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Chatterjee I, Hilal B. Investigating the association between symptoms and functional activity in brain regions in schizophrenia: A cross-sectional fmri-based neuroimaging study. Psychiatry Res Neuroimaging 2024; 344:111870. [PMID: 39142172 DOI: 10.1016/j.pscychresns.2024.111870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/20/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
Schizophrenia is a persistent neurological disorder profoundly affecting cognitive, emotional, and behavioral functions, prominently characterized by delusions, hallucinations, disordered speech, and abnormal motor activity. These symptoms often present diagnostic challenges due to their overlap with other forms of psychosis. Therefore, the implementation of automated diagnostic methodologies is imperative. This research leverages Functional Magnetic Resonance Imaging (fMRI), a neuroimaging modality capable of delineating functional activations across diverse brain regions. Furthermore, the utilization of evolving machine learning techniques for fMRI data analysis has significantly progressive. Here, our study stands as a novel attempt, focusing on the comprehensive assessment of both classical and atypical symptoms of schizophrenia. We aim to uncover associated changes in brain functional activity. Our study encompasses two distinct fMRI datasets (1.5T and 3T), each comprising 34 schizophrenia patients for the 1.5T dataset and 25 schizophrenia patients for the 3T dataset, along with an equal number of healthy controls. Machine learning algorithms are applied to assess data subsets, enabling an in-depth evaluation of the current functional condition concerning symptom impact. The identified voxels contribute to determining the brain regions most influenced by each symptom, as quantified by symptom intensity. This rigorous approach has yielded various new findings while maintaining an impressive classification accuracy rate of 97 %. By elucidating variations in activation patterns across multiple brain regions in individuals with schizophrenia, this study contributes to the understanding of functional brain changes associated with the disorder. The insights gained may inform differential clinical interventions and provide a means of assessing symptom severity accurately, offering new avenues for the management of schizophrenia.
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Affiliation(s)
- Indranath Chatterjee
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, United Kingdom; School of Technology, Woxsen University, Hyderabad, India.
| | - Bisma Hilal
- Department of Information Technology, Cluster University, Srinagar, India
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Vita A, Nibbio G, Barlati S. Conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. Psychiatry Res 2024; 340:116126. [PMID: 39128169 DOI: 10.1016/j.psychres.2024.116126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
Cognitive impairment represents one of the core features of schizophrenia, involves both neurocognition and social cognition domains, and has a significant negative impact on real-world functioning. The present review provides a framework for the conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. In this conceptualization, primary cognitive impairment can be defined as a consequence of the neurobiological alterations that underlie psychopathological manifestations of the disorder, while secondary cognitive impairment can be defined as the results of a source issue that has a negative impact on cognitive performance. Sources of secondary cognitive impairment are frequent in people with schizophrenia and include several different factors, such as positive and negative symptoms, depressive symptoms, autistic symptoms, pharmacotherapy, substance abuse, metabolic syndrome, social deprivation, and sleep disorders. It can be hypothesized that secondary cognitive impairment may be improved by effectively resolving the source issue, while primary cognitive impairment may benefit from dedicated treatment. Further research is required to confirm this hypothesis, to better characterize the distinction between primary and secondary cognitive impairment in a clinical and in a neurobiological perspective, and to evaluate the impact of systematically assessing and treating secondary cognitive impairment.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Mishra A, Maiti R, Ramasubbu MK, Srinivasan A. Evaluation of the pharmacodynamic interaction effect of augmentation agents with clozapine in patients with treatment-resistant schizophrenia: A simulation study of clinical data. Psychiatry Res 2024; 338:115989. [PMID: 38824710 DOI: 10.1016/j.psychres.2024.115989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION The aim of the study was to evaluate interaction effect of various augmentation strategies with clozapine in patients with Treatment-resistant schizophrenia. METHODS Data was extracted for change in positive and negative syndrome scale (PANSS) or brief psychiatric rating scale (BPRS) scores for monotherapy with various antipsychotic agents alone and their combination with clozapine. Individual patient data was generated using simulation of data (factorial trial framework) from published clinical trials for sample sizes from eight to 400 to evaluate interaction effect through linear modeling. Dose equivalents were calculated, and best fit models were determined for simulated data. RESULTS The polynomial model was found to be the best fit for the simulated data to determine interaction effect of combination. The clozapine augmentation with risperidone and ziprasidone was found to be antagonistic, whereas it was additive for haloperidol, aripiprazole, and quetiapine. A synergistic effect was observed for ECT combined with clozapine (Interaction effect: -7.62; p <0.001). A sample size of 250-300 may be sufficient to demonstrate a clinically significant interaction in future trials. CONCLUSION Clozapine may be augmented with electroconvulsive therapy, leading to the enhancement of antipsychotic effect. Though some antipsychotics like aripiprazole demonstrate additive effects, they may also add to the adverse effects.
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Affiliation(s)
- Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Mathan Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar 751019, India.
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Fornaro M, Caiazza C, Billeci M, Berk M, Marx W, Balanzá-Martinez V, De Prisco M, Pezone R, De Simone G, Solini N, Iasevoli F, Berna F, Fond G, Boyer L, Carvalho AF, Dragioti E, Fiedorowicz JG, de Bartolomeis A, Correll CU, Solmi M. Nutraceuticals and phytoceuticals in the treatment of schizophrenia: a systematic review and network meta-analysis "Nutra NMA SCZ". Mol Psychiatry 2024:10.1038/s41380-024-02645-y. [PMID: 39026098 DOI: 10.1038/s41380-024-02645-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Abstract
Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU). We assessed nutraceuticals/phytoceutical augmentation strategies via network meta-analysis. Randomized controlled trials in schizophrenia/schizoaffective disorder were identified via the following databases: PubMed, MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL, and ClinicalTrials.gov. Change (Standardized Mean Difference = SMD) in total symptomatology and acceptability (Risk Ratio = RR) were co-primary outcomes. Secondary outcomes were positive, negative, cognitive, and depressive symptom changes, general psychopathology, tolerability, and response rates. We conducted subset analyses by disease phase and sensitivity analyses by risk of bias and assessed global/local inconsistency, publication bias, risk of bias, and confidence in the evidence. The systematic review included 49 records documenting 50 studies (n = 2384) documenting 22 interventions. Citicoline (SMD =-1.05,95%CI = -1.85; -0.24), L-lysine (SMD = -1.04,95%CI = -1.84; -0.25), N-acetylcysteine (SMD = -0.87, 95%CI = -1.27; -0.47) and sarcosine (SMD = -0.5,95%CI = -0.87-0.13) outperformed placebo for total symptomatology. High heterogeneity (tau2 = 0.10, I2 = 55.9%) and global inconsistency (Q = 40.79, df = 18, p = 0.002) emerged without publication bias (Egger's test, p = 0.42). Sarcosine improved negative symptoms (SMD = -0.65, 95%CI = -1.10; -0.19). N-acetylcysteine improved negative symptoms (SMD = -0.90, 95%CI = -1.42; -0.39)/general psychopathology (SMD = -0.76, 95%CI = -1.39; -0.13). No compound improved total symptomatology within acute phase studies (k = 7, n = 422). Sarcosine (SMD = -1.26,95%CI = -1.91; -0.60), citicoline (SMD = -1.05,95%CI = -1.65;-0.44), and N-acetylcysteine (SMD = -0.55,95%CI = -0.92,-0.19) outperformed placebo augmentation in clinically stable participants. Sensitivity analyses removing high-risk-of-bias studies confirmed overall findings in all phases and clinically stable samples. In contrast, the acute phase analysis restricted to low risk-of-bias studies showed a superior effect vs. placebo for N-acetylcysteine (SMD = -1.10, 95%CI = -1.75,-0.45), L-lysine (SMD = -1.05,95%CI = -1.55, -0.19), omega-3 fatty acids (SMD = -0.83,95%CI = -1.31, -0.34) and withania somnifera (SMD = -0.71,95%CI = -1.21,-0.22). Citicoline (SMD = -1.05,95%CI = -1.86,-0.23), L-lysine (SMD = -1.04,95%CI = -1.84,-0.24), N-acetylcysteine (SMD = -0.89,95%CI = -1.35,-0.43) and sarcosine (SMD = -0.61,95%CI = -1.02,-0.21) outperformed placebo augmentation of TAU ("any phase"). Drop-out due to any cause or adverse events did not differ between nutraceutical/phytoceutical vs. placebo+TAU. Sarcosine, citicoline, and N-acetylcysteine are promising augmentation interventions in stable patients with schizophrenia, yet the quality of evidence is low to very low. Further high-quality trials in acute phases/specific outcomes/difficult-to-treat schizophrenia are warranted.
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Affiliation(s)
- Michele Fornaro
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.
| | - Claudio Caiazza
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
| | - Martina Billeci
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation Strategic Research Centre, School of Medicine, Geelong, VIC, Australia
- Mental Health Drug and Alcohol Services, Barwon Health, Geelong, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Wolfgang Marx
- Food & Mood Centre, Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Vicent Balanzá-Martinez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), University of Valencia, Valencia, Spain
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Rosanna Pezone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
| | - Giuseppe De Simone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
| | - Niccolò Solini
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
| | - Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples "Federico II", Naples, Italy
| | - Fabrice Berna
- Department of Psychiatry, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Fondation FondaMental Fondation de Coopération Scientifique en Santé Mentale, Université Paris Est, Créteil, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Fondation FondaMental Fondation de Coopération Scientifique en Santé Mentale, Université Paris Est, Créteil, France
| | - Andre Fèrrer Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Elena Dragioti
- Pain and Rehabilitation Center, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea de Bartolomeis
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples "Federico II", Naples, Italy
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Smucny J, Lesh TA, Albuquerque MD, Rhilinger JP, Carter CS. Predicting Clinical Improvement in Early Psychosis Using Circuit-Based Resting-State Functional Magnetic Resonance Imaging. Schizophr Bull 2024:sbae117. [PMID: 38979781 DOI: 10.1093/schbul/sbae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND HYPOTHESIS Identifying biomarkers that predict treatment response in early psychosis (EP) is a priority for psychiatry research. Previous work suggests that resting-state connectivity biomarkers may have promise as predictive measures, although prior results vary considerably in direction and magnitude. Here, we evaluated the relationship between intrinsic functional connectivity of the attention, default mode, and salience resting-state networks and 12-month clinical improvement in EP. STUDY DESIGN Fifty-eight individuals with EP (less than 2 years from illness onset, 35 males, average age 20 years) had baseline and follow-up clinical data and were included in the final sample. Of these, 30 EPs showed greater than 20% improvement in Brief Psychiatric Rating Scale (BPRS) total score at follow-up and were classified as "Improvers." STUDY RESULTS The overall logistic regression predicting Improver status was significant (χ2 = 23.66, Nagelkerke's R2 = 0.45, P < .001, with 85% concordance). Significant individual predictors of Improver status included higher default mode within-network connectivity, higher attention-default mode between-network connectivity, and higher attention-salience between-network connectivity. Including baseline BPRS as a predictor increased model significance and concordance to 92%, and the model was not significantly influenced by the dose of antipsychotic medication (chlorpromazine equivalents). Linear regression models predicting percent change in BPRS were also significant. CONCLUSIONS Overall, these results suggest that resting-state functional magnetic resonance imaging connectivity may serve as a useful biomarker of clinical outcomes in recent-onset psychosis.
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA
| | - Tyler A Lesh
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA
| | | | - Joshua P Rhilinger
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Irvine, CA, USA
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Solmi M, Cobey K, Moher D, Ebrahimzadeh S, Dragioti E, Shin JI, Radua J, Cortese S, Shea B, Veronese N, Hartling L, Pollock M, Egger M, Papatheodorou S, Ioannidis JP, Carvalho AF. Protocol for the development of a reporting guideline for umbrella reviews on epidemiological associations using cross-sectional, case-control and cohort studies: the Preferred Reporting Items for Umbrella Reviews of Cross-sectional, Case-control and Cohort studies (PRIUR-CCC). BMJ Open 2024; 14:e071136. [PMID: 38889936 PMCID: PMC11191798 DOI: 10.1136/bmjopen-2022-071136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/23/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Observational studies are fraught with several biases including reverse causation and residual confounding. Overview of reviews of observational studies (ie, umbrella reviews) synthesise systematic reviews with or without meta-analyses of cross-sectional, case-control and cohort studies, and may also aid in the grading of the credibility of reported associations. The number of published umbrella reviews has been increasing. Recently, a reporting guideline for overviews of reviews of healthcare interventions (Preferred Reporting Items for Overviews of Reviews (PRIOR)) was published, but the field lacks reporting guidelines for umbrella reviews of observational studies. Our aim is to develop a reporting guideline for umbrella reviews on cross-sectional, case-control and cohort studies assessing epidemiological associations. METHODS AND ANALYSIS We will adhere to established guidance and prepare a PRIOR extension for systematic reviews of cross-sectional, case-control and cohort studies testing epidemiological associations between an exposure and an outcome, namely Preferred Reporting Items for Umbrella Reviews of Cross-sectional, Case-control and Cohort studies (PRIUR-CCC). Step 1 will be the project launch to identify stakeholders. Step 2 will be a literature review of available guidance to conduct umbrella reviews. Step 3 will be an online Delphi study sampling 100 participants among authors and editors of umbrella reviews. Step 4 will encompass the finalisation of PRIUR-CCC statement, including a checklist, a flow diagram, explanation and elaboration document. Deliverables will be (i) identifying stakeholders to involve according to relevant expertise and end-user groups, with an equity, diversity and inclusion lens; (ii) completing a narrative review of methodological guidance on how to conduct umbrella reviews, a narrative review of methodology and reporting in published umbrella reviews and preparing an initial PRIUR-CCC checklist for Delphi study round 1; (iii) preparing a PRIUR-CCC checklist with guidance after Delphi study; (iv) publishing and disseminating PRIUR-CCC statement. ETHICS AND DISSEMINATION PRIUR-CCC has been approved by The Ottawa Health Science Network Research Ethics Board and has obtained consent (20220639-01H). Participants to step 3 will give informed consent. PRIUR-CCC steps will be published in a peer-reviewed journal and will guide reporting of umbrella reviews on epidemiological associations.
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Affiliation(s)
- Marco Solmi
- Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Cobey
- Open Science and Meta-Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linkopings universitet, Linkoping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Jae Il Shin
- Yonsei University College of Medicine, Seoul, The Republic of Korea
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Beverley Shea
- Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | | | - Lisa Hartling
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Matthias Egger
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stefania Papatheodorou
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
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Augustin E, Beaudoin M, Giguère S, Ziady H, Phraxayavong K, Dumais A. The Relationship between Sense of Presence, Emotional Response, and Clinical Outcomes in Virtual Reality-Based Therapy for Treatment-Resistant Schizophrenia: An Exploratory Correlational Study. J Pers Med 2024; 14:614. [PMID: 38929835 PMCID: PMC11204393 DOI: 10.3390/jpm14060614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Avatar therapy (AT) is a novel virtual reality-based psychotherapy that has been developed to treat auditory verbal hallucinations (AVH) in treatment-resistant schizophrenia. Various psychotherapeutic components, such as emotions and sense of presence, could contribute to clinical outcomes. However, the interplay between sense of presence, emotions, and clinical response has seldom been investigated. This study aimed to explore the relations between sense of presence, emotions, and clinical outcomes in AT. To conduct this investigation, data from previous and ongoing AT trials were used. Sense of presence and emotions were assessed using standardized questionnaires. AVH were evaluated using the Psychotic Symptom Rating Scales. While sense of presence was positively associated with positive emotions such as control and serenity, no significant associations were found for negative emotions. Moreover, a higher level of sense of presence was associated with a bigger decrease in AVH. Overall, positive emotions seem to be associated with sense of presence in AT. Sense of presence also seems to be involved in the therapeutic outcome, thereby suggesting that this could be an important component related to clinical response. More studies are needed to confirm these trends, which could be generalized to other virtual reality-based psychotherapies.
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Affiliation(s)
- Elischa Augustin
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Sabrina Giguère
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- School of Social Work, Faculty of Arts and Sciences, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Hind Ziady
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | | | - Alexandre Dumais
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada;
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Vita G, Tavella A, Ostuzzi G, Tedeschi F, De Prisco M, Segarra R, Solmi M, Barbui C, Correll CU. Efficacy and safety of long-acting injectable versus oral antipsychotics in the treatment of patients with early-phase schizophrenia-spectrum disorders: a systematic review and meta-analysis. Ther Adv Psychopharmacol 2024; 14:20451253241257062. [PMID: 38831918 PMCID: PMC11145998 DOI: 10.1177/20451253241257062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Background Long-acting injectable antipsychotics (LAIs) have advantages over oral antipsychotics (OAPs) in preventing relapse and hospitalization in chronically ill patients with schizophrenia-spectrum disorders (SSDs), but evidence in patients with first-episode/recent-onset, that is, early-phase-SSDs is less clear. Objectives To assess the relative medium- and long-term efficacy and safety of LAIs versus OAPs in the maintenance treatment of patients with early-phase SSDs. Method We searched major electronic databases for head-to-head randomized controlled trials (RCTs) comparing LAIs and OAPs for the maintenance treatment of patients with early-phase-SSDs. Design Pairwise, random-effects meta-analysis. Relapse/hospitalization and acceptability (all-cause discontinuation) measured at study-endpoint were co-primary outcomes, calculating risk ratios (RRs) with their 95% confidence intervals (CIs). Subgroup analyses sought to identify factors moderating differences in efficacy or acceptability between LAIs and OAPs. Results Across 11 head-to-head RCTs (n = 2374, median age = 25.2 years, males = 68.4%, median illness duration = 45.8 weeks) lasting 13-104 (median = 78) weeks, no significant differences emerged between LAIs and OAPs for relapse/hospitalization prevention (RR = 0.79, 95%CI = 0.58-1.06, p = 0.13) and acceptability (RR = 0.92, 95%CI = 0.80-1.05, p = 0.20). The included trials were highly heterogeneous regarding methodology and patient populations. LAIs outperformed OAPs in preventing relapse/hospitalization in studies with stable patients (RR = 0.65, 95%CI = 0.45-0.92), pragmatic design (RR = 0.67, 95%CI = 0.54-0.82), and strict intent-to-treat approach (RR = 0.64, 95%CI = 0.52-0.80). Furthermore, LAIs were associated with better acceptability in studies with schizophrenia patients only (RR = 0.87, 95%CI = 0.79-0.95), longer illness duration (RR = 0.88, 95%CI = 0.80-0.97), unstable patients (RR = 0.89, 95%CI = 0.81-0.99) and allowed OAP supplementation of LAIs (RR = 0.90, 95%CI = 0.81-0.99). Conclusion LAIs and OAPs did not differ significantly regarding relapse prevention/hospitalization and acceptability. However, in nine subgroup analyses, LAIs were superior to OAPs in patients with EP-SSDs with indicators of higher quality and/or pragmatic design regarding relapse/hospitalization prevention (four subgroup analyses) and/or reduced all-cause discontinuation (five subgroup analyses), without any instance of OAP superiority versus LAIs. More high-quality pragmatic trials comparing LAIs with OAPs in EP-SSDs are needed. Trial registration CRD42023407120 (PROSPERO).
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Affiliation(s)
- Giovanni Vita
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Angelantonio Tavella
- Department of Translational Biomedicine and Neuroscience, University of Bari ’Aldo Moro’, Bari, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Segarra
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Bilbao, Spain
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, ON, Canada
- SCIENCES Lab, Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Christoph U. Correll
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
- The Zucker Hillside Hospital, Department of Psychiatry, 75-59 263rd Street, Northwell Health, Glen Oaks, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Northwell Health, New Hyde Park, NY, USA
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
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9
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Cedeno R, Jaramillo AP, Khan AR. Comparative Effectiveness of Amisulpride and Clozapine in the Treatment of Schizophrenia: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e62625. [PMID: 39027775 PMCID: PMC11257608 DOI: 10.7759/cureus.62625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
In approximately one-third of individuals with schizophrenia, the illness demonstrates a poor response to standard antipsychotic treatments. Although a relatively small proportion fails to achieve remission after the initial exposure to either first- or second-generation antipsychotic drugs, the condition often becomes progressively more resistant to medication following subsequent relapses. We conducted comprehensive searches in databases such as PubMed and PubMed Central, extracting and assessing data quality using the Cochrane risk-of-bias tool for randomized clinical trials (RCTs). A random effects model was employed to calculate the pooled prevalence and explore heterogeneity, utilizing the I2 statistic. Subgroup analyses differentiated between experimental and placebo groups, while sensitivity analyses assessed the robustness of our findings, and publication bias was examined. Our meta-analysis included a sample size of 323 patients from seven studies out of the 10 selected articles. The pooled sample evaluated the effectiveness of amisulpride and clozapine in treating schizophrenia, with Positive and Negative Syndrome Scale (PANSS)-positive and PANSS-negative scores used in the subgroup analysis. The analysis revealed a heterogeneity of 78% and a statistically significant p-value of <0.05, favoring amisulpride and clozapine for treating schizophrenia either as monotherapy or in combination. These findings indicate that the effectiveness of these drugs is statistically significant. Our study underscores the necessity of conducting larger RCTs to further elucidate the optimal dosage and guideline criteria for prescribing amisulpride, clozapine, or their combination for patients resistant to first- and second-generation antipsychotics.
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Affiliation(s)
- Rommy Cedeno
- Molecular Pharmacology and Therapeutics in Psychiatry, Columbia University, New York, USA
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10
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Kane JM, Schoretsanitis G, Rubio JM, Correll CU. Clozapine in treatment-resistant schizophrenia: Reflections from the Hallmark US clinical trial and beyond. Schizophr Res 2024; 268:9-13. [PMID: 38290942 DOI: 10.1016/j.schres.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Affiliation(s)
- John M Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland.
| | - Jose M Rubio
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin, Germany
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11
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Mishra A, Maiti R, Mishra BR, Srinivasan A. Augmentation Strategies for Partial or Non-responders to Clozapine in Patients with Schizophrenia: A Bayesian Network Meta-analysis of Randomized Controlled Trials. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:232-252. [PMID: 38627071 PMCID: PMC11024692 DOI: 10.9758/cpn.23.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/03/2023] [Accepted: 10/19/2023] [Indexed: 04/20/2024]
Abstract
Clozapine is the only approved drug for treatment-resistant schizophrenia, but the response to the drug is often inadequate. Augmentation with other antipsychotics, anticonvulsants, and antidepressants is recommended for such patients, but there is a lack of evidence regarding the most effective therapy. This network meta-analysis was conducted to evaluate the efficacy of pharmacological agents used in the augmentation strategies in patients who were partial/ non-responders to clozapine. Relevant data were extracted from 30 randomized controlled trials through searches of electronic databases (MEDLINE/PubMed, Embase, Cochrane, clinical trial registries). PRISMA guidelines were followed for the extraction, management, analysis, and reporting of the data. The outcome measure in this study was a reduction in symptom severity according to total PANSS/BPRS and was reported as the standardized mean difference with a 95% credible interval. Bayesian network meta-analysis with random effects model and uninformative priors was conducted, and the ranking probability of each intervention was done. Meta-regression was done to assess the effect of duration on the reduction in symptom severity scores. Mirtazapine (-5.2 [95%CrI: -7.7, -2.7]) and memantine (-2.1 [95%CrI: -4.0, -0.19]] were more efficacious than placebo for augmentation of clozapine in partial/non-responders and were the most effective adjunctive agents as per SUCRA scores. Both drugs did not cause a significant increase in frequency of adverse events compared to placebo. There was a significant effect of duration on the reduction in symptom severity. There was no evident publication bias. Mirtazapine and memantine may prove beneficial for augmentation of clozapine in non/partial responders to monotherapy.
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Affiliation(s)
- Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Biswa Ranjan Mishra
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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12
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Guinart D, Fagiolini A, Fusar-Poli P, Giordano GM, Leucht S, Moreno C, Correll CU. On the Road to Individualizing Pharmacotherapy for Adolescents and Adults with Schizophrenia - Results from an Expert Consensus Following the Delphi Method. Neuropsychiatr Dis Treat 2024; 20:1139-1152. [PMID: 38812809 PMCID: PMC11133879 DOI: 10.2147/ndt.s456163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes. Methods A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population. Results There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient's diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment. Conclusion Individualized care can help provide effective, tailored treatments based on an individual's clinical characteristics, disease trajectory, family and social environment, and goals and preferences.
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Affiliation(s)
- Daniel Guinart
- Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain
- Hospital Del Mar Research Institute, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King’s College London, London, UK
- Outreach and Support in South-London (OASIS) Service, South London and Maudsley (Slam) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | | | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (LISGM), Madrid, Spain
- Centro de Investigación Biomedica en Red (CIBERSAM), ISCIII, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Christoph U Correll
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, New York, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitatsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
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13
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Kotov R, Carpenter WT, Cicero DC, Correll CU, Martin EA, Young JW, Zald DH, Jonas KG. Psychosis superspectrum II: neurobiology, treatment, and implications. Mol Psychiatry 2024; 29:1293-1309. [PMID: 38351173 DOI: 10.1038/s41380-024-02410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Alternatives to traditional categorical diagnoses have been proposed to improve the validity and utility of psychiatric nosology. This paper continues the companion review of an alternative model, the psychosis superspectrum of the Hierarchical Taxonomy of Psychopathology (HiTOP). The superspectrum model aims to describe psychosis-related psychopathology according to data on distributions and associations among signs and symptoms. The superspectrum includes psychoticism and detachment spectra as well as narrow subdimensions within them. Auxiliary domains of cognitive deficit and functional impairment complete the psychopathology profile. The current paper reviews evidence on this model from neurobiology, treatment response, clinical utility, and measure development. Neurobiology research suggests that psychopathology included in the superspectrum shows similar patterns of neural alterations. Treatment response often mirrors the hierarchy of the superspectrum with some treatments being efficacious for psychoticism, others for detachment, and others for a specific subdimension. Compared to traditional diagnostic systems, the quantitative nosology shows an approximately 2-fold increase in reliability, explanatory power, and prognostic accuracy. Clinicians consistently report that the quantitative nosology has more utility than traditional diagnoses, but studies of patients with frank psychosis are currently lacking. Validated measures are available to implement the superspectrum model in practice. The dimensional conceptualization of psychosis-related psychopathology has implications for research, clinical practice, and public health programs. For example, it encourages use of the cohort study design (rather than case-control), transdiagnostic treatment strategies, and selective prevention based on subclinical symptoms. These approaches are already used in the field, and the superspectrum provides further impetus and guidance for their implementation. Existing knowledge on this model is substantial, but significant gaps remain. We identify outstanding questions and propose testable hypotheses to guide further research. Overall, we predict that the more informative, reliable, and valid characterization of psychopathology offered by the superspectrum model will facilitate progress in research and clinical care.
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Affiliation(s)
- Roman Kotov
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA.
| | | | - David C Cicero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - David H Zald
- Rutgers University, The State University of New Jersey, New Brunswick, NJ, USA
| | - Katherine G Jonas
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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14
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Etchecopar-Etchart D, Yon DK, Wojciechowski P, Aballea S, Toumi M, Boyer L, Fond G. Comprehensive evaluation of 45 augmentation drugs for schizophrenia: a network meta-analysis. EClinicalMedicine 2024; 69:102473. [PMID: 38356727 PMCID: PMC10864200 DOI: 10.1016/j.eclinm.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Background Antipsychotics are the gold standard treatment for schizophrenia, but many patients who receive treatment experience persistent symptoms. The aim of this network meta-analysis was to determine the efficacy of augmentation drugs for the treatment of schizophrenia. Methods In accordance with the PRISMA statement, the PubMed, Web of Science, Google Scholar, CENTRAL, clinical trial and EUDRACT databases were searched from inception to May 15th, 2023. To ensure the robustness of the results, only double-blind randomised controlled trials with a low risk of bias (measured by the Risk Of Bias v2 (ROB2) tool) were included. The studies were categorised according to the background regimen: participants were treated with risperidone, mixed antipsychotics or clozapine. A Bayesian network meta-analysis was conducted using a random effects model. PROSPERO register: CRD42023420964. Findings A total of 44 trials (comprising 45 augmentation drugs and 3358 participants) were included in the analysis. One-third of the drugs (16 drugs) demonstrated significant efficacy vs. placebo for at least one outcome. The most notable effect sizes (ESs) were observed for the use of tropisetron (standard mean difference: -0.83 [95% interval confidence -1.12 to -0.55]), memantine (-0.50 [-0.66 to -0.32]) and minocycline (-0.56 [-0.72 to -0.39]) to treat negative symptoms among patients treated with risperidone (moderate-to-high ESs). Studies involving mixed antipsychotics yielded lower ESs (small-to-moderate). Sodium benzoate (-0.41 [-0.60 to -0.21]) and memantine (-0.23 [-0.36 to -0.11]) were found have significant effects on positive symptoms, while memantine demonstrated efficacy for negative symptoms (-0.32 [-0.45 to -0.19]) and general psychopathology (-0.32 [-0.44 to -0.20]). Studies focusing exclusively on patients treated with clozapine revealed that duloxetine produced the best results (negative symptoms: -1.12 [-1.35 to -0.91]). Sodium benzoate was the only augmentation drug that demonstrated efficacy in relieving persistent positive symptoms (-0.32 [-0.59 to -0.08]) among patients treated with clozapine. Treatment with clozapine in combination with antipsychotics yielded small-to-moderate ESs. Interpretation The GRADE framework indicated that the quality of the evidence among the included studies was moderate, primarily due to the limited number of randomised controlled trials with a low risk of bias. Important drugs did not appear in these results due to insufficient low-risk-of-bias data for these medications. These results highlight new pathways for treating schizophrenia that should be incorporated into future guidelines after further validation. Funding No funding.
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Affiliation(s)
- Damien Etchecopar-Etchart
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Assistance Publique des Hôpitaux de Marseille AP-HM, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | | | | | - Mondher Toumi
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- InovIntell, Krakow, Poland
| | - Laurent Boyer
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Assistance Publique des Hôpitaux de Marseille AP-HM, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Guillaume Fond
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Assistance Publique des Hôpitaux de Marseille AP-HM, Marseille, France
- FondaMental Foundation, Creteil, France
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15
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Tandon R, Nasrallah H, Akbarian S, Carpenter WT, DeLisi LE, Gaebel W, Green MF, Gur RE, Heckers S, Kane JM, Malaspina D, Meyer-Lindenberg A, Murray R, Owen M, Smoller JW, Yassin W, Keshavan M. The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophr Res 2024; 264:1-28. [PMID: 38086109 DOI: 10.1016/j.schres.2023.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI 49008, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine Cincinnati, OH 45267, United States of America
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, United States of America
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Dusseldorf, Heinrich-Heine University, Dusseldorf, Germany
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States of America; Greater Los Angeles Veterans' Administration Healthcare System, United States of America
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States of America
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY 11004, United States of America
| | - Dolores Malaspina
- Department of Psychiatry, Neuroscience, Genetics, and Genomics, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannhein/Heidelberg University, Mannheim, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK
| | - Michael Owen
- Centre for Neuropsychiatric Genetics and Genomics, and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Psychiatric and Neurodevelopmental Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Walid Yassin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
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16
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Smucny J, Carter CS, Maddock RJ. Greater Choline-Containing Compounds and Myo-inositol in Treatment-Resistant Versus Responsive Schizophrenia: A 1H-Magnetic Resonance Spectroscopy Meta-analysis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:137-145. [PMID: 37925074 PMCID: PMC11192527 DOI: 10.1016/j.bpsc.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The neurobiology of treatment-resistant schizophrenia (TRS) is poorly understood, and meta-analytic consensus regarding magnetic resonance spectroscopic profiles of glutamate, choline-containing compounds, myo-inositol, and other metabolites in the condition is lacking. METHODS In this meta-analysis, we examined published findings for N-acetylaspartate, choline-containing compounds (phosphocholine+glycerophosphocholine), myo-inositol, creatine+phosphocreatine, glutamate, and glutamate+glutamine in the anterior cingulate cortex and dorsal striatum in people with TRS versus non-TRS as well as TRS versus healthy control participants (HCs) and TRS versus ultra TRS (i.e., TRS with clozapine resistance). A MEDLINE search revealed 9 articles including 239 people with pooled TRS and ultra TRS, 59 with ultra TRS, 175 with non-TRS, and 153 (HCs) that met meta-analytic criteria. RESULTS Significant effects included higher anterior cingulate cortex phosphocholine+glycerophosphocholine and myo-inositol in the pooled TRS and ultra TRS group than in both the non-TRS group and HCs as well as higher dorsal striatal phosphocholine+glycerophosphocholine in ultra TRS versus HCs, but no differences in other regional metabolites. CONCLUSIONS The observed metabolite profile in TRS (higher phosphocholine+glycerophosphocholine and myo-inositol signal) is consistent with the hypothesis that TRS has a neuroinflammatory component, although this meta-analysis is not a critical test of that hypothesis. A similar profile is seen in healthy aging, which is known to involve increased neuroinflammation and glial activation. Because the overall number of datasets was low, however, results should be considered preliminary and highlight the need for additional studies of brain metabolites in TRS and their possible association with inflammatory processes.
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California.
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California
| | - Richard J Maddock
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California
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17
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Fornaro M, Caiazza C, Billeci M, Berk M, Marx W, Balanzá-Martínez V, De Prisco M, Pezone R, De Simone G, Solini N, Iasevoli F, Berna F, Fond G, Boyer L, Carvalho AF, Dragioti E, Fiedorowicz J, de Bartolomeis A, Correll C, Solmi M. Nutraceuticals and phytoceuticals in the treatment of schizophrenia: a systematic review and network meta-analysis. RESEARCH SQUARE 2024:rs.3.rs-3787917. [PMID: 38260297 PMCID: PMC10802721 DOI: 10.21203/rs.3.rs-3787917/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU). Methods We assessed nutraceuticals/phytoceutical augmentation strategies via network meta-analysis. Randomized controlled trials in schizophrenia/schizoaffective disorder were identified via the following databases: PubMed, MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL, and ClinicalTrials.gov. Change (Standardized Mean Difference=SMD) in total symptomatology and acceptability (Risk Ratio=RR) were co-primary outcomes. Secondary outcomes were positive, negative, cognitive, and depressive symptom changes, general psychopathology, tolerability, and response rates. We conducted subset analyses by disease phase and sensitivity analyses by risk of bias and assessed global/local inconsistency, publication bias, risk of bias, and confidence in the evidence. Results The systematic review included 49 records documenting 50 studies (n=2,384) documenting 22 interventions. Citicoline (SMD=-1.05,95%CI=-1.85; -.24), L-lysine (SMD=-1.04,95%CI=-1.84;-.25), N-acetylcysteine (SMD=-.87,95%CI=-1.27;-.47) and sarcosine (SMD=-.5,95%CI=-.87-.13) outperformed placebo for total symptomatology. High heterogeneity (tau2=.10, I2=55.9%) and global inconsistency (Q=40.79, df=18, p=.002) emerged without publication bias (Egger's test, p=.42). Sarcosine improved negative symptoms (SMD=-.65, 95%CI=-1.10; -.19). N-acetylcysteine improved negative symptoms (SMD=-.90, 95%CI=-1.42; -.39)/general psychopathology (SMD=-.76, 95%CI=-1.39; -.13). No compound improved total symptomatology within acute phase studies (k=7, n=422). Sarcosine (SMD=-1.26,95%CI=-1.91; -.60), citicoline (SMD=-1.05,95%CI=-1.65;-.44), and N-acetylcysteine (SMD=-.55,95%CI=-.92,-.19) outperformed placebo augmentation in clinically stable participants. Sensitivity analyses removing high-risk-of-bias studies confirmed overall findings in all phases and clinically stable samples. In contrast, the acute phase analysis restricted to low risk-of-bias studies showed a superior effect vs. placebo for N-acetylcysteine (SMD=-1.10,95%CI=-1.75,-.45), L-lysine (SMD=-1.05,95%CI=-1.55,-.19), omega-3 fatty acids (SMD=-.83,95%CI=-1.31,-.34) and withania somnifera (SMD=-.71,95%CI=-1.21,-.22). Citicoline (SMD=-1.05,95%CI=-1.86,-.23), L-lysine (SMD=-1.04,95%CI=-1.84,-.24), N-acetylcysteine (SMD=-.89,95%CI=-1.35,-.43) and sarcosine (SMD=-.61,95%CI=-1.02,-.21) outperformed placebo augmentation of TAU ("any phase"). Drop-out due to any cause or adverse events did not differ between nutraceutical/phytoceutical vs. placebo+TAU. Conclusions Sarcosine, citicoline, and N-acetylcysteine are promising augmentation interventions in stable patients with schizophrenia, yet the quality of evidence is low to very low. Further high-quality trials in acute phases/specific outcomes/difficult-to-treat schizophrenia are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Laurent Boyer
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Elena Dragioti
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Jess Fiedorowicz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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18
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Li JR, Yeh LL, Lin JY, Pan YJ. Medication Dosage Impact on Mortality in Old-Age Individuals with Schizophrenia: A National Cohort Study. Pharmaceuticals (Basel) 2024; 17:78. [PMID: 38256911 PMCID: PMC10820447 DOI: 10.3390/ph17010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
As the prevalence of old-age individuals with schizophrenia (OAS) increases in a society undergoing demographic aging, the exploration of medication choices becomes increasingly crucial. Due to the current scarcity of literature on OAS, this study seeks to examine how the utilization and cumulative dosages of psychotropic medications influence both overall and cause-specific mortality risks within this population. A national cohort of 6433 individuals diagnosed with OAS was followed up for 5 years. This study involved comparing the mortality rates associated with low, moderate, and high dosages of antipsychotics, antidepressants, mood stabilizers, and sedative/hypnotic drugs against the 'no exposure' category, based on individual dosages. Cox regression was employed for survival analyses to compare overall mortality and specific-cause mortality across various dosage groups. The exposure variable examined was the dosage of a specific psychotropic medication. Covariates were adjusted accordingly. The analysis revealed that patients on low/moderate antipsychotic doses had improved survival compared to non-exposed individuals. Moderate antipsychotic use corresponded to reduced cardiovascular disease mortality risk. Similarly, those exposed to antidepressants had enhanced survival in low and moderate doses. Sedative-hypnotic exposure was linked to decreased mortality risk in low doses. This study observed that low/moderate antipsychotic doses in older adults with schizophrenia were associated with decreased all-cause mortality, emphasizing the significance of precise medication selection and dosing. It underscores the need for vigilant polypharmacy management and tailored medication strategies in addressing the complexities of treating OAS.
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Affiliation(s)
- Jia-Ru Li
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10025, Taiwan
| | - Ling-Ling Yeh
- Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, New Taipei City 20842, Taiwan;
| | - Ji-Yu Lin
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin 64041, Taiwan;
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City 32003, Taiwan
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19
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Davidson M, Carpenter WT. Targeted Treatment of Schizophrenia Symptoms as They Manifest, or Continuous Treatment to Reduce the Risk of Psychosis Recurrence. Schizophr Bull 2024; 50:14-21. [PMID: 37929893 PMCID: PMC10754173 DOI: 10.1093/schbul/sbad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Current pharmacological treatment of schizophrenia employs drugs that interfere with dopamine neurotransmission, aiming to suppress acute exacerbation of psychosis and maintenance treatment to reduce the risk of psychosis recurrence. According to this treatment scheme, available psychotropic drugs intended to treat negative symptoms, cognitive impairment, or anxiety are administered as add-ons to treatment with antipsychotics. However, an alternative treatment scheme proposes a targeted or intermittent treatment approach, by which antipsychotic drugs are administered upon psychosis exacerbation and discontinued upon remission or stabilization, while negative symptoms, cognitive impairment, or anxiety are treated with specific psychotropics as monotherapy. Along these lines, antipsychotics are renewed only in the event of recurrence of psychotic symptoms. This 50-year-old debate between targeted and continuous treatment schemes arises from disagreements about interpreting scientific evidence and discordant views regarding benefit/risk assessment. Among the debate's questions are: (1) what is the percentage of individuals who can maintain stability without antipsychotic maintenance treatment, and what is the percentage of those who exacerbate despite antipsychotic treatment? (2) how to interpret results of placebo-controlled 9- to 18-month-long maintenance trials in a life-long chronic disorder, and how to interpret results of the targeted trials, some of which are open label or not randomized; (3) how to weigh the decreased risk for psychotic recurrence vs the almost certainty of adverse effects on patient's quality of life. Patients' profiles, preferences, and circumstances of the care provision should be considered as the targeted vs continuous treatment options are considered.
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Affiliation(s)
- Michael Davidson
- Department of Basic and Clinical Sciences, Psychiatry, University of Nicosia Medical School, 2414, Nicosia, Cyprus and Minerva Neurosciences, 1500 District Avenue, Burlington, MA 01803, USA
| | - William T Carpenter
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
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20
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Vita A, Nibbio G, Barlati S. Pharmacological Treatment of Cognitive Impairment Associated With Schizophrenia: State of the Art and Future Perspectives. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae013. [PMID: 39144119 PMCID: PMC11207676 DOI: 10.1093/schizbullopen/sgae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Cognitive Impairment Associated with Schizophrenia (CIAS) represents one of the core dimensions of Schizophrenia Spectrum Disorders (SSD), with an important negative impact on real-world functional outcomes of people living with SSD. Treatment of CIAS represents a therapeutic goal of considerable importance, and while cognition-oriented evidence-based psychosocial interventions are available, effective pharmacological treatment could represent a game-changer in the lives of people with SSD. The present critical review reports and discusses the evidence regarding the effects of several pharmacological agents that are available in clinical practice or are under study, commenting on both current and future perspectives of CIAS treatment. In particular, the effects on CIAS of antipsychotic medications, anticholinergic medications, benzodiazepines, which are currently commonly used in the treatment of SSD, and of iclepertin, d-serine, luvadaxistat, xanomeline-trospium, ulotaront, anti-inflammatory molecules, and oxytocin, which are undergoing regulatory trials or can be considered as experimental agents, will be reported and discussed. Currently, available pharmacological agents do not appear to provide substantial benefits on CIAS, but accurate management of antipsychotic medications and avoiding treatments that can further exacerbate CIAS represent important strategies. Some molecules that are currently being investigated in Phase 2 and Phase 3 trials have provided very promising preliminary results, but more information is currently required to assess their effectiveness in real-world contexts and to provide clear recommendations regarding their use in clinical practice. The results of ongoing and future studies will reveal whether any of these molecules represents the awaited pharmacological game-changer in the treatment of CIAS.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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21
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Yu Y, He J, Huang Z, Li Y, Wu Y, Shen Y, Zhou Y, Bao C, Jin Z, Li H. Safety, tolerability, and pharmacokinetics of JX11502MA in Chinese healthy subjects: a first-in-human, randomized, double-blind, placebo-controlled study following single-dose administration. Expert Opin Investig Drugs 2024; 33:51-61. [PMID: 38054696 DOI: 10.1080/13543784.2023.2291470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND JX11502MA is a potent partial agonist of dopamine D2 and D3 receptors, with a preferential binding profile for D3 receptors in vitro, potentially for treating schizophrenia. METHODS A first-in-human, randomized, double-blind, placebo-controlled, single ascending dose clinical trial was designed. The subjects were randomly assigned to receive JX11502MA and placebo capsules with seven ascending dose groups: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 6 mg, and 8 mg. The PK profiles of JX11502MA and its metabolites were evaluated, along with a safety and tolerability assessment. RESULTS Considering the safety of participants, the dose escalation was halted at 3 mg. Following single-dose administration, JX11502MA exhibited rapid absorption with a median Tmax ranging from 1 to 1.75 h. The terminal half-life of JX11502MA ranged from 73.62 to 276.85 h. The most common treatment-emergent adverse events (TEAEs) for subjects receiving JX11502MA were somnolence (56.3%), dizziness (18.8%), nausea (21.9%), vomiting (18.8%), and hiccups (18.8%). CONCLUSIONS JX11502MA was generally well tolerated at a single dose of 0.25 to 3 mg. The PK profiles and safety characteristics in this study indicated that JX11502MA has the potential to be a favorable treatment option for patients with schizophrenia. TRIAL REGISTRATION https://clinicaltrials.gov (identifier: NCT05233657).
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Affiliation(s)
- Yimin Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjing He
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co.,Ltd, Shanghai, China
| | - Zhiwei Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanling Zhou
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co.,Ltd, Shanghai, China
| | - Cungang Bao
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co.,Ltd, Shanghai, China
| | - Zhiping Jin
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co.,Ltd, Shanghai, China
| | - Huafang Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Clinical Research Center for Mental Health, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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22
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Köhler-Forsberg O, Stiglbauer V, Brasanac J, Chae WR, Wagener F, Zimbalski K, Jefsen OH, Liu S, Seals MR, Gamradt S, Correll CU, Gold SM, Otte C. Efficacy and Safety of Antidepressants in Patients With Comorbid Depression and Medical Diseases: An Umbrella Systematic Review and Meta-Analysis. JAMA Psychiatry 2023; 80:1196-1207. [PMID: 37672261 PMCID: PMC10483387 DOI: 10.1001/jamapsychiatry.2023.2983] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 09/07/2023]
Abstract
Importance Every third to sixth patient with medical diseases receives antidepressants, but regulatory trials typically exclude comorbid medical diseases. Meta-analyses of antidepressants have shown small to medium effect sizes, but generalizability to clinical settings is unclear, where medical comorbidity is highly prevalent. Objective To perform an umbrella systematic review of the meta-analytic evidence and meta-analysis of the efficacy and safety of antidepressant use in populations with medical diseases and comorbid depression. Data Sources PubMed and EMBASE were searched from inception until March 31, 2023, for systematic reviews with or without meta-analyses of randomized clinical trials (RCTs) examining the efficacy and safety of antidepressants for treatment or prevention of comorbid depression in any medical disease. Study Selection Meta-analyses of placebo- or active-controlled RCTs studying antidepressants for depression in individuals with medical diseases. Data Extraction and Synthesis Data extraction and quality assessment using A Measurement Tool for the Assessment of Multiple Systematic Reviews (AMSTAR-2 and AMSTAR-Content) were performed by pairs of independent reviewers following PRISMA guidelines. When several meta-analyses studied the same medical disease, the largest meta-analysis was included. Random-effects meta-analyses pooled data on the primary outcome (efficacy), key secondary outcomes (acceptability and tolerability), and additional secondary outcomes (response and remission). Main Outcomes and Measures Antidepressant efficacy presented as standardized mean differences (SMDs) and tolerability (discontinuation for adverse effects) and acceptability (all-cause discontinuation) presented as risk ratios (RRs). Results Of 6587 references, 176 systematic reviews were identified in 43 medical diseases. Altogether, 52 meta-analyses in 27 medical diseases were included in the evidence synthesis (mean [SD] AMSTAR-2 quality score, 9.3 [3.1], with a maximum possible of 16; mean [SD] AMSTAR-Content score, 2.4 [1.9], with a maximum possible of 9). Across medical diseases (23 meta-analyses), antidepressants improved depression vs placebo (SMD, 0.42 [95% CI, 0.30-0.54]; I2 = 76.5%), with the largest SMDs for myocardial infarction (SMD, 1.38 [95% CI, 0.82-1.93]), functional chest pain (SMD, 0.87 [95% CI, 0.08-1.67]), and coronary artery disease (SMD, 0.83 [95% CI, 0.32-1.33]) and the smallest for low back pain (SMD, 0.06 [95% CI, 0.17-0.39]) and traumatic brain injury (SMD, 0.08 [95% CI, -0.28 to 0.45]). Antidepressants showed worse acceptability (24 meta-analyses; RR, 1.17 [95% CI, 1.02-1.32]) and tolerability (18 meta-analyses; RR, 1.39 [95% CI, 1.13-1.64]) compared with placebo. Antidepressants led to higher rates of response (8 meta-analyses; RR, 1.54 [95% CI, 1.14-1.94]) and remission (6 meta-analyses; RR, 1.43 [95% CI, 1.25-1.61]) than placebo. Antidepressants more likely prevented depression than placebo (7 meta-analyses; RR, 0.43 [95% CI, 0.33-0.53]). Conclusions and Relevance The results of this umbrella systematic review of meta-analyses found that antidepressants are effective and safe in treating and preventing depression in patients with comorbid medical disease. However, few large, high-quality RCTs exist in most medical diseases.
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Victoria Stiglbauer
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jelena Brasanac
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Woo Ri Chae
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Frederike Wagener
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Kim Zimbalski
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Oskar H. Jefsen
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Shuyan Liu
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Malik R. Seals
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Gamradt
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph U. Correll
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Stefan M. Gold
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- Department of Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Institute of Neuroimmunology and Multiple Sclerosis, Universitätsklinikum Hamburg–Eppendorf, Hamburg, Germany
| | - Christian Otte
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
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23
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McCutcheon RA, Harrison PJ, Howes OD, McGuire PK, Taylor DM, Pillinger T. Data-Driven Taxonomy for Antipsychotic Medication: A New Classification System. Biol Psychiatry 2023; 94:561-568. [PMID: 37061079 PMCID: PMC10914668 DOI: 10.1016/j.biopsych.2023.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Globally, there are more than 25 licensed antipsychotic medications. Antipsychotics are commonly described as either typical or atypical, but this dichotomous classification does not reflect the diversity of their pharmacological and clinical profiles. There is a need for a data-driven antipsychotic classification scheme suitable for clinicians and researchers that maps onto both pharmacological and clinical effects. Receptor affinity provides one starting point for such a scheme. METHODS We analyzed affinities of 27 antipsychotics for 42 receptors from 3325 in vitro receptor binding studies. We used a clustering algorithm to group antipsychotics based on receptor affinity. Using a machine learning model, we examined the ability of this grouping to predict antipsychotic-induced clinical effects quantified according to an umbrella review of clinical trial and treatment guideline data. RESULTS Clustering resulted in 4 groups of antipsychotics. The predominant receptor affinity and clinical effect "fingerprints" of these 4 groups were defined as follows: group 1, muscarinic (M2-M5) receptor antagonism (cholinergic and metabolic side effects); group 2, dopamine (D2) partial agonism and adrenergic antagonism (overall low side-effect burden); group 3, serotonergic and dopaminergic antagonism (overall moderate side-effect burden); and group 4, dopaminergic antagonism (extrapyramidal side effects and hyperprolactinemia). Groups 1 and 4 were more efficacious than groups 2 and 3. The classification was shown to predict out-of-sample clinical effects of individual drugs. CONCLUSIONS A receptor affinity-based grouping not only reflects compound pharmacology but also detects meaningful clinical differences. This approach has the potential to benefit both patients and researchers by guiding treatment and informing drug development.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Department of Health, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Department of Health, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom; H. Lundbeck A/S, København, Denmark
| | - Philip K McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Department of Health, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom; National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - David M Taylor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
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24
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Fond G, Mallet J, Urbach M, Benros ME, Berk M, Billeci M, Boyer L, Correll CU, Fornaro M, Kulkarni J, Leboyer M, Llorca PM, Misdrahi D, Rey R, Schürhoff F, Solmi M, Sommer IEC, Stahl SM, Pignon B, Berna F. Adjunctive agents to antipsychotics in schizophrenia: a systematic umbrella review and recommendations for amino acids, hormonal therapies and anti-inflammatory drugs. BMJ MENTAL HEALTH 2023; 26:e300771. [PMID: 37852631 PMCID: PMC10583081 DOI: 10.1136/bmjment-2023-300771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/02/2023] [Indexed: 10/20/2023]
Abstract
QUESTION This umbrella review and guidelines aimed to provide evidence to support the rational choice of selected adjunctive therapies for schizophrenia. STUDY SELECTION AND ANALYSIS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and World Federation of Societies of Biological Psychiatry (WFSBP)-grading recommendations, 63 randomised control trials (RCTs) (of which 4219 unique participants have completed the RCTs) and 29 meta-analyses were analysed. FINDINGS Provisional recommendations (WFSBP-grade 1) could be made for two molecules in augmentation to antipsychotics: (1) N-acetyl-cysteine (NAC, 1200-3600 mg/day, for >12 consecutive weeks) in improving negative symptoms, general psychopathology (positive and negative syndrome scale for schizophrenia (PANSS) general psychopathology factor (G)-G subscale), with the RCTs with the longer duration showing the most robust findings; (2) polyunsaturated fatty acids (3000 mg/day of eicosapentaenoic acid, for >12 weeks) in improving general psychopathology. Weaker recommendations (ie, WFSBP-grade 2) could be drawn for sarcosine (2 g/day) and minocycline (200-300 mg/day) for improving negative symptoms in chronic schizophrenia (not early schizophrenia), and NAC for improving positive symptoms and cognition. Weak recommendations are not ready for clinical practice. There is provisional evidence that oestrogens and raloxifene are effective in some patients, but further research is needed to determine their benefit/risk ratio. CONCLUSIONS The results of this umbrella review should be interpreted with caution as the number of RCTs included in the meta-analyses was generally small and the effect sizes were weak or medium. For NAC, two RCTs with low risk of bias have provided conflicting results and the WFSBP-grade recommendation included also the results of meta-analyses. These drugs could be provisionally prescribed for patients for whom no other treatments have been effective, but they should be discontinued if they prove ineffective.
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Affiliation(s)
- Guillaume Fond
- Department of psychiatry, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Fondation FondaMental, Creteil, France
- CEReSS-Health Service Research and Quality of Life Center, AMU, Marseille, France
| | - Jasmina Mallet
- Fondation FondaMental, Creteil, France
- Department of Psychiatry, Louis Mourier Hospital, Colombes, France
| | - Mathieu Urbach
- Fondation FondaMental, Creteil, France
- Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Michael Eriksen Benros
- Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Berk
- Deakin University, School of Medicine, and Barwon Health; IMPACT, the Institute for Mental and Physical Health and Clinical Translation; Orygen The National Centre of Excellence in Youth Mental Health, The Florey Institute of Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martina Billeci
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, Federico II University of Naples, Naples, Italy
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, AMU, Marseille, France
- Département d'information médicale, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
| | - Michele Fornaro
- Department of Neuroscience, Reproductive Sciences, and Dentistry, Section of Psychiatry, Federico II University of Naples, Naples, Italy
| | - Jayashri Kulkarni
- Department of Psychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University,607StKildaRd, Level4, Melbourne, Victoria, Australia 3004, Melbourne, Victoria, Australia
| | - Marion Leboyer
- Fondation FondaMental, Creteil, France
- Department of psychiatry, Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM U955, IMRB, translational Neuropsychiatry, F-94010 Creteil, France, Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Creteil, France
- Département de psychiatrie, Université Clermont Auvergne, CMP-B CHU, CNRS,Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - David Misdrahi
- Fondation FondaMental, Creteil, France
- Departement de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens; Univ. Bordeaux, CNRS, UMR 5287, F-33000, INCIA, Bordeaux, France
| | - Romain Rey
- Fondation FondaMental, Creteil, France
- Schizophrenia Expert Centre, Le Vinatier Hospital; INSERM, U1028; CNRS, UMR5292; University Lyon 1; Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France
| | - Franck Schürhoff
- Fondation FondaMental, Creteil, France
- Department of psychiatry, Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM U955, IMRB, translational Neuropsychiatry, F-94010 Creteil, France, Créteil, France
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Champlain First Episode Psychosis Program, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Iris E C Sommer
- Department of Psychiatry, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Baptiste Pignon
- Fondation FondaMental, Creteil, France
- Department of psychiatry, Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM U955, IMRB, translational Neuropsychiatry, F-94010 Creteil, France, Créteil, France
| | - Fabrice Berna
- Fondation FondaMental, Creteil, France
- Psychiatry, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
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García-Carmona JA, Pappa S. Cumulative Clinical Experience of the Use of Paliperidone Palmitate 3-Monthly Long-Acting Injection in the Treatment of Schizophrenia: A Critical Appraisal. Drug Healthc Patient Saf 2023; 15:113-123. [PMID: 37720806 PMCID: PMC10504906 DOI: 10.2147/dhps.s339170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Paliperidone palmitate 3-monthly (PP3M), an approved maintenance treatment for patients with schizophrenia, was the first long-acting antipsychotic injectable (LAI) to require only four administrations per year. Here, we aimed to review the available evidence about its use in the management of schizophrenia to date and highlight key study findings in order to provide a balanced overview of current experience in clinical practice. For that purpose, an extensive search of available literature from PubMed, Embase, and Web of Science was conducted in March 2023. Emerging data from real-world studies appear to signal that the benefits of the use of PP3M may well extent beyond the obvious convenience for patients and resource efficiency for services and may be actually associated with improved effectiveness and patient satisfaction. Large naturalistic studies from Australia, Europe and the US comparing treatment continuation between newer LAIs and/or oral antipsychotics showed that patients treated with PP3M had higher compliance rates and a longer period of continuous use. The risk of relapse, re-hospitalization and number of bed days was also lower with PP3M compared to PP1M and other LAIs as demonstrated by several cohort studies. Furthermore, patients treated with PP3M were using lower doses of benzodiazepines and concomitant oral antipsychotics compared with other LAIs. What is more, PP3M appears to positively impact patients' satisfaction and quality of life, facilitating long-term goals. In fact, recent studies recorded better quality-adjusted life years and decreased stigma, with improved social acceptability and promotion of rehabilitation for patients transitioning to PP3M. The rates of general satisfaction rates with PP3M were also higher among psychiatrists and caregivers who reported overall less concerns. In conclusion, clinical exposure and a growing body of evidence thus far, reinforce the use of PP3M in an effort to enhance patient outcomes alongside individual experience and treatment persistence.
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Affiliation(s)
- Juan Antonio García-Carmona
- Department of Neurology, Santa Lucia University Hospital, Cartagena, Murcia, Spain
- Unit of Acute Psychiatry, Reina Sofía University Hospital, Murcia, Spain
- Group of Clinical and Experimental Pharmacology, Institute for Biomedical Research of Murcia (IMIB), Murcia, Spain
| | - Sofia Pappa
- West London NHS Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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Capuzzi E, Caldiroli A, Quitadamo C, Butturini F, Surace T, Clerici M, Buoli M. Novel pharmacotherapy targeting the positive symptoms of schizophrenia. Expert Opin Pharmacother 2023; 24:1623-1648. [PMID: 37401388 DOI: 10.1080/14656566.2023.2231346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION The severity of positive symptoms in schizophrenia is associated with poor prognosis. About one-third of schizophrenia patients partially respond to treatment with available antipsychotics. The purpose of the present manuscript is to provide an updated overview of novel pharmacotherapy targeting positive symptoms in schizophrenia. AREAS COVERED A comprehensive research on the main database sources (PubMed, PsychINFO, Isi Web of Knowledge, MEDLINE, and EMBASE) was performed to obtain original articles published till 31st January 2023 about new pharmacological strategies for the treatment of positive symptoms in schizophrenia. EXPERT OPINION The most promising compounds include: lamotrigine, pro-cognitive-compounds (donepezil - in the short term, idazoxan and piracetam) and drugs acting partially or totally outside the Central Nervous System (CNS) (anti-inflammatory drugs: celecoxib, methotrexate; cardiovascular compounds: L-theanine, mononitrate isosorbide, propentofylline, sodium nitroprusside; metabolic regulators: diazoxide, allopurinol; others: bexarotene, raloxifene [in women]). The effectiveness of the latter compounds indicates that other biological systems, such as immunity or metabolism can be object of future research to identify pharmacological targets for positive symptoms of schizophrenia. Mirtazapine could be useful for treating negative symptoms without increasing the risk of a worsening of delusions/hallucinations. Nevertheless, the lack of replication of studies prevents to draw definitive conclusions and future studies are needed to confirm the findings presented in this overview.
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Affiliation(s)
- Enrico Capuzzi
- Fondazione IRCCS, Department of Mental Health and Addiction, San Gerardo Dei Tintori, Monza, Italy
| | - Alice Caldiroli
- Fondazione IRCCS, Department of Mental Health and Addiction, San Gerardo Dei Tintori, Monza, Italy
| | - Cecilia Quitadamo
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, Italy
| | - Francesco Butturini
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, Italy
| | - Teresa Surace
- Fondazione IRCCS, Department of Mental Health and Addiction, San Gerardo Dei Tintori, Monza, Italy
| | - Massimo Clerici
- Fondazione IRCCS, Department of Mental Health and Addiction, San Gerardo Dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Marder SR, Umbricht D. Negative symptoms in schizophrenia: Newly emerging measurements, pathways, and treatments. Schizophr Res 2023; 258:71-77. [PMID: 37517366 DOI: 10.1016/j.schres.2023.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
The negative symptoms of schizophrenia, which often appear earlier than any other symptom, are prominent and clinically relevant in the majority of patients. As a result, interest in their treatment has increased. Patients who exhibit significant negative symptoms have worse functional outcomes than those without, resulting in impairments in occupational, household, and recreational functioning, as well as difficulties in relationships. Yet treatment with currently available medications does not lead to any significant improvements in this core component of schizophrenia. An increased understanding of the pathophysiology underlying negative symptoms and the discovery of novel treatments that do not directly target dopamine offer the potential to develop therapies that may reduce negative symptoms and increase quality of life for patients. The current article will discuss the impact of negative symptoms, outline current measurement tools for the assessment of negative symptoms, and examine how these measures may be improved. Insights into the neural circuitry underlying negative symptoms will be discussed, and promising targets for the development of effective treatments for these symptoms will be identified. As more prospective, large-scale, randomized studies focus on the effects of treatments on negative symptoms, progress in this area is foreseeable. However, improvements in clinical assessment instruments, a better understanding of the underlying neural mechanisms, development of novel treatments with varied targets, and a greater focus on personalized treatment are all important to produce significant benefits for patients with negative symptoms of schizophrenia.
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Affiliation(s)
- Stephen R Marder
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America.
| | - Daniel Umbricht
- Xperimed LLC, Basel, Switzerland; University of Zurich, Zurich, Switzerland
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Meyer JM, Correll CU. Increased Metabolic Potential, Efficacy, and Safety of Emerging Treatments in Schizophrenia. CNS Drugs 2023; 37:545-570. [PMID: 37470979 PMCID: PMC10374807 DOI: 10.1007/s40263-023-01022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
Patients with schizophrenia experience a broad range of detrimental health outcomes resulting from illness severity, heterogeneity of disease, lifestyle behaviors, and adverse effects of antipsychotics. Because of these various factors, patients with schizophrenia have a much higher risk of cardiometabolic abnormalities than people without psychiatric illness. Although exposure to many antipsychotics increases cardiometabolic risk factors, mortality is higher in patients who are not treated versus those who are treated with antipsychotics. This indicates both direct and indirect benefits of adequately treated illness, as well as the need for beneficial medications that result in fewer cardiometabolic risk factors and comorbidities. The aim of the current narrative review was to outline the association between cardiometabolic dysfunction and schizophrenia, as well as discuss the confluence of factors that increase cardiometabolic risk in this patient population. An increased understanding of the pathophysiology of schizophrenia has guided discovery of novel treatments that do not directly target dopamine and that not only do not add, but may potentially minimize relevant cardiometabolic burden for these patients. Key discoveries that have advanced the understanding of the neural circuitry and pathophysiology of schizophrenia now provide possible pathways toward the development of new and effective treatments that may mitigate the risk of metabolic dysfunction in these patients. Novel targets and preclinical and clinical data on emerging treatments, such as glycine transport inhibitors, nicotinic and muscarinic receptor agonists, and trace amine-associated receptor-1 agonists, offer promise toward relevant therapeutic advancements. Numerous areas of investigation currently exist with the potential to considerably progress our knowledge and treatment of schizophrenia.
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Affiliation(s)
- Jonathan M Meyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Dróżdż W, Wiciński M, Szota AM, Szambelan M, Radajewska I, Popławski I, Wojciechowski P. Augmentation Therapies as Treatments for Coexisting Somatic Problems in Schizophrenia-A Systematic Review. J Clin Med 2023; 12:4012. [PMID: 37373704 DOI: 10.3390/jcm12124012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this review is to appraise the data from available randomized clinical trials (RCT) regarding the possible combinations of neuroleptic and non-antipsychotic treatment which could enhance antipsychotic therapy efficacy whilst simultaneously addressing somatic symptoms in individuals with schizophrenia. A systematic search of the PubMed database up to February 2022 was conducted. Inclusion criteria: randomized controlled trials using augmentation therapy in chronic schizophrenia in adults, written in English, and only studies with psychometric assessments of schizophrenia were incorporated. Exclusion criteria: non-clinical, first episode of schizophrenia, patients on medication other than antipsychotics augmented, and not adjunctive therapy. Overall, 37 studies of 1931 patients with schizophrenia who received a combination of antipsychotic medication with other drugs were selected. A statistically significant reduction of negative and positive symptoms of schizophrenia, measured with the PANSS scale, when using a combination of antipsychotic treatment along with aspirin, simvastatin, N-acetylcysteine, or pioglitazone was found. A combination of antipsychotic medication with aspirin, simvastatin, N-acetylcysteine, or pioglitazone seems to be effective in the reduction of symptoms of schizophrenia in adults, but long-term studies are required to confirm this effect.
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Affiliation(s)
- Wiktor Dróżdż
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Michał Wiciński
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Anna Maria Szota
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Monika Szambelan
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Izabela Radajewska
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Igor Popławski
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Paweł Wojciechowski
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
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Hudon A, Lammatteo V, Rodrigues-Coutlée S, Dellazizzo L, Giguère S, Phraxayavong K, Potvin S, Dumais A. Exploration of the role of emotional expression of treatment-resistant schizophrenia patients having followed virtual reality therapy: a content analysis. BMC Psychiatry 2023; 23:420. [PMID: 37308864 DOI: 10.1186/s12888-023-04861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Emotional responses are an important component of psychotherapeutic processes. Avatar therapy (AT) is a virtual reality-based therapy currently being developed and studied for patients suffering from treatment resistant schizophrenia. Considering the importance of identifying emotions in therapeutical processes and their impact on the therapeutic outcome, an exploration of such emotions is needed. METHODS The aim of this study is to identify the underlying emotions at the core of the patient-Avatar interaction during AT by content analysis of immersive sessions transcripts and audio recordings. A content analysis of AT transcripts and audio recordings using iterative categorization was conducted for 16 patients suffering from TRS who underwent AT between 2017 and 2022 (128 transcripts and 128 audio recordings). An iterative categorization technique was conducted to identify the different emotions expressed by the patient and the Avatar during the immersive sessions. RESULTS The following emotions were identified in this study: Anger, Contempt/ Disgust, Fear, Sadness, Shame/ Embarrassment, Interest, Surprise, Joy and Neutral. Patients expressed mostly neutral, joy and anger emotions whereas the Avatar expressed predominantly interest, disgust/contempt, and neutral emotions. CONCLUSIONS This study portrays a first qualitative insight on the emotions that are expressed in AT and serves as a steppingstone for further investigation in the role of emotions in the therapeutic outcomes of AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | | | - Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sabrina Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, QC, Canada.
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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Rubio JM, Guinart D, Kane JM, Correll CU. Early Non-Response to Antipsychotic Treatment in Schizophrenia: A Systematic Review and Meta-Analysis of Evidence-Based Management Options. CNS Drugs 2023; 37:499-512. [PMID: 37261669 DOI: 10.1007/s40263-023-01009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Early non-response is a well-established prognostic marker but evidence-based and consistent recommendations to manage it are limited. The aim of this systematic review and meta-analysis was to generate evidence-based strategies for the management of schizophrenia patients with early non-response to 2 weeks of antipsychotic treatment. METHODS We conducted a systematic review and meta-analysis of randomized trials comparing antipsychotic dose escalation, switch, augmentation and continuation in individuals with study-defined early antipsychotic treatment non-response. Eligibility criteria were (1) clinical trials of primary psychosis treating for at least 2 weeks with antipsychotic monotherapy with study-defined operationalized criteria for early non-response; and (2) randomization to at least two of the following treatment strategies: dose escalation, switch, augmentation, or treatment continuation. Information sources were Pubmed, PsycINFO, and EMBASE, and risk of bias was assessed using Jadad scores. Results were synthesized using random-effects meta-analysis, comparing each intervention with treatment continuation for total symptom change as the primary outcome, generating standardized mean differences (SMDs) and 95% confidence intervals (CIs). Studies meeting the selection criteria but providing insufficient data for a meta-analysis were presented separately. RESULTS We screened 454 records by 1 August 2022, of which 12 individual datasets met the inclusion criteria, representing 947 research participants. Of those studies, five provided data to include in the meta-analysis (four with early non-response at 2 weeks, one at 3 weeks). Early non-response was defined within a timeline of 2 weeks in eight datasets, with the remaining datasets ranging between 3 and 4 weeks. The rates of early non-response ranged between 72.0 and 24.1%, and the endpoint ranged within 4-24 weeks post randomization. Quality was good (i.e., Jadad score of ≥3) in 8 of the 12 datasets. Overall, three studies compared antipsychotic switch versus continuation and two compared antipsychotic switch versus augmentation, in both cases without significant pooled between-group differences for total symptom severity (n = 149, SMD 0.18, 95% CI -0.14 to 0.5). Individually, two relatively large studies for antipsychotic switch versus continuation found small advantages for switching antipsychotics for total symptom severity (n = 149, SMD -0.49, 95% CI -1.05 to -0.06). One relatively large study found an advantage for dose escalation, although this finding has not been replicated and was not included in the meta-analysis. None of the alternatives included antipsychotic switch to clozapine. CONCLUSIONS Despite robust accuracy of early antipsychotic non-response predicting ultimate response, the evidence for treatment strategies that should be used for early non-response after 2-3 weeks is limited. While meta-analytic findings were non-significant, some individual studies suggest advantages of antipsychotic switch or dose escalation. Therefore, any conclusions should be interpreted carefully, given the insufficient high-quality evidence.
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Affiliation(s)
- Jose M Rubio
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel Guinart
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - John M Kane
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.
- Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA.
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Peitl V, Puljić A, Škrobo M, Nadalin S, Fumić Dunkić L, Karlović D. Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia. Biomedicines 2023; 11:biomedicines11041072. [PMID: 37189691 DOI: 10.3390/biomedicines11041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Clozapine is considered the gold standard for patients with treatment-resistant schizophrenia (TRS) who have previously tried other antipsychotics at adequate doses (two or more, with at least one being atypical). However, despite optimal treatment, a subgroup of TRS patients with what is known as ultra-treatment-resistant schizophrenia (UTRS) fails to respond to clozapine, which occurs in 40–70% of cases. The most common approach to manage UTRS involves augmenting clozapine with pharmacological or non-pharmacological interventions, with a growing body of evidence that supports the use of electroconvulsive therapy (ECT) as an augmenter. This prospective non-randomized 8-week study, which followed the TRIPP Working Group guidelines and is one of few that separate TRS from UTRS, aimed to evaluate the effectiveness of clozapine in TRS patients and the efficacy of ECT augmentation of clozapine in UTRS patients. Patients with TRS were assigned to receive clozapine alone (clozapine group), whereas UTRS patients received bilateral ECT in addition to their current medication regimen (ECT plus clozapine group). The severity of symptoms was evaluated using the Clinical Global Impression Scale (CGI) and Positive and Negative Syndrome Scale (PANSS) at baseline and at the end of the 8-week trial. Both treatment approaches resulted in improved CGI and PANSS scores. The results suggest that both clozapine and ECT are effective treatment options for patients with TRS and UTRS, respectively, and that adherence to guidelines should provide a better frame for future clinical studies.
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Affiliation(s)
- Vjekoslav Peitl
- Department of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Antonia Puljić
- Department of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Mislav Škrobo
- Department of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Sergej Nadalin
- Department of Psychiatry, General Hospital “Dr. Josip Benčević”, 35000 Slavonski Brod, Croatia
| | - Lidija Fumić Dunkić
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
- Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Dalibor Karlović
- Department of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
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Gaebler AJ, Haen E, Omar NB, Endres K, Hiemke C, Schoretsanitis G, Paulzen M. Lower sertraline plasma concentration in patients co-medicated with clozapine-Implications for pharmacological augmentation strategies in schizophrenia. Pharmacol Res Perspect 2023; 11:e01065. [PMID: 36825450 PMCID: PMC9950877 DOI: 10.1002/prp2.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Augmentation of antipsychotic treatment with antidepressants represents a common and beneficial treatment strategy in patients suffering from schizophrenia. Combining clozapine and the selective serotonin reuptake inhibitor (SSRI) sertraline represents a clinically important strategy in patients with therapy-resistant schizophrenia, but there is limited knowledge about mutual pharmacokinetic interactions. In the present study, we assessed the impact of clozapine on sertraline plasma concentrations. Based on a therapeutic drug monitoring (TDM) database, sertraline plasma concentrations were compared between two groups: patients receiving a combined treatment with sertraline and clozapine (N = 15) and a matched control group receiving sertraline but no clozapine (N = 17). Group differences with respect to raw and dose-adjusted concentrations were assessed using nonparametric tests. Comedication with clozapine was associated with 67% lower median sertraline plasma concentrations (16 vs. 48 ng/mL; p = .022) and 28% lower median dose-adjusted plasma concentrations (C/D; 0.21 vs. 0.29 (ng/mL)/(mg/day); p = .049) as compared to the control group. Scatter plots revealed a complex relationship between the dosage of clozapine and dose-adjusted sertraline concentrations composed of an initial decrease at clozapine doses below 300 mg, an increase between 300 and 600 mg and a final decrease at 800 mg which was best modeled by a third order polynomial term. Cotreatment with clozapine may lead to reduced sertraline plasma concentrations which may be explained by clozapine-induced gastrointestinal hypo-mobility already present at low doses and cytochrome P450 3A4 inducing properties at high clozapine doses. For this drug combination, clinicians should consider TDM to confirm therapeutically effective plasma concentrations of sertraline.
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Affiliation(s)
- Arnim Johannes Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Aachen, Germany.,JARA - Translational Brain Medicine, Aachen, Germany.,Institute of Physiology, Medical Faculty, Aachen, Germany
| | - Ekkehard Haen
- Clinical Pharmacology Institute AGATE gGmbH, Pentling, Germany.,Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Nagia Ben Omar
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | | | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, New York, New York, USA.,University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Aachen, Germany.,JARA - Translational Brain Medicine, Aachen, Germany.,Alexianer Hospital Aachen, Aachen, Germany
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Harris A. Approach to schizophrenia. Intern Med J 2023; 53:473-480. [PMID: 37070777 DOI: 10.1111/imj.16068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 04/19/2023]
Abstract
Schizophrenia is the most common of a group of psychotic disorders that occur in approximately 3% of the population over the lifespan. It has clear genetic antecedents, which are shared across the spectrum of psychotic disorders; however, a range of other biological and social factors influence the onset and treatment of the disorder. Schizophrenia is diagnosed by a characteristic set of symptoms (positive, negative, disorganisation, cognitive and affective) accompanied by a functional decline. Investigations are used to exclude other organic causes of psychosis and to provide a baseline for the negative effects of pharmacological treatments. Treatment requires a combination of pharmacological and psychosocial interventions. Physical health is poor in this group of people and this is not helped by inconsistent care from health services. Although earlier intervention has improved the immediate outcomes, the longer-term outcome has not significantly shifted.
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Affiliation(s)
- Anthony Harris
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Prevention Early Intervention and Recovery Service, Western Sydney Local Health District, Sydney, New South Wales, Australia
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Feasibility and Effect of Increasing Clozapine Plasma Levels in Long-Stay Patients With Treatment-Resistant Schizophrenia. J Clin Psychopharmacol 2023; 43:97-105. [PMID: 36825865 DOI: 10.1097/jcp.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND It is unknown whether increasing the clozapine plasma level to 400, 750, or even 1000 ng/mL is a feasible and effective strategy in patients with treatment-resistant schizophrenia (TRS). We investigated this in long-stay patients with TRS. METHODS In long-stay TRS patients, doses of clozapine were increased gradually to reach target plasma levels of 400, 750, or 1000 ng/mL, depending on the clinical response and tolerability. After an effective or tolerated level was reached, positive and negative syndrome scale scores were evaluated after 3 months and 1 year. RESULTS Twenty-eight patients were included. Overall, 54% of the patients, and especially patients 60 years and older, could not achieve one of the clozapine target levels because of adverse effects. Three physically vulnerable patients died, probably not directly related to clozapine use. Although only 21% of patients achieved a more than 20% reduction in total symptoms at the 1-year follow-up, the mean severity of positive symptoms decreased from 18.18 to 15.10 ( P < 0.01). The largest decrease in positive symptoms was seen in TRS patients who achieved a plasma level of 750 ng/mL of clozapine. CONCLUSIONS Most TRS patients older than 60 years could not tolerate high clozapine levels and so this should not be attempted in older or otherwise physically vulnerable patients. Increasing clozapine levels to approximately 750 ng/mL in middle-aged patients with longstanding TRS may modestly reduce the severity of positive symptoms and improve the response rate.
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Abstract
PURPOSE Clozapine represents the criterion standard therapy for patients with treatment-resistant schizophrenia. Unfortunately, a significant percentage of such patients are also partial responders to clozapine. Consequently, several augmentation strategies have been proposed with various and sometimes controversial efficacy. Among these add-on treatments, lurasidone has been recently introduced and could represent a potential option, especially for the additional positive effect on cognitive symptoms. METHODS This case series aims to determine possible advantages of lurasidone augmentation in four patients treated with clozapine, who were diagnosed with treatment-resistant schizophrenia. Positive and Negative Syndrome Scales were used to evaluate psychopathology, the Udvalg for Kliniske Undersøgelser scale for tolerability and safety. FINDING All patients achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects to be reported. IMPLICATIONS Our observation suggests that lurasidone can lead to clinically significant improvements in psychopathology with a good tolerability profile when added to clozapine.
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Godin O, Pignon B, Szoke A, Boyer L, Aouizerate B, Schorr B, André M, Capdevielle D, Chereau I, Coulon N, Dassing R, Dubertret C, Etain B, Leignier S, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Urbach M, Schürhoff F, Leboyer M, Fond G, Andre M, Andrieu-Haller C, Aouizerate B, Berna F, Blanc O, Bourguignon E, Capdevielle D, Chereau-Boudet I, Clauss-Kobayashi J, Coulon N, D'Amato T, Dassing R, Dorey JM, Dubertret C, Esselin A, Fond G, Gabayet F, Jarroir M, Lacelle D, Lançon C, Laouamri H, Leboyer M, Leignier S, Llorca, Mallet J, Metairie E, Michel T, Misdrahi D, Passerieux C, Petrucci J, Pignon B, Peri P, Portalier C, Rey R, Roman C, Schorr B, Schürhoff F, Szöke A, Tessier A, Urbach M, Wachiche G, Zinetti-Bertschy A. 3-year incidence and predictors of metabolic syndrome in schizophrenia in the national FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110641. [PMID: 36122839 DOI: 10.1016/j.pnpbp.2022.110641] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022]
Abstract
AIMS Metabolic Syndrome (MetS) is a major health epidemic of Western countries and patients with schizophrenia is a particularly vulnerable population due to lifestyle, mental illness and treatment factors. However, we lack prospective data to guide prevention. The aim of our study is then to determine MetS incidence and predictors in schizophrenia. METHOD Participants were recruited in 10 expert centers at a national level and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Inverse probability weighting methods were used to correct for attrition bias. RESULTS Among the 512 participants followed-up for 3 years, 77.9% had at least one metabolic disturbance. 27.5% were identified with MetS at baseline and excluded from the analyses. Among the rest of participants (N = 371, mean aged 31.2 (SD = 9.1) years, with mean illness duration of 10.0 (SD = 7.6) years and 273 (73.6%) men), MetS incidence was 20.8% at 3 years and raised to 23.6% in tobacco smokers, 29.4% in participants receiving antidepressant prescription at baseline and 42.0% for those with 2 disturbed metabolic disturbances at baseline. Our multivariate analyses confirmed tobacco smoking and antidepressant consumption as independent predictors of MetS onset (adjusted odds ratios (aOR) = 3.82 [1.27-11.45], p = 0.016, and aOR = 3.50 [1.26-9.70], p = 0.0158). Antidepressant prescription predicted more specifically increased lipid disturbances and paroxetine was associated with the highest risk of MetS onset. CONCLUSION These results are an alarm call to prioritize MetS prevention and research in schizophrenia. We have listed interventions that should be actively promoted in clinical practice.
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Affiliation(s)
- O Godin
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - B Pignon
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - A Szoke
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - L Boyer
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; INRAE, NutriNeuro, University of Bordeaux, U1286, Bordeaux F-33076, France
| | - B Schorr
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - M André
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - N Coulon
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - R Dassing
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - B Etain
- Fondation FondaMental, Créteil, France; Assistance Publique des Hopitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisiere - Fernand Widal, DMU Neurosciences, Departement de Psychiatrie et de Medecine Addictologique, INSERM UMRS 1144, Universite de Paris, Paris, France
| | - S Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France; University of Bordeaux, CNRS UMR 5287-INCIA «Neuroimagerie et Cognition Humaine», France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028 CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - G Fond
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | | | - M Andre
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - C Andrieu-Haller
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation Fondamental, France; University Department of General Psychiatry), Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - F Berna
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - O Blanc
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - E Bourguignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - D Capdevielle
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau-Boudet
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Clauss-Kobayashi
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - N Coulon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - T D'Amato
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - R Dassing
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - J M Dorey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Dubertret
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - A Esselin
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Fond
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - F Gabayet
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - M Jarroir
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - D Lacelle
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - C Lançon
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | | | - M Leboyer
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - S Leignier
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - Llorca
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Mallet
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - E Metairie
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - T Michel
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - D Misdrahi
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - C Passerieux
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - J Petrucci
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - B Pignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - P Peri
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - C Portalier
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - R Rey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Roman
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - B Schorr
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - F Schürhoff
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Szöke
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Tessier
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - M Urbach
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Wachiche
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Zinetti-Bertschy
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
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Vasiliu O. The pharmacogenetics of the new-generation antipsychotics - A scoping review focused on patients with severe psychiatric disorders. Front Psychiatry 2023; 14:1124796. [PMID: 36873203 PMCID: PMC9978195 DOI: 10.3389/fpsyt.2023.1124796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Exploring the possible correlations between gene variations and the clinical effects of the new-generation antipsychotics is considered essential in the framework of personalized medicine. It is expected that pharmacogenetic data will be useful for increasing the treatment efficacy, tolerability, therapeutic adherence, functional recovery, and quality of life in patients with severe psychiatric disorders (SPD). This scoping review investigated the available evidence about the pharmacokinetics, pharmacodynamics, and pharmacogenetics of five new-generation antipsychotics, i.e., cariprazine, brexpiprazole, aripiprazole, lumateperone, and pimavanserin. Based on the analysis of 25 primary and secondary sources and the review of these agents' summaries of product characteristics, aripiprazole benefits from the most relevant data about the impact of gene variability on its pharmacokinetics and pharmacodynamics, with significant consequences on this antipsychotic's efficacy and tolerability. The determination of the CYP2D6 metabolizer status is important when administering aripiprazole, either as monotherapy or associated with other pharmacological agents. Allelic variability in genes encoding dopamine D2, D3, and serotonin, 5HT2A, 5HT2C receptors, COMT, BDNF, and dopamine transporter DAT1 was also associated with different adverse events or variations in the clinical efficacy of aripiprazole. Brexpiprazole also benefits from specific recommendations regarding the CYP2D6 metabolizer status and the risks of associating this antipsychotic with strong/moderate CYP2D6 or CYP3A4 inhibitors. US Food and Drug Administration (FDA) and European Medicines Agency (EMA) recommendations about cariprazine refer to possible pharmacokinetic interactions with strong CYP3A4 inhibitors or inducers. Pharmacogenetic data about cariprazine is sparse, and relevant information regarding gene-drug interactions for lumateperone and pimavanserin is yet lacking. In conclusion, more studies are needed to detect the influence of gene variations on the pharmacokinetics and pharmacodynamics of new-generation antipsychotics. This type of research could increase the ability of clinicians to predict favorable responses to specific antipsychotics and to improve the tolerability of the treatment regimen in patients with SPD.
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Affiliation(s)
- Octavian Vasiliu
- Department of Psychiatry, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
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Croatto G, Vancampfort D, Miola A, Olivola M, Fiedorowicz JG, Firth J, Alexinschi O, Gaina MA, Makkai V, Soares FC, Cavaliere L, Vianello G, Stubbs B, Fusar-Poli P, Carvalho AF, Vieta E, Cortese S, Shin JI, Correll CU, Solmi M. The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials. Mol Psychiatry 2023; 28:369-390. [PMID: 36138129 PMCID: PMC9493151 DOI: 10.1038/s41380-022-01770-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. METHODS Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). RESULTS Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). CONCLUSIONS Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.
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Affiliation(s)
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven University, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Alessandro Miola
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Miriam Olivola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | | | - Marcel A Gaina
- Institute of Psychiatry "Socola", Iasi, Romania
- Psychiatry, Department of Medicine III, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | | | | | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King's College London, London, UK
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- The Ottawa Hospital, Ottawa, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Psychosis Studies, King's College London, London, UK.
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
- Department of Psychiatry, University of Ottawa, Ontario, Canada.
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Efficacy and acceptability of psychosocial interventions in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. Mol Psychiatry 2023; 28:354-368. [PMID: 35999275 DOI: 10.1038/s41380-022-01727-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
Psychosocial interventions are recommended in schizophrenia and first-episode psychosis/early psychosis (EP). Nevertheless, literature is heterogeneous and often contradictory. We conducted an umbrella review of (network) meta-analyses of randomized controlled trials (RCTs) comparing psychosocial interventions vs treatment as usual (TAU)/active interventions(ACTIVE)/MIXED controls. Primary outcome was total symptoms (TS); secondary outcomes were positive/negative/depressive symptoms (PS/NS/DS), cognition, functioning, relapse, hospitalization, quality of life (QoL), treatment discontinuation. Standardized mean difference (SMD)/odds ratio (OR)/risk ratio (RR) vs TAU/ACTIVE/MIXED were summarized at end-of-treatment (EoT)/follow-up (FU). Quality was rated as high/medium/low (AMSTAR-PLUS). Eighty-three meta-analyses were included (RCTs = 1246; n = 84,925). Against TAU, regarding TS, Early Intervention Services (EIS) were superior EoT/FU in EP (SMD = -0.32/-0.21), cognitive behavioral therapy (CBT) in schizophrenia EoT/FU (SMD = -0.38/-0.19). Regarding secondary outcomes, in EP, EIS were superior for all outcomes EoT except cognition, and at FU for PS/NS/QoL, specific family interventions (FI-s) prevented relapse EoT; in schizophrenia, superiority emerged EoT for CBT for PS/NS/relapse/functioning/QoL; psychoeducation (EDU)/any FI for relapse; cognitive remediation therapy (CRT) for cognition/functioning; and hallucination-focused integrative treatment for PS. Against ACTIVE, in EP, mixed family interventions (FI-m) were superior at FU regarding TS (SMD = -0.61) and for functioning/relapse among secondary outcomes. In schizophrenia, regarding TS, mindfulness and social skills training (SST) were superior EoT, CBT at FU; regarding secondary outcomes superiority emerged at EoT for computerized cognitive drill-and-practice training for PS/DS, CRT for cognition/functioning, EDU for relapse, individual placement and support (IPS) for employment; and at FU CBT for PS/NS. Against MIXED, in schizophrenia, CRT/EDU were superior for TS EoT (d = -0.14/SMD = -0.33), CRT regarding secondary outcomes EoT for DS/social functioning, both EoT/FU for NS/cognition/global functioning; compensatory cognitive interventions for PS/functioning EoT/FU and NS EoT; CBT for PS at FU, and EDU/SST for relapse EoT. In conclusion, mental health services should consider prioritizing EIS/any FI in EP and CBT/CRT/any FI/IPS for schizophrenia, but other interventions may be helpful for specific outcomes.
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Abstract
Schizophrenia is a disabling condition impacting approximately 1% of the worldwide population. Symptoms include positive symptoms (eg, hallucinations, delusions), negative symptoms (eg, avolition, anhedonia), and cognitive impairment. There are likely many different environmental and pathophysiologic etiologies involving distinct neurotransmitters and neurocircuits. Pharmacologic treatment at present consists of dopamine receptor antagonists, which are reasonably effective at treating positive symptoms, but less effective at treating cognitive and negative symptoms. Nondopaminergic medications targeting alternative receptors are under investigation. Supportive psychosocial treatments can work in tandem with antipsychotic medications and optimize patient care.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine at Temple University, 100 East Lehigh Avenue, Suite 305B, Philadelphia, PA 19125, USA.
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42
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Glutamatergic dysfunction in Schizophrenia. Transl Psychiatry 2022; 12:500. [PMID: 36463316 PMCID: PMC9719533 DOI: 10.1038/s41398-022-02253-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
The NMDA-R hypofunction model of schizophrenia started with the clinical observation of the precipitation of psychotic symptoms in patients with schizophrenia exposed to PCP or ketamine. Healthy volunteers exposed to acute low doses of ketamine experienced mild psychosis but also negative and cognitive type symptoms reminiscent of the full clinical picture of schizophrenia. In rodents, acute systemic ketamine resulted in a paradoxical increase in extracellular frontal glutamate as well as of dopamine. Similar increase in prefrontal glutamate was documented with acute ketamine in healthy volunteers with 1H-MRS. Furthermore, sub-chronic low dose PCP lead to reductions in frontal dendritic tree density in rodents. In post-mortem ultrastructural studies in schizophrenia, a broad reduction in dendritic complexity and somal volume of pyramidal cells has been repeatedly described. This most likely accounts for the broad, subtle progressive cortical thinning described with MRI in- vivo. Additionally, prefrontal reductions in the obligatory GluN1 subunit of the NMDA-R has been repeatedly found in post-mortem tissue. The vast 1H-MRS literature in schizophrenia has documented trait-like small increases in glutamate concentrations in striatum very early in the illness, before antipsychotic treatment (the same structure where increased pre-synaptic release of dopamine has been reported with PET). The more recent genetic literature has reliably detected very small risk effects for common variants involving several glutamate-related genes. The pharmacological literature has followed two main tracks, directly informed by the NMDA-R hypo model: agonism at the glycine site (as mostly add-on studies targeting negative and cognitive symptoms); and pre-synaptic modulation of glutamatergic release (as single agents for acute psychosis). Unfortunately, both approaches have failed so far. There is little doubt that brain glutamatergic abnormalities are present in schizophrenia and that some of these are related to the etiology of the illness. The genetic literature directly supports a non- specific etiological role for glutamatergic dysfunction. Whether NMDA-R hypofunction as a specific mechanism accounts for any important component of the illness is still not evident. However, a glutamatergic model still has heuristic value to guide future research in schizophrenia. New tools to jointly examine brain glutamatergic, GABA-ergic and dopaminergic systems in-vivo, early in the illness, may lay the ground for a next generation of clinical trials that go beyond dopamine D2 blockade.
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Kang D, Lu J, Liu W, Shao P, Wu R. Association between olanzapine concentration and metabolic dysfunction in drug-naive and chronic patients: similarities and differences. SCHIZOPHRENIA 2022; 8:9. [PMID: 35228573 PMCID: PMC8885747 DOI: 10.1038/s41537-022-00211-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
AbstractSecond-generation antipsychotics are widely used to treat schizophrenia but their use could induce metabolic dysfunction. To balance efficacy and side effects, various guidelines recommend the use of therapeutic drug monitoring. Given the controversial relationship between olanzapine serum concentration and metabolic dysfunction, its use in clinical practice is still debated. To address this issue, we conducted a prospective cohort study to explore the associations in patients with schizophrenia. Specifically, first-episode drug-naive patients and patients with chronic schizophrenia were recruited. All participants received olanzapine monotherapy for 8 weeks. Anthropometric parameters and metabolic indices were tested at baseline and at week 8, and olanzapine serum concentration was tested at week 4. After 8 weeks of observation, body weight and BMI increased significantly in drug-naive patients. Moreover, triglycerides and LDL increased significantly in both drug-naive and chronic patients. Among chronic patients, those who have never used olanzapine/clozapine before had a significantly higher increase in weight and BMI than those who have previously used olanzapine/clozapine. Furthermore, olanzapine concentration was associated with changes in weight, BMI, and LDL levels in the drug-naive group and glucose, triglyceride and LDL levels in chronic patients who have not used olanzapine/clozapine previously. In conclusion, the metabolic dysfunction induced by olanzapine is more severe and dose-dependent in drug-naive patients but independent in patients with chronic schizophrenia. Future studies with a longer period of observation and a larger sample are warranted.
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Ferrara M, Franchini G, Funaro M, Cutroni M, Valier B, Toffanin T, Palagini L, Zerbinati L, Folesani F, Murri MB, Caruso R, Grassi L. Machine Learning and Non-Affective Psychosis: Identification, Differential Diagnosis, and Treatment. Curr Psychiatry Rep 2022; 24:925-936. [PMID: 36399236 PMCID: PMC9780131 DOI: 10.1007/s11920-022-01399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW This review will cover the most relevant findings on the use of machine learning (ML) techniques in the field of non-affective psychosis, by summarizing the studies published in the last three years focusing on illness detection and treatment. RECENT FINDINGS Multiple ML tools that include mostly supervised approaches such as support vector machine, gradient boosting, and random forest showed promising results by applying these algorithms to various sources of data: socio-demographic information, EEG, language, digital content, blood biomarkers, neuroimaging, and electronic health records. However, the overall performance, in the binary classification case, varied from 0.49, which is to be considered very low (i.e., noise), to over 0.90. These results are fully justified by different factors, some of which may be attributable to the preprocessing of the data, the wide variety of the data, and the a-priori setting of hyperparameters. One of the main limitations of the field is the lack of stratification of results based on biological sex, given that psychosis presents differently in men and women; hence, the necessity to tailor identification tools and data analytic strategies. Timely identification and appropriate treatment are key factors in reducing the consequences of psychotic disorders. In recent years, the emergence of new analytical tools based on artificial intelligence such as supervised ML approaches showed promises as a potential breakthrough in this field. However, ML applications in everyday practice are still in its infancy.
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Affiliation(s)
- Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy.
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Giorgia Franchini
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Via Campi 213/B, Modena, Italy
- Department of Mathematics and Computer Science, University of Ferrara, Via Macchiavelli 33, Ferrara, Italy
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St., New Haven, CT, USA
| | - Marcello Cutroni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Beatrice Valier
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, via Fossato di Mortara 64/A, Ferrara, Italy
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Zhao T, Shi Z, Ling N, Qin J, Zhou Q, Wu L, Wang Y, Lin C, Ma D, Song X. Sevoflurane Ameliorates Schizophrenia in a Mouse Model and Patients: A Pre-Clinical and Clinical Feasibility Study. Curr Neuropharmacol 2022; 20:2369-2380. [PMID: 35272593 DOI: 10.2174/1570159x20666220310115846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND GABAergic deficits have been considered to be associated with the pathophysiology of schizophrenia, and hence, GABA receptors subtype A (GABAARs) modulators, such as commonly used volatile anesthetic sevoflurane, may have therapeutic values for schizophrenia. The present study investigates the therapeutic effectiveness of low-concentration sevoflurane in MK801-induced schizophrenia-like mice and schizophrenia patients. METHODS Three weeks after MK801 administration (0.5 mg kg-1, i.p. twice a day for 5 days), mice were exposed to 1% sevoflurane 1hr/day for 5 days. Behavioral tests, immunohistochemical analysis, western blot assay, and electrophysiology assessments were performed 1-week post-exposure. Ten schizophrenia patients received 1% sevoflurane 5 hrs per day for 6 days and were assessed with the Positive and Negative Syndrome Scale (PANSS) and the 18-item Brief Psychiatric Rating Scale (BPRS-18) at week 1 and week 2. RESULTS MK801 induced hypolocomotion and social deficits, downregulated expression of NMDARs subunits and postsynaptic density protein 95 (PSD95), reduced parvalbumin - and GAD67-positive neurons, altered amplitude and frequency of mEPSCs and mIPSCs, and increased the excitation/inhibition ratio. All these changes induced by MK-801 were attenuated by sevoflurane administration. Six and eight patients achieved a response defined as a reduction of at least 30% in the PANSS total score at 1st and 2nd week after treatments. The BPRS-18 total score was found to be significantly decreased by 38% at the 2nd week (p < 0.01). CONCLUSION Low-concentration sevoflurane effectively reversed MK801-induced schizophrenialike disease in mice and alleviated schizophrenia patients' symptoms. Our work suggests sevoflurane to be a valuable therapeutic strategy for treating schizophrenia patients.
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Affiliation(s)
- Tianyun Zhao
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ziwen Shi
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Nongxi Ling
- Department of Psychiatry, The Third People\'s Hospital of Xinhui District, Guangdong, China
| | - Jingwen Qin
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Quancai Zhou
- Department of Psychiatry, The Third People\'s Hospital of Xinhui District, Guangdong, China
| | - Lingzhi Wu
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Yuansheng Wang
- Department of Anesthesiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Guangdong, China
| | - Chuansong Lin
- Department of Psychiatry, The Third People\'s Hospital of Xinhui District, Guangdong, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Xingrong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Monteleone AM, Pellegrino F, Croatto G, Carfagno M, Hilbert A, Treasure J, Wade T, Bulik CM, Zipfel S, Hay P, Schmidt U, Castellini G, Favaro A, Fernandez-Aranda F, Il Shin J, Voderholzer U, Ricca V, Moretti D, Busatta D, Abbate-Daga G, Ciullini F, Cascino G, Monaco F, Correll CU, Solmi M. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev 2022; 142:104857. [PMID: 36084848 PMCID: PMC9813802 DOI: 10.1016/j.neubiorev.2022.104857] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/27/2022] [Accepted: 09/02/2022] [Indexed: 02/07/2023]
Abstract
MONTELEONE, A.M., F. Pellegrino, G. Croatto, M. Carfagno, A. Hilbert, J. Treasure, T. Wade, C. Bulik, S. Zipfel, P. Hay, U. Schmidt, G. Castellini, A. Favaro, F. Fernandez-Aranda, J. Il Shin, U. Voderholzer, V. Ricca, D. Moretti, D. Busatta, G. Abbate-Daga, F. Ciullini, G. Cascino, F. Monaco, C.U. Correll and M. Solmi. Treatment of Eating Disorders: a systematic meta-review of meta-analyses and network meta-analyses. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2022.- Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also, antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults).
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Affiliation(s)
| | | | | | - Marco Carfagno
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tracey Wade
- Flinders Institute for Mental Health and Well-Being, the Blackbird Initiative, Flinders University, South Australia, Australia
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tuebingen, Germany; Centre of Excellence for Eating Disorders Tuebingen (KOMET), Germany
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angela Favaro
- Neurosciences Department, University of Padua, Padua, Italy
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL and CIBERobn, ISCIII, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital of Munich, Munich, Germany
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Davide Moretti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniele Busatta
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Filippo Ciullini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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47
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Simon N, Torrents R, Azorin JM. Comorbidities and the right dose: antipsychotics. Expert Opin Drug Metab Toxicol 2022; 18:507-518. [PMID: 35979611 DOI: 10.1080/17425255.2022.2113378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The effects of antipsychotic drugs are dose-dependent, which is particularly true for their efficacy, each antipsychotic having a specific dose-response curve. This may justify individualizing doses for these agents. AREAS COVERED We review the pharmacokinetic profiles of seven oral antipsychotics: haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole. Their main indications are psychotic and affective disorders. They are prescribed in a very large population which may have comorbidities. Hence, we analyze the impact of the latter on the pharmacokinetic profiles of these antipsychotics, focusing on renal and hepatic impairment. Reviews and clinical trials were discussed based on a systematic literature search (PubMed) ranging from 1995 to 2022. EXPERT OPINION Factors liable to impact antipsychotic dosage are numerous and their subsequent effects often hard to predict, due to multi-level interactions and compensatory phenomena. In clinical practice, physicians must be aware of these potential effects, but base their decisions on monitoring antipsychotic plasma levels.
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Affiliation(s)
- Nicolas Simon
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Marseille, France
| | - Romain Torrents
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Marseille, France
| | - Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital. 13009 Marseille, France
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48
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Neill E, Rossell SL, Yolland C, Meyer D, Galletly C, Harris A, Siskind D, Berk M, Bozaoglu K, Dark F, Dean OM, Francis PS, Liu D, Phillipou A, Sarris J, Castle DJ. N-Acetylcysteine (NAC) in Schizophrenia Resistant to Clozapine: A Double-Blind, Randomized, Placebo-Controlled Trial Targeting Negative Symptoms. Schizophr Bull 2022; 48:1263-1272. [PMID: 35857752 PMCID: PMC9673271 DOI: 10.1093/schbul/sbac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N-acetylcysteine (NAC). STUDY DESIGN A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks. STUDY RESULTS NAC did not significantly improve negative symptoms (P = .62), overall cognition (P = .71) or quality of life (Manchester quality of life: P = .11; Assessment of quality of life: P = .57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P = .26). CONCLUSIONS NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with "Australian and New Zealand Clinical Trials" on the 30 May, 2016 (Registration Number: ACTRN12615001273572).
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Affiliation(s)
- Erica Neill
- To whom correspondence should be addressed; Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, 3122, Australia, tel: 858-642-1269, e-mail:
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia,Department of Mental Health, St Vincent’s Hospital, Melbourne, Australia
| | - Caitlin Yolland
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia,Department of Mental Health, St Vincent’s Hospital, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia
| | - Cherrie Galletly
- Department of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia,Ramsay Health Care (SA) Mental Health, Adelaide, Australia,Northern Adelaide Local Health Network, Adelaide, Australia
| | - Anthony Harris
- Specialty of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia,Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Australia,UQ School of Clinical Medicine, Brisbane, Australia
| | - Michael Berk
- Deakin University, IMPACT—the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Melbourne, Australia,Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Kiymet Bozaoglu
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia,Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Brisbane, Australia,UQ School of Clinical Medicine, Brisbane, Australia
| | - Olivia M Dean
- Deakin University, IMPACT—the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Melbourne, Australia
| | - Paul S Francis
- School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, VIC, Australia
| | - Dennis Liu
- Department of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia,Northern Adelaide Local Health Network, Adelaide, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia
| | - Jerome Sarris
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Melbourne, Australia,NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia,Professional Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - David J Castle
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia,Department of Mental Health, St Vincent’s Hospital, Melbourne, Australia,Department of Psychiatry, University of Melbourne, Melbourne, Australia
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49
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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50
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Correll CU, Agid O, Crespo-Facorro B, de Bartolomeis A, Fagiolini A, Seppälä N, Howes OD. A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia. CNS Drugs 2022; 36:659-679. [PMID: 35759211 PMCID: PMC9243911 DOI: 10.1007/s40263-022-00932-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
Treatment-resistant schizophrenia (TRS) will affect about one in three patients with schizophrenia. Clozapine is the only treatment approved for TRS, and patients should be treated as soon as possible to improve their chances of achieving remission. Despite its effectiveness, concern over side effects, monitoring requirements, and inexperience with prescribing often result in long delays that can expose patients to unnecessary risks and compromise their chances of achieving favorable long-term outcomes. We critically reviewed the literature on clozapine use in TRS, focusing on guidelines, systematic reviews, and algorithms to identify strategies for improving clozapine safety and tolerability. Based on this, we have provided an overview of strategies to support early initiation of clozapine in patients with TRS based on the latest evidence and our clinical experience, and have summarized the key elements in a practical, evidence-based checklist for identifying and managing patients with TRS, with the aim of increasing confidence in prescribing and monitoring clozapine therapy.
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Affiliation(s)
- C U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Ofer Agid
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Andrea de Bartolomeis
- Section on Clinical Psychiatry and Psychology, Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, University of Naples Federico II, Naples, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Niko Seppälä
- Department of Psychiatry Satasairaala, Harjavalta, Finland
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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