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Visualizing threat and trustworthiness prior beliefs in face perception in high versus low paranoia. 在高度偏执狂和低度偏执狂的人脸感知中,将威胁和可信度先验信念可视化。
Q2 PSYCHIATRY Pub Date : 2024-03-20 DOI: 10.1038/s41537-024-00459-z
Antonia Bott, Hanna C Steer, Julian L Faße, Tania M Lincoln

Predictive processing accounts of psychosis conceptualize delusions as overly strong learned expectations (prior beliefs) that shape cognition and perception. Paranoia, the most prevalent form of delusions, involves threat prior beliefs that are inherently social. Here, we investigated whether paranoia is related to overly strong threat prior beliefs in face perception. Participants with subclinical levels of high (n = 109) versus low (n = 111) paranoia viewed face stimuli paired with written descriptions of threatening versus trustworthy behaviors, thereby activating their threat versus trustworthiness prior beliefs. Subsequently, they completed an established social-psychological reverse correlation image classification (RCIC) paradigm. This paradigm used participants' responses to randomly varying face stimuli to generate individual classification images (ICIs) that intend to visualize either facial prior belief (threat vs. trust). An independent sample (n = 76) rated these ICIs as more threatening in the threat compared to the trust condition, validating the causal effect of prior beliefs on face perception. Contrary to expectations derived from predictive processing accounts, there was no evidence for a main effect of paranoia. This finding suggests that paranoia was not related to stronger threat prior beliefs that directly affected face perception, challenging the assumption that paranoid beliefs operate on a perceptual level.

精神病的预测加工理论将妄想概念化为影响认知和感知的过于强烈的习得性预期(先验信念)。妄想症是妄想症中最常见的一种,它涉及到具有内在社会性的威胁先验信念。在此,我们研究了妄想症是否与人脸感知中过于强烈的威胁先验信念有关。亚临床水平的高度(n = 109)和低度(n = 111)偏执狂被试观看了与威胁性和可信性行为的书面描述配对的人脸刺激,从而激活了他们的威胁性和可信性先验信念。随后,他们完成了一个成熟的社会心理学反向相关图像分类(RCIC)范式。该范式利用被试对随机变化的面部刺激的反应来生成个体分类图像(ICIs),目的是将面部先验信念(威胁与信任)形象化。独立样本(n = 76)将这些 ICIs 评为威胁条件下比信任条件下更具威胁性,从而验证了先验信念对人脸感知的因果效应。与根据预测处理理论得出的预期相反,没有证据表明偏执狂会产生主效应。这一发现表明,偏执狂与直接影响人脸感知的更强的威胁先验信念无关,这对偏执狂信念在感知层面发挥作用的假设提出了质疑。
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引用次数: 0
Mapping the landscape: a bibliometric analysis of resting-state fMRI research on schizophrenia over the past 25 years. 绘制图景:对过去 25 年精神分裂症静息态 fMRI 研究的文献计量分析。
Q2 PSYCHIATRY Pub Date : 2024-03-15 DOI: 10.1038/s41537-024-00456-2
Linhan Fu, Remilai Aximu, Guoshu Zhao, Yayuan Chen, Zuhao Sun, Hui Xue, Shaoying Wang, Nannan Zhang, Zhihui Zhang, Minghuan Lei, Ying Zhai, Jinglei Xu, Jie Sun, Juanwei Ma, Feng Liu

Schizophrenia, a multifaceted mental disorder characterized by disturbances in thought, perception, and emotion, has been extensively investigated through resting-state fMRI, uncovering changes in spontaneous brain activity among those affected. However, a bibliometric examination regarding publication trends in resting-state fMRI studies related to schizophrenia is lacking. This study obtained relevant publications from the Web of Science Core Collection spanning the period from 1998 to 2022. Data extracted from these publications included information on countries/regions, institutions, authors, journals, and keywords. The collected data underwent analysis and visualization using VOSviewer software. The primary analyses included examination of international and institutional collaborations, authorship patterns, co-citation analyses of authors and journals, as well as exploration of keyword co-occurrence and temporal trend networks. A total of 859 publications were retrieved, indicating an overall growth trend from 1998 to 2022. China and the United States emerged as the leading contributors in both publication outputs and citations, with Central South University and the University of New Mexico being identified as the most productive institutions. Vince D. Calhoun had the highest number of publications and citation counts, while Karl J. Friston was recognized as the most influential author based on co-citations. Key journals such as Neuroimage, Schizophrenia Research, Schizophrenia Bulletin, and Biological Psychiatry played pivotal roles in advancing this field. Recent popular keywords included support vector machine, antipsychotic medication, transcranial magnetic stimulation, and related terms. This study systematically synthesizes the historical development, current status, and future trends in resting-state fMRI research in schizophrenia, offering valuable insights for future research directions.

精神分裂症是一种以思维、感知和情感障碍为特征的多发性精神障碍,人们通过静息态 fMRI 对精神分裂症进行了广泛的研究,发现了患者大脑自发活动的变化。然而,有关精神分裂症静息态 fMRI 研究发表趋势的文献计量学研究尚属空白。本研究从科学网核心藏书中获取了1998年至2022年期间的相关出版物。从这些出版物中提取的数据包括国家/地区、机构、作者、期刊和关键词等信息。收集到的数据使用 VOSviewer 软件进行了分析和可视化。主要分析包括对国际和机构合作、作者身份模式、作者和期刊的共同引用分析,以及对关键词共同出现和时间趋势网络的探索。共检索到 859 篇出版物,显示出从 1998 年到 2022 年的总体增长趋势。中国和美国在出版物产出和引文方面均居领先地位,中南大学和新墨西哥大学被认为是产出最高的机构。Vince D. Calhoun 的论文数量和引用次数均居首位,而 Karl J. Friston 则根据共同引用次数被评为最具影响力的作者。神经影像》(Neuroimage)、《精神分裂症研究》(Schizophrenia Research)、《精神分裂症公报》(Schizophrenia Bulletin)和《生物精神病学》(Biological Psychiatry)等重要期刊在推动这一领域的发展方面发挥了关键作用。最近流行的关键词包括支持向量机、抗精神病药物、经颅磁刺激和相关术语。本研究系统地总结了精神分裂症静息态 fMRI 研究的历史发展、现状和未来趋势,为未来的研究方向提供了宝贵的见解。
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引用次数: 0
Relationship between social cognition and premorbid adjustment in psychosis: a systematic review. 精神病患者的社会认知与病前适应之间的关系:系统性综述。
Q2 PSYCHIATRY Pub Date : 2024-03-15 DOI: 10.1038/s41537-023-00428-y
P Punsoda-Puche, A Barajas, M Mamano-Grande, A Jiménez-Lafuente, S Ochoa

This systematic review provides a comprehensive overview of the association between premorbid adjustment and social cognition in people with psychotic spectrum disorder. Obtaining evidence of this association will facilitate early detection and intervention before the onset of psychosis. Literature searches were conducted in Scopus, PubMed and PsycINFO. Studies were eligible if they included patients with a psychotic disorder or at a high-risk state; social cognition and premorbid adjustment were measured; and the relationship between premorbid adjustment and social cognition was analysed. The authors independently extracted data from all included articles, and discrepancies were resolved through discussion. Literature searches were conducted in Scopus, PubMed and PsycINFO. Studies were eligible if they included patients with a psychotic disorder or at a high-risk state; social cognition and premorbid adjustment were measured; and the relationship between premorbid adjustment and social cognition was analysed. The authors independently extracted data from all included articles, and discrepancies were resolved through discussion. Of 229 studies identified, 23 met the inclusion criteria. Different methods of assessment were used to measure premorbid adjustment, such as the Premorbid Adjustment Scale or premorbid IQ, among others. Social cognition was assessed as a global measure or by domains using different instruments. A total of 16 articles found a relationship between social cognition (or its domains) and premorbid adjustment: general social cognition (n = 3); Theory of Mind (n  = 12); Emotional Recognition and Social Knowledge (n  = 1). This review shows evidence of a significant relationship between social cognition and premorbid adjustment, specifically between Theory of Mind and premorbid adjustment. Social cognition deficits may already appear in phases prior to the onset of psychosis, so an early individualized intervention with stimulating experiences in people with poor premorbid adjustment can be relevant for prevention. We recommend some future directions, such as carrying out longitudinal studies with people at high-risk of psychosis, a meta-analysis study, broadening the concept of premorbid adjustment, and a consensual assessment of social cognition and premorbid adjustment variables. PROSPERO registration number: CRD42022333886.

本系统综述全面概述了精神病谱系障碍患者病前适应与社会认知之间的关联。获得这种关联的证据将有助于在精神病发作前进行早期检测和干预。我们在 Scopus、PubMed 和 PsycINFO 中进行了文献检索。符合条件的研究包括:精神病患者或处于高危状态的患者;测量社会认知和病前适应;分析病前适应与社会认知之间的关系。作者从所有纳入的文章中独立提取数据,并通过讨论解决差异。文献检索在 Scopus、PubMed 和 PsycINFO 中进行。符合条件的研究包括:纳入了患有精神障碍或处于高危状态的患者;测量了社会认知和病前适应;分析了病前适应与社会认知之间的关系。作者从所有纳入的文章中独立提取数据,并通过讨论解决差异。在确定的 229 项研究中,有 23 项符合纳入标准。研究采用了不同的评估方法来衡量病前适应情况,如病前适应量表或病前智商等。对社会认知的评估则是采用不同的工具进行整体或分域测量。共有 16 篇文章发现了社会认知(或其领域)与病前适应之间的关系:一般社会认知(3 篇);心智理论(12 篇);情感识别和社会知识(1 篇)。本综述显示,有证据表明社会认知与病前适应之间存在显著关系,特别是心智理论与病前适应之间的关系。社会认知缺陷可能已经出现在精神病发病前的阶段,因此对病前适应不良者进行早期个体化干预,提供刺激性体验,对预防精神病有重要意义。我们建议了一些未来的研究方向,例如对精神病高危人群进行纵向研究、荟萃分析研究、拓宽病前适应性的概念,以及对社会认知和病前适应性变量进行一致评估。PROSPERO 注册号:CRD42022333886。
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引用次数: 0
Exploring functional dysconnectivity in schizophrenia: alterations in eigenvector centrality mapping and insights into related genes from transcriptional profiles. 探索精神分裂症的功能性连接障碍:特征向量中心性图谱的改变以及从转录谱图谱中了解相关基因。
Q2 PSYCHIATRY Pub Date : 2024-03-15 DOI: 10.1038/s41537-024-00457-1
Yuan Ji, Mengjing Cai, Yujing Zhou, Juanwei Ma, Yijing Zhang, Zhihui Zhang, Jiaxuan Zhao, Ying Wang, Yurong Jiang, Ying Zhai, Jinglei Xu, Minghuan Lei, Qiang Xu, Huaigui Liu, Feng Liu

Schizophrenia is a mental health disorder characterized by functional dysconnectivity. Eigenvector centrality mapping (ECM) has been employed to investigate alterations in functional connectivity in schizophrenia, yet the results lack consistency, and the genetic mechanisms underlying these changes remain unclear. In this study, whole-brain voxel-wise ECM analyses were conducted on resting-state functional magnetic resonance imaging data. A cohort of 91 patients with schizophrenia and 91 matched healthy controls were included during the discovery stage. Additionally, in the replication stage, 153 individuals with schizophrenia and 182 healthy individuals participated. Subsequently, a comprehensive analysis was performed using an independent transcriptional database derived from six postmortem healthy adult brains to explore potential genetic factors influencing the observed functional dysconnectivity, and to investigate the roles of identified genes in neural processes and pathways. The results revealed significant and reliable alterations in the ECM across multiple brain regions in schizophrenia. Specifically, there was a significant decrease in ECM in the bilateral superior and middle temporal gyrus, and an increase in the bilateral thalamus in both the discovery and replication stages. Furthermore, transcriptional analysis revealed 420 genes whose expression patterns were related to changes in ECM, and these genes were enriched mainly in biological processes associated with synaptic signaling and transmission. Together, this study enhances our knowledge of the neural processes and pathways involved in schizophrenia, shedding light on the genetic factors that may be linked to functional dysconnectivity in this disorder.

精神分裂症是一种以功能连接障碍为特征的精神疾病。特征向量中心性图谱(ECM)已被用于研究精神分裂症患者功能连接性的改变,但研究结果缺乏一致性,而且这些改变的遗传机制仍不清楚。本研究对静息态功能磁共振成像数据进行了全脑体素ECM分析。在发现阶段,研究人员纳入了 91 名精神分裂症患者和 91 名匹配的健康对照组。此外,在复制阶段,有 153 名精神分裂症患者和 182 名健康人参与。随后,研究人员利用来自六个死后健康成人大脑的独立转录数据库进行了综合分析,以探索影响所观察到的功能性连接障碍的潜在遗传因素,并研究已识别基因在神经过程和通路中的作用。研究结果表明,精神分裂症患者多个脑区的ECM发生了明显而可靠的改变。具体来说,在发现阶段和复制阶段,双侧颞上回和颞中回的 ECM 均显著减少,而双侧丘脑的 ECM 则显著增加。此外,转录分析还发现有 420 个基因的表达模式与 ECM 的变化有关,这些基因主要集中在与突触信号和传递相关的生物过程中。总之,这项研究增进了我们对精神分裂症所涉及的神经过程和通路的了解,揭示了可能与这种疾病的功能性连接障碍有关的遗传因素。
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引用次数: 0
Smoking affects symptom improvement in schizophrenia: a prospective longitudinal study of male patients with first-episode schizophrenia. 吸烟影响精神分裂症症状的改善:一项针对男性首发精神分裂症患者的前瞻性纵向研究。
Q2 PSYCHIATRY Pub Date : 2024-03-15 DOI: 10.1038/s41537-024-00449-1
Xishu Mu, Wenjing Wu, Sisi Wang, Xiuru Su, Hengyong Guan, Xiaoni Guan, Xiaobing Lu, Zezhi Li

Patients with schizophrenia (SCZ) smoke up to three times more than general people. However, there are conflicting results regarding the relationship between tobacco smoke and clinical symptom severity in SCZ. The aim of this study was to assess the impact of smoking on clinical symptoms after antipsychotic treatment in a 12-week cohort study after controlling for confounding factors. One hundred and forty-five male patients with drug-naïve first-episode (DNFE) SCZ received antipsychotic monotherapy for 12 weeks. Symptom severity was assessed at baseline and at week 12 by the Positive and Negative Syndrome Scale (PANSS). We found no differences in clinical symptoms among male smokers with SCZ compared with male nonsmokers. However, male smokers showed greater improvement in negative symptoms after 12 weeks of treatment, controlling for age, years of education, onset age, and baseline body mass index (BMI). Our study showed that after 12 weeks of treatment with antipsychotics, male smokers showed greater improvement in negative symptoms than male nonsmokers.

精神分裂症(SCZ)患者的吸烟量是普通人的三倍。然而,关于烟草烟雾与精神分裂症临床症状严重程度之间关系的研究结果却相互矛盾。本研究旨在通过一项为期12周的队列研究,在控制了混杂因素后,评估吸烟对抗精神病治疗后临床症状的影响。145名初次发病(DNFE)的男性SCZ患者接受了为期12周的抗精神病单药治疗。在基线和第12周时,用阳性和阴性综合征量表(PANSS)评估症状的严重程度。我们发现,男性吸烟者与男性非吸烟者相比,在临床症状方面没有差异。然而,在控制年龄、受教育年限、发病年龄和基线体重指数(BMI)的情况下,男性吸烟者在接受12周治疗后的阴性症状改善程度更大。我们的研究表明,在接受12周的抗精神病药物治疗后,男性吸烟者的阴性症状比男性非吸烟者有更大的改善。
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引用次数: 0
Author Correction: Parkinson's disease and schizophrenia interactomes contain temporally distinct gene clusters underlying comorbid mechanisms and unique disease processes. 作者更正:帕金森病和精神分裂症相互作用组包含时间上不同的基因簇,这些基因簇是合并症机制和独特疾病过程的基础。
Q2 PSYCHIATRY Pub Date : 2024-03-13 DOI: 10.1038/s41537-024-00455-3
Kalyani B Karunakaran, Sanjeev Jain, Samir K Brahmachari, N Balakrishnan, Madhavi K Ganapathiraju
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引用次数: 0
Cortical white matter microstructural alterations underlying the impaired gamma-band auditory steady-state response in schizophrenia. 精神分裂症患者伽马波段听觉稳态反应受损背后的皮质白质微结构改变
Q2 PSYCHIATRY Pub Date : 2024-03-12 DOI: 10.1038/s41537-024-00454-4
Daisuke Koshiyama, Ryoichi Nishimura, Kaori Usui, Mao Fujioka, Mariko Tada, Kenji Kirihara, Tsuyoshi Araki, Shintaro Kawakami, Naohiro Okada, Shinsuke Koike, Hidenori Yamasue, Osamu Abe, Kiyoto Kasai

The gamma-band auditory steady-state response (ASSR), primarily generated from the auditory cortex, has received substantial attention as a potential brain marker indicating the pathophysiology of schizophrenia. Previous studies have shown reduced gamma-band ASSR in patients with schizophrenia and demonstrated correlations with impaired neurocognition and psychosocial functioning. Recent studies in clinical and healthy populations have suggested that the neural substrates of reduced gamma-band ASSR may be distributed throughout the cortices surrounding the auditory cortex, especially in the right hemisphere. This study aimed to investigate associations between the gamma-band ASSR and white matter alterations in the bundles broadly connecting the right frontal, parietal and occipital cortices to clarify the networks underlying reduced gamma-band ASSR in patients with schizophrenia. We measured the 40 Hz ASSR using electroencephalography and diffusion tensor imaging in 42 patients with schizophrenia and 22 healthy comparison subjects. The results showed that the gamma-band ASSR was positively correlated with fractional anisotropy (an index of white matter integrity) in the regions connecting the right frontal, parietal and occipital cortices in healthy subjects (β = 0.41, corrected p = 0.075, uncorrected p = 0.038) but not in patients with schizophrenia (β = 0.17, corrected p = 0.46, uncorrected p = 0.23). These findings support our hypothesis that the generation of gamma-band ASSR is supported by white matter bundles that broadly connect the cortices and that these relationships may be disrupted in schizophrenia. Our study may help characterize and interpret reduced gamma-band ASSR as a useful brain marker of schizophrenia.

伽马波段听觉稳态反应(ASSR)主要由听觉皮层产生,作为精神分裂症病理生理学的潜在脑标记已受到广泛关注。以往的研究表明,精神分裂症患者的伽马波段听觉稳态反应减弱,并与神经认知和社会心理功能受损有关。最近在临床和健康人群中进行的研究表明,伽马波段ASSR降低的神经基底可能分布在听觉皮层周围的皮层中,尤其是右半球。本研究旨在调查伽马波段ASSR与广泛连接右侧额叶、顶叶和枕叶皮层的白质束改变之间的关联,以明确精神分裂症患者伽马波段ASSR降低的基础网络。我们使用脑电图和弥散张量成像技术测量了42名精神分裂症患者和22名健康对比受试者的40赫兹ASSR。结果显示,伽马波段 ASSR 与健康受试者右侧额叶、顶叶和枕叶皮层连接区域的分数各向异性(白质完整性指数)呈正相关(β = 0.41,校正后 p = 0.075,未校正 p = 0.038),但与精神分裂症患者无关(β = 0.17,校正后 p = 0.46,未校正 p = 0.23)。这些发现支持了我们的假设,即伽马波段 ASSR 的产生是由广泛连接大脑皮层的白质束支持的,而精神分裂症患者的这些关系可能会被破坏。我们的研究可能有助于描述和解释伽马波段ASSR的减少,并将其作为精神分裂症的一个有用的脑标记。
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引用次数: 0
Genetic overlap between schizophrenia and cognitive performance. 精神分裂症与认知能力之间的基因重叠。
Q2 PSYCHIATRY Pub Date : 2024-03-05 DOI: 10.1038/s41537-024-00453-5
Jianfei Zhang, Hao Qiu, Qiyu Zhao, Chongjian Liao, Yuxuan Guoli, Qi Luo, Guoshu Zhao, Nannan Zhang, Shaoying Wang, Zhihui Zhang, Minghuan Lei, Feng Liu, Yanmin Peng

Schizophrenia (SCZ), a highly heritable mental disorder, is characterized by cognitive impairment, yet the extent of the shared genetic basis between schizophrenia and cognitive performance (CP) remains poorly understood. Therefore, we aimed to explore the polygenic overlap between SCZ and CP. Specifically, the bivariate causal mixture model (MiXeR) was employed to estimate the extent of genetic overlap between SCZ (n = 130,644) and CP (n = 257,841), and conjunctional false discovery rate (conjFDR) approach was used to identify shared genetic loci. Subsequently, functional annotation and enrichment analysis were carried out on the identified genomic loci. The MiXeR analyses revealed that 9.6 K genetic variants are associated with SCZ and 10.9 K genetic variants for CP, of which 9.5 K variants are shared between these two traits (Dice coefficient = 92.8%). By employing conjFDR, 236 loci were identified jointly associated with SCZ and CP, of which 139 were novel for the two traits. Within these shared loci, 60 exhibited consistent effect directions, while 176 had opposite effect directions. Functional annotation analysis indicated that the shared genetic loci were mainly located in intronic and intergenic regions, and were found to be involved in relevant biological processes such as nervous system development, multicellular organism development, and generation of neurons. Together, our findings provide insights into the shared genetic architecture between SCZ and CP, suggesting common pathways and mechanisms contributing to both traits.

精神分裂症(SCZ)是一种高度遗传性精神疾病,以认知障碍为特征,但人们对精神分裂症与认知表现(CP)之间的共同遗传基础的程度仍然知之甚少。因此,我们旨在探索 SCZ 和 CP 之间的多基因重叠。具体来说,我们采用了双变量因果混合模型(MiXeR)来估计SCZ(n = 130,644)和CP(n = 257,841)之间的遗传重叠程度,并采用联合误发现率(conjunctional false discovery rate,conjFDR)方法来识别共有遗传位点。随后,对确定的基因组位点进行了功能注释和富集分析。MiXeR分析显示,960万个基因变异与SCZ相关,1090万个基因变异与CP相关,其中950万个变异在这两个性状之间共享(骰子系数=92.8%)。通过使用 conjFDR,确定了 236 个与 SCZ 和 CP 共同相关的基因位点,其中 139 个是这两个性状的新基因位点。在这些共有位点中,60个位点的效应方向一致,176个位点的效应方向相反。功能注释分析表明,共享基因位点主要位于内含子区和基因间区,参与了神经系统发育、多细胞生物体发育和神经元生成等相关生物学过程。总之,我们的研究结果揭示了SCZ和CP的共同遗传结构,提示了导致这两种性状的共同途径和机制。
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引用次数: 0
Reduction of N-acetyl aspartate (NAA) in association with relapse in early-stage psychosis: a 7-Tesla MRS study. N-乙酰天冬氨酸(NAA)的减少与早期精神病复发有关:一项 7-Tesla MRS 研究。
IF 3 Q2 PSYCHIATRY Pub Date : 2024-03-01 DOI: 10.1038/s41537-024-00451-7
Marina Mihaljevic, Yu-Ho Chang, Ashley M Witmer, Jennifer M Coughlin, David J Schretlen, Peter B Barker, Kun Yang, Akira Sawa

Understanding the biological underpinning of relapse could improve the outcomes of patients with psychosis. Relapse is elicited by multiple reasons/triggers, but the consequence frequently accompanies deteriorations of brain function, leading to poor prognosis. Structural brain imaging studies have recently been pioneered to address this question, but a lack of molecular investigations is a knowledge gap. Following a criterion used for recent publications by others, we defined the experiences of relapse by hospitalization(s) due to psychotic exacerbation. We hypothesized that relapse-associated molecules might be underscored from the neurometabolites whose levels have been different between overall patients with early-stage psychosis and healthy subjects in our previous report. In the present study, we observed a significant decrease in the levels of N-acetyl aspartate in the anterior cingulate cortex and thalamus in patients who experienced relapse compared to patients who did not. Altogether, decreased N-acetyl aspartate levels may indicate relapse-associated deterioration of neuronal networks in patients.

了解复发的生物学基础可以改善精神病患者的预后。复发是由多种原因/诱因引起的,但其后果往往伴随着大脑功能的恶化,导致预后不良。最近,大脑结构成像研究已成为解决这一问题的先驱,但分子研究的缺乏却是一个知识空白。根据其他人最近发表的文章所采用的标准,我们将精神病恶化导致的住院经历定义为复发。我们假设,与复发相关的分子可能来自神经代谢物,在我们之前的报告中,早期精神病患者与健康人之间的神经代谢物水平存在差异。在本研究中,我们观察到,与未复发的患者相比,复发患者前扣带回皮层和丘脑中的 N-乙酰天冬氨酸水平明显下降。总之,N-乙酰天冬氨酸水平的降低可能表明患者的神经元网络因复发而恶化。
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引用次数: 0
Real-world predictors of relapse in patients with schizophrenia and schizoaffective disorder in a large health system. 大型医疗系统中精神分裂症和情感分裂症患者复发的现实预测因素。
Q2 PSYCHIATRY Pub Date : 2024-02-29 DOI: 10.1038/s41537-024-00448-2
Anne Rivelli, Veronica Fitzpatrick, Michael Nelson, Kimberly Laubmeier, Courtney Zeni, Srikrishna Mylavarapu
<p><p>Schizophrenia is often characterized by recurring relapses, which are associated with a substantial clinical and economic burden. Early identification of individuals at the highest risk for relapse in real-world treatment settings could help improve outcomes and reduce healthcare costs. Prior work has identified a few consistent predictors of relapse in schizophrenia, however, studies to date have been limited to insurance claims data or small patient populations. Thus, this study used a large sample of health systems electronic health record (EHR) data to analyze relationships between patient-level factors and relapse and model a set of factors that can be used to identify the increased prevalence of relapse, a severe and preventable reality of schizophrenia. This retrospective, observational cohort study utilized EHR data extracted from the largest Midwestern U.S. non-profit healthcare system to identify predictors of relapse. The study included patients with a diagnosis of schizophrenia (ICD-10 F20) or schizoaffective disorder (ICD-10 F25) who were treated within the system between October 15, 2016, and December 31, 2021, and received care for at least 12 months. A relapse episode was defined as an emergency room or inpatient encounter with a pre-determined behavioral health-related ICD code. Patients' baseline characteristics, comorbidities and healthcare utilization were described. Modified log-Poisson regression (i.e. log Poisson regression with a robust variance estimation) analyses were utilized to estimate the prevalence of relapse across patient characteristics, comorbidities and healthcare utilization and to ultimately identify an adjusted model predicting relapse. Among the 8119 unique patients included in the study, 2478 (30.52%) experienced relapse and 5641 (69.48%) experienced no relapse. Patients were primarily male (54.72%), White Non-Hispanic or Latino (54.23%), with Medicare insurance (51.40%), and had baseline diagnoses of substance use (19.24%), overweight/obesity/weight gain (13.06%), extrapyramidal symptoms (48.00%), lipid metabolism disorder (30.66%), hypertension (26.85%), and diabetes (19.08%). Many differences in patient characteristics, baseline comorbidities, and utilization were revealed between patients who relapsed and patients who did not relapse. Through model building, the final adjusted model with all significant predictors of relapse included the following variables: insurance, age, race/ethnicity, substance use diagnosis, extrapyramidal symptoms, number of emergency room encounters, behavioral health inpatient encounters, prior relapses episodes, and long-acting injectable prescriptions written. Prevention of relapse is a priority in schizophrenia care. Challenges related to historical health record data have limited the knowledge of real-world predictors of relapse. This study offers a set of variables that could conceivably be used to construct algorithms or models to proactively monitor demographic,
精神分裂症通常以反复复发为特征,而复发与巨大的临床和经济负担相关。在实际治疗环境中及早识别复发风险最高的患者,有助于改善治疗效果和降低医疗成本。之前的研究发现了一些精神分裂症复发的一致预测因素,但迄今为止的研究仅限于保险理赔数据或小规模患者群体。因此,本研究利用医疗系统电子病历(EHR)的大样本数据分析了患者层面的因素与复发之间的关系,并建立了一套可用于识别复发率增加的因素模型,复发是精神分裂症的一个严重且可预防的现实问题。这项回顾性观察队列研究利用从美国中西部最大的非营利性医疗保健系统中提取的电子病历数据来确定复发的预测因素。研究对象包括被诊断为精神分裂症(ICD-10 F20)或分裂情感障碍(ICD-10 F25)的患者,这些患者在 2016 年 10 月 15 日至 2021 年 12 月 31 日期间在该系统内接受治疗,并接受了至少 12 个月的护理。复发事件被定义为急诊室或住院病人遇到预先确定的行为健康相关 ICD 代码。对患者的基线特征、合并症和医疗保健使用情况进行了描述。利用修正的对数泊松回归(即具有稳健方差估计的对数泊松回归)分析来估计不同患者特征、合并症和医疗保健使用情况下的复发率,并最终确定预测复发的调整模型。在纳入研究的 8119 名患者中,有 2478 人(30.52%)复发,5641 人(69.48%)未复发。患者主要为男性(54.72%)、非西班牙裔或拉丁裔白人(54.23%)、有医疗保险(51.40%),基线诊断为药物使用(19.24%)、超重/肥胖/体重增加(13.06%)、锥体外系症状(48.00%)、脂代谢紊乱(30.66%)、高血压(26.85%)和糖尿病(19.08%)。复发患者与未复发患者在患者特征、基线合并症和使用情况方面存在许多差异。通过建立模型,最终的调整模型包含了所有重要的复发预测因素,其中包括以下变量:保险、年龄、种族/民族、药物使用诊断、锥体外系症状、急诊就诊次数、行为健康住院就诊次数、之前的复发发作以及开具的长效注射剂处方。预防复发是精神分裂症治疗的首要任务。与历史健康记录数据相关的挑战限制了人们对现实世界中复发预测因素的了解。本研究提供了一组变量,可用于构建算法或模型,以主动监测使患者面临复发风险的人口统计学、合并症、药物治疗和医疗保健使用参数,并修改护理方法以避免未来复发。
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Schizophrenia (Heidelberg, Germany)
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