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/ajp.161.10.1822
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发表时间：
2004-10
期刊：
影响因子：
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通讯作者：
L. Adler;A. Olincy;E. Cawthra;K. McRae;Josette G. Harris;H. Nagamoto;M. Waldo;M. Hall;Amanda Bowl
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文献类型：
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作者：
L. Adler;A. Olincy;E. Cawthra;K. McRae;Josette G. Harris;H. Nagamoto;M. Waldo;M. Hall;Amanda Bowl
目的通过使用配对听觉刺激范式测量听觉诱发反应来评估精神分裂症患者的感觉门控缺陷。第二个或测试刺激的P50反应幅度与第一个或条件刺激的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，其比例通常不到40%。患有精神分裂症的受试者及其一半的一级亲属在感觉门控方面存在缺陷，P50比率通常大于50%。用典型的抗精神病药物治疗并不能扭转这一缺陷。然而，先前的研究表明，氯氮平是一种非典型的神经镇静剂，可以改善临床反应患者的这种缺陷。这项研究试图确定其他非典型抗精神病药物是否能改善P50比率。方法对132例精神分裂症患者和177例健康体检者进行P50诱发电位检测。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]和奎硫平[N=9])。34名患者服用了典型的抗精神病药物，10名患者未服用药物。结果健康受试者的P50抑制明显好于接受典型抗精神病药治疗的精神分裂症患者(平均值分别为19.8%[SD=21.0%]和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物治疗的患者进行比较时，只有氯氮平组的平均P50比率在正常范围内。所有其他组的听觉P50反应抑制显著低于健康受试者。结论接受氯氮平治疗的患者P50门控改善最明显。
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.