Ribolsi Michele, Fiori Nastro Federico, Pelle Martina, Esposto Eleonora, Jannini Tommaso B, Di Lorenzo Giorgio
Department of Life Science, Health, and Health Professions, Link Campus University, 00165 Rome, Italy.
Department of Systems Medicine, Tor Vergata University of Rome, 00133 Rome, Italy.
J Clin Med. 2025 Aug 1;14(15):5432. doi: 10.3390/jcm14155432.
Schizophrenia (SCZ) is a debilitating disorder with substantial societal and economic impacts. The clinical high risk of psychosis (CHR-P) state generally precedes the onset of SCZ, offering a window for early intervention. However, treatment guidelines for CHR-P individuals remain contentious, particularly regarding antipsychotic (AP) medications. Although several studies have examined the effects of APs on reducing the risk of conversion to psychosis, the novelty of this narrative review lies in its focus on differentiating APs' effects on positive and negative symptoms, as well as cognitive functioning, in CHR-P individuals. Evidence suggests that APs may be cautiously recommended for attenuated positive symptoms to stabilize individuals for psychological interventions, but their use in treating negative symptoms is generally discouraged due to limited efficacy and potential side effects. Similarly, the effects of APs on cognitive abilities remain underexplored, with results indicating a lack of significant neurocognitive outcomes. In conclusion, APs' use in CHR-P patients requires careful consideration due to limited evidence and potential adverse effects. Future research should focus on individual symptom domains and treatment modalities to optimize outcomes in this critical population. Until then, a cautious approach emphasizing non-pharmacological interventions is advisable.
精神分裂症（SCZ）是一种具有重大社会和经济影响的致残性疾病。精神病临床高危（CHR-P）状态通常先于SCZ发病，为早期干预提供了一个窗口。然而，CHR-P个体的治疗指南仍存在争议，尤其是在抗精神病药物（AP）方面。尽管多项研究已经考察了APs对降低转化为精神病风险的作用，但这篇叙述性综述的新颖之处在于其重点关注APs对CHR-P个体的阳性和阴性症状以及认知功能的影响差异。有证据表明，对于减轻的阳性症状，可谨慎推荐使用APs以使个体稳定下来以便进行心理干预，但由于疗效有限和潜在副作用，一般不鼓励使用APs治疗阴性症状。同样，APs对认知能力的影响仍未得到充分研究，结果表明缺乏显著的神经认知结果。总之，由于证据有限和潜在不良反应，在CHR-P患者中使用APs需要谨慎考虑。未来的研究应关注个体症状领域和治疗方式，以优化这一关键人群的治疗效果。在此之前，建议采取强调非药物干预的谨慎方法。
