Kambeitz-Ilankovic Lana, Strube Wolfgang, Baune Bernhard T, Falkai Peter, Röll Lukas, Leucht Stefan
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland.
Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, Universität Augsburg, Augsburg, Deutschland.
Nervenarzt. 2024 Nov 26. doi: 10.1007/s00115-024-01773-8.
Longitudinal outcome studies confirm that the majority of patients with schizophrenic psychoses develop cognitive impairments associated with schizophrenia (CIAS).
To provide an overview of the epidemiology, diagnostics and evidence for various treatment options for CIAS.
Literature review of the current level of evidence regarding the efficacy of different treatment strategies for CIAS.
Up to 85% of patients with schizophrenic psychoses exhibit CIAS, in some cases even before the development of positive or negative symptoms. The CIAS are associated with extensive individual burden due to impairments in many areas of cognitive and psychosocial functioning relevant to daily life. Various test instruments are available for clinical assessment with the Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery (MCCB) as an established standard for clinical trials and special clinical issues. The treatment of CIAS warrants a multimodal approach with non-drug strategies (e.g., cognitive remediation, exercise) currently providing the best level of evidence. Noninvasive neurostimulation procedures and dopaminergic antipsychotic drugs of the first and second generations have demonstrated low effectiveness on cognitive function disorders in schizophrenic psychoses.
The CIAS is a frequent disease-immanent symptom in schizophrenic psychoses that should be considered in the clinical routine as it substantially impairs those affected in the functional level and quality of life. Current treatment options are limited but innovative psychosocial interventions show low to moderate effects. In addition, new medications developed based on current neurobiological findings and combinations with psychosocial and neurostimulation procedures could open up new perspectives.
纵向结果研究证实，大多数精神分裂症患者会出现与精神分裂症相关的认知障碍（CIAS）。
概述CIAS的流行病学、诊断方法以及各种治疗方案的证据。
对当前关于CIAS不同治疗策略疗效的证据水平进行文献综述。
高达85%的精神分裂症患者表现出CIAS，在某些情况下甚至在阳性或阴性症状出现之前就已出现。由于与日常生活相关的认知和心理社会功能的许多领域受损，CIAS给个体带来了沉重负担。有多种测试工具可用于临床评估，以精神分裂症认知改善测量与治疗研究（MATRICS）共识认知成套测验（MCCB）作为临床试验和特殊临床问题的既定标准。CIAS的治疗需要多模式方法，目前非药物策略（如认知康复、运动）提供了最佳证据水平。第一代和第二代非侵入性神经刺激程序以及多巴胺能抗精神病药物对精神分裂症患者的认知功能障碍疗效较低。
CIAS是精神分裂症常见的疾病固有症状，在临床常规中应予以考虑，因为它会严重损害患者的功能水平和生活质量。目前的治疗选择有限，但创新的心理社会干预显示出低至中等程度的效果。此外，基于当前神经生物学发现开发的新药物以及与心理社会和神经刺激程序的联合应用可能会开辟新的前景。
