Effect of nicotine replacement therapy on agitation in smokers with schizophrenia: a double-blind, randomized, placebo-controlled study
Open accessAbstract
OBJECTIVE: The authors conducted a randomized, placebo-controlled study of nicotine replacement therapy for the reduction of agitation and aggression in smokers with schizophrenia. METHOD: Participants were 40 smokers 18-65 years of age admitted to a psychiatric emergency service with a diagnosis of schizophrenia confirmed by the Mini International Neuropsychiatric Interview. Patients were screened for agitation with the excited component subscale of the Positive and Negative Syndrome Scale (PANSS) and for nicotine dependence with the Fagerström Test for Nicotine Dependence. A score of at least 14 on the PANSS excited component subscale and at least 6 on the Fagerström test were required for study eligibility. Participants in the nicotine replacement group received a 21-mg nicotine transdermal patch, and those in the placebo group were treated with a placebo patch. Participants received usual care with antipsychotics. The Agitated Behavior Scale and other agitation measures were administered at baseline and again at 4 and 24 hours. RESULTS: At baseline, participants were at least moderately agitated, and 28% reported aggressive behavior in the previous week. The mean Agitated Behavior Scale score for the nicotine replacement group was 33% lower at 4 hours and 23% lower at 24 hours than for the placebo group. Participants with lower levels of nicotine dependence responded better than those with higher levels of dependence. CONCLUSIONS: The drug-placebo difference in this study was similar to that obtained in trials of parenteral antipsychotics in similar populations. This finding suggests that in patients with schizophrenia, smoking status should be included in the assessment of agitation and nicotine replacement included in the treatment of those who are smokers.
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In a double-blind, placebo controlled trial of transdermal nicotine in adult smokers with schizophrenia, participants in the active arm experienced a 33% reduction in agitation as measured by the Agitated Behavior Scale, versus a 23% reduction for the placebo arm.
“In this study, participants in the active arm experienced a 33% reduction in agitation as measured by the Agitated Behavior Scale (Corrigan, 1989), versus a 23% reduction for the placebo arm.”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Allen et al., 2011
There were significant differences in the PANSS excited component subscale, with participants in the intervention arm showing more significant reductions than those who received placebo.
“there were significant differences in the positive and negative symptoms of schizophrenia scale (PANSS) excited component subscale, with participants in the intervention arm showing more significant reductions than those who received placebo”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Allen et al., 2011
These differences were larger in patients with less severe nicotine dependence as measured by the Fagerstrom scale.
“these differences were larger in patients with less severe nicotine dependence as measured by the Fagerstrom scale (Fagerstrom, 1978)”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Allen et al., 2011
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- Authors
- Allen, M. H., Debanné, M., Lazignac, C., Adam, E., Dickinson, L. M., & Damsa, C.
- Affiliations
- University of Geneva (CH)
- From the Depression Center, University of Colorado School of Medicine, Aurora; Faculty of Psychology and Faculty of Medicine, University of Geneva, Switzerland; and International Mental Health SA, Grand Lancy, Switzerland.
- ORCID
- Dickinson, L. Miriam
- Venue
- American Journal of Psychiatry
- Published
- 2011-04
- Volume
- 168
- Issue
- 4
- Pages
- 395-399
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2155255064
- Cited by
- 78
- References
- 22
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 5 · 2017: 8 · 2016: 9 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 5
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Keywords
- nicotine replacement therapy, schizophrenia, agitation, aggression, smoking, nicotine dependence, psychiatric emergency care, antipsychotic drugs
- MeSH terms
- Adolescent, Adult, Aged, Double-Blind Method, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Nicotine, Psychiatric Department, Hospital, Psychiatric Status Rating Scales, Psychomotor Agitation, Schizophrenia, Schizophrenic Psychology, Smoking, Violence, Smoking Cessation, Young Adult, Transdermal Patch
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