![]() ![]() Therefore, it is important to examine the beneficial effects on negative symptoms in the acute phase 10, 11. As a result, most patients with acute schizophrenia will continue the same medication for many months or years 9. Generally, a drug that is effective in the acute phase will also be prescribed for relapse prevention. However, it must be kept in mind that relapse prevention with antipsychotic medications is recommended in guidelines 7, 8. Therefore, negative symptoms are often not considered to be a relevant outcome in acute phase trials. In acute phase trials of antipsychotic medication, a reduction in negative symptoms along with positive and total symptoms has been observed but has been mostly considered to be unspecific or to reflect a reduction in secondary negative symptoms 6. Primary negative symptoms are thought to be intrinsic to schizophrenia, whereas secondary negative symptoms can be caused by positive symptoms, depression, medication side effects, and substance abuse.Ĭurrent recommendations for drug trials for negative symptoms recommend a duration of at least 6 months 5. Negative symptoms of schizophrenia can be categorized as primary or secondary 4. ![]() Negative symptoms tend to persist over time and remain a major treatment challenge 3. The burden of the disease is strongly determined by negative symptoms, which include social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal-directed activity 2. Schizophrenia is a debilitating disease and is ranked among the top 15 causes of disability worldwide 1. Additional RCTs are necessary to establish the optimal dose. Most dose-response curves suggested that the near-maximum effective doses could be in the lower-to-medium range of the licensed dose. ![]() The shape of the dose-response curves varied across different drugs with most drugs showing a plateau at higher doses. The 95% effective doses per day for the 13 antipsychotics included and 3 long acting were mostly different for negative and positive symptoms: amisulpride (481 mg, 690.6 mg) aripiprazole (11.9 mg, 11 mg) asenapine (7.61 mg, 5.66 mg) brexpiprazole (2.1 mg, 4 mg) cariprazine (4 mg, 6.51 mg) haloperidol (6.34 mg, 7.36 mg) lurasidone (58.2 mg, 86.3 mg) olanzapine (15.5 mg, 9.52 mg) olanzapine long-acting injection (15.7 mg, 13.5 mg) paliperidone (7.2 mg, 7 mg) paliperidone long-acting injection (7.5 mg, 5.9 mg) quetiapine instant-release (264.2 mg, 316.5 mg) quetiapine extended-release (774 mg, 707.2 mg) risperidone (7.5 mg, 7.7 mg) risperidone long-acting injection (5.13 mg, 6.7 mg) sertindole (13.5 mg, 16.3 mg) and ziprasidone (71.6 mg, 152.6 mg). Forty RCTs included a total of 15,689 patients. Therefore, we conducted a formal dose-response meta-analysis of negative symptoms and positive symptoms based on a systematic review of fixed-dose randomized controlled trials (RCTs) that examined the effectiveness of antipsychotics for the acute exacerbation of schizophrenia. The effect of antipsychotics on negative symptoms should be taken into account because patients will often continue on the treatment received in the acute phase. Determining the optimal antipsychotic target dose in acute phase treatment is of high clinical relevance.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |