Vreeker Annabel, van Bergen Annet H, Kahn René S
University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands.
University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands.
Eur Neuropsychopharmacol. 2015 Jul;25(7):969-1002. doi: 10.1016/j.euroneuro.2015.04.014. Epub 2015 Apr 18.
Cognitive dysfunction is a core feature of schizophrenia and is also present in bipolar disorder (BD). Whereas decreased intelligence precedes the onset of psychosis in schizophrenia and remains relatively stable thereafter; high intelligence is a risk factor for bipolar illness but cognitive function decreases after onset of symptoms. While in schizophrenia, many studies have been conducted on the development of cognitive enhancing agents; in BD such studies are almost non-existent. This review focuses on the pharmacological agents with putative effects on cognition in both schizophrenia and bipolar illness; specifically agents targeting the dopaminergic, cholinergic and glutamatergic neurotransmitter pathways in schizophrenia and the cognitive effects of lithium, anticonvulsants and antipsychotics in BD. In the final analysis we conclude that cognitive enhancing agents have not yet been produced convincingly for schizophrenia and have hardly been studied in BD. Importantly, studies should focus on other phases of the illness. To be able to treat cognitive deficits effectively in schizophrenia, patients in the very early stages of the illness, or even before - in the ultra-high risk stages - should be targeted. In contrast, cognitive deficits occur later in BD, and therefore drugs should be tested in BD after the onset of illness. Hopefully, we will then find effective drugs for the incapacitating effects of cognitive deficits in these patients.
认知功能障碍是精神分裂症的核心特征，在双相情感障碍（BD）中也存在。在精神分裂症中，智力下降先于精神病发作，且此后相对稳定；而高智商是双相情感障碍的一个危险因素，但认知功能在症状发作后会下降。虽然在精神分裂症方面，已经对认知增强剂的研发进行了许多研究；但在双相情感障碍方面，此类研究几乎不存在。本综述聚焦于对精神分裂症和双相情感障碍认知功能可能有影响的药物制剂；具体而言，是针对精神分裂症中多巴胺能、胆碱能和谷氨酸能神经递质途径的药物制剂，以及双相情感障碍中锂盐、抗惊厥药和抗精神病药的认知作用。最后我们得出结论，尚未有令人信服的认知增强剂用于治疗精神分裂症，且在双相情感障碍方面几乎未开展相关研究。重要的是，研究应关注疾病的其他阶段。为了能够有效治疗精神分裂症的认知缺陷，应针对疾病极早期甚至更早——超高风险阶段的患者。相比之下，双相情感障碍的认知缺陷出现较晚，因此药物应在疾病发作后在双相情感障碍患者中进行测试。希望届时我们能找到有效药物来治疗这些患者认知缺陷所带来的失能影响。
