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Szerman N, Parro C, Vega P, Basurte-Villamor I, Ruiz-Veguilla M. Tobacco use disorder in patients with other mental disorders: a dual disorder perspective from clinical neuroscience. Front Psychiatry 2024; 15:1427561. [PMID: 39465048 PMCID: PMC11502350 DOI: 10.3389/fpsyt.2024.1427561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 09/17/2024] [Indexed: 10/29/2024] Open
Abstract
Tobacco smoking is the leading cause of disability and preventable deaths worldwide, but it should be differentiated from tobacco use disorder, which is, according to the Diagnostic and Statistical Manual of Mental Disorders, a bona fide mental disorder. The rapid delivery of nicotine to the brain activates acetylcholine receptors and stimulates the release of dopamine, both systems implicated in other mental disorders. Rates of tobacco use disorder are much higher among people suffering from other mental disorders and these patients find it more difficult to quit. Dual disorders, from a transdiagnostic perspective, identify patients with substance use disorder, in this case tobacco use disorder, and other mental disorders. A dual disorder is a complex clinical condition that is often underdiagnosed, undertreated, and difficult to manage. Appropriate and integrated tobacco use disorder treatment programs for people also suffering from other mental disorders could improve outcomes. Bio-psycho-social approaches to tobacco use disorder include specific biological treatments (e.g., bupropion, varenicline, cytisine, nicotine replacement therapy or deep trans-magnetic stimulation). However, these treatments don't have the same outcomes in patients with dual disorders. Therefore, as in other dual disorders, harm reduction measures, such as vaping nicotine through electronic cigarettes or tobacco replacement therapies should be considered as alternative tools for dual tobacco use disorder management. These clinical considerations emerge from a narrative literature review and expert consensus and will specifically address considerations for changes in clinical practice to improve the treatment of tobacco use disorder and other mental disorders.
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Affiliation(s)
- Nestor Szerman
- World Association of Dual Disorders, WPA Section on Dual Disorders, Madrid, Spain
- Institute of Psychiatry and Mental Health, Gregorio Marañón University Hospital, Madrid, Spain
| | - Carlos Parro
- Institute of Psychiatry and Mental Health, Gregorio Marañón University Hospital, Madrid, Spain
| | - Pablo Vega
- Institute for Addictions, Madrid Salud, Madrid City Council, Madrid, Spain
| | | | - Miguel Ruiz-Veguilla
- Virgen del Rocío Hospital, IBIS Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain
- University of Seville, Seville, Spain
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Martínez-Cao C, García-Fernández A, González-Blanco L, Sáiz PA, Bobes J, García-Portilla MP. Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment? Schizophr Res Cogn 2024; 37:100317. [PMID: 38745931 PMCID: PMC11092394 DOI: 10.1016/j.scog.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Background Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function. Methods A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions. Results The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = -11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = -1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p < 0.001) and cigarettes per day (B = 1.331, p < 0.001) predicted a better global cognitive score. Conclusion This study identified specific predictors of global cognition in schizophrenia, with anticholinergic burden emerging as the strongest factor. Our findings underscore the importance of considering the anticholinergic burden of treatments, in addition to negative symptoms, when designing interventions to optimize or maintain cognitive function in patients with schizophrenia.
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Affiliation(s)
- Clara Martínez-Cao
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
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Asmita, Patil PS, Sahu N. Evaluating the Impact of Motivational Enhancement Therapy on Tobacco Cessation in Schizophrenia: A Comprehensive Review. Cureus 2024; 16:e70046. [PMID: 39469376 PMCID: PMC11516333 DOI: 10.7759/cureus.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/22/2024] [Indexed: 10/30/2024] Open
Abstract
Tobacco use is markedly prevalent among individuals with schizophrenia, presenting significant challenges to their physical health and psychiatric treatment. This comprehensive review evaluates the impact of motivational enhancement therapy (MET) on tobacco cessation in this population. Schizophrenia, a chronic mental disorder characterized by symptoms such as delusions and hallucinations, is frequently accompanied by high rates of smoking, which exacerbates health risks and complicates treatment regimens. MET, a client-centered approach rooted in motivational interviewing, aims to enhance intrinsic motivation for behavior change through empathetic and non-confrontational therapeutic sessions. This review synthesizes evidence from clinical studies on MET's effectiveness in promoting smoking cessation among individuals with schizophrenia. The review highlights the therapy's strengths, including its adaptability and client-focused nature, which are particularly beneficial for addressing the unique challenges faced by this population. It also discusses the broader health benefits of smoking cessation, such as improved physical health and enhanced efficacy of psychiatric medications. Despite promising results, the review identifies limitations and challenges in applying MET, such as potential barriers to implementation and the need for further research. In conclusion, MET offers a valuable intervention for tobacco cessation in individuals with schizophrenia, with the potential to significantly improve health outcomes and quality of life. Future research should focus on optimizing MET strategies and exploring their broader impacts on this vulnerable population.
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Affiliation(s)
- Asmita
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pradeep S Patil
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Namita Sahu
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhang K, Ren YQ, Xue Y, Duan D, Zhou T, Ding YZ, Li X, Gong WK, Guan JQ, Ma L. Alpha 2-adrenoceptor participates in anti-hyperalgesia by regulating metabolic demand. Front Pharmacol 2024; 15:1359319. [PMID: 38584597 PMCID: PMC10996398 DOI: 10.3389/fphar.2024.1359319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/20/2024] [Indexed: 04/09/2024] Open
Abstract
The α2-adrenoceptor agonist dexmedetomidine is a commonly used drug for sedatives in clinics and has analgesic effects; however, its mechanism of analgesia in the spine remains unclear. In this study, we systematically used behavioural and transcriptomic sequencing, pharmacological intervention, electrophysiological recording and ultrasound imaging to explore the analgesic effects of the α2-adrenoceptor and its molecular mechanism. Firstly, we found that spinal nerve injury changed the spinal transcriptome expression, and the differential genes were mainly related to calcium signalling and tissue metabolic pathways. In addition, α2-adrenoceptor mRNA expression was significantly upregulated, and α2-adrenoceptor was significantly colocalised with markers, particularly neuronal markers. Intrathecal dexmedetomidine suppressed neuropathic pain and acute inflammatory pain in a dose-dependent manner. The transcriptome results demonstrated that the analgesic effect of dexmedetomidine may be related to the modulation of neuronal metabolism. Weighted gene correlation network analysis indicated that turquoise, brown, yellow and grey modules were the most correlated with dexmedetomidine-induced analgesic effects. Bioinformatics also annotated the involvement of metabolic processes and neural plasticity. A cardiovascular-mitochondrial interaction was found, and ultrasound imaging revealed that injection of dexmedetomidine significantly enhanced spinal cord perfusion in rats with neuropathic pain, which might be regulated by pyruvate dehydrogenase kinase 4 (pdk4), cholesterol 25-hydroxylase (ch25 h) and GTP cyclohydrolase 1 (gch1). Increasing the perfusion doses of dexmedetomidine significantly suppressed the frequency and amplitude of spinal nerve ligation-induced miniature excitatory postsynaptic currents. Overall, dexmedetomidine exerts analgesic effects by restoring neuronal metabolic processes through agonism of the α2-adrenoceptor and subsequently inhibiting changes in synaptic plasticity.
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Affiliation(s)
- Ke Zhang
- Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Qing Ren
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Xue
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongxia Duan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Zhou
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Zhuo Ding
- Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Department of Pharmacy, Shanghai, China
| | - Xiang Li
- Department of Orthopedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wan-Kun Gong
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiao-Qiong Guan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Ma
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Molnár H, Marosi C, Becske M, Békési E, Farkas K, Stefanics G, Czigler I, Csukly G. A comparison of visual and acoustic mismatch negativity as potential biomarkers in schizophrenia. Sci Rep 2024; 14:992. [PMID: 38200103 PMCID: PMC10782025 DOI: 10.1038/s41598-023-49983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Mismatch negativity (MMN) is an event-related potential (ERP) component generated when an unexpected deviant stimulus occurs in a pattern of standard stimuli. Several studies showed that the MMN response to both auditory and visual stimuli is attenuated in schizophrenia. While previous studies investigated auditory and visual MMN in different cohorts, here we examined the potential clinical utility of MMN responses to auditory and visual stimuli within the same group of patients. Altogether 39 patients with schizophrenia and 39 healthy controls matched in age, gender, and education were enrolled. We recorded EEG using 64 channels in eight experimental blocks where we presented auditory and visual stimulus sequences. Mismatch responses were obtained by subtracting responses to standard from the physically identical deviant stimuli. We found a significant MMN response to the acoustic stimuli in the control group, whereas no significant mismatch response was observed in the patient group. The group difference was significant for the acoustic stimuli. The 12 vane windmill pattern evoked a significant MMN response in the early time window in the control group but not in the patient group. The 6 vane windmill pattern evoked MMN only in the patient group. However, we found no significant difference between the groups. Furthermore, we found no correlation between the clinical variables and the MMN amplitudes. Our results suggest that predictive processes underlying mismatch generation in patients with schizophrenia may be more affected in the acoustic compared to the visual domain. Acoustic MMN tends to be a more promising biomarker in schizophrenia.
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Affiliation(s)
- Hajnalka Molnár
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Csilla Marosi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Melinda Becske
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Emese Békési
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Kinga Farkas
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gábor Stefanics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - István Czigler
- Institute of Cognitive Neuroscience and Psychology, RCNS, HU-RES, Budapest, Hungary
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
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Dopamine, Psychosis, and Symptom Fluctuation: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10091713. [PMID: 36141325 PMCID: PMC9498563 DOI: 10.3390/healthcare10091713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
It has been hypothesized since the 1960s that the etiology of schizophrenia is linked to dopamine. In the intervening 60 years, sophisticated brain imaging techniques, genetic/epigenetic advances, and new experimental animal models of schizophrenia have transformed schizophrenia research. The disease is now conceptualized as a heterogeneous neurodevelopmental disorder expressed phenotypically in four symptom domains: positive, negative, cognitive, and affective. The aim of this paper is threefold: (a) to review recent research into schizophrenia etiology, (b) to review papers that elicited subjective evidence from patients as to triggers and repressors of symptoms such as auditory hallucinations or paranoid thoughts, and (c) to address the potential role of dopamine in schizophrenia in general and, in particular, in the fluctuations in schizophrenia symptoms. The review also includes new discoveries in schizophrenia research, pointing to the involvement of both striatal neurons and glia, signaling pathway convergence, and the role of stress. It also addresses potential therapeutic implications. We conclude with the hope that this paper opens up novel avenues of research and new possibilities for treatment.
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