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Abstract
Introduction.
Clozapine, the most widely used option in treatment-resistant schizophrenia, has been shown to be superior to other antipsychotic medications in improving cognitive function in patients. However, the results have not been consistent and the mechanisms underlying this effect have not been elucidated. Thus, the purpose of the present study was to evaluate verbal and nonverbal cognition (using visuospatial processing tests) in patients treated with clozapine (initially treatment resistant) and those treated with other second-generation antipsychotics, relative healthy control subjects. Furthermore, we examined neural correlates of visuospatial processing in the three groups.
Methods.
Twenty schizophrenia patients treated with clozapine (TR-C group), 23 patients stabilised with atypical antipsychotics other than clozapine (NTR group), and 21 healthy control participants completed a battery of verbal and visuospatial cognitive tests. In addition, participants underwent functional magnetic resonance imaging (fMRI) while performing one of the visuospatial tests (the mental rotation task). The fMRI data were analysed separately in each group using Statistical Parametric Mapping software (SPM5).
Results.
Overall, schizophrenia patients exhibited deficit on verbal and nonverbal processing relative to the healthy controls, but we observed some interesting differences between the two groups of patients. Specifically, the NTR group performed better than the TR-C group on the Block Design and the Raven's Progressive Matrices. With respect to brain function during mental rotation, the NTR group showed significant activations in regions of the temporal and occipital cortex, whereas the TR-C patients did not. The relative deactivations associated with the task were also more robust in NTR compared to the other group of patients, despite a similar performance.
Conclusion.
Present results suggest better visuospatial processing in the NTR relative to the TR-C group. This difference could be attributed to the treatment resistance itself or a lack of beneficial effect of clozapine relative to other atypical antipsychotics in ameliorating nonverbal abilities. Future studies of the relationship between clozapine and cognition, as well as between treatment resistance and cognition, are warranted.
The authors wish to thank the participants of the study. All authors affirm that they have no conflicts of interest. This study was funded by the operating grant from the Canadian Institutes of Health Research (CIHR Institute of Gender and Health). The principal investigator (Dr. Mendrek) is a Research Scholar of the FRSQ (Fonds de la recherche en santé Québec) and has been supported by the Louis-H. Lafontaine Hospital Research Foundation. The funding sources had no further role in designing the study; in data collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
The authors wish to thank the participants of the study. All authors affirm that they have no conflicts of interest. This study was funded by the operating grant from the Canadian Institutes of Health Research (CIHR Institute of Gender and Health). The principal investigator (Dr. Mendrek) is a Research Scholar of the FRSQ (Fonds de la recherche en santé Québec) and has been supported by the Louis-H. Lafontaine Hospital Research Foundation. The funding sources had no further role in designing the study; in data collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.