Angeliki Andreopoulou

Doubtful association of antipsychotic polypharmacy and high dosage with cognition in chronic schizophrenia

Despite consistent recommendations for antipsychotic monotherapy, antipsychotic polypharmacy (the use of two or more antipsychotic agents) and the administration of excessive doses (higher than 1000 mgr/day of chloropromazine equivalents) is a common practice in schizophrenia. The therapeutic and adverse effects of this practice are poorly studied, in particular with regards to the cognitive symptoms of the disease. In this cross-sectional study we investigated the cognitive effects of antipsychotic polypharmacy and excessive doses in 53 patients with chronic schizophrenia using non-verbal cognitive tasks involving speed of movement, memory and executive functions. No significant difference in performance scores was found between the groups under polypharmacy and monotherapy, or the groups receiving either excessive or normal doses of antipsychotics. Since these groups did not also differ in demographic, clinical, other pharmacologic parameters, in the relative anticholinergic potency of antipsychotics, or in intelligence scores, we raise doubts about the association of polypharmacy and excessive doses with non-verbal cognitive performance in chronic schizophrenia.

S61. THE ASSOCIATION OF VERBAL LEARNING DEFICITS WITH AGE AND SYMPTOMS IN SCHIZOPHRENIA

Abstract Background The relationship of age and symptoms with the performance on verbal learning and memory tasks in schizophrenia could provide useful information for optimizing and individualizing the efforts to remediate the cognitive impairments of patients. Methods During a cross-sectional study, 97 medicated and stabilized patients with chronic schizophrenia (61 males and 36 females, mean age=43.74 years, standard deviation-SD=11.59), which were consecutively referred to our Unit, were assessed using the Hopkins Verbal Learning Test (HVLT) and the Positive and Negative Syndrome Scale (PANSS). A linear regression analysis was conducted in order to investigate the effect of symptoms and age on HVLT performance. Results Increased age and total PANSS symptoms were associated with worse total recall (raw scores) (B=-0.109. 95% confidence interval-C.I.- =-0.18, -0.038, t=-3.038, df=90 p=0.003 and B=-0.053, 95%CI=-0.097, -0.008, t=-2.356, df=90, p=0.021, respectively). The effect of symptoms on HVLT total recall was significant for positive (B=-0.166, 95%CI=-0.316, -0.015, t=-2.189, df=90, p=0.031), negative (B=-0.167, 95%CI=-0.279, -0.054, t=-2.949, df=90, p=0.004), but not for general psychopathology symptoms (B=-0.05, 95%CI=-0.129, 0.03, t=-1.247, df=90, p=0.216). Further analyses revealed the significant negative correlations of total symptoms with the performance in immediate recall during the first HVLT trial (B=-0.021, 95% CI=-0.036, -0.005, df=89, p=0.011), and age during the second (B=-0.046, 95%CI=-0.076,-0.017, p=0.003) and third (B=-0.048, 95%CI=-0.083, -0.014, df=89, p=0.007) HVLT immediate recall trials. Both total symptoms and age were significantly negatively correlated with the performance in recognition discrimination (raw scores) (symptoms: B=-0.199, 95%CI=-0.363, -0.035, df=87, t=-2.415, p=0.017 and age: B=-0.357, 95%CI=-0.617, -0.098, df=87, t=-2.737, p=0.008). We failed to find any significant correlation between either age or symptoms with delayed recall. Discussion Age and symptoms are associated with immediate verbal learning and memory impairments but not with deficits in verbal delayed recall in schizophrenia. The effects of medication remain to be explored in future analyses. Cognitive remediation programmes against verbal learning deficits in individuals with schizophrenia should take into account their age as well as their symptomatology.

F61. THE RELATIONSHIP OF AGE AND SYMPTOMS WITH COGNITIVE PLANNING IN SCHIZOPHRENIA

Abstract Background The relationship of age and symptoms with the performance on non-verbal cognitive planning tasks in schizophrenia could be useful for the development of cognitive remediation programmes. Methods During a cross-sectional study, 97 medicated and stabilized patients with chronic schizophrenia (61 males and 36 females, mean age=43.74 years, standard deviation-SD=11.59), which were consecutively referred to our Unit, were assessed using the Stockings of Cambridge (SOC) task of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Positive and Negative Syndrome Scale (PANSS). Linear regression analyses were conducted in order to investigate the correlations of symptoms and age with SOC performance. Results Age and PANSS total scores negatively correlated with optimal SOC solutions (problems solved in minimum moves) (age: B=-0.05, 95% CI=-0.089, -0–012, df=86, t=-2.599, p=0.011, symptoms: B=-0.047, 95%CI=-0.071, -0.024, df=86, t=-3.982, p<0.001). The effects of total symptoms were driven by positive (B=-0.149, 95%CI=-0.229, -0.068, df=86 t=-3.672, p<0.001), negative (B=-0.087, 95%CI=-0.150, -0.023, df=86, t=-2.717, p=0.008) and general psychopathology symptoms (B=-0.065, 95%CI=-0.108, -0.023, df=86, t=-3.045, p=0.03). PANSS total scores positively correlated with mean excess moves in 2- (B=0.007, 95%CI=0.002, 0.012, df=86, t=2.656, p=0.009), 3- (B=0.014, 95%CI=0.005, 0.023, df=86, t=2.951, p=0.004) and 5-move (B=0.026, 95%CI=0.008, 0.044, df=86, t=2.923, p=0.004) problems and age only in 4- (B=0.026, 95%CI=0.006, 0.046, df=86, t=2.571, p=0.012) and 5-move (B=0.032, 95%CI=0.002, 0.061, df=86, t=2.152, p=0.034) problems. We could not find any association between PANSS scores and age with initial or subsequent thinking times during the SOC task. Discussion Cognitive planning deficits in schizophrenia are associated with patients’ symptoms and age. Whereas the effect of symptoms appears to be independent of task difficulty, the age effect emerges when the planning tasks become more complex. The role of drugs remains to be examined in future analyses.

P03-78 - No effects of polypharmacy and antipsychotic dose on spatial working memory in schizophrenia

Objectives Antipsychotic polypharmacy and high doses have been associated with poor outcome and increased adverse effects in schizophrenia. However, their relation to cognition has been poorly studied. Methods 40 right-handed patients (mean age: 42.87 years; SD:10.57) with DSM-IV schizophrenia, were recruited in an acute psychiatric ward. They were assessed on the Spatial Working Memory test (SWM) of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wechsler Adult Intelligence Scale (WAIS-III) at a time when they were able to cooperate with neuropsychological testing. The pattern of their pharmacological treatment was also assessed. Statistical correlation and Mann-Whitney tests were performed using the SPSS, as appropriate. Results 18 patients were receiving antipsychotic polypharmacy (≥2 antipsychotics) and 22 monotherapy. 13 patients received an excessive (≥1000 chloropromazine mEq(CmEq)/day), and 22 a normal antipsychotic dosage. No significant difference was detected on any of the SWM performance measures between the two groups of patients receiving either polypharmacy or monotherapy. These groups did not also differ in the WAIS full scale, performance or verbal IQ scores. When the patients were divided into two groups receiving either an excessive or a normal dose of antipsychotics, these two groups also showed a similar SWM and WAIS performance. The total antipsychotic dose showed negative but nonsignificant correlations with the SWM performance scores. Conclusions We did not detect any influence of antipsychotic polypharmacy or excessive dosing on spatial working memory in schizophrenia. This finding supports the independence of working memory deficits from the effects of treatment in schizophrenia.

The effect of psychopathology on set shifting and reversal learning in schizophrenia

The effect of psychopathology on set shifting and reversal learning in schizophrenia Eirini Theochari, Dimitrios Kontis, Spiros Kleisas, Stamatina Kalogerakou, Angeliki Andreopoulou, Charalambos Karouzos, Eleftheria Tsaltas From 1 International Congress on Neurobiology and Clinical Psychopharmacology and European Psychiatric Association Conference on Treatment Guidance Thessaloniki, Greece. 19-22 November 2009

Relationship of parental age with set shifting and reversal learning in schizophrenia

Relationship of parental age with set shifting and reversal learning in schizophrenia Dimitrios Kontis, Spiros Kleisas, Eirini Theochari, Stamatina Kalogerakou, Angeliki Andreopoulou, Rafail Psaras, Charalambos Karouzos, Eleftheria Tsaltas From 1 International Congress on Neurobiology and Clinical Psychopharmacology and European Psychiatric Association Conference on Treatment Guidance Thessaloniki, Greece. 19-22 November 2009