Effects of cigarette smoking and nicotine nasal spray on psychiatric symptoms and cognition in schizophrenia.

Schizophrenic patients have among the highest rates of smoking of any group of patients. Previous studies have identified psychophysiological and potential nicotinic receptor abnormalities which may be associated with this phenomenon. The effects of acute smoking or acute administration of nicotine nasal spray, after smoking abstinence, on negative symptoms and neurocognitive function have been less extensively studied in experimental designs. This study investigated the effects of smoking of high nicotine or denicotinized cigarettes, and receiving active or placebo nicotine nasal sprays, on positive and negative symptoms and cognitive functions in schizophrenic patients. The study utilized a placebo controlled crossover experimental design with pre- and post-drug evaluations on each experimental day. Smoking high nicotine cigarettes decreased negative symptoms more than denicotinized cigarettes, but smoking neither cigarette changed scores of positive symptoms, anxiety, or depression. Active nicotine nasal spray did not differentially decrease negative symptoms compared with placebo, but did improve performance on a spatial organization task, and tended to improve some measures of verbal memory and two-choice reaction time in schizophrenic patients. Both high and denicotinized cigarettes improved performance on the spatial processing task, but there was no statistically significant differential drug (Cigarette type) effect. These results suggest that acute smoking of cigarettes may transiently decrease negative symptoms in patients with schizophrenia, but it is unclear whether this effect is attributable to nicotine, other components of cigarettes, or the act of smoking. Nicotine nasal spray may modestly improve some selected aspects of cognitive function in schizophrenia.

Effects of Cigarette Smoking on Psychopathology Scores in Patients With Schizophrenia: An Experimental Study.

Cigarette smoking and/or nicotine administration have been shown to transiently ameliorate several psychophysiological deficits in patients with schizophrenia such as indicators of deficient sensory gating and attention, but acute effects of smoking on positive and negative symptoms in schizophrenia have not been evaluated in experimental paradigms. The current study assessed whether smoking of cigarettes, after 6-12 h abstinence, transiently alters the expression of negative and/or positive symptoms in patients with schizophrenia who have a history of regular smoking. In a double-blind, placebo controlled study patients with schizophrenia participated in two sessions in which they smoked either cigarettes moderately high in nicotine content or denicotinized cigarettes. They were interviewed pre-and postsmoking to obtain ratings of PANSS and SANS scales, and had blood pressure and pulse serially recorded before and after smoking. Pulse rate and blood pressure were slightly higher after smoking in the high nicotine cigarette session. Negative symptom scores on both scales were significantly lower after cigarette smoking compared to same-day predrug baseline, but there were no differences in active versus denicotinized cigarette drug effects. These results suggest that acute smoking of cigarettes reduces negative symptoms in patients with schizophrenia in this experimental paradigm. Future work needs to identify the mechanism responsible for this behavioral effect.

Association of internalizing disorders and allergies in a child and adolescent psychiatry clinical sample.

OBJECTIVE: To investigate the specificity of the association between internalizing disorders (anxiety and depression) and atopic disorders (asthma, allergic rhinitis, urticaria, and atopic dermatitis) in a child and adolescent psychiatric clinical sample. METHOD: A sample of 184 youths was evaluated for current DSM-IV psychiatric disorders (clinical interview) and lifetime history of atopic disorders (parent report and chart review) in a child and adolescent psychiatry clinic from September 1, 2001, through December 31, 2002. Logistic regression analyses were used to assess the differential likelihood of having a lifetime history of atopic disorders among psychiatrically ill youths with and without internalizing disorders. RESULTS: Youths with internalizing disorders were significantly more likely than those with noninternalizing disorders to have a lifetime history of atopic disorders (odds ratio [OR] = 1.95, 95% CI = 1.02 to 3.73, p = .04). Moreover, analyses distinguishing youths with "pure" internalizing disorders from those with comorbid internalizing and externalizing disorders, "pure" externalizing disorders, and other psychiatric disorders showed that the association with atopic disorders was specific for "pure" internalizing disorders only (OR = 2.40, 95% CI = 1.09 to 5.30, p = .03). CONCLUSIONS: Atopic disorders may be associated specifically with "pure" internalizing disorders in psychiatrically ill youths. Additional studies are needed to identify the underlying mechanisms of this specificity for the subsequent development of effective treatment and prevention interventions that target both disorders.