title: Varenicline as a smoking cessation aid in schizophrenia: effects on smoking behavior and reward sensitivity.
abstract: BACKGROUND
  Smoking rates are up to five times higher in people with schizophrenia than in the general population, placing these individuals at high risk for smoking-related health problems. Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, is a promising aid for smoking cessation in this population. To maximize treatment efficacy while minimizing risks, it is critical to identify reliable predictors of positive response to varenicline in smokers with schizophrenia.
  
  
  OBJECTIVE
  Negative symptoms of schizophrenia are related to dysfunctions in the brain reward system, are associated with nicotine dependence, and may be improved by nicotine or nicotinic receptor agonists, suggesting that smoking cessation may be especially difficult for patients with substantial negative symptoms. The purpose of the study was to evaluate negative symptoms as predictors of response to varenicline.
  
  
  METHODS
  Patients with schizophrenia (N = 53) completed a 12-week smoking cessation trial combining varenicline with cognitive behavioral therapy. Negative symptoms were assessed via the Scale for the Assessment of Negative Symptoms (Andreasen 1983). Outcomes included smoking abstinence as assessed by self-report and expired carbon monoxide. Change in performance on a probabilistic reward task was used as an index of change in reward sensitivity during treatment.
  
  
  RESULTS
  At week 12, 32 participants met criteria for 14-day point-prevalence abstinence. Patients with lower baseline symptoms of affective flattening (more typical affect) were more likely to achieve smoking abstinence and demonstrated larger increases in reward sensitivity during treatment.
  
  
  CONCLUSIONS
  These data suggest that affective flattening symptoms in smokers with schizophrenia may predict response to varenicline.
authors.affiliation: Department of Psychology, Yale University, P.O. Box 208205, New Haven, CT 06520, USA.
authors.forename: Sunny J
authors.initials: SJ
authors.lastname: Dutra
authors.forename: Luke E
authors.initials: LE
authors.lastname: Stoeckel
authors.forename: Sara V
authors.initials: SV
authors.lastname: Carlini
authors.forename: Diego A
authors.initials: DA
authors.lastname: Pizzagalli
authors.forename: A Eden
authors.initials: AE
authors.lastname: Evins
mesh_terms: D000328:Adult; D001552:Benzazepines / Q000494:pharmacology / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000187:drug effects* / Q000502:physiology; D011810:Quinoxalines / Q000494:pharmacology / Q000627:therapeutic use*; D012201:Reward; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D012907:Smoking / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D011810:Quinoxalines; D000068580:Varenicline