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Improved antisaccade performance in schizophrenia with risperidone
  1. S B Hutton
  1. Department of Experimental Psychology, University of Sussex, Falmer, Brighton BN1 9QG, UK
  1. Correspondence to: 
 Dr S B Hutton; 

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Atypical treatment improves cognitive function

Several recent studies have suggested that atypical antipsychotic medications such as risperidone can ameliorate certain cognitive deficits associated with schizophrenia.1 Such findings have important implications, as cognitive impairment is a significant predictor of both social and occupational functioning in schizophrenia. In this issue, Burke and Reveley (pp 449–454)2 show that patients treated with the atypical antipsychotic risperidone make fewer antisaccade errors than when they are treated with conventional antipsychotic drugs.

The antisaccade task has a number of advantages over more traditional neuropsychological indices of cognitive function in schizophrenia: it is quick to administer, the instructions are simple to comprehend, and performance can be measured objectively and accurately. Furthermore, antisaccade errors (reflexive saccades towards a sudden onset target, instead of away from it) are thought to reflect dysfunctional inhibitory control processes. Such processes are generally associated with the dorsolateral prefrontal cortex and are particularly impaired in schizophrenia. The author's findings support suggestions that oculomotor paradigms may prove to be a particularly sensitive tool for evaluating the neurocognitive effects of antipsychotic medications.3

Recently, increased antisaccade errors have been reported in the first degree relatives of patients with schizophrenia, leading to the suggestion that saccadic disinhibition may be a useful marker of genetic vulnerability to the disorder.4 The findings of Burke and Reveley suggest that saccadic disinhibition may reflect “state” as well as “trait” factors. This has important implications for the utility of antisaccade error rate as a biological marker for schizophrenia and merits further investigation.

By using a counterbalanced crossover design, in which one group of patients switched from typical antipsychotics to risperidone and another group switched in the opposite direction, Burke and Reveley were able to show that the reduction in antisaccade errors associated with risperidone treatment is not simply the result of practice effects. Given that many of the claims for beneficial effects of atypical antipsychotic medications on cognition are based on less robust methods,5 this is a considerable contribution. However, it should be noted that the groups studied by Burke and Reveley were small and it is important that their findings are replicated and extended in a larger sample.

Atypical treatment improves cognitive function