Effects of Smoking on Network Connectivity in Patients With Schizophrenia Symptoms in Scz Patients
Using Functional Magnetic Resonance Imaging (fMRI) to Assess the Effects of Acceptance and Commitment Therapy for Smoking Cessation and Reduction of Psychotic Symptoms in Patients With Schizophrenia
The Hong Kong Polytechnic University
90 participants
Mar 1, 2023
INTERVENTIONAL
Conditions
Summary
The prevalence of smoking among people with schizophrenia (SCZ) is substantially higher at 54% to 90% (McClave et al., 2010). About half of all deaths amongst people with scz are attributed to smoking-related diseases and cancer involving the lung, the cardiovascular system, and the liver (Kely et al., 2011; WHO, 2019). Acceptance and commitment therapy (ACT) is effective for treating psychotic symptoms and addictive behaviours. In a local randomised controlled trial comparing individual ACT to social support for smoking cessation in adult scz smokers, the self-reported quit rates in ACT group were higher than in the social support group (6 months: 12.3% vs. 7.7%, p=0.56 ; 12 months: 10.8% vs. 7.7%, p=0.76; Mak, Loke, and Leung, 2021). In this study, functional neuroimaging (fMRI) will be combined with symptoms assessment in order to ascertain whether group-based ACT is effective in modifying the brain's responses in general and specifically to tobacco craving cues and resting-state functional connectivity in three time points (pre-, post-intervention, and 6-month follow-up) among people with schizophrenia.
Eligibility
Inclusion Criteria4
- Individuals who have been diagnosed with schizophrenia or schizoaffective disorder and after at least one-year followup;
- currently taking anti-psychotic medications for ≥ 3 months with good compliance;
- aged 18 years or above;
- able to communicate in Cantonese
Exclusion Criteria11
- Have any other current or past psychotic disorders;
- with fleeting or actual suicidal/self-harm ideations, or acting-out behavior in the past;
- with a known history of violence/aggression and a forensic history
- Categorized with special care or intensive care (e.g., arson, battery, physical assault, rape, murder, etc.)
- Have a lifetime history of substance abuse and/or are currently receiving treatment for substance abuse (e.g., opioids, cocaine, marijuana, or stimulants);
- With alcohol consumption exceeding 25 standard drinks/week for men and 20 standard drinks/week for women over the last 6 months;
- Have received a diagnosis of alcohol or drug dependence in the year preceding recruitment;
- Are pregnant, breast-feeding, or planning a pregnancy for the duration of the study;
- Have a history or current diagnosis of attention-deficit hyperactivity disorder (ADHD);
- Have a history of epilepsy or a seizure disorder;
- Experience disorientation, have developmental disabilities, and/or an organic mental disorder;
Interventions
Acceptance and Commitment Smoking Cessation (ACT-SC) Group: Participants in the ACT group will be given a group-based face-to-face ACT intervention, with up to six individuals per group. Participants will attend a total of eight sessions, twice per week, with each session lasting 1.5 hours. The intervention focuses on helping participants (i) to increase acceptance of thoughts and feelings related to cigarette cravings and withdrawal symptoms; (ii) to clarify and engage with life values; and (iii) to build up patterns of committed values identified even in the presence of cravings and/or withdrawal symptoms. Participants will also be encouraged to practice mindfulness and ACT skills in between sessions. The protocol is listed in the appendix 2: ACT intervention protocol.
Usual Care Smoking Cessation (5A-SC) Group: Participants in the 5A-SC group also receive an intervention of the same duration and be given the same amount of attention as the intervention group - namely, a smoking cessation intervention based on the '5A' and '5R' models proposed by the World Health Organization. The '5A' model emphasizes five steps: Asking about tobacco use, Advising smokers to quit, Assessing their willingness to quit, Assisting in quitting, and Arranging for follow-up (Whitlock et al., 2002). The model is used in our government-funded Youth Quitline, operated by the School of Nursing, PolyU. (Please refer to the appendix 3: 5A smoking cessation protocol. The intervention will be conducted by a research assistant (RA2) trained in the 5A approach.
Locations(5)
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NCT07441928