Abstract Background In the treatment of schizophrenia, traditional drug therapy has a bottleneck in improving patients’ emotional apathy, depression, and social withdrawal behavior. Physical rehabilitation resources are limited by space and manpower allocation, making it difficult to achieve high-frequency personalized training. Currently, computer network technology provides a controllable virtual interactive medium for mental rehabilitation, and by building a low social pressure digital environment, it is expected to become a new way to regulate patients’ psychological functions. Therefore, the study investigated the intervention efficacy of structured computer network environment on negative emotions and adaptive behaviors in patients with schizophrenia, in order to demonstrate the clinical value of digital methods in psychiatric adjuvant therapy. Methods 160 patients with chronic schizophrenia in a closed ward of a mental health center were selected as experimental subjects and divided into a network intervention group and a conventional control group, with 80 patients in each group. The control group maintained the original atypical antipsychotic drug treatment and routine nursing care. On this basis, the network intervention group entered a specially designed LAN virtual community rehabilitation system for training, including emotion recognition interactive games, network social scenario simulation, and cognitive task collaboration. The frequency was 5 times a week, each session lasting 60 minutes, with a continuous intervention period of 24 weeks. The study used the Positive and Negative Syndrome Scale (PANSS) to assess the severity of psychiatric symptoms, and introduced the Nurses’ Observation Scale for Inpatient Evaluation (NOSIE) and Self Rating Depression Scale (SDS) to evaluate patients’ hospitalization behavior and depressive mood, respectively. Results After 24 weeks of systematic intervention, experimental data showed that the online intervention group was significantly better than the conventional control group in improving emotional delay and enhancing positive social behavior. There was no statistically significant difference in baseline indicators between the two groups at the time of enrollment, but there were significant statistical differences in various indicators after intervention. Among them, the SDS depression index of the online intervention group decreased to 41.23 points, significantly lower than the control group’s 52.45 points, and the difference was statistically significant (p<.05). The instant feedback and achievement reward mechanism in the online environment effectively alleviate patients’ low mood. At the same time, the total score of NOSIE reflecting behavioral function reached 168.34 in the online intervention group, and the social interest factor score improved significantly, indicating that online virtual social training can gradually be transferred to the real environment, promoting the benign reshaping of patients’ interpersonal communication initiative and social adaptation behavior. Discussion Structured interventions in computer network environments can effectively compensate for the shortcomings of simple drug therapy in improving negative symptoms and emotional disorders, and reduce patients’ social anxiety by simulating safe social situations. Future research directions should focus on developing immersive rehabilitation systems that combine virtual reality technology with wearable biofeedback devices, in order to further explore personalized mental rehabilitation pathways based on artificial intelligence algorithms.

Abstract Background Patients with chronic mental illness often experience fragmented self-identity and impaired social functioning. The traditional biomedical model has limitations in promoting the reconstruction of patient agency. Narrative medicine provides a humanistic framework for understanding illness experiences through attention, representation, and belonging. Painting art therapy, utilizing nonverbal expression, facilitates the exploration and integration of the self. Existing research predominantly focuses on symptom relief, with limited exploration of art therapy's profound impact on self-identity reconstruction from a narrative medicine perspective. Against this backdrop, this study investigates the effects of painting art therapy on self-identity reconstruction in chronic mental illness patients from a narrative medicine framework. It aims to validate whether painting art therapy integrated with narrative medicine principles can effectively promote self-identity reconstruction in chronic mental illness patients, offering a new pathway for mental health interventions that combines clinical efficacy with humanistic care. Methods Employing a mixed-methods design, the study recruited 60 patients diagnosed with stable chronic schizophrenia or bipolar disorder from a mental health center. Participants were randomly assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group received 12 weeks of narrative medicine-guided art therapy (twice weekly), featuring structured activities such as illness story illustration, emotional symbol creation, and life map integration, supplemented by narrative interviews and reflective discussions. The control group maintained routine rehabilitation activities. Quantitative assessments were conducted using the Sense of Identity Scale (SIS), General Self-Efficacy Scale (GSES), and Symptom Checklist-90 (SCL-90) at baseline, post-intervention, and 3 months post-intervention. Semi-structured interviews were conducted with intervention group participants, and thematic analysis was performed on the textual data. Results Experimental results indicate that following the intervention, the total scores on the self-identity scale were significantly higher in the intervention group than in the control group (68.42 ± 6.31 vs. 58.15 ± 7.24, t = 5.892, p<.001), and their general self-efficacy scores also showed a marked improvement (28.50 ± 4.16 vs. 23.21 ± 4.80, t = 4.576, p<.001). The SCL-90 scale revealed that the intervention group exhibited more significant reductions in depression, anxiety, and interpersonal sensitivity factor scores compared to the control group (all p<.05). Qualitative analysis identified three core themes: “visual reconstruction of illness narratives,” “transformation of trauma symbols,” and “emergence of new self-narratives,” indicating that painting facilitated patients' acceptance of illness experiences and integration of personal life stories. Follow-up data showed stable self-identity scores in the intervention group, with sustained improvement in some indicators. Discussion This study confirms that art therapy grounded in narrative medicine effectively promotes self-identity reconstruction in chronic mental illness patients, yielding sustained effects in enhancing self-efficacy and alleviating psychological symptoms. By facilitating visual storytelling and reflective dialogue, this intervention helps patients transform fragmented illness experiences into coherent life narratives, holding significant clinical and public health implications. Future community mental health rehabilitation services should incorporate such humanities-art integrated intervention strategies. Multicenter, large-scale studies are recommended to validate long-term efficacy and underlying mechanisms, thereby providing evidence to advance holistic and humanized mental health service development.

Short- and long-term associations between antipsychotic treatment patterns and functional outcomes in chronic schizophrenia: A 10-year retrospective study using lagged mixed-effects modeling.

Prevalence of suicidal ideation and its correlates in young and elderly patients with chronic schizophrenia.

Theory of mind (ToM), the ability of mental state attribution, is an important aspect of social cognition. The autism-psychosis diametrical model suggests that there is an opposite impact of autistic traits and psychotic-like experiences (PLE) upon ToM, with autistic traits associated with under-mentalizing and PLE linked to over-mentalizing. This exploratory study aimed to examine the diametrical model at both subclinical and clinical levels. We recruited 240 college students (Study 1), 28 patients with chronic schizophrenia and their demographically-matched controls (Study 2). The animated shapes task was used to assess ToM ability. This task was a non-verbal task involving the interpretation of geometric figure interactions in random and ToM conditions. All participants completed the Community Assessment of Psychic Experiences (CAPE) and the Autism-Spectrum Quotient (AQ) to measure PLE and autistic traits. The positive symptom subscale (PANSS-P) and the dimensional autism severity score (PAUSS) of the PANSS were additionally used to assess the severity of positive symptoms and autistic phenotypes in clinical populations. Patients with chronic schizophrenia demonstrated a mixed pattern of ToM impairment, combining over-mentalizing for random movements and under-mentalizing for movements involving mental state. Correlational analysis preliminarily suggested that regardless of diagnostic status, PLE was associated with over-mentalizing, that is, more intentionality attribution to random movement. Autistic-like symptoms among patients were related to less intentionality with less appropriate answers in ToM condition. However, the interaction of the two symptoms, or the co-occurrence of PLE and autistic traits had no significant beneficial effect on ToM performances. Autistic traits and positive psychotic symptoms may have differential effects on mentalizing, but there is no support that ToM impairments would be attenuated in individuals with mixed symptom expressions.

Retinal morphological and functional alterations, such as changes in the thickness and volume of the retinal neural layers, architecture of the microvasculature, and functioning of neurons, have been observed in schizophrenia and have been interpreted in terms of neurodegenerative aspects of the disorder. However, little consideration has been given to the issue of whether, and the extent to which, these retinal differences may reflect neurodevelopmental features of schizophrenia. There are also no current conceptualizations that integrate retinal alteration findings in schizophrenia across different stages of illness, thereby helping to integrate neurodevelopmental and neurodegenerative perspectives on pathophysiology. Therefore, the present review aims to organize evidence of retinal abnormalities in schizophrenia in terms of findings from clinical high-risk for psychosis (CHR), genetic risk, first-episode psychosis (FEP), and chronic schizophrenia samples, and to consider factors such as age and duration of illness. Our goal is to move toward a lifespan model that integrates and transcends prior neurodevelopmental and neurodegenerative viewpoints. Toward this end, we also review studies of retinal alterations among those with prenatal/perinatal insults, neurodevelopmental disorders, and neurological soft signs, as such data can inform what has been observed in schizophrenia. We also mention, where appropriate, relevant findings from neurodegenerative disorders. A better understanding of the trajectories of central nervous system differences throughout the lifespan in people with schizophrenia, as observed in the retina (often called “a window to the brain”), can aid in understanding brain dysfunction in the disorder, assist with characterizing heterogeneity in clinical course, and inform more targeted prevention, monitoring, and intervention efforts.

Schizophrenia is a multifactorial psychiatric disorder in which monoaminergic neurotransmission, particularly dopamine (DA), serotonin (5-HT), and norepinephrine (NE), is implicated in both pathophysiology and response to treatments. However, the regional composition and functional interaction among these neurotransmitters and their catabolites remain unclear. In this study, using high-performance liquid chromatography (HPLC), we quantified DA, 5-HT, NE and their metabolites, HVA, DOPAC, and 5-HIAA, along with protein levels of key monoamine-metabolizing enzymes (MAO-A, MAO-B, and COMT isoforms) in post-mortem dorsolateral prefrontal cortex (DLPFC) and hippocampus from chronic schizophrenia patients and matched healthy controls. Although absolute monoamine and enzyme levels did not differ between cases and controls, partial correlation analyses revealed remarkable schizophrenia-specific interactions. In particular, patients exhibited distinct 5-HT-DOPAC correlations in both regions, suggesting an abnormal coupling between serotonergic and dopaminergic metabolism. In the DLPFC, the DA-NE correlation was markedly attenuated in schizophrenia, potentially reflecting disrupted catecholaminergic integration relevant to cognitive function and salience processing. Furthermore, an increased 5-HIAA-5-HT correlation emerged in the hippocampus of schizophrenia patients, indicative of abnormal serotonin turnover. In conclusion, our observations indicate that while the cerebral concentrations of monoamines and their catabolites remain relatively stable in patients with schizophrenia, their interactions are significantly dysregulated compared to those reported in healthy controls. These postmortem findings provide new insights into the monoaminergic neurotransmission crosstalk in the schizophrenia brain.

Interrelationships among oxidative stress, niacin response, cognition, and symptoms in chronic schizophrenia: a case-control study

Forthcoming changes to clozapine monitoring present an opportunity to expand, not dilute, specialist care for chronic schizophrenia. Reduced administrative burden should support timely clozapine use, structured assessment, access to psychological therapies and embedded physical health care. Experience from Cambridgeshire shows that secondary-plus clinics within community mental health teams can deliver sustained, equitable long-term care.

This study explores the effect of music and painting dual art therapy on the cognitive and social functions of hospitalized chronic schizophrenia patients and evaluates its clinical value as an adjunctive treatment. A retrospective study design was used to collect clinical data from chronic schizophrenia patients hospitalized between January 2023 and January 2025. Based on whether they received music and painting dual art therapy, patients were divided into an intervention group and a routine care group. Propensity score matching was used for 1:1 matching to include 116 patients (58 in each group). Matching variables included age, sex, disease duration, education level, etc. The intervention group received 4 weeks of systematic music and painting dual art therapy in addition to routine care. The assessment indicators included positive and negative syndrome scale (PANSS), cognitive function (MoCA, Wisconsin card sorting test [WCST]), social function (social disability screening schedule), activities of daily living, and quality of life (schizophrenia quality of life scale). Changes before and after the intervention and group differences were compared. The baseline characteristics of the 2 groups were balanced. After matching, no significant differences were found between the 2 groups in terms of age (routine group: 42.3 ± 10.2 years vs dual group: 42.7 ± 10.4 years, P = .853), sex, disease duration, education level, or age at first hospitalization (P >.05 for all). After the intervention, the dual art therapy group showed significant improvements over the routine care group in multiple indicators, including PANSS-positive and negative symptoms, MoCA total score, WCST correct responses, perseverative errors, categories completed, social function score, quality of life, and activities of daily living (P <.01). For example, MoCA score increased from 17.5 before the intervention to 23.0, WCST categories completed increased to 4.3 ± 1.4, and PANSS-negative symptom scores decreased significantly, indicating a positive impact of dual art therapy on cognitive and social functions. Music and painting dual art therapy can serve as an effective adjunctive intervention for hospitalized chronic schizophrenia patients. It significantly improves cognitive function, mental symptoms, and social adaptability, enhancing quality of life with high feasibility and potential for widespread application.

Schizophrenia is a multifaceted and heterogeneous psychiatric disorder, marked by the presence of positive, negative, and cognitive symptom domains. In the chronic course, few symptoms remain persistent, leading to socio-occupational impairment. Few studies have used memantine (an NMDA receptor antagonist) as an adjunctive treatment, noting reductions in both positive and negative symptoms, accompanied by improvements in cognitive performance and overall functioning. The present study explored the effectiveness of adding memantine for cognitive symptoms in schizophrenia with a chronic course. This prospective, single-arm, open-label study used a pre-post design. A total of 30 individuals with schizophrenia, diagnosed based on ICD-10 criteria and having an illness duration of more than two years, were included. Socio-demographic data were collected, and the Addenbrooke's Cognitive Examination Scale-Revised (ACE-R) was administered at baseline. Subsequently, memantine was added to their ongoing treatment regimen. The ACE-R assessment was repeated after eight weeks. Data was analyzed using R software version 4.4.1. Different ACE-R score variables were compared before and after adding memantine. A significant relationship was found between ACE-R scores after adding memantine and the baseline scores (p < .001), except for the writing subcomponent of the language variable. The results of this study suggest that adding memantine to an antipsychotic treatment regimen may provide beneficial effects on cognitive symptoms in chronic schizophrenia, with good tolerability and minimal adverse effects. The study was registered under the Clinical Trials Registry in India (CTRI), CTRI/2024/12/077774.

BackgroundDrug-induced liver injury is an uncommon, idiosyncratic adverse reaction with heterogeneous clinical presentations, ranging from asymptomatic transaminase elevations to acute liver failure. Sodium-glucose cotransporter 2 inhibitors, widely prescribed for type 2 diabetes due to their glycaemic, cardiovascular, and renal benefits, are generally considered safe to the liver. Nonetheless, rare cases of cholestatic and hepatocellular drug-induced liver injury have been reported, highlighting the need for vigilance and systematic evaluation when liver dysfunction occurs in patients receiving these agents.Case reportWe describe a 56-year-old man with type 2 diabetes and chronic schizophrenia who developed cholestatic liver injury 36 days after initiating empagliflozin 10 mg od. The patient presented with jaundice, dark urine, and pale stools, with laboratory findings revealing elevated bilirubin, gamma-glutamyl transferase, and alkaline phosphatase disproportionate to alanine aminotransferase. Comprehensive work-up excluded viral, autoimmune, metabolic, and obstructive causes. Imaging confirmed intrahepatic cholestasis without biliary obstruction. Causality assessment using the Roussel Uclaf Causality Assessment Method, Maria and Victorino and Naranjo scores indicated probable adverse drug reaction. Liver biopsy demonstrated acute cholestatic injury with portal inflammatory infiltrates and ductular reaction, consistent with drug-related pathology. Empagliflozin withdrawal led to gradual clinical and biochemical recovery.ConclusionEmpagliflozin can, in rare cases, trigger idiosyncratic cholestatic drug-induced liver injury, even in patients with cirrhosis. Early recognition, prompt drug withdrawal, and systematic evaluation are essential. This case adds to the limited literature on sodium-glucose cotransporter 2 inhibitor-associated hepatotoxicity.LEARNING POINTSDrug-induced liver injury is a diagnosis of exclusion. Clinicians must rule out other causes, especially biliary obstruction, and use structured causality assessment tools to identify the offending drug.Empagliflozin and other sodium-glucose cotransporter 2 inhibitors can, in rare cases, cause liver injury. Monitoring liver function after initiating these drugs is advisable, particularly in patients with pre-existing liver disease.There is no specific treatment for idiosyncratic drug-induced liver injury. Prompt withdrawal of the offending and supportive care are usually sufficient for recovery.

ObjectiveThis study examined the prevalence and predictors of obstructive sleep apnea (OSA) risk in patients with chronic schizophrenia.MethodsA cross-sectional survey was conducted with 441 institutionalized patients with schizophrenia at hospital. Participants completed the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and STOP-Bang Questionnaire (SBQ) assessing risk of OSA. Logistic regression analysis was used to identify factors associated with OSA risk (SBQ score ≥3).ResultsOSA risk was identified in 236 participants (53.5%). Each 1-cm increase in waistline was associated with an 8% increased risk of OSA (OR = 1.08), and each 1-point increase in insomnia severity score was associated with a 9% increased risk (OR = 1.09).ConclusionsOver half of patients with chronic schizophrenia were at elevated risk for OSA, with insomnia severity and central obesity as the main correlates. Early screening, ongoing monitoring, and collaboration with mental health professional staff are essential for timely intervention, tailored care, and health promotion.

ObjectiveThis study aimed to investigate the effects of atypical antipsychotic drugs (AAPDs) on changes in body composition and fat distribution characteristics in patients with first-episode schizophrenia (FSCZ) and chronic schizophrenia (CSCZ), as well as to predict their temporal trends.MethodsA total of 70 inpatients (51 FSCZ, 19 CSCZ) admitted to Tianjin Anding Hospital from January 2023 to June 2024 were enrolled. Body composition indicators, including weight (W), Body Mass Index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), abdominal skinfold thickness (ASF), body fat (BF), body fat percentage (BFP), and visceral fat area (VFA) were measured at baseline and every 4 weeks over a 12-week period. A linear mixed-effects model (LMM) was used to analyze dynamic changes, and independent t-tests were used to compare baseline differences.ResultsIn FSCZ patients, W, BMI, WC, ASF, BF, and BFP increased significantly over time (P < 0.05). The olanzapine group (Group A) showed the steepest slopes for W (1.85 kg/4 weeks), BMI (0.70 kg/m²/4 weeks), and WC (3.07 cm/4 weeks) (P < 0.01), indicating central obesity. In CSCZ patients, no significant changes in body composition were observed (P ≥ 0.08), but baseline values of W, BMI, and WC were higher than those of FSCZ patients (P < 0.05). A LMM predicted that FSCZ patients would reach CSCZ levels in W, BMI, and WC in approximately 64, 42, and 28 weeks, respectively, with other indices reaching similar levels within 22.2–67.7 weeks.ConclusionIn this preliminary longitudinal study, AAPDs - particularly olanzapine - were associated with rapid and significant increases in central obesity among FSCZ patients. whereas CSCZ patients exhibited metabolic stability over the short observation period. These findings suggest that both disease stage and treatment phase play critical roles in shaping body fat distribution trajectories. The early phase of antipsychotic treatment may represent a vulnerable period for targeted metabolic monitoring and timely intervention to prevent long-term cardiometabolic risks. While these results provide preliminary evidence for stage-specific metabolic patterns, confirmation in larger, randomized, and longer-term studies is required.

Effect of computerized cognitive training on P300 ERP impairments in Indian patients with schizophrenia.

The Effectiveness of Recovery-Oriented Cognitive Therapy on Positive and Negative Symptoms and Cognitive Insight in Patients with Chronic Schizophrenia

The feasibility and acceptability of metacognitive therapy in a forensic setting: a case report of chronic paranoid schizophrenia with persistent depressive symptoms

Exploring theory of mind abilities in Lebanese chronic patients with schizophrenia: A cross-sectional study.

Effectiveness of Music Therapy Based on Virtual Reality and Progressive Muscle Relaxation on Physical Symptoms and Anxiety of Chronic Schizophrenia Patients

How psychotic symptoms, depressive symptoms, cognitive deficits, and functional impairment may interact with one another in schizophrenia or bipolar disorder is unclear. This study explored these interactions in a discovery sample of 339 Chinese, of whom 146 had first-episode schizophrenia and 193 had bipolar disorder. Psychotic symptoms were assessed using the Positive and Negative Symptom Scale; depressive symptoms, using the Hamilton Depression Rating Scale; cognitive deficits, using tests of processing speed, executive function, and logical memory; and functional impairment, using clinical assessments. Network models connecting the four types of variables were developed and compared between men and women and between disorders. Potential causal relationships among the variables were explored through directed acyclic graphing. The results in the discovery sample were compared to those obtained for a validation sample of 235 Chinese, of whom 138 had chronic schizophrenia and 97 had bipolar disorder. In the discovery and validation cohorts, schizophrenia and bipolar disorder showed similar networks of associations, in which the central hubs included 'disorganized' symptoms, depressive symptoms, and deficits in processing speed during the digital symbol substitution test. Directed acyclic graphing suggested that disorganized symptoms were upstream drivers of cognitive impairment and functional decline, while core depressive symptoms (e.g. low mood) drove somatic and anxiety symptoms. Our study advocates for transdiagnostic, network-informed strategies prioritizing the mitigation of disorganization and depressive symptoms to disrupt symptom cascades and improve functional outcomes in schizophrenia and bipolar disorder.