Neuropsychological differences between treatment-resistant and treatment-responsive schizophrenia: a meta-analysis.
Neuropsychological differences between treatment-resistant and treatment-responsive schizophrenia: a meta-analysis.
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DOI：
10.1017/s0033291721004128
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发表时间：
2022-01
影响因子：
6.9
通讯作者：
Kravariti E
中科院分区：
文献类型：
--
作者：
Millgate E;Hide O;Lawrie SM;Murray RM;MacCabe JH;Kravariti E
抗精神病药物治疗耐药性影响了多达三分之一的精神分裂症患者。据报道，在受影响的人中，70-84% 从一开始就对治疗产生耐药性。这提出了治疗抵抗的神经生物学机制在精神病发作之前就出现并且具有神经发育起源的可能性。神经心理学研究可以为难治性精神分裂症（TRS）的性质、起源和病理生理学提供重要见解，但新兴研究领域的方法学局限性掩盖了 TRS 的神经心理学区分性。我们报告了首次系统评价和荟萃分析，以调查 17 项已发表研究（1864 名受试者）中 TRS 患者和治疗反应对照之间的神经心理学差异。进行了五项荟萃分析，涉及（1）执行功能，（2）一般认知功能，（3）注意力、工作记忆和处理速度，（4）言语记忆和学习，以及（5）视觉空间记忆和学习。所有领域都出现了小到中等的效应。与之前文献中未选择的、未用药的和首发精神分裂症样本与健康对照之间的比较类似，在言语记忆和学习中观察到最大的效应大小[dl = -0.53； 95% 置信区间 (CI) -0.29 至 -0.76； z = 4.42； p < 0.001]。从主要领域中提取的语言相关功能的子分析产生了可比较的效应大小（dl = -0.53，95% CI -0.82 至 -0.23；z = 3.45；p < 0.001）。操纵我们的采样策略以包括或排除为氯氮平反应选择的样本并不影响结果的模式。我们的研究结果与 TRS 可能的病因学贡献相关进行了讨论。
Antipsychotic treatment resistance affects up to a third of individuals with schizophrenia. Of those affected, 70–84% are reported to be treatment resistant from the outset. This raises the possibility that the neurobiological mechanisms of treatment resistance emerge before the onset of psychosis and have a neurodevelopmental origin. Neuropsychological investigations can offer important insights into the nature, origin and pathophysiology of treatment-resistant schizophrenia (TRS), but methodological limitations in a still emergent field of research have obscured the neuropsychological discriminability of TRS. We report on the first systematic review and meta-analysis to investigate neuropsychological differences between TRS patients and treatment-responsive controls across 17 published studies (1864 participants). Five meta-analyses were performed in relation to (1) executive function, (2) general cognitive function, (3) attention, working memory and processing speed, (4) verbal memory and learning, and (5) visual−spatial memory and learning. Small-to-moderate effect sizes emerged for all domains. Similarly to previous comparisons between unselected, drug-naïve and first-episode schizophrenia samples v. healthy controls in the literature, the largest effect size was observed in verbal memory and learning [dl = −0.53; 95% confidence interval (CI) −0.29 to −0.76; z = 4.42; p < 0.001]. A sub-analysis of language-related functions, extracted from across the primary domains, yielded a comparable effect size (dl = −0.53, 95% CI −0.82 to −0.23; z = 3.45; p < 0.001). Manipulating our sampling strategy to include or exclude samples selected for clozapine response did not affect the pattern of findings. Our findings are discussed in relation to possible aetiological contributions to TRS.
影响因子：
2.5
作者：
Moulier V;Krir MW;Dalmont M;SURECT Group;Guillin O;Rothärmel M
通讯作者：
Rothärmel M