Incentives Plus Bupropion for Smoking in Schizophrenics

描述（由申请人提供）：精神分裂症患者中吸烟的患病率很高，但针对这些患者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表明，有可能通过货币强化来减少吸烟，结果很有希望。类似地，几项针对精神分裂症患者的吸烟治疗研究也显示了安非他酮sr的良好效果。我们的长期目标是为精神分裂症吸烟者开发一种有效、可行、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，我们将采用2 × 2组间因子设计，评估128名有兴趣在未来戒烟的精神分裂症患者。主要目的是：(1)与非偶然强化相比，评估通过加强唾液可替宁减少来塑造戒烟的新型应急管理程序的有效性；(2)评价300mg /d安非他酮sr与安慰剂的疗效；(3)评价偶然强化与安非他酮联合减少吸烟与单独干预的效果。次要目的是(1)评估性别或个体差异在尼古丁依赖和动机方面是否会调节对每种干预措施的反应；(2)评估禁欲是否与精神症状、锥体外系症状或认知功能的改变有关。本研究将提供关于使用应急管理和吸烟药物治疗相结合治疗精神分裂症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.