O papel do agrupamento semântico na relação entre memória verbal e funcionalidade na esquizofrenia e transtorno bipolar : uma possível via cognitiva distinta

Contexto: A memória verbal está comumente prejudicada em esquizofrenia (SZ) e transtorno bipolar (TB), além de associada com funcionalidade. No entanto, há uma escassez de pesquisas analisando o papel de componentes da memória verbal nesses transtornos. O agrupamento semântico, particularmente, é um componente de possível relevância para tal associação, uma vez que é um processo cognitivo complexo dependente de atividade pré-frontal. Objetivos: Investigar componentes da memória verbal na SZ e TB e o papel do agrupamento semântico no relacionamento entre memória verbal e funcionalidade. Método: 495 participantes foram incluídos – 154 SZ, 172 TB, e 167 controles saudáveis (CS) – e passaram por uma avaliação clínica e neuropsicológica. A Hopkins Verbal Learning Test – Revised foi usada para avaliar memória verbal e a Functioning Assessment Short Test para funcionalidade. Conduzimos uma ANOVA para comparações clínicas e sociodemográficas, e uma ANCOVA para comparações em memória verbal, controlando para idade, sexo, e anos de estudo. Para investigar o papel do agrupamento semântico entre desempenho em memória verbal e funcionalidade, conduzimos análises de regressão linear. Resultados: SZ apresentou pior desempenho geral em memória verbal que TB, que por sua vez foi pior que CS. CS usaram mais agrupamento semântico que SZ e TB, porém não houve diferenças entre os dois grupos. Nos CS, o agrupamento semântico impactou o relacionamento entre desempenho em memória verbal e funcionalidade. No entanto, tal interação não ocorreu em SZ e TB. Conclusões: Nossos resultados indicam que SZ e BD podem utilizar uma via cognitiva alternativa na qual o relacionamento entre memória verbal e funcionalidade é independente de processos cognitivos complexos como agrupamento semântico.Introduction: Verbal memory (VM) is commonly impaired in schizophrenia (SZ) and bipolar disorder (BD), as well as associated with functioning. However, there is a lack of research analyzing the role of VM components in these disorders. Semantic clustering, particularly, is an interesting component of relevance for such association, as it is a complex cognitive mechanism reliant on prefrontal activity. Objectives: To investigate VM components in SZ and BD and the role of semantic clustering in the relationship between VM and functioning. Methods: 495 participants were included - 156 SZ, 172 BD, and 167 healthy controls (HC) - and underwent a clinical and neuropsychological evaluation. The Hopkins Verbal Learning Test – Revised was used to assess VM and the Functioning Assessment Short Test for functioning. We conducted an ANOVA for clinical and sociodomographical comparison, and an ANCOVA for VM comparison, controlling for age, sex, and years of education. To investigate the role of semantic clustering in the relationship between VM performance and functioning, we conducted linear regression analyses. Results: SZ had overall worse VM performance than BD, which performed worse than HC. HC used more semantic clustering than SZ and BD, but there were no differences among the two groups. In HC, semantic clustering impacted the relationship between VM performance and functioning. However, no interaction occurred in SZ or BD. Conclusions: Our results indicate that SZ and BD may use an alternative cognitive pathway in which the relationship between VM and functioning is independent of complex cognitive processes such as semantic clustering

Clozapine use decreases the number of hospitalizations per year in patients with treatment-resistant schizophrenia

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS

Clozapine use decreases the number of hospitalizations per year in patients with treatment-resistant schizophrenia.

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS

Long-term treatment with clozapine and verbal memory performance in schizophrenia

Clozapine is more efficacious than first-generation antipsychotics for positive and negative symptoms, although it is related with serious adverse effects. Because of this profile, it could also have an impact on cognition. Therefore, we evaluated learning ability of 31 treatment-resistant individuals with SZ using clozapine uninterruptedly for 18.23 ± 4.71 years and 26 non-treatment-resistant using other antipsychotics that never used clozapine. Long-term treatment with clozapine did not improve verbal learning ability better than other antipsychotics. Although clozapine has a unique profile for reducing clinical symptoms, it may not have an additional benefit for cognition when started later on the course of schizophrenia