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Cognitive evaluation in patients with schizophrenia and persecutory delusion/ Evaluarea cognitiei la pacientii cu schizofrenie si ideatie deliranta de persecutie.

INTRODUCTION

Patients with schizophrenia show mild or moderate cognitive impairment compared to healthy subjects (1, 2). Cognitive impairment occurs even before the onset of psychotic symptoms (3, 4) and is a key determinant of future development (5, 6, 7). Early intervention in psychosis is a topical approach for both individuals who are in the early years of the disease and for those groups at risk for schizophrenia (8). This intervention involves reducing the duration of untreated psychosis (DUP) which is associated with a subsequent unfavourable trend with low cognitive performance (9).

Several studies have shown that antipsychotic treatment with SGA (second generation antipsychotics) are associated with better cognitive profile than those treated with FGA (first generation antipsychotics), but this still remains controversial. Antipsychotics vary in their ability to bind to muscarinic receptors, and those having high anticholinergic activity are involved in cognitive adverse effects (10, 11). The results of comparative studies on cognition remain uncertain (12, 13).

OBJECTIVES

The aim of the study was to assess cognitive performance in patients with schizophrenia and persecutory delusion reported to the healthy group.

METHODS

All study-related procedures were performed in Psychiatry and Neurology Hospital Brasov during 2010-2012. The study group consisted in 120 patients with a diagnosis of schizophrenia according to DSM-IV-TR (14), aged 18 to 45 years. Comparative analysis was done with a control group of 60 healthy individuals recruited from the medical staff of the hospital. Exclusion criteria included mental retardation, pregnancy, neurological disorders, and addiction to alcohol or drugs. Socio-demographic data included age, sex, duration of schooling of individual parents through school and clinical variables studied were age of onset, disease duration and type of antipsychotic.

Positive and Negative Symptom Assessment was done using the PANSS scale (15), and the analysis of persecutory delusion was made with PSYRATS (16). Treatment on day of cognitive assessment was registered in terms of the type, dose and complementary treatment (benzodiazepines, mood stabilizers, anticholinergics).

Cognitive assessment was done with MATRICS Consensus Cognitive Battery (MCCB) (17). International multicenter studies have shown high fidelity in this battery of cognitive assessment and inter-correlation between raters. MCCB contains ten tests which measure cognitive performance in seven domains: processing speed, attention/vigilance, working memory, verbal learning, spatial learning, reasoning and problem solving, and social cognition.

RESULTS

a. Schizophrenia group

Of 120 patients, 36 were men (30%) with a mean age of 37.12 years (SD 2.98). Assessment of delusions with PSYRATS revealed absence of difference between men and women (36.50 vs. 33.95, p = 0.19). Worry among patients with schizophrenia was made using PSWQ questionnaire which indicated higher levels for women, without significant gender differences (48.77 vs. 53.34, p = 0.06).

The cognitive assessment included the following tests: TMT (Trail Making Test), BACSSC (Brief Assessment of Cognition) and FLUENCE which appreciate the speed of information processing), HVLT-R (Hopkins Verbal Learning Test-Revised) assessing verbal learning, WMS (Wechsler Memory Scale) and LNS (Letter-Number Span) assessing working memory, NAB (Neuropsychological Assessment Battery) assessing reasoning and problem solving and BVMT-R (Brief Visuo-Spatial Memory Test-Revised) assessing visual learning. There were statistically significant differences between men and women for BACS-SC (p = 0.002), HVLT-R (p = 0.0003) and NAB (p = 0.00001) as it is shown in Table I.

b. Control group

The control group, consisting in 60 healthy volunteers, included 21 men (35%) and 39 women (65%) with a mean age of 34.23 years (SD 6.68). In this group, there were no statistically significant differences between genders in terms of cognitive assessment (Table II).

c. Comparison schizophrenia vs. control

Cognitive impairment among patients with schizophrenia and persecutory delusion was significant, patients presented low scores in all tests compared to those registered in healthy group (Table III).

d. Antipsychotics

All patients received treatment with antipsychotic during hospitalization. Most of them have been treated with olanzapine (N = 37, 30.8%), followed by haloperidol (N = 29, 24.1%) and clozapine (N = 14, 11.6%). Other antipsychotics administered were risperidone, amisulpride, quetiapine, and aripiprazole (Figure 1).

As it can be seen in Figure 2, the doses used were those recommended for schizophrenia treatment in international guidelines.

Statistical analysis of cognitive performance achieved by patients with schizophrenia according to the type of antipsychotic use showed that there were significant differences for the tests: HVLT-R (verbal learning), BVMT-R (visual learning) and FLUENCE (verbal fluency). For HVLT-R test, patients treated with aripiprazole had the highest scores (27.11) and those treated with clozapine, the lowest (20.79). For the BMVT-R test, the highest results were obtained in patients treated with aripiprazole (20.78) and the lowest in those treated with clozapine (13.64). FLUENCE assessment revealed significant differences between patients receiving quetiapine (19.29) compared to those treated with amisulpride (14.64).

DISCUSSION

The aim of study was the cognitive assessment in patients with schizophrenia and persecutory delusion in patients aged 18 to 45, using the MATRICS cognitive battery. Assessment of delusional ideation was done with the PSYRATS scale and it revealed no statistical differences between men and women (36.50 vs. 33.95, p = 0.19). Tests revealed statistically significant differences between men and women for BACS-SC (p = 0.002), HVLT-R (p = 0.0003) and NAB (p = 0.00001). Cognitive impairment among patients with schizophrenia and persecutory delusion was significant compared to healthy group in all tests.

The statistical analysis of cognitive performance in patients with schizophrenia according to the type of the antipsychotic showed that there were significant differences between the drugs for: HVLT-R, BVMT-R and FLUENCE.

It seems that patient treated with aripiprazole had the better score for verbal and visual learning. Our study just shows better results on some cognitive tests in patients treated with aripiprazole. Aripiprazole is a partial D2 agonist with partial agonist at the 5-[HT.sub.1A] antagonist and the 5-[HT.sub.2A] receptors (18, 19). As a result of its unique profile, aripiprazole has a stabilizing dopaminergic activity, being investigated as a potential antipsychotic effect procognitiv (20-24). Regarding verbal fluency (FLUENCE test), patients treated with quetiapine registered highest scores.

There were concordances between our results and international published studies. The deterioration of verbal learning is one of the most consistent and proven changes in schizophrenia (25) and one of the most researched areas. Most studies have investigated the effect of conventional and atypical antipsychotics on verbal learning. On the other hand, much less attention has been paid to the visual learning in schizophrenia and the results were inconclusive. Tyson et al, comparing the effect of antipsychotics with high or low affinity for the 5-[HT.sub.2A] receptor on visual learning (26), reported that patients treated with risperidone, olanzapine and clozapine were part of the group with lower cognitive performance compared with those treated with quetiapine or amisulpride.

The working memory has a limited capacity and the temporary storage of schizophrenia was evaluated frequently (27). Most studies focused on the effect of antipsychotics showed beneficial effects for both, typical and atypical antipsychotics. Others, such as the study of Rollnik et al., did not find any differences between the two classes of antipsychotics in relation to the working memory (28).

Processing speed is considered a key element of cognitive function and it refers to the speed at which the brain processes information and it can be assessed by quantifying the number of correct answers in a given period of time (29). As in other areas of cognition, processing speed has been measured in terms regarding different types of antipsychotics. The theory that atypical antipsychotics improve cognition compared with conventional ones was also investigated. A study about the processing speed in patients treated with amisulpride compared to patients treated with olanzapine showed that it did not improve in either group (30).

Reasoning and problem solving, as part of executive function, appears as a subject of research in numerous studies. Tyson et al. (31) compared antipsychotics with high or low affinity for the 5-[HT.sub.2A] receptors found that response latency in problem solving was lower in the group with low affinity. Purdon et al. (32), comparing the effect of olanzapine, risperidone and haloperidol, showed that olanzapine was superior in improving reasoning and problem solving.

Generally, studies show that improving cognition with atypical antipsychotics is still a controversy, some are in favour (33, 34) and others are not (35).

The limitations of the study were the small number of patients and the variable exposure to the antipsychotics in the study group.

Further randomized controlled studies are necessary for more accurate data regarding antipsychotic treatment, cognition in patients with schizophrenia and persecutory delusions.

CONCLUSIONS

Patients with schizophrenia and persecutory delusion present cognitive deficits in all investigated areas. Their performances are significantly lower compared to the healthy population. Antipsychotics differ in terms of processing speed, reasoning and problem solving. Improving and maintaining cognitive ability must be priority therapeutic targets in treating schizophrenia.

ACKNOWLEDGMENTS AND DISCLOSURE

The authors declare that they have no potential conflicts of interest to disclose.

REFERENCES

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(36.) Burris, K. D., Molski, T. F., Xu, C., Ryan, E., Tottori, K., Kikuchi, T. et al., Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors, J Pharmacol Exp Ther. 2002; 302:381-389

Andreea Teodorescu--Ph. D. Student, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; M. D., Junior Psychiatrist, Hospital of Psychiatry and Neurology, Brasov, Romania

Petru Ifteni--M. D., Ph. D., Assistant Professor, Faculty of Medicine; Department of Psychiatry, "Transylvania" University, Brasov; Senior Psychiatrist, Hospital for Psychiatry and Neurology, Brasov, Romania

Victoria Burtea--M. D., Ph. D., Assistant Professor, Faculty of Medicine; Department of Psychiatry, "Transylvania" University, Brasov; Senior Psychiatrist, Hospital for Psychiatry and Neurology, Brasov, Romania

Liana Fodoreanu--M. D., Ph. D., Professor, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; Senior Psychiatrist, County Clinical Hospital Cluj-Napoca, First Department of Psychiatry, Cluj-Napoca, Romania

Correspondence:

ANDREEA TEODORESCU

Hospital of Psychiatry and Neurology Brasov, Str. Mihai Eminescu no. 18, Brasov, Romania

Tel./Fax: +40 268 415 245

Str. Sanpetrului no. 45, Harman, jud. Brasov, Romania

Tel.: +40 747 621 927

Email: andre_martie@yahoo.com

Date of Submission: May, 23, 2014/ Acceptance: August, 14, 2014
Table I. Cognitive evaluation with MATRICS in schizophrenia group.

Variables   WOMEN                MEN                  P

            Mean    N    SD      Mean    N    SD

TMT         80.57   84   32.17   71.66   36   37.62   0.18
BACS-SC     28.11   84   10.65   21.66   36   10.28   0.002
HVLT-R      23.78   84   7.56    18.83   36   4.03    0.0003
WMS         11.57   84   4.09    11.16   36   5.08    0.64
LNS         11.71   84   3.97    11.50   36   4.48    0.79
NAB         7.00    84   4.59    11.23   36   4.35    0.00001
BVMT-R      18.04   84   8.35    16.16   36   5.28    0.21
FLUENCE     16.35   84   4.49    15.83   36   3.48    0.53

Table II. Cognitive evaluation with MATRICS in control group

Variables   WOMEN                   MEN                  P

            Mean    N    SD         Mean    N    SD

TMT         44.18   39   12.56566   48.71   21   14.30   0.36
BACS-SC     48.62   39   9.74252    51.35   21   13.75   0.53
HVLT-R      27.25   39   4.69752    27.64   21   2.59    0.78
WMS         13.93   39   4.05740    13.92   21   2.30    0.99
LNS         17.68   39   2.84532    17.21   21   4.13    0.71
NAB         19.25   39   3.94124    18.78   21   5.47    0.78
BVMT-R      32.00   39   4.19524    31.92   21   4.26    0.96
FLUENCE     25.18   39   7.37761    25.71   21   4.51    0.81
PSWQ        36.12   39   6.53070    33.07   21   8.49    0.27

Table III. Schizophrenia vs. control with MATRICS

Variables   Schizophrenia   Control         t-value    p
            [N = 120]       [N = 60]

            Mean    SD      Mean    SD

TMT         77.90   33.99   46.30   13.37   4.9866     0.0001
BACS-SC     26.18   10.92   49.90   11.66   -10.4998   0.0001
HVLT-R      22.30   7.07    27.43   3.80    -3.8361    0.0002
WMS         11.45   4.39    13.93   3.30    -2.8950    0.0044
LNS         11.65   4.12    17.47   3.45    -7.1288    0.0001
NAB         8.25    4.90    19.03   4.64    -10.8951   0.0001
BVMT-R      17.48   7.59    31.97   4.16    -10.0609   0.0001
FLUENCE     16.20   4.21    25.43   6.11    -9.7423    0.0001
PSWQ        51.98   12.26   34.70   7.54    7.3674     0.0001

Table IV. MATRICS results and antipsychotic type

Variables   HAL=29   QUE=7   CLZ=14   OLZ=37   ARI=9   RIS=13

            Mean     Mean    Mean     Mean     Mean    Mean

TMT         74.14    76.57   86.50    79.89    85.67   64.62
BACS-SC     28.07    25.43   23.36    24.35    29.33   31.08
HVLT-R      23.00    21.43   20.79    21.68    27.11   22.08
WMS         11.52    11.14   10.64    11.27    12.44   12.77
LNS         11.72    10.43   11.64    11.22    13.56   12.23
NAB         8.07     6.86    9.21     7.70     9.22    10.38
BVMT-R      18.03    16.71   13.64    17.95    20.78   19.23
FLUENCE     16.24    19.29   15.00    16.51    16.00   16.31
PSWQ        52.28    49.29   50.21    53.95    45.67   50.85

Variables   AMI=11   p

            Mean

TMT         80.36    0.50
BACS-SC     23.09    0.29
HVLT-R      21.36    0.05
WMS         10.73    0.93
LNS         11.45    0.91
NAB         6.91     0.82
BVMT-R      15.09    0.05
FLUENCE     14.64    0.05
PSWQ        55.00    0.88

Figure 1. Antipsychotics type used in schizophrenia group

Antipsychotics

haloperidol   29
quetiapina    7
clozapina     14
olarzapina    37
aripiprazol   9
risperidona   13
amisulprid    11

Note: Table made from pie chart.

Figure 2. Antipsychotics mean doses

Antipsychotics doses [mg]

haloperidol   6.98
quetiapina    557.14
clozapina     392.85
olarzapina    13.37
aripiprazol   13.33
risperidona   4.3
amisulprid    440.9

Note: Table made from bar graph.


INTRODUCERE

Pacientii cu schizofrenie prezinta afectare cognitiva de intensitate usoara sau chiar moderata comparativ cu subiectii sanatosi (1, 2). Afectarea cognitiva apare frecvent inaintea debutului simptomelor psihotice (3, 4) si reprezinta un factor determinant al evolutiei ulterioare (5, 6, 7). Interventia precoce in psihoza este o abordare de actualitate atat in cazul indivizilor aflati in primii ani de boala, cat si pentru cei aflati in grupurile cu risc pentru schizofrenie (8). Interventia precoce implica reducerea duratei psihozei netratate (DUP) care se asociaza cu o evolutie ulterioara nefavorabila si cu performante cognitive scazute (9).

Exista studii care au aratat ca tratamentul antipsihotic cu SGA (second generation antipsychotics) se asociaza cu un profil cognitiv mai bun decat in cazul FGA (first generation antipsychotics), dar acest fapt ramane, in continuare, controversat. Antipsihoticele difera in capacitatea lor de a se lega de receptorii muscarinici, cele cu activitate anticolinergica ridicata avand astfel efecte cognitive nefavorabile (10, 11). Rezultatele studiilor comparative pe cognitie raman incerte (12, 13).

OBIECTIVE

Scopul studiului a fost de a evalua performanta cognitiva la pacientii cu schizofrenie si ideatie deliranta de persecutie.

MATERIAL SI METODA

Toate procedurile legate de studiu au fost realizate in cadrul Spitalului de Psihiatrie si Neurologie Brasov in perioada 2010-2012. In studiu au intrat 120 de pacienti cu diagnosticul de schizofrenie in conformitate cu criteriile DSM-IV-TR (14), cu varsta cuprinsa intre 18 si 45 ani. Analiza comparativa s-a facut cu ajutorul unui lot martor de 60 de indivizi sanatosi care a fost recrutat din randul personalului medical al spitalului. Criteriile de excludere au cuprins retardul mental, sarcina, afectiunile neurologice, dependenta de alcool sau droguri. Datele socio-demografice au inclus varsta, sexul, durata scolarizarii individuale, durata scolarizarii parintilor, iar variabilele clinice studiate au fost varsta de debut, durata bolii si tipul de antipsihotic folosit.

Evaluarea simptomelor pozitive si negative s-a facut cu ajutorul scalei PANSS (15), iar analiza ideatiei delirante de persecutie, cu scala PSYRATS (16). Tipul de tratament in ziua evaluarii cognitive a fost inregistrat in ceea ce priveste tipul, doza, precum si tratamentul complementar (benzodiazepine, stabilizatoare de dispozitie, anticolinergice).

Evaluarea cognitiva s-a facut cu MATRICS Consensus Cognitive Battey (MCCB) (17). Studii internationale multicentrice au demonstrat fidelitatea in evaluarea acestei baterii cognitive, precum si intercorelarea intre evaluatori. MCCB contine zece teste care masoara performanta cognitiva in sapte domenii: viteza de procesare, atentia/ vigilenta, memoria de lucru, invatarea verbala, invatarea spatiala, rationamentul si rezolvarea problemelor, precum si cognitia sociala.

REZULTATE

a. Lotul cu schizofrenie

In studiu au intrat 120 de pacienti, dintre care 36 de barbati (30%) cu varsta medie de 37,12 ani (DS: 2,98). Evaluarea ideatiei delirante s-a facut cu scala PSYRATS care a relevat absenta diferentei intre barbati si femei (36,50 vs. 33,95, p = 0,19).

Nivelul ingrijorarii in randul pacientilor cu schizofrenie s-a analizat cu ajutorul chestionarului PSWQ care a indicat nivele mai ridicate pentru femei, fara diferente semnificative statistic intre sexe (48,77 vs. 53,34, p = 0,06).

Evaluarea cognitiva a cuprins testele: TMT (Trail Making Test), BACS-SC (Brief Assessment of Cognition) si FLUENCE care apreciaza viteza de procesare a informatiei, HVLT-R (Hopkins Verbal Learning Test-Revised) care evalueaza invatarea verbala, WMS (Wechsler Memory Scale) si LNS (Letter--Number Span) care analizeaza memoria de lucru, NAB Neuropsychological Assessment Battery) care urmareste rationamentul si rezolvarea problemelor si BVMT-R (Brief Visuospatial Memory Test-Revised) care are in vedere invatarea vizuala. Au existat diferente semnificative statistic intre barbati si femei pentru BACS-SC (p = 0,002), HVLT-R (p = 0,0003) si NAB (p = 0,00001) prezentate in tabelul 1.

b. Lotul de control

Lotul martor alcatuit din 60 de voluntari sanatosi a cuprins 21 de barbati (35%) si 39 de femei (65%) cu varsta medie de 34,23 ani (DS: 6,68).

In cadrul acestui grup nu au existat diferente semnificative statistic intre sexe in privinta evaluarii cognitive (tabelul II).

c. Comparatie schizofrenie vs. control

Deficitul cognitiv in randul pacientilor cu schizofrenie si ideatie deliranta de persecutie a fost semnificativ, acestia inregistrand scoruri infe rioare comparativ cu lotul sanatos la toate tes tele (tabelul III).

d. Antipsihotice

Toti pacientii au primit tratament cu antipsihotice pe durata spitalizarii. Majoritatea au fost tratati cu olanzapina (N = 37, 30,8%), urmata de haloperidol (N = 29, 24,1%) si clozapina (N = 14, 11,6%). Alte antipsihotice administrate au fost risperidona, amisulpridul, quetiapina si aripiprazolul (figura 1).

Dupa cum se poate observa din figura 2, dozele folosite in cazul antipsihoticelor au fost cele recomandate pentru tratamentul schizofreniei de ghidurile terapeutice.

Analiza statistica a performantelor cognitive realizate de catre pacientii cu schizofrenie in functie de tipul de antipsihotic folosit a aratat ca au existat diferente semnificative intre antipsihotice pentru testele: HVLT-R (invatarea verbala), BVMT-R (invatarea vizuala) si FLUENCE (fluenta verbala). In cazul HVLT-R, pacientii tratati cu aripiprazol au avut cele mai mari scoruri (27,11), iar cei tratati cu clozapina, cele mai mici (20,79). Pentru testul BMVT-R, cele mai bune rezultate le-au obtinut cei tratati cu aripiprazol (20,78) iar cele mai mici, cei tratati cu clozapina (13,64). Evaluarea FLUENCE a relevat diferente mari intre pacientii care au primit quetiapina (19,29) fata de cei tratati cu amisulprid (14,64).

DISCUTII

Studiul si-a propus evaluarea cognitiva la pacientii cu schizofrenie si ideatie deliranta de persecutie (pacienti cu varsta cuprinsa intre 18 si 45 de ani) cu ajutorul bateriei cognitive MATRICS. Evaluarea ideatiei delirante s-a facut cu scala PSYRATS care a relevat absenta diferentei intre barbati si femei (36,50 vs. 33,95, p = 0,19). Testele au relevat diferente semnificative statistic intre barbati si femei pentru BACS-SC (p = 0,002), HVLT-R (p = 0,0003) si NAB (p = 0,00001). Deficitul cognitiv in randul pacientilor cu schizofrenie si ideatie deliranta de persecutie a fost semnificativ, acestia inregistrand scoruri inferioare comparativ cu lotul sanatos la toate testele.

Analiza statistica a performantelor cognitive realizate de catre pacientii cu schizofrenie in functie de tipul de antipsihotic folosit a aratat ca au existat diferente semnificative intre antipsihotice pentru testele: HVLT-R, BVMT-R si FLUENCE.

Studiul nostru arata doar rezultate mai bune la unele teste cognitive la pacientii tratati cu aripiprazol. Acesta este un agonist partial D2 cu activitate partial agonista pe receptorii 5-HT1A si antagonist pe receptorii 5-[HT.sub.2A] (18, 19). Ca rezultat al profilului sau unic, aripiprazolul are o activitate de stabilizare dopaminergica, fiind investigat ca un potential antipsihotic cu efect procognitiv (20-24). Testul FLUENCE a relevat scorurile cele mai mari la pacientii tratati cu quetiapina.

Rezultatele noastre au fost in concordanta cu studii internationale publicate. Deteriorarea invatarii verbale reprezinta una dintre cele mai consistente si dovedite modificari din schizofrenie (25), fiind si unul dintre domeniile cele mai cercetate. Majoritatea studiilor au investigat efectul antipsihoticelor conventionale si atipice asupra invatarii verbale. Comparativ cu aceasta, mult mai putina atentie a fost acordata invatarii vizuale in schizofrenie, iar rezultatele au fost neconcludente. Tyson si colab. au comparat efectul medicatiei antipsihotice cu afinitate mare sau mica pentru receptorii 5-HT2A asupra invatarii vizuale (26). Pacientii tratati cu risperidona, olanzapina si clozapina au facut parte din grupul cu performante cognitive inferioare celui tratat cu quetiapina sau amisulprid.

Memoria de lucru care are o capacitate limitata si temporara de stocare a fost evaluata frecvent in schizofrenie (27). Majoritatea studiilor focalizate pe efectul antipsihoticelor au aratat ca atat cele tipice, cat si atipicele ar avea efecte benefice. Rollnik si colab. nu au gasit diferente intre cele doua clase de antipsihotice in privinta memoriei de lucru (28).

Viteza de procesare este considerata un element-cheie al functiei cognitive si se refera la viteza cu care creierul proceseaza informatia. Poate fi evaluata prin cuantificarea numarului de raspunsuri corecte intr-o anumita perioada de timp (29). Ca si pentru alte domenii ale cognitiei, viteza de procesare a fost evaluata in functie de tratamentul antipsihotic. Teoria conform careia antipsihoticele atipice imbunatatesc cognitia comparativ cu cele conventionale a fost, de asemenea, cercetata. Un studiu care a comparat viteza de procesare a pacientilor tratati cu amisulprid fata de cei tratati cu olanzapina a aratat ca aceasta nu s-a imbunatatit in niciun grup (30).

Rationamentul si rezolvarea problemelor, ca parte a functiei executive, apare ca subiect de cercetare in numeroase studii. Tyson si colab. (31) au comparat antipsihoticele cu afinitate scazuta pentru receptorii 5-HT2A fata de cele cu afinitate mare. Latenta raspunsului la rezolvarea problemelor a fost mai mica in grupul cu afinitate scazuta. Purdon si colab. (32), comparand efectul olanzapinei, risperidonei si haloperidolului, au aratat ca olanzapina a fost superioara in ameliorarea rationamentului si rezolvarii problemelor. Dupa efectuarea corectiilor insa, niciunul dintre antipsihotice nu a mai avut efecte de crestere a vitezei de rationare.

In general, studiile arata ca imbunatatirea cognitiei cu atipice este inca o controversa, unele fiind in favoarea ideii (33, 34), iar altele, nu (35). Limitarile studiului au fost numarul relativ mic de pacienti si durata variabila a expunerii pacientilor la antipsihotice anterior studiului. Studii viitoare randomizate sunt necesare pentru obtinerea de date mai precise legate de cognitia pacientilor cu schizofrenie si idei delirante de persecutie in functie de tratamentul antipsihotic.

CONCLUZII

Pacientii cu schizofrenie si ideatie deliranta de persecutie prezinta deficite cognitive in toate domeniile investigate. Performantele acestora sunt semnificativ mai scazute comparativ cu populatia sanatoasa. Antipsihoticele prezinta diferente in privinta vitezei de procesare, a rationamentului si a rezolvarii problemelor. Ameliorarea si mentinerea capacitatii cognitive trebuie sa fie obiective terapeutice prioritare in tratarea schizofreniei.

MULTUMIRI SI DEVOALARI

Autorii nu declara existenta vreunui conflict de interese legat de acest articol.

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Andreea Teodorescu--Doctorand, Universitatea de Medicina si Farmacie "Iuliu Hatieganu", Cluj-Napoca; Medic specialist Psihiatru, Spitalul de Psihiatrie si Neurologie, Brasov, Romania

Petru Ifteni--Sef de lucrari, Facultatea de Medicina a Universitatii "Transilvania", Departamentul de Psihiatrie; Medic primar Psihiatru, Spitalul de Psihiatrie si Neurologie, Brasov, Romania

Victoria Burtea--Conferentiar universitar, Facultatea de Medicina a Universitatii "Transilvania"; Medic primar Psihiatru, Spitalul de Psihiatrie si Neurologie, Brasov, Romania

Liana Fodoreanu--Profesor universitar, Universitatea de Medicina si Farmacie "Iuliu Hatieganu", Cluj-Napoca; Medic primar Psihiatru, Spitalul Clinic Judetean Cluj-Napoca, Sectia Psihiatrie I, Cluj-Napoca, Romania

Corespondenta:

ANDREEA TEODORESCU

Spitalul de Psihiatrie si Neurologie Brasov Str. Mihai Eminescu nr. 18, Brasov, Romania

Tel./Fax: +40 268 415 245

Str. Sanpetrului nr. 45, Harman, jud. Brasov, Romania

Tel.: +40 747 621 927

Email: andre_martie@yahoo.com

Primire: 23 mai 2014 / Acceptare: 14 august 2014
Tabelul I. Evaluarea cognitiva cu MATRICS a lotului cu schizofrenie

Variabile   FEMEI                BARBATI              P

            Media   N    DS      Media   N    DS

TMT         80,57   84   32,17   71,66   36   37,62   0,18
BACS-SC     28,11   84   10,65   21,66   36   10,28   0,002
HVLT-R      23,78   84   7,56    18,83   36   4,03    0,0003
WMS         11,57   84   4,09    11,16   36   5,08    0,64
LNS         11,71   84   3,97    11,50   36   4,48    0,79
NAB         7,00    84   4,59    11,23   36   4,35    0,00001
BVMT-R      18,04   84   8,35    16,16   36   5,28    0,21
FLUENCE     16,35   84   4,49    15,83   36   3,48    0,53

Tabelul II. Evaluarea cognitiva cu MATRICS a lotului de control

Variabile   FEMEI                   BARBATI                P

            Media   N    DS         Media     N    DS

TMT         44,18   39   12,56566   48,71     21   14,30   0,36
BACS-SC     48,62   39   9,74252    51,35     21   13,75   0,53
HVLT-R      27,25   39   4,69752    27,64     21   2,59    0,78
WMS         13,93   39   4,05740    13,92     21   2,30    0,99
LNS         17,68   39   2,84532    17,21     21   4,13    0,71
NAB         19,25   39   3,94124    18,78     21   5,47    0,78
BVMT-R      32,00   39   4,19524    31,92     21   4,26    0,96
FLUENCE     25,18   39   7,37761    25,71     21   4,51    0,81
PSWQ        36,12   39   6,53070    33,07     21   8,49    0,27

Tabelul III. Comparatie lot schizofrenie vs. lot control cu MATRICS

Variabile   Schizofrenie    Control [N = 60]t-value     p
            [N = 120]

            Media   DS      Media   DS

TMT         77,90   33,99   46,30   13,37   4,9866      0,0001
BACS-SC     26,18   10,92   49,90   11,66   -10,4998    0,0001
HVLT-R      22,30   7,07    27,43   3,80    -3,8361     0,0002
WMS         11,45   4,39    13,93   3,30    -2,8950     0,0044
LNS         11,65   4,12    17,47   3,45    -7,1288     0,0001
NAB         8,25    4,90    19,03   4,64    -10,8951    0,0001
BVMT-R      17,48   7,59    31,97   4,16    -10,0609    0,0001
FLUENCE     16,20   4,21    25,43   6,11    -9,7423     0,0001
PSWQ        51,98   12,26   34,70   7,54    7,3674      0,0001

Tabelul IV. Teste cognitive in functie de tipul de antipsihotic

Variabile   HAL=29   QUE=7   CLZ=14   OLZ=37   ARI=9   RIS=13

            Media    Media   Media    Media    Media   Media

TMT         74,14    76,57   86,50    79,89    85,67   64,62
BACS-SC     28,07    25,43   23,36    24,35    29,33   31,08
HVLT-R      23,00    21,43   20,79    21,68    27,11   22,08
WMS         11,52    11,14   10,64    11,27    12,44   12,77
LNS         11,72    10,43   11,64    11,22    13,56   12,23
NAB         8,07     6,86    9,21     7,70     9,22    10,38
BVMT-R      18,03    16,71   13,64    17,95    20,78   19,23
FLUENCE     16,24    19,29   15,00    16,51    16,00   16,31
PSWQ        52,28    49,29   50,21    53,95    45,67   50,85

Variabile   AMI=11   p

            Media

TMT         80,36    0,50
BACS-SC     23,09    0,29
HVLT-R      21,36    0,05
WMS         10,73    0,93
LNS         11,45    0,91
NAB         6,91     0,82
BVMT-R      15,09    0,05
FLUENCE     14,64    0,05
PSWQ        55,00    0,88

Figura 1. Tipurile de antipsihotice folosite

Antipsihotice-nr cazuri

haloperidol   29
quetiapina    7
clozapina     14
olarzapina    37
aripiprazol   9
risperidona   13
amisulprid    11

Note: Table made from pie chart.

Figura 2. Doza medie de antipsihotic

Antipsihotice-doze[mg]

haloperidol   6.98
quetiapina    557.14
clozapina     392.85
olarzapina    13.37
aripiprazol   13.33
risperidona   4.3
amisulprid    440.9

Note: Table made from bar graph.
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Author:Teodorescu, Andreea; Ifteni, Petru; Burtea, Victoria; Fodoreanu, Liana
Publication:Bulletin of Integrative Psychiatry
Article Type:Report
Date:Sep 1, 2014
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