The International Journal of Neuropsychopharmacology

Research Article

Quetiapine and flupentixol differentially improve anterior cingulate cortex function in schizophrenia patients: an event-related potential study

Sabrina Schneidera1 c1, Thomas Juergen Bahmera2a3, Florian Gerhard Metzgera1a3, Andreas Reifa3, Thomas Polaka3, Bruno Pfuhlmanna3, Gudrun Waltera1, Mark-Christian Eberlea1, Lena Helene Ernsta1a3, Andreas Jochen Fallgattera1a3 and Ann-Christine Ehlisa1a3

a1 Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany

a2 Medical Department, University of Tuebingen, Germany

a3 Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Germany


Atypical antipsychotic agents are a frequently and effectively used treatment in schizophrenia and psychotic disorders. Other than conventional antipsychotics, which mainly exert their pharmacological effect in subcortical dopaminergic systems, atypical antipsychotics additionally affect partly serotonergically innervated structures within prefrontal areas, such as the anterior cingulate cortex (ACC). However, only few controlled, randomized studies have so far investigated direct and indirect effects of atypical antipsychotics on the ACC and, up until now, no clinical investigation has exclusively addressed the specific effects of quetiapine on ACC function. The present study assessed ACC function in 18 quetiapine-medicated patients and 13 flupentixol-treated patients suffering from schizophrenia by means of the error-related negativity (ERN), a neurophysiological marker of ACC function, in a pre-post design. Between-group comparisons revealed different effects of quetiapine and flupentixol on ACC function despite similar improvement in psychopathology, cognitive performance and quality of life. Whereas atypical treatment was associated with an increase in amplitudes over time, there were prolonged ERN peak latencies in patients treated with the typical agent. Moreover, treatment effects depended on baseline prefrontal cortex function in both groups. We conclude that both flupentixol and quetiapine improve prefrontal function especially in patients with weak initial ACC function which might be due to their shared affinity for serotonin receptors in frontal brain regions. However, since this affinity is more pronounced for quetiapine, patients treated with quetiapine seemed to profit more evidently concerning their prefrontal cortex function compared to patients of the flupentixol group, who exhibited a compensatory prolongation of processes.

(Received December 20 2012)

(Reviewed January 24 2013)

(Revised April 05 2013)

(Accepted April 22 2013)

(Online publication June 12 2013)

Key words

  • ACC;
  • error-related negativity;
  • event-related potentials;
  • schizophrenia;
  • treatment effects


c1 Address for correspondence: S. Schneider, Psychophysiology and Optical Imaging; Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany. Tel.: +49 7071 29 87103 Fax: +49 7071 29 4141 Email: