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 Recent news - Schizophrenia
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        Reducing Dose of Antipsychotic Drug May Improve Cognitive Function in Patients With Schizophrenia: Presented at AAGP

        By Nancy A. Melville

        LOS ANGELES -- March 19, 2013 -- A reduction in the dose of antipsychotic therapy shows efficacy in reducing cognitive impairment in adults age 50 years and older with schizophrenia, according to results of a pilot study presented at the 2013 Annual Meeting of the American Association for Geriatric Psychiatry (AAGP).

        Cognitive impairment is a key symptom of schizophrenia, and the dopamine receptor blockade by antipsychotic drugs taken by patients with schizophrenia is believed to contribute to cognitive impairment.

        Researchers in previous studies have shown that patients with schizophrenia who have an estimated dopamine D2/3 receptor (D2/3R) occupancy by antipsychotics of 78% or higher demonstrated significantly more cognitive impairment -- particularly in the area of attention -- than did those with lower occupancy levels.

        Shinichiro Nakajima, MD, PhD, Centre for Addiction and Mental Health, Toronto, Ontario, and colleagues evaluated data on 8 patients (4 female) aged 50 years or more from a prospective antipsychotic dose-reduction positron-emission tomography (PET) study in individuals with schizophrenia. He presented the results here on March 15.

        The subjects had been clinically stable and were on oral risperidone at a steady dose of 2 mg/day or higher for at least 6 months.

        The mean dose of the antipsychotic drug risperidone was decreased from 3.4 1.6 mg/day to 2.4 1.0 mg/day (P <.001), and D2/3R occupancy in the putamen decreased from 73 8% to 62 11% (P = 0.018), with a median change in occupancy of 9%.

        The subjects next were divided into 2 groups denoting large and small changes in D2/3R occupancy, which was assessed by PET scan before and after the dose reduction; they were then compared on cognitive measures. Using a median split, the large and small D2/3R occupancy-change groups demonstrated changes in occupancy of 19.2 6.9% and 2.6 1.8%, respectively.

        The 2 groups only differed in duration of illness (small- vs large-change group: 28 6 years vs 37 5 years; P = 0.04).

        The large-change group experienced a significantly greater improvement in terms of cognition in the attention-task scores (Stroop Neuropsychological Screening Test 2) than did the small-change group: 10.8 11.5 versus -2.8 6.7 (P = 0.042).

        No other differences were observed in any other cognitive measure.

        "These preliminary results confirm and extend the current literature on the relationship between D2/3R blockade and deficits in attention among individuals with schizophrenia, by demonstrating this relationship in a longitudinal study design," the authors concluded.

        "The [results] also suggest that these deficits are potentially reversible with appropriate dosing," they added.

        [Presentation title: Improvement in Attention after Antipsychotic Dose Reduction in Late-life Schizophrenia: A Pilot PET-Cognition Study. Abstract EI 83]




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