Firth J, Stubbs B, Sarris J, Rosenbaum S, Teasdale S, Berk M, Yung A R
Division of Psychology and Mental Health,University of Manchester,Manchester,UK.
Physiotherapy Department,South London and Maudsley NHS Foundation Trust, London,UK.
Psychol Med. 2017 Jul;47(9):1515-1527. doi: 10.1017/S0033291717000022. Epub 2017 Feb 16.
When used as an adjunctive with antipsychotics, certain vitamins and minerals may be effective for improving symptomatic outcomes of schizophrenia, by restoring nutritional deficits, reducing oxidative stress, or modulating neurological pathways.
We conducted a systematic review of all randomized controlled trials (RCTs) reporting effects of vitamin and/or mineral supplements on psychiatric symptoms in people with schizophrenia. Random-effects meta-analyses were used to calculate the standardized mean difference between nutrient and placebo treatments.
An electronic database search in July 2016 identified 18 eligible RCTs, with outcome data for 832 patients. Pooled effects showed that vitamin B supplementation (including B6, B8 and B12) reduced psychiatric symptoms significantly more than control conditions [g = 0.508, 95% confidence interval (CI) 0.01-1.01, p = 0.047, I 2 = 72.3%]. Similar effects were observed among vitamin B RCTs which used intention-to-treat analyses (g = 0.734, 95% CI 0.00-1.49, p = 0.051). However, no effects of B vitamins were observed in individual domains of positive and negative symptoms (both p > 0.1). Meta-regression analyses showed that shorter illness duration was associated with greater vitamin B effectiveness (p = 0.001). There were no overall effects from antioxidant vitamins, inositol or dietary minerals on psychiatric symptoms.
There is preliminary evidence that certain vitamin and mineral supplements may reduce psychiatric symptoms in some people with schizophrenia. Further research is needed to examine how the benefits of supplementation relate to nutrient deficits and the impact upon underlying neurobiological pathways, in order to establish optimal nutrient formulations for improving clinical outcomes in this population. Future studies should also explore the effects of combining beneficial nutrients within multi-nutrient formulas.
某些维生素和矿物质与抗精神病药物联合使用时，可能通过恢复营养缺乏、减轻氧化应激或调节神经通路，有效改善精神分裂症的症状结局。
我们对所有报告维生素和/或矿物质补充剂对精神分裂症患者精神症状影响的随机对照试验（RCT）进行了系统评价。采用随机效应荟萃分析计算营养素治疗与安慰剂治疗之间的标准化平均差异。
2016年7月的电子数据库检索确定了18项符合条件的RCT，涉及832例患者的结局数据。汇总效应表明，补充维生素B（包括B6、B8和B12）比对照条件显著更能减轻精神症状[g = 0.508，95%置信区间（CI）0.01 - 1.01，p = 0.047，I² = 72.3%]。在采用意向性分析的维生素B RCT中也观察到类似效果（g = 0.734，95%CI 0.00 - 1.49，p = 0.051）。然而，在阳性和阴性症状的各个领域均未观察到B族维生素的效果（p均>0.1）。荟萃回归分析表明，病程较短与维生素B的疗效更佳相关（p = 0.001）。抗氧化维生素、肌醇或膳食矿物质对精神症状无总体影响。
有初步证据表明，某些维生素和矿物质补充剂可能减轻部分精神分裂症患者的精神症状。需要进一步研究以探讨补充剂的益处与营养缺乏的关系以及对潜在神经生物学通路的影响，从而确定改善该人群临床结局的最佳营养配方。未来研究还应探索在多种营养素配方中联合有益营养素的效果。
