Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Int J Neuropsychopharmacol. 2023 Apr 17;26(4):249-258. doi: 10.1093/ijnp/pyad004.
There are ongoing efforts to examine the effect of 5-HT1A receptor partial agonists as an add-on therapy for several symptoms of schizophrenia. By conducting a systematic review and meta-analysis, we evaluated whether augmentation with 5-hydroxtrypatamine (5-HT)1A partial agonists of the azapirone class improves psychotic symptoms and attention/processing speed, a key domain of cognition, in patients with schizophrenia.
A literature search was performed from 1987 to February 25, 2022, to identify randomized controlled trials. The standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated when there were 2 or more studies. Seven studies, involving 435 patients, met the inclusion criteria.
Random-effects model meta-analyses revealed that add-on therapy with buspirone or tandospirone had a significant beneficial effect on overall psychotic symptoms (SMD = -1.13, 95% CI = -1.98 to -0.27) and positive symptoms (SMD = -0.72, 95% CI =-1.31 to -0.12), while the effect on negative symptoms did not reach statistical significance (SMD = -0.93, 95% CI = -1.90 to 0.04). A significant positive effect was also observed on attention/processing speed (SMD = 0.37, 95% CI = 0.12 to 0.61).
These findings support the idea that some compounds that stimulate 5-HT1A receptors provide an effective pharmacologic enhancer in the treatment of schizophrenia. Further clinical trials are warranted to determine the benefits of the adjunctive use of 5-HT1A partial agonists in ameliorating symptoms and improving functional outcomes in patients with schizophrenia or other psychiatric disorders.
目前正在努力研究 5-HT1A 受体部分激动剂作为几种精神分裂症症状的附加治疗方法。通过系统评价和荟萃分析，我们评估了阿扎吡隆类 5-羟色胺（5-HT）1A 部分激动剂作为增效剂是否能改善精神分裂症患者的精神病症状和注意力/加工速度，这是认知的一个关键领域。
从 1987 年到 2022 年 2 月 25 日进行了文献检索，以确定随机对照试验。当有 2 项或更多研究时，计算标准化均数差（SMD）和 95%置信区间（CI）。符合纳入标准的有 7 项研究，共 435 名患者。
随机效应模型荟萃分析显示，丁螺环酮或坦度螺酮的附加治疗对总体精神病症状（SMD=-1.13，95%CI=-1.98 至-0.27）和阳性症状（SMD=-0.72，95%CI=-1.31 至-0.12）有显著的有益效果，而对阴性症状的影响没有达到统计学意义（SMD=-0.93，95%CI=-1.90 至 0.04）。注意力/加工速度也有显著的积极影响（SMD=0.37，95%CI=0.12 至 0.61）。
这些发现支持这样一种观点，即一些刺激 5-HT1A 受体的化合物在治疗精神分裂症方面提供了一种有效的药物增强剂。需要进一步的临床试验来确定 5-HT1A 部分激动剂作为增效剂在改善精神分裂症或其他精神障碍患者症状和改善功能结局方面的益处。
