Depression Center, University of Colorado School of Medicine, Aurora, 80045, USA.
Am J Psychiatry. 2011 Apr;168(4):395-9. doi: 10.1176/appi.ajp.2010.10040569. Epub 2011 Jan 18.
The authors conducted a randomized, placebo-controlled study of nicotine replacement therapy for the reduction of agitation and aggression in smokers with schizophrenia.
Participants were 40 smokers 18-65 years of age admitted to a psychiatric emergency service with a diagnosis of schizophrenia confirmed by the Mini International Neuropsychiatric Interview. Patients were screened for agitation with the excited component subscale of the Positive and Negative Syndrome Scale (PANSS) and for nicotine dependence with the Fagerström Test for Nicotine Dependence. A score of at least 14 on the PANSS excited component subscale and at least 6 on the Fagerström test were required for study eligibility. Participants in the nicotine replacement group received a 21-mg nicotine transdermal patch, and those in the placebo group were treated with a placebo patch. Participants received usual care with antipsychotics. The Agitated Behavior Scale and other agitation measures were administered at baseline and again at 4 and 24 hours.
At baseline, participants were at least moderately agitated, and 28% reported aggressive behavior in the previous week. The mean Agitated Behavior Scale score for the nicotine replacement group was 33% lower at 4 hours and 23% lower at 24 hours than for the placebo group. Participants with lower levels of nicotine dependence responded better than those with higher levels of dependence.
The drug-placebo difference in this study was similar to that obtained in trials of parenteral antipsychotics in similar populations. This finding suggests that in patients with schizophrenia, smoking status should be included in the assessment of agitation and nicotine replacement included in the treatment of those who are smokers.
作者进行了一项尼古丁替代疗法治疗吸烟精神分裂症患者激越和攻击行为的随机、安慰剂对照研究。
40 名年龄在 18-65 岁之间的吸烟者参加了这项研究，他们被收入精神病急诊服务，通过 Mini 国际神经精神访谈（MINI）确诊为精神分裂症。患者使用阳性和阴性症状量表（PANSS）的兴奋成分亚量表筛查激越症状，使用尼古丁依赖测试（FTND）筛查尼古丁依赖。PANSS 兴奋成分亚量表得分至少 14 分，FTND 得分至少 6 分，才有资格参加研究。尼古丁替代组患者接受 21mg 尼古丁透皮贴片治疗，安慰剂组患者接受安慰剂贴片治疗。所有患者均接受抗精神病药物常规治疗。在基线时和 4 小时、24 小时时，采用激越行为量表和其他激越评估工具进行评估。
在基线时，患者至少有中度激越，28%的患者在过去一周内有攻击行为。尼古丁替代组的激越行为量表评分在 4 小时时降低了 33%，在 24 小时时降低了 23%，而安慰剂组则无明显变化。尼古丁依赖程度较低的患者的反应优于依赖程度较高的患者。
本研究中药物与安慰剂的差异与类似人群中使用注射用抗精神病药物的试验结果相似。这一发现表明，在精神分裂症患者中，应将吸烟状况纳入激越评估，对于吸烟者，应将尼古丁替代治疗纳入治疗方案。
