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Lungu PF, Lungu CM, Ciobica A, Balmus IM, Vitalaru R, Mavroudis I, Dobrin R, Cimpeanu M, Gurzu IL. The Effect of Antipsychotics on Cognition in Schizophrenia-A Current Narrative Review. Brain Sci 2024; 14:359. [PMID: 38672011 PMCID: PMC11047912 DOI: 10.3390/brainsci14040359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
The majority of schizophrenia-affected individuals display deficiencies in multiple cognitive domains such as attention, working memory, long-term memory, and learning, deficiencies that are stable throughout the disease. The purpose of this narrative review was to examine the effect of antipsychotics on several cognitive domains affected by schizophrenia. Methods: We searched MEDLINE, Elsevier, Scopus, and DOAJ databases for randomized controlled trials and other studies investigating the effects of typical and atypical antipsychotics on cognition in patients with schizophrenia in studies conducted in the last decade. Results: The majority of studies included in this review showed that antipsychotics (especially SGAs) have positive effects on both cognition and general psychopathology of schizophrenia. We mention that treatment with antipsychotic substances represents an ongoing effort of the researchers, who are constantly searching for the best approach to meet the mental health needs of schizophrenia patients. Conclusions: Even with those positive results, it should be noted that more studies are needed in order to fully observe the various effects of certain antipsychotic substances on cognition.
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Affiliation(s)
- Petru Fabian Lungu
- Faculty of Biology, Biology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania; (P.F.L.); (M.C.)
| | - Corina Miruna Lungu
- Faculty of Psychology and Educational Sciences, Psychology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania
| | - Alin Ciobica
- Faculty of Biology, Biology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania; (P.F.L.); (M.C.)
- Center of Biomedical Research, Romanian Academy, Iasi Branch, Teodor Codrescu 2, 700481 Iasi, Romania
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
- Preclinical Department, Apollonia University, Strada Păcurari 11, 700511 Iasi, Romania
| | - Ioana Miruna Balmus
- Institute of Interdisciplinary Research, Department of Exact Sciences and Natural Sciences, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania;
- CENEMED Platform for Interdisciplinary Research, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16th Universitatii Street, 700115 Iasi, Romania
| | - Raluca Vitalaru
- Institute of Psychiatry “Socola”, Iasi Str. Bucium 36, 700282 Iasi, Romania (R.D.)
| | - Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK
| | - Romeo Dobrin
- Institute of Psychiatry “Socola”, Iasi Str. Bucium 36, 700282 Iasi, Romania (R.D.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Mirela Cimpeanu
- Faculty of Biology, Biology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania; (P.F.L.); (M.C.)
| | - Irina Luciana Gurzu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
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Irak M, Karahan A. Investigating False Memory and Illusory Pattern Perception Bias in Schizophrenia Patients with and without Delusions. COGNITIVE THERAPY AND RESEARCH 2023; 47:1-12. [PMID: 37363747 PMCID: PMC10212733 DOI: 10.1007/s10608-023-10393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
Background Whether the false memory dysfunction in schizophrenia is at the early (encoding, perceptual) or later (retrieval) stages and how delusions affect it remains unclear. Method In this study, we examined the perception and memory biases in schizophrenia patients with (Sch/D; n = 31) and without delusions (Sch/Nd; n = 32) and compared them with healthy controls (HCs; n = 35). We used the Deese Roediger McDermott (DRM) Paradigm and the Noise Task to measure the false memory and illusory pattern perception (IPP) biases, respectively. Results We found that the patient groups performed lower in both the recall and recognition phases for the DRM and the Noise tasks and made more errors compared to the HC group. Additionally, the performance of the Sch/D group was remarkably lower than the Sch/Nd and HC groups. Conclusions Our results indicated that the information-processing problem in schizophrenia exists in both the encoding and retrieval stages. Also found significant relationship between the presence of delusions and the increase in cognitive deficits. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10393-6.
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Affiliation(s)
- Metehan Irak
- Department of Psychology, Brain and Cognition Research Laboratory, Bahcesehir University, Çırağan Cad. No:4 Beşiktaş, Istanbul, 34353 Turkey
| | - Ayşen Karahan
- Department of Psychiatry, University of Health Sciences Istanbul Bağcılar Training and Research Hospital Dr. Sadık Ahmet Cad. Bağcılar, 34093 Istanbul, Turkey
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Haddad C, Salameh P, Sacre H, Clément JP, Calvet B. Effects of antipsychotic and anticholinergic medications on cognition in chronic patients with schizophrenia. BMC Psychiatry 2023; 23:61. [PMID: 36694187 PMCID: PMC9872384 DOI: 10.1186/s12888-023-04552-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses. STUDY DESIGN A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool. STUDY RESULTS A significantly higher BACS total score (r = -0.33, p < 0.001), higher verbal memory (r = -0.26, p = 0.004), higher working memory (r = -0.20, p = 0.03), higher motor speed (r = -0.36, p < 0.001), and higher attention and speed of information processing (r = -0.27, p = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p = .028), higher chlorpromazine equivalent dose (SB = -.30; p = .001), and taking mood stabilizer medications (SB = -.24; p = .004) were significantly associated with lower cognition. CONCLUSION This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia.
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Affiliation(s)
- Chadia Haddad
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France. .,Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000, Limoges, France. .,Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon. .,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon. .,School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon. .,School of Medicine, Lebanese American University, Byblos, Lebanon.
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411323.60000 0001 2324 5973School of Medicine, Lebanese American University, Byblos, Lebanon ,grid.413056.50000 0004 0383 4764Department of Primary Care and Population Health, University of Nicosia Medical School, 2417 Nicosia, Cyprus ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Jean-Pierre Clément
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France ,grid.477071.20000 0000 9883 9701Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de L’Adulte, de l’Agée Et d’Addictologie, Centre Hospitalier Esquirol, 87000 Limoges, France
| | - Benjamin Calvet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France ,grid.477071.20000 0000 9883 9701Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de L’Adulte, de l’Agée Et d’Addictologie, Centre Hospitalier Esquirol, 87000 Limoges, France
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Haddad C, Salameh P, Sacre H, Polin C, Clément JP, Calvet B. Subjective cognitive complaints and relations to objective cognitive performance among Lebanese patients with schizophrenia. BMC Psychiatry 2021; 21:549. [PMID: 34753438 PMCID: PMC8576858 DOI: 10.1186/s12888-021-03564-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with schizophrenia have a particularly low level of insight into their illness compared to people with other mental health disorders. The objectives of the study were to evaluate: 1) subjective cognitive complaints in individuals with schizophrenia in comparison with health controls, 2) the relation between subjective cognitive complaint (SCC) and objective cognitive performance in the patients group, and 3) factors related to cognitive complaint, such as depression, insight, autonomy, and psychological symptoms. METHODS Cross-sectional study was conducted between July 2019 and March 2020 enrolled 120 patients with schizophrenia disorders, selected from the Psychiatric Hospital of the Cross (HPC) - Lebanon and 60 healthy controls. The Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) was used to measure people living with schizophrenia perception of their cognitive impairment, while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate their cognitive functioning. RESULTS A significant difference was found between schizophrenia patients and healthy controls in all neurocognition and SASCCS tests. The hierarchical regression analysis showed that the BACS total score (Beta = -.06, p = .04), the PANSS general psychopathology (Beta = .29, p = .003), higher depression (Beta = .75, p = .003) were significantly associated with higher SCC. However, higher autonomy (Beta = - 6.35, p = .001) was significantly associated with lower SCC. A Structural equation model showed that the two most contributing variables were general psychopathology (Standardized Beta (SB): .33, p < 0.001) and autonomy (SB: -.29, p < 0.001). CONCLUSION A significant proportion of patients with schizophrenia could estimate their cognitive impairment. It also showed a positive correlation between depression and activity of daily living with SCC, suggesting that this aspect should be investigated alongside the clinical symptoms when a patient with schizophrenia presents with SCC.
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Affiliation(s)
- Chadia Haddad
- Research department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. .,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon. .,INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000, Limoges, France. .,Pôle Universitaire de Psychiatrie de l'Adulte, de l'Agée et d'Addictologie, centre hospitalier Esquirol, 87025, Limoges, France.
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Beirut, Lebanon ,grid.413056.50000 0004 0383 4764University of Nicosia Medical School, Nicosia, Cyprus
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Clément Polin
- grid.9966.00000 0001 2165 4861INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de l’Adulte, de l’Agée et d’Addictologie, centre hospitalier Esquirol, 87025 Limoges, France ,grid.477071.20000 0000 9883 9701Centre mémoire de ressources et de recherche du Limousin, centre hospitalier Esquirol, 87025 Limoges, France
| | - Jean-Pierre Clément
- grid.9966.00000 0001 2165 4861INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de l’Adulte, de l’Agée et d’Addictologie, centre hospitalier Esquirol, 87025 Limoges, France ,grid.477071.20000 0000 9883 9701Centre mémoire de ressources et de recherche du Limousin, centre hospitalier Esquirol, 87025 Limoges, France
| | - Benjamin Calvet
- grid.9966.00000 0001 2165 4861INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de l’Adulte, de l’Agée et d’Addictologie, centre hospitalier Esquirol, 87025 Limoges, France ,grid.477071.20000 0000 9883 9701Centre mémoire de ressources et de recherche du Limousin, centre hospitalier Esquirol, 87025 Limoges, France ,grid.477071.20000 0000 9883 9701Unité Recherche et Innovations, centre hospitalier Esquirol, 87025 Limoges, France
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Spellmann I, Riedel M, Städtler J, Zill P, Obermeier M, Cerovecki A, Dehning S, Schennach R, Epple M, Opgen-Rhein M, Müller N, Bondy B, Möller HJ, Musil R. Associations of NEUROD2 polymorphisms and change of cognitive dysfunctions in schizophrenia and schizoaffective disorder after eight weeks of antipsychotic treatment. Cogn Neuropsychiatry 2017; 22:280-297. [PMID: 28470106 DOI: 10.1080/13546805.2017.1322502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION NEUROD2 is a neurospecific helix-loop-helix transcription factor which has an impact on the regulation of glutamatergic and GABAergic genes. We investigated an association of NEUROD2 with neurocognitive dysfunctions in schizophrenia and schizoaffective disorder patients before and during treatment with different second-generation antipsychotics. METHODS Patients were genotyped for four different polymorphisms of the NEUROD2 gene ((rs9889354(A/G), rs1877032(C/T), rs12453682(C/T) and rs11078918(C/G)). Cognitive function was assessed at baseline and week 8. Results of individual neuropsychological tests were assigned to six cognitive domains (reaction time and quality; executive function; working, verbal and visual memory) and a general cognitive index. RESULTS 167 patients were included in the study. The NEUROD2 exonic polymorphism rs11078918 showed significant associations with verbal memory and executive functions, whereas the NEUROD2 polymorphism rs12453682 was significantly associated with working and verbal memory, executive functions and with a cognitive index. Significant associations were found at baseline and after eight weeks. Moreover, significant associations between the change in neuropsychological test results during antipsychotic treatment and the NEUROD2 polymorphisms rs11078918 and rs12453682 were observed. CONCLUSIONS Our findings suggest that the NEUROD2 gene could play a role in the pathophysiology of neurocognitive dysfunctions as well as in the change of cognitive symptoms under antipsychotic treatment in schizophrenia and schizoaffective disorder.
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Affiliation(s)
- Ilja Spellmann
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Michael Riedel
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Julia Städtler
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Peter Zill
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Michael Obermeier
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Anja Cerovecki
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Sandra Dehning
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Rebecca Schennach
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Maria Epple
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Markus Opgen-Rhein
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Norbert Müller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Brigitta Bondy
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Hans-Jürgen Möller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Richard Musil
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
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Pharmacokinetic patterns of risperidone-associated adverse drug reactions. Eur J Clin Pharmacol 2016; 72:1091-8. [DOI: 10.1007/s00228-016-2085-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/20/2016] [Indexed: 01/03/2023]
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Abstract
Olanzapine is a novel antipsychotic, approved for the acute and maintenance treatment of schizophrenia and bipolar I disorder. Despite the publicity regarding reported adverse events with the novel antipsychotics, such as weight gain and Type II diabetes mellitus, olanzapine remains a useful and important medicine. It is a selective monoaminergic antagonist with high-affinity binding to a number of receptors thought to be implicated in some psychotic and mood symptoms. The complex pharmacology of olanzapine has lead to studies exploring its use in treating substance abuse, aggression/violence, borderline personality disorder, schizotypal personality disorder, obsessive-compulsive disorder and as a neuroprotective agent in schizophrenia. As the pharmacology of olanzapine and other novel antipsychotics becomes better understood, future effective treatment strategies are likely to match an individual's genetic makeup and receptor profiles to the most compatible agent.
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Affiliation(s)
- Kimberly H Littrell
- The Promedica Research Center 4460 Atlanta Highway Suite B Loganville, GA 30052, USA.
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Subjective cognitive complaints in schizophrenia: relation to antipsychotic medication dose, actual cognitive performance, insight and symptoms. PLoS One 2013; 8:e83774. [PMID: 24376745 PMCID: PMC3869800 DOI: 10.1371/journal.pone.0083774] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subjective cognitive complaints are prevalent in those affected by functional psychoses and a variety of possible associated factors have been investigated. However, few studies have examined these potential factors within single studies or analyses. METHODS Patients with a history of a schizophrenia spectrum disorder (n = 115) and a non-clinical comparison group (n = 45) completed the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) and the Brief Assessment of Cognition in Schizophrenia (BACS). The patient group also completed the Positive and Negative Syndromes Scale (PANSS), the Birchwood Insight Scale (IS), and the Hospital Anxiety and Depression Scale (HADS). RESULTS The BACS and SSTICS scores were associated in the non-clinical comparison group, but not in the patient group. In the patient group worse subjective cognition was associated positively with good insight, greater dysphoria and greater positive symptoms. Linear regression revealed that, once other variables had been accounted for, dysphoria (HADS anxiety and depression factor) was the only significant predictor of SSTICS scores. CONCLUSIONS Subjective cognitive impairment in patients with psychosis in the absence of formal testing should not be taken as evidence of impaired cognitive functioning. Mood should be investigated when patients present with subjective cognitive complaints.
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Hori H, Yoshimura R, Katsuki A, Hayashi K, Ikenouchi-Sugita A, Umene-Nakano W, Nakamura J. Several prescription patterns of antipsychotic drugs influence cognitive functions in Japanese chronic schizophrenia patients. Int J Psychiatry Clin Pract 2012; 16:138-42. [PMID: 22136174 DOI: 10.3109/13651501.2011.631018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We hypothesized that an excessive dose of antipsychotic drug and/or a larger number of antipsychotic drug worsens cognitive functions in schizophrenia patients. To confirm the hypothesis, we compared several cognitive functions in the patients taking a second-generation antipsychotic drug (SGA) only (SGA monotherapy group) with those in patients taking more than two kinds of antipsychotic drugs (polypharmacy group). METHODS The cognitive functions of 136 chronic schizophrenia patients were evaluated using the Brief Assessment of Cognition in Schizophrenia, Japanese-language version (BACS-J). RESULTS A significantly negative correlation was found between the composite score in the BACS-J and the chlorpromazine equivalence of doses of antipsychotic drugs in whole patients (r = -0.43, P < 0.001). Schizophrenia patients in the polypharmacy group had lower composite scores than those in the SGA monotherapy group in the BACS-J. No difference was observed in the composite score and the primary score in each item in the BACS-J between patients with first- plus second-generation antipsychotic drug (FGA + SGA group) and those with two kinds of SGA (SGA + SGA group). CONCLUSION These results suggest that an excessive dose of antipsychotic drugs regardless of FGA and SGA might cause the deterioration of cognitive functions in chronic Japanese schizophrenia patients.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health Japan, School of Medicine, Kitakyushu, Japan.
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The cognitive profile of aripiprazole differs from that of other atypical antipsychotics in schizophrenia patients. J Psychiatr Res 2012; 46:757-61. [PMID: 22464338 DOI: 10.1016/j.jpsychires.2012.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 02/22/2012] [Accepted: 02/23/2012] [Indexed: 11/23/2022]
Abstract
We investigated the effects of the atypical antipsychotics risperidone, olanzapine, and aripiprazole on the cognitive functions of Japanese patients with schizophrenia with respect to dosage amounts and dosing schedules. We performed a cross-sectional survey using the Brief Assessment of Cognition in Schizophrenia - Japanese Language Version (BACS-J) to evaluate the neurocognitive functions of 101 schizophrenic patients who took the same dose of one of the three aforementioned antipsychotics for at least 3 months. The BACS-J composite score correlated negatively with the prescribed dosages of risperidone and olanzapine. In contrast, we did not find a correlation between the BACS-J composite score and the prescribed dosage of aripiprazole. Moreover, the primary scores for verbal learning, motor function, and attention and processing speed were significantly lower among the patients who were taking the prescribed dosage of risperidone. The scores for verbal learning and motor function were also significantly lower when correlated with the prescribed dosage of olanzapine. We did not find a correlation between any of the primary scores on the BACS-J and the prescribed dosage of aripiprazole. In fact, the results suggest there is no linear relationship between the dose of aripiprazole and cognitive impairment, which may be due to its unique pharmacological profile.
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Vothknecht S, Schoevers RA, de Haan L. Subjective well-being in schizophrenia as measured with the Subjective Well-Being under Neuroleptic Treatment scale: a review. Aust N Z J Psychiatry 2011; 45:182-92. [PMID: 21438745 DOI: 10.3109/00048674.2010.545984] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Subjective Well-being under Neuroleptic Treatment scale (SWN) is the most widely used self-rating scale in recent research of subjective well-being in schizophrenia. We reviewed all available publications on relevant research of subjective well-being using the SWN, in order to evaluate measurement of subjective well-being with a single instrument. METHOD A MEDLINE and Embase search was performed for studies published between January 1994 and August 2010, analysing controlled and open clinical trials using the SWN. RESULTS A total of 52 publications were identified covering 44 studies. Strong evidence exists for improvement of subjective well-being during treatment. Atypical antipsychotics are associated with a higher level of well-being. However, dosage is more important than the kind of medication. Striatal dopamine D(2) receptor occupancy is correlated with subjective well-being. Early positive response of subjective well-being is predictive of a better outcome. Research on determinants of subjective well-being is rapidly expanding, focusing mostly on the effects of medication. CONCLUSIONS Subjective well-being of schizophrenia patients is a valuable outcome measure. It can be improved by optimizing antipsychotic treatment. More research on psychological and genetic predictors of subjective well-being is needed.
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Affiliation(s)
- Sylke Vothknecht
- Department of Training and Research, Arkin Mental Health Amsterdam, The Netherlands.
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12
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Elie D, Poirier M, Chianetta J, Durand M, Grégoire C, Grignon S. Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder. J Psychopharmacol 2010; 24:1037-44. [PMID: 19164494 DOI: 10.1177/0269881108100777] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antipsychotic polypharmacy and high doses have been associated with poorer outcome, longer hospital stays, and increased side effects. The present naturalistic study assessed the cognitive effects of antipsychotics in 56 patients with a diagnosis of schizophrenia or schizoaffective disorder, using the Brief Assessment of Cognition in Schizophrenia (BACS). Antipsychotic daily dose (ADD) was expressed as mg risperidone equivalents/day (RIS eq), using a model based on drug doses from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study for second generation antipsychotics (SGA) and chlorpromazine equivalents for first generation antipsychotics (FGA), with a 1/1 equivalence between haloperidol and risperidone. Increasing age was associated with polypharmacy, FGA prescription and decreasing BACS score. FGA prescription, in turn, predicted a poorer cognitive functioning, independently of age, PANSS subscores and ADD. ADD was associated with decreasing cognitive scores, an effect that remained significant after controlling for age, PANSS or polypharmacy. The detrimental cognitive effects of polypharmacy, in turn, appeared to be mediated by ADD. Different methods of data fitting suggested that ADD above 5-6 mg RIS eq/day were associated with lower BACS scores. Overall, these results show that increasing antipsychotic daily dose is associated with poorer cognitive functioning at doses lower than previously thought, independently of the number of antipsychotic drugs.
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Affiliation(s)
- D Elie
- Department of Psychiatry, Sherbrooke University, Sherbrooke, QC, Canada, and Department of Psychiatry, CHUQ-Hôtel Dieu, Québec, QC, Canada
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Øie M, Sundet K, Rund BR. Neurocognitive decline in early-onset schizophrenia compared with ADHD and normal controls: evidence from a 13-year follow-up study. Schizophr Bull 2010; 36:557-65. [PMID: 18801881 PMCID: PMC2879697 DOI: 10.1093/schbul/sbn127] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The issue of neurodegeneration in schizophrenia is controversial. Although most studies indicate that neurocognitive deficits are relatively stable over the course of the illness, conclusions are limited by relatively short follow-up periods and absence of age-matched control groups. Furthermore, nearly all studies deal with adult-onset schizophrenia, and few studies have considered the possible effect of age of onset. The current study represents the first attempt to compare groups of adolescents with schizophrenia, attention deficit/hyperactivity disorder (ADHD), and normal controls on a comprehensive neurocognitive test battery in a longitudinal design over 13 years. In the baseline study, adolescents with schizophrenia were examined with a broad battery of neurocognitive tests. The comparison groups consisted of adolescents with ADHD and adolescents without a psychiatric diagnosis, between 12 and 18 years of age. In the follow-up study, the schizophrenia group consisted of 15 of the initial 19 individuals, the ADHD group of 19 of the 20 individuals, and the normal comparison group of all 30 individuals. They were reevaluated with the neurocognitive test battery and clinical measures. Subjects with schizophrenia showed a significant decline or arrest in neurocognitive functioning compared with the other 2 groups, particularly in verbal memory, attention, and processing speed. The impairments may be specific to early-onset schizophrenia due to interaction between ongoing brain maturation during adolescence and disease-related mechanisms and/or secondary to neuroleptic treatment in young age and/or social isolation.
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Affiliation(s)
- Merete Øie
- Division Mental Health Care, Innlandet Hospital Trust Lillehammer, Anders Sandvigsgate 17, 2629 Lillehammer, Norway.
| | - Kjetil Sundet
- Center for the Study of Human Cognition, Institute of Psychology, University of Oslo, Norway
| | - Bjørn Rishovd Rund
- Asker and Bærum Hospital Trust, Institute of Psychology, University of Oslo, Norway
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Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, Kissling W, Leucht S. Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev 2010:CD006654. [PMID: 20238348 PMCID: PMC4169107 DOI: 10.1002/14651858.cd006654.pub2] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In many countries of the industrialised world second generation ("atypical") antipsychotics have become the first line drug treatment for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examined how the efficacy and tolerability of olanzapine differs from that of other second generation antipsychotics. OBJECTIVES To evaluate the effects of olanzapine compared to other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychosis. SEARCH STRATEGY 1. Electronic searching We searched the Cochrane Schizophrenia Group Trials Register (April 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.2. Reference searching We inspected the reference of all identified studies for more trials.3. Personal contact We contacted the first author of each included study for missing information.4. Drug companies We contacted the manufacturers of all atypical antipsychotics included for additional data. SELECTION CRITERIA We included all randomised trials that used at least single-blind (rater-blind) design, comparing oral olanzapine with oral forms of amisulpride, aripiprazole, clozapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random effects model. MAIN RESULTS The review currently includes 50 studies and 9476 participants which provided data for six comparisons (olanzapine compared to amisulpride, aripiprazole, clozapine, quetiapine, risperidone or ziprasidone). The overall attrition from the included studies was considerable (49.2%) leaving the interpretation of results problematic.Olanzapine improved the general mental state (PANSS total score) more than aripiprazole (2 RCTs, n=794, WMD -4.96 CI -8.06 to -1.85), quetiapine (10 RCTs, n=1449, WMD -3.66 CI -5.39 to -1.93), risperidone (15 RCTs, n=2390, WMD -1.94 CI -3.31 to -0.58) and ziprasidone (4 RCTs, n=1291, WMD -8.32 CI -10.99 to -5.64), but not more than amisulpride or clozapine. This somewhat better efficacy was confirmed by fewer participants in the olanzapine groups leaving the studies early due to inefficacy of treatment compared to quetiapine (8 RCTs, n=1563, RR 0.56 CI 0.44 to 0.70, NNT 11 CI 6 to 50), risperidone (14 RCTs, n=2744, RR 0.78 CI 0.62 to 0.98, NNT 50 CI 17 to 100) and ziprasidone (5 RCTs, n=1937, RR 0.64 CI 0.51 to 0.79, NNT 17, CI 11 to 33).Fewer participants in the olanzapine group than in the quetiapine (2 RCTs, n=876, RR 0.56 CI 0.41 to 0.77, NNT 11 CI 7 to 25) and ziprasidone (2 RCTs, n=766, RR 0.65 CI 0.45 to 0.93, NNT 17 CI 9 to 100) treatment groups, but not in the clozapine group (1 RCT, n=980, RR 1.28 CI 1.02 to 1.61, NNH not estimable), had to be re-hospitalised in the trials.Except for clozapine, all comparators induced less weight gain than olanzapine (olanzapine compared to amisulpride: 3 RCTs, n=671, WMD 2.11kg CI 1.29kg to 2.94kg; aripiprazole: 1 RCT, n=90, WMD 5.60kg CI 2.15kg to 9.05kg; quetiapine: 7 RCTs, n=1173, WMD 2.68kg CI 1.10kg to 4.26kg; risperidone: 13 RCTs, n=2116, WMD 2.61kg CI 1.48kg to 3.74kg; ziprasidone: 5 RCTs, n=1659, WMD 3.82kg CI 2.96kg to 4.69kg). Associated problems such as glucose and cholesterol increase were usually also more frequent in the olanzapine group.Other differences in adverse effects were less well documented. Nevertheless, olanzapine may be associated with slightly more extrapyramidal side effects than quetiapine (use of antiparkinson medication (6 RCTs, n=1090, RR 2.05 CI 1.26 to 3.32, NNH 25 CI 14 to 100), but less than risperidone (use of antiparkinson medication 13 RCTs, n=2599, RR 0.78 CI 0.65 to 0.95, NNH 17 CI 9 to 100) and ziprasidone (use of antiparkinson medication 4 RCTs, n=1732, RR 0.70 CI 0.50 to 0.97, NNH not estimable). It may also increase prolactin somewhat more than aripiprazole, clozapine and quetiapine, but clearly less so than risperidone (6 RCTs, n=1291, WMD -22.84 CI -27.98 to -17.69). AUTHORS' CONCLUSIONS Olanzapine may be a somewhat more efficacious drug than some other second generation antipsychotic drugs. This small superiority in efficacy needs to be weighed against a larger weight gain and associated metabolic problems than most other second generation antipsychotic drugs, except clozapine. These conclusions are tentative due to the large number of people leaving the studies early which possibly limits the validity of the findings. Further large, well-designed trials are necessary to establish the relative effects of different second generation antipsychotic drugs.
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Affiliation(s)
- Katja Komossa
- Klinik und Poliklinik für Psychosomatische und Medizin und Psychotherapie, Technische Universität München, Klinikum rechts der Isar, München, Germany
| | - Christine Rummel-Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, 04103 Leipzig, Germany
| | - Heike Hunger
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | - Franziska Schmid
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | - Sandra Schwarz
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | | | - Werner Kissling
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | - Stefan Leucht
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
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15
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Lai JS, Butt Z, Wagner L, Sweet JJ, Beaumont JL, Vardy J, Jacobsen PB, Shapiro PJ, Jacobs SR, Cella D. Evaluating the dimensionality of perceived cognitive function. J Pain Symptom Manage 2009; 37:982-95. [PMID: 19500722 PMCID: PMC2737504 DOI: 10.1016/j.jpainsymman.2008.07.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 07/14/2008] [Accepted: 07/25/2008] [Indexed: 10/20/2022]
Abstract
Decrements in cognitive function are common in cancer patients and other clinical populations. As direct neuropsychological testing is often not feasible or affordable, there is potential utility in screening for deficits that may warrant a more comprehensive neuropsychological assessment. Furthermore, some evidence suggests that perceived cognitive function (PCF) is independently associated with structural and functional changes on neuroimagery, and may precede more overt deficits. To appropriately measure PCF, one must understand its components and the underlying dimensional structure. The purpose of this study was to examine the dimensionality of PCF in people with cancer. The sample included 393 cancer patients from four clinical trials who completed a questionnaire consisting of the prioritized areas of concerns identified by patients and clinicians: self-reported mental acuity, concentration, memory, verbal fluency, and functional interference. Each area contained both negatively worded (i.e., deficit) and positively worded (i.e., capability) items. Data were analyzed by using Cronbach's alpha, item-total correlations, one-factor confirmatory factor analysis, and a bi-factor analysis model. Results indicated that perceived cognitive problem items are distinct from cognitive capability items, supporting a two-factor structure of PCF. Scoring of PCF based on these two factors should lead to improved assessment of PCF for people with cancer.
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Affiliation(s)
- Jin-Shei Lai
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Rubloff Bldg., 9th floor, 750N. Lake Shore Dr., Chicago, IL 60611, USA.
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16
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Associations of SNAP-25 polymorphisms with cognitive dysfunctions in Caucasian patients with schizophrenia during a brief trail of treatment with atypical antipsychotics. Eur Arch Psychiatry Clin Neurosci 2008; 258:335-44. [PMID: 18347838 DOI: 10.1007/s00406-007-0800-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 12/04/2007] [Indexed: 10/22/2022]
Abstract
The synaptosomal-associated protein of 25 kDa (SNAP-25) is part of the soluble N-ethylmaleimide-sensitive fusion protein (NSF) attachment receptor (SNARE), which mediates synaptic neurotransmission. In earlier studies a possible involvement of this protein in schizophrenia has been shown. As neurocognitive impairment is a core feature in the pathology of schizophrenia and considered to be a putative endophenotype according to genetic studies we investigated the influences of different SNAP-25 polymorphisms on neuropsychological test results before and during treatment with atypical antipsychotics. A total of 104 schizophrenic patients treated with atypical antipsychotics were genotyped for three different polymorphisms of the SNAP-25 gene (MnlI, TaiI and DdeI in the 3'-UTR). Cognitive function was assessed at baseline, week 4 or 6 and week 8 or 12. Results of individual neuropsychological tests were assigned to six cognitive domains (reaction time and quality; executive function; working, verbal and visual memory) and a general cognitive index. The MnlI and TaiI polymorphisms showed no associations to deficits on neuropsychological test results. In contrast, we observed a significant relation between the DdeI polymorphism of the SNAP-25 gene and cognitive dysfunctions. Homozygote T/T allele carriers of the DdeI polymorphism showed significant better neuropsychological test results in cognitive domains verbal memory and executive functions than those with the combined T/C and C/C genotypes (P < 0.01) at all three time points, but no differences in response to treatment with atypical antipsychotics. Additionally, TT carriers exhibited significantly better results in a general cognitive index (P < 0.05). As we observed an association between the DdeI polymorphism of the SNAP-25 gene and cognitive dysfunctions of schizophrenic patients our finding suggests that the SNAP-25 gene could play a role in the pathophysiology of neurocognitive dysfunctions in schizophrenia but is not predictive for treatment response with atypical antipsychotics.
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Moritz S, Rufer M, Fricke S, Karow A, Morfeld M, Jelinek L, Jacobsen D. Quality of life in obsessive-compulsive disorder before and after treatment. Compr Psychiatry 2005; 46:453-9. [PMID: 16275213 DOI: 10.1016/j.comppsych.2005.04.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 04/04/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The assessment of Quality of Life (QoL) is an important tool for elucidating target symptoms that are particularly bothersome to patients. The present study was designed to explore predictors of decreased QoL in obsessive-compulsive disorder (OCD) patients and to explore which aspects of QoL are most affected in OCD. Furthermore, the study investigated changes in QoL after treatment and the association between QoL change scores with symptomatic outcome. In line with prior research, it was expected that low QoL in OCD patients would be most pronounced for the emotional and social aspects of the construct. METHODS Seventy-nine OCD patients were initially recruited. Patients were assessed with the SF-36 both before and after treatment. Norm values were derived from the general population to characterize status of impairment. OCD patients were contrasted with published SF-36 scores from 2 OCD samples as well as a newly recruited psychiatric and healthy control sample. RESULTS Correlations with QoL were most pronounced for depression severity and number of OCD symptoms. Apart from low social and emotional QoL in the majority of patients, a large subgroup also reported lower physical well-being. Decreased scores on this subscale were mainly associated with length of illness, depression, and number of compulsions. Overall, QoL was significantly improved in therapy responders relative to nonresponders. CONCLUSIONS The results largely correspond to previous findings showing that OCD patients share severely compromised well-being. Somewhat unexpected from previous research, QoL deficits were not restricted to emotional and social aspects of QoL but extended to somatic domains. The present results suggest that clinicians should thoroughly explore for depression as well as physical impairments in OCD patients, which, when present, may be additionally targeted to achieve comprehensive treatment success.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Hospital of Hamburg, Germany.
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18
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Soyka M, Kagerer S, Brunnauer A, Laux G, Möller HJ. Driving ability in schizophrenic patients: effects of neuroleptics. Int J Psychiatry Clin Pract 2005; 9:168-74. [PMID: 24937786 DOI: 10.1080/13651500510029237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent studies indicate that individuals with schizophrenia have a two-fold incidence of traffic accidents. Cognitive and psychomotor impairment as a core feature of schizophrenia and the effects of neuroleptic treatment play an essential role in this respect. Few experimental studies have been conducted so far looking at the effects of neuroleptics on driving ability in schizophrenia. Controlled, randomised trials are totally missing. The limited database indicates that most schizophrenic patients show significant impairment in cognitive functions relevant for driving ability compared to healthy controls. There is some but limited evidence that patients under novel atypical neuroleptics show less impairment compared to conventional neuroleptics. More clinical and experimental studies are warranted.
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Soyka M, Winter C, Kagerer S, Brunnauer M, Laux G, Möller HJ. Effects of haloperidol and risperidone on psychomotor performance relevant to driving ability in schizophrenic patients compared to healthy controls. J Psychiatr Res 2005; 39:101-8. [PMID: 15504428 DOI: 10.1016/j.jpsychires.2004.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2003] [Revised: 04/20/2004] [Accepted: 04/22/2004] [Indexed: 11/29/2022]
Abstract
The effects of antipsychotic treatment on the psychomotor performance and driving ability of schizophrenic patients is subject of investigation. The present study was designed to evaluate the effects of an atypical neuroleptic (risperidone) in comparison to a conventional dopamine antagonist neuroleptic (haloperidol) on several dimensions of psychomotor performance (visual perception, attention, reaction time, and sensorimotor performance) considered to be of relevance in evaluating driving fitness. Psychomotor performance was assessed by means of the ART 90 (act-and-react test), a computerized test battery which is frequently used in diagnosis of psychomotor performance. The 40 participating patients were examined at discharge following psychopathological stabilisation; 20 received haloperidol medication, 20 received the atypical neuroleptic risperidone. Nineteen healthy individuals were studied as a control group. Our findings indicate a remarkably reduced psychomotor performance in both groups of schizophrenic patients compared to healthy controls. We did find a significant but low correlation between age and some items of the RST3 and between age and the tracking performance on the PVT. The younger patients showed a better test performance than older patients. The BPRS-score was significantly correlated with only two items of the RST3. However, patients under treatment with risperidone showed significantly better results compared to patients treated with haloperidol. Only one (5%) subject passed all subtests without major failures and could be regarded as competent to drive. Among patients with risperidone, seven patients (35%) passed all test parameters without major failures. Clinical implications of these findings are discussed.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, Ludwig-Maximilians-University of Munich, Naussbaumstrasse 7, D-80336 Munich, Germany
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Peuskens J, Demily C, Thibaut F. Treatment of cognitive dysfunction in schizophrenia. Clin Ther 2005; 27 Suppl A:S25-37. [PMID: 16198199 DOI: 10.1016/j.clinthera.2005.07.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment has always been regarded as an important characteristic of schizophrenia. Many domains of cognition are disrupted with varying degrees of deficit: attention, executive functions, verbal and visuospatial working memory, learning, and memory. However, it is only recently that cognitive dysfunction has been recognized as a primary and enduring core deficit in schizophrenia (rather than the previous focus on positive and negative symptoms). OBJECTIVE This article discusses cognitive impairment and the therapeutic effects of newer antipsychotic agents on cognitive functioning in patients with schizophrenia. CONCLUSIONS Cognitive dysfunction occurs before the first psychotic episode and persists throughout the course of the illness. It involves every aspect of cognitive functioning and has an important impact on long-term social and occupational outcomes. Improvement of cognitive functioning by antipsychotic treatment can be due indirectly to the improvement of therapeutic profiles of the newer antipsychotic agents (eg, higher efficacy on positive and negative symptoms, fewer side effects, less anticholinergic effects) or directly to effects on cerebral functioning (eg, by restoring dopamine prefrontal activity). However, further research is needed regarding the therapeutic effects of the newer antipsychotic drugs on cognitive functioning and their impact on psychosocial outcome. Although newer medications may improve cognitive functioning, they do not normalize neurocognitive deficits in schizophrenia. In addition, various nonpharmacologic, psychological interventions have been used in the rehabilitation of patients with cognitive deficits.
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Affiliation(s)
- Joseph Peuskens
- Department of Psychiatry, University Center St. Jozef, Kortenberg, Belgium.
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Moritz S, Ferahli S, Naber D. Memory and attention performance in psychiatric patients: lack of correspondence between clinician-rated and patient-rated functioning with neuropsychological test results. J Int Neuropsychol Soc 2004; 10:623-33. [PMID: 15327740 DOI: 10.1017/s1355617704104153] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2003] [Revised: 01/29/2004] [Indexed: 11/05/2022]
Abstract
In the present study, the correspondence between clinician-assessed and self-reported neurocognitive performance was contrasted with scores obtained from psychometric neuropsychological tests in 148 psychiatric in-patients. Results revealed that self-reported cognitive functioning was strongly associated with depressive symptomatology but was only poorly related to psychometric neurocognitive performance, particularly in schizophrenia. After illness denial was controlled for, the overall association between subjective and objective test performance was slightly increased but still failed to reach significance in six out of eight analyses. In approximately 20% to 40% of all cases, clinicians judged memory performance to be normal despite substantial impairment revealed by neuropsychological test results (attention parameters: 7-51%). Since (ecological) validity and reliability have been demonstrated for many neurocognitive paradigms, the present results question the validity of non-psychometric neurocognitive assessment and call for a complementation of clinical judgment with neurocognitive assessment. Reasons for decreased sensitivity of self-reported and clinician-assessed neurocognitive functioning are discussed.
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Affiliation(s)
- Steffen Moritz
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
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Ritsner M, Perelroyzen G, Ilan H, Gibel A. Subjective response to antipsychotics of schizophrenia patients treated in routine clinical practice: a naturalistic comparative study. J Clin Psychopharmacol 2004; 24:245-54. [PMID: 15118477 DOI: 10.1097/01.jcp.0000125684.82219.53] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In routine practice, subjective response to antipsychotics is becoming a critical outcome measure among schizophrenia patients. This study sought to compare subjective response to atypical (risperidone and olanzapine) and typical antipsychotic drugs. Using a naturalistic cross-sectional design, we examined subjective response to antipsychotics (satisfaction with medication and subjective tolerability), psychopathology, side effects, emotional distress, and awareness in schizophrenia patients stabilized on atypical (n = 78) and typical (n = 55) drugs. Analysis of variance and multiple regression analysis were applied. We found that atypical drugs were superior to typical antipsychotics in both measures of subjective response, which were positively correlated (r = 0.52, P < 0.001). Poor subjective response was associated with severity of emotional distress, negative, and activation symptoms in the atypical group and with extrapyramidal side effects and positive symptoms in the typical group. Awareness of treatment is a positive factor that accounted for 20% and 34% of variation in the subjective responses to atypical and typical antipsychotic drugs, respectively. Demographic variables, age of onset, illness duration, and adjunctive drugs did not relate significantly to subjective response to antipsychotic drugs. Thus, atypical drugs are characterized by better subjective response compared with typical antipsychotics; their determinants differed considerably. Satisfaction with medication together with subjective tolerability needs to be considered in clinical trials.
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Affiliation(s)
- Michael Ritsner
- Sha'ar Menashe Mental Health Center, Mobile Post Hefer 38814, Hadera, Israel.
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23
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Chen PS, Yang YK, Su SF, Liao YC, Chang JW, Yeh TL. Correlation between scores on Continuous Performance Test and plasma concentration for schizophrenic patients on risperidone. Psychiatry Clin Neurosci 2004; 58:168-72. [PMID: 15009822 DOI: 10.1111/j.1440-1819.2003.01212.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of the present paper was to evaluate the relationship between plasma antipsychotics concentration and cognitive task performance. This may provide valuable information for rational dosage titration. Literature on the relationship between plasma risperidone (RIS) concentration and performance on the Continuous Performance Test (CPT) remains scarce. Ten patients (four male, six female) were given RIS for more than 1 year. Steady-state plasma concentrations of the parent drug RIS and its active metabolite, 9-hydroxy-risperidone (9-OH-RIS), were measured using specific liquid chromatography-tandem mass spectrometry assay. Psychopathology, side-effects of extrapyramidal symptoms (EPS) and CPT were also assessed. A negative correlation was found between CPT performance and the plasma RIS, 9-OH-RIS and its active moiety (RIS + 9-OH-RIS) concentrations. Both RIS and 9-OH-RIS have an impact on the CPT performance of schizophrenic patients. Optimal active moiety plasma concentration for best cognitive performance needs further study.
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Affiliation(s)
- Po See Chen
- Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Williams LM, Loughland CM, Green MJ, Harris AWF, Gordon E. Emotion perception in schizophrenia: an eye movement study comparing the effectiveness of risperidone vs. haloperidol. Psychiatry Res 2003; 120:13-27. [PMID: 14500110 DOI: 10.1016/s0165-1781(03)00166-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We used a psychophysiological marker of visual attention (the visual scanpath) to investigate the effects of atypical (risperidone) vs. typical (haloperidol) antipsychotic medication on facial emotion perception in schizophrenia (n=28) and healthy control (n=28) groups. Of the schizophrenia subjects, 15 were prescribed risperidone. Visual scanpaths to 'happy', 'sad' and 'neutral' faces were recorded using video-oculography, and concurrent emotion-recognition accuracy was assessed using multiple-option tasks. Compared to control subjects, both schizophrenia subgroups showed a restriction in visual scanning (reduced total fixation number and decreased scanpath length). Haloperidol-treated schizophrenia subjects exhibited an additional and consistent pattern of reduced attention (fixation) to salient features for neutral and happy. By contrast, risperidone-treated subjects showed a relatively greater attention to salient features for these expressions, in which they did not differ from controls. Recognition accuracy for happy and neutral showed a similar lack of impairment. These findings suggest that risperidone may play a specific role in schizophrenia in the ability to attend to salient features, and to integrate this information into an accurate percept for neutral and positive expressions in particular.
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Affiliation(s)
- Leanne M Williams
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
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