Berman I, Merson A, Sison C, Allan E, Schaefer C, Loberboym M, Losonczy M F
Harvard Medical School, Boston, MA, USA.
Psychopharmacol Bull. 1996;32(1):95-100.
Although there is evidence that some schizophrenia patients may have altered regional cerebral blood flow patterns, few studies have addressed the relationship between cortical activity and changes in psychiatric symptoms following treatment, particularly in the elderly. We took advantage of an existing safety and tolerance study of risperidone in the elderly and examined the possible relationship between changes in psychiatric symptoms following risperidone and changes in relative cortical perfusion in a group of 6 elderly schizophrenia patients. All subjects were at least 65 years old and diagnosed with schizophrenia according to DSM-III-R criteria. The patients were assessed using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and Mini-Mental Status Examination (MMSE) and had single photon emission computed tomography (SPECT) studies before and at least 3 weeks after change of their previous neuroleptic to risperidone. The frontal/total cortex and temporal/total cortex counts in the slice ratios, and 99mTechnitium-hexamethylpropylene amine oxime (99mTc-HMPAO) percentage uptake in the whole cortical area in the slice were used for data analysis. With risperidone, patients (age 66-81) scored better on the PANSS, particularly in the positive symptom subtests. The changes in positive symptom scores correlated directly with those in frontal and temporal relative activity and 99mTc-HMPAO percentage uptake in the whole cortical area in the slice. Our findings suggest that the improvement in psychotic symptoms after risperidone is associated with a decrease in frontal and temporal activity and a reduction in 99mTc-HMPAO percentage uptake in the entire cortical area in the slice and agree with data from younger populations. Comparative studies assessing the therapeutic impact of neuroleptics on cortical activity in different age groups could be helpful in examining both the mechanisms of action of various drugs and the links between symptoms and specific brain areas.
尽管有证据表明一些精神分裂症患者可能存在局部脑血流模式改变，但很少有研究探讨治疗后皮质活动与精神症状变化之间的关系，尤其是在老年人中。我们利用一项现有的利培酮在老年人中的安全性和耐受性研究，在一组6例老年精神分裂症患者中，研究了利培酮治疗后精神症状变化与相对皮质灌注变化之间的可能关系。所有受试者年龄至少65岁，根据DSM-III-R标准诊断为精神分裂症。患者使用精神分裂症阳性和阴性症状量表（PANSS）和简易精神状态检查表（MMSE）进行评估，并在将之前的抗精神病药物换为利培酮之前和至少3周后进行单光子发射计算机断层扫描（SPECT）研究。切片比率中的额叶/总皮质和颞叶/总皮质计数，以及切片中整个皮质区域的99m锝-六甲基丙烯胺肟（99mTc-HMPAO）摄取百分比用于数据分析。使用利培酮后，患者（年龄66-81岁）在PANSS上得分更高，尤其是在阳性症状子测试中。阳性症状评分的变化与额叶和颞叶相对活动以及切片中整个皮质区域的99mTc-HMPAO摄取百分比的变化直接相关。我们的研究结果表明，利培酮治疗后精神病症状的改善与额叶和颞叶活动的减少以及切片中整个皮质区域99mTc-HMPAO摄取百分比的降低有关，这与年轻人群的数据一致。评估抗精神病药物对不同年龄组皮质活动治疗影响的比较研究，可能有助于研究各种药物的作用机制以及症状与特定脑区之间的联系。
