Schizophrenia Spectrum Disorders Research Articles

Adolescents Hospitalized in an Acute Psychiatric Ward: The Difference between Males and Females in the Pre- and Pandemic/Post-Pandemic Periods.

(1) Background: The pandemic lowered by 10% the psychological wellness among adolescents worldwide. (2) Methods: This observational retrospective study compared the demographic and clinical variables of male and female adolescents hospitalized in an acute psychiatric ward during the pre-pandemic, from 1 July 2017 to 28 February 2020, and the pandemic/post-pandemic, from 1 March 2020 to 30 June 2023. (3) Results: In total, 153 adolescents of 15.8 years on average (±1.14 DS) were more frequently hospitalized (n = 131, 54.4%) in the pre-pandemic than in the pandemic/post-pandemic (n = 110, 45.6%), but female hospitalizations increased in the post-pandemic more than male hospitalizations (62.9% vs. 37.1%) (Pearson Chi2 = 8.54, p = 0.003); in the pandemic/post-pandemic, we reported increased aggressive behavior and schizophrenia spectrum and emotional disorders in males, whereas in females, depressive and emotional disorders were prevalent; more adolescents previously treated in Child Mental Health Services were hospitalized in the pandemic/post-pandemic period; and males hospitalized in the study period reported higher Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scores. (4) Conclusions: In the pandemic/post-pandemic, females more frequently required hospitalizations for depressive behavior and males for aggressive behavior and schizophrenia spectrum disorders, whereas, in both males and females, hospitalizations due to emotional disorders increased. Our results suggest the need for mental health prevention in adolescents, who represent the most vulnerable population in the case of disaster.

White blood cell counts, ratios, and C-reactive protein among individuals with schizophrenia spectrum disorder and associations with long-term outcomes: a population-based study

BackgroundImmune mechanisms are associated with adverse outcomes in schizophrenia; however, the predictive value of various peripheral immune biomarkers has not been collectively investigated in a large cohort before. ObjectiveTo investigate how white blood cell (WBC) counts, ratios, and C-Reactive Protein (CRP) levels influence the long-term outcomes of individuals with schizophrenia spectrum disorder (SSD). MethodsWe identified all adults in the Central Denmark Region during 1994–2013 with a measurement of WBC counts and/or CRP at first diagnosis of SSD. WBC ratios were calculated, and both WBC counts and ratios were quartile-categorized (Q4 upper quartile). We followed these individuals from first diagnosis until outcome of interest (death, treatment resistance and psychiatric readmissions), emigration or December 31, 2016, using Cox regression analysis to estimate adjusted hazard ratios (aHRs). ResultsAmong 6,845 participants, 375 (5.5 %) died, 477 (6.9 %) exhibited treatment resistance, and 1470 (21.5 %) were readmitted during follow-up. Elevated baseline levels of leukocytes, neutrophils, monocytes, LLR, NLR, MLR, and CRP increased the risk of death, whereas higher levels of lymphocytes, platelets, and PLR were associated with lower risk. ROC analysis identified CRP as the strongest predictor for mortality (AUC=0.84). Moreover, elevated levels of leukocytes, neutrophils, monocytes, LLR, NLR and MLR were associated with treatment resistance. Lastly, higher platelet counts decreased the risk of psychiatric readmissions, while elevated LLR increased this risk. ConclusionsElevated levels of WBC counts, ratios, and CRP at the initial diagnosis of SSD are associated with mortality, with CRP demonstrating the highest predictive value. Additionally, certain WBC counts and ratios are associated with treatment resistance and psychiatric readmissions.

Fetal Gene Regulatory Gene Deletions are Associated with Poor Cognition and Altered Cortical Morphology in Schizophrenia and Community-Based Samples.

Schizophrenia spectrum disorders (SSDs) are characterized by substantial clinical and genetic heterogeneity. Multiple recurrent copy number variants (CNVs) increase risk for SSDs; however, how known risk CNVs and broader genome-wide CNVs influence clinical variability is unclear. The current study examined associations between borderline intellectual functioning or childhood-onset psychosis, known risk CNVs, and burden of deletions affecting genes in 18 previously validated neurodevelopmental gene-sets in 618 SSD individuals. CNV associations were assessed for replication in 235 SSD relatives and 583 controls, and 9,930 youth from the Adolescent Brain Cognitive Development (ABCD) Study. Known SSD- and neurodevelopmental disorder (NDD)-risk CNVs were associated with borderline intellectual functioning in SSD cases (odds ratios (OR) = 7.09 and 4.57, respectively); NDD-risk deletions were nominally associated with childhood-onset psychosis (OR = 4.34). Furthermore, deletion of genes involved in regulating gene expression during fetal brain development was associated with borderline intellectual functioning across SSD cases and non-cases (OR = 2.58), with partial replication in the ABCD cohort. Exploratory analyses of cortical morphology showed associations between fetal gene regulatory gene deletions and altered gray matter volume and cortical thickness across cohorts. Results highlight contributions of known risk CNVs to phenotypic variability in SSD and the utility of a neurodevelopmental framework for identifying mechanisms that influence phenotypic variability in SSDs, as well as the broader population, with implications for personalized medicine approaches to care.

Structural brain differences in patients with schizophrenia spectrum disorders with and without auditory verbal hallucinations

Schizophrenia spectrum disorders (SSD) are debilitating, with auditory verbal hallucinations (AVHs) being a core characteristic. While gray matter volume (GMV) reductions are commonly replicated in SSD populations, the neural basis of AVHs remains unclear. Using previously published data, this study comprises two main analyses, one of GMV dissimilarities between SSD and healthy controls (HC), and one of GMV differences specifically associated with AVHs. Structural brain images from 71 adults with (n = 46) and without (n = 25) SSD were employed. Group differences in GMVs of the cortex, anterior cingulate (ACC), superior temporal gyrus (STG), hippocampi, and thalami were assessed. Additionally, volumes of left Heschl's gyrus (HG) in a subgroup experiencing AVHs (AVH+, n = 23) were compared with those of patients who did not (AVH-, n = 23). SSD patients displayed reduced GMVs of the cortex, ACC, STG, hippocampi, and thalami compared to HC. AVH+ had significantly reduced left HG volume when compared to AVH-. Finally, a right-lateralized ventral prefrontal cluster was found to be uniquely associated with AVH severity. This study corroborates previous findings of GMV reductions in SSD cohorts. Chiefly, our secondary analysis suggests that AVHs are associated with language areas and their contralateral homologues.

Treatment of Cognitive Impairment Associated with Schizophrenia Spectrum Disorders: New Evidence, Challenges, and Future Perspectives.

Cognitive impairment associated with schizophrenia (CIAS) represents one of the core features of the disorder and has a significant impact on functional and rehabilitation outcomes of people living with schizophrenia spectrum disorders (SSD). The aim of this critical review is to highlight the most recent evidence on effective treatments available for CIAS, to discuss the current challenges in this field, and to present future perspectives that may help to overcome them. Concerning psychopharmacological approaches, among the most indicated strategies for the management and prevention of CIAS is to favor second-generation antipsychotic medications and avoid long-term and high-dose treatments with anticholinergic medications and benzodiazepines. Moreover, non-pharmacological approaches such as cognitive remediation and physical exercise-based programs represent evidence-based interventions in the treatment of CIAS that have shown reliable evidence of effectiveness on both cognitive and functional outcomes. These treatments, however, are still delivered to people accessing mental health services with a diagnosis of CIAS in an uneven manner, even in high-income countries. Academic and clinical partnership and collaboration, as well as advocacy from service users, families, carers, and stakeholders' organizations could help to reduce the bench to bedside gap in the treatment of CIAS. Future perspectives include the development of novel pharmacological agents that could be effective in the treatment of CIAS, the implementation of novel technologies such as telemedicine and virtual reality in the delivery of evidence-based interventions to improve accessibility and engagement, and further research in the field of non-invasive brain stimulation.

The Relationship between Cognitive Impairment and Violent Behavior in People Living with Schizophrenia Spectrum Disorders: A Critical Review and Treatment Considerations.

Cognitive impairment is a core feature of schizophrenia spectrum disorders (SSD). Violent and aggressive behavior represents a complex issue in psychiatry, and people with SSD have been shown to be at risk of being both victims and perpetrators of violence. In this review, the complex relationship between cognitive impairment and violent behavior is explored, also considering the usefulness of treating cognitive impairment to improve violence-related outcomes. Several studies report that cognitive impairment is linked to violent behavior, but significant differences between domains and conflicting results are also present, leaving the identification of specific cognitive profiles predicting violent behavior in SSD as an important aim for future research. Evidence regarding the effectiveness of treating cognitive impairment to improve violent behavior, while heterogeneous, provides more consistent results: cognition-targeting interventions appear to provide significant benefits also in the prevention of aggression in people living with SSD, and preliminary evidence shows cognition-focused interventions targeting violent behavior improve both cognition- and violence-related outcomes. Implementing these interventions in clinical practice could be of great usefulness, particularly in forensic contexts. Physical exercise, which improves cognitive performance and psychosocial functioning in SSD, appears to reduce violent behavior in healthy individuals, but requires further studies in clinical samples.

Perceived Stigma Toward Cognitive Impairment Among People With Schizophrenia.

Stigma toward schizophrenia spectrum disorders is pervasive and negatively influences service access and delivery. Cognitive impairment associated with schizophrenia (CIAS) is common, but its association with stigma is unknown. In this study, the authors examined whether individuals with CIAS receiving cognitive remediation treatment report experiencing CIAS-related stigma and sought to establish associations between CIAS-related stigma and recovery-relevant outcomes. Data from 48 individuals with schizophrenia spectrum diagnoses were drawn from a larger study evaluating cognitive remediation. Participants completed measures of CIAS-related stigma, internalized mental illness stigma, self-perceived cognitive impairment, cognitive performance, and interviewer-rated quality of life. CIAS-related stigma was commonly reported and significantly positively associated with internalized stigma and self-perceived cognitive impairment. CIAS-related stigma was also significantly negatively associated with motivation to engage in goal-directed behavior and daily activities. CIAS-related stigma exists and warrants additional exploration with regard to implications for psychiatric service delivery.

Cumulative Effect of Psychosis and Aging on Cognitive Function in Patients Diagnosed With Schizophrenia Spectrum Disorders: A Cognitive Domain Approach.

Schizophrenia spectrum disorders are characterized by cognitive decline, which is evident even in the prodromal phase. Aging is a complex gradual procedure that affects, among other organs, the central nervous system, resulting in age-related cognitive decline. The objective of this study is to assess the cognitive function of patients diagnosed with psychotic disorders, in comparison with healthy controls, along the age spectrum. Sixty patients diagnosed with schizophrenia spectrum disorders in remission, 20-59 years old, and 60 healthy controls, matched by age and educational level, from the region of Thessaly in Central Greece, were evaluated, with respect to their cognitive performance, using the Greek version of the Montreal Cognitive Assessment (MoCA). Correlations between age and MoCA total and cognitive domains' scores, as well as statistical analysis of variance (ANOVA) and t-test among age groups, were performed using Statistical Product and Service Solutions (SPSS, version 23; IBM SPSS Statistics for Windows, Armonk, NY). The MoCA score was negatively correlated with age, both in the patients' group (p<0.001) and in the control group (p=0.001).A significant statistical difference in mean MoCA scores between patients and healthy controls was observed, not only in the total sample (p<0.001) but also in all age groups (20-29: p=0.006, 40-49: p=0.024, 50-59: p<0.001), except for age group 30-39 (30-39: p=0.356).Statistically significant differences were also found between patients and healthy controls in the total sample, regarding specific cognitive domains, in the visuospatial and executive function domain (p=0.01), attention domain (p<0.001), language domain (p<0.001), and orientation domain (p<0.005). Interestingly, different deterioration patterns in cognitive domains were observed in each age group. Specifically,in the age group 20-29, statistically significant differences were found between patients and healthy controls in the language domain (p<0.014) and orientation domain (p<0.041). No difference was found in the age group 30-39, while statistically significant differences were found between patients and healthy controls in the age group 40-49 inthe attention domain (p<0.001) and language domain (p<0.001). Finally, in the age group 50-59, such differences were found in the visuospatial and executive function domain (p=0.041), attention domain (p=0.006), and language domain (p=0.001).Statistically significant cognitive decline occurs in a shorter period in the patients' group, suggesting an accelerated cognitive decline in psychotic patients after middle age. Age-related cognitive decline in psychotic patients occurs at an accelerated rate in relation to the control sample, with age-specific cognitive domain decline patterns, due to the cumulative effect of aging and psychosis on cognition. Further, larger, multicenter research should focus on establishing these results and designing relevant procognitive interventions.

The Roles of Emotion Regulation and Alexithymia in the Relationship Between Sleep and Social Functioning.

Poor sleep quality has been tied to worse social functioning outcomes, including greater loneliness, fewer social interactions, and lower social integration. Other factors likely play a role in the relationship between sleep quality and social functioning. Specifically, alexithymia and emotion regulation may serve as moderators in these relationships. Data for this study came from the Pittsburgh Cold Study 3, a publicly available dataset (N = 213). Participants completed self-report measures including the Pittsburgh Sleep Quality Index, the Emotional Regulation Questionnaire, Toronto Alexithymia Scale, and four measures of social functioning: Social Network Index, Social Participation Measure, Short Loneliness Scale, and Interpersonal Support Evaluation List for providing support to others. Sleep quality was significantly related to the social functioning variables. Further, the use of the emotion regulation strategy reappraisal significantly moderated the relationship between sleep quality and social participation. Worse sleep quality was related to lower engagement in social activities, only for participants high in use of reappraisal. Additionally, the use of reappraisal significantly moderated the relationship between sleep quality and giving of support. Worse sleep quality was related to less self-reported giving of support to others only for participants high in the use of reappraisal. Results suggest that the use of reappraisal may be an important factor to consider in the relationship between sleep and social functioning. Future work should extend these findings to the general population and a sample of individuals with relevant diagnoses, such as borderline personality or schizophrenia-spectrum disorders.

Sex versus gender differences in childhood trauma and its associations with symptom profiles in first-episode schizophrenia spectrum disorders

Sex and gender differences in childhood trauma (CT) and its relationships with symptom profiles were examined in 77 patients with first-episode schizophrenia spectrum disorders compared to 64 controls. In patients, but not in controls, we found independent associations of sex vs. gender with abuse vs. neglect. In patients, there were also sex and gender differences in age of onset and psychopathology. Sex-specific associations between CT and symptom profiles were also found. Our results indicated that the assessment of both sex and gender provides a more nuanced insight into CT associations with symptoms compared to sex in isolation.

Gender differences in first episode psychosis: Some arguments to develop gender specific treatment strategies

IntroductionSome aspects of gender differences in patients with schizophrenia spectrum disorders (SSD) have been studied, especially in cross-sectional designs and with a short-term follow-up. However, only a few studies have considered the evolution during the follow-up of SSD patients according to their gender. In this study, we explore gender differences from the time of entry in an early intervention program for psychosis, up to three years follow-up. MethodsWe conducted a prospective study including a cohort of 474 patients treated at the Treatment and Early Intervention in Psychosis (TIPP) program, 319 men and 155 women, having presented a first episode of psychosis (FEP). Data regarding premorbid and baseline sociodemographic, psychopathological and patient functioning, were collected. These data were reassessed longitudinally after 2, 6, 12, 18, 24, 30 and 36 months after entry in TIPP. ResultsRegarding premorbid and baseline characteristics, woman developed threshold symptoms of a FEP 1 year later than men on average. Women were more likely to be married, men were more likely to live in pension or care home facility or to be homeless. Women displayed a higher rate of history of suicide attempts and exposure to childhood trauma, while men were more likely to have a forensic history, a history of abuse of alcohol and cannabis as well as a dependency to cannabis at the time of entry in TIPP. Regarding evolution, men were more prone to violent acts and were less likely to decrease their usage of substances. The longitudinal analysis highlighted that men displayed greater negative symptoms over the entire treatment period, lower functioning after 6 months and on all assessment points after. Both genders displayed similar rate of improvement in these 3 dimensions over time. ConclusionOur study confirms that there are some gender differences in the early phase of psychosis that may require differentiation of assessment and treatment to improve recovery.

Differences in social adjustment during adulthood between adoptees with high and low risk for schizophrenia spectrum disorders - the Finnish adoptive family study of schizophrenia.

To investigate differences in social adjustment during adulthood between adoptees with high genetic risk (HR) and low genetic risk (LR) for schizophrenia spectrum disorders. This study is a subsample of the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 120 adoptees whose biological mothers had DSM-III-R verified schizophrenia spectrum disorders, and 142 socio-demographically matched control adoptees. The social adjustment of the adoptees was assessed using the interview-based Adult Adjustment Scale (AAS). A lower proportion of the HR adoptees (61.7%) fell into the category of good adaptation compared to LR adoptees (74.6%) (p = 0.024). In addition, the median AAS score among HR adoptees was lower compared to LR adoptees (p = 0.023). Poorer results among HR adoptees were also found regarding some individual items and the social health -domain within the AAS. The psychiatric morbidity, excluding schizophrenia spectrum disorders, was higher among HR adoptees. Psychiatric morbidity was shown to mediate the association of genetic status to total AAS, and, also to the domain of social health. According to our results, genetic susceptibility to schizophrenia is associated with weakened social adjustment during adulthood. Although our results demonstrated that psychiatric morbidity has notable effect on the association of genetic status to adult adjustment scores, the impact of other determinants, like psychosocial factors or health-related behaviour, cannot be ruled out. The comparable rearing environment provided by the adoption design in conjunction with reliable diagnostics provide new information on the relation of genetic susceptibility and social adjustment.

Health and disability – a multi-group latent class analysis of the World Health Organization Disability Assessment Schedule 2.0 among those with mental and physical health conditions

BackgroundThis study aims to identify disability classes among people with schizophrenia spectrum disorder, depression, anxiety or diabetes via the WHODAS 2.0; investigate the invariance of disability patterns among the four diagnostic groups; and examine associations between disability classes and sociodemographic variables.MethodsPatients seeking treatment for schizophrenia spectrum disorder, depression, anxiety or diabetes (n=1076) were recruited. Latent class analysis was used to identify disability classes based on WHODAS 2.0 responses. Measurement invariance was tested using multi-group latent class analysis. Associations between classes and sociodemographic variables were tested via multinomial logistic regression.ResultsA five-class solution was identified; examination of model invariance showed that the partially constrained five-class model was most appropriate, suggesting that class structure was consistent while class membership differed across diagnostic groups. Finally, significant associations were found between class membership and ethnicity, education level, and employment status.ConclusionsThe results show the feasibility of using the WHODAS 2.0 to identify and compare different disability classes among people with mental or physical conditions and their sociodemographic correlates. Establishing a typology of different disability profiles will help guide research and treatment plans that tackle not just clinical but also functional aspects of living with either a chronic psychiatric or physical condition.

Strategies for Achieving Better Cognitive Health in Individuals with Schizophrenia Spectrum: A Focus on the Canadian Landscape: Stratégies pour atteindre une meilleure santé cognitive chez les personnes souffrant du spectre de la schizophrénie : un regard sur le paysage canadien.

Schizophrenia spectrum disorders (SSDs) are a group of psychiatric disorders characterized by positive and negative symptoms as well as cognitive impairment that can significantly affect daily functioning. We reviewed evidence-based strategies for improving cognitive function in patients with SSDs, focusing on the Canadian landscape. Although antipsychotic medications can address the positive symptoms of SSDs, cognitive symptoms often persist, causing functional impairment and reduced quality of life. Moreover, cognitive function in patients with SSDs is infrequently assessed in clinical practice, and evidence-based recommendations for addressing cognitive impairment in people living with schizophrenia are limited. While cognitive remediation (CR) can improve several domains of cognitive function, most individuals with SSDs are currently not offered such an intervention. While the development of implementation strategies for CR is underway, available and emerging pharmacological treatments may help overcome the limited capacity for psychosocial approaches. Furthermore, combining pharmacological with non-pharmacological interventions may improve outcomes compared to pharmacotherapy or CR alone. This review highlights the challenges and discusses the potential solutions related to the assessment and management of cognitive impairment to help mental health-care practitioners better manage cognitive impairment and improve daily functioning in individuals with SSDs.

Speech-Gesture Matching and Schizotypal Traits: A Network Approach.

Impaired speech-gesture matching has repeatedly been shown in patients with schizophrenia spectrum disorders. Here, we tested the hypothesis that schizotypal traits in the general population are related to reduced speech-gesture matching performance and reduced self-reports about gesture perception. We further explored the relationships between facets of schizotypy and gesture processing in a network model. Participants (1094 mainly healthy adults) were presented with concrete or abstract sentences accompanied with videos showing related or unrelated gestures. For each video, participants evaluated the alignment between speech and gesture. They also completed self-rating scales about the perception and production of gestures (Brief Assessment of Gesture scale) and schizotypal traits (Schizotypal Personality Questionnaire-Brief 22-item version). We analyzed bivariate associations and estimated a non-regularized partial Spearman correlation network. We characterized the network by analyzing bridge centrality and controllability metrics of nodes. We found a negative relationship between both concrete and abstract gesture-speech matching performance and overall schizotypy. In the network, disorganization had the highest average controllability and it was negatively related to abstract speech-gesture matching. Bridge centralities indicated that self-reported production of gestures to enhance communication in social interactions connects self-reported gesture perception, schizotypal traits, and gesture processing task performance. The association between impaired abstract speech-gesture matching and disorganization supports a continuum between schizophrenia and schizotypy. Using gestures to facilitate communication connects subjective and objective aspects of gesture processing and schizotypal traits. Future interventional studies in patients should test the potential causal pathways implied by this network model.

Association between preferred language and use of mental health services among home care recipients with schizophrenia spectrum and other psychotic disorders: A retrospective cohort study in Ontario, Canada, 2010 to 2015

Language is an important demographic factor that may impact patients’ interactions with the healthcare system. This may become more apparent for individuals with a mental illness. The objective of this study was to evaluate whether individual language was associated with the use of inpatient and outpatient psychiatric services among home care recipients with schizophrenia spectrum and other psychotic disorders. We conducted a population-based retrospective cohort study using health administrative data. The study population included all individuals aged 18–105 with schizophrenia spectrum and other psychotic disorders, identified via a validated algorithm, who were receiving home care in Ontario, Canada between January 1, 2010 and December 31, 2015. Home care data was used to identify patients’ primary language, categorized as Anglophone, Francophone, or Allophone. Mental health service use was evaluated over a one-year period following their first home care assessment in the study period and included the rate of outpatient psychiatrist visits and mental health-related emergency department (ED) visits and hospitalizations. Multivariable regression evaluated the association between primary language and mental health service use. The cohort consisted of 9,436 patients (85.8% Anglophones, 3.3% Francophones, 11.0% Allophones). Mental health service use was low among all linguistic groups during the one-year study period, with 53.4% with no outpatient psychiatrist visits and 83.3% and 83.0% with no mental health-related hospitalizations or ED visits, respectively. Francophones had a higher rate of mental health-related hospitalizations compared to Anglophones (adjusted relative risk = 1.36, 95% confidence interval 1.02–1.80), with no differences in hospitalization rates between Allophones and Anglophones. Language was not associated with the rate of outpatient psychiatrist visits or mental health-related ED visits. Mental health service use among homecare patients with schizophrenia spectrum and other psychotic disorders was low. While Francophones had a higher hospitalization rate than Anglophones, language was otherwise not associated with mental health service use.

Clozapine Safety in Pregnancy: A Clinical Study.

Pregnant women with persistent schizophrenia and related disorders may require ongoing antipsychotic treatment, including clozapine. However, the potential risks of using clozapine during pregnancy and the postnatal period remain uncertain. We conducted a nested case-control study using the National Register of Antipsychotic Medication in Pregnancy (NRAMP) database. Our study assessed pregnancy outcomes among Australian women diagnosed with schizophrenia spectrum disorder and treated with clozapine (n = 14) during the first trimester. These women were compared to 2 subgroups: those treated with quetiapine (n = 53) and those not taking any medication (n = 24) during pregnancy. We observed higher rates of miscarriage in the clozapine group compared to the quetiapine and drug-free groups. The clozapine group had a higher early pregnancy body mass index but lower overall pregnancy weight gain than the other groups. The prevalence of gestational diabetes was significantly higher in the clozapine group. The percentage of vaginal delivery was higher in the clozapine group than in the other 2 groups. Neonatal outcomes such as gestational age, and Apgar scores were similar across groups. The birth weight was lower in the clozapine group compared to the other 2 groups. This study suggests that pregnant women taking clozapine and their babies have greater adverse outcomes compared to other groups. Clozapine appears to be associated with a greater risk of miscarriages, maternal gestational diabetes, and lower birth weight. However, the gestational age, Apgar scores, and admission to NICU/SCN were comparable between all groups.

Dynamic Prediction of Recidivism in Violence in Community-Based Schizophrenia Spectrum Disorder Patients: A Joint Model

To construct a model for predicting recidivism in violence in community-based schizophrenia spectrum disorder patients (SSDP) by adopting a joint modeling method. Based on the basic data on severe mental illness in Southwest China between January 2017 and June 2018, 4565 community-based SSDP with baseline violent behaviors were selected as the research subjects. We used a growth mixture model (GMM) to identify patterns of medication adherence and social functioning. We then fitted the joint model using a zero-inflated negative binomial regression model and compared it with traditional static models. Finally, we used a 10-fold training-test cross validation framework to evaluate the models' fitting and predictive performance. A total of 157 patients (3.44%) experienced recidivism in violence. Medication compliance and social functioning were fitted into four patterns. In the counting model, age, marital status, educational attainment, economic status, historical types of violence, and medication compliance patterns were predictive factors for the frequency of recidivism of violence (P<0.05). In the zero-inflated model, age, adverse drug reactions, historical types of violence, medication compliance patterns, and social functioning patterns were predictive factors for the recidivism in violence (P<0.05). For the joint model, the average value of Akaike information criterion (AIC) for the train set was 776.5±9.4, the average value of root mean squared error (RMSE) for the testing set was 0.168±0.013, and the average value of mean absolute error (MAE) for the testing set was 0.131±0.018, which were all lower than those of the traditional static models. Joint modeling is an effective statistical strategy for identifying and processing dynamic variables, exhibiting better predictive performance than that of the traditional static models. It can provide new ideas for promoting the construction of comprehensive intervention systems.

Reproducible gut microbial signatures in bipolar and schizophrenia spectrum disorders: A metagenome-wide study

BackgroundNumerous studies report gut microbiome variations in bipolar disorder (BD) and schizophrenia spectrum disorders (SSD) compared to healthy individuals, though, there is limited consensus on which specific bacteria are associated with these disorders. MethodsIn this study, we performed a comprehensive metagenomic shotgun sequencing analysis in 103 Dutch patients with BD/SSD and 128 healthy controls matched for age, sex, body mass index and income, while accounting for diet quality, transit time and technical confounders. To assess the replicability of the findings, we used two validation cohorts (total n = 203), including participants from a distinct population with a different metagenomic isolation protocol. ResultsThe gut microbiome of the patients had a significantly different β-diversity, but not α-diversity nor neuroactive potential compared to healthy controls. Initially, twenty-six bacterial taxa were identified as differentially abundant in patients. Among these, the previously reported genera Lachnoclostridium and Eggerthella were replicated in the validation cohorts. Employing the CoDaCoRe learning algorithm, we identified two bacterial balances specific to BD/SSD, which demonstrated an area under the receiver operating characteristic curve (AUC) of 0.77 in the test dataset. These balances were replicated in the validation cohorts and showed a positive association with the severity of psychiatric symptoms and antipsychotic use. Last, we showed a positive association between the relative abundance of Klebsiella and Klebsiella pneumoniae with antipsychotic use and between the Anaeromassilibacillus and lithium use. ConclusionsOur findings suggest that microbial balances could be a reproducible method for identifying BD/SSD-specific microbial signatures, with potential diagnostic and prognostic applications. Notably, Lachnoclostridium and Eggerthella emerge as frequently occurring bacteria in BD/SSD. Last, our study reaffirms the previously established link between Klebsiella and antipsychotic medication use and identifies a novel association between Anaeromassilibacillus and lithium use.

Molecular overlaps of neurological manifestations of COVID-19 and schizophrenia from a proteomic perspective.

COVID-19, a complex multisystem disorder affecting the central nervous system, can also have psychiatric sequelae. In addition, clinical evidence indicates that a diagnosis of a schizophrenia spectrum disorder is a risk factor for mortality in patients with COVID-19. In this study, we aimed to explore brain-specific molecular aspects of COVID-19 by using a proteomic approach. We analyzed the brain proteome of fatal COVID-19 cases and compared it with differentially regulated proteins found in postmortem schizophrenia brains. The COVID-19 proteomic dataset revealed a strong enrichment of proteins expressed by glial and neuronal cells and processes related to diseases with a psychiatric and neurodegenerative component. Specifically, the COVID-19 brain proteome enriches processes that are hallmark features of schizophrenia. Furthermore, we identified shared and distinct molecular pathways affected in both conditions. We found that brain ageing processes are likely present in both COVID-19 and schizophrenia, albeit possibly driven by distinct processes. In addition, alterations in brain cell metabolism were observed, with schizophrenia primarily impacting amino acid metabolism and COVID-19 predominantly affecting carbohydrate metabolism. The enrichment of metabolic pathways associated with astrocytic components in both conditions suggests the involvement of this cell type in the pathogenesis. Both COVID-19 and schizophrenia influenced neurotransmitter systems, but with distinct impacts. Future studies exploring the underlying mechanisms linking brain ageing and metabolic dysregulation may provide valuable insights into the complex pathophysiology of these conditions and the increased vulnerability of schizophrenia patients to severe outcomes.