Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029 OYS, Oulu, Finland.
Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Box 189, CB2 0QQ Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, CB2 0SZ Cambridge, United Kingdom.
Eur Psychiatry. 2017 Sep;45:50-58. doi: 10.1016/j.eurpsy.2017.06.004. Epub 2017 Jun 27.
Higher lifetime antipsychotic exposure has been associated with poorer cognition in schizophrenia. The cognitive effects of adjunctive psychiatric medications and lifetime trends of antipsychotic use remain largely unclear. We aimed to study how lifetime and current benzodiazepine and antidepressant medications, lifetime trends of antipsychotic use and antipsychotic polypharmacy are associated with cognitive performance in midlife schizophrenia.
Sixty participants with DSM-IV schizophrenia from the Northern Finland Birth Cohort 1966 were examined at 43years of age with an extensive cognitive test battery. Cumulative lifetime and current use of psychiatric medications were collected from medical records and interviews. The associations between medication and principal component analysis-based cognitive composite score were analysed using linear regression.
Lifetime cumulative DDD years of benzodiazepine and antidepressant medications were not significantly associated with global cognition. Being without antipsychotic medication (for minimum 11months) before the cognitive examination was associated with better cognitive performance (P=0.007) and higher lifetime cumulative DDD years of antipsychotics with poorer cognition (P=0.020), when adjusted for gender, onset age and lifetime hospital treatment days. Other lifetime trends of antipsychotic use, such as a long antipsychotic-free period earlier in the treatment history, and antipsychotic polypharmacy, were not significantly associated with cognition.
Based on these naturalistic data, low exposure to adjunctive benzodiazepine and antidepressant medications does not seem to affect cognition nor explain the possible negative effects of high dose long-term antipsychotic medication on cognition in schizophrenia.
终生抗精神病药物暴露与精神分裂症认知功能较差有关。辅助精神药物的认知影响和抗精神病药物使用的终生趋势在很大程度上仍不清楚。我们旨在研究一生中及目前使用苯二氮䓬类药物和抗抑郁药、抗精神病药物使用的终生趋势以及抗精神病药物联合用药与中年精神分裂症认知功能的关系。
来自芬兰北部出生队列 1966 年的 60 名 DSM-IV 精神分裂症患者在 43 岁时接受了广泛的认知测试。从病历和访谈中收集了累积的终生和当前使用的精神药物。使用线性回归分析药物与基于主成分分析的认知综合评分之间的关联。
终生累积 DDD 年的苯二氮䓬类药物和抗抑郁药物与总体认知无显著相关性。在认知测试前至少 11 个月未使用抗精神病药物（P=0.007）与认知表现更好相关，而终生累积 DDD 年的抗精神病药物与认知能力较差相关（P=0.020），同时调整了性别、发病年龄和终生住院治疗天数。其他抗精神病药物使用的终生趋势，如在治疗史早期有较长的无抗精神病药物期，以及抗精神病药物联合用药，与认知无显著相关性。
基于这些自然主义数据，辅助使用苯二氮䓬类药物和抗抑郁药物的低暴露似乎不会影响认知，也不能解释高剂量长期抗精神病药物对精神分裂症认知的可能负面影响。
