Improvement In Psychiatric Symptoms Research Articles

Factors that can influence neurocognitive performance: a case study in a controlled environment

ABSTRACT This is a case study of a patient in her 50s who presents with severe malnutrition, alcohol dependence, and untreated Bipolar Affective Disorder. She was hospitalized multiple times and placed in a group home 1 year after symptom onset. Cognitive and functional improvements are observed over a 6-year period, as demonstrated by 3 comprehensive neuropsychological evaluations. Residing in a monitored and structured environment for 6 years, with stability in psychiatric medications, monitored nutrition and abstinence from alcohol are attributed to this improvement. This study provides unique evidence of the impact of balanced nutrition and improvements in psychiatric symptoms on cognition.

Pituitary macroadenoma with panhypopituitarism masquerading as schizophrenia: a diagnostic dilemma managed conservatively

Introduction and importance: Secretory pituitary macroadenoma also known as prolactinoma are benign neoplasm comprising very minimal cases of intracranial masses. Among the various presentation suggestive of panhypopituitarism, psychosis, and features of schizophrenia is very rarely seen. In the majority of cases, neurosurgical intervention for the excision of tumor is considered a standard treatment modality but conservative management with dopamine agonist and steroids have also been shown to provide an optimal level of care also improving the quality of level of patient. Case presentation: A 42-year-old Asian male presented with a history of talking to self, delusion of persecution, over talkativeness, hallucination, increased suspiciousness, and history of lost and found in the streets where he was working as a migrant worker. The patient was initially managed in line of schizophrenia with the antipsychotics drug of choice. On further assessment there was no improvement of psychiatric symptoms but they further deteriorated with additional neuropsychiatric symptoms; hence, MRI brain was carried out. Following which, the diagnosis of pituitary macroadenoma was confirmed and further more hormonal analysis was done, which showed findings suggestive of panhypopituitarism. The patient was then managed conservatively with dopamine agonist and steroids, which showed rapid improvement of psychiatric symptoms with a massive reduction in the size of the pituitary macroadenoma. Clinical discussion: With the incidence of 100 per million cases pituitary adenomas are considered locally invading with the characteristic compression of the surrounding structure, presenting as visual hallucinations, olfactory hallucinations, episodes of losing time, apathy, and features suggestive of adrenal insufficiency, hypogonadotrophic hypogonadism, and symptoms secondary to hormonal imbalance such as hypothyroidism. Psychiatric symptomatic presentations are considered a very rare presentation in cases of pituitary macroadenoma. Also, psychiatric features and symptoms of psychosis are associated with prolcatinomas through idiopathic mechanism and the basic casualty has not been established. Surgical intervention such as trans-sphenoidal resection of the mass can be undertaken in case where mass effects is present but long-term remission and prognosis is found not to be fruitful. Conservative treatment with dopamine agonist such as cabergoline and steroids also plays a meaningful role in abrupt management in such cases. Conclusion: Pituitary macroadenoma presenting as a patient of schizophrenia is noted very rarely in medical literature; hence, investigations in view of neurosurgical diagnosis in cases presenting as psychosis should be considered for ideal holistic management. Conservative management can also be a breakthrough treatment modality in complete recovery of pituitary macroadenoma.

The impact of the number of previous illness episodes on early response to electroconvulsive therapy (ECT) in psychosis, mania, depression, psychotic depression, and catatonia: A naturalistic transdiagnostic analysis

Electroconvulsive Therapy (ECT) is an effective treatment for mood and psychotic disorders but there is growing evidence of treatment resistant to ECT. Our study aimed to investigate the relationship between the number of previous illness episodes and the symptomatic improvement after acute ECT treatment. We conducted a retrospective naturalistic cohort analysis of patients’ ECT registry data from March 2017 to February 2023. We categorized the number of previous illness episodes into “0–3″ and “>3 episodes”, paired T-tests were used to compare the changes in scores of clinical assessments, generalized linear models were used to analyze the association between the number of previous illness episodes and change in symptomatic scores. A total of 1137 patients were included for analysis. There was a significant global improvement in psychiatric symptoms (CGI) after 6 ECT treatments across five indications. We observed that compared to patients with less previous illness episodes, patients with more than 3 previous illness episodes had 30% lower chance of response to acute ECT treatment. Thus, our study suggests that use ECT earlier in the course of illness is associated with greater response and support offering ECT earlier in the disease course.

Comparative effectiveness of aripiprazole and olanzapine on neurocognitive profile of patients with schizophrenia.

Schizophrenia causes significant neurocognitive impairment. Treatment with antipsychotics leads to improvement in psychopathology and neurocognitive functions. To see comparative effectiveness of aripiprazole and olanzapine on neurocognitive profile of patients with schizophrenia. This was a comparative, prospective, and interventional study. Patients with schizophrenia as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), were assessed on Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), and neuropsychological tests at baseline. Patients were randomly assigned to aripiprazole (10-30 mg per day, orally) and olanzapine (5-20 mg per day, orally) groups on the basis of computer-generated random table number. Patients were reassessed at 10 weeks. A total of 40 patients completed the study duration of 10 weeks. At baseline, the majority of patients showed significant impairment in one or more domains of neurocognition. Both aripiprazole and olanzapine led to improvement in psychiatric symptoms as well as neurocognitive profile. Aripiprazole treatment leads to significant improvement in mental speed as compared to olanzapine. A highly significant decrease in the value of the Stroop effect indicates improvement (P = 0.000**) with aripiprazole and visual-spatial constructive ability (P < 0.001). The olanzapine group showed highly significant improvement in performance of category fluency (P < 0.01) and verbal fluency (P < 0.01). The study concludes that aripiprazole and olanzapine have strong potential to improve specific domains of neurocognitive profile.

Longitudinal changes in brain structure and their relationship with subclinical psychiatric symptoms in parents who lost their only child in China

ABSTRACT Background: Losing an only child (Shidu) is a grievous traumatic event that may affect brain structure, even if it does not lead to psychiatric disorders. However, longitudinal changes in brain structure and their relationship to subclinical psychiatric symptoms (SPS) have not been well investigated in Shidu parents without any psychiatric disorders (SDNP). Objectives: This study aimed to investigate cross-sectional and longitudinal changes in cortical thickness and surface area in SDNP, and to explore their relationship with SPS. Methods: A total of 50 SDNP and 40 matched healthy controls (HC) were enrolled. All participants underwent structural MRI scans and clinical assessment at baseline and at the 5-year follow-up. Differences in brain structural phenotypes (cortical thickness, surface area, and their annual rate of change) between the SDNP and HC groups were compared using FreeSurfer. Correlations between significant brain structural phenotypes and SPS in the SDNP group were evaluated using multiple linear regressions. Results: The SDNP group showed a smaller surface area in the left inferior parietal cortex than the HC group at baseline and follow-up. The SDNP group showed slower rates of cortical thinning and surface area loss in several brain regions than the HC group from baseline to follow-up. Moreover, slower rates of cortical thinning in the left insula, superior frontal cortex, and superior temporal cortex were associated with greater reductions in avoidance, depression, and trauma re-experiencing symptoms scores over time in the SDNP group, respectively. Conclusions: Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms. The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

Impact of hyperthyroidism and its treatment on the outcome of mental health, occupational functioning, and quality of life: A naturalistic, prospective study.

Hyperthyroidism has a major impact on mental health. We intended to determine the magnitude of the unmet need for mental health support in patients with hyperthyroidism attending an endocrinology clinic. General Hospital Endocrine Department, Prospective Study. In a naturalistic, prospective study, consecutive (n = 176) hyperthyroid patients were assessed for anxiety (generalized anxiety disorder, GAD-7), depression (Patient Health Questionnaire PHQ-9), functional impairment (work and social adjustment scale, WSAS), and quality of life (EuroQol ED5D) using standardized instruments. Percentages, mean and standard deviation (SD), Chi-square, Student's t-test, ANOVA, Spearman's correlation. A considerable proportion (40.5%) of patients had moderate and severe anxiety, around half (50.6%) had moderate or severe depression, and 20.8% had severe functional impairment at presentation. Mean EQ5D score was 59.6 ± 23.5. The scores of anxiety, depression, and functional impairment were significantly correlated with each other and negatively correlated with QOL. Following treatment of hyperthyroidism, improvement in psychiatric symptoms was noted which could be correlated with the lowering of T4. However, a significant proportion of patients continued to have psychiatric symptoms and functional impairment despite achieving euthyroidism. There was no correlation between the severity of hyperthyroidism to persistence of mental health parameters. Our findings of high prevalence and persistence of impairment of mental health and functional status of patients with hyperthyroidism have highlighted the unmet needs for these patients.

Effectiveness of the Shugan Jieyu Capsule against Psychiatric Symptoms in Epilepsy: a protocol for systematic review and meta-analysis

Psychiatric symptoms in epilepsy are very common, and the most common symptoms are depression, insomnia, and anxiety. These symptoms not only lower the quality of life of epilepsy patients, but also elevate the risk of epileptic seizures. There are no specific criteria for the available antiepileptic drugs to ameliorate these symptoms in patients with epilepsy, and there is a lack of evidence to support the efficacy and safety of existing drugs. The Shugan Jieyu capsule (SJC) is a traditional herbal medicine composed of Acanthopanax senticosus and Hypericum perforatum and is reported to be effective in relieving psychiatric symptoms. The purpose of this study was to assess the efficacy of SJC as a treatment for psychiatric symptoms in epilepsy patients. Electronic databases will be investigated for publications in English, Korean, Japanese, and Chinese. The participants of the study are epilepsy patients with psychiatric symptoms diagnosed using any validated criteria. All types of controls will be compared-placebo, conventional treatments, and no treatment-to groups treated with SJC or modified SJC. We will measure the degree of improvement in psychiatric symptoms and check epileptic symptoms, such as the frequency of seizures. The study selection and data extraction will be performed by two independent reviewers, who will also assess methodological quality using the risk-of-bias tool by Cochrane. We will use Review Manager software (RevMan) to carry out all statistical analyses. This systematic review and meta-analysis will be performed in accordance with the PRISMA-P statement. This systematic review is the first study to assess the efficacy and safety of SJC for the treatment of psychiatric symptoms in epilepsy. We expect that this study will provide clinically applicable evidence for patients with epilepsy when selecting drug treatments.

Laparoscopic Enucleation for Treatment of Insulinoma Promotes Improvement in Psychiatric Symptoms: Case Report

Laparoscopic Enucleation for Treatment of Insulinoma Promotes Improvement in Psychiatric Symptoms: Case Report

Beyond Supported Housing: Correlates of Improvements in Quality of Life Among Homeless Adults with Mental Illness.

The goal of supported housing, aside from exiting homelessness, is to improve overall quality of life. The contribution of factors that enhance quality of life in supported housing programs, beyond housing itself, have not been empirically identified. Five-year follow-up data from two arms of a randomized trial comparing case management with and without housing vouchers (n = 278) were examined to identify correlates of improved quality of life, beyond housing resources. Access to a housing contributed to 4% of the variance in improved quality of life. Improvement in psychiatric symptoms, alcohol and drug use, employment, total income, and social support were associated with an additional 34-43% of variance in improved quality of life above and beyond housing. Improvements in quality of life were more strongly associated with improvements in mental health and other aspects of social well-being than housing alone.

Stages of the Smoke-Free Policy Implementation in a Psychiatric Hospital: Evolution, Effects, and Complications

Background: The Smoke-free Policy represents a challenge in mental health services. Aim: To compare the stages of a smoke-free policy in a psychiatric hospital, according to the prevalence of smokers, hospital admission acceptance by hospitalized people, psychiatric complications, and the prescription of psychotropic drugs. Methods: Cross-sectional study was conducted with a comparison before and after implementing the Smoke-free Policy in a psychiatric hospital. Secondary data were obtained in 2020 from the medical records of 573 discharged people from psychiatric hospitalizations between September 2017 and August 2018. Fisher’s exact test and the Kruskal-Wallis test were applied. Results: In the transition stage, there were more hospitalizations by court order, discharge motivated by the patient’s disruptiveness behavior, administration of psychotropic drugs before the schedule time, physical aggression, physical/chemical restraints, length of stay, and dosage of psychotropic drugs. After the ban, there was a reduction in discharges motivated by the patient’s disruptiveness behavior and an increase in discharge due to improvement in psychiatric symptoms, less occurrence of anticipation or modification in the use of psychotropic drugs, and fewer attempts to escape, aggressiveness, and physical restraint. Conclusion: The implementation of the Smoke-free Policy has a positive impact on psychiatric hospitalizations, with an increase in discharge due to improvement in psychiatric symptoms and a reduction in discharges due to other reasons. However, the transition stage requires greater attention from the nursing team, as the moment of adaptation to new rules and routines is followed by a momentary worsened behavior of those hospitalized.

Effects of electroconvulsive therapy on cognition and quality of life in schizophrenia

The effects of electroconvulsive therapy (ECT) on quality of life (QoL), and its relationship with symptom and cognitive change remains unclear. We aim to examine the association of QoL changes with psychiatric symptom and cognitive changes among patients with schizophrenia who underwent ECT. This is a retrospective cohort study of 132 patients who received ECT from July 2017 to December 2019. Sociodemographic and clinical characteristics were obtained from medical records. Changes in QoL, psychiatric symptoms and cognition function were examined after 6 sessions of ECT. Generalised linear regression was used to examine the associations of Brief Psychiatric Rating Scale (BPRS) scores and Montreal Cognitive Assessment (MoCA) scores with QoL as measured by EQ-5D scores. The mean (standard error) improvements after ECT were statistically significant for the assessment scales of EQ-5D utility score: 0.77 (0.02) to 0.89 (0.02), P<0.001; EuroQol-5-Dimension (EQ-5D) visual analogue scale score: 66.82 (2.61) to 73.05 (1.93), P=0.012; and EQ-5D subdomain scores. Both improvement in BPRS (adjusted β coefficient -0.446, 95% confidence interval [CI] -0.840 to -0.052) and MoCA (adjusted β 12.068, 95% CI 0.865 to 12.271) scores were significantly associated with improvement in EQ-5D utility scores after adjustment for sociodemographic and clinical characteristics. Improvement of BPRS scores (psychiatric symptoms) was significantly associated with improvement of the patients' mental health that was assessed by EQ-5D subdomain scores of pain (adjusted β coefficient 0.012, 95% CI 0.004 to 0.021) and anxiety (adjusted β coefficient 0.013, 95% CI 0.002 to 0.024). Improvement of MoCA scores (cognitive function) was significantly associated with patients' physical health as assessed by EQ-5D subdomain score of usual activity (adjusted β coefficient -0.349, 95% CI -0.607 to -0.09). ECT was associated with an overall improvement of QoL among patients with schizophrenia. The improvement of psychiatric symptoms was found to be significantly associated with better mental health while the improvement of cognitive function was associated with better physical health.

One Year On: Evaluation of the Cambridgeshire and Peterborough Staff Mental Health Service, a Bespoke Mental Health Clinic for Healthcare Workers

AimsThe Staff Mental Health Service (SMHS) at the Cambridgeshire and Peterborough NHS Foundation Trust is a multidisciplinary team providing rapid access assessments and treatments to NHS staff in all roles. The service was launched in September 2020 and obtained recurrent funding in 2021. Previously we reported initial clinical findings from the service suggesting high rates of moderate to severe depression, anxiety, and post-traumatic stress symptoms (Kaser et al. 2021). In this report, we present the clinical and demographic findings, and post-treatment outcomes from the first-year evaluation of the SMHS.MethodsDemographic and clinical data were collected as part of service evaluation at the SMHS. Depression, anxiety, and posttraumatic stress symptoms were evaluated by Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7), and Posttraumatic Symptom Checklist – Civilian Version (PCL-C). Non-parametric Wilcoxon rank test was used to compare pre- and post-treatment symptom scores.ResultsThe service received 515 referrals in the first year. 39.6% of the patients were off work at the time of the referral. 81.2% patients were female and 75.3% were of white ethnicity. Median time from referral to assessment was 14 days. According to the clinical data (n = 320), 85.3% of the patients had moderate to severe depressive symptoms (mean PHQ-9: 16.25 ± 6.1), and 80.9% of the patients had moderate to severe levels of anxiety symptoms (mean GAD-7: 13.62 ± 4.7). Staff patients endorsed high levels of traumatic stress with 82.5% scoring higher than the established cut-off (PCL-C &gt; 14) (PCL-C mean score: 19.14 ± 5.7). Analyses from patients completing treatment at the service showed significant improvements in depression (Z=−3.38, p = 0.001), anxiety (Z= -4.09, p &lt; 0.001), and PTSD symptoms (Z= -4.99, p &lt; 0.001).ConclusionThe Staff Mental Health Service had a persistent noticeable demand in its first year corresponding to two percent of the total workforce of the local trusts. Healthcare workers presenting to the service had high rates of moderate to severe depression, anxiety, and PTSD symptoms. Multidisciplinary treatment at the SMHS led to significant improvements in psychiatric symptoms. A health economics analysis of the service is currently underway.

Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings.

Accessible SummaryWhat is known on the subject? Individuals with a severe mental illness (SMI) are less physically active and have a lower life expectancy than the general population due to increased risks of cardiometabolic diseases (obesity, diabetes and respiratory diseases) and other health risks.Physical activity has been used as an adjunct therapy for individuals with SMI yielding improvements in cognitive functioning, quality of life and a reduction in psychiatric symptoms.Individuals with SMI residing within a secure forensic setting have reduced physical activity opportunities, possibly due to a number of factors including low motivation and restricted access to exercise facilities combined with a lack of knowledge and/or confidence in staff members to assist in physical activity programmes. What the paper adds to existing knowledge? This review demonstrates that little is known around the effects of physical activity for people with SMI who reside in secure forensic settings, with little to no long‐term effects reported.Physical activity interventions have shown some positive results through decreasing weight and waist circumference as well as a reduction in negative symptom scores in an exercise group compared with the “no treatment” control group post‐intervention. What are the implications for practice? Service users’ reluctance to engage in physical activity may be overcome by improving staff commitment, creating a motivational atmosphere and promoting service user decision making. IntroductionParticipating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill‐health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings.MethodA systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they had participants with SMI; were based in a forensic setting; involved a physical activity programme and reported physical and mental health outcomes.ResultsA total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared with a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups; however, statistically significant changes in weight and waist circumference were evident (p < .001). No adverse effects were reported.ConclusionOnly a small number of studies were included and of limited design and quality, with no follow‐up assessments; therefore, more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting.This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.

Correlation between Post-Acute Electroconvulsive Therapy Alpha-Band Spectrum Power Increase and Improvement of Psychiatric Symptoms.

The results of quantitative electroencephalography (qEEG) studies on electroconvulsive therapy (ECT) have been inconsistent, and indicators of the efficacy of ECT have not been clearly identified. In this study, we examined whether qEEG could be used as an indicator of the effect of ECT by measuring it during the course of treatment. We analyzed qEEG data before and after acute-phase ECT in 18 patients with schizophrenia, mood disorders, and other psychiatric disorders. We processed the qEEG data and compared the spectral power between the data acquired before and after ECT. The spectral power increased significantly after ECT in the delta, theta, and alpha bands. There was a strong significant correlation between the increase in the spectral power of the alpha band after acute ECT and improvement in the Brief Psychiatric Rating Scale score. Our results suggest that an increase in the alpha-band spectral power may be useful as an objective indicator of the treatment effect of acute ECT.

Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis

Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness. A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs. For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02). Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.

Ceremonial Ayahuasca in Amazonian Retreats-Mental Health and Epigenetic Outcomes From a Six-Month Naturalistic Study.

Ayahuasca is a natural psychoactive brew, used in traditional ceremonies in the Amazon basin. Recent research has indicated that ayahuasca is pharmacologically safe and its use may be positively associated with improvements in psychiatric symptoms. The mechanistic effects of ayahuasca are yet to be fully established. In this prospective naturalistic study, 63 self-selected participants took part in ayahuasca ceremonies at a retreat centre in the Peruvian Amazon. Participants undertook the Beck Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI), Self-compassion Scale (SCS), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), as well as secondary measures, pre- and post-retreat and at 6-months. Participants also provided saliva samples for pre/post epigenetic analysis. Overall, a statistically significant decrease in BDI-II (13.9 vs. 6.1, p < 0.001), STAI (44.4 vs. 34.3 p < 0.001) scores, and CORE-OM scores were observed (37.3 vs. 22.3 p < 0.001) at post-retreat, as well as a concurrent increase in SCS (3.1 vs. 3.6, p < 0.001). Psychometric improvements were sustained, and on some measures values further decreased at 6-month follow-up, suggesting a potential for lasting therapeutic effects. Changes in memory valence were linked to the observed psychometric improvements. Epigenetic findings were equivocal, but indicated that further research in candidate genes, such as sigma non-opioid intracellular receptor 1 (SIGMAR1), is warranted. This data adds to the literature supporting ayahuasca's possible positive impact on mental health when conducted in a ceremonial context. Further investigation into clinical samples, as well as greater analyses into the mechanistic action of ayahuasca is advised.

Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial.

BackgroundCognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent.ObjectiveWe aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia.MethodsParticipants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel–based analyses were used to identify the cognitive improvement–related functional connectivity in the visual network of the brain.ResultsAfter VR cognitive training, significant improvement was found in the total score (F1,39=14.69, P=.001) and basic components score of the RCFT copy task (F1,39=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F1,39=3.55, P=.07), verbal memory delayed recall (F1,39=3.03, P=.09), and phonemic fluency (F1,39=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F1,39=7.02, P=.01), affect (F1,39=14.40, P=.001 for positive affect; F1,39=4.23, P=.047 for negative affect), and quality of life (F1,39=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group.ConclusionsFully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity.Trial RegistrationClinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa

Early Improvement of Psychiatric Symptoms with Long-Acting Injectable Antipsychotic Predicts Subsequent Social Functional Remission in Patients with Schizophrenia.

PurposeThe aim of this study was to clarify whether early symptomatic improvement in response to a long-acting injectable antipsychotic (LAI) contributes to subsequent social functional remission in patients with schizophrenia using the previous clinical trial data (EudraCT registration number: 2011-004889-15). Associations between other factors and social functional remission were also explored.Patients and MethodsWe analyzed 428 patients with schizophrenia in which the personal and social performance scale (PSP) and the involvement evaluation questionnaire (IEQ) at the time of the base line were recorded. Social functional remission was defined as participants who scored PSP >70 at the end of 65 weeks. Logistic regression analyses were done to examine associations between social functional remission and clinical and demographic characteristics including early symptomatic response evaluated by Positive and Negative Syndrome Scale (PANSS) at week one.ResultsOne hundred out of 428 patients showed social functional remission at the end of the observation period. Shorter duration of illness, higher baseline score of supervision evaluated by IEQ and higher baseline PSP were significantly associated with the social functional remission. Improvement of positive subscale of PANSS at one week was significantly associated with later social functional remission when baseline PSP scores were excluded from predictive variables.ConclusionShorter duration of illness, residual type of schizophrenia, higher baseline score of supervision and higher baseline social functioning were predictors of subsequent social functional remission. Although its effect seems to be limited, early symptomatic improvement could be also was a predictor of social functional remission.

Stigma of Treatment Stages for First-Episode Psychosis: A Conceptual Framework for Early Intervention Services.

Early intervention services (EIS; in the United States, Coordinated Specialty Care) can lead to substantial improvements in psychiatric symptoms and social functioning for individuals with first-episode psychosis who engage in treatment. Nevertheless, stigma associated with early intervention services can limit their full potential benefits by preventing or reducing participation. Drawing from Corrigan's "why try" model positing relationships between public and self-stigma, engagement in treatment services, and the EIS treatment model, this article proposes a framework that delineates how distinct forms of stigma are linked to given stages of treatment engagement in first-episode psychosis. We identify three phases of engagement: (1) community outreach, which has associations with public stigma; (2) the referral and evaluation process, which primarily has associations with self-stigma; and (3) EIS, which have associations with self-stigma and its psychosocial consequences. For each phase, we describe evidence-based strategies typically provided by EIS programs, using OnTrackNY as an exemplary model, to illustrate potential linkages in our conceptual framework. By specifying how distinct forms of stigma are associated with EIS treatment stages, this framework is intended to guide EIS programs in explicitly addressing stigma to optimize recovery of individuals with first-episode psychosis.

Clinical Usefulness of Amisulpride Add-on Therapy in Schizophrenia Patients without Treatment Response to Second-generation Antipsychotics.

ObjectiveThe response to antipsychotics in patients with schizophrenia is still unsatisfactory. Therefore, augmentation with other antipsychotics is common in clinical situations. The purpose of this study was to evaluate the improvement of psychiatric symptoms and side effects after amisulpride add-on therapy.MethodsForty patients with schizophrenia or schizoaffective disorder without treatment response to second-generation antipsychotics were included in this study. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Korean version of Calgary Depression Scale for Schizophrenia (CDSS) at baseline, 4 weeks, and 8 weeks after the addition of amisulpride.ResultsAmong the 29 subjects who completed the 8-week study, 34.5% were responders according to PANSS total score. At week 8, the mean positive (p < 0.001), negative (p < 0.001), general (p < 0.001), and total (p < 0.001) PANSS scores and CDSS scores (p = 0.002) showed significant improvement compared to baseline. There was no increase in extrapyramidal side effects according to Simpson Angus Scale (p = 0.379) and Barnes Akathisia Rating Scale (p = 0.070) and no weight gain (p = 0.308) after the add-on treatment.ConclusionThe addition of amisulpride for schizophrenia patients without therapeutic response to second-generation antipsychotics is considered an effective and safe treatment. This study's results suggested that augmentation of second-generation antipsychotics with amisulpride could be a useful option for patients with schizophrenia unresponsive to second-generation antipsychotics. Further studies investigating the efficacy of amisulpride add-on therapy using placebo control are necessary to confirm these results.