Negative Symptoms Of Schizophrenia Research Articles

Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol

IntroductionNegative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive–behavioural therapy...

412. Efficacy of Karxt on Negative Symptoms in Acute Schizophrenia: A Post Hoc Analysis of Participants With Prominent Negative Symptoms

412. Efficacy of Karxt on Negative Symptoms in Acute Schizophrenia: A Post Hoc Analysis of Participants With Prominent Negative Symptoms

414. Understanding the Role of Muscarinic M1 and M4 Receptors in Neural Circuits That Modulate Negative Symptoms of Schizophrenia

414. Understanding the Role of Muscarinic M1 and M4 Receptors in Neural Circuits That Modulate Negative Symptoms of Schizophrenia

Striatal Functional Hypoconnectivity in Patients With Schizophrenia Suffering From Negative Symptoms, Longitudinal Findings.

Negative symptoms in schizophrenia (SZ), such as apathy and diminished expression, have limited treatments and significantly impact daily life. Our study focuses on the functional division of the striatum: limbic-motivation and reward, associative-cognition, and sensorimotor-sensory and motor processing, aiming to identify potential biomarkers for negative symptoms. This longitudinal, 2-center resting-state-fMRI (rsfMRI) study examines striatal seeds-to-whole-brain functional connectivity. We examined connectivity aberrations in patients with schizophrenia (PwSZ), focusing on stable group differences across 2-time points using intra-class-correlation and associated these with negative symptoms and measures of cognition. Additionally, in PwSZ, we used negative symptoms to predict striatal connectivity aberrations at the baseline and used the striatal aberration to predict symptoms 9 months later. A total of 143 participants (77 PwSZ, 66 controls) from 2 centers (Berlin/Geneva) participated. We found sensorimotor-striatum and associative-striatum hypoconnectivity. We identified 4 stable hypoconnectivity findings over 3 months, revealing striatal-fronto-parietal-cerebellar hypoconnectivity in PwSZ. From those findings, we found hypoconnectivity in the bilateral associative striatum with the bilateral paracingulate-gyrus and the anterior cingulate cortex in PwSZ. Additionally, hypoconnectivity between the associative striatum and the superior frontal gyrus was associated with lower cognition scores in PwSZ, and weaker sensorimotor striatum connectivity with the superior parietal lobule correlated negatively with diminished expression and could predict symptom severity 9 months later. Importantly, patterns of weaker sensorimotor striatum and superior parietal lobule connectivity fulfilled the biomarker criteria: clinical significance, reflecting underlying pathophysiology, and stability across time and centers.

A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia.

Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.

DYNAMICS ASSESSMENT OF PSYCHOPATHOLOGICAL CHARACTERISTICS OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA

The aim of the study. To determine the dynamics of the psychopathological structure and severity of negative symptoms depending on the stage of the disease in patients with negative symptoms in schizophrenia in order to improve the diagnosis and treatment of patients with schizophrenia.
 Materials and methods: 252 patients with negative symptoms of schizophrenia took part in the study: 83 patients with the first episode of schizophrenia, 88 patients with schizophrenia in a state of exacerbation, and 81 patients with schizophrenia in a state of remission. A comprehensive approach, which consisted from clinical-psychopathological, psychometric (Scale for Evaluating Negative Disorders, G.V. Logvinovych, 1990) and statistical research methods, were used in the study.
 Results. Features of the dynamics of negative symptoms in patients with negative symptoms in schizophrenia at different stages of the disease were established: patients with the first episode of schizophrenia were characterized by mild quantitative and qualitative impairments in the emotional sphere, slight quantitative and qualitative changes in the associative sphere, and mild quantitative impairments in the volitional sphere in combination with moderate qualitative changes in the volitional sphere. Patients with schizophrenia in a state of exacerbation were characterized by moderate quantitative impairments of the emotional sphere and manifested distortion of the emotional sphere, manifested quantitative and qualitative impairments in the associative sphere and minor quantitative and qualitative impairments of the volitional sphere. Patients with schizophrenia in a state of remission were characterized by moderate and manifested quantitative and qualitative impairments in the emotional-volitional sphere and moderate quantitative and qualitative impairments in the associative sphere.
 Conclusions. The obtained data can be used to establish diagnostic criteria for patients with negative symptoms in schizophrenia, depending on the dynamics of the disease.

Pupillary responses as a biomarker of cognitive effort and the impact of task difficulty on reward processing in schizophrenia

Negative symptoms of schizophrenia robustly predict functional outcomes but remain relatively resistant to available treatments. Better measures of negative symptoms, especially motivational deficits, are needed to better understand these symptoms and improve treatment development. Recent research shows promise in linking behavioral effort tasks to motivational negative symptoms, reward processing deficits, and defeatist attitudes, but few studies account for individual or group (patient v. control) differences in cognitive ability to perform the tasks. Individuals with poorer abilities might be less motivated to perform tasks because they find them more difficult to perform. This study used a personalized digit span task to control task difficulty while measuring task effort via pupillary responses (greater dilation indicates greater cognitive effort) at varying monetary rewards ($1 & $2). Participants with schizophrenia (N = 34) and healthy controls (N = 41) performed a digit span task with personalized max span lengths and easy (max− 2 digits) and overload (max+ 2 digits) conditions. Consistent with many studies, pupillary responses (cognitive effort) increased with greater difficulty until exceeding capacity. A similar pattern of reward responsivity was seen in both groups, such that greater reward increased dilation (effort) comparably for both groups when difficulty was within capacity. Neither patients nor controls exerted increased effort for greater reward when difficulty exceeded capacity. In patients, positive relationships were found between pupil dilation and defeatist performance beliefs if task difficulty was within capacity; a relationship that reversed if the task was too difficult. The findings demonstrate the importance of accounting for cognitive capacity and task difficulty when evaluating motivation and reward sensitivity and illustrate the utility of pupillary responses as an objective measure of effort in schizophrenia.

Clinical and Sociodemographic Correlations with Neurological Soft Signs in Hospitalized Patients with Schizophrenia: A Preliminary Longitudinal Study.

Schizophrenia is a severe, chronic neuropsychiatric disorder characterized by symptoms that profoundly impact behavior, cognition, perception, and emotions, leading to a reduced quality of life and physical impairment. Given the complexity of schizophrenia, there is a pressing need for clinical markers and tools to predict its course, enhance disease staging, facilitate early intervention, improve differential diagnosis, and tailor individualized treatment approaches. Previous studies focused on the relationship between neurological soft signs (NSS) and factors such as age, illness duration, and symptomatology, indicating NSS as state markers improving in parallel with psychotic symptom remission or predicting treatment resistance. However, there is a lack of consensus on NSS assessment tools, hindering routine clinical monitoring despite diagnostic and prognostic potential. The present longitudinal study involved 81 psychiatric inpatients diagnosed with schizophrenia. Patients were assessed at three time points: baseline, 1 month, and 6 months. The examination included the use of scales to evaluate psychotic and neurological symptoms, as well as the identification of adverse extrapyramidal reactions caused by neuroleptic treatment. The progression of NSS was correlated to both the symptomatology and the sociodemographic data of the patients. The main findings from the present investigation revealed a statistical correlation between NSS and psychopathological symptoms, especially with negative symptoms of schizophrenia. However, it is important to note that neuroleptic side effects only had a limited impact on NSS. Therefore, instead of being linked to extrapyramidal symptoms caused by neuroleptics, NSS appears to be more frequently related with symptoms of schizophrenia. Our findings provide further support for their strong association with the course of schizophrenia, independent of treatment side effects, thus emphasizing their potential as reliable assessment tools in both research and clinical settings.

The Secure Therapeutic Effects of Recently Developed Antipsychotic Drugs and Updated Neural Networks in Schizophrenia

Introduction:: Schizophrenia and schizoaffective disorder are treated in most cases with antipsychotic drugs of the second generation. These drugs block dopaminergic and serotonergic receptors, i.e., D2 and 5-HT2A receptors, and cause different adverse effects, for example, movement disturbances of the extrapyramidal system and adverse effects of vital parameters and of the heart. These drugs treat positive symptoms in schizophrenia and, to a lesser extent, negative symptoms. This review presents the development of newer antipsychotic drugs. Methods/Material:: References were taken from PubMed after using the following keywords: schizophrenia, schizoaffective disorder, antipsychotic drug, neurotransmitter and neuropeptide. Among these newer antipsychotic drugs are cariprazine, brexipiprazole and lumateperone, which exert a partial agonistic effect at D2 and 5-HT2A receptors, pimavanserin, a 5-HT2A receptor antagonist which treats negative symptoms in schizophrenia as add-on therapy, olanzapine combined with samidorphan, which reduces weight gain, and M4 or M1 receptor agonists, for example, xanomeline with an antipsychotic effect combined with trospium, an anticholinergic drug. Neural networks were updated in order to deduce the antipsychotic mechanism of action of newer antipsychotic drugs, especially xanomeline. Results:: The newer antipsychotic drugs cariprazine, brexipiprazole and lumateperone show antipsychotic, antimanic and anti-depressive effects, however, the efficacy on psychotic symptoms in long-term treatment has not yet been examined. Pimavanserin reduces negative symptoms in schizophrenia as an additional pharmacotherapy to treat this disorder. Olanzapine combined with samidorphan exerts good antipsychotic effects and reduces weight gain. The new antipsychotic drug xanomeline, the antipsychotic effect of which is quite different from the antidopaminergic effect, treats positive and negative symptoms in schizophrenia. Its mechanism of action was deduced from the neural networks presented. The long-term efficacy should still be examined. Conclusion:: This review is focused on newer antipsychotic drugs. The long-term efficacy of cariprazine, brexipiprazole and lumateperone in the treatment of schizophrenia should be examined further. Neural networks in the brain areas involved in schizophrenia should be examined and updated furthermore. Newer antipsychotic drugs ,for example, xanomeline, an M4 or M1 receptor agonist, which has been combined with trospium, an anticholinergic drug, the mechanism of action of which can be derived from the neural network suggested in this review.

A Review on Biological Mechanisms of Negative Symptoms in Chronic Schizophrenia

Research about the negative symptoms of chronic schizophrenia (SZ) is still lagging behind, in order to more comprehensively and systematically understand the biological and molecular mechanisms behind them, as well as to explore more valuable research directions and treatment options. By summarizing the results of previous studies and exploring them at the levels of neurobiology, genetics, molecular biology and microbiology, the authors provide a preliminary review of the new research progress in recent years. The authors hypothesize neurodevelopmental disorders by thoroughly investigating the anatomical features of various brain regions and the corresponding abnormalities in neurotransmitters. This paper then provides a relatively fresh perspective by summarizing the potential pathogenic mechanisms in terms of the brain-gut axis and metabolic syndrome. Ultimately, it is determined that the pathophysiology of chronic schizophrenia is associated with multiple biological mechanisms within the body, primarily arising from neurological abnormalities within the brain. On the basis of this, the author provides a conceptualization of the pathophysiology and a potential course of treatment.

Socio-demographic characteristics of patients with negative and positive symptoms in schizophrenia

Schizophrenia is a severe mental disorder that leads to impaired social adaptation, interpersonal interaction, and disability. Negative symptoms are an integral part of schizophrenia. In the world psychiatric science and practice, there are still many questions about the typology of schizophrenia, the description of its clinical manifestations, first of all, the features of negative symptoms in schizophrenia. Psychiatrists of different countries draw attention to the fact that these descriptions do not always coincide. Socio-demographic factors can be considered as factors affecting the prognosis of the course and outcome of schizophrenia. In this regard, a comprehensive approach to the study of socio-demographic characteristics of patients with schizophrenia involves the study of the influence of social factors on the formation and course of schizophrenia and determines the relevance of this study. The purpose of the study was to determine the features of socio-demographic characteristics of patients with schizophrenia in order to improve diagnosis and create psycho-corrective measures. 252 patients with negative symptoms of schizophrenia and 79 patients with positive symptoms of schizophrenia were examined. During the research, a comprehensive approach was used, consisting  in the use of clinical-psychopathological, clinical-anamnestic and statistical research methods. Socio-demographic features of patients with negative symptoms in schizophrenia were established, consisting in the predominance of women; patients aged 20-29 years; persons with special secondary education; divorced and single persons; patients busy with physical labor; average level of material wealth; very poor and poor living conditions. Socio-demographic characteristics of patients with positive symptoms in schizophrenia were outlined by the predominance of men; patients aged 30-49 years; persons with incomplete higher education and with higher education; divorced and single persons; patients with disabilities; with extremely low and low levels of material well-being and a satisfactory level of living conditions. The conducted research made it possible to draw conclusions that socio-demographic features of patients with negative and positive symptoms have their own specificity, which should be taken into account when diagnosing patients with schizophrenia.

Understanding the Therapeutic Action of Antipsychotics: From Molecular to Cellular Targets With Focus on the Islands of Calleja.

The understanding of the pathophysiology of schizophrenia as well as the mechanisms of action of antipsychotic drugs remains a challenge for psychiatry. The demonstration of the therapeutic efficacy of several new atypical drugs targeting multiple different receptors, apart from the classical dopamine D2 receptor as initially postulated unique antipsychotic target, complicated even more conceptualization efforts. Here we discuss results suggesting a main role of the islands of Calleja, still poorly studied GABAergic granule cell clusters in the ventral striatum, as cellular targets of several innovative atypical antipsychotics (clozapine, cariprazine, and xanomeline/emraclidine) effective in treating also negative symptoms of schizophrenia. We will emphasize the potential role of dopamine D3 and M4 muscarinic acetylcholine receptor expressed at the highest level by the islands of Calleja, as well as their involvement in schizophrenia-associated neurocircuitries. Finally, we will discuss the implications of new data showing ongoing adult neurogenesis of the islands of Calleja as a very promising antipsychotic target linking long-life neurodevelopment and dopaminergic dysfunction in the striatum.

Effort-cost decision-making associated with negative symptoms in schizophrenia and bipolar disorder

Motivational deficits and reduced goal-directed behavior for external rewards have long been considered an important features of negative symptoms in patients with schizophrenia (SCZ). Negative symptoms have also a high prevalence in bipolar disorder (BP). We used a transdiagnostic approach in order to examine association between negative symptoms and effort allocation for monetary rewards. 41 patients with SCZ and 34 patients with BP were enrolled in the study along with 41 healthy controls (HC). Effort-Expenditure for Rewards Task (EEfRT) was used to measure subjects' effort allocation for monetary rewards. Generalized estimating equation models were used to analyze EEfRT choice behavior. Negative symptoms were assessed using the Brief Negative Symptom Scale (BNSS). SCZ and BP groups expended lower effort to obtain a monetary rewards compared to HC. Severity of negative symptoms was negatively correlated with EEfRT performance in both diagnostic groups. Each diagnostic group showed lower effort allocation for monetary rewards compared to HC suggesting reduced motivation for monetary rewards. In addition, our results suggest that abnormal effort-based decision-making might be a transdiagnostic factor underlying negative symptoms.

Psychosocial Correlates of the Experience of Caregiving Among Caregivers of Patients With Schizophrenia.

Family caregivers provide essential support to their loved ones with schizophrenia with profound outcomes for themselves. The caregiver burden fails to consider the entire caregiving experience, which also incorporates positive aspects of caring. Many potentially significant variables are associated with this. To examine the correlates of the experience of caregiving in caregivers of patients with schizophrenia. The specific objectives were to examine the socio-demographic variables of the patients and caregivers, clinical variables of the patient, caregivers' knowledge of illness, caregivers' perspectives of family functioning, caregiver coping, their social support, psychological distress, quality of life,and their spirituality, religiosity and personal beliefs and the associations of these variables with the caregivers' experience of caregiving. This cross-sectional observational study was conducted between August 2018 and January 2021 at All India Institute of Medical Sciences, New Delhi, India. One hundred and fifty-eightdyads of patients with schizophrenia and their family caregivers were recruited using purposive sampling. Experience of Caregiving Inventory was used to evaluate the caregiving experience. The caregivers were also assessed on socio-demographics, knowledge of illness, family functioning, coping, social support, general mental health, quality of life, and spiritual, religious, and personal beliefs. Patient socio-demographics and clinical variables were also assessed. A negative experience of caregiving was reported by caregivers of patients who had higher positive or negative symptoms of schizophrenia. Impaired Communication, Roles, Affective Responsiveness, Affective Involvement, and General Functioning aspects of family functioning were associated with a negative experience of caregiving. Denial/blame and seeking social support as coping were also associated with a negative experience of caregiving. A negative experience of caregiving was significantly positively correlated with greater psychological distress and poorer quality of life. Greater inner peace was associated with a less negative experience of caregiving. Spiritual strength was associated with a more positive experience of caregiving. Knowledge of mental illness and caregiver social support were not significantly associated with the experience of caregiving. Experience of caregiving is a relevant construct, the understanding of which can help inform caregiver-directed interventions in the future. Specifically, family-based interventions, which include ameliorating patient symptomatology, improving the family environment, strengthening caregivers' coping strategies, attending to caregiver distress, and encouraging spirituality among caregivers, may lead to a less negative and more positive experience of caregiving; and a better quality of life for caregivers.

Interaction between baseline BMI and baseline disease severity predicts greater improvement in negative symptoms in first-episode schizophrenia.

Several studies have reported that baseline symptom severity in patients with schizophrenia (SCZ) is associated with the efficacy of antipsychotic medication. Overweight/obesity is common in SCZ and has also been reported to be correlated with therapeutic response to antipsychotics. This study aimed to evaluate whether baseline body mass index (BMI) and disease severity were associated with improvements in negative symptoms in patients with first-episode and medication-naïve (FEMN) SCZ. A total of 241 FEMN patients were recruited in this study and treated with oral risperidone over 3months. Clinical symptoms were measured by the Positive and Negative Syndrome Scale (PANSS) and BMI was assessed at baseline and 3-month follow-up. We found that baseline BMI was correlated with the baseline severity of symptoms. Baseline BMI or baseline disease severity was associated with improvement in negative symptoms after 3months of treatment. Linear regression analysis indicated that the interaction of BMI and disease severity at baseline was associated with improvement in negative symptoms in the early stage of SCZ after controlling for sex, age, and dose of risperidone. Our study suggests that the interaction of baseline BMI and disease severity may play a role in predicting negative symptom improvement after 3months of risperidone treatment.

Abnormal ambiguous facial expression recognition in Chinese patients with schizophrenia

BackgroundPatients with schizophrenia (SCZ) exhibit difficulties deficits in recognizing facial expressions with unambiguous valence. However, only a limited number of studies have examined how these patients fare in interpreting facial expressions with ambiguous valence (for example, surprise). Thus, we aimed to explore the influence of emotional background information on the recognition of ambiguous facial expressions in SCZ.MethodsA 3 (emotion: negative, neutral, and positive) × 2 (group: healthy controls and SCZ) experimental design was adopted in the present study. The experimental materials consisted of 36 images of negative emotions, 36 images of neutral emotions, 36 images of positive emotions, and 36 images of surprised facial expressions. In each trial, a briefly presented surprised face was preceded by an affective image. Participants (36 SCZ and 36 healthy controls (HC)) were required to rate their emotional experience induced by the surprised facial expressions. Participants’ emotional experience was measured using the 9-point rating scale. The experimental data have been analyzed by conducting analyses of variances (ANOVAs) and correlation analysis.ResultsFirst, the SCZ group reported a more positive emotional experience under the positive cued condition compared to the negative cued condition. Meanwhile, the HC group reported the strongest positive emotional experience in the positive cued condition, a moderate experience in the neutral cued condition, and the weakest in the negative cue condition. Second, the SCZ (vs. HC) group showed longer reaction times (RTs) for recognizing surprised facial expressions. The severity of schizophrenia symptoms in the SCZ group was negatively correlated with their rating scores for emotional experience under neutral and positive cued condition.ConclusionsRecognition of surprised facial expressions was influenced by background information in both SCZ and HC, and the negative symptoms in SCZ. The present study indicates that the role of background information should be fully considered when examining the ability of SCZ to recognize ambiguous facial expressions.

Approval of a comprehensive psychosocial rehabilitation program for patients with negative symptoms in schizophrenia

The aim of the work is to develop and evaluate the effectiveness of a comprehensive program of psychosocial rehabilitation of patients with negative symptoms in schizophrenia. Materials and methods. The study involved 168 patients with negative symptoms of schizophrenia: 94 patients who underwent a comprehensive psychosocial rehabilitation program (main group) and 74 patients who underwent a course of therapy according to the traditional scheme (control group). The criteria that evaluated the effectiveness of a comprehensive program of psychosocial rehabilitation in patients with negative symptoms in schizophrenia were: clinical dynamics of negative disorders, the degree of improvement/deterioration of compliance and social functioning, and the degree of restoration of basic life functions. Psychometric (Social Avoidance and Distress Scale (SADS), Personal and Social Functioning (PSP), Level of Compliance questionnaire, and the Severity of Negative Symptoms (SANS)) and statistical research methods were used to assess effectiveness. Results. The proposed scheme of a complex program of psychosocial rehabilitation is based on the principles of a complex, individually oriented and differentiated approach, and its targets are defined as clinical manifestations of negative symptoms in schizophrenia, impaired social adaptation, communication skills, decreased motivational sphere, compliance and impaired social functioning. Rehabilitation is implemented in four stages: diagnostic, therapeutic, rehabilitation and preventive. The effectiveness of the proposed scheme of psychosocial rehabilitation of patients with negative symptoms in schizophrenia was proven, which consisted in a more pronounced reduction of clinical manifestations of abulia, anhedonia, inattention, reduction of distress and social avoidance, improvement of social functioning in the main spheres of life, and improvement of social and behavioral compliance. Conclusions. The developed comprehensive program of psychosocial rehabilitation of patients with negative symptoms in schizophrenia has shown its effectiveness and can be used in psychocorrective measures aimed at treating patients with negative symptoms in schizophrenia.

Assessing the impact of sex on high-frequency repetitive transcranial magnetic stimulation´s clinical response in schizophrenia - results from a secondary analysis.

Background: The evidence for repetitive transcranial magnetic stimulation (rTMS) to treat negative symptoms in schizophrenia (SCZ) is increasing, although variable response rates remain a challenge. Subject´s sex critically influences rTMS´ treatment outcomes. Females with major depressive disorder are more likely to respond to rTMS, while SCZ data is scarce.Methods: Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we assessed the impact of sex on rTMS´ clinical response rate from screening up to 105 days after intervention among SCZ patients. The impact of resting motor threshold (RMT) on response rates was also assessed.Results: 157 patients received either active or sham rTMS treatment. No significant group differences were observed. Linear mixed model showed no effects on response rates (all p > 0.519). Apart from a significant sex*time interaction for the positive subscale of the positive and negative syndrome scale (PANSS) scores (p = 0.032), no other significant effects of sex on continuous PANSS scores were observed. RMT had no effect on response rate.Conclusion: In the largest rTMS trial on the treatment of SCZ negative symptoms we did not observe any significant effect of sex on treatment outcomes. Better assessments of sex-related differences could improve treatment individualization.

Attitude towards mental help-seeking, motivation, and economic resources in connection with positive, negative, and general psychopathological symptoms of schizophrenia: a pilot study of a psychoeducation program.

Schizophrenia is typically treated with medication as the first approach, but additional strategies are necessary to enhance the effectiveness of this treatment for better outcomes. However, it is crucial to explore methods, alongside medication, that promote a positive attitude towards seeking mental health support and alleviate symptom severity among non-institutionalized individuals of different age groups in Pakistan. Thus, this pilot study aimed to utilize a psychoeducation program to enhance patients' motivation and attitudes toward seeking treatment, decrease symptom severity, and investigate the role of financial factors in their illness journey. In this preliminary investigation, our focus was on individuals who had been diagnosed with schizophrenia and were receiving treatment from various hospitals and primary care clinics. Following a thorough screening process, 255 participants met the eligibility criteria, and 220 completed the psychoeducation program. The study included both male and female participants, with 143 (56.08%) being men and 112 (43.82%) being women. Regarding marital status, 123 (48.24%) were single, 98 (38.43%) were married, and 34 (13.33%) were divorced widowers or widows. The age range of the respondents varied from 18 to 52 years, with a mean age of 35.45 and a standard deviation of 10.27. The results indicated a decrease in symptom severity following a 16-week psychoeducation program. The psychoeducation program significantly reduced the positive symptoms, negative symptoms, and general psychopathological symptoms among patients. Similarly, significant improvement was observed in patients' motivation toward treatment and they actively participated in treatment after getting psychoeducation about the treatment. Similarly, after the psychoeducation program significant improvement was seen in patients' attitudes towards help-seeking and perceived mental health functioning. In summary, the findings suggest that our psychoeducation program has the potential to positively impact the motivation and help-seeking attitudes of schizophrenia patients towards treatment. Moreover, there is a need for further exploration of psychoeducation programs for schizophrenia, particularly in countries facing economic challenges. This study paves the way for the development of an indigenous psychoeducation program tailored to Pakistani schizophrenia patients, with potential applicability for Urdu-speaking individuals. https://www.thaiclinicaltrials.org/show/TCTR20210208003, identifier TCTR20210208003.

Efficacy and safety of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia: A Meta-analysis and Systematic review.

The efficacy and safety of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia are still inconclusive. This meta-analysis summarized relevant studies to compare the efficacy and safety of Xiaoyao Pill combined with Western medicine and Western medicine alone in the treatment of schizophrenia, aiming to provide guidance for clinical treatment. In this meta-analysis, we searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM databases from the establishment of the databases to August 2023. The study proposed to include studies that reported combination of Xiaoyao Pill with Western medicine and Western medicine alone in the treatment of schizophrenia, excluding published literature, unpublished literature, literature with incomplete or inadequate information, animal experiments, literature reviews and systematic studies. Data were analyzed using Review manager 5.3. About 9 studies (6 RCTs and 3 case-control studies) were included in this meta-analysis. The sample size ranged from 60 to 128, with a total of 779 patients, including 395 in the combined treatment group and 384 in the control group. Pooled results showed that the total effective rate of combined treatment group was significantly higher than that of Western medicine alone (OR = 4.21, 95% CI: 1.50-11.83, P = .006). Positive and Negative Syndrome Scale (PANSS) (-) (MD = -2.30, 95% CI: -3.72 ~ -0.89, P = .001) and PANSS (+) (MD = -2.60, 95% CI: -3.34 ~ -1.86, P < .00001) of combined treatment group were all significantly lower than that of Western medicine alone. Additionally, PRL levels of combined treatment group was significantly lower than that of Western medicine alone (MD = -28.78, 95% CI: -42.20 ~ -15.35, P < .0001). However, there was no significant difference in BPRS and total PANSS between combined treatment group and Western medicine alone group. Notably, pooled results showed that there was no significant difference in incidence of adverse events between combined treatment group and Western medicine alone group. The effective rate of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia is higher than that of Western medicine alone, which can effectively relieve the positive and negative symptoms of schizophrenia, and can significantly reduce the level of PRL. In the treatment of schizophrenia, clinicians can give priority to Xiaoyao Pill combined with Western medicine therapy.