1
|
Verplaetse TL, Weinberger AH, Ashare RL, Pittman BP, Shi JM, Tetrault JM, Lavery M, McKee SA. Pilot investigation of the effect of carvedilol on stress-precipitated smoking-lapse behavior. J Psychopharmacol 2018; 32:1003-1009. [PMID: 29692206 PMCID: PMC6258014 DOI: 10.1177/0269881118767647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Separate α1- and β-adrenergic antagonists have shown efficacy in reducing nicotine-motivated behaviors in rodents and humans, supporting a role for the noradrenergic system in mediating the reinforcing properties of drugs of abuse. However, the effect of the combined α1- and β-adrenergic antagonist, carvedilol, on stress-related smoking is unknown. METHODS Using a well-established human laboratory model of stress-precipitated smoking-lapse behavior, we examined whether carvedilol (0 or 50 mg/day; between subject, n=17 per group), administered to steady-state, would attenuate the ability to resist smoking following stress imagery (vs. neutral imagery) and reduce subsequent smoking self-administration in nicotine-deprived smokers ( n = 34 total). Tobacco craving, withdrawal, and physiologic reactivity were also assessed. RESULTS Latency to start smoking and number of cigarettes smoked during the self-administration period did not differ by medication condition. Counter to our hypothesis, tobacco craving demonstrated a medication × time effect, with greater craving in the carvedilol condition. Systolic blood pressure and heart rate demonstrated lower values in the carvedilol versus placebo group, consistent with known effects of carvedilol. CONCLUSION While carvedilol attenuated physiologic reactivity consistent with its clinical indication, beneficial effects on smoking outcomes were absent in this preliminary investigation and may suggest possible worsening. Future work may benefit from discerning the single versus combined effects of α1- and β-adrenergic antagonism on smoking outcomes.
Collapse
Affiliation(s)
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rebecca L. Ashare
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Brian P. Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Julia M. Shi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeanette M. Tetrault
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Meaghan Lavery
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Correspondence to: Sherry McKee, PhD, 2 Church Street South, Suite 109, Yale University School of Medicine, New Haven, CT 06519; Tele: 203.737.3529 Fax: 203.737-4243
| |
Collapse
|
2
|
Sandiego CM, Matuskey D, Lavery M, McGovern E, Huang Y, Nabulsi N, Ropchan J, Picciotto MR, Morris ED, McKee SA, Cosgrove KP. The Effect of Treatment with Guanfacine, an Alpha2 Adrenergic Agonist, on Dopaminergic Tone in Tobacco Smokers: An [ 11C]FLB457 PET Study. Neuropsychopharmacology 2018; 43:1052-1058. [PMID: 28944773 PMCID: PMC5854798 DOI: 10.1038/npp.2017.223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Abstract
Guanfacine, a noradrenergic alpha2a agonist, reduced tobacco smoking in a 4-week trial and in animal models has been shown to reduce cortical dopamine release, which is critically involved in the reinforcing effect of tobacco smoking. We measured amphetamine-induced extrastriatal dopamine release before and after treatment with guanfacine with [11C]FLB457, a dopamine D2/D3 receptor radiotracer, and positron emission tomography (PET). Sixteen tobacco smokers had one set of [11C]FLB457 PET scans on the same day, one before and one at 2.5-3 h after amphetamine (0.4-0.5 mg/kg, PO). A subset (n=12) then underwent guanfacine treatment (3 mg/day for 3 weeks) and the set of scans were repeated. [11C]FLB457-binding potential (BPND) was measured pre- and post amphetamine in extrastriatal brain regions. The fractional change in BPND after vs before amphetamine (Δ BPND) is an indirect measure of DA release and was compared between the untreated and guanfacine-treated conditions. Guanfacine treatment attenuated amphetamine-induced DA release; however, the change was due to a global 8% decrease in baseline BPND from the untreated to the guanfacine-treated condition. Chronic guanfacine treatment reduced [11C]FLB457 BPND in tobacco smokers, suggesting an increase in dopaminergic tone. Guanfacine-induced normalization of dopamine signaling may be an important mesocortical mechanism contributing to its ability to aid in tobacco smoking cessation.
Collapse
Affiliation(s)
- Christine M Sandiego
- Department of Psychiatry, Yale University, New Haven, CT, USA
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - David Matuskey
- Department of Psychiatry, Yale University, New Haven, CT, USA
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Meaghan Lavery
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Erin McGovern
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Yiyun Huang
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Nabeel Nabulsi
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Jim Ropchan
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | | | - Evan D Morris
- Department of Psychiatry, Yale University, New Haven, CT, USA
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale University, New Haven, CT, USA
- PET Center, Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| |
Collapse
|
3
|
Pantalon MV, Murphy MK, Barry DT, Lavery M, Swanson AJ. Predictors and moderators of aftercare appointment-keeping following brief motivational interviewing among patients with psychiatric disorders or dual diagnosis. J Dual Diagn 2014; 10:44-51. [PMID: 25392061 DOI: 10.1080/15504263.2013.867785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Non-adherence to psychiatric and substance abuse treatment recommendations, especially with regard to aftercare outpatient appointment-keeping following hospitalizations, exacts a high cost on mental health spending and prevents patients from receiving therapeutic doses of treatment. Our primary objective was to evaluate the relationship between potential predictors and moderators of aftercare appointment-keeping among a group of adult patients immediately following hospitalization for severe psychiatric disorders or dual diagnosis. METHODS Candidate predictors and moderator variables included demographics, psychiatric status, psychiatric symptom severity, and inpatient group adherence, while aftercare appointment-keeping was defined as attendance at the first aftercare appointment. Participants were 121 adult inpatients with a psychiatric disorder or dual diagnosis originally enrolled in an earlier randomized controlled trial comparing standard treatment with standard treatment plus brief motivational interviewing for increasing adherence. RESULTS RESULTS indicated that, across treatment conditions, those who were female, did not have dual diagnosis, were older (older than 33 years), and were less educated (<high school) attended their first aftercare appointment at significantly higher rates than their counterparts. A treatment-by-gender interaction was noted, where only men were significantly more likely to keep their first aftercare appointment if they received standard treatment plus brief motivational interviewing, compared to standard treatment alone (OR = 9.58, p < .001). CONCLUSIONS Findings suggest that gender, dual diagnosis status, age and education may be an important predictors of aftercare treatment adherence and that gender may be a moderator of motivational interviewing among individuals with psychiatric disorders or dual diagnosis.
Collapse
Affiliation(s)
- Michael V Pantalon
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | | | | | | | | |
Collapse
|
4
|
McKee SA, Sinha R, Weinberger AH, Sofuoglu M, Harrison EL, Lavery M, Wanzer J. Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. J Psychopharmacol 2011; 25:490-502. [PMID: 20817750 PMCID: PMC3637660 DOI: 10.1177/0269881110376694] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have developed a novel human laboratory model to examine two primary aspects of stress-precipitated tobacco relapse: (1) Does stress reduce the ability to resist the first cigarette? (2) Once the first cigarette is initiated, does stress facilitate subsequent smoking? Using a within-subject design, daily smokers (n = 37) who were nicotine deprived overnight received a personalized imagery induction (stress or neutral) on two separate days, and then had the option of initiating a tobacco self-administration session or delaying initiation for up to 50 min in exchange for three levels of monetary reinforcement. Subsequently, the tobacco self-administration session entailed a 1-hour period in which subjects could choose to smoke using a smoking topography system. Following the stress induction, subjects were less able to resist smoking, smoked more intensely (increased puffs, shorter inter-puff interval, and greater peak puff velocity), and perceived greater satisfaction and reward from smoking. Stress significantly increased hypothalamus-pituitary-adrenal (HPA) axis reactivity, tobacco craving, negative emotion, and physiologic reactivity relative to the neutral condition. In addition, increased cortisol, ACTH, and tobacco craving were associated with reduced ability to resist smoking following stress. These findings have implications for understanding the impact of stress on smoking relapse and model development to assess smoking lapse behavior.
Collapse
Affiliation(s)
- Sherry A. McKee
- CORRESPONDING AUTHOR: Sherry A. McKee, Ph.D., Department of Psychiatry, Yale University School of Medicine, 2 Church St. South, Suite 109, New Haven, CT, USA, 06519. Phone: (203) 737-3529, Fax (203) 737-4243,
| | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
The Passy Muir speaking valve is a device that facilitates communication and airway maintenance for patients who require artificial airways. The critical care nurse's role includes collaboration with speech and respiratory therapy in identifying, preparing, and monitoring the patient who uses the Passy Muir valve.
Collapse
Affiliation(s)
- K Kaut
- Fairfax Hospital, Falls Church, VA, USA
| | | | | |
Collapse
|
6
|
Lavery M. Tea and sympathy ... and Guinness too. Nurs Stand 1995; 10:50-1. [PMID: 8546966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
7
|
Lavery M. Home comforts. Nurs Times 1995; 91:46-7. [PMID: 7479137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
8
|
Lavery M, McKenna H. Learning disabilities. A computer assisted learning package. Nurs Stand 1993; 8:29-32. [PMID: 8312159 DOI: 10.7748/ns.8.12.29.s48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Computers are currently playing a major role in the education of nurses. In terms of the education of patients and clients, however, technological software is in its infancy. The main aim of this study was to design a computer assisted learning (CAL) package on shape recognition and use it in one to one teaching sessions with children who had learning disabilities. A secondary aim was to evaluate whether in fact the use of this package would improve the ability of these children to recognise different shapes.
Collapse
|
9
|
Lavery M. Death and dying, oh no! Sr Nurse 1993; 13:32-5. [PMID: 8265956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
10
|
|
11
|
Affiliation(s)
- D R Berry
- Division of Applied Microbiology Department of Bioscience and Biotechnology, University of Strathclyde, Glasgow, Scotland
| | | | | |
Collapse
|