ABSTRACT
BACKGROUND: Depressive symptoms occur in several psychiatric disorders, often in the absence of a formal diagnosis of depression. We aimed to evaluate the efficacy and the tolerability of amisulpride, both alone and as augmentation therapy, in the treatment of depressive symptoms in individuals with any major psychiatric disorder. METHODS: We searched PubMed, Embase, PsycINFO, GreyLit, OpenGrey and ProQuest up to March 2020 for randomised controlled trials focussing on the treatment of an acute depressive episode in any major psychiatric disorder. A random-effect meta-analysis was performed to synthesize the findings on depressive symptoms (primary outcome), response rate and tolerability. RESULTS: We retrieved 11 studies including 2065 patients with a diagnosis of dysthymia (eight studies), major depression (one study) or schizophrenia (two studies). Amisulpride 50 mg/day was associated with a larger reduction of depressive symptoms compared to placebo (standardised mean difference [SMD] = -0.70, CI 95% -0.92, -0.49; I2 = 0.0%), and was found to be comparable to selective serotonin reuptake inhibitors (SSRIs; SMD = -0.08, CI 95% -0.23, 0.06, I2 = 0.0%), amineptine, imipramine and amitriptyline in the treatment of dysthymia (three studies, not pooled). In individuals with schizophrenia, amisulpride administered at higher doses (>400 mg/day) was comparable to olanzapine and risperidone (two studies, not pooled). In terms of tolerability, amisulpride was superior to placebo for dysthymia (odds ratio [OR] = 3.94, CI 95% 1.07, 14.48; I2 = 0.0) and comparable with SSRIs (OR = 0.94, CI 95% 0.55, 1.62; I2 = 0.0%). CONCLUSION: Treatment with amisulpride could be a valid choice for selected individuals with dysthymia or depressive symptoms in the context of schizophrenia. More studies on the efficacy and tolerability of amisulpride are needed to draw firm conclusions on its potential benefits in other psychiatric disorders.
Subject(s)
Antipsychotic Agents , Depressive Disorder, Major , Amisulpride/adverse effects , Antipsychotic Agents/adverse effects , Depression , Depressive Disorder, Major/drug therapy , Dysthymic Disorder/drug therapy , HumansABSTRACT
Resumen La esquizofrenia es una enfermedad crónica, severa y que afecta aproximadamente al 1% de la población mundial. Pacientes con esta enfermedad presentan severos déficits en la cognición social (DCS). Estos déficits han sido observados en pacientes de primer episodio y familiares de primer grado. Los DCS determinan el pronóstico a largo plazo en esta enfermedad y son susceptibles de rehabilitación si es que se detectan precozmente. Solo recientemente se han caracterizado los déficits de la cognición social en sujetos de alto riesgo de desarrollar psicosis crónica. Estos sujetos presentan una oportunidad única para modificar la inserción social y modificar el pronóstico, pues no han sido afectados mayormente por la cronicidad de la enfermedad y presentan una sintomatología más leve que en etapas residuales. El presente trabajo pretende realizar una revisión de cómo los DCS están presentes desde etapas prodrómicas de la esquizofrenia y su importancia en la detección precoz de esta enfermedad.
Schizophrenia is a severe chronic disease that affects approximately 1 % of the world's population. Those who suffer this disease have serious deficits in social cognition (DSC), deficits that have been observed in first psychotic episode patients and first-degree relatives. The DSC determine the long-term prognosis in this disease and are susceptible to rehabilitation if they are detected early. Only recent studies have characterized deficits of social cognition in subjects with a high risk of developing chronic psychosis. These subjects present a unique opportunity to modify their social insertion and medical prognosis, as they have not been affected by the chronicity of the disease and present a milder symptomatology than in residual stages. This paper aims to make a review about how the DSC are present in schizophrenia from its prodromal stages and about its importance in the early detection of this disease.
Subject(s)
Humans , Psychotic Disorders , Schizophrenia , Social Isolation/psychology , Cognition , Cognitive DysfunctionABSTRACT
Schizophrenia is a disease with a complex non-Mendelian inheritance mechanism in most cases involving the combined action of a large number of genes. Identifying of genomic variations associated with schizophrenia endophenotypes has a great potential. This review describes genetic markers of the disease, current methods of their analysis, including genome-wide association study (GWAS). Certain genes with mutations that increase the risk of schizophrenia are described. Functional polymorphisms with phenotypic expression, which are significantly associated with clinical manifestation of schizophrenia, can serve as useful genetic markers. The authors highlight that currently there are no certain susceptibility genes. Further global research and search for markers in different population groups are needed.
