Department of Psychology, Yale University, P.O. Box 208205, New Haven, CT 06520, USA.
Psychopharmacology (Berl). 2012 Jan;219(1):25-34. doi: 10.1007/s00213-011-2373-6. Epub 2011 Jun 22.
Smoking rates are up to five times higher in people with schizophrenia than in the general population, placing these individuals at high risk for smoking-related health problems. Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, is a promising aid for smoking cessation in this population. To maximize treatment efficacy while minimizing risks, it is critical to identify reliable predictors of positive response to varenicline in smokers with schizophrenia.
Negative symptoms of schizophrenia are related to dysfunctions in the brain reward system, are associated with nicotine dependence, and may be improved by nicotine or nicotinic receptor agonists, suggesting that smoking cessation may be especially difficult for patients with substantial negative symptoms. The purpose of the study was to evaluate negative symptoms as predictors of response to varenicline.
Patients with schizophrenia (N = 53) completed a 12-week smoking cessation trial combining varenicline with cognitive behavioral therapy. Negative symptoms were assessed via the Scale for the Assessment of Negative Symptoms (Andreasen 1983). Outcomes included smoking abstinence as assessed by self-report and expired carbon monoxide. Change in performance on a probabilistic reward task was used as an index of change in reward sensitivity during treatment.
At week 12, 32 participants met criteria for 14-day point-prevalence abstinence. Patients with lower baseline symptoms of affective flattening (more typical affect) were more likely to achieve smoking abstinence and demonstrated larger increases in reward sensitivity during treatment.
These data suggest that affective flattening symptoms in smokers with schizophrenia may predict response to varenicline.
精神分裂症患者的吸烟率比普通人群高 5 倍，使这些人面临与吸烟相关的健康问题的高风险。伐伦克林是一种α4β2 烟碱型乙酰胆碱受体部分激动剂，是该人群戒烟的有前途的辅助手段。为了最大限度地提高治疗效果，同时将风险降至最低，识别对精神分裂症吸烟者使用伐伦克林产生积极反应的可靠预测因子至关重要。
精神分裂症的阴性症状与大脑奖励系统的功能障碍有关，与尼古丁依赖有关，并且可能通过尼古丁或烟碱受体激动剂得到改善，这表明对于有大量阴性症状的患者来说，戒烟可能特别困难。该研究的目的是评估阴性症状作为对伐伦克林反应的预测因子。
精神分裂症患者（N=53）完成了一项为期 12 周的戒烟试验，将伐伦克林与认知行为疗法相结合。使用 Scale for the Assessment of Negative Symptoms（Andreasen 1983）评估阴性症状。结果包括自我报告和呼出的一氧化碳评估的吸烟戒断。在治疗期间，概率奖励任务的表现变化被用作奖励敏感性变化的指标。
在第 12 周，32 名参与者符合 14 天点预患病率戒断的标准。基线时情感迟钝（更典型的情感）症状较低的患者更有可能实现戒烟，并在治疗过程中表现出更大的奖励敏感性增加。
这些数据表明，精神分裂症吸烟者的情感迟钝症状可能预测对伐伦克林的反应。
