Institute of Mental Health, The Second Xiangya Hospital, Central South University, Changsha, China.
Neurosci Lett. 2011 Oct 3;503(2):141-6. doi: 10.1016/j.neulet.2011.08.027. Epub 2011 Aug 24.
The study aimed to assess the cognitive effects of first- and second-generation antipsychotics on neurocognition under naturalistic treatment conditions. In a 12-month, open-label, multicenter study, 698 patients with early-stage schizophrenia (duration of illness ≤5 years) were prescribed chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine, or aripiprazole monotherapy. A neuropsychological battery including tests of attention, processing speed, learning/memory, and executive functioning was administered at baseline, 6- and 12-months. The primary outcome was change in a cognitive composite score after 12-months of treatment. At 12 months, treatment resulted in mild to moderate neurocognitive improvements of z=0.32 for chlorpromazine, 0.33 for sulpiride, 0.43 for clozapine, 0.51 for risperidone, 0.69 for olanzapine, 0.64 for quetiapine and 0.46 for aripiprazole. However, the olanzapine and quetiapine groups demonstrated greater improvement in the composite score and processing speed than did the chlorpromazine and sulpiride groups. Both first- and second-generation antipsychotics may improve cognitive function in patients with early-stage schizophrenia. Given that some neurocognitive improvement is attributable to a practice effect, any improvement is likely to be in the range of a small effect size.
本研究旨在评估第一代和第二代抗精神病药在自然治疗条件下对神经认知的影响。在一项为期 12 个月、开放标签、多中心的研究中，698 例早期精神分裂症患者（病程≤5 年）被处方氯丙嗪、舒必利、氯氮平、利培酮、奥氮平、喹硫平或阿立哌唑单药治疗。在基线、6 个月和 12 个月时，使用神经心理学成套测验进行注意力、加工速度、学习/记忆和执行功能测试。主要结局是治疗 12 个月后认知综合评分的变化。12 个月时，治疗导致轻度至中度神经认知改善，氯丙嗪组为 z=0.32，舒必利组为 0.33，氯氮平组为 0.43，利培酮组为 0.51，奥氮平组为 0.69，喹硫平组为 0.64，阿立哌唑组为 0.46。然而，奥氮平和喹硫平组在综合评分和加工速度方面的改善优于氯丙嗪和舒必利组。第一代和第二代抗精神病药都可能改善早期精神分裂症患者的认知功能。鉴于一些神经认知的改善归因于练习效应，任何改善都可能处于小效应量的范围。
