Generic placeholder image

Current Psychopharmacology

Editor-in-Chief

ISSN (Print): 2211-5560
ISSN (Online): 2211-5579

Research Article

Improvement of Negative Symptoms in Schizophrenia: A Double-blind Clinical Trial by Escitalopram in Male Patients

Author(s): Saeed S. Shafti*

Volume 9, Issue 3, 2020

Page: [211 - 217] Pages: 7

DOI: 10.2174/2211556009999200513074605

Price: $65

Abstract

Background: The negative symptoms of schizophrenia remain a major clinical trouble against psychiatric rehabilitation and available therapeutic treatments.

Objective: Escitalopram is known as the most selective SSRI with minimal effects on norepinephrine and dopamine neuronal uptake. The aim of the present study is to assess the effect of escitalopram on negative symptoms of schizophrenia.

Methods: This study was an eight-week, randomized, placebo-controlled trial of escitalopram set against placebo, as an add-on medication, in the treatment of 50 patients with a diagnosis of schizophrenia. While the Scale for Assessment of Negative Symptoms was used as the primary outcome measure, the Scale for Assessment of Positive Symptoms, the Simpson-Angus Scale and the Hamilton Depression Scale, as well, were used as a secondary measure for evaluation of positive, extrapyramidal and depressive symptoms, respectively.

Results: The primary outcome of the present assessment was a significant reduction in the mean total score of the Scale for Assessment of Negative Symptoms (SANS) in the target group, compared to placebo, at the end of eight weeks. In this regard, most of the subscales of SANS, as well, demonstrated significant improvements by escitalopram.

Conclusion: According to the findings, escitalopram can be helpful, as add-on medication, in amelioration of negative symptoms of schizophrenia.

Keywords: Add-on medication, adjunctive treatment, deficit syndrome, escitalopram, negative symptoms, schizophrenia.

Graphical Abstract

[1]
Messinger JW, Trémeau F, Antonius D, et al. Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research. Clin Psychol Rev 2011; 31(1): 161-8.
[http://dx.doi.org/10.1016/j.cpr.2010.09.002 ] [PMID: 20889248]
[2]
Foussias G, Siddiqui I, Fervaha G, Agid O, Remington G. Dissecting negative symptoms in schizophrenia: opportunities for translation into new treatments. J Psychopharmacol (Oxford) 2015; 29(2): 116-26.
[http://dx.doi.org/10.1177/0269881114562092 ] [PMID: 25516370]
[3]
Carpenter WT Jr. The treatment of negative symptoms: pharmacological and methodological issues. Br J Psychiatry Suppl 1996; 168(29): 17-22.
[http://dx.doi.org/10.1192/S0007125000298279 ] [PMID: 8733819]
[4]
Galderisi S, Mucci A, Bitter I, et al. Persistent negative symptoms in first episode patients with schizophrenia: results from the European first episode schizophrenia trial. Eur Neuropsychopharmacol 2013; 23(3): 196-204.
[http://dx.doi.org/10.1016/j.euroneuro.2012.04.019 ] [PMID: 22647933]
[5]
Buchanan RW. Persistent negative symptoms in schizophrenia: an overview. Schizophr Bull 2007; 33(4): 1013-22.
[http://dx.doi.org/10.1093/schbul/sbl057 ] [PMID: 17099070]
[6]
Rabinowitz J, Levine SZ, Garibaldi G, Bugarski-Kirola D, Berardo CG, Kapur S. Negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: analysis of CATIE data. Schizophr Res 2012; 137(1-3): 147-50.
[http://dx.doi.org/10.1016/j.schres.2012.01.015 ] [PMID: 22316568]
[7]
Barnes TR, McPhillips MA. How to distinguish between the neuroleptic-induced deficit syndrome, depression and disease-related negative symptoms in schizophrenia. Int Clin Psychopharmacol 1995; 10(Suppl. 3): 115-21.
[PMID: 8866773]
[8]
Veerman SRT, Schulte PFJ, de Haan L. Treatment for negative symptoms in schizophrenia: a comprehensive review. Drugs 2017; 77(13): 1423-59.
[http://dx.doi.org/10.1007/s40265-017-0789-y ] [PMID: 28776162]
[9]
Rammou A, Fisher HL, Johnson S, et al. Negative symptoms in first‐episode psychosis: clinical correlates and 1‐year follow‐up outcomes in London Early Intervention Services. Early Interv Psychiatry 2017; 16: 115-23.
[PMID: 29148264]
[10]
Bobes J, Arango C, Garcia-Garcia M, Rejas J. Prevalence of negative symptoms in outpatients with schizophrenia spectrum disorders treated with antipsychotics in routine clinical practice: findings from the CLAMORS study. J Clin Psychiatry 2010; 71(3): 280-6.
[http://dx.doi.org/10.4088/JCP.08m04250yel ] [PMID: 19895779]
[11]
Buckley PF, Stahl SM. Pharmacological treatment of negative symptoms of schizophrenia: therapeutic opportunity or cul-de-sac? Acta Psychiatr Scand 2007; 115(2): 93-100.
[http://dx.doi.org/10.1111/j.1600-0447.2007.00992.x ] [PMID: 17244172]
[12]
Evins AE, Goff DC. Adjunctive antidepressant drug therapies in the treatment of negative symptoms of schizophrenia. CNS Drugs 1996; 6: 130-47.
[http://dx.doi.org/10.2165/00023210-199606020-00005]
[13]
Goff DC, Evins AE. Negative symptoms in schizophrenia: neurobiological models and treatment response. Harv Rev Psychiatry 1998; 6(2): 59-77.
[http://dx.doi.org/10.3109/10673229809000313 ] [PMID: 10370450]
[14]
Silver H, Nassar A. Fluvoxamine improves negative symptoms in treated chronic schizophrenia: an add-on double-blind, placebo-controlled study. Biol Psychiatry 1992; 31(7): 698-704.
[http://dx.doi.org/10.1016/0006-3223(92)90279-9 ] [PMID: 1599987]
[15]
Shoja Shafti S. Drug-Specific Responsiveness of Negative Symptoms. Int J Psychosoc Rehabil 2005; 10(1): 177-86.
[16]
Shoja Shafti S. Treatment-responsiveness of negative symptoms in schizophrenia: a double-blind placebo-control clinical trial. Iran J Med Sci 2006; 31: 135-8.
[17]
Goff DC, Midha KK, Sarid-Segal O, Hubbard JW, Amico E. A placebo-controlled trial of fluoxetine added to neuroleptic in patients with schizophrenia. Psychopharmacology (Berl) 1995; 117(4): 417-23.
[http://dx.doi.org/10.1007/BF02246213 PMID: 7604142]
[18]
Shoja Shafti S. Effectiveness of bromocriptine, flouxetine and nortriptyline in ameliorating the negative symptoms of schizophrenia. Quarterly Rehabilitation 2004; 5(16): 58-63.
[19]
Salokangas RK, Saarijärvi S, Taiminen T, et al. Citalopram as an adjuvant in chronic schizophrenia: a double-blind placebo-controlled study. Acta Psychiatr Scand 1996; 94(3): 175-80.
[http://dx.doi.org/10.1111/j.1600-0447.1996.tb09844.x ] [PMID: 8891083]
[20]
Shoja Shafti S. Effectiveness of citalopram, alprazolam and clomipramine in amelioration of negative symptoms in schizophrenia. Quarterly Rehabilitation 2003; 3(12): 42-9.
[21]
Yamagami S, Soejima K. Effect of maprotiline combined with conventional neuroleptics against negative symptoms of chronic schizophrenia. Drugs Exp Clin Res 1989; 15(4): 171-6.
[PMID: 2570687]
[22]
Shoja Shafti S, Jafarabad MS, Azizi R. Amelioration of deficit syndrome of schizophrenia by norepinephrine reuptake inhibitor. Ther Adv Psychopharmacol 2015; 5(5): 263-70.
[http://dx.doi.org/10.1177/2045125315591953 ] [PMID: 26557982]
[23]
Shoja Shafti S, Azizi Khoei A. Effectiveness of rivastigmine on positive, negative, and cognitive symptoms of schizophrenia: a double-blind clinical trial. Ther Adv Psychopharmacol 2016; 6(5): 308-16.
[http://dx.doi.org/10.1177/2045125316656334 ] [PMID: 27721970]
[24]
Shoja Shafti S, Akbari S. Intractability of deficit syndrome of schizophrenia against adjunctive modafinil. J Clin Psychopharmacol 2016; 36(1): 45-9.
[http://dx.doi.org/10.1097/JCP.0000000000000437 ] [PMID: 26658259]
[25]
World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310(20): 2191-4.
[http://dx.doi.org/10.1001/jama.2013.281053 ] [PMID: 24141714]
[26]
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev.. Washington, DC: American Psychiatric Association 2000.
[27]
Andreasen N. The Scale for Assessment of Negative Symptoms (SANS). Iowa: University of Iowa, Department of Psychiatry 1981.
[28]
Andreasen N. The Scale for Assessment of Positive Symptoms (SAPS). Iowa: University of Iowa, Department of Psychiatry 1984.
[29]
Simpson GM, Angus JW. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 1970; 212(44): 11-9.
[http://dx.doi.org/10.1111/j.1600-0447.1970.tb02066.x ] [PMID: 4917967]
[30]
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56-62.
[http://dx.doi.org/10.1136/jnnp.23.1.56 PMID: 14399272]
[31]
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
[http://dx.doi.org/10.1016/0022-3956(75)90026-6 ] [PMID: 1202204]
[32]
Melle I, Larsen TK, Haahr U, et al. Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Arch Gen Psychiatry 2008; 65(6): 634-40.
[http://dx.doi.org/10.1001/archpsyc.65.6.634 ] [PMID: 18519821]
[33]
Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005; 162(10): 1785-804.
[http://dx.doi.org/10.1176/appi.ajp.162.10.1785 ] [PMID: 16199825]
[34]
Aleman A, Lincoln TM, Bruggeman R, et al. Treatment of negative symptoms: where do we stand, and where do we go? Schizophr Res 2017; 186: 55-62.
[http://dx.doi.org/10.1016/j.schres.2016.05.015 ] [PMID: 27293137]
[35]
Kishi T, Iwata N. Meta-analysis of noradrenergic and specific serotonergic antidepressant use in schizophrenia. Int J Neuropsychopharmacol 2014; 17(2): 343-54.
[http://dx.doi.org/10.1017/S1461145713000667 ] [PMID: 23823741]
[36]
Sepehry AA, Potvin S, Elie R, Stip E. Selective serotonin reuptake inhibitor (SSRI) add-on therapy for the negative symptoms of schizophrenia: a meta-analysis. J Clin Psychiatry 2007; 68(4): 604-10.
[http://dx.doi.org/10.4088/JCP.v68n0417 PMID: 17474817]
[37]
Singh SP, Singh V, Kar N, Chan K. Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis. Br J Psychiatry 2010; 197(3): 174-9.
[http://dx.doi.org/10.1192/bjp.bp.109.067710 ] [PMID: 20807960]
[38]
Barnes TR, Leeson VC, Paton C, et al. Antidepressant Controlled Trial For Negative Symptoms In Schizophrenia (ACTIONS): a double-blind, placebo-controlled, randomised clinical trial. Health Technol Assess 2016; 20(29): 1-46.
[http://dx.doi.org/10.3310/hta20290 ] [PMID: 27094189]
[39]
Sharma RP, Singh V, Janicak PG, Javaid JI, Pandey GN. The prolactin response to fenfluramine in schizophrenia is associated with negative symptoms. Schizophr Res 1999; 39(1): 85-9.
[http://dx.doi.org/10.1016/S0920-9964(99)00014-6 ] [PMID: 10480671]
[40]
Meltzer HY, Nash JF. Effects of antipsychotic drugs on serotonin receptors. Pharmacol Rev 1991; 43(4): 587-604.
[PMID: 1685568]
[41]
Möller HJ. Non-neuroleptic approaches to treating negative symptoms in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2004; 254(2): 108-16.
[http://dx.doi.org/10.1007/s00406-004-0503-4 ] [PMID: 15146340]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy