Antiglucocorticoid and Related Treatments for Psychosis

Summary

A Cochrane review [Abstract] 1 included 11 studies with a total of 509 adults with schizophrenia, schizoaffective disorder or psychotic depression. Only short-term outcomes (up to 12 weeks) were assessed in all trials and none of them examined relapse or remission rates.

• Mifepristone vs. placebo as sole treatment (2 trials): Limited data from one trial showed no difference in the proportion responding to mifepristone when mental state was assessed immediately post intervention using the Brief Psychiatric Rating Scale (BPRS) (MD -5.20, 95% CI -17.91 to 7.51; 1 RCT, n = 5); depressive symptoms (Hamilton Rating Scale for Depression (HAMD) total) were also similar between groups (MD 1.67, 95% CI -16.44 to 19.78; 1 RCT, n=5). However, a significant difference favoured treatment at short-term follow-up for global state (30% reduction in total BPRS, RR 0.58, 95% CI 0.38 to 0.89; 1 RCT, n = 221). This effect was also seen for short-term positive psychotic symptoms (50% reduction in BPRS positive symptom subscale, RR 0.60, 95% CI 0.43 to 0.84; 1 RCT, n = 221). Participants receiving mifepristone experienced a similar overall number of adverse effects as those receiving placebo (RR 0.92, 95% CI 0.77 to 1.09; 2 RCTs, n = 226).
• Dehydroepiandrosterone (DHEA) as an adjunct to atypical antipsychotic treatment vs. adjunctive placebo (one trial): Analysis of useable data showed no significant effects of treatment on mental state or adverse effects. Data on global state, general functioning and quality of life were not available.
• Antiglucocorticoid drugs as an adjunct to combination treatment vs. adjunctive placebo (6 trials): there were no significant differences between groups in mean endpoint scores for overall psychotic symptoms (SMD 0.01, 95% CI - 0.29 to 0.32; 6 RCTs, n = 171) or positive psychotic symptoms (SMD -0.07, 95% CI - 0.40 to 0.25; 5 RCTs, n = 151). Data from 3 trials (n=94) showed no differences between groups in mean endpoint scores for negative symptoms (MD 2.21, 95% CI -0.14 to 4.55). One study (n=30) found improvements in global state that were similar between groups (RR 0.58, 95% CI 0.32 to 1.06). In this comparison, pooled results showed that antiglucorticoids caused a greater overall number of adverse events (RR 2.66, 95% CI 1.33 to 5.32; 7 RCTs, n = 199), but no quality of life data were available.