People with schizophrenia spectrum disorder often struggle with daily tasks like holding a job or managing money. This trial asked if adding methylphenidate extended-release could help. The study involved 24 stable adults who received this medication for four weeks alongside their usual care. Researchers measured how well participants functioned using a virtual reality tool that simulates real-life tasks. They also checked cognitive skills and symptom severity. The results showed clear improvement in daily function scores. Participants who started with medication first saw gains early on. These gains lasted even after the initial medication phase ended. Symptom scores for delusions and social withdrawal also improved while on the drug. Cognitive tests showed better performance in specific areas like symbol coding. Importantly, none of the participants experienced a worsening of their psychosis. About three-quarters of the group continued taking the medication after the study. However, the study had a small number of participants and was open-label, meaning patients knew they were getting the drug. These factors mean the results should be viewed with some caution.
Methylphenidate ER Improves Functional Capacity in Stable SchizophreniaMethylphenidate extended-release improved daily function in stable schizophrenia patients
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Key Takeaway
Consider methylphenidate ER as a potential adjunct to improve functional capacity and cognition in stable schizophrenia, but interpret cautiously due to open-label design and small sample.
This randomized open-label trial included 24 stable adults with DSM-5 schizophrenia spectrum disorder. Participants received either 4 weeks of methylphenidate extended-release (ER) followed by treatment-as-usual (TAU) or TAU first followed by methylphenidate ER. The primary outcome was functional capacity measured by the Virtual Reality Functional Capacity Assessment Tool (VRFCAT).
VRFCAT scores improved significantly over time. The medication-first arm showed improvement versus the TAU-first arm in the first period. Overall gains from baseline to week 8 were 303.47 seconds and 159.91 seconds, respectively, and were sustained after medication. Cognitive performance, assessed by the Brief Assessment of Cognition in Schizophrenia (BACS), showed significant improvements in the TAU-first arm during the medication phase for Symbol Coding and Tower of London. Symptom severity, measured by the Positive and Negative Symptoms Scale (PANSS-6), improved significantly while on study medication, notably in delusions and social withdrawal.
No psychosis exacerbation occurred during the study. After the trial, 75% of participants resumed methylphenidate ER. Key limitations include the open-label design and small sample size, which warrant cautious interpretation. These findings suggest a potential role for methylphenidate ER in improving functional and cognitive outcomes in stable schizophrenia, but further controlled studies are needed.
What this means for you:
Methylphenidate extended-release improved function and reduced symptoms in a small group of stable adults with schizophrenia spectrum disorder. More on Schizophrenia
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View Original Abstract ↓
BACKGROUND: Cognitive impairment severely disrupts functioning and recovery in schizophrenia. Methylphenidate extended-release (ER) shows promise for cognition in attention-deficit/hyperactivity disorder but has limited, inconsistent evidence in schizophrenia. This study investigates low-dose methylphenidate ER's effects on cognitive and functional outcomes in schizophrenia, addressing a critical therapeutic gap.
METHODS: In an 8-week, open-label, randomized crossover trial, 24 stable adults with Diagnostic and Statistical Manual of Mental Disorders, 5th edition, diagnosis of schizophrenia spectrum disorder received 4 weeks of methylphenidate ER or treatment-as-usual (TAU), with crossover at week 4, and follow-up at week 12. The primary outcome was improvement in functional capacity, measured by the Virtual Reality Functional Capacity Assessment Tool (VRFCAT), while secondary outcomes included cognitive performance, assessed by the Brief Assessment of Cognition in Schizophrenia (BACS), and symptom severity evaluated by Positive and Negative Symptoms Scale (PANSS).
RESULTS: VRFCAT scores improved significantly over time; in the first period (baseline to week 4), the medication-first arm showed improvement versus the TAU-first arm, with overall gains from baseline to week 8 of 303.47 seconds and 159.91 seconds, respectively, sustained post medication. BACS showed significant improvements in the TAU-first arm during the medication phase for Symbol Coding and Tower of London. PANSS-6 improved significantly while on study medication, notably in delusions and social withdrawal, without psychosis exacerbation. At 2-month follow-up, 75% resumed methylphenidate ER.
CONCLUSIONS: While results are interpreted cautiously due to the open-label design and small sample size, this trial suggests low-dose methylphenidate ER may enhance functional capacity, specific cognitive domains, and symptoms in schizophrenia without exacerbating psychosis.
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