PANSS Negative Symptoms Research Articles

Intermittent theta burst stimulation for negative symptoms in schizophrenia patients with moderate to severe cognitive impairment: A randomized controlled trial.

This study aims to assess the therapeutic effects of intermittent theta burst stimulation (iTBS) targeting the bilateral dorsomedial prefrontal cortex (DMPFC) on negative symptoms in patients with schizophrenia, utilizing functional near-infrared spectroscopy for evaluation. Thirty-five schizophrenia patients with negative symptoms and moderate to severe cognitive impairment were randomly assigned to a treatment group (n = 18) or a control group (n = 17). The treatment group received iTBS via bilateral DMPFC. Negative symptoms, cognitive function, emotional state, and social function were assessed using Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Montreal Cognitive Assessment (MoCA), Calgary Depression Scale for Schizophrenia (CDSS), and Social Dysfunction Screening Questionnaire (SDSS) scales at pretreatment, posttreatment, and follow-up at 4, 8, and 12 weeks. Brain activation in regions of interest (ROIs) was evaluated through verbal fluency tasks. Prior to treatment there was no significant difference in the two groups. After 20 iTBS sessions, a significant difference was observed in SANS total score, its related subscales, PANSS total score, and PANSS-negative symptoms (all P < 0.05). The group-by-time interaction showed statistical significance, indicating improvements in negative symptoms and related dimensions over time, with therapeutic effects persisting for at least 8 weeks posttreatment. Prior to treatment, there were no significant differences in activation across all ROIs between the two groups. Posttreatment, the activation of right inferior frontal gyrus (t = 2.19, P = 0.036) and right frontal eye field (t = 2.14, P = 0.04) in the treatment group was significantly higher than in the control group. iTBS stimulation of bilateral DMPFC demonstrates therapeutic effects in improving negative symptoms in schizophrenia patients, and this treatment approach has the potential to enhance activation within the prefrontal cortex.

Efficacy and safety of a Chinese medicine formula Diankuang Mengxing Decoction combined with antipsychotics in the treatment of schizophrenia: A meta-analysis of randomized controlled trials.

In patients with schizophrenia, Diankuang Mengxing Decoction with antipsychotics is one of the treatments for it. However, little information is available regarding the difference between the therapeutic effect of Diankuang Mengxing Decoction with antipsychotics and other treatments. Systematic evaluation is conducted to assess the efficacy and safety of Diankuang Mengxing Decoction and other antipsychotics, which are used to treat schizophrenia. We performed a systematic review (PROSPERO ID: CRD42023414603). This entailed a computerized search of several research databases from their respective dates of establishment until April 11, 2023, which collected clinical randomized controlled trials of Diankuang Mengxing Decoction combined with antipsychotics. The databases that contributed to this study were PubMed, Web of Science, Embase, EBSCOhost, Cochrane, Scopus, and Google Scholar. Each publication was screened according to defined inclusion and exclusion criteria, and appropriate literature was extracted and evaluated for quality, for which meta-analysis was performed using RevMan 5.4. A literature review of 456 publications resulted in the inclusion of 18 randomized controlled trials with data collected from a total of 1636 patients. Meta-analytical results showed combination with risperidone, olanzapine, chlorpromazine, clozapine, ziprasidone, or aripiprazole increased the overall effectiveness of Diankuang Mengxing Decoction when treating schizophrenia (P < . 00001), among whom olanzapine demonstrated the greatest enhancement (Z = 3.65, odds ratio = 4.26, 95% CI: 1.96-9.28, P = .0003). The 4-week/30-day treatment (P = .0003) and a dosage of 400 mL/d of Diankuang Mengxing Decoction (P = .0004) were more effective. Also, there were widespread reductions to the Positive And Negative Syndrome Scale (PANSS) total scores, PANSS-positive symptom scores, PANSS-negative symptom scores, general psychopathology scores (P < .05 for all), as well as the incidence of adverse effects (Z = 2.79, odds ratio = 0.34, 95% CI: 0.16-0.73, P = .005) in patients with schizophrenia. The combination of Diankuang Mengxing Decoction with different antipsychotics can improve the overall prognosis of patients with schizophrenia; Diankuang Mengxing Decoction combined olanzapine, a dosage of 400 mL/d and a duration of 4 weeks/30 days being the best in this regard, by alleviating the symptoms and diminishing the disorder's adverse effects. To build on this work, more large-sample, multi-center, and high-quality clinical studies in the future would help to further validate our findings.

Amphetamine-Induced Dopamine Release Predicts 1-Year Outcome in First-Episode Psychosis: A Naturalistic Observation.

The dopamine theory of schizophrenia suggests that antipsychotics alleviate symptoms by blocking dopamine D2/3 receptors, yet a significant subset of patients does not respond adequately to treatment. To investigate potential predictors, we evaluated d-amphetamine-induced dopamine release and 1-year clinical outcomes in 21 antipsychotic-naive patients with first-episode schizophrenia. Twenty-one antipsychotic-naive patients (6 female) underwent dopamine D2/3 receptor radioligand [11C]-(+)-PHNO positron emission tomography. For estimating dopamine release, scans were performed with and without d-amphetamine pretreatment. The Positive and Negative Syndrome Scale was performed at regular intervals over 1 year while receiving treatment in a naturalistic setting (Clinical Trial Registry: EUDRACT 2010-019586-29). A group analysis revealed no significant differences in d-amphetamine-induced dopamine release between patients with or without clinically significant improvement. However, d-amphetamine-induced dopamine release in ventral striatum was significantly associated with reductions in positive symptoms (r = 0.54, P = .04; uncorrected P-values); release in globus pallidus correlated with a decrease in PANSS negative (r = 0.58, P = .02), general (r = 0.53, P = .04), and total symptom scores (r = 0.063, P = .01). Higher dopamine release in substantia nigra/ventral tegmental area predicted larger reductions in general symptoms (r = 0.51, P = .05). Post-amphetamine binding in putamen correlated positively with negative symptom scores at baseline (r = 0.66, P = .005) and throughout all follow-up visits. These exploratory results support a relationship between d-amphetamine-induced dopamine release and the severity and persistence of symptoms during the first year of psychosis.

Association of serum interleukin-6 with negative symptoms in stable early-onset schizophrenia

BACKGROUND Accumulating evidence suggests that the inflammatory cytokine interleukin-6 (IL-6) contributes to the pathophysiology of psychiatric disorders. However, there was no study concerning the relationship between IL-6 concentrations and clinical features in the chronic phase of early-onset schizophrenia (EOS). AIM To investigate the relationship between serum IL-6 concentration and the clinical features of EOS. METHODS We measured serum IL-6 Levels from 74 patients with chronic schizophrenia, including 33 with age at onset &lt; 21 years (EOS group) and 41 with onset ≥ 21 years in [adult-onset schizophrenia (AOS) group], and from 41 healthy controls. Symptom severities were evaluated using the Positive and Negative Syndrome Scale (PANSS). RESULTS Serum IL-6 concentrations were higher in both EOS and AOS groups than healthy controls (F = 22.32, P &lt; 0.01), but did not differ significantly between EOS and AOS groups (P &gt; 0.05) after controlling for age, body mass index, and other covariates. Negative symptom scores were higher in the EOS group than the AOS group (F = 6.199, P = 0.015). Serum IL-6 concentrations in the EOS group were negatively correlated with both total PANSS-negative symptom score (r = -0.389, P = 0.032) and avolition/asociality subscore (r = -0.387, P = 0.026). CONCLUSION Patients with EOS may have more severe negative symptoms than those with adult-onset schizophrenia during the chronic phase of the illness. IL-6 signaling may regulate negative symptoms and its avolition/asociality subsymptoms among the early-onset chronic schizophrenic patients.

Longitudinal assessment of ventricular volume trajectories in early-stage schizophrenia: evidence of both enlargement and shrinkage

BackgroundLateral ventricular enlargement represents a canonical morphometric finding in chronic patients with schizophrenia; however, longitudinal studies elucidating complex dynamic trajectories of ventricular volume change during critical early disease stages are sparse.MethodsWe measured lateral ventricular volumes in 113 first-episode schizophrenia patients (FES) at baseline visit (11.7 months after illness onset, SD = 12.3) and 128 age- and sex-matched healthy controls (HC) using 3T MRI. MRI was then repeated in both FES and HC one year later.ResultsCompared to controls, ventricular enlargement was identified in 18.6% of patients with FES (14.1% annual ventricular volume (VV) increase; 95%CI: 5.4; 33.1). The ventricular expansion correlated with the severity of PANSS-negative symptoms at one-year follow-up (p = 0.0078). Nevertheless, 16.8% of FES showed an opposite pattern of statistically significant ventricular shrinkage during ≈ one-year follow-up (-9.5% annual VV decrease; 95%CI: -23.7; -2.4). There were no differences in sex, illness duration, age of onset, duration of untreated psychosis, body mass index, the incidence of Schneiderian symptoms, or cumulative antipsychotic dose among the patient groups exhibiting ventricular enlargement, shrinkage, or no change in VV.ConclusionBoth enlargement and ventricular shrinkage are equally present in the early stages of schizophrenia. The newly discovered early reduction of VV in a subgroup of patients emphasizes the need for further research to understand its mechanisms.

Gender differences in the effect of rtms with the H7-coil on physical and social anhedonia in schizophrenia spectrum disorder; a randomized, sham-controlled trial

IntroductionStudies of differences in the incidence and severity of physical and social anhedonia between women and men diagnosed with schizophrenia spectrum disorder (SSD) are often inconsistent, and gender differences in treatment response have not been well studied. Hormonal factors, such as those related to the menstrual cycle, pregnancy or menopause, as well as social and cultural patterns and roles, may influence treatment response. The incidence of affective or stress-related psychiatric comorbidities may be gender-specific, which could also complicate the treatment of anhedonia and other negative symptoms of SSD. Finally, there is no evidence of sufficient quality on gender differences in the effects of rTMS, but the results are intriguing and point to the need for further research.ObjectivesTo investigate gender differences in the effect of rTMS with the H7-coil on physical and social anhedonia in patients diagnosed with SSD with dominant negative symptoms.MethodsWe conducted a randomized, sham-controlled trial during 2000-2023 in the population of patients diagnosed with SSD with primary negative symptoms defined as PANSS negative symptoms subscale score &gt; 24, and PANSS positive symptoms subscale score &lt; 20. The intervention was HF rTMS H7 coil (Brainsway Ltd. Jerusalem, Israel) once daily for 20 days applied to the prefrontal cortex (mPFC and ACC) at 100% motor threshold with a frequency of 18 Hz, and total of 39600 pulses. The outcomes were Physical and Social Anhedonia Scales (PAS, and SAS). We controlled for the large number of relevant covariates.ResultsWe randomized 49 men and 29 women of similar age. The effect on physical anhedonia was statistically significant in women (b = 9.04; p = 0.016), but not in men (b = 2.87; p = 0.272). The effect on social anhedonia was similar, but the difference was smaller (for men b = 3.71; p = 0.082; for women b = 5.42; p = 0.043). However, the Wald test showed no statistically significant differences between the beta coefficients for women and men.ConclusionsBased on this study, it is not possible to make valid and reliable conclusions about the existence of gender differences in the effects of rTMS treatment of anhedonia with the H7 coil. However, it is possible to claim that the treatment of anhedonia with this protocol is effective in women.Disclosure of InterestNone Declared

Unraveling the Influence of Age, IQ, Education, and Negative Symptoms on Neurocognitive Performance in Schizophrenia: A Conditional Inference Tree Analysis.

The complex nature of neurocognitive impairment in schizophrenia has been discussed in light of the mixed effects of antipsychotic drugs, psychotic symptoms, dopamine D2 receptor blockade, and intelligence quotient (IQ). These factors have not been thoroughly examined before. This study conducted a comprehensive re-analysis of the CATIE data using machine learning techniques, in particular Conditional Inference Tree (CTREE) analysis, to investigate associations between neurocognitive functions and moderating factors such as estimated trough dopamine D2 receptor blockade with risperidone, olanzapine, or ziprasidone, Positive and Negative Syndrome Scale (PANSS), and baseline IQ in 573 patients with schizophrenia. The study reveals that IQ, age, and education consistently emerge as significant predictors across all neurocognitive domains. Furthermore, higher severity of PANSS-negative symptoms was associated with lower cognitive performance scores in several domains. CTREE analysis, in combination with a genetic algorithm approach, has been identified as particularly insightful for illustrating complex interactions between variables. Lower neurocognitive function was associated with factors such as age>52 years, IQ<94/95,<12/13 education years, and more pronounced negative symptoms (score<26). These findings emphasize the multifaceted nature of neurocognitive functioning in patients with schizophrenia, with the PANSS-negative score being an important predictor. This gives rise to a role in addressing negative symptoms as a therapeutic objective for enhancing cognitive impairments in these patients. Further research must examine nonlinear relationships among various moderating factors identified in this work, especially the role of D2 occupancy.

Community-based multi-site randomized controlled trial of behavioral activation for patients with negative symptoms of schizophrenia

Negative symptoms are closely related to the poor prognosis of schizophrenia, for which there is no effective treatment to date. Behavioral activation (BA), which is an effective treatment for depression, is a behavioral approach that targets low levels of response-contingent positive reinforcement. This study aimed to explore BA as an effective intervention for relieving the negative symptoms of schizophrenia. This was a randomized single-blind controlled trial. Eighty-four patients with schizophrenia were enrolled in community mental health settings. Excluding 14 patients who opted out of the study, 70 were randomly assigned to receive BA in addition to treatment-as-usual (BA+TAU) or treatment-as-usual (TAU) only. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and Brief Negative Symptom Scale (BNSS) at baseline, post-treatment, and 6-months follow-up. Significant differences between the BA+TAU and TAU only groups were observed in the measures of negative symptoms post-treatment. The total score of CAINS was significantly decreased after BA treatment (η2=0.13). The tendency of the BA+TAU treatment effect was also observed for the BNSS total score and PANSS negative symptom subscale (η2=0.10 and η2=0.11, respectively). However, the difference between the two groups was not sustained at the six-month follow-up. Our findings suggest that BA could be a promising time-limited and structured psychosocial intervention for schizophrenia-associated negative symptoms with the merit of easy dissemination. Further studies are needed to examine the factors involved in sustaining improvement.

The Correlation of Positive and Negative Symptoms (PANSS Scores) in Patients with Schizophrenia According to Gender.

Schizophrenia is chronic and debilitating psychiatric disorder, characterized by a constellation of clinical signs and symptoms that are categorized into distinct positive, negative, disorganization and cognitive symptom domains. The outcome of the disease is better in female patients compared to male patients who have a higher risk of rehospitalization and twice as long duration of hospital treatment. In male patients with schizophrenia an earlier onset of the disease, negative symptoms and a more severe clinical picture are noted, with a less promising therapeutic response to neuroleptics. The onset of negative symptoms is more variable. The aim of the study was to determine the correlation of positive and negative symptoms (PANSS scores) in patients with schizophrenia according to gender. The sample included 40 subjects with schizophrenia (21 males; 19 females). The study was conducted at the Department of Psychiatry Clinical Center University of Sarajevo. All male subjects have a PANSS negative symptoms score of 17 or higher, while all female subjects have a PANSS negative symptoms score of less than 17. While the difference in the variances is not statistically significant, the results show that the difference in the average values of the PANSS symptom score between male and female subjects is statistically significant for both positive and negative symptoms (p=0.026). Diminished sociality, emotional responsiveness, and drive during childhood have been reported in a substantial minority of patients with schizophrenia. This aspect of the illness may account for the low level of emotional expression and neuromotor dysfunction in infants who subsequently have schizophrenia. In other patients, the negative symptoms first occur after the onset of psychosis.

Multidimensional predictors of negative symptoms in antipsychotic-naive first-episode psychosis.

Background:Despite a large body of schizophrenia research, we still have no reliable predictors to guide treatment from illness onset. The present study aimed to identify baseline clinical or neurobiological factors — including peripheral brain-derived neurotrophic factor (BDNF) levels and amygdala or hippocampal relative volumes — that could predict negative symptomatology and persistent negative symptoms in first-episode psychosis after 1 year of follow-up.Methods:We recruited 50 drug-naive patients with first-episode psychosis and 50 age- and sex-matched healthy controls to study brain volumes. We performed univariate and multiple and logistic regression analyses to determine the association between baseline clinical and neurobiological variables, score on the PANSS negative subscale and persistent negative symptoms after 1 year of follow-up.Results:Low baseline serum BDNF levels (p = 0.011), decreased left amygdala relative volume (p = 0.001) and more severe negative symptomatology (p = 0.021) predicted the severity of negative symptoms at 1 year, as measured by the PANSS negative subscale. Low baseline serum BDNF levels (p = 0.012) and decreased left amygdala relative volume (p = 0.010) predicted persistent negative symptoms at 1 year.Limitations:We were unable to assess negative symptoms and their dimensions with next-generation scales, which were not available when the study was initiated.Conclusion:This study shows that a set of variables at baseline, including low BDNF levels, smaller left amygdala relative volume and score on the PANSS negative subscale are significant predictors of outcomes in first-episode psychosis. These findings might offer an initial step for tailoring treatments in first-episode psychosis.

The Correlation of PANSS Scores and P100 Latency in Patients with Schizophrenia and Migrene Hedache Using Visual Evoked Potentials (VEPS) According to Gender and Age.

The VEPs provide an objective measure of brain function, analyzing integrity of visual processing. With patients affected with schizophrenia, the changes with the implementation of VEP are evident, such as symmetrical deceleration of the impulse and the continuance of latency, which points to a degenerative illness, suggesting the presence of optical neuritis or hemianopsia conjoined with mentioned intracranial illness. The aim of the study was to determine the correlation of positive and negative symptoms (PANSS scores) and P100 latency between patients with schizophrenia and patients with migraine headache according to gender and age. Visual evoked potentials (VEPs) were applied. The sample included 80 subjects: a) S group- 40 patients with schizophrenia (21 males; 19 females); b) H group-40 healthy subjects with migraine headache (10 males; 30 females). The study was conducted at the Department of Psychiatry and Neurology University Clinical Center Sarajevo. Our research revealed positive correlation of the P100 latency and the PANSS score of negative symptoms, which means that the subjects of the observed group with a higher latency of the P100 wave of the entire visual field in both eyes have higher PANSS scores of negative symptoms. The correlation is significantly higher in female subjects (37% shared variance) than in male subjects (12% shared variance). All male subjects have a PANSS negative symptoms score of 17 or higher, while all female subjects have a PANSS negative symptoms score of less than 17 positive correlations were registered in P100 latency in left view field of both eyes and in P100 amplitude in the region of right eye (p=0.01) in comparation with left eye region (p=0.05) in patients with schizophrenia. Results imply that the cognitive impairment seen in schizophrenia is not just due to deficits in higher order aspects of cognition but also encompasses significant deficits in early sensory processing. Our study is useful to initiate new questions and recommendations for further studies, specifically on changes in the occipital lobe in the schizophrenic patient's brain.

Assessment of Negative Symptoms in Clinical Trials of Acute Schizophrenia: Test of a Novel Enrichment Strategy.

Drug trials for negative symptoms in schizophrenia select patients based on the severity and stability of negative symptoms, using criteria that are not suitable for trials of acute exacerbation of schizophrenia. Here we present a method to prognostically enrich subjects having a predefined factor structure in PANSS and apply it to the measurement of negative symptoms specifically in trials of acute schizophrenia. A vector of 1335 elements based on between- and within-item variances, covariances, and differences of PANSS items was created to calculate an index of heterogeneity and to enrich for a predetermined symptom construct in PANSS. Using prerandomization PANSS scores across N = 4876 subjects in 13 trials of acute schizophrenia, we demonstrate an ability to select for a subpopulation having the greatest amount of variance explained across the 7-items of the Marder PANSS negative symptom (MPNS) construct. Network analyses on subjects enriched for MPNS construct confirm that negative symptoms were most influential in overall psychopathology, distinct from subjects without the MPNS construct. As expected for D2 antagonists, drug-placebo differences on negative symptoms with lurasidone were not specific to the subpopulation having the MPNS construct. In contrast, the novel TAAR1 agonist ulotaront demonstrated specific improvements in negative symptoms which were greatest in the MPNS subpopulation. These results demonstrate the utility of a novel prognostic enrichment strategy that can address heterogeneity in clinical trials, where patients can be selected on the basis of a greater likelihood of having the measured symptom construct (negative symptoms) related to the disorder (schizophrenia). ClinicalTrials.gov Identifiers: NCT0296938, NCT00088634, NCT00549718, NCT00615433, NCT00790192.

Effect of mGluR2 positive allosteric modulation on frontostriatal working memory activation in schizophrenia.

Negative symptoms and cognitive deficits contribute strongly to disability in schizophrenia, and are resistant to existing medications. Recent drug development has targeted enhanced NMDA function by increasing mGluR2/3 signaling. However, the clinical utility of such agents remains uncertain, and markers of brain circuit function are critical for clarifying mechanisms and understanding individual differences in efficacy. We conducted a double-blind, placebo-controlled, randomized cross-over (14 day washout) pilot study evaluating adjunctive use of the mGluR2 positive allosteric modulator AZD8529 (80mg daily for 3 days), in chronic stable patients with schizophrenia (n=26 analyzed). We focused on 3T fMRI response in frontostriatal regions during an n-back working memory task, testing the hypothesis that AZD8529 produces fMRI changes that correlate with improvement in negative symptoms and cognition. We found that AZD8529 did not produce significant group-average effects on symptoms or cognitive accuracy. However, AZD8529 did increase n-back fMRI activation in striatum (p<0.0001) and anterior cingulate/paracingulate (p=0.002). Greater drug-versus-placebo effects on caudate activation significantly correlated with greater reductions in PANSS negative symptom scores (r=−0.42, p=0.031), and exploratory correlations suggested broader effects across multiple symptom domains and regions of interest. These findings demonstrate that fMRI responses to mGluR2 positive modulation relate to individual differences in symptom reduction, and could be pursued for future biomarker development. Negative clinical results at the group level should not lead to premature termination of investigation of this mechanism which may benefit an important subset of individuals with schizophrenia. Imaging biomarkers may reveal therapeutic mechanisms, and help guide treatment towards specific populations.

Effects of High-Frequency rTMS on Negative Symptoms and Cognitive Function in Hospitalized Patients With Chronic Schizophrenia: A Double-Blind, Sham-Controlled Pilot Trial.

This study aimed to evaluate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral pre-frontal cortex (DLPFC) in ameliorating negative symptoms and cognitive impairments in patients with chronic schizophrenia. Fifty-two patients with chronic schizophrenia were randomly assigned to two groups: active rTMS group and sham rTMS group, with existing antipsychotic drugs combined 20 sessions of 10 Hz active/sham rTMS over DLPFC (20 min/session, 5 times/week). The PANSS, RBANS, and SCWT were used to evaluate the clinical symptoms and cognitive functions of the patients. Our results indicated significant improvements in clinical symptoms (PANSS total and subscale scores) and cognitive functions (RBANS total and subscale scores, card 1 and card 3 of the SCWT test) (All p <0.05) after 4-week intervention both in active and sham rTMS group. Moreover, the active rTMS group showed more effective on ameliorating negative symptoms (p = 0.002), immediate memory (p = 0.016) and delayed memory (p = 0.047) compared to the sham group. Interestingly, PANSS negative symptom scores was negatively correlated with RBANS language scores in the real stimulation group (p = 0.046). The study found that the high frequency rTMS stimulation over left DLPFC as a supplement to antipsychotics may have potential benefits in improving clinical symptoms and cognitive functions in patients with chronic schizophrenia.

Can Microfinance-Based Poverty Alleviation Programs Help Patients with Severe Mental Illness?

Background: While the social security programs offer financial assistance to patients with severe mental illness in high-income countries, no such systems exist in low- and middle-income countries. During recent years, poverty alleviation programs have been found to alleviate poverty in many countries. However, such programs have not been tried in persons with severe mental illness. We report 1-year outcomes of a microfinance program to alleviate poverty in patients with schizophrenia in a low-income country. Objectives: The objectives were to assess the feasibility and acceptability of a poverty alleviation program and to study the effect of the program on clinical and financial variables. Methods: Twenty-five (25) unemployed, young persons (19–35) with severe mental illness living with the family were recruited into a microfinance-based poverty alleviation program. Feasibility was assessed through recruitment and retention. Psychopathology and functioning were assessed through Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale, and Global Assessment of Functioning at baseline and 12 months. Results: The program was feasible and acceptable, with excellent recruitment and retention rates. There were statistically significant improvements in PANSS-positive symptoms (P &lt; 0.000), PANSS-negative symptoms (P &lt; 0.000), PANSS-general score (P &lt; 0.000), and functioning (P &lt; 0.001). At 12 months, participants earned an average of $USD 40/month, with an average of $USD 10 spent on medication, $USD 12.5 on loan repayment, and $USD 17.5 contribution to family living. Conclusions: Poverty alleviation programs can be used to help younger persons with severe mental illness. However, this study has numerous limitations, and there is a need to conduct definitive trials in this area.

Alterations in functional network centrality in first-episode drug-naïve adolescent-onset schizophrenia.

Schizophrenia is a disorder resulting from aberrant brain networks and circuits. In the current study, we aimed to investigate specific network alterations in adolescent-onset schizophrenia (AOS) and to help identify the neurophysiological mechanisms of this adolescent disorder. We recruited forty-one subjects, including 20 AOS patients and 21 matched healthy controls (HCs), and we acquired brain images to examine the specific changes in functional network patterns using degree centrality (DC), which quantifies the strength of the local functional connectivity hubs. Whole-brain correlation analysis was applied to assess the relationships between clinical characteristics and DC measurements. The AOS group exhibited increased DC in the right inferior frontal lobe, right fusiform gyrus and right thalamus (p < 0.05, AlphaSim correction). Whole-brain correlation analysis found that the DC value in the right parahippocampus was positively correlated with PANSS-positive symptom scores (r = 0.80); DC in the right superior parietal lobe (SPL) was positively correlated with PANSS-negative symptom scores (r = 0.79); DC in the left precuneus was positively correlated with self-certainty (SC) scores (r = 0.70); and DC in the left medial frontal gyrus (MFG) was negatively correlated with self-reflectiveness (SR) scores (r = 0.69). We conclude that frontoparietal network and cortico-thalamo-cortical pathway disruptions could play key roles in the neurophysiological mechanisms underlying AOS. In AOS patients, the right parahippocampus and SPL are important structures associated with positive and negative symptoms, respectively, and the left precuneus and MFG contribute to deficits in cognitive insights.

Negative symptoms of schizophrenia in patients with acute and transient psychotic disorders

IntroductionThe ICD-10 acute and transient psychotic disorders (ATPD, F23) without symptoms of schizophrenia are considered predominantly reactive psychotic disorders or affective pathology. However, negative symptoms of schizophrenia may be revealed in some of these cases after the psychotic reduction.ObjectivesTo investigate the association between the developmental characteristics of psychosis and the negative symptoms detection after the psychotic reduction of ATPD without symptoms of schizophrenia.Methods68 adult inpatients with ATPD without symptoms of schizophrenia (F23.0) were examined. Negative symptoms were assessed with the PANSS negative symptom subscale (PANSS-NSS). The sample was divided into two groups: with PANSS-NSS score&gt;14 (n=12) and with PANSS-NSS score≤14 (n=56), respectively. Clinical-psychopathological, psychometric and statistical methods were applied.ResultsThe results of the study are presented in Table 1.Table 1. The ATPD developmental featuresFeaturesThe 1st group (n=12)The 2nd group (n=56)Pearson’s contingency coefficient (C)Males7 (58,3%)37 (66,1%)0.062Females5 (41,7%)19 (33,9%)0.062Mean age of psychotic onset, years (М±m)24,9±10,530,8±10,2-Family history of schizophrenia*4 (33,3%)1 (1,8%)0.418Poor premorbid social adaptation*5 (41,7%)00.520Prodromal functional decline*9 (75,0%)4 (7,1%)0.550Prodromal non-psychotic symptoms9 (75,0%)30 (53,6%)0.163Associated acute stress4 (33,3%)27 (48,2%)0.113*p&lt;0,001ConclusionsThe probability of negative symptoms detection in ATPD without symptoms of schizophrenia is relatively strongly associated with the family history of schizophrenia, poor premorbid social adaptation and functional decline prior to the psychotic onset.DisclosureNo significant relationships.

Comparative study of effectiveness of augmentation with ECT in clozapine resistant schizophrenia (CRS) and non-clozapine resistant schizophrenia (Non-CRS)

Background There is limited evidence for different treatment strategies in patients with clozapine resistant schizophrenia (CRS). Aim To determine the effectiveness of ECT in patients with clozapine resistant schizophrenia and compare the same with a group of patients with non-clozapine resistant schizophrenia, receiving ECT. Results Out of a total of 68 patients with schizophrenia, 27 (38.66%) of patients had CRS. With 6 ECTs, there was a significant reduction in PANSS positive, negative, general psychopathology, prosocial score and depression symptoms in the CRS (p < 0.001) and Non-CRS group (p < 0.001), but no statistically significant difference was seen between the 2 groups in terms of proportion of patients showing >40% response on PANSS total score. The reduction in PANSS score of >40% in CRS group was seen in 48.1% of patients in the positive symptoms subscale, in 25.9% of patients in negative symptoms subscale, in 46.7% of cases in the general psychopathology subscale, in 44.4% of the patients in Depression subscale, in 29.6% of the patients in the modified prosocialsubscaleand in 29.6% of the patients in total PANSS score. Conclusion ECT is an effective augmentation strategy for patients with CRS and it is as effective as when used in patients with non-CRS.

Muscarinic Cholinergic Receptor Agonist and Peripheral Antagonist for Schizophrenia

BackgroundThe muscarinic receptor agonist xanomeline has antipsychotic properties and is devoid of dopamine receptor–blocking activity but causes cholinergic adverse events. Trospium is a peripherally restricted muscarinic receptor antagonist that reduces peripheral cholinergic effects of xanomeline. The efficacy and safety of combined xanomeline and trospium in patients with schizophrenia are unknown.MethodsIn this double-blind, phase 2 trial, we randomly assigned patients with schizophrenia in a 1:1 ratio to receive twice-daily xanomeline–trospium (increased to a maximum of 125 mg of xanomeline and 30 mg of trospium per dose) or placebo for 5 weeks. The primary end point was the change from baseline to week 5 in the total score on the Positive and Negative Syndrome Scale (PANSS; range, 30 to 210, with higher scores indicating more severe symptoms of schizophrenia). Secondary end points were the change in the PANSS positive symptom subscore, the score on the Clinical Global Impression–Severity (CGI-S) scale (range, 1 to 7, with higher scores indicating greater severity of illness), the change in the PANSS negative symptom subscore, the change in the PANSS Marder negative symptom subscore, and the percentage of patients with a response according to a CGI-S score of 1 or 2.ResultsA total of 182 patients were enrolled, with 90 assigned to receive xanomeline–trospium and 92 to receive placebo. The PANSS total score at baseline was 97.7 in the xanomeline–trospium group and 96.6 in the placebo group. The change from baseline to week 5 was −17.4 points with xanomeline–trospium and −5.9 points with placebo (least-squares mean difference, −11.6 points; 95% confidence interval, −16.1 to −7.1; P<0.001). The results for the secondary end points were significantly better in the xanomeline–trospium group than in the placebo group, with the exception of the percentage of patients with a CGI-S response. The most common adverse events in the xanomeline–trospium group were constipation, nausea, dry mouth, dyspepsia, and vomiting. The incidences of somnolence, weight gain, restlessness, and extrapyramidal symptoms were similar in the two groups.ConclusionsIn a 5-week trial, xanomeline–trospium resulted in a greater decrease in the PANSS total score than placebo but was associated with cholinergic and anticholinergic adverse events. Larger and longer trials are required to determine the efficacy and safety of xanomeline–trospium in patients with schizophrenia. (Funded by Karuna Therapeutics and the Wellcome Trust; ClinicalTrials.gov number, NCT03697252.)

Comparative study of olanzapine and risperidone in the control of positive and negative symptoms in the treatment of schizophrenia

Objective: To compare the efficacy of olanzapine and risperidone in the treatment of positive and negative symptoms of schizophrenia. Materials and Methods: The study was conducted in MGM medical college Navi Mumbai between October 2012 to September 2014. The study included 110 patients of schizophrenia. The positive and negative symptoms were assessed with the help of the PANSS (positive & negative symptom score) scale. Results: We observed that the mean percentage reduction in score in the positive scale of PANSS was 48.74% in the risperidone and 49.40% in the olanzapine group .The negative score reduced by 56.32% in the Risperidone group and by 61.59% in the olanzapine group on the PANSS. Conclusion: olanzapine was superior to risperidone in controlling the positive as well as negative symptoms of schizophrenia clinically but the results were not statistically significant. Keywords: Olanzaine, Risperidone, Schizophrenia.