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W95

MEMANTINE FOR THE TREATMENT OF PRIMARY NEGATIVE SYMPTOMS IN SCHIZOPHRENIA: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Sajoy Varghese — Houlin Hong2, Jack Donlon3, Martin Schaefer4, Susanne Sarkar5, Dragana Bugarski-Kirola6, Mujeeb Shad7, Wei Hou8, Matthias Kirschner9, Ludmil Mitrev10, Valentina Echeverria11, John Dibato12, Selene Veerman13, Trevor Stone14, Maju koola15 1Clinical Resource Hub, VISN 23, Minneapolis VA Health System, 2Center for Systems and Community Design, CUNY School of Public Health and Health Policy, 3Cooper Medical School of Rowan University, 4 Evang Kliniken Essen-Mitte, Essen, Germany, 5CharitéUniversitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany, 6Acadia Pharmaceuticals, 7University of Nevada, 8Stony Brook University, 9University Hospitals of Geneva, 10Division of Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, 11Facultad de Medicina y Ciencias, Universidad San Sebastián, 12Cooper Research Institute, Cooper Medical School of Rowan University, 13Community Mental Health, Mental Health Service Noord-Holland Noord, 14University of Oxford, 15George Washington University School of Medicine and Health Sciences

2026 ASCP Annual Meeting

Methodological Issue Being Addressed: The large effect size (d=2.16) for primary negative symptoms (anhedonia, avolition, alogia, blunted affect, and asociality) obtained after adjusting for confounding factor appears promising with memantine treatment. However, the effect size observed for overall negative symptoms (d=0.79) is likely more reliable and consistent with findings from prior meta-analyses. Predominant negative symptoms with minimal psychosis, depression, and extrapyramidal symptoms are suggestive of primary negative symptoms. We criticize deficit versus nondeficit syndrome.

Introduction

There are no approved treatments for negative symptoms in schizophrenia. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist. There is a growing body of evidence for memantine as an adjunctive therapy for the negative symptoms of schizophrenia.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines and searched for relevant publications in PubMed, Cochrane Library, PsycINFO, Embase, and China Journal Net databases from inception using the following search terms: memantine, schizophrenia, randomized controlled trials (RCTs), RCT, and clinical trial. Searches were limited to English-and Chinese-language articles to date. Standardized mean differences (SMDs) with 95% confidence intervals were calculated using RevMan 5.4 to assess the effect size. Risk of bias was assessed using RoB 2.0.

Results

In total, 13 RCTs were identified (N=681). Memantine was superior to placebo in treating negative symptoms, with an SMD of 0.79 (p=0.0001, N=631, 12 RCTs). Analysis of three studies whose corresponding authors provided original datasets showed an SMD of 2.16 (p = 0.25, N = 97) after adjusting for change in psychosis, depression, and extrapyramidal symptoms, suggesting that memantine is efficacious in treating primary negative symptoms. Additionally, cognitive testing significantly improved, with an SMD of 0.66 (p=0.0001, N=395, eight RCTs). Positive symptoms were not significantly improved (SMD=0.24, p=0.1, N=631, 12 RCTs).

Conclusion

This is the first study, to our knowledge, showing a large effect size for treating primary negative symptoms with memantine. Although statistical significance was not reached because of the small sample size (N=97), the results were as expected because drugs such as memantine that act at NMDA receptors are unlikely to be effective as stand-alone treatments. Future RCTs should evaluate medications modulating NMDA in combination with complementary medications to optimize therapeutic effects for all three domains of schizophrenia psychopathology. W96. DELIBERATE SELF-HARM IN BOSNIA AND HERZEGOVINA (BIH), WITH SPECIAL REFERENCE TO GENDER, AGE AND ETHNICITY Emina Music*1 1Psychiatric clinic,Norra Alvsborgs Länssjukhus,Trollhattan,Sweden

The aim of the present study is to investigate deliberate self-harm (DSH) in Bosnia and Herzegovina (BiH), with special reference to gender, age and ethnicity. Between 2001 and 2003, known hospital cases of DSH in persons aged 15 or older in the Sarajevo area were monitored using standardised methods. In total, 1428 DSH events were registered, giving an annual mean DSH event rate of 119 per 100 000 (118 for women, 120 for men) and a DSH person rate of 110 (108 for women, 111 for men). The mean person-based DSH rate was 124 for Bosniaks (Muslims), 128 for Croats (Catolics), and 88 for Serbs (Orthodox Christians). Selfpoisoning was the most commonly used method in all three ethnic groups (66%), with secondmost common method self-harm by a sharp object (17%). A very low proportion used guns or explosives. The rates of DSH in Sarajevo during the study period were comparable to those of many other regions in Europe, though with a quite unique pattern of higher rates among men. We identified fluctuating but significantly not different rates between ethnic groups. The general belief that religious denomination is decisive for level of DSH-rates was not supported by the findings of this study; rather the post-war situation with huge demographic changes was reflected in the results. Disruptions to social integration as a consequence of the war are put forward as possible explanations.