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175. Effects of the Nicotinic Partial Agonist Varenicline on Smoking Lapse in Smokers with and without Schizophrenia
Biological Psychiatry
Thursday Abstracts
175. Effects of the Nicotinic Partial Agonist Varenicline on Smoking Lapse in Smokers with and without Schizophrenia Alexandria Coles1, Karolina Kozak1, Maryam Sharif-Razi2, Sherry McKee3, and Tony George4 1
Centre for Addiction and Mental Health, University of Toronto, 2Centre for Addiction and Mental Health, 3 Department of Psychiatry, Yale School of Medicine, 4 Centre of Addiction and Mental Health Background: Varenicline is currently the most effective smoking cessation aid that has been found to improve abstinence rates in patients with schizophrenia. Smokers with schizophrenia have high rates of smoking cessation failure, are more highly nicotine dependent and experience greater cognitive dysfunction during withdrawal. Thus the importance of determining an effective treatment to successfully maintain smoking abstinence and prevent smoking relapse is warranted. Methods: Varenicline, a nicotinic partial agonist, was titrated up to 2mg/day over 4 days and continued for a total of 6 days using a randomized, double-blind, cross-over design in patients with schizophrenia (N514) and healthy controls (N514). Results: We found that in the total sample (N533), varenicline (versus placebo) had a small effect on time to lapse in both patient (Cohen’s d50.35) and control groups (d5 0.28), but that in a subset of smokers with heavy nicotine dependence (FTND6), the effect size for varenicline was significantly higher in patients with schizophrenia (d50.48) compared to healthy controls (d50.28). Conclusions: Implications suggest an adjunctive treatment is necessary for smoking lapse prevention in patients with schizophrenia. Future studies may examine the use of brain stimulation such as repetitive transcranial magnetic stimulation combined with varenicline to increase ability to resist smoking in this vulnerable population. Supported By: GRAND 2012 Award Keywords: Schizophrenia, Cigarette Smoking, Varenicline, Smoking Lapse, Tobacco Use Disorder
176. The Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Smoking Behaviour and Cognition in Smokers with Schizophrenia versus NonPsychiatric Control Smokers 1
2
3
Erin Gaudette , Karolina Kozak , Mera Barr , and Tony George3 1
Centre for Addiction and Mental Health, University of Toronto, Centre for Addiction and Mental Health; Institute of Medical Sciences, University of Toronto, 3Centre for Addiction and Mental Health; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; Institute of Medical Sciences, University of Toronto 2
Background: Rates of tobacco smoking and smoking cessation failure in schizophrenia (SZ) are higher than the general population. While first-line cessation aids such as
bupropion, varenicline, and nicotine replacement therapies have shown promise, better treatments are needed. Our preliminary studies have shown high frequency rTMS suppresses tobacco craving in smokers with SZ. As such, we sought to determine the effects of active versus placebo-sham rTMS on smoking behavior and cognition in smokers with and without SZ. Methods: Fourteen smokers with SZ, and n514 controls were studied at baseline (smoking satiated), after 16 hours of smoking abstinence and after reinstatement of smoking, using a 3-day human laboratory paradigm. 20 Hz active and sham rTMS treatments were administered bilaterally to the dorsolateral prefrontal cortex. Treatment conditions were counterbalanced across subjects. Outcomes included a cognitive battery, tobacco craving, and psychiatric symptoms. Results: Overnight abstinence produced a significant increase in tobacco craving and withdrawal in both groups (p’s,0.05) and these effects were reversed with smoking reinstatement (p’s,0.05); however, active rTMS did not modify this pattern of results. Compared to sham, active rTMS had no significant effects on any cognitive outcomes. Conclusions: Short-term high-frequency rTMS treatment did not modify smoking abstinence-induced changes in cognition and tobacco craving in smokers with SZ. Compared to our previous findings, which used a 1-week rTMS treatment paradigm, shortterm administration of rTMS may not be sufficient to modify cognition, craving and withdrawal outcomes in smokers with SZ. Further research on effects of rTMS on smoking behaviours in SZ using longer-term treatments is warranted. Supported By: Canadian Institutes of Health Research (CIHR) Operating Grant (MOP 115145), to Dr. George and a 2013 Brain and Behavior Research Young Investigator Award to Dr. Barr. Keywords: Schizophrenia, Cigarette Smoking, Repetitive Transcranial Magnetic Stimulation, Tobacco Use Disorder, Neurocognition
177. Autism Behavior Inventory – A Novel Tool for Assessment of Changes in Core and Associated Symptoms of Autism Spectrum Disorder Abigail Bangerter2, Seth Ness2, David Lewin2, Michael Aman3, Anna Esbensen4, Matthew Goodwin5, Geraldine Dawson6, Robert Hendren7, Bennett Leventhal8, Mark Opler9, Kai Fai Ho10, and Gahan Pandina1 Janssen Research & Development, 2Janssen Research & Development, LLC, 3Department of Psychology, Ohio State University, 4Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, 5Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 6 Duke Center for Autism and Brain Development, Duke University, 7University of California, San Francisco, 8UCSF Benioff Children’s Hospital, 9ProPhase, LLC, NYU School of Medicine, Columbia University Medical Center, 10STATTU Inc, Toronto, Canada 1
Background: There are lack of validated tools for measuring change in the core and associated symptoms of
Biological Psychiatry May 15, 2017; 81:S1–S139 www.sobp.org/journal
S73
Thursday Abstracts
175. Effects of the Nicotinic Partial Agonist Varenicline on Smoking Lapse in Smokers with and without Schizophrenia Alexandria Coles1, Karolina Kozak1, Maryam Sharif-Razi2, Sherry McKee3, and Tony George4 1
Centre for Addiction and Mental Health, University of Toronto, 2Centre for Addiction and Mental Health, 3 Department of Psychiatry, Yale School of Medicine, 4 Centre of Addiction and Mental Health Background: Varenicline is currently the most effective smoking cessation aid that has been found to improve abstinence rates in patients with schizophrenia. Smokers with schizophrenia have high rates of smoking cessation failure, are more highly nicotine dependent and experience greater cognitive dysfunction during withdrawal. Thus the importance of determining an effective treatment to successfully maintain smoking abstinence and prevent smoking relapse is warranted. Methods: Varenicline, a nicotinic partial agonist, was titrated up to 2mg/day over 4 days and continued for a total of 6 days using a randomized, double-blind, cross-over design in patients with schizophrenia (N514) and healthy controls (N514). Results: We found that in the total sample (N533), varenicline (versus placebo) had a small effect on time to lapse in both patient (Cohen’s d50.35) and control groups (d5 0.28), but that in a subset of smokers with heavy nicotine dependence (FTND6), the effect size for varenicline was significantly higher in patients with schizophrenia (d50.48) compared to healthy controls (d50.28). Conclusions: Implications suggest an adjunctive treatment is necessary for smoking lapse prevention in patients with schizophrenia. Future studies may examine the use of brain stimulation such as repetitive transcranial magnetic stimulation combined with varenicline to increase ability to resist smoking in this vulnerable population. Supported By: GRAND 2012 Award Keywords: Schizophrenia, Cigarette Smoking, Varenicline, Smoking Lapse, Tobacco Use Disorder
176. The Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Smoking Behaviour and Cognition in Smokers with Schizophrenia versus NonPsychiatric Control Smokers 1
2
3
Erin Gaudette , Karolina Kozak , Mera Barr , and Tony George3 1
Centre for Addiction and Mental Health, University of Toronto, Centre for Addiction and Mental Health; Institute of Medical Sciences, University of Toronto, 3Centre for Addiction and Mental Health; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; Institute of Medical Sciences, University of Toronto 2
Background: Rates of tobacco smoking and smoking cessation failure in schizophrenia (SZ) are higher than the general population. While first-line cessation aids such as
bupropion, varenicline, and nicotine replacement therapies have shown promise, better treatments are needed. Our preliminary studies have shown high frequency rTMS suppresses tobacco craving in smokers with SZ. As such, we sought to determine the effects of active versus placebo-sham rTMS on smoking behavior and cognition in smokers with and without SZ. Methods: Fourteen smokers with SZ, and n514 controls were studied at baseline (smoking satiated), after 16 hours of smoking abstinence and after reinstatement of smoking, using a 3-day human laboratory paradigm. 20 Hz active and sham rTMS treatments were administered bilaterally to the dorsolateral prefrontal cortex. Treatment conditions were counterbalanced across subjects. Outcomes included a cognitive battery, tobacco craving, and psychiatric symptoms. Results: Overnight abstinence produced a significant increase in tobacco craving and withdrawal in both groups (p’s,0.05) and these effects were reversed with smoking reinstatement (p’s,0.05); however, active rTMS did not modify this pattern of results. Compared to sham, active rTMS had no significant effects on any cognitive outcomes. Conclusions: Short-term high-frequency rTMS treatment did not modify smoking abstinence-induced changes in cognition and tobacco craving in smokers with SZ. Compared to our previous findings, which used a 1-week rTMS treatment paradigm, shortterm administration of rTMS may not be sufficient to modify cognition, craving and withdrawal outcomes in smokers with SZ. Further research on effects of rTMS on smoking behaviours in SZ using longer-term treatments is warranted. Supported By: Canadian Institutes of Health Research (CIHR) Operating Grant (MOP 115145), to Dr. George and a 2013 Brain and Behavior Research Young Investigator Award to Dr. Barr. Keywords: Schizophrenia, Cigarette Smoking, Repetitive Transcranial Magnetic Stimulation, Tobacco Use Disorder, Neurocognition
177. Autism Behavior Inventory – A Novel Tool for Assessment of Changes in Core and Associated Symptoms of Autism Spectrum Disorder Abigail Bangerter2, Seth Ness2, David Lewin2, Michael Aman3, Anna Esbensen4, Matthew Goodwin5, Geraldine Dawson6, Robert Hendren7, Bennett Leventhal8, Mark Opler9, Kai Fai Ho10, and Gahan Pandina1 Janssen Research & Development, 2Janssen Research & Development, LLC, 3Department of Psychology, Ohio State University, 4Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, 5Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 6 Duke Center for Autism and Brain Development, Duke University, 7University of California, San Francisco, 8UCSF Benioff Children’s Hospital, 9ProPhase, LLC, NYU School of Medicine, Columbia University Medical Center, 10STATTU Inc, Toronto, Canada 1
Background: There are lack of validated tools for measuring change in the core and associated symptoms of
Biological Psychiatry May 15, 2017; 81:S1–S139 www.sobp.org/journal
S73