氯氮平
齐拉西酮
医学
荟萃分析
样本量测定
拉莫三嗪
随机对照试验
米氮平
内科学
精神分裂症(面向对象编程)
精神科
抗抑郁药
癫痫
数学
统计
海马体
作者
Sandeep Grover,Siddharth Sarkar
出处
期刊:Acta Neuropsychiatrica
[Cambridge University Press]
日期:2022-11-16
卷期号:35 (2): 65-75
被引量:1
摘要
Abstract Background: Several augmentation strategies have been used to improve symptomatology in patients not adequately responding to clozapine. Several randomised controlled trials (RCTs) have evaluated the efficacy of different strategies to augment clozapine. This systematic review and meta-analysis reviewed the available RCTs that have evaluated the clinical efficacy of various pharmacological agents, non-pharmacological strategies (occupational therapy, cognitive behaviour therapy), and somatic treatment [electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation, etc.)] as augmenting agents to clozapine. Methods: Data were extracted using standard procedures, and risk of bias was evaluated. Effect sizes were computed for the individual studies. Results: Forty-five clinical trials were evaluated. The pooled effect size for various antipsychotic medications was 0.103 (95% CI: 0.288–0.493, p < 0.001); when the effect size was evaluated for specific antipsychotics for which more than one trial was available, the effect size for risperidone was −0.27 and that for aripiprazole was 0.57. The effect size for lamotrigine was 0.145, and that for topiramate was 0.392. The effect size for ECT was 0.743 (CI: 0.094–1.392). Risk of bias was low (mean Jadad score – 3.93). Largest effect sizes were seen for mirtazapine (effect size of 5.265). Most of the studies can be considered underpowered and limited by small sample sizes. Conclusions: To conclude, based on the findings of the present systematic review and meta-analysis, it can be said that compared to other treatment strategies, clozapine non-responsive patients respond maximum to mirtazapine followed by ECT.
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