Abstract
There is evidence that sodium benzoate (BZ) may be an effective adjunctive treatment for schizophrenia. The clinical efficacy of BZ has been investigated in chronic schizophrenia; however, the efficacy of this agent has not been studied in individuals with early psychosis. To examine the clinical efficacy of the adjunctive use of BZ for symptoms in people with early psychosis. Using a placebo-controlled double-masked parallel-group design, this randomized clinical trial was conducted from August 2015 to July 2018. Participants aged between 15 and 45 years experiencing early psychosis were enrolled from 5 major clinical sites in Queensland, Australia. Data analysis was conducted from October 2018 to February 2020. Participants were randomized 1:1 (50 participants in each group) to receive 500 mg of sodium benzoate twice daily or placebo for 12 weeks. The primary efficacy outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 12 weeks. The key secondary efficacy measures were (1) the Clinical Global Impression score, (2) the Hamilton Depression Rating Scale for depression, (3) functioning as assessed by the clinician-rated Global Assessment of Function, and (4) the Assessment of Quality of Life Scale. The PANSS subscale scores and impact on selected amino acid concentrations were also assessed. The study comprised 100 participants with a mean (SD) age of 21.4 (4.1) years, of whom 73 (73%) were male individuals. The mean (SD) baseline PANSS score was 75.3 (15.4). We found no improvement in total PANSS score in the BZ group compared with the placebo group. The end result of least-squares mean difference (SE) for total PANSS was -1.2 (2.4) (P = .63). There were no differences in any subscales of the PANSS, any secondary measures, nor any amino acid concentrations. The dose of BZ was well tolerated without any clinically significant treatment-emergent adverse event differences between BZ and placebo groups. In this randomized clinical trial, there was no evidence that adjunctive use of 500 mg of BZ twice daily is an effective treatment for individuals with early psychosis. anzctr.org.au Identifier: ACTRN12615000187549.
Highlights
People living with psychosis all too commonly experience symptoms that are refractory to treatment, which contributes to significant disability,[1] resulting in a high disease burden.[2]
We found no improvement in total Positive and Negative Syndrome Scale (PANSS) score in the BZ group compared with the placebo group
The dose of BZ was well tolerated without any clinically significant treatmentemergent adverse event differences between BZ and placebo groups. In this randomized clinical trial, there was no evidence that adjunctive use of 500 mg of BZ twice daily is an effective treatment for individuals with early psychosis
Summary
People living with psychosis all too commonly experience symptoms that are refractory to treatment, which contributes to significant disability,[1] resulting in a high disease burden.[2] Treatment guidelines for psychosis recommend antipsychotic therapy accompanied by psychosocial interventions.[3] While antipsychotic medications modulating dopaminergic activity are generally effective in reducing positive symptoms, many people continue to experience persistent impairment. It is recognized that the pathophysiology underlying psychosis extends beyond dopaminergic dysregulation. Hypofunction of the N-methyl-D-aspartate (NMDA) receptors[4] is another proposed mechanism that is not addressed by standard antipsychotic medications. Trials of pharmacological agents that act on molecular targets such as the NMDA receptors may allow us to expand psychosis treatments.[5]
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