Zhang TianHong, Wei YanYan, Tang XiaoChen, Cui HuiRu, Xu LiHua, Hu YeGang, Tang YingYing, Hu Qiang, Liu HaiChun, Wang ZiXuan, Chen Tao, Li ChunBo, Wang JiJun
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China.
Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, People's Republic of China.
Child Adolesc Psychiatry Ment Health. 2024 May 4;18(1):53. doi: 10.1186/s13034-024-00743-x.
The effects of antipsychotic (AP) medications on cognitive functions in individuals at clinical high-risk (CHR) of psychosis are poorly understood. This study compared the effects of AP treatment on cognitive improvement in CHR adolescents and adults.
A total of 327 CHR participants, with an age range of 13 to 45 years, who underwent baseline neuropsychological assessments and a 1-year clinical follow-up were included. Participants with CHR were categorized into four groups based on their age: adolescents (aged < 18) and adults (aged ≥ 18), as well as their antipsychotic medication status (AP+ or AP-). Therefore, the four groups were defined as Adolescent-AP-, Adolescent-AP+, Adult-AP-, and Adult-AP+.
During the follow-up, 231 CHR patients received AP treatment, 94 converted to psychosis, and 161 completed the 1-year follow-up. The Adolescent-AP+ group had more positive symptoms, lower general functions, and cognitive impairments than the Adolescent-AP- group at baseline, but no significant differences were observed among adults. The Adolescent-AP+ group showed a significant increase in the risk of conversion to psychosis (p < 0.001) compared to the Adolescent-AP- group. The Adult-AP+ group showed a decreasing trend in the risk of conversion (p = 0.088) compared to the Adult-AP- group. The Adolescent-AP- group had greater improvement in general functions (p < 0.001), neuropsychological assessment battery mazes (p = 0.025), and brief visuospatial memory test-revised (p = 0.020), as well as a greater decrease in positive symptoms (p < 0.001) at follow-up compared to the Adolescent-AP+ group. No significant differences were observed among adults.
Early use of AP was not associated with a positive effect on cognitive function in CHR adolescents. Instead, the absence of AP treatment was associated with better cognitive recovery, suggesting that AP exposure might not be the preferred choice for cognitive recovery in CHR adolescents, but may be more reasonable for use in adults.
抗精神病药物（AP）对临床高危（CHR）精神病患者认知功能的影响尚不清楚。本研究比较了AP治疗对CHR青少年和成人认知改善的影响。
共纳入327名年龄在13至45岁之间、接受了基线神经心理学评估并进行了1年临床随访的CHR参与者。CHR参与者根据年龄分为四组：青少年（年龄<18岁）和成人（年龄≥18岁），以及他们的抗精神病药物使用情况（AP+或AP-）。因此，这四组被定义为青少年-AP-组、青少年-AP+组、成人-AP-组和成人-AP+组。
在随访期间，231名CHR患者接受了AP治疗，94人转变为精神病，161人完成了1年随访。青少年-AP+组在基线时比青少年-AP-组有更多的阳性症状、更低 的总体功能和认知障碍，但成人组之间未观察到显著差异。与青少年-AP-组相比，青少年-AP+组转变为精神病的风险显著增加（p<0.001）。与成人-AP-组相比，成人-AP+组转变风险呈下降趋势（p=0.088）。与青少年-AP+组相比，青少年-AP-组在随访时总体功能改善更大（p<0.001）、神经心理学评估电池迷宫测试（p=0.025）和修订后的简短视觉空间记忆测试（p=0.020）改善更大，阳性症状减少也更多（p<0.001）。成人组之间未观察到显著差异。
早期使用AP对CHR青少年的认知功能没有积极影响。相反，未接受AP治疗与更好的认知恢复相关，这表明接触AP可能不是CHR青少年认知恢复的首选，但对成人使用可能更合理。
