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Symptomatic, functional and quality of life measures of remission in 194 outpatients with schizophrenia followed naturalistically in a 6-month, non-interventional study of aripiprazole once-monthly. 194名门诊精神分裂症患者的症状、功能和生活质量缓解指标,对阿立哌唑进行了为期6个月的非干预性研究,每月一次。
Pub Date : 2023-11-08 DOI: 10.1038/s41537-023-00405-5
Christoph U Correll, Andreas Brieden, Wolfgang Janetzky

An important goal in the treatment of patients with schizophrenia is remission in various domains, i.e., of symptoms, psychosocial functioning and subjective well-being. We undertook a post hoc analysis of pre-stabilized outpatients with schizophrenia and complete outcome data who had been enrolled in a 6-month non-interventional study of aripiprazole once-monthly (AOM) at 75 German sites. Key outcomes were (i) symptomatic remission (cross-sectional Andreasen et al. criteria (≤mild positive and negative key symptoms on the Brief Psychiatric Rating Scale (BPRS))); (ii) functional remission (Global Assessment of Functioning (GAF) scale score >70), and (iii) subjective well-being remission (WHO-5 scale score ≥13) at week 24. Of 242 enrolled patients, 194 (80.2%) (age = 43.9 ± 15.3 years; 51.5% male, illness duration = 14.0 ± 12.0 years) with complete data were analyzed. While 61.3% of the patients achieved symptomatic remission and 76.8% achieved remission regarding subjective well-being, only 24.7% achieved psychosocial functioning remission at 6 months. Remission rates were similar for men and women and across strata of disease duration with, on average, less remission in patients with longer illness duration. Correlations of improvements on the BPRS and GAF were weak, with the weakest correlation between the BPRS depressive mood item and the GAF scale, but similarly high correlation between BPRS subscales or the BPRS depressive mood item and subjective well-being. These findings suggest that while treatment with AOM can lead to symptomatic remission and remission regarding subjective well-being, additional interventions such as psychosocial therapy or supported employment and education may be necessary to achieve functional remission.

精神分裂症患者治疗的一个重要目标是在各个领域得到缓解,即症状、心理社会功能和主观幸福感。我们对在75个德国地点进行了为期6个月的阿立哌唑非介入性研究的精神分裂症预稳定门诊患者和完整的结果数据进行了事后分析。关键结果是(i)症状缓解(Andreasen等人的横断面标准(≤简要精神病评定量表(BPRS)中的轻度阳性和阴性关键症状);(ii)功能缓解(全球功能评估(GAF)量表得分>70),以及(iii)第24周的主观幸福感缓解(WHO-5量表得分≥13)。在242名入选患者中,194名(80.2%)(年龄 = 43.9 ± 15.3年;51.5%男性,患病时间 = 14 ± 12.0年)。61.3%的患者在主观幸福感方面实现了症状缓解,76.8%的患者在6个月时实现了心理社会功能缓解。男性和女性的缓解率相似,不同疾病持续时间的患者的缓解率平均较低。BPRS和GAF改善的相关性较弱,其中BPRS抑郁情绪项目与GAF量表之间的相关性最弱,但BPRS分量表或BPRS抑郁心情项目与主观幸福感之间的相关性相似。这些发现表明,虽然AOM治疗可以导致症状缓解和主观幸福感缓解,但可能需要额外的干预措施,如心理社会治疗或支持就业和教育,以实现功能缓解。
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引用次数: 0
Capsaicin alleviates neuronal apoptosis and schizophrenia-like behavioral abnormalities induced by early life stress. 辣椒素可减轻早期生活压力引起的神经元凋亡和精神分裂症样行为异常。
Pub Date : 2023-11-07 DOI: 10.1038/s41537-023-00406-4
Shilin Xu, Keke Hao, Ying Xiong, Rui Xu, Huan Huang, Huiling Wang

Early life stress (ELS) is associated with the later development of schizophrenia. In the rodent model, the maternal separation (MS) stress may induce neuronal apoptosis and schizophrenia-like behavior. Although the TRPV1 agonist capsaicin (CAP) has been reported to reduce apoptosis in the central nervous system, its effect in MS models is unclear. Twenty-four hours of MS of Wistar rat pups on postnatal day (PND9) was used as an ELS. Male rats in the adult stage were the subjects of the study. CAP (1 mg/kg/day) intraperitoneal injection pretreatment was undertaken before behavioral tests for 1 week and continued during the tests. Behavioral tests included open field, novel object recognition, Barnes maze test, and pre-pulse inhibition (PPI) test. MS rats showed behavioral deficits and cognitive impairments mimicking symptoms of schizophrenia compared with controls. MS decreased the expression of TRPV1 in the frontal association cortex (FrA) and in the hippocampal CA1, CA3, and dentate gyrus (DG) regions compared with the control group resulting in the increase of pro-apoptotic proteins (BAX, Caspase3, Cleaved-Caspase3) and the decrease of anti-apoptotic proteins (Bcl-2). The number of NeuN++TUNEL+ cells increased in the MS group in the FrA, CA1, CA3, and DG compared with the control group. Neuronal and behavioral impairments of MS were reversed by treatment with CAP. Exposure to ELS may lead to increased neuronal apoptosis and impaired cognitive function with decreased TRPV1 expression in the prefrontal cortex and hippocampus in adulthood. Sustained low-dose administration of CAP improved neuronal apoptosis and cognitive function. Our results provide evidence for future clinical trials of chili peppers or CAP as dietary supplements for the reversal treatment of schizophrenia.

早期生活压力(ELS)与精神分裂症的后期发展有关。在啮齿类动物模型中,母体分离(MS)应激可能诱导神经元凋亡和精神分裂症样行为。尽管TRPV1激动剂辣椒素(CAP)已被报道可减少中枢神经系统的细胞凋亡,但其在MS模型中的作用尚不清楚。Wistar大鼠幼崽在出生后24小时的MS(PND9)用作ELS。成年期雄性大鼠为研究对象。帽(1 mg/kg/天)腹膜内注射预处理1周,并在测试期间继续。行为测试包括开放视野、新物体识别、巴恩斯迷宫测试和脉冲前抑制(PPI)测试。与对照组相比,MS大鼠表现出类似精神分裂症症状的行为缺陷和认知障碍。与对照组相比,MS降低了额相关皮层(FrA)和海马CA1、CA3和齿状回(DG)区域TRPV1的表达,导致促凋亡蛋白(BAX、Caspase3、Cleaved-Caspase3)增加和抗凋亡蛋白(Bcl-2)减少。与对照组相比,MS组FrA、CA1、CA3和DG中NeuN++TUNEL+细胞的数量增加。多发性硬化症的神经元和行为障碍通过CAP治疗得以逆转。暴露于ELS可能导致神经元凋亡增加和认知功能受损,成年后前额叶皮层和海马中TRPV1的表达减少。持续低剂量给予CAP可改善神经元凋亡和认知功能。我们的研究结果为辣椒或CAP作为膳食补充剂逆转治疗精神分裂症的未来临床试验提供了证据。
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引用次数: 0
Better adherence to guidelines among psychiatrists providing pharmacological therapy is associated with longer work hours in patients with schizophrenia. 精神分裂症患者更好地遵守提供药物治疗的精神科医生的指导方针与更长的工作时间有关。
Pub Date : 2023-11-07 DOI: 10.1038/s41537-023-00407-3
Satsuki Ito, Kazutaka Ohi, Yuka Yasuda, Michiko Fujimoto, Hidenaga Yamamori, Junya Matsumoto, Kentaro Fukumoto, Fumitoshi Kodaka, Naomi Hasegawa, Keiichiro Ishimaru, Kenichiro Miura, Norio Yasui-Furukori, Ryota Hashimoto

Schizophrenia is a psychiatric disorder that is associated with various social dysfunctions, including shorter work hours. To measure the degree to which psychiatrists adhere to guidelines for pharmacological therapy of schizophrenia, we recently developed the individual fitness score (IFS) for adherence among psychiatrists in each patient. However, it remains unclear whether better adherence among psychiatrists is associated with higher patients' social functional outcomes, such as work hours. In this study, we examined the relationship between adherence to guidelines among psychiatrists and work hours in patients with schizophrenia. To evaluate the association between adherence to guidelines for pharmacological therapy among psychiatrists for treating schizophrenia and work hours, we used the IFS and social activity assessment, respectively, in 286 patients with schizophrenia. The correlation between IFS values and work hours was investigated in the patients. The adherence among psychiatrists to guidelines was significantly and positively correlated with work hours in patients with schizophrenia (rho = 0.18, p = 2.15 × 10-3). When we divided the patients into treatment-resistant schizophrenia (TRS) and nontreatment-resistant schizophrenia (non-TRS) groups, most patients with TRS (n = 40) had shorter work hours (0-15 h/week). Even after excluding patients with TRS, the positive correlation between adherence to guidelines among psychiatrists and work hours in patients with non-TRS (n = 246) was still significant (rho = 0.19, p = 3.32 × 10-3). We found that work hours were longer in patients who received the guideline-recommended pharmacotherapy. Our findings suggest that widespread education and training for psychiatrists may be necessary to improve functional outcomes in patients with schizophrenia.

精神分裂症是一种精神障碍,与各种社会功能障碍有关,包括工作时间缩短。为了衡量精神科医生对精神分裂症药物治疗指南的遵守程度,我们最近开发了每个患者的精神科医生遵守情况的个人适合度评分(IFS)。然而,目前尚不清楚精神科医生更好的依从性是否与患者更高的社会功能结果(如工作时间)有关。在这项研究中,我们检验了精神分裂症患者遵守指南与工作时间之间的关系。为了评估精神科医生对精神分裂症药物治疗指南的依从性与工作时间之间的关系,我们分别对286名精神分裂症患者进行了IFS和社会活动评估。研究了患者IFS值与工作时间之间的相关性。精神分裂症患者的精神科医生对指南的依从性与工作时间显著正相关(rho = 0.18,p = 2.15 × 10-3)。当我们将患者分为治疗抵抗性精神分裂症(TRS)和非治疗抵抗性心理分裂症(非TRS)组时,大多数TRS(n = 40)的工作时间较短(0-15 h/周)。即使在排除TRS患者后,精神科医生对指南的遵守与非TRS患者的工作时间之间的正相关(n = 246)仍然显著(rho = 0.19,p = 3.32 × 10-3)。我们发现,接受指南推荐药物治疗的患者工作时间更长。我们的研究结果表明,对精神科医生进行广泛的教育和培训对于改善精神分裂症患者的功能结果可能是必要的。
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引用次数: 0
Influence of psychopathology and metabolic parameters on quality of life in patients with first-episode psychosis before and after initial antipsychotic treatment. 首次精神病患者在首次抗精神病药物治疗前后的精神病理学和代谢参数对生活质量的影响。
Pub Date : 2023-11-07 DOI: 10.1038/s41537-023-00402-8
Anne Sofie A Dahl, Victor Sørensen, Karen S Ambrosen, Mikkel E Sørensen, Grímur H Mohr, Mette Ø Nielsen, Kirsten B Bojesen, Birte Y Glenthøj, Margaret Hahn, Julie Midtgaard, Bjørn H Ebdrup

The impact of psychological and physical health on quality of life (QoL) in patients with early psychosis remain relatively unexplored. We evaluated the predictive value of psychopathological and metabolic parameters on QoL in antipsychotic-naïve patients with first-episode psychosis before and after initial antipsychotic treatment. At baseline, 125 patients underwent assessments of psychopathology, prevalence of metabolic syndrome (MetS), and QoL. After 6 weeks of antipsychotic monotherapy, 89 patients were re-investigated. At baseline, the prevalence of MetS was 19.3% (n = 22). After 6 weeks, body weight (1.3 kg, p < 0.001) and body mass index (0.4 kg/m2, p < 0.001) increased, and four additional patients developed MetS. Multivariate linear regression revealed that positive and negative symptoms, and to some degree waist circumference, were predictors of QoL at both time points. Our findings suggest that in the earliest stages of antipsychotic treatment, metabolic side-effects may be less influential on QoL than psychopathological severity.

心理和身体健康对早期精神病患者生活质量(QoL)的影响相对未被探索。我们评估了在最初的抗精神病药物治疗前后,精神病理学和代谢参数对首次发作的精神病患者生活质量的预测价值。在基线时,125名患者接受了精神病理学、代谢综合征(MetS)患病率和生活质量评估。抗精神病药物单药治疗6周后,对89名患者进行了重新调查。在基线时,MetS的患病率为19.3%(n = 22)。6周后,体重(1.3 kg,p 2,p
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引用次数: 0
Association of elevated levels of peripheral complement components with cortical thinning and impaired logical memory in drug-naïve patients with first-episode schizophrenia. 首发精神分裂症药物幼稚患者外周补体成分水平升高与皮质变薄和逻辑记忆受损的关系。
Pub Date : 2023-11-07 DOI: 10.1038/s41537-023-00409-1
Hua Yu, Peiyan Ni, Yang Tian, Liansheng Zhao, Mingli Li, Xiaojing Li, Wei Wei, Jinxue Wei, Qiang Wang, Wanjun Guo, Wei Deng, Xiaohong Ma, Jeremy Coid, Tao Li

Schizophrenia has been linked to polymorphism in genes encoding components of the complement system, and hyperactive complement activity has been linked to immune dysfunction in schizophrenia patients. Whether and how specific complement components influence brain structure and cognition in the disease is unclear. Here we compared 52 drug-naïve patients with first-episode schizophrenia and 52 healthy controls in terms of levels of peripheral complement factors, cortical thickness (CT), logical memory and psychotic symptoms. We also explored the relationship between complement factors with CT, cognition and psychotic symptoms. Patients showed significantly higher levels of C1q, C4, factor B, factor H, and properdin in plasma. Among patients, higher levels of C3 in plasma were associated with worse memory recall, while higher levels of C4, factor B and factor H were associated with thinner sensory cortex. These findings link dysregulation of specific complement components to abnormal brain structure and cognition in schizophrenia.

精神分裂症与编码补体系统成分的基因多态性有关,而精神分裂症患者的补体活性亢进与免疫功能障碍有关。在这种疾病中,特定的补体成分是否以及如何影响大脑结构和认知尚不清楚。在这里,我们比较了52名首次服用药物的精神分裂症患者和52名健康对照者的外周补体因子水平、皮层厚度(CT)、逻辑记忆和精神病症状。我们还探讨了补体因子与CT、认知和精神病症状之间的关系。患者的血浆中C1q、C4、B因子、H因子和丙烯醛水平显著升高。在患者中,血浆中C3水平较高与记忆回忆较差有关,而C4、B因子和H因子水平较高与感觉皮层较薄有关。这些发现将特定补体成分的失调与精神分裂症患者大脑结构和认知的异常联系起来。
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引用次数: 0
fMRI fluctuations within the language network are correlated with severity of hallucinatory symptoms in schizophrenia. 语言网络中的功能磁共振成像波动与精神分裂症幻觉症状的严重程度相关。
IF 3 Q2 PSYCHIATRY Pub Date : 2023-10-30 DOI: 10.1038/s41537-023-00401-9
Chiara Spironelli, Marco Marino, Dante Mantini, Riccardo Montalti, Alexander R Craven, Lars Ersland, Alessandro Angrilli, Kenneth Hugdahl

Although schizophrenia (SZ) represents a complex multiform psychiatric disorder, one of its most striking symptoms are auditory verbal hallucinations (AVH). While the neurophysiological origin of this pervasive symptom has been extensively studied, there is so far no consensus conclusion on the neural correlates of the vulnerability to hallucinate. With a network-based fMRI approach, following the hypothesis of altered hemispheric dominance (Crow, 1997), we expected that LN alterations might result in self-other distinction impairments in SZ patients, and lead to the distressing subjective experiences of hearing voices. We used the independent component analysis of resting-state fMRI data, to first analyze LN connectivity in three groups of participants: SZ patients with and without hallucinations (AVH/D+ and AVH/D-, respectively), and a matched healthy control (HC) group. Then, we assessed the fMRI fluctuations using additional analyses based on fractional Amplitude of Low Frequency-Fluctuations (fALFF), both at the network- and region of interest (ROI)-level. Specific LN nodes were recruited in the right hemisphere (insula and Broca homologous area) for AVH/D+ , but not for HC and AVH/D-, consistent with a left hemisphere deficit in AVH patients. The fALFF analysis at the ROI level showed a negative correlation between fALFF Slow-4 and P1 Delusions PANSS subscale and a positive correlation between the fALFF Slow-5 and P3 Hallucination PANSS subscale for AVH/D+ only. These effects were not a consequence of structural differences between groups, as morphometric analysis did not evidence any group differences. Given the role of language as an emerging property resulting from the integration of many high-level cognitive processes and the underlying cortical areas, our results suggest that LN features from fMRI connectivity and fluctuations can be a marker of neurophysiological features characterizing SZ patients depending on their vulnerability to hallucinate.

尽管精神分裂症(SZ)是一种复杂的多种形式的精神障碍,但其最显著的症状之一是听觉-言语幻觉(AVH)。虽然这种普遍症状的神经生理学起源已经得到了广泛的研究,但到目前为止,对易产生幻觉的神经相关性还没有达成一致的结论。根据半球优势改变的假设(Crow,1997),通过基于网络的fMRI方法,我们预计LN改变可能会导致SZ患者的自我-其他区分障碍,并导致听觉声音的痛苦主观体验。我们使用静息状态fMRI数据的独立成分分析,首先分析了三组参与者的LN连接:有和没有幻觉的SZ患者(分别为AVH/D+和AVH/D-)和匹配的健康对照组(HC)。然后,我们使用基于低频波动分数振幅(fALFF)的额外分析,在网络和感兴趣区域(ROI)水平上评估fMRI波动。在右半球(脑岛和Broca同源区)招募特定的LN淋巴结用于AVH/D+ , 但HC和AVH/D-没有,这与AVH患者的左半球缺损一致。在ROI水平上的fALFF分析显示,仅在AVH/D+的情况下,fALFF Slow-4和P1幻觉PANSS分量表之间呈负相关,而fALFF Slow-5和P3幻觉PANSS量表之间呈正相关。这些影响不是组间结构差异的结果,因为形态计量学分析没有证明任何组间差异。鉴于语言作为一种新兴特性的作用,是由许多高级认知过程和潜在皮层区域的整合产生的,我们的研究结果表明,功能磁共振成像连接和波动的LN特征可以作为SZ患者神经生理学特征的标志,这取决于他们对幻觉的易感性。
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引用次数: 0
Mediation and longitudinal analysis to interpret the association between clozapine pharmacokinetics, pharmacogenomics, and absolute neutrophil count. 解释氯氮平药代动力学、药物基因组学和中性粒细胞绝对计数之间关系的中介和纵向分析。
Pub Date : 2023-10-18 DOI: 10.1038/s41537-023-00404-6
Siobhan K Lock, Sophie E Legge, Djenifer B Kappel, Isabella R Willcocks, Marinka Helthuis, John Jansen, James T R Walters, Michael J Owen, Michael C O'Donovan, Antonio F Pardiñas

Clozapine is effective at reducing symptoms of treatment-resistant schizophrenia, but it can also induce several adverse outcomes including neutropenia and agranulocytosis. We used linear mixed-effect models and structural equation modelling to determine whether pharmacokinetic and genetic variables influence absolute neutrophil count in a longitudinal UK-based sample of clozapine users not currently experiencing neutropenia (N = 811). Increased daily clozapine dose was associated with elevated neutrophil count, amounting to a 133 cells/mm3 rise per standard deviation increase in clozapine dose. One-third of the total effect of clozapine dose was mediated by plasma clozapine and norclozapine levels, which themselves demonstrated opposing, independent associations with absolute neutrophil count. Finally, CYP1A2 pharmacogenomic activity score was associated with absolute neutrophil count, supporting lower neutrophil levels in CYP1A2 poor metabolisers during clozapine use. This information may facilitate identifying at-risk patients and then introducing preventative interventions or individualised pharmacovigilance procedures to help mitigate these adverse haematological reactions.

氯氮平能有效减轻耐治性精神分裂症的症状,但也会导致一些不良后果,包括中性粒细胞减少症和粒细胞缺乏症。我们使用线性混合效应模型和结构方程模型来确定药代动力学和遗传变量是否影响目前未经历中性粒细胞减少症的氯氮平使用者的英国纵向样本中的绝对中性粒细胞计数(N = 811)。每日氯氮平剂量的增加与中性粒细胞计数的升高有关,氯氮平剂量每增加一个标准差,中性粒细胞数就会增加133个/mm3。氯氮平总剂量的三分之一是由血浆氯氮平和去氯氮平水平介导的,这两种水平本身与绝对中性粒细胞计数呈相反、独立的相关性。最后,CYP1A2药物基因组活性评分与中性粒细胞绝对计数相关,支持氯氮平使用期间CYP1A2不良代谢者的中性粒细胞水平较低。这些信息可能有助于识别高危患者,然后引入预防性干预措施或个性化药物警戒程序,以帮助缓解这些血液学不良反应。
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引用次数: 0
Efficacy of standard operating procedures for fall protection in hospitalized patients with schizophrenia. 精神分裂症住院患者跌倒防护标准操作程序的疗效。
Pub Date : 2023-10-17 DOI: 10.1038/s41537-023-00396-3
Hui Li, Caixing Liu, Zengyun Ge, Xishu Mu, Xuan Wang, Meihong Xiu, Xinfu Wang, Zezhi Li

Fall-related injury is the most common cause of functional disability and mortality in the older population. Falls in patients with schizophrenia are one of the major concerns in psychiatric hospitals. This study aimed to examine the impact of standardized operating procedures (SOP) on falls in veterans with schizophrenia. Veterans with schizophrenia were allocated to the control group (n = 345) and to the fall protection standardized operating procedures (FP-SOP) group (n = 342). Patients in the control group were given routine nursing for falls, and patients in the FP-SOP group were intervened with FP-SOP plus routine nursing. All patients were observed for one year. The study methods comply with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. We found a fall rate of 1.5% in the FP-SOP group and 4.6% in the control group, with a significant difference in the fall rate between the two groups. In addition, the difference in patient satisfaction between the two groups was statistically significant. Our findings suggest that FP-SOP is an effective strategy for fall prevention in psychiatric hospitals.

跌倒相关损伤是老年人功能残疾和死亡的最常见原因。精神分裂症患者的跌倒是精神病院关注的主要问题之一。本研究旨在检验标准化操作程序(SOP)对精神分裂症退伍军人跌倒的影响。患有精神分裂症的退伍军人被分配到对照组(n = 345)和坠落保护标准化操作程序(FP-SOP)组(n = 342)。对照组给予跌倒的常规护理,FP-SOP组给予FP-SOP加常规护理干预。所有患者均观察一年。研究方法符合《加强流行病学观察研究报告》(STROBE)检查表。我们发现FP-SOP组的跌倒率为1.5%,对照组为4.6%,两组之间的跌倒率有显著差异。此外,两组患者满意度的差异具有统计学意义。我们的研究结果表明,FP-SOP是精神病院预防跌倒的有效策略。
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引用次数: 0
Aberrant sense of agency induced by delayed prediction signals in schizophrenia: a computational modeling study. 精神分裂症延迟预测信号引起的异常代理感:一项计算建模研究。
Pub Date : 2023-10-16 DOI: 10.1038/s41537-023-00403-7
Tsukasa Okimura, Takaki Maeda, Masaru Mimura, Yuichi Yamashita

Aberrant sense of agency (SoA, a feeling of control over one's own actions and their subsequent events) has been considered key to understanding the pathology of schizophrenia. Behavioral studies have demonstrated that a bidirectional (i.e., excessive and diminished) SoA is observed in schizophrenia. Several neurophysiological and theoretical studies have suggested that aberrancy may be due to temporal delays (TDs) in sensory-motor prediction signals. Here, we examined this hypothesis via computational modeling using a recurrent neural network (RNN) expressing the sensory-motor prediction process. The proposed model successfully reproduced the behavioral features of SoA in healthy controls. In addition, simulation of delayed prediction signals reproduced the bidirectional schizophrenia-pattern SoA, whereas three control experiments (random noise addition, TDs in outputs, and TDs in inputs) demonstrated no schizophrenia-pattern SoA. These results support the TD hypothesis and provide a mechanistic understanding of the pathology underlying aberrant SoA in schizophrenia.

异常的代理感(SoA,一种对自己的行为及其后续事件的控制感)被认为是理解精神分裂症病理学的关键。行为研究表明,在精神分裂症中观察到双向(即过量和减少)SoA。一些神经生理学和理论研究表明,畸变可能是由于感觉运动预测信号的时间延迟(TDs)引起的。在这里,我们通过使用表达感觉运动预测过程的递归神经网络(RNN)的计算建模来检验这一假设。所提出的模型成功地再现了健康对照中SoA的行为特征。此外,延迟预测信号的模拟再现了双向精神分裂症模式SoA,而三个对照实验(随机噪声添加、输出中的TDs和输入中的TDs)没有显示精神分裂症图案SoA。这些结果支持了TD假说,并为精神分裂症异常SoA的病理学提供了一个机制上的理解。
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引用次数: 0
Low-dose lithium adjunct to atypical antipsychotic treatment nearly improved cognitive impairment, deteriorated the gray-matter volume, and decreased the interleukin-6 level in drug-naive patients with first schizophrenia symptoms: a follow-up pilot study. 低剂量锂辅助非典型抗精神病药物治疗几乎改善了首次出现精神分裂症症状的药物初始患者的认知障碍,恶化了灰质体积,并降低了白细胞介素-6水平:一项后续试点研究。
Pub Date : 2023-10-14 DOI: 10.1038/s41537-023-00400-w
Chuanjun Zhuo, Shuiqing Hu, Guangdong Chen, Lei Yang, Ziyao Cai, Hongjun Tian, Deguo Jiang, Chunmian Chen, Lina Wang, Xiaoyan Ma, Ranli Li

This study was conducted to investigate the effects of long-term low-dose lithium adjunct to antipsychotic agent use on the cognitive performance, whole-brain gray-matter volume (GMV), and interleukin-6 (IL-6) level in drug-naive patients with first-episode schizophrenia, and to examine relationships among these factors. In this double-blind randomized controlled study, 50 drug-naive patients with first-episode schizophrenia each took low-dose (250 mg/day) lithium and placebo (of the same shape and taste) adjunct to antipsychotic agents (mean, 644.70 ± 105.58 and 677.00 ± 143.33 mg/day chlorpromazine equivalent, respectively) for 24 weeks. At baseline and after treatment completion, the MATRICS Consensus Cognitive Battery (MCCB) was used to assess cognitive performance, 3-T magnetic resonance imaging was performed to assess structural brain alterations, and serum IL-6 levels were quantified by immunoassay. Treatment effects were assessed within and between patient groups. Relationships among cognitive performance, whole-brain GMVs, and the IL-6 level were investigated by partial correlation analysis. Relative to baseline, patients in the lithium group showed improved working memory, verbal learning, processing speed, and reasoning/problem solving after 24 weeks of treatment; those in the placebo group showed only improved working memory and verbal learning. The composite MCCB score did not differ significantly between groups. The whole-brain GMV reduction was significantly lesser in the lithium group than in the placebo group (0.46% vs. 1.03%; P < 0.001). The GMV and IL-6 reduction ratios correlated with each other in both groups (r = -0.17, P = 0.025). In the lithium group, the whole-brain GMV reduction ratio correlated with the working memory improvement ratio (r = -0.15, P = 0.030) and processing speed (r = -0.14, P = 0.036); the IL-6 reduction ratio correlated with the working memory (r = -0.21, P = 0.043) and verbal learning (r = -0.30, P = 0.031) improvement ratios. In the placebo group, the whole-brain GMV reduction ratio correlated only with the working memory improvement ratio (r = -0.24, P = 0.019); the IL-6 reduction ratio correlated with the working memory (r = -0.17, P = 0.022) and verbal learning (r = -0.15, P = 0.011) improvement ratios. Both treatments implemented in this study nearly improved the cognitive performance of patients with schizophrenia; relative to placebo, low-dose lithium had slightly greater effects on several aspects of cognition. The patterns of correlation among GMV reduction, IL-6 reduction, and cognitive performance improvement differed between groups.

本研究旨在研究长期低剂量锂辅助抗精神病药物使用对初次服药的精神分裂症患者认知能力、全脑灰质体积(GMV)和白细胞介素-6(IL-6)水平的影响,并探讨这些因素之间的关系。在这项双盲随机对照研究中,50名初次服药的精神分裂症患者每人服用低剂量(250 mg/天)锂和安慰剂(形状和味道相同)与抗精神病药物(平均644.70 ± 105.58和677.00 ± 143.33 mg/天氯丙嗪当量)治疗24周。在基线和治疗完成后,使用MATRICS共识认知电池(MCCB)评估认知表现,进行3-T磁共振成像评估大脑结构变化,并通过免疫测定测定血清IL-6水平。在患者组内部和患者组之间评估治疗效果。通过偏相关分析研究了认知能力、全脑GMVs和IL-6水平之间的关系。与基线相比,锂组患者在治疗24周后表现出工作记忆、语言学习、处理速度和推理/问题解决能力的改善;安慰剂组的人只表现出工作记忆和语言学习的改善。复合MCCB评分在各组之间没有显著差异。锂组的全脑GMV降低显著低于安慰剂组(0.46%对1.03%;P
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Schizophrenia (Heidelberg, Germany)
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