Assessment of Craving in Nicotine-Dependent Patients With Schizophrenia Using Virtual Reality
Condition: Nicotine Dependence
MeSH terms: Tobacco Use Disorder; Schizophrenia
Study type: Observational

Summary: 
      Background:

        -  The prevalence of cigarette smoking among individuals with schizophrenia is noticeably
           higher than in the general population, and smoking cessation attempts frequently are
           unsuccessful in this population. Little is known about the effects of cigarette/nicotine
           craving in individuals with schizophrenia. Researchers are interested in learning more
           about how craving affects people with schizophrenia and developing new ways to treat
           cravings and improve the effectiveness of smoking cessation therapies and treatments.

        -  In recent years, virtual reality (VR) has been studied to determine whether it can be
           used to induce craving by using life-like cue settings. VR cues involving cigarette use,
           including images of cigarettes and scent cues of tobacco smoke, may be used to elicit
           craving in smokers. Researchers are interested in learning more about how individuals
           with schizophrenia respond to specific VR cues and settings.

      Objectives:

        -  To determine the feasibility of using a contextual real-world paradigm using virtual
           reality involving cigarette smoking in people with schizophrenia.

        -  To examine if virtual reality cues will elicit craving in smokers with schizophrenia.

      Eligibility:

      - Current smokers (five or more cigarettes per day for at least 1 year) between 18 and 45
      years of age who have been diagnosed with schizophrenia/schizoaffective disorder.

      Design:

        -  The study will involve three sessions, with an initial screening visit, a test session,
           and a follow-up session.

        -  Screening visit: Participants will be screened with a medical and psychiatric history,
           and will answer questions about smoking history, current smoking habits and craving
           patterns, and general anxiety levels. This session will also introduce participants to
           the operation and use of the VR equipment. Participants who are comfortable using the VR
           system will return within 2 days for the test session.

        -  Test session: Participants will use the VR equipment to view neutral scenes and scenes
           that are designed to elicit cravings for cigarettes. After viewing each scene,
           participants will answer questions about their overall mood, anxiety levels, and any
           cigarette cravings they may have.

        -  Follow-up session: Participants will return 1 week after the VR session to answer
           questions about mood, anxiety levels, and current smoking habits and craving patterns.
    

Detailed description: 
      Objective:

      Nicotine use is high in people with schizophrenia; however, interventions to aid in smoking
      cessation have not been overwhelmingly successful. Craving, particularly situational craving,
      is one reason people relapse. Craving paradigms in people with schizophrenia need to be
      optimized in order to test new treatments on craving measures in this population. Thus, the
      purpose of this study is to determine the feasibility and effects of virtual reality cues on
      craving intensity for smoking in patients with schizophrenia

      Study population:

      We will enroll 25 smokers with a DSM IV diagnosis of schizophrenia with the goal of obtaining
      a total of 16 completers.

      Design:

      This study uses a comparison-controlled, within-subject design. All subjects will undergo a
      baseline assessment and acclimation period and then participate in an experimental condition
      in which four cues will be presented in separate rooms in the VR program. These include two
      smoking cues and two neutral cues in four different rooms. A follow up session for craving
      and symptom assessments will occur one week after the experimental session.

      Outcome Measures:

      During the Cue trials the Cigarette Craving Visual Analogue Scale (CCVAS), a four-item scale,
      and the Tobacco Craving Questionnaire-Short Form (TCQ-SF)will be administered to measure
      cigarette craving during the virtual reality session. At the end of each of the 4 cues
      (neutral, smoking cue with no interaction, smoking cue with interaction, neutral)
      participants will be asked about craving. The CCVAS will be projected into the VR environment
      and participants will respond via hand controller. To assess mood status, the Mood form will
      also be administered at baseline as well as at the end of each of the 4 cues. Before and
      after the experimental session participants will also be rated on the Brief Psychiatric
      Rating Scale (BPRS), Schedule for the Assessment of Negative Symptoms (SANS), side effects,
      and the State-Trait Anxiety Inventory (STAI). The Immersion Questionnaire and Imagery Realism
      Presence Questionnaire (PQ) will be given at the conclusion of the experimental session.
      During the experiment participants will be monitored for physiological reactivity (heart
      rate, blood pressure, and skin conductance response) to cues of smoking as well as neutral
      cues measured. Additionally, subjects will be assessed before and after the experimental
      session
    

Time perspective: Prospective
Keywords: Tobacco Craving; Virtual Reality; Schizophrenia; Smoking