Introduction
All symptoms in schizophrenia may impact functioning. Although Food and Drug Administration-approved medications typically benefit positive symptoms, negative symptoms are generally refractory to medication interventions. N-acetylcysteine's (NAC) influence on glutamatergic neurotransmission has been established. An emerging body of research has attempted to correlate this action with reduction in symptom severity, evaluating response in positive, negative, and cognitive symptom domains.
Methods
A literature review was performed to analyze available data on NAC intervention and improvement in the positive, negative, and cognitive symptom domains in patients with schizophrenia. Quality of evidence was systematically assessed to determine level of certainty in results.
Results
Three randomized controlled trials were identified. Across studies, negative symptoms decreased more with NAC compared to placebo; ranging between 11.9% and 24.1%. The assessment determined a low level of certainty regarding benefit of NAC on negative and cognitive symptoms and moderate certainty for NAC regarding findings of side effects and lack of benefit on positive symptoms.
Discussion
Consistent reporting of benefit in negative symptoms is found across studies of NAC intervention. These improvements are notable for symptoms that have generally remained refractory to medication intervention. Inconsistent benefit was reported in positive and cognitive symptoms. GRADE (grading of recommendations assessment, development and evaluation) assessment of current evidence indicates a low certainty of benefit for negative symptoms with standard use of NAC in patients with schizophrenia. However, a trial of this low-risk intervention may be warranted in patients with resistant negative symptoms and subsequent impaired functioning despite appropriate antipsychotic therapy as they may experience additional benefit in this symptom domain.
The purpose of the current study was to assess the frequency and distribution of the 9-Item Patient Health Questionnaire (PHQ-9) among individuals with type 2 diabetes with and without depression. The current case-control study used electronic medical record data from two primary care institutions. The sample was divided into cases with coexisting depression and type 2 diabetes and controls without depression. Data included demographics, biomarkers, number of services delivered, and clinic visits in 2013. Similar PHQ-9 use was seen between unique primary care practices. However, less than one third of patients at either site received depression screening with the PHQ-9 in 2013. Male and older adult patients were less likely to receive assessment. Guideline ambiguity and lack of accountability in primary care practice has made the use of depression metrics arbitrary in diabetic populations at risk for depression. To assure adequate care provision, it is imperative that proven tools for assessing depressive symptoms are used.
These culture-specific findings, showing unique tobacco use characteristics and increased cessation among the Bhutanese refugee population, provide novel information helpful to professionals identifying and treating these individuals for tobacco cessation. More research is needed to confirm our results and findings.
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