黄奕和聂远的爱情:戒烟药物能够改善一些精神分裂症症状

为什么那么多患有精神分裂症的病人吸烟呢？

It may be because it makes them feel better. Nicotine is known to transiently improve several neurological and cognitive impairments in patients with schizophrenia. 

也许是因为这能够让他们感觉更舒服。众所周知，尼古丁能够短暂的改善精神分裂症患者的严重的神经和认知损害

And now scientists have found that the antismoking medication varenicline (Chantix) can improve some of these functions as well.

现在，科学家已经发现，戒烟药物伐伦克林也能够改善一些功能。

The study was headed by L. Elliot Hong, M.D., an associate professor of psychiatry at the University of Maryland. Results were published online August 1 in the Archives of General Psychiatry.

这项研究是由马里兰大学精神病学副教授L·埃利奥特·洪的带领下进行的。研究结果于8月1日发表在在线期刊一般精神病档案上。

Although nicotine, for a while at least, improves a number of functions in patients with schizophrenia, it's not clear which nicotinic acetylcholine receptors in the brain are responsible for these effects. However, there is one particularly strong candidate, alpha4beta2, because it plays a major role in nicotine's actions in the brain. Moreover, varenicline is known to act on this receptor. 

尽管至少在一段时间内，尼古丁改善精神分裂症患者的一些功能，究竟是大脑中的哪种尼古丁乙酰胆碱受体起到作用不是很清楚。然而有一个特别明显的候选对象，就是alpha4beta2，因为该受体在尼古丁在大脑中的反应中扮演了主要角色。而且，已知伐伦克林就是通过该受体产生起作用。

Thus Hong and his group wondered whether varenicline might be able to improve some of the neurobiological impairments experienced by people with schizophrenia. 

这样，洪教授和他的团队怀疑，伐伦克林是否可能改善了精神分裂症患者所经历的一些神经损害症状。

The cohort of their study included 69 subjects with schizophrenia or schizoaffective disorder, aged 18 to 60, and all on antipsychotic medications and stable. They were randomly assigned to either a treatment group or a placebo group. Half received, for eight weeks, a moderate dose of varenicline (1 mg a day, which is half the recommended dose for smoking cessation). The rest received a placebo during the eight-week period. 

他们的这组研究包括了69个具有精神分裂症或情感分裂性精神障碍的实验对象，年龄在18到60岁之间，都在服用抗精神病药物，且病情稳定。他们被随机安排到治疗组和安慰剂组。一半接受八周中等剂量的伐伦克林（每天1毫克，给戒烟者推荐剂量的一半）。其余的则在这八周期间服用安慰剂。

At the start of the study, during it, and at the end, all subjects were evaluated for neurobiological functions often impaired in schizophrenia, but also known to benefit from nicotine—information-processing speed, saccades, sensory gating, spatial working memory, startle reactivity, and sustained attention. Their use of tobacco was also determined. 

研究开始，过程中以及研究结束三个阶段，所有实验对象接受受到精神分裂症损害的神经生物学功能评估，但是也知道从尼古丁那里得到的益处---信息处理速度、跳阅、感觉门控、空间工作记忆、惊跳反应和保持关注。他们的吸烟情况也是明确的。

They found that varenicline significantly reduced startle reactivity and saccade errors, regardless of subjects' smoking status. The medication also significantly reduced sensory-gating deficits in nonsmokers, but not in smokers. It had no significant effect in either smokers or nonsmokers on spatial working memory, information processing speed, or sustained attention. 

他们发现，不论被试对象的吸烟情况如何，伐伦克林能显著减轻惊跳反应和跳阅错误。治疗也显著减轻了非吸烟者感觉门控的不足，但是对吸烟者来说并没有这个作用。在空间工作记忆、信息处理速度或者持续关注方面，对吸烟者和非吸烟者来说都没有显著作用。

The subjects getting varenicline were also evaluated to see whether it exacerbated their symptoms or made them depressed or suicidal. Such an evaluation was especially crucial since varenicline has been linked in postmarketing reports, studies, and lawsuits with suicide and violence in some people who have used it to stop smoking (Psychiatric News, March 7, 2008; August 7, 2009; February 4 and June 17). And there is a Food and Drug Administration black-box warning on the label for varenicline. Yet the researchers for the current study found no sign of varenicline producing such adverse effects. 

服用伐伦克林的实验对象也接受了评估，以观察药物是否加重了他们的症状或者让他们感觉更沮丧或者想自杀。这样一种评估是很关键的，因为在上市后的报告、研究和诉讼中，伐伦克林已经和自杀和暴力联系起来了，这些人曾服用该药物来戒烟。食品和药品管理局对此也发出了警告。然而，目前的研究者没有发现伐伦克林产生这种副作用的迹象。

“Our study reveals that moderate-dose treatment with varenicline has a long-term effect on specific biomarkers,” Hong and his group concluded. “A longer-term treatment and/or a doseranging design could reveal further improvements because core neurophysiological impairments in schizophrenia are chronic and entrenched.” 

“我们的研究显示，用中等剂量的伐伦克林治疗对特别的生物标志物有长期作用，”洪教授和他的团队得出这样的结论。“长期的治疗和或剂量范围设计能够发现进一步的改善，因为精神分裂患者身上核心的神经生理损害是慢性的、根深蒂固的。”

“We are cautiously excited that a number of improvements were seen in the patients,” Hong told Psychiatric News. Although it is too soon to recommend varenicline as a treatment for patients with schizophrenia, he said, “these findings do encourage a more thorough evaluation, especially whether this or other nicotinic receptor drugs may help specific biological deficits associated with schizophrenia.” 

“我们感到谨慎乐观的是，在病人身上看到了许多改善的情况，”洪教授说。尽管把伐伦克林作为治疗精神分裂症的推荐药物为时尚早，他说，“这些发现鼓励人们进行更加全面的评估，特别是是否这种或其它尼古丁受体药物能够帮助与精神分裂症相关的具体的生物方面的不足。”

These findings, Hong and his group believe, should also further the development of novel compounds that act similarly to varenicline on the alpha4beta2 receptor and that “are safe and effective for treating specific neurobiological deficits.” 

洪教授和他的团队相信这些发现应该也能促进新化合物的开发，这些化合物与伐伦克林相似，对alpha4beta2受体起作用，“对治疗特殊的神经生理不足来说是安全有效的。”

“This is an interesting study,” Ann Olincy, M.D., an associate professor of psychiatry at the University of Colorado at Denver who has done research in this area, told Psychiatric News. Since varenicline is only a partial agonist—not a full agonist—at the alpha4beta2 receptor site, it performs differently in smokers and nonsmokers, she said. And this fact may explain some of the findings regarding it, she believes—for example, why treatment with it improved sensory gating in nonsmoking subjects, but not in smokers. 

“这个研究很有趣，”科罗拉多州丹佛大学的精神病学副教授，医学博士安·阿林西说，他也在做这个领域的研究。对alpha4beta2受体来说，既然伐伦克林仅是部分激动剂--不是完全激动剂，它对吸烟者和非吸烟者的作用是不同的，她说。这个事实可以解释有关它的一些发现，她相信----例如，为什么用该药物可以改善非吸烟实验对象的感觉门控，但是对吸烟者无效。

The study was funded by the Stanley Medical Research Institute, the National Institutes of Health, and the University of Maryland General Clinical Research Center.

资助这项研究的是由斯坦利医学研究所，国立卫生研究院和马里兰大学一般临床研究中心。