Kumar Pattath Narayanan Suresh, Mohemmedali Seema P, Anish P K, Andrade Chittaranjan
Department of Psychiatry, KMCT Medical College, Calicut, Kerala, India.
Department of Pharmacology, Government Medical College, Manjeri, Malappuram, Kerala, India.
Indian J Psychiatry. 2017 Apr-Jun;59(2):219-224. doi: 10.4103/psychiatry.IndianJPsychiatry_133_16.
An important challenge in schizophrenia therapeutics is to develop an efficacious treatment for cognitive impairment. Acetylcholinesterase inhibitors, such as rivastigmine, have been studied for improving cognitive performance in these patients.
Rivastigmine (uptitrated to 6 mg/day) was given as an add-on therapy to risperidone-treated stable schizophrenia patients in a randomized, double-blind, placebo-controlled design. Of 67 patients who met eligibility criteria, 55 were recruited into the study. Twenty-eight were assigned to rivastigmine and 27 to placebo. These patients completed tests of attention, executive functioning, verbal skills, verbal and visuospatial working memory, and psychomotor speed on five occasions: at baseline, and at the end of the 1, 3, 6, and 12 months.
The groups were similar in terms of sociodemographic profile and baseline clinical characteristics (Positive and Negative Syndrome Scale and Clinical Global Impression-Severity). Contrary to expectations, rivastigmine patients showed poorer outcomes on several cognitive measures. Rivastigmine patients experienced also more psychological as well as neurological side effects. Core psychopathology ratings, however, did not differ between rivastigmine and placebo groups.
Our study does not support the long-term use of rivastigmine as an augmentation agent in schizophrenia. Rivastigmine may be associated with higher incidence of psychological and neurological side effects in patients with schizophrenia.
精神分裂症治疗中的一项重要挑战是开发出一种有效的认知障碍治疗方法。已对诸如卡巴拉汀等乙酰胆碱酯酶抑制剂进行研究，以改善这些患者的认知表现。
采用随机、双盲、安慰剂对照设计，将卡巴拉汀（剂量递增至6毫克/天）作为附加疗法给予接受利培酮治疗的稳定型精神分裂症患者。在67名符合入选标准的患者中，55名被纳入研究。28名被分配接受卡巴拉汀治疗，27名接受安慰剂治疗。这些患者在五个时间点完成了注意力、执行功能、语言技能、语言和视觉空间工作记忆以及精神运动速度的测试：基线时，以及第1、3、6和12个月结束时。
两组在社会人口统计学特征和基线临床特征（阳性和阴性症状量表以及临床总体印象-严重程度）方面相似。与预期相反，卡巴拉汀组在多项认知测量中表现出更差的结果。卡巴拉汀组患者还经历了更多的心理和神经方面的副作用。然而，卡巴拉汀组和安慰剂组在核心精神病理学评分上没有差异。
我们的研究不支持长期使用卡巴拉汀作为精神分裂症的增效剂。卡巴拉汀可能与精神分裂症患者心理和神经副作用的较高发生率相关。
