哮喘联盟

摘要
   原理：与没有注意力缺陷多动障碍（ADHD）的个体相比，ADHD患者戒烟存在更多困难。与该风险增加有关的行为学机制目前了解较少。
   目的：本试验在有和没有ADHD的成人吸烟者中评价24 h戒烟对下列转归的影响：吸烟强化反应、吸烟终止和认知功能。
   方法：研究入选33名成人吸烟者（ADHD：n=16；非ADHD：n=17）（每天吸烟不少于10支）。每名参与者完成2个试验阶段：一个阶段为与往常一样吸烟，一个阶段为经生物学证实的24-h戒烟。通过渐进性比例任务检测吸烟强化反应、通过问卷调查检测戒烟和连续性能试验（CPT）检测认知，用于对两个试验进行评价。
   结果：戒烟能显著增加两组对烟草的反应。不管条件如何，ADHD吸烟者的反应更大。与女性相比，不管条件如何，两组的男性因吸烟更多，在CPT中出错也更多。戒烟能增加两组出现戒烟症状的比例。不管条件如何，ADHD吸烟者主诉更多的觉醒、习惯终止和躯体不适症状。在两组中，戒烟能降低CPT时抑制性控制并能够增加反应时间的变异性。在两组中，戒烟诱导的抑制性控制和负向情感变化能预测吸烟强化反应。
   结论：ADHD吸烟者，不管条件如何，主诉较高水平的戒断症状和吸烟更多，这有助于解释更高水平的尼古丁依赖和较差的戒烟转归。不管是否存在ADHD，戒烟诱导的吸烟强化反应变化与抑制性控制和负向情感相关，这有助于开发新的预防和治疗措施。

(林江涛 审校)
Psychopharmacology (Berl). 2012 Dec 18. [Epub ahead of print]

 

Effects of smoking abstinence on smoking-reinforced responding, withdrawal, and cognition in adults with and without attention deficit hyperactivity disorder.

Kollins SH, English JS, Roley ME, O'Brien B, Blair J, Lane SD, McClernon FJ.

Source
Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC, 27705, USA, scott.kollins@duke.edu.

Abstract
RATIONALE: Individuals with attention deficit hyperactivity disorder (ADHD) have a more difficult time quitting smoking compared to their non-ADHD peers. Little is known about the underlying behavioral mechanisms associated with this increased risk.
OBJECTIVES: This study aims to assess the effects of 24-h smoking abstinence in adult smokers with and without ADHD on the following outcomes: smoking-reinforced responding, withdrawal, and cognitive function.
METHODS: Thirty-three (n = 16 with ADHD, 17 without ADHD) adult smokers (more than or equal to ten cigarettes/day) were enrolled. Each participant completed two experimental sessions: one following smoking as usual and one following biochemically verified 24-h smoking abstinence. Smoking-reinforced responding measured via a progressive ratio task, smoking withdrawal measured via questionnaire, and cognition measured via a continuous performance test (CPT) were assessed at each session.
RESULTS: Smoking abstinence robustly increased responding for cigarette puffs in both groups, and ADHD smokers responded more for puffs regardless of condition. Males in both groups worked more for cigarette puffs and made more commission errors on the CPT than females, regardless of condition. Smoking abstinence also increased ratings of withdrawal symptoms in both groups and smokers with ADHD, regardless of condition, reported greater symptoms of arousal, habit withdrawal, and somatic complaints. Across groups, smoking abstinence decreased inhibitory control and increased reaction time variability on the CPT. Abstinence-induced changes in inhibitory control and negative affect significantly predicted smoking-reinforced responding across groups.
CONCLUSIONS: Smokers with ADHD reported higher levels of withdrawal symptoms and worked more for cigarette puffs, regardless of condition, which could help explain higher levels of nicotine dependence and poorer cessation outcomes in this population. Abstinence-induced changes in smoking-reinforced responding are associated with changes in inhibitory control and negative affect regardless of ADHD status, a finding that may lead to novel prevention and treatment programs.

Psychopharmacology (Berl). 2012 Dec 18. [Epub ahead of print]