安非他酮对精神分裂症患者认知功能影响
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摘要
目的精神分裂症(schizophrenia,SCH)是一种常见的重性精神疾病,患者认知功能障碍给家庭和社会带来沉重的经济及精神负担。本研究探讨安非他酮对精神分裂症患者认知功能的干预效果。方法选取2017-01-01-2017-10-31泰安市精神病医院收治的80例精神分裂症患者为研究对象。根据配比的方法分为研究组和对照组各40例,研究组完成36例,对照组完成38例。研究组在原有利培酮剂量不变的基础上,联用安非他酮150mg/d;对照组原有利培酮剂量不变。两组患者于治疗前和治疗8周后分别接受量表评定。采用中文版认知功能成套测验工具(MATRICS consensus cognitive battery,MCCB)评定对认知功能的临床疗效;阳性与阴性症状量表(positive and negative syndrome scale,PANSS)评定治疗前后患者精神病性症状的变化;不良反应量表(treatment emergent symptom scale,TESS)及化验和辅助检查进行安全性评定。结果治疗后研究组处理速度、注意警觉、工作记忆、视觉学习和记忆、推理与问题解决及MCCB测验成绩均高于对照组,差异有统计学意义,均P<0.05。治疗后研究组阴性量表分为(12.01±2.18)分,低于对照组的(15.29±3.07)分,t=5.256,P<0.001;PANSS总分为(46.22±7.02)分,低于对照组的(49.88±7.61)分,t=2.140,P=0.035。研究组不良反应发生率为33.33%(12/36),高于对照组的13.16%(5/38),χ2=4.25,P=0.04。结论利培酮联合低剂量安非他酮可以改善精神分裂症患者的认知功能。
OBJECTIVE Schizophrenia is a common severe mental disorder.The cognitive impairment of patients brings heavy economic and mental burden to family and society.This study is to investigate the effect of bupropion on cognitive function in schizophrenic patients.METHODS From January 1 to October 31 in 2017,80 consecutive schizophrenic patients in Taian Psychiatric Hospital were selected as the research subjects.According to the method of matching,they were divided into study group and control group,with 40 cases in each group.36 patients in study group and 38 patients in control group completed the study.On the basis of the same dosage of risperidone,the study group was treated with amphetamine 150 mg/d,while the control group was treated with risperidone at the same dosage.Two groups of patients were assessed by scale before treatment and after 8 weeks of treatment.The clinical efficacy of cognitive function was assessed using the Chinese version of the MAPTCS consensus cognitive battery(MCCB).The positive and negative syndrome scale(PANSS)was used to assess the changes in psychotic symptoms before and after treatment.The treatment emergent symptom scale(TESS)and laboratory and auxiliary examination were used for safety assessment.RESULTS After treatment,the study group's treatment speed,attention alertness,working memory,visual learning and memory,reasoning and problem solving,and MCCB test scores were significantly better compared with the control group,all P<0.05.After treatment,the negative scale of the study group was(12.01±2.18)points,which was lower than that of the control group(15.29±3.07),t=5.256,P<0.001.The total score of PANSS was(46.22±7.02),which was lower than that of the control group(49.88±7.61),t=2.140,P=0.035.The incidence of adverse reactions in the study group was33.33%(12/36),which was higher than 13.16%(5/38)of the control group,χ~2=4.25,P=0.04.CONCLUSION Low-dose bupropion combined with risperidone may improve the cognition function of patients with schizophrenia.
OBJECTIVE Schizophrenia is a common severe mental disorder.The cognitive impairment of patients brings heavy economic and mental burden to family and society.This study is to investigate the effect of bupropion on cognitive function in schizophrenic patients.METHODS From January 1 to October 31 in 2017,80 consecutive schizophrenic patients in Taian Psychiatric Hospital were selected as the research subjects.According to the method of matching,they were divided into study group and control group,with 40 cases in each group.36 patients in study group and 38 patients in control group completed the study.On the basis of the same dosage of risperidone,the study group was treated with amphetamine 150 mg/d,while the control group was treated with risperidone at the same dosage.Two groups of patients were assessed by scale before treatment and after 8 weeks of treatment.The clinical efficacy of cognitive function was assessed using the Chinese version of the MAPTCS consensus cognitive battery(MCCB).The positive and negative syndrome scale(PANSS)was used to assess the changes in psychotic symptoms before and after treatment.The treatment emergent symptom scale(TESS)and laboratory and auxiliary examination were used for safety assessment.RESULTS After treatment,the study group's treatment speed,attention alertness,working memory,visual learning and memory,reasoning and problem solving,and MCCB test scores were significantly better compared with the control group,all P<0.05.After treatment,the negative scale of the study group was(12.01±2.18)points,which was lower than that of the control group(15.29±3.07),t=5.256,P<0.001.The total score of PANSS was(46.22±7.02),which was lower than that of the control group(49.88±7.61),t=2.140,P=0.035.The incidence of adverse reactions in the study group was33.33%(12/36),which was higher than 13.16%(5/38)of the control group,χ~2=4.25,P=0.04.CONCLUSION Low-dose bupropion combined with risperidone may improve the cognition function of patients with schizophrenia.
引文
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[6]司天梅.精神分裂症首次发作患者早期治疗对预后的影响[J].中华精神科杂志,2018,51(1):68-69.
[7]孙志刚,王学义.精神分裂症认知功能缺陷的药物治疗研究进展[J].临床精神医学杂志,2017,27(2):140-142.
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[10]罗晓玉,王惠玲,冒海赢,等.复发与首发精神分裂症患者认知功能损害的比较研究[J].神经损伤与功能重建,2017,12(3):225-227.
[11] Fuller RL,Nopoulos PC,Amdt S,et al.An investigation of premorbid cognitive functioning in schizophrenia using theiowa-test of basic skills and theiow a test of educational development[J].Schizophr Res,2001,49(1-2):133.
[12]梁静文,许瑞环.精神分裂症患者认知功能障碍的相关基因研究进展[J].精神医学杂志,2017,30(6):465-471.
[13]郭丽华,周桂华,孙红立,等.精神分裂症的认知功能与去甲肾上腺素的关联性研究[J].精神医学杂志,2014,27(2):157-160.
[14] Wilkes S.Bupropion[J].Drugs Today,2006,42(10):671-681.
[15]石璐.安非他酮辅助改善精神分裂症阴性症状的临床观察[J].北方药学,2013,10(1):28.
[16]江春运.去甲肾上腺素与精神病理[J].国外医学:精神病学分册,2003,30(4):196-198.
[17] Tsoi DT,Porwal M.Efficacy and safety of bupropion for smoking cessation and reduction in schizophrenia:Systematic review and meta-analysis[J].Br J Psychiatry,2010,196(5):346-353.
[2] Allott KA,Cotton SM,Chinnery GL,et a1.The relative contribution of neurocogn-ition and social cognition to 6-month vocational outcomes following Individual Place-ment and Support in first-episode psychosis[J].Schizophr Res,2013,150(1):136-143.
[3] Fett AK,Viechtbauer W,Dominguez MD,et a1.The relationship between neuroco-gnition and social cognition with functional outcomes in schizophrenia:A meta-anal ysis[J].Neurosci Biobehav Rev,2011,35(3):573-588.
[4] Emsley R,Kilian S.How long should antipsychotic treatment be continued after a single episode of schizophrenia?[J].Curr Opin Psychiatry,2016,29(3):224-229.
[5] Miyamoto S,Miyake N,Jarskog LF,et al.Pharmacological treatment of schizophrenia:A critical review of the pharmacology and clinical effects of current and future therapeutic agents[J].Mol Psychiatry,2012,17(12):1206-1227.
[6]司天梅.精神分裂症首次发作患者早期治疗对预后的影响[J].中华精神科杂志,2018,51(1):68-69.
[7]孙志刚,王学义.精神分裂症认知功能缺陷的药物治疗研究进展[J].临床精神医学杂志,2017,27(2):140-142.
[8] Opler LA,Medalia A,Opler MG,et a1.Pharmacotherapy of cognitive deficits in schizophrenia[J].CNS Spectr,2014,19(2):142-156.
[9] Wallace TL,Ballard TM,Pouzet B,et al.Drug targets for cognitive enhancement in neuropsychiatric disorders[J].Pharmacol Biochem Behav,2011,99(2):130-145.
[10]罗晓玉,王惠玲,冒海赢,等.复发与首发精神分裂症患者认知功能损害的比较研究[J].神经损伤与功能重建,2017,12(3):225-227.
[11] Fuller RL,Nopoulos PC,Amdt S,et al.An investigation of premorbid cognitive functioning in schizophrenia using theiowa-test of basic skills and theiow a test of educational development[J].Schizophr Res,2001,49(1-2):133.
[12]梁静文,许瑞环.精神分裂症患者认知功能障碍的相关基因研究进展[J].精神医学杂志,2017,30(6):465-471.
[13]郭丽华,周桂华,孙红立,等.精神分裂症的认知功能与去甲肾上腺素的关联性研究[J].精神医学杂志,2014,27(2):157-160.
[14] Wilkes S.Bupropion[J].Drugs Today,2006,42(10):671-681.
[15]石璐.安非他酮辅助改善精神分裂症阴性症状的临床观察[J].北方药学,2013,10(1):28.
[16]江春运.去甲肾上腺素与精神病理[J].国外医学:精神病学分册,2003,30(4):196-198.
[17] Tsoi DT,Porwal M.Efficacy and safety of bupropion for smoking cessation and reduction in schizophrenia:Systematic review and meta-analysis[J].Br J Psychiatry,2010,196(5):346-353.