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High-dose glycine added to olanzapine and risperidone for the treatment of schizophrenia

  • Uriel Heresco-Levy
    Correspondence
    Address reprint requests to Uriel Heresco-Levy, M.D., Ezrath Nashim-Herzog Memorial Hospital, P.O.B. 35300, Jerusalem 91351, Israel.
    Affiliations
    Ezrath Nashim-Herzog Memorial Hospital (UH-L, ME, PL, GB), Jerusalem, Israel

    Department of Psychiatry (UH-L, ME, PL), Hadassah Medical School-Hebrew University, Jerusalem, Israel
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  • Marina Ermilov
    Affiliations
    Ezrath Nashim-Herzog Memorial Hospital (UH-L, ME, PL, GB), Jerusalem, Israel

    Department of Psychiatry (UH-L, ME, PL), Hadassah Medical School-Hebrew University, Jerusalem, Israel
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  • Pesah Lichtenberg
    Affiliations
    Ezrath Nashim-Herzog Memorial Hospital (UH-L, ME, PL, GB), Jerusalem, Israel

    Department of Psychiatry (UH-L, ME, PL), Hadassah Medical School-Hebrew University, Jerusalem, Israel
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  • Gali Bar
    Affiliations
    Ezrath Nashim-Herzog Memorial Hospital (UH-L, ME, PL, GB), Jerusalem, Israel
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  • Daniel C Javitt
    Affiliations
    Nathan S. Kline Institute for Psychiatric Research (DCJ), Orangeburg, New York, USA

    Department of Psychiatry (DCJ), New York University, New York, New York, USA
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      Abstract

      Background

      Clinical trials indicate that glycine site agonists of the N-methyl-D-aspartate (NMDA) receptors may reduce negative and cognitive symptoms in treatment-resistant schizophrenia when used as adjuvants to conventional antipsychotics but possibly not to clozapine. In this study, we assessed whether high-dose glycine may also be therapeutically beneficial when added to olanzapine and risperidone treatment.

      Methods

      Seventeen olanzapine- or risperidone-treated schizophrenia patients participated in a double-blind, placebo-controlled, 6-week crossover treatment trial with .8 g/kg/day glycine added to their ongoing antipsychotic medication. Clinical assessments were performed biweekly throughout the study. Clinical laboratory parameters and amino acid serum levels were monitored.

      Results

      Glycine treatment was well tolerated and resulted in a significant (p < .0001) 23% ± 8% reduction in negative symptoms. Significant improvements were also registered in cognitive and positive symptoms. The negative symptoms improvement remained significant even following covariation for changes in other symptom clusters and extrapyramidal side effects. High posttreatment glycine serum levels significantly predicted (r = .60) clinical response.

      Conclusions

      These findings indicate that the efficacy of olanzapine and risperidone may be augmented using high-dose adjuvant glycine treatment and suggest that these atypical antipsychotics may affect NMDA receptor-mediated neurotransmission differently than clozapine.

      Keywords

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