Schizophrenia Research最新文献

Background and hypothesis: The Positive and Negative Syndrome Scale (PANSS), comprehensively assesses schizophrenia severity. While network analyses of schizophrenic symptoms have yielded inconsistent results, components of disorganized thought consistently rank high in centrality. The present study aims to explore the centrality of disorganized thought across patient subgroups and its potential as a treatment target. We hypothesize that disorganized thought will emerge as a central feature in the symptom network across different patient populations.

Study design: We conducted a network psychometric analysis on data from 1435 schizophrenia patients, stratified into four groups based on family history and sex. Local and global network properties, including centrality, clustering coefficient, degree, density, and community detection, were investigated. Network comparisons were performed across groups, and results were validated using an independent dataset.

Study results: Disorganized thought emerged as the most central factor in Marder 5-factor model, maintaining stability across family history and sex differences. While family history did not significantly impact symptom structures (Females: M = 0.2, P = 0.4; S = 0.4, P = 0.7; Males: M = 0.2, P = 0.7; S = 0.1, P = 0.9), significant differences were observed between male and female symptom structures (Positive family history: M = 0.3, P < 0.05; Negative family history: M = 0.3, P < 0.01). The centrality and high stability of disorganized thought were further confirmed in the validation dataset.

Conclusions: The consistent centrality of disorganized thought across different patient subgroups suggests its potential as a key treatment target for schizophrenia.

Background and hypothesis: While maternal schizophrenia is linked to chronic childhood medical conditions, little is known about the risk of acute asthma exacerbations among children whose mothers have schizophrenia. This population-based study used health data for all of Ontario, Canada to evaluate whether having a mother with schizophrenia was associated with increased risk of asthma exacerbations.

Study design: The study cohort included 385,989 children diagnosed with asthma from age 2 years onward, followed from the time of their asthma diagnosis up to a maximum of age 19 years. Children whose biological mother was diagnosed with schizophrenia prior to the child's asthma diagnosis (n = 1407) were compared children whose mother was not (n = 384,582). Study outcomes were asthma-related hospitalization, and separately, asthma-related emergency department (ED) visit, each up to a maximum child age of 19 years. First exacerbations were evaluated using Cox proportional hazards models, and recurrent exacerbations by Andersen-Gill regression, adjusted for covariates.

Study results: First hospitalization for an asthma exacerbation occurred in 76 (6.9 per 1000 person-years) vs. 19,679 (5.4 per 1000 person-years) children with and without maternal schizophrenia (adjusted hazard ratio [aHR] 1.21, 95 % CI 0.97-1.51). For first asthma-related ED exacerbations, the rates were 25.1 vs. 20.7 per 100 person-years (aHR 1.06, 95 % CI 0.93-1.21). The adjusted rate ratio (aRR) for recurrent hospitalizations for asthma exacerbations was 1.27 (95 % CI 0.98-1.66), and 1.11 (95 % CI 0.94-1.31) for recurrent asthma-related ED exacerbations.

Conclusions: This study did not observe meaningful differences in acute care utilization for asthma exacerbations among children whose biological mothers had schizophrenia.

Background: Meta-analytic evidence has linked shame separately to both potentially traumatic events (PTEs) and psychosis, but the influence of shame on the relationship between PTEs and psychosis has not yet been examined. This study used meta-analytic structural equation modelling (MASEM) to examine whether shame plays a mediatory role between PTEs and experiences of psychosis.

Methods: A nested search was conducted within a previous systematic review on psychosis and shame to identify articles that contained a measure of PTEs. Included studies reported a quantitative association between psychosis and shame, and additionally a quantitative relationship between either i) PTEs and psychosis; or ii) PTEs and shame.

Findings: Of the 40 articles initially included, 14 met criteria and 13 were included in the analyses. Overall, shame partially mediated the relationship between PTE's and psychosis, observed through a significant indirect effect (β = 0.15, 95 % CI: 0.11-0.19) and a reduction in the direct path that remained significant (β = 0.13, 95 % CI: 0.06-0.20). Indirect paths through shame between childhood PTEs and psychosis (β = 0.07, 95 % CI: 0.03-0.11), and between lifespan PTEs and psychosis (β = 0.09, 95 % CI: 0.03-0.11), were both small but significant. Both direct paths remained significant, suggesting that shame acts a partial mediator for both types of PTE.

Conclusions: Shame is one path through which potentially traumatic events may influence the experience of psychosis and should be considered alongside other affective types in future modelling of psychosis. Qualitative research may aid further understanding of the mechanisms by which shame operates in this relationship.

Although exercise is medicine for outpatients with schizophrenia, it is unclear if one-year adherence-supported exercise leads to a "tipping point", at which the exercise becomes a routine manifested as life-long training in the patient group.

Methods: Forty-eight outpatients (28 men/20 women: 35 ± 11 (mean ± SD) years) with schizophrenia (ICD-10: F20-29) were randomised to: 1) collaborative care group (TG), performing aerobic interval (AIT; 4 × 4-min treadmill walking/running at ∼90 % peak heart rate) and leg press maximal strength training (MST; 4 × 4 repetitions at ∼90 % maximal strength [1RM]) 2d·wk.^-1 for 1-year, supported by transportation and training supervision; or 2) control group (CG). Peak oxygen uptake (V̇O_2peak) and walking work efficiency were measured directly along with scaled 1RM/power, anthropometry, blood pressure, and blood samples at inclusion, 1-year, and 5-years post-intervention.

Results: The TG increased V̇O_2peak (11 %, p < .01), scaled 1RM (40 %, p < .001), and power (26 %, p < .001) compared to CG after 1-year. At follow-up, no intergroup differences in these factors were observed (all p > .05). Both groups improved walking work efficiency (TG: 11 %; CG: 18 %; both p < .05) after 1-year (no intergroup difference, p > .05), but not at follow-up (both p > .05). At follow-up, HDL (high-density lipoprotein)-cholesterol (-15 %, p < .01) and glucose (26 %, p < .01) decreased/increased(respectively) more in the TG than CG. No other intergroup differences were observed in anthropometry or blood samples.

Conclusion: 1-year adherence-supported high-intensity training improves V̇O_2peak, 1RM, and power in outpatients with schizophrenia. However, the improvements in these factors key to longevity are not maintained after 5 years. These findings highlight the importance of long-lasting cost-efficient adherence support, ultimately affecting the population's prognosis.

Understanding the relationship between insight, depression, and suicidality in first-episode psychosis (FEP) is crucial for improving clinical outcomes and preventing suicide during early treatment stages. This longitudinal cohort study examined 264 participants enrolled in coordinated specialty care (CSC) services for FEP to investigate how insight and depression at admission impact suicidality at 6 and 12 months, assess the mediating role of depression at admission between insight and suicidality, and evaluate the persistence of depression over time. Regression analyses assessed the relationships among these variables, while mediation analyses explored the mediating effect of depression at admission. Significant predictors of suicidality at 6 months were insight (OR 0.71, 95 % CI: 0.53-0.94), depression (OR 5.40, 95 % CI: 2.45-12.61), and previous suicide attempts (OR 2.91, 95 % CI: 1.21-7.00). At 12 months, insight (OR 0.70, 95 % CI: 0.52-0.92) and depression (OR 2.82, 95 % CI: 1.26-6.50) remained significant. Depression at admission mediated 27.32 % of the effect of insight on suicidality at 6 months and 19.76 % at 12 months. Despite a general decrease in depression, a subset of participants remained persistently depressed. The study highlights the significant mediating role of depression at admission in the relationship between insight and suicidality, identifying it as the strongest predictor of suicidality. Early detection and treatment of depression in FEP should be prioritized, and further research should focus on targeted interventions within CSC.

Migrant status and ethnic minority background have been associated with increased risk for psychosis. However, it remains unclear if such association exists with subclinical forms of psychosis. In two general population samples, totaling 460 subjects, we investigated whether migrant status and/or ethnicity predict self-reported positive, negative and/or disorganized dimensions of psychosis (as measured by the SPQ-B). In comparison to the reference population, we observed higher scores in the negative dimension among both first and second-generation migrants as well as in some ethnic minority groups (particularly North Africa and French overseas). Our findings highlight the need to understand the mechanisms underlying this association between negative schizotypal traits and migrant/ethnic minority status. The fact that migration/ethnicity are associated with both psychotic disorders and subclinical manifestations of psychosis also support the psychosis continuum theory. The higher rates of negative schizotypal traits in these populations underscores the necessity for tailored policies and interventions to enhance mental health and prevent the transition to psychosis in these subgroups.

This systematic review evaluates the efficacy of psychosocial interventions for individuals experiencing first-episode psychosis (FEP) across multiple recovery outcomes. Drawing from 35 studies, the analysis synthesizes evidence on symptom reduction, social and role functioning improvement, continuity of care, hospitalization rates, and other psychological outcomes. Regarding symptom reduction, specialized FEP programs demonstrated decreases across positive, negative, and general symptoms. Cognitive Behavioral Therapy (CBT) interventions also showed promise in improving psychiatric symptoms, while skills training interventions were effective in enhancing positive and negative symptoms. Social and role functioning improvements were observed across different interventions, including specialized FEP care and vocational support. Furthermore, specialized FEP programs generally led to reduced hospitalization rates and improved continuity of care, while CBT and other interventions improved psychological outcomes, such as enhanced coping skills and cognitive functioning. Most studies, particularly those of higher quality, reported positive outcomes across multiple domains. Future research should prioritize comparative efficacy, intervention duration and modality effects, and address disparities in access and utilization of FEP interventions across diverse contexts. By advancing our understanding of effective psychosocial interventions for FEP, this review offers valuable insights for clinicians, researchers, and policymakers aiming to optimize outcomes and mitigate the burden of psychosis-related disabilities.

Background: Given the widespread adoption of smartphone technologies, digital health strategies to address schizophrenia spectrum disorders hold considerable promise. However, there are relatively few trials of digital health interventions for schizophrenia. The App for Independence (A4i) is a multi-function digital platform co-designed by people with schizophrenia, their families, and service providers.

Hypothesis: This trial was designed to assess the feasibility of A4i.

Study design: The study was a single-blinded randomized trial. This trial was undertaken to generate feasibility data that might inform the design and utility of future effectiveness and implementation trials. The study took place in Toronto, Canada, with 91 participants randomized to 6 months of A4i use or treatment as usual. Feasibility metrics included recruitment, engagement and retention targets, qualitative and satisfaction data, and a secondary assessment of clinical, quality of life, and treatment adherence outcomes.

Study results: The COVID-19 pandemic markedly affected the recruitment of both primary participants and clinicians. Feasibility outcomes were difficult to interpret, though they presented some useful information for future trials. Engagement objectives were not achieved. However, A4i-user satisfaction ratings and qualitative feedback were positive, and technology engagement was fairly positive despite implementation challenges.

Conclusions: This study adds to emerging discourse regarding how technologies such as A4i are implemented. It suggests that digital technologies are of interest and are received positively by severe mental illness populations, though more work is needed to understand how they are implemented and the optimal methods for researching them.

Background: Social Support has been found to contribute to lower mental illness burden, higher treatment adherence, enhanced social functioning, and better quality of life. Individuals with schizophrenia report lower social support compared to non-clinical populations, yet the factors contributing to this discrepancy are not fully clear. Specifically, the person-related variables that may enhance or hinder SS in people with schizophrenia are unknown. Evidence from affective neuroscience research has implicated emotion awareness and regulation as key predictors of social functioning, a correlate of social support. However, their potential impact on social support in schizophrenia has not been investigated.

Methods: We examined emotion awareness, emotion regulation and social support in 90 individuals with schizophrenia and 26 healthy controls.

Results: The schizophrenia group reported significantly poorer emotion awareness, more frequent use of suppression to regulate emotions, as well as lower social support. Within the schizophrenia group, results from mediation analyses pointed to significant indirect effects of specific emotion regulation strategies on social support through emotion awareness, with use of suppression predicting lower social support via decreased emotion awareness, and conversely, use of cognitive reappraisal predicting greater social support via increased emotion awareness. Notably, emotion awareness was more strongly associated with social support from friends than from family members.

Conclusions: The results highlight poor emotion awareness as a key variable critical to enhancing social support in people schizophrenia. We discuss potential mechanisms underlying the links between emotion awareness, emotion regulation, and SS, along with the therapeutic implications of the findings.