Short-Term Cognitive Improvement in Schizophrenics Treated with Typical and Atypical Neuroleptics

Abstract

Objective: Atypical neuroleptics seem to be more beneficial than typical ones with respect to long-term neuropsychological functioning. Thus, most studies focus on the long-term effects of neuroleptics. We were interested in whether atypical neuroleptic treatment is also superior to typical drugs over relatively short periods of time. Methods: We studied 20 schizophrenic patients [10 males, mean age 35.5 years, mean Brief Psychiatric Rating Scale (BPRS) score at entry 58.9] admitted to our hospital with acute psychotic exacerbation. Nine of them were treated with typical and 11 with atypical neuroleptics. In addition, 14 healthy drug-free subjects (6 males, mean age 31.2 years) were enrolled in the study and compared to the patients. As neuropsychological tools, a divided attention test, the Vienna reaction time test, the Benton visual retention test, digit span and a Multiple Choice Word Fluency Test (MWT-B) were used during the first week after admission, within the third week and before discharge (approximately 3 months). Results: Patients scored significantly worse than healthy controls on nearly all tests (except Vienna reaction time). Clinical ratings [BPRS and Positive and Negative Symptom Scale for Schizophrenia (PANSS)] improved markedly (p < 0.01), without a significant difference between typical and atypical medication. Clinical improvement (PANSS total score) correlated with less mistakes on the Benton test (r = 0.762, p = 0.017) and an improvement on the divided attention task (r = 0.705, p = 0.034). Neuropsychological functioning (explicit memory, p < 0.01; divided attention, p < 0.05) moderately improved for both groups under treatment but without a significant difference between atypical and typical antipsychotic drugs. Conclusions: Over short periods of time (3 months), neuropsychological disturbances in schizophrenia seem to be moderately responsive to both typical and atypical neuroleptics.

Detection of the Moderately Beneficial Cognitive Effects of Low-Dose Treatment with Haloperidol or Clozapine in an Animal Model of the Attentional Impairments of Schizophrenia

“…The absence of detrimental effects of low doses of haloperidol in control subjects and the demonstration of beneficial cognitive effects in patients by equivalent, low doses of haloperidol (Green et al, 2002;Harvey et al, 2005;Keefe et al, 2006b;Mishara and Goldberg, 2004;Remillard et al, 2005;Rollnik et al, 2002) together suggest that conclusions about the cognitive profile of FGAs require careful consideration of dose and receptor occupancy.…”

“…Rather, several studies indicated that members of both classes of antipsychotic drugs produce moderate and largely equivalent improvements in cognitive function, particularly when administered at relatively low doses (Green et al, 2002;Harvey et al, 2005;Keefe et al, 2006b;Mishara and Goldberg, 2004;Remillard et al, 2005;Rollnik et al, 2002). Thus, the goal of our research was to define an animal model capable of detecting the limited beneficial cognitive effects of low-dose treatment of an FGA (haloperidol) and an SGA (clozapine; see 'Methods' for the definition and justification of low doses of either drug; Kapur et al, 2003).…”

Efficiency of the CATIE and BACS neuropsychological batteries in assessing cognitive effects of antipsychotic treatments in schizophrenia

“…In general, modest cognitive benefits from antipsychotic medications are characterized by reduction of generalized cognitive deficits across a wide range of abilities, rather than particular effects on a specific neuropsychological domain (Buchanan et al, 1994;Cassens et al, 1990;Hill et al, 2004a;Rollnik et al, 2002).…”

La valutazione economica del trattamento farmacologico con antipsicotici nella schizofrenia: una revisione sistematica della letteratura

“…Queste caratteristiche hanno permesso di aumentare la compliance del trattamento e di diminuire il numero di ricadute e di successive ospedalizzazioni [1,[17][18][19][20][21][22][23][24][25]. Peraltro non tutti sono concordi nel considerare gli atipici come la terapia di prima scelta nel trattare i soggetti affetti da schizofrenia [26].…”