Schizoaffective Research Articles

Demographic and Geographic Trends in First-Episode Psychosis: A Cross-Sectional Study of Hospital Discharge Data in Adolescents and Young Adults.

This cross-sectional study aimed to assess the demographic and geographic variations in the visit rate for first-episode psychosis (FEP), identify trends and diagnostic patterns, and explore factors associated with FEP visits in Nebraska. Inpatient and emergency department data spanning 2017-2021 were collected by the Nebraska Hospital Association (NHA). The study focused on Nebraska residents aged 14-35 admitted for FEP, identified through specific ICD-10 codes. The sample was derived using a multi-step process, and the data included patient demographics, Behavioral Health Regions, rural vs. urban residency, and neighborhood characteristics. Mann-Kendall tests were used to test for significant trends over time. T-tests and chi-squared tests were used to assess differences in each of the measures between patients with and without psychotic disorders. The study findings revealed a significant increase in visits related to psychotic disorders from 2017 to 2021. In 2021, the FEP visit rate was 116 per 100,000 individuals, varying considerably by age, gender, and Behavioral Health Region. Schizoaffective disorder bipolar type was the most frequent psychotic disorder. Patients with psychotic disorders tended to be older, predominantly male, and treated in acute care settings. The rising trend underlines the need for continued investment in early intervention programs and highlights challenges in rural areas, necessitating targeted interventions. The findings provide valuable insights to inform planning, advocate for funding, and address the specific needs of diverse populations. Future research should explore additional influencing factors and extend the study period to understand FEP trends comprehensively.

COVID-19 in patients with severe mental illness: An analysis of in-patients at a psychiatric hospital in Cape Town

Background: Psychiatric patients in specialist units are more vulnerable to infections such as SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) because of hospital infrastructure and patients’ mental health.Aim: This study aimed to describe the psychiatric and medical profile, and the risk factors associated with more severe disease and clinical outcomes of coronavirus disease 2019 (COVID-19) in patients with severe mental illness (SMI) admitted to a specialist psychiatric hospital in South Africa between 01 April 2020 and 30 September 2021.Setting: The study was executed at the Vàlkenberg Hospital (VBH), which is a government-funded, specialised psychiatric hospital. The hospital comprises 370 beds made up of 145 forensic service beds and 225 acute service beds. It provides in-patient and out-patient services.Methods: Demographic and clinical information were collected for all VBH in-patients who tested positive for SARS-COV-2 from 01 April 2020 to 30 September 2021.Results: A total of 254 participants tested positive for SARS-COV-2. The sample comprised 75% (n = 191) males with a mean age of 35.7 years. Most patients were diagnosed with schizophrenia (37%, n = 94), bipolar disorder (21%, n = 54) and schizoaffective disorder (19%, n = 49). Reported comorbidities included nicotine use (71%, n = 181), hypertension (11%, n = 28) and human immunodeficiency virus (7%, n = 18). Most patients (62%, n = 156) were symptomatic for COVID-19. Seven per cent (n = 17) required transfer to a medical ward. Almost all patients (99%, n = 252) recovered and 1% (n = 2) died.Conclusion: Contrary to early fears of high mortality among institutionalised SMI patients, most experienced mild COVID-19 illness and recovered.Contribution: This descriptive study provided information on in-patients with COVID-19 disease at a specialised psychiatric hospital during the pandemic.

Effectiveness of a Videoconference-Based Cognitive Behavioral Therapy Program for Patients with Schizophrenia: Pilot Randomized Controlled Trial.

Cognitive behavioral therapy for psychosis (CBTp) is not sufficiently widespread in clinical practice, although evidence has been presented. The purpose of this study was to explore whether one-on-one videoconference-based CBTp (vCBTp) is more effective than usual care (UC) alone for improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp program was conducted once a week, with each session lasting for 50 minutes, for a total of 7 sessions conducted in real-time and in a one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline (week 0) to posttest (week 8). The study included 24 participants. There were no significant differences between the 2 groups at baseline. With regard to significant differences between the 2 groups in terms of the primary outcome, the mean change in the PANSS total score from baseline to week 8 in the vCBTp plus UC group was -9.5 (95% CI -12.09 to -6.91) and the mean change in the UC alone group was 6.9 (95% CI 1.54-12.30). The difference between the 2 groups was significant (P<.001). In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder-7 (GAD-7; P=.04) and EQ-5D-5L (P=.005). There were no dropouts and no serious adverse events in this study. A total of 7 remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life. However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the 2 groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety regarding transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. University Hospital Medical Information Network Clinical Trials Registry UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544. RR2-10.1136/bmjopen-2022-069734.

65 Year Old Woman with Schizoaffective Disorder Very Late Onset dan Withdrawal Benzodiazepine

Schizoaffective disorder is characterized by a combination of symptoms of schizophrenia and of affective disorders. This paper reports a 65-year-old female with sychotic symptoms and agitation. The patient was diagnosed as bipolar type schizoaffective with benzodiazepine withdrawal based on the presence of symptoms of schizophrenia and mood involvement and a history of abrupt discontinuation of benzodiazepines. Patient carried out daily activities independently even though her social relations are disrupted. Schizoaffective onset over 60 years is very rare. Unspecific symptoms and comorbidities may delay diagnosis.

Investigation of peripheral markers of inflammation in patients with different diagnoses on the psychosis spectrum: an observational cross-sectional study

BackgroundIncreasing evidence suggests that inflammatory dysfunction may be important across the psychotic spectrum. In this study, we investigated whether there is a difference between different diagnostic groups, in which psychosis is the common pathway, and healthy controls in markers of peripheral inflammation, such as platelet-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), systemic inflammatory response index (SIRI) and systemic immune-inflammatory index (SII), determined by haemogram. Our hypotheses are as follows: patients with a common history of psychosis but with different diagnoses have higher severity of peripheral inflammation compared to healthy controls, regardless of the specific diagnosis. In addition, the severity of peripheral inflammation is similar across different diagnoses across the psychosis spectrum.ResultsBefore and after correction for age and sex, there was no statistically significant difference in PLR between the groups. However, a substantial statistical difference in NLR and SIRI was observed between the groups. According to the post hoc analysis performed to determine which groups the difference was between, schizophrenia and the healthy control group, schizoaffective disorder and the healthy control group, and autism spectrum disorder and the healthy control group differed in terms of NLR; there was only a significant difference in SIRI between autism spectrum disorder and the healthy control group. In addition, there was a statistically significant difference between groups for SII before and after correction for age and sex; however, when paired groups were evaluated using post hoc analysis, no statistically significant differences were found between any two groups. When comparing disorder groups within the psychotic spectrum, it was observed that PLR, NLR, SIRI, and SII levels were comparable.ConclusionsOur results showed that several disorders including schizophrenia, schizoaffective disorder and autistic spectrum disorder, with different diagnoses but similarities in terms of a history of psychosis, had increased inflammation compared to healthy controls. This study contributes to the psychosis spectrum approach in that there was no statistically significant difference in the severity of inflammation in disorder groups with a history of psychosis but with different diagnostic categories. However, further research is needed to completely understand the psychosis spectrum, as bipolar disorder patients have similar inflammation levels to those without mental disorders.

Quantitative magnetization transfer and g-ratio imaging of white matter myelin in early psychotic spectrum disorders.

Myelin abnormalities in white matter have been implicated in the pathophysiology of psychotic spectrum disorders (PSD), which are characterized by brain dysconnectivity as a core feature. Among evidence from in vivo MRI studies, diffusion imaging findings have largely supported disrupted white matter integrity in PSD; however, they are not specific to myelin changes. Using a multimodal imaging approach, the current study aimed to further delineate myelin and microstructural changes in the white matter of a young PSD cohort. We utilized quantitative magnetization transfer (qMT) imagingcombined with advanced diffusion imaging to estimate specific myelin-related biophysical properties in 51 young adult PSD patients compared with 38 age-matched healthy controls. The macromolecular proton fraction (MPF) obtained from qMT was used as a specific marker of myelin content. Additionally, MPF was employed along with diffusion metrics of axonal density (vic) and extra-cellular volume fraction to derive the g-ratio, a measure of relative myelin sheath thickness defined as the ratio of inner to outer axonal diameter. Compared to controls, we observed a widespread MPF reduction and localized g-ratio increase in patients, primarily those with a diagnosis of schizophrenia or depressive schizoaffective disorder. No between-group differences were noted in vic, suggesting similar axonal densities across groups. Correlation analysis revealed that lower MPF was significantly related to poorer working memory performance in PSD, while the HC group showed a positive association for working memory with both g-ratio and vic. The pattern of changes observed in our multimodal imaging markers suggests that PSD, depending on symptomatology, is characterized by specific alterations in white matter integrity and myelin-axonal geometry of major white matter tracts, which may impact working memory function. These findings provide a more detailed view of myelin-related white matter changes in early stages of PSD.

Contemporary Perspectives in Critical Care of Neuroleptic Malignant Syndrome.

Neuroleptic malignant syndrome (NMS) is a psychiatric-neurologic emergency that may require intensive care management. There is a paucity of information about NMS as a critical illness. We reviewed the Mayo Clinic experience. A comprehensive data extraction was completed within the Mayo Clinic system diagnosed with NMS using International Classification of Diseases, ninth revision (ICD-9); ICD-9, Clinical Modification; ICD-10; ICD-10, Clinical Modification; and Health Insurance Claim (HIC) codes between the years of 1995 and 2023. Major criteria included fever, rigidity, tachycardia, and exposure to a neuroleptic agent. Minor criteria included rhabdomyolysis and dysautonomia. Criteria for exclusion were Parkinson's disease, abrupt discontinuation of baclofen or levodopa, concomitant selective serotonin reuptake inhibitors use or serotonin syndrome, malignant catatonia, or a classic dystonic reaction. A total of 332 patients had diagnostic codes of NMS, but only 20 patients fulfilled DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision), diagnostic criteria. The average age was 48.2years (range 20-93years). Four patients received antipsychotics following postoperative acute agitation or delirium (20%). Previous psychiatric diagnoses were schizophrenia or schizoaffective disorder in six patients (33%), major depressive disorder in five patients (20%), and bipolar disorder in two patients (10%). Haloperidol was the sole inciting neuroleptic in five patients (25%), but the remainder was associated with atypical or second-generation antipsychotics. A total of nine patients (45%) required mechanical ventilation. The majority of patients had rhabdomyolysis, which led to acute kidney failure in nearly half of them, but none required hemodialysis. Most patients recovered promptly, and no fatalities were directly attributable to NMS; however, four patients (20%) died within 1month, and four patients died years from diagnosis and unrelated to NMS. Neuroleptic malignant syndrome can become a critical illness, but there is often rapid recovery. Mortality proximate to NMS was uncommon, but late mortality remained substantial. The overwhelming majority of cases coded as NMS did not meet DSM-5 diagnostic criteria. Stricter criteria should be applied when diagnosing NMS in critical care and emergency medicine settings.

Comorbidity of Addictive Disorders and Mental Disorders: Experience of a Hospital Women’s Psychiatry Department

Background: Problem substance use is a frequent reason for consultation. Whether isolated or co-morbid with another pathology, it remains important to manage within a dual framework. Objective: The objective of this work is to describe the sociodemographic and clinical characteristics and addictive behaviors of patients who were admitted to the psychiatric emergency department (women’s unit) of the Ar-Razi university psychiatric hospital from July 1 to September 30, 2021 as well as present the different comorbidities found in these patients. Method: A retrospective cross-sectional study on the files of 65 patients who were admitted to the psychiatric emergency department (women’s unit) for three months, using an evaluation sheet grouping together the sociodemographic criteria of the patients, addictive behaviors and psychiatric comorbidities. Results: The average age was 36.81 years. 52% of participants were single. Tobacco and cannabis are the most consumed substances in our sample. The psychiatric comorbidities found in our patients were as follows: schizophrenia (40%), schizoaffective disorder (26%), depression (17%), personality disorder (14%), bipolar I disorder (13%), acute psychotic disorder (3%), bipolar disorder type II (3%) and anxiety disorder (2%). Conclusion: To sum up, the most frequent addictive behaviors in this category of patients are: tobacco, cannabis, benzodiazepines and alcohol. Regarding psychiatric comorbidities, we note that psychosis, depression and bipolar disorders are the most frequent in our sample. These results should encourage all practitioners to have the reflex to look for possible addictive comorbidities in patients with psychiatric disorders for better patient care and prognosis.

General medical comorbidities in psychotic disorders in the Finnish SUPER study

Schizophrenia (SZ), schizoaffective disorder (SZA), bipolar disorder (BD), and psychotic depression (PD) are associated with premature death due to preventable general medical comorbidities (GMCs). The interaction between psychosis, risk factors, and GMCs is complex and should be elucidated. More research particularly among those with SZA or PD is warranted. We evaluated the association between registry-based psychotic disorders and GMC diagnoses in a large national sample of participants with different psychotic disorders. In addition, we examined whether body mass index (BMI) and smoking as risk factors for GMCs explain differences between diagnostic groups. This was a cross-sectional study of a clinical population of participants (n = 10,417) in the Finnish SUPER study. Registry-based diagnoses of psychotic disorders and hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cancers, ischemic heart disease, and liver disorders were obtained. Participants’ BMI and self-reported smoking were recorded. Total effect of diagnostic category adjusted for age and sex as well as direct effect including known risk factors was calculated using logistic regression. Regardless of diagnostic category, participants had high BMI (average 30.3 kg/m2), and current smoking was common (42.4%). Diabetes and COPD were more common in SZ than in other diagnostic categories. The differences between psychotic disorders were not explained by obesity or smoking status only. Obesity and smoking were prevalent in all diagnostic categories of psychotic disorders, and continued efforts at prevention are warranted. Additional differences in GMC prevalence exist between psychotic disorders that are not explained by obesity and smoking.

Genetic analysis of psychosis Biotypes: shared Ancestry-adjusted polygenic risk and unique genomic associations.

The Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP) created psychosis Biotypes based on neurobiological measurements in a multi-ancestry sample. These Biotypes cut across DSM diagnoses of schizophrenia, schizoaffective disorder, and bipolar disorder with psychosis. Two recently developed post hoc ancestry adjustment methods of Polygenic Risk Scores (PRSs) generate Ancestry-Adjusted PRSs (AAPRSs), which allow for PRS analysis of multi-ancestry samples. Applied to schizophrenia PRS, we found the Khera AAPRS method to show superior portability and comparable prediction accuracy as compared with the Ge method. The three Biotypes of psychosis disorders had similar AAPRSs across ancestries. In genomic analysis of Biotypes, 12 genes, and isoforms showed significant genomic associations with specific Biotypes in a Transcriptome-Wide Association Study (TWAS) of genetically regulated expression (GReX) in the adult brain and fetal brain. TWAS inflation was addressed by the inclusion of genotype principal components in the association analyses. Seven of these 12 genes/isoforms satisfied Mendelian Randomization (MR) criteria for putative causality, including four genes TMEM140, ARTN, C1orf115, CYREN, and three transcripts ENSG00000272941, ENSG00000257176, ENSG00000287733. These genes are enriched in the biological pathways of Rearranged during Transfection (RET) signaling, Neural Cell Adhesion Molecule 1 (NCAM1) interactions, and NCAM signaling for neurite out-growth. The specific associations with Biotypes suggest that pharmacological clinical trials and biological investigations might benefit from analyzing Biotypes separately.

Features of mental state and reproductive function in dynamics inmentally ill women with infertility

Women suffering from a mental disorder are faced with the problem of pregnancy and the realisation of their reproductive rights throughout their lives. The presence of a mental disorder largely determines the onset, course and outcome of pregnancy. A deterioration in mental health is often accompanied by an impairment of menstrual and reproductive function, and an improvement contributes to their recovery.Objective: to analyse individual indicators of reproductive function in women with various mental disorders and infertility in dynamics according to the follow-up data.Material and methods. The study included 120 women with various mental disorders and infertility, who were observed for 2 years by a psychiatrist and a gynaecologist on the background of treatment of the existing disorders.Results. In 70% of cases, mentally ill women have primary infertility, with idiopathic infertility predominating (63.3%), especially in the context of secondary infertility (77.8%; p&lt;0.05). Treatment of infertility by gynaecologists and mental disorders by psychiatrists leads to the normalization of the menstrual cycle and the onset of pregnancy. Pregnancy is usually accompanied by obstetric and somatic complications (fetal growth retardation and miscarriage, placental disorders, hypertension, oedema, lipid metabolism disorders, gestational diabetes mellitus). Reproductive function is impaired mostly in patients with schizophrenia and affective disorders, they account for 80.8% of observed infertility. Fertility is lowest in patients with paranoid schizophrenia: pregnancy occurred in 12.9% of patients, none of them gave birth. In schizoaffective disorder, 43.75% of women became pregnant, but only 20% gave birth. In bipolar affective disorder (BAD) type I, pregnancy occurred in 87.5% of patients (of which 57.1% resulted in a childbirth), in bipolar disorder type II – in 43.75% (of which 42.8% resulted in a childbirth), and in recurrent depressive disorder – in 60% (of which 50% resulted in a childbirth). In these disorders, the duration of infertility correlates with the duration of the disease (p&lt;0.05). In neurotic disorders, fertility suffers to a lesser extent: pregnancy with recovery or significant improvement of the mental condition occurred in 75–100% of cases, but only 66.7% of cases resulted in a child birth. Childbirth was mainly performed by caesarean section.Conclusion. Reproductive function in mentally ill women depends largely on the type of mental disorder, the characteristics of its course, the efficacy of psychopharmacotherapy, the quality of remission and the degree of social and family adaptation, which must be taken into account in the diagnosis and treatment of infertility.

Gene Variant Related Neurological and Molecular Biomarkers Predict Psychosis Progression, with Potential for Monitoring and Prevention.

The (MTHFR) C677T gene polymorphism is associated with neurological disorders and schizophrenia. Patients diagnosed with schizophrenia and schizoaffective disorder and controls (n 134) had data collected for risk factors, molecular and neuro-sensory variables, symptoms, and functional outcomes. Promising gene variant-related predictive biomarkers were identified for diagnosis by Receiver Operating Characteristics and for illness duration by linear regression. These were then analyzed using Spearman's correlation in relation to the duration of illness. Significant correlations were ranked by strength and plotted on graphs for each MTHFR C677T variant. Homozygous MTHFR 677 TT carriers displayed a mid-illness switch to depression, with suicidality and a late-phase shift from lower to higher methylation, with activated psychosis symptoms. MTHFR 677 CC variant carriers displayed significant premorbid correlates for family history, developmental disorder, learning disorder, and head injury. These findings align with those of low methylation, oxidative stress, multiple neuro-sensory processing deficits, and disability outcomes. Heterozygous MTHFR 677 CT carriers displayed multiple shifts in mood and methylation with multiple adverse outcomes. The graphically presented ranked biomarker correlates for illness duration allow a perspective of psychosis development across gene variants, with the potential for phase of illness monitoring and new therapeutic insights to prevent or delay psychosis and its adverse outcomes.

Depression Treatment After a Positive Depression Screen Result

As primary care practices increase depression screening, it is unknown whether screening is associated with appropriate and equitable treatment. To investigate factors associated with initial treatment among patients who screen positive for depression and/or suicidal ideation (SI). Cohort study using electronic health record data from September 2017 to September 2021, from a large US academic health system. Participants were adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥10) and/or SI, excluding patients with baseline depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. Data were analyzed from December 30, 2022, to February 17, 2024. Patient characteristics including gender, age, preferred language, and race and ethnicity. Primary outcome was antidepressant or mental health referral ordered at screening. Secondary outcomes were antidepressant/referral and antidepressant/referral or follow-up visit within 8 weeks. Of 60 062 patients screened, 3980 (7%) reported elevated depressive symptoms or SI. The cohort was 68.1% women (2711), and the mean (SD) age was 46.5 (17.6) years; 0.8% were 12.4% African American or Black (493), American Indian or Alaska Native (30), 24.8% Asian (988), 14.6% Latino/Latina/Latinx (582), 1.5% Pacific Islander (58), and 36.9% White (1470), and 9.0% other/unknown (359); 5.6% preferred a non-English language (223). Approximately 38% (1518) received antidepressants/referrals when screened (including 44% of 461 patients [203] with SI). By 8 weeks, 2785 patients (70%) received antidepressant/referral and/or follow-up (including 75% of 783 patients with SI). In multivariable logistic regression models adjusting for site and clustered on primary care physician, there were no statistically significant differences in the primary outcome by gender, preferred language, or health insurance. African American or Black and Asian patients had lower estimated probabilities of treatment ordered when screened (34.0% [95% CI, 28.4%-39.6%] for Black patients and 35.4% [95% CI, 31.5%-39.4%] for Asian patients) than White patients (40.5% [95% CI 37.4%-43.5%]). Estimated treatment decreased with increasing age (46.4% [95% CI, 41.2%-51.5%] for patients aged 18-30 years and 17.5% [95% CI, 12.1%-22.9%] for patients aged ≥75 years). Patients with SI had greater estimated treatment than those without SI (43.5% [95% CI, 39.9%-47.1%] vs 35.2% [95% CI, 33.0%-37.5%]), although treatment was overall low for this high-risk group. Secondary outcomes were consistent, although there were no statistically significant differences in follow-up visits for African American or Black and Asian patients compared with White patients. In this cohort study, moderate rates of initial treatment among patients with elevated depressive symptoms and/or SI were found. Targeted interventions are needed for patients at risk of undertreatment, including patients with SI, African American or Black and Asian patients, and older adults.

Genetic Analysis of Psychosis Biotypes: Shared Ancestry-Adjusted Polygenic Risk and Unique Genomic Associations.

The Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP) created psychosis Biotypes based on neurobiological measurements in a multi-ancestry sample. These Biotypes cut across DSM diagnoses of schizophrenia, schizoaffective disorder and bipolar disorder with psychosis. Two recently developed post hoc ancestry adjustment methods of Polygenic Risk Scores (PRSs) generate Ancestry-Adjusted PRSs (AAPRSs), which allow for PRS analysis of multi-ancestry samples. Applied to schizophrenia PRS, we found the Khera AAPRS method to show superior portability and comparable prediction accuracy as compared with the Ge method. The three Biotypes of psychosis disorders had similar AAPRSs across ancestries. In genomic analysis of Biotypes, 12 genes and isoforms showed significant genomic associations with specific Biotypes in Transcriptome-Wide Association Study (TWAS) of genetically regulated expression (GReX) in adult brain and fetal brain. TWAS inflation was addressed by inclusion of genotype principal components in the association analyses. Seven of these 12 genes/isoforms satisfied Mendelian Randomization (MR) criteria for putative causality, including four genes TMEM140, ARTN, C1orf115, CYREN, and three transcripts ENSG00000272941, ENSG00000257176, ENSG00000287733. These genes are enriched in the biological pathways of Rearranged during Transfection (RET) signaling, Neural Cell Adhesion Molecule 1 (NCAM1) interactions, and NCAM signaling for neurite out-growth. The specific associations with Biotypes suggest that pharmacological clinical trials and biological investigations might benefit from analyzing Biotypes separately.

Real-World Treatment of Schizophrenia in Adults With a 22q11.2 Microdeletion: Traitement dans le monde réel de la schizophrénie chez des adultes atteints du syndrome de microdélétion 22q11.2.

One in every 4 individuals born with a 22q11.2 microdeletion will develop schizophrenia. Thirty years of clinical genetic testing capability have enabled detection of this major molecular susceptibility for psychotic illness. However, there is limited literature on the treatment of schizophrenia in individuals with a 22q11.2 microdeletion, particularly regarding the issue of treatment resistance. From a large, well-characterized adult cohort with a typical 22q11.2 microdeletion followed for up to 25 years at a specialty clinic, we studied all 107 adults (49 females, 45.8%) meeting the criteria for schizophrenia or schizoaffective disorder. We performed a comprehensive review of lifetime (1,801 patient-years) psychiatric records to determine treatments used and the prevalence of treatment-resistant schizophrenia (TRS). We used Clinical Global Impression-Improvement (CGI-I) scores to compare within-individual responses to clozapine and nonclozapine antipsychotics. For a subgroup with contemporary data (n = 88, 82.2%), we examined antipsychotics and dosage at the last follow-up. Lifetime treatments involved on average 4 different antipsychotic medications per individual. Sixty-three (58.9%) individuals met the study criteria for TRS, a significantly greater proportion than for a community-based comparison (42.9%; χ2 = 10.38, df = 1, p < 0.01). The non-TRS group was enriched for individuals with genetic diagnosis before schizophrenia diagnosis. Within-person treatment response in TRS was significantly better for clozapine than for nonclozapine antipsychotics (p < 0.0001). At the last follow-up, clozapine was the most common antipsychotic prescribed, followed by olanzapine, risperidone, and paliperidone. Total antipsychotic chlorpromazine equivalent dosages were in typical clinical ranges (median: 450 mg; interquartile range: 300, 750 mg). The results for this large sample indicate that patients with 22q11.2 microdeletion have an increased propensity to treatment resistance. The findings provide evidence about how genetic diagnosis can inform clinical psychiatric management and could help reduce treatment delays. Further research is needed to shed light on the pathophysiology of antipsychotic response and on strategies to optimize outcomes.

RNA Editing Signatures Powered by Artificial Intelligence: A New Frontier in Differentiating Schizophrenia, Bipolar, and Schizoaffective Disorders.

Mental health disorders are devastating illnesses, often misdiagnosed due to overlapping clinical symptoms. Among these conditions, bipolar disorder, schizophrenia, and schizoaffective disorder are particularly difficult to distinguish, as they share alternating positive and negative mood symptoms. Accurate and timely diagnosis of these diseases is crucial to ensure effective treatment and to tailor therapeutic management to each individual patient. In this context, it is essential to move beyond standard clinical assessment and employ innovative approaches to identify new biomarkers that can be reliably quantified. We previously identified a panel of RNA editing biomarkers capable of differentiating healthy controls from depressed patients and, among depressed patients, those with major depressive disorder and those with bipolar disorder. In this study, we integrated Adenosine-to-Inosine RNA editing blood biomarkers with clinical data through machine learning algorithms to establish specific signatures for bipolar disorder and schizophrenia spectrum disorders. This groundbreaking study paves the way for the application of RNA editing in other psychiatric disorders, such as schizophrenia and schizoaffective disorder. It represents a first proof-of-concept and provides compelling evidence for the establishment of an RNA editing signature for the diagnosis of these psychiatric conditions.

Comparison of Psychiatric Readmission Rates for Child and Adolescent Patients on Long-Acting Injectable Antipsychotics Versus Oral Antipsychotics: A Mirror Study.

Objectives: Current literature shows a benefit in clinical outcomes when long-acting injectable antipsychotics (LAIAs) are utilized in adult patients with psychiatric disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder. Literature regarding LAIA use in pediatric patients is sparse. The objective of this study is to compare the number of acute psychiatric admissions, psychiatric emergency services (PES) visits, and total number of days admitted to an acute psychiatric hospital 1 year prior to and 1-year post-mirror point of index hospitalization and LAIA initiation. Methods: This was a single-site retrospective mirror-image review of patients <18 years of age initiated on an LAIA during an acute psychiatric hospitalization between October 1, 2015, and October 31, 2022. The number of admissions to the acute psychiatric hospital, number of PES visits, and total number of days hospitalized at the acute psychiatric hospital were captured 1-year pre-index hospitalization admission and 1-year post-index hospitalization discharge, with LAIA administration during index hospitalization being the mirror point. Descriptive statistics and a two-tailed paired t-test were utilized to analyze the data. Results: There were 45 unique pediatric patients initiated on an LAIA during the specified timeframe. Across these 45 patients, there were 47 psychiatric admissions 1-year pre-index hospitalization and 38 psychiatric admissions 1-year post-index hospitalization discharge (p = 0.37). Additionally, there were 24 PES visits 1-year pre-index hospitalization admission and 16 PES visits 1-year post-index hospitalization discharge (p = 0.25). Finally, across the 45 patients, there were a total of 1040 days admitted to the acute psychiatric hospital in the 1-year prior to index hospitalization admission compared with 774 days admitted to the acute psychiatric hospital in the 1-year post-index hospitalization discharge (p = 0.48). Conclusions: In this cohort of pediatric patients initiated on an LAIA, there was a positive trend favoring LAIA therapy over oral antipsychotic therapy with LAIA injection as the mirror point; however, there was no statistically significant difference in the number of psychiatric admissions, number of PES visits, or total number of days admitted to an acute psychiatric hospital. Further studies are required to fully understand the impact of LAIA therapy on clinical outcomes for child and adolescent patients with psychiatric disorders.

Hormone therapy reduces psychotic relapse risk in women of menopausal age

Women of menopausal age with schizophrenia or schizoaffective disorder who used menopausal hormone therapy experienced a reduced risk of psychotic relapse compared with non‐use, a study using a within‐individual design has found. Relapse risk was decreased in women who initiated hormone therapy between the ages of 40 and 55.

Prevalence of Neurodevelopmental, Mental, and Behavioral Disorders in a Sample of U.S. Commercially Sexually Exploited Youth, and Associations with Health and Health Care Access

ABSTRACT Little is known about the prevalence of neurodevelopmental, mental, or behavioral disorders among CSEC survivors, and the experiences of CSEC survivors with these disorders with health care. We conducted a self-report survey study with N = 269 youths between the ages of 13 and 24 years old who disclosed that they had experienced CSEC prior to age 18 in the United States. The vast majority, 82%, reported that they had ever been diagnosed with a neurodevelopmental disorder or neurological impairment (i.e. ADHD, autism, intellectual disability, or learning disorder), a serious mental illness (i.e. schizophrenia, schizoaffective disorder, or bipolar disorder), a mood disorder (i.e. PTSD, depression, or anxiety), or a behavioral disorder (substance use, eating, or conduct disorder). Approximately 26% reported seeking healthcare while being exploited. Those with Serious mental illness (SMI) or behavioral disorder were more likely than other subsets of CSEC survivors to report poor mental and physical health, and negative experiences in the healthcare setting. Our findings have direct implications for efforts that align with the UN's Sustainable Development Goal of “promoting just, peaceful and inclusive societies,” in that they provide support for the idea that health care providers will benefit from training in supporting human trafficking survivors with neurodevelopmental, mental, and behavioral disorders.

Successful Management of Schizoaffective Disorder (Manic Type) in a Pregnant Woman with Electroconvulsive Therapy: A Case Report

Successful Management of Schizoaffective Disorder (Manic Type) in a Pregnant Woman with Electroconvulsive Therapy: A Case Report