Huang Junchao, Zhu Yu, Fan Fengmei, Chen Song, Hong Yuan, Cui Yimin, Luo Xingguang, Tan Shuping, Wang Zhiren, Shang Lan, Yuan Ying, Zhang Jianxin, Yang Fude, Li Chiang-Shan R, Rowland Laura M, Kochunov Peter, Zhang Fengyu, Hong L Elliot, Tan Yunlong
Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China.
Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, United States.
Psychiatry Res Neuroimaging. 2020 Feb 4;297:111043. doi: 10.1016/j.pscychresns.2020.111043.
Some patients with schizophrenia do not respond to pharmacotherapy. More severe cognitive dysfunctions have been associated with treatment-resistant schizophrenia (TRS). This study examines cognitive functions and hippocampal volumes in 43 patients with TRS and compared them to 43 treatment-responsive patients (NTRS), matched on age, sex and education, as well as 53 healthy controls (HC). The results showed that there were significant deficits in all domains of cognition and hippocampal volumes in TRS as compared to HC group. However, TRS specific deficits, as indicated by comparisons with matched NTRS, were limited to poorer performance in working memory (p = 0.003) and smaller total hippocampal volume (p = 0.01). Logistic regression analysis showed that working memory deficits [OR 0.94 (95% CI 0.89-0.98), p = 0.005] and smaller hippocampal volume [OR 0.89 (95% CI 0.81-0.97), p = 0.01], but not their interactions (p = 0.68), contributed to higher risk of treatment resistance. The findings suggest that treatment-resistance to currently available antipsychotic medications may not be due to global cognitive deficits in these patients, but be associated with specific deficits in working memory and hippocampus deficits in the subgroup of schizophrenia.
一些精神分裂症患者对药物治疗没有反应。更严重的认知功能障碍与难治性精神分裂症（TRS）有关。本研究调查了43例TRS患者的认知功能和海马体积，并将他们与43例年龄、性别和教育程度相匹配的治疗反应性患者（NTRS）以及53名健康对照者（HC）进行比较。结果显示，与HC组相比，TRS患者在所有认知领域和海马体积方面均存在显著缺陷。然而，与匹配的NTRS组相比，TRS特有的缺陷仅限于工作记忆表现较差（p = 0.003）和海马总体积较小（p = 0.01）。逻辑回归分析表明，工作记忆缺陷[比值比0.94（95%置信区间0.89 - 0.98），p = 0.005]和较小的海马体积[比值比0.89（95%置信区间0.81 - 0.97），p = 0.01]，而非它们的相互作用（p = 0.68），导致了更高的治疗抵抗风险。研究结果表明，对目前可用抗精神病药物的治疗抵抗可能并非由于这些患者的整体认知缺陷，而是与精神分裂症亚组中工作记忆的特定缺陷和海马缺陷有关。
