
Adjunctive Simvastatin in Early Schizophrenia
Because schizophrenia is associated with increased inflammation, studies on the effects of anti-inflammatory statins are warranted.
RESEARCH UPDATE
CASE VIGNETTE
“Ms T” is a 25-year-old African American female with an 8-year history of chronic schizophrenia. The onset of her illness was at age 17, and symptoms included auditory hallucinations of demonic figures, visual hallucinations of dead people, delusions of reference that the television is talking about her and thought broadcasting. She was stabilized on antipsychotic medication and has never required psychiatric hospitalization.
On routine metabolic monitoring at age 19, the patient was found to have elevated total (212 mg/dL) and LDL (160 mg/dL) cholesterol, low HDL cholesterol (37 mg/dL), and normal triglycerides (78 mg/dL). A decision was made to start her on adjunctive simvastatin. Subsequently, over the next year her lipid panel normalized except for persistent low HDL (37-40 mg/dL). However, there were no clinically appreciable changes in her symptoms or cognitive function during that time period.
Studying Simvastatin
Many patients with schizophrenia-spectrum disorders (SSDs)
Primary outcomes were symptom severity as measured by the Positive and Negative Syndrome Scale (PANSS) and neurocognitive functioning as assessed by the Brief Assessment of Cognition in Schizophrenia (BACS) at the end of 12 months of treatment. Secondary outcomes included PANSS subscale scores, global assessment of functioning, extrapyramidal symptoms, akathisia, depressive symptoms, and the metabolic syndrome. Data were analyzed using linear mixed models for repeated measurements.
One hundred nineteen participants were
There was a significant treatment by time interaction effect, with higher general functioning (GAF) in the simvastatin group at 24 months (mean 4.9 points). There was also a significant decrease in total cholesterol, LDL cholesterol, and non-HDL cholesterol in the simvastatin group over time compared to placebo. Serious adverse events were more common the placebo group (19% versus 7%). There were no significant differences in adverse events between participant groups, including those particularly relevant to treatment with statins, namely dark-colored urine and myalgias.
The authors
The Bottom Line
Antiinflammatory augmentation may not be beneficial for symptom severity and cognition in schizophrenia, although this does not preclude the possibility that a subset of patients may benefit from this approach. Future studies—especially in patients with evidence of inflammation—are warranted.
Dr Miller is professor in the Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia. He is on the Editorial Board and serves as the schizophrenia section chief for Psychiatric TimesTM. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the Stanley Medical Research Institute.
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