利培酮及氯氮平对首发精神分裂症患者认知功能及P300的影响

Comparison of cognitive function and P300 potentials in first-episode schizophrenia treated with risperidone and clozapine.

目的比较利培酮和氯氮平对首发精神分裂症患者认知功能的影响。方法对64例首发精神分裂症采用随机对照研究法观察12周,利培酮组33例,平均有效治疗剂量(4.5±1.2)mg/d,氯氮平组31例,平均有效治疗剂量(269.4±133.3)mg/d。于治疗前后行阴性和阳性症状量表(PANSS)、韦氏记忆量表(WMS)和事件相关电位P300检测。结果首发精神分裂症患者在长时记忆、短时记忆、瞬时记忆及记忆商数(MQ)受损较为明显,与对照组比较有显著性差异(P<0.05)。P300电位成分中P2、N2及P3潜伏期明显延长,P2及P3波幅明显降低,与对照组比较均有显著性差异(P<0.05)。经过12周治疗利培酮和氯氮平组PANSS总分、阳性症状分、阴性症状分及一般精神病理症状分均降低,2组无显著性差异(P>0.05)。利培酮组的WMS的再认、联想及记忆商(MQ)明显高于氯氮平组;2组治疗前后P300各指标均无显著性差异。结论首发精神分裂症患者存在着认知功能障碍,利培酮对首发精神分裂症认知功能的改善明显优于氯氮平。两药均不能改善患者的P300。

Objective To compare the effects of risperidone and clozapine on cognitive function in first-episode schizophrenic patients. Methods A randomized comparative clinical study was used to compare the cognitive function of risperidone and clozapine before and after 12-week treatment. 64 patients with first-episode schizophrenia were divided two groups. 33 cases were treated with risperidone in an average therapeutic dose of (4.5±1.2) mg/d. 31 cases were treated with clozapine in an average therapeutic dose of (269.4±133.3) mg/d. PANSS, WMS and P300 were used to evaluate effects of drugs and cognitive function. Results The long-term memory, short-term memory, immediate memory, MQ of first-episode schizophrenia were damaged obviously. Latency periods of P2、N2 and P3 of P300 potentials with first-episode schizophrenia group was longer than the control group, the amplitude of P2 and P3 of P300 potentials with first-episode schizophrenia group was lower than the control group. There were significant difference between the two groups ( P < 0.05 ). After 12-week treatment, some of the scores in two groups were decreased significantly, including total scores of PANSS, scores of positive symptom scores, negative symptom and general psychopathology subscales. There were no significant differences between the two groups. The recognize,association, MQ of WMS were significantly higher in risperidone than in clozapine, while no differences in P300 between two groups before and after drug treatment. Conclusions The presence of cognitive dysfunction in first-episode schizophrenia has been confirmed. The study suggests that the effects of risperidone on cognitive function are better than those of clozapine. Two medicines can not improve the patient's P300.