Incentives Plus Bupropion for Smoking in Schizophrenics

描述(申请人提供)：精神分裂症患者中吸烟的发生率很高，但针对这些患者开发的吸烟治疗方法很少。实验室和临床研究已经开始描述影响精神分裂症患者吸烟的环境和生物因素。最近的实验室可行性研究显示，通过对减少吸烟的应急资金支持，取得了令人振奋的结果。同样，几项针对精神分裂症患者的吸烟治疗研究显示，安非他酮-SR的治疗效果令人振奋。我们的长期目标是为患有精神分裂症的吸烟者开发一种有效的、可行的、基于研究的戒烟计划。在这项以实验室为基础的可行性研究中，我们将使用2×2组间析因设计来评估128名患有精神分裂症的男性和女性吸烟者未来有兴趣戒烟。主要目的是：(1)评估一种新的应急管理程序的有效性，通过加强唾液可替宁的减少来形成戒烟，与非应急强化相比；(2)与安慰剂相比，评估300毫克/天的安非他酮-SR的疗效；(3)评估应急强化与安非他酮联合戒烟的有效性，与单独干预相比。次要目标是(1)评估尼古丁依赖和动机方面的性别或个人差异是否对每个干预措施的反应适度；(2)评估戒酒是否与精神症状、锥体外系症状或认知功能的变化有关。这项研究将提供有关联合使用应急管理和吸烟药物疗法治疗精神分裂症患者吸烟的有效性和可行性的重要信息。

DESCRIPTION (provided by applicant): There is a high prevalence of cigarette smoking among people with schizophrenia, but few smoking treatments have been developed for these patients. Laboratory and clinical studies have begun to delineate environmental and biological factors that affect smoking in schizophrenics. Recent laboratory feasibility studies have shown promising results with contingent monetary reinforcement for smoking reductions. Similarly, several smoking treatment studies in schizophrenics have shown promising results with bupropion- SR. Our long-term goal is to develop an effective, feasible, research-based smoking cessation program for smokers with schizophrenia. In this laboratory-based feasibility study, we will evaluate 128 male and female smokers with schizophrenia who are interested in quitting smoking in the future, using a 2 x 2 between groups factorial design. The primary aims are: (1) to evaluate the efficacy of a novel contingency management procedure for shaping smoking abstinence by reinforcing salivary cotinine reductions, compared to non-contingent reinforcement; (2) to evaluate the efficacy of 300 mg/day bupropion-SR, compared to placebo; (3) to evaluate the efficacy of combining contingent reinforcement for smoking reductions with bupropion, versus either intervention alone. Secondary aims are (1) to evaluate whether gender or individual differences in nicotine dependence and motivation moderate responsivity to each intervention; (2) to evaluate whether abstinence is related to changes in psychiatric symptoms, extrapyramidal symptoms or cognitive functioning. This study will provide significant information regarding the efficacy and feasibility of using a combination of contingency management and smoking pharmacotherapy to treat smoking in schizophrenics.