Weinberger D R, Gallhofer B
Clinical Brain Disorders Branch, National Institute of Mental Health, Neurosciences Center at Saint Elizabeths, Washington, DC 20032, USA.
Int Clin Psychopharmacol. 1997 Sep;12 Suppl 4:S29-36. doi: 10.1097/00004850-199709004-00006.
Impaired cognitive function in schizophrenia, once thought to be a secondary effect of the psychosis, is now seen as an enduring and core feature. It has many manifestations, but the most disruptive element is arguably a fundamental defect in the patient's ability to manipulate available information. The magnitude of the cognitive deficit in schizophrenia is considerable and remains relatively stable despite fluctuations in other symptoms. The degree of dysfunction also has a high predictive value for long-term disability. In recent years, more attention has been directed towards cognitive dysfunction in schizophrenia as a result of which assessment scales and diagnostic systems increasingly incorporate cognitive dysfunction as an independent domain. Good cognitive function depends upon the brain's ability to prioritize tasks and to switch from parallel processing to sequential processing when the processing load is excessive. This requires working executive memory. Neuroimaging and functional analyses suggest that such cognitive function relies upon unimpaired prefrontal activity. In addition, there is increasing evidence that antipsychotic drugs with 5-hydroxytryptamine (5-HT)2A-blocking activity produce better cognitive function in patients with schizophrenia than drugs with predominantly dopamine (D)2-blocking activity (conventional neuroleptics). The development of sophisticated, computer-delivered maze tasks has shown that newer antipsychotics, such as clozapine and risperidone, differ from conventional neuroleptics in their effects on cognitive function. The prospects, therefore, are that patients treated with drugs having 5-HT2A-blocking activity will have better cognitive function and will be better able to function in life's roles than will patients treated with conventional neuroleptics.
精神分裂症患者认知功能受损，曾经被认为是精神病的一种次要效应，现在则被视为一种持久的核心特征。它有许多表现形式，但最具破坏性的因素可以说是患者处理现有信息能力的根本缺陷。精神分裂症患者认知缺陷的程度相当大，并且尽管其他症状有波动，但仍相对稳定。功能障碍的程度对长期残疾也具有很高的预测价值。近年来，人们越来越关注精神分裂症中的认知功能障碍，因此评估量表和诊断系统越来越多地将认知功能障碍纳入独立领域。良好的认知功能取决于大脑对任务进行优先级排序以及在处理负荷过大时从并行处理切换到顺序处理的能力。这需要有效的执行记忆。神经影像学和功能分析表明，这种认知功能依赖于未受损的前额叶活动。此外，越来越多的证据表明，具有5-羟色胺（5-HT）2A阻断活性的抗精神病药物比主要具有多巴胺（D）2阻断活性的药物（传统抗精神病药物）能使精神分裂症患者产生更好的认知功能。复杂的计算机迷宫任务的发展表明，新型抗精神病药物，如氯氮平和利培酮，在对认知功能的影响方面与传统抗精神病药物不同。因此，前景是，与接受传统抗精神病药物治疗的患者相比，接受具有5-HT₂A阻断活性药物治疗的患者将具有更好的认知功能，并且在生活角色中功能也会更好。
