High-dose of multiple antipsychotics and cognitive function in schizophrenia: The effect of dose-reduction

Kawai, Nobuyoshi; Yamakawa, Yuriko; Baba, Atsuomi; Nemoto, Kiyotaka; Tachikawa, Hirokazu; Hori, Takafumi; Asada, Takashi; Iidaka, Tetsuya

doi:10.1016/j.pnpbp.2006.03.013

Cited by 49 publications

(20 citation statements)

References 12 publications

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“…Kawai and colleagues (Kawai, et al, 2006) investigated the differential effects of high doses of typical antipsychotics in a group of schizophrenia patients on the Wisconsin Card Sorting Test. These subjects were tested on 2,200 mg chlorpromazine equivalent and again on a reduced dose of 1,315 mg chlorpromazine equivalent.…”

Section: Discussionmentioning

confidence: 99%

Effects of haloperidol on cognition in schizophrenia patients depend on baseline performance: A saccadic eye movement study

Babin¹,

Hood²,

Wassef

et al. 2011

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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Schizophrenic patients are heterogeneous with respect to voluntary eye movement performance, with some showing impairment (e.g., high antisaccade error rates) and others having intact performance. To investigate how this heterogeneity may correlate with different cognitive outcomes after treatment, we used a prosaccade and antisaccade task to investigate the effects of haloperidol in schizophrenic subjects at three time points: baseline (before medication), 3–5 days post-medication, and 12–14 days post-medication. We also investigated changes on the Stroop Task and the Positive and Negative Syndrome Scale (PANSS) in these same subjects. Results were compared to matched controls. When considered as a single patient group, haloperidol had no effects across sessions on reflexive and voluntary saccadic eye movements of schizophrenic patients. In contrast, the performance of the Control group improved slightly but significantly across sessions on the voluntary eye movement task. When each subject was considered separately, interestingly, for schizophrenic patients change in voluntary eye movement performance across sessions depended on the baseline performance in a non-monotonic manner. That is, there was maximal worsening of voluntary eye movement performance at an intermediate level of baseline performance and the worsening decreased on either side of this intermediate baseline level. When patients were divided into categorical subgroups (nonimpaired and impaired), consistent with the non-monotonic relationship, haloperidol worsened voluntary eye movement performance in the nonimpaired patients and improved performance in the impaired patients. These results were only partially reflected in the Stroop Test. Both patient subgroups showed clinically significant improvement over time as measured by the PANSS. These findings suggest that haloperidol has different effects on cognitive performance in impaired and nonimpaired schizophrenic patients that are not evident in clinical ratings based on the PANSS. Given that good cognitive function is important for long-term prognosis and that there is heterogeneity in schizophrenia, these findings are critical for optimal evaluation and treatment of schizophrenic patients.

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Section: Discussionmentioning

confidence: 99%

Effects of haloperidol on cognition in schizophrenia patients depend on baseline performance: A saccadic eye movement study

Babin¹,

Hood²,

Wassef

et al. 2011

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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“…As the procognitive advantages of atypical APDs reported in comparative studies, which could be caused by the use of high dosages of the drugs administered in the conventional APD group [8], remain controversial, the absence of differences in the present study can be considered more robust. Nevertheless, high dosages of conventional antipsychotics may probably impair cognition as dose reduction in patients with high dosages may lead to cognitive improvement, as shown recently [41]. …”

Section: Discussionmentioning

confidence: 99%

The switch from conventional to atypical antipsychotic treatment should not be based exclusively on the presence of cognitive deficits. A pilot study in individuals with schizophrenia

et al. 2010

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BackgroundAtypical antipsychotics provide better control of the negative and affective symptoms of schizophrenia when compared with conventional neuroleptics; nevertheless, their heightened ability to improve cognitive dysfunction remains a matter of debate. This study aimed to examine the changes in cognition associated with long-term antipsychotic treatment and to evaluate the effect of the type of antipsychotic (conventional versus novel antipsychotic drugs) on cognitive performance over time.MethodsIn this naturalistic study, we used a comprehensive neuropsychological battery of tests to assess a sample of schizophrenia patients taking either conventional (n = 13) or novel antipsychotics (n = 26) at baseline and at two years after.ResultsContinuous antipsychotic treatment regardless of class was associated with improvement on verbal fluency, executive functions, and visual and verbal memory. Patients taking atypical antipsychotics did not show greater cognitive enhancement over two years than patients taking conventional antipsychotics.ConclusionsAlthough long-term antipsychotic treatment slightly improved cognitive function, the switch from conventional to atypical antipsychotic treatment should not be based exclusively on the presence of these cognitive deficits.

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“…However, naturalistic, cross-sectional studies have suggested that higher doses of antipsychotics (Élie et al, 2010, Hori et al, 2006, Torniainen et al, 2012) or antipsychotic polypharmacy (Hori et al, 2006) may be associated with poorer cognitive functioning in schizophrenia, supported also by the finding of a positive effect of dose-reduction on cognition (Kawai et al, 2006, Takeuchi et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

Lifetime antipsychotic medication and cognitive performance in schizophrenia at age 43 years in a general population birth cohort

Husa

Moilanen

Murray

et al. 2017

Psychiatry Research

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This naturalistic study analysed the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia after an average of 16.5 years of illness. Sixty participants with schizophrenia and 191 controls from the Northern Finland Birth Cohort 1966 were assessed at age 43 years with a neurocognitive test battery. Cumulative lifetime antipsychotic dose-years were collected from medical records and interviews. The association between antipsychotic dose-years and a cognitive composite score based on principal component analysis was analysed using linear regression. Higher lifetime antipsychotic dose-years were significantly associated with poorer cognitive composite score, when adjusted for gender, onset age and lifetime hospital treatment days. The effects of typical and atypical antipsychotics did not differ. This is the first report of an association between cumulative lifetime antipsychotic dose and global cognition in midlife schizophrenia. Based on these data, higher lifetime antipsychotic dose-years may be associated with poorer cognitive performance at age 43 years. Potential biases related to the naturalistic design may partly explain the results; nonetheless, it is possible that large antipsychotic doses harm cognition in schizophrenia in the long-term.

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High-dose of multiple antipsychotics and cognitive function in schizophrenia: The effect of dose-reduction

Cited by 49 publications

References 12 publications

Effects of haloperidol on cognition in schizophrenia patients depend on baseline performance: A saccadic eye movement study

Effects of haloperidol on cognition in schizophrenia patients depend on baseline performance: A saccadic eye movement study

The switch from conventional to atypical antipsychotic treatment should not be based exclusively on the presence of cognitive deficits. A pilot study in individuals with schizophrenia

Lifetime antipsychotic medication and cognitive performance in schizophrenia at age 43 years in a general population birth cohort

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