Supplementation of vitamin C with atypical antipsychotics reduces oxidative stress and improves the outcome of schizophrenia Vitamin B6 as add-on treatment in chronic schizophrenic and schizoaffective patients: a double-blind, placebo-controlled study. Oxidative–antioxidative systems and their relation with serum S100 B levels in patients with schizophrenia: Effects of short term antipsychotic treatment A randomized placebo-controlled trial of an omega-3 fatty acid and vitamins E+C in schizophrenia The impact of omega-3 fatty acids, vitamins E and C supplementation on treatment outcome and side effects in schizophrenia patients treated with haloperidol: an open-label pilot study. Randomized multicenter investigation of folate plus vitamin B12 supplementation in schizophrenia. Vitamin D supplementation during the first year of life and risk of schizophrenia: a Finnish birth cohort study Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males Omega-3 fatty acids in first-episode schizophrenia - a randomized controlled study of efficacy and relapse prevention (OFFER): rationale, design, and methods Effect of megavitamin treatment on mental performance and plasma vitamin B6 concentrations in mentally retarded young adults. Assessing the infrequent oral supplementation of olanzapine long-acting injection in the treatment of schizophrenia. Relationship of Cognition to Clinical Response in First-Episode Schizophrenia Spectrum Disorders. More evidence on additive antipsychotic effect of adjunctive mirtazapine in schizophrenia: an extension phase of a randomized controlled trial Salience network and olanzapine in schizophrenia: implications for treatment in anorexia nervosa. Randomized, Placebo-Controlled Clinical Trial of Omega-3 as Supplemental Treatment in Schizophrenia Antipsychotic treatment and functional connectivity of the striatum in first-episode schizophrenia. Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment.
Rationale Several investigators implicated role of free radical-mediated pathology in schizophrenia . No study has ever examined the effect of vitamin C with atypical antipsychotics in the treatment of schizophrenia . Objective The aim of this study was to examine the effect of oral vitamin C with atypical antipsychotics on serum malondialdehyde ( MDA ) , plasma ascorbic acid levels , and brief psychiatric rating scale ( BPRS ) score in schizophrenic patients . Method Forty schizophrenic patients participated in a prospect i ve , double-blind , placebo-controlled , noncrossover , 8-week study . The patients with schizophrenia were divided r and omly into placebo and vitamin C group of 20 each . Serum MDA and plasma ascorbic acid were estimated by methods of Nischal and Aye , respectively . Result Increased serum MDA and decreased plasma ascorbic acid levels were found in schizophrenic patients . These levels were reversed significantly after treatment with vitamin C along with atypical antipsychotics compared to placebo with atypical antipsychotics .  BPRS change scores at 8 weeks improved statistically significant with vitamin C as compared to placebo . Conclusion Oral supplementation of vitamin C with atypical antipsychotic reverses ascorbic acid levels , reduces oxidative stress , and improves BPRS score , hence both the drugs in combination can be used in the treatment of schizophrenia BACKGROUND Vitamin B6 , or pyridoxine , plays an intrinsic role in the synthesis of certain neurotransmitters that take part in development of psychotic states . Several reports indicate that vitamin B6 may be a factor in a number of psychiatric disorders and related conditions , such as autism , Alzheimer 's disease , hyperactivity , learning disability , anxiety disorder , and depression . Moreover , there are anecdotal reports of a reduction in psychotic symptoms after vitamin B6 supplementation of psychopharmacologic treatment of patients suffering from schizophrenia or organic mental disorder . The aim of this study was to examine whether vitamin B6 therapy influences psychotic symptoms in patients suffering from schizophrenia and schizoaffective disorder . METHOD The effects of the supplementation of vitamin B6 to antipsychotic treatment on positive and negative symptoms in 15 schizophrenic and schizoaffective patients ( DSM-IV criteria ) were examined in a double-blind , placebo-controlled , crossover study spanning 9 weeks . All patients had stable psychopathology for at least 1 month before entry into the study and were maintained on treatment with their pre study  psychoactive and antiparkinsonian medications  throughout the study . All patients were assessed using the Positive and Negative Syndrome Scale ( PANSS ) for schizophrenia on a weekly basis . Patients r and omly received placebo or vitamin B6 , starting at 100 mg/day in the first week and increasing to 400 mg/day in the fourth week by 100-mg increments each week . RESULTS PANSS scores revealed no differences between vitamin B6- and placebo-treated patients in amelioration of their mental state . CONCLUSION Further studies with larger population s and shorter duration of illness are needed to clarify the question of the possible efficacy of vitamin B6 in treatment of psychotic symptoms in schizophrenia Oxidative stress may be a contributing factor in the etiopathophysiology of schizophrenia , which may be exacerbated by the treatment with antipsychotics with pro-oxidant properties . Increased levels of S100 B are associated with neurodegenerative disorders , including schizophrenia . The aim of the present study was to investigate the role of oxidative cell damage in the pathogenesis of schizophrenia . Forty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for schizophrenia and 35 healthy control subjects were included in the study .  Serum S100 B level was determined to investigate brain damage . Plasma malondialdehyde ( MDA ) levels and susceptibility of red blood cell ( RBC ) to oxidation were determined to investigate the oxidative status and plasma vitamin E , vitamin C , serum total carotenoid levels and total antioxidant capacity and RBC superoxide dismutase ( SOD ) and whole blood glutathione peroxidase activities were measured to investigate the antioxidative defence before and after 6 weeks of antipsychotic treatment .  Plasma MDA and serum S100 B levels and RBC-SOD activity were significantly higher in the schizophrenia group than those of the control group . Treatment did not modify any of the oxidative-antioxidative system parameters or serum S100 B levels . S100 B level was significantly higher in patients with negative symptoms than the patients with positive symptoms and the control subjects . S100 B levels were significantly reduced after 6 weeks of treatment in patients with negative symptoms . The results of the present study might support the oxidative cell injury hypothesis of the schizophrenia . Furthermore , the underlying mechanisms of the subgroups of schizophrenia might be different as suggested by the increased S100 B levels and its decrement after treatment in patients with negative symptoms Membrane lipid metabolism and redox regulation may be disturbed in schizophrenia . We examined the clinical effect of adding an omega-3 fatty acid and /or vitamins E+C to antipsychotics . It was hypothesized that lower baseline levels of polyunsaturated fatty acids ( PUFAs ) would predict more benefit from the add-on treatment . The trial had a multicenter , r and omized , double-blind , placebo-controlled 2 × 2 factorial design . Patients aged 18–39 years with schizophrenia or related psychoses were consecutively included at admission to psychiatric departments in Norway . They received active or placebo ethyl-eicosapentaenoate ( EPA ) 2 g day−1 and active or placebo vitamin E 364 mg day−1+vitamin C 1000 mg day−1 ( vitamins ) for 16 weeks . The main outcome measures were Positive and Negative Syndrome Scale ( PANSS ) total and subscales scores , analyzed by linear mixed models . Ninety-nine patients were included . At baseline , erythrocyte PUFA were measured in 97 subjects . Given separately , EPA and vitamins  increased drop-out rates , whereas when combined they did not differ from placebo . In low PUFA patients , EPA alone impaired the course of total PANSS ( Cohen ’s d=0.29 ; P=0.03 ) and psychotic symptoms ( d=0.40 ; P=0.003 ) , especially persecutory delusions ( d=0.48 ; P=0.0004 ) . Vitamins alone impaired the course of psychotic symptoms ( d= 0.37 ; P=0.005 ) , especially persecutory delusions ( d=0.47 ; P=0.0005 ) . Adding vitamins to EPA neutralized the detrimental effect on psychosis ( interaction d=0.31 ; P=0.02 ) . In high PUFA patients , there were no significant effects of trial drugs on PANSS scales . In conclusion , given separately during an acute episode , EPA and vitamins E+C  induce psychotic symptoms in patients with low levels of PUFA . Combined , these agents seem safe Classical antipsychotics like haloperidol are suggested to increase oxidative stress and oxidative cell injury in the brain . Pro-oxidant effect of haloperidol may influence the course and treatment outcomes of schizophrenia . Dietary supplementation of either antioxidants or omega-3 fatty acids was found to improve symptoms of schizophrenia . Thus we decided to assess the impact of combining omega-3 fatty acids , vitamins E and C supplementation on treatment outcome and side effects in schizophrenia patients treated with haloperidol .  Ongoing  haloperidol treatment of 17 schizophrenia patients was supplemented with 1000 mg capsule of omega-3 fatty acids ( 180 mg EPA+120 mg DHA ) bid , vitamin E 400 IU bid and vitamin C 1000 mg/day . Patients were assessed with Brief Psychiatric Rating Scale ( BPRS ) , Scale for the Assessment of Negative Symptoms ( SANS ) , Simpson Angus Scale ( SAS ) and Barnes Akathisia Rating Scale ( BARS ) over a 4 month period . Gluthatione peroxidase , superoxide dismutase , malondialdehyde , vitamin E and C levels were also evaluated at baseline and at the end of study . BPRS , SANS , SAS and BARS scores obtained at follow-up visits were significantly lower compared to baseline . Superoxide dismutase level was significantly lower at the end of study . No significant differences were detected in other laboratory parameters . Our results support the beneficial effect of the supplementation on positive and negative symptoms of schizophrenia as well as the severity of side effects induced by haloperidol . The effect of supplementation on akathisia is especially noteworthy and it has not been investigated in previous studies IMPORTANCE More effective treatments are needed for negative symptoms of schizophrenia , which are typically chronic , disabling , and costly . Negative symptoms have previously been associated with reduced blood folate levels , especially among patients with low-functioning variants in genes that regulate folate metabolism , suggesting the potential utility of folate supplementation . OBJECTIVES To determine whether folic acid plus vitamin B12 supplementation reduces negative symptoms of schizophrenia and whether functional variants in folate-related genes influence treatment response . DESIGN Parallel-group , r and omized , double-blind , placebo-controlled clinical trial of 16 weeks of treatment with 2 mg of folic acid and 400 μg of vitamin B12 . SETTING Three community mental health centers affiliated with academic medical centers in the United States . PARTICIPANTS Out patients with chronic schizophrenia who were psychiatrically stable but displayed persistent symptoms despite antipsychotic treatment . Eligible patients were 18 to 68 years old , were treated with an antipsychotic agent for 6 months or more at a stable dose for 6 weeks or more , and scored 60 or more on the Positive and Negative Syndrome Scale . INTERVENTION One hundred forty subjects were r and omized to receive daily oral folic acid plus vitamin B12 or placebo . MAIN OUTCOME MEASURES Change in negative symptoms ( Scale for the Assessment of Negative Symptoms [ SANS ] ) , as well as positive and total symptoms ( Positive and Negative Syndrome Scale ) . RESULTS Folate plus vitamin B12  improved negative symptoms significantly compared with placebo ( group difference , -0.33 change in SANS score per week ; 95 % CI , -0.62 to -0.05 ) when genotype was taken into account but not when genotype was excluded . An interaction of the 484C > T variant of FOLH1 ( rs202676 ) with treatment was observed ( P = .02 ) , where only patients homozygous for the 484 T allele demonstrated significantly greater benefit with active treatment ( -0.59 change in SANS score per week ; 95 % CI , -0.99 to -0.18 ) . In parallel , we observed an inverse relationship between red blood cell folate concentration at baseline and 484C allele load ( P = .03 ) , which persisted until 8 weeks of treatment . Change in positive and total symptoms did not differ between treatment groups . CONCLUSIONS Folate plus vitamin B12 supplementation can improve negative symptoms of schizophrenia , but treatment response is influenced by genetic variation in folate absorption . These findings support a personalized medicine approach for the treatment of negative symptoms . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00611806 OBJECTIVE Based on clues from epidemiology and animal experiments , low vitamin D during early life has been proposed as a risk factor for schizophrenia . The aim of this study was to explore the association between the use of vitamin D supplements during the first year of life and risk of developing schizophrenia . METHOD Subjects were drawn from the Northern Finl and 1966 Birth Cohort ( n=9,114 ) . During the first year of life , data were collected about the frequency and dose of vitamin D supplementation . Our primary outcome measures were schizophrenia , psychotic disorders other than schizophrenia , and nonpsychotic disorders as diagnosed by age 31 years . Males and females were examined separately . RESULTS In males , the use of either irregular or regular vitamin D supplements was associated with a reduced risk of schizophrenia ( Risk ratio (RR)=0.08 , 95 % CI 0.01 - 0.95 ; RR=0.12 , 95 % CI 0.02 - 0.90 , respectively ) compared with no supplementation . In males , the use of at least 2000 IU of vitamin D was associated with a reduced risk of schizophrenia ( RR=0.23 , 95 % CI 0.06 - 0.95 ) compared to those on lower doses . There were no significant associations between either the frequency or dose of vitamin D supplements  and ( a ) schizophrenia in females , nor with ( b ) nonpsychotic disorder or psychotic disorders other than schizophrenia in either males or females . CONCLUSION Vitamin D supplementation during the first year of life is associated with a reduced risk of schizophrenia  in males . Preventing hypovitaminosis D during early life may reduce the incidence of schizophrenia Rationale A significant proportion of the general population report supplementing their diet with one or more vitamins or minerals , with common reasons for doing so being to combat stress and fatigue and to improve mental functioning . Few studies have assessed the relationship between supplementation with vitamins/minerals and psychological functioning in healthy cohorts of non-elderly adults . Objectives The present r and omised , placebo-controlled , double – blind , parallel groups trial assessed the cognitive and mood effects of a high-dose B-complex vitamin and mineral supplement ( Berocca ® ) in 215 males aged 30 to 55 years , who were in full-time employment . Methods Participants attended the laboratory prior to and on the last day of a 33-day treatment period where they completed the  Profile of Mood States ( POMS ) , Perceived Stress Scale ( PSS ) and  General Health Question naire  ( GHQ-12 ) . Cognitive performance and task-related modulation of mood/fatigue were assessed with the 60 min cognitive dem and battery . On the final day , participants also completed the Stroop task for 40 min whilst engaged in inclined treadmill walking and subsequent executive function was assessed . Results Vitamin/mineral supplementation led to significant improvements in ratings on the PSS , GHQ-12 and the ‘ vigour ’ subscale of the POMS . The vitamin/mineral group also performed better on the Serial 3s subtractions task and rated themselves as less ‘ mentally tired ’ both pre- and post-completion of the cognitive dem and battery . Conclusions Healthy members of the general population may benefit from augmented levels of vitamins/minerals via direct dietary supplementation . Specifically , supplementation led to improved ratings of stress , mental health and vigour and improved cognitive performance during intense mental processing Background Polyunsaturated fatty acid ( PUFA ) metabolism abnormalities have been long implicated in the etiology of schizophrenia . Although several r and omized clinical trials have been carried out to assess the efficacy of omega-3 PUFA as add-on therapy in reducing psychopathology in population s of chronic patients with schizophrenia , only a few concern first-episode schizophrenia . The majority of these studies used a 12-week intervention based on ethyl-eicosapentaenoic acid ( ethyl-EPA ) , however , with conflicting results . An intervention based on docosahexaenoic acid plus EPA has not been used in first-episode schizophrenia studies so far . No add-on supplementation studies have been carried out in medicated first-episode schizophrenia patients to assess the efficacy of omega-3 PUFA in preventing relapses . Methods A r and omized placebo-controlled one-center trial will be used to compare the efficacy of 26-week intervention , composed of either 1320 mg/day of EPA and 880 mg/day of DHA , or olive oil placebo with regard to symptom severity and relapse rate in first-episode schizophrenia patients . Eighty-two patients ( aged 16–35 ) will be recruited for the study . Eligible patients will be r and omly allocated to one of two intervention arms : an active arm or a placebo arm ( olive oil ) . The primary outcome measure of the clinical evaluation is schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale ( PANSS ) . Other outcomes include depressive symptoms , patient functioning and the level of insight . Correlates of change measured during the study will include structural brain changes , oxidative stress and defense , as well as neuroplasticity indicators . Metabolic syndrome components will also be assessed throughout the study . Discussion By comparing 26-week administration of EPA + DHA or ( placebo ) olive oil as add-on therapy in reducing symptom severity and one-year relapse rate in patients with first episode schizophrenia , it is intended to provide new insights into the efficacy of omega-3 PUFA and correlates of change , and contribute to the improvement of mental health care for individuals suffering from schizophrenia . Trial registration This study has been registered at Clinical Trials.gov with the following number : NCT02210962 Other workers have reported preliminary results suggesting that vitamin and mineral supplements might improve the mental performance of mentally retarded children . The current study examined the effect of 20 wk of the suggested supplement on Stanford Binet scores in mentally retarded adults with nonspecific diagnoses , Down 's syndrome , and subjects receiving anticonvulsant medication .  No improvement in Stanford Binet scores was observed . However , serum pyridoxal phosphate concentrations were significantly ( p less than 0.05 ) increased in subjects with Down 's syndrome receiving the supplement compared with subjects with nonspecific diagnoses receiving the same treatment thus providing further evidence of abnormal vitamin B6 metabolism in Down 's syndrome OBJECTIVE Adding another antipsychotic to a treatment regimen was previously used in evaluating the medication 's efficacy . Supplementation of depot antipsychotics with oral antipsychotics is particularly meaningful because depot formulations are typically chosen for patients struggling with adherence to oral antipsychotics . This post-hoc analysis assessed supplementation of olanzapine long-acting injection ( olanzapine-LAI ) with oral olanzapine . SUBJECTS AND METHODS We used 12 months of data from an open-label , single-arm extension study of patients with schizophrenia or schizoaffective disorder ( N=931 ) treated with olanzapine-LAI .  The prevalence , duration , time to first supplementation , and best predictors of oral supplementation were assessed . RESULTS Oral supplementation occurred in 21 % of patients for a median of 31 days with mean modal dose of 10.8 mg/day . Mean time to first supplementation was shorter for patients who were at least moderately ill at baseline compared to less ill patients ( 47 vs. 97 days , p<0.001 ) . Best predictors of oral supplementation included a more severe illness profile at baseline , lower olanzapine-LAI dose prior to oral supplementation , supervised living arrangements , and being African-American . CONCLUSION Supplementation of olanzapine-LAI appears to be infrequent , of relatively short duration , and reserved for more severely ill patients who may require a targeted rescue medication due to signs of impending relapse First-episode schizophrenia ( FES ) spectrum disorders are associated with pronounced cognitive dysfunction across all domains . However , less is known about the course of cognitive functioning , following the first presentation of psychosis , and the relationship of cognition to clinical course during initial treatment . The present longitudinal study examined the magnitude of neurocognitive impairment , using the MATRICS Consensus Cognitive Battery , in patients experiencing their first episode of psychosis at baseline and after 12 weeks of r and omized antipsychotic treatment with either aripiprazole or risperidone .  At baseline , FES patients evidence d marked impairments in cognitive functioning . Notably , performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial . Performance on indices of general cognitive function , working memory , and verbal learning improved over time , but these improvements were mediated by improvements in both positive and negative symptoms . We did not detect any differential effects of antipsychotic medication assignment ( aripiprazole vs risperidone ) on cognitive functioning . Our results suggest that a brief paper- and -pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication . However , improvements in cognitive functioning over time were related to clinical symptom improvement , reflecting " pseudospecificity . Adjunctive mirtazapine improved negative symptoms of schizophrenia  in several studies . Recently , we found an improvement also in positive symptoms when mirtazapine was added to first generation antipsychotics ( FGAs ) in a 6 week r and omized controlled trial ( RCT ) . The short duration of that trial was its limitation . This study aim ed to explore whether longer treatment is worthwhile UNLABELLED The salience network ( SN ) , a set of brain regions composed of the anterior fronto-insular cortex ( aFI ) and the anterior cingulate cortex ( ACC ) , is usually involved in interoception , self-regulating , and action selection . Accumulating evidence indicates that dysfunctions in this network are associated with various pathophysiological deficits in both schizophrenia and eating disorders , stemming mainly from dysfunctional information processing of internal or external stimuli . In addition , the metabolic side effects of some antipsychotics ( APs ) , as well as their pharmacological mechanisms of action , also suggest a link between the functional and neurophysiological changes in the brain in both schizophrenia and in eating disorders . Nevertheless , there is still a knowledge gap in explicitly and directly linking the metabolic side effects associated with AP treatment with the dysfunction in SN associated with processing of food-related information in schizophrenia . Here we provide neuroimaging evidence for such a link , by presenting data on a group of schizophrenia patients who followed 16 weeks of olanzapine treatment and undertook a passive viewing task while their brain activity was recorded . In response to food-related dynamic stimuli ( video clips ) , we observed a decreased activity in SN ( aFI and ACC ) after the treatment , which also correlated with ghrelin plasma concentration and a measure of dietary restraint . Taken together with past findings regarding the role of SN in both schizophrenia and eating disorders , our results suggest that enhancing the reactivity in the SN has the potential to be a treatment strategy in people with anorexia nervosa . CLINICAL TRIAL REGISTRATION NUMBER NCT 00290121 Introduction : Recent studies found omega-3 fatty acid deficiency in brain cell membranes of schizophrenic patients . Conventional antipsychotics have many adverse reactions . Safety , availability and low price made omega-3 as a potential supplement for treatment of these patients . This study investigated the efficacy of omega-3 fatty acid as add-on treatment in schizophrenia . Material & Methods : A r and omized , double blind , placebo controlled fixed-dose , add-on clinical trial conducted over 8 weeks . 60 patients with documented schizophrenia r and omly divided into two groups : omega-3(1000 mg/day ) ( n=30 ) and placebo ( n=30 ) . Patients received omega-3 or placebo in addition to their st and ard antipsychotic treatment . Patient follow up was done using Positive and Negative syndrome Scale ( PANSS ) . Data analyzed using SPSS software v.20 . Result : At the end of 8 weeks treatment , PANSS score decreased significantly in both groups ( p<0.05 ) in comparison to baseline . Efficacy of omega-3 in decreasing general psychopathologic and total scores was significant in comparison to placebo group from 4 and 6 weeks after onset of treatment , respectively ( p<0.05 ) . Totally , omega-3 supplement therapy efficacy in comparison to sole conventional antipsychotics was 0.86 which was not significant ( p>0.05 ) . Conclusion : We found that supplemental omega-3 might increase efficacy of conventional antipsychotics in decreasing symptoms of schizophrenia . Low price , rare adverse reactions and availability of omega-3 made this substance a potential supplement in improved treatment of schizophrenia IMPORTANCE Previous evidence has implicated corticostriatal abnormalities in the pathophysiology of psychosis . Although the striatum is the primary target of all efficacious antipsychotics , the relationship between its functional connectivity and symptomatic reduction remains unknown . OBJECTIVE To explore the longitudinal effect of treatment with second-generation antipsychotics on functional connectivity of the striatum during the resting state in patients experiencing a first episode of psychosis . DESIGN , SETTING , AND PARTICIPANTS This prospect i ve controlled study took place at a clinical research center and included 24 patients with first-episode psychosis and 24 healthy participants matched for age , sex , education , and h and edness . Medications were administered in a double-blind r and omized manner . INTERVENTIONS Patients were scanned at baseline and after 12 weeks of treatment with either risperidone or aripiprazole . Their symptoms were evaluated with the Brief Psychiatric Rating Scale at baseline and follow-up . Healthy participants were scanned twice within a 12-week interval . MAIN OUTCOMES AND MEASURES Functional connectivity of striatal regions was examined via functional magnetic resonance imaging using a seed-based approach . Changes in functional connectivity of these seeds were compared with reductions in ratings of psychotic symptoms . RESULTS Patients had a median exposure of 1 day to antipsychotic medication prior to being scanned ( mean [ SD ] = 4.5 [ 6.1 ] ) . Eleven patients were treated with  aripiprazole and 13 patients were treated with risperidone . As psychosis improved , we observed an increase in functional connectivity between striatal seed regions and the anterior cingulate , dorsolateral prefrontal cortex , and limbic regions such as the hippocampus and anterior insula ( P < .05 , corrected for multiple comparisons ) . Conversely , a negative relationship was observed between reduction in psychosis and functional connectivity of striatal regions with structures within the parietal lobe ( P < .05 , corrected for multiple comparisons ) . CONCLUSIONS AND RELEVANCE Our results indicated that corticostriatal functional dysconnectivity in psychosis is a state-dependent phenomenon . Increased functional connectivity of the striatum with prefrontal and limbic regions may be a biomarker for improvement in symptoms associated with antipsychotic treatment This study prospect ively compared the effectiveness of atypical antipsychotic medications to that of conventional neuroleptics in reducing violent behavior  among patients with schizophrenia under " usual care " conditions in the community . Participants ( n = 229 ) were adults with schizophrenia spectrum disorders receiving inpatient or outpatient services in public sector mental health systems in North Carolina . Subjects were followed for 2 years in an observational study using multiple methods of data collection at 6-month intervals to assess treatment , sociodemographic characteristics , clinical features , and violence outcomes . Treatment with atypical antipsychotic medications ( clozapine , risperidone , or olanzapine ) was found to significantly reduce the risk of violent behavior , whereas treatment with conventional neuroleptics did not have this same beneficial effect . A cumulative effect on reduced violence was attributable to consistent compliance with atypical antipsychotic medications over a 2-year period . Concurrent reductions in psychotic symptoms , substance abuse , and adverse medication side effects were found to mediate the association between adherence with atypicals and lower violence risk . Treatment with atypical antipsychotic medications should be considered as an important component of violence risk management for schizophrenia patients at risk for violent behavior
There were no overall effects from antioxidant vitamins , inositol or dietary minerals on psychiatric symptoms .
There is preliminary evidence that certain vitamin and mineral supplements may reduce psychiatric symptoms in some people with schizophrenia .
BACKGROUND When used as an adjunctive with antipsychotics , certain vitamins and minerals may be effective for improving symptomatic outcomes of schizophrenia , by restoring nutritional deficits , reducing oxidative stress , or modulating neurological pathways .