GENETIC PREDICTORS OF PHYSICAL AND PSYCHOLOGICAL NICOTINE DEPENDENCE AND GENETICALLY-BASED TREATMENT PROTOCOLS FOR TOBACCO SMOKING

Abstract Genetic predictors of physical and psychological nicotine dependence and genetically-based treatment protocols for tobacco smoking. Background: Current clinical practice utilizes methods of assessing tobacco dependence (F17.2) based on clinical interview, history taking and diagnostic questionnaires. At the same time, there is no differentiated algorithm of the therapy for patients with predominantly psychological, physiological and combined forms of addiction. Aims and objectives: based on the analysis of clinical cases with different types of tobacco addiction, including in the diagnostic algorithm the genetic study of genes DRD2 (predictor of psychological addiction) and CHRNA5 (predictor of physiological addiction), to form a differentiated approach to effective treatment. Materials and Methods Three clinical cases with polymorphisms in DRD2 or CHRNA5 genes or polymorphisms in both genes were reviewed. Male A., 43 years old, smoking experience of 25 years, smokes 1 packet of cigarettes per day. According to the results of diagnostics of psychological status with the help of hospital scale HADS clinically expressed anxiety (A:17) and clinically expressed depression (A:17), Spielberger-Hanin anxiety scale STAI - situational anxiety 64 points, personality anxiety 52 points. Fagerstrom FTND test 8 points. In DRD2 gene polymorphism rs1800497 genotype G/A (psychological dependence ) was revealed. An individual course of psychotherapy of 3 sessions (hypnotherapy), antidepressant pharmacotherapy (bupropion) was carried out. Smoking cessation for at least 12 months. Male K., 38 years old, smoking experience of 22 years, smokes 1-1.5 packets of cigarettes per day. He made attempts to quit smoking independently, but within 3 days he experienced manifestations of pronounced withdrawal syndrome. Psycho-emotional status was not burdened with anxiety and depressive manifestations. Fagerströ m FTND test 10 points. In CHRNA5 gene polymorphism rs16969968 genotype A/G (physiological dependence) was detected. A course of treatment with varenicline was carried out. The patient attended a psychological support group for 1 month. Smoking cessation for at least 12 months. Female S., 51 years old, smoking experience of 31 years, smokes 0.5-1 packet of cigarettes per day. Psycho-emotional status is aggravated by high anxiety and depression scores: hospital HADS anxiety scale - A:15, depression D:17, Spielberger-Hanin STAI anxiety scale - high situational anxiety, high personality anxiety. Fagerströ m FTND test 9 points. Polymorphisms in both genes were revealed. A course of individual hypnotherapy, a course of cognitive-behavioural therapy (12 sessions) was conducted, and the patient attended a psychological support group for 6 months. Drug therapy included bupropion and varenicline. Smoking cessation and remission period was 4 years. Conclusions The introduction of genetic predictors of psychological and physiological dependence on nicotine into the diagnostic evaluation allows building an effective treatment algorithm, varying the combination of psychotherapeutic and pharmacological support. In the presence of comorbid anxiety-depressive disorders, it is necessary to choose the reduction of anxiety-depressive symptoms with subsequent release from nicotine dependence. During the period of preparation of the patient for complete tobacco cessation, it is possible to use approaches that reduce the negative impact of burning.