利培酮对首发和慢性精神分裂症患者惊跳反射弱刺激抑制和P50的影响

Effect of risperidone on prepulse inhibition of the startle reflex and P50 deficit in patients with first-episode and chronic schizophrenia

目的:探讨非典型抗精神病药物利培酮单一药物对首发和慢性精神分裂症患者惊跳反射弱刺激抑制(PPI)和P50缺陷的影响。方法:应用德国脑诱发电位新技术,数字随机抽取2017年1月至2019年6月金华市第二医院2个病房的精神病患者,对38例精神分裂症首发患者和36例慢性精神分裂症入组患者,采用可变剂量(2~6 mg/d)的利培酮治疗,分别于治疗前及治疗8周后同日完成PPI和P50的测定。应用阳性与阴性症状量表(PANSS)评定精神症状,PANSS减分率评定疗效。结果:治疗前PPI和P50指标在两组患者之间差异无统计学意义(PPI比值首发组43%±29%,慢性组42%±27%,P>0.05。P50 S2/S1比值首发组83%±33%,慢性组82%±24%,P>0.05)。PPI和P50抑制指标与精神分裂症临床症状(PANSS总分、阳性总分、阴性总分及一般精神病理分)之间无相关性(P>0.05)。治疗前后比较,除P50中的S2波幅的组别主效应显著,差异有统计学意义(F=5.75,P=0.019)外,其余P50测量指标以及PPI抑制率的主效应及交互作用差异无统计学意义(P50 S2/S1比值,首发组治疗前83%±33%,治疗后85%±49%,P>0.05,慢性组治疗前82%±44%,治疗后84%±35%,P>0.05。PPI比值首发组治疗前43%±29%,治疗后42%±27%,P>0.05,慢性组治疗前42%±27%,治疗后41%±28%,P>0.05)。但是利培酮对PPI和P50测量指标的影响与疗效无关。结论:首发和慢性精神分裂症均存在感觉门控抑制缺陷;利培酮难以改善PPI和P50抑制缺陷。

Objective To investigate the effect of antipsychotic medicine risperidone on prepulse inhibition of the startle reflex(PPI)and P50 deficit in patients with first-episode and chronic.Methods Thirty-eight patients with first-episode schizophrenia and 36 patients with chronic schizophrenia,both in acute stage,were enrolled in the study.All patients were treated with risperidone of different doses(2 to 6mg/d).All patients fulfilled the evaluation of PPI and P50 before treatment and 8 weeks after treatment.The psychotic symptoms were assessed with Positive and Negative Syndrome Scale(PANSS),and the therapeutic effects were evaluated with PANSS reduction rate.Results(1)There was no significant difference in PPI and P50 parameters between the two groups before treatment(PPI ratio:first group 43%±29%,chronic group 42%±27%,P>0.05;P50 S2/S1 ratio:first group 83%±33%,chronic group 82%±24%,P>0.05).(2)There was no significant correlation between PPI and P50 inhibition parameters and disease course,psychotic episodes and psychiatric symptoms(PANSS total score,positive symptoms score,negative symptoms score and general psychopathology symptoms score)of schizophrenia(P>0.05).(3)Except the group main effect for S2 amplitude(F=5.75,P=0.019),there was no significant change for main effect and interaction of the other P50 and PPI inhibition ratio parameters after treatment(P50 S2/S1 ratio:first group before treatment 83%±33%,after treatment 85%±49%,P>0.05;chronic group before treatment 82%±44%,after treatment 84%±35%,P>0.05.PPI ratio:first group before treatment 43%±29%,after treatment 42%±27%;chronic group before treatment 42%±27%,after treatment 41%±28%,P>0.05).The effect of risperidone on P50 and PPI parameters was not related to the therapeutic effect.Conclusion Deficit in sensory gating inhibition exists in both first-episode schizophrenia and chronic schizophrenia,and risperidone is not effective in treating the deficit in sensory gating(PPI and P50)inhibition of schizophrenia.