P.1.j.051 Effects atypical and conventional antipsychotics on
cognition in schizophrenia
A. Arous1, W. Chebbi1, J. Mrizak1, H. Ben Ammar1, Z. El Hechmi1.
1
Razi Hospital, Psychiatry ward F, Mannouba, Tunisian Republic. Background :
Neurocogntive impairement are core features of schizophrenia. This cognitive deficiency is now recognized as a major element of
social and professional integration of these patients. It is admitted that atypical antipsychotics have fewer side effects than
conventional antipsychotic and improve cognition. Although, effects of typical and atypical antipsychotic medications on
neurocognition is controversial with considerable variations in the methodology and results.
The aim of the study was to compare cognitive functions in patients with schizophrenia treated by different antipsychotics (haloperidol,
olanzapine, risperidone)
Methods :
27 patients with stable schizophrenia were treated by monotherapy with haloperidol or olanzapine or risperidone. Symptomatology
evaluation comprised: The Positive and Negative Syndrome Scale (PANSS). Patients also completed a neurocognitive battery
comprising the following tests : the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the
Stroop Test (ST), the « Double Barrage » of Zazzo test (DBZ),the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the
Trail Making Test-Part A (TMT-A) and the Digit Span (DS).
Table I : Comparaison between the groups on tests evaluating memory
Resultats and discussion
Tests
Groupe
Groupe
Groupe
P
Patients under treatment with atypical atypsychotics
«H»
«O»
«R»
showed significant better cognitive performance HVLT
compared to patients treated with haloperidol. These
Immediate recall
20,66 +3,51
22,60 +4,33
18,50 +3,00
0,046
results were confirmed by many studies in different
Delayed recall
8,66 +1,52
8,00 +3,24
7,50 +3,00
0,869
population ; elderly patients [1], patients with treatement
Delayed recognition 9,66 +2,08
9,60 +2,30
9,25 +1,50
0,954
refractory [2] or in early psychosis [3].
Empan test
However patients under treatment with olanzapine
Empan direct
5,00 +1,41
4,60 +0,89
4,00 +0,81
0,463
showed significantly better results on verbal learning and
Empan indirect
2,88 +0,79
3,00 +1,00
3,25 +0,95
0,911
memory tested by the Hopkins Verbal Learning Test
Verbal fluency
12,92 +4,500 13,67 +3,497 10,50 +1,73
0,075
(p=0,046). There were not a significant difference
betwen the three groups on other tests evaluating
memory. Purdon and al [4] found also that olanzapine
« H » = Haloperidol; « 0 » = olanzapine; « R » = Risperidone
was associated with a significantly greater change from
baseline on RAVLT performance after 54 weeks in the Table II: Comparaison between the groups on tests evaluating attention
group of patients with early-phase schizophrenia (mean
Tests
Groupe
Groupe « O » Groupe « R »
P
scores, 44.30 for risperidone and 50.00 for olanzapine; P
«H»
= 0.043).
DBZ
Our study showed also a significant difference in R1
11,35 +6,35 12,96 +7,20
3,98 +1,97
0,108
attention tested by the Double Barrage of Zazzo test in R2
0,144
10,71 +5,90 13,05 +7,89
4,20 +2,58
favor of olanzapine (p=0,017). In littérature, there is four Execution time
362 +50,37 271,80 +46,33 523,25 +48,86
0,017
studies [5] used the CPT to compare the effects of
LDST
17,66 +3,05 19,40 +6,46
15,50 +5,74
0,604
risperidone and other atypical antipsychotics on
attention/ vigilance and in which we didn’t find any
Table III : Comparaison between the groups on tests evaluating
difference between different groups.
executive functions
On the executive functions, there was not a significant
Tests
Groupe «
Groupe « O » Groupe « R »
p
difference in scores of the stroop test and the Modified
Card Sorting Test between the three groups of patients.
H»
Conclusion :
Our study showed a greater neurocognitive function in
patients treated by olanzapine rather than with
risperidone or haloperidol especially in the domains of
verbal learning and memory as well as attention in
patients with schizophrenia. These differences may be
useful supplemental guides in clinical practice to improve
outcomes.
References
1. Harvey PD, Napolitano JA, Mao L, Gharabawi G. Comparative effects of risperidone and olanzapine on
cognition in elderly patients with schizophrenia or schizoaffective disorder. Int J Geriatr Psychiatry.
2003;18:820‑9.
2. Keefe RSE, Seidman LJ, Christensen BK, Hamer RM, Sharma T, Sitskoorn MM, et al. Comparative effect of
atypical and conventional antipsychotic drugs on neurocognition in first-episode psychosis: a randomized,
double-blind trial of olanzapine versus low doses of haloperidol. Am J Psychiatry. 2004;161:985‑95.
3. Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman B, et al. Neurocognitive effects of
clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective
disorder. Am J Psychiatry. 2002;159:1018‑28.
4. Purdon SE, Jones BD, Stip E, Labelle A, Addington D, David SR, et al. Neuropsychological change in early
phase schizophrenia during 12 months of treatment with olanzapine, risperidone, or haloperidol. The Canadian
Collaborative Group for research in schizophrenia. Arch Gen Psychiatry. 2000;57:249‑58.
5. Harvey PD, Green MF, McGurk SR, Meltzer HY. Changes in cognitive functioning with risperidone and
olanzapine treatment: a large-scale, double-blind, randomized study. Psychopharmacology (Berl). 2003.
TMT-A temps (s)
WCST
60,50 +24,74 96,40 +27,63
94,25 +17,46
0,712
Execution time
378,33
352,60
430,00
0,123
Catégories number
6,33 +1,15
5,40 +2,50
3,75 +1,50
0,255
Number of error
9,00 +5,00
11,60 +6,68
18,75 +6,87
0,524
Execution time A
120,50
116,60
168,33
0,790
Execution time B
98,50
78,40
132,66
0,290
Execution time C
167,50
218,60
224,00
0,759
7,00 +2,82
5,80 +1,92
4,00 +2,16
0,281
Le test de Stroop
Verbal fluency