Systematic Review of Local Studies Regarding Efficiency of Add-On Medications on Negative Symptoms of Schizophrenia: A Meta-Analysis

2019 ◽  
Vol 8 (2) ◽  
pp. 113-122
Author(s):  
Saeed Shoja Shafti
Keyword(s):  
Effect Size ◽  
Psychotropic Drugs ◽  
Negative Symptoms ◽  
Meta Analysis ◽  
Combined Effect ◽  
Placebo Control ◽  
Double Blind ◽  
Deficit Syndrome ◽  
Text Revision ◽  
Diagnostic And Statistical Manual

Background: While negative symptoms are connected with poor functioning and quality of life, pharmacological managements have imperfect effects on deficit syndrome and may even subsidize or aggravate secondary negative symptoms. Meanwhile, management of negative symptoms by means of add-on medications has resulted in instable consequences. Objective: In the current tryout, some of the indigenous systematic issued studies have been the theme of a new meta-analysis, to assess the effectiveness of adjunctive psychotropic drugs on deficit syndrome of schizophrenia. Methods: Twelve randomized placebo-control trials (n=433), which had been implemented in Razi psychiatric hospital in the last 14 years, had been selected for the present analysis. As a shared protocol, all cases had been selected amongst the male inpatients, who were hospitalized in chronic section of the hospice and had been diagnosed schizophrenia in line with “Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision”. In this regard, the aforesaid samples had been entered into matching-group, double-blind assessments for random assignment to a psychotropic medication (like antidepressant, benzodiazepine, psycho-stimulant, Acetyl-cholinesterase inhibitors) or placebo in addition to their current drug. In these trials, “Scale for Assessment of Negative Symptoms (SANS)” had been used as the main outcome measure for evaluation of negative symptoms. Also, response was defined as a decrease in >20% in the severity of SANS score (over-all and/or sub-scales). Results: While the heterogeneity of the present meta-analysis was intermediate, the “Combined Effect Size” of the aforesaid assessments has revealed a significant influence respecting efficiency of psychotropic drugs on negative symptoms of schizophrenia (OR = 5.40, CI=2.69- 10.85, z= 5.32, p<0.000). Similar results, as well, could be found in connection with various negative symptoms. In this regard, ‘Anhedonia-Asociality’ showed the best “Combined Effect Size”, afterwards “Affective Blunting”, “Avolitio -Apathy”, “Attention Deficit”, and last of all “Alogia”. “Heterogeneity” of all said analysis was insignificant and therefore appropriate. Conclusion: According to the findings, psychotropic drugs, as add-on medications, have valuable influence in regard to amelioration of negative symptoms of schizophrenia.

Systematic review and exploratory meta-analysis of the efficacy, safety, and biological effects of psychostimulants and atomoxetine in patients with schizophrenia or schizoaffective disorder

CNS Spectrums ◽  
2018 ◽  
Vol 24 (5) ◽  
pp. 479-495 ◽  
Author(s):  
Marco Solmi ◽  
Michele Fornaro ◽  
Kuniyoshi Toyoshima ◽  
Andrè F. Carvalho ◽  
Cristiano A. Köhler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Problem Solving ◽  
Executive Functions ◽  
Negative Symptoms ◽  
Biological Effects ◽  
Meta Analysis ◽  
Cortical Activation ◽  
Therapeutic Effects ◽  
Double Blind ◽  
Relapse Prediction

ObjectiveOur aim was to summarize the efficacy and safety of atomoxetine, amphetamines, and methylphenidate in schizophrenia.MethodsWe undertook a systematic review, searching PubMed/Scopus/Clinicaltrials.gov for double-blind, randomized, placebo-controlled studies of psychostimulants or atomoxetine in schizophrenia published up to 1 January 2017. A meta-analysis of outcomes reported in two or more studies is presented.ResultsWe included 22 studies investigating therapeutic effects of stimulants (k=14) or measuring symptomatic worsening/relapse prediction after stimulant challenge (k=6). Six studies of these two groups plus one additional study investigated biological effects of psychostimulants or atomoxetine. No effect resulted from interventional studies on weight loss (k=1), smoking cessation (k=1), and positive symptoms (k=12), and no improvement was reported with atomoxetine (k=3) for negative symptoms, with equivocal findings for negative (k=6) and mood symptoms (k=2) with amphetamines. Attention, processing speed, working memory, problem solving, and executive functions, among others, showed from no to some improvement with atomoxetine (k=3) or amphetamines (k=6). Meta-analysis did not confirm any effect of stimulants in any symptom domain, including negative symptoms, apart from atomoxetine improving problem solving (k=2, standardized mean difference (SMD)=0.73, 95% CI=0.10–1.36,p=0.02, I2=0%), and trending toward significant improvement in executive functions with amphetamines (k=2, SMD=0.80, 95% CI=−1.68 to +0.08,p=0.08, I2=66%). In challenge studies, amphetamines (k=1) did not worsen symptoms, and methylphenidate (k=5) consistently worsened or predicted relapse. Biological effects of atomoxetine (k=1) and amphetamines (k=1) were cortical activation, without change in β-endorphin (k=1), improved response to antipsychotics after amphetamine challenge (k=2), and an increase of growth hormone–mediated psychosis with methylphenidate (k=2). No major side effects were reported (k=6).ConclusionsNo efficacy for stimulants or atomoxetine on negative symptoms is proven. Atomoxetine or amphetamines may improve cognitive symptoms, while methylphenidate should be avoided in patients with schizophrenia. Insufficient evidence is available to draw firm conclusions.

scholarly journals Meta-analysis of double-blind placebo control trials evaluating the role of coenzyme Q10 on semen parameters

2018 ◽  
Vol 110 (4) ◽  
pp. e167-e168 ◽  
Author(s):  
A. Agarwal ◽  
A. Sharma ◽  
K. Master ◽  
R. Sharma ◽  
R. Henkel
Keyword(s):  
Coenzyme Q10 ◽  
Meta Analysis ◽  
Semen Parameters ◽  
Placebo Control ◽  
Double Blind ◽  
Double Blind Placebo

Efficacy of lurasidone across five symptom dimensions of schizophrenia: Pooled analysis of short-term, placebo-controlled studies

2015 ◽  
Vol 30 (1) ◽  
pp. 26-31 ◽  
Author(s):  
A. Loebel ◽  
J. Cucchiaro ◽  
R. Silva ◽  
Y. Mao ◽  
J. Xu ◽  
...  
Keyword(s):  
Effect Size ◽  
Repeated Measures ◽  
Negative Symptoms ◽  
Mixed Model ◽  
Five Factor Model ◽  
Pooled Analysis ◽  
Positive Symptoms ◽  
Factor Scores ◽  
Short Term ◽  
Double Blind

AbstractObjective:To evaluate the efficacy of lurasidone for schizophrenia using an established five-factor model of the Positive and Negative Syndrome Scale (PANSS).Methods:Patient-level data were pooled from five randomized, double-blind, placebo-controlled, 6-week studies of lurasidone (fixed doses, 40–160 mg/d) for patients with an acute exacerbation of schizophrenia. Changes in five established PANSS factors were assessed using mixed-model repeated measures analysis.Results:Compared with placebo (n = 496), lurasidone (n = 1029, dose groups pooled) significantly improved the PANSS total score at Week 6 (−22.6 vs. −12.8; P < 0.001; effect size, 0.45), as well as all factor scores (P < 0.001 for each): positive symptoms (−8.4 vs. −6.0; effect size, 0.43), negative symptoms (−5.2 vs. −3.3; effect size, 0.33), disorganized thought (−4.9 vs. −2.8; effect size, 0.42), hostility/excitement (−2.7 vs. −1.6; effect size, 0.31), and depression/anxiety (−3.2 vs. −2.3; effect size, 0.31). Separation from placebo occurred at Week 1 for the positive symptoms, disorganized thought, and hostility/excitement factors and at Week 2 for the other factors.Conclusions:In this pooled analysis of short-term studies in patients with acute schizophrenia, lurasidone demonstrated significant improvement for each of the five PANSS factor scores, indicating effectiveness across the spectrum of schizophrenia symptoms.

Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis

2008 ◽  
Vol 39 (1) ◽  
pp. 65-75 ◽  
Author(s):  
D. J. L. G. Schutter
Keyword(s):  
Prefrontal Cortex ◽  
Transcranial Magnetic Stimulation ◽  
Effect Size ◽  
High Frequency ◽  
Magnetic Stimulation ◽  
Dorsolateral Prefrontal Cortex ◽  
Meta Analysis ◽  
Double Blind ◽  
Left Dlpfc ◽  
Dorsolateral Prefrontal

BackgroundFor more than a decade high-frequency repetitive transcranial magnetic stimulation (rTMS) has been applied to the left dorsolateral prefrontal cortex (DLPFC) in search of an alternative treatment for depression. The aim of this study was to provide an update on its clinical efficacy by performing a meta-analysis involving double-blind sham-controlled studies.MethodA literature search was conducted in the databases PubMed and Web of Science in the period between January 1980 and November 2007 with the search terms ‘depression’ and ‘transcranial magnetic stimulation’. Thirty double-blind sham-controlled parallel studies with 1164 patients comparing the percentage change in depression scores from baseline to endpoint of activeversussham treatment were included. A random effects meta-analysis was performed to investigate the clinical efficacy of fast-frequency rTMS over the left DLPFC in depression.ResultsThe test for heterogeneity was not significant (QT=30.46,p=0.39). A significant overall weighted mean effect size,d=0.39 [95% confidence interval (CI) 0.25–0.54], for active treatment was observed (z=6.52,p<0.0001). Medication resistance and intensity of rTMS did not play a role in the effect size.ConclusionsThese findings show that high-frequency rTMS over the left DLPFC is superior to sham in the treatment of depression. The effect size is robust and comparable to at least a subset of commercially available antidepressant drug agents. Current limitations and future prospects are discussed.

scholarly journals Meta-analysis of the relationship between mathematics anxiety and mathematics achievement

2016 ◽  
Vol 6 (3) ◽  
pp. 371-392 ◽  
Author(s):  
Süleyman Nihat Şad ◽  
Ali Kış ◽  
Mustafa Demir ◽  
Niyazi Özer
Keyword(s):  
Middle School ◽  
Mathematics Achievement ◽  
Effect Size ◽  
Mathematics Anxiety ◽  
Meta Analysis ◽  
Moderate Level ◽  
Combined Effect ◽  
School Level ◽  
And Mathematics ◽  
Middle School Level

This meta-analysis study aims to synthesize the results of individual studies on respectively small samples investigating the correlations between Mathematics anxiety and Mathematics achievement. Meta-analysis included a total of 11 studies which investigated the association between Mathematics anxiety and Mathematics achievement on Turkish students which were published between 2005 and 2014. These studies were conducted totally on 8327 students from different educational stages. The results of the analysis for all eleven studies involved suggested negative and statistically significant correlations between mathematics anxiety and mathematics achievement. The combined effect size was calculated for all studies according to both Fixed (r=-.39) and Random (r=-.44) Effect Models. Moderator analysis based on the school level revealed that the combined effect size for the studies conducted at middle school level was significant, negative and at moderate level. In addition, the effect size for the studies conducted at high school level was significant, negative and at moderate level. Moreover, the comparison between the combined effect sizes with regard to different school levels revealed a statistically significant difference in favor of middle school level.

scholarly journals IMMU-02. CH14.18 IN THE TREATMENT OF HIGH-RISK NEUROBLASTOMA: A META-ANALYSIS

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i27-i27
Author(s):  
Sameerah Abdel-Khaleq ◽  
Lina Alim ◽  
Atholl Johnston ◽  
Khloud Adam
Keyword(s):  
High Risk ◽  
Effect Size ◽  
Standard Error ◽  
Meta Analysis ◽  
Combined Effect ◽  
Bibliographic Databases ◽  
Survival Outcomes ◽  
Weighted Mean ◽  
Term Survival ◽  
And Control

Abstract High-risk neuroblastoma (HRNB) is a rare malignancy that mainly affects young children. Long-term survival remains low despite aggressive, multimodal treatment regimens. The aim is to assess the effect of Ch14.18, a novel anti-GD2 antibody, on survival in HRNB. In this meta-analysis, Pubmed/MEDLINE, EMBASE, Cochrane CENTRAL and Clinicaltrials.gov bibliographic databases were searched from inception to 1st July 2018. Prospective or retrospective interventional clinical trials with at least two arms or observational cohort or case-control studies were eligible. Participants had to have HRNB. Ch14.18 was the intervention of choice. Any control, comparator treatments were accepted. Studies were appraised for inclusion by two independent reviewers. Data was extracted from published reports. Primary outcomes assessed were Event-Free Survival (EFS) and Overall Survival (OS) and presented as Weighted Mean EFS (%) ± Standard Error (SE) and Weighted Mean OS (%) ± Standard Error (SE), respectively. Combined effect size was elicited for EFS±SE and OS±SE. The search yielded 367 results of which 7 studies conducted on 1727 patients were eligible for inclusion. The weighted mean EFS±SE for Ch14.18 regimens (n=779) and control regimens (n=787) were 55.6±2.0% and 41.2±1.7%, respectively. The weighted mean OS±SE for Ch14.18 regimens (n=430) and control regimens (n=348) were 63.4±2.3% and 53.6±2.7%, respectively. Results of the meta analysis yielded statistical power &gt;94%. The combined effect size of Ch14.18 regimens for EFS±SE was 0.2907±0.05 [95% CI: 0.19–0.39, p&lt;0.001] and the combined effect size for OS±SE was 0.26±0.07 [95% CI: 0.11- 0.4, p&lt;0.001]. Significant superior survival outcomes were achieved with the use of Ch14.18 in the treatment of HRNB. These findings support using Ch14.18 as an adjunct in maintenance therapy in high-risk neuroblastoma. This meta analysis is the first of its kind. Survival outcomes are to be interpreted with caution due to confounding bias.

scholarly journals The efficacy of transcranial magnetic stimulation (TMS) for negative symptoms in schizophrenia: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Rasmus Lorentzen ◽  
Tuan Dang Nguyen ◽  
Alexander McGirr ◽  
Fredrik Hieronymus ◽  
Soren Dinesen Ostergaard
Keyword(s):  
Systematic Review ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Negative Symptoms ◽  
Meta Analysis ◽  
Preliminary Evidence ◽  
Pooled Analysis ◽  
P Value ◽  
Number Needed To Treat ◽  
Double Blind

Several trials have shown preliminary evidence for efficacy using Transcranial Magnetic Stimulation (TMS) as a treatment for negative symptoms in schizophrenia. Here, we synthesize this literature using a systematic review and quantitative meta-analysis of double-blind randomized controlled trials of TMS in patients with schizophrenia. Specifically, MEDLINE, EMBASE, Web of Science, and PsycINFO were searched for sham-controlled, randomized trials of TMS among patients with schizophrenia. The standardized mean difference (SMD, Cohen's d) with 95% confidence intervals (CI) was calculated for each study (TMS vs. sham) and pooled across studies using an inverse variance random effects model. We identified 56 studies with a total of 2550 participants that were included in the meta-analysis. The pooled analysis showed statistically significant superiority of TMS (SMD=0.37, 95%CI: 0.23; 0.52, p-value <0.00001), corresponding to a number needed to treat of 4.85. Furthermore, stratified analyses suggested that TMS targeting the left dorsolateral prefrontal cortex, using a stimulation frequency >1 Hz, and a stimulation intensity at or above the motor threshold, was most efficacious. There was, however, substantial heterogeneity and high risk of bias among the included studies. In conclusion, TMS appears to be an efficacious treatment option for patients with schizophrenia suffering from negative symptoms, but the optimal TMS parameters have yet to be resolved.

Meta-Analysis of Controlled Trials of Drug Therapy in Mild Chronic Asthma: The Role of Inhaled Corticosteroids

1994 ◽  
Vol 28 (11) ◽  
pp. 1285-1289 ◽  
Author(s):  
Gary Milavetz ◽  
H. William Kelly ◽  
Hind T. Hatoum ◽  
Glen T. Schumock ◽  
Donald L. Kendzierski
Keyword(s):  
Effect Size ◽  
English Language ◽  
Inhaled Corticosteroids ◽  
Meta Analysis ◽  
Weighted Average ◽  
Chronic Asthma ◽  
Success Rates ◽  
Double Blind ◽  
Effect Size Calculation

OBJECTIVE: To determine the role of inhaled corticosteroids in the treatment of mild chronic asthma. SOURCE OF STUDIES: Searches of MEDLINE and Index Medicus for English language literature dealing with asthma and inhaled corticosteroids. DESIGN: All retrieved articles were subjected to predetermined criteria for inclusion in the meta-analysis. Inclusion criteria centered around randomized, double-blind studies reporting objective clinical endpoint(s) for subjects with mild chronic asthma who were treated for more than seven days. Studies that were included were not allowed to have any predetermined exclusion criteria. RESULTS: The literature search identified 129 articles, of which 41 satisfied some but not all of the criteria for inclusion. Five articles met all the criteria and were subjected to meta-analysis. The total number of subjects was 141. Peak expiratory flow rate (PEFR) was used as the objective endpoint for effect size calculation. Subjecting these five studies to quality review revealed a range of 0.607–0.741, with 1 as the highest attainable quality and 0 the lowest. Reported results for the different studies were found to be homogenous, thus allowing for the calculation of overall effect size. Inclusion of children in some of the studies added variance to the reported studies, but not to the point at which studies would be considered heterogenous. Effect sizes ranged between 0.41 and 0.89, and the overall weighted average effect size for PEFR was 0.59, with the calculated 95 percent confidence interval at 0.32 to 0.84. A tabulated display of binomial effect size for included trials provided ranges of success rates for treatment versus control values. Results of the studies were judged robust, as 92 studies reporting no significant effects are needed to turn the finding of the meta-analysis insignificant. CONCLUSIONS: Based on the results of the meta-analysis, the existing literature suggests a role for inhaled corticosteroids in the treatment of mild chronic asthma.

scholarly journals Effectiveness of Integrated Neurocognitive Therapy on Cognitive Impairment and Functional Outcome for Schizophrenia Outpatients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Andreana De Mare ◽  
Miriam Cantarella ◽  
Giovanni Galeoto
Keyword(s):  
Cognitive Impairment ◽  
Functional Outcome ◽  
Effect Size ◽  
Negative Symptoms ◽  
Social Cognitive ◽  
Meta Analysis ◽  
Positive Symptoms ◽  
Global Functioning ◽  
Cognitive Domains ◽  
Treatment Research

Cognitive impairment is highly prevalent in patients with schizophrenia and schizoaffective disorder. Many interventions have been developed to treat cognitive deficit, since it has a strong impact on functional outcome; however, there are no integrated interventions targeting multiple neuro- and social-cognitive domains with a particular focus on the generalization of the effects of therapy on the functional outcome. Recently, a group of experts has developed a cognitive remediation group therapy approach called Integrated Neurocognitive Therapy (INT), which includes exercises to improve the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) neuro- and social-cognitive domains. This systematic review and meta-analysis aimed to assess the efficacy of this approach. We conducted a search of PubMed, Scopus, Web of Science, and PsycINFO to select primary studies evaluating INT in schizophrenic and schizoaffective patients. The primary outcomes of the meta-analysis included negative and positive symptoms and global functioning. Two randomized controlled trials met inclusion criteria. A total of 217 participants were included. Based on the results from the Positive and Negative Syndrome Scale (PANSS), a significant pooled effect size was observed for negative symptoms, which demonstrated not only an improvement in the patients treated immediately after therapy but also a permanence of positive results at a 9–12-month follow-up. On the other hand, no significant effect size was observed for positive symptoms. In addition, a significant pooled effect size was found for Global Assessment of Functioning (GAF), which shows how INT’s integrated approach has lasting positive implications on patients’ functional outcome. We concluded that INT might be an effective treatment for negative symptoms and global functioning in patients with schizophrenia, compared to treatment as usual (TAU).

scholarly journals Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis

2017 ◽  
Vol 44 ◽  
pp. 198-207 ◽  
Author(s):  
T.R. Moukhtarian ◽  
R.E. Cooper ◽  
E. Vassos ◽  
P. Moran ◽  
P. Asherson
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Meta Analysis ◽  
Emotional Lability ◽  
Adhd Symptoms ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Ovid Medline ◽  
Weighted Effect ◽  
The Difference

AbstractBackground:Emotional lability (EL) is an associated feature of attention-deficit/hyperactivity disorder (ADHD) in adults, contributing to functional impairment. Yet the effect of pharmacological treatments for ADHD on EL symptoms is unknown. We conducted a systematic review and meta-analysis to examine the effects of stimulants and atomoxetine on symptoms of EL and compare these with the effects on core ADHD symptoms.Methods:A systematic search was conducted on the databases Embase, PsychInfo, and Ovid Medline®and the clinicaltrials.gov website. We included randomised, double-blind, placebo-controlled trials of stimulants and atomoxetine in adults aged 18–60 years, with any mental health diagnosis characterised by emotional or mood instability, with at least one outcome measure of EL. All identified trials were on adults with ADHD. A random-effects meta-analysis with standardised mean difference and 95% confidence intervals was used to investigate the effect size on EL and compare this to the effect on core ADHD symptoms.Results:Of the 3,864 publications identified, nine trials met the inclusion criteria for the meta-analysis. Stimulants and atomoxetine led to large mean weighted effect-sizes for on ADHD symptoms (n= 9, SMD = −0.8, 95% CI:−1.07 to −0.53). EL outcomes showed more moderate but definite effects (n= 9, SMD = −0.41, 95% CI:−0.57 to −0.25).Conclusions:In this meta-analysis, stimulants and atomoxetine were moderately effective for EL symptoms, while effect size on core ADHD symptoms was twice as large. Methodological issues may partially explain the difference in effect size. Reduced average effect size could also reflect heterogeneity of EL with ADHD pharmacotherapy responsive and non-responsive sub-types. Our findings indicate that EL may be less responsive than ADHD symptoms overall, perhaps indicating the need for adjunctive psychotherapy in some cases. To clarify these questions, our findings need replication in studies selecting subjects for high EL and targeting EL as the primary outcome.

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