Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder
Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder
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DOI：
10.1177/0269881108100777
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发表时间：
2010-07-01
影响因子：
4.1
通讯作者：
Grignon, S.
中科院分区：
文献类型：
--
作者：
Elie, D.;Poirier, M.;Grignon, S.
抗精神病药物的多重用药和高剂量与较差的预后、较长的住院时间和增加的副作用有关。本自然主义研究使用精神分裂症认知简要评估 (BACS) 评估了 56 名诊断为精神分裂症或分裂情感障碍的患者抗精神病药物的认知影响。抗精神病药物每日剂量 (ADD) 以 mg 利培酮当量/天 (RIS eq) 表示，使用基于第二代抗精神病药物 (SGA) 临床抗精神病药物干预效果 (CATIE) 研究的药物剂量和第一代抗精神病药物 (FGA) 氯丙嗪当量 (FGA) 的药物剂量模型，氟哌啶醇和利培酮之间的当量为 1/1。年龄的增长与多重用药、FGA 处方和 BACS 评分下降相关。反过来，FGA 处方预测认知功能较差，与年龄、PANSS 分项评分和 ADD 无关。 ADD 与认知评分下降相关，在控制年龄、PANSS 或多药治疗后，这种影响仍然显着。反过来，多药治疗对认知的不利影响似乎是由ADD介导的。不同的数据拟合方法表明，ADD 超过 5-6 mg RIS eq/天与较低的 BACS 评分相关。总体而言，这些结果表明，增加抗精神病药物的每日剂量与低于先前认为的剂量时认知功能较差相关，与抗精神病药物的数量无关。
Antipsychotic polypharmacy and high doses have been associated with poorer outcome, longer hospital stays, and increased side effects. The present naturalistic study assessed the cognitive effects of antipsychotics in 56 patients with a diagnosis of schizophrenia or schizoaffective disorder, using the Brief Assessment of Cognition in Schizophrenia (BACS). Antipsychotic daily dose (ADD) was expressed as mg risperidone equivalents/day (RIS eq), using a model based on drug doses from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study for second generation antipsychotics (SGA) and chlorpromazine equivalents for first generation antipsychotics (FGA), with a 1/1 equivalence between haloperidol and risperidone. Increasing age was associated with polypharmacy, FGA prescription and decreasing BACS score. FGA prescription, in turn, predicted a poorer cognitive functioning, independently of age, PANSS subscores and ADD. ADD was associated with decreasing cognitive scores, an effect that remained significant after controlling for age, PANSS or polypharmacy. The detrimental cognitive effects of polypharmacy, in turn, appeared to be mediated by ADD. Different methods of data fitting suggested that ADD above 5-6 mg RIS eq/day were associated with lower BACS scores. Overall, these results show that increasing antipsychotic daily dose is associated with poorer cognitive functioning at doses lower than previously thought, independently of the number of antipsychotic drugs.