European Archives of Psychiatry and Clinical Neuroscience最新文献

Background: Personality traits influence symptoms, functioning, and illness trajectory in chronic psychosis. However, their role in early-stage psychosis remains poorly defined, particularly regarding potential differences from healthy controls and their association with clinical outcomes.

Methods: We conducted a systematic review and meta-analysis of studies assessing personality domains in early-stage psychosis using validated dimensional instruments. Searches were performed in PubMed/MEDLINE, CINAHL, and Web of Science until March 2025. The meta-analysis included studies using the NEO Five-Factor Inventory (NEO-FFI), with patient scores compared to published normative data. Studies reporting T-scores and those reporting raw scores were analyzed separately. Associations between personality domains and clinical features were narratively synthesized.

Results: Eighteen studies met the inclusion criteria; eight were included in the meta-analysis (n = 1109). Considering studies reporting T-scores, individuals with early-stage psychosis showed higher neuroticism (MD = 27.4, 95% CI [25.0 to 29.9]) and lower extraversion (MD = -6.0, 95% CI [-8.6 to -3.5]) and conscientiousness (MD = -5.5, 95% CI [-7.9 to -3.2]), relative to normative data. Analyses of studies reporting raw scores showed similar effects, though not statistically significant. The same personality domains were consistently associated with symptom severity, treatment adherence, functioning, and service use.

Conclusions: Early-stage psychosis may be characterized by a specific personality profile that modulates clinical presentation. Early personality assessment may guide tailored treatment strategies. Longitudinal studies are needed to clarify their prognostic relevance and potential role in the personalization of treatment.

This study aims to identify the factors influencing the age of first hospitalization in patients with chronic schizophrenia, focusing on clinical features and blood parameters. A total of 1271 patients diagnosed with chronic schizophrenia were recruited from 17 psychiatric hospitals across China. Demographic and clinical data, including age of first hospitalization, were collected. The study also included assessments of psychiatric symptoms, duration of untreated psychosis (DUP), and various blood parameters. Statistical analyses were conducted to examine the relationships between these factors and the age of first hospitalization. The average age of first hospitalization was 28.07 ± 9.993 years. Single patients and those with a family history of mental illness were hospitalized at a younger age. Patients with suicidal ideation or behavior also had an earlier hospitalization age compared to those without such history. Regression analysis revealed that marital status (single), family history of mental illness, and suicide ideation or behavior were significant risk factors for earlier hospitalization age. Conversely, DUP, total protein (TP), and low-density lipoprotein (LDL) levels were positively correlated with the age of first hospitalization, while antipsychotic medication dosage and albumin (ALB) levels were negatively correlated. The study identifies significant demographic, clinical, and biochemical factors associated with the age of first hospitalization in chronic schizophrenia patients in China. These findings underscore the importance of early intervention and targeted support for high-risk groups to improve treatment outcomes.

The deficit of oligodendrocyte family cells has commonly been implicated in the dysfunction of neuronal networks in schizophrenia. Previously we reported a significant deficit of oligodendrocytes (Ol) and oligodendrocyte clusters (OlC), containing differentiating oligodendrocyte progenitors, in the cortical hubs of fronto-parietal cognitive (FPN) and default mode (DMN) networks, and in the striatum which is a central relay of the numerous networks. Anterior cingulate cortex (ACC) is crucial for integration of cognitive and emotional processes in support of goal-directed behavior and it's connections with FPN, DMN and basal ganglia are altered in schizophrenia. Few studies have examined changes in Ol family cell numbers in the ACC in schizophrenia, however, decreased expression of myelin- and oligodendrocyte-related genes in the ACC are characteristic of schizophrenia. We used optical disector method to estimate the numerical density (Nv) of oligodendrocytes and oligodendrocyte clusters in layer 5 of dorsal ACC (dACC) in schizophrenia (18 cases per group) as compared to healthy controls (13 cases per group). A significant reduction in the Nv of oligodendrocytes (- 23%; p < 0.01) and NvOlC (- 28%, p = 0.012) was found in schizophrenia as compared to the control group. We found significant correlations between the NvOl and the NvOlC in both control (R = 0.9; p < 0.001) and schizophrenia groups (R = 0.77; p = 0.014). The deficits in the number of OL and OlC in layer 5 of dACC may be tightly linked with reduced reciprocal ACC-thalamic connectivity in patients brain which were reported strongly correlate with positive symptoms fundamental for schizophrenia.

Background: Patients with schizophrenia spectrum disorder (SSD) suffer from impaired cognitive functions. Previous studies in healthy individuals have shown that a single bout of physical exercise benefits cognitive functions. Such enhancements in cognitive function would be highly beneficial, particularly for patients with SSD, as cognitive abilities play a vital role in both mental and physical health.

Methods: We examined the impact of a single bout of aerobic exercise on cognitive function in 25 patients with SSD and 24 healthy controls. Participants performed a single bout of aerobic exercise adjusted to their individual fitness level. Cognitive function was examined pre- and postexercise via oculomotor tasks consisting of saccadic (i.e., pro- and antisaccades) and smooth pursuit eye movements (SPEM). Furthermore, long-term physical fitness and movement activity were assessed through an anaerobic threshold testing and self-reports of physical activity.

Results: As expected, SSD-patients showed higher antisaccade error rates and were impaired in both SPEM initiation and maintenance with higher disorganization levels being related to lower SPEM performance. Neither the patient nor control group benefited from a single bout of exercise in terms of improved saccade or SPEM performance. However, higher fitness levels and more extensive long-term movement activity were associated with lower antisaccade error rates in patients.

Conclusion: These findings do not demonstrate a single bout postexercise benefit in cognition; however, results indicate an association between greater cognitive control and long-term movement activity and thus underscore the importance of conducting further investigations into long-term exercise interventions as a complementary therapeutic approach.

Background: Deficits in the hippocampus are a consistent finding in schizophrenia and have also been demonstrated in early-stage psychosis. Moreover, alterations in hippocampal anatomy and connectivity have been implicated in aberrant functional interactions in subcortical and cortical networks. However, the nature and extent of these alterations and their association with frontal and subcortical regions remain unclear.

Methods: To address these questions, we analysed resting state fMRI functional connectivity and graph properties in n = 93 individuals at clinical high-risk for psychosis (CHR-P), n = 26 patients with first-episode psychosis (FEP), n = 31 individuals with affective disorders and substance abuse as well as n = 58 healthy controls. We used novel denoising techniques and individually optimised functional connectivity matrices, which were compared across clinical groups. Finally, the centrality of the hippocampus as well as network segregation and integration were assessed using graph-based analysis.

Results: Both the FEP and CHR-P groups were characterised by reduced functional connectivity between the hippocampus and inferior frontal cortex albeit the differences in CHR-P individuals did not survive corrections for multiple comparisons. Compared to CHR-P, FEP show lower centrality of the hippocampus but increased network segregation.

Conclusions: Our findings show lower connectivity between the hippocampus and frontal cortex in early-stage psychosis, with FEP patients showing stronger decreases in connectivity compared to CHR-Ps. Furthermore, network-based analyses highlight reduced centrality in FEPs compared to CHR-Ps, indicating reduced influence on the wider network. Thus, altered connectivity along the hippocampal-frontal axis could be a potential marker of illness stage in early-stage psychosis.

Background: Elevated homocysteine levels, known as hyperhomocysteinemia (HHcy), have been implicated in the pathophysiology of schizophrenia. Most prior studies focused on first-episode or acute-phase schizophrenia patients, leaving the prevalence, determinants, and clinical correlates of HHcy in chronic schizophrenia understudied. This study aims to investigate the prevalence and determinants of HHcy in patients with chronic schizophrenia, as well as its clinical correlates. ​​METHODS: A cross-sectional study was conducted involving 509 patients diagnosed with chronic schizophrenia, recruited from multiple psychiatric hospitals in China. Demographic, clinical, and lifestyle data were collected through structured interviews and medical record reviews. Blood samples were analyzed for homocysteine levels and other biochemical parameters. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD), Insomnia Severity Index (ISI), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess clinical symptoms and cognitive function. Binary logistic regression analysis was performed to identify independent predictors of HHcy. RESULTS​​: ​​The prevalence of HHcy in the study population was 56.2%. Patients with HHcy were significantly older (mean age: 52.1 ± 12.2 years) and had a higher proportion of males (67.1%) compared to those without HHcy. The HHcy group exhibited milder positive and general psychopathology symptoms, as indicated by lower PANSS scores, revealing unexpected inverse associations with symptom severity. Elevated levels of C-reactive protein (CRP), total bilirubin (TBIL), and creatine phosphokinase (CPK) were observed in the HHcy group. Binary logistic regression analysis identified female gender and older age as independent predictors of HHcy.

Conclusions: ​​This study highlights a high prevalence of HHcy in patients with chronic schizophrenia, associated with older age and male gender. Contrary to expectations, HHcy was linked to milder symptom severity, suggesting a potential paradoxical relationship.

Psychotic disorders, particularly schizophrenia, are characterized by significant cognitive and social impairments, with early identification being crucial for effective intervention. Cholesterol plays a vital role in brain function and is primarily synthesized within the central nervous system. We analyzed plasma levels of total cholesterol and specific oxysterols, including 24-hydroxycholesterol, 27-hydroxycholesterol, and others, in a cohort of 61 ultra-high risk individuals and 44 healthy controls. Our findings indicate no difference in total cholesterol levels between groups; however, ultra-high risk individuals exhibited significantly increased levels of all measured oxysterols, suggesting dysregulation of cholesterol metabolism. Furthermore, a weak correlation was found between 27-hydroxycholesterol levels and positive psychotic symptoms. These results highlight the potential role of altered cholesterol metabolism in the early stages of psychotic disorders, proposing that specific oxysterols may serve as biomarkers for early detection and intervention strategies. This study contributes to the understanding of the biochemical underpinnings of psychosis and emphasizes the need for further investigation related to lipid metabolism and psychotic disorders.

Past studies indicate that individuals at clinical high-risk for psychosis (CHR) display emotion regulation abnormalities that predict increased symptom severity and poor functional outcome. However, it is unclear which neurophysiological processes contribute to impairments in implementing various strategies to down-regulate negative emotion. The current study used electroencephalography (EEG) to determine whether individuals at CHR have difficulty implementing reappraisal and distraction. Participants included individuals at CHR (n = 25) and healthy controls (CN: n = 36) who completed an EEG task while unpleasant or neutral stimuli were presented and they were required to either passively view or down-regulate negative emotion using reappraisal or distraction. The late positive potential (LPP) event related potential component was calculated from the EEG data and used as an objective neurophysiological indicator of emotion regulation effectiveness. CN effectively decreased the amplitude of the LPP for both reappraisal and distraction compared with unpleasant passive viewing; however, CHR did not differ in LPP amplitude for unpleasant passive viewing, reappraisal, and distraction, suggesting an implementation abnormality. Difficulty implementing distraction was associated with greater severity of attenuated positive symptoms. Collectively, these findings suggest that CHR display neurophysiological patterns of emotion regulation impairment that are similar to those that have been identified among individuals with schizophrenia in past studies. Interventions have been developed to target these mechanisms. It may be beneficial to apply these interventions to psychosis-spectrum populations where they would have relevance for both treatment of established symptoms and prevention of illness among those at CHR.

The hypothalamus is key to body homeostasis, including regulating cortisol, testosterone, vasopressin, and oxytocin hormones, modulating aggressive behavior. Animal studies have linked the morphology and function of the hypothalamus to aggression and affiliation, with a subregional pattern reflecting the functional division between the hypothalamic nuclei. We explored the relationship between hypothalamic subunit volumes in violent offenders with (PSY-V) and without (NPV) a psychotic disorder, and the association with psychopathy traits. 3T MRI scans (n = 628, all male 18-70 years) were obtained from PSY-V, n = 38, NPV, n = 20, non-violent psychosis patients (PSY-NV), n = 134, and healthy controls (HC), n = 436. The total hypothalamus volume and its eleven nuclei were delineated into five subunits using Freesurfer v7.3. Psychopathy traits were assessed with Psychopathy Checklist-revised (PCL-R). ANCOVAs and linear regressions were used to analyze associations with subunit volumes. Both groups with a history of violence exhibited smaller anterior-superior subunit volumes than HC (NPV Cohen's d = 0.56, p = 0.01 and PSY-V d = 0.38, p = 0.01). There were no significant differences between HC and PSY-NV. PCL-R scores were positively associated with the inferior tubular subunit on a trend level (uncorrected p = 0.045, Cohen's d = 0.04). We found distinct hypothalamic subunit volume reductions in persons with a history of violence independent of concomitant psychotic disorder but not in persons with psychosis alone. The results provide further information about the involvement of the hypothalamus in aggression, which ultimately may lead to the development of targeted treatment for the clinical and societal challenge of aggression and violent behavior.