Search Results (50)

Background: Cognitive behavioral therapy (CBT) has shown consistent efficacy in individuals with psychosis, as supported by many trials. One classical distinction is that between affective and non-affective psychosis. Few studies have specifically examined the possible moderating role of substantial affective elements. In this systematic review and meta-regression analysis, we assess how CBT response differs across the affective spectrum in psychosis. Methods: We included studies assessing various CBT modalities, including third-wave therapies, administered in people with psychosis. The study protocol is published in the Open Science Framework. Meta-regression was conducted to assess whether the proportion of participants with affective psychosis (AP), as proxied by a documented diagnosis of schizoaffective (SZA) disorder, moderated CBT efficacy across positive, negative, and depressive symptom domains. Results: The literature search identified 4457 records, of which 39 studies were included. The median proportion of SZA disorder participants was 17%, with a total of 422 AP participants represented. Meta-regression showed a trend toward lower CBT efficacy for positive symptoms with a higher SZA disorder proportion (β = +0.10 SMD per 10% increase in AP; p = 0.12), though it was not statistically significant. No significant associations were found for negative (β = +0.05; p = 0.73) or depressive symptoms (β = −0.02; p = 0.78). Heterogeneity was substantial across all models (I² ranging from 54% to 80%), and funnel plot asymmetry was observed in negative and depressive symptoms, indicating possible publication bias. Risk of bias assessment showed the anticipated inherent difficulty of psychotherapies in blinding and possibly dropout rates affecting some studies. Conclusions: Affective symptoms may reduce the effectiveness of CBT for positive symptoms in psychotic disorders, although the findings did not reach statistical significance. Other patient-level characteristics in psychosis could indicate which patients can benefit most from CBT modalities. Full article

Psychiatric disorders, particularly schizophrenia (SCZ), bipolar disorder (BD), and schizoaffective disorder (SAD), present significant diagnostic challenges. Current diagnostic methods rely on clinical observation and self-reported symptoms, leading to under-diagnosis and delayed treatment. To address this gap, we applied mass spectrometry-based metabolomic profiling and targeted analysis of inflammatory proteins to plasma samples from patients versus controls, aiming to uncover disease-related molecular patterns and enhance our understanding of the underlying pathophysiology of these complex disorders. This study included 26 patients with BD, 34 with SCZ, 16 with SAD, and age- and sex-matched controls. All diagnoses were established according to DSM-5 criteria. Unsupervised analysis shows a clear separation between controls and patients, indicating distinct metabolic and inflammatory profiles. However, the lack of clear differentiation among the three disease subgroups suggests shared biological profiles across these psychiatric disorders. Biomolecules driving this separation between controls and patients includes decreased levels of proinflammatory cytokines, amino acids, and glycerophospholipids, and increased levels of acylcarnitines. This study represents a step towards addressing the limitations of current diagnostic approaches to severe psychiatric disorders, which rely heavily on clinical symptoms, by using omics approaches to refine their diagnosis and treatment. Full article

There is a growing interest in ToM performance among individuals with psychiatric disorders. However, the difference and the performance level between different diagnoses are unclear. Here, we compared the ToM abilities of schizophrenia (SZ), schizoaffective (SZaff), and borderline personality individuals (BPD) with healthy individuals. Individuals with SZ (n = 44), SZaff (n = 11), BPD (n = 11), and healthy individuals (n = 18) were recruited from Mazor Mental Health Center. All groups underwent the Reading Mind in the Eyes (RME) and the Faux Pas recognition test (FB) to assess TOM ability and completed empathy and autism questionnaires. The current results show that the three diagnostic groups performed worse in the RME and FB test compared to healthy individuals. However, women with BPD performed significantly better in ToM tasks than women with SZ and SZaff. Individuals with schizophrenia and BPD scored higher on the autism spectrum questionnaire, while all the diagnostic groups scored lower on the empathy quotient scale than healthy individuals. Finally, a positive correlation was found between ToM ability and empathy. Strikingly, our findings challenge the ability to use ToM as a differential clinical diagnostic tool, especially among men, and strengthen the correlation between decreased empathy and impaired ToM. Full article

Background: The primary treatment of schizophrenia is pharmacotherapy with antipsychotic agents, such as risperidone and paliperidone. Population pharmacokinetic (PopPK) modelling plays a crucial role in optimising therapy by predicting of plasma concentrations, therapeutic efficacy, and the risk of adverse effects using model informed precision dosing. Objectives: This systematic review examined the PopPK models of risperidone and paliperidone in patients diagnosed with schizophrenia based on the available scientific evidence. Methods: A systematic review of the health science databases was conducted. The inclusion criteria were original articles published in peer-reviewed journals, studies focusing on the development of original PopPK models of risperidone and paliperidone, and clinical studies. The exclusion criteria were full-text articles that could not be retrieved; studies not including subjects diagnosed with schizophrenia or schizoaffective disorders; and studies that did not investigate risperidone or paliperidone. Results: A total of 19 studies developing PopPK models were analysed, including one- or two-compartment PopPK model structures. Interindividual variability in the pharmacokinetic parameters was shown to be influenced by factors such as CYP2D6 activity, renal function, body mass index, and sex. Parameter estimation revealed high variability in clearance and volume of distribution. Conclusion: Numerous PopPK models for risperidone and paliperidone have been published with a detailed characterisation of absorption, metabolism, and elimination. Therefore, future research should focus on the external validation of these models to facilitate their integration into clinical practice and optimise individualised dosing, ultimately improving treatment efficacy and safety across diverse patient populations. Full article

Few studies have examined how committing criminal acts of violence impacts the lives of perpetrators who were mentally ill at the time of offence and in which the act itself reflects behaviour that is uncharacteristic of the individual. Theoretical accounts and clinical reports describe a phenomenon termed moral injury, which profiles the deleterious emotional effects that can arise from actions that transgress moral beliefs and expectations. Shame, guilt, spiritual/existential conflict, and loss of trust are considered to be core symptoms of moral injury with growing empirical studies which examine moral injury in military and public safety worker samples. The extent to which these kinds of moral injury phenomena might be evident among mentally ill perpetrators was explored using a qualitative-methods approach in a sample of 19 adult participants hospitalized in a Canadian forensic programme inpatient service. The sample consisted of 13 male and 6 female patients, with a mean age of 36.2 years (SD = 10.8), and the majority diagnosed with schizophrenia or schizoaffective disorder. A qualitative interview was conducted where participants were asked to describe feelings about the index offence, the effect it has had on their well-being, and how they have coped with having committed the offence. Using a reflexive thematic analysis process, 5 themes and 23 subthemes were generated that relate to the various resultant impacts. The five themes which emerged were (1) Living with the Emotional Aftermath; (2) Trying to Make Sense and Coming to Terms; (3) My Eyes Have Opened; (4) Facing the Music; and (5) Moving On. The findings are discussed in terms of their implications for understanding forensic inpatients who may be attempting to come to terms with violence they committed while mentally ill and for informing moral injury intervention strategies which might be adapted for forensic mental health services and public health recidivism prevention programmes. Full article

Background and Objectives: Research in this area focuses on acute schizophrenia-like psychotic disorder, as more than half of cases progress to a chronic course, manifesting as schizophrenia or schizoaffective disorder. Research has shown a link between viral infection and the onset of psychosis, and the influence of viruses on the clinical course of the disease is also being studied. Consequently, in cases where this type of psychosis co-occurs with a viral illness, there is a compelling rationale for identifying commonalities in both treatment and outcome. The ongoing global pandemic of COVID-19 provides a unique opportunity to assess these changes. The aim of this study is twofold: first, to examine the clinical characteristics of acute schizophrenia-like psychotic disorder in the context of the pandemic, and second, to analyze therapeutic interventions and outcomes. Materials and Methods: A non-invasive observational study was conducted in which 310 patients with acute schizophrenia-like psychotic disorder admitted as inpatients to a psychiatric hospital were divided into two groups according to the presence of COVID-19 (group I—F23.2 with COVID-19): 222 patients; Group II—F23.2 without COVID-19: 88 patients). After discharge, the patients in both groups were clinically followed in outpatient treatment for 36 months. Results: The results showed that acute schizophrenia-like psychotic disorder associated with COVID-19 was characterized by a greater severity of productive symptoms and the inclusion of the pandemic theme in psychotic symptoms. These patients were given higher doses of antipsychotic medication. Conclusions: The outcome of this type of psychosis is consistent, irrespective of the infection suffered at the onset of the disease, and is characterized by a chronic course with a predominant transition to the schizophrenic process. Full article

Older adults with serious mental illness (SMI) (i.e., schizophrenia, schizoaffective disorder, bipolar disorder) have compromised physical function that adversely affects their quality of life. Exercise is an effective intervention to improve function in older persons; however, older people with SMI experience barriers to exercise engagement. This study sought to obtain feedback on an exercise program in development for older people with SMI that comprised home-based exercise delivery, individualized exercise prescription, and motivational health coaching calls. Individual interviews and focus groups were conducted with older Veterans with SMI (n = 3) and clinical staff serving this population (directors: n = 3; clinicians: n = 15, k = 3) to elicit feedback on the perceived feasibility and acceptability of the preliminary program and recommendations for modifications to the program. Rapid analysis was used to summarize transcripts of audio-recorded interviews and focus groups. Results indicated a strong perceived feasibility and acceptability of the preliminary intervention because of how the individualized exercise prescription component (i.e., exercise plan) would be personalized to the Veteran’s preferences and abilities. Clinical staff participants expressed concerns about how the lack of real-time supervision would negatively affect exercise completion. Participants recommended tailoring the home-based exercise delivery and motivational health coaching calls components to each Veteran’s unique context. Full article

The (MTHFR) C677T gene polymorphism is associated with neurological disorders and schizophrenia. Patients diagnosed with schizophrenia and schizoaffective disorder and controls (n 134) had data collected for risk factors, molecular and neuro-sensory variables, symptoms, and functional outcomes. Promising gene variant-related predictive biomarkers were identified for diagnosis by Receiver Operating Characteristics and for illness duration by linear regression. These were then analyzed using Spearman’s correlation in relation to the duration of illness. Significant correlations were ranked by strength and plotted on graphs for each MTHFR C677T variant. Homozygous MTHFR 677 TT carriers displayed a mid-illness switch to depression, with suicidality and a late-phase shift from lower to higher methylation, with activated psychosis symptoms. MTHFR 677 CC variant carriers displayed significant premorbid correlates for family history, developmental disorder, learning disorder, and head injury. These findings align with those of low methylation, oxidative stress, multiple neuro-sensory processing deficits, and disability outcomes. Heterozygous MTHFR 677 CT carriers displayed multiple shifts in mood and methylation with multiple adverse outcomes. The graphically presented ranked biomarker correlates for illness duration allow a perspective of psychosis development across gene variants, with the potential for phase of illness monitoring and new therapeutic insights to prevent or delay psychosis and its adverse outcomes. Full article

Mental health disorders are devastating illnesses, often misdiagnosed due to overlapping clinical symptoms. Among these conditions, bipolar disorder, schizophrenia, and schizoaffective disorder are particularly difficult to distinguish, as they share alternating positive and negative mood symptoms. Accurate and timely diagnosis of these diseases is crucial to ensure effective treatment and to tailor therapeutic management to each individual patient. In this context, it is essential to move beyond standard clinical assessment and employ innovative approaches to identify new biomarkers that can be reliably quantified. We previously identified a panel of RNA editing biomarkers capable of differentiating healthy controls from depressed patients and, among depressed patients, those with major depressive disorder and those with bipolar disorder. In this study, we integrated Adenosine-to-Inosine RNA editing blood biomarkers with clinical data through machine learning algorithms to establish specific signatures for bipolar disorder and schizophrenia spectrum disorders. This groundbreaking study paves the way for the application of RNA editing in other psychiatric disorders, such as schizophrenia and schizoaffective disorder. It represents a first proof-of-concept and provides compelling evidence for the establishment of an RNA editing signature for the diagnosis of these psychiatric conditions. Full article

Background/Objectives: Although rare in the Western world, dog bites may be lethal or lead to physically severe outcomes. However, little attention is given to their psychological consequences. We aimed to review their psychological consequences in children 1–14 years of age, focusing on the prevalence and nature of psychological disorders, evaluating the impact on future mental health of children and their families, and assessing the effectiveness of preventive interventions and measures. Methods: On 23 May 2024, we investigated the PubMed, CINAHL, and PsycINFO/PsycARTICLES databases using (“dog bite” OR animal-induced OR animal-caused) AND (psychol* OR mental OR psychiatr* OR anxiety OR anxious OR depress* OR obsess* OR trauma* OR psychosis OR psychotic OR schizophren* OR schizoaffect*) filtered for ages 0–18 years. This resulted in 311 records, of which 50 were eligible. These included original research, case reports, patient surveys, and reviews/meta-analyses. Results: Findings indicate that younger children are particularly vulnerable, often suffering head/neck bites, leading to severe injuries and psychological distress, with post-traumatic stress disorder (PTSD) being a common outcome. Symptoms such as nightmares, flashbacks, anxiety, and social withdrawal were frequently reported. Positive parental support and timely psychological interventions were found to mitigate these effects. Conclusions: Interdisciplinary approaches integrating education, cognitive restructuring, and behaviour modification are needed to effectively prevent and address the psychological impacts of dog bites. Summarising, dog bites in children result in substantial psychological sequelae, necessitating robust prevention and intervention strategies to improve their quality of life and reduce the risk of chronic mental conditions. Full article

Background: Psychotic disorders are major psychiatric disorders that can impact multiple domains including physical, social, and psychological functioning within individuals with these conditions. Being able to better predict the outcomes of psychotic disorders will allow clinicians to identify illness subgroups and optimize treatment strategies in a timely manner. Objective: In this scoping review, we aimed to examine the accuracy of the use of artificial intelligence (AI) methods in predicting the clinical outcomes of patients with psychotic disorders as well as determine the relevant predictors of these outcomes. Methods: This review was guided by the PRISMA Guidelines for Scoping Reviews. Seven electronic databases were searched for relevant published articles in English until 1 February 2024. Results: Thirty articles were included in this review. These studies were mainly conducted in the West (63%) and Asia (37%) and published within the last 5 years (83.3%). The clinical outcomes included symptomatic improvements, illness course, and social functioning. The machine learning models utilized data from various sources including clinical, cognitive, and biological variables such as genetic, neuroimaging measures. In terms of main machine learning models used, the most common approaches were support vector machine, random forest, logistic regression, and linear regression models. No specific machine learning approach outperformed the other approaches consistently across the studies, and an overall range of predictive accuracy was observed with an AUC from 0.58 to 0.95. Specific predictors of clinical outcomes included demographic characteristics (gender, socioeconomic status, accommodation, education, and employment); social factors (activity level and interpersonal relationships); illness features (number of relapses, duration of relapses, hospitalization rates, cognitive impairments, and negative and disorganization symptoms); treatment (prescription of first-generation antipsychotics, high antipsychotic doses, clozapine, use of electroconvulsive therapy, and presence of metabolic syndrome); and structural and functional neuroimaging abnormalities, especially involving the temporal and frontal brain regions. Conclusions: The current review highlights the potential and need to further refine AI and machine learning models in parsing out the complex interplay of specific variables that contribute to the clinical outcome prediction of psychotic disorders. Full article

Schizophrenia is one of the most disabling of the psychiatric diseases. The Brief Psychiatric Rating Scale Extended (BRSE) is used to evaluate the severity of psychiatric symptoms. Long-acting injectable (LAI) antipsychotics are commonly used and are preferred over oral antipsychotic medications. A two-center-based cross-sectional study was performed on 130 patients diagnosed with schizophrenia or schizoaffective disorder based on the International Classification of Diseases 10 criteria. We studied the relation between the development of cardiovascular risk factors and the antipsychotic medication that was administered in these patients. Our study demonstrates strong links between several cardiovascular risk factors and the duration of psychosis; the duration of the LAI antipsychotic treatment; the duration between the onset of the disease and the start of LAI antipsychotic treatment; and the use of specific LAI antipsychotic medications. Full article

Background: Outcomes of bariatric surgery (BS) in patients with schizophrenia are poorly understood. We aimed to analyze the effects of BS in patients with schizophrenia (SZ) or schizoaffective disorder (SZA). Methods: This was a multicenter, retrospective case-control study in patients with SZ or SZA who had undergone BS in seven public referral hospitals in Spain. Controls without psychiatric comorbidity were selected in a 1:4 ratio. Detailed clinical and biochemical data were collected preoperatively and at 12, 24, 36, 48, and 60 months after BS. Results: Twenty patients with SZ (n = 15; 75%) or SZA (n = 5; 25%) and 80 matched controls were studied. There were no differences between patients and controls concerning the evolution of the percentage of total weight loss. The remission rate of the main comorbidities was similar between groups except for hypertension, which was lower in patients with a psychotic disorder from year 3. There were no mortalities within 30 days of surgery in either group. The psychiatric medication burden did not change during follow-up. Conclusions: BS is safe and effective in carefully selected patients with SZ. The course of the psychiatric disease does not seem to be worsened by the procedure. Full article

Identifying phenotypes at high risk of suicidal behaviour is a relevant objective of clinical and translational research and can facilitate the identification of possible candidate biomarkers. We probed the potential association and eventual stability of neuropsychological profiles and serum BDNF concentrations with lifetime suicide ideation and attempts (LSI and LSA, respectively) in individuals with schizophrenia (SCZ) and schizoaffective disorder (SCA) in a 2-year follow-up study. A secondary analysis was conducted on a convenience sample of previously recruited subjects from a single outpatient clinic. Retrospectively assessed LSI and LSA were recorded by analysing the available longitudinal clinical health records. LSI + LSA subjects consistently exhibited lower PANSS-defined negative symptoms and better performance in the BACS-letter fluency subtask. There was no significant association between BDNF levels and either LSI or LSA. We found a relatively stable pattern of lower negative symptoms over two years among patients with LSI and LSA. No significant difference in serum BDNF concentrations was detected. The translational viability of using neuropsychological profiles as a possible avenue for the identification of populations at risk for suicide behaviours rather than the categorical diagnosis represents a promising option but requires further confirmation. Full article

(1) Background: Approximately 1% of the global population is affected by schizophrenia, a disorder marked by cognitive deficits, delusions, hallucinations, and language issues. It is associated with genetic, neurological, and environmental factors, and linked to dopaminergic hyperactivity and neurotransmitter imbalances. Recent research reveals that patients exhibit significant language impairments, such as reduced verbal output and fluency. Advances in machine learning and natural language processing show potential for early diagnosis and personalized treatments, but additional research is required for the practical application and interpretation of such technology. The objective of this study is to explore the applications of natural language processing in patients diagnosed with schizophrenia. (2) Methods: A scoping review was conducted across multiple electronic databases, including Medline, PubMed, Embase, and PsycInfo. The search strategy utilized a combination of text words and subject headings, focusing on schizophrenia and natural language processing. Systematically extracted information included authors, population, primary uses of the natural language processing algorithms, main outcomes, and limitations. The quality of the identified studies was assessed. (3) Results: A total of 516 eligible articles were identified, from which 478 studies were excluded based on the first analysis of titles and abstracts. Of the remaining 38 studies, 18 were selected as part of this scoping review. The following six main uses of natural language processing were identified: diagnostic and predictive modeling, followed by specific linguistic phenomena, speech and communication analysis, social media and online content analysis, clinical and cognitive assessment, and linguistic feature analysis. (4) Conclusions: This review highlights the main uses of natural language processing in the field of schizophrenia and the need for more studies to validate the effectiveness of natural language processing in diagnosing and treating schizophrenia. Full article