Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N5694, standardized mean difference, SMD5-0.53, 95% CI: 20.87 to 20.19, p50.002). However, superiority was only apparent in open-label and low-quality trials (both p<0.001), but not in double-blind and high-quality ones (p50.120 and 0.226, respectively). Study-defined response was similar between antipsychotic augmentation and monotherapy (14 studies, N5938, risk ratio 5 1.19, 95% CI: 0.99 to 1.42, p50.061), being clearly non-significant in double-blind and high-quality studies (both p50.990). Findings were replicated in clozapine and nonclozapine augmentation studies. No differences emerged regarding all-cause/specific-cause discontinuation, global clinical impression, as well as positive, general and depressive symptoms. Negative symptoms improved more with augmentation treatment (18 studies, N5931, SMD5-0.38, 95% CI: 20.63 to 20.13, p<0.003), but only in studies augmenting with aripiprazole (8 studies, N5532, SMD5-0.41, 95% CI: 20.79 to 20.03, p50.036). Few adverse effect differences emerged: D2 antagonist augmentation was associated with less insomnia (p50.028), but more prolactin elevation (p50.015), while aripiprazole augmentation was associated with reduced prolactin levels (p<0.001) and body weight (p50.030). These data suggest that the common practice of antipsychotic augmentation in schizophrenia lacks double-blind/high-quality evidence for efficacy, except for negative symptom reduction with aripiprazole augmentation.

Objective The objective of this meta-analysis is to estimate the pooled prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. Methods A systematic literature search was conducted via the following databases: PubMed, PsycINFO, MEDLINE, China Journals Full-Text Databases, Chongqing VIP database for Chinese Technical Periodicals and Wan Fang Data. Statistical analysis used the Comprehensive Meta-Analysis program. Results Eight studies met the inclusion criteria for the analysis; five reported on the prevalence of suicidal ideation and seven on that of suicide attempts. The estimated lifetime prevalence figures of suicidal ideation and suicide attempts were 3.9% (95% Confidence interval [CI]: 2.5%–6.0%) and 0.8% (95% CI: 0.7%–0.9%), respectively. The estimated female-male ratio for lifetime prevalence of suicidal ideation and suicide attempts was 1.7 and 2.2, respectively. Only the difference of suicide attempts between the two genders was statistically significant. Conclusion This was the first meta-analysis of the prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. The pooled lifetime prevalence of both suicidal ideation and suicide attempts are relatively low; however, caution is required when assessing these self-report data. Women had a modestly higher prevalence for suicide attempts than men. The frequency for suicidal ideation and suicide attempts in urban regions was similar to those in rural areas.

There are conflicting prevalence estimates of autism spectrum disorders (ASDs) in mainland China (China thereafter). This study is a comprehensive meta-analysis of the pooled prevalence of ASDs in the general population in China. Study investigators independently conducted a systematic literature search of the following databases: PubMed, EMBASE, PsycINFO, China National Knowledge Infrastructure, Chinese biomedical literature service system, and Wan Fang. Studies reporting prevalence of ASDs and autism in Chinese population were identified and analysed using the Comprehensive Meta-Analysis program with the random effects model. Forty-four studies were included in the meta-analysis comprising 2,337,321 subjects of whom 46.66 % were females. The mean age of subjects ranged from 1.6 to 8 years. Based on diagnostic criteria the pooled prevalence of ASDs was 39.23 per 10,000 (95% CI: 28.44-50.03 per 10,000, I2=89.2%); specifically, the prevalence of autism was 10.18 per 10,000 (95% CI: 8.46-11.89 per 10,000, I2=92.5%). Subgroup analyses revealed significant difference in the prevalence of ASDs between genders (72.77 per 10,000 in males vs. 16.45 per 10,000 in females). In conclusion, the prevalence of ASDs and autism in China was found generally lower than those reported in other countries. Further studies are needed to clarify the variation in prevalence.