Schizophrenia, Related Troubles and Glutathione: Clinical Trial. Effects of Oral Administration of N-Acetylcysteine (NAC) on the Brain Glutathione Level and on the Symptoms of Schizophrenia
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Purpose
The results of the study "schizophrenia, related disorders and glutathione" conducted at the Laboratory of Psychiatric Neuroscience (LUNEP) DUPA of Lausanne, reinforce the hypothesis proposed that a deficit intracerebral glutathione is a vulnerability factor for Schizophrenia at least for a subgroup of patients. While pursuing the baseline study, it is appropriate now to try to restore a higher level of glutathione in patients to see if this increase is accompanied by an improvement in symptoms, particularly negative symptoms and disorders cognitive, particularly resistant to current therapy. N-acetyl-cystein (NAC) is a precursor of glutathione which is used clinically for various indications, well tolerated even at high doses. The investigators propose a double-blind cross-over with the aim to study if the N-acetyl-cystein (at a dose of oral 2g/day) leads on the one hand a rising glutathione brain (measured in resonance magnetic spectroscopic) and also improved patients' conditions (determined by clinical assessments, psychopathological, neuropsychological, biochemical and physiological), while recording any side effects. As a first step, this study should include at least thirty patients and last for two to three years. It is important to note that this is not a study of medication suggested by a pharmaceutical industry, but a medical search.
| Condition | Intervention | Phase |
|---|---|---|
|
Schizophrenia |
Drug: N-Acetyl-Cysteine (NAC) |
Phase 1 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Crossover Assignment Masking: Double Blind (Subject, Caregiver, Investigator) Primary Purpose: Treatment |
| Official Title: | Schizophrenia, Related Troubles and Glutathione: Clinical Trial. Effects of Oral Administration of N-Acetylcysteine (NAC) on the Brain Glutathione Level and on the Symptoms of Schizophrenia: Double-blind and Crossover Study |
- Positive and Negative Syndrome Scale (PANSS) [ Time Frame: 8 months ] [ Designated as safety issue: No ]Improvment of the negative symptoms, measured with the PANSS: positive and negative syndrome scale". (Score:1= absence of the symptom - 7= extreme symptoms)
- frankfurt Complaint Questionnaire (FCQ) [ Time Frame: 8 months ] [ Designated as safety issue: No ]Assessment of subjective troubles, " basic symptoms ": troubles of perceptive, cognitive or motor functions frequently observed in prodromal or remission phases.
- Global Assessment of Functioning - (GAF) [ Time Frame: 8 months ] [ Designated as safety issue: No ]Assessment of the psychological, social and professional state of the patient at a given moment.
- Clinical Global Impression - (CGI) [ Time Frame: 8 months ] [ Designated as safety issue: No ]Allows punctual evaluation of the severity of the disease, of the improvement and of the side effects
- Neuropsychological evaluation [ Time Frame: 8 months ] [ Designated as safety issue: No ]The neuropsychological tests aim to assess cognitive functions : working memory, attention, planning; also include a WAIS
- Neurological scales for the assessment of extrapyramidal symptoms [ Time Frame: 8 months ] [ Designated as safety issue: No ]AIMS (Abnormal Involuntary Movements Scale): quantitative assessment of secondary hyperkinesia (excluding tremor) due to neuroleptics.
- • Magnetic Resonance Spectroscopy (MRS) [ Time Frame: 8 months ] [ Designated as safety issue: No ]A MRS method has originally been developed for the determination of brain GSH levels in vivo (Trabesinger et al., 1999), allowing us to observe a 51% GSH decrease in prefrontal cortex of schizophrenic patients (Do et al., 2000).
- EEG/evoked potentials [ Time Frame: 8 months ] [ Designated as safety issue: No ]Anomalies of amplitude and latency of the P300 wave evoked under the "auditory oddball" paradigm are reliable neurophysiological markers of schizophrenia, correlating with the negative symptoms
- Blood and fibroblasts biochemistry [ Time Frame: 8 months ] [ Designated as safety issue: No ]I. Plasma GSH and metabolites, plasma amino acids, particularly the sulfur containing ones II. activity of enzymes involved in GSH metabolism III. genetic analysis of enzymes involved in GSH metabolism IV. cell counts and tests of hepatic, renal and thyroid functions
- Neurological scales for the assessment of extrapyramidal symptoms [ Time Frame: 8 months ] [ Designated as safety issue: No ]Simpson-Angus scale for extrapyramidal signs: tremor, rigidity, akinesia.
- Neurological scales for the assessment of extrapyramidal symptoms [ Time Frame: 8 months ] [ Designated as safety issue: No ]Barnes scale: specific assessment of akathisia.
| Enrollment: | 13 |
| Study Start Date: | August 2003 |
| Study Completion Date: | September 2006 |
| Primary Completion Date: | December 2004 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: patients who receive NAC first
this group will receive 2g/day of NAC (2 caps of 0.5g twice day)for a duration of 8 weeks first, and after this 8 weeks their receive placebo for 8 weeks.
|
Drug: N-Acetyl-Cysteine (NAC)
Once included, the patients will be randomly placed in two groups: one group (1) will receive 2 g/day of NAC (2caps of 0.5g twice a day) and the other group (2) a placebo, for a duration of 8 weeks. At the end of the 8 weeks, group (2) will receive NAC and (1) the placebo for another 8 weeks
|
|
Placebo Comparator: patients who receive placebo first
this patients will receive first placebo for a duration of 8 weeks, and after this 8 weeks their receive NAC for 8 weeks
|
Drug: N-Acetyl-Cysteine (NAC)
Once included, the patients will be randomly placed in two groups: one group (1) will receive 2 g/day of NAC (2caps of 0.5g twice a day) and the other group (2) a placebo, for a duration of 8 weeks. At the end of the 8 weeks, group (2) will receive NAC and (1) the placebo for another 8 weeks
|
Detailed Description:
The results of the study "schizophrenia, related disorders and glutathione" conducted at the Laboratory of Psychiatric Neuroscience (LUNEP) DUPA of Lausanne, reinforce the hypothesis proposed that a deficit intracerebral glutathione is a vulnerability factor for Schizophrenia at least for a subgroup of patients. While pursuing the baseline study, it is appropriate now to try to restore a higher level of glutathione in patients to see if this increase is accompanied by an improvement in symptoms, particularly negative symptoms and disorders cognitive, particularly resistant to current therapy. N-acetyl-cysteine (NAC) is a precursor of glutathione which is used clinically for various indications, well tolerated even at high doses. The investigators propose a double-blind cross-over with the aim to study if the N-acetyl-cystein (at a dose of oral 2g/day) leads on the one hand a rising glutathione brain (measured in resonance magnetic spectroscopic) and also improved patients' conditions (determined by clinical assessments, psychopathological, neuropsychological, biochemical and physiological), while recording any side effects. As a first step, this study should include at least thirty patients and last for two to three years. It is important to note that this is not a study of medication suggested by a pharmaceutical industry, but a medical search.
Eligibility| Ages Eligible for Study: | 18 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- patients (male or female, aged 18 to 65 years, QI>70) meeting the DSM-IV criteria (established by a senior psychiatrist) for schizophrenia and have the capacity to consent to the study. The study population include both inpatients and outpatients who are currently taking at least one of the following:Olanzapine, Clozapine, Haloperidol, Risperidone, Flupenthixol, or Fluphenazine. The following guidelines have been established for potential medication changes that patients may undergo during the course of the trial.
- dose changes to existing medication (either increases or decreases in dose) will be accepted and participants will be allowed to continue with the trial.
- A change in primary antipsychotics from one medication to another will require participants to withdrawn from the study.
- An addiction of another antipsychotic, secondary to the existing antipsychotic treatment (primary antipsychotic) will be acceptable providing that there isn't a complete change from one antipsychotic to another.
Exclusion Criteria:
- pregnancy
- acute psychotic state, preventing the patient cooperation
- co-morbidity with drug dependency
- organic cerebral disease, major somatic diseases
- abnormal renal, hepatic, thyroid or hematological findings
- treatment with a regulator of mood(lithium, valproate, topiramate, lamotrigine et carbamazepine)
- allergy to NAC
- treatment with antioxidants
Contacts and Locations More Information
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Dresse Kim Q. Do, Professor, Centre Hospitalier Universitaire Vaudois |
| ClinicalTrials.gov Identifier: | NCT01506765 History of Changes |
| Other Study ID Numbers: | 106/03 CE |
| Study First Received: | January 3, 2012 |
| Last Updated: | January 17, 2012 |
| Health Authority: | United States: Food and Drug Administration Switzerland: Swissmedic |
Keywords provided by Centre Hospitalier Universitaire Vaudois:
|
Schizophrenia glutathione NAC Neurological scales Magnetic Resonance Spectroscopy (MRS) |
EEG/evoked potentials fibroblasts patients who receive NAC patients who receive placebo |
Additional relevant MeSH terms:
|
Schizophrenia Schizophrenia and Disorders with Psychotic Features Mental Disorders Acetylcysteine N-monoacetylcystine Antiviral Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
Expectorants Respiratory System Agents Free Radical Scavengers Antioxidants Molecular Mechanisms of Pharmacological Action Protective Agents Physiological Effects of Drugs Antidotes |
ClinicalTrials.gov processed this record on May 19, 2013