BÜLENT KAYAHAN, Baybars VEZNEDAROĞLU, Özgür ÖZTÜRK, Mehmet Akif ERSOY

3125

Atipik antipsikotik ilaçların şizofreni hastalarında kısa kognitif muayene (KKM) üzerine etkisi: Tipik antipsikotiklerle karşılaştırılmalı-doğal izlem çalışması

Amaç: Atipik antipsikotik ilaçların şizofrenideki bilişsel bozukluklara etkisini araştırmak ve bu etkiyi tipik antipsikotik ilaçlarla karşılaştırmak. Yöntem: Ege Üniversitesi Tıp Fakültesi Psikiyatri Kliniği'nde ayaktan tedavi başlanan, 25 tipik antipsikotik ve 38 atipik antipsikotik kullanan toplam 63 hasta alındı. Hastalara tedavinin başlangıcında ve ikinci ayın sonunda Pozitif Belirtileri değerlendirme Ölçeği (SAPS), Negatif Belirtileri Değerlendirme Ölçeği (SANS), Hamilton Depresyon Derecelendirme Ölçeği (HDRS) ve Kısa Kognitif Muayene (KKM) Ölçeği uygulandı. Sonuç: Yirmi dört tipik antipsikotik ve 31 atipik antipsikotik kullanan toplam 55 hasta çalışmayı tamamladı. Atipik antipsikotik ilaç kullanan hasta grubunda ikinci ayın sonunda bilişsel bozukluğun şiddetinde anlamlı düzelme saptanmıştır. Ancak tipik antipsikotik kullanan hasta grubu ile atipik antipsikotik kullanan hasta grubu arasında bilişsel bozukluğun şiddetindeki düzelme açısından anlamlı fark saptanmamıştır. Tipik antipsikotik grubunda bilişsel işlevlerdeki düzelme hem negatif hem de pozitif belirtilerdeki düzelmeyle anlamlı olarak ilişkili bulunurken, atipik antipsikotik grubunda ise bilişsel işlevlerdeki düzelme sadece negatif belirtilerdeki düzelmeyle ilişkili bulunmuştur. Tartışma: Çalışmamızda atipik ve tipik antipsikotik ilaçların bilişsel işlevlerde anlamlı oranda düzelmeye neden olduğu bulunmuştur. Ancak bu konuda tüm değişkenlerin kontrol edildiği, izlem süresinin daha uzun olduğu ve hastaların randomize olarak seçildiği daha geniş örneklemli çalışmalara ihtiyaç vardır.
Anahtar Kelimeler:

Nörodavranışsal belirtiler, Şizofreni, Antipsikotik ajanlar

The effect of atypical antipsychotics on MMSE in schizophrenic patients: A naturalistic and comparative study with typical antipsychotics

Objective: To investigate the effect of atypical antipsychotic drugs on cognitive dysfunction in schizophrenia and to compare this effect with typical antipsychotics. Method: Sixty-three patients from Ege University Faculty of Medicine Department of Psychiatry who was treated as outpatient were enrolled to study. Twenty-five patients were on typical antipsychotic treatment and the rest 38 patients were on atypical. We applied Scale for Assessment of Positive and Negative Symptoms (SANS and SAPS), Hamilton Depression Rating Scale (HDRS) and MMSE at the beginning of treat-ment and at the end of second month to all patients. Results: Fifty-five patients of whom 24 were on typical and 31 on atypical antipsychotic treatment completed the study. The severity of cognitive dysfunction in atypical antipsychotic group significantly decreased at the end of second month. There was no significant difference between typical and atypical antipsychotic groups in decreasing the severity of cognitive dysfunction. The improvement of cognitive dysfunction in typical antipsychotic group is significantly correlated with both the improvement in negative and positive symptoms while the improvement of cognitive dysfunction in atypical antipsychotic group is only significantly correlated with the improvement in negative, symptoms. Discussion: We found that both typical and atypical antipsychotics significantly improve cognitive functions in schizophrenia. Randomized, long term and larger sampled studies where more variables might be controlled are needed on this issue.
Keywords:

Neurobehavioral Manifestations, Schizophrenia, Antipsychotic Agents,

PDF

___

  • 1. Lindström LH. Long-term clinical and social outcome studies in schizophrenia in relation to the cognitive and emotional side effects of antipsychotic drugs. Acta Psychiatr Scand 1994; 89 (suppl 380):74-76.
  • 2. Weinberger DR, Gallhofer B. Cognitive function in schizophrenia. Int Clin Psychopharmacology 1997; 12 (suppl 4):S29-S36.
  • 3. Borison RL. The role of cognition in the risk-benefit and safety analysis of antipsychotic medication. Acta Psychiatr Scand 1996; 94:5-11.
  • 4. Mortimer AM. Cognitive functions in schizophrenia-Do neuroleptics make difference? Pharmacol Biochem Behav 1997; 56:789-795.
  • 5. Ganguli R, Brar JS, Vemulapalli H, Jafar H, Ahuja R, Sharma S ve ark. Mini-Mental State Examination (MMSE) performance of partially remitted community-dwelling patients with schizophrenia. Schizophr Res 1998; 33:45-52.
  • 6. Gallhofer B, Lis S, Meyer-Lindenberg A, Krieger S. Cognitive dysfunction in schizophrenia: a new set of tools for the assessment of cognition and drug effects. Acta Psychiatr Scand 1999; 99 (Suppl 395): 118-128.
  • 7. Hagger C, Buckley P, Kenny JT, Friedman L, Ubogy D, Meltzer HY. Improvement in cognitive function and psychiatric symptoms in treatment-refractory schizophrenic patients receiving clozapine. Biol Psychiatry 1993; 34:702-712.
  • 8. Goldberg TE, Torrey EF, Gold JM, Ragland JD, Bigelow LB, Weinberger DR. The effect of clozapine on cogniton and psychiatric symptoms in patients with schizophrenia. Br J Psychiatry 1993; 162:43-48.
  • 9. Buchanan RW, Holstein C, Breier A. The comparative efficacy and long-term effect of clozapine treatment on neuropsychological test performance. Biological Psychiatry 1994; 36:717-725.
  • 10. Stip E, Lussier I. The effect of risperidone on cognition in patients with schizophrenia. Canadian Journal Psychiatry 1996; 41(Suppl 2):35-40.
  • 11. Rossi A, Mancini F, Stratta P, Mattei P, Gismondi R, Pozzi F ve ark. Risperidone, negative symptoms, and cognitive deficit in schizophrenia: An open study. Acta Psychiatr Scand 1997; 95:40-43.
  • 12. Lee MA, Jayathilake K, Meltzer HY. A comparison of the effect of clozapine with typical neuroleptics on cognitive function on neuroleptic responsive schizophrenia. Schizophrenia Research 1999; 37:1-11.
  • 13. Meltzer HY, Mc Gurk SR. The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia. Schizophrenia Bulletin 1999; 25:233-255.
  • 14. Pallanti S, Quercioli L, Pazzagli A. Effects of clozapine on awareness of illness and cognition in schizophrenia. Psychiatry Res 1999; 86:239-245.
  • 15. Weiser M, Shneider-Beeri M, Nakash N ve Brill N, Bawnik O, Reiss S ve ark. Improvement in cognition associated with novel antipsychotic drugs: a direct drug effect or reduction of EPS? Schizophr Res 2000; 46:81-89.
  • 16. Cuesta MJ, Peralta V, Zarzuela A. Effects of olanzapine and other antipsychotics on cognitive function in chronic schizophrenia: a longitudinal study. Schizophr Res 2001; 48:17-28.
  • 17. Barkic J, Filakovic P, Radanovic-Grguric L, Koic O, Laufer D, Pozgain I ve ark. The influnce of risperidone on cognitive functions in schizophrenia. Coll Antropol 2003; 27 (Suppl 1):111-118.
  • 18. Harvey PD, Siu CO, Romano S. Randomized, controlled, double-blind, multicenter comparison of the cognitive effects of ziprasidone versus olanzapine in acutely ill inpatient with schizophrenia or schizoaffective disorder. Psychopharmacology 2004; 172:324-332.
  • 19. Sharma T, Hughes C, Soni W, Kumari V. Cognitive effects of olanzapine and clozapine treatment in chronic schizophrenia. Psychopharmacology 2003; 169:398-403.
  • 20. Stip E, Remington GJ, Dursun SM, Reiss JP, Rotstein E, MacEwan GW ve ark. A Canadian multicenter trial assessing memory and executive functions in patients with schizophrenia spectrum disorders treated with olanzapine. J Clin Psychopharmacol 2003; 23:400-404.
  • 21. American Psychiatric Association. Diagnostic Criteria from DSM-IV. American Psychiatric Association, Washington DC, 1994.
  • 22. Kayatekin MS, Öztürk MD, Savaşır I. Kısa Kognitif Muayene (KKM) çizelgesinin güvenilirlik ve geçerlilik çalışmaları. Düşünen Adam 1986; 1:63-66.
  • 23. Erkoç Ş, Arkonaç O, Ataklı C, Özmen E. Pozitif Semptomları Değerlendirme Ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam 1991a; 4:20-24.
  • 24. Erkoç Ş, Arkonaç O, Ataklı C, Özmen E. Negatif Semptomları Değerlendirme Ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam 1991b; 4:16-19.
  • 25. Kaplan HI, Sadock BJ. Kaplan and Sadock’s synopsis of psychiatry: behavioral sciences, clinical psychiatry. Eighth Edition. Baltimore, Williams and Wilkins, 1997a, s.1083-1092,1107,
  • 26. Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003; 64:663-667.
  • 27. Kaplan HI, Sadock BJ. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. Sekizinci baskı, Baltimore, Williams and Wilkins, 1997b, s.1996,
  • 28. Galletly CA, Clark CR, Mc Farlane AC, Weber DL. Relationships between changes in symptom ratings, neurophysiological test performance and quality of life in schizophrenic patients treated with clozapine. Psychiatry Res 1997; 72:161-166.
  • 29. Velligan DI, Prihoda TJ, Sui D, Ritch JL, Maples N, Miller AL. The effectiveness of quetiapine versus conventional antipsychotics in improving cognitive and functional outcomes in standard treatment settings. J Clin Psychiatry 2003; 64:524-531.
  • 30. Good KP, Kiss I, Buiteman C, Woodley H, Rui Q, Whitehorn D ve ark. Improvement in cognitive functioning in patients with first episode psychosis during treatment with quetiapine: an interim analysis. Br J Psychiatry Suppl. 2002; 43:45-49.
  • 31. Velligan DI, Newcomer J, Pultz J, Csernansky J, Hoff AL, Mahurin R ve ark. Does cognitive function improve with quetiapine in comparison to haloperidol? Schizophr Res 2002; 53:239-248.
  • 32. Purdon SE, Malla A, Labelle A, Lit W. Neuropsychological change in patients with schizophrenia after treatment with quetiapine or haloperidol. J Psychiatry Neurosci 2001; 26:137-149.
  • 33. Mazza M, Tozzini C, Giosue P, De Risio A, Palmucci M, Roncone R ve ark. Social cognition and atypical antipsychotic agents in the treatment of persons with schizophrenia: preliminary data from a naturalistic study. Clin Ther 2003; 154:79-83.
  • 34. Chua J, Chong SA, Pang E, Ng VP, Chan YH. The effect of risperidone on cognitive functioning in a sample of Asian patients with schizophrenia in Singapore. Singapore Med J 2001; 42:243-246.
  • 35. Mc Gurk SR, Lee MA, Jayathilake K, Meltzer HY. Cognitive effects of olanzapine treatment in schizophrenia. Med Gen Med 2004; 6:27.
Anadolu Psikiyatri Dergisi-Cover
  • ISSN: 1302-6631
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 2000
  • Yayıncı: -
Arşiv
Sayıdaki Diğer Makaleler

Çok sayıda ruhsal bozukluğu taklit eden bir yapay bozukluk olgusu

Almıla EROL, Suat BAYRAM, Levent METE

Madde bağımlılığını önlemede öğretmen ve ebeveyn eğitimlerinin etkinliğinin değerlendirilmesi

Kültegin ÖGEL, Sevil TANER, Yılmazçetin Ceyda EKE, Bilge EROL

Gaziantep Üniversitesi Mediko-Sosyal Merkezi'nde psikiyatrik açıdan incelenen öğrencilerin klinik ve sosyo-demografik özellikleri

Necmeddin İNANÇ, Haluk A. SAVAŞ, Hamdi TUTKUN, Hasan HERKEN, Esen SAVAŞ

Bipolar affektif bozukluklu hastalarda lityum ve olanzapin tedavisinin etkileri: Beyin MRSs bulguları

Elbozan Birgül CUMURCU, Rifat KARLIDAĞ, Kaya SARAÇ, SÜHEYLA ÜNAL, Cemal ÖZCAN

Atipik antipsikotik ilaçların şizofreni hastalarında kısa kognitif muayene (KKM) üzerine etkisi: Tipik antipsikotiklerle karşılaştırılmalı-doğal izlem çalışması

BÜLENT KAYAHAN, Baybars VEZNEDAROĞLU, Özgür ÖZTÜRK, Mehmet Akif ERSOY