Schizophrenia Bulletin最新文献

Motor signs are critical features of psychosis that remain underutilized in clinical practice. These signs, including social motor behaviors, mechanistically relevant motor signs, and other motor abnormalities, have demonstrated potential as biomarkers for early detection and intervention. However, their application in clinical settings remains limited due to challenges such as cost, accessibility, and integration into clinical workflows. Recent advancements in related research fields, such as Human Movement Sciences and Affective Computing, offer promising solutions, enabling scalable and precise measurement of patients motor signs. In this editorial, we explore the spectrum of motor signs and highlight the evolving role of motor assessments in psychosis research. By examining traditional assessment methods alongside alternative and innovative tools, we underscore the potential of leveraging technology and methodology to bridge the gap between research and clinical application, ultimately advancing personalized care and improving outcomes.

Background and hypothesis: Subclinical psychotic symptoms (also known as psychotic experiences comprising positive features only, and schizotypy comprising positive, negative, and disorganized features) are important markers of schizophrenia liability. Different assessment methods detect different sources of meaningful variance and are vulnerable to different biases and sources of measurement error. Whereas interview-rated psychotic symptoms in childhood are known to predict adult schizophrenia diagnosis, the predictive value of parent-rated psychotic symptoms remains unknown. We tested whether clinician-rated psychotic symptoms and parent-rated positive, negative, and disorganized schizotypy in early adolescence are nonredundant predictors of schizophrenia diagnosis by age 38 years.

Study design: In a representative birth cohort (n = 1037) from Dunedin, New Zealand, psychotic symptoms were assessed by clinical interview at age 11 years, schizotypy was assessed by parent or caregiver ratings at ages 13- and 15 years, and lifetime schizophrenia diagnosis was assessed throughout adulthood until age 38 years. We tested for redundancy using bootstrapped multivariable logistic regression.

Study results: Clinician-rated psychotic symptoms at age 11 predicted adult schizophrenia diagnosis (OR = 2.68, 95% CI = 1.42, 5.06), as did parent-rated total schizotypy (OR = 1.83, 95% CI = 1.42, 2.36). In univariable models, clinician-rated psychotic experiences and parent-rated positive, negative, and disorganized schizotypy were significant predictors of schizophrenia diagnosis. In multivariable models where clinician- and parent-rated scores were entered, only parent-rated negative and disorganized schizotypy did not predict adult schizophrenia diagnosis.

Conclusions: Parent-rated schizotypy and clinician-rated subclinical psychotic symptoms are valid, nonredundant indicators of lifetime risk for schizophrenia.

Background and hypothesis: Gene-by-environment (GxE) studies in psychosis have exclusively focused on negative exposures. However, evidence supports the resilience-enhancing effect of positive factors on psychosis outcome. The Differential Susceptibility (DS) model proposes that common genetic variants may confer not only disproportionate responsiveness to negative environments, but also greater sensitivity to positive, resilience-enhancing conditions. This study is the first to apply the DS model to the expression of subclinical psychosis, employing polygenic risk scores of environmental sensitivity (PRS-ES). PRS-ES were hypothesized to moderate, in a DS manner, associations between childhood adversity and psychosis, affective, and anxiety dimensions in young adults. An exploratory goal examined whether PRS for psychotic-like experiences (PRS-PLE) also showed DS patterns.

Study design: PRS, schizotypy, PLE, depression, anxiety, and childhood adversity ratings were obtained for 197 nonclinical young adults. LEGIT software for testing competitive-confirmatory GxE models was employed.

Study results: Results largely supported DS: Individuals high on PRS-ES showed increased subclinical psychosis, depression, and anxiety if they had experienced elevated childhood adversity, and lower symptoms if exposed to low levels of adversity as compared with those with low PRS-ES. Similarly, PRS-PLE moderated the effect of adversity on PLE, positive schizotypy, and depression following the DS model, but only PRS-ES moderation on PLE survived statistical correction.

Conclusions: Our results suggest that genetic DS to the environment is relevant to psychosis, depression, and anxiety. Current debates on reconceptualization of genetic "risk" and resilience may benefit from this insight that support optimistic views on preventative efforts for early detection and intervention.

Background: Guidelines issued by professional organizations recommend that all patients with psychotic disorders who have had several psychotic relapses, continue maintenance anti-psychotic treatment. However, some patients discontinue anti-psychotics and do not later relapse. This study attempted to characterize those patients with psychotic disorders early in their disease not taking maintenance antipsychotics, who were not later hospitalized.

Study design: This population-based cohort study combined registry data on patients diagnosed in their first psychotic episode (ICD 10 code: F20-29) from Sweden (n = 20 848), and Israel (n = 10 045), and followed them for up to 7 years for re-hospitalization or death. Multivariate analyses assessed sociodemographic and clinical risk factors predicting rehospitalization or death in patients with one hospitalization and did not fill prescriptions for antipsychotics; results from Sweden and Israel were then meta-analyzed.

Study results: The main analysis of this paper included 1611 patients from Sweden and 1607 from Israel. Male gender (adjusted hazard ratio [aHR], 1.57; 95% confidence interval [CI], 1.16-2.13) and a diagnosis of narrowly defined schizophrenia (F20.0-F20.9; aHR, 1.85; 95% CI, 1.55-2.2) were associated with increased risk of a second hospitalization or death among those who did not use antipsychotics. No sociodemographic or clinical characteristics were associated with a decreased risk of a second hospitalization or death.

Conclusions: Based on registry data, it was not possible to characterize, in a clinically meaningful way, those patients who can safely discontinue anti-psychotic medications and not be re-hospitalized or die. Male gender and a diagnosis of narrowly defined schizophrenia were associated with an increased risk of later relapse.