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Cognitive effects of conventional and atypical antipsychotics in schizophrenia

Published online by Cambridge University Press:  06 August 2018

Tonmoy Sharma
Tonmoy Sharma*
Affiliation:
Institute of Psychiatry, London
*
Correspondence: Dr T. Sharma, Section of Cognitive Psychopharmacology, Department of Psychological Medicine, Institute of Psychiatry, Denmark Hill, London SE5 8AF. Tel: 0171 9193342; Fax: 01717405208; e-mail: [email protected]
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Extract

“Mental efficiency is always diminished to a considerable extent. The patients are distracted, inattentive, tired, dull, do not take pleasure in work, their mind wanders, they lose the connection, they ‘cannot keep the thought in mind‘…” (Kraepelin, 1898)

Cognitive dysfunction has long been recognised as a cardinal feature of schizophrenia, dating back to Kraepelin's description of dementia praecox (1919). Cognitive dysfunction in schizophrenia is seen early in the illness and is initially mild, increasing in severity in some chronic patients. It is recognised as a primary and pervasive deficit that is independent of positive symptoms in that it persists after resolution of acute symptoms. It is not restricted to a subgroup and is seen to a greater or lesser extent in almost all patients suffering from schizophrenia (Goldberg et al, 1990).

Type
Research Article
Information
The British Journal of Psychiatry , Volume 174 , Issue S38: New antipsychotics - preclinical and clinical comparisons , May 1999 , pp. 44 - 51
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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References

Andreasen, N. C., Rezai, K., Alliger, R., et al (1992) Hypofrontality in neuroleptic-naive patients and in patients with chronic schizophrenia. Assessment with xenon-133 single-photon emission computed tomography and the Tower of London. Archives of General Psychiatry, 49, 943–958.Google Scholar
Benton, A. L. (1974) The Revised Visual Retention Test (4th edn). New York: Psychological Corporation.Google Scholar
Benton, A. L. & Hamsher, K. de S. (1989) Multilingual Aphasia Examination. Iowa City, IO: University of Iowa, AJA Associates.Google Scholar
Berman, K. F., F., Zec, R. & Weinberger, D. R. (1986) Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. II. Role of neuroleptic treatment, attention and mental effort. Archives of General Psychiatry, 43, 126–135.Google Scholar
Bilder, R. M., Lipschutz Broch, L., Reiter, G., et al (1992a) Intellectual deficits in first-episode schizophrenia: evidence for progressive deterioration. Schizophrenia Bulletin, 18, 437–448.Google Scholar
Bilder, R., Turkei, E., Lipschutz Broch, L., et al (1992b) Antipsychotic medication effects on neuropsychological functions. Psychopharmacology Bulletin, 28, 353–366.Google Scholar
Braff, D. L. & Geyer, M. A. (1990) Sensorimotor gating and schizophrenia. Human and animal model studies. Archives of General Psychiatry, 47, 181–188.Google Scholar
Buchanan, R. W., Holstein, C. & Breier, A. (1994) The comparative efficacy and long-term effect of clozapine treatment on neuropsychological test performance. Biological Psychiatry, 36, 717–725.Google Scholar
Carter, C. S., Robertson, L. C. & Nordahl, T. E. (1992) Abnormal processing of irrelevant information in chronic schizophrenia: selective enhancement of Stroop facilitation. Psychiatry Research, 41, 37–46.Google Scholar
Carter, C. S., Robertson, L. C. & Nordahl, T. E., et al (1993) Abnormal processing of irrelevant information in schizophrenia: the role of illness subtype. Psychiatry Research, 48, 17–26.Google Scholar
Cassens, G., Inglis, A. K., Applebaum, P. S., et al (1990) Neuroleptics: effects on neuropsychological function in chronic schizophrenic patients. Schizophrenia Bulletin, 16, 477–499.Google Scholar
Classen, W. & Laux, G. (1988) Sensorimotor and cognitive performance of schizophrenic inpatients treated with haloperidol, flupenthixol or clozapine. Pharmacopsychiatry, 21, 295–297.Google Scholar
Cleghorn, J. M., Kaplan, R. D., Szechman, B., et al (1990) Neuroleptic drug effects on cognitive function in schizophrenia. Schizophrenia Research, 3, 211–219.Google Scholar
Cohen, J. D. & Servan Schreiber, D. (1992) Context, cortex, and dopamine: a connectionist approach to behavior and biology in schizophrenia. Psychological Review, 99, 45–77.Google Scholar
Damasio, A. & Anderson, S. W. (1993) The frontal lobes. In Clinical Neuropsychology (eds Helman, K. M. and Valenstein, E.), pp. 409–460. New York: Oxford University Press.Google Scholar
Daniel, D. G. (1994) Comparison of risperidone and clozapine on clinical cognitive functions in psychotic disorders (abstract). Biological Psychiatry, 35, 667.Google Scholar
Davidson, M. & Keefe, R. S. (1995) Cognitive impairment as a target for pharmacological treatment in schizophrenia. Schizophrenia Research, 17, 123–129.Google Scholar
Delahunty, A., Morice, R. & Frost, B. (1993) Specific cognitive flexibility rehabilitation in schizophrenia. Psychological Medicine, 23, 221–227.Google Scholar
Dimascio, A., Havens, L. L. & Klerman, G. L. (1963) The psychopharmacology of phenothiazine compounds: a comparative study of the effects of chlorpromazine, promethiazine, trifluoperazine and perphenazine in normal males. Introduction, aims and methods. Journal of Nervous and Mental Disease, 136, 15–28.Google Scholar
Farde, L. & Nordstrom, A.-L. (1992) PETanalysis indicates atypical central dopamine receptor occupancy in clozapine-treated patients. British Journal of Psychiatry, 160 (suppl. 17), 30–33.CrossRefGoogle Scholar
Fujii, D. E. M., Ahmed, I., Jokumsen, M., et al (1997) The effects of clozapine on cognitive functioning in treatment-resistant schizophrenic patients. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 240–245.Google Scholar
Gallhofer, B., Bauer, U., Gruppe, H., et al (1996a) First episode schizophrenia: the importance of compliance and preserving cognitive function. Journal of Practical Psychiatry and Behavioral Health, 2, 16S–24S.Google Scholar
Gallhofer, B., Bauer, U., Lis, S., et al (1996b) Cognitive dysfunction in schizophrenia: comparison of treatment with atypical antipsychotic agents and conventional neuroleptic drugs. European Neuropsychopharmacology, 6 (suppl. 2), S13–S20.Google Scholar
Gold, J. M., Randolph, C., Carpenter, C. J., et al (1992) Forms of memory failure in schizophrenia. Journal of Abnormal Psychology, 101, 487–494.Google Scholar
Gold, J. M. & Harvey, P. D. (1993) Cognitive deficits in schizophrenia. Psychiatric Clinics of North America, 16, 295–312.Google Scholar
Goldberg, T. E., Weinberger, D. R., Berman, K. F., et al (1987) Further evidence for dementia of the prefrontal type in schizophrenia? A controlled study of teaching the Wisconsin Card Sorting Test. Archives of General Psychiatry, 44, 1008–1014.Google Scholar
Goldberg, T. E., Ragland, J. D., Torrey, E. F., et al (1990) Neuropsychological assessment of monozygotic twins discordant for schizophrenia. Archives of General Psychiatry, 47, 1066–1072.Google Scholar
Goldberg, T. E., Greenberg, R. D., Griffin, S. J., et al (1993a) The effect of clozapine on cognition and psychiatric symptoms in patients with schizophrenia. British Journal of Psychiatry, 162, 43–48.Google Scholar
Goldberg, T. E., Torrey, E. F., Gold, J. M., et al (1993b) Learning and memory in monozygotic twins discordant for schizophrenia. Psychological Medicine, 23, 71–85.Google Scholar
Green, M. F. (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153, 321–330.Google ScholarPubMed
Green, M. F., Marshall, B. D., Wirshing, M. D., et al (1997) Does risperidone improve verbal working memory in treatment-resistant schizophrenia? American Journal of Psychiatry, 154, 799–804.Google Scholar
Hagger, C., Buckley, P., Kenny, J. T., et al (1993) Improvement in cognitive functions and psychiatric symptoms in treatment-refractory schizophrenic patients receiving clozapine. Biological Psychiatry, 34, 702–712.Google Scholar
Hartley, L. R. (1983) Arousal, temporal and spatial uncertainty and drug effects. Progress in Neurospychopharmacology and Biological Psychiatry, 7, 29–37.Google Scholar
Harvey, P. D., Lombardi, J., Kincaid, M. M., et al (1995) Cognitive functioning in chronically hospitalized schizophrenic patients: age-related changes and age disorientation as a predictor of impairment. Schizophrenia Research, 17, 15–24.Google Scholar
Heaton, R. (1981) Wisconsin Card Sorting Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Heaton, R., Paulsen, J. S., McAdams, L. A., et al (1994) Neuropsychological deficits in schizophrenics. Relationship to age, chronicity, and dementia. Archives of General Psychiatry, 51, 469–476.Google Scholar
Hoff, A. L., Riordan, H., O'Donnell, D. W., et al (1992) Neuropsychological functioning of first-episode schizophreniform patients. American Journal of Psychiatry, 149, 898–903.Google Scholar
Hoff, A. L., Faustman, W. O., Wieneke, M., et al (1996) The effects of clozapine on symptom reduction, neurocognitive function, and clinical management in treatment-refractory state hospital schizophrenic inpatients. Neuropsychopharmacology, 15, 361–369.Google Scholar
Jaeger, J. & Douglas, E. (1992) Neuropsychiatric rehabilitation for persistent mental illness. Psychiatry Quarterly, 63, 71–94.Google Scholar
Kane, J., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.Google Scholar
Keefe, R. S., Roitman, S. E., Harvey, P. D., et al (1995) A pen-and-paper human analogue of a monkey prefrontal cortex activation task: spatial working memory in patients with schizophrenia. Schizophrenia Research, 17, 25–33.Google Scholar
Kenny, J. T. & Meltzer, H. Y. (1991) Attention and higher cortical functions in schizophrenia. Journal of Neuropsychiatry and Clinical Neuroscience, 3, 269–275.Google Scholar
King, D. J. (1990) The effect of neuroleptics on cognitive and psychomotor function. British Journal of Psychiatry, 157, 799–811.Google Scholar
King, D. J. (1994) Psychomotor impairment and cognitive disturbances induced by neuroleptics. Acta Psychiatrica Scandinavica, 380 (suppl. 38), 53–58.Google Scholar
Kornetsky, C., Pettit, M., Wynne, R., et al (1959) A comparison of the psychological effects of acute and chronic administration of chlorpromazine and secobarbital (quinalbarbitone) in schizophrenic patients. Journal of Mental Science, 105, 190–198.Google Scholar
Kraepelin, E. (1919) Dementia Praecox and Paraphrenia. Edinburgh: Livingstone.Google Scholar
Kremen, W. C., Tsuang, M. T., Faraone, S. V., et al (1992) Using vulnerability indicators to compare conceptual models of genetic heterogeneity in schizophrenia. Journal of Nervous and Mental Disease, 180, 141–152.Google Scholar
Lee, M. A., Thompson, P. A. & Meltzer, H. Y. (1994) Effects of clozapine on cognitive function in schizophrenia. Journal of Clinical Psychiatry, 55 (suppl. B), 82–87.Google Scholar
Lieberman, J. A., Saltz, B. L., Johns, C. A., et al (1991) The effects of clozapine on tardive dyskinesia. British Journal of Psychiatry, 158, 503–510.Google Scholar
Liljequist, R., Linnoila, M. & Mattila, M. J. (1978) Effects of two weeks treatment with thioridizine, chlorpromazine, sulpiride and bromazepam, alone or in combination with alcohol, on learning and memory in man. Psychopharmacalogia, 55, 205–208.Google Scholar
McKenna, P. J., Tamlyn, D., Lund, C. E., et al (1990) Amnesic syndrome in schizophrenia. Psychological Medicine, 20, 967–972.Google Scholar
Marder, S. R. & Meibach, R. C. (1994) Risperidone in the treatment of schizophrenia. American Journal of Psychiatry, 151, 825–835.Google Scholar
Medallia, A., Gold, J. & Merriam, A. (1988) The effects of neuroleptics on neuropsychological test results of schizophrenics. Archives of Clinical Neuropsychology, 3, 249–271.Google Scholar
Meltzer, H. Y. (1991) The mechanism of action of novel atypical antipsychotic drugs. Schizophrenia Bulletin, 17, 263–287.Google Scholar
Meltzer, H. Y. (1992) Dimensions of outcome with clozapine. British Journal of Psychiatry, 160 (suppl. 17), 46–53.Google Scholar
Mirsky, A. F., Primae, D. W. & Bates, R. (1959) The effects of chlorpromazine and secoarbital on the continuous performance test. Journal of Nervous and Mental Disease, 128, 12–17.Google Scholar
Morice, R. (1990) Cognitive inflexibility and prefrontal dysfunction in schizophrenia and mania. British Journal of Psychiatry, 157, 50–54.Google Scholar
Nelson, H. E., Pantelis, C., Carruthers, K., et al (1990) Cognitive functioning and symptomatology in chronic schizophrenia. Psychological Medicine, 20, 357–365.Google Scholar
Nuechterlein, K. H. (1983) Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive children. Journal of Abnormal Psychology, 92, 4–28.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H. & Dawson, M. E. (1984) Information processing and attentional functioning in the developmental course of schizophrenic disorders. Schizophrenia Bulletin, 19, 160–203.Google Scholar
Nuechterlein, K. H. & Dawson, M. E. & Green, M. F. (1994) Information-processing abnormalities as neuropsychological vulnerability indicators for schizophrenia. Acta Psychiatrica Scandinavica, (suppl. 384), 71–79.Google Scholar
Oltmanns, T. F. & Neale, J. M. (1975) Schizophrenic performance when distractors are present: attentional deficit or differential task difficulty? Journal of Abnormal Psychology, 84, 205–209.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychiatric Reports, 10, 799–812.Google Scholar
Park, S. & Holzman, P. S. (1992) Schizophrenics show spatial working memory deficits. Archives of General Psychiatry, 49, 975–982.Google Scholar
Plisken, N., Raz, N., Raz, S., et al (1987) Neuroleptic withdrawal and deterioration of verbal fluency in schizophrenia: a preliminary report. Journal of Clinical Experimental Neuropsychology, 9, 62.Google Scholar
Rappaport, B. J., Webster, J. S. & Dutra, R. L. (1994) Digit span performance and unilateral neglect. Neuropsychologia, 32, 517–525.Google Scholar
Robins, T. W. & Brown, V. B. (1990) The role of the striatum in the mental chronometry of action: a theoretical review. Review of Neuroscience, 2, 181–204.Google Scholar
Rosvold, H. E., Mirsky, A. F., Sarason, A. F., et al (1956) A continuous performance test of brain damage. Journal of Consulting Psychology, 20, 343–350.Google Scholar
Roxborough, H., Muir, W. J., Blackwood, D. H. R., et al (1993) Neuropsychological and P300 abnormalities in schizophrenics and their relatives. Psychological Medicine, 23, 305–314.Google Scholar
Saletu, B., Grunberger, J., Linzmayer, L., et al (1987) Comparative placebo-controlled pharmacodynamic studies with zotepine and clozapine utilizing pharmaco-EEG and psychometry. Pharmacopsychiatry, 20, 12–27.Google Scholar
Saykin, A. J., Gur, R. C., Gur, R. E., et al (1991) Neuropsychological function in schizophrenia. Selective impairment in memory and learning. Archives of General Psychiatry, 48, 618–624.Google Scholar
Saykin, A. J., Shtasel, D. L., Gur, R. E., et al (1994) Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Archives of General Psychiatry, 51, 124–131.Google Scholar
Schreiber, H., Stolz Born, G., Kornhuber, H. H., et al (1992) Event-related potential correlates of impaired selective attention in children at high risk for schizophrenia. Biological Psychiatry, 32, 634–651.Google Scholar
Sharma, T. (1995) Structural and functional endophenotypes in schizophrenia. In Neurobiology and Psychiatry (ed. Kerwin, R.), vol. 3, pp. 25–32. Cambridge: Cambridge University Press.Google Scholar
Sharma, T. (1996) Schizophrenia: recent advances in psychopharmacology. British Journal of Hospital Medicine, 55, 194–198.Google Scholar
Sharma, T. & Mockler, D. (1998) The cognitive efficacy of atypical antipsychotics in schizophrenia. Journal of Clinical Psychopharmacology, 2, (suppl. 1), 12S–19S.Google Scholar
Spohn, H. E. & Strauss, M. E. (1989) Relation of neuroleptic and anticholinergic medication to cognitive functions in schizophrenia. Journal of Abnormal Psychology, 98, 367–380.Google Scholar
Sullivan, E. V., Mathalon, D. H., Ha, C. N., et al (1992) The contribution of constructional accuracy and organizational strategy to nonverbal recall in schizophrenia and chronic alcoholism. Biological Psychiatry, 32, 312–333.Google Scholar
Sweeney, J. A., Keilp, J. G., Haas, G. L., et al (1991) Relationships between medication treatments and neuropsychological test performance in schizophrenia. Psychiatry Research, 37, 297–308.Google Scholar
Sweeney, J., Haas, G. L. & Li, S. (1992) Neuropsychological and eye movement abnormalities in first-episode and chronic schizophrenia. Schizophrenia Bulletin, 18, 283–293.CrossRefGoogle ScholarPubMed
Talland, G. A. (1965) Deranged Memory. New York: Academic Press.Google Scholar
Treisman, A. & Fearnley, S. (1969) The Stroop test: selective attention to colours and words. Nature, 222, 437–439.Google Scholar
Tune, L. E., Lew, M. F., Breitlinger, E., et al (1982) Serum levels of anticholinergic drugs and impaired recent memory in chronic schizophrenic patients. American Journal of Psychiatry, 139, 1460–1462.Google Scholar
Waddington, J. L., Youssef, H. A. & Kinsella, A. (1990) Cognitive dysfunction in schizophrenia followed up over 5 years and its longitudinal relationship to the emergence of tardive dyskinesia. Psychological Medicine, 20. 835–842.Google Scholar
Walker, E. (1981) Attentional and neuro-motor functions in schizophrenia, schizoaffectives and patients with other affective disorders. Archives of General Psychiatry, 38, 1355–1358.Google Scholar
Wechsler, D. (1974) WISC-R Manual. Wechsler Intelligence Scale for Children – Revised. New York: Psychological Corporation.Google Scholar
Wechsler, D. (1981) WAIS-R Manual. Wechsler Adult Intelligence Scale – Revised. New York: Psychological Corporation.Google Scholar
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