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- It has been well established that schizophrenia patients have
neurocognitive deficits, but it is not known how these deficits influence the daily life
of patients. In a review of the literature on correlates and predictors of functional
outcome, including several studies from our Research Center, the most consistent finding
was that verbal memory was associated with all types of functional outcome. Vigilance was
related to social problem solving and skill acquisition. Verbal memory and vigilance
appear to be necessary for adequate functional outcome. These abilities may restrict the
patient from attaining their optimal adaptation and hence act as "neurocognitive rate
limiting factors."
- Preliminary analyses from a randomized, double-blind, multi-site trial
suggest that treatment resistant schizophrenic subjects randomized to risperidone
treatment had a somewhat greater improvement on measures of psychopathology, much lower
use of anticholinergics (17% versus 50%), and better performance on several neurocognitive
measures.
- Symptom monitoring data has shown that the beginning of periods of
negative symptoms of schizophrenia occurs simultaneously with the beginning of periods of
positive symptoms more often than expected by chance. This finding suggests that these two
dimensions of psychopathology are partially interconnected within subjects.
- In a double-blind comparison of clozapine and haloperidol in treatment
refractory outpatients, Marder and coworkers have reported that 60% of patients met
improvement criteria on clozapine compared with only 12% on haloperidol.
- New antipsychotic medications could potentially impact other aspects of
disability in schizophrenia such as neurocognitive deficits. In a double blind comparison,
risperidone treatment had a beneficial effect on verbal working memory compared with
haloperidol treatment. Neither benztropine status nor psychotic symptom severity were
significantly related to performance at either phase. The beneficial effects of
risperidone on verbal working memory appear to be due, at least partially, to a direct
effect of the drug, possibly through antagonism of the 5-HT2A receptor.
- Analysis of data compiled from five major experimental studies of
"more versus less" neuroleptic in the maintenance treatment of schizophrenia
found no consistent evidence within the low-to-moderate dosage range that higher levels of
neuroleptic treatment were associated with increased disability or poorer role
functioning. Some researchers had speculated that if such effects did exist, they would
alter the cost-benefit ratio for neuroleptic treatment. These analyses confirmed that
lower doses are associated with increased risk of symptom exacerbation, and failed to find
any offsetting advantage to intermittent or other low dose strategies in the domain of
functional outcome. Other factors, such as increased side effects with higher doses,
remain important clinical considerations in maintenance treatment.
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