Augmentation Of Antipsychotic Treatment With Memantine In Patients With Schizophrenia: A Systematic Review And Meta-Analysis

Objective: Many patients with schizophrenia respond partially to treatment with antipsychotic medications. A wide range of pharmaceutical agents are utilized as augmentation therapy in order to increase the efficacy of antipsychotic medication treatment. Memantine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist is one of these add-on agents. In this study we aimed to assess the efficacy of memantine augmentation by conducting a systematic review and meta-analysis on the psychopathology of patients with schizophrenia receving antipsychotic medication. Method: We analyzed the double-blind, randomized, placebo-controlled trials of memantine add-on treatment given to schizophrenia patients receiving antipsychotic medications. The primary outcome measure was amelioration of negative symptoms and the secondary outcome measures were amelioration of positive, total and general psycopathology symptoms. Publication bias was evaluated by the Funnel plot and Egger test. Results: Eleven studies on a total of 570 cases were included. Although memantine add-on treatment was superior to placebo for ameliorating negative symptoms (SMD=0.596, 95% CI=0.075-1.118, p=0.025), there were not any statistically significant differences in the amelioration of general psycopathology (SMD=0.034, 95% CI=0.419-0.488, p=0.883), the positive (SMD=-0.041, 95% CI=0.217-0.135, p=0.650) and the overall symptoms. (SMD=0.315, 95% CI=0.256-0.887, p=0.280). Publication bias was not observed between studies according to the results of the Funnel plots and Egger tests. Conclusion: Memantine augmentation treatment is beneficial for treating particularly the negative symptoms of schizophrenia patients. Further studies on the subject with larger sample size and longer follow-up durations are needed.WoSScopu

S103. Examination Of Formal Thought Disorder And Its Clinical Correlates With The Turkish Version Of The Thought And Language Disorder Scale (Tald-Tr) In Schizophrenia

Background Formal thought disorder (FTD) is considered to be a fundamental feature of schizophrenia (SZ). It is crucial to assess FTD comprehensively in a practical, operationalized way for etiopathogenesis, neurobiology and imaging studies. Kircher and his colleagues (2014) have developed the Thought and Language Disorder (TALD) scale which captures both positive/negative and objective/subjective FTD symptoms. This study aims to analyze psychometric properties of the Turkish version of TALD (TALD-TR) and investigate the relationship between FTD and various clinical characteristics in patients with SZ. Methods The original TALD manual was adapted into Turkish and applied to a total of 149 participants of which 114 had DSM-5 psychiatric diagnoses (schizophrenia N=70, mania N=20, depression N=24) and 35 were healthy controls. To analyze interrater reliability of the TALD-TR, interviews of 20 patients diagnosed with SZ were recorded on video. The records were viewed and scored by two independent raters. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impression-Severity Scale were administered to detect illness severity. Results The principle component analyses revealed that the TALD-TR consisted of four factors including the Objective Positive (OP), Subjective Negative, Objective Negative (ON) and Subjective Positive symptom dimensions which were in line with the original TALD factorial structure. The crohnbach alpha values of the factors were found to be 0.91, 0.78, 0.76, 0.53 respectively. Intraclass correlation coefficient was 0.95. It was concluded that TALD-TR shows strong construct validity and high interrater reliability. The correlation analyses with TALD-TR and PANSS showed that there are significant positive correlations between the TALD-TR total score and the PANSS total and subscale scores. In the SZ group, a strong correlation was found between TALD-TR total score and PANSS Conceptual disorganization item. Following PANSS items, which were highly correlated with TALD-TR total score, were Stereotyped thinking, Suspiciousness, Delusions and Unusual thought content. The mania group exhibited the highest mean total score in the OP, whereas the SZ group exhibited the highest mean total score in the ON factor. In the SZ group, age controlled partial correlation analysis revealed that there was a positive correlation between the TALD-TR total score and the duration of illness. A negative correlation was found between the TALD-TR total score and age at illness onset. Additionally, clozapine users had higher TALD-TR ON score than non-clozapine users. Discussion This study showed that TALD-TR is a valid and reliable tool with good psychometric properties to assess FTD by its unique four-factorial structure as in the original study. The correlation between FTD and PANSS items associated with thought content suggest that thought content and thought process are not completely discrete entities. The comparison of FTD among different diagnostic groups showed a distinct pattern regarding the TALD-TR factors. In line with literature, the results of this study suggest that FTD is related with higher illness severity, longer duration of illness and early age at illness onset in patients with SZ. These findings emphasize the need to develop new treatment strategies aiming to improve FTD from the early stages of SZ. In patients with treatment refractory schizophrenia, especially the Objective Negative symptoms remain to be one of the main treatment targets. Finally, successful adaptation of TALD into different languages seems to be possible, bringing in an international tool for research on FTD.PubMe

Reasons for clozapine discontinuation in patients with treatment-resistant schizophrenia

Although clozapine is more effective than other antipsychotics in the treatment of schizophrenia, the rate of its discontinuation is also high. The aim of this retrospective chart-review study was to investigate the causes of clozapine discontinuation in patients with treatment-resistant schizophrenia. This study included a total of 396 patients with schizophrenia, 240 still on clozapine therapy and 156 who discontinued clozapine, and compared their clinical characteristics. Those who discontinued clozapine had a longer history of illness and more hospitalizations before clozapine and tended to be older. Inadequate response was more common among clozapine discontinuers compared to continuers. The most common reason for discontinuation was the side-effects associated with clozapine (49%). Discontinuation from patient decision or by the psychiatrist due to noncompliance was the second (29.7%) and discontinuation due to lack of efficacy was the third most frequent reason (21.3%). The patients who discontinued clozapine because of cardiac side effects were younger, had shorter duration of clozapine use, and had lower maximum clozapine dose compared to the other discontinuers. Our findings point out the importance of enhancing psychiatrists' ability to handle manageable side effects to minimize discontinuations and maximize the benefits of clozapine in patients with treatment-resistant schizophrenia

Predictors of discontinuation and hospitalization during long-acting injectable antipsychotic treatment in patients with schizophrenia spectrum disorder

The aim of this study was to evaluate discontinuation and hospitalization rates in patients with schizophrenia spectrum disorder who were treated with long-acting injectable (LAI) antipsychotics. We recorded clinical data about the period before the LAI treatment, when LAI treatment was initiated, and during the LAI treatment. Variables related to early (<8 weeks) and other LAI discontinuations and hospitalization were analyzed. Out of 452 patients, 14.4% of them discontinued their LAI treatment before 8 weeks, another 24.8% of the patients stopped their LAI by themselves later. Early discontinuers were younger, had shorter duration of illness, and less educated. Sixty-two (27.2%) of the patients were hospitalized under LAI treatment and 40% of the hospitalizations occurred in initial 6 months. Rate of hospitalization was 36.1% in the group who discontinued LAI after 8 weeks. In logistic regression analysis, younger age, history of combined antipsychotic treatment, number of hospitalizations before LAI, use of LAI for less than 6 months and alcohol abuse under LAI treatment were found related to hospitalization. Our findings suggested that discontinuation and hospitalization are still common among the patients who were treated with LAI antipsychotics