抗精神病药物未使用的第一发精神病患者的认知功能和可变性:系统性审查和元分析
Maria Lee1, Martin Cernvall2, Jacqueline Borg1,3
1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden.
JAMA psychiatry
|February 28, 2024
概括
患有第一发精神病 (FEP) 的个人在抗精神病治疗前表现出显著的认知障碍. 这项研究量化了这些缺陷,并突出了FEP患者认知功能的相当大的变化,建议进行个性化干预.
科学领域:
- 神经科学是一个神经科学.
- 精神病学是一个精神病学.
- 认知心理学 认知心理学
背景情况:
- 认知障碍是精神病患者临床结果和功能水平的一个重要因素.
- 这些障碍在精神病发作时可以在群体层面上观察到,但患者之间的认知功能的异质性需要进行系统的调查.
- 抗精神病治疗可能会影响认知功能的评估.
研究的目的:
- 量化抗精神病药物素朴的第一发精神病 (FEP) 患者的认知障碍.
- 与健康对照组相比,研究FEP组内认知功能的变化.
- 在抗精神病治疗的潜在混影响之前提供最新的分析.
主要方法:
- 一个系统的审查和PubMed文章的元分析发表到2022年9月15日.
- 包括原始研究报告的认知功能数据在抗精神病药物前的FEP患者.
- 使用随机效应模型对平均差异和变量系数比率 (CVRs) 的元分析进行数据提取和合成,重点关注 6 个 MATRICS 认知领域和执行功能.
主要成果:
- 50项研究包括2625名FEP患者和2917名健康对照.
- 与对照组相比,FEP组在所有认知领域都表现出显著的损伤,效果大小很大 (Hedges g范围从-0.88到-1.16).
- 与对照人群相比,FEP患者在所有领域的认知功能 (CVR范围,1.34-1.92) 中表现出明显更大的变化.
结论:
- 在FEP患者接受抗精神病治疗之前,认知障碍显而易见,其特点是效果大小.
- 在FEP患者中认知功能的实质性 intra-group 变异性强调了需要识别有更糟糕结果风险的个体.
- 这些发现支持针对那些表现出更严重认知缺陷的FEP患者开发有针对性的认知补救策略.
相关概念视频
01:28Psychosis and Antipsychotic Drugs: Overview
253
The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
253
01:26Psychosis: Goals of Pharmacotherapy
128
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
128
01:21Antipsychotic Drugs: Typical and Atypical Agents
198
Antipsychotic drugs are classified into first-generation (typical) drugs including phenothiazines; and second-generation (atypical) drugs. Chlorpromazine hydrochloride (Thorazine), a phenothiazine derivative, broadly impacts the central, autonomic, and endocrine systems. This drug, along with typical agents like haloperidol (Haldol), primarily works by antagonizing D2 receptors, thus reducing dopaminergic neurotransmission. However, typical antipsychotics can cause side effects such as sedation...
198
01:28Drug Therapy
43
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
43
01:27Psychosis: Pathophysiology of Schizophrenia and Other Psychotic Disorders
631
Schizophrenia is a neurodevelopmental disorder whose origins are rooted in complex genetic components. Despite our burgeoning understanding, the pathophysiology of this disorder remains incompletely deciphered.
Researchers have identified genetic factors that increase susceptibility to schizophrenia, underscoring the intricate interplay between genetics and environment in disease development. At the core of schizophrenia's pathophysiology is excessive dopaminergic neurotransmission within...
Researchers have identified genetic factors that increase susceptibility to schizophrenia, underscoring the intricate interplay between genetics and environment in disease development. At the core of schizophrenia's pathophysiology is excessive dopaminergic neurotransmission within...
631
01:24Mania and Antimanic Drugs: Overview
179
Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
179