Department of psychiatry, School of Medicine, Kashan University of Medical Science, Kashan, Iran.
Department of psychiatry, School of Medicine, Kashan University of Medical Science, Kashan, Iran.
Prog Neuropsychopharmacol Biol Psychiatry. 2018 Mar 2;82:289-296. doi: 10.1016/j.pnpbp.2017.11.001. Epub 2017 Nov 7.
Schizophrenia is one of the most disabling psychiatric syndromes with the prevalence of 1% in the general population. Despite availability of various antipsychotics, negative symptoms and cognitive impairment are difficult to treat. In addition antipsychotic monotherapy is not effective in most of these patients. Current evidence indicates the roles of glutamatergic system in this disorder. N-acetyl cysteine (NAC) also increases extracellular glutamate. This study was conducted to evaluate the clinical effects of oral NAC as an add-on to maintenance medication for the treatment of chronic schizophrenia.
This 12-week, double-blind, randomized, placebo-controlled, clinical trial was performed to determine the effectiveness of 1200mg N-acetyl cysteine as an adjunctive treatment with conventional antipsychotic medications in 84 patients with chronic schizophrenia. The subjects were evaluated with the Positive and Negative Syndrome Scale (PANSS), Mini-Mental State Examination (MMSE), and a standard neuropsychological screening test. Data were analyzed with SPSS-16 software.
NAC-treated patients showed significantly improvement in the positive (F=5.47, P=0.02) and negative (F=0.20, df=1) PANSS subscale. Also the general and total PANSS score of NAC group declined over times whilst it was increased for placebo group. Regarding cognitive functions, improvement was observed in some explored areas, such as attention, short-term and working memory, executive functioning and speed of processing. There was no significant difference between the 2 groups in the frequency of adverse effects.
The present study detected improvement in positive, negative, general and total psychopathology symptoms as well as cognitive performance with NAC treatment. It is also well-tolerated, safe and easy-to-use agent as an effective therapeutic strategy to improve outcome in schizophrenia treatment.
精神分裂症是最具致残性的精神综合征之一，其在普通人群中的患病率为 1%。尽管有各种抗精神病药物可用，但阴性症状和认知障碍仍难以治疗。此外，大多数此类患者对抗精神病药物单药治疗反应不佳。目前的证据表明，谷氨酸能系统在这种疾病中起作用。N-乙酰半胱氨酸（NAC）也会增加细胞外谷氨酸。本研究旨在评估口服 NAC 作为维持治疗药物的附加治疗，用于治疗慢性精神分裂症的临床效果。
这是一项为期 12 周的双盲、随机、安慰剂对照临床试验，旨在确定 1200mg N-乙酰半胱氨酸作为辅助治疗慢性精神分裂症常规抗精神病药物的有效性。采用阳性和阴性症状量表（PANSS）、简易精神状态检查（MMSE）和标准神经心理筛选测试对受试者进行评估。数据采用 SPSS-16 软件进行分析。
NAC 治疗组在阳性（F=5.47，P=0.02）和阴性（F=0.20，df=1）PANSS 量表上的症状显著改善。NAC 组的一般和总 PANSS 评分随时间下降，而安慰剂组的评分则上升。在认知功能方面，一些探索性领域（如注意力、短期和工作记忆、执行功能和处理速度）的认知功能得到改善。两组在不良反应发生率方面无显著差异。
本研究检测到 NAC 治疗可改善阳性、阴性、一般和总精神病理学症状以及认知表现。它也是一种耐受性良好、安全且易于使用的药物，作为改善精神分裂症治疗效果的有效治疗策略。
