You have already added 0 works in your ORCID record related to the merged Research product.
Predictors of Abstinence and Changes in Psychiatric Symptoms in a Pooled Sample of Smokers With Schizophrenia Receiving Combination Pharmacotherapy and Behavioral Therapy for Smoking Cessation
Copyright policy )To the Editors: Adults with schizophrenia have higher rates of smoking and nicotine dependence and lower rates of smoking cessation than other adults (1-3). Further, the medical and economic burden of smoking on mentally ill persons is enormous (3, 4) so the development of safe and effective pharmacotherapies for these smokers is of considerable public health significance. FDA-approved smoking cessation pharmacotherapies like nicotine replacement therapy (NRT) and sustained-release bupropion (Zyban®, GlaxoSmithKline) appear to be safe and efficacious for smokers with schizophrenia (see (5) for review); however quit rates are modest and it is therefore important to determine characteristics of those who are responsive to interventions. Further, it is important to address the continued clinical concern that smoking cessation will exacerbate psychiatric symptoms for patients with serious mental illnesses (6). The current analyses examined predictors of smoking abstinence and changes in psychiatric symptoms in a pooled sample (N=135) from three sequential controlled clinical trials for nicotine dependent adult cigarette smokers with schizophrenia or schizoaffective disorder conducted through the Program for Research in Smokers with Mental Illness (PRISM) at the Yale University School of Medicine between 1998 and 2007 (see (7-9) for study details). The first study ((7); N=45) was an open-label trial of transdermal nicotine patch (TNP; 21mg/24h) plus one of two behavioral treatments. Participants in the second study ((8); N=32) received sustained-release bupropion (300 mg/day) or placebo and participants in the third study ((9); N=58) received TNP (21 mg/24h) with sustained-release bupropion (300 mg/day) or placebo. All studies had similar treatment protocols (e.g., 10 week duration), similar research staff, included manualized group behavioral counseling, and stratified treatment by antipsychotic medication class. Written informed consent was obtained from all participants and research protocols were approved by the Yale University School of Medicine's Human Investigation Committee. Participants in all studies completed measures of demographics, daily smoking (cigarettes per day, CPD), nicotine dependence (Fagerstrom Test for Nicotine Dependence, FTND, (10)), and psychiatric symptoms (Positive and Negative Symptoms Scale for Schizophrenia, PANSS, (11); Beck Depression Inventory-II, BDI-II, (12)). The primary outcome measures were smoking abstinence during the last week of the trials (End of Trial, EOT) and continuous abstinence (CA) over the last four weeks of the trials. Self-reported abstinence was biochemically verified by expired breath carbon monoxide (CO) levels 0.05). EOT symptoms of schizophrenia and depression were related significantly to baseline measures of the respective symptoms (positive symptoms p<0.001; negative symptoms p<0.001; depression p<0.01). EOT negative symptoms were related to between-study variability (p<0.05), confounded with TNP use. There was a trend for abstinence to be related to an increase in depression symptoms (p=0.06). Abstinence was associated with a 2.97 unit increase in BDI scores as compared to no change in BDI scores for non-abstinent participants with all other variables in the model being held constant. The results did not substantively change with CA as the measure of abstinence.
Microsoft Academic Graph classification: Nicotine medicine.drug medicine Abstinence media_common.quotation_subject media_common Odds ratio Schizoaffective disorder medicine.disease Nicotine replacement therapy Smoking cessation medicine.medical_treatment Bupropion Psychiatry medicine.medical_specialty Psychology Schizophrenia
Pharmacology (medical), Psychiatry and Mental health, Article, Adult, Bupropion, Cognitive Behavioral Therapy, Combined Modality Therapy, Female, Forecasting, Humans, Male, Middle Aged, Schizophrenia, Schizophrenic Psychology, Smoking, Smoking Cessation
Pharmacology (medical), Psychiatry and Mental health, Article, Adult, Bupropion, Cognitive Behavioral Therapy, Combined Modality Therapy, Female, Forecasting, Humans, Male, Middle Aged, Schizophrenia, Schizophrenic Psychology, Smoking, Smoking Cessation
Microsoft Academic Graph classification: Nicotine medicine.drug medicine Abstinence media_common.quotation_subject media_common Odds ratio Schizoaffective disorder medicine.disease Nicotine replacement therapy Smoking cessation medicine.medical_treatment Bupropion Psychiatry medicine.medical_specialty Psychology Schizophrenia
- University of Toronto Canada
- Yale University United States
- Brown University United States
- University of Toronto Canada
- Yale University United States
- Brown University United States
To the Editors: Adults with schizophrenia have higher rates of smoking and nicotine dependence and lower rates of smoking cessation than other adults (1-3). Further, the medical and economic burden of smoking on mentally ill persons is enormous (3, 4) so the development of safe and effective pharmacotherapies for these smokers is of considerable public health significance. FDA-approved smoking cessation pharmacotherapies like nicotine replacement therapy (NRT) and sustained-release bupropion (Zyban®, GlaxoSmithKline) appear to be safe and efficacious for smokers with schizophrenia (see (5) for review); however quit rates are modest and it is therefore important to determine characteristics of those who are responsive to interventions. Further, it is important to address the continued clinical concern that smoking cessation will exacerbate psychiatric symptoms for patients with serious mental illnesses (6). The current analyses examined predictors of smoking abstinence and changes in psychiatric symptoms in a pooled sample (N=135) from three sequential controlled clinical trials for nicotine dependent adult cigarette smokers with schizophrenia or schizoaffective disorder conducted through the Program for Research in Smokers with Mental Illness (PRISM) at the Yale University School of Medicine between 1998 and 2007 (see (7-9) for study details). The first study ((7); N=45) was an open-label trial of transdermal nicotine patch (TNP; 21mg/24h) plus one of two behavioral treatments. Participants in the second study ((8); N=32) received sustained-release bupropion (300 mg/day) or placebo and participants in the third study ((9); N=58) received TNP (21 mg/24h) with sustained-release bupropion (300 mg/day) or placebo. All studies had similar treatment protocols (e.g., 10 week duration), similar research staff, included manualized group behavioral counseling, and stratified treatment by antipsychotic medication class. Written informed consent was obtained from all participants and research protocols were approved by the Yale University School of Medicine's Human Investigation Committee. Participants in all studies completed measures of demographics, daily smoking (cigarettes per day, CPD), nicotine dependence (Fagerstrom Test for Nicotine Dependence, FTND, (10)), and psychiatric symptoms (Positive and Negative Symptoms Scale for Schizophrenia, PANSS, (11); Beck Depression Inventory-II, BDI-II, (12)). The primary outcome measures were smoking abstinence during the last week of the trials (End of Trial, EOT) and continuous abstinence (CA) over the last four weeks of the trials. Self-reported abstinence was biochemically verified by expired breath carbon monoxide (CO) levels 0.05). EOT symptoms of schizophrenia and depression were related significantly to baseline measures of the respective symptoms (positive symptoms p<0.001; negative symptoms p<0.001; depression p<0.01). EOT negative symptoms were related to between-study variability (p<0.05), confounded with TNP use. There was a trend for abstinence to be related to an increase in depression symptoms (p=0.06). Abstinence was associated with a 2.97 unit increase in BDI scores as compared to no change in BDI scores for non-abstinent participants with all other variables in the model being held constant. The results did not substantively change with CA as the measure of abstinence.