Smoking abstinence and lapse effects in smokers with schizophrenia and controls

描述（由申请人提供）：精神分裂症与异常高的吸烟率有关。患有精神分裂症的吸烟者戒烟率很低，即使他们有戒烟的动机，并参加了高度支持性的治疗。本研究项目的总体目标是了解生物和环境因素如何控制精神分裂症吸烟者的吸烟，并利用这些知识为这些患者设计更有效的吸烟治疗方法。这个R21探索性/发展性项目的具体目标是检验关于精神分裂症吸烟者戒烟率低的两个假设：(1)这些吸烟者在戒烟期间比同等重度的没有精神疾病的吸烟者经历更严重和持续的负面影响水平；(2)精神分裂症吸烟者在吸烟期间比没有精神疾病的吸烟者经历更强的吸烟强化效应，特别是尼古丁的强化效应。这些假设有坚实的理论和临床前支持，但尚未在人体中进行测试。在这项探索性/发展性研究中，我们将使用高价值的偶然货币强化，使患有精神分裂症的吸烟者和同样严重的没有精神疾病的吸烟者连续戒烟3天。在戒烟期间，每天测量两次消极影响和吸烟冲动。实验室评估尼古丁偏好和对吸烟的享乐反应将在基线和戒烟期后进行。在第二个尼古丁偏好任务之后，如果参与者再坚持一天，他们将得到一个小值强化物。然后，我们将这些组的潜伏期与第二次发作进行比较，并检查第二次发作的预测因素。患有精神分裂症的吸烟者在戒断期间会有更强烈的负面影响和渴望，在程序性失效期间，尼古丁和吸烟的强化作用会更强。这些因素有望预测两组患者的第二次发病时间。该项目将扩大现有的关于精神分裂症患者吸烟影响因素的知识，这对于开发有效治疗这些吸烟者是必要的。公共卫生相关性：精神分裂症患者的吸烟率异常高，相应地，这些患者中与吸烟相关的发病率和死亡率也很高。这个项目的目的是比较患有精神分裂症的吸烟者和没有精神疾病的重度吸烟者在尝试戒烟过程中的负面影响和渴望以及吸烟失败的积极强化效应。该项目将扩大现有的关于精神分裂症患者吸烟影响因素的知识，这对于开发有效治疗这些吸烟者是必要的。

DESCRIPTION (provided by applicant): Schizophrenia is associated with an unusually high rate of cigarette smoking. Smokers with schizophrenia have low quit rates, even when they are motivated to quit and enroll in highly-supportive treatments. The overall aim of this research program is to learn how biological and environmental factors control smoking in smokers with schizophrenia and to use this knowledge to design more effective smoking treatments for these patients. The specific objectives of this R21 Exploratory/ Developmental project are to test two hypotheses concerning the low cessation rates in smokers with schizophrenia: (1) that these smokers experience more severe and sustained levels of negative affect during abstinence than equally-heavy smokers without psychiatric illness, and (2) that smokers with schizophrenia experience stronger reinforcing effects of smoking and specifically of nicotine during a smoking lapse than smokers without psychiatric illness. These hypotheses have solid theoretical and preclinical support, but have not been tested in humans. In this exploratory/ developmental study, we will use high-value contingent monetary reinforcement to engender 3 days of continuous abstinence in smokers with schizophrenia and equally-heavy smokers without psychiatric illness. During the abstinence period, negative affect and smoking urge will be measured twice-daily. Laboratory assessments of nicotine preference and hedonic response to smoking will be conducted at baseline and after the abstinence period. After the second nicotine preference task, participants will receive a small-value reinforcer if they continue to abstain for another day. We will then compare latency to the second lapse in these groups and examine predictors of the second lapse. Smokers with schizophrenia are expected to have stronger levels of negative affect and craving during abstinence and stronger reinforcing effects of nicotine and smoking during the programmed lapse. These factors are expected to predict time to second lapse in both groups. This project will expand existing knowledge concerning factors that affect smoking in people with schizophrenia, which is necessary for the development of effective treatments for these smokers. PUBLIC HEALTH RELEVANCE: There is an unusually high rate of cigarette smoking among people with schizophrenia and correspondingly high rates of smoking-related morbidity and mortality in these patients. The aim of this project is to compare, in smokers with schizophrenia and heavy smokers without psychiatric illness, negative affect and craving during a practice quit attempt and positive reinforcing effects of a smoking lapse. This project will expand existing knowledge concerning factors that affect smoking in people with schizophrenia, which is necessary for the development of effective treatments for these smokers.