Prefrontal cognitive dysfunction is associated with tobacco dependence treatment failure in smokers with schizophrenia

Abstract

Background Patients with schizophrenia have higher rates of smoking (58–88%) than in the general population (~22%), and are more refractory to smoking cessation. These patients also exhibit numerous neurocognitive deficits, some of which may be ameliorated by cigarette smoking. The neurocognitive benefits derived from nicotine may, in turn, contribute to elevated rates of smoking and smoking persistence in schizophrenia. The present study examined the relationship between neurocognitive function and smoking cessation in schizophrenia. Methods Treatment-seeking smokers with schizophrenia (N =58) participated in a 10-week placebo-controlled trial of sustained-release (SR) bupropion plus transdermal nicotine patch. Neuropsychological performance was evaluated in a subset of patients (n=31), prior to pharmacological treatment, using a neurocognitive battery. Results Subjects were compared as a function of endpoint smoking status (Quit versus Not Quit, assessed by end of trial 7-day point prevalence abstinence, confirmed by CO level (<10 ppm) on demographic traits, smoking, and clinical outcomes. While there were no significant baseline differences between quitters and non-quitters, non-quitters exhibited significantly greater deficits in performance on TMT-B (p=0.01) and on Digit Span backwards (p=0.04) compared to quitters. No associations were found between quit status and performance on other neuropsychological measures. Conclusions Our findings extend results of previous studies which suggest deficits in frontal executive function are associated with smoking cessation failure in schizophrenia. This may have implications for the development of tailored smoking cessation treatments in this population.

Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with serious mental illness: a systematic review and network meta‐analysis

“…57–58 As such, the pairwise meta-analysis efficacy and tolerability odds ratios are presented with their 95% CI for this comparison. Nine trials were conducted in participants with a diagnosis of schizophrenia or schizoaffective disorder, 43,46–50,52,55,56,58,59 two trials in participants with a diagnosis of schizophrenia 44,45,57 and three trials were conducted in participants with a diagnosis of bipolar affective disorder. 50,52,53 Characteristics of all included studies can be found in table one.…”

Antidepressants for cognitive impairment in schizophrenia — A systematic review and meta-analysis

“…The number of included studies and subjects was small. Data from five studies utilizing bupropion that tested cognition (Culhane et al, 2008; Evins et al, 2007; Evins et al, 2005a; Evins et al, 2005b; George et al, 2002; George et al, 2008; George et al, 2006; Moss et al, 2009; Weiner et al, 2012) were not meta-analyzable as presented in the published papers and were not obtainable from the authors. Notably, however, all bupropion studies targeted smoking cessation, and cognition was only a secondary outcome.…”

Effects of Smoking Abstinence on Cigarette Craving, Nicotine Withdrawal, and Nicotine Reinforcement in Smokers With and Without Schizophrenia

“…Given the overlap between depression symptoms and negative schizophrenia symptoms, and the fact that other smoking studies have not reported elevated depression symptoms in SS versus CS (e.g., George et al, 2002), future studies assessing mediators of smoking lapse in this population should use instruments such as the Calgary Depression Scale (Addington, Addington, & Maticka-Tyndale, 1993), which has minimal overlap with negative symptoms, and the Positive and Negative Syndrome Scale (Kay, Fiszbein, & Opler, 1987) or Scale for the Assessment of Negative Symptoms (Andreasen, 1984) that may better differentiate between the roles of depression and negative symptoms in mediating smoking behavior in SS. A third limitation is that we did not assess several factors that contribute to smoking cessation outcomes in SS, such as self-efficacy for cessation, task persistence, and other measures of executive functioning (Mann-Wrobel, Bennett, Weiner, Buchanan, & Ball, 2011;Moss et al, 2009;Steinberg et al, 2012). The relative contributions of these factors could be examined in future studies using the current model.…”