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.

Dynamic functional network connectivity impairment in bipolar disorder and its relationship with global functioning.

Meta-analysis of recurrence rate and influencing factors of bipolar disorder.

Background/Objectives: People suffering from mental illnesses are more likely to experience adverse social and health outcomes. Various interventions have been shown to help people with mental illness achieve better results in terms of symptom reduction, functional status, and quality of life. Psychiatric rehabilitation interventions integrate evidence-based practices, promising approaches, and emerging methods that can be effectively implemented to enhance health outcomes in this population. This study aims to examine whether the rehabilitative treatment provided to a group of patients with mental illness leads to improvements in health outcomes and psychiatric symptomatology. Methods: This study employed a retrospective quasi-experimental design. Data were collected between 2023 and 2025 within the Partial Hospitalization Program of the Psychiatry and Mental Health Service of Soria (Spain). The sample consisted of 58 participants who received rehabilitative treatment in this setting. Data were collected at the time of patients’ admission and at discharge. Gender, age, psychiatric diagnosis according to ICD-10, and the average length of stay in the rehabilitation program were assessed. The questionnaires administered were psychometrically validated scales related to heteroaggressiveness, perceived quality of life, global functioning, attitudes toward medication, and the risk of suicide. Results: A significant improvement was observed in the Global Assessment of Functioning (GAF) Scale (t = −7.1, p < 0.001), with mean scores increasing from 42.17 at admission to 69.13 at discharge. Additionally, reductions in suicidal risk and hetero-aggressive behavior were noted, alongside improvements in quality of life and treatment adherence. Conclusions: The findings highlight the effectiveness of implementing activities and programs focused on psychiatric rehabilitation processes to promote positive health outcomes. Future research directions and practical implications are discussed to support the continued development and optimization of psychiatric rehabilitation programs.

Clinical outcomes of youth at familial risk for bipolar disorder: A 2-year longitudinal, observational study.

This prospective 12-week randomized controlled trial tested an adherence promotion approach called Customized Adherence Enhancement in schizophrenia (CAE-S) vs. Enhanced Treatment as Usual (eTAU) in 36 poorly adherent individuals. Patients were randomized to either CAE-S or eTAU at baseline and were assessed at 12-week follow-up. Primary outcomes were program attendance, patient satisfaction and change in schizophrenia symptoms as measured by the Positive and Negative Syndrome Scale (PANSS). Additional evaluations were adherence measured by the Tablets Routine Questionnaire (TRQ), Clinical Global Impression (CGI), Short Form Health Survey (SF-12), Global Assessment of Functioning (GAF), and Strauss-Carpenter Level of Functioning Scale (SCLFS). Mean age was 44.9 (Standard deviation/SD 12) years. 12-week attrition was 19.4%. At screening, mean past 7-day TRQ (proportion of days with missed dose) was 29.7% (SD 23.8) for CAE and 41.7% (SD 26.5) for eTAU. By baseline, mean TRQ improved to 11.3% (SD 15.8) in CAE-S, and to 19.3% (SD 25.7) in eTAU. Mean session attendance (out of a maximum of 6) was 4.89 (SD 1.9) for CAE and 3.88 (SD 2.5) for ETAU. CAE and ETAU satisfaction were both high. From baseline to 12 weeks, mean PANSS improved significantly in both CAE-S (p < .05) and eTAU (p < .01) with no difference between arms. There was no significant change in TRQ, while CGI and GAF improved significantly in both arms with no significant difference between arms. Mean SCLFS improved in both arms, with results favoring CAE (p < .001). Telehealth CAE-S is feasible and acceptable among poorly adherent patients with schizophrenia. Adherence improved rapidly with monitoring, which could explain improvement in schizophrenia symptoms and largely similar outcomes across intervention arms.

Long-term outcome of subgenual cingulum and uncinate fasciculus deep brain stimulation for the treatment of post-traumatic stress disorder.

Background: Numerous studies have explored the dysfunction experienced by patients and their families due to psychotic disorders such as schizophrenia. However, there is a paucity of research comparing schizophrenia with neurotic disorders like obsessive-compulsive disorder (OCD). Aim: To assess and compare disability, quality of life (QoL), and family burden in treatment naïve patients with schizophrenia and OCD. Materials and Methods: A comparative study including 50 treatment naïve patients with schizophrenia and 50 with OCD. Severity of symptoms was evaluated by Positive and Negative Syndrome Scale in schizophrenia and by Yale-Brown Obsessive Compulsive Scale in OCD. All subjects were assessed using Indian Disability Evaluation and Assessment Scale (IDEAS), 36-Item Short Form Health Survey Questionnaire (SF-36), Family Burden Interview Schedule (FBIS), and Global Assessment of Functioning (GAF) scale. Results: Regarding disability, a significant difference was observed in all domains and the global score of IDEAS, with higher scores in schizophrenia, except in the work domain. QoL also had significantly poor scores in both groups and within themselves; schizophrenia showed poorer QoL in all the domains. Regarding family burden, a significant difference was observed in all domains of FBIS, more in schizophrenia except in domain of disruption of routine family activities. Conclusion: Treatment naïve patients with schizophrenia and OCD have significant impairment in overall functioning, OCD being comparable to schizophrenia. This study shows the need of early identification and intervention to reduce disability and family burden and to improve QoL in these disorders.

BACKGROUNDSleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders, even during remission. Persistent disruptions in sleep may reflect underlying pathophysiological mechanisms and contribute to impaired psychosocial recovery. By comparing remitted bipolar disorder (BD) and major depressive disorder (MDD) patients with healthy controls, the present study sought to clarify the extent of these disturbances and their correlates.AIMTo evaluate differences in sleep quality, psychosocial functioning, and insomnia severity among remitted patients with BD and MDD, in comparison with healthy controls. A secondary aim was to examine the clinical and psychosocial factors influencing sleep quality within these groups.METHODSThe study included 135 participants: 45 remitted BD patients, 45 remitted MDD patients, and 45 healthy controls. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, psychosocial functioning with the global assessment of functioning, and insomnia severity with the Insomnia Severity Index. Sociodemographic and clinical characteristics were also recorded. Comparative analyses were conducted to evaluate differences between groups, and regression models were used to identify predictors of sleep quality.RESULTSBoth BD and MDD groups demonstrated significantly poorer sleep quality and higher insomnia severity compared with healthy controls. Poor sleep quality was observed in 75.6% of BD patients and 57.8% of MDD patients. Group differences were most pronounced in Pittsburgh Sleep Quality Index subdomains including sleep latency, sleep duration, and habitual sleep efficiency. Regression analysis identified insomnia severity (β = 0.510) and functional capacity (β = -0.043) as significant correlates of sleep quality, indicating that greater insomnia severity and lower functioning were independently associated with poorer sleep.CONCLUSIONThe findings underscore that even during remission, BD and MDD are accompanied by substantial impairments in sleep quality and psychosocial functioning. These results highlight the importance of addressing residual symptoms, particularly insomnia and functional difficulties, in long-term management strategies. Interventions aimed at improving sleep and enhancing daily functioning should be considered essential components of treatment to promote recovery and quality of life in remitted patients.

ObjectiveThis study investigated whether quantitative electroencephalography (qEEG) features, combined with clinical data, could predict treatment outcomes in female adolescents with non-suicidal self-injury (NSSI).MethodsWe analyzed clinical and EEG data from 104 female adolescent inpatients with repetitive NSSI. Resting-state EEG was recorded, and various brain activity patterns across frequency bands were extracted. Clinical outcomes were assessed using pre- and post-admission scores on the Health of the Nation Outcome Scales (HoNOS), Clinical Global Impression-Severity (CGI-S), World Health Organization Disability Assessment Schedule (WHODAS), and Global Assessment of Functioning (GAF). Machine learning models were trained to predict outcomes using EEG and medication data. Model performance was evaluated using cross-validation, and feature importance was interpreted using SHapley Additive exPlanations (SHAP) analysis.ResultsAll predictive models demonstrated excellent predictive performance (R2≥0.96, mean squared error [MSE] as low as 0.02). The HoNOS model showed the highest performance (R2=0.99, MSE=0.32), followed by the WHODAS (R2=0.98, MSE=1.32), GAF (R2=0.97, MSE=0.76), and CGI-S (R2=0.96, MSE=0.02) models. Key qEEG predictors included relative low-beta power at Pz, absolute theta power at Fp1, and the delta-to-beta ratio at Cz. Pre-admission clinical severity, particularly CGI-S and HoNOS, also significantly contributed to prediction accuracy.ConclusionOur findings suggest that qEEG features, combined with machine learning, can effectively predict treatment response in adolescents with NSSI, supporting their use as neurophysiological biomarkers for individualized care.

Medication adherence is crucial for long-term outcomes in bipolar disorder. Despite the rising use of aripiprazole, a longacting injectable for bipolar disorder, once monthly to improve adherence and manage side effects, research on its effects in South Korean patients with bipolar disorder is limited. In this non-interventional, retrospective study, medical records were used to analyze aripiprazole once monthly treatment from its initiation in routine clinical settings. The data were collected at 1, 3, 6, 9, and 12 months. Functional level and symptom severity were measured using the Global Assessment of Functioning (GAF), Clinical Global Impression-Bipolar-Severity (CGI-BP-S), Young Mania Rating Scale (YMRS), Korean version of the Montgomery-Åsberg Depression Rating Scale (K-MADRS), and Hamilton Anxiety Rating Scale (HAM-A). Additionally, the dosages and number of pills of mood stabilizers and antipsychotics, and the total number of medications, were recorded. Among 24 patients with bipolar disorder, significant functional improvement and symptom relief were observed over 1 year, with a significant reduction in total pill count and dosages of mood stabilizers and antipsychotics. Specifically, the GAF score increased by 25.7% (p=0.001), while CGI-BP-S, YMRS, K-MADRS, and HAM-A scores decreased by 24.4% (p=0.001), 81.2% (p=0.001), 36.2% (p=0.002), and 36.1% (p=0.003), respectively. Six patients reported side effects such as akathisia, tremors, weight gain, and headache, but no severe adverse effects were noted. This study showed significant improvement in functional outcomes and mood symptoms with monthly aripiprazole treatment in bipolar disorder. Mood stabilizer and antipsychotic dosages were also reduced. The results highlight the proactive role of longacting injectable antipsychotics in enhancing functioning, symptoms, and quality of life in bipolar disorder.

Objective This study aims to evaluate the short-term efficacy, safety, tolerability, and side effect profile of the two-injection start (TIS) regimen of aripiprazole once-monthly long-acting injection (AOM 400 mg) in individuals diagnosed with schizophrenia. Methods This retrospective study included 50 patients diagnosed with schizophrenia according to DSM-5 criteria who received the TIS regimen of AOM 400 mg. Patients were divided into two groups: those followed with AOM monotherapy (Group 1) and those receiving AOM with oral agents (Group 2). Assessments included the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression scales (CGI-S, CGI-I, CGI-SE), and the Global Assessment of Functioning (GAF). Evaluations were performed at baseline and at weeks 1, 2, and 4. Hospital stay duration and side effects were recorded. Results Both groups showed significant reductions in hospital stay and PANSS scores, with improved GAF and CGI-I scores (p < 0.001). No serious side effects occurred, and mild effects resolved by week 4. Conclusion The TIS regimen of AOM 400 mg demonstrated rapid symptomatic and functional improvement with good tolerability. Further large-scale prospective studies are warranted.

Thyroid hormones play a crucial role in regulating mood and cognitive function. However, the effect of thyroid function on psychiatric symptoms remains unclear. In this study, we investigated the association between psychiatric symptoms and thyroid hormone levels in patients with depression and mania. In this retrospective cross-sectional study, we enrolled patients with depression or mania admitted to the Department of Psychiatry of the National Kohnodai Medical Center from April 2014 to March 2023. We examined the association between thyroid function at admission and psychiatric symptoms using the Global Assessment of Functioning (GAF) score. A total of 309 patients with depression (199 females, mean age = 62 ± 15 years) and 91 patients with mania (60 females, mean age = 50 ± 16 years) were included. In the depression group, the median TSH level was 1.05 μIU/mL, the median free T3 level was 2.76 pg/mL, and the median free T4 level was 0.95 ng/dL. In the mania group, the median TSH level was 1.09 μIU/mL, the median free T3 level was 3.28 pg/mL, and the median free T4 level was 1.06 ng/dL. In patients with depression, the GAF score showed a weak but significant negative correlation with the free T4 level (r = -0.212, p < 0.001) and with the free T3 level (r = -0.253, p = 0.008). In patients with mania, the GAF score was negatively correlated with the free T4 level (r = -0.225, p = 0.033) and positively correlated with the TSH level (r = 0.226, p = 0.031). These findings suggest that higher thyroid hormone levels may be associated with more severe psychiatric symptoms. Our study presents possible associations between thyroid hormone levels and psychiatric symptoms.

Allostatic load in major depressive disorder: An in-patient clinical study.

Background:Individual responses to repetitive transcranial magnetic stimulation (rTMS) in schizophrenia vary, and predictive clinical tools are lacking.Objectives:To develop and interpret machine learning models predicting individual rTMS treatment response using baseline clinical features.Design:Exploratory, hypothesis-generating study using retrospective patient data with internal validation and interpretability analysis.Methods:We analyzed 156 patients with schizophrenia, assessing baseline Positive and Negative Syndrome Scale (PANSS) and global assessment of functioning (GAF) scores. Machine learning models (Random Forest, XGBoost, support vector machine, logistic regression) were trained on demographic and clinical features. Performance was evaluated via cross-validation and a temporal hold-out test set. Shapley additive explanations (SHAP) were used for model interpretation.Results:Baseline characteristics were comparable between groups (all p > 0.1). Although both groups improved clinically, between-group differences were not statistically significant. The Random Forest model achieved the highest performance: cross-validated area under the receiver operating characteristic curve (AUC) = 0.84, temporal hold-out AUC = 0.70. Learning curve analysis indicated performance plateaued around 100 cases. SHAP and decision tree analysis highlighted moderate baseline GAF and higher PANSS as key predictors for response.Conclusion:Despite modest group-level efficacy, interpretable machine learning models identified baseline features associated with individual response to rTMS. These findings can inform personalized interventions, though future external validation is needed.Trail registration:Not applicable.

Persistent oxidative stress and functional outcomes in early psychosis: A longitudinal study.

Sex-based differences in neurocognitive functioning in first-episode psychosis: An exploratory analysis.

Structural alterations related to emotion dysregulation, anxiety and self-harm in adolescents borderline personality disorder. A source-based morphometry study.

In numerous countries, including Serbia, therapeutic drug monitoring (TDM) for clozapine is unavailable, leaving dose adjustments based solely on clinical judgment, could increase risk of therapeutic failure or adverse outcomes. The present study aimed to assess associations between clozapine and norclozapine serum concentrations, measured via Dried Blood Spot (DBS), and symptom severity, functioning, disability, and side effects in Serbian inpatients with treatment-resistant schizophrenia (TRS). In a cross-sectional design, patients with TRS with ongoing clozapine treatment and who did not meet exclusion criteria, were to be included. For clinical assessments of symptom severity, functionality, disability and side effects, were used: Simplified Interview for Negative and Positive Symptoms (SNAPSI), Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), WHO Disability Assessment Schedule (WHODAS) and the Clozapine Adverse Effects Scale (GASS-C). Spearman's analysis showed no significant correlation between GASS-C scores and clozapine dose or plasma levels. WHODAS scores showed significant positive correlations with clozapine dose (ρ=0.409, P=0.006), clozapine (ρ=0.333, P=0.038) and norclozapine (ρ=0.481, P=0.002) levels. GAF scores negatively correlated with clozapine (ρ=-0.354, P=0.027) and norclozapine (ρ=-0.370, P=0.020). GASS-C scores were significantly associated with female sex (P=0.003), body mass index (BMI; ρ=-0.678, P<0.0005) and WHODAS scores (ρ=0.372, P=0.014). Regression analysis identified clozapine dose, clozapine level, BMI, SNAPSI and CGI scores as significantly associated with GASS-C (P=0.045). Norclozapine, BMI and CGI scores significantly associated with WHODAS (P=0.018). In the present study, it was found that clozapine and norclozapine concentrations are significantly associated with functioning, disability and side effects in patients with TRS treated without TDM. DBS-based monitoring may offer a valuable alternative for optimizing treatment. Further longitudinal studies are needed to clarify the clinical utility of (nor) clozapine level-guided care in such settings.

Recent research suggests that environmental factors may contribute to psychosis through at least partially distinct pathways. This study examined how neighborhood socioeconomic deprivation and social fragmentation relate to impaired social functioning in individuals at clinical high risk for psychosis (CHR-P) via social and contextual risk factors. Data were collected from the North American Prodrome Longitudinal Study Phase 3. Neighborhood characteristics were geocoded using participant addresses at baseline. Social and contextual risk factors were derived from the Structural Assessment of Violence Risk in Youth. Social functioning was measured using the Global Assessment of Functioning: Social Scale. Neighborhood social fragmentation was associated with greater peer rejection (β = 0.11; 95% CI, 0.01-0.22, P= .034), which, in turn, was negatively associated with social functioning (β = -0.18; 95% CI, -0.23 to -0.12, P< .001). Both neighborhood social fragmentation (β = 0.18; 95% CI, 0.03-0.33, P= .022) and neighborhood socioeconomic deprivation (β = 0.34; 95% CI, 0.21-0.48, P< .001) were associated with greater community disorganization, which was negatively associated with social functioning (β = -0.08; 95% CI, -0.17 to -0.01, P= .046). Neighborhood socioeconomic deprivation had a direct negative association with social functioning (β = -0.15; 95% CI, -0.29 to -0.02, P= .03). This study identified shared and distinct pathways relating neighborhood characteristics to impaired social functioning among CHR-P individuals. Understanding how environmental factors impact social functioning may help develop effective interventions for youth at high risk.