Smith Robert C, Lindenmayer Jean-Pierre, Davis John M, Cornwell James, Noth Kathryn, Gupta Sanjay, Sershen Henry, Lajtha Abel
Department of Psychiatry, New York University Medical School, NY 11557-0316, United States.
Schizophr Res. 2009 May;110(1-3):149-55. doi: 10.1016/j.schres.2009.02.001. Epub 2009 Feb 28.
Varenicline has been shown to be an effective anti-smoking treatment in smokers without identified psychiatric illness, and the drug's pharmacology suggests possibilities of pro-cognitive effects. However, recent reports suggest varenicline may have the potential for important psychiatric side-effects in some people. We present the first prospective quantitative data on the effects of varenicline on cognitive function, cigarette smoking, and psychopathology in a small sample of schizophrenic patients.
Fourteen schizophrenic smokers were enrolled in an open-label study of varenicline with a pre-post design. Measures of cognitive function (RBANS, Virtual Water-Maze Task), cigarette smoking (cotinine levels, CO levels, self-reported smoking and smoking urges), and psychopathology (PANSS) were evaluated prior to and during treatment with varenicline. Data on psychopathology changes among schizophrenic smokers in another drug study, in which patients were not receiving varenicline, were used for comparison.
12 patients completed the study, and 2 patients terminated in the first two weeks of active varenicline because of complaints of nausea or shaking. Varenicline produced significant improvements in some cognitive test scores, primarily associated with verbal learning and memory, but not in scores on visual-spatial learning or memory, or attention. Varenicline significantly decreased all indices of smoking, but did not produce complete smoking abstinence in most patients. During treatment with varenicline there were no significant increases in psychopathology scores and no patient developed signs of clinical depression or suicidal ideation.
Our small prospective study suggests that treatment with varenicline appears to have some beneficial cognitive effects which need to be confirmed in larger studies with additional neuropsychological tests. Varenicline appears to have some anti-smoking efficacy in schizophrenia but longer studies are needed to determine whether it will produce rates of smoking abstinence similar to those found in control smokers. Treatment with varenicline may not increase psychopathology or depression in most patients with schizophrenia, but we cannot accurately estimate the absolute risk of a potentially rare side-effect from this small sample.
伐尼克兰已被证明是一种对未患精神疾病的吸烟者有效的戒烟治疗药物，且该药物的药理学特性提示其可能具有促认知作用。然而，近期报告表明伐尼克兰在某些人身上可能存在重要的精神副作用。我们展示了关于伐尼克兰对一小部分精神分裂症患者认知功能、吸烟行为及精神病理学影响的首份前瞻性定量数据。
14名精神分裂症吸烟者参与了一项采用前后设计的伐尼克兰开放标签研究。在使用伐尼克兰治疗前及治疗期间，对认知功能（RBANS、虚拟水迷宫任务）、吸烟情况（可替宁水平、一氧化碳水平、自我报告的吸烟量及吸烟冲动）和精神病理学（阳性和阴性症状量表）进行评估。另一个药物研究中未接受伐尼克兰治疗的精神分裂症吸烟者的精神病理学变化数据用于比较。
12名患者完成了研究，2名患者在伐尼克兰治疗的前两周因恶心或颤抖的主诉而终止治疗。伐尼克兰使一些认知测试分数有显著改善，主要与言语学习和记忆有关，但视觉空间学习或记忆以及注意力方面的分数未改善。伐尼克兰显著降低了所有吸烟指标，但大多数患者并未完全戒烟。在伐尼克兰治疗期间，精神病理学分数没有显著增加，也没有患者出现临床抑郁或自杀意念的迹象。
我们的小型前瞻性研究表明，伐尼克兰治疗似乎有一些有益的认知效果，这需要在更大规模的研究中通过额外的神经心理学测试来证实。伐尼克兰在精神分裂症患者中似乎有一定的戒烟疗效，但需要更长时间的研究来确定其戒烟率是否与对照吸烟者相似。伐尼克兰治疗在大多数精神分裂症患者中可能不会增加精神病理学或抑郁，但从这个小样本中我们无法准确估计潜在罕见副作用的绝对风险。
