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Moccia L, Bardi F, Anesini MB, Barbonetti S, Kotzalidis GD, Rossi S, Caso R, Grisoni F, Mandracchia G, Margoni S, Callovini T, Janiri D, Mazza M, Simonetti A, Montanari S, Autullo G, Camardese G, Pepe M, Di Nicola M, Di Giorgio V, Conti F, Sani G. Pharmacological Interventions for Negative Symptoms in Schizophrenia: A Systematic Review of Randomised Control Trials. Biomedicines 2025; 13:540. [PMID: 40149518 PMCID: PMC11940281 DOI: 10.3390/biomedicines13030540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Revised: 02/11/2025] [Accepted: 02/13/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: While positive symptoms of schizophrenia are often satisfactorily controlled, negative symptoms are difficult to treat, persisting despite treatment. Different strategies have been devised to deal with this problem. We aimed to review drug treatment for negative symptoms of schizophrenia in controlled trials of marketed drugs. Methods: We searched the PubMed database and the resulting records' reference lists to identify eligible trials using schizophrenia[ti] AND "negative symptom*"[ti] as a search strategy. We determined eligibility through Delphi rounds among all authors. Results: On 11 February 2025, we identified 1485 records on PubMed and 3 more from reference lists. Eligible were 95 records. Most studies were double-blind, randomized controlled trials, carried-out in add-on in patients stabilized with antipsychotics. Other antipsychotics were the most frequent comparators, followed by antidepressants, and recently, antioxidants are gaining importance in trials. Many trials, especially those conducted in the Western world, found no significant effects compared to placebo, while most Iranian studies were positive, although not with a strong effect size. Conclusions: Current research has contributed little to progress in the treatment of the negative symptoms of schizophrenia. The reason might reside in the absence of knowledge of the mechanisms whereby these symptoms are generated, which prevents us from designing possibly effective treatment strategies, and/or to the chronicity of negative symptoms, as they are the first to be established even when they do not become fully apparent.
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Affiliation(s)
- Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesca Bardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Rossi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Romina Caso
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Stella Margoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Tommaso Callovini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Silvia Montanari
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianna Autullo
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Life Science, Health, and Health Professions, Link Campus University, Via del Casale di S. Pio V, 44, 00165 Rome, Italy
| | - Maria Pepe
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vassilij Di Giorgio
- Istituto di Neuroscienze, Neomesia Kos Group, Via Nomentana 1362, 00137 Rome, Italy; (V.D.G.); (F.C.)
| | - Fabio Conti
- Istituto di Neuroscienze, Neomesia Kos Group, Via Nomentana 1362, 00137 Rome, Italy; (V.D.G.); (F.C.)
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (F.B.); (M.B.A.); (S.B.); (S.R.); (R.C.); (F.G.); (G.M.); (S.M.); (T.C.); (D.J.); (M.M.); (A.S.); (S.M.); (G.A.); (M.P.); (M.D.N.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Tsapakis EM, Treiber M, Mitkani C, Drakaki Z, Cholevas A, Spanaki C, Fountoulakis KN. Pharmacological Treatments of Negative Symptoms in Schizophrenia-An Update. J Clin Med 2024; 13:5637. [PMID: 39337126 PMCID: PMC11432821 DOI: 10.3390/jcm13185637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little improvement in the burden of negative symptoms. This article reviews current pharmacological strategies for treating negative symptoms. Dopaminergic, glutamatergic, serotonergic, noradrenergic, cholinergic, anti-inflammatory compounds, hormones, and psychostimulants are explored. Finally, we review pharmacological global treatment guidelines for negative symptoms. In general, switching to a second-generation antipsychotic seems to be most often recommended for patients with schizophrenia on first-generation antipsychotics, and an add-on antidepressant is considered when depression is also present. However, the treatment of negative symptoms remains an unmet need. Future, larger clinical studies and meta-analyses are needed to establish effective pharmacological agents for the effective treatment of negative symptoms.
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Affiliation(s)
- Evangelia Maria Tsapakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Michael Treiber
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, 1090 Vienna, Austria
| | - Calypso Mitkani
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Neurology, Agios Pavlos General Hospital of Thessaloniki, 55134 Thessaloniki, Greece
| | - Zoe Drakaki
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Anastasios Cholevas
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Cleanthe Spanaki
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Neurology, University Hospital of Heraklion, Voutes, 71110 Crete, Greece
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Peng A, Chai J, Wu H, Bai B, Yang H, He W, Zhao Y. New Therapeutic Targets and Drugs for Schizophrenia Beyond Dopamine D2 Receptor Antagonists. Neuropsychiatr Dis Treat 2024; 20:607-620. [PMID: 38525480 PMCID: PMC10961082 DOI: 10.2147/ndt.s455279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Schizophrenia is a disease with a complex pathological mechanism that is influenced by multiple genes. The study of its pathogenesis is dominated by the dopamine hypothesis, as well as other hypotheses such as the 5-hydroxytryptamine hypothesis, glutamate hypothesis, immune-inflammatory hypothesis, gene expression abnormality hypothesis, and neurodevelopmental abnormality hypothesis. The first generation of antipsychotics was developed based on dopaminergic receptor antagonism, which blocks dopamine D2 receptors in the brain to exert antipsychotic effects. The second generation of antipsychotics acts by dual blockade of 5-hydroxytryptamine and dopamine receptors. From the third generation of antipsychotics onwards, the therapeutic targets for antipsychotic schizophrenia expanded beyond D2 receptor blockade to explore D2 receptor partial agonism and the antipsychotic effects of new targets such as D3, 5-HT1A, 5-HT7, and mGlu2/3 receptors. The main advantages of the second and third generation antipsychotics over first-generation antipsychotics are the reduction of side effects and the improvement of negative symptoms, and even though third-generation antipsychotics do not directly block D2 receptors, the modulation of the dopamine transmitter system is still an important part of their antipsychotic process. According to recent research, several receptors, including 5-hydroxytryptamine, glutamate, γ-aminobutyric acid, acetylcholine receptors and norepinephrine, play a role in the development of schizophrenia. Therefore, the focus of developing new antipsychotic drugs has shifted towards agonism or inhibition of these receptors. Specifically, the development of NMDARs stimulants, GABA receptor agonists, mGlu receptor modulators, cholinergic receptor modulators, 5-HT2C receptor agonists and alpha-2 receptor modulators has become the main direction. Animal experiments have confirmed the antipsychotic effects of these drugs, but their pharmacokinetics and clinical applicability still require further exploration. Research on alternative targets for antipsychotic drugs, beyond the dopamine D2 receptor, has expanded the potential treatment options for schizophrenia and gives an important way to address the challenge of refractory schizophrenia. This article aims to provide a comprehensive overview of the research on therapeutic targets and medications for schizophrenia, offering valuable insights for both treatment and further research in this field.
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Affiliation(s)
- Aineng Peng
- Heilongjiang University of Chinese Medicine, Harbin, 150040, People’s Republic of China
| | - Jianbo Chai
- Heilongjiang Mental Hospital, Harbin, 150036, People’s Republic of China
| | - Haiyuan Wu
- Heilongjiang University of Chinese Medicine, Harbin, 150040, People’s Republic of China
| | - Bing Bai
- Tongde Hospital of Zhejiang Province, Hangzhou, 311100, People’s Republic of China
| | - Huihui Yang
- Heilongjiang University of Chinese Medicine, Harbin, 150040, People’s Republic of China
| | - Weizhi He
- Heilongjiang University of Chinese Medicine, Harbin, 150040, People’s Republic of China
| | - Yonghou Zhao
- Heilongjiang Mental Hospital, Harbin, 150036, People’s Republic of China
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