Neuroleptics: Effects on Neuropsychological Function in Chronic Schizophrenic Patients

Abstract

We have reviewed the literature from the 1950's to the present on the effects of neuroleptics on perceptual and neuropsychological function in chronic schizophrenic patients. In contrast to previous reviews, we have delineated the acute and chronic effects of neuroleptics on individual cognitive and motor tasks by drug, dose, and length of administration. To date, studies have shown that acute administration of neuroleptics impairs performance on some, but not all, tasks requiring vigilance and attention, and on some tasks requiring motor behavior. Chronic administration of neuroleptics, however, improves performance on some tasks requiring sustained attention and visuomotor problem-solving skills depending on dose and length of administration. Moreover, there is consistent evidence to suggest that chronic administration of neuroleptics in this patient population does not impair neuropsychological function independent of motor function. These findings have direct implications regarding the risk/benefit ratio and legal ramifications for the use of neuroleptics in chronic schizophrenic patients.

Moderator variables of executive functioning in Schizophrenia: Meta-analytic findings

“…Correlations between neuroleptic dosage and effect sizes were nonsignificant. This is consistent with Cassens et al’s review (1990), which suggested that the use of chronic neuroleptics may improve sustained attention and visual-motor problem solving, whereas acute administration may impair attention and motor skills. It may also be that the inherent problems in estimating and controlling for drug dosage in research (Spohn and Strauss 1989) limit the ability of this analysis to detect a potential relationship between CPZE and effect sizes.…”

Moderator variables of executive functioning in Schizophrenia: Meta-analytic findings

“…Correlations between neuroleptic dosage and effect sizes were nonsignificant. This is consistent with Cassens et al’s review (1990), which suggested that the use of chronic neuroleptics may improve sustained attention and visual-motor problem solving, whereas acute administration may impair attention and motor skills. It may also be that the inherent problems in estimating and controlling for drug dosage in research (Spohn and Strauss 1989) limit the ability of this analysis to detect a potential relationship between CPZE and effect sizes.…”

Neuropsychological Change in Early Phase Schizophrenia During 12 Months of Treatment With Olanzapine, Risperidone, or Haloperidol

“…45 The lack of change observed in subjects treated with haloperidol is consistent with prior reports. [13][14][15] The lack of change in subjects treated with risperidone is somewhat discrepant with prior reports, but the comprehensive neuropsychological battery used in our study is not directly comparable to the restricted range of tests used in prior research with risperidone. [22][23][24] Although preliminary, these results implicate the value of additional research toward a neuropsychological differentiation of antipsychotic treatments.…”

Patterns of content, contextual, and working memory impairments in schizophrenia and nonamnesic alcoholism.

“…The deficits observed in the schizophrenic group are not clearly related to the estimated degree of anticholinergic receptor affinity inherent in these patients' medications. Indeed, the general lack of difference in performance between high- and low-anticholinergic medication groups is consistent with other studies, which have shown that certain areas of performance, including memory, commonly remain unchanged or improve when patients are on antipsychotics (Cassens, Inglis, Applebaum, & Gutheil, 1990; Heaton & Crowley, 1981; Rizzo et al, 1996; Small, LaRue, Komo, Kaplan, & Mandelkern, 1995; Susser, Fennig, Jandorf, Amador, & Bromet, 1995). This improvement can occur despite the adverse effects anticholinergic agents are known to have on explicit memory processes.…”

Moderator variables of executive functioning in Schizophrenia: Meta-analytic findings

“…Correlations between neuroleptic dosage and effect sizes were nonsignificant. This is consistent with Cassens et al’s review (1990), which suggested that the use of chronic neuroleptics may improve sustained attention and visual-motor problem solving, whereas acute administration may impair attention and motor skills. It may also be that the inherent problems in estimating and controlling for drug dosage in research (Spohn and Strauss 1989) limit the ability of this analysis to detect a potential relationship between CPZE and effect sizes.…”

Neuropsychological Change in Early Phase Schizophrenia During 12 Months of Treatment With Olanzapine, Risperidone, or Haloperidol

“…45 The lack of change observed in subjects treated with haloperidol is consistent with prior reports. [13][14][15] The lack of change in subjects treated with risperidone is somewhat discrepant with prior reports, but the comprehensive neuropsychological battery used in our study is not directly comparable to the restricted range of tests used in prior research with risperidone. [22][23][24] Although preliminary, these results implicate the value of additional research toward a neuropsychological differentiation of antipsychotic treatments.…”

Patterns of content, contextual, and working memory impairments in schizophrenia and nonamnesic alcoholism.

“…The deficits observed in the schizophrenic group are not clearly related to the estimated degree of anticholinergic receptor affinity inherent in these patients' medications. Indeed, the general lack of difference in performance between high- and low-anticholinergic medication groups is consistent with other studies, which have shown that certain areas of performance, including memory, commonly remain unchanged or improve when patients are on antipsychotics (Cassens, Inglis, Applebaum, & Gutheil, 1990; Heaton & Crowley, 1981; Rizzo et al, 1996; Small, LaRue, Komo, Kaplan, & Mandelkern, 1995; Susser, Fennig, Jandorf, Amador, & Bromet, 1995). This improvement can occur despite the adverse effects anticholinergic agents are known to have on explicit memory processes.…”

Moderator variables of executive functioning in Schizophrenia: Meta-analytic findings

“…Correlations between neuroleptic dosage and effect sizes were nonsignificant. This is consistent with Cassens et al’s review (1990), which suggested that the use of chronic neuroleptics may improve sustained attention and visual-motor problem solving, whereas acute administration may impair attention and motor skills. It may also be that the inherent problems in estimating and controlling for drug dosage in research (Spohn and Strauss 1989) limit the ability of this analysis to detect a potential relationship between CPZE and effect sizes.…”

Neuropsychological Change in Early Phase Schizophrenia During 12 Months of Treatment With Olanzapine, Risperidone, or Haloperidol

“…45 The lack of change observed in subjects treated with haloperidol is consistent with prior reports. [13][14][15] The lack of change in subjects treated with risperidone is somewhat discrepant with prior reports, but the comprehensive neuropsychological battery used in our study is not directly comparable to the restricted range of tests used in prior research with risperidone. [22][23][24] Although preliminary, these results implicate the value of additional research toward a neuropsychological differentiation of antipsychotic treatments.…”

Patterns of content, contextual, and working memory impairments in schizophrenia and nonamnesic alcoholism.

“…The deficits observed in the schizophrenic group are not clearly related to the estimated degree of anticholinergic receptor affinity inherent in these patients' medications. Indeed, the general lack of difference in performance between high- and low-anticholinergic medication groups is consistent with other studies, which have shown that certain areas of performance, including memory, commonly remain unchanged or improve when patients are on antipsychotics (Cassens, Inglis, Applebaum, & Gutheil, 1990; Heaton & Crowley, 1981; Rizzo et al, 1996; Small, LaRue, Komo, Kaplan, & Mandelkern, 1995; Susser, Fennig, Jandorf, Amador, & Bromet, 1995). This improvement can occur despite the adverse effects anticholinergic agents are known to have on explicit memory processes.…”