Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials
Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials
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DOI：
10.1093/schbul/sbu170
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发表时间：
2015-07-01
影响因子：
6.6
通讯作者：
McGuire, Philip
中科院分区：
文献类型：
--
作者：
Fusar-Poli, Paolo;Papanastasiou, Evangelos;McGuire, Philip
目的：现有的精神分裂症治疗方法可以改善阳性症状，但尚不清楚它们是否对阴性症状有任何影响。本荟萃分析旨在评估现有治疗精神分裂症阴性症状的有效性。研究方法：检索了截至2013年12月的精神分裂症阴性症状干预措施的所有随机对照试验;使用了168项独特和独立的安慰剂对照试验。提取基线和随访时的阴性症状评分、疾病持续时间、药物剂量、干预类型和样本人口统计学资料。用I-2和Q统计量解决异质性。计算每项研究中阴性症状评定量表值的标准化平均差异作为主要结局指标。结果：纳入治疗组6503例患者和安慰剂组5815例患者。没有发现发表偏倚的证据。与安慰剂相比，大多数治疗在随访时减少了阴性症状：第二代抗精神病药：-0.579（-0.755至-0.404）;抗抑郁药：-0.349（-0.551至-0.146）;药物联合用药：-0.518（-0.757 ~-0.279）;镇痛药：-0.289（-0.478 ~-0.1）;心理干预：-0.396（-0.563 ~-0.229）。第一代抗精神病药：-0.531（-1.104至0.041）和脑刺激：-0.228（-0.775至0.319）没有发现显著影响。根据临床总体印象严重程度量表测量，大多数治疗的效果无临床意义。结论和相关性：尽管对阴性症状的一些统计学显着影响很明显，但没有达到临床显着改善的阈值。
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.