Rezvani Amir H, Kholdebarin Ehsan, Dawson Elizabeth, Levin Edward D
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 3412, USA.
Int J Neuropsychopharmacol. 2008 Feb;11(1):63-70. doi: 10.1017/S1461145706007528. Epub 2007 Feb 13.
Cognitive impairment is very prevalent in schizophrenia and is currently undertreated in most patients. Attentional deficit is one of the hallmark symptoms of schizophrenia. Antipsychotic drugs, which can be quite effective in combating hallucinations are often ineffective in reducing cognitive impairment and can potentiate cognitive impairment. Previously, we found that the antipsychotic drug clozapine impaired, while nicotine improved, the accuracy of rats performing a visual signal detection attentional task in normal rats. For the current study, in a model of cognitive impairment of schizophrenia with the NMDA antagonist dizocilpine (0.05 mg/kg), we examined the effects of clozapine and nicotine on significantly impaired attentional hit accuracy. This dizocilpine-induced impairment was significantly (p<0.05) reversed by either clozapine (1.25 mg/kg) or nicotine (0.025 mg/kg). Interestingly, when clozapine and nicotine were given together, they blocked each other's beneficial effects. When the effective doses of 1.25 mg/kg clozapine and 0.025 mg/kg nicotine were given together the combination no longer significantly reversed the dizocilpine-induced hit-accuracy impairment. Given that the great majority of people with schizophrenia smoke, the potential beneficial effects of clozapine on attentional function may be largely blocked by self-administered nicotine. In addition, there are promising results concerning the development of nicotinic treatments to reverse cognitive deficits including attentional impairment. This is supported in the current study by the reversal of the dizocilpine-induced attentional impairment by nicotine. However, in schizophrenia the efficacy of nicotinic treatments may be limited by co-treatment with antipsychotic drugs like clozapine. It will be important to determine which of the complex effects of clozapine and nicotine are key in reversing attentional impairment and how they block each other's effects for the development of therapy to combat the attentional impairment of schizophrenia.
认知障碍在精神分裂症中非常普遍,目前大多数患者的认知障碍未得到充分治疗。注意力缺陷是精神分裂症的标志性症状之一。抗精神病药物在对抗幻觉方面可能相当有效,但在减轻认知障碍方面往往无效,甚至可能加重认知障碍。此前,我们发现抗精神病药物氯氮平会损害正常大鼠执行视觉信号检测注意力任务的准确性,而尼古丁则可改善这一准确性。在当前研究中,我们使用NMDA拮抗剂地佐环平(0.05mg/kg)建立精神分裂症认知障碍模型,研究氯氮平和尼古丁对显著受损的注意力命中准确性的影响。这种地佐环平诱导的损伤可被氯氮平(1.25mg/kg)或尼古丁(0.025mg/kg)显著(p<0.05)逆转。有趣的是,当氯氮平和尼古丁同时给药时,它们会相互抵消对方的有益作用。当同时给予1.25mg/kg氯氮平和0.025mg/kg尼古丁的有效剂量时,该组合不再能显著逆转地佐环平诱导的命中准确性损伤。鉴于绝大多数精神分裂症患者吸烟,氯氮平对注意力功能的潜在有益作用可能在很大程度上被患者自行摄入的尼古丁所阻断。此外,在开发用于逆转包括注意力障碍在内的认知缺陷的烟碱类治疗方法方面,有一些有前景的研究结果。本研究中尼古丁逆转地佐环平诱导的注意力损伤支持了这一点。然而,在精神分裂症中,烟碱类治疗的疗效可能会受到与氯氮平这类抗精神病药物联合治疗的限制。确定氯氮平和尼古丁的哪些复杂作用是逆转注意力损伤的关键,以及它们如何相互阻断对方的作用,对于开发对抗精神分裂症注意力损伤的治疗方法至关重要。