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. 2004 Oct 18;2004(4):CD004964.
doi: 10.1002/14651858.CD004964.

Amphetamines for schizophrenia

S Nolte  1 , D Wong, G Lachford
Affiliations

Amphetamines for schizophrenia

S Nolte et al. Cochrane Database Syst Rev. .

Abstract

Background: It is estimated that between 10% and 65% of people with schizophrenia use illicit drugs such as amphetamines. This group have an increased rate of hospitalisation, homelessness, unemployment and suicide compared with those with schizophrenia who do not abuse drugs.

Objectives: To evaluate the effects of amphetamines for people with schizophrenia in terms of clinically meaningful outcomes, cognitive functioning and physiological tests.

Search strategy: We searched the Cochrane Schizophrenia Group's Register (February 2002).

Selection criteria: We included all randomised controlled trials investigating the effects of amphetamines on people with schizophrenia, compared with a placebo intervention.

Data collection and analysis: Working independently, we selected and critically appraised studies, extracted data and analysed on an intention-to-treat basis. Where possible and appropriate we calculated risk ratios (RR) and their 95% confidence intervals (CI), with the number needed to treat (NNT). For continuous data we calculated Weighted Mean Differences (WMD).

Main results: We included four short studies with a total of 83 participants. Data were few and poorly reported. The results indicated a reduction of negative symptoms for people allocated to amphetamines (n = 16, 1 RCT, WMD -3 CI -5.02 to -0.98). No such effect was found for positive symptom change (n = 16, 1 RCT, WMD 0 CI -4.46 to 4.46). Compared with placebo, amphetamines significantly increased metabolism in the left and right cerebellum (n = 23, 1 RCT, WMD 0.12 CI 0.06 to 0.18; n = 23 1 RCT, WMD 0.12 CI 0.06 to 0.18) and left striatum (n = 23, 1 RCT, WMD 0.14 CI 0.00 to 0.28) and also significantly decreased metabolism in the left dorsolateral prefrontal cortex (n = 23, 1 RCT, WMD -0.09 CI -0.17 to -0.01).

Reviewers' conclusions: Understandably amphetamines are rarely formally evaluated in randomised studies and therefore unpublished work in this area is likely to exist. Addition of more studies may clarify reasons why people with schizophrenia persist in taking these harmful stimulants.

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Conflict of interest statement

None known.

Figures

1
1
Crossover design. Example of an AB/BA crossover design with washout period
1.1
1.1. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 1 Mental state: Average change in symptoms ‐ by <3 hours (decline = good).
1.2
1.2. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 2 Leaving the study early.
1.3
1.3. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 3 Adverse effects: 1. Average change in movement disorders ‐ by <3 hours (AIMS, decline = good).
1.4
1.4. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 4 Physiological: 1a. Cerebral function ‐ local cerebral metabolic rate (percentage change <3 hours).
1.5
1.5. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 5 Physiological: 1b. Cerebral function ‐ cerebral metabolic rate <3.5 hours (µm/100g/min).
1.6
1.6. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 6 Physiological: 1c. Cerebral function ‐ ratio of regional to whole brain metabolic rate <3.5hours.
1.7
1.7. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 7 Physiological: 2. Cerebral blood flow change <3 hours (ml/100 g/min).
1.8
1.8. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 8 Physiological: 3a. Cardio‐respiratory function by <1 hour.
1.9
1.9. Analysis
Comparison 1 AMPHETAMINES vs PLACEBO, Outcome 9 Physiological: 3b. Cardio‐respiratory function by 4 weeks.
See this image and copyright information in PMC

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