Olivier M R, Killian S, Chiliza B, Asmal L, Schoeman R, Oosthuizen P P, Kidd M, Emsley R
Department of Psychiatry,Faculty of Medicine and Health Sciences,Stellenbosch University,Tygerberg Campus,Cape Town,South Africa.
Centre for Statistical Consultation,Stellenbosch University,South Africa.
Psychol Med. 2015 Oct;45(13):2873-83. doi: 10.1017/S0033291715000860. Epub 2015 May 22.
Several questions remain unanswered regarding the magnitude and time course of cognitive improvement in response to antipsychotic treatment. The purpose of this study was to assess changes in cognitive performance in antipsychotic-naive or minimally medicated patients with first-episode schizophrenia during the first 12 months of treatment, in a case-control design. Patients were treated with flupenthixol decanoate depot injection, according to a standard algorithm. The primary outcome measure was change in MATRICS Cognitive Consensus Battery (MCCB) composite score over 12 months.
The sample comprised 92 patients and 100 healthy controls matched for age, sex, ethnicity and educational status. Cognitive function was assessed by means of the MCCB.
A mixed-effects model identified a significant group × time effect (p ≤ 0.0001) for the MCCB composite score, with patients showing a greater degree of change than the controls. For the other MCCB domains there were significant group × time effects at adjusted significance level for attention and vigilance (p ≤ 0.0001), visual learning (p ≤ 0.0001), verbal learning (p = 0.005) and working memory (p ≤ 0.0001), but not for reasoning and problem solving (p = 0.04), speed of processing (p = 0.03) and social cognition (p = 0.06). There were moderate correlations between change in MCCB composite score and change in symptomatology as assessed by Positive and Negative Syndrome Scale factor analysis-derived domains.
Substantial improvements in cognitive function were observed over and above a practice effect, and were significantly correlated with improvements in psychopathology and functionality.
关于抗精神病药物治疗后认知功能改善的程度和时间进程，仍有几个问题尚未得到解答。本研究旨在通过病例对照设计，评估初发精神分裂症的未使用过抗精神病药物或用药极少的患者在治疗的前12个月内认知表现的变化。根据标准算法，患者接受癸酸氟奋乃静长效注射治疗。主要结局指标是12个月内MATRICS认知共识成套测验（MCCB）综合得分的变化。
样本包括92例患者和100名年龄、性别、种族和教育程度相匹配的健康对照者。通过MCCB评估认知功能。
混合效应模型显示，MCCB综合得分存在显著的组×时间效应（p≤0.0001），患者的变化程度大于对照组。对于MCCB的其他领域，在调整后的显著性水平上，注意力和警觉性（p≤0.0001）、视觉学习（p≤0.0001）、言语学习（p = 0.005）和工作记忆（p≤0.0001）存在显著的组×时间效应，但推理和问题解决（p = 0.04）、处理速度（p = 0.03）和社会认知（p = 0.06）不存在显著的组×时间效应。MCCB综合得分的变化与通过阳性和阴性症状量表因子分析得出的症状学变化之间存在中度相关性。
观察到认知功能有显著改善，超出了练习效应，并且与精神病理学和功能的改善显著相关。
