1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China.
2 Guangzhou Civil Affairs Bureau Psychiatric Hospital, China.
J Psychopharmacol. 2018 May;32(5):524-532. doi: 10.1177/0269881118756062. Epub 2018 Mar 1.
The long-term effects of dose reduction of atypical antipsychotics on cognitive function and symptomatology in stable patients with schizophrenia remain unclear. We sought to determine the change in cognitive function and symptomatology after reducing risperidone or olanzapine dosage in stable schizophrenic patients.
Seventy-five stabilized schizophrenic patients prescribed risperidone (≥4 mg/day) or olanzapine (≥10 mg/day) were randomly divided into a dose-reduction group ( n=37) and a maintenance group ( n=38). For the dose-reduction group, the dose of antipsychotics was reduced by 50%; for the maintenance group, the dose remained unchanged throughout the whole study. The Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery were measured at baseline, 12, 28, and 52 weeks. Linear mixed models were performed to compare the Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects and MATRICS Consensus Cognitive Battery scores between groups.
The linear mixed model showed significant time by group interactions on the Positive and Negative Syndrome Scale negative symptoms, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, attention/vigilance, working memory and total score of MATRICS Consensus Cognitive Battery (all p<0.05). Post hoc analyses showed significant improvement in Positive and Negative Syndrome Scale negative subscale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, working memory and total score of MATRICS Consensus Cognitive Battery for the dose reduction group compared with those for the maintenance group (all p<0.05).
This study indicated that a risperidone or olanzapine dose reduction of 50% may not lead to more severe symptomatology but can improve speed of processing, working memory and negative symptoms in patients with stabilized schizophrenia.
减少非典型抗精神病药物剂量对稳定期精神分裂症患者认知功能和症状的长期影响尚不清楚。我们旨在确定减少利培酮或奥氮平剂量后稳定期精神分裂症患者认知功能和症状的变化。
75 例服用利培酮（≥4mg/天）或奥氮平（≥10mg/天）的稳定精神分裂症患者被随机分为剂量减少组（n=37）和维持组（n=38）。剂量减少组减少抗精神病药物剂量 50%；维持组在整个研究过程中剂量保持不变。在基线、12、28 和 52 周时，采用阳性和阴性综合征量表（PANSS）、阴性症状评定量表-16（SANS-16）、锥体外系副作用评定量表（ESRS）和精神分裂症认知治疗评估量表（MATRICS）共识认知成套测验进行测量。采用线性混合模型比较两组间 PANSS、SANS-16、ESRS 和 MATRICS 共识认知成套测验评分的差异。
线性混合模型显示，PANSS 阴性症状、SANS-16、ESRS、速度处理、注意力/警觉、工作记忆和 MATRICS 共识认知成套测验总分的时间与组间存在显著交互作用（均 P<0.05）。事后分析显示，与维持组相比，剂量减少组的 PANSS 阴性量表、SANS-16、ESRS、速度处理、工作记忆和 MATRICS 共识认知成套测验总分显著改善（均 P<0.05）。
本研究表明，减少 50%的利培酮或奥氮平剂量可能不会导致更严重的症状，但可以改善稳定期精神分裂症患者的速度处理、工作记忆和阴性症状。
