Sharma Tonmoy, Antonova Lena
Clinical Neuroscience Research Centre, Stonehouse Hospital, Cotton Lane, Dartford, Kent DA2 6AU, UK.
Psychiatr Clin North Am. 2003 Mar;26(1):25-40. doi: 10.1016/s0193-953x(02)00084-9.
This article has discussed the relationship between cognitive deficits and functional outcome in schizophrenia. This relationship was noted first by Kraepelin and Bleuler at the beginning of the twentieth century. With the introduction of conventional neuroleptics, the focus shifted toward the treatment of positive symptoms. In the past few decades, cognitive dysfunction has been recognized as a fundamental feature of schizophrenia and has been shown repeatedly to have a negative association with functional outcome [6]. Improvement in cognitive functioning became one of the most important clinical targets in the treatment of schizophrenia in the 1990s [82]. Main domains of cognition that are disrupted significantly in schizophrenia include attention, executive function, verbal and visuospatial working memory, and learning and memory. Although conventional antipsychotics are effective in treating positive symptoms, they lack the ability to improve cognitive impairment and produce poor functional outcome. Previous research has shown superior efficacy of atypical antipsychotics on cognitive impairments in schizophrenia compared with conventional antipsychotics. Because the heterogeneity of atypical antipsychotics in their pharmacologic properties, they have differential profiles of cognitive efficacy in patients with schizophrenia. Establishing the cognitive profile of each atypical antipsychotic is an important task. This knowledge can be used to address individual cognitive problems and needs. Because cognitive deficits have been shown to have associations with different aspects of clinical symptoms, limited learning in rehabilitation programs, and functional outcome in schizophrenia, targeting individual cognitive deficits would lead to greater treatment success in terms of clinical and functional outcome. Although atypical antipsychotics have some benefit on cognitive function, further efforts to improve cognitive function are required. Attempts at improving cognition in schizophrenia with specific cognitive enhancers pharmacologically and psychological therapies such as cognitive remediation might lead to better functional outcome in patients with schizophrenia.
本文探讨了精神分裂症中认知缺陷与功能结局之间的关系。这种关系在20世纪初由克雷佩林和布鲁勒首次提出。随着传统抗精神病药物的引入，重点转向了阳性症状的治疗。在过去几十年中，认知功能障碍已被公认为精神分裂症的一个基本特征，并多次被证明与功能结局呈负相关[6]。认知功能的改善在20世纪90年代成为精神分裂症治疗中最重要的临床目标之一[82]。在精神分裂症中受到显著破坏的主要认知领域包括注意力、执行功能、言语和视觉空间工作记忆以及学习和记忆。虽然传统抗精神病药物在治疗阳性症状方面有效，但它们缺乏改善认知障碍的能力，并且会导致不良的功能结局。先前的研究表明，与传统抗精神病药物相比，非典型抗精神病药物在治疗精神分裂症认知障碍方面具有更高的疗效。由于非典型抗精神病药物在药理特性上的异质性，它们在精神分裂症患者中的认知疗效存在差异。确定每种非典型抗精神病药物的认知特征是一项重要任务。这些知识可用于解决个体的认知问题和需求。由于认知缺陷已被证明与精神分裂症临床症状的不同方面、康复项目中的有限学习以及功能结局相关，针对个体认知缺陷将在临床和功能结局方面带来更大的治疗成功。虽然非典型抗精神病药物对认知功能有一定益处，但仍需要进一步努力改善认知功能。尝试通过特定的认知增强药物和心理治疗（如认知康复）来改善精神分裂症患者的认知，可能会使患者获得更好的功能结局。
