Pub Date : 2024-05-04DOI: 10.1093/schizbullopen/sgae009
D. Mamah, Victoria N Mutiso, C. Musyimi, Michael P Harms, Andrey P Anokhin, Shing Shiun Chen, John Torous, Levi Muyela, Jerome Nashed, Yazen Al-Hosni, Arthur Odera, Alaina Yarber, Semyon Golosheykin, Masoomeh Faghankhani, Megan Sneed, D. Ndetei
The Accelerating Medicines Partnership Schizophrenia (AMP SCZ) funds a longitudinal study of 43 research sites across 5 continents to develop tools to stratify developmental trajectories of youth at clinical high risk for psychosis (CHR) and identify homogenous targets for future clinical trials. However, there are no sites in Africa, leaving a critical gap in our knowledge of clinical and biological outcomes among CHR individuals. We describe the development of the Kenya Psychosis-Risk Outcomes Study (KePROS), a five-year NIH-funded project in Kenya designed to harmonize with AMP SCZ. The study will recruit over 100 CHR and 50 healthy participants and conduct multiple clinical and biomarker assessments over two years. Capacity building is a key component of the study, including the construction of an EEG laboratory and the upgrading of a local 3T MRI machine. We detail community recruitment, study methodologies and protocols, and unique challenges with this pioneering research in Africa. This paper is descriptive only. Planned future analyses will investigate possible predictors of clinical outcomes and will be compared to results from other global populations. KePROS will provide the research community with a rich longitudinal clinical and biomarker dataset from an African country in the developing Global South, which can be used alongside AMP SCZ data to delineate CHR outcome groups for future treatment development. Training in mental health assessment and investment in cutting-edge biomarker assessment and other technologies is needed to facilitate the inclusion of African countries in large-scale research consortia.
{"title":"Kenya Psychosis-Risk Outcomes Study (KePROS): Development of an Accelerated Medicine Partnership Schizophrenia (AMP SCZ)-Aligned Project in Africa","authors":"D. Mamah, Victoria N Mutiso, C. Musyimi, Michael P Harms, Andrey P Anokhin, Shing Shiun Chen, John Torous, Levi Muyela, Jerome Nashed, Yazen Al-Hosni, Arthur Odera, Alaina Yarber, Semyon Golosheykin, Masoomeh Faghankhani, Megan Sneed, D. Ndetei","doi":"10.1093/schizbullopen/sgae009","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae009","url":null,"abstract":"\u0000 \u0000 \u0000 The Accelerating Medicines Partnership Schizophrenia (AMP SCZ) funds a longitudinal study of 43 research sites across 5 continents to develop tools to stratify developmental trajectories of youth at clinical high risk for psychosis (CHR) and identify homogenous targets for future clinical trials. However, there are no sites in Africa, leaving a critical gap in our knowledge of clinical and biological outcomes among CHR individuals.\u0000 \u0000 \u0000 \u0000 We describe the development of the Kenya Psychosis-Risk Outcomes Study (KePROS), a five-year NIH-funded project in Kenya designed to harmonize with AMP SCZ. The study will recruit over 100 CHR and 50 healthy participants and conduct multiple clinical and biomarker assessments over two years. Capacity building is a key component of the study, including the construction of an EEG laboratory and the upgrading of a local 3T MRI machine. We detail community recruitment, study methodologies and protocols, and unique challenges with this pioneering research in Africa.\u0000 \u0000 \u0000 \u0000 This paper is descriptive only. Planned future analyses will investigate possible predictors of clinical outcomes and will be compared to results from other global populations.\u0000 \u0000 \u0000 \u0000 KePROS will provide the research community with a rich longitudinal clinical and biomarker dataset from an African country in the developing Global South, which can be used alongside AMP SCZ data to delineate CHR outcome groups for future treatment development. Training in mental health assessment and investment in cutting-edge biomarker assessment and other technologies is needed to facilitate the inclusion of African countries in large-scale research consortia.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"78 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141014596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03DOI: 10.1093/schizbullopen/sgae012
Bar Urkin, J. Parnas, Andrea Raballo, Danny Koren
Assigning a psychiatric diagnosis in real-world situations is often difficult, given that the clinical presentation does not usually conform to the list of condensed, simplified behavioral descriptors of mainstream operational taxonomies (MOT) (e.g. ICD-11 and DSM-5). The goal of this study was to benchmark diagnostic accuracy and reliability on a central and severe spectrum of psychopathology (i.e., the schizophrenia spectrum disorders [SSD]), adopting a pragmatic approach as close as possible to real-world clinical settings. We examined the diagnostic performance of 30 international psychiatrists expert in SSD. The clinicians were asked to make their clinical best diagnostic estimate for two written clinical vignettes excerpted from real-world SSD cases. In the first vignette, 22 out of the 30 clinicians (73.5%) indicated a schizophrenia spectrum disorder as their main diagnostic hypothesis. In the second vignette, 12 clinicians (40%) chose SSD as their main diagnostic hypothesis. Only 10 of the 30 clinicians (33%) correctly identified both vignettes as cases of SSD. The level of inter-rater diagnostic agreement (Fleiss’ Kappa) was but statistically significant (KFleiss = 0.08, p = 0.01). The results suggest that, even in a sample of influential international psychiatrists, the diagnostic accuracy and reliability on SSD presentations is poor and substantially inferior to those obtained in reliability studies using structured or semi-structured interviews. The widespread adoption of MOT systems in the last decades may have inadvertently eroded ability of clinicians to detect a typical pattern of psychiatric illnesses.
{"title":"Schizophrenia spectrum disorders (SSD): an empirical benchmark study of real-world diagnostic accuracy and reliability among leading international psychiatrists","authors":"Bar Urkin, J. Parnas, Andrea Raballo, Danny Koren","doi":"10.1093/schizbullopen/sgae012","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae012","url":null,"abstract":"\u0000 \u0000 \u0000 Assigning a psychiatric diagnosis in real-world situations is often difficult, given that the clinical presentation does not usually conform to the list of condensed, simplified behavioral descriptors of mainstream operational taxonomies (MOT) (e.g. ICD-11 and DSM-5). The goal of this study was to benchmark diagnostic accuracy and reliability on a central and severe spectrum of psychopathology (i.e., the schizophrenia spectrum disorders [SSD]), adopting a pragmatic approach as close as possible to real-world clinical settings.\u0000 \u0000 \u0000 \u0000 We examined the diagnostic performance of 30 international psychiatrists expert in SSD. The clinicians were asked to make their clinical best diagnostic estimate for two written clinical vignettes excerpted from real-world SSD cases.\u0000 \u0000 \u0000 \u0000 In the first vignette, 22 out of the 30 clinicians (73.5%) indicated a schizophrenia spectrum disorder as their main diagnostic hypothesis. In the second vignette, 12 clinicians (40%) chose SSD as their main diagnostic hypothesis. Only 10 of the 30 clinicians (33%) correctly identified both vignettes as cases of SSD. The level of inter-rater diagnostic agreement (Fleiss’ Kappa) was but statistically significant (KFleiss = 0.08, p = 0.01).\u0000 \u0000 \u0000 \u0000 The results suggest that, even in a sample of influential international psychiatrists, the diagnostic accuracy and reliability on SSD presentations is poor and substantially inferior to those obtained in reliability studies using structured or semi-structured interviews. The widespread adoption of MOT systems in the last decades may have inadvertently eroded ability of clinicians to detect a typical pattern of psychiatric illnesses.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"81 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141016154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1093/schizbullopen/sgae011
Mubarika Alavi, S. Ridout, Catherine Lee, Brooke Harris, Kathryn K. Ridout
Long-acting injectable (LAI) antipsychotics improve patient outcomes and are recommended by treatment guidelines for patients with limited medication adherence in schizophrenia spectrum, bipolar, and other psychotic disorders. Reports of LAI antipsychotic use in these disorders and if use aligns with treatment guidelines are lacking. This study aimed to report patient characteristics associated with LAI antipsychotic use in these disorders. Retrospective observational study of patients ≥18-years-old with bipolar or psychotic disorders at a large, integrated, community-based health system. Patient demographic and clinical characteristics served as exposures for the main outcome of adjusted odds ratio (aOR) for LAI versus oral antipsychotic medication use from 1/1/2017 to 12/31/2023. There were N=2,685 LAI and N=31,531 oral antipsychotic users. Being non-white (aOR=1.3-2.0; p<.0001), non-female (aOR=1.5; p<.0001), from a high deprivation neighborhood (NDI, aOR=1.3; p<.0007),having a higher body mass index(BMI, aOR=1.3-1.7; p<.0009), having a schizophrenia/schizoaffective (aOR=5.8-6.8; p<.0001), psychotic (aOR=1.6, p<.0001), or substance use disorder (aOR=1.4; p<.0001), and outpatient psychiatry (aOR=2.3-7.5; p<.0001) or inpatient hospitalization (aOR=2.4; p<.0001) utilization in the prior year with higher odds and age ≥40 (aOR=0.4-0.7; p<.0001) or bipolar disorder (aOR=0.9; p<.05) were associated with lower odds of LAI use. Non-white, non-female, age 18-39, and high NDI patients had higher LAI use regardless of treatment adherence markers. Smoking and cardiometabolic markers were also associated with LAI use. Demographic and clinical factors are associated with increased LAI use irrespective of treatment adherence. Research on utilization variation informing equitable formulation use aligned with treatment guideline recommendations is warranted.
长效注射型（LAI）抗精神病药物可改善患者的治疗效果，治疗指南推荐其用于精神分裂症谱系、双相情感障碍和其他精神病性障碍中服药依从性有限的患者。关于LAI抗精神病药物在这些疾病中的使用情况以及使用是否符合治疗指南的报告尚缺。本研究旨在报告在这些疾病中使用 LAI 抗精神病药物的相关患者特征。 本研究是一项回顾性观察研究，研究对象是一个大型综合社区医疗系统中年龄≥18岁的双相情感障碍或精神病患者。患者的人口统计学特征和临床特征作为主要研究结果的暴露因子，即从2017年1月1日至2023年12月31日期间，LAI与口服抗精神病药物使用的调整几率比（aOR）。 LAI 使用者为 2,685 人，口服抗精神病药物使用者为 31,531 人。非白人（aOR=1.3-2.0；p<.0001）、非女性（aOR=1.5；p<.0001）、来自高贫困社区（NDI，aOR=1.3；p<.0007）、体重指数（BMI，aOR=1.3-1.7；p<.0009）较高、患有精神分裂症/情感性精神分裂症（aOR=5.8-6.8；p<.0001）、精神病（aOR=1.6，p<.0001）或药物使用障碍（aOR=1.4；p<.0001），以及前一年使用精神科门诊（aOR=2.3-7.5；p<.0001）或住院（aOR=2.4；p<.0001）的几率较高，而年龄≥40（aOR=0.4-0.7；p<.0001）或双相情感障碍（aOR=0.9；p<.05）与使用LAI的几率较低有关。非白人、非女性、18-39 岁和 NDI 高的患者使用 LAI 的几率更高，与治疗依从性指标无关。吸烟和心脏代谢指标也与 LAI 的使用有关。 无论治疗依从性如何，人口统计学和临床因素都与 LAI 使用率的增加有关。有必要对使用差异进行研究，以便根据治疗指南的建议公平使用制剂。
{"title":"Predictors of Long-Acting Injectable Antipsychotic Medication Use in Patients with Schizophrenia Spectrum, Bipolar, and Other Psychotic Disorders in a United States Community-based, Integrated Health System","authors":"Mubarika Alavi, S. Ridout, Catherine Lee, Brooke Harris, Kathryn K. Ridout","doi":"10.1093/schizbullopen/sgae011","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae011","url":null,"abstract":"\u0000 \u0000 \u0000 Long-acting injectable (LAI) antipsychotics improve patient outcomes and are recommended by treatment guidelines for patients with limited medication adherence in schizophrenia spectrum, bipolar, and other psychotic disorders. Reports of LAI antipsychotic use in these disorders and if use aligns with treatment guidelines are lacking. This study aimed to report patient characteristics associated with LAI antipsychotic use in these disorders.\u0000 \u0000 \u0000 \u0000 Retrospective observational study of patients ≥18-years-old with bipolar or psychotic disorders at a large, integrated, community-based health system. Patient demographic and clinical characteristics served as exposures for the main outcome of adjusted odds ratio (aOR) for LAI versus oral antipsychotic medication use from 1/1/2017 to 12/31/2023.\u0000 \u0000 \u0000 \u0000 There were N=2,685 LAI and N=31,531 oral antipsychotic users. Being non-white (aOR=1.3-2.0; p<.0001), non-female (aOR=1.5; p<.0001), from a high deprivation neighborhood (NDI, aOR=1.3; p<.0007),having a higher body mass index(BMI, aOR=1.3-1.7; p<.0009), having a schizophrenia/schizoaffective (aOR=5.8-6.8; p<.0001), psychotic (aOR=1.6, p<.0001), or substance use disorder (aOR=1.4; p<.0001), and outpatient psychiatry (aOR=2.3-7.5; p<.0001) or inpatient hospitalization (aOR=2.4; p<.0001) utilization in the prior year with higher odds and age ≥40 (aOR=0.4-0.7; p<.0001) or bipolar disorder (aOR=0.9; p<.05) were associated with lower odds of LAI use. Non-white, non-female, age 18-39, and high NDI patients had higher LAI use regardless of treatment adherence markers. Smoking and cardiometabolic markers were also associated with LAI use.\u0000 \u0000 \u0000 \u0000 Demographic and clinical factors are associated with increased LAI use irrespective of treatment adherence. Research on utilization variation informing equitable formulation use aligned with treatment guideline recommendations is warranted.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"45 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1093/schizbullopen/sgae003
Viviane Machado, Lais Fonseca, Matheus Ghossain Barbosa, Rodrigo A. Bressan, P. Pan, L. A. Rohde, E. Miguel, G. A. Salum, Carolina Ziebold, Ary Gadelha
When occurring in adolescence, psychotic experiences (PE), subclinical psychotic symptoms, can be an early marker of mental illnesses. Studies with high-risk populations for psychosis show that anxiety symptoms often precede the onset of psychosis. Although anxiety symptoms are frequently experienced across the continuum of psychosis, no previous study has analyzed this association using a cross-lagged panel model longitudinally to identify if anxiety can be a predictor of PE over time or vice versa. The aim of the current study was to investigate whether one symptom domain predicts the other over time. 2,194 children from the Brazilian High-Risk Cohort (BHRC) were evaluated at baseline (T0), and 76.5% completed a 3-year follow-up (T1) interview. Childhood anxiety symptoms and PE were assessed using a standardized self-report questionnaire at both time points. Cross-lagged panel models evaluated time-lagged associations between PE and anxiety longitudinally. Higher levels of anxiety in childhood predicted an increase in PE levels in adolescence. The cross-lagged effect of anxiety scores at T0 on PE scores at T1 was significant (β=0.03, SE=0.01, p=<0.001) and PE in childhood did not increase levels of anxiety in adolescence, when controlling for sociodemographic and clinical characteristics. Our findings reinforce that anxiety may represent an early marker of psychosis proneness, not a consequence of already presenting PE, which can help to develop better screening approaches. Therefore, future studies should focus on identifying biological or other clinical markers to increase prediction accuracy.
在青少年时期出现的精神病性经验（PE），即亚临床精神病性症状，可能是精神疾病的早期标志。对精神病高危人群的研究表明，焦虑症状往往出现在精神病发作之前。虽然焦虑症状在精神病的整个过程中都会经常出现，但此前还没有研究采用跨滞后面板模型对这种关联进行纵向分析，以确定焦虑是否可以随着时间的推移预测 PE，反之亦然。本研究的目的是调查一个症状领域是否会随着时间的推移预测另一个症状领域。 来自巴西高风险队列（BHRC）的 2194 名儿童接受了基线（T0）评估，76.5% 的儿童完成了为期 3 年的随访（T1）。在这两个时间点，均使用标准化的自我报告问卷对儿童焦虑症状和PE进行了评估。交叉滞后面板模型对 PE 与焦虑之间的时滞关联进行了纵向评估。 儿童期焦虑程度越高，预示着青春期 PE 水平越高。T0时的焦虑评分对T1时的PE评分的交叉滞后效应是显著的（β=0.03，SE=0.01，p=<0.001），而且在控制社会人口学和临床特征的情况下，儿童时期的PE并不会增加青少年时期的焦虑水平。 我们的研究结果进一步说明，焦虑可能是精神病易感性的早期标志，而不是已经出现的 PE 的后果，这有助于制定更好的筛查方法。因此，今后的研究应侧重于确定生物或其他临床标记，以提高预测的准确性。
{"title":"Childhood Anxiety Symptoms as a Predictor of Psychotic Experiences in Adolescence in a High-Risk Cohort for Psychiatric Disorders","authors":"Viviane Machado, Lais Fonseca, Matheus Ghossain Barbosa, Rodrigo A. Bressan, P. Pan, L. A. Rohde, E. Miguel, G. A. Salum, Carolina Ziebold, Ary Gadelha","doi":"10.1093/schizbullopen/sgae003","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae003","url":null,"abstract":"\u0000 \u0000 \u0000 When occurring in adolescence, psychotic experiences (PE), subclinical psychotic symptoms, can be an early marker of mental illnesses. Studies with high-risk populations for psychosis show that anxiety symptoms often precede the onset of psychosis. Although anxiety symptoms are frequently experienced across the continuum of psychosis, no previous study has analyzed this association using a cross-lagged panel model longitudinally to identify if anxiety can be a predictor of PE over time or vice versa. The aim of the current study was to investigate whether one symptom domain predicts the other over time.\u0000 \u0000 \u0000 \u0000 2,194 children from the Brazilian High-Risk Cohort (BHRC) were evaluated at baseline (T0), and 76.5% completed a 3-year follow-up (T1) interview. Childhood anxiety symptoms and PE were assessed using a standardized self-report questionnaire at both time points. Cross-lagged panel models evaluated time-lagged associations between PE and anxiety longitudinally.\u0000 \u0000 \u0000 \u0000 Higher levels of anxiety in childhood predicted an increase in PE levels in adolescence. The cross-lagged effect of anxiety scores at T0 on PE scores at T1 was significant (β=0.03, SE=0.01, p=<0.001) and PE in childhood did not increase levels of anxiety in adolescence, when controlling for sociodemographic and clinical characteristics.\u0000 \u0000 \u0000 \u0000 Our findings reinforce that anxiety may represent an early marker of psychosis proneness, not a consequence of already presenting PE, which can help to develop better screening approaches. Therefore, future studies should focus on identifying biological or other clinical markers to increase prediction accuracy.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"53 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09DOI: 10.1093/schizbullopen/sgae004
M. Husain, I. Chaudhry, A. Khoso, M. I. Husain, Moin Ansari, Nasir Mehmood, Haider Naqvi, A. Nizami, U. Talib, A. H. Rajput, Paul Bassett, G. Foussias, Bill Deakin, Nusrat Husain
Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation, inflammation, and by interfering with NMDA neurotransmission. N-acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDA neurotransmission have been mixed. This may reflect poor target engagement but also that risk mechanisms act in parallel. Sodium Benzoate (NaB) could have an additive with NAC to act on several pathophysiological mechanisms implicated in schizophrenia. A multicentre, twelve-week, 2x2 factorial design, randomized double-blind placebo-controlled feasibility trial of NaB and NAC added to standard treatment in 68 adults with early schizophrenia. Primary feasibility outcomes included recruitment, retention, completion of assessments as well as acceptability of the study interventions. Psychosis symptoms, functioning and cognitive assessments were also assessed. We recruited our desired sample (n=68) and retained 78% (n=53) at 12-weeks, supporting the feasibility of recruitment and retention. There were no difficulties in completing clinical outcome schedules. Medications were well tolerated with no dropouts due to side effects. This study was not powered to detect clinical effect and as expected no main effects were found on the majority of clinical outcomes. We demonstrated feasibility of conducting a clinical trial of NaB and NAC. Given the preliminary nature of this study, we cannot draw firm conclusions about the clinical efficacy of either agent and a large scale trial is needed to examine if significant differences between treatment groups emerge.
{"title":"Add-on Sodium Benzoate and N-Acetylcysteine in patients with early schizophrenia spectrum disorder: a multicentre, double-blind, randomised placebo controlled feasibility trial","authors":"M. Husain, I. Chaudhry, A. Khoso, M. I. Husain, Moin Ansari, Nasir Mehmood, Haider Naqvi, A. Nizami, U. Talib, A. H. Rajput, Paul Bassett, G. Foussias, Bill Deakin, Nusrat Husain","doi":"10.1093/schizbullopen/sgae004","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae004","url":null,"abstract":"\u0000 \u0000 \u0000 Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation, inflammation, and by interfering with NMDA neurotransmission. N-acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDA neurotransmission have been mixed. This may reflect poor target engagement but also that risk mechanisms act in parallel. Sodium Benzoate (NaB) could have an additive with NAC to act on several pathophysiological mechanisms implicated in schizophrenia.\u0000 \u0000 \u0000 \u0000 A multicentre, twelve-week, 2x2 factorial design, randomized double-blind placebo-controlled feasibility trial of NaB and NAC added to standard treatment in 68 adults with early schizophrenia. Primary feasibility outcomes included recruitment, retention, completion of assessments as well as acceptability of the study interventions. Psychosis symptoms, functioning and cognitive assessments were also assessed.\u0000 \u0000 \u0000 \u0000 We recruited our desired sample (n=68) and retained 78% (n=53) at 12-weeks, supporting the feasibility of recruitment and retention. There were no difficulties in completing clinical outcome schedules. Medications were well tolerated with no dropouts due to side effects. This study was not powered to detect clinical effect and as expected no main effects were found on the majority of clinical outcomes.\u0000 \u0000 \u0000 \u0000 We demonstrated feasibility of conducting a clinical trial of NaB and NAC. Given the preliminary nature of this study, we cannot draw firm conclusions about the clinical efficacy of either agent and a large scale trial is needed to examine if significant differences between treatment groups emerge.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139789926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09DOI: 10.1093/schizbullopen/sgae004
M. Husain, I. Chaudhry, A. Khoso, M. I. Husain, Moin Ansari, Nasir Mehmood, Haider Naqvi, A. Nizami, U. Talib, A. H. Rajput, Paul Bassett, G. Foussias, Bill Deakin, Nusrat Husain
Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation, inflammation, and by interfering with NMDA neurotransmission. N-acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDA neurotransmission have been mixed. This may reflect poor target engagement but also that risk mechanisms act in parallel. Sodium Benzoate (NaB) could have an additive with NAC to act on several pathophysiological mechanisms implicated in schizophrenia. A multicentre, twelve-week, 2x2 factorial design, randomized double-blind placebo-controlled feasibility trial of NaB and NAC added to standard treatment in 68 adults with early schizophrenia. Primary feasibility outcomes included recruitment, retention, completion of assessments as well as acceptability of the study interventions. Psychosis symptoms, functioning and cognitive assessments were also assessed. We recruited our desired sample (n=68) and retained 78% (n=53) at 12-weeks, supporting the feasibility of recruitment and retention. There were no difficulties in completing clinical outcome schedules. Medications were well tolerated with no dropouts due to side effects. This study was not powered to detect clinical effect and as expected no main effects were found on the majority of clinical outcomes. We demonstrated feasibility of conducting a clinical trial of NaB and NAC. Given the preliminary nature of this study, we cannot draw firm conclusions about the clinical efficacy of either agent and a large scale trial is needed to examine if significant differences between treatment groups emerge.
{"title":"Add-on Sodium Benzoate and N-Acetylcysteine in patients with early schizophrenia spectrum disorder: a multicentre, double-blind, randomised placebo controlled feasibility trial","authors":"M. Husain, I. Chaudhry, A. Khoso, M. I. Husain, Moin Ansari, Nasir Mehmood, Haider Naqvi, A. Nizami, U. Talib, A. H. Rajput, Paul Bassett, G. Foussias, Bill Deakin, Nusrat Husain","doi":"10.1093/schizbullopen/sgae004","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae004","url":null,"abstract":"\u0000 \u0000 \u0000 Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation, inflammation, and by interfering with NMDA neurotransmission. N-acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDA neurotransmission have been mixed. This may reflect poor target engagement but also that risk mechanisms act in parallel. Sodium Benzoate (NaB) could have an additive with NAC to act on several pathophysiological mechanisms implicated in schizophrenia.\u0000 \u0000 \u0000 \u0000 A multicentre, twelve-week, 2x2 factorial design, randomized double-blind placebo-controlled feasibility trial of NaB and NAC added to standard treatment in 68 adults with early schizophrenia. Primary feasibility outcomes included recruitment, retention, completion of assessments as well as acceptability of the study interventions. Psychosis symptoms, functioning and cognitive assessments were also assessed.\u0000 \u0000 \u0000 \u0000 We recruited our desired sample (n=68) and retained 78% (n=53) at 12-weeks, supporting the feasibility of recruitment and retention. There were no difficulties in completing clinical outcome schedules. Medications were well tolerated with no dropouts due to side effects. This study was not powered to detect clinical effect and as expected no main effects were found on the majority of clinical outcomes.\u0000 \u0000 \u0000 \u0000 We demonstrated feasibility of conducting a clinical trial of NaB and NAC. Given the preliminary nature of this study, we cannot draw firm conclusions about the clinical efficacy of either agent and a large scale trial is needed to examine if significant differences between treatment groups emerge.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"190 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139849836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-18DOI: 10.1093/schizbullopen/sgae002
J. Kindler, Ishida Takuya, Chantal Michel, A. Klaassen, Miriam Stüble, Nadja Zimmermann, Roland Wiest, Michael Kaess, Yosuke Morishima
Resting-state network (RSN) functional connectivity analyses have profoundly influenced our understanding of the pathophysiology of psychoses and their clinical high risk (CHR) states. However, conventional RSN analyses address the static nature of large-scale brain networks. In contrast, novel methodological approaches aim to assess the momentum state and temporal dynamics of brain network interactions. Fifty CHR individuals and 33 healthy controls (HC) completed a resting-state functional MRI scan. We performed an Energy Landscape analysis, a data-driven method using the pairwise maximum entropy model, to describe large-scale brain network dynamics such as duration and frequency of, and transition between, different brain states. We compared those measures between CHR and HC, and examined the association between neuropsychological measures and neural dynamics in CHR. Our main finding is a significantly increased duration, frequency, and higher transition rates to an infrequent brain state with coactivation of the salience, limbic, default mode and somatomotor RSNs in CHR as compared to HC. Transition of brain dynamics from this brain state was significantly correlated with processing speed in CHR. In CHR, temporal brain dynamics are attracted to an infrequent brain state, reflecting more frequent and longer occurrence of aberrant interactions of default mode, salience, and limbic netowrks. Concurrently, more frequent and longer occurrence of the brain state is associated with core cognitive dysfunctions, predictors of future onset of full-blown psychosis.
{"title":"Aberrant brain dynamics in individuals with clinical high risk of psychosis","authors":"J. Kindler, Ishida Takuya, Chantal Michel, A. Klaassen, Miriam Stüble, Nadja Zimmermann, Roland Wiest, Michael Kaess, Yosuke Morishima","doi":"10.1093/schizbullopen/sgae002","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgae002","url":null,"abstract":"\u0000 \u0000 \u0000 Resting-state network (RSN) functional connectivity analyses have profoundly influenced our understanding of the pathophysiology of psychoses and their clinical high risk (CHR) states. However, conventional RSN analyses address the static nature of large-scale brain networks. In contrast, novel methodological approaches aim to assess the momentum state and temporal dynamics of brain network interactions.\u0000 \u0000 \u0000 \u0000 Fifty CHR individuals and 33 healthy controls (HC) completed a resting-state functional MRI scan. We performed an Energy Landscape analysis, a data-driven method using the pairwise maximum entropy model, to describe large-scale brain network dynamics such as duration and frequency of, and transition between, different brain states. We compared those measures between CHR and HC, and examined the association between neuropsychological measures and neural dynamics in CHR.\u0000 \u0000 \u0000 \u0000 Our main finding is a significantly increased duration, frequency, and higher transition rates to an infrequent brain state with coactivation of the salience, limbic, default mode and somatomotor RSNs in CHR as compared to HC. Transition of brain dynamics from this brain state was significantly correlated with processing speed in CHR.\u0000 \u0000 \u0000 \u0000 In CHR, temporal brain dynamics are attracted to an infrequent brain state, reflecting more frequent and longer occurrence of aberrant interactions of default mode, salience, and limbic netowrks. Concurrently, more frequent and longer occurrence of the brain state is associated with core cognitive dysfunctions, predictors of future onset of full-blown psychosis.\u0000","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"107 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139614600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1093/schizbullopen/sgad035
Ben Gray, Matthew Sisto
This article is a first- person and lived experience account on providing peer support in a mental health unit. The intertwining of process (a lived experience and first-person account by someone with schizophrenia) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems in an inpatient environment. It focuses on the meaning, value, processes, emotions, themes and outcomes of Peer Support Work. Ben has a diagnosis of schizophrenia and psychosis. Matt has lived experience as a peer support worker/ supervisor and team leader. This article is drawn from a co-produced and lived experience evaluation conducted by the Peer Support Workers (PSWs) as a Lived Experience Evaluation Team (LEET). The article finishes by highlighting barriers to peer support in psychiatric hospital and so provides a guide to challenges for prospective and current PSWs. It should be noted that this first-person account and lived experience article expresses the perspective of the first author (Ben). It does not necessarily reflect the views of the co-author (Matt), the Peer Support Team or the NHS Trust.
{"title":"Peer Support Work in Hospital: A First Person and Lived Experience Guide","authors":"Ben Gray, Matthew Sisto","doi":"10.1093/schizbullopen/sgad035","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgad035","url":null,"abstract":"This article is a first- person and lived experience account on providing peer support in a mental health unit. The intertwining of process (a lived experience and first-person account by someone with schizophrenia) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems in an inpatient environment. It focuses on the meaning, value, processes, emotions, themes and outcomes of Peer Support Work. Ben has a diagnosis of schizophrenia and psychosis. Matt has lived experience as a peer support worker/ supervisor and team leader. This article is drawn from a co-produced and lived experience evaluation conducted by the Peer Support Workers (PSWs) as a Lived Experience Evaluation Team (LEET). The article finishes by highlighting barriers to peer support in psychiatric hospital and so provides a guide to challenges for prospective and current PSWs. It should be noted that this first-person account and lived experience article expresses the perspective of the first author (Ben). It does not necessarily reflect the views of the co-author (Matt), the Peer Support Team or the NHS Trust.","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"34 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.1093/schizbullopen/sgad034
{"title":"How Schizophrenia Almost Made Me a Card Carrying Member of the Undead","authors":"","doi":"10.1093/schizbullopen/sgad034","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgad034","url":null,"abstract":"","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"7 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138584818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-17DOI: 10.1093/schizbullopen/sgad026
Liam Myles, Jane Garrison, Lucy Cheke
The Salience Hypothesis posits that aberrations in the assignment of salience culminate in hallucinations and unusual beliefs, the ‘positive symptoms’ of schizophrenia. Evidence for this comes from studies on latent inhibition, referring to the phenomenon that prior exposure to a stimulus impedes learning about the relationship between that stimulus and an outcome. This paper reviewed all published studies examining the relationship between latent inhibition and both schizophrenia and schizotypy. Contemporary literature suggests that latent inhibition is attenuated in both people with schizophrenia and those loading highly on measures of schizotypy, the multidimensional derivative of schizophrenia. This suggests that these individuals assign greater salience to stimuli than healthy controls and people scoring low on measures of schizotypy, respectively. However, several confounds limit these conclusions. Studies on people with schizophrenia are limited by the confounding effects of psychotropic medications, idiosyncratic parsing of samples, variation in dependent variables and lack of statistical power. Moreover, latent inhibition paradigms are limited by the confounding effects of learned irrelevance, conditioned inhibition, negative priming and novel pop-out effects. This review concludes with the recommendation that researchers develop novel paradigms that overcome these limitations to evaluate the predictions of the Salience Hypothesis.
{"title":"Latent Inhibition in Schizophrenia and Schizotypy","authors":"Liam Myles, Jane Garrison, Lucy Cheke","doi":"10.1093/schizbullopen/sgad026","DOIUrl":"https://doi.org/10.1093/schizbullopen/sgad026","url":null,"abstract":"The Salience Hypothesis posits that aberrations in the assignment of salience culminate in hallucinations and unusual beliefs, the ‘positive symptoms’ of schizophrenia. Evidence for this comes from studies on latent inhibition, referring to the phenomenon that prior exposure to a stimulus impedes learning about the relationship between that stimulus and an outcome. This paper reviewed all published studies examining the relationship between latent inhibition and both schizophrenia and schizotypy. Contemporary literature suggests that latent inhibition is attenuated in both people with schizophrenia and those loading highly on measures of schizotypy, the multidimensional derivative of schizophrenia. This suggests that these individuals assign greater salience to stimuli than healthy controls and people scoring low on measures of schizotypy, respectively. However, several confounds limit these conclusions. Studies on people with schizophrenia are limited by the confounding effects of psychotropic medications, idiosyncratic parsing of samples, variation in dependent variables and lack of statistical power. Moreover, latent inhibition paradigms are limited by the confounding effects of learned irrelevance, conditioned inhibition, negative priming and novel pop-out effects. This review concludes with the recommendation that researchers develop novel paradigms that overcome these limitations to evaluate the predictions of the Salience Hypothesis.","PeriodicalId":21348,"journal":{"name":"Schizophrenia Bulletin Open","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139264898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：