Department of Psychiatry and Psychotherapy, University Medical Centre, Georg-August-University, Göttingen, Germany; Centre of Mental Health, Darmstadt-Dieburg Clinics, Groß-Umstadt, Germany.
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
Schizophr Res. 2013 Jun;147(1):132-139. doi: 10.1016/j.schres.2013.03.001. Epub 2013 Mar 26.
Studies and meta-analyses investigating the influence of substance use disorder (SUD) (substance abuse or dependence) on psychopathology and neurocognitive function in schizophrenia patients have revealed controversial results. Most studies did only have small samples and did not focus exclusively on first-episode schizophrenia patients.
In a post-hoc analysis of the European First Episode Schizophrenia Trial (EUFEST) psychopathology and cognitive performances of patients with (FE-SUD, N=119, consisting of N=88 patients with persisting SUD at baseline and N=31 patients with previous SUD) and without SUD (FE-non-SUD, N=204) were compared at baseline and 6 months follow-up. Neurocognitive assessment included the Rey Auditory Verbal Learning Test (RAVLT); Trail Making Tests A and B (TMT), Purdue Pegboard and Digit-Symbol Coding.
In total 31.1% of patients reported SUD, and 22.2% of patients used cannabis. There were no significant differences between patients with and without SUD concerning PANSS scores, extrapyramidal motor symptoms or neurocognitive measures except better performance in psychomotor speed (TMT-A, p=0.033, Cohen's d=0.26) in patients with SUD at 6 months follow-up. Interestingly, SUD patients with ongoing substance use at follow-up showed elevated positive symptoms (PANSS positive score, p=0.008, Cohen's d=0.84) compared to those who abstained. PANSS scores at baseline were increased in patients with an onset of SUD before the age of 16 years. In addition we found a correlation between longer duration of cannabis use and higher cognitive performance as well as reduced symptom improvement and more extrapyramidal motor symptoms in patients with higher frequency of cannabis consumption.
FE-SUD and FE-non-SUD show similar psychopathology and neuropsychological performances at baseline and during the first 6 months of antipsychotic treatment.
研究和荟萃分析调查了物质使用障碍（SUD）（物质滥用或依赖）对精神分裂症患者的精神病理学和神经认知功能的影响，结果存在争议。大多数研究的样本量较小，并且没有专门针对首发精神分裂症患者进行研究。
在欧洲首发精神分裂症试验（EUFEST）的事后分析中，比较了有（FE-SUD，N=119，包括基线时持续存在 SUD 的 N=88 名患者和基线时有 SUD 的 N=31 名患者）和无 SUD（FE-non-SUD，N=204）的患者的精神病学和认知表现。神经认知评估包括 Rey 听觉言语学习测试（RAVLT）；TMT 测试 A 和 B（TMT）、Purdue 钉板和数字符号编码。
共有 31.1%的患者报告有 SUD，22.2%的患者使用大麻。在 PANSS 评分、锥体外系运动症状或神经认知测量方面，有 SUD 和无 SUD 的患者之间没有显著差异，除了在 6 个月随访时 SUD 患者的精神运动速度（TMT-A，p=0.033，Cohen's d=0.26）更好。有趣的是，在随访时继续使用药物的 SUD 患者与那些戒断的患者相比，阳性症状升高（PANSS 阳性评分，p=0.008，Cohen's d=0.84）。此外，我们发现，在 16 岁之前发病的 SUD 患者的 PANSS 评分升高。此外，我们发现，大麻使用时间较长与认知表现较高以及较高的大麻消费频率与症状改善减少和更多的锥体外系运动症状相关。
FE-SUD 和 FE-non-SUD 在基线和抗精神病药物治疗的头 6 个月期间表现出相似的精神病学和神经心理学表现。
