title: A test of the cognitive self-medication hypothesis of tobacco smoking in schizophrenia.
abstract: BACKGROUND
  Heavier tobacco smoking among people with schizophrenia (SCZ) has been suggested to reflect self-medication of cognitive deficits. The idea that cognitive-enhancing effects of nicotine are a primary motivator of tobacco consumption in SCZ and that abstinence would deprive SCZ of such beneficial effects might explain hesitation among providers to pursue smoking cessation in SCZ. This study tested predictions of the cognitive self-medication hypothesis.
  
  
  METHODS
  In three counterbalanced sessions, 17 SCZ and 17 healthy control subjects (HCS), all smokers, were tested under ad libitum smoking or 3.5 hours after abstaining and receiving a nicotine (14 mg/24 hours) or placebo patch.
  
  
  RESULTS
  Attention task performance was improved by transdermal nicotine relative to placebo, with intermediate performance by ad libitum smoking. These effects were of similar size in SCZ and HCS and did not reflect remediation of functions disproportionately impaired in SCZ. Although more SCZ reported that the need to concentrate influenced their smoking, this was not reflected by the actual behavior of these patients. Self-reported ability to concentrate changed with nicotine status in HCS but not SCZ, suggesting insensitivity of SCZ to nicotine-derived performance benefits. Nicotine plasma concentrations after ad libitum smoking were not associated with performance benefits but instead with the propensity to experience nicotine withdrawal upon abstinence. This association was seen selectively in SCZ, suggesting a possible reason for heavier smoking.
  
  
  CONCLUSIONS
  These findings suggest that subjective or objective attentional benefits are unlikely the primary driving force of tobacco consumption in SCZ and should not discourage providers from supporting quit attempts.
authors: Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA. bhahn@mprc.umaryland.edu
authors: Britta
authors: B
authors: Hahn
authors: Alexander N
authors: AN
authors: Harvey
authors: Marta
authors: M
authors: Concheiro-Guisan
authors: Marilyn A
authors: MA
authors: Huestis
authors: Henry H
authors: HH
authors: Holcomb
authors: James M
authors: JM
authors: Gold
mesh_terms: D000328:Adult; D001288:Attention / Q000187:drug effects*; D003072:Cognition Disorders / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000032:analysis / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D012651:Self Medication; D012907:Smoking; D013375:Substance Withdrawal Syndrome / Q000523:psychology
chemical_list: D009538:Nicotine
keywords: Cognitive deficits; nicotine; schizophrenia; self-medication; smoking; withdrawal
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