Schizophrenia (Heidelberg, Germany)最新文献

Schizophrenia ranks among the top ten causes of disability worldwide. The provision of healthcare services requires estimates on the epidemiology of schizophrenia, but recent data for Germany are lacking. Based on a large German health claims database (GePaRD), we identified persons aged 0-64 years with treated schizophrenia, i.e., persons having at least one inpatient/outpatient ICD-10 diagnosis (F20) with at least one prescription for a schizophrenia-recommended antipsychotic in the same calendar year. For each year from 2012 (eligible persons: 9,589,084) to 2021 (eligible persons: 12,450,531), we calculated the standardized incidence proportion (SIP) and the prevalence of schizophrenia. Analyses were stratified by sex, age, and population density in the region of residence. The SIP of treated schizophrenia remained stable from 2012 to 2017 (46.0-46.5/100,000) and subsequently declined to 41.3/100,000 in 2021, with higher SIP in men (45.3/100,000) than in women (37.1/100,000). In 2021, the SIP was comparable in urban, rural, and sparsely populated rural districts (36.3-38.5/100,000) and higher in large urban cities (48.3/100,000). SIP estimates among children and adolescents (aged 0-17 years) varied between 3.5/100,000 and 4.1/100,000 over the study period. The standardized prevalence of schizophrenia declined from 366.1/100,000 in 2012 to 334.0/100,000 in 2021. Similar to other Western countries, there has been a decline in the incidence and prevalence of schizophrenia in Germany over the last few years. The higher incidence in males and those living in large urban areas highlights the health care needs of these populations.

Disruptions in language processing observed in Individuals diagnosed with schizophrenia (ISZ) are likely to impair turn-taking fluency and social functioning. While turn-taking research in ISZ is limited and mostly interview-based, this study examines fluency differences between ISZ and controls in free conversations and their links to social outcomes and symptoms. We recruited 20 ISZ, 20 healthy interacting partners (IP), and 20 matched controls (MAT). Each IP, unaware of the ISZ diagnosis, had a 6-min conversation with an ISZ and a MAT, and then rated their willingness to interact again. Voice recordings were analyzed for pauses, gaps, and overlaps. Results revealed that conversations with ISZ featured fewer overlaps, more and longer gaps, and extended pauses. Additionally, the gap duration influenced participants' willingness to engage in future interactions. ISZ symptoms disrupted their speech and were linked to longer gaps and pauses in their partner's speech. This study extends fluency research in ISZ by shedding light on natural conversational dynamics.

Current preventative measures for clozapine-induced agranulocytosis (CIA) include indefinite haematological monitoring. Another safeguard against CIA is patient and carer education to identify and respond to potential symptoms of this adverse effect. Our aim was to explore how informed patients and carers are about the potential symptoms of CIA and what actions to take. An anonymous cross-sectional survey was distributed electronically to patients or family/carers prescribed clozapine across England. A mixed methods approach was used to assess how informed patients and carers are about CIA, identifying potential symptoms of CIA and the appropriate actions to take. Quantitative data were analysed using descriptive and inferential statistics, and qualitative responses were analysed thematically. A total of 354 individuals participated in the survey (310 patients and 44 unrelated family carers). Overall, 122 (35%) were aware that clozapine can cause agranulocytosis. The odds of awareness were significantly higher among carers (AOR = 2.90; 95% CI, 1.45-5.88) and lower among males (AOR = 0.60; 95% CI, 0.36-1.00), Black individuals (AOR = 0.33; 95% CI, 0.17-0.61) and individuals in the other ethnicity group (AOR = 0.39; 95% CI, 0.16-0.89). Among those who reported CIA awareness, 45 (37%) participants could name at least one of the signs or symptoms of CIA. A typology of responses to experiencing signs or symptoms of CIA were derived from the thematic analysis, categorised into seeking immediate medical attention (two subthemes), consulting healthcare professionals (four subthemes), uncertainty or lack of knowledge (two subthemes), involvement of family or care providers (two subthemes), self-care (three subthemes) and reluctance to seek help (two subthemes). Our results indicate that most patients and carers are unaware of CIA. There is a need to better inform patients and carers about CIA, about how to identify symptoms and the importance of consulting their treating clinician when suspicions arise. This is particularly important if calls for reduced haematological monitoring are implemented.

Early-onset schizophrenia (EOS) patients are at greater risk of poor long-term outcomes compared to later-onset patients, so it is essential to identify unique pathomechanisms and prognostic biomarkers for this EOS patient group. Deficits in neurotrophic and oxidative stress resistance are implicated in EOS, so this study investigated associations of EOS risk with peripheral blood platelet-derived growth factor (PDGF) subtype concentrations and superoxide dismutase (SOD) isoenzyme activities. Serum PDGF subtype concentrations and plasma SOD isoenzyme activities were measured in 99 first-episode drug-naïve EOS patients (ages 12-18 years) and 40 matched healthy controls (HCs). Disease severity was assessed using the five-factor model of the Positive and Negative Syndrome Scale (positive, negative, cognitive, excitement/hostility, and anxiety/depression). Serum PDGF-AB and PDGF-BB concentrations, as well as plasma total (T)-SOD and Mn-SOD activities, were significantly lower in EOS patients than HCs (all, P < 0.001 except for T-SOD, where P = 0.003). Serum PDGF-AB concentration was positively correlated with plasma Mn-SOD activity (r = 0.267, P = 0.007), while serum PDGF-BB concentration was negatively correlated with cognitive symptom severity (r = -0.406, P < 0.001), and T-SOD activity was negatively correlated with excitement/hostility symptom severity (r = -0.354, P < 0.001). Multivariate analysis with dichotomized factors identified low PDGF-AB (RR = 1.788, 95% CI: 1.226-2.608, P = 0.003), low PDGF-BB (RR = 1.758, 95% CI: 1.208-2.558, P = 0.003), and a significant PDGF-AB × Mn-SOD interaction (RR = 1.460, 95% CI: 1.044-2.042, P = 0.027) as independent EOS risk factors, with 44.1%, 43.1%, and 31.5% attributable risk, respectively, and population attributable risk fractions of 34.5%, 33.7%, and 23.6%, respectively. Reduced PDGF and SOD levels may contribute to the earlier onset of schizophrenia symptoms and exacerbate symptom severity. Peripheral blood PDGF concentrations and SOD activities may thus be valuable biomarkers for EOS detection.

Schizophrenia is a complex mental health condition characterized by a range of heterogenous symptoms. Cognitive impairment associated with schizophrenia (CIAS) interferes with individuals' ability to manage their daily activities and has a detrimental effect on everyday life. The Schizophrenia Cognition Rating Scale (SCoRS) is an interview-based assessment, which was developed to provide a detailed evaluation of the performance of everyday tasks in the real world. The assessment is completed by clinicians with input from patients with schizophrenia and caregivers. The scale has good psychometric properties and has been used across several trials. Nevertheless, the relevance of the SCoRS from the caregivers' perspective has not been confirmed. The aim of this study was to confirm the content of the SCoRS from the caregivers' perspective. A cross-sectional qualitative study was conducted with primary (live-in, for example, a family member) and secondary (professionally trained) caregivers in the US caring for patients with schizophrenia. The caregiver research confirmed the concepts that clinicians and patients had previously identified in the creation of the PRECIS scale as clear cognitive deficits of patients with schizophrenia. Understanding that family and professional caregivers confirm these cognitive impairments to be real, independently from the patient and clinicians, is helpful to determine the validity of the cognitive impairment concept. Overall, the findings confirmed that the SCoRS captures relevant aspects of cognitive functioning in patients with schizophrenia and support the relevance and clarity of instructions, domains, and items with primary and secondary informants.

Cognitive impairment associated with schizophrenia (CIAS) places a significant burden on patients and caregivers. This study explored the burden experienced by primary (informal) and secondary (formal) caregivers. A secondary qualitative analysis was performed on interviews from a Schizophrenia Cognition Rating Scale (SCoRS) confirmation study. Thematic analysis was utilised to investigate the characteristics of caregiver burden. Quotes were analysed across 3 levels (Level 1: caregiver experience of patient cognitive symptoms; Level 2: caregiver experience of patient burden; Level 3: overarching caregiver burden) to establish themes. Subsequently, themes were mapped to SCoRS domains. Twenty primary caregivers and 20 secondary caregivers were enrolled. Caregivers described patient difficulties with memory, learning, social communication, and everyday tasks. Caregivers assisted patients by engaging in sustained teaching for new activities, encouraging social communication and repeating reminders to accomplish tasks. Caregiver burden was substantial among both groups. Thematic analysis identified 2 main themes: caregiving difficulty and caregiving necessity. These themes reflected the extensive roles and responsibilities assumed by caregivers due to the impacts of CIAS symptoms. Illustrative quotes were reported for 60% of primary caregivers and 55% of secondary caregivers. Six of the 8 SCoRS domains (memory, learning, attention, problem-solving, language, social cognition)were mapped to themes identified at each level. A high level of objective caregiving burden was found in relation to CIAS symptoms among primary and secondary caregivers. The SCoRS domains of memory, learning, attention, problem-solving, language and social cognition are key areas to treat in patients with schizophrenia to reduce caregiver burden.

Speech-based detection of early psychosis is progressing at a rapid pace. Within this evolving field, the Accelerating Medicines Partnership® in Schizophrenia (AMP® SCZ) is uniquely positioned to deepen our understanding of how language and related behaviors reflect early psychosis. We begin with detailed standard operating procedures (SOPs) that govern every stage of collection. These SOPs specify how to elicit speech, capture facial expressions, and record acoustics in synchronized audio-video files-both on-site and through remote platforms. We then explain how we chose our sampling tasks, hardware, and software, and how we built streamlined pipelines for data acquisition, aggregation, and processing. Robust quality-assurance and quality-control (QA/QC) routines, along with standardized interviewer training and certification, ensure data integrity across sites. Using natural language processing parsers, large language models, and machine-learning classifiers, we analyzed Data Release 3.0 to uncover systematic grammatical markers of psychosis risk. Speakers at clinical high risk (CHR) produced more referential language but fewer adjectives, adverbs, and nouns than community controls (CC), a pattern that replicated across sampling tasks. Some effects were task-specific: CHR participants showed elevated use of complex syntactic embeddings in two elicitation conditions but not the third, underscoring the importance of the language sampling task. Together, these results demonstrate how computational linguistics can turn everyday speech into a scalable, objective biomarker, paving the way for earlier and more precise detection of psychosis.Video Link: https://vimeo.com/1112291965?fl=pl&fe=sh.

A growing body of evidence has indicated an increased risk of violence among patients with schizophrenia. While childhood trauma (CT) has been robustly associated with increased violent behavior in schizophrenia spectrum disorders, the neurobiological mechanisms underlying this relationship remain underexplored. The objectives of this study are to investigate the potential role of functional connectivity (FC) in the relationship between CT and violence. This study enrolled 55 patients with schizophrenia and 36 healthy controls. Seed-based functional connectivity between a predefined seed in the orbitofrontal cortex and other brain voxels was compared across groups, with significant results regarding FC used in further mediation analysis. The seed-based analysis revealed decreased FC between the right orbital part of the inferior frontal gyrus (ORBinf) and the right middle temporal gyrus as well as the right superior frontal gyrus in violent schizophrenia patients (VSP) compared to both healthy controls (HC) and non-violent schizophrenia patients (NVSP). VSP also exhibited decreased FC between the right ORBinf and the right middle frontal gyrus compared to NVSP. Furthermore, the mediation analysis indicated that the relationship between CT and violence was completely mediated by the strength of FC between the right ORBinf and the right MTG. The present study suggested that alterations of FC between certain brain regions may be associated with violence and offer valuable insights into potential neural targets for interventions aiming to address CT and violence in patients with schizophrenia.

Historically, large samples of individuals at clinical high risk (CHR) for psychosis have mirrored overt psychotic disorders in both sex (predominantly male) and age representation (adolescent to early adulthood onset). We report on a recent CHR sample suggesting a shift in these distributions and explore contributing factors and clinical implications. We hypothesized that demographic differences would be related to recruitment sources and that age, sex, and recruitment sources would be related to baseline clinical profiles. Baseline data were included from the recent computerized assessment of psychosis risk (CAPR) study and the second and third waves of the North American Prodrome Longitudinal Study (NAPLS-2 and 3). Hierarchical regression was used to examine differences in sex, age, and recruitment sources between samples and relationships with clinical characteristics. Univariate analyses revealed a significant shift to female predominance, older age, and a change in recruitment source from NAPLS to CAPR. Multivariate analyses indicated that between-study differences in sex and age were conditional on recruitment source, with the apparent study effect driven by differences in the non-self-referred groups. More than 60% of participants recruited through internet self-referrals were female across samples. Clinical heterogeneity was partly related to age, sex, and recruitment source differences. Internet-based self-referrals were older and showed less severe negative symptoms, disorganization, and general symptoms and higher role functioning than non-self-referred participants. Findings highlight the importance of recruitment sources for CHR sample characteristics. Recruitment source effects, including those from internet sources, should be investigated in other CHR samples.

While voice-hearing in psychosis has received much attention, perceptual experiences in other sensory modalities and psychiatric conditions have remained relatively overlooked. The present review aimed to address this gap by providing an overview of voices/altered perceptual experiences (APE) across psychotic, mood and anxiety disorders in terms of phenomenological characteristics, biopsychosocial mechanisms, etiological models and therapeutic interventions. Where possible, lived experience perspectives and transcultural considerations were embedded. A narrative literature review was conducted. Knowledge pertaining to voices in psychosis formed the foundation, broadened to include other sensory modalities and diagnostic conditions. Quality assessment demonstrated an excellent rating of 12/12. Notable findings related to: (i) phenomenological heterogeneity in voices/APE within individuals and across diagnostic conditions, with multisensory/multimodal experiences relatively widespread; (ii) existing mechanistic studies mainly focusing on the role of trauma and neurocognition in voices; (iii) prevailing explanatory models mostly focusing on voices; (iv) a need for emerging interventions to extrapolate to encompass broader therapeutic applications; and (v) wide-ranging specificity issues and transcultural considerations to be addressed. Future research should invest in appropriate assessment tools as well as ensuring methodological consistency in mechanistic studies. Incorporating lived experience perspectives and meaningfully embedding transcultural considerations in theoretical and empirical ways are also essential.