Neuroleptics: Effects on Neuropsychological Function in Chronic Schizophrenic Patients

Cassens, Geraldine; Inglis, Aleida K.; Appelbaum, Paul S.; Gutheil, Thomas G.

doi:10.1093/schbul/16.3.477

Cited by 257 publications

(105 citation statements)

References 73 publications

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“…Cross-sectional assessments have not indicated declining cognition in schizophrenia: in 10 studies published in 1964-1980 (15), IQ and year of study were uncorrelated (r=0.09, df=8, p>0.1). Instead, many psychotic patients show improvements in cognition during antipsychotic treatment, generally with otherwise improved clinical status (16)(17)(18).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of postmortem studies of Alzheimer's disease-like neuropathology in schizophrenia [published erratum appears in Am J Psychiatry 1997 Aug;154(8):1180]

Baldessarini

Hegarty²,

Bird³

et al. 1997

AJP

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P ositive long-term outcomes in studies of patients with schizophrenia may have declined since the 1970s. Several reasons have been suggested for the decline, including the possibility that it is related to narrowing of diagnostic criteria and that more severely or chronically ill subjects are now available for study (1, 2). Another suggestion is that there has been an increase in the rate of dementia associated with neuropathological changes in schizophrenia. These include an excess of the type of senile plaques and neurofibrillary tangles seen in Alzheimer's disease-particularly since the 1950s, when neuroleptic treatment was introduced (2-4). In view of the fact that a century of research seeking a specific neurohistopathology in schizophrenia has yielded largely negative or inconclusive findings (5), and because of the potential public health significance of the possibility that there has been an increase in neuropathological changes in schizophrenia related to long-term neuroleptic treatment, this possibility requires closer consideration. Accordingly, we conducted a meta-analysis of available data concerning the risk of Alzheimer's disease-like neuropathology in schizophrenia, paying particular attention to evidence of secular trends that might be consistent with a rising incidence of such neuropathology in the current era of long-term antipsychotic therapy. METHODA computer-assisted literature search identified studies of postmortem neuropathology in schizophrenia. We evaluated studies of the presence or absence of Alzheimer's disease-like neuropathology in the postmortem brains of patients with schizophrenia, normal comparison subjects, and comparison subjects with affective disorders. MantelHaenszel chi-square analysis was applied for risk differences in the individual studies, for an overall effect of schizophrenia, and for homogeneity of rates across studies. Odds ratios and their 95% confidence intervals also were computed. Correlations between the incidence of Alzheimer's disease-like changes and the year of the report and the subjects' mean age were tested with Spearman rank correlation analysis; t tests were used compare means and standard deviations. RESULTS

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of postmortem studies of Alzheimer's disease-like neuropathology in schizophrenia [published erratum appears in Am J Psychiatry 1997 Aug;154(8):1180]

Baldessarini

Hegarty²,

Bird³

et al. 1997

AJP

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“…FGAs demonstrated in reviews and most studies only minor beneficial effects on cognition (e.g., Cassens et al 1990;Sharma 1999), whereby inappropriately large dose ranges, combined with EPS or concomitant anticholinergic medication, may have had a negative effect on cognition. In a meta-analysis including studies comparing the effects of FGAs to those of placebo or no medication, modest to moderate gains in multiple cognitive domains were found for FGAs (Mishara and Goldberg 2004).…”

Section: Cognitive Symptomsmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Long-term treatment of schizophrenia

Falkai

Wobrock

Lieberman

et al. 2006

The World Journal of Biological Psychiatry

201

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These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A Á/D). This second part of the guidelines covers the long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.Key words: Schizophrenia, long-term treatment, evidence-based medicine, practice guidelines, biological treatment, antipsychotics EXECUTIVE SUMMARY OF RECOMMENDATIONS General recommendationsSpecific treatment strategies are required not only for patients suffering from acute schizophrenia, but also in the stabilisation and stable phase of the disease. The stabilisation period follows the acute phase and constitutes a time-limited transition to continuing treatment in the stable phase. The stable phase represents a prolonged period of treatment and rehabilitation during which symptoms are under adequate control and the focus is on improving functioning and recovery. The goals of long-term therapy have to be discussed with the patient on the background of adequately provided information and his personal goals in order to find common ground to encourage a long-term medication strategy (shared-decision making). In this regard a treatment plan must be formulated and implemented. During the stabilisation phase, the main goals of treatment are to facilitate continued reduction in symptoms, consolidate remission, and promote the process of recovery. The main goals of treatment during the stable phase are to ensure that symptom remission or control is sustained, that the patient is maintaining or improving the level of functioning and quality of life, to prevent relapse, and to ensure that monitoring for adverse treatment effects continues. The antipsychotic pharmacological therapy should be accompanied by psychosocial interventions. A number of psychosocial...

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“…In general, modest cognitive benefits from antipsychotic medications are characterized by reduction of generalized cognitive deficits across a wide range of abilities, rather than particular effects on a specific neuropsychological domain (Buchanan et al, 1994;Cassens et al, 1990;Hill et al, 2004a;Rollnik et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Efficiency of the CATIE and BACS neuropsychological batteries in assessing cognitive effects of antipsychotic treatments in schizophrenia

Hill

Sweeney

Hamer

et al. 2008

J. Inter. Neuropsych. Soc.

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Efficient and reliable assessments of cognitive treatment effects are essential for the comparative evaluation of procognitive effects of pharmacologic therapies. Yet, no studies have addressed the sensitivity and efficiency with which neurocognitive batteries evaluate cognitive abilities before and after treatment. Participants were primarily first episode schizophrenia patients who completed baseline (n 5 367) and 12-week (n 5 219) assessments with the BACS (Brief Assessment of Cognition in Schizophrenia) and CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) neuropsychological batteries in a clinical trial comparing olanzapine, quetiapine, and risperidone. Exploratory factor analysis revealed that performance on both batteries was characterized by a single factor of generalized cognitive deficit for both baseline performance and cognitive change after treatment. Both batteries estimated similar levels of change following treatment, although the BACS battery required half the administration time. Because a unitary factor characterized baseline cognitive abilities in early psychosis as well as cognitive change after treatment with atypical antipsychotic medications, short batteries such as the BACS may efficiently provide sufficient assessment of procognitive treatment effects with antipsychotic medications. Assessment of cognitive effects of adjunctive therapies targeting specific cognitive domains or impairments may require more extensive testing of the domains targeted to maximize sensitivity for detecting specific predicted cognitive outcomes. (JINS, 2008, 14, 209-221.)

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Neuroleptics: Effects on Neuropsychological Function in Chronic Schizophrenic Patients

Cited by 257 publications

References 73 publications

Meta-analysis of postmortem studies of Alzheimer's disease-like neuropathology in schizophrenia [published erratum appears in Am J Psychiatry 1997 Aug;154(8):1180]

Meta-analysis of postmortem studies of Alzheimer's disease-like neuropathology in schizophrenia [published erratum appears in Am J Psychiatry 1997 Aug;154(8):1180]

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Long-term treatment of schizophrenia

Efficiency of the CATIE and BACS neuropsychological batteries in assessing cognitive effects of antipsychotic treatments in schizophrenia

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