Antipsychotic Augmentation With N-Acetylcysteine for Patients With Schizophrenia.

N-acetylcysteine (NAC) augmentation of antipsychotic medication is one of very many antipsychotic augmentation strategies that have been studied in schizophrenia. A recent systematic review and meta-analysis of 6 randomized controlled trials (RCTs) found that NAC (median dose, 2,000 mg/d) improved several clinical outcomes at different time points with medium to large effect sizes; however, many of the significant findings in this meta-analysis are suspect because they appeared to be influenced by 2 short-term (8-week) RCTs with outlying characteristics. Important findings not influenced by the 2 outlying RCTs were significant attenuation by NAC of negative symptom (3 RCTs) and total psychopathology (2 RCTs) ratings at ≥ 24 weeks and improvement in working memory but not processing speed (3 RCTs). Of these findings, reduction in psychopathology ratings, though statistically significant, appeared too small to be clinically meaningful. Finally, a newly published, moderately large RCT of NAC (2,000 mg/d) in schizophrenia patients refractory to clozapine found that 1 year of treatment with NAC did not outperform placebo for any clinical, cognitive, or quality of life outcome. The take-home message is that it is premature to recommend the use of NAC to treat schizophrenia for any target domain in routine clinical practice and that there does not appear to be a role for NAC for any indication in clozapine-refractory schizophrenia. However, it may be worth studying whether NAC, dosed at 2,000 mg/d or higher for 6 months or longer, improves functional outcomes in schizophrenia.

Markers of Social and Emotional Health in College Students During the COVID-19 Pandemic.

Objective: Research on effects of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of youth have mostly focused on the occurrence of negative states such as anxiety and depression. The objective of this study was to assess the social and emotional health of university students in India, as influenced by COVID-19 test results and the experience of isolation or quarantine.Methods: A cross-sectional online survey was conducted in India during July and early August 2021 among university students aged 20-25 years. The Social Emotional Health Survey-Higher Education (SEHS-HE) was used to assess 4 domains: belief in self, belief in others, emotional competence, and engaged living.Results: There were 187 respondents from 78 institutions in 14 of 29 states of India. The sample was 51% male. The mean SEHS-HE scores were approximately 75% of the maximum score in each domain. In multivariable regression analysis, sex, residence with family, and a negative COVID-19 report had little effect on SEHS-HE domains. COVID-19 positivity was associated with significantly lower scores on all domains (P < .01). Isolation/quarantine was associated with significantly or near-significantly higher scores on all domains (P < .01). In all cases, ß coefficients and the proportion of the variance explained by the regression were small.Conclusions: Major pandemic-related internal and environmental determinants of SEHS-HE remain to be identified. Strategies to improve the well-being of college students should be directed toward those who have tested positive for the disease. The experience of isolation/quarantine is not pathoplastic.