尽管还没有胆碱能药物和血清素激活受体类药物单独应用可改善认知功能的证据，但《英国精神病学杂志》（The British Journal of Psychiatry）9月在线发表的一项Meta分析显示，胆碱能药物对精神分裂症患者的语言学习和记忆有微弱的改善作用，对空间学习和记忆有中等程度的改善作用，胆碱能和谷氨酸能药物可改善阴性症状及一般身症状，血清素激活受体类药物可改善阳性症状[

BJ Psych.2013,203:172-178]。

研究概述

    研究者纳入26项精神分裂症和分裂情感障碍的双盲安慰剂对照研究，调查胆碱能药物、谷氨酸能药物和血清素激活受体类药物。

　　本研究对精神分裂症认知及症状改善药物的相对疗效进行了比较，分析有改善希望的认知领域，并确定对联合认知校正的治疗性研究效果有扩大作用的可选药物。

　　结果显示，胆碱能受体药物可微弱的改善患者的语言学习和记忆（d=0.23，P=0.06），胆碱能受体激动剂多奈哌齐，可中等程度地改善患者的空间学习和记忆（d=0.58）。胆碱能和谷氨酸能药物对阴性症状有中等改善作用（d=0.54，d=0.62），对一般症状的改善程度较小（d=0.46，d=0.41）。血清素受体药物对阳性症状有微弱的改善作用（d=0.33）。 

文章摘要：Adjunctive pharmacotherapy for cognitive deficits in schizophrenia:meta-analytical investigation of efficacy

Background：A growing number of studies have investigated the efficacy of novel, adjunctive pharmacotherapies for treatment of cognitive deficits in schizophrenia with conflicting results.

Aims：To investigate the comparative efficacy of these agents on cognition and symptoms in schizophrenia, and to identify promising cognitive domains and candidate medications that can be incorporated in treatment trials combined with cognitive remediation to maximise treatment effects.

Method：A total of 26 double-blind, placebo-controlled studies investigating medications targeted at cholinergic, glutamatergic or serotonergic receptor classes and with participants with schizophrenia or schizoaffective disorder were identified.

Results：Medications targeted at the cholinergic receptor class produced marginal improvements in verbal learning and memory (d = 0.23, P = 0.06), and donepezil, a specific type of cholinergic agonist, produced a moderate effect (d = 0.58) on spatial learning and memory. Cholinergic and glutamatergic agents produced moderate effect-size improvements on negative symptoms (d = 0.54 and d = 0.62 respectively), and small effect-size improvements on general symptoms (d = 0.46 and d = 0.41 respectively). Serotonergic agents produced small effect-size improvements in positive symptoms (d = 0.33).

Conclusions：Cholinergic medications produced marginal improvement in verbal learning and memory and moderate improvements on spatial learning and memory, although there was no evidence to support the use of glutamatergic or serotonergic medications as a stand-alone treatment for improving cognitive function. Cholinergic and glutamatergic agents improved negative and general symptoms, whereas serotenergic medications improved positive symptoms.

扩展阅读：

1、精神分裂症“指南中的指南”发布

2、长效注射药可有效治疗精神分裂症

3、精神分裂症死亡率：吸烟为重要推手

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