Smoking and Schizophrenia: Understanding and Breaking the Cycle of Addiction

Newswise, April 21, 2016– Smoking addiction in schizophrenia can be explained by significantly increased activation of the ventro-medial prefrontal cortex (vmPFC), a region involved in the brain reward system.

These new data, the result of a study by researchers at the Institut universitaire en santé mentale de Montréal (CIUSSS EST, Montreal) and the University of Montreal confirms the tendency to smoke and low smoking cessation rates of people with schizophrenia.

“Smoking is a real problem for people with schizophrenia,” said Stéphane Potvin, a researcher at the Institut universitaire en santé mentale de Montréal and lead author of the study.

"Their health and life expectancy are often undermined by this addiction, whose brain mechanisms were until now largely unknown," said the associate professor at the University of Montreal’s Faculty of Medicine.

Essentially, the research team observed greater neuronal activation of a specific region of the brain (vmPFC) in schizophrenia smokers compared with healthy subjects when presented with appetitive cigarette images.

At the behavioural level, the researchers also found that schizophrenia smokers had more depressive symptoms than did participants in the control group.

“These observations suggest that smoking has a greater rewarding effect in schizophrenia smokers. This corroborates the hypothesis already formulated of their increased vulnerability to this addiction but also demonstrates the great difficulty for them when it comes to quitting smoking," said Potvin.

The prevalence of smoking in people with schizophrenia is high, and cessation rates are low. Schizophrenia smokers are twelve more times likely to die from heart disease related to smoking than are those who do not smoke.

“It is necessary to explore avenues that will help people in their efforts to free themselves from smoking,” said Potvin. “

That is why we want to continue our research into whether this activation of the ventro-medial prefrontal cortex (vmPFC) is caused by the disease itself or by the effects of antipsychotics,” concluded the researcher.

Simultaneous Cocaine, Alcohol Use Linked to Suicide Risk

Photo By Psychonaught - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9818612

Newswise, April 14, 2016--In a general sense, medical studies support the popular intuition -- a staple of movies and literature -- that suicidal behavior and substance misuse are linked. But the relationship between the two is not so simple.

A new study of hundreds of suicidal emergency department (ED) patients from around the U.S. found that the significance of the link varied with age, gender and race. Across the board, however, the use of cocaine and alcohol together was a red flag.

"One unexpected finding was that, when examined independently, alcohol use had no significant association and cocaine use had a borderline significant association," wrote authors of the study in the journal Crisis.

"However, reporting both alcohol misuse and cocaine use was significantly associated with a future suicide attempt."

Led by Sarah Arias, assistant professor (research) of psychiatry and human behavior in the Alpert Medical School of Brown University, the team examined 874 men and women who presented at one of eight emergency departments around the country between 2010 and 2012.

The patients were participants in the Emergency Department Safety Assessment and Follow-up Evaluation study, led by the University of Massachusetts Medical School. Individuals included in the analysis received standard care and either reported a recent suicide attempt or were actively engaged in suicidal thoughts at the time of the initial ED visit.

In another arm of the study, not included in this analysis, patients received an experimental intervention. Researchers gathered demographic and substance use information from the participants and then followed them for a full year afterward.

The key outcome in Arias' new study was whether people attempted suicide in the year following the ED visit. Of the 874 people, 195 people did at least once.

What Arias, who is also a research psychologist at Butler Hospital, and her colleagues found was that although people in the study reported misusing many different substances, including marijuana, prescription painkillers, tranquilizers and stimulants, only cocaine and alcohol appeared to have a significant association with suicide risk.

Of the entire study population, 298 misused alcohol, 72 were using cocaine and 41 were using both. Specifically, of those using both, the chance of attempting suicide again was 2.4 times greater than among people in the study who were not.

They also found that substance misuse was less likely an indicator of suicide risk among whites and women. Older people, meanwhile, were more likely to have an association between substance misuse and suicide.

Women are not less likely to be suicidal, the researchers note. In fact, they were more likely than men to have reported prior attempts. But the data showed that substance abuse was less likely to be involved among women.

"These disparate findings emphasize the complex interaction of sex, substance use, and suicide attempts," Arias and her co-authors wrote. "They also suggest women may be differentially at risk depending on whether they report substance use or past suicide attempts."

The study does not say anything about whether substance abuse causes suicidal behavior because it only reports observations of associations.

But Arias said she hopes the data will advance the understanding of how misuse of particular substances, among particular patients, may affect their risk of suicide.

"It's not a clear-cut, straightforward association," Arias said. "Even though substance use is often touted as a very strong predictor of suicidal intentions and behaviors, when we look at individual substances we're seeing that there's not that consistency in the future association with behavior."

Figuring out the specific cases where substance misuse is predictive could help save lives.

"We're on our way to trying to identify factors that can be used to better assess and identify people who are at risk for suicide, and ultimately I think this is a step in the right direction to get a better picture," she said.

"Patients who have potentially comorbid alcohol and cocaine use may be at a higher risk. Findings like these can be useful for informing suicide risk assessment."

###

In addition to Arias, the study's other authors are Orianne Dumas, Ashley Sullivan, Edwin Boudreaux, Ivan Miller and Carlos Camargo Jr. The research was funded by the National Institute of Mental Health (grant: U01MH088278).

Parkinson’s Disease Medications Increase Risk of Compulsive Gambling, Shopping and Binge Eating in Some Patients

Newswise, April 7, 2016 – Drugs commonly prescribed to treat Parkinson’s disease have been linked to impulse control disorders such as pathological gambling, compulsive buying, hypersexuality and binge eating in some patients, according to a review article by neurologists at Loyola Medicine and Loyola University Chicago Stritch School of Medicine.

These disorders can have disastrous personal, professional and financial consequences if not recognized or treated, according to the article in the journal Expert Review of Neurotherapeutics. Authors of the paper include José Biller, MD, and first author Adolfo Ramirez-Zamora, MD, who completed a residency in neurology at Loyola.

The paper details the latest findings for treating impulse control disorders (ICDs) in Parkinson’s disease patients, including adjusting medications, deep brain stimulation and a counseling technique called cognitive behavioral therapy.

One large, previous national study found that approximately 14 percent of Parkinson’s disease patients experience at least one ICD. The disorders are more common in men.

Men are more likely to display hypersexuality and pathological gambling, while women are more likely to exhibit compulsive eating and buying. Potentially catastrophic consequences include financial ruin, divorce and loss of employment.

Patients often lack insight and underestimate the presence and severity of ICDs and related conditions, the authors write. ICDs are probably more prevalent in Parkinson’s disease patients than previously reported.

The primary risk factor for ICDs is the use of a class of Parkinson’s disease medications called dopamine agonists, which help control tremors and other Parkinson’s symptoms.

These drugs include pramipexole (Mirapex®) and ropinirole (Requip®). Other risk factors include younger age, smoking, alcohol abuse and personality traits such as impulsivity, obsessive-compulsive disorder, depression and anxiety.

Management of ICDs is particularly difficult and no treatment guidelines for ICDs in Parkinson’s patients are available. Treatment should be individualized, and careful selection of specific interventions is critical. Treatments that have been considered include switching, reducing or discontinuing Parkinson’s medications.

But this can be challenging. Patients often are reluctant to change medications because they do not want their tremors to get worse. Patients also can experience withdrawal symptoms when taken off dopamine agonists, including anxiety, panic attacks, depression, irritability and fatigue.

The authors discuss alternative treatment strategies for Parkinson’s disease and medications that may help control ICDs, such as antidepressants, atypical antipsychotics and antiepileptic drugs.

Other potential nondrug treatments include cognitive behavioral therapy and a “brain pacemaker” called deep brain stimulation. The authors provide a much-needed, practical and detailed review of the factors important making management decisions

Families also play a critical role. Spouses and other family members should be warned that Parkinson’s medications can cause ICDs. Families should report to the patient’s physician any “unexplained absences, changes in routine behaviors, irritability, hiding evidence of the impulse control disorders and monetary consequences,” the authors write. Helpful non-pharmacological approaches include limiting access to bank accounts, credit cards and the internet.

Dr. Biller is chair of the department of neurology of Loyola University Chicago Stritch School of Medicine. Dr Ramirez-Zamora, a former resident in Loyola’s department of neurology, is now at Albany Medical College and serves as the Phyllis E. Duke Endowed Chair in Movement Disorders. Other co-authors are Lucy Gee of Albany Medical College and James Boyd, MD, of the University of Vermont College of Medicine.

Their article is titled, “Treatment of impulse control disorders in Parkinson’s disease: Practical considerations and future directions.”