Varied effects of atypical neuroleptics on P50 auditory gating in schizophrenia patients
Varied effects of atypical neuroleptics on P50 auditory gating in schizophrenia patients
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DOI：
10.1176/appi.ajp.161.10.1822
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发表时间：
2004-10-01
影响因子：
17.7
通讯作者：
Freedman, R
中科院分区：
文献类型：
--
作者：
Adler, LE;Olincy, A;Freedman, R
目的：对精神分裂症患者的感觉门控缺陷进行评估，可采用配对听觉刺激范式测量听觉诱发反应，第二刺激或测试刺激的P50反应幅度与第一刺激或条件刺激的P50反应幅度之比以百分比表示。正常受试者一般会抑制第二反应，比例通常低于40%。精神分裂症患者及其半数一级亲属有感觉门控功能缺陷，P50比值一般大于50%。用典型的抗精神病药物治疗并不能逆转这种缺陷。然而，先前的研究表明，氯氮平（一种非典型抗精神病药）治疗可以改善临床反应性患者的这种缺陷。本研究旨在确定其他非典型抗精神病药是否能改善P50比率。方法：对132例精神分裂症患者和177例健康对照者进行P50诱发电位记录。88例患者接受非典型抗精神病药物治疗（氯氮平[N=26]，奥氮平[N=31]，利培酮[N=22]，喹硫平[N=9]）。34例患者服用典型的抗精神病药物，10例患者未服用。结果：健康受试者的P50抑制明显优于接受典型抗精神病药物治疗的精神分裂症患者（平均19.8% [SD= 21.0%]对110.1% [SD=87.9%]）。接受非典型抗精神病药物治疗的患者的平均P50比值介于这两个平均值之间（平均值=70.4%，SD=53.7%）。当不同非典型抗精神病药治疗的患者进行比较时，只有氯氮平组的平均P50比值在正常范围内。所有其他组表现出听觉P50反应抑制显著低于健康受试者。结论：P50门控的改善似乎在氯氮平治疗的患者中最大。
Objective: Sensory gating deficits found in schizophrenia can be assessed by using a paired auditory stimulus paradigm to measure auditory evoked response, The ratio of the P50 response amplitude of the second or test stimulus to that of the first or conditioning stimulus is expressed as a percentage. Normal subjects generally suppress the second response and typically have ratios of less than 40%. Subjects with schizophrenia and half their first-degree relatives have deficits in sensory gating, with P50 ratios that are generally greater than 50%. Treatment with typical neuroleptics does not reverse this deficit. However, previous studies have shown that treatment with clozapine, an atypical neuroleptic, ameliorates this deficit in clinically responsive patients. This study sought to determine whether other atypical neuroleptics improve P50 ratios.Method: P50 evoked potential recordings were obtained from 132 patients with schizophrenia and 177 healthy comparison subjects. Eighty-eight patients were being treated with atypical neuroleptics (clozapine [N=26], olanzapine [N=31], risperidone [N=22], and quetiapine [N=9]). Thirty-four patients were taking typical neuroleptics, and 10 were unmedicated.Results: Healthy subjects exhibited P50 suppression that was significantly better than the schizophrenia patients receiving typical neuroleptics (mean=19.8% [SD= 21.0%] versus 110.1% [SD=87.9%]). Patients receiving atypical neuroleptics had a mean P50 ratio that fell between these two means (mean=70.4%, SD=53.7%). When patients treated with different atypical neuroleptics were compared, only the clozapine group had mean P50 ratios that were in the normal range. All other groups exhibited auditory P50 response inhibition that was significantly poorer than that of the healthy subjects.Conclusions: Improvement in P50 gating appears to be greatest in patients treated with clozapine.