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Change of severity of positive, negative symptoms and general psychopathology (PANSS) in schizophrenics after 6 weeks augmentation of antipsychotics therapy with glicyne or donepezil

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In aetiopathogenesis of schizophrenia the key role is played by dopaminergic, but also serotoninergic, glutamatergic systems as well as cholinergic neurons. Donepezil is a mixed inhibitor of acetylcholinesterase, selectively inhibiting acetylcholinesterase. A review of the studies, in which donepezil was used for augmentation of antipsychotic treatment does not provide explicit information on the effects of such procedures within a change of scores on PANSS. Pursuant to the assumptions of hypoglutamatergic hypothesis of schizophrenia, the transmission was stimulated within this system. To its stimulation through NMDA receptor among others glycine was used, i.e. prevalent amino acid of the simplest structure, the
basic transmitter of glycinergic neurons counted among class I – neurotransmitters, additionally functioning as a coagonist and modulator, also within the glutamatergic system. In 2005 a meta-analysis of studies appeared, from which it results that glycine and D-serine significantly decrease the severity of negative symptoms. The study was aimed at establishing whether or not adjunctive glycine or donepezil applied for 6 weeks with antipsychotic treatment statistically significantly affect a change in the severity of positive symptoms, negative symptoms, general psychopathology in patients at a stable period of the disease. Subjected to the study was a group of 62 patients aged 18-55 years, suffering from paranoidal schizophrenia (DSM-IV) at the mental condition stabilised for at least half a year, without a change in the type and dose of antipsychotic drug at that time. The following methods were used: 1) confirmation of stabilization of the mental condition and stable pharmacotherapy for the required period according to analysis of medical documentation, interview and evaluation of the current status; 2) augmentation of the hitherto applied antipsychotic treatment by adding donepezil or glycine and 3) evaluation of the severity of negative symptoms, positive symptoms and general psychopathology (PANSS) before and after 6 week augmentation by donepezil or glycine and occurrence of adverse symptoms. Results: Statistically significant differences were obtained after 6 weeks in a group treated with antipsychotic drugs and glycine (primarily within negative symptoms and general psychopathology, less within positive symptoms), whereas in the group additionally treated with donepezil no such differences were found.

Słowa kluczowe
schizophrenia, antipsychotics therapy, augmentation, glycine, donepezil