Fusar-Poli Paolo, Papanastasiou Evangelos, Stahl Daniel, Rocchetti Matteo, Carpenter William, Shergill Sukhwinder, McGuire Philip
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;
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK;
Schizophr Bull. 2015 Jul;41(4):892-9. doi: 10.1093/schbul/sbu170. Epub 2014 Dec 20.
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.
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.
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.
Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.
精神分裂症的现有治疗方法可改善阳性症状，但它们对阴性症状是否有任何影响尚不清楚。进行这项荟萃分析以评估精神分裂症阴性症状现有治疗方法的疗效。
检索了截至2013年12月所有针对精神分裂症阴性症状干预措施的随机对照试验；使用了168项独特且独立的安慰剂对照试验。提取了基线和随访时的阴性症状评分、病程、药物剂量、干预类型和样本人口统计学数据。使用I(2)和Q统计量处理异质性。计算每项研究中使用的阴性症状评定量表值的标准化平均差作为主要结局指标。
治疗组纳入6503例患者，安慰剂组纳入5815例患者。未发现发表偏倚的证据。与安慰剂相比，大多数治疗在随访时可减轻阴性症状：第二代抗精神病药物：-0.579（-0.755至-0.404）；抗抑郁药：-0.349（-0.551至-0.146）；药物联合治疗：-0.518（-0.757至-0.279）；谷氨酸能药物：-0.289（-0.478至-0.1）；心理干预：-0.396（-0.563至-0.229）。第一代抗精神病药物：-0.531（-1.104至0.041）和脑刺激：-0.228（-0.775至0.319）未发现显著效果。根据临床总体印象严重程度量表测量，大多数治疗的效果在临床上无意义。
虽然对阴性症状有一些统计学上的显著影响，但均未达到临床显著改善的阈值。
