Tongyi Zhang, Xin Zhao, B T Thomas Yeo, Xiaoning Huo, Simon B Eickhoff, Ji Chen
Background Executive function (EF) impairments are often seen in mental disorders, particularly schizophrenia (SZ), where they relate to adverse outcomes. As a heterogeneous construct, how specifically each dimension of EF to characterize the diagnostic and prognostic aspects of SZ remains opaque. Study Design We used classification models with a stacking approach on systematically measured EFs using 6 tasks to discriminate 195 patients with SZ from healthy individuals. Baseline EF measurements were moreover employed to predict symptomatically remitted or non-remitted prognostic subgroups. EF feature importance was determined at the group-level and the ensuing individual importance scores were associated with 4 symptom dimensions. Study Results The models highlighted the importance of inhibitory control (interference and response inhibitions) or working memory (WM) in accurately identifying individuals with SZ (area under the curve [AUC] = 0.87) or those in remission (AUC = 0.81). Patients who are correctly classified, in the association with the contribution of interference inhibition function to our diagnostic classifier, present more severe baseline negative symptoms compared to those who are more likely to be misclassified. Also, linked to the function of WM updating, patients who are successfully classified as remitted display milder cognitive symptoms at follow-up. Remitted patients do not differ significantly from non-remitted cases in baseline EF assessments or overall symptom severity. Conclusions Our work indicates that impairments in specific EF dimensions in SZ are differentially linked to individual symptom-load and prognostic outcomes. Thus, assessments and models based on EF may be promising in the clinical evaluation of this disorder.
{"title":"Leveraging Stacked Classifiers for Multi-task Executive Function in Schizophrenia Yields Diagnostic and Prognostic Insights","authors":"Tongyi Zhang, Xin Zhao, B T Thomas Yeo, Xiaoning Huo, Simon B Eickhoff, Ji Chen","doi":"10.1093/schbul/sbaf218","DOIUrl":"https://doi.org/10.1093/schbul/sbaf218","url":null,"abstract":"Background Executive function (EF) impairments are often seen in mental disorders, particularly schizophrenia (SZ), where they relate to adverse outcomes. As a heterogeneous construct, how specifically each dimension of EF to characterize the diagnostic and prognostic aspects of SZ remains opaque. Study Design We used classification models with a stacking approach on systematically measured EFs using 6 tasks to discriminate 195 patients with SZ from healthy individuals. Baseline EF measurements were moreover employed to predict symptomatically remitted or non-remitted prognostic subgroups. EF feature importance was determined at the group-level and the ensuing individual importance scores were associated with 4 symptom dimensions. Study Results The models highlighted the importance of inhibitory control (interference and response inhibitions) or working memory (WM) in accurately identifying individuals with SZ (area under the curve [AUC] = 0.87) or those in remission (AUC = 0.81). Patients who are correctly classified, in the association with the contribution of interference inhibition function to our diagnostic classifier, present more severe baseline negative symptoms compared to those who are more likely to be misclassified. Also, linked to the function of WM updating, patients who are successfully classified as remitted display milder cognitive symptoms at follow-up. Remitted patients do not differ significantly from non-remitted cases in baseline EF assessments or overall symptom severity. Conclusions Our work indicates that impairments in specific EF dimensions in SZ are differentially linked to individual symptom-load and prognostic outcomes. Thus, assessments and models based on EF may be promising in the clinical evaluation of this disorder.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"27 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Halide Bilge Türközer, Victor Zeng, Dung Hoang, Jothini Sritharan, Neha Iska, Elena I Ivleva, Brett A Clementz, Godfrey D Pearlson, Sarah Keedy, Elliot S Gershon, Carol A Tamminga, Matcheri S Keshavan, Paulo Lizano
Background and Hypothesis The visual system is a significant site of pathology in psychosis spectrum disorders (PSD). However, there is limited research investigating visual cortex (VC) subregions in this population. Using data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes Consortium (BSNIP-1/BSNIP-2/PARDIP), this study examined structural measures in VC subregions in individuals with PSD (IwP). Study Design Cortical surface area and thickness in 5 VC subregions (hOc1, hOc2, hOc3v, hOc4v, MT) were quantified using FreeSurfer v7.1.0 and compared between IwP (n = 1211) and healthy controls (HC, n = 734). Regional specificity was examined by controlling for total surface area or mean thickness. ComBat was used to harmonize scanner effects. Associations between VC measures and symptom severity, cognition, and childhood trauma scores were assessed. Study Results IwP demonstrated smaller surface area in hOc1, hOc2, and hOc3v, and lower cortical thickness in all 5 VC subregions compared to HC. Thickness reductions in hOc1, hOc4v, and MT were regionally specific. hOc4v and MT were among the top 3 regions exhibiting the most robust thickness deficits (d = −0.38 to −0.40) across all VC and Desikan–Killiany brain regions. Lower thickness in mid-level visual subregions was associated with greater positive symptoms and poorer cognition. Childhood trauma scores were related to thickness alterations in VC subregions. Conclusions This study demonstrates that the VC is among the most profoundly affected brain regions in PSD. Different patterns of area and thickness alterations across early and mid-level visual subregions, along with varying associations with clinical measures, suggest distinct developmental and disease-related influences.
{"title":"Neuroanatomical Deficits in Visual Cortex Subregions of Individuals With Psychosis Spectrum Disorders Linked to Symptoms, Cognition, and Childhood Trauma","authors":"Halide Bilge Türközer, Victor Zeng, Dung Hoang, Jothini Sritharan, Neha Iska, Elena I Ivleva, Brett A Clementz, Godfrey D Pearlson, Sarah Keedy, Elliot S Gershon, Carol A Tamminga, Matcheri S Keshavan, Paulo Lizano","doi":"10.1093/schbul/sbaf262","DOIUrl":"https://doi.org/10.1093/schbul/sbaf262","url":null,"abstract":"Background and Hypothesis The visual system is a significant site of pathology in psychosis spectrum disorders (PSD). However, there is limited research investigating visual cortex (VC) subregions in this population. Using data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes Consortium (BSNIP-1/BSNIP-2/PARDIP), this study examined structural measures in VC subregions in individuals with PSD (IwP). Study Design Cortical surface area and thickness in 5 VC subregions (hOc1, hOc2, hOc3v, hOc4v, MT) were quantified using FreeSurfer v7.1.0 and compared between IwP (n = 1211) and healthy controls (HC, n = 734). Regional specificity was examined by controlling for total surface area or mean thickness. ComBat was used to harmonize scanner effects. Associations between VC measures and symptom severity, cognition, and childhood trauma scores were assessed. Study Results IwP demonstrated smaller surface area in hOc1, hOc2, and hOc3v, and lower cortical thickness in all 5 VC subregions compared to HC. Thickness reductions in hOc1, hOc4v, and MT were regionally specific. hOc4v and MT were among the top 3 regions exhibiting the most robust thickness deficits (d = −0.38 to −0.40) across all VC and Desikan–Killiany brain regions. Lower thickness in mid-level visual subregions was associated with greater positive symptoms and poorer cognition. Childhood trauma scores were related to thickness alterations in VC subregions. Conclusions This study demonstrates that the VC is among the most profoundly affected brain regions in PSD. Different patterns of area and thickness alterations across early and mid-level visual subregions, along with varying associations with clinical measures, suggest distinct developmental and disease-related influences.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"1 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mylène Moyal, Aline Lefebvre, Sahar Allouch, Sophie B Sebille, David M Alexander, Laura Dugué, Mahmoud Hassan, Victor Férat, Marie-Odile Krebs, Martine Gavaret, Boris Chaumette, Marion Plaze, Anton Iftimovici
Background and Hypothesis Identifying reliable diagnostic biomarkers in catatonia remains a key challenge to improve early intervention and reduce morbidity and mortality. Since its pathophysiology may involve cortical dysconnectivity, electroencephalography (EEG) could provide accessible disease-associated measures, such as power spectral density (PSD), peak alpha frequency (PAF), and C and D microstates. However, EEG is yet to be used for this purpose. Study Design This study is a case–control retrospective transdiagnostic hospital-based cohort. We analyzed resting-state EEG data from patients diagnosed with schizophrenia or mood disorders, both with (n = 102) and without (n = 519) catatonia. Linear regression models assessed associations between catatonia status and PSD, PAF, and microstates, adjusting for age, sex, medication (computed as olanzapine, fluoxetine, and diazepam equivalents), and comorbid neurodevelopmental or neurological conditions. Study Results Patients with catatonia showed increased delta power (T = 2.37, PFDR = .03), decreased alpha power (T = −3.55, PFDR = .002) and increased gamma power (T = 3.14, PFDR = .008), reduced PAF (T = −2.60, P = .03), and longer mean duration of microstate C (T = 2.17, P = .03). Conclusions Routine clinical EEG revealed quantitative neurophysiological differences between patients with and without catatonia in a transdiagnostic population with psychotic and mood disorders. PSD, alpha peak frequency, and microstate anomalies in catatonia shed light on its underlying pathophysiology, suggesting a probable neurodevelopmentally-related excitation/inhibition dysregulation. Importantly, this indicates that routine clinical EEG could be used for diagnostic biomarker development, which would ultimately improve early detection and treatment.
{"title":"Neurophysiological Resting-State Markers of Catatonia in Schizophrenia and Mood Disorders","authors":"Mylène Moyal, Aline Lefebvre, Sahar Allouch, Sophie B Sebille, David M Alexander, Laura Dugué, Mahmoud Hassan, Victor Férat, Marie-Odile Krebs, Martine Gavaret, Boris Chaumette, Marion Plaze, Anton Iftimovici","doi":"10.1093/schbul/sbag011","DOIUrl":"https://doi.org/10.1093/schbul/sbag011","url":null,"abstract":"Background and Hypothesis Identifying reliable diagnostic biomarkers in catatonia remains a key challenge to improve early intervention and reduce morbidity and mortality. Since its pathophysiology may involve cortical dysconnectivity, electroencephalography (EEG) could provide accessible disease-associated measures, such as power spectral density (PSD), peak alpha frequency (PAF), and C and D microstates. However, EEG is yet to be used for this purpose. Study Design This study is a case–control retrospective transdiagnostic hospital-based cohort. We analyzed resting-state EEG data from patients diagnosed with schizophrenia or mood disorders, both with (n = 102) and without (n = 519) catatonia. Linear regression models assessed associations between catatonia status and PSD, PAF, and microstates, adjusting for age, sex, medication (computed as olanzapine, fluoxetine, and diazepam equivalents), and comorbid neurodevelopmental or neurological conditions. Study Results Patients with catatonia showed increased delta power (T = 2.37, PFDR = .03), decreased alpha power (T = −3.55, PFDR = .002) and increased gamma power (T = 3.14, PFDR = .008), reduced PAF (T = −2.60, P = .03), and longer mean duration of microstate C (T = 2.17, P = .03). Conclusions Routine clinical EEG revealed quantitative neurophysiological differences between patients with and without catatonia in a transdiagnostic population with psychotic and mood disorders. PSD, alpha peak frequency, and microstate anomalies in catatonia shed light on its underlying pathophysiology, suggesting a probable neurodevelopmentally-related excitation/inhibition dysregulation. Importantly, this indicates that routine clinical EEG could be used for diagnostic biomarker development, which would ultimately improve early detection and treatment.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"13 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa G Zandstra, Floortje E Scheepers, Gabriela Lunansky, Silvana Galderisi, Birte Y Glenthøj, Inge Winter-van Rossum, Metten Somers, Edwin van Dellen
Background and Hypothesis: Treatment response in first-episode psychosis varies substantially, yet underlying factors remain poorly understood. Symptom network theory suggests that inter-symptom relationships may influence treatment response. We hypothesized that symptom networks at baseline, as well as dynamic interactions over time, would differ between remitters and non-remitters, and that specific antipsychotics would show differential symptom-targeting effects. Study Design: We compared baseline and temporal symptom networks between remitters (n = 250) and non-remitters (n = 196) from the OPTiMiSE trial using 21-item Positive and Negative Syndrome Scale (PANSS) data. Baseline networks were estimated using Gaussian graphical models and compared with the Network Comparison Test. Temporal networks across baseline, week 2, and week 4 were modeled using Cross-Lagged Panel Network analysis. Key symptoms were identified by in- and out-prediction values. Group differences were assessed via non-zero edge weight correlations and Jaccard Index (JI). Network Intervention Analysis was used to examine differential effects of continuing amisulpride versus switching to olanzapine in non-responders (n = 85). Study Results: Baseline networks did not differ between outcome groups. However, temporal networks showed substantial differences: remitters and non-remitters had minimal overlap in symptom connections (baseline→week 2: JI = 0.014; week 2 → week 4: JI = 0.055) and virtually no correlation in connection strengths (baseline→week 2: r = -0.089, P = .447; week 2 → week 4: r = 0.005, P = .968). Key nodes (highest in/out-prediction) differed between groups. No robust symptom-specific medication effects emerged. Conclusions: Temporal symptom dynamics, rather than static baseline relationships, differentiate response trajectories and could inform future research on early markers of non-remission. Absence of antipsychotic-specific effects suggests generic treatment mechanisms.
{"title":"Symptom Network Dynamics during Antipsychotic Treatment in First-Episode Psychosis","authors":"Melissa G Zandstra, Floortje E Scheepers, Gabriela Lunansky, Silvana Galderisi, Birte Y Glenthøj, Inge Winter-van Rossum, Metten Somers, Edwin van Dellen","doi":"10.1093/schbul/sbag016","DOIUrl":"https://doi.org/10.1093/schbul/sbag016","url":null,"abstract":"Background and Hypothesis: Treatment response in first-episode psychosis varies substantially, yet underlying factors remain poorly understood. Symptom network theory suggests that inter-symptom relationships may influence treatment response. We hypothesized that symptom networks at baseline, as well as dynamic interactions over time, would differ between remitters and non-remitters, and that specific antipsychotics would show differential symptom-targeting effects. Study Design: We compared baseline and temporal symptom networks between remitters (n = 250) and non-remitters (n = 196) from the OPTiMiSE trial using 21-item Positive and Negative Syndrome Scale (PANSS) data. Baseline networks were estimated using Gaussian graphical models and compared with the Network Comparison Test. Temporal networks across baseline, week 2, and week 4 were modeled using Cross-Lagged Panel Network analysis. Key symptoms were identified by in- and out-prediction values. Group differences were assessed via non-zero edge weight correlations and Jaccard Index (JI). Network Intervention Analysis was used to examine differential effects of continuing amisulpride versus switching to olanzapine in non-responders (n = 85). Study Results: Baseline networks did not differ between outcome groups. However, temporal networks showed substantial differences: remitters and non-remitters had minimal overlap in symptom connections (baseline→week 2: JI = 0.014; week 2 → week 4: JI = 0.055) and virtually no correlation in connection strengths (baseline→week 2: r = -0.089, P = .447; week 2 → week 4: r = 0.005, P = .968). Key nodes (highest in/out-prediction) differed between groups. No robust symptom-specific medication effects emerged. Conclusions: Temporal symptom dynamics, rather than static baseline relationships, differentiate response trajectories and could inform future research on early markers of non-remission. Absence of antipsychotic-specific effects suggests generic treatment mechanisms.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"7 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jenifer L Vohs, Sümeyra N Tayfur, Fangyong Li, Zhiqian Song, Nicholas J K Breitborde, John Cahill, Serena Chaudhry, Maria Ferrara, Stephan Heckers, Audrey Satchivi, Steve Silverstein, Stephan F Taylor, Ivy F Tso, Ashley Weiss, Alan Breier, Vinod H Srihari
Background and Hypotheses Hospitalization is common during first-episode psychosis (FEP) and is linked to functional decline, stigma, and healthcare burden. Coordinated Specialty Care (CSC) programs aim to reduce hospitalization and improve outcomes through early, multidisciplinary intervention. This study examined hospitalization outcomes and predictors among participants in the Academic Community Early Psychosis Intervention Network that included 6 CSCs in the United States. Study Design Participants with FEP (N = 701; mean age = 21.6 years, 64% male) were followed after CSC admission, with analyses restricted to the first 24 months. Primary outcomes included time to first hospitalization, number of hospitalizations, and length of stay (LOS). Kaplan–Meier survival and multivariable Cox regression examined predictors of time to first hospitalization, while negative binomial regression assessed hospitalization frequency and LOS. Study Results Hospitalization rates declined after CSC enrollment. Females had shorter time to first hospitalization (HR = 2.79, 95% CI, 1.16-6.74) and more frequent admissions (IRR = 1.43, 95% CI, 1.10-1.85) than males. Younger age also predicted earlier (HR = 0.80, 95% CI, 0.67-0.95) and more frequent hospitalizations (IRR = 0.70 per 5 years, 95% CI, 0.58-0.84). Prior hospitalization predicted more admissions (IRR = 4.89, 95% CI, 3.32-7.19) and longer LOS (RR = 10.54, 95% CI, 6.70-16.59). Black/African American participants had longer LOS than White participants (RR = 1.59, 95% CI, 1.08-2.34). Conclusions While hospitalization declined after CSC entry, females, younger individuals, and those with prior admissions remain at elevated risk. These findings underscore the need for tailored strategies to mitigate disparities and optimize early psychosis care.
{"title":"Psychiatric Hospitalization After Enrollment in Coordinated Specialty Care: Unexpected Gender- and Age-Related Disparities","authors":"Jenifer L Vohs, Sümeyra N Tayfur, Fangyong Li, Zhiqian Song, Nicholas J K Breitborde, John Cahill, Serena Chaudhry, Maria Ferrara, Stephan Heckers, Audrey Satchivi, Steve Silverstein, Stephan F Taylor, Ivy F Tso, Ashley Weiss, Alan Breier, Vinod H Srihari","doi":"10.1093/schbul/sbaf260","DOIUrl":"https://doi.org/10.1093/schbul/sbaf260","url":null,"abstract":"Background and Hypotheses Hospitalization is common during first-episode psychosis (FEP) and is linked to functional decline, stigma, and healthcare burden. Coordinated Specialty Care (CSC) programs aim to reduce hospitalization and improve outcomes through early, multidisciplinary intervention. This study examined hospitalization outcomes and predictors among participants in the Academic Community Early Psychosis Intervention Network that included 6 CSCs in the United States. Study Design Participants with FEP (N = 701; mean age = 21.6 years, 64% male) were followed after CSC admission, with analyses restricted to the first 24 months. Primary outcomes included time to first hospitalization, number of hospitalizations, and length of stay (LOS). Kaplan–Meier survival and multivariable Cox regression examined predictors of time to first hospitalization, while negative binomial regression assessed hospitalization frequency and LOS. Study Results Hospitalization rates declined after CSC enrollment. Females had shorter time to first hospitalization (HR = 2.79, 95% CI, 1.16-6.74) and more frequent admissions (IRR = 1.43, 95% CI, 1.10-1.85) than males. Younger age also predicted earlier (HR = 0.80, 95% CI, 0.67-0.95) and more frequent hospitalizations (IRR = 0.70 per 5 years, 95% CI, 0.58-0.84). Prior hospitalization predicted more admissions (IRR = 4.89, 95% CI, 3.32-7.19) and longer LOS (RR = 10.54, 95% CI, 6.70-16.59). Black/African American participants had longer LOS than White participants (RR = 1.59, 95% CI, 1.08-2.34). Conclusions While hospitalization declined after CSC entry, females, younger individuals, and those with prior admissions remain at elevated risk. These findings underscore the need for tailored strategies to mitigate disparities and optimize early psychosis care.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"49 3 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Hypothesis Persistent symptoms and disability are common in psychotic disorders. This may be partly attributable to inadequate antipsychotic treatment, but there has not been a recent overview of what constitutes inadequate treatment and its impact on outcomes. Study Design We focus on the latest meta-analyses to critically appraise the relationship between markers of inadequate antipsychotic treatment and outcomes from the first episode of psychosis onwards, relating outcomes to periods without antipsychotic use, antipsychotic treatment of subtherapeutic dose/duration, and antipsychotic partial/non-adherence. Study Results Inadequate antipsychotic treatment is common (non-adherence rates = 44%-56%), and repeatedly associated with poorer outcomes across several key patient-centered outcomes, including increased risk of relapse (relative risk (RR) up to 2.70, n = 13 988), more severe overall symptoms (standardized mean difference (SMD) up to 0.78, n = 8878), poorer quality-of-life (SMD up to 0.50, n = 1421), poorer functioning (SMD up to 0.55, n = 1988) and higher mortality (RR up to 1.83, n = 272 030). We also find there is more evidence for schizophrenia than other psychotic disorders. Conclusions We identify that there are no operationalized criteria for the minimally adequate treatment of psychosis, in contrast to major depression, for example. We propose that a longer duration of inadequate treatment (DIT) may be an important predictor of outcome, although this has not been tested. To address this and support the development of interventions to reduce inadequate treatment, we propose operationalized criteria for the minimally adequate treatment of psychosis and the DIT, proposing both clinically applicable and research criteria. Finally, we consider future directions for research and practice.
背景与假设持续症状和残疾在精神障碍中很常见。这可能部分归因于抗精神病药物治疗不足，但最近还没有关于治疗不足及其对结果影响的概述。研究设计我们关注最新的荟萃分析，以批判性地评估抗精神病药物治疗不足的标记物与首次精神病发作后的结果之间的关系，与不使用抗精神病药物的时期、亚治疗剂量/持续时间的抗精神病药物治疗以及抗精神病药物部分/不依从性的相关结果。研究结果抗精神病治疗常见的不足(不率= 44% - -56%),并多次与贫穷有关结果在几个关键的以病人为中心的结果,包括增加复发的风险(相对危险度(RR) 2.70, 13 n = 988),整体更严重的症状(标准平均差(SMD) 0.78, n = 8878),贫穷的生活质量(SMD 0.50 n = 1421),贫穷的功能(SMD 0.55 n = 1988)和更高的死亡率(RR 1.83,N = 272 030)。我们还发现，与其他精神疾病相比，精神分裂症的证据更多。结论：我们发现，与抑郁症相比，对于精神病的最低限度适当治疗没有可操作的标准。我们认为，较长的不充分治疗时间（DIT）可能是预后的一个重要预测因素，尽管尚未经过测试。为了解决这一问题并支持干预措施的发展以减少治疗不足，我们提出了精神病和DIT的最低限度适当治疗的可操作标准，提出了临床应用和研究标准。最后，对未来的研究和实践方向进行了展望。
{"title":"What is Minimally Adequate Treatment of Psychosis and Should Duration of Inadequate Treatment be a Clinical and Research Target? A Perspective and State-of-the-Art Review","authors":"Martin Osugo, Oliver D Howes","doi":"10.1093/schbul/sbag017","DOIUrl":"https://doi.org/10.1093/schbul/sbag017","url":null,"abstract":"Background and Hypothesis Persistent symptoms and disability are common in psychotic disorders. This may be partly attributable to inadequate antipsychotic treatment, but there has not been a recent overview of what constitutes inadequate treatment and its impact on outcomes. Study Design We focus on the latest meta-analyses to critically appraise the relationship between markers of inadequate antipsychotic treatment and outcomes from the first episode of psychosis onwards, relating outcomes to periods without antipsychotic use, antipsychotic treatment of subtherapeutic dose/duration, and antipsychotic partial/non-adherence. Study Results Inadequate antipsychotic treatment is common (non-adherence rates = 44%-56%), and repeatedly associated with poorer outcomes across several key patient-centered outcomes, including increased risk of relapse (relative risk (RR) up to 2.70, n = 13 988), more severe overall symptoms (standardized mean difference (SMD) up to 0.78, n = 8878), poorer quality-of-life (SMD up to 0.50, n = 1421), poorer functioning (SMD up to 0.55, n = 1988) and higher mortality (RR up to 1.83, n = 272 030). We also find there is more evidence for schizophrenia than other psychotic disorders. Conclusions We identify that there are no operationalized criteria for the minimally adequate treatment of psychosis, in contrast to major depression, for example. We propose that a longer duration of inadequate treatment (DIT) may be an important predictor of outcome, although this has not been tested. To address this and support the development of interventions to reduce inadequate treatment, we propose operationalized criteria for the minimally adequate treatment of psychosis and the DIT, proposing both clinically applicable and research criteria. Finally, we consider future directions for research and practice.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"17 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why Women With Psychosis Need Extra Attention-An Introduction to Special Theme Issue Women's Mental Health.","authors":"Bodyl A Brand, Iris E C Sommer","doi":"10.1093/schbul/sbaf240","DOIUrl":"10.1093/schbul/sbaf240","url":null,"abstract":"","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 2","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kai Chen, Xingxing Li, Ran Tang, Yongming Xu, Wenhao Zhuang, Zan Chen, Jiayi Fu, Chao Zhang, Lian Li, Yaqing Shao, Jinjin Wen, Shen Li, Dongsheng Zhou
Background and hypothesis: Working memory (WM) deficits are a core cognitive impairment in schizophrenia (SCZ). High-definition transcranial direct current stimulation (HD-tDCS) targeting the dorsolateral prefrontal cortex (DLPFC) has shown promise for improving WM, yet biomarkers indicating its efficacy remain limited. We hypothesized that HD-tDCS would enhance WM in SCZ and that changes in transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) metrics can serve as potential biomarkers of treatment response.
Study design: Sixty-three SCZ patients were randomized to receive either active (n = 32) or sham (n = 31) HD-tDCS. WM was assessed using the accuracy (ACC) and reaction time (RT) of the 2-back task before and after the 20-day intervention. TMS-EEG was conducted before and after the first HD-tDCS session to measure cortical responses. Changes in global mean field amplitude (GMFA) components were analyzed for their association with WM improvement.
Study results: Active HD-tDCS significantly improved ACC (P<.001) and reduced RT (P<.001), whereas performance remained unchanged in the sham (all P>.05). A single session of active HD-tDCS reduced the N45 amplitude (P=.038), with no significant differences observed in the sham (all P>.05). The N45 reduction correlated with the ACC improvement (r = -0.452, P=.009). Stepwise regression confirmed the N45 reduction as a significant contributor of ACC improvement (β = -0.03, t = -2.15, P=.040).
Conclusions: HD-tDCS effectively improved WM in SCZ patients. Reduction in N45 amplitude may serve as a neurophysiological marker of HD-tDCS treatment response.
{"title":"Acute Cortical Excitability Change is Associated with Long-Term Working Memory Improvement by HD-tDCS Treatment in Schizophrenia: a TMS-EEG Study.","authors":"Kai Chen, Xingxing Li, Ran Tang, Yongming Xu, Wenhao Zhuang, Zan Chen, Jiayi Fu, Chao Zhang, Lian Li, Yaqing Shao, Jinjin Wen, Shen Li, Dongsheng Zhou","doi":"10.1093/schbul/sbaf241","DOIUrl":"10.1093/schbul/sbaf241","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Working memory (WM) deficits are a core cognitive impairment in schizophrenia (SCZ). High-definition transcranial direct current stimulation (HD-tDCS) targeting the dorsolateral prefrontal cortex (DLPFC) has shown promise for improving WM, yet biomarkers indicating its efficacy remain limited. We hypothesized that HD-tDCS would enhance WM in SCZ and that changes in transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) metrics can serve as potential biomarkers of treatment response.</p><p><strong>Study design: </strong>Sixty-three SCZ patients were randomized to receive either active (n = 32) or sham (n = 31) HD-tDCS. WM was assessed using the accuracy (ACC) and reaction time (RT) of the 2-back task before and after the 20-day intervention. TMS-EEG was conducted before and after the first HD-tDCS session to measure cortical responses. Changes in global mean field amplitude (GMFA) components were analyzed for their association with WM improvement.</p><p><strong>Study results: </strong>Active HD-tDCS significantly improved ACC (P<.001) and reduced RT (P<.001), whereas performance remained unchanged in the sham (all P>.05). A single session of active HD-tDCS reduced the N45 amplitude (P=.038), with no significant differences observed in the sham (all P>.05). The N45 reduction correlated with the ACC improvement (r = -0.452, P=.009). Stepwise regression confirmed the N45 reduction as a significant contributor of ACC improvement (β = -0.03, t = -2.15, P=.040).</p><p><strong>Conclusions: </strong>HD-tDCS effectively improved WM in SCZ patients. Reduction in N45 amplitude may serve as a neurophysiological marker of HD-tDCS treatment response.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 2","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jenna Räsänen, Ilkka Ojansuu, Jari Tiihonen, Johannes Lieslehto, Markku Lähteenvuo
Background and hypothesis: Individuals with psychosis have an increased risk of committing and being victims of violence. There are frequent media reports of psychotic individuals assaulting strangers, which may cause fear and stigmatization among the general public. We hypothesize that homicides targeting strangers by psychotic individuals are rare.
Study design: Systematic review and meta-analysis to assess what percentage of homicide offenders suffering from psychosis target strangers. Medline database was searched with search term 'psychosis OR schizophrenia AND homicide' from inception to 10/2024. Articles published in peer-reviewed journals, written in English, and reporting the total number of homicide offenders with psychosis (ICD-10: F20, F22, F25, F30-F31, F32.3, F29) and stranger victims were included. PRISMA guidelines were followed. Studies with inadequate data were excluded. A random-effects meta-analysis using meta and metafor packages in R version 4.4.2 was conducted using the restricted maximum-likelihood (REML) method to account for variability across studies. The primary outcome was the pooled rate of stranger homicides among individuals with psychosis who committed a homicide, expressed as a proportion with 95% confidence intervals (CIs).
Study results: Thirteen studies were included, comprising a total of 1,438 perpetrators who had killed 177 strangers. Meta-analysis of these studies indicates that 12.7% (95% CI: 7.85-17.56 and heterogeneity I2 89.49%) of the homicides by psychotic individuals are targeted at strangers. Male gender explained 26.9% of between-study variance (P-value<0.05).
Conclusions: Although still rare, the percentage of homicides committed by psychotic individuals and targeted at strangers is higher than previously reported.
背景与假设：精神病患者实施暴力和成为暴力受害者的风险增加。媒体经常报道精神病患者袭击陌生人，这可能会引起公众的恐惧和污名化。我们假设精神病患者以陌生人为目标的杀人案很少见。研究设计：系统回顾和荟萃分析，以评估患有精神病的杀人罪犯以陌生人为目标的比例。检索Medline数据库，检索词为“psychosis OR schizophrenia AND homicide”，检索时间为创建之日至2024年10月。发表在同行评议期刊上的文章，用英文撰写，并报告精神病杀人罪犯（ICD-10: F20, F22, F25, F30-F31, F32.3, F29）和陌生人受害者的总数。遵循PRISMA准则。排除了数据不充分的研究。随机效应荟萃分析使用R 4.4.2版本中的元和元软件包，使用限制性最大似然（REML）方法来解释研究之间的可变性。主要结果是在犯下杀人罪的精神病患者中陌生人杀人的总比率，以95%置信区间（ci）的比例表示。研究结果：纳入了13项研究，共涉及1438名行凶者，他们杀害了177名陌生人。这些研究的荟萃分析表明，12.7% （95% CI: 7.85-17.56，异质性I2 89.49%）的精神病个体杀人是针对陌生人的。男性性别解释了26.9%的研究间差异（p值）。结论：虽然仍然很少见，但精神病患者针对陌生人实施的杀人案的比例比之前报道的要高。
{"title":"Systematic review of stranger homicides by psychotic individuals.","authors":"Jenna Räsänen, Ilkka Ojansuu, Jari Tiihonen, Johannes Lieslehto, Markku Lähteenvuo","doi":"10.1093/schbul/sbaf246","DOIUrl":"10.1093/schbul/sbaf246","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Individuals with psychosis have an increased risk of committing and being victims of violence. There are frequent media reports of psychotic individuals assaulting strangers, which may cause fear and stigmatization among the general public. We hypothesize that homicides targeting strangers by psychotic individuals are rare.</p><p><strong>Study design: </strong>Systematic review and meta-analysis to assess what percentage of homicide offenders suffering from psychosis target strangers. Medline database was searched with search term 'psychosis OR schizophrenia AND homicide' from inception to 10/2024. Articles published in peer-reviewed journals, written in English, and reporting the total number of homicide offenders with psychosis (ICD-10: F20, F22, F25, F30-F31, F32.3, F29) and stranger victims were included. PRISMA guidelines were followed. Studies with inadequate data were excluded. A random-effects meta-analysis using meta and metafor packages in R version 4.4.2 was conducted using the restricted maximum-likelihood (REML) method to account for variability across studies. The primary outcome was the pooled rate of stranger homicides among individuals with psychosis who committed a homicide, expressed as a proportion with 95% confidence intervals (CIs).</p><p><strong>Study results: </strong>Thirteen studies were included, comprising a total of 1,438 perpetrators who had killed 177 strangers. Meta-analysis of these studies indicates that 12.7% (95% CI: 7.85-17.56 and heterogeneity I2 89.49%) of the homicides by psychotic individuals are targeted at strangers. Male gender explained 26.9% of between-study variance (P-value<0.05).</p><p><strong>Conclusions: </strong>Although still rare, the percentage of homicides committed by psychotic individuals and targeted at strangers is higher than previously reported.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 2","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maxime Huot-Lavoie, Olivier Corbeil, Laurent Béchard, Valérie Jomphe, Sophie L'Heureux, Amal Abdel-Baki, Anne-Marie Essiambre, Chantale Thériault, Ingrid Salvini, Olivier Roy, Sébastien Brodeur, Paulina Montserrat Rodriguez Cervantes, William James Desrosiers, Isabelle Giroux, Magali Dufour, Yasser Khazaal, Marie-France Demers, Marc-André Roy
Background and hypothesis: First-episode psychosis (FEP) often coincides with comorbidities that hinder recovery. Gaming disorder (GD) has emerged as a potential concern; however, data on its prevalence and clinical impact in FEP populations remain limited. We hypothesized that GD would be more prevalent among individuals with FEP than in the general population and associated with more severe psychotic symptoms and poorer functional outcomes.
Study design: In this prospective cohort study, 284 consecutive patients aged 18-35 years admitted to an Early Intervention Service in Quebec, Canada, were assessed for GD using International Classification of Diseases-11 criteria, with up to 24 months follow-up. Psychotic symptoms and functioning were measured at baseline and at 6-month intervals using the Positive and Negative Syndrome Scale-6 items (PANSS-6) and the Social and Occupational Functioning Assessment Scale (SOFAS).
Study results: Gaming disorder was present in 7.04% (95% CI: [4.35%, 10.67%]) of the sample, exceeding the 3.3% general population estimates. Among the 105 patients who reported gaming at least monthly, those with GD (n = 20) more often played Massively Multiplayer Online Role-Playing Games, while non-GD gamers (n = 85) preferred action-adventure games. GD was associated with significantly higher PANSS-6 scores (P = .04), driven by elevated negative symptoms (P = .04). SOFAS scores were consistently lower among individuals with GD, with effect sizes increasing over time.
Conclusions: Gaming disorder is a prevalent and clinically meaningful comorbidity in FEP, linked to greater negative symptom burden and functional impairment. These findings support the need for systematic GD screening in early psychosis services and highlight the importance of developing tailored interventions.
{"title":"Gaming Disorder in First Episode Psychosis: Prevalence and Impact on Symptomatology and Functioning in a Prospective Cohort Study.","authors":"Maxime Huot-Lavoie, Olivier Corbeil, Laurent Béchard, Valérie Jomphe, Sophie L'Heureux, Amal Abdel-Baki, Anne-Marie Essiambre, Chantale Thériault, Ingrid Salvini, Olivier Roy, Sébastien Brodeur, Paulina Montserrat Rodriguez Cervantes, William James Desrosiers, Isabelle Giroux, Magali Dufour, Yasser Khazaal, Marie-France Demers, Marc-André Roy","doi":"10.1093/schbul/sbaf232","DOIUrl":"10.1093/schbul/sbaf232","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>First-episode psychosis (FEP) often coincides with comorbidities that hinder recovery. Gaming disorder (GD) has emerged as a potential concern; however, data on its prevalence and clinical impact in FEP populations remain limited. We hypothesized that GD would be more prevalent among individuals with FEP than in the general population and associated with more severe psychotic symptoms and poorer functional outcomes.</p><p><strong>Study design: </strong>In this prospective cohort study, 284 consecutive patients aged 18-35 years admitted to an Early Intervention Service in Quebec, Canada, were assessed for GD using International Classification of Diseases-11 criteria, with up to 24 months follow-up. Psychotic symptoms and functioning were measured at baseline and at 6-month intervals using the Positive and Negative Syndrome Scale-6 items (PANSS-6) and the Social and Occupational Functioning Assessment Scale (SOFAS).</p><p><strong>Study results: </strong>Gaming disorder was present in 7.04% (95% CI: [4.35%, 10.67%]) of the sample, exceeding the 3.3% general population estimates. Among the 105 patients who reported gaming at least monthly, those with GD (n = 20) more often played Massively Multiplayer Online Role-Playing Games, while non-GD gamers (n = 85) preferred action-adventure games. GD was associated with significantly higher PANSS-6 scores (P = .04), driven by elevated negative symptoms (P = .04). SOFAS scores were consistently lower among individuals with GD, with effect sizes increasing over time.</p><p><strong>Conclusions: </strong>Gaming disorder is a prevalent and clinically meaningful comorbidity in FEP, linked to greater negative symptom burden and functional impairment. These findings support the need for systematic GD screening in early psychosis services and highlight the importance of developing tailored interventions.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 2","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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