bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2022-56-3-66-79bekhterev-721Research ArticleИССЛЕДОВАНИЯINVESTIGATIONSНарушения когнитивных функций при шизофрении, их ассоциация с оксидативным стрессомCognitive impairments in schizophrenia and their impact on oxidative stresshttps://orcid.org/0000-0002-8932-7418ПятойкинаА. С.PiatoikinaA. S.

Пятойкина Анна Сергеевна – врач-психиатр медико-реабилитационного отделения государственного бюджетного учреждения здравоохранения

Нижний Новгород

Anna S. Piatoikina

Nizhny Novgorod

annapiatoikina@ya.ruhttps://orcid.org/0000-0001-6155-1007ЖиляеваТ. В.ZhilyaevaT. V.

Жиляева Татьяна Владимировна – доктор медицинских наук, доцент, доцент кафедры психиатрии Федерального государственного бюджетного образовательного учреждения высшего образования; ведущий научный сотрудник отделения трансляционной психиатрии

Нижний Новгород;

Санкт-Петербург

Tatiana V. Zhilyaeva

Nizhny Novgorod;

Saint-Petersburg

bizet@inbox.ruhttps://orcid.org/0000-0001-7910-9129МазоГ. Э.MazoG. E.

Мазо Галина Элевна – доктор медицинских наук, заместитель директора по инновационному научному развитию, руководитель института трансляционной психиатрии

Санкт-Петербург

Galina E. Mazo

Saint-Petersburg

 

galina-mazo@yandex.ruКлиническая психиатрическая больница № 1РоссияNizhny Novgorod Clinical Psychiatric Hospital № 1Russian FederationПриволжский исследовательский медицинский университет; Национальный медицинский исследовательский центр психиатрии и неврологии имени В.М. БехтереваРоссияPrivolzhsky Research Medical University; V.M. Bekhterev National Research Medical Center for Psychiatry and NeurologyRussian FederationНациональный медицинский исследовательский центр психиатрии и неврологии имени В.М. БехтереваРоссияV.M. Bekhterev National Research Medical Center for Psychiatry and NeurologyRussian Federation2022151020225636679Copyright © Пятойкина А.С., Жиляева Т.В., Мазо Г.Э., 20222022Пятойкина А.С., Жиляева Т.В., Мазо Г.Э.Piatoikina A.S., Zhilyaeva T.V., Mazo G.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/721

Статья посвящена современным представлениям о когнитивных расстройствах при шизофрении. Нейрокогнитивный дефицит может выражаться в гетерогенных паттернах нарушений, включая внимание, слухоречевую память, моторные навыки, рабочую память, скорость обработки информации и исполнительные функции. Особое внимание в настоящее время обращается на нарушение скорости обработки информации и кодирования символов как на ключевые когнитивные нарушения при шизофрении, способные привести к ухудшению социального функционирования. Также рассмотрены две гипотезы о динамике нейрокогнитивных нарушений при шизофрении: теория «статической энцефалопатии» и прогредиентного нарушения когнитивных функций.

В данном обзоре выполнена оценка результатов сравнительного анализа эффективности антипсихотиков первой и второй генерации в терапии когнитивной дисфункции. В результате анализа имеющихся данных сделан вывод о том, что антипсихотики первого поколения, вероятнее всего, непосредственно не нарушают когнитивных способностей, но они могут делать это косвенно, за счет одновременного применения антихолинергических препаратов, компрометирующих некоторые нейрокогнитивные способности. Антипсихотики второго поколения имеют преимущество по сравнению с препаратами первого поколения, однако высказано мнение, что большинство антипсихотиков приводят к легкому улучшению когнитивного функционирования, а специфическое воздействие на его отдельные домены отсутствует.

Проведен анализ данных о взаимосвязи маркеров окислительного стресса с психопатологическими особенностями и когнитивным профилем пациентов с шизофренией. В частности, рассмотрен механизм стресс-индуцированной гибели клеток в префронтальной и передней лобной области и уменьшение объема мозга в этих регионах, приводящий к снижению когнитивных и исполнительных функций.

Кроме этого, рассмотрены механизмы ассоциации редокс-дисбаланса с истощением мозгового нейротрофического фактора (BDNF), гипофункцией NMDA-рецептора, изменением уровня провоспалительных цитокинов, нейрогенезом и клеточным апоптозом.

The article is devoted to modern concepts of cognitive disorders in schizophrenia. Neurocognitive deficits can be expressed in impaired attention, auditory memory, motor skills, working memory, processing speed and executive function. The attention of researchers is currently being paid to the violation of the speed of information processing and character encoding that can lead to impaired social functioning in patients with schizophrenia. Two hypotheses about the dynamics of neurocognitive impairments in schizophrenia are also considered: the theory of «static encephalopathy» and progressive impairment of cognitive functions.

This review evaluates the results of a comparative analysis of the effectiveness of first and second generation antipsychotics in the treatment of cognitive dysfunction. As a result of the analysis of the available data, it was concluded that first-generation antipsychotics most likely do not directly impair cognitive abilities, but they can do so indirectly, due to the simultaneous use of anticholinergic drugs that compromise some neurocognitive abilities. Second-generation antipsychotics have an advantage over first-generation drugs, however, it has been argued that most antipsychotics lead to a slight improvement in cognitive functioning, and there is no specific effect on its specific domains.

An analysis of data on the relationship between oxidative stress markers and psychopathological characteristics and cognitive profile of patients with schizophrenia was carried out. In particular, the mechanism of stress-induced cell death in the prefrontal and anterior frontal regions and a decrease in brain volume in these regions, leading to a decrease in cognitive and executive functions, are considered. In addition, the mechanisms of association of redox imbalance with brain-derived neurotrophic factor (BDNF) depletion, hypofunction of the NMDA receptor, changes in the level of pro-inflammatory cytokines, neurogenesis, and cell apoptosis were considered.

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The authors declare that there are no conflicts of interest present.