Ahn Yong Min, Lee Kyu Young, Kim Chul-Eung, Kim Jae-Jin, Kang Dae-Yeob, Jun Tae-Youn, Choi Jin Sook, Chung In-Won, Kim Se Hyun, Hwang Samuel S-H, Kim Yong Sik
Department of Psychiatry and Behavioral Science and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Chongno-Gu, Seoul, Korea.
J Clin Psychopharmacol. 2009 Apr;29(2):117-23. doi: 10.1097/JCP.0b013e31819a6995.
We examined short- and long-term changes in neurocognitive functions in patients with schizophrenia who were either started or switched to amisulpride in comparison with the normal controls. Fifty-seven patients treated with amisulpride and 60 normal controls completed a comprehensive neurocognitive function test battery at the baseline, the 8-week, and the 1-year follow-up. We conducted and compared the results of both intention-to-treat (ITT) and per-protocol (PP) analyses to account for the follow-up loss. Three general results obtained were as follows: (1) the degree of the improvements in neurocognitive function was comparable to those of other second-generation antipsychotics in both ITT and PP analysis; (2) in light of the relative effect size, the composite effect size and the effect size in most measures in both ITT and PP analyses were smaller for the patient group than those of the control group, signifying that improvement in performance may be largely attributable to practice effects; and (3) nonetheless, there were evidences of both short- and long-term improvements in some cognitive tasks, such as in the Korean-Wechsler Adult Intelligence Scale vocabulary subtest and the Trail Making Test, that may not be accounted by practice effect. These results suggest the need to include a healthy control group to validate the medication effect of cognitive improvements in patients with schizophrenia and to consider practice effect in interpreting the results of repeated administration of neurocognitive function tests.
我们研究了开始使用或换用氨磺必利的精神分裂症患者神经认知功能的短期和长期变化，并与正常对照组进行比较。57例接受氨磺必利治疗的患者和60名正常对照在基线、8周和1年随访时完成了一套全面的神经认知功能测试。我们进行并比较了意向性治疗（ITT）分析和符合方案（PP）分析的结果，以考虑随访失访情况。获得的三个总体结果如下：（1）在ITT和PP分析中，神经认知功能的改善程度与其他第二代抗精神病药物相当；（2）从相对效应量来看，患者组在ITT和PP分析中大多数指标的综合效应量和效应量均小于对照组，这表明表现的改善可能很大程度上归因于练习效应；（3）尽管如此，在一些认知任务中，如韩国韦氏成人智力量表词汇分测验和连线测验，仍有短期和长期改善的证据，这些改善可能无法用练习效应来解释。这些结果表明，需要纳入健康对照组来验证精神分裂症患者认知改善的药物疗效，并在解释重复进行的神经认知功能测试结果时考虑练习效应。
