治疗高血压之关键在于改善精神分裂症患者之认知?


  【24drs.com】一篇新研究认为高血压和精神分裂症者的认知受损有关,认为治疗高血压可改善此类心智疾病患者的结果。
  
  这篇小型研究发现,相较于对照组,高脉搏压与精神分裂症患者的广义神经认知缺陷有关。
  
  研究作者、纽约州立大学Lindsay F. Morra博士与Gregory P. Strauss博士指出,这些研究结果支持代谢异常对于精神分裂症患者之广义神经认知缺陷的影响,也认为治疗高血压可能有助于缓解这些患者的认知缺陷。
  
  这篇研究在线发表于7月7日 、致Schizophrenia Research期刊的一封信中。
  
  尽管精神分裂症患者的代谢异常率增加,且事实上,在一般人中,代谢异常对认知缺陷具有明确的影响,但少有研究探讨精神分裂症患者的此一关联。
  
  研究者在27名临床稳定的门诊精神分裂症或分裂情感性障碍患者、以及33名精神与神经系统健康的对照组探讨此一关联,所有研究对象的年龄、性别、父母的教育和种族相似。
  
  研究对象完成神经精神检测问卷,包括:DSM-IV之结构式诊断晤谈量表(Structured Clinical Interview for DSM-IV)、简要负性症状量表(Brief Negative Symptom Scale)、简要精神疾病量表(Brief Psychiatric Rating Scale)以及MATRICS 共识认知量表(MATRICS Consensus Cognitive Battery [MCCB])。
  
  研究也测量了各种代谢因素,主要根据血压值分类高血压,动脉血压是在肱动脉测量,禁食整夜后、在早上8-10点测量空腹血糖值,用卷尺测量腰臀围比。
  
  结果显示,较高的脉搏压可以预测精神分裂症患者的广义神经认知缺陷,但健康对照组则无。
  
  精神分裂症患者中,脉搏压较高与更糟糕的处理速度(P < .01)、注意/警觉(P < .01)、操作记忆(P = .04)、语言学习(P = .02)、视觉学习(P = .02)以及整体认知(P < .01)有关。
  
  不论是精神分裂症患者或对照组,血压值和腰臀围比与认知之间都没有显著关联。
  
  作者们指出,研究限制包括:样本数少、没有测量其它已知的影响认知的因素,如氧化压力与发炎,事实上,已知MCCB对于局部回路功能和区别特定认知范围的分析是不精确的。
  
  他们写道,未来的研究可能要使用其它方法,如认知神经科学检测、神经影像、电生理学,以更精准评估认知功能范围。
  
  目前的治疗选项包括促进认知药物和认知补救方案,对于精神分裂症患者的效果有限。
  
  研究者指出,他们的研究结果对于精神分裂症患者的认知缺陷治疗可能有重大影响。
  
  作者们结论指出,这些研究结果支持代谢异常对于精神分裂症患者的广义神经认知缺陷有所影响,认为治疗高血压对于精神分裂症的认知缺陷补救,是一个新的辅助治疗目标。
  
  费城宾州大学Perelman医学院精神科教授Raquel Gur博士对研究结果发表评论时表示,没有足够信息让我们审慎评估医师们可从本研究中获得的重要意义和潜在结论。
  
  她指出,样本数少,研究对象的年龄信息、医疗史、共病症、使用的药物等,诸多因素都未纳入。
  
  资料来源:http://www.24drs.com/
  
  Native link:Treating High BP Key to Improved Cognition in Schizophrenia?

Treating High BP Key to Improved Cognition in Schizophrenia?

By Fran Lowry
Medscape Medical News

A new study links hypertension to cognitive impairment in schizophrenia, suggesting the possibility that treating high blood pressure may improve outcomes in patients with this mental illness.

In a small study, higher pulse pressure was found to be associated with generalized neurocognitive deficit in patients with schizophrenia in comparison with control persons.

The finding provides support for the role of metabolic abnormalities in the generalized neurocognitive deficits seen in patients with schizophrenia and also suggests that treatment of hypertension may help alleviate cognitive deficits in these patients, study authors Lindsay F. Morra, PhD, and Gregory P. Strauss, PhD, State University of New York at Binghamton, note.

The research was published online July 7 in a communication to Schizophrenia Research.

Novel Adjunctive Treatment

Despite increased rates of metabolic abnormalities in schizophrenia patients and the fact that in the general population, metabolic abnormalities play a clear role in cognitive impairment, few studies have examined the association in patients with schizophrenia.

The investigators explored this association in 27 outpatients with schizophrenia or schizoaffective disorder whose conditions were clinically stable and in 33 psychiatrically and neurologically healthy control persons. All study participants were similar with respect to age, sex, parental education, and ethnicity.

Participants completed a battery of neuropsychological tests, including the Structured Clinical Interview for DSM-IV, the Brief Negative Symptom Scale, the Brief Psychiatric Rating Scale, and the MATRICS Consensus Cognitive Battery (MCCB).

Various metabolic factors were also measured. Blood pressure was the primary dependent measure used to index hypertension. Arterial blood pressure was measured at the brachial level. Fasting blood glucose levels were measured between 8:00 am and 10:00 am after an overnight fast. Waist-to-hip ratio was taken using a cloth measuring tape.

Results showed that higher pulse pressure was predictive of generalized neurocognitive deficit in schizophrenia patients but not in healthy control persons.

In schizophrenia patients, higher pulse pressure was associated with worse processing speed (P < .01), attention/vigilance (P < .01), working memory (P = .04), verbal learning (P = .02), visual learning (P = .02), and global cognition (P < .01).

There was no significant relationship between blood glucose levels and waist-to-hip ratio and cognition either in patients with schizophrenia or control persons.

The authors note that the limitations of their study include small sample size, failure to measure other factors known to affect cognition, such as oxidative stress and inflammation, and the fact that the MCCB is known to be imprecise in localizing circuit level function and in isolating specific cognitive domains.

"Future studies may want to use other approaches such as cognitive neuroscience measures, neuroimaging, and electrophysiology, which evaluate more precise domains of cognitive function," they write.

Current treatment options, which include cognition-enhancing drugs and cognition remediation programs, are of limited benefit for patients with schizophrenia.

The researchers note that their findings may have significant implications for the treatment of cognitive impairment in schizophrenia patients.

"These findings provide support for the role of metabolic abnormalities in the generalized neurocognitive deficit in schizophrenia, and suggest that treatment of hypertension may be a novel adjunctive treatment target for remediating cognitive deficits in schizophrenia," the authors conclude.

Not Enough Information

Commenting on the findings for Medscape Medical News, Raquel Gur, MD, PhD, professor of psychiatry at the University of Pennsylvania Perelman School of Medicine, Philadelphia, said there is "not enough information for us to critically evaluate the significance and potential conclusions that the clinician should take away from this.

"The sample is small, the information on the age of the participants, the past medical history, comorbidity, medications that they are on ─ there are so many factors that are not there," she added.

The study was supported by the US National Institute of Mental Health and the American Psychological Association. Dr Morra has disclosed no relevant financial relationships. Dr Strauss has received royalties and consultation fees from ProPhase LLC in connection with commercial use of the Brief Negative Symptom Scale and other professional activities.

Schizophr Res. Published online July 7, 2016.

    
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