A Test of the Cognitive Self-Medication Hypothesis of Tobacco Smoking in Schizophrenia
A Test of the Cognitive Self-Medication Hypothesis of Tobacco Smoking in Schizophrenia
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DOI：
10.1016/j.biopsych.2013.03.017
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发表时间：
2013-09-15
影响因子：
10.6
通讯作者：
Gold, James M.
中科院分区：
文献类型：
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作者：
Hahn, Britta;Harvey, Alexander N.;Gold, James M.
背景：精神分裂症患者吸烟较多(SCZ)被认为反映了认知缺陷的自我用药。认为尼古丁的认知增强作用是SCZ烟草消费的主要动机以及戒烟会剥夺SCZ的这种有益影响的想法可能解释了提供者在SCZ寻求戒烟的犹豫。本研究检验了认知自我用药假说的预测。方法：在三个平衡阶段，17名SCZ和17名健康对照受试者，全部吸烟者，在戒烟和接受尼古丁(14 mg/24小时)或安慰剂贴片后3.5小时接受测试。结果：相对于安慰剂，透皮尼古丁提高了注意力任务的成绩，而临时吸烟的成绩居中。这些影响在SCZ和HCS中的大小相似，并不反映对SCZ中不成比例受损的功能的补救。尽管更多的SCZ报告说，集中注意力的需要影响了他们吸烟，但这些患者的实际行为并没有反映出这一点。自我报告的集中能力随着HCS中尼古丁状态的变化而变化，但不随SCZ中尼古丁状态的变化而变化，这表明SCZ对尼古丁衍生的绩效益处不敏感。随意吸烟后的尼古丁血浆浓度与表现益处无关，而是与戒烟后经历尼古丁戒断的倾向有关。这种关联在SCZ中被选择性地发现，这可能是吸烟加重的原因。结论：这些发现表明主观或客观的注意力益处不太可能是SCZ烟草消费的主要驱动力，不应该阻止提供者支持戒烟尝试。
Background: Heavier tobacco smoking among people with schizophrenia (SCZ) has been suggested to reflect self-medication of cognitive deficits. The idea that cognitive-enhancing effects of nicotine are a primary motivator of tobacco consumption in SCZ and that abstinence would deprive SCZ of such beneficial effects might explain hesitation among providers to pursue smoking cessation in SCZ. This study tested predictions of the cognitive self-medication hypothesis.Methods: In three counterbalanced sessions, 17 SCZ and 17 healthy control subjects (HCS), all smokers, were tested under ad libitum smoking or 3.5 hours after abstaining and receiving a nicotine (14 mg/24 hours) or placebo patch.Results: Attention task performance was improved by transdermal nicotine relative to placebo, with intermediate performance by ad libitum smoking. These effects were of similar size in SCZ and HCS and did not reflect remediation of functions disproportionately impaired in SCZ. Although more SCZ reported that the need to concentrate influenced their smoking, this was not reflected by the actual behavior of these patients. Self-reported ability to concentrate changed with nicotine status in HCS but not SCZ, suggesting insensitivity of SCZ to nicotine-derived performance benefits. Nicotine plasma concentrations after ad libitum smoking were not associated with performance benefits but instead with the propensity to experience nicotine withdrawal upon abstinence. This association was seen selectively in SCZ, suggesting a possible reason for heavier smoking.Conclusions: These findings suggest that subjective or objective attentional benefits are unlikely the primary driving force of tobacco consumption in SCZ and should not discourage providers from supporting quit attempts.