Copenhagen University Hospital, Mental Health Centre Copenhagen,Copenhagen,Denmark.
Orygen, The National Centre of Excellence in Youth Mental Health,Melbourne,Australia.
Psychol Med. 2019 May;49(7):1138-1147. doi: 10.1017/S0033291718001836. Epub 2018 Jul 30.
The effect of antipsychotics medication on cognitive functioning in patients diagnosed with schizophrenia is poorly understood. Some studies of second generation antipsychotics indicated that they improved cognitive functioning while other studies have found that they decrease the level of cognitive functioning.
We included patients with schizophrenia who were in treatment with antipsychotics 1.5 years (baseline) after initiation of treatment and followed them up 3.5 years later (n = 189). At follow-up 60 (32%) had discontinued their antipsychotic treatment and 129 (68%) were still taking antipsychotics. Using the Brief Assessment of Cognition in Schizophrenia (BACS) we assessed cognition at baseline and follow-up.
The patients who discontinued their medication had a higher level of cognitive functioning in all domains at baseline, as well as Global cognitive function [mean z-score -1.50 (s.d. 1.24) v. -2.27 (s.d. 1.30), p = 0.00015]. After controlling for relevant confounders those who discontinued antipsychotic medication improved significantly more than those who remained on antipsychotic medication during the course of the follow-up on the Token Motor task [estimated mean change difference -0.46 (95% CI -0.89 to -0.04)], the Speed of Processing Domain [estimated mean change difference -0.38 (95% CI -0.68 to -0.08)] and global cognition [estimated mean change difference -0.36 (95% CI -0.66 to -0.07)].
Due to the naturalistic design, we cannot conclude on the direction of the relationship between antipsychotics and cognition. There is no evidence that discontinuation of medication had a negative effect on cognitive functioning. Rather, we found that that discontinuation of medication was associated with better cognitive functioning.
抗精神病药物对诊断为精神分裂症患者认知功能的影响知之甚少。一些第二代抗精神病药物的研究表明，它们改善了认知功能，而其他研究则发现它们降低了认知功能水平。
我们纳入了在开始治疗后 1.5 年（基线）接受抗精神病药物治疗并在 3.5 年后（n=189）接受随访的精神分裂症患者。在随访时，60 人（32%）已停用抗精神病药物，129 人（68%）仍在服用抗精神病药物。使用简明精神分裂症认知评估量表（BACS）评估基线和随访时的认知功能。
停药组患者在基线时所有认知域以及总体认知功能[平均 z 分数-1.50（s.d. 1.24）v. -2.27（s.d. 1.30），p=0.00015]的认知功能水平均较高。在控制了相关混杂因素后，与继续服用抗精神病药物的患者相比，停药患者在随访过程中在代币运动任务[估计平均变化差异-0.46（95%CI-0.89 至-0.04）]、速度处理域[估计平均变化差异-0.38（95%CI-0.68 至-0.08）]和总体认知功能[估计平均变化差异-0.36（95%CI-0.66 至-0.07）]上的改善更为显著。
由于采用自然主义设计，我们无法得出抗精神病药物与认知功能之间的关系方向。没有证据表明停药会对认知功能产生负面影响。相反，我们发现停药与更好的认知功能相关。
