Schizophrenia Research最新文献

Background

Aims

Methods

Results

Conclusions

Background

Prior studies have found that individuals with schizophrenia often have an enlarged “personal space”. However, the neurocognitive mechanisms underlying this consistent finding remain unknown.

Methods

The well-validated Stop Distance Procedure was used to measure the personal space preferences of individuals with psychotic disorders (PD, N = 22) and demographically-matched healthy controls (HC, N = 20) in response to human and virtual (avatar) intruders. Physiological arousal and subjective discomfort were measured during intrusions into personal space and modeled across different interpersonal distances. Additionally, participants were interviewed to assess their subjective awareness of their personal space preferences.

Results

Personal space measurements with humans and avatars were highly correlated and reliable over repeated trials, and influenced by the displayed emotion and gender of the intruders, in both groups. The PD group exhibited a larger personal space than the HC group (all p < 0.028), and the size of personal space with avatar intruders was significantly correlated with positive symptom severity in the PD subjects. Moreover, the magnitude of arousal responses to personal space intrusions was proportional to a power (exponent) of the distance between subjects and intruders, with a significantly smaller exponent in the PD (compared to the HC) for both human (p = 0.026) and avatar (p = 0.011) intruders, indicating a less steep function. Lastly, much of the participants' qualitative impressions of their personal space behaviors were consistent or correlated with the quantitative findings, reflecting some awareness of the determinants of personal space.

Conclusions

These findings reveal both intact and altered aspects of personal space regulation in psychotic disorders, and the potential utility of personal space measurements, given their high reliability, to serve as objective targets of interventions.

Background

People experiencing their first episode of psychosis have high risk of suicide, and programs specializing in early psychosis have not always achieved reduced risk. The present study analyzes patterns of suicide ideation, self-harm, and suicide attempts within the Connection Learning Healthcare System of 23 early psychosis programs in Pennsylvania and Maryland that follow the Coordinated Specialty Care treatment model.

Method

People with first episode psychosis (n = 1101) were assessed at admission and every six months using a standardized battery that included self-reported past-month ideation and clinician-reported past-six-month ideation, self-harm, and suicide attempts.

Results

At admission, there were 28 % rates of self-reported past-month suicide ideation and 52 % rates clinician-reported past-six-month suicide ideation, 23 % rate of clinician-reported self-harm, and 15 % rate of attempts. After the first six months of treatment there were significantly lower rates of clinician-reported suicidality (with reductions of at least 77 %), and after the first year of treatment there was significantly lower self-reported ideation (with approximately 54 % reporting lower past-month ideation). Changes were not accounted for by differential early discharge. A range of psychosocial variables predicted within- and between-subject variability in suicidality. Social and role functioning, depressive symptom severity, and a sense of recovery were significant within-subject predictors of all four measures of suicidality.

Conclusions

Compared to admission, we observed substantially lower rates of suicidality within the first year of treatment for clients with first episode psychosis in Coordinated Specialty Care. Reductions were predicted by some of the variables targeted by the treatment model.

Identifying individuals at clinical high risk for psychosis (CHRP) is crucial for preventing psychosis and improving the prognosis for schizophrenia. Individuals at CHR-P may exhibit mild forms of formal thought disorder (FTD), making it possible to identify them using natural language processing (NLP) methods. In this study, speech samples of 62 CHR-P individuals and 45 healthy controls (HCs) were elicited using Thematic Apperception Test images. The evaluation involved various NLP measures such as semantic similarity, generic, and part-of-speech (POS) features. The CHR-P group demonstrated higher sentence-level semantic similarity and reduced mean image-to-text similarity. Regarding generic analysis, they demonstrated reduced verbosity and produced shorter sentences with shorter words. The POS analysis revealed a decrease in the utilization of adverbs, conjunctions, and first-person singular pronouns, alongside an increase in the utilization of adjectives in the CHR-P group compared to HC. In addition, we developed a machine-learning model based on 30 NLP-derived features to distinguish between the CHR-P and HC groups. The model demonstrated an accuracy of 79.6 % and an AUC-ROC of 0.86. Overall, these findings suggest that automated language analysis of speech could provide valuable information for characterizing FTD during the clinical high-risk phase and has the potential to be applied objectively for early intervention for psychosis.

Aim

Service disengagement is a major problem for “Early Intervention in Psychosis” (EIP). Understanding predictors of engagement is also crucial to increase effectiveness of mental health treatments, especially in young people with First Episode Psychosis (FEP). No Italian investigation on this topic has been reported in the literature to date. The goal of this research was to assess service disengagement rate and predictors in an Italian sample of FEP subjects treated within an EIP program across a 2-year follow-up period.

Methods

All patients were young FEP help-seekers, aged 12–35 years, recruited within the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were carried out.

Results

489 FEP subjects were enrolled in this study. Across the follow-up, a 26 % prevalence rate of service disengagement was found. Particularly strong predictors of disengagement were living with parents, poor treatment adherence at entry and a low baseline PANSS “Disorganization” factor score.

Conclusion

More than a quarter of our FEP individuals disengaged the Pr-EP program during the first 2 years of intervention. A possible solution to reduce disengagement and to facilitate re-engagement of these young patients might be to offer the option of low-intensity monitoring and support, also via remote technology and tele-mental health care.

In a previous study on ionotropic glutamate receptors, we have shown that [³H]kainate, but not [³H]AMPA or [³H]NMDA, receptor binding was lower in Brodmann's area (BA) 9 from people with schizophrenia. Subsequently, we defined a subgroup within the syndrome of schizophrenia who are termed the Muscarinic Receptor Deficit subgroup of Schizophrenia (MRDS) as they have markedly lower levels of [³H]pirenzepine binding to the muscarinic M1 receptor. The previous glutamate receptor study did not contain enough people with MRDS and other forms of schizophrenia (non-MRDS) to study any subgroup-specific differences. Hence, in this study we first measured [³H]pirenzepine binding to the muscarinic M1 receptor to confirm the MRDS subgroup, then measured [³H]kainate, [³H]AMPA and [³H]NMDA receptor binding using autoradiography in BA 9 from people with MRDS, non-MRDS and controls. We also measured binding in BA 10 as our gene expression study indicated that BA 10 is disproportionally affected by the molecular pathology of schizophrenia. As expected, due to case-selection criteria, [³H]pirenzepine binding to the M1 receptor was lower in BA 9 and BA 10 from people with MRDS, although more profound in BA 10. [³H]kainate receptor binding was lower only in BA 9 from people with MRDS, while [³H]AMPA and [³H]NMDA receptor binding was not altered in either region. Muscarinic M1 receptors and kainate receptors are both located on glutamatergic pyramidal neurons so a perturbation in both receptors could indicate altered excitatory neurotransmission in BA 9 from people with MRDS.