Schizophrenia Spectrum Disorders Research Articles

Exploring the acceptability, and feasibility of a modified virtual reality-based AVATAR therapy in schizophrenia spectrum disorders: A case series report

Schizophrenia spectrum disorder poses a complex challenge in psychiatric treatment due to its multifaceted symptomatology. Modified AVATAR therapy, an innovative virtual reality-based intervention integrating Cognitive Behavioral Therapy (CBT) techniques such as systematic desensitization, and Acceptance and Commitment Therapy (ACT) approach offers a promising avenue for addressing auditory verbal hallucinations (AVH). This case series report investigates the acceptability and feasibility of a modified AVATAR therapy in three patients diagnosed with schizophrenia spectrum disorder who experience distressing AVH. The study provides detailed demographic and clinical information, outlines the modified AVATAR therapy protocol, and presents outcomes measured through standardized assessments.The findings indicate a decrease in the severity of AVHs, along with enhancements in overall symptomatology after modified AVATAR therapy sessions. Moreover, qualitative perspectives from patients shed light on their favorable experiences and perceptions of this adapted intervention. Nonetheless, the results exhibited inconsistency across individual cases, underscoring challenges for future research and clinical applications in this domain. Nevertheless, in light of the hurdles accompanying the rehabilitation of schizophrenia patients, along with the evaluation and subsequent measurement of parameters affecting efficacy, modified AVATAR therapy could present a valuable addition to schizophrenia patient care.

Theta Burst Stimulation Protocols for Schizophrenia

To date, several theta burst stimulation (TBS) protocols, such as intermittent TBS (iTBS), have been proposed; however, previous systematic reviews have revealed inconsistent efficacy findings in individual TBS studies for schizophrenia. To examine which TBS protocols are associated with the most favorable and acceptable outcomes in adults with schizophrenia. The Cochrane Library, PubMed, and Embase databases were searched for studies published before May 22, 2024. The inclusion criteria were as follows: (1) published and unpublished randomized clinical trials (RCTs) of any TBS treatment and (2) RCTs including individuals with schizophrenia spectrum disorders, other psychotic disorders, or both. This study followed the Cochrane standards for data extraction and data quality assessment and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for reporting. The risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis application was used to rate the certainty of evidence for meta-analysis results. At least 2 authors double-checked the literature search, data transfer accuracy, and calculations. The primary outcome of this study was improvement in scores related to negative symptoms. Our frequentist network meta-analysis used a random-effects model. The standardized mean difference (SMD) or odds ratio for continuous or dichotomous variables, respectively, was calculated with 95% CIs. A total of 30 RCTs of 9 TBS protocols, with 1424 participants, were included. Only iTBS over the left dorsolateral prefrontal cortex (L-DLPFC) was associated with reduced negative symptom scores (SMD, -0.89; 95% CI, -1.24 to -0.55), overall symptom scores (SMD, -0.81; 95% CI, -1.15 to -0.48), Positive and Negative Syndrome Scale general subscale scores (SMD, -0.57; 95% CI, -0.89 to -0.25), depressive symptom scores (SMD, -0.70; 95% CI, -1.04 to -0.37), and anxiety symptom scores (SMD, -0.58; 95% CI, -0.92 to -0.24) and improved overall cognitive impairment scores (SMD, -0.52; 95% CI, -0.89 to -0.15) compared with a sham. However, positive symptom score changes, all-cause discontinuation rate, discontinuation rate due to adverse events, headache incidence, and dizziness incidence did not significantly differ between any TBS protocols and sham. In this network meta-analysis, iTBS over the L-DLPFC was associated with improved scores for negative, depressive, anxiety, and cognitive symptoms in individuals with schizophrenia and was well tolerated by the participants. Other forms of TBS were not associated with benefit. Further research is needed to assess the potential role of TBS in the treatment of schizophrenia.

Clinical symptoms and psychosocial functioning in patients with schizophrenia spectrum disorders testing seropositive for anti-NMDAR antibodies: a case–control comparison with patients testing negative

Antibodies against the N-methyl-D-aspartate receptor (NMDAR) have been described in the serum of people with schizophrenia spectrum disorders (schizophrenia). However, the prevalence and clinical relevance of these antibodies in schizophrenia is unclear. This knowledge gap includes the possibility of such antibodies being associated with a distinct clinical profile, which in turn might warrant a distinct treatment approach. We aimed to assess the seroprevalence of anti-NMDAR antibodies in schizophrenia, and compare symptoms and psychosocial functioning between patients with schizophrenia who were seropositive and seronegative for these antibodies. In this case-control comparison, by combining new and existing studies, we included patients diagnosed with schizophrenia from four independent cohorts for whom anti-NMDAR serostatus had been assessed (or could be assessed by us) with live cell-based assays. Included cohorts were from the EULAST study (a trial conducted across 15 European countries and Israel), the OPTiMiSE study (an interventional study in Europe), and the PPiP1 and PPiP2 studies (conducted in the UK). Patients from these cohorts were analysed if they had complete Positive and Negative Syndrome Scale (PANSS) data. No participant had been diagnosed with autoimmune encephalitis or received treatment for this condition. After calculating the prevalence of serum anti-NMDAR antibodies, we examined possible differences in PANSS scores (negative, positive, and general symptom subscales, and total score) between anti-NMDAR-seropositive and anti-NMDAR-seronegative patients. Psychosocial functioning as measured by Personal Social Performance (PSP) score was also compared. All analyses were exploratory and no adjustment was done for multiple testing. People with lived experience were not involved in the conduct of this study. We collected individual patient data from 1114 patients with schizophrenia across the four cohorts. The study population had a mean age of 28·6 years (SD 7·6) and comprised 382 (34·3%) women and 732 (65·7%) men, including patients of White (929 [83·4%]), Asian (54 [4·8%]), Black (68 [6·1%]), and other (62 [5·6%]) ethnicities. Overall, 41 (3·7%) participants (range 3·1-4·0% across cohorts) tested positive for serum anti-NMDAR antibodies. Lower symptom severity on the negative symptoms PANSS subscale was observed for anti-NMDAR-seropositive patients (mean score 15·8 [SD 6·4]) than for anti-NMDAR-seronegative patients (18·2 [6·8]; Cohen's d=0·36; p=0·026), as well as on the general symptoms PANSS subscale (32·9 [8·9] vs 36·1 [10·1]; d=0·33; p=0·029) and total PANSS score (65·5 [18·5] vs 72·6 [19·3]; d=0·37; p=0·013). Mean PSP score was better in anti-NMDAR-positive patients (62·0 [17·0]) than in anti-NMDAR-negative patients (53·5 [16·3]; d=0·52; p=0·014). Serum NMDAR antibodies are present in 3-4% of patients with schizophrenia and are associated with relatively low severity of negative symptoms and relatively good psychosocial functioning. Thus, although the findings await replication in cohorts from other geographical regions, serum anti-NMDAR antibodies might be associated with a different form of psychotic illness. These findings could inform future prognostic and interventional studies examining whether anti-NMDAR antibodies are associated with a specific course of illness or with treatment response. None.

Long term mortality trends in people with severe mental illnesses and how COVID-19, ethnicity and other chronic mental health comorbidities contributed: a retrospective cohort study.

People with schizophrenia-spectrum and bipolar disorders (severe mental illnesses; 'SMI') experience excess mortality. Our aim was to explore longer-term trends in mortality, including the COVID-19 pandemic period, with a focus on additional vulnerabilities (psychiatric comorbidities and race/ ethnicity) in SMI. Retrospective cohort study using electronic health records from secondary mental healthcare, covering a UK region of 1.3 million people. Mortality trends spanning fourteen years, including the COVID-19 pandemic, were assessed in adults with clinician-ascribed ICD-10 diagnoses for schizophrenia-spectrum and bipolar disorders. The sample comprised 22 361 people with SMI with median follow-up of 10.6 years. Standardized mortality ratios were more than double the population average pre-pandemic, increasing further during the pandemic, particularly in those with SMI and psychiatric comorbidities. Mortality risk increased steadily among people with SMI and comorbid depression, dementia, substance use disorders and anxiety over 13-years, increasing further during the pandemic. COVID-19 mortality was elevated in people with SMI and comorbid depression (sub-Hazard Ratio: 1.48 [95% CI 1.03-2.13]), dementia (sHR:1.96, 1.26-3.04) and learning disabilities (sHR:2.30, 1.30-4.06), compared to people with only SMI. COVID-19 mortality risk was similar for minority ethnic groups and White British people with SMI. Elevated all-cause mortality was evident in Black Caribbean (adjusted Rate Ratio: 1.40, 1.11-1.77) and Black African people with SMI (aRR: 1.59, 1.07-2.37) during the pandemic relative to earlier years. Mortality has increased over time in people with SMI. The pandemic exacerbated pre-existing trends. Actionable solutions are needed which address wider social determinants and address disease silos.

Second Opinions for Diagnoses of Psychotic Disorders: Delivering Stage-Specific Recommendations.

The impact of obtaining second-opinion consultations on diagnoses of schizophrenia spectrum disorders was evaluated. A retrospective chart review was conducted for 177 patients referred to a psychosis consultation service at an academic medical center from January 1, 2017, to October 1, 2023; these consultations aimed to clarify a diagnosis of psychosis. Diagnoses made before and after consultations were compared, and treatment recommendations resulting from the consultation visit were summarized. Among patients without a preconsultation diagnosis of schizophrenia, 28% (N=28 of 100) received a postconsultation diagnosis of schizophrenia. Among 62 patients with a postconsultation diagnosis of treatment-resistant schizophrenia (TRS), 56% (N=35) received this diagnosis only after consultation. Nearly all of these patients were advised to begin taking clozapine, and electroconvulsive therapy was less commonly recommended. Expert consultation facilitates timely identification and optimal treatment of schizophrenia and its more severe subtype, TRS.

Different abnormalities of mismatch negativity in schizophrenia and depression as assessed with magnetoencephalography

Mismatch negativity (MMN) is widely considered a candidate diagnostic biomarker for schizophrenia (SCZ). Although blunted MMN responses have been reliably observed in psychosis, the evidence for MMN deficits in other disorders, such as major depressive disorder (MDD), is mixed. This study explores whether MMN alterations in amplitude or latency are unique to SCZ or extend to non-psychotic MDD patients. Seventeen patients diagnosed with a first MDD episode, 18 with recurrent MDD, 17 with first episode of SCZ spectrum disorder, and 18 with chronic SCZ, along with two groups of age- and sex-matched neurotypical controls (NC, 17 and 18), participated in a passive auditory MMN task during magnetoencephalography (MEG) recording. We examined the magnetic MMN (mMMN) amplitude and latency, exploring potential links between observed MMN alterations and psychotropic medication treatments. The mMMN amplitudes were significantly attenuated in SCZ compared to NC. Although, on average, mMMN amplitudes also appeared to be small in MDD, there was no significant difference between MDD and SCZ or NC. Notably, MDD patients had longer mMMN latencies compared to SCZ and NC, especially those with recurrent MDD. These results remained consistent after controlling for mood stabilizers, antidepressants, or benzodiazepines. These findings show that mMMN amplitude reductions may be more pronounced in psychotic disorders than in depressive disorders, whereas abnormal mMMN latencies may be more specific to MDD, suggesting differential mMMN alterations in SCZ and MDD. Caution is advised regarding mMMN amplitude as a diagnostic biomarker for SCZ, as small reductions also occur in MDD.

Age-dependent deficits of auditory brainstem responses in juvenile Neurexin1α knockout rats.

Abnormal sensory processing is core to neuropsychiatric and neurodevelopmental disorders, such as schizophrenia and autism spectrum disorders. Developing efficient therapies requires understanding the basic sensory pathways and identifying circuit abnormalities during early development. Auditory brainstem responses (ABRs) are well-established biomarkers for auditory processing on the brainstem level. Beyond their advantage of being easily applicable in clinics (given their non-invasive nature), ABRs have high reproducibility in rodents and translate well to humans (e.g. wave identity), despite species differences (e.g. wave features). We hypothesized that ABRs would reveal sensory abnormalities in neurodevelopmental models with construct validity, such as Neurexin1α knockout (Nrxn1α KO) rats during their development. In a previous study, adult Nrxn1α KO rats showed altered cortical auditory-evoked potentials and impaired prediction error to auditory stimuli (Janz in Transl Psychiat, 12:455, 2022 ). This study used ABR measurements to assess brainstem physiology during auditory processing in Nrxn1α KO rats and their wild-type littermates. Therefore, we followed the development trajectories of ABRs from the age of 3weeks to 12weeks longitudinally. We found that juvenile Nrxn1α KO rats (3weeks of age) show altered ABRs, which normalized during further development. This alteration was confined to increased latency in waves II, III, and IV of the ABRs, suggesting impaired auditory processing on the level of the superior olivary complex and inferior colliculus. In conclusion, our results suggest that early but transient deficits in the processing of auditory information on the level of the brainstem are present in Nrxn1α KO rats, which may contribute to later cortical auditory processing deficits observed in adulthood. Our study emphasizes the value of ABRs as a functional readout of auditory brainstem circuit function with potential value as a translational biomarker.

Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review.

Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown. This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care. Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes. Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review.

The dimensional structure of the Positive and Negative Syndrome Scale in first-episode schizophrenia spectrum disorders: an Exploratory Graph Analysis from the OPTiMiSE trial

The Positive and Negative Syndrome Scale (PANSS) is the most widely used rating scale to assess psychotic symptoms in patients with schizophrenia and other primary psychoses. However, a definitive consensus regarding its dimensional structure remains elusive. The present work aims to determine the number of dimensions of the scale through a network analysis approach in a sample of individuals experiencing first-episode schizophrenia spectrum disorder (FE-SSD) with minimal or no prior exposure to antipsychotic treatment. Baseline data of 446 participants (age 25.96 ± 5.99 years, 70% males) enrolled in the OPTiMiSE trial were analysed. Exploratory Graph Analysis (EGA) was conducted to evaluate the dimensionality of the PANSS, and a bootstrap approach (bootEGA) was employed to assess model stability. The analysis was replicated, excluding unstable items with stability values below 0.75, until a stable model was achieved. The analysis of the 30 items of the PANSS revealed inadequate structural consistency, resulting in the exclusion of 9 unstable items. The final model comprised 21 symptoms distributed across four communities (Positive, Cognitive/Disorganised, Excited/Aggressive and Negative) but lacked a depressive domain. In conclusion, we propose a concise version of the PANSS, incorporating 21 items, to better assess the core symptoms of the first episode of SSD. This revised version provides clinicians with a robust psychometric tool with reduced administration time, but the complementary administration of a dedicated instrument for evaluating affective symptoms is advisable.

Catatonia and neurocognitive disorder in the context of schizophrenia spectrum disorders

Background. Currently, researchers are aiming to establish the relationship between neurocognitive disorder and other clinical manifestations of endogenous diseases and functional indicators of the patient’s adaptation to social life. According to some data, the development of cognitive disorders is associated with the severity of catatonic disorders in the clinical picture of various diseases, in particular the presence of catatonic symptoms determines the worst indicators of cognitive functioning in the case of schizophrenia.The aim. To study the clinical and psychopathological features of catatonic syndrome in connection with schizophrenia spectrum disorders, as well as its connection with neurocognitive disorder manifestations among patients with endogenous disorders.Methods. From September 2022 to March 2024, we conducted a prospective, multicenter study of patients (n = 69) suffering from paroxysmal schizophrenia with primary catatonic symptoms in the structure of attacks. Mental status, the severity of catatonic symptoms using Bush – Francis Catatonia Rating Scale, neurocognitive profile using a number of validated scales (Montreal Cognitive Scale, Brief Assessment of Cognition in Schizophrenia, Frontal Assessment Battery) were assessed.Results. Neurocognitive disorder was revealed in all cases studied. It has been noted that, depending on the presence/absence of affective symptoms, various domains of the neurocognitive profile are affected. Thus, in patients without severe affective symptoms, auditory and verbal memory, attention, processing speed, and motor skills are impaired. In patients with pronounced affective disorders, processing speed, motor skills, and problem-solving behavior are affected.Conclusion. Based on the results of processing the material, it was revealed that the most pronounced neurocognitive disorders were found in case of the manifestation of paroxysmal paranoid schizophrenia in male patients with a relatively early onset of the disease and hypokinetic catatonic disorders. In the future, we are planning to compare these results with the results of control group of patients with endogenous diseases and without catatonia.

Longitudinal changes in DNA methylation associated with clozapine use in treatment-resistant schizophrenia from two international cohorts

The second-generation antipsychotic clozapine is used as a medication for treatment-resistant schizophrenia. It has previously been associated with epigenetic changes in pre-clinical rodent models and cross-sectional studies of treatment-resistant schizophrenia. Cross-sectional studies are susceptible to confounding, however, and cannot disentangle the effects of diagnosis and medication. We therefore profiled DNA methylation in sequential blood samples (n = 126) from two independent cohorts of patients (n = 38) with treatment-resistant schizophrenia spectrum disorders who commenced clozapine after study enrolment and were followed up for up to six months. We identified significant non-linear changes in cell-type proportion estimates derived from DNA methylation data - specifically B-cells - associated with time on clozapine. Mixed effects regression models were used to identify changes in DNA methylation at specific sites associated with time on clozapine, identifying 37 differentially methylated positions (DMPs) (p < 5 × 10-5) in a linear model and 90 DMPs in a non-linear quadratic model. We compared these results to data from our previous epigenome-wide association study (EWAS) meta-analysis of psychosis, finding evidence that many previously identified DMPs associated with schizophrenia and treatment-resistant schizophrenia might reflect exposure to clozapine. In conclusion, our results indicate that clozapine exposure is associated with changes in DNA methylation and cellular composition. Our study shows that medication effects might confound many case-control studies of neuropsychiatric disorders performed in blood.

Long-Term Changes in Cognition Among Patients With Schizophrenia Spectrum Disorders and Different Durations of Illness: A Meta-Analysis.

Long-Term Changes in Cognition Among Patients With Schizophrenia Spectrum Disorders and Different Durations of Illness: A Meta-Analysis.

Geographic Access to Community Mental Healthcare and Adherence to Treatment Among Patients with Schizophrenia Spectrum Disorders

Non-adherence to antipsychotic medications is a commonly recognized problem that can lead to lack of follow-up for patients with schizophrenia spectrum disorders, increasing risk for psychotic symptoms, hospitalizations, and decreased quality of life. We conducted a secondary data analysis of electronic health record data of patients with schizophrenia spectrum disorders (n = 1,341) in Central Florida to explore relationships between geographic access to mental healthcare facilities, socioeconomic factors, and follow-up visits, and whether these conditions contributed to adherence over 1 years’ time. Using Geographic Information Systems among six mental health facilities, spatial analysis and logistic regression indicated that patients had 27.9% increased odds (p = 0.02) of adherence to treatment when travel time to facilities was 30 min or less. Spatial autocorrelation revealed significant positive clusters in areas with low travel time (15 min or less). Patients who had Medicaid, a case manager and/or a life skills coach, medication side effects, a substance use disorders history, and/or closer proximity to mental healthcare services, had an increased likelihood of attending four or more follow-up visits in 1 year. Identifying effects of spatial and non-spatial variables on non-adherence to treatment can provide useful insights for developing targeted interventions to improve treatment outcomes.

Transcriptomic characterization of human lateral septum neurons reveals conserved and divergent marker genes across species.

The lateral septum (LS) is a midline, subcortical structure, which regulates social behaviors that are frequently impaired in neurodevelopmental disorders including schizophrenia and autism spectrum disorder. Mouse studies have identified neuronal populations within the LS that express a variety of molecular markers, including vasopressin receptor, oxytocin receptor, and corticotropin releasing hormone receptor, which control specific facets of social behavior. Despite its critical role in regulating social behavior and notable gene expression patterns, comprehensive molecular profiling of the human LS has not been performed. Here, we conducted single nucleus RNA-sequencing (snRNA-seq) to generate the first transcriptomic profiles of the human LS using postmortem human brain tissue samples from 3 neurotypical donors. Our analysis identified 5 transcriptionally distinct neuronal cell types within the human LS that are enriched for TRPC4, the gene encoding Trp-related protein 4. Differential expression analysis revealed a distinct LS neuronal cell type that is enriched for OPRM1, the gene encoding the μ-opioid receptor. Leveraging recently generated mouse LS snRNA-seq datasets, we conducted a cross-species analysis. Our results demonstrate that TRPC4 enrichment in the LS is highly conserved between human and mouse, while FREM2, which encodes FRAS1 related extracellular matrix protein 2, is enriched only in the human LS. Together, these results highlight transcriptional heterogeneity of the human LS, and identify robust marker genes for the human LS.

Identification of novel genomic loci for anxiety symptoms and extensive genetic overlap with psychiatric disorders.

Anxiety disorders are prevalent and anxiety symptoms (ANX) co-occur with many psychiatric disorders. We aimed to identify genomic loci associated with ANX, characterize its genetic architecture, and genetic overlap with psychiatric disorders. We included a genome-wide association study of ANX (meta-analysis of UK Biobank and Million Veterans Program, n = 301,732), schizophrenia (SCZ), bipolar disorder (BIP), major depression (MD), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), and validated the findings in the Norwegian Mother, Father, and Child Cohort (n = 95,841). We employed the bivariate causal mixture model and local analysis of covariant association to characterize the genetic architecture including overlap between the phenotypes. Conditional and conjunctional false discovery rate analyses were performed to boost the identification of loci associated with anxiety and shared with psychiatric disorders. Anxiety was polygenic with 12.9k genetic variants and overlapped extensively with psychiatric disorders (4.1k-11.4k variants) with predominantly positive genetic correlations between anxiety and psychiatric disorders. We identified 119 novel loci for anxiety by conditioning on the psychiatric disorders, and loci shared between anxiety and MD , BIP , SCZ , ADHD , and ASD . Genes annotated to anxiety loci exhibit enrichment for a broader range of biological pathways including cell adhesion and neurofibrillary tangle compared with genes annotated to the shared loci. Anxiety is highly polygenic phenotype with extensive genetic overlap with psychiatric disorders, and we identified novel loci for anxiety implicating new molecular pathways. The shared genetic architecture may underlie the extensive cross-disorder comorbidity of anxiety, and the identified molecular underpinnings may lead to potential drug targets.

A comparison of challenging and positive caregiving experiences for caregivers of individuals with schizophrenia spectrum and bipolar disorders

BackgroundCaregivers of people with serious mental illness experience challenges that may affect their mental health. Few researchers have explored whether positive or negative caregiver experiences differ due to disorder characteristics of the person receiving care. We aimed to determine whether caregiver appraisals and psychological functioning differed between caregivers of those diagnosed with schizophrenia spectrum (SSD) and bipolar disorder (BD). MethodsCaregivers of people with SSD and BD participated in an online self-report survey assessing appraisals, distress, anxiety, depression, and psychological wellbeing. Independent samples t-tests and multivariate generalised linear models determined group differences, and Pearson correlation coefficients and Fisher z-score transformations determined differences in the strength of correlations between groups. Results108 caregivers participated in the study. Caregivers of people with SSD reported significantly greater negative appraisals of the care recipient's negative symptoms and dependency. Caregivers did not differ on positive appraisals. Both groups reported moderate distress, mild anxiety and depression, and moderate psychological wellbeing, but did not differ. Higher negative caregiver appraisals were more strongly associated with higher distress, anxiety and depression, and lower psychological wellbeing, for caregivers of those with SSD than BD. LimitationsSmall between group sample sizes, and analyses may have been moderated by significant demographic differences between groups. ConclusionsCaregivers can experience difficulties associated with their role, and some differences may be attributed to the care recipient's disorder. Future research and interventions should consider specific disorder characteristics, such as symptom profiles, to better support caregivers in having their specific needs addressed whilst themselves providing care.

Magnetic resonance imaging-based machine learning classification of schizophrenia spectrum disorders: a meta-analysis.

Recent advances in multivariate pattern recognition have fostered the search for reliable neuroimaging-based biomarkers in psychiatric conditions, including schizophrenia. These approaches consider the complex pattern of alterations in brain function and structure, overcoming the limitations of traditional univariate methods. To assess the reliability of neuroimaging-based biomarkers and the contribution of study characteristics in distinguishing individuals with schizophrenia spectrum disorder (SSD) from healthy controls (HCs), we conducted a systematic review of the studies that used multivariate pattern recognition for this objective. We systematically searched PubMed, Scopus, and Web of Science for studies on SSD classification using multivariate pattern analysis on magnetic resonance imaging data. We employed a bivariate random-effects meta-analytic model to explore the classification of sensitivity (SE) and specificity (SP) across studies while also evaluating the moderator effects of clinical and non-clinical variables. A total of 119 studies (with 12,723 patients with SSD and 13,196 HCs) were identified. The meta-analysis estimated a SE of 79.1% (95% confidence interval [CI], 77.1%-81.0%) and a SP of 80.0% (95% CI, 77.8%-82.0%). In particular, the Positive and Negative Syndrome Scale and the Global Assessment of Functioning scores, age, age of onset, duration of untreated psychosis, deep learning, algorithm type, features selection, and validation methods had significant effects on classification performance. Multivariate pattern analysis reliably identifies neuroimaging-based biomarkers of SSD, achieving ∼80% SE and SP. Despite clinical heterogeneity, discernible brain modifications effectively differentiate SSD from HCs. Classification performance depends on patient-related and methodological factors crucial for the development, validation, and application of prospective models in clinical settings.

Experience of socio-psychological rehabilitation of patients suffering from schizophrenia spectrum disorders using the Therapy with Creative Self-Expression by M. E. Burno

Socio-psychological rehabilitation is an essential component of modern complex therapy of schizophrenia spectrum disorders. Psychotherapy is one of the main forms of such rehabilitation, and Therapy with Creative Self-Expression by M. E. Burno (TCSE) is one of psychotherapeutic techniques suitable for use in this area. This domestic method is actively applied today in various regions of the Russian Federation, but its official recognition is still insufficient. The purpose of the study: to supplement the available information on the effectiveness of TCSE in the field of socio-psychological rehabilitation of patients with schizophrenia spectrum disorders based on summarizing many years of experience in the practical use of this method. Materials and methods. The study was conducted on the basis of the Republican Clinical Mental Health Center (Izhevsk), where group TCSE has been used for the past 25 years. In total, 270 patients with schizophrenia spectrum disorders passed through the TCSE groups during this period; of these, 240 patients received short-term TCSE (4 months) and 30 patients — long-term TCSE (2–5 years or more). To assess the rehabilitation effect of the method, two study samples corresponding to the two variants of TCSE were formed, with 30 participants in each. Results. The use of short-term TCSE in patients significantly reduced the severity of most psychopathological symptoms assessed on the SCL-90‑R scale (the decrease in the overall symptom severity index was 16.67 %) and considerably increased the indicators of 7 out of 13 subscales of schizophrenia patients' quality of life questionnaire by V. L. Kozlovsky and S. Yu. Maslovsky. The use of long-term TCSE reduced the average annual rate of hospitalization to a mental health hospital by 71.4 % and the average duration of one hospitalization by 21.5 %. Conclusion. The TCSE method is quite effective in the field of socio-psychological rehabilitation of patients with schizophrenia spectrum disorders. It is proposed to include this technique in official clinical guidelines for the treatment of the specified disorders.

The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta-analysis.

Nonadherence/discontinuation of antipsychotic (AP) medications represents an important clinical issue in patients across psychiatric disorders, including schizophrenia spectrum disorders (SSDs). While antipsychotic-induced weight gain (AIWG) is a reported contributor to nonadherence, a systematic review of the association between AIWG and medication nonadherence/discontinuation has not been explored previously. A systematic search was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and CENTRAL databases, among others, to help identify all studies which explored adherence, study dropouts, AP switching and/or discontinuations attributable to AIWG among individuals with severe mental illness. A meta-analysis was also completed where applicable. We identified two categories of studies for the meta-analysis. Category 1 included three studies, which compared measures of AP adherence or discontinuation across BMI classes/degrees of self-reported weight gain. When compared to normal weight individuals receiving APs or those who did not report AIWG, individuals who were either overweight or obese or reported weight gain in relation to AP use had an increased odds of AP nonadherence (OR 2.37; 95% CI 1.51-3.73; p = 0.0002). Category 2 had 14 studies which compared measures of discontinuation related to weight gain reported as an adverse effect across different APs. Olanzapine was associated with a 3.32 times (95% CI 2.32-4.74; p < 0.00001) increased likelihood of nonadherence or discontinuation when compared to other APs with lower weight gain liabilities. Similarly, APs with moderate weight gain liability (paliperidone, risperidone, and quetiapine) increased the odds of nonadherence or discontinuation by 2.25 (95% CI 1.31-3.87; p = 0.003) when compared to APs considered to have lower weight gain liability (i.e. haloperidol and aripiprazole). The qualitative summary also confirmed these findings. This review and meta-analysis suggests that AIWG influences medication nonadherence/discontinuation, whereby APs with higher weight gain liability are associated with nonadherence/discontinuation. Additional studies are needed to confirm these findings.

Childhood adversities and suicidal ideation among young adults with serious mental illnesses: The mediating roles of perceived stress, dispositional hope, and mental health hope

BackgroundRates of suicidality are high among young adults and minoritized groups are disproportionately affected. Despite evidence that adverse childhood experiences (ACEs) may increase suicide-related risk, the underlying mechanisms through which ACEs may impact suicidal ideation (SI) remain poorly understood, especially among marginalized young adults with serious mental illnesses (SMI) such as schizophrenia-spectrum, major depressive, and bipolar disorders. This study examines associations between ACEs and SI, and whether perceived stress, dispositional hope, and mental health hope may mediate the relationship. MethodsThe sample consisted of 114 young adults of color with SMI who participated in a larger randomized trial. Data were analyzed using a structural equation modeling (SEM) approach. ResultsYoung adults with more ACEs reported higher perceived stress, which in turn, was associated with more SI. Higher perceived stress was associated with lower dispositional and mental health hope. Although dispositional hope was negatively associated with SI on a bivariate level, neither dispositional nor mental health hope was significantly associated with SI in the multivariate SEM. This suggests that over and above perceived stress, hope does not appear to be associated with SI. LimitationsKey limitations include a cross-sectional design, a modest sample size, and an assessment of select ACEs. ConclusionAddressing stress-related processes may be one promising target for suicide prevention efforts in the context of ACEs. Policy interventions focused on the allocation of resources and changing environments that are stress and trauma-inducing are needed to reduce the occurrence of ACEs and their negative sequelae.