Glycine treatment of the risk syndrome for psychosis: report of two pilot studies

Abstract

Patients meeting criteria for the risk syndrome for psychosis have treatment needs including positive and negative symptoms and cognitive impairment. These features could potentially respond to NMDA glycine-site agonists. The present objective was to determine which symptoms or domains of cognition promise to show the greatest response to glycine in risk syndrome patients. We conducted two short-term pilot studies of glycine used without adjunctive antipsychotic medication. In the first trial, 10 risk syndrome subjects received open-label glycine at doses titrated to 0.8 g/kg/d for 8 weeks, followed by discontinuation and 16 weeks of evaluation for durability of effects. In the second, 8 subjects were randomized to double-blind glycine vs. placebo for 12 weeks, followed by open-label glycine for another 12 weeks. Patients were evaluated every 1-2 weeks with the Scale Of Psychosis-risk Symptoms (SOPS) and before and after treatment with a neurocognitive battery. Within-group and between-group effect sizes were calculated. Effect sizes were large for positive (open-label within-group -1.10, double-blind between-group -1.11) and total (-1.39 and -1.15) symptoms and medium-to-large (-0.74 and -0.79) for negative symptoms. Medium or large effect sizes were also observed for several neurocognitive measures in the open-label study, although data were sparse. No safety concerns were identified. We conclude that glycine was associated with reduced symptoms with promising effect sizes in two pilot studies and a possibility of improvement in cognitive function. Further studies of agents that facilitate NMDA receptor function in risk syndrome patients are supported by these preliminary findings.

Trial registration: ClinicalTrials.gov NCT00268749 NCT00291226.

Keywords: Glycine; NMDA receptor; Prodrome; Psychosis; Risk syndrome; Schizophrenia.

Figure 1

Open-label glycine: SOPS total scores over time. Subject numbers indicate consecutive patients evaluated for risk syndrome research diagnoses who met criteria, consented, and began treatment with open-label glycine for 8 weeks. SOPS—Scale Of Psychosis-risk Symptoms.

Figure 2

Double-blind glycine vs. placebo: SOPS total scores over time. Filled circles: glycine; open circles: placebo. Subject numbers indicate consecutive patients evaluated for risk syndrome research diagnoses who met criteria, consented, and began treatment with double-blind glycine vs. placebo for 12 weeks. The first 8 weeks of treatment are shown. SOPS—Scale Of Psychosis-risk Symptoms.