Search Results (334)

The German IQVIA Disease Analyzer (DA) database has become an increasingly important source of real-world evidence for psychiatric research. Over the past decade, and particularly since 2020, DA-based studies have addressed a broad spectrum of psychiatric outcomes including depression, anxiety disorders, schizophrenia, bipolar disorder, dementia, sleep disorders, and the mental health consequences of chronic somatic diseases and of contracting COVID-19. Using large, representative outpatient cohorts, these studies have examined factors associated with the incidence of psychiatric disorders, patterns of psychiatric and somatic comorbidity, treatment trajectories, and long-term outcomes under routine care conditions. The DA database’s longitudinal structure, nationwide coverage, and inclusion of multiple medical specialties enable it to capture psychiatric disorders throughout patient lifetimes and across different clinical contexts. This narrative review summarizes psychiatric research using the DA database that has been published since 2020, focusing on study design, main findings, methodological strengths and limitations, and implications for future psychiatric epidemiology and clinical research. Full article

Background/Objectives: The long-term impact of intubation during infancy or early childhood on later childhood or adolescence remains unclear. This study investigates the association between early-life intubation and subsequent mental health outcomes. Methods: We conducted a retrospective cohort study using nationwide data on children born in Korea between 2002 and 2005. Those who underwent intubation (exposed cohort) were compared with 1:10 matched unexposed controls who did not undergo intubation. Results: The exposed cohort (n = 18,799) had a significantly higher incidence rate of mental health disorders than controls (28.2 vs. 13.9 per 1000 person-years; HR 1.82, 95% CI 1.74–1.93). Autism spectrum disorder (HR 3.09) and attention-deficit/hyperactivity disorder (HR 1.61) increased in early childhood, while bipolar disorders (HR 2.36), schizophrenia spectrum disorders (HR 2.27), depressive disorders (HR 1.94) and anxiety disorders (HR 1.84) increased in adolescence. Higher incidence was noted in females, children not admitted to intensive care units, and those without congenital heart disease or bronchopulmonary dysplasia (p < 0.05). Hospitalization length correlated with mental health outcomes (p < 0.001), but ventilator duration did not (p = 0.694). Conclusions: Early-life intubation is associated with an increased risk of mental health disorders, highlighting the need for long-term follow-up and support for these children. In particular, increased clinical awareness is needed during follow-up care for patients at higher risk, such as females, children without congenital heart disease or bronchopulmonary dysplasia, those intubated at an older age, and those with longer hospitalizations. Full article

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16–29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η² = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases. Full article

Neurodevelopmental disorders (NDDs) are defined as a group of conditions that result from impaired brain development. Disorders that are commonly classified under NDDs include intellectual disability (ID), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), communication and learning disorders, developmental delay (DD), brain malformations, cerebral palsy, Down syndrome, schizophrenia, and childhood epilepsies. A significant hinderance in the development of targeted treatments for NDDs are gaps in understanding how underlying genetic changes alter cellular physiology and how these changes may converge or diverge across NDDs with similar symptoms. Here, we focus on the genetic overlap between epilepsy, ASD, and other NDDs to identify common cellular and molecular mechanisms that may inform future treatments for each of these disorders individually or together. We describe several genes—including CDKL5, TSC1/2, SCN1a, and TANC2—that have been associated with epilepsy, ASD, or other NDD phenotypes that play a critical role in regulating one or more stages of brain development or function but differ widely in their disease-causing mechanisms. We also describe genotype–phenotype relationships. Finally, how a gene may cause NDDs through distinct functional pathways, or where different types of pathogenic variants within the same gene can have significantly different phenotypic outcomes is detailed. Full article

The purpose of this research is to determine whether retinal vasculatures differ between participants with schizophrenia spectrum disorder (SSD) and controls. Ninety participants (51 SSD, mean age 35.8 ± 13.5, and 39 controls, mean age 35.5 ± 11.4) underwent 3 × 3 mm² macular and 6 × 6 mm² optic nerve head (ONH) optical coherence tomography angiography (OCTA) scans. En face macula and ONH region images were divided into quadrants, binarized, and then skeletonized. Skeletonized vessel densities were compared between our two groups. Additionally, the foveal avascular zone (FAZ) size and acircularity index were compared between the two groups. There was significantly decreased vessel density in the temporal region of the ONH in the SSD group compared to controls (p = 0.033). Interestingly, the decreased vessel density was already present in patients with SSD in younger adulthood as compared to the controls (p = 0.006). There were no significant group differences in vessel density in any other region of the ONH, the ONH overall, any region of the macula, or the macula overall. There were also no significant group differences in the FAZ size or acircularity index. These data suggest there may be abnormal peripapillary retinal vasculature in patients with SSD. Whether this is a specific ocular vascular deficit or related to more systemic vascular abnormalities in SSD remains to be determined. Full article

Psychotic disorders such as schizophrenia (SCH) and bipolar affective disorder (BD) are associated with lipid metabolism abnormalities and inflammatory dysregulation. The niacin skin flush test (NSFT) has long been investigated as a non-invasive indicator of these disturbances. This study used deep learning models to assess the diagnostic utility of SKINREMS, a computerized system for automated temporal analysis of skin flush responses. The study included a total of 188 participants, comprising individuals with psychotic disorders and healthy controls. Sequential skin images were recorded after topical application of methyl nicotinate. Five convolutional neural network architectures—ResNet50, ResNet101, DenseNet121, InceptionV3, and EfficientNetB0—were evaluated for their performance in analyzing these time-dependent dermatological responses in a binary classification task. Accuracy, precision, recall, F1-score, and AUC were calculated at four time points (frames 1, 10, 20, 30). The models demonstrated distinct temporal performance profiles. ResNet50 showed consistent high performance across all time points, making it suitable for clinical environments requiring stable predictions. DenseNet121 achieved the highest AUC (up to 0.99) after 15 min, indicating its potential in extended monitoring. EfficientNetB0 offered gradual performance improvement with lower computational demands, while InceptionV3 was most effective at intermediate time points. ResNet101 showed initial high performance but declined mid-phase. AUC remained stable across all models, suggesting robust discriminative capability over time. This study highlights the importance of selecting appropriate deep learning architectures based on the temporal dynamics of biological responses. The findings demonstrate potential for future clinical application of AI in non-invasive diagnostics of psychotic spectrum disorders. Full article

Treatment-resistant psychiatric disorders represent a major clinical challenge, with a significant proportion of patients remaining refractory to conventional pharmacological and psychotherapeutic interventions. Deep brain stimulation (DBS), a neurosurgical technique delivering targeted electrical impulses to specific brain regions, has emerged as a promising intervention across a spectrum of refractory psychiatric conditions. This comprehensive narrative review synthesizes current evidence on the efficacy, safety, and practical considerations of DBS for treatment-resistant major depressive disorder, obsessive–compulsive disorder, bipolar disorder, schizophrenia, addictions, Tourette’s syndrome, anorexia nervosa, post-traumatic stress disorder, and refractory aggression in autism spectrum disorder with severe intellectual disability. Across most conditions, DBS demonstrates clinically meaningful symptom reductions, with response and remission rates in depression and obsessive–compulsive disorder approaching 48% and 35%, respectively. For Tourette’s syndrome and refractory aggression in autism, over two-thirds of patients’ experience > 50% symptom reduction. Preliminary data in bipolar disorder, schizophrenia, addictions, and anorexia nervosa are encouraging but limited by small sample sizes and methodological heterogeneity. Safety profiles are generally acceptable, with the majority of adverse events being device- or procedure-related; psychiatric adverse effects and rare serious complications underscore the importance of careful patient selection and monitoring. However, the literature is constrained by inconsistent study designs, a paucity of randomized controlled trials, heterogeneity in DBS targets and stimulation parameters, and limited long-term and quality-of-life outcomes. Optimization of anatomical targeting, stimulation protocols, and patient selection criteria remains an ongoing challenge. Future directions require larger, rigorously controlled trials with standardized outcome measures, integration of neurobiological biomarkers, and multidisciplinary collaboration. In summary, while DBS offers transformative potential for select cases of refractory psychiatric illness, its application must be guided by scientific rigor, ethical prudence, and individualized patient-centered care. Full article

Background/Objectives: Schizophrenia Spectrum Disorder (SSD) represents a major challenge for healthcare systems due to its chronic nature, comorbid conditions, and high socioeconomic impact. Ensuring high-quality care for patients with SSD requires well-defined quality criteria based on consensus from healthcare professionals, patients, and caregivers. This study aims to identify and prioritize quality criteria for SSD care. Methods: A qualitative research approach was applied, including incorporating two focus groups—one with patients and caregivers (n = 7) and another with healthcare professionals (n = 8)—alongside the Delphi technique. The Delphi panel included 32 participants from psychiatry, primary care, mental health nursing, social work, and patient associations. The first round had an 88.9% response rate, while the second round achieved full participation (100%). The Delphi process was conducted and reported according to recommended guidelines for consensus methods (ACCORD checklist), specifying panel composition, rounds, predefined consensus thresholds, and controlled feedback between rounds. Results: A total of 26 quality criteria were ultimately selected, categorized into 16 identified barriers to effective care. Key priorities included early diagnosis protocols, coordinated multidisciplinary care, and improved access to specialized mental health services. Conclusions: The findings underscore the necessity of integrating patient experience into healthcare evaluation and highlight the potential for implementing a certification system to standardize SSD care across healthcare settings. Full article

Zinc (Zn²⁺) is a trace element essential for its catalytic, antioxidant, and immunomodulatory roles extending to synaptic signalling in the central nervous system. In this narrative review, we aim to offer the reader evidence linking perturbations of the Zn²⁺ homeostasis, including deficiency, excess, or transportation anomalies, to neuropsychiatric conditions such as Alzheimer’s disease (AD), Parkinson’s disease (PD), autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). A targeted, unsystematic PubMed search followed by an extensive pearl-growing strategy was applied to further augment study selection based on the extensive expertise of study authors. Overall, most of the evidence currently available suggests a modest benefit for a Zn²⁺ supplement of around 25–30 mg/day as an augmentation to MDD treatment, with potential benefits of smaller magnitude in paediatric ADHD. Evidence for perturbations of Zn²⁺ as a biomarker of risk for these neuropsychiatric disorders remains unconvincing. The role of Zn²⁺ supplements in the treatment of the selected conditions remains largely unknown due to the lack of specific, randomised controlled trials conducted to explore their efficacy. The long-term safety, optimal doses for specific applications, and the exploration of possible biomarkers to stratify patient selection to identify the optimal candidate for Zn²⁺ supplements remain unanswered questions. Full article

Background/Objectives: Residual symptoms—such as persistent negative or cognitive symptoms—and relapse remain common in schizophrenia (SCZ) despite the proven efficacy of antipsychotics. As a result, add-on medications are frequently prescribed in real-world clinical practice. Although these agents are often used chronically, most evidence supporting their benefits comes from short-term trials. This systematic review aimed to assess the effect of adjunctive medication on long-term clinical outcomes and relapse prevention. Methods: Following PRISMA guidelines, we searched PubMed and Scopus (2000–2025) for trials of add-on agents administered for ≥24 weeks in SCZ spectrum disorders. Eligible studies compared antipsychotic treatment as usual with and without an add-on pharmacological agent (or with an added placebo). The primary outcome was long-term symptom change evaluated via established clinical scales, while relapse was the secondary outcome. Risk of bias was assessed with the Cochrane RoB 2 tool (PROSPERO registration: CRD420251075647). Results: The 22 of 4101 selected studies were classified into a group of frequently used add-on agents in clinical practice (antidepressants, mood stabilizers) and a group of less common agents, encompassing cognitive enhancers, antibiotics and antioxidants/anti-inflammatory agents. Results regarding clinical efficacy were mixed for both groups and respective subcategories. Overall, no drug class produced robust benefits. Relapse was systematically reported in only one study, with low overall relapse rates (2.5%). Risk-of-bias assessment did not reveal significant methodological concerns, apart from high attrition (average 29.5%). Conclusions: Evidence for the long-term efficacy of add-on pharmacological treatments in SCZ is inconsistent, with no agent demonstrating reliable benefits. These findings raise concerns regarding long-term polypharmacy and also highlight the need for further investigations. Future studies should prioritize longer follow-up, relapse outcomes and realistic treatment patterns. Full article

Plasticity is a fundamental property of the brain that enables the nervous system to respond appropriately to internal and external stimuli. It primarily involves changes at the synaptic level, mediated by a wide array of molecules, ultimately leading to cognitive and behavioral changes. This review critically contrasts the developmental timing and mechanisms of plasticity in Autism spectrum disorder (early hyperplasticity and excitation–inhibition imbalance) versus Schizophrenia (adolescent overpruning and NMDAR hypofunction) and evaluates evidence for interventions that harness plasticity to improve cognitive and behavioral outcomes. Preclinical and small clinical studies suggest that interventions targeting plasticity-related pathways may improve specific cognitive and behavioral domains. However, effects appear to be symptom-domain-specific and protocol-dependent and larger randomized controlled trials are needed to confirm efficacy. Cognitive remediation for Schizophrenia has been associated with improved executive function and increased hippocampal volume, while virtual reality-based training for Autism spectrum disorder has shown gains in attention and planning skills. By highlighting both molecular mechanisms and therapeutic strategies, this review aims to provide an integrated perspective on how plasticity-targeted interventions could be optimized across neurodevelopmental and neuropsychiatric disorders. Full article

Background: Gamma-range auditory steady-state responses (ASSRs) are emerging as promising translational biomarkers of neural network function. While extensively studied in human neuropsychiatric and neurodevelopmental research, their application in animal models has expanded in recent years, providing mechanistic insights into disease-related neural dynamics. However, methodological approaches vary widely, findings remain fragmented, and outcomes are not easily generalized. Methods: A literature search was conducted in March 2025 across PubMed and Scopus to identify studies investigating gamma-range ASSRs (30–100 Hz) in animal models with relevance to psychiatric and developmental conditions. Results: Most studies employed rodents, with a smaller number involving non-human primates, and used pharmacological, genetic, lesion-based, or developmental manipulations relevant to schizophrenia, autism spectrum disorder, and related conditions. ASSRs were highly sensitive to NMDA receptor antagonism, state- and trait-related factors, and exhibited region- and layer-specific generation patterns centered on the auditory cortex. Less common paradigms, such as chirps and gap-in-noise, also demonstrated translational potential. Conclusions: Animal research confirms that gamma-range ASSRs provide a sensitive, cross-species readout of circuit dysfunctions observed in psychiatric and neurodevelopmental disorders. To maximize their translational utility, future work should prioritize methodological harmonization, systematic inclusion of sex and behavioral state factors, and replication across laboratories. Strengthening these aspects will enhance the value of ASSRs as biomarkers for early detection, patient stratification, and treatment monitoring in clinical psychiatry. Full article

(1) Background: Individuals affected by schizophrenia spectrum disorders (SSDs) have an increased risk for cardiometabolic diseases. Improved cardiorespiratory fitness (CRF) is associated with lower cardiometabolic risk. The aim of the study was to analyze the effect of a six-month-long physical exercise intervention on CRF and cardiometabolic risk factors as well as whether the effect differed between sexes and different baseline CRF in SSD patients. (2) Methods: 122 patients at psychiatric open care units agreed to participate, 55 did not provide blood samples, and 14 dropped out, leaving 53 patients with complete pre–post data. BMI, waist–hip ratio, blood pressure, HbA1c, blood lipids, and CRF from ergometer bicycle tests were measured before and after the intervention. CRF was stratified into three groups. (3) Results: Cardiometabolic disturbances were common at baseline. After the intervention, all females and the group with the lowest CRF at baseline improved in triglyceride levels. The latter group also improved in CRF. (4) Conclusions: Females and those with the lowest baseline CRF had improved post-intervention, but causality cannot be inferred because our study was a non-randomized study without a control group. Full article

Background: Adolescence is a vulnerable period for the onset of severe psychiatric conditions, such as psychotic spectrum disorders. Non-adherence to antipsychotics is a common problem in young people with these conditions and paves the way for relapse, rehospitalization, and functional impairment. Co-occurring substance use disorders (SUDs) further undermine adherence and worsen outcomes. Long-acting injectable antipsychotics (LAIs) improve adherence and outcomes in adults, but none are licensed for use in individuals under 18. This review seeks to distill the available evidence on LAIs’ use in adolescents, from efficacy to safety, and to outline clinical practice recommendations. Methods: A narrative review was conducted. The evidence was organized by drug class: risperidone, paliperidone, aripiprazole, and other antipsychotics (olanzapine, haloperidol, first-generation depots). Results: Evidence in adolescents remains sparse and heterogeneous. Risperidone LAI has shown improvements in symptom severity, functioning, and behavioral control in bipolar disorder and schizophrenia, though commonly associated with side effects. Paliperidone palmitate demonstrated benefit in first-episode schizophrenia and autism spectrum disorder with intellectual disability, reducing hospital use but carrying risks of EPS and hyperprolactinemia. Aripiprazole LAI showed functional gains, short-term tolerability, and encouraging acceptance in case reports. Other LAIs were used in highly resistant cases with some clinical benefit, though extrapyramidal adverse events were common. Conclusions: The current literature provides limited data, and no clinical guidelines exist for the use of LAI in adolescents. Nonetheless, off-label use is reported in selected cases in clinical practice. Best practice is to start with oral stabilization, then use the lowest effective LAI with psychosocial support and close monitoring. When SUD co-occurs, LAIs may also help mitigate risks related to misuse/diversion of oral medication, provided that care includes systematic SUD screening and early intervention. Prospective controlled studies are urgently needed to establish long-term efficacy and safety in this vulnerable population. Full article