Effects of NAC on Symptoms of CHR Patients

NCT ID: NCT05142735

Last Updated: 2024-02-26

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 90 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-01-13
• Study Completion Date: 2024-12-31

Brief Summary

Schizophrenia is a chronic debilitating psychotic disorder. Identifying persons with "clinical high-risk" (CHR) symptoms, which are like those of schizophrenia but less severe, and providing psychiatric care to these individuals has been shown to help prevent psychosis. Current medications used for CHR symptoms, however, are associated with substantial side effect burden. Therefore, practice guidelines do not recommend current medications as routine treatment for the CHR state, and there is a need to identify new treatments for this condition.

Research suggests that abnormal brain oxidative stress may contribute to schizophrenia, offering a potential novel treatment target in the CHR state. Oxidative stress is an excess of free radicals, which are generated from normal metabolism and environmental exposures, and can damage cells. Antioxidants in the body normally neutralize free radicals. Antioxidant deficiency could result in excess oxidative stress that damages brain cells, leading to schizophrenia. Recent studies suggest that N-acetylcysteine (NAC), a precursor of the most abundant brain antioxidant, glutathione, may be a safe, well-tolerated treatment for schizophrenia. In light of this, NAC may also reduce symptoms and brain abnormalities in CHR patients.

Detailed Description

The primary aim is to examine the effect of NAC on psychosis-like symptoms in CHR patients. Secondary aims are to examine the effect of NAC, in these patients, on the amplitude of the mismatch negativity (MMN), an electroencephalographic event-related potential (ERP) response to rare sounds among frequent ones; and the amplitude of the N400 semantic priming effect, an ERP response to unexpected compared to expected meaningful stimuli (e.g., words, pictures); both of which have been found to be reduced in both schizophrenia and the CHR state.

This will be a randomized, double-blind, placebo-controlled trial. Ninety CHR patients will take either NAC 2000 mg orally or placebo, daily for 8 weeks. Psychosis-like symptoms will be assessed at baseline, week 4 and week 8 using the Positive symptom score of the Scale of Psychosis-Risk Symptoms in the Structured Interview for Psychosis-Risk Syndromes. MMN amplitude and the N400 semantic priming effect will be measured at baseline and week 8. We hypothesize that patients will have more improvement in psychosis-like symptoms, and greater increases in MMN amplitudes and N400 semantic priming effects, after taking NAC vs. placebo. If we find that NAC improves psychosis-like symptoms and/or these neurophysiological biomarkers of the CHR state, this would support further research on NAC as a preventive treatment against psychosis.

Conditions

Prodromal Schizophrenia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Experimental

N-Acetylcysteine 2000 mg (4 x 500-mg tablets) orally every morning for 8 weeks

Group Type: EXPERIMENTAL

N-Acetylcysteine

Intervention Type: DIETARY_SUPPLEMENT

2000 mg (4 x 500-mg tablets) every morning

Placebo Comparator

N-Acetylcysteine Placebo tablet matching N-Acetylcysteine orally every morning for 8 weeks

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DIETARY_SUPPLEMENT

4 placebo tablets every morning

Interventions

N-Acetylcysteine

2000 mg (4 x 500-mg tablets) every morning

Intervention Type: DIETARY_SUPPLEMENT

Placebo

4 placebo tablets every morning

Intervention Type: DIETARY_SUPPLEMENT

Other Intervention Names

NAC

Eligibility Criteria

Inclusion Criteria

1. meeting Criteria of Psychosis-Risk Syndromes (COPS) criteria on the Structured Interview for Psychosis-Risk Syndromes (SIPS)

2. capacity to provide informed consent

3. if female, participant is not of child-bearing potential, defined as females who have undergone a sterilization procedure or have been post-menopausal for at least 1 year prior to screening OR participant is of child-bearing potential and agrees to use a medically approved method of birth control for the duration of the study

Exclusion Criteria

1. meeting criteria for any other DSM-5 diagnosis at the time of the study (except -personality disorder, nicotine use disorder, or other substance use disorder in full remission)

2. concomitant or past neurological condition

3. visual impairment which is not corrected to normal by prescription glasses history of reading disability

4. past antipsychotic treatment at a therapeutic dose

5. current treatment with a psychotropic medication except antidepressants on which the participants has been on a stable dose for at least 30 days.

6. pregnancy (as identified on self-report and/or rapid urine pregnancy test) or intent to become pregnant according to self-report

7. breastfeeding or plan to do so

8. history of kidney stones

9. current treatment with an antibiotic

10. current treatment with nitroglycerin

11. allergy to any ingredients in either the investigational product or placebo product

• Minimum Eligible Age: 16 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centre for Addiction and Mental Health

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Michael Kiang, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Centre for Addiction and Mental Health

Locations

Centre for Addiction and Mental Health

Toronto, Ontario, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Michael Kiang, MD, PhD

Role: CONTACT

michael.kiang@camh.ca

416-535-8501 ext. 30337

Jenny Lepock, PhD

Role: CONTACT

jenny.lepock@camh.ca

416-535-8501 ext. 34639

Facility Contacts

Jenny Lepock, PhD

Role: primary

jenny.lepock@camh.ca

4167026423

Michael Kiang

Role: backup

michael.kiang@camh.ca

References

Addington J, Addington D, Abidi S, Raedler T, Remington G. Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis. Can J Psychiatry. 2017 Sep;62(9):656-661. doi: 10.1177/0706743717719895. Epub 2017 Jul 21.

Reference Type: BACKGROUND

PMID: 28730848 (View on PubMed)

Atkinson RJ, Michie PT, Schall U. Duration mismatch negativity and P3a in first-episode psychosis and individuals at ultra-high risk of psychosis. Biol Psychiatry. 2012 Jan 15;71(2):98-104. doi: 10.1016/j.biopsych.2011.08.023. Epub 2011 Oct 13.

Reference Type: BACKGROUND

PMID: 22000060 (View on PubMed)

Breier A, Liffick E, Hummer TA, Vohs JL, Yang Z, Mehdiyoun NF, Visco AC, Metzler E, Zhang Y, Francis MM. Effects of 12-month, double-blind N-acetyl cysteine on symptoms, cognition and brain morphology in early phase schizophrenia spectrum disorders. Schizophr Res. 2018 Sep;199:395-402. doi: 10.1016/j.schres.2018.03.012. Epub 2018 Mar 24.

Reference Type: BACKGROUND

PMID: 29588126 (View on PubMed)

Cabungcal JH, Counotte DS, Lewis E, Tejeda HA, Piantadosi P, Pollock C, Calhoon GG, Sullivan E, Presgraves E, Kil J, Hong LE, Cuenod M, Do KQ, O'Donnell P. Juvenile antioxidant treatment prevents adult deficits in a developmental model of schizophrenia. Neuron. 2014 Sep 3;83(5):1073-1084. doi: 10.1016/j.neuron.2014.07.028. Epub 2014 Aug 14.

Reference Type: BACKGROUND

PMID: 25132466 (View on PubMed)

Conus P, Seidman LJ, Fournier M, Xin L, Cleusix M, Baumann PS, Ferrari C, Cousins A, Alameda L, Gholam-Rezaee M, Golay P, Jenni R, Woo TW, Keshavan MS, Eap CB, Wojcik J, Cuenod M, Buclin T, Gruetter R, Do KQ. N-acetylcysteine in a Double-Blind Randomized Placebo-Controlled Trial: Toward Biomarker-Guided Treatment in Early Psychosis. Schizophr Bull. 2018 Feb 15;44(2):317-327. doi: 10.1093/schbul/sbx093.

Reference Type: BACKGROUND

PMID: 29462456 (View on PubMed)

Flatow J, Buckley P, Miller BJ. Meta-analysis of oxidative stress in schizophrenia. Biol Psychiatry. 2013 Sep 15;74(6):400-9. doi: 10.1016/j.biopsych.2013.03.018. Epub 2013 May 15.

Reference Type: BACKGROUND

PMID: 23683390 (View on PubMed)

Hsieh MH, Shan JC, Huang WL, Cheng WC, Chiu MJ, Jaw FS, Hwu HG, Liu CC. Auditory event-related potential of subjects with suspected pre-psychotic state and first-episode psychosis. Schizophr Res. 2012 Sep;140(1-3):243-9. doi: 10.1016/j.schres.2012.06.021. Epub 2012 Jul 10.

Reference Type: BACKGROUND

PMID: 22784684 (View on PubMed)

Jahshan C, Cadenhead KS, Rissling AJ, Kirihara K, Braff DL, Light GA. Automatic sensory information processing abnormalities across the illness course of schizophrenia. Psychol Med. 2012 Jan;42(1):85-97. doi: 10.1017/S0033291711001061. Epub 2011 Jul 11.

Reference Type: BACKGROUND

PMID: 21740622 (View on PubMed)

Kim M, Lee TH, Yoon YB, Lee TY, Kwon JS. Predicting Remission in Subjects at Clinical High Risk for Psychosis Using Mismatch Negativity. Schizophr Bull. 2018 Apr 6;44(3):575-583. doi: 10.1093/schbul/sbx102.

Reference Type: BACKGROUND

PMID: 29036493 (View on PubMed)

Lavoie S, Jack BN, Griffiths O, Ando A, Amminger P, Couroupis A, Jago A, Markulev C, McGorry PD, Nelson B, Polari A, Yuen HP, Whitford TJ. Impaired mismatch negativity to frequency deviants in individuals at ultra-high risk for psychosis, and preliminary evidence for further impairment with transition to psychosis. Schizophr Res. 2018 Jan;191:95-100. doi: 10.1016/j.schres.2017.11.005. Epub 2017 Nov 11.

Reference Type: BACKGROUND

PMID: 29132815 (View on PubMed)

Lepock JR, Ahmed S, Mizrahi R, Gerritsen CJ, Maheandiran M, Drvaric L, Bagby RM, Korostil M, Light GA, Kiang M. Relationships between cognitive event-related brain potential measures in patients at clinical high risk for psychosis. Schizophr Res. 2020 Dec;226:84-94. doi: 10.1016/j.schres.2019.01.014. Epub 2019 Jan 22.

Reference Type: BACKGROUND

PMID: 30683525 (View on PubMed)

Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Cannon T, Ventura J, McFarlane W, Perkins DO, Pearlson GD, Woods SW. Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull. 2003;29(4):703-15. doi: 10.1093/oxfordjournals.schbul.a007040.

Reference Type: BACKGROUND

PMID: 14989408 (View on PubMed)

Nagai T, Tada M, Kirihara K, Yahata N, Hashimoto R, Araki T, Kasai K. Auditory mismatch negativity and P3a in response to duration and frequency changes in the early stages of psychosis. Schizophr Res. 2013 Nov;150(2-3):547-54. doi: 10.1016/j.schres.2013.08.005. Epub 2013 Sep 6.

Reference Type: BACKGROUND

PMID: 24012461 (View on PubMed)

Perez VB, Woods SW, Roach BJ, Ford JM, McGlashan TH, Srihari VH, Mathalon DH. Automatic auditory processing deficits in schizophrenia and clinical high-risk patients: forecasting psychosis risk with mismatch negativity. Biol Psychiatry. 2014 Mar 15;75(6):459-69. doi: 10.1016/j.biopsych.2013.07.038. Epub 2013 Sep 16.

Reference Type: BACKGROUND

PMID: 24050720 (View on PubMed)

Schmidt SJ, Schultze-Lutter F, Schimmelmann BG, Maric NP, Salokangas RK, Riecher-Rossler A, van der Gaag M, Meneghelli A, Nordentoft M, Marshall M, Morrison A, Raballo A, Klosterkotter J, Ruhrmann S. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry. 2015 Mar;30(3):388-404. doi: 10.1016/j.eurpsy.2015.01.013. Epub 2015 Mar 3.

Reference Type: BACKGROUND

PMID: 25749390 (View on PubMed)

Sepehrmanesh Z, Heidary M, Akasheh N, Akbari H, Heidary M. Therapeutic effect of adjunctive N-acetyl cysteine (NAC) on symptoms of chronic schizophrenia: A double-blind, randomized clinical trial. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Mar 2;82:289-296. doi: 10.1016/j.pnpbp.2017.11.001. Epub 2017 Nov 7.

Reference Type: BACKGROUND

PMID: 29126981 (View on PubMed)

Shaikh M, Valmaggia L, Broome MR, Dutt A, Lappin J, Day F, Woolley J, Tabraham P, Walshe M, Johns L, Fusar-Poli P, Howes O, Murray RM, McGuire P, Bramon E. Reduced mismatch negativity predates the onset of psychosis. Schizophr Res. 2012 Jan;134(1):42-8. doi: 10.1016/j.schres.2011.09.022. Epub 2011 Oct 24.

Reference Type: BACKGROUND

PMID: 22024244 (View on PubMed)

Steullet P, Cabungcal JH, Monin A, Dwir D, O'Donnell P, Cuenod M, Do KQ. Redox dysregulation, neuroinflammation, and NMDA receptor hypofunction: A "central hub" in schizophrenia pathophysiology? Schizophr Res. 2016 Sep;176(1):41-51. doi: 10.1016/j.schres.2014.06.021. Epub 2014 Jul 5.

Reference Type: BACKGROUND

PMID: 25000913 (View on PubMed)

Zheng W, Zhang QE, Cai DB, Yang XH, Qiu Y, Ungvari GS, Ng CH, Berk M, Ning YP, Xiang YT. N-acetylcysteine for major mental disorders: a systematic review and meta-analysis of randomized controlled trials. Acta Psychiatr Scand. 2018 May;137(5):391-400. doi: 10.1111/acps.12862. Epub 2018 Feb 18.

Reference Type: BACKGROUND

PMID: 29457216 (View on PubMed)

Other Identifiers

054-2020

Identifier Type: -

Identifier Source: org_study_id