Characteristics Of Clinical Pathology And Cognitive Impairment In Treatment Resistant Patients With Schizophrenia

Objective: Schizophrenia is a chronic mental disease that seriously endangers human health.Its pathogenesis is complex,clinical heterogeneity is high,and the course of disease is prolonged.Antipsychotics are the main means to treat schizophrenia at present,but about 30% of schizophrenic patients are not well treated with antipsychotics,that is,treatment resistant schizophrenia(TRS).Previous studies have suggested that TRS may be a disease subtype of schizophrenia,which may be different from non-refractory schizophrenia(NTRs)in psychopathology and neurocognition.However,the clinical phenotype and cognitive deficit characteristics of TRS are still unclear.The purpose of this study is to systematically compare and analyze the differences in clinical symptoms and cognitive function between TRS and NTRs patients,to explore the clinical pathological and neurophysiological characteristics of TRS patients,and to explore the relationship between clozapine treatment and TRS clinical symptoms and cognitive function.Methods: This study included 69 patients with TRS and 32 patients with NTRs who met the dsm-5 and TRS diagnostic criteria.The patients with TRS were further divided into clozapine TRS group(C-TRS,34cases)and non clozapine TRS group(NC-TRS,,35 cases)according to clozapine Administration(clozapine was applied for at least 2 months(>400mg / day).The negative and positive symptom scale(PANSS),the matrix cognitive battery(MCCB)and the general functional assessment scale(GAF)were used to evaluate the clinical symptoms and cognitive function of all subjects.The scores of symptoms and cognitive function among the three groups were compared and analyzed by ANOVA.Results:1.Clinical symptoms: Compared with NTRs group,patients in TRS group had higher scores in negative symptoms,positive symptoms and general psychopathological symptoms(P < 0.05);The scores of positive symptoms and general psychopathological symptoms in c-trs group were higher than those in NT group(P<0.05),and the scores of positive symptoms and general psychopathological symptoms in NC-TRS group were higher than those in NTRs group(P<0.05).The scores of positive symptoms and general psychopathological symptoms in NC-TRS group were higher than those in C-TRS group(P;There was no significant difference in negative symptom score between C-TRS group and NC-TRS group(P>0.05).2.Cognitive function: In terms of general cognitive function,the GAF score in TRS group was significantly lower than that in NTRs group(P<0.05);The general cognitive function score of C-TRS group was significantly lower than that of NTRs group(P<0.05),and that of NC-TRS group was significantly lower than that of NTRs group(P<0.05).It was found that the scores of general cognitive function in C-TRS group were significantly lower than those in NC-TRS group(P<0.05).3.Specific field of cognition: the scores of visual spatial memory function in patients with TRS were significantly lower than those in patients with NTRs(P<0.001);The score of visual spatial memory in C-TRS group was significantly lower than that in NTRs group(P <0.05),and the score of visual spatial memory in NC-TRS group was significantly lower than that in NTRs group(P<0.05).There was no significant difference in visual spatial memory between C-TRS group and NC-TRS group(P > 0.05).There was no significant difference among the three groups in processing speed,attention,working memory,speech learning and memory,reasoning and problem-solving ability.Conclusion: This study showed that compared with patients in NTRs group,patients in TRS group had more serious negative symptoms,positive symptoms and general pathological symptoms;The general cognitive function and visual spatial memory of patients in TRS group were worse.In patients with TRS,NC-TRS group had more severe positive symptoms,general pathological symptoms and worse general cognitive function than C-TRS group,suggesting that clozapine may improve the positive symptoms,general pathological symptoms and general cognitive function of patients with TRS.