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Schizophr Bull. 2015 Jul;41(4):892-9. doi: 10.1093/schbul/sbu170. Epub 2014 Dec 20.

Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials.

Author information

1
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK; OASIS team, South London and the Maudsley NHS Foundation Trust, London, UK;
2
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK; evangelos.e.papanastasiou@kcl.ac.uk.
3
Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK;
4
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy;
5
Department of Psychiatry and Pharmacology, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD.
6
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK;

Abstract

OBJECTIVES:

Existing treatments for schizophrenia can improve positive symptoms, but it is unclear if they have any impact on negative symptoms. This meta-analysis was conducted to assess the efficacy of available treatments for negative symptoms in schizophrenia.

METHODS:

All randomized-controlled trials of interventions for negative symptoms in schizophrenia until December 2013 were retrieved; 168 unique and independent placebo-controlled trials were used. Negative symptom scores at baseline and follow-up, duration of illness, doses of medication, type of interventions, and sample demographics were extracted. Heterogeneity was addressed with the I (2) and Q statistic. Standardized mean difference in values of the Negative Symptom Rating Scale used in each study was calculated as the main outcome measure.

RESULTS:

6503 patients in the treatment arm and 5815 patients in the placebo arm were included. No evidence of publication biases found. Most treatments reduced negative symptoms at follow-up relative to placebo: second-generation antipsychotics: -0.579 (-0.755 to -0.404); antidepressants: -0.349 (-0.551 to -0.146); combinations of pharmacological agents: -0.518 (-0.757 to -0.279); glutamatergic medications: -0.289 (-0.478 to -0.1); psychological interventions: -0.396 (-0.563 to -0.229). No significant effect was found for first-generation antipsychotics: -0.531 (-1.104 to 0.041) and brain stimulation: -0.228 (-0.775 to 0.319). Effects of most treatments were not clinically meaningful as measured on Clinical Global Impression Severity Scale.

CONCLUSIONS AND RELEVANCE:

Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.

KEYWORDS:

antipsychotics; negative symptoms; psychosis; schizophrenia; treatment

PMID:
25528757
PMCID:
PMC4466178
DOI:
10.1093/schbul/sbu170
[Indexed for MEDLINE]
Free PMC Article

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