Dalack G W, Becks L, Hill E, Pomerleau O F, Meador-Woodruff J H
Ann Arbor VA Medical Center, University of Michigan, USA.
Neuropsychopharmacology. 1999 Aug;21(2):195-202. doi: 10.1016/S0893-133X(98)00121-3.
The prevalence of smoking is markedly elevated in schizophrenia. Low smoking cessation rates and reports that some smokers with schizophrenia experience an acute increase in symptoms during attempts to quit smoking, suggest a self-medication model. Alternatively, smoking may modulate medication side effects. The effects of treated and untreated smoking abstinence on psychotic symptoms and medication side effects were examined in this study. Nineteen outpatients with schizophrenia or schizoaffective disorder participated in a randomized, double-blind, balanced crossover study: 1 day of ad libitum smoking followed by 3 days of acute smoking abstinence while wearing 22 mg/day active or placebo transdermal nicotine patches, with a return to 3 days of smoking between patch conditions. Daily symptom and side-effect ratings, nicotine and cotinine blood levels were collected. Twelve subjects completed the study. Neither positive symptoms nor mood symptoms changed. An increase in negative symptoms during the first abstinent day occurred in both placebo and active patch conditions, but was not sustained over subsequent abstinent days. Despite physiological signs of withdrawal, completers did not endorse increased nicotine withdrawal symptoms. Dropouts reported higher withdrawal symptoms, but also had no increase in psychiatric symptoms in either phase of the study. Of note, dyskinesias decreased during abstinence and placebo patch treatment, but increased during abstinence and the active patch conditions. Acute exacerbation of psychiatric symptoms is an unlikely explanation for any difficulty smokers with schizophrenia have in early abstinence.
精神分裂症患者的吸烟率显著升高。戒烟率低，且有报告称一些精神分裂症吸烟者在尝试戒烟期间症状会急性加重，这提示了一种自我用药模型。另外，吸烟可能会调节药物副作用。本研究考察了已治疗和未治疗的戒烟对精神病症状及药物副作用的影响。19名精神分裂症或分裂情感性障碍门诊患者参与了一项随机、双盲、平衡交叉研究：先有1天随意吸烟期，随后是3天急性戒烟期，期间佩戴22毫克/天的活性或安慰剂透皮尼古丁贴片，在贴片条件转换期间恢复3天吸烟期。收集每日症状和副作用评分、血液中的尼古丁和可替宁水平。12名受试者完成了研究。阳性症状和情绪症状均未改变。在安慰剂和活性贴片条件下，戒断首日阴性症状均出现增加，但在随后的戒断日未持续存在。尽管有戒断的生理迹象，但完成研究的受试者并未认可尼古丁戒断症状增加。退出研究的受试者报告有更高的戒断症状，但在研究的任何阶段精神症状也未增加。值得注意的是，在戒断和安慰剂贴片治疗期间运动障碍减少，但在戒断和活性贴片条件下增加。精神症状急性加重不太可能是精神分裂症吸烟者早期戒烟困难的原因。
