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Warum rauchen Schizophreniepatienten?

Why do schizophrenic patients smoke?

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Zusammenfassung

Patienten mit schizophrenen Störungen zeigen eine erhöhte Prävalenz der Nikotinabhängigkeit. Diese Arbeit beleuchtet die Zusammenhänge zwischen Schizophrenie und Nikotinkonsum. Es gibt deutliche Hinweise dafür, dass wesentliche Bereiche kognitiver Funktionen bei Patienten mit schizophrenen Erkrankungen durch Nikotin verbessert werden, insbesondere Daueraufmerksamkeit, gerichtete Aufmerksamkeit, Arbeitsgedächtnis, Kurzzeitgedächtnis und Wiedergabe aus dem Gedächtnis. Auch konnten in einigen Studien mittels ereigniskorrelierten Potenzialen (P50-Paradigma) und der Präpulsinhibition des akustisch ausgelösten Schreckreflexes gezeigt werden, dass präattentive Maße der Informationsverarbeitung, die eine zentrale Rolle in der Schizophrenie spielen, durch Gabe von Nikotin verbessert werden können. Weiterhin kann Rauchen die durch antipsychotische Medikamente hervorgerufenen extrapyramidalen Nebenwirkungen verbessern, und es induziert das Zytochrom P4501A2, das auch an der Metabolisierung einiger Neuroleptika beteiligt ist. Zusammenfassend kann festgestellt werden, dass die Nikotinzufuhr bei Patienten mit schizophrenen Störungen eine Form der „Selbstmedikation“ darstellen könnte, um Defizite im Bereich Aufmerksamkeit, Kognition und Informationsverarbeitung zu verbessern und um Nebenwirkungen von Antipsychotika zu reduzieren. Mögliche pharmakotherapeutische Ansätze zur Behandlung der gestörten Neurotransmission am nikotinergen Azetylcholinrezeptor werden diskutiert.

Summary

Patients suffering from schizophrenia are known to show an increased prevalence of nicotine addiction. The aim of this paper is to elucidate the relationship between schizophrenia and (chronic) use of nicotine. Nicotine seems to improve cognitive functions critically affected in schizophrenia, in particular sustained attention, focused attention, working memory, short-term memory, and recognition memory. Furthermore, several studies using evoked potentials (P50 paradigm) and prepulse inhibition of the acoustic startle reflex suggest that deficient preattentive information processing, a core feature of schizophrenia illness, is improved following treatment with nicotine. Smoking can also improve extrapyramidal secondary effects of antipsychotic medication and it induces cytochrome P4501A2, an enzyme system involved in the metabolism of several antipsychotics. There is substantial evidence that nicotine could be used by patients with schizophrenia as a “self-medication” to improve deficits in attention, cognition, and information processing and to reduce side effects of antipsychotic medication. Possible pharmacotherapeutic approaches for the regulation of abnormal neurotransmission at nicotinic acetylcholine receptors are discussed.

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Authors and Affiliations

  1. Psychiatrische Poliklinik, Inselspital, Bern, Schweiz

    K. Cattapan-Ludewig

  2. Forschungsabteilung, Psychiatrische Dienste des Kantons Aargau, Brugg, Schweiz

    K. Cattapan-Ludewig,  K. Cattapan-Ludewig, S. Ludewig, E. Jaquenoud Sirot & M. Etzensberger

  3. Abteilung Klinische Forschung, Psychiatrische Universitätsklinik, Zürich, Schweiz

    F. Hasler

  4. Psychiatrische Poliklinik, Inselspital, Murtenstraße 21, 3010, Bern, Schweiz

    K. Cattapan-Ludewig

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  1. K. Cattapan-Ludewig
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  3. E. Jaquenoud Sirot
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Cattapan-Ludewig, K., Ludewig, S., Jaquenoud Sirot, E. et al. Warum rauchen Schizophreniepatienten? . Nervenarzt 76, 287–294 (2005). https://doi.org/10.1007/s00115-004-1818-0

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