Harvey Philip D, Sacchetti Emilio, Galluzzo Alessandro, Romeo Fabio, Gorini Barbara, Bilder Robert M, Loebel Antony D
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30032, United States.
Schizophr Res. 2008 Oct;105(1-3):138-43. doi: 10.1016/j.schres.2007.11.014. Epub 2008 Feb 20.
Recent data have suggested few differences in the cognitive effects of antipsychotic medications. However, assessment of such effects can be complex, due to a number of factors. Clozapine has previously shown greater clinical and lesser cognitive benefits than other atypicals. This study compared the cognitive benefits of clozapine and ziprasidone in schizophrenia patients (n=130) with a history of either failure to respond to or intolerance of previous adequate antipsychotic treatments.
Patients were randomized (double-blind) to either clozapine or ziprasidone in a single country (Italy), multi-site trial. The cognitive assessments examined episodic memory (RAVLT), executive functioning (Stroop test), and processing speed (Trail-making test (TMT) Parts A and B).
Analyses found statistically significant within-group improvements for ziprasidone in learning and delayed recall on the RAVLT and on TMT Parts A and B. Clozapine-treated patients improved on the RAVLT, but not on the TMT. A composite cognitive score improved from baseline in both groups, but the improvements were significantly larger in the ziprasidone group (p=.029).
These results indicated that cognitive functioning improved following treatment with ziprasidone in patients with a history of either treatment resistance or intolerance, and that the effects are comparable or greater than those observed with clozapine. One interpretation of these findings is that clozapine treatment interferes with the performance benefits associated with practice.
近期数据表明抗精神病药物的认知效应差异不大。然而，由于多种因素，对此类效应的评估可能较为复杂。氯氮平先前已显示出比其他非典型抗精神病药物更大的临床益处和较小的认知益处。本研究比较了氯氮平和齐拉西酮对有既往充分抗精神病治疗无效或不耐受史的精神分裂症患者（n = 130）的认知益处。
在一个国家（意大利）的多中心试验中，患者被随机（双盲）分为氯氮平组或齐拉西酮组。认知评估包括情景记忆（雷伊听觉词语学习测验）、执行功能（斯特鲁普测验）和处理速度（连线测验A和B部分）。
分析发现，齐拉西酮组在雷伊听觉词语学习测验的学习和延迟回忆以及连线测验A和B部分上有统计学显著的组内改善。氯氮平治疗的患者在雷伊听觉词语学习测验上有改善，但在连线测验上没有。两组的综合认知评分均从基线有所改善，但齐拉西酮组的改善显著更大（p = 0.029）。
这些结果表明，对于有治疗抵抗或不耐受史的患者，使用齐拉西酮治疗后认知功能得到改善，且其效果与氯氮平相当或优于氯氮平。对这些发现的一种解释是，氯氮平治疗会干扰与练习相关的表现益处。
