Nicotine Effects on Endophenotypes of Schizophrenia

Study Overview
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Brief Summary
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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
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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.

Official Title
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Nicotine Effects on Endophenotypes of Schizophrenia

Conditions
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Schizophrenia

Intervention / Treatment
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* Drug: Transdermal nicotine patch
* Drug: Placebo patch


Participation Criteria
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Eligibility Criteria
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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 exclusion criteria as controls

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Nicotine Patch<br>Transdermal nicotine patch | Drug: Transdermal nicotine patch<br>* 7mg transdermal nicotine patch (non-smoking subjects) 14mg transdermal nicotine patch (smoking subjects)<br>* Other names: NiQuitin Clear, GlaxoSmithKline Germany;|
| Placebo Comparator: Placebo patch<br>Placebo patch | Drug: Placebo patch<br>* Placebo patch<br>* Other names: band-aid by Fink and Walter GmbH, Germany;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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. | Three hours after patch application | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nicotine, schizophrenia, endophenotype