Smoking abstinence and lapse effects in smokers with schizophrenia and controls

描述(申请人提供)：精神分裂症与吸烟率异常高有关。患有精神分裂症的吸烟者戒烟率很低，即使他们有戒烟动机并参加高度支持性的治疗。这项研究计划的总体目标是了解生物和环境因素如何控制患有精神分裂症的吸烟者吸烟，并利用这一知识为这些患者设计更有效的吸烟治疗方法。这个R21探索/发展项目的具体目标是测试两个关于精神分裂症吸烟者戒烟率低的假设：(1)这些吸烟者在戒烟期间比没有精神疾病的同等重度吸烟者经历更严重和持续的负面影响，(2)患有精神分裂症的吸烟者在吸烟间歇期间比没有精神疾病的吸烟者经历更强的吸烟，特别是尼古丁的强化作用。这些假说有坚实的理论和临床前支持，但还没有在人体上进行测试。在这项探索性/发展性研究中，我们将使用高价值或有货币强化措施，在患有精神分裂症的吸烟者和没有精神疾病的同等重度吸烟者中产生连续3天的戒烟。在戒烟期间，将每天测量两次负面情绪和吸烟冲动。尼古丁偏好和对吸烟的享乐反应的实验室评估将在基线和戒烟期之后进行。在第二次尼古丁偏好任务之后，如果参与者继续戒烟一天，他们将获得一种小价值的增强剂。然后，我们将比较这些组中的延迟和第二次失误，并检查第二次失误的预测因素。在戒烟期间，患有精神分裂症的吸烟者预计会有更强的负面情绪和渴望，在程序化的错误期间，尼古丁和吸烟的强化作用更强。这些因素预计将预测两组第二次失误的时间。该项目将扩大关于影响精神分裂症患者吸烟因素的现有知识，这对于开发针对这些吸烟者的有效治疗是必要的。公共卫生相关性：精神分裂症患者的吸烟率异常高，与吸烟相关的发病率和死亡率也相应较高。该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期间的负面情绪和渴望，以及戒烟后的积极强化效果。该项目将扩大关于影响精神分裂症患者吸烟因素的现有知识，这对于开发针对这些吸烟者的有效治疗是必要的。

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.