Health Science Centre, Bryan, TX 77807-3260, USA
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Williams JM, Gandhi KK, Lu SE, Steinberg ML, Benowitz NL. Rapid smoking may not be aversive in schizophrenia. Nicotine Tob Res 2012; 15:262-6. [PMID: 22318691 DOI: 10.1093/ntr/ntr314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Aversive smoking has been investigated as a smoking cessation technique that involves rapid smoking in a clinic or laboratory and typically involves (a) puffing every 6-10 s or (b) smoking 3 or more cigarettes sequentially in 8-20 min. Rapid smoking usually results in dizziness, sore throat, nausea, and other unpleasant feelings. METHODS To explore rapid smoking, 161 smokers (75 with schizophrenia [SS]; 86 controls [CON]) were assessed in a single day (24 ± 2 hr), ad libitum smoking topography session using the Clinical Research Support System micro portable topography device. RESULTS SS smoked significantly more cigarettes in the 24-hr period versus CON and the time between puffs, or interpuff interval (IPI) was shorter in SS versus CON by an average of 6.5 s (p < .001). The median IPI was also significantly shorter in SS versus CON (9.3 vs.15.7 s; p < .001). SS were twice as likely to have IPIs ≤ 6 s than CON (OR = 2.32, 95% CI = 1.68, 3.20; p < .001). SS were also more likely to smoke 3 or more cigarettes in any 20 min during a 24-hr topography session (OR = 2.32, 95% CI = 1.03, 2.44; p < .001). Rapid smoking was associated with baseline characteristics of smoking more cigarettes per day, higher Fagerström score, and higher carbon monoxide level but not with serum cotinine values or trans-3'-hydroxycotinine/cotinine ratios. CONCLUSIONS Using either definition, SS exhibit patterns of rapid smoking that they seemingly do not experience as aversive, since it reflects their naturalistic pattern of smoking, outside of the laboratory.
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Affiliation(s)
- Jill M Williams
- School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA.
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Cigarette smoking in male patients with chronic schizophrenia in a Chinese population: prevalence and relationship to clinical phenotypes. PLoS One 2012; 7:e30937. [PMID: 22347412 PMCID: PMC3274516 DOI: 10.1371/journal.pone.0030937] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 12/26/2011] [Indexed: 01/11/2023] Open
Abstract
The high prevalence of smoking in schizophrenia of European background may be related to smoking's reducing clinical symptoms and medication side effects. Because smoking prevalence and its associations with clinical phenotypes are less well characterized in Chinese than European patients with schizophrenia, we assessed these smoking behaviors using clinician-administered questionnaires and the Fagerstrom Test for Nicotine Dependence (FTND) in 776 Chinese male schizophrenia and 560 control subjects. Patients also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS). We found that the schizophrenia patients had a higher lifetime incidence of smoking (79% vs 63%), were more likely to be heavy smokers (61% vs 31%), and had lower smoking cessation rates (4% vs 9%) (all p<0.0001) than controls. Among the schizophrenia patients smoking prevalence increased with age, with the largest difference from controls in the age cohort of 55-75 years: 75% vs 46% (p<0.0001). Among the schizophrenia smokers 73% started to smoke before the onset of their illness by an average of 7.6 years. The patients with schizophrenia who were current smokers scored significantly lower on the PANSS negative symptom subscore (p<0.005), and on the SAES symptom scale (p<0.04; Bonferroni corrected p>0.05) than the non-smoking patients. These results suggest that Chinese males with schizophrenia smoke more frequently than the general population. Further, smokers with schizophrenia may display fewer negative symptoms and possibly less parkinsonism than non-smokers with schizophrenia.
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Olincy A, Freedman R. Nicotinic mechanisms in the treatment of psychotic disorders: a focus on the α7 nicotinic receptor. Handb Exp Pharmacol 2012:211-32. [PMID: 23027417 PMCID: PMC3692393 DOI: 10.1007/978-3-642-25758-2_8] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nicotine is heavily abused by persons with schizophrenia. Nicotine better enables people with schizophrenia to filter out extraneous auditory stimuli. Nicotine also improves prepulse inhibition when compared to placebo. Nicotine similarly increases the amplitude of patients' duration mismatch negativity. The 15q13-14 region of the genome coding for the α7 nicotinic receptor is linked to schizophrenia. Multiple single nucleotide polymorphisms have been identified in this 15q13-14 gene promoter region that are more frequently present in people with schizophrenia than in normal controls. Abnormalities in expression and regulation of central nicotinic cholinoceptors with decreased α7 binding in multiple brain regions are also present. Nicotine enhances cognition in schizophrenia. Alternative agents that activate the nicotinic receptor have been tested including 3-[2,4-dimethoxybenzylidene]anabaseine (DMXB-A). This compound improved attention, working memory, and negative symptoms in an add-on study in nonsmoking patients with schizophrenia. There are multiple other nicotinic agents, including positive allosteric modulators, in the preclinical stages of development. Finally, the effects of varenicline and clozapine and their relation to smoking cessation are discussed.
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Affiliation(s)
- Ann Olincy
- Department of Psychiatry, University of Colorado, Denver, 13001 East 17th Place, Mail Stop, F546, Aurora, CO 80045, USA
| | - Robert Freedman
- Department of Psychiatry, University of Colorado, Denver, 13001 East 17th Place, Mail Stop, F546, Aurora, CO 80045, USA
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Pachas GN, Cather C, Pratt SA, Hoeppner B, Nino J, Carlini SV, Achtyes ED, Lando H, Mueser KT, Rigotti NA, Goff DC, Evins AE. Varenicline for Smoking Cessation in Schizophrenia: Safety and Effectiveness in a 12-Week, Open-Label Trial. J Dual Diagn 2012; 8:117-125. [PMID: 22888309 PMCID: PMC3414422 DOI: 10.1080/15504263.2012.663675] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES: Varenicline was approved by the FDA in 2006. In 2009, based largely on case reports, the FDA issued a warning of possible adverse neuropsychiatric effects including depression and suicidal thoughts and behavior for varenicline and bupropion. Prospective trials of varenicline have not reported increased incidence of psychiatric adverse events other than sleep disturbance, but smokers with major mental illness have been excluded from large prospective trials of varenicline to date. We sought to evaluate the effect of a standard open-label 12-week varenicline trial on prospectively assessed safety and smoking outcomes in stable, treated adults with schizophrenia spectrum disorder and nicotine dependence. METHODS: One-hundred-and-twelve stable outpatients who smoked >10 cigarettes/day participated in a 12-week, open-label, smoking cessation trial of varenicline and weekly group cognitive behavioral therapy. Participants took varenicline for 4 weeks before attempting cessation. Trained raters collected safety and smoking outcome data weekly. RESULTS: Participants demonstrated improved psychotic symptoms, depressive symptoms and nicotine withdrawal symptoms from baseline to week 12 or early termination. At the end of 12 weeks open label treatment, the 14- and 28-day continuous abstinence rates were 47.3 and 34%, respectively. Expired CO declined significantly during treatment in those who did not achieve abstinence. CONCLUSIONS: This prospective study suggests that varenicline may be well-tolerated and effective for smoking cessation in combination with group CBT in stable outpatients with schizophrenia, a group with high rates of smoking and smoking-attributable morbidity and mortality.
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Abstract
Nicotine addiction is a complex process that begins with self-administration. Consequently, this process has been studied extensively using animal models. A person is usually not called "smoker" if s/he has smoked for a week or a month in a lifetime; in general, a smoker has been smoking for many years. Furthermore, a smoker has free access to cigarettes and can smoke whenever she/he wants, provided there are no social/legal restraints. Subsequently, in an animal model of tobacco addiction, it will be desirable to expose the animal to free access nicotine for 24 hours/day for many weeks, starting at different stages of development.
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Affiliation(s)
- Allan C Collins
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, USA
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Li MD, van der Vaart AD. MicroRNAs in addiction: adaptation's middlemen? Mol Psychiatry 2011; 16:1159-68. [PMID: 21606928 PMCID: PMC4251867 DOI: 10.1038/mp.2011.58] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 02/07/2023]
Abstract
A central question in addiction is how drug-induced changes in synaptic signaling are converted into long-term neuroadaptations. Emerging evidence reveals that microRNAs (miRNAs) have a distinct role in this process through rapid response to cellular signals and dynamic regulation of local mRNA transcripts. Because each miRNA can target hundreds of mRNAs, relative changes in the expression of miRNAs can greatly impact cellular responsiveness, synaptic plasticity and transcriptional events. These diverse consequences of miRNA action occur through coordination with genes implicated in addictions, the most compelling of these being the neurotrophin BDNF, the transcription factor cAMP-responsive element-binding protein (CREB) and the DNA-binding methyl CpG binding protein 2 (MeCP2). In this study, we review the recent progress in the understanding of miRNAs in general mechanisms of plasticity and neuroadaptation and then focus on specific examples of miRNA regulation in the context of addiction. We conclude that miRNA-mediated gene regulation is a conserved means of converting environmental signals into neuronal response, which holds significant implications for addiction and other psychiatric illnesses.
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Affiliation(s)
- M D Li
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22911, USA.
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Wing VC, Wass CE, Soh DW, George TP. A review of neurobiological vulnerability factors and treatment implications for comorbid tobacco dependence in schizophrenia. Ann N Y Acad Sci 2011; 1248:89-106. [DOI: 10.1111/j.1749-6632.2011.06261.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Williams JM, Gandhi KK, Lu SE, Kumar S, Steinberg ML, Cottler B, Benowitz NL. Shorter interpuff interval is associated with higher nicotine intake in smokers with schizophrenia. Drug Alcohol Depend 2011; 118:313-9. [PMID: 21596491 PMCID: PMC3655704 DOI: 10.1016/j.drugalcdep.2011.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/11/2011] [Accepted: 04/11/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with schizophrenia are frequent and heavy smokers. METHODS The objective of this study was to measure serum nicotine levels and ad libitum smoking behavior for 24+2h using the CReSS micro topography device in 75 smokers with schizophrenia (SCZ) and compare these to 86 control smokers (CON) without mental illness. Mean values of repeatedly measured topography variables were compared using three-level nested linear models to adjust for between subject differences and the double nested data. RESULTS Smokers with SCZ smoked more cigarettes in the 24h period and took an average of 2.8 more puffs per cigarette than CON (p<0.001). The time between puffs, or interpuff interval (IPI), was shorter in SCZ by an average of 6.5s (p<0.001). The peak flow rate was higher in SCZ by an average of 4.9 ml/s (p<0.05). Smokers with SCZ spent an average of 1.0 min less time smoking a single cigarette vs. CON (p<0.001). Smokers with SCZ also had shorter IPI and more puffs per cigarette in an analysis of first cigarette of the day. For all subjects, a decrease in IPI by 1s was associated with an increase in serum nicotine of 0.19 ng/ml and in cotinine of 5.01 ng/ml (both p<0.05). After controlling for diagnosis group, higher craving scores on QSU Factor 2 (urgent desire to smoke) were associated with shorter IPI. DISCUSSION Smokers with schizophrenia demonstrate more intense cigarette puffing that is associated with greater nicotine intake. This pattern may provide insight into other heavily dependent smokers.
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Affiliation(s)
- Jill M. Williams
- UMDNJ-Robert Wood Johnson Medical School, United States,UMDNJ-School of Public Health, United States,Corresponding author at: UMDNJ-Robert Wood Johnson Medical School, 317 George Street, Suite 105, New Brunswick, NJ 08901-2008, United States. Tel.: +1 732 235 4341; fax: +1 732 235 4277. (J.M. Williams)
| | - Kunal K. Gandhi
- UMDNJ-Robert Wood Johnson Medical School, United States,UMDNJ-School of Public Health, United States
| | - Shou-En Lu
- UMDNJ-Robert Wood Johnson Medical School, United States,UMDNJ-School of Public Health, United States
| | - Supriya Kumar
- UMDNJ-Robert Wood Johnson Medical School, United States
| | - Marc L. Steinberg
- UMDNJ-Robert Wood Johnson Medical School, United States,UMDNJ-School of Public Health, United States
| | - Brett Cottler
- UMDNJ-Robert Wood Johnson Medical School, United States
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