Biobehavioral nicotine dependence in persons with schizophrenia

Tobacco use is the leading cause of preventable death in the United States. While the prevalence of smoking by adults in the United States has decreased, those with mental illness are estimated to consume nearly one-half of all cigarettes smoked in the United States. Persons with schizophrenia have the highest reported smoking prevalence, reaching as high as 83%. In addition, those with schizophrenia are more likely to be heavy smokers.; Schizophrenia is a debilitating disease associated with varied symptomology, including impaired cognitive functioning. The ability to study factors that influence health such as nicotine dependence in persons with schizophrenia has been challenged by this impaired functioning. Persons with schizophrenia have variable performance on decision making capacity scores. They perform lower than subjects without mental illness, but higher than those with dementia. Recent strategies and educational interventions regarding informed consent have enhanced the ability of those with schizophrenia to recall, understand, and provide informed consent. These techniques were used in the current study and are reported in the first manuscript.; Persons with schizophrenia use nicotine to self-medicate for symptoms of the disease process and for side effects of their antipsychotic medications. The use of biological markers to assess nicotine dependence in this population has relied predominantly upon carbon monoxide levels with relatively few studies using nicotine and cotinine concentrations. Limited smoking-related research in persons with schizophrenia indicated a need to further nicotine dependence according to the type of antipsychotic medication category labeled as atypical and typical antipsychotics. Persons on atypical antipsychotics have shown lower levels of nicotine dependence with corresponding lower levels of carbon monoxide. The second manuscript focuses on the extant research on pharmacological smoking cessation interventions in persons with schizophrenia.; This dissertation study recruited smokers with schizophrenia prescribed either atypical or typical antipsychotic medications to address the research aims of comparing the two groups on atypical and typical antipsychotic medications at baseline and to determine if there were changes either within or between the groups over time during eight weeks of bupropion use. Individuals were enrolled after correctly completing all items of the comprehension questionnaire related to the study's informed consent. Each participant was prescribed bupropion sustained release tablets for a period of eight weeks. Bupropion is classified as an effective smoking cessation pharmacotherapy. Four visits were scheduled: baseline, and at two, four, and eight weeks. This study incorporated multiple measures to examine the biobehavioral characteristics of smoking in person with schizophrenia. Measurements included smoking topography (the unique way an individual puffs a cigarette), carbon monoxide in exhaled air, plasma nicotine, and plasma cotinine concentrations. To assess for safety and side effects of bupropion, standardized tests of Montgomery-Asberg Depression Rating Scale and Positive and Negative Symptom Scale for Schizophrenia were conducted at baseline and at four and eight weeks. The Abnormal Involuntary Movement Scale was completed at baseline and eight weeks.; Our study found no significant differences between the two groups in either smoking topography or biological measures at baseline. When comparing data over the four visits, changes were noted in the way that the cigarette was smoked in both groups. There were significant within subject differences over time in both groups on interpuff interval, flow rate, and peak flow. Interpuff intervals shortened over time in the atypical medication group; flow rate and peak flow increased over time in both groups. Carbon monoxide boost pre to post-cigarette was significantly different over time between groups with a dec...