治療高血壓之關鍵在於改善精神分裂症患者之認知?


  【24drs.com】一篇新研究認為高血壓和精神分裂症者的認知受損有關,認為治療高血壓可改善此類心智疾病患者的結果。
  
  這篇小型研究發現,相較於對照組,高脈搏壓與精神分裂症患者的廣義神經認知缺陷有關。
  
  研究作者、紐約州立大學Lindsay F. Morra博士與Gregory P. Strauss博士指出,這些研究結果支持代謝異常對於精神分裂症患者之廣義神經認知缺陷的影響,也認為治療高血壓可能有助於緩解這些患者的認知缺陷。
  
  這篇研究線上發表於7月7日 、致Schizophrenia Research期刊的一封信中。
  
  儘管精神分裂症患者的代謝異常率增加,且事實上,在一般人中,代謝異常對認知缺陷具有明確的影響,但少有研究探討精神分裂症患者的此一關聯。
  
  研究者在27名臨床穩定的門診精神分裂症或分裂情感性障礙患者、以及33名精神與神經系統健康的對照組探討此一關聯,所有研究對象的年齡、性別、父母的教育和種族相似。
  
  研究對象完成神經精神檢測問卷,包括:DSM-IV之結構式診斷晤談量表(Structured Clinical Interview for DSM-IV)、簡要負性症狀量表(Brief Negative Symptom Scale)、簡要精神疾病量表(Brief Psychiatric Rating Scale)以及MATRICS 共識認知量表(MATRICS Consensus Cognitive Battery [MCCB])。
  
  研究也測量了各種代謝因素,主要根據血壓值分類高血壓,動脈血壓是在肱動脈測量,禁食整夜後、在早上8-10點測量空腹血糖值,用捲尺測量腰臀圍比。
  
  結果顯示,較高的脈搏壓可以預測精神分裂症患者的廣義神經認知缺陷,但健康對照組則無。
  
  精神分裂症患者中,脈搏壓較高與更糟糕的處理速度(P < .01)、注意/警覺(P < .01)、操作記憶(P = .04)、語言學習(P = .02)、視覺學習(P = .02)以及整體認知(P < .01)有關。
  
  不論是精神分裂症患者或對照組,血壓值和腰臀圍比與認知之間都沒有顯著關聯。
  
  作者們指出,研究限制包括:樣本數少、沒有測量其他已知的影響認知的因素,如氧化壓力與發炎,事實上,已知MCCB對於局部迴路功能和區別特定認知範圍的分析是不精確的。
  
  他們寫道,未來的研究可能要使用其他方法,如認知神經科學檢測、神經影像、電生理學,以更精準評估認知功能範圍。
  
  目前的治療選項包括促進認知藥物和認知補救方案,對於精神分裂症患者的效果有限。
  
  研究者指出,他們的研究結果對於精神分裂症患者的認知缺陷治療可能有重大影響。
  
  作者們結論指出,這些研究結果支持代謝異常對於精神分裂症患者的廣義神經認知缺陷有所影響,認為治療高血壓對於精神分裂症的認知缺陷補救,是一個新的輔助治療目標。
  
  費城賓州大學Perelman醫學院精神科教授Raquel Gur博士對研究結果發表評論時表示,沒有足夠資訊讓我們審慎評估醫師們可從本研究中獲得的重要意義和潛在結論。
  
  她指出,樣本數少,研究對象的年齡資訊、醫療史、共病症、使用的藥物等,諸多因素都未納入。
  
  資料來源: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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