Managing Negative Symptoms of Schizophrenia: How Far Have We Come?

anon79999497 · April 12, 2017, 10:41am

ncbi.nlm.nih.gov

Managing Negative Symptoms of Schizophrenia: How Far Have We Come?

JT Kantrowitz, CNS drugs, May 2017

The specific efficacy of antipsychotics on negative symptoms is questionable, suggesting an urgent need for specific treatments for negative symptoms. This review includes studies published since 2014 with a primary or secondary focus on treating negative symptoms in schizophrenia. Special emphasis is given to recently published meta-analyses. Topics include novel pharmacological approaches, including glutamatergic-based and nicotinic-acetylcholinergic treatments, treatments approved for other indications by the US FDA (or other regulatory bodies) (antipsychotics, antidepressants, and mood stabilizers), brain stimulation, and behavioral- and activity-based approaches, including physical exercise. Potential complications regarding the design of current negative symptom trials are discussed and include inconsistent placebo effects, lack of reliable biomarkers, negative symptom scale and inclusion criteria variability, attempts to distinguish between primary and secondary negative symptoms, lack of focus on early psychosis, and the potential iatrogenic bias of clinical trials.

http://sci-hub.cc/10.1007/s40263-017-0428-x (full review)

everhopeful · April 12, 2017, 10:45am

I think if min-101 makes it to market and treats negative symptoms and becomes a blockbuster drug for that reason, suddenly you’ll see a plethora of drugs treating negative symptoms.

Anonaccount · April 12, 2017, 11:14am

We haven’t come very far. I’m still struggling to wash my hair, take showers and change my clothes.

Indecisive · April 14, 2017, 12:49am

My social interaction and cognitive symptoms are becoming terrible… I hope it does not take long

anon31257746 · April 14, 2017, 1:33am

I’ve been keeping a schedule lately. I think that helps

anon11056724 · April 14, 2017, 3:58am

How are they going to treat brain damage?

twinklestars · April 14, 2017, 5:08am

@firemonkey that was a good article. I couldn’t read it on my phone, if anyone else had trouble, I had to read it on my computer.

This was possibly the most intriguing part:

"NMDAR dysfunction is thought to lead to elevations in
glutamate release, which may serve to trigger permanent
structural changes if not prevented early in the course of
the disorder [96, 97]. Animal models support the ability of
NMDAR agonists to reverse these changes [98] and thus
their potential to modify the course of disease as well as
ongoing symptoms. To the extent that this is correct, glutamatergic
drugs may be specifically effective in early
schizophrenia, particularly in the clinical high-risk (CHR)
period before psychotic symptoms fully form. Additionally,
the majority of individuals showing CHR symptoms
do not convert to schizophrenia even without treatment but
nevertheless show significant social and occupational
impairments that are significantly mediated by negative
symptoms. This suggests that negative symptoms in the
CHR population represent an independent target for intervention
[99] over and above psychosis conversion.
Following a proof-of-concept study with glycine [100],
a recent study in 44 individuals supported the efficacy of Dserine
in CHR without adjunctive antipsychotics [57]. DSerine
induced a 36% improvement in negative symptoms,
which was significant compared with placebo (d = 0.68,
p = 0.03). Scale of Prodromal Symptoms (SOPS) [101]
total scores improved at a trend level (p = 0.07; d = 0.67).
An exploratory analysis showed that changes in IL-6 levels
correlated significantly with improvement in negative
symptoms across groups (r = 0.4, p = 0.037), further
supporting the potential role of NMDAR dysfunction-induced
elaboration of pro-inflammatory cytokines in the
etiology of negative symptoms"