Zeng JiaHui, Raballo Andrea, Ye JiaYi, Gao YuQing, Su WenJun, Wei YanYan, Tang XiaoChen, Xu LiHua, Hu YeGang, Zhang Dan, Cui HuiRu, Tang YingYing, Liu XiaoHua, Liu HaiChun, Chen Tao, Li ChunBo, Wang JiJun, Zhang TianHong
Shanghai Mental Health Center, https://ror.org/05bd2wa15Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
Eur Psychiatry. 2025 May 22;68(1):e69. doi: 10.1192/j.eurpsy.2025.2459.
Clinical high risk for psychosis (CHR) is often managed with antipsychotic medications, but their effects on neurocognitive performance and clinical outcomes remain insufficiently explored. This study investigates the association between aripiprazole and olanzapine use and cognitive and clinical outcomes in CHR individuals, compared to those receiving no antipsychotic treatment.
A retrospective analysis was conducted on 127 participants from the Shanghai At Risk for Psychosis (SHARP) cohort, categorized into three groups: aripiprazole, olanzapine, and no antipsychotic treatment. Neurocognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were assessed through the Structured Interview for Prodromal Syndromes (SIPS) at baseline, 8 weeks, and one year.
The non-medicated group demonstrated greater improvements in cognitive performance, clinical symptoms, and functional outcomes compared to the medicated groups. Among the antipsychotic groups, aripiprazole was associated with better visual learning outcomes than olanzapine. Improvements in neurocognition correlated significantly with clinical symptom relief and overall functional gains at follow-up assessments.
These findings suggest potential associations between antipsychotic use and cognitive outcomes in CHR populations while recognizing that observed differences may reflect baseline illness severity rather than medication effects alone. Aripiprazole may offer specific advantages over olanzapine, underscoring the importance of individualized risk-benefit evaluations in treatment planning. Randomized controlled trials are needed to establish causality.
精神病临床高危人群（CHR）通常采用抗精神病药物治疗，但其对神经认知功能和临床结局的影响仍未得到充分研究。本研究调查了与未接受抗精神病药物治疗的人群相比，阿立哌唑和奥氮平的使用与CHR个体的认知及临床结局之间的关联。
对来自上海精神病高危人群（SHARP）队列的127名参与者进行回顾性分析，将其分为三组：阿立哌唑组、奥氮平组和未接受抗精神病药物治疗组。使用MATRICS共识认知成套测验（MCCB）评估神经认知功能，同时在基线、8周和1年时通过前驱综合征结构化访谈（SIPS）评估临床症状。
与用药组相比，未用药组在认知功能、临床症状和功能结局方面有更大改善。在抗精神病药物组中，阿立哌唑在视觉学习结局方面比奥氮平表现更好。在随访评估中，神经认知功能的改善与临床症状缓解及总体功能改善显著相关。
这些发现表明CHR人群中抗精神病药物使用与认知结局之间可能存在关联，同时认识到观察到的差异可能反映了基线疾病严重程度，而非仅由药物作用导致。与奥氮平相比，阿立哌唑可能具有特定优势，这凸显了在治疗计划中进行个体化风险效益评估的重要性。需要进行随机对照试验来确定因果关系。
