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Plever S, Kisely SR, Bonevski B, Siskind D, Guillaumier A, McCarter K, Gartner CE. Interventions for smoking cessation in inpatient psychiatry settings. Cochrane Database Syst Rev 2024; 9:CD015934. [PMID: 39229858 PMCID: PMC11372853 DOI: 10.1002/14651858.cd015934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. To assess whether the effects of smoking cessation interventions differ according to psychiatric diagnosis or type of intervention or comparator condition.
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Affiliation(s)
- Sally Plever
- School of Public Health, The University of Queensland, Brisbane, Australia
- Metro North Mental Health, Metro North HHS, Brisbane, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Australia
| | - Steve R Kisely
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Billie Bonevski
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Australia
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
| | - Dan Siskind
- School of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Kristen McCarter
- School of Psychological Sciences, The University of Newcastle, Callaghan, Australia
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Brisbane, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Australia
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2
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Arsenault‐Mehta K, Hochman‐Bérard M, Johnson A, Semenova D, Nguyen B, Willis J, Mouravska N, Joober R, Zhand N. Pharmacological management of neurocognitive impairment in schizophrenia: A narrative review. Neuropsychopharmacol Rep 2024; 44:2-16. [PMID: 37794723 PMCID: PMC10932777 DOI: 10.1002/npr2.12382] [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: 01/23/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cognitive impairment are among the core features of schizophrenia, experienced by up to 75% of patients. Available treatment options for schizophrenia including dopamine antagonists and traditional antipsychotic medications have not been shown to confer significant benefits on cognitive deficits. Contrary to the focus on management of positive symptoms in schizophrenia, cognitive abilities are main predictor of independent living skills, functional abilities, employment, engagement in relapse prevention, and patients' subjective sense of well-being and quality of life. This review aims to provide a summary of recent literature on pharmacological options for the treatment of cognitive deficits in schizophrenia. METHODS We conducted a literature search of studies from 2011 to 2021 across four electronic databases including PubMed, PsycInfo, MEDLINE, and Embase. Human studies using a pharmacological treatment for cognitive impairment in schizophrenia were included. RESULTS Fifty-eight eligible publications, representing 11 pharmacological classes, were included in this review. Major limitations involved small sample size, methodological limitations as well as heterogeneity of participants and outcome measures. CONCLUSIONS Overall evidence remains inconclusive for any pharmacological classes studied for the treatment of cognitive deficits in schizophrenia. Methodological limitations in a majority of the studies rendered their findings preliminary. We further discuss possible explanations for these findings that could guide future research.
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Affiliation(s)
- Kyle Arsenault‐Mehta
- The Royal Ottawa Mental Health CenterThe University of Ottawa Faculty of MedicineOttawaOntarioCanada
| | | | | | - Dar'ya Semenova
- The University of Ottawa Faculty of MedicineOttawaOntarioCanada
| | - Bea Nguyen
- The University of Ottawa Faculty of MedicineOttawaOntarioCanada
| | - Jessie Willis
- The University of Ottawa Faculty of MedicineOttawaOntarioCanada
| | - Natalia Mouravska
- The Royal Ottawa Mental Health CenterThe University of Ottawa Faculty of MedicineOttawaOntarioCanada
| | - Ridha Joober
- Department of PsychiatryMcGill UniversityMontrealQuebecCanada
| | - Naista Zhand
- The Royal Ottawa Mental Health CenterThe University of Ottawa Faculty of MedicineOttawaOntarioCanada
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3
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Xu C, Xu H, Liu B. Head and neck squamous cell carcinoma-specific prognostic signature and drug sensitive subtypes based on programmed cell death-related genes. PeerJ 2023; 11:e16364. [PMID: 38025757 PMCID: PMC10668860 DOI: 10.7717/peerj.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background As a complex group of malignancies, head and neck squamous cell carcinoma (HNSC) is one of the leading causes of cancer mortality. This study aims to establish a reliable clinical classification and gene signature for HNSC prognostic prediction and precision treatments. Methods A consensus clustering analysis was performed to group HNSC patients in The Cancer Genome Atlas (TCGA) database based on genes linked to programmed cell death (PCD). Differentially expressed genes (DEGs) between subtypes were identified using the "limma" R package. The TCGA prognostic signature and PCD-related prognostic genes were found using a least absolute shrinkage and selection operator (LASSO) regression analysis and univariate Cox regression analysis. The robustness of the LASSO analysis was validated using datasets GSE65858 and GSE41613. A cell counting kit-8 (CCK-8) test, Western blot, and real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) were used to evaluate the expression and viability of prognostic genes. Results Four molecular subtypes were identified in PCD-related genes. Subtype C4 had the best prognosis and the highest immune score, while subtype C1 exhibited the most unfavorable outcomes. Three hundred shared DEGs were identified among the four subtypes, and four prognostic genes (CTLA4, CAMK2N1, PLAU and CALML5) were used to construct a TCGA-HNSC prognostic model. High-risk patients manifested poorer prognosis, more inflammatory pathway enrichment, and lower immune cell infiltration. High-risk patients were more prone to immune escape and were more likely to be resistant to Cisplatin and 5-Fluorouracil. Prognosis prediction was validated in external datasets. The expression of CTLA4, CAMK2N1, PLAU and CALML5 was enhanced in CAL-27 and SCC-25 cell lines, and CALML5 inhibited CAL-27 and SCC-25 cell viability. Conclusion This study shares novel insights into HNSC classification and provides a reliable PCD-related prognostic signature for prognosis prediction and treatment for patients with HNSC.
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Affiliation(s)
- Chengbo Xu
- Department of Otolaryngology Head and Neck Surgery, Jinhua Wenrong Hospital, Jinhua, China
| | - Hongfang Xu
- Department of Otolaryngology Head and Neck Surgery, Jinhua Wenrong Hospital, Jinhua, China
| | - Baimei Liu
- Department of Otolaryngology Head and Neck Surgery, Yongkang First People’s Hospital, Yongkang, China
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Creedon TB, Wayne GF, Progovac AM, Levy DE, Cook BL. Trends in cigarette use and health insurance coverage among US adults with mental health and substance use disorders. Addiction 2023; 118:353-364. [PMID: 36385708 PMCID: PMC11346593 DOI: 10.1111/add.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 09/10/2022] [Indexed: 11/18/2022]
Abstract
AIMS To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). DESIGN Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008-19 public use data from the National Survey on Drug Use and Health, an annual, cross-sectional survey. SETTING USA. PARTICIPANTS A nationally representative sample of non-institutionalized respondents aged 18-64 years (n = 448 762). MEASUREMENTS Outcome variables were three measures of recent cigarette use and one measure of past-year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past-year mental illness, predicted from Kessler-6 and the World Health Organization-Disability Assessment Schedule impairment scale; SUD: met survey-based DSM-IV criteria for past-year alcohol, cannabis, cocaine or heroin use disorder) and over time. FINDINGS Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3-6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3-5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = -3.0 to 0.9 pts). In 2018-19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. CONCLUSIONS Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage.
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Affiliation(s)
- Timothy B. Creedon
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC, USA
| | | | - Ana M. Progovac
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Douglas E. Levy
- Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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5
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Khan SS, Khatik GL, Datusalia AK. Strategies for Treatment of Disease-Associated Dementia Beyond Alzheimer's Disease: An Update. Curr Neuropharmacol 2023; 21:309-339. [PMID: 35410602 PMCID: PMC10190146 DOI: 10.2174/1570159x20666220411083922] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 11/22/2022] Open
Abstract
Memory, cognition, dementia, and neurodegeneration are complexly interlinked processes with various mechanistic pathways, leading to a range of clinical outcomes. They are strongly associated with pathological conditions like Alzheimer's disease, Parkinson's disease, schizophrenia, and stroke and are a growing concern for their timely diagnosis and management. Several cognitionenhancing interventions for management include non-pharmacological interventions like diet, exercise, and physical activity, while pharmacological interventions include medicinal agents, herbal agents, and nutritional supplements. This review critically analyzed and discussed the currently available agents under different drug development phases designed to target the molecular targets, including cholinergic receptor, glutamatergic system, GABAergic targets, glycine site, serotonergic targets, histamine receptors, etc. Understanding memory formation and pathways involved therein aids in opening the new gateways to treating cognitive disorders. However, clinical studies suggest that there is still a dearth of knowledge about the pathological mechanism involved in neurological conditions, making the dropouts of agents from the initial phases of the clinical trial. Hence, a better understanding of the disease biology, mode of drug action, and interlinked mechanistic pathways at a molecular level is required.
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Affiliation(s)
- Sabiya Samim Khan
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
| | - Gopal L. Khatik
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
| | - Ashok K. Datusalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Lucknow (UP) India
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6
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Joshi YB. Cholinergic Functioning, Cognition, and Anticholinergic Medication Burden in Schizophrenia. Curr Top Behav Neurosci 2022; 63:393-406. [PMID: 36441495 DOI: 10.1007/7854_2022_400] [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] [Indexed: 11/29/2022]
Abstract
Acetylcholine (ACh) signaling is critical for central nervous function and is known to be abnormal in schizophrenia (SZ), a chronic neuropsychiatric disorder in which cognitive deficits persist, despite treatment. This review provides a summary of the clinical evidence linking ACh abnormalities to SZ-associated cognitive deficits, an overview of ACh-based pro-cognitive strategies attempted in SZ, and a survey of recent studies that describe the impact of anticholinergic medication burden on cognitive outcomes in SZ. Methodological challenges that currently limit more substantial investigation of ACh in SZ patients and future directions are also discussed.
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Affiliation(s)
- Yash B Joshi
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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7
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Néstor S, Carlos P, Cristina P, José MR, Ignacio B, Pilar S. TOBACCO USE DISORDER AND DUAL DISORDERS Joint statement by the Spanish Psychiatry Society and the Spanish Dual Disorders Society. ACTAS ESPANOLAS DE PSIQUIATRIA 2022; 50:77-138. [PMID: 35731182 PMCID: PMC11095114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Tobacco Use Disorder (TUD) is a health problem of the first order in the world population, affecting a vulnerable population, such as people with other mental disorders, whose morbidity and mortality are increased as a result.
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Affiliation(s)
- Szerman Néstor
- Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Parro Carlos
- Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Pinet Cristina
- Unidad Toxicomanías, Servicio de Psiquiatría, Hospital Sant Pau, Barcelona, España. Miembro de la Sociedad Española de Psiquiatría (SEP)
| | - Martínez-Raga José
- Departamento de Psiquiatría y Psicología Médica. Hospital Universitario Doctor Peset y Universitat de Valencia. Valencia, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Basurte Ignacio
- Dirección médica de Psiquiatría y Salud Mental de la Clínica López Ibor. Madrid, España. Profesor vinculado de la Universidad Europea de Madrid. Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Saiz Pilar
- Catedrática de Psiquiatría. Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Instituto de Investigación sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA). Asturias, España. Miembro de la Sociedad Española de Psiquiatría (SEP)
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8
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Mills J. Varenicline (Chantix): The Smoking Cessation Medication Prescribers May Be Avoiding. Issues Ment Health Nurs 2022; 43:489-494. [PMID: 35412411 DOI: 10.1080/01612840.2022.2061806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, A Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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9
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Thomas KH, Dalili MN, López-López JA, Keeney E, Phillippo D, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-224. [PMID: 34668482 DOI: 10.3310/hta25590] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. OBJECTIVES To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. DESIGN Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. SETTING Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. PARTICIPANTS Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. INTERVENTIONS Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. MAIN OUTCOME MEASURES Effectiveness - continuous or sustained abstinence. Safety - serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. DATA SOURCES Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. REVIEW METHODS Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. RESULTS Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. LIMITATIONS Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. CONCLUSIONS Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. FUTURE WORK Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041302. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kyla H Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael N Dalili
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Faculty of Life Sciences, School of Psychological Science, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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10
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Cognitive Deficit in Schizophrenia: From Etiology to Novel Treatments. Int J Mol Sci 2021; 22:ijms22189905. [PMID: 34576069 PMCID: PMC8468549 DOI: 10.3390/ijms22189905] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 01/09/2023] Open
Abstract
Schizophrenia is a major mental illness characterized by positive and negative symptoms, and by cognitive deficit. Although cognitive impairment is disabling for patients, it has been largely neglected in the treatment of schizophrenia. There are several reasons for this lack of treatments for cognitive deficit, but the complexity of its etiology-in which neuroanatomic, biochemical and genetic factors concur-has contributed to the lack of effective treatments. In the last few years, there have been several attempts to develop novel drugs for the treatment of cognitive impairment in schizophrenia. Despite these efforts, little progress has been made. The latest findings point to the importance of developing personalized treatments for schizophrenia which enhance neuroplasticity, and of combining pharmacological treatments with non-pharmacological measures.
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11
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Wang Y, van Boven JFM, Bos JHJ, Schuiling-Veninga CCM, Boezen HM, Wilffert B, Hak E. Risk of neuropsychiatric adverse events associated with varenicline treatment for smoking cessation among Dutch population: A sequence symmetry analysis. Pharmacoepidemiol Drug Saf 2021; 31:158-166. [PMID: 34464494 PMCID: PMC9292305 DOI: 10.1002/pds.5351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022]
Abstract
Purpose Varenicline is an effective treatment for smoking cessation. While clinical trials did not confirm a causal role, case reports suggested a possible link of varenicline with neuropsychiatric adverse drug events (NPAEs). This study aims to investigate the risk of NPAEs associated with varenicline initiation among the general population in a real‐world setting. Methods We conducted a sequence symmetry analysis (SSA) based on the University of Groningen IADB.nl prescription database. We selected incident users of both varenicline and marker drugs for NPAEs, including depression, anxiety and sleep disorder within different time‐intervals. Adjusted sequence ratios (aSR) were calculated for each time‐interval. Results Within 365‐days' time‐interval 1066 patients were incident users of both varenicline and NPAE marker drugs. In total, 505 patients were prescribed varenicline before NPAE marker drugs and 561 vice versa (crude sequence ratio [cSR] 0.90, 95% CI: 0.80–1.02). After adjustments for trends in prescriptions, overall a null association was found (aSR 1.00, 95% CI: 0.89–1.13). Regarding specific NPAEs, no increased risks were found for depression nor anxiety within any time‐interval. A small transient increased risk was found for sleep disorders, particularly in earlier time‐intervals 3 and 6 months (aSRs 1.52, 95% CI: 1.10–2.11 and 1.45, 95% CI: 1.15–1.83, respectively). Subgroup and sensitivity analyses showed similar findings. Conclusions Varenicline initiation was unlikely to be associated with an increased risk of taking anti‐depressants nor anti‐anxiety drugs. Yet a small, but statistically significant, transient association with drugs for sleep disorders was noticed, possibly associated with withdrawal symptoms caused by smoking cessation.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Caroff SN, Gutman AR, Northrop J, Leong SH, Berkowitz RM, Campbell EC. Effect of Varenicline on Tardive Dyskinesia: A Pilot Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:355-360. [PMID: 33888664 PMCID: PMC8077061 DOI: 10.9758/cpn.2021.19.2.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023]
Abstract
Objective Although evidence implicates striatal cholinergic impairment as a mechanism underlying tardive dyskinesia, trials of nonspecific cholinergic agents have been inconclusive. As a partial agonist at specific nicotinic receptor subtypes, varenicline reduces drug-induced dyskinesias in animal models suggesting promise as a treatment for tardive dyskinesia. Methods Three schizophrenia patients with tardive dyskinesia who were smokers underwent an open trial of varenicline. After a 2-week baseline, subjects received varenicline 1 mg twice daily. Changes from baseline on the Abnormal Involuntary Movement Scale were measured after a 4-week varenicline stabilization period, and 6 weeks after the smoking quit date in one patient. Results Varenicline had no effect on mean Abnormal Involuntary Movement Scale scores after 4 weeks. Although smoking decreased after 4 weeks on varenicline and diminished further in one patient after 10 weeks, this also appeared to have no effect on ratings of tardive dyskinesia. Conclusion In contrast to animal models, no significant change in tardive dyskinesia occurred in response to varenicline replacement in three schizophrenia patients. Further investigations of cholinergic mechanisms in tardive dyskinesia are worthwhile as agents for specific cholinergic targets become available for treatment. In addition, treatment trials of tardive dyskinesia should control for smoking status, while patients on antipsychotics receiving nicotine replacement therapies for smoking should be studied further for changes in movement.
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Affiliation(s)
- Stanley N Caroff
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alisa R Gutman
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - John Northrop
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Shirley H Leong
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rosalind M Berkowitz
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - E Cabrina Campbell
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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13
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Effectiveness of multimodal interventions focused on smoking cessation in patients with schizophrenia: A systematic review. Schizophr Res 2021; 231:145-153. [PMID: 33857662 DOI: 10.1016/j.schres.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking is a significant risk factor for mortality and morbidity among patients with schizophrenia. OBJECTIVE To clarify the effectiveness of multimodal smoking cessation interventions in adult smokers diagnosed with schizophrenia. METHODS A systematic review was conducted according to PRISMA guidelines. Relevant electronic databases were searched for clinical trials that combined pharmacological and non-pharmacological smoking cessation interventions for patients with schizophrenia, published up to October 2020. Primary outcomes were smoking abstinence and smoking reduction. Secondary outcomes consisted in psychiatric symptoms. RESULTS A final sample of nine articles was obtained from a total of 208 studies. All studies reported higher biochemically validated smoking reduction rates after treatment. However, the majority of the studies reported low smoking abstinence rates, which progressively decreased over time. Multimodal interventions did not worsen psychiatric symptoms. CONCLUSION Evidence suggests that multimodal smoking cessation interventions for individuals diagnosed with schizophrenia should be recommended by clinicians, as they showed to be effective in reducing smoking without worsening psychiatric symptoms. Further studies are needed to understand how interventions can become more effective in helping patients achieve long-term smoking abstinence.
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14
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Komiyama M, Ozaki Y, Miyazaki Y, Yasoda A, Wada H, Yamakage H, Satoh-Asahara N, Morimoto T, Shimatsu A, Takahashi Y, Hasegawa K. Short-term Changes in Self-rating Depression Scale Scores after Smoking Cessation in Neurotic Patients. Intern Med 2021; 60:1175-1181. [PMID: 33055476 PMCID: PMC8112982 DOI: 10.2169/internalmedicine.4868-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective The psychological status is a key factor in smoking continuance. However, details on short-term changes in mild depressive states after smoking cessation (SC) are still unknown. The purpose of the present study was to investigate these short-term changes. Methods A total of 989 patients who visited our SC Clinic were assessed using the Zung Self-Rating-Depression-Scale (SDS), an official instrument to measure depressive tendencies. The participants were classified into normal and neurotic groups based on their SDS scores during their initial visit; they were assessed again 2, 4, 8, and 12 weeks thereafter. Results The majority of patients in the neurotic group were women. These patients were also younger, with a higher nicotine dependence, and presented with a lower successful SC rate than the patients in the normal group. A decrease in SDS scores after starting the SC treatment was observed only in the neurotic group, especially during the first two weeks. In patients who continued to smoke, no improvement in depressive tendencies was noted in this period. Conclusion Depressive tendencies of patients with neurosis improve in the initial stages of the SC treatment (i.e., within two weeks after starting the treatment). This finding fills the mentioned knowledge gap regarding the effects of SC on mild depressive states in the short term.
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Affiliation(s)
- Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yuka Ozaki
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yusuke Miyazaki
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka, Japan
| | - Akihiro Yasoda
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Hiromichi Wada
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Hajime Yamakage
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Noriko Satoh-Asahara
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Tatsuya Morimoto
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka, Japan
| | - Akira Shimatsu
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yuko Takahashi
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Koji Hasegawa
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
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15
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Ioannou M, Foiselle M, Mallet J, Stam EL, Godin O, Dubertret C, Terro E, Sommer IEC, Haarman BCM, Leboyer M, Schoevers RA. Towards precision medicine: What are the stratification hypotheses to identify homogeneous inflammatory subgroups. Eur Neuropsychopharmacol 2021; 45:108-121. [PMID: 33189523 DOI: 10.1016/j.euroneuro.2020.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 12/17/2022]
Abstract
Diverse lines of research testify a link, presumably causal, between immune dysregulation and the development, course and clinical outcome of psychiatric disorders. However, there is a large heterogeneity among the patients' individual immune profile and this heterogeneity prevents the development of precise diagnostic tools and the identification of therapeutic targets. The aim of this review was to delineate possible subgroups of patients on the basis of clinical dimensions, investigating whether they could lead to particular immune signatures and tailored treatments. We discuss six clinical entry points; genetic liability to immune dysregulation, childhood maltreatment, metabolic syndrome, cognitive dysfunction, negative symptoms and treatment resistance. We describe the associated immune signature and outline the effects of anti-inflammatory drugs so far. Finally, we discuss advantages of this approach, challenges and future research directions.
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Affiliation(s)
- M Ioannou
- University of Groningen, University Medical Center Groningen, Research School of Behavioral and Cognitive Neurosciences (BCN), Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Biomedical Sciences, Cells and Systems, Groningen, The Netherlands.
| | - M Foiselle
- Hôpitaux de Paris, Université Paris Est Créteil DMU Impact, Department of Addictology and Psychiatry, Mondor University Hospitals, Créteil, France; INSERM U955, IMRB, Team 15, "Translational NeuroPsychiatry", Créteil, France; Fondation FondaMental, Créteil, France
| | - J Mallet
- Hôpitaux de Paris Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France; Université de Paris, Faculté de médecine, Paris, France; Fondation FondaMental, Créteil, France
| | - E L Stam
- University of Groningen, University Medical Center Groningen, Research School of Behavioral and Cognitive Neurosciences (BCN), Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - O Godin
- INSERM U955, IMRB, Team 15, "Translational NeuroPsychiatry", Créteil, France; Fondation FondaMental, Créteil, France
| | - C Dubertret
- Hôpitaux de Paris Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France; Université de Paris, Faculté de médecine, Paris, France
| | - E Terro
- INSERM U955, IMRB, Team 15, "Translational NeuroPsychiatry", Créteil, France
| | - I E C Sommer
- University of Groningen, University Medical Centre Groningen, Department of Biomedical Sciences, Cells and Systems, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - B C M Haarman
- University of Groningen, University Medical Center Groningen, Research School of Behavioral and Cognitive Neurosciences (BCN), Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - M Leboyer
- Hôpitaux de Paris, Université Paris Est Créteil DMU Impact, Department of Addictology and Psychiatry, Mondor University Hospitals, Créteil, France; INSERM U955, IMRB, Team 15, "Translational NeuroPsychiatry", Créteil, France; Fondation FondaMental, Créteil, France
| | - R A Schoevers
- University of Groningen, University Medical Center Groningen, Research School of Behavioral and Cognitive Neurosciences (BCN), Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Groningen, The Netherlands
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16
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Shortall SE, Brown AM, Newton-Mann E, Dawe-Lane E, Evans C, Fowler M, King MV. Calbindin Deficits May Underlie Dissociable Effects of 5-HT 6 and mGlu 7 Antagonists on Glutamate and Cognition in a Dual-Hit Neurodevelopmental Model for Schizophrenia. Mol Neurobiol 2020; 57:3439-3457. [PMID: 32533466 PMCID: PMC7340678 DOI: 10.1007/s12035-020-01938-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022]
Abstract
Despite several compounds entering clinical trials for the negative and cognitive symptoms of schizophrenia, few have progressed beyond phase III. This is partly attributed to a need for improved preclinical models, to understand disease and enable predictive evaluation of novel therapeutics. To this end, one recent approach incorporates "dual-hit" neurodevelopmental insults like neonatal phencyclidine plus isolation rearing (PCP-Iso). Glutamatergic dysfunction contributes to schizophrenia pathophysiology and may represent a treatment target, so we used enzyme-based microsensors to evaluate basal- and drug-evoked glutamate release in hippocampal slices from rats that received neonatal PCP and/or isolation rearing. 5-HT6 antagonist-evoked glutamate release (thought to be mediated indirectly via GABAergic disinhibition) was reduced in PCP-Iso, as were cognitive effects of a 5-HT6 antagonist in a hippocampal glutamate-dependent novel object discrimination task. Yet mGlu7 antagonist-evoked glutamatergic and cognitive responses were spared. Immunohistochemical analyses suggest these findings (which mirror the apparent lack of clinical response to 5-HT6 antagonists in schizophrenia) are not due to reduced hippocampal 5-HT input in PCP-Iso, but may be explained by reduced calbindin expression. This calcium-binding protein is present in a subset of GABAergic interneurons receiving preferential 5-HT innervation and expressing 5-HT6 receptors. Its loss (in schizophrenia and PCP-Iso) would be expected to reduce interneuron firing and potentially prevent further 5-HT6 antagonist-mediated disinhibition, without impacting on responses of VIP-expressing interneurons to mGlu7 antagonism. This research highlights the importance of improved understanding for selection of appropriate preclinical models, especially where disease neurobiology impacts on cells mediating the effects of potential therapeutics.
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Affiliation(s)
- Sinead E Shortall
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Angus M Brown
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Eliot Newton-Mann
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Erin Dawe-Lane
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Chanelle Evans
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Maxine Fowler
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Madeleine V King
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK.
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17
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Thompson M, Schnoll R, Serrano K, Leone F, Gross R, Collman RG, Ashare RL. The effect of varenicline on mood and cognition in smokers with HIV. Psychopharmacology (Berl) 2020; 237:1223-1231. [PMID: 31938877 PMCID: PMC7125016 DOI: 10.1007/s00213-020-05451-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/02/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE Barriers to smoking cessation, including negative affect and cognitive dysfunction, may contribute to high smoking rates among people living with HIV/AIDS (PLWH). Varenicline may help PLWH quit smoking by improving mood and cognition, yet this has not been explored. OBJECTIVES The goal of this study was to evaluate the effect of varenicline on mood and cognition among PLWH enrolled in a smoking cessation clinical trial. METHODS In this secondary analysis of a varenicline trial (NCT01710137), we assessed mood (depression, anxiety) and cognition (attention, working memory) at weeks 0 (baseline), 1, 3, and 12 (end-of-treatment, EOT). Primary outcomes were changes in mood and cognition from baseline to EOT. Secondarily, mood and cognition were evaluated as predictors of biochemically confirmed 7-day point-prevalence abstinence at EOT. RESULTS Overall, 173 subjects (87 varenicline, 86 placebo) were included. At EOT, varenicline reduced anxiety (P < 0.001), vs. placebo (P = 0.31; interaction P = 0.05). Across both treatment arms, reductions in anxiety from baseline to EOT were associated with a higher likelihood of abstinence (OR = 1.3, 95% CI 1.1 to 1.6, P = 0.01). There were no significant treatment by time interactions for cognition or depression. CONCLUSIONS These data suggest that varenicline operates, at least in part, by reducing anxiety. Anxiety should be an intervention target for smokers with HIV interested in quitting.
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Affiliation(s)
- Morgan Thompson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Robert Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Katrina Serrano
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Frank Leone
- Pulmonary, Allergy, & Critical Care Division, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald G Collman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA.
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18
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Kozak K, George TP. Pharmacotherapy for smoking cessation in schizophrenia: a systematic review. Expert Opin Pharmacother 2020; 21:581-590. [PMID: 32011186 DOI: 10.1080/14656566.2020.1721466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Rates of tobacco smoking are high in people with schizophrenia with greater difficulty of quitting smoking compared to the general population, which also relate to the increased cardiovascular and cancer risks in this co-occurring disorder. Therefore, effective smoking cessation pharmacotherapies addressing tobacco co-morbidity are imperative.Areas covered: In this review, the authors performed an extensive systematic electronic literature review examining the efficacy and safety of first-line pharmacotherapies for smoking cessation, including varenicline, sustained-release bupropion, and nicotine replacement therapies (NRT) using continuous abstinence rates over 10-12-week periods in smokers with schizophrenia. Twelve trials reporting smoking cessation outcomes using interventions in schizophrenia were included and risk ratio (RR) was used.Expert opinion: Our findings support the efficacy and safety of first-line pharmacotherapies for the treatment of tobacco use disorder in smokers with schizophrenia. Further research on the long-term effectiveness and safety of these agents in community samples is warranted. Smoking cessation pharmacotherapies may warrant the consideration of the emerging use of electronic nicotine delivery systems while neuromodulation techniques also offer promise.
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Affiliation(s)
- Karolina Kozak
- Institute of Medical Science (IMS), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Tony P George
- Institute of Medical Science (IMS), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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19
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Kagabo R, Gordon AJ, Okuyemi K. Smoking cessation in inpatient psychiatry treatment facilities: A review. Addict Behav Rep 2020; 11:100255. [PMID: 32467844 PMCID: PMC7244912 DOI: 10.1016/j.abrep.2020.100255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 12/02/2022] Open
Abstract
Smoking rates are high among people with psychiatric illness. Smoking cessation interventions are rarely available in inpatient psychiatry settings. Smokers with psychiatric illness are just as interested in quitting smoking.
Background Tobacco-related diseases are a leading cause of death among individuals with severe mental illness (SMI), yet interventions to address tobacco cessation are rare in inpatient settings where persons with SMI are hospitalized. While cigarette smoking rates have declined in the general population, they remain high in persons with SMI. Inpatient settings would be a prime location to intervene on tobacco consumption among persons with SMI. The objective of this review was to examine evidence of smoking cessation interventions in psychiatric inpatient facilities. Method Using narrative overview guidelines, we searched PubMed, PsycINFO, and CINAHL for smoking cessation RCT studies published between 1950 and 2018. Studies included had to have at least started in inpatient psychiatry settings. Examples of search terms included: smoking cessation in inpatient psychiatry, smoking cessation in inpatient mental health treatment facilities, and smoking cessation and mental health. Results Following the inclusion criteria, eight RCT studies were reviewed. One study was among adolescent psychiatric inpatient smokers ages 13–17, and 7 were among adult psychiatric inpatients with mean age 41 years. Treatment periods lasting 8 to 12 weeks started in inpatient settings and continued post discharge. A combination of behavioral and pharmacological interventions were used. Pharmacological interventions were nicotine replacement therapies, and at least one study used varenicline. At baseline, participants smoked an average of 18.1 cigarettes per day. Conclusion Smoking cessation in inpatient psychiatry settings is rare or delayed. There is a need for more tailored treatments among this population to help them quit smoking.
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Affiliation(s)
- Robert Kagabo
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Corresponding author at: 375 Chipeta Way Ste. A, Salt Lake City, UT 84108, United States.
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Kola Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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20
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Pharmacological enrichment of polygenic risk for precision medicine in complex disorders. Sci Rep 2020; 10:879. [PMID: 31964963 PMCID: PMC6972917 DOI: 10.1038/s41598-020-57795-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/03/2020] [Indexed: 12/29/2022] Open
Abstract
Individuals with complex disorders typically have a heritable burden of common variation that can be expressed as a polygenic risk score (PRS). While PRS has some predictive utility, it lacks the molecular specificity to be directly informative for clinical interventions. We therefore sought to develop a framework to quantify an individual’s common variant enrichment in clinically actionable systems responsive to existing drugs. This was achieved with a metric designated the pharmagenic enrichment score (PES), which we demonstrate for individual SNP profiles in a cohort of cases with schizophrenia. A large proportion of these had elevated PES in one or more of eight clinically actionable gene-sets enriched with schizophrenia associated common variation. Notable candidates targeting these pathways included vitamins, antioxidants, insulin modulating agents, and cholinergic drugs. Interestingly, elevated PES was also observed in individuals with otherwise low common variant burden. The biological saliency of PES profiles were observed directly through their impact on gene expression in a subset of the cohort with matched transcriptomic data, supporting our assertion that this gene-set orientated approach could integrate an individual’s common variant risk to inform personalised interventions, including drug repositioning, for complex disorders such as schizophrenia.
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21
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Varenicline for cognitive impairment in people with schizophrenia: systematic review and meta-analysis. Psychopharmacology (Berl) 2020; 237:11-19. [PMID: 31792645 DOI: 10.1007/s00213-019-05396-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/08/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with schizophrenia frequently have cognitive dysfunction, which does not respond to pharmacological interventions. Varenicline has been identified as a potential treatment option for nicotinic receptor dysfunction with a potential to treat cognitive impairment in schizophrenia. METHODS We conducted a systematic review of Pubmed, Embase, Psycinfo, CINAHL and the Cochrane Schizophrenia Trial Registry for randomised controlled trials of varenicline in people with schizophrenia for cognitive dysfunction. We excluded trials among people with dementia. We then undertook a meta-analysis with the primary outcome of difference in change of cognitive measures between varenicline and placebo as well as secondary outcomes of difference in rates of adverse events. We conducted a sensitivity analysis on smoking status and study duration. RESULTS We included four papers in the meta-analysis (n = 339). Varenicline was not superior to placebo for overall cognition (SMD = -0.022, 95% CI -0.154-0.110; Z = -0.333; p = 0.739), attention (SMD = -0.047, 95% CI -0.199-0.104; Z = -0.613; p = 0.540), executive function (SMD = -0.060, 95% CI -0.469-0.348; Z =- 0.290; p = 0.772) or processing speed (SMD = 0.038, 95% CI -0.232-0.308; Z = 0.279; p = 0.780). There was no difference in psychotic symptoms, but varenicline was associated with higher rates of nausea. Sensitivity analyses for smoking status and study duration did not alter the results. CONCLUSION Within the present literature, varenicline does not appear to be a useful target compound for improving cognitive impairment in schizophrenia. Based on these results, a trial would need over 2500 participants to be powered to show statistically significant findings.
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22
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Pearsall R, Smith DJ, Geddes JR. Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: a systematic review and meta-analysis of randomised trials. BMJ Open 2019; 9:e027389. [PMID: 31784428 PMCID: PMC6924825 DOI: 10.1136/bmjopen-2018-027389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Smoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness. METHOD A systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration's tool for assessing the risk of bias. RESULTS Twenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low. CONCLUSION The new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.
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Affiliation(s)
- Robert Pearsall
- Department of Psychiatry, Monklands Hospital, Airdrie, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
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Positive allosteric modulation of the α7 nicotinic acetylcholine receptor as a treatment for cognitive deficits after traumatic brain injury. PLoS One 2019; 14:e0223180. [PMID: 31581202 PMCID: PMC6776323 DOI: 10.1371/journal.pone.0223180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
Cognitive impairments are a common consequence of traumatic brain injury (TBI). The hippocampus is a subcortical structure that plays a key role in the formation of declarative memories and is highly vulnerable to TBI. The α7 nicotinic acetylcholine receptor (nAChR) is highly expressed in the hippocampus and reduced expression and function of this receptor are linked with cognitive impairments in Alzheimer's disease and schizophrenia. Positive allosteric modulation of α7 nAChRs with AVL-3288 enhances receptor currents and improves cognitive functioning in naïve animals and healthy human subjects. Therefore, we hypothesized that targeting the α7 nAChR with the positive allosteric modulator AVL-3288 would enhance cognitive functioning in the chronic recovery period of TBI. To test this hypothesis, adult male Sprague Dawley rats received moderate parasagittal fluid-percussion brain injury or sham surgery. At 3 months after recovery, animals were treated with vehicle or AVL-3288 at 30 min prior to cue and contextual fear conditioning and the water maze task. Treatment of TBI animals with AVL-3288 rescued learning and memory deficits in water maze retention and working memory. AVL-3288 treatment also improved cue and contextual fear memory when tested at 24 hr and 1 month after training, when TBI animals were treated acutely just during fear conditioning at 3 months post-TBI. Hippocampal atrophy but not cortical atrophy was reduced with AVL-3288 treatment in the chronic recovery phase of TBI. AVL-3288 application to acute hippocampal slices from animals at 3 months after TBI rescued basal synaptic transmission deficits and long-term potentiation (LTP) in area CA1. Our results demonstrate that AVL-3288 improves hippocampal synaptic plasticity, and learning and memory performance after TBI in the chronic recovery period. Enhancing cholinergic transmission through positive allosteric modulation of the α7 nAChR may be a novel therapeutic to improve cognition after TBI.
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Çakici N, van Beveren NJM, Judge-Hundal G, Koola MM, Sommer IEC. An update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis. Psychol Med 2019; 49:2307-2319. [PMID: 31439071 PMCID: PMC6763537 DOI: 10.1017/s0033291719001995] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/04/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accumulating evidence shows that a propensity towards a pro-inflammatory status in the brain plays an important role in schizophrenia. Anti-inflammatory drugs might compensate this propensity. This study provides an update regarding the efficacy of agents with some anti-inflammatory actions for schizophrenia symptoms tested in randomized controlled trials (RCTs). METHODS PubMed, Embase, the National Institutes of Health website (http://www.clinicaltrials.gov), and the Cochrane Database of Systematic Reviews were systematically searched for RCTs that investigated clinical outcomes. RESULTS Our search yielded 56 studies that provided information on the efficacy of the following components on symptom severity: aspirin, bexarotene, celecoxib, davunetide, dextromethorphan, estrogens, fatty acids, melatonin, minocycline, N-acetylcysteine (NAC), pioglitazone, piracetam, pregnenolone, statins, varenicline, and withania somnifera extract. The results of aspirin [mean weighted effect size (ES): 0.30; n = 270; 95% CI (CI) 0.06-0.54], estrogens (ES: 0.78; n = 723; CI 0.36-1.19), minocycline (ES: 0.40; n = 946; CI 0.11-0.68), and NAC (ES: 1.00; n = 442; CI 0.60-1.41) were significant in meta-analysis of at least two studies. Subgroup analysis yielded larger positive effects for first-episode psychosis (FEP) or early-phase schizophrenia studies. Bexarotene, celecoxib, davunetide, dextromethorphan, fatty acids, pregnenolone, statins, and varenicline showed no significant effect. CONCLUSIONS Some, but not all agents with anti-inflammatory properties showed efficacy. Effective agents were aspirin, estrogens, minocycline, and NAC. We observed greater beneficial results on symptom severity in FEP or early-phase schizophrenia.
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Affiliation(s)
- N. Çakici
- Department of Psychiatry and Amsterdam Neuroscience, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Antes Center for Mental Health Care, Albrandswaardsedijk 74, 3172 AA, Poortugaal, the Netherlands
| | - N. J. M. van Beveren
- Antes Center for Mental Health Care, Albrandswaardsedijk 74, 3172 AA, Poortugaal, the Netherlands
- Department of Psychiatry, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
- Department of Neuroscience, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - G. Judge-Hundal
- Antes Center for Mental Health Care, Albrandswaardsedijk 74, 3172 AA, Poortugaal, the Netherlands
- Department of Psychiatry and Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Deusinglaan 2, 9713AW Groningen, the Netherlands
| | - M. M. Koola
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, 2300I St NW, Washington, DC 20052, USA
| | - I. E. C. Sommer
- Department of Psychiatry and Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Deusinglaan 2, 9713AW Groningen, the Netherlands
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Underner M, Perriot J, Brousse G, de Chazeron I, Schmitt A, Peiffer G, Harika-Germaneau G, Jaafari N. Arrêt et réduction du tabac chez le patient souffrant de schizophrénie. L'ENCEPHALE 2019; 45:345-356. [PMID: 31153585 DOI: 10.1016/j.encep.2019.04.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023]
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Butler K, Le Foll B. Impact of Substance Use Disorder Pharmacotherapy on Executive Function: A Narrative Review. Front Psychiatry 2019; 10:98. [PMID: 30881320 PMCID: PMC6405638 DOI: 10.3389/fpsyt.2019.00098] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Substance use disorders are chronic, relapsing, and harmful conditions characterized by executive dysfunction. While there are currently no approved pharmacotherapy options for stimulant and cannabis use disorders, there are several evidence-based options available to help reduce symptoms during detoxification and aid long-term cessation for those with tobacco, alcohol and opioid use disorders. While these medication options have shown clinical efficacy, less is known regarding their potential to enhance executive function. This narrative review aims to provide a brief overview of research that has investigated whether commonly used pharmacotherapies for these substance use disorders (nicotine, bupropion, varenicline, disulfiram, acamprosate, nalmefene, naltrexone, methadone, buprenorphine, and lofexidine) effect three core executive function components (working memory, inhibitory control and cognitive flexibility). While pharmacotherapy-induced enhancement of executive function may improve cessation outcomes in dependent populations, there are limited and inconsistent findings regarding the effects of these medications on executive function. We discuss possible reasons for the mixed findings and suggest some future avenues of work that may enhance the understanding of addiction pharmacotherapy and cognitive training interventions and lead to improved patient outcomes.
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Affiliation(s)
- Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- Alcohol Research and Treatment Clinic, Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Lucatch AM, Lowe DJE, Clark RC, Kozak K, George TP. Neurobiological Determinants of Tobacco Smoking in Schizophrenia. Front Psychiatry 2018; 9:672. [PMID: 30574101 PMCID: PMC6291492 DOI: 10.3389/fpsyt.2018.00672] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose of review: To provide an overview of the underlying neurobiology of tobacco smoking in schizophrenia, and implications for treatment of this comorbidity. Recent findings: Explanations for heavy tobacco smoking in schizophrenia include pro-cognitive effects of nicotine, and remediation of the underlying pathophysiology of schizophrenia. Nicotine may ameliorate neurochemical deficits through nicotine acetylcholine receptors (nAChRs) located on the dopamine, glutamate, and GABA neurons. Neurophysiological indices including electroencephalography, electromyography, and smooth pursuit eye movement (SPEM) paradigms may be biomarkers for underlying neuronal imbalances that contribute to the specific risk of tobacco smoking initiation, maintenance, and difficulty quitting within schizophrenia. Moreover, several social factors including socioeconomic factors and permissive smoking culture in mental health facilities, may contribute to the smoking behaviors (initiation, maintenance, and inability to quit smoking) within this disorder. Summary: Tobacco smoking may alleviate specific symptoms associated with schizophrenia. Understanding the neurobiological underpinnings and psychosocial determinants of this comorbidity may better explain these potential beneficial effects, while also providing important insights into effective treatments for smoking cessation.
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Affiliation(s)
- Aliya M. Lucatch
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Darby J. E. Lowe
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Rachel C. Clark
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Karolina Kozak
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Division and Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Potasiewicz A, Golebiowska J, Popik P, Nikiforuk A. Procognitive effects of varenicline in the animal model of schizophrenia depend on α4β2- and α 7-nicotinic acetylcholine receptors. J Psychopharmacol 2018; 33:269881118812097. [PMID: 30501536 DOI: 10.1177/0269881118812097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Varenicline, a partial agonist of the α4β2 nicotinic acetylcholine receptor (α4β2-nAChR), is currently used to facilitate smoking cessation. Preclinical and clinical studies have suggested that this compound may also be effective in treating cognitive impairments in schizophrenia. However, it is unclear which nicotinic acetylcholine receptor subtypes may be involved because varenicline is not only a partial agonist for α4β2-nAChRs but also a full agonist for α7 nicotinic acetylcholine receptors (α7-nAChRs). AIM We investigated the effects of varenicline, compared to the α4β2-nAChR partial agonist TC-2403 and the α7-nAChR full agonist PNU-282987, in a ketamine-based model of schizophrenia-like cognitive deficits on the attentional set-shifting task in rats. The second goal was to elucidate whether the procognitive efficacy of varenicline was due to the compound's action on α4β2-nAChRs or α7-nAChRs. METHODS Ketamine was administered to rats for 10 consecutive days and the test was performed 14 days following the last injection. The tested compounds were administered 30 min prior to the attentional set-shifting task. RESULTS Varenicline, TC-2403 and PNU-282987 ameliorated ketamine-evoked set-shifting deficits. While the α4β2-nAChR antagonist dihydro-β-erythroidine and the α7-nAChR antagonist methyllycaconitine completely prevented the procognitive actions of TC-2403 and PNU-282987, respectively, varenicline's effect was only partially blocked by any given antagonist. Moreover, the combined treatment with TC-2403 and PNU-282987 more effectively facilitated rats' set-shifting ability than activation of either type of nicotinic acetylcholine receptor alone. CONCLUSION The present findings demonstrated that varenicline's actions on both α7-nAChRs and α4β2-nAChRs may be necessary to produce its full procognitive effect in the present experimental setting.
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Affiliation(s)
- Agnieszka Potasiewicz
- Institute of Pharmacology, Polish Academy of Sciences, Department of Behavioral Neuroscience and Drug Development, Kraków, Poland
| | - Joanna Golebiowska
- Institute of Pharmacology, Polish Academy of Sciences, Department of Behavioral Neuroscience and Drug Development, Kraków, Poland
| | - Piotr Popik
- Institute of Pharmacology, Polish Academy of Sciences, Department of Behavioral Neuroscience and Drug Development, Kraków, Poland
| | - Agnieszka Nikiforuk
- Institute of Pharmacology, Polish Academy of Sciences, Department of Behavioral Neuroscience and Drug Development, Kraków, Poland
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Hidese S, Matsuo J, Ishida I, Hiraishi M, Teraishi T, Ota M, Hattori K, Kunugi H. Association between lower estimated premorbid intelligence quotient and smoking behavior in patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 15:7-13. [PMID: 30310770 PMCID: PMC6176847 DOI: 10.1016/j.scog.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/26/2018] [Accepted: 09/30/2018] [Indexed: 12/18/2022]
Abstract
Aim We aimed to investigate the involvement of premorbid intelligence quotient in higher prevalence of smoking in patients with schizophrenia. Methods Participants included 190 patients with schizophrenia (mean ± standard deviation age: 37.7 ± 10.8 years; 88 males and 102 females) and 312 healthy individuals (mean ± standard deviation age: 38.1 ± 13.8; 166 males and 146 females), matched for age, sex, and ethnicity (Japanese). Premorbid intelligence quotient was estimated using the Japanese Adult Reading Test and distress symptoms were assessed using the Hopkins Symptom Check List. Current smoking information was collected according to self-declarations. Results As expected, the smoking rate was higher, while mean education level and Japanese Adult Reading Test scores were significantly lower, in patients with schizophrenia than in healthy individuals (p < 0.01). The mean education level and Japanese Adult Reading Test scores were significantly lower in the smoker group than in the non-smoker group in both patients and healthy individuals (p < 0.05). In the patient group alone, Hopkins Symptom Check List subscale and total scores were significantly higher in the smoker group than in the non-smoker group (p < 0.05). A multivariate regression analysis showed that the Japanese Adult Reading Test score was a significant and negative predictor for smoking (p < 0.001, odds ratio = 0.97; 95% confidence interval: 0.96–0.99). Conclusion Our results suggest that lower estimated premorbid intelligence quotient is an important variable in elucidating smoking behavior in humans and may be associated with higher prevalence of smoking in patients with schizophrenia. Lower premorbid intelligence quotient (IQ) was observed in patients with schizophrenia who were smokers. Lower education level was observed in patients with schizophrenia who were smokers. Lower premorbid IQ and education level were also seen in smokers in the healthy group. Distress symptoms were higher in smokers with schizophrenia. In total, premorbid IQ was a negative predictor for smoking.
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Key Words
- ANCOVA, Analysis of covariance
- CI, Confidence interval
- Distress symptom
- Education level
- HSCL, Hopkins Symptom Check List
- IQ, Intelligence quotient
- JART, Japanese Adult Reading Test
- MANCOVA, Multivariate analysis of covariance
- NART, National Adult Reading Test
- OR, Odds ratio
- PANSS, Positive and Negative Syndrome Scale
- PSQI, Pittsburgh Sleep Quality Index
- Premorbid intelligence quotient
- Schizophrenia
- Smoking
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Affiliation(s)
- Shinsuke Hidese
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Moeko Hiraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-Higashi, 4-1-1, Kodaira, Tokyo, 187-8502, Japan
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Boggs DL, Surti TS, Esterlis I, Pittman B, Cosgrove K, Sewell RA, Ranganathan M, D’Souza DC. Minimal effects of prolonged smoking abstinence or resumption on cognitive performance challenge the "self-medication" hypothesis in schizophrenia. Schizophr Res 2018; 194:62-69. [PMID: 28392208 PMCID: PMC5630481 DOI: 10.1016/j.schres.2017.03.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 01/22/2023]
Abstract
One prominent, long-standing view is that individuals with schizophrenia smoke cigarettes more than the general population to "self-medicate" cognitive deficits and other symptoms. This study tested the self-medication hypothesis by examining the effects of smoking abstinence and resumption on cognition in patients with schizophrenia. Nicotine-dependent smokers with schizophrenia (n=26) were trained on a cognitive battery and then hospitalized to achieve and maintain confirmed abstinence from smoking for ~1 week. Cognition was tested while smoking as usual (baseline), one day after smoking cessation (early abstinence), ~1 week later (extended abstinence), and within ~3 weeks of resuming smoking (resumption). The test battery included measures of processing speed, attention, conflict resolution, verbal memory, working memory, verbal fluency, and executive function to evaluate multiple cognitive domains affected by schizophrenia. Positive and negative symptoms of schizophrenia, depressive symptoms, and dyskinesia were also measured at baseline and after prolonged abstinence. There were no significant changes in global cognitive test performance with smoking cessation, abstinence, or resumption. There were small decreases in a measure of processing speed and delayed verbal recall with abstinence, but these findings failed to survive adjustments for multiple comparisons. Surprisingly, in this within subject "On-Off-Off-On" design, there were no significant effects of early or prolonged abstinence from smoking on cognitive and behavioral measures in smokers with schizophrenia. The results of this study challenge the widely held "self-medication" hypothesis of smoking and schizophrenia, question the extent of pro-cognitive effects of smoking and nicotine in schizophrenia, and support encouraging smoking cessation in schizophrenia.
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Affiliation(s)
- Douglas L Boggs
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Toral S. Surti
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Kelly Cosgrove
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - R. Andrew Sewell
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Deepak Cyril D’Souza
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
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Shawen AE, Drayton SJ. Review of pharmacotherapy for smoking cessation in patients with schizophrenia. Ment Health Clin 2018; 8:78-85. [PMID: 29955550 PMCID: PMC6007740 DOI: 10.9740/mhc.2018.03.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Smoking cessation is a chronic issue surrounding individuals with schizophrenia. It is estimated that up to 90% of patients diagnosed with schizophrenia smoke cigarettes. The purpose of this article is to provide a nonsystematic review of the efficacy of smoking cessation interventions as well as to explore the potential neuropsychiatric adverse effects of these agents in patients with schizophrenia. Eighteen studies were found and included in the review. Overall, nicotine replacement therapy, bupropion, and varenicline have all proven their effectiveness at either promoting smoking abstinence or a significant reduction in cigarette use.
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Affiliation(s)
- Avery E Shawen
- Student, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina,
| | - Shannon J Drayton
- Associate Professor, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina
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García-Portilla MP, Bobes J. Smoking cessation programs for persons with schizophrenia: An urgent unmet need. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 9:181-184. [PMID: 27969002 DOI: 10.1016/j.rpsm.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 01/19/2023]
Affiliation(s)
- María Paz García-Portilla
- Área de Psiquiatría y Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, Asturias, España
| | - Julio Bobes
- Área de Psiquiatría y Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Oviedo, Oviedo, Asturias, España.
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Theng YM, Wahab S, Wahab NAA, Sidi H, Das S. Schizophrenia and Nicotine Dependence: What Psychopharmacological Treatment Options are Available for the Duo Perturbationes? Curr Drug Targets 2017; 20:173-181. [PMID: 29046149 DOI: 10.2174/1389450118666171017163741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/27/2017] [Accepted: 10/12/2017] [Indexed: 11/22/2022]
Abstract
Nicotine dependence has progressively become a foremost community health interest in both the developed and developing nations due to the economic burden and health-related problems. Smoking was significantly higher among patients with schizophrenia in comparison to the general population. Nicotine dependence is not only associated with public stress, but among patients with schizophrenia, smoking brings major challenges to the management. Nicotine may diminish the therapeutic efficacy of the bioavailability of the psychopharmacological agents in-vivo. These duo perturbations, i.e. two clinical conditions co-existed may prevent psychotic symptoms remission among patients suffering from schizophrenia who smoke at the same time. The aim of this review was to highlight the role of pharmacological treatment options and strategies for patients with nicotine dependence in schizophrenia with emphasis on the underlying neurobiological process. The role of nicotine replacement therapy, i.e. norepinephrine-dopamine reuptake inhibition (NDRI) e.g. bupropion and selective partial agonist of α4β2 and full α7-nicotinic acetylcholine receptor e.g. varenicline was deliberated. An ideal choice of drug targets for patients with schizophrenia with nicotine dependence is pivotal to foster a better therapeutic alliance.
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Affiliation(s)
- Yoong Mei Theng
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Noor Alaudin A Wahab
- Audiology Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
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Predictors of tobacco abstinence in outpatient smokers with schizophrenia or bipolar disorder treated with varenicline and cognitive behavioral smoking cessation therapy. Addict Behav 2017; 71:89-95. [PMID: 28285208 DOI: 10.1016/j.addbeh.2017.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/09/2017] [Accepted: 02/23/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The estimated mortality gap between those with and without serious mental illness (SMI) is increasing, now estimated at 28years, which is largely due to smoking-related diseases. AIMS We sought to identify predictors of 14-day continuous abstinence in stable outpatient smokers with SMI. METHOD Adult smokers with schizophrenia spectrum (n=130) or bipolar disorder (n=23) were enrolled in a 12-week course of varenicline and cognitive-behavioral therapy for smoking cessation. RESULTS Independent predictors of abstinence included reduction in withdrawal symptoms prior to the quit day, fewer cigarettes smoked per day at baseline, better baseline attention, remitted alcohol dependence, and lower expectation of peer support to aid quitting. CONCLUSIONS Interventions that consider these targets may improve smoking cessation outcomes in those with SMI.
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Smoking cessation in severe mental ill health: what works? an updated systematic review and meta-analysis. BMC Psychiatry 2017; 17:252. [PMID: 28705244 PMCID: PMC5513129 DOI: 10.1186/s12888-017-1419-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with severe mental ill health are more likely to smoke than those in the general population. It is therefore important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost -effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings. METHODS This is an update of a previous systematic review. Electronic databases were searched during September 2016 for randomised controlled trials comparing smoking cessation interventions to each other, usual care, or placebo. Data was extracted on biochemically-verified, self-reported smoking cessation (primary outcome), as well as on smoking reduction, body weight, psychiatric symptom, and adverse events (secondary outcomes). RESULTS We included 26 trials of pharmacological and/or behavioural interventions. Eight trials comparing bupropion to placebo were pooled showing that bupropion improved quit rates significantly in the medium and long term but not the short term (short term RR = 6.42 95% CI 0.82-50.07; medium term RR = 2.93 95% CI 1.61-5.34; long term RR = 3.04 95% CI 1.10-8.42). Five trials comparing varenicline to placebo showed that that the addition of varenicline improved quit rates significantly in the medium term (RR = 4.13 95% CI 1.36-12.53). The results from five trials of specialised smoking cessation programmes were pooled and showed no evidence of benefit in the medium (RR = 1.32 95% CI 0.85-2.06) or long term (RR = 1.33 95% CI 0.85-2.08). There was insufficient data to allowing pooling for all time points for varenicline and trials of specialist smoking cessation programmes. Trials suggest few adverse events although safety data were not always reported. Only one pilot study reported cost effectiveness data. CONCLUSIONS Bupropion and varenicline, which have been shown to be effective in the general population, also work for people with severe mental ill health and their use in patients with stable psychiatric conditions. Despite good evidence for the effectiveness of smoking cessation interventions for people with severe mental ill health, the percentage of people with severe mental ill health who smoke remains higher than that for the general population.
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Cather C, Hoeppner S, Pachas G, Pratt S, Achtyes E, Cieslak KM, Evins AE. Improved Depressive Symptoms in Adults with Schizophrenia During a Smoking Cessation Attempt with Varenicline and Behavioral Therapy. J Dual Diagn 2017; 13:168-178. [PMID: 28414583 DOI: 10.1080/15504263.2017.1319585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Smoking prevalence rates are elevated in individuals with schizophrenia spectrum disorders (SSD) compared with the general population, with attendant disproportionate smoking-related morbidity and mortality. Pharmacotherapies that improve abstinence rates in this population are underutilized, partly due to concerns about neuropsychiatric safety, particularly for those with comorbid depression or prior suicide attempt. Prospective assessment of the psychiatric safety profile of varenicline in those with SSD is needed. METHODS Adult smokers with SSD entered a 12-week trial of varenicline and behavioral therapy for smoking cessation. Depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS) at baseline and weekly thereafter. Participants with baseline and one or more postbaseline CDSS assessments, n = 179, were included in a secondary analysis of change in depressive symptoms with varenicline treatment, adjusting for abstinence status and baseline depressive symptoms. RESULTS Twenty-seven percent of participants had a CDSS score at baseline consistent with current major depressive disorder, and more than half had a prior suicide attempt. Forty-one percent (74/179) achieved two or more weeks of continuous abstinence at the end of treatment. CDSS scores declined 31% during the 12-week treatment period. Controlling for baseline CDSS scores, depressive symptoms declined over time in those who completed the trial, independent of abstinence status, and either declined or remained unchanged in those with major depressive disorder or prior suicide attempt or who were taking antidepressant medication. Those who did not complete the trial had no change in depressive symptoms. DISCUSSION Depressive symptoms declined in adults with schizophrenia during 12 weeks of varenicline treatment and cognitive behavioral therapy, independent of tobacco abstinence. Smokers with SSD who have significant depressive symptoms may be successful in smoking cessation attempts with pharmacotherapeutic aids such as varenicline while maintaining stable psychiatric symptoms. This is a secondary analysis of data collected as part of a clinical trial registered as NCT00621777, at www.clinicaltrials.gov .
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Affiliation(s)
- Corinne Cather
- a Center for Addiction Medicine, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
| | - Susanne Hoeppner
- a Center for Addiction Medicine, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Gladys Pachas
- a Center for Addiction Medicine, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
| | - Sarah Pratt
- c Geisel School of Medicine , Dartmouth University , Concord , New Hampshire , USA
| | - Eric Achtyes
- d Cherry Health and Michigan State University College of Human Medicine , Grand Rapids , Michigan , USA
| | - Kristina M Cieslak
- a Center for Addiction Medicine, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
| | - A Eden Evins
- a Center for Addiction Medicine, Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
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Evins AE, Hoeppner SS, Schoenfeld DA, Hoeppner BB, Cather C, Pachas GN, Cieslak KM, Maravic MC. Maintenance pharmacotherapy normalizes the relapse curve in recently abstinent tobacco smokers with schizophrenia and bipolar disorder. Schizophr Res 2017; 183:124-129. [PMID: 27956009 PMCID: PMC5432398 DOI: 10.1016/j.schres.2016.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effect of maintenance pharmacotherapy on sustained abstinence rates between recently abstinent smokers with schizophrenia and bipolar disorder (SBD) and general population smokers without psychiatric illness. METHOD We performed a person-level, pooled analysis of two randomized controlled trials of maintenance varenicline, conducted in adult smokers with SBD and general population smokers, controlling for severity of dependence. Smokers abstinent after 12-weeks of open varenicline treatment were randomly assigned to ≥12-weeks maintenance varenicline or identical placebo. RESULTS In those assigned to maintenance placebo, the abstinence rate at week-24 was lower in those with SBD than for those without psychiatric illness (29.4±1.1% vs. 61.8±0.4%, OR:0.26, 95% CI: 0.13, 0.52, p<0.001). In smokers assigned to maintenance pharmacotherapy, however, there was no effect of diagnosis on abstinence rates at week-24 (87.2±0.8% vs. 81.9±0.2%, OR: 1.68, 95% CI: 0.53, 5.32, p=0.38). Time to first lapse was shortest in those with SBD assigned to maintenance placebo (Q1=12days, 95%CI: 4, 16), longer in those without psychiatric illness assigned to maintenance placebo (Q1=17days, 95%CI: 17, 29), still longer in general-population smokers assigned to maintenance varenicline (Q1=88, 95% CI:58,91, and longest in those with SBD who received maintenance varenicline (Q1>95days, 95%CI:non-est), (Χ23df=96.99, p<0.0001; all pairwise comparisons p<0.001). CONCLUSIONS Following a standard 12-week course of pharmacotherapy, people with schizophrenia and bipolar disorder were more likely to relapse to smoking without maintenance varenicline treatment. Maintenance pharmacotherapy could improve longer-term tobacco abstinence rates and reduce known smoking-related health disparities in those with SMI.
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Affiliation(s)
- A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A. Schoenfeld
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bettina B. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gladys N. Pachas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kristina M. Cieslak
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Melissa Culhane Maravic
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Lewis AS, van Schalkwyk GI, Bloch MH. Alpha-7 nicotinic agonists for cognitive deficits in neuropsychiatric disorders: A translational meta-analysis of rodent and human studies. Prog Neuropsychopharmacol Biol Psychiatry 2017; 75:45-53. [PMID: 28065843 PMCID: PMC5446073 DOI: 10.1016/j.pnpbp.2017.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 12/24/2016] [Accepted: 01/03/2017] [Indexed: 12/28/2022]
Abstract
Cognitive dysfunction in schizophrenia (SCZ) and Alzheimer's disease (AD) is a major driver of functional disability but is largely unresponsive to current therapeutics. Animal models of cognitive dysfunction relevant to both disorders suggest the α7 nicotinic acetylcholine receptor (nAChR) may be a promising drug development target, with multiple clinical trials subsequently testing this hypothesis in individuals with SCZ and AD. However, the translational value of rodent cognitive tasks for predicting the overall efficacy of this therapeutic target in clinical trials is unknown. To compare effect sizes between rodent and human studies, we searched PubMed and the Cochrane Library for all randomized, placebo-controlled trials of compounds with pharmacological activity at the α7 nAChR for treatment of cognitive dysfunction in SCZ and AD and identified 18 studies comprising 2670 subjects treated with eight different compounds acting as full or partial agonists. Cognitive outcomes were standardized, and random-effects meta-analyses revealed no statistically significant effects of α7 nAChR agonists on overall cognition or any of eight cognitive subdomains when all doses were included (Range of all cognitive outcomes: Cohen's d=-0.077 to 0.12, negative favoring drug). In contrast, analysis of 29 rodent studies testing the same α7 agonists revealed large effect sizes in multiple commonly used preclinical behavioral tests of cognition (Range: d=-1.18 to - 0.73). Our results suggest that targeting the α7 nAChR with agonists is not a robust treatment for cognitive dysfunction in SCZ or AD and necessitate a better understanding of the translational gap for therapeutics targeting the α7 nAChR.
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Affiliation(s)
- Alan S. Lewis
- Department of Psychiatry, Yale University, 34 Park Street, 3rd Floor, Research, New Haven, CT 06508, United States,Corresponding author at: 34 Park Street, 3rd Floor, Research, New Haven, CT 06508, United States. (A.S. Lewis)
| | | | - Michael H. Bloch
- Yale Child Study Center, 230 S. Frontage Road, New Haven, CT 06520, United States
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McGregor AL, D'Souza G, Kim D, Tingle MD. Varenicline improves motor and cognitive deficits and decreases depressive-like behaviour in late-stage YAC128 mice. Neuropharmacology 2017; 116:233-246. [DOI: 10.1016/j.neuropharm.2016.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 02/03/2023]
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Peterson DJ, Gill WD, Dose JM, Hoover DB, Pauly JR, Cummins ED, Burgess KC, Brown RW. The effects of nicotine in the neonatal quinpirole rodent model of psychosis: Neural plasticity mechanisms and nicotinic receptor changes. Behav Brain Res 2017; 325:17-24. [PMID: 28235586 DOI: 10.1016/j.bbr.2017.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 01/06/2023]
Abstract
Neonatal quinpirole (NQ) treatment to rats increases dopamine D2 receptor sensitivity persistent throughout the animal's lifetime. In Experiment 1, we analyzed the role of α7 and α4β2 nicotinic receptors (nAChRs) in nicotine behavioral sensitization and on the brain-derived neurotrophic factor (BDNF) response to nicotine in NQ- and neonatally saline (NS)-treated rats. In Experiment 2, we analyzed changes in α7 and α4β2 nAChR density in the nucleus accumbens (NAcc) and dorsal striatum in NQ and NS animals sensitized to nicotine. Male and female Sprague-Dawley rats were neonatally treated with quinpirole (1mg/kg) or saline from postnatal days (P)1-21. Animals were given ip injections of either saline or nicotine (0.5mg/kg free base) every second day from P33 to P49 and tested on behavioral sensitization. Before each injection, animals were ip administered the α7 nAChR antagonist methyllycaconitine (MLA; 2 or 4mg/kg) or the α4β2 nAChR antagonist dihydro beta erythroidine (DhβE; 1 or 3mg/kg). Results revealed NQ enhanced nicotine sensitization that was blocked by DhβE. MLA blocked the enhanced nicotine sensitization in NQ animals, but did not block nicotine sensitization. NQ enhanced the NAcc BDNF response to nicotine which was blocked by both antagonists. In Experiment 2, NQ enhanced nicotine sensitization and enhanced α4β2, but not α7, nAChR upregulation in the NAcc. These results suggest a relationship between accumbal BDNF and α4β2 nAChRs and their role in the behavioral response to nicotine in the NQ model which has relevance to schizophrenia, a behavioral disorder with high rates of tobacco smoking.
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Affiliation(s)
- Daniel J Peterson
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, United States
| | - W Drew Gill
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, United States
| | - John M Dose
- Department of Psychology, St. Norbert College, De Pere, WI, 54115,United States
| | - Donald B Hoover
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, United States
| | - James R Pauly
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY 40536, United States
| | - Elizabeth D Cummins
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, United States
| | - Katherine C Burgess
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, United States
| | - Russell W Brown
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, United States.
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Harvey PD, Sand M. Pharmacological Augmentation of Psychosocial and Remediation Training Efforts in Schizophrenia. Front Psychiatry 2017; 8:177. [PMID: 28993740 PMCID: PMC5622160 DOI: 10.3389/fpsyt.2017.00177] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022] Open
Abstract
Pharmacological approaches to cognitive enhancement have received considerable attention but have not had considerable success in improving their cognitive and functional targets. Other intervention strategies, such as cognitive remediation therapy (CRT), have been shown to enhance cognitive performance but have not been found to improve functional outcomes without additional psychosocial interventions. Recently, several studies have attempted to enhance the effects of CRT by adding pharmacological interventions to the CRT treatments. In addition, as CRT has been shown to synergistically improve the effects of psychosocial interventions, the combination of pharmacological therapies aimed at cognition and psychosocial interventions may itself provide a promising strategy for improving functional outcomes. This review and commentary examines the current state of interventions combining CRT and psychosocial treatments with pharmacological augmentation. Our focus is on the specific level of effect of the pharmacological intervention, which could be enhancing motivation, training efficiency, or the consolidation of therapeutic gains. Different pharmacological strategies (e.g., stimulants, plasticity-inducing agents, or attentional or alertness enhancers) may have the potential to lead to different types of gains when combined with CRT or psychosocial interventions. The relative potential of these different mechanisms for immediate and durable effects is considered.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States
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Effects of varenicline on motor cortical plasticity in non-smokers with schizophrenia. Schizophr Res 2016; 178:50-55. [PMID: 27613505 DOI: 10.1016/j.schres.2016.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nicotinic acetylcholine receptors (nAChR) have been implicated in the pathophysiology of schizophrenia, and deficits in this system may contribute to high rates of cigarette smoking in this population. nAChR stimulation may modulate neuroplasticity, or long-term potentiation (LTP), which is a key mediator of cognitive performance. Varenicline is a nAChR partial agonist that may improve cognitive deficits in both smokers and non-smokers with schizophrenia; however, the mechanism by which varenicline alters cognition in schizophrenia remains unclear. Thus, the aim of this randomized, double-blind, placebo-controlled, crossover study was to determine the effects of varenicline on LTP-like plasticity indexed through transcranial magnetic stimulation (TMS) in non-smokers with schizophrenia. METHODS Varenicline (0.5mg BID × 5 doses) or placebo was administered to 9 non-smokers with schizophrenia and 10 non-smoker healthy subjects. LTP-like plasticity was induced by TMS and paired associative stimulation (PAS) at 0.1Hz to the left motor cortex and measured every 15min for two hours post-PAS. RESULTS There was a significant diagnosis × medication interaction on peak potentiation (F (3, 34)=6.04, p<0.02) and post-hoc analyses indicated that varenicline significantly increased LTP in schizophrenia and decreased LTP in healthy subjects. CONCLUSIONS These preliminary findings suggest that varenicline may produce differential effects in non-smoking schizophrenia compared to control subjects. Given the role of LTP in learning and memory, these observations may suggest the potential for varenicline in the treatment of cognitive deficits in patients with schizophrenia.
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Jeon DW, Shim JC, Kong BG, Moon JJ, Seo YS, Kim SJ, Oh MK, Jung DU. Adjunctive varenicline treatment for smoking reduction in patients with schizophrenia: A randomized double-blind placebo-controlled trial. Schizophr Res 2016; 176:206-211. [PMID: 27543252 DOI: 10.1016/j.schres.2016.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Smoking is more common among patients with schizophrenia than it is in the general population. Varenicline, a partial and full agonist at the α4β2 and α7 nicotine acetylcholine receptors, respectively, has been shown to be an effective anti-smoking treatment. This study examined the effects of varenicline treatment on smoking reduction in patients with schizophrenia. METHODS Sixty smokers with schizophrenia were recruited and randomized to receive either varenicline or placebo. Smoking behavior was assessed with the Minnesota Nicotine Withdrawal Scale (mNWS), Brief Questionnaire of Smoking Urge (QSU-brief), and Modified Cigarette Evaluation Questionnaire (mCEQ). Exhaled carbon monoxide was also measured to assess smoking dependency and status. Data were analyzed with the two-tailed Student's t-test, χ(2) test, and repeated measures ANOVA. RESULTS During the 8-week study, there was a significant time×group interaction, which showed that smoking decreased over time in the varenicline group. Expired CO levels also decreased in the varenicline group, showing a significant time effect, group effect, and time×group interaction. Total mCEQ scores decreased in the varenicline group, demonstrating a significant time×group interaction. Among the five domains of the mCEQ, the smoking satisfaction, psychological reward, and enjoyment of respiratory tract sensation domains showed significant time×group interactions in the varenicline group. The QSU-brief and mNWS demonstrated a significant time effect, but not significant time×group interactions. Adjunctive varenicline treatment with antipsychotics was generally well-tolerated and safe. CONCLUSIONS Varenicline showed significant efficacy in reducing smoking in people with schizophrenia.
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Affiliation(s)
- Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Joo-Cheol Shim
- Shim Joo Cheol Psychiatry Clinic, Busan, Republic of Korea.
| | - Bo-Geum Kong
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Young-Soo Seo
- Department of Psychiatry, Sharing and Happiness Hospital, Busan, Republic of Korea.
| | - Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Min-Kyung Oh
- Department of Clinical Pharmacology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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McClure JB, Anderson ML, Bradley K, An LC, Catz SL. Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study. JMIR Mhealth Uhealth 2016; 4:e94. [PMID: 27489247 PMCID: PMC4989120 DOI: 10.2196/mhealth.6002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/27/2016] [Accepted: 07/20/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested. OBJECTIVE To assess feasibility and acceptability of the My Mobile Advice Program (MyMAP) smoking cessation program and estimate its effects on smoking cessation and medication adherence to inform future research planning. METHODS Sixty-six smokers ready to quit were recruited from a large regional health care system and randomized to one of two mHealth programs: (1) standard self-help including psychoeducational materials and guidance how to quit smoking or (2) an adaptive and interactive program consisting of the same standard mHealth self-help content as controls received plus a) real-time, adaptively tailored advice for managing nicotine withdrawal symptoms and medication side-effects and b) asynchronous secure messaging with a cessation counselor. Participants in both arms were also prescribed a 12-week course of varenicline. Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3 months post-TQD, and 5 months post-TQD. Indices of program feasibility and acceptability included acceptability ratings, utilization metrics including use of each MyMAP program component (self-help content, secure messaging, and adaptively tailored advice), and open-ended feedback from participants. Smoking abstinence and medication adherence were also assessed to estimate effects on these treatment outcomes. RESULTS Utilization data indicated the MyMAP program was actively used, with higher mean program log-ins by experimental than control participants (10.6 vs 2.7, P<.001). The majority of experimental respondents thought the MyMAP program could help other people quit smoking (22/24, 92%) and consistently take their stop-smoking medication (17/22, 97%) and would recommend the program to others (20/23, 87%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67%) of experimental participants and three-quarters (25/33, 76%) of controls prematurely discontinued their varenicline use (P=.29). CONCLUSIONS The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program's effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted. CLINICALTRIAL ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj).
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van Amelsvoort T, Hernaus D. Effect of Pharmacological Interventions on the Fronto-Cingulo-Parietal Cognitive Control Network in Psychiatric Disorders: A Transdiagnostic Systematic Review of fMRI Studies. Front Psychiatry 2016; 7:82. [PMID: 27242552 PMCID: PMC4870274 DOI: 10.3389/fpsyt.2016.00082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/26/2016] [Indexed: 01/10/2023] Open
Abstract
Executive function deficits, such as working memory, decision-making, and attention problems, are a common feature of several psychiatric disorders for which no satisfactory treatment exists. Here, we transdiagnostically investigate the effects of pharmacological interventions (other than methylphenidate) on the fronto-cingulo-parietal cognitive control network, in order to identify functional brain markers for future procognitive pharmacological interventions. Twenty-nine manuscripts investigated the effect of pharmacological treatment on executive function-related brain correlates in psychotic disorders (n = 11), depression (n = 4), bipolar disorder (n = 4), ADHD (n = 4), OCD (n = 2), smoking dependence (n = 2), alcohol dependence (n = 1), and pathological gambling (n = 1). In terms of impact on the fronto-cingulo-parietal network, the preliminary evidence for catechol-O-methyl-transferase inhibitors, nicotinic receptor agonists, and atomoxetine was relatively consistent, the data for atypical antipsychotics and anticonvulsants moderate, and interpretation of the data for antidepressants was hampered by the employed study designs. Increased activity in task-relevant areas and decreased activity in task-irrelevant areas were the most common transdiagnostic effects of pharmacological treatment. These markers showed good positive and moderate negative predictive value. It is concluded that fronto-cingulo-parietal activity changes can serve as a marker for future procognitive interventions. Future recommendations include the use of randomized double-blind designs and selective cholinergic and glutamatergic compounds.
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Affiliation(s)
- Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University , Maastricht , Netherlands
| | - Dennis Hernaus
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, School for Mental Health and NeuroScience MHeNS Maastricht University , Maastricht , Netherlands
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