Effects of Risperidone and Olanzapine Dose Reduction on Cognitive Function in Stable Patients With Schizophrenia: An Open-Label, Randomized, Controlled, Pilot Study

Takeuchi, Hiroyoshi; Suzuki, Takefumi; Remington, Gary; Bies, Robert R.; Abe, Takayuki; Graff‐Guerrero, Ariel; Watanabe, Koichiro; Mimura, Masaru; Uchida, Hiroyuki

doi:10.1093/schbul/sbt090

Cited by 96 publications

(76 citation statements)

References 20 publications

(22 reference statements)

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“…We posit that this relationship reflects, at least in part, the impact of EPS on test taking ability rather than a shared core underlying vulnerability to both EPS and cognitive impairment. Our results are thus consistent with previous work suggesting that interventions that affect EPS also impact cognitive test performance (Takeuchi et al, 2013).…”

Section: Discussionsupporting

confidence: 93%

Extrapyramidal symptoms and cognitive test performance in patients with schizophrenia

Fervaha

Agid

Takeuchi

et al. 2015

Schizophrenia Research

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Section: Discussionsupporting

confidence: 93%

Extrapyramidal symptoms and cognitive test performance in patients with schizophrenia

Fervaha

Agid

Takeuchi

et al. 2015

Schizophrenia Research

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“…11 Antipsychotic-induced weight gain,15 metabolic disturbance,16 and hyperprolactinemia17 are particularly important due to their potential impact on future physical health. Antipsychotics can also impair cognition 18. Many of these adverse effects are dose-related 14…”

Section: Antipsychotic Medication and Schizophreniamentioning

confidence: 99%

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Haddad¹,

Brain²,

Scott³

2014

PROM

454

418

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Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness’s association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.

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“…Although antipsychotics can have both positive and negative effects (direct and/or indirect) on cognition in actively psychotic patients, their cognitive side-effects become clear once patients are stabilized. In recent studies, both dose reduction and guided discontinuation of SGAs were shown to lead to cognitive improvement in stable patients (Faber et al 2012;Takeuchi et al 2013). Several factors associated with cognitive dysfunction in healthy subjects, such as metabolic syndrome, chronic substance use and stress (Johnsen & Asbjørnsen, 2008;Panza et al 2010;Stavro et al 2013), are more common in schizophrenia and there is no doubt that they can contribute to cognitive impairment in schizophrenia.…”

Section: Neurodevelopment and Medical Co-morbidities Substance Use Amentioning

confidence: 99%

Neurodevelopmental origin of cognitive impairment in schizophrenia

2014

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Cognitive impairment is a common feature of schizophrenia; however, its origin remains controversial. Neurodevelopmental abnormalities clearly play a role in pre-morbid cognitive dysfunction in schizophrenia, yet many authors believe that schizophrenia is characterized by illness-related cognitive decline before and after onset of the psychosis that can be the result of neurodegenerative changes. The main reasons behinds such arguments include, first, the evidence showing that effect sizes of the cognitive deficits in subjects who develop adult schizophrenia gradually increase in the first two decades of life and, second, the fact that there is functional decline in many patients with schizophrenia over the years. In this Editorial, I argue that current evidence suggests that illness-related cognitive impairment is neurodevelopmental in origin and characterized by slower gain (developmental lag) but not cognitive decline continuing throughout the first two decades of life. I introduce a model suggesting that neurodevelopmental abnormality can in fact explain the course of cognitive dysfunction and variations in the trajectory of functional decline throughout the life in individuals with schizophrenia. In this model, the severity of underlying neurodevelopmental abnormality determines the age that cognitive deficits first become apparent and contributes to the cognitive reserve of the individual. Interaction of neurodevelopmental abnormality with clinical symptoms, especially negative symptoms and aging, vascular changes, psychological and iatrogenic factors contributes to the heterogeneity of the functional trajectory observed in this disorder.

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Effects of Risperidone and Olanzapine Dose Reduction on Cognitive Function in Stable Patients With Schizophrenia: An Open-Label, Randomized, Controlled, Pilot Study

Cited by 96 publications

References 20 publications

Extrapyramidal symptoms and cognitive test performance in patients with schizophrenia

Extrapyramidal symptoms and cognitive test performance in patients with schizophrenia

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Neurodevelopmental origin of cognitive impairment in schizophrenia

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