Nicotine withdrawal and psychiatric symptoms in smokers with schizophrenia
摘要
Individuals with schizophrenia are more likely than the general population to be heavy smokers. Some cross-sectional studies have suggested that smoking may be a marker of more severe schizophrenic illness and may affect treatment by modulating side effects of antipsychotic medication (Sandyk and Kay 1991; Goff et al 1992). The clinical observation that smokers with schizophrenia have great difficulty abstaining even briefly from cigarettes suggests that acute nicotine withdrawal may lead to an exacerbation of psychiatric symptoms or treatment-related side effects, and a return to smoking. To test this hypothesis, we are measuring withdrawal symptoms, psychiatric symptoms, nicotine blood levels, and medication side effects in well-characterized, psychiatrically stable, nicotine-addicted smokers with chronic schizophrenia under the following conditions: ad libitum smoking over one day (no blind) followed by (in a randomized, cross-over design) acute smoking abstinence (over 3 days) while wearing placebo 24-hour transdermal nicotine patch (double-blind), or acute smoking abstinence (over 3 days) wearing 21mg/day, 24-hour transdermal nicotine patch (double-blind) with a return to 4 days of ad libitum smoking between the two patch conditions. Subjects followed at the Ann Arbor VAMC Mental Health Clinic, are hospitalized for two four-day periods in the CRC at the University of Michigan Medical Center for the day of ad libitum smoking followed by three days of treated or untreated smoking abstinence. About one-third of the subjects who entered to date, dropped out due to difficulties tolerating acute withdrawal, with elevations in some psychiatric symptoms also noted. For those who have completed the study thus far, preliminary results indicate that in both patch conditions, subjects are acutely abstaining (per daily nicotine blood levels and CO measurements). In the placebo condition, clinically significant decreases in heart rate suggest that they are experiencing withdrawal. Further analysis will assess the relationships among withdrawal symptoms, psychiatric symptoms (BPRS, SANS, HAM-D) and treatment-related side effects (parkinson-like, and tardive dyskinesia) by patch condition and day of withdrawal.