Effectiveness of Vitamin Supplementation in Treating People With Residual Symptoms of Schizophrenia

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Donald C. Goff, MD, Massachusetts General Hospital
ClinicalTrials.gov Identifier:
NCT00611806
First received: February 7, 2008
Last updated: July 31, 2014
Last verified: July 2014

February 7, 2008
July 31, 2014
December 2007
August 2010   (final data collection date for primary outcome measure)
Positive and Negative Syndrome Scale (PANSS) [ Time Frame: Baseline vs. Week 16 ] [ Designated as safety issue: No ]
The change from baseline on the Positive and Negative Syndrome Scale (PANSS).The PANNS has three subscales: positive (score range 7-49), negative (score range 7-49), and general psychopathology (score range 16-112). The PANSS positive symptom sub-scale is comprised of 7 items rated on a scale of 1-7, representing positive symptoms of schizophrenia. The PANSS negative symptom subscale is comprised of 7 items rated on a scale of 1-7 representing the negative symptoms of schizophrenia, and the general psychopathology subscale is comprised of 16 items rated on a scale of 1-7 representing symptoms of general psychopathology in mental illness. The total score was computed by adding all the items on the sub-scale together. Scores reported are change in symptoms per week, relative to baseline. A negative score represents a decrease in total PANSS score per week, whereas a positive score represents an increase in total PANSS score per week.
Reduction in schizophrenia symptoms, as measured by the change from baseline in Positive and Negative Syndrome Scale (PANSS) total score [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT00611806 on ClinicalTrials.gov Archive Site
  • Cognitive Deficits, as Measured by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Cognitive Battery Composite Score [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
  • Positive Sub Scale of the Positive and Negative Syndrome Scale (PANSS) [ Time Frame: Baseline vs. Week 16 ] [ Designated as safety issue: No ]
    The change from baseline on the positive symptom sub-scale of the Positive and Negative Syndrome Scale (PANSS). Total PANSS positive symptom sub-scale scores range from 7-49. The PANSS positive symptom sub-scale is comprised of 7 items rated on a scale of 1-7: delusions, conceptual disorganization, hallucinatory behavior, excitement, grandiosity, suspiciousness/persecution, and hostility. A score of one on each item 1 absent, 2 is minimal, 3 is mild, 4 is moderate, 5 is moderately severe, 6 is severe, and 7 is extreme. The total score was computed by adding all the items on the sub-scale together. Scores reported are change in symptoms per week, relative to baseline. A negative score represents a decrease in total PANSS score per week, whereas a positive score represents an increase in total PANSS score per week.
  • Scale for Assessment of Negative Symptoms (SANS) [ Time Frame: Baseline vs. Week 16 ] [ Designated as safety issue: No ]
    The change from baseline on the scale for the assessment of negative symptoms (SANS) total score. Total SANS scores range from 0-100. The SANS is comprised of 5 subscores: Affective Flattening or Blunting (score range 0-35), Alogia (score range 0-20), Avolition-Apathy (score range 0-15), Anhedonia-Asociality (score range 0-20), and Attention (0-10). For each scale, the higher the score the more prominent the negative symptoms were. The total score was computed by adding all the sub-scale total scores. Scores reported are change in symptoms per week, relative to baseline. A negative score represents a decrease in total SANS score per week, whereas a positive score represents an increase in total SANS score per week.
  • Positive and Negative Syndrome Scale (PANSS) and FOLH1, MTHRF, MTR, and COMT Genotype [ Time Frame: Baseline vs. Week 16 ] [ Designated as safety issue: No ]
    The change from baseline on the Positive and Negative Syndrome Scale (PANSS) (including FOLH1, MTHRF, MTR, and COMT genotype simultaneously into a linear mixed model).The PANNS has three sub-scales: positive (score range 7-49), negative (score range 7-49), and general psychopathology (score range 16-112). The PANSS negative and positive symptom sub-scale is comprised of 7 items rated on a scale of 1-7 representing the negative and positive symptoms of schizophrenia, respectively, and the general psychopathology sub-scale is comprised of 16 items rated on a scale of 1-7 representing symptoms of general psychopathology in mental illness. The total score was computed by adding all the items on the sub-scale together. Scores reported are change in symptoms per week, relative to baseline. A negative score represents a decrease in total PANSS score per week, whereas a positive score represents an increase in total PANSS score per week.
  • Relationship Between Response of Negative and Positive Symptoms and the Change in RBC Folate, Serum Folate, Serum B12, and Plasma Homocysteine Concentrations [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
  • Cognitive deficits, as measured by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) cognitive battery composite score [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
  • Psychotic symptoms, as measured by the PANSS psychosis subscale score [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
  • Negative symptoms, as measured by the modified Scale for Assessment of Negative Symptoms (SANS) total score [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
  • Relationship among PANSS total score; negative and positive symptoms; cognitive performance; baseline serum and red blood cell (RBC) folate, plasma homocysteine, and B12 concentrations; tobacco intake; and MTHFR C677T gene status [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
  • Relationship between response of negative and positive symptoms and the change in RBC folate, serum folate, serum B12, and plasma homocysteine concentrations [ Time Frame: Measured at Week 16 ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Effectiveness of Vitamin Supplementation in Treating People With Residual Symptoms of Schizophrenia
A Placebo-Controlled Trial of Folate With B12 in Schizophrenia Patients With Residual Symptoms

This study will evaluate the effectiveness of folate and B12 supplementation in reducing negative symptoms in people with schizophrenia.

About 30% of people with schizophrenia suffer from treatment-resistant psychotic symptoms, which may include social withdrawal, apathy, and depression. These negative symptoms can produce substantial distress for those affected, often disrupting social and occupational functioning and resulting in hospitalization. Although atypical antipsychotic medications have demonstrated some success in treating negative symptoms, the degree to which many negative symptoms respond is unclear. Depression and poor response to antidepressant medication have been linked to deficiency in the vitamins folate and B12. It is believed that vitamin supplementation with folate and B12 may offer a safe and inexpensive approach to improve outcomes for people with schizophrenia who have residual negative symptoms and have exhibited poor treatment response. This study will compare the effectiveness of folate and B12 versus placebo in reducing negative symptoms in people with schizophrenia.

Participation in this double-blind study will last 19 weeks. Potential participants will undergo initial screening, which will include a medical and psychiatric evaluation, physical exam, blood draw, urine sampling, and questionnaires. Participants will also be asked for permission to use a portion of the blood sample for genetic analysis. Eligible participants will be randomly assigned to take folate with B12 or placebo. Participants will first complete a 2-week stabilization phase, followed by the 16-week treatment study. Medication visits, occurring every 2 weeks during treatment, will include questions about medication side effects and the distribution of study medication. During specified medication visits, participants will complete various assessments, which will include questionnaires about schizophrenia, tests of learning and memory, repeat blood tests, and pregnancy tests. The medication visits will last between 15 minutes and 4 hours, depending on the scheduled assessments for that visit.

Interventional
Phase 4
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Schizophrenia
  • Dietary Supplement: Folic Acid
    Folic acid 2mg po daily
  • Dietary Supplement: B12
    B12 400 micrograms po daily
    Other Name: cobalamin
  • Other: Placebo
    1 capsule po daily
  • Active Comparator: Folate with B12
    Participants will take folic acid plus B12 for 18 weeks.
    Interventions:
    • Dietary Supplement: Folic Acid
    • Dietary Supplement: B12
  • Placebo Comparator: Placebo
    Participants will take placebo for 18 weeks.
    Intervention: Other: Placebo
Roffman JL, Lamberti JS, Achtyes E, Macklin EA, Galendez GC, Raeke LH, Silverstein NJ, Smoller JW, Hill M, Goff DC. Randomized multicenter investigation of folate plus vitamin B12 supplementation in schizophrenia. JAMA Psychiatry. 2013 May;70(5):481-9. doi: 10.1001/jamapsychiatry.2013.900.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
140
December 2010
August 2010   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Diagnosis of schizophrenia, any subtype
  • Treated with an antipsychotic medication for at least 6 months at a stable dose for at least 6 weeks before study entry
  • PANSS total score of at least 60, with a score of at least 3 (moderate) on one negative symptom item or on one positive symptom item
  • Simpson Angus Scale (SAS) for Extrapyramidal Syndrome (EPS) total score of 12 or less
  • A score of 2 (mild) or less on all items of the Calgary Depression Scale (CDS)
  • Speaks English adequately enough to complete cognitive testing

Exclusion Criteria:

  • Serum B12 concentration less than 300 ug/L
  • Complete blood count results consistent with megaloblastic anemia
  • Serum creatinine concentration greater than 1.4
  • Current use of folate or B12 supplementation
  • Current use of any of the following medications: phenobarbital, phenytoin, carbamazepine, valproic acid, fosphenytoin, primidone, or pyrimethamine
  • Alcohol or other substance abuse within 3 months before study entry (nicotine allowed)
  • Positive baseline urine toxic screen
  • Unstable medical illness
  • Unstable psychiatric illness
  • Seizure disorder
  • Pregnant or breastfeeding
Both
18 Years to 68 Years
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00611806
R01 MH070831, R01MH070831, DATR A5-ETPD
Yes
Donald C. Goff, MD, Massachusetts General Hospital
Massachusetts General Hospital
National Institute of Mental Health (NIMH)
Principal Investigator: Donald Goff, MD Massachusetts General Hospital
Massachusetts General Hospital
July 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP