Schizophrenia bulletin open最新文献

Background: This paper presents the recruitment sources of clinical high-risk (CHR) and community controls (CC) from the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program, which aims to study various clinical variables and biomarkers in 2040 CHR and 652 CC participants.

Methods: A total of 1640 CHR and 514 CC had recruitment source data. The Positive Symptoms and Diagnostic Criteria for the Comprehensive Assessment of At-Risk Mental States Harmonized with the SIPS was utilized to assess CHR criteria and severity of attenuated psychotic symptoms (APSs), and the Global Functioning: Social Scale was used for social functioning. Participants were recruited through various methods, including referrals from healthcare providers, schools, and community agencies, and self-referrals via outreach efforts and advertising.

Results: Participants were recruited from 13 different sources, with self-referral being the most common for both CHR and CC. Other notable sources included child and youth services and psychiatric hospitals and departments. Regional differences in recruitment patterns were observed across continents. Differences in age, APS, and social functioning for CHR participants were examined in the top 5 recruitment sources. Overall, self-referred individuals were typically older, with less severe APS and higher levels of functioning, whereas those from adult community mental health services had poorer functioning and more severe APS. The remaining recruitment groups fell between these 2 extremes.

Conclusion: This paper highlights the diverse recruitment sources for the AMP SCZ program. Self-referral was a significant source, particularly in North America, reflecting changing help-seeking behaviors influenced by the internet and social media. The findings underscore the importance of understanding recruitment sources to optimize future CHR research.

Background and hypothesis: Unpacking the pathophysiological mechanisms of schizophrenia is necessary for advancing prediction, prevention, and treatment efforts. Mechanisms can be identified using easy-to-use and scalable clinical biomarkers, which reflect illness processes. Pupillometry is one such biomarker. Blunted dilation related to cognitive demand has been interpreted as a metric of diminished effort in schizophrenia, while blunted constriction to light has been interpreted as a metric of altered autonomic balance in schizophrenia. However, these 2 sets of findings may also reflect a common mechanism of schizophrenia. Therefore, this study aimed to explore the association between blunted cognitive dilation and blunted constriction to light to provide a parsimonious mechanism of autonomic and effort disturbances experienced by individuals with schizophrenia.

Study design: We assessed light-induced constriction and cognitive dilation during a double-step task in individuals with schizophrenia (n = 84) and demographically matched healthy controls (HC, n = 69), compared these metrics between groups, and computed their correlation within each group.

Study results: Replicating prior findings, dilation and constriction were blunted in schizophrenia relative to HC. Blunted constriction and dilation were positively correlated in schizophrenia but not HC (although the 2 correlations did not differ significantly).

Conclusions: Findings provide, for the first time, preliminary support of a common mechanism linking blunted pupil constriction to light and dilation to cognitive demands in schizophrenia. We propose that individuals with schizophrenia may exhibit impaired top-down modulation of autonomic control. Future studies are needed to validate this proposed mechanism.

Background: Insecure attachment may increase the risk of impaired social functioning in patients with a psychosis spectrum disorder. However, the pathways by which insecure attachment determines social functioning remain underexplored.

Aims: To investigate the effects of insecure (anxious and avoidant) attachment styles on social functioning (defined as satisfaction with role performance) and the role of three candidate mediators (ie, psychotic, depressive, and anxiety symptoms) in patients with psychosis.

Methods: Cross-sectional study as part of the UP's multicenter cohort study on recovery from psychotic disorders. Structural equation modeling was used to estimate direct and indirect paths of attachment styles and psychotic, depressive, and anxiety symptoms in relation to social functioning. Analyses were performed using data from a complete Psychosis Attachment Measure sample, N = 287.

Results: The final model showed a mediation effect only for depressive symptoms, which appeared stronger for the association between anxious attachment and social functioning (-0.10, 95% CI -0.19 to -0.02) than for the association between avoidant attachment and social functioning (-0.04, 95% CI -0.08 to -0.01).

Conclusions: Our results suggest that insecure attachment and depressive symptoms are relevant to improving social functioning in individuals with psychosis.

Background and hypothesis: Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS), yet the time course of clinical response in naturalistic settings is not well characterized. We hypothesized that patients initiated on clozapine in an outpatient clinic would demonstrate measurable symptom reduction over time, including delayed response in a subset of patients.

Study design: We conducted a retrospective study of TRS patients (N = 26) newly initiated on clozapine at an outpatient clozapine clinic. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up visits. Linear spline regression modeled PANSS trajectories over time. Response was defined as achieving either a ≥ 20% reduction in PANSS total score or a mild level of illness (PANSS score ≤ 58).

Study results: Patients demonstrated a mean 18.1-point reduction in PANSS total score during the first year of clozapine treatment, with significant improvements in positive and general psychopathology symptoms. Negative symptoms showed a modest, nonsignificant change. Overall, 20 patients (76.9%) achieved a ≥ 20% PANSS reduction, and 15 (57.7%) reached a mild symptom level. Six patients (23.1%) met response criteria only after 12 months of treatment.

Conclusions: In this naturalistic study, clozapine was associated with substantial symptom improvement, particularly within the first year. A subset of patients demonstrated delayed but clinically meaningful response, supporting the continued use of clozapine beyond 12 months. These findings underscore the value of sustained treatment in TRS.

Background and hypothesis: Schizophrenia spectrum disorders are known to affect the patient's functional performance. The functioning of those who are at familial risk for these disorders is less well understood. In this study, we compared the real-world functioning of adoptees with a genetic high-risk (HR) for schizophrenia spectrum disorders with adoptees without this risk (low-risk, LR). We hypothesized that the HR-group would have more difficulties in real-world functioning compared to the LR-group.

Study design: The data were based on the Finnish Adoptive Family Study of Schizophrenia project. The study sample included 127 HR- and 130 LR-adoptees. An interview-based method, Strauss-Carpenter Level of Function (SCLF)-scale, was used to measure functional performance in a setup of adoptees living in comparable adoptive families. The SCLF-scale comprises domains for function, symptoms, social contacts, and work. The Structured Interview of Schizotypy was utilized in assessments of possible schizotypal traits of the HR- and LR-adoptees.

Study results: No significant differences in the real-world functioning in total scores or scores of any SCLF domains were observed between HR- and LR-adoptees. Of single SCLF items, the HR-adoptees were characterized as being less likely to have achieved formal education and the LR-adoptees needed more help with their own basic needs.

Conclusions: No differences were found in the real-world functioning between HR- and LR-populations. This indicates that the real-world functioning does not express one's genetic risk for schizophrenia spectrum disorders. Our findings highlight the importance of considering environmental factors when comparing genetically different groups.

Background and hypothesis: The distressing nature of delusional beliefs is considered key to their persistence. One potential mechanism underlying delusional distress is global emotion dysregulation. Global emotion dysregulation is associated with general psychotic symptom severity, but its specific relationship to delusional distress has yet to be closely examined.

Study design: People with (n = 100) and without (n = 52) schizophrenia-spectrum disorders completed measures of delusional ideation (Peters Delusion Inventory; PDI-21) and global emotion dysregulation (Difficulties in Emotion Regulation Scale; DERS-16). Participants with schizophrenia also completed a measure of delusion severity (Psychotic Symptom Rating Scales; PSYRATS). Relationships between delusion severity and global emotion dysregulation were assessed with linear regression, controlling for age, sex, and group. Associations between delusional distress and aspects of emotion dysregulation were determined using stepwise linear regression.

Study results: Global emotion dysregulation was significantly elevated in those with schizophrenia compared to non-clinical controls, across all subscales (P < .001). Emotion dysregulation was significantly associated with delusional distress on both the PDI-21 (P < .001) and PSYRATS (P < .001). Stepwise regressions revealed a specific association between limited access to emotion regulation strategies and delusional distress on both scales (P's < .001). Delusional distress remained associated with emotion dysregulation when controlling for delusional preoccupation, and emotion dysregulation was not significantly associated with delusional conviction on either scale.

Conclusions: Emotion dysregulation, particularly the sense that there is little one can do to regulate themselves when upset, relates to delusional distress. Interventions that increase access to more emotion regulation strategies may help decrease distress associated with delusional thinking.

Background and hypothesis: Cognitive impairments are a core feature of psychosis that are often evident before illness onset and have substantial impact on both clinical and real-world functional outcomes. Therefore, these are an excellent target for stratification and early detection in order to facilitate early intervention. While many studies have aimed to characterize the effects of cognition at the group level and others have aimed to detect individual differences by referencing subjects against existing norms, these studies have limited generalizability across clinical populations, demographic backgrounds, and instruments and do not fully account for the interindividual heterogeneity inherent in psychosis.

Study design: Here, we outline the rationale, design, and analysis plan for the PRECOGNITION project, which aims to address these challenges.

Study results: This project is a collaboration between partners in 5 European countries. The project will not generate any primary data, but by leveraging existing datasets and combining these with novel analytic methods, it will produce multiple contributions including: (i) translating normative modeling approaches pioneered in brain imaging to psychosis data, to yield "cognitive growth charts" for longitudinal tracking and individual prediction; (ii) developing machine learning models for harmonizing and stratifying cohorts on the basis of these models; and (iii) providing integrated next-generation norms, having broad sociodemographic coverage including different languages and distinct norms for individuals with psychosis and unaffected individuals.

Conclusions: This study will enable precision stratification of psychosis cohorts and furnish predictions for a broad range of functional outcome measures. It will be guided throughout by lived experience experts.

Background and hypothesis: Psychosis refers to the state whereby one's experience of reality differs from those around them. The ineffability of psychosis does not render the experience void of meaning, and the ways individuals integrate their experiences of psychosis into their life narratives cannot be dismissed. Meaning is an essential part of recovery. This review aimed to identify categories of personal explanations that people with psychosis use to explain their experiences.

Study design: This systematic review is based on a preregistered protocol (CRD42023421125). Four databases, MEDLINE, Embase, Scopus, and PsycINFO, and 5 journals were searched April to November 2023. Qualitative and mixed-methods studies that explored the personal explanations employed by adults who experience psychosis, regardless of diagnostic status, were included.

Study results: Twenty-five studies met the inclusion criteria, representing the views of 682 participants from 15 countries. Included studies were appraised using the CASP Qualitative Studies Checklist.

Results: were synthesized using thematic analysis. Personal explanations for psychosis experiences were grouped into 5 themes: Physical and psychiatric; Traumatic and adversarial; Emotional; Religious, spiritual, and magical; No explanation. Participants reported multiple explanations for their experiences.

Conclusions: Individuals with experience of psychosis seek to explain these experiences, and these personal explanations may be multiple and complex in nature. The identified personal explanations can be used to further explore the ways that people situate their experiences into their personal context. This understanding should be utilized by professionals to support the provision of recovery-oriented care, with implications for assessment, treatment, intervention, and recovery outcomes.

Background: Psychosis-related environmental risks in autism, along with genetic overlaps between autism and psychosis, have been well-established. However, their moderating roles in the relationship between autistic traits (ATs) and psychotic experiences (PEs) remain underexplored.

Methods: First-wave data from 792 twins and siblings (mean age: 17.47 ± 3.6, 60.23% female) in the TwinssCan Project were analyzed. PEs and ATs were assessed using the Community Assessment of Psychic Experiences and the Autism-Spectrum Quotient, respectively. Polygenic risk scores for schizophrenia and psychosis-associated environmental factors (ie, childhood trauma (CT), bullying, negative life events, obstetric complications, cannabis use, winter birth, and hearing impairment) were tested for their independent effects on PEs and their interaction effects with ATs in moderating the relationship between ATs and PEs using separate multilevel linear regression models with Bonferroni's correction.

Results: ATs, all CT subtypes, bullying, and negative life events were positively associated with PEs (all P < .004). Moderation analyses revealed that the association between ATs and PEs was amplified by emotional abuse (B:0.08, 95% CI, 0.05-0.11, P < .001), physical abuse (B:0.11, P = .001), sexual abuse (B:0.09, 95% CI, 0.03-0.15, P = .002), and physical neglect (B:0.06, 95% CI, 0.03-0.10, P = .001), emotional neglect (B:0.04, 95% CI, 0.01-0.07, P = .007), and negative life events (B:0.007, 95% CI, 0.0005-0.014, P = .04), although the latter 2 risks did not survive Bonferroni's correction. No significant main or interacting effects of genetic and other risk factors were found.

Conclusions: People with high ATs were more likely to have PEs when exposed to CT. Trauma screening and early interventions might be warranted in this at-risk population.

Background and hypothesis: Psychotic disorders are among the top causes of disability worldwide. Guidelines emphasize the need for psychotherapeutic approaches in the acute phase of this illness. Motivational interviewing (MI) is highly suitable for establishing a therapeutic alliance wherein the patient's intrinsic motivation can be strengthened to adhere to therapy. This pilot study investigated the feasibility and impact of MI for patients with acute psychosis.

Study design: A feasibility study was conducted, comparing MI and supportive counseling. The sample included 20 inpatients, who all received 4 therapy sessions. In line with CONSORT guidelines for pilot and feasibility studies, we measured various feasibility outcomes. Clinical outcomes were assessed using linear regression models, with baseline values used as covariates.

Study results: The recruitment target (N = 24) was achieved at 83% in a reasonable timeframe (8 months), with a retention rate of 83% and a completion rate of 71%. The eligibility rate (82 %) was high, the consent rate (48%) was moderate, and both the dropout rate 17% and the missing data rate (0.3%) were low. Regarding the clinical outcomes, a group difference was found for the severity of psychotic symptoms, with an advantage for MI (b = -12.0, 95% CI: [-18.7, -5.2], P < 0.01), although the small sample size must be kept in mind.

Conclusions: The study demonstrated the feasibility and acceptability of a clinical trial with MI for patients with psychosis in an inpatient setting. MI could offer benefits, particularly in terms of reducing psychotic symptoms.