| ObjectiveAs we all know, with the higher disability rate than that of other mental illness, patients with schizophrenia are always suffering from the cognition dysfunction, which is the most usual origination to those impairments. Now they have been absorbed more attention by the patients, clinical psychiatrists and medical scientists.These deficits are often shown as the abilities’ decrease of cognition, such as executing, learning, memory and so on. And these cognitive activities have a common basic, the attention. Being the important part of cognition, attention including sustained attention and selective attention, was proofed that it is impaired in schizophrenia by our prior study results. Meanwhile, antipsychotics could improve the attention function in the prior trails. But there are something unclarified on vigilance and inhibition, two functional parts of attention, in these patients. This study was designed to explore the situations of vigilance and inhibition and the factors affected them. And we also aim to compare the situations of patients treated with ziprasidone, amisulpride, which have different receptor-binding mechanisms.MethodsIn this case-control study, there were ninety one patients with paranoid schizophrenia collected and entering the case group. According to the same age, gender and educational background, these patients were paired by healthy volunteers, the normal control group, with the ratio of 1:1. Both of two groups were attained the written informed consent. The general demographics data and the psychopathological data were acquired by self-made questionnaire. And the sleep quality, the sleepiness extent were surveyed by Pittsburgh sleep quality index and modified Epworth sleepiness scale. The severities of depression and anxiety were investigated by Self-rating depression scale or Self-rating anxiety scale. The subjective feelings of belittling or discrimination were assessed by Perceived devaluation-discrimination scale, and the psychopathological symptoms were scanned by Positive and negative symptoms scale. The continuous performance test (CPT) and Stroop color word test (CWT) were used to evaluate the situations of vigilance and inhibition. When all subjects had been divided into control group or case group, they should complete the baseline evaluation. After 8 weeks, twenty eight normal people were randomly picked out to retest by CPT and CWT. In the meantime, the case group received antipsychotics monotherapy by ziprasidone or amisulpride in this eight weeks open-lable trail, which was beforehand separated into Ziprasidone group and Amisulpride group in accordance with random number table. Achieving the 8-weeks medications, they were interviewed and reinvestigated by the above scales or tests in schedule. And at the end of 4,8 weeks posttreatment, they also accepted the physical and assistant examinations, which were included in blood routine, urine routine, blood biochemical test and electrocardiogram. The dose of medications had been required to reach the mini-level,80 mg per day of Ziprasidone and 0.4 g per day of Amisulpride at the 7 days after treatment. And the combination medicines should be recorded. During the whole observation, the adverse events were monitored, cared and dealed duly. The software of SPSS 18.0 was applied to the statistical analysis, including chi-square test, non-parametric test, Spearman’s correlation analysis for enumeration data; t-test, one-way analysis of variance, Pearson correlation analysis for measurement data; and multivariate regression, non-conditional binary logistic regression for the multiple-factors analysis.Results1 Adjusted with the factors of age, gender, education level, it was confirmed that there was remarkably worse condition of vigilance and inhibition in the patients of prior-treatment than that of control group, that were showed by the indexes of CPT and CWT, included of CPT Mistaken Number, CPT Omitting Number, CWT Completed Number, CWT Error Number and Time Per Correct Answer (t=4.11,2.13,2.03,3.97, 2.94, p all<0.05). The part situations of vigilance and inhibition, showed by CPTOmitting Number and CWT Completed Number were improved in some extent by the medications in patients group, and they had reached the normal levels (t=0.85,1.75,p all>0.05). But there were still some dysfunctions, such as vigilance accuracy, inhibition efficiency, in the patients, which were showed worse than that of normal people by the CPT Mistaken Number, CWT Error Number and Time Per Correct Answer (t=2.01,2.63, 1.99,p all<0.05).2 In the control group, it was affirmed that there were a few of factors which could affect the functions of vigilance and inhibition, such as education levels, type of making living(mental worker or manual worker), family economic status, sleep quality, sleepiness, depression and anxiety. And it was proved that the learning effect could be neglected by the retest results of CPT and CWT in control group.3 It was proved by the single or multiple factors analysis that there were many factors that could interfere with the functions of vigilance and inhibition in cases group ahead of medications, included in education levels, marital status, type of making living, family economic status, sleep quality, sleepiness, depression, anxiety, devaluation discrimination, course of disease and four sub-factors of PANSS (positive symptoms; negative symptoms; agitation and hostility; cognition defect).4 In baseline there was no difference on the results of CPT and CWT between Ziprasidone group vs. Amisulpride group. Then after 8 weeks treatment, they all showed to make a progress of the functions dramatically. And there were some different indicators found between the two medication groups. It was found that there was less CPT Mistaken Number, but more CWT Completed Number and Error Number in Amisulpride group than those in Ziprasidone group. In addition, all post-treatment indexes of CPT and CWT were better than that of prior-treatment in Amisulpride group(t=4.75,2.40,3.05,2.87,3.14,p all<0.05). And the dramatical improvements were also confirmed between prior-treatment and post-treatment of Ziprasidone group (t=3.45, 2.38,2.59,2.84,3.07, p all<0.05).5 Between the prior-treatment vs. post-treatment, it was verified that the variation extent of sleep quality, sleepiness, depression, anxiety, devaluation discrimination and five sub-factors of PANSS can cause the change of CPT and CWT.6 After eight weeks of treatment, the impairments of vigilance and inhibition could lessen partly with the use of ziprasidone and amisulpride. However the benefits of medications were different on some indicators of CPT and CWT between them. With the multiple-factors analysis, the factors involved in antipsychotics, combination medications, side-effects and their severity were sufficiently analyzed. And it was demonstrated that the type of antipsychotics, combination with lorazepam and propranolol and the happening of side-effects (including extra-pyramidal symptoms, anxiety caused by antipsychotics and excessive sedation) made the result variations of CPT and CWT.Conclusions1 The dysfunctions of vigilance and inhibition in patients with schizophrenia wer expressed on the accuracy, reaction-speed or persistence decrease of vigilance; at the same time, on the reaction-speed, accuracy or efficiency reduction of inhibition.2 Besides of biological factors, familial elements, social environments, and psychological items, there are other factors clarified by this study, such as type of antipsychotics, combination medications and adverse effects, which can affect these functions.3 With the various action mechanisms of receptors, ziprasidone and amisulpride have disparate influences on the functions of vigilance and inhibition. Amisulpride, dopamine receptor antagonist, could enhance vigilance significantly than ziprasidone. However, there were more improvements on inhibition by ziprasidone than by amisulpride. The causes lie in the difference of antipsychotics features and individuals. |
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