抗精神病药对精神分裂症患者认知功能的影响

目的：比较非经典抗精神病药奎硫平、奥氮平、氯氮平与经典抗精神病药氯丙嗪对精神分裂症患者认知功能的影响。方法：对160例住院精神分裂症患者随机开放分配接受奎硫平、奥氮平、氯氮平和氯丙嗪药物治疗。12周的急性期治疗后，获得临床稳定期的患者阳性与阴性量表（PANSS）总分≤60或减分率／〉50％]进入固定剂量的24周治疗。分别在基线、治疗12周和24周进行威斯康星卡片分类测验（WCST）、言语流畅性测验、霍普金斯词语学习测验（HVLT-R）、持续操作功能测验（CPT）、韦克斯勒记忆测定（WMS）、韦克斯勒智能测定（WAIS）、连线试验测定、手指叩击试验测定。结果：奎硫平组、奥氮平组、氯氮平组治疗12周和24周后认知功能均有不同程度的改善（P均〈0．05），明显优于氯丙嗪，而氯丙嗪组无显著改善。治疗12周后奎硫平组在改善执行功能、言语流畅性和警觉性显著优于奥氮平组和氯氮平组（P〈0．05）。奥氮平组在数字特征和连线测定上明显优于氯氮平组（P〈0．05）。3种非经典抗精神病药在认知功能总分的改善与PANSS总分、阴性症状分的改善有显著相关性（r=-0．32，P〈0．05）。结论：3种非经典抗精神病药奎硫平、奥氮平、氯氮平可不同程度改善精神分裂症患者的认知功能。

Effects of antipsychotic drugs on cognitive function in the schizophrenia

Objective：To compare the effects of atypical antipsychotic drugs quetiapine,olanzapine,clozapine, and conventional antipsychotic drugs chlopromazine on cognitive function in patients with schizophrenia. Method： 160 patients were randomly openly assigned to treatment with quetiapine, olanzapine, elozapine and chlorpromazine. Patients received treatment with fixed dose for 12 week when gained symptoms remission （ PANSS total score≤60 or PANSS reduced rate ≥50% ） after 12 weeks. Cognitive function were assessed at baseline, week 12 and 24, including Wisconsin card sorting test （WCST）, verbal fluency test, adult verbal learning test, continuous performance test （ CPT）, Wechsler memory scale （ WMS ）, Wechsler adult intelligence scale （ WAIS）, trail making test and finger tapping test. Results： Quetiapine, olanzapine and clozapine group improved significantly in cognitive function （P 〈 0.05 ） and more than chlorpromazine group. At week 12 quetiapine group showed more significant improvement on executive function,verbal fluency and vigilance than olanzapine and elozapine group （ P 〈 0.05 ）. Olanzapine group showed more significant improvement on digit symbol and trail making test than clozapine group. Cognitive function improvements were correlated with total and negative scores of PANSS （ r = - 0. 32, P 〈 0.05 ）. Conclusion： The atypical antipsychotic drugs quetiapine, olazapine and clozapine group can improve cognitive functions in the schizophrenia.