Schizophrenia
Conditions
Keywords
nicotine, schizophrenia, endophenotype
Brief summary
The purpose of this study is to test the effects of nicotine on cognition with the following schizophrenia endophenotypes: prepulse inhibition, antisaccades, the continuous performance test, spatial working memory and a verbal memory task. Schizophrenia patients, unaffected first-degree relatives of schizophrenia patients and healthy controls receive transdermal nicotine in a double-blind, placebo-controlled, crossover study.
Detailed description
Convergent findings suggest that an altered neuronal nicotinic acetylcholine receptor system may contribute to the pathophysiology of schizophrenia. Nicotine consumption through cigarette smoking might represent a form of self-medication in schizophrenia as nicotine reduces cognitive and physiological deficits in schizophrenia. The present study aims to investigate how nicotine affects attentional and executive schizophrenia endophenotypes and how genetic polymorphisms relating to the cholinergic system might play a role in inter-individual differences in the magnitude of nicotine effects. Schizophrenia patients, first-degree relatives of schizophrenia patients as well as healthy controls will receive transdermal nicotine in a double-blind, placebo-controlled, crossover study and will be assessed with prepulse inhibition, antisaccades, the continuous performance test, spatial working memory and a verbal memory task. Subjects will be overnight-abstinent smokers and non-smokers. However, the investigators will particularly test non-smokers in order to eliminate confounding effects of nicotine withdrawal and reinstatement. Main hypotheses: * Schizophrenia patients will perform worse than matched controls in all cognitive tests (validating our endophenotypes). * Nicotine administration will enhance cognitive performance in overnight-abstinent smokers. * Improvement of cognitive performance in smokers with schizophrenia will be stronger than in control smokers. * Improvement of cognitive performance in smoking first-degree relatives of schizophrenia patients will be stronger than in control smokers. * Nicotine administration will affect cognitive functioning in non-smoking subjects. * Nicotine administration will improve cognitive functioning in non-smoking schizophrenia patients. * The effects of nicotine in non-smoking subjects are stronger in those subjects who are cognitively more impaired (i.e. performing below the median of the respective group). The present research contributes to the issue whether nicotinic cholinergic receptor agonists may have therapeutic value in the treatment of cognition in schizophrenia.
Interventions
DRUGTransdermal nicotine patch
7mg transdermal nicotine patch (non-smoking subjects) 14mg transdermal nicotine patch (smoking subjects)
DRUGPlacebo patch
Placebo patch
Sponsors
German Research Foundation
University Hospital, Bonn
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
Patients: * Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) diagnosis of schizophrenia * age 18-55 years old * able to provide informed consent * treated with antipsychotic medications at a stable dose for at least 6 weeks * normal or corrected to normal vision * smokers (Fagerström Test for Nicotine Dependence \> 4) * non-smokers (\< 100 cigarettes/lifetime, not having smoked in the past year) Controls: * age 18-55 years old * able to provide informed consent * normal or corrected to normal vision * smokers (Fagerström Test for Nicotine Dependence \> 4) * non-smokers (\< 100 cigarettes/lifetime, not having smoked in the past year) Unaffected First-Degree Relatives of Schizophrenia Patients: * same inclusion criteria as controls plus * having an adult first-degree relative (sibling, parent, child) with a DSM IV diagnosis of schizophrenia
Exclusion criteria
Patients: * substance dependence * clinical instability * changes in medication in the last 6 weeks * anticholinergic medication * untreated hypertension * cardiovascular disease * insulin-dependent diabetes mellitus * phaeochromocytoma * uncontrolled hyperthyroidism * renal or hepatic impairment * central nervous system disease * pulmonary disease * generalised dermatological disorders (neurodermatitis, psoriasis, chronic dermatitis, urticaria, etc.) * gastric or intestinal ulcer * hypersensitivity to nicotine * allergy to patches * women: pregnancy, lactation Controls: * substance dependence * having a first-, second-, or third-degree relative with a psychotic disorder * DSM IV Axis I disorder * anticholinergic medication * untreated hypertension * cardiovascular disease * insulin-dependent diabetes mellitus * phaeochromocytoma * uncontrolled hyperthyroidism * renal or hepatic impairment * central nervous system disease * pulmonary disease * generalised dermatological disorders (neurodermatitis, psoriasis, chronic dermatitis, urticaria, etc.) * gastric or intestinal ulcer * hypersensitivity to nicotine * allergy to patches * women: pregnancy, lactation Unaffected First-Degree Relatives of Schizophrenia Patients: * same
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Error Percentage in Antisaccade Task | Three hours after patch application | Three hours after the application of a nicotine or a placebo patch, performance on the antisaccade task is assessed. In the antisaccade task participants visually fixate a central stimulus which is replaced by a sudden onset target that appears at some distance to the left or right. Participants are told to refrain from looking at the peripheral target, and direct their gaze instead in the opposite direction (i.e. they have to make an antisaccade). Participants typically fail to achieve this on a significant number of trials and instead make reflexive glances towards the target (i.e. making a so-called antisaccade error). Error percentage in the antisaccade task is the unit of measure in this task. Error percentage in the antisaccade task = number of antisaccade errors / total number of trials. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| All Study Participants Includes groups randomized to receive nicotine first and placebo first. Number of all study participants = 121. | 121 |
| Total | 121 |
Baseline characteristics
| Characteristic | All Study Participants |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 121 Participants |
| Age, Continuous | 30.23 years STANDARD_DEVIATION 9.26 |
| Region of Enrollment Germany | 121 participants |
| Sex: Female, Male Female | 53 Participants |
| Sex: Female, Male Male | 68 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 5 / 61 | 5 / 60 |
| serious Total, serious adverse events | 0 / 61 | 0 / 60 |
Outcome results
Primary
Error Percentage in Antisaccade Task
Three hours after the application of a nicotine or a placebo patch, performance on the antisaccade task is assessed. In the antisaccade task participants visually fixate a central stimulus which is replaced by a sudden onset target that appears at some distance to the left or right. Participants are told to refrain from looking at the peripheral target, and direct their gaze instead in the opposite direction (i.e. they have to make an antisaccade). Participants typically fail to achieve this on a significant number of trials and instead make reflexive glances towards the target (i.e. making a so-called antisaccade error). Error percentage in the antisaccade task is the unit of measure in this task. Error percentage in the antisaccade task = number of antisaccade errors / total number of trials.
Time frame: Three hours after patch application
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nicotine Patch | Error Percentage in Antisaccade Task | 22.6 Error Percentage in Antisaccade Task | Standard Deviation 17 |
| Placebo Patch | Error Percentage in Antisaccade Task | 29.1 Error Percentage in Antisaccade Task | Standard Deviation 19.1 |
Comparison: Null hypothesis is that there was no difference in change of error percentage in the antisaccade task between nicotine and placebo. An ANOVA model was used with treatment (nicotine, placebo) as a within-subjects factor. The test was performed with a significance level of 0.05 (two-sided). Results showed significantly better antisaccade performance (i.e. less antisaccade errors) in the nicotine condition.p-value: <0.05ANOVA