氯丙嗪和氯氮平对未经系统治疗精神分裂症患者认知功能的影响

目的 比较典型和非典型抗精神病药对未经系统治疗的精神分裂症患者认知功能的影响.方法 将164例未经系统治疗的精神分裂症住院患者随机分为氯丙嗪组(83例)和氯氮平组(81例),进行双盲对照治疗研究.于治疗前和治疗第12周末各做1次韦氏成人智力量表(WAIS-R)、韦氏记忆量表(WMS)、铁槽铁钉测验、手指敲击试验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验(WCST)及言语流利性测验10项神经心理测查.结果 治疗第12周末,氯氮平组各项认知功能测查结果 均明显好于氯丙嗪组(P<0.05～0.01);在控制入组时测查的水平和可能的干扰因素(年龄、文化程度和治疗第12周末的阳性症状、阴性症状、药物副反应的程度)后,大部分检测指标两组间差异仍有显著性氯丙嗪组和氯氮平组WAIS-R操作智商分别为(76.8±19.2)分和(90.5±16.9)分,WMS总分分别为(56.3±24.5)分和(75.4±21.9)分,完成连线测验B的时间分别为(213.9±97.4)s和(143.7±78.5)s,P均=0.000];氯氮平组各项认知功能指标均有所好转,而氯丙嗪组在16项认知功能指标中有7项恶化.结论 未经系统治疗的精神分裂症患者在第1次住院治疗时,氯氮平对其认知功能有改善作用,而氯丙嗪对认知功能的某些方面有损害.

A contrast study of the effect of chlorpromazine and clozapine on the cognitive function in non-system therapeutical schizophrenic patients

Objective To compare the effect of typical and atypical antipsychotics on the cognitive function in non system therapeutical schizophrenic patients Methods 164 non system therapeutical schizophrenic patients were randomly divided into two groups and administered chlorpromazine or clozapine respectively Cognitive function of all the patients was blindly evaluated with 10 cognitive tests, including Weschler Adult Intelligence Scale, Weschler Memory Scale, Grooved Pegboard Test, Finger Tapping Test, a motor function test, a hand coordination test, Trail Making Test A and B, Wisconsin Card Sort Test, and a verbal fluency test before and after 12 week treatment Results After 12 week treatment, the clozapine group showed significantly better cognitive function than chlorpromazine group on all the cognitive tests, and most of these differences remained significant after controlling for pretreatment test results, age, educational level, severity of positive symptoms, negative symptoms and extrapyramidal syndrome side effect Despite significant improvement of positive and negative symptoms in both groups, several cognitive functions deteriorated significantly in chlorpromazine group while improved significantly in clozapine group Conclusion Clozapine treatment in non system therapeutical schizophrenic patients may improve their cognitive function while treatment with chlorpromazine worsen their cognitive function