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Atypical antipsychotics in the treatment of depressive and psychotic symptoms in patients with chronic schizophrenia: a naturalistic study. 非典型抗精神病药物治疗慢性精神分裂症患者的抑郁和精神病症状:一项自然主义研究
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-01-21 DOI: 10.1155/2013/423205
Marco Innamorati, Stefano Baratta, Cristina Di Vittorio, David Lester, Paolo Girardi, Maurizio Pompili, Mario Amore

Objectives. The aim of this naturalistic study was to investigate whether treatment with clozapine and other atypical antipsychotics for at least 2 years was associated with a reduction in psychotic and depressive symptoms and an improvement in chronic schizophrenia patients' awareness of their illness. Methods. Twenty-three adult outpatients (15 men and 8 women) treated with clozapine and 23 patients (16 men and 7 women) treated with other atypical antipsychotics were included in the study. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS), and insight was assessed with the Scale to Assess Unawareness of Mental Disorder (SUMD). Results. The sample as a whole had a significant reduction in positive, negative, and general symptoms, whereas the reduction in depression was significant only for patients with CDSS scores of 5 and higher at the baseline. At the follow-up, patients treated with other atypical antipsychotics reported a greater reduction in depression than patients treated with clozapine, but not when limiting the analyses to those with clinically relevant depression. Conclusions. Atypical antipsychotics may be effective in reducing psychotic and depressive symptoms and in improving insight in patients with chronic schizophrenia, with no differences in the profiles of efficacy between compounds.

目标。这项自然主义研究的目的是调查氯氮平和其他非典型抗精神病药物治疗至少2年是否与精神病和抑郁症状的减轻以及慢性精神分裂症患者对其疾病的认识的改善有关。方法。本研究纳入了23例接受氯氮平治疗的成人门诊患者(15男8女)和23例接受其他非典型抗精神病药物治疗的患者(16男7女)。使用阳性和阴性综合征量表(PANSS)评估精神病症状,使用卡尔加里精神分裂症抑郁量表(CDSS)评估抑郁症状,使用精神障碍无意识评估量表(SUMD)评估洞察力。结果。整个样本的阳性、阴性和一般症状都有显著减少,而抑郁的减少只有在基线时CDSS评分为5分及以上的患者才有显著减少。在随访中,接受其他非典型抗精神病药物治疗的患者比接受氯氮平治疗的患者抑郁程度更低,但当分析仅限于临床相关抑郁症患者时,情况并非如此。结论。非典型抗精神病药物可能在减轻精神病和抑郁症状以及改善慢性精神分裂症患者的洞察力方面有效,不同化合物的疗效概况没有差异。
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引用次数: 8
Cognitive training for schizophrenia in developing countries: a pilot trial in Brazil. 发展中国家精神分裂症的认知训练:巴西的试点试验。
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-10-30 DOI: 10.1155/2013/321725
Livia M M Pontes, Camila B Martins, Isabel C Napolitano, Juliana R Fonseca, Graça M R Oliveira, Sandra M K Iso, Anny K P M Menezes, Adriana D B Vizzotto, Elaine S di Sarno, Hélio Elkis

Cognitive deficits in schizophrenia can massively impact functionality and quality of life, furthering the importance of cognitive training. Despite the development of the field in Europe and in the United States, no programmes have been developed and tested in developing countries. Different cultural backgrounds, budget restrictions, and other difficulties may render treatment packages created in high income countries difficult for adoption by developing nations. We performed a pilot double-blind, randomized, controlled trial in order to investigate the efficacy and feasibility of an attention and memory training programme specially created in a developing nation. The intervention used simple, widely available materials, required minimal infrastructure, and was conducted in groups. The sample included seventeen stable Brazilians with schizophrenia. Sessions were conducted weekly during five months. The cognitive training group showed significant improvements in inhibitory control and set-shifting over time. Both groups showed improvements in symptoms, processing speed, selective attention, executive function, and long-term visual memory. Improvements were found in the control group in long-term verbal memory and concentration. Our findings reinforce the idea that cognitive training in schizophrenia can be constructed using simple resources and infrastructure, facilitating its adoption by developing countries, and it may improve cognition.

精神分裂症患者的认知缺陷会严重影响患者的功能和生活质量,这进一步表明认知训练的重要性。尽管欧洲和美国在这一领域取得了发展,但在发展中国家还没有制定和试验任何方案。不同的文化背景、预算限制和其他困难可能使高收入国家制定的治疗方案难以被发展中国家采用。我们进行了一项双盲、随机、对照试验,以调查专门在发展中国家创建的注意力和记忆训练计划的有效性和可行性。干预使用简单,广泛可用的材料,需要最少的基础设施,并在小组中进行。样本包括17名病情稳定的巴西精神分裂症患者。在五个月的时间里,每周进行一次会议。随着时间的推移,认知训练组在抑制控制和设定转移方面表现出显著的改善。两组在症状、处理速度、选择性注意、执行功能和长期视觉记忆方面均有改善。对照组在长期言语记忆和注意力方面有所改善。我们的研究结果加强了这样一种观点,即精神分裂症的认知训练可以使用简单的资源和基础设施来构建,促进了发展中国家的采用,并且它可能会改善认知。
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引用次数: 6
Satisfaction with Life of Schizophrenia Outpatients and Their Caregivers: Differences between Patients with and without Self-Reported Sleep Complaints. 精神分裂症门诊患者及其照顾者的生活满意度:有与无自我报告睡眠抱怨患者的差异
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-10-27 DOI: 10.1155/2013/502172
Sofia Brissos, Pedro Afonso, Fernando Cañas, Julio Bobes, Ivan Bernardo Fernandez, Carlos Guzman

Patients with schizophrenia often present sleep complaints, but its relationship with general satisfaction with life (SWL) and burden for caregivers has been understudied. We aimed to assess the differences in SWL between patients with and without self-reported sleep disturbances and that of their caregivers. In a noninterventional study, 811 schizophrenia adult outpatients were screened for their subjective perception of having (or not) sleep disturbances and evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Pittsburgh Sleep Quality Index (PSQI). Patients self-reporting sleep disturbances were significantly more symptomatic (P < 0.001), presented significantly worse family support (P = 0.0236), and self-reported worse SWL in all domains. Caregivers of patients with schizophrenia self-reporting sleep disturbances also reported worse SWL in all domains, as compared to caregivers of patients without subjective sleep disturbances. Patient and caregivers' SWL was significantly correlated to patients' quality of sleep (P < 0.0001 for all domains). Patient' and caregivers' SWL was negatively affected by patients' poor quality of sleep. We found that patients self-reporting sleep disturbances showed greater symptom severity, worse quality of sleep, worse SWL, and less caregiver support. SWL was also worse for caregivers of patients with schizophrenia reporting sleep disturbances.

精神分裂症患者经常出现睡眠抱怨,但其与生活总体满意度(SWL)和照顾者负担的关系尚未得到充分研究。我们的目的是评估有和没有自我报告睡眠障碍的患者及其照顾者在SWL方面的差异。在一项非介入性研究中,对811名精神分裂症成年门诊患者进行了主观感知有无睡眠障碍的筛查,并使用简短精神病学评定量表(BPRS)和匹兹堡睡眠质量指数(PSQI)进行了评估。自我报告睡眠障碍的患者明显更有症状(P < 0.001),家庭支持明显更差(P = 0.0236),自我报告的所有领域的SWL都更差。自我报告睡眠障碍的精神分裂症患者的护理人员在所有领域的SWL也比没有主观睡眠障碍的患者的护理人员更差。患者和护理人员的SWL与患者睡眠质量显著相关(各领域P < 0.0001)。患者睡眠质量差对患者和护理人员的主观幸福感有负向影响。我们发现,自我报告睡眠障碍的患者表现出更严重的症状、更差的睡眠质量、更差的SWL和更少的护理支持。对于报告睡眠障碍的精神分裂症患者的护理人员来说,SWL也更糟。
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引用次数: 23
Cognitive remediation in schizophrenia: current status and future perspectives. 精神分裂症的认知修复:现状与未来展望。
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-12-17 DOI: 10.1155/2013/156084
Stefano Barlati, Giacomo Deste, Luca De Peri, Cassandra Ariu, Antonio Vita

Objectives. This study is aimed to review the current scientific literature on cognitive remediation in schizophrenia. In particular, the main structured protocols of cognitive remediation developed for schizophrenia are presented and the main results reported in recent meta-analyses are summarized. Possible benefits of cognitive remediation in the early course of schizophrenia and in subjects at risk for psychosis are also discussed. Methods. Electronic search of the relevant studies which appeared in the PubMed database until April 2013 has been performed and all the meta-analyses and review articles on cognitive remediation in schizophrenia have been also taken into account. Results. Numerous intervention programs have been designed, applied, and evaluated, with the objective of improving cognition and social functioning in schizophrenia. Several quantitative reviews have established that cognitive remediation is effective in reducing cognitive deficits and in improving functional outcome of the disorder. Furthermore, the studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and even in subjects at risk of the disease. Conclusions. Cognitive remediation is a promising approach to improve real-world functioning in schizophrenia and should be considered a key strategy for early intervention in the psychoses.

目标。本研究旨在回顾目前有关精神分裂症认知修复的科学文献。特别地,介绍了为精神分裂症开发的认知补救的主要结构化方案,并总结了最近荟萃分析报告的主要结果。认知修复在精神分裂症早期病程和精神病风险受试者中可能的益处也进行了讨论。方法。对PubMed数据库中截至2013年4月的相关研究进行了电子检索,所有关于精神分裂症认知修复的荟萃分析和综述文章也被考虑在内。结果。为了改善精神分裂症患者的认知和社会功能,已经设计、应用和评估了许多干预方案。一些定量综述已经证实,认知修复在减少认知缺陷和改善功能障碍方面是有效的。此外,现有的研究支持认知补救在精神分裂症的早期过程中甚至在有疾病风险的受试者中应用的有效性。结论。认知修复是改善精神分裂症患者现实生活功能的一种有希望的方法,应该被认为是精神病早期干预的关键策略。
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引用次数: 103
The Pathways to the First Contact with Mental Health Services among Patients with Schizophrenia in Lagos, Nigeria. 尼日利亚拉各斯精神分裂症患者第一次接触精神卫生服务的途径
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-12-31 DOI: 10.1155/2013/769161
Increase Ibukun Adeosun, Abosede Adekeji Adegbohun, Tomilola Adejoke Adewumi, Oyetayo O Jeje

There is increasing evidence that delay in the commencement of treatment, following the onset of schizophrenia, may be related to the pathways patients navigate before accessing mental health care. Therefore, insight into the pattern and correlates of pathways to mental care of patients with schizophrenia may inform interventions that could fast track their contact with mental health professionals and reduce the duration of untreated psychosis. This study assessed the pathways to mental health care among patients with schizophrenia (n = 138), at their first contact with mental health services at the Federal Neuro-Psychiatric Hospital Yaba Lagos, Nigeria. Traditional and religious healers were the first contact for the majority (69%) of the patients. Service users who first contacted nonorthodox healers made a greater number of contacts in the course of seeking help, eventuating in a longer duration of untreated psychosis (P < 0.001). However, the delay between the onset of psychosis and contact with the first point of care was shorter in patients who patronized nonorthodox practitioners. The findings suggest that collaboration between orthodox and nonorthodox health services could facilitate the contact of patients with schizophrenia with appropriate treatment, thereby reducing the duration of untreated psychosis. The need for public mental health education is also indicated.

越来越多的证据表明,精神分裂症发病后开始治疗的延迟可能与患者在获得精神卫生保健之前的途径有关。因此,深入了解精神分裂症患者精神护理途径的模式和相关因素,可能会为干预措施提供信息,从而可以快速追踪他们与精神卫生专业人员的联系,并缩短精神病未治疗的持续时间。本研究评估了138名精神分裂症患者(n = 138)在尼日利亚亚巴拉各斯联邦神经精神病院首次接触精神卫生服务时的精神卫生保健途径。传统和宗教治疗师是大多数(69%)患者的第一个接触者。首次接触非正统治疗师的服务使用者在寻求帮助的过程中接触的次数更多,最终导致精神病未治疗的持续时间更长(P < 0.001)。然而,精神病发作和接触第一个护理点之间的延迟在非正统医生的光顾的病人更短。研究结果表明,正统和非正统卫生服务机构之间的合作可以促进精神分裂症患者与适当治疗的联系,从而缩短精神病未治疗的持续时间。报告还指出,需要开展公共心理健康教育。
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引用次数: 56
Can we trust the internet to measure psychotic symptoms? 我们能信任互联网来测量精神病症状吗?
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-07-10 DOI: 10.1155/2013/457010
Steffen Moritz, Niels Van Quaquebeke, Tania M Lincoln, Ulf Köther, Christina Andreou

Online studies are increasingly utilized in applied research. However, lack of external diagnostic verification in many of these investigations is seen as a threat to the reliability of the data. The present study examined the robustness of internet studies on psychosis against simulation. We compared the psychometric properties of the Community Assessment of Psychic Experiences scale (CAPE), a self-report instrument measuring psychotic symptoms, across three independent samples: (1) participants with a confirmed diagnosis of schizophrenia, (2) participants with self-reported schizophrenia who were recruited over the internet, and (3) clinical experts on schizophrenia as well as students who were asked to simulate a person with schizophrenia when completing the CAPE. The CAPE was complemented by a newly developed 4-item psychosis lie scale. Results demonstrate that experts asked to simulate schizophrenia symptoms could be distinguished from real patients: simulators overreported positive symptoms and showed elevated scores on the psychosis lie scale. The present study suggests that simulated answers in online studies on psychosis can be distinguished from authentic responses. Researchers conducting clinical online studies are advised to adopt a number of methodological precautions and to compare the psychometric properties of online studies to established clinical indices to assert the validity of their results.

在线学习越来越多地用于应用研究。然而,在许多这些调查中,缺乏外部诊断验证被视为对数据可靠性的威胁。本研究检验了网络研究对模拟精神病的稳健性。我们比较了精神体验社区评估量表(CAPE)的心理测量特性,这是一种测量精神病症状的自我报告工具,跨越三个独立样本:(1)确诊为精神分裂症的参与者,(2)通过互联网招募的自我报告为精神分裂症的参与者,以及(3)精神分裂症临床专家以及在完成CAPE时被要求模拟精神分裂症患者的学生。CAPE辅以新开发的4项精神病谎言量表。结果表明,被要求模拟精神分裂症症状的专家可以与真实患者区分开来:模拟者夸大了阳性症状,并在精神病谎言量表上显示出更高的分数。本研究表明,在线精神病研究中的模拟回答可以与真实回答区分开来。建议进行临床在线研究的研究人员采取一些方法学上的预防措施,并将在线研究的心理测量特性与已建立的临床指标进行比较,以断言其结果的有效性。
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引用次数: 44
Factor structure of social cognition in schizophrenia: is empathy preserved? 精神分裂症患者社会认知的因素结构:共情是否保留?
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-12-15 DOI: 10.1155/2013/409205
Silvia Corbera, Bruce E Wexler, Satoru Ikezawa, Morris D Bell

Social cognitive impairments are core features of schizophrenia and are closely associated with poor functional outcome. This study sought to identify specific aspects of social cognition and their relationships to measures of social function, quality of life, and neurocognition. Principal component analysis was performed using social cognitive measures in patients with schizophrenia and healthy matched controls and revealed three factors: Interpersonal Discomfort, Basic Social Cognition, and Empathy. Patients had higher scores on Interpersonal Discomfort and lower scores on Basic Social Cognition than controls, but the two groups were the same on Empathy. Lower social performance was significantly correlated with poor Basic Social Cognition in patients and with high Interpersonal Discomfort in controls. While neurocognition was significantly associated with Basic Social Cognition in both groups, it was not associated with Empathy. Social cognitive interventions should emphasize improving basic social cognitive processing deficits, managing Interpersonal Discomfort, and utilizing preserved capacity for empathy as a potential strength in social interactions.

社会认知障碍是精神分裂症的核心特征,与不良的功能预后密切相关。本研究试图确定社会认知的具体方面及其与社会功能、生活质量和神经认知的关系。采用社会认知测量方法对精神分裂症患者和健康对照者进行主成分分析,发现人际不适、基本社会认知和共情三个因素。与对照组相比,患者在人际不适方面得分较高,在基本社会认知方面得分较低,但两组在同理心方面得分相同。较低的社会表现与患者较差的基本社会认知和对照组较高的人际不适显著相关。在两组中,神经认知与基本社会认知显著相关,但与移情无关。社会认知干预应强调改善基本的社会认知加工缺陷,管理人际不适,并利用保留的共情能力作为社会互动中的潜在优势。
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引用次数: 41
Cryoglobulins as potential triggers of inflammation in schizophrenia. 低温球蛋白作为精神分裂症炎症的潜在诱因。
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-12-15 DOI: 10.1155/2013/125264
Andranik Chavushyan, Meri Hovsepyan, Anna Boyajyan

This case study aimed to investigate effects of type III cryoglobulins isolated from the blood of patients with schizophrenia on the production of proinflammatory cytokines interleukin(IL)-1 β , IL-6 and tumor necrosis factor- α (TNF- α ), anti-inflammatory cytokine IL-10, and chemotactic cytokines IL-8 and monocyte chemoattractant protein-1 (MCP-1) by peripheral blood mononuclear cells (PBMCs). The experiments were performed in vitro using PBMCs healthy subjects and the blood of patients whit schizoprenia. The enzyme-linked immunosorbent assay and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay were used upon study. The results obtained indicated significant increase (P < 0.05) in IL-1 β , IL-6, TNF- α , IL-8, and MCP-1 production by cultured PBMCs when incubating for 24 hours with cryoglobulins, beginning from 0.4 mg/mL. The gender difference does not affect the cryoglobulins-induced production of these cytokines by PBMCs. No influence of cryoglobulins on production of IL-10 by PBMCs was observed. Also, it was shown that cryoglobulins in concentration ≤4 mg/mL possessed no cytotoxic effect towards cultured PBMCs. Based upon the results obtained, we concluded that type III cryoglobulins are implicated in schizophrenia-associated alterations in the immune response through induction of the expression of proinflammatory and chemotactic cytokines by PBMCs.

本研究旨在探讨从精神分裂症患者血液中分离的III型冷球蛋白对外周血单核细胞(PBMCs)产生促炎细胞因子白介素(IL)-1 β、IL-6和肿瘤坏死因子- α (TNF- α)、抗炎细胞因子IL-10、趋化细胞因子IL-8和单核细胞趋化蛋白-1 (MCP-1)的影响。实验采用pbmc健康受试者和精神分裂症患者的血液进行体外实验。采用酶联免疫吸附法和3-(4,5-二甲基噻唑-2-基)-2,5-二苯基溴化四唑测定法。结果表明,从0.4 mg/mL开始,低温球蛋白孵育24小时后,培养的pbmc细胞IL-1 β、IL-6、TNF- α、IL-8和MCP-1的产量显著增加(P < 0.05)。性别差异不影响冷球蛋白诱导pbmc产生这些细胞因子。未观察到低温球蛋白对PBMCs产生IL-10的影响。低温球蛋白浓度≤4 mg/mL对培养的PBMCs无细胞毒作用。基于所获得的结果,我们得出结论,III型冷球蛋白通过诱导促炎和趋化细胞因子的表达,与精神分裂症相关的免疫反应改变有关。
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引用次数: 3
Treatment engagement of psychotic patients with a mobile mental health unit in rural areas in Greece: a five-year study. 希腊农村地区流动精神卫生单位对精神病患者的治疗:一项为期五年的研究。
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-10-03 DOI: 10.1155/2013/613956
Vaios Peritogiannis, Athina Tatsioni, Nefeli Menti, Aikaterini Grammeniati, Vassiliki Fotopoulou, Venetsanos Mavreas

Objectives. Treatment of psychotic disorders is impended by high rates of disengagement from mental health services and poor adherence to antipsychotic medication. This study examined the engagement rates of psychotic patients with a community mental health service during a 5-year period. Methods. The Mobile Mental Health Unit of Ioannina and Thesprotia (MMHU I-T) delivers services in remote, rural, mountainous areas using the resources of the primary care system. Clinical and demographic information for patients with a diagnosis of schizophrenia and related psychoses was obtained from the medical records of our unit. Results. A total of 74 psychotic patients initially engaged in treatment with our unit. In half of cases treatment was home-based. With the exclusion of patients who died or discharged, engagement rates were 67.2%. Statistical analysis was performed for 64 patients, and no differences were found between engaged and disengaged patients regarding clinical and demographic parameters. All engaged patients regularly refilled their antipsychotic prescriptions. Conclusion. Engagement rates in our study were comparable to previous research, involving urban settings and shorter follow-up duration. Community mental health teams may ensure treatment continuation for psychotic patients in deprived, remote areas. This is important for low-income countries, affected by economic crisis, such as Greece.

目标。精神障碍的治疗受到脱离精神卫生服务的高比率和抗精神病药物依从性差的影响。本研究调查了精神病患者在5年期间与社区精神卫生服务的参与率。方法。约阿尼纳和塞斯普罗提亚流动精神卫生股利用初级保健系统的资源在偏远、农村和山区提供服务。诊断为精神分裂症和相关精神病的患者的临床和人口统计信息来自本单位的医疗记录。结果。共有74名精神病患者最初在我单位接受治疗。在一半的病例中,治疗以家庭为基础。排除死亡或出院患者后,参与率为67.2%。对64例患者进行了统计分析,在临床和人口学参数方面,没有发现参与和未参与患者之间的差异。所有参与治疗的患者都定期补充抗精神病药物处方。结论。我们研究的参与率与之前的研究相当,涉及城市环境和更短的随访时间。社区精神卫生小组可以确保贫困偏远地区的精神病患者继续接受治疗。这对希腊等受经济危机影响的低收入国家非常重要。
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引用次数: 21
Schizophrenia as a disorder of communication. 精神分裂症是一种沟通障碍。
IF 2.4 Q3 Medicine Pub Date : 2013-01-01 Epub Date: 2013-05-12 DOI: 10.1155/2013/952034
Margaret A Niznikiewicz, Marek Kubicki, Christoph Mulert, Ruth Condray
The first characterizations of schizophrenia invoked the concept of disordered thought and broken mind as central to its clinical presentation [1, 2]. Interestingly, Bleuler's characterization of schizophrenia was couched in terms of four A's association, with its focus on disordered language, affectivity, ambivalence, and autism, all of which implicate different aspects of social function [3]. Bleuler captured much that is still relevant to the study of cognitive dysfunction in schizophrenia and, in fact, covers quite well the topic of social communication dysfunction highlighted in this issue. The research that followed these early characterizations firmly established the link between abnormal brain structure and function, mediated by genetics, and many clinical and cognitive manifestations of this devastating disease [4–6]. Over the last several years, great progress has been achieved in the understanding of mechanisms of schizophrenia [7–10]. And while a comprehensive theory of schizophrenia is still elusive, many compelling accounts of schizophrenia pathology have been put forward and generated valuable insights [8, 9, 11–15].
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引用次数: 10
期刊
Schizophrenia Research and Treatment
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