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Rogóż Z, Kamińska K, Wąsik A. N-acetylcysteine enhances the antipsychotic effect of aripiprazole in the neurodevelopmental rat model of schizophrenia. Pharmacol Biochem Behav 2025; 252:174028. [PMID: 40316146 DOI: 10.1016/j.pbb.2025.174028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 04/15/2025] [Accepted: 04/29/2025] [Indexed: 05/04/2025]
Abstract
Symptoms of schizophrenia are well characterized, but the mechanism underlying the pathogenesis of the disease still remains unknown. In addition, therapy of negative symptoms and cognitive deficits in schizophrenic patients is a serious clinical problem. Some clinical studies have shown that the atypical antipsychotic drug aripiprazole (ARI), and the antioxidant N-acetylcysteine (NAC) are effective in reducing positive and negative symptoms of schizophrenia in patients. The aim of the present study was to evaluate the influence of repeated co-treatment with low doses of ARI and NAC on the schizophrenia-like behavior in adult rats. The schizophrenia-like behavior was induced in Sprague-Dawley male pups in the neonatal days p5-p16 by repeated administration of the glutathione synthesis inhibitor L-butionine-(S,R)-sulfoximine (BSO) given together with the dopamine reuptake inhibitor 1-[2-[Bis-4(fluorophenyl)methoxy]ethyl]-4-3-(3-phenylpropyl) (GBR 12909). Adult rats received repeated co-treatment with ARI (0.1 mg/kg) and NAC (10 mg/kg) for 21 days, and their effects on schizophrenia-like behavior were assessed (on p90-91) using the social interaction test and novel object recognition test. The present data indicated that the studied drugs at higher doses: ARI (0.3 mg/kg but not 0.1 mg/kg) and NAC (30 mg/kg but not 10 mg/kg) reversed schizophrenia-like symptoms in the tested model. Moreover, repeated co-treatment with low doses of ARI with NAC also reversed schizophrenia-like behavior in the neurodevelopmental rat model of schizophrenia. The above results indicated that NAC enhanced the action of ARI in the used neurodevelopmental rat model of schizophrenia, and the mechanism of action of the used drugs in this model is discussed.
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Affiliation(s)
- Zofia Rogóż
- Maj Institute of Pharmacology Polish Academy of Sciences, Department of Pharmacology and Brain Biostructure, Kraków, Poland; University of Applied Sciences, Institute of Health, Faculty of Cosmetology, Nowy Targ, Poland
| | - Kinga Kamińska
- Maj Institute of Pharmacology Polish Academy of Sciences, Department of Pharmacology and Brain Biostructure, Kraków, Poland
| | - Agnieszka Wąsik
- Maj Institute of Pharmacology Polish Academy of Sciences, Department of Neurochemistry, Kraków, Poland.
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Pejčić AV. Targeting muscarinic receptors in schizophrenia treatment: Novel antipsychotic xanomeline/trospium chloride. World J Psychiatry 2025; 15:105409. [DOI: 10.5498/wjp.v15.i6.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 04/04/2025] [Accepted: 05/13/2025] [Indexed: 05/29/2025] Open
Abstract
This minireview explores the role of acetylcholine and muscarinic receptors in the pathophysiology of schizophrenia and summarizes the latest data on xanomeline/trospium chloride, a novel antipsychotic approved by the United States Food and Drug Administration in September 2024. Evidence suggests that cholinergic dysfunction, particularly an imbalance in the expression of the M1 and M4 muscarinic receptors, may contribute to the pathophysiology and symptoms of schizophrenia. Xanomeline/trospium chloride combines xanomeline, an M1 and M4 receptor agonist, with trospium chloride, a non-selective peripheral muscarinic receptor antagonist that reduces peripheral cholinergic side effects. Clinical trials have demonstrated significant reductions in the positive and negative symptoms of schizophrenia, with improvements in Positive and Negative Syndrome Scale scores observed as early as two weeks. A post-hoc analysis of one trial revealed cognitive improvements in patients with baseline cognitive impairment. This medication was generally well-tolerated, with mild-to-moderate gastrointestinal symptoms being the most common adverse events. While these results are promising, further research is needed to better understand its effectiveness and safety in real-world clinical practice, and to define its optimal role in managing this complex psychiatric disorder.
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Affiliation(s)
- Ana V Pejčić
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
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Shimada T, Ito S, Yamanushi A, Koizumi A, Kobayashi M. Effect of aerobic exercise versus cognitive remediation versus a combination of both on cognition among patients with schizophrenia: A three-arm, randomized controlled study. Psychiatry Res 2025; 348:116454. [PMID: 40138764 DOI: 10.1016/j.psychres.2025.116454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Revised: 03/16/2025] [Accepted: 03/19/2025] [Indexed: 03/29/2025]
Abstract
Aerobic exercise (AE) and cognitive remediation (CR) have both shown promising effects on cognition in schizophrenia. However, the efficacy of combining these interventions has not been thoroughly evaluated. We conducted a randomized controlled trial to test the 3-month effects of AE, CR, and their combination on cognition and functioning in patients with schizophrenia. A total of 59 patients were randomized into three groups: AE alone (n = 19), CR alone (n = 19), or a combination of both (n = 21). The intervention consisted of a combination of individual and group AEs and a computer-assisted CR. The overall retention rate was 91.53 %. The primary outcome was the change in cognition from baseline, assessed using the Brief Assessment of Cognition in Schizophrenia (BACS). Significant improvements from baseline to post-treatment were observed in the combined AE and CR group compared to the AE alone group for verbal memory, executive function, and the composite score on the BACS. Similarly, greater improvements were found in the combined AE and CR group than in the CR group alone in verbal memory, working memory, attention, executive function, and the composite BACS score, with effect sizes ranging from moderate to large. No significant differences were found in functional level changes from baseline to post-treatment in the pairwise comparisons between groups, as assessed using the modified Global Assessment of Functioning for social functioning Scale. Our results indicate that patients with schizophrenia in the combined AE and CR group achieved greater cognitive improvement than those in the AE or CR alone group.
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Affiliation(s)
- Takeshi Shimada
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan.
| | - Shoko Ito
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Ayumi Yamanushi
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan; Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Ami Koizumi
- Medical Corporation Seitaikai Mental Support Soyokaze Hospital, Nagano, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
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Chen LH, Guo Q, Hu Y, Liu XH, Hu H, Chen HY, Liu CP, Li HF, Chen JD, Li GJ. Effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia with and without prominent negative symptoms: A prospective study. World J Psychiatry 2025; 15:103701. [DOI: 10.5498/wjp.v15.i5.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/24/2025] [Accepted: 03/17/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Blonanserin, a novel antipsychotic, has demonstrated efficacy in treating both positive and negative symptoms. However, limited research exists on its dose-dependent effectiveness and safety in patients with and without prominent negative symptoms (PNS).
AIM To evaluate the effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia in real-world clinical settings and to explore the efficacy and safety of different doses of blonanserin for patients with PNS and without PNS.
METHODS A 12-week, multicenter, prospective post-marketing surveillance was conducted. In this study, we included patients with first-episode schizophrenia who received blonanserin monotherapy. Patients were divided into those with PNS and without PNS, based on the Brief Psychiatric Rating Scale (BPRS) negative symptoms subscale scores. Additionally, patients were labeled as high-dose and low-dose groups according to the maximum daily dose they received. Effectiveness was assessed using the BPRS, and safety was evaluated through the incidence of adverse drug reactions (ADRs).
RESULTS A total of 653 patients were included in the analysis, with 613 completing the study. The BPRS total score decreased significantly from 47.94 ± 16.31 at baseline to 26.88 ± 9.47 at 12 weeks (P < 0.001). A significant interaction of PNS × dose × time was observed for BPRS total scores (F = 3.47, P = 0.040) and negative symptom subscale scores (F = 6.76, P = 0.002). In the PNS group, the high-dose group showed greater reductions in BPRS total scores (P = 0.001) and negative symptom subscale scores (P = 0.003) than the low-dose group in week 12. In the without PNS group, no significant difference was observed between the high-dose and low-dose groups at any visit. Most adverse reactions were mild or moderate, with extrapyramidal symptoms (9.3%) being most common; 1.5% of patients gained ≥ 7% body weight at 12 weeks.
CONCLUSION Blonanserin effectively alleviated the clinical symptoms of first-episode schizophrenia with an acceptable safety profile. High-dose blonanserin is particularly beneficial for patients with PNS in the acute phase of first-episode schizophrenia. However, due to the limitation of ADR reporting the real world, the ADR incidence observed in this study may be underestimated.
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Affiliation(s)
- Li-He Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Qian Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yao Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiao-Hua Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Hao Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Hai-Ying Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Cai-Ping Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Hua-Fang Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jin-Dong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Guan-Jun Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
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Bitter I, Czobor P, Tombor L. Is There a Link Between Type 2 Diabetes Mellitus and Negative Symptoms in Schizophrenia? A Scoping Review. Brain Sci 2025; 15:499. [PMID: 40426670 PMCID: PMC12110311 DOI: 10.3390/brainsci15050499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2025] [Revised: 05/06/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES Type 2 diabetes mellitus (T2DM) and impaired glucose metabolism are more prevalent among patients with schizophrenia than in the general population. The incidence of T2DM is associated with lifestyle factors that are often influenced by the negative symptoms of schizophrenia; comorbid T2DM may contribute to the reduced life expectancy observed in patients with schizophrenia. The existing literature reveals a scarcity of data regarding the potential causal relationship between T2DM and negative symptoms. METHODS A scoping review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, utilizing the PubMed database to identify clinical studies investigating the association between T2DM and the negative (but not cognitive) symptom domain of schizophrenia. Subsequently, the reference lists of these identified publications were searched. RESULTS Seventeen publications were included. There is evidence supporting the association between impaired glucose tolerance and increased negative symptoms in patients with first-episode psychosis, and several studies indicate that poorer glucose metabolic status correlates with more severe negative symptoms. Patients with T2DM and chronic schizophrenia, however, had milder negative symptom scores compared to those without diabetes, although this association was less pronounced than in early disease stages. CONCLUSIONS There is insufficient confirmatory evidence regarding the potential causality of T2DM on the negative symptoms of schizophrenia. Further, preferably prospective studies are needed to explore the complex and potentially causal relationship between T2DM and negative symptoms of schizophrenia. If T2DM were found to have a causal relationship with negative symptoms or to exacerbate pre-existing symptoms, it could lead to significant changes in therapeutic approaches for schizophrenia.
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Affiliation(s)
- István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1083 Budapest, Hungary
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Damiani S, D'Imperio A, Radua J, Fortea L, Calò M, Crippa A, Esposito CM, Lumer ELL, Patron S, Peviani A, Piccolo A, Provenzani U, Santilli F, Spallarossa C, Fusar-Poli L, Papanastasiou E, Cella M, Patel R, Galderisi S, Leucht S, Stahl D, Fusar-Poli P. A systematic review and synthesis of 489 studies investigating treatments for negative symptoms in the schizophrenia spectrum: Trial designs, demographics and clinical characteristics. Psychiatry Res 2025; 347:116406. [PMID: 40015036 DOI: 10.1016/j.psychres.2025.116406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/08/2025] [Accepted: 02/16/2025] [Indexed: 03/01/2025]
Abstract
Negative symptoms in schizophrenia spectrum are associated with minimal treatment responses. The search for effective treatments is potentially hampered by heterogenous study-designs and sample characteristics depending on the intervention category. This PRISMA-compliant systematic review/synthesis aims to describe the literature on negative symptoms interventions for schizophrenia spectrum disorders by comparing 12 study design, demographical and clinical variables in different intervention categories: antipsychotics (AP), other pharmacological agents (OPA), brain stimulation (BS), psychological/psychosocial (PSI), lifestyle (LS), mixed interventions. Kruskal-Wallis and Chi-square tests measured differences between intervention-groups. Out of 19,935 articles, 489 (AP=149/OPA=187/BS=49/PSI=79/LS=19/mixed=6) were selected for data extraction. Concerning study designs, AP had the largest average arm size (mean ± SD=91.1 ± 122.8participants), OPA the highest double/triple-blinding (97.9 %) rates, PSI the longest follow-up (26.7 ± 21.8weeks). Age/gender demographical differences were significant but of negligible magnitude. OPA illness duration (14.8 ± 9.0years) was longer compared to AP (11.4 ± 6.7years). Positive and Negative Syndrome Scale (PANSS) negative scores were milder in PSI (18.6 ± 6.9) compared to AP/OPA/BS (23.8 ± 6.4/23.4 ± 4.9/24.2 ± 9.2). PANSS total scores were worse in AP (83.6 ± 18.2) than in OPA/BS/PSI (77.1 ± 20.5/75.5 ± 14.7/67.0 ± 23.3). The same was true for dropout rates (AP=25.5 %, OPA/BS/PSI=14.3/9.7/14.5 %). Prevalent treatment as usual was "none" for AP (36.7 %) and "antipsychotic" for other categories (42.3-82.8 %). Implementing cross-over, factorial or multi-arm designs may increase the comparability between studies investigating different intervention categories. Concerning clinical differences, reporting individual treatments at baseline and clinical severity, evaluating cognitive profiles and considering patients' perspectives will allow to better understand the efficacy of the available treatments and develop tailored interventions.
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Affiliation(s)
- Stefano Damiani
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy.
| | - Aldo D'Imperio
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy; Helsingborg General Hospital, Adult Psychiatric Clinic, Helsingborg, Sweden; Lund University, Division of Psychiatry, Clinical Sciences Helsingborg, Lund, Sweden
| | - Joaquim Radua
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Institute of Neuroscience, Barcelona, Spain
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Institute of Neuroscience, Barcelona, Spain
| | - Matteo Calò
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Andrea Crippa
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Cecilia Maria Esposito
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy; IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy
| | | | - Sara Patron
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Alessandro Peviani
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Alessandro Piccolo
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Umberto Provenzani
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Fabrizio Santilli
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Cecilia Spallarossa
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | - Laura Fusar-Poli
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy
| | | | - Matteo Cella
- South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Rashmi Patel
- Department of Psychiatry, University of Cambridge, UK
| | | | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, University of Munich, Germany
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Paolo Fusar-Poli
- University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Outreach and Support in South-London (OASIS) service, South London and Maudlsey (SLaM) NHS Foundation Trust, UK
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Liu H, Pan X, Huang X, Tian H, Shao X, Wang D, Wen L, Bao C, Fang X, Yi Z. Do interpersonal trust and social avoidance mediate the association between psychotic symptoms and social functioning in chronic schizophrenia patients? Front Psychiatry 2025; 16:1433763. [PMID: 40201062 PMCID: PMC11975657 DOI: 10.3389/fpsyt.2025.1433763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 03/03/2025] [Indexed: 04/10/2025] Open
Abstract
Objective Schizophrenia is a complex mental disorder that significantly impacts social functioning. The present study aimed to investigate the relationship between psychotic symptoms and social functioning in individuals with chronic schizophrenia. Specifically, we examined the mediating roles of social avoidance and impaired interpersonal trust in this relationship, as these factors are most worrisome in individuals with schizophrenia. Methods A total of 223 outpatients with chronic schizophrenia and 201 unrelated healthy controls were included. The Positive and Negative Syndrome Scale (PANSS), the Interpersonal Trust Scale (ITS), the Social Avoidance and Distress Scale (SAD), and the simplified Chinese version of the Social Disability Screening Schedule (SDSS) were used for evaluation. Mediation analysis was performed using the PROCESS macro in SPSS23.0. Results Our results showed that individuals with chronic schizophrenia scored significantly lower on the ITS total and two index scores but higher on the SAD total and two index scores than healthy controls. The ITS score was significantly associated with the psychotic symptoms (both PANSS total score and subscale score) and social functioning in those patients. Interestingly, we further found that interpersonal trust had a significantly mediating effect on the relationship between psychotic symptoms (including positive, negative, cognitive, excited, and depressed symptoms) and social functioning in individuals with schizophrenia. Conclusion Our preliminary findings suggest that improving interpersonal trust may be a promising approach to enhance social functioning and improve prognosis in individuals with schizophrenia. This insight underscores the importance of incorporating trust-building interventions into clinical practice, which could potentially lead to better social outcomes for patients.
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Affiliation(s)
- Hongyang Liu
- The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou, China
| | - Xinming Pan
- Department of Psychiatry, The Second People’s Hospital of Jiangning District, Nanjing, China
| | - Xinxin Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haijia Tian
- The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou, China
| | - Xueke Shao
- The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou, China
| | - Dandan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Wen
- Department of Psychiatry, The Second People’s Hospital of Jiangning District, Nanjing, China
| | - Chenxi Bao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyu Fang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Mental Health, Fudan University, Shanghai, China
- Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China
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Govil P, Kantrowitz JT. Negative Symptoms in Schizophrenia: An Update on Research Assessment and the Current and Upcoming Treatment Landscape. CNS Drugs 2025; 39:243-262. [PMID: 39799532 DOI: 10.1007/s40263-024-01151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2024] [Indexed: 01/15/2025]
Abstract
The negative symptoms of schizophrenia include diminished emotional expression, avolition, alogia, anhedonia, and asociality, and due to their low responsiveness to available treatments, are a primary driver of functional disability in schizophrenia. This narrative review has the aim of providing a comprehensive overview of the current research developments in the treatment of negative symptoms in schizophrenia, and begins by introducing the concepts of primary, secondary, prominent, predominant, and broadly defined negative symptoms. We then compare and contrast commonly used research assessment scales for negative symptoms and review the evidence for the specific utility of widely available off-label and investigational treatments that have been studied for negative symptoms. Mechanism of action/putative treatments included are antipsychotics (D2R antagonists), N-methyl-D-aspartate receptor (NMDAR) and other glutamatergic modulators, serotonin receptor (5-HTR) modulators, anti-inflammatory agents, antidepressants, pro-dopaminergic modulators (non-D2R antagonists), acetylcholine modulators, oxytocin, and phosphodiesterase (PDE) inhibitors. With the caveat that no compounds are definitively proven as gold-standard treatments for broadly defined negative symptoms, the evidence base supports several potentially beneficial off-label and investigational medications for treating negative symptoms in schizophrenia, such as monotherapy with cariprazine, olanzapine, clozapine, and amisulpride, or adjunctive use of memantine, setrons such as ondansetron, minocycline, and antidepressants. These medications are widely available worldwide, generally tolerable and could be considered for an off-label, time-limited trial for a predesignated period of time, after which a decision to switch or stay can be made based on clinical response. Among investigational medications, NMDAR agonists, muscarinic agonists, and LB-102 remain under study. Suggestions for future research include reducing placebo effects by designing studies with a smaller number of high-quality study sites, potentially increasing the use of more precise rating scales for negative symptoms, and focused studies in people with predominant negative symptoms.
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Affiliation(s)
- Preetika Govil
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Joshua T Kantrowitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
- College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
- Nathan Kline Institute, Orangeburg, NY, 10962, USA.
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Kruk D, Gawęda Ł, Arciszewska-Leszczuk A, Kalisz A, Błądziński P, Frydecka D, Cechnicki A. The Role of Negative Symptoms on the Continuum of Psychosis Risk as a Mediator of the Relationship Between Personality and Functioning in Individuals With Psychotic-Like Experiences. Early Interv Psychiatry 2025; 19:e70027. [PMID: 40055936 DOI: 10.1111/eip.70027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 02/11/2025] [Accepted: 02/23/2025] [Indexed: 05/13/2025]
Abstract
AIM Psychotic-like experiences (PLEs) may increase the risk of psychosis. Most of the research on PLEs focuses on their positive dimension-for example, hallucinatory-like experiences or delusion-like thoughts. Relatively little is known about the role of PLEs on the continuum of negative symptoms. The aim of this study was to examine whether negative symptoms, both in the experiential and expressive dimensions, could mediate the effects of temperament and character on the level of functioning of individuals with PLEs. METHODS The study was conducted on 107 healthy young adults with the highest severity of PLEs, selected from a larger sample of 6722 people recruited for another study. Participants were examined using the Cloninger Temperament and Character Inventory, the Brief Negative Symptom Rating Scale, and the Social and Occupational Functioning Assessment Scale. RESULTS Both functioning and certain personality traits, such as harm avoidance, persistence, self-directedness, and cooperativeness, were more strongly associated with the occurrence of experiential rather than expressive negative symptoms. We have developed four models, in which we have shown that the experiential negative symptoms mediated the impact of the temperament and character traits on socio-occupational functioning. In each model, negative symptoms weakened the direct effect of the personality trait on functioning. CONCLUSIONS These findings suggest that, like at the other stages of psychosis risk, a constellation of specific temperament and character traits is a risk factor for functional decline, which may be partly explained by the effect of experiential negative symptoms. The study also confirms the different impact of the two domains of negative symptoms on functional outcomes, suggesting the need for developing targeted interventions.
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Affiliation(s)
- Dawid Kruk
- Community Psychiatry and Psychosis Research Center, Chair of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Aneta Kalisz
- Community Psychiatry and Psychosis Research Center, Chair of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Błądziński
- Community Psychiatry and Psychosis Research Center, Chair of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Cechnicki
- Community Psychiatry and Psychosis Research Center, Chair of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
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10
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Li W, Zhao J, Hu N, Zhang W. Network analysis of clinical features in patients with treatment-resistant schizophrenia. Front Psychiatry 2025; 16:1537418. [PMID: 39980982 PMCID: PMC11839625 DOI: 10.3389/fpsyt.2025.1537418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 01/13/2025] [Indexed: 02/22/2025] Open
Abstract
Objective This study compares the clinical features of Treatment-Resistant Schizophrenia (TRS) and Non-Treatment-Resistant Schizophrenia (NTRS) using network analysis. Methods We recruited 511 patients, dividing them into TRS (N = 269) and NTRS (N = 242) groups. Eight scales were used: Positive and Negative Syndrome Scale (PANSS), Positive Symptom Assessment Scale (SAPS), Scale for Assessment of Negative Symptoms (SANS), Simpson-Angus Scale (SAS), Abnormal Involuntary Movements Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Calgary Schizophrenia Depression Scale (CDSS), and Global Assessment of Functioning Scale (GAF). Demographic and clinical data were analyzed using T-tests and Chi-square tests. Network analysis was then applied to compare clinical features. Results Significant differences were found in the overall architectures (S = 1.396, p < 0.002) and edge weights (M = 0.289, p < 0.009) of TRS and NTRS networks. Nine edges (p < 0.05) and five nodes (p < 0.01) differed, indicating a correlation between clinical symptoms of the two groups. TRS core symptoms were linked to social functions through both positive (SAPS) and negative symptoms (SANS), while NTRS core symptoms were related to general psychopathological symptoms (PANSS-G). Conclusion For TRS, it is essential to address both negative and positive symptoms, focusing on the impact of negative symptoms on functioning. Additionally, managing medication side effects is crucial to avoid worsening negative symptoms.
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Affiliation(s)
- Wei Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Jing Zhao
- College of Art and Design, Beijing University of Technology, Beijing, China
| | - Na Hu
- Department of Psychosomatic Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Wanling Zhang
- Department of Psychosomatic Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
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11
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Zeng G, Liang R, Xiao L, Cao W, Zhou W, Wang W, Liu C, Zhou H, Shi X, Chen B, Chen W. Factors Affecting Negative Symptoms in Schizophrenia and Their Relationship with Anxiety and Depression. Neuropsychiatr Dis Treat 2025; 21:229-240. [PMID: 39931198 PMCID: PMC11808049 DOI: 10.2147/ndt.s492849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 11/11/2024] [Indexed: 02/13/2025] Open
Abstract
Objective Negative symptoms significantly impair daily functioning and worsen clinical outcomes. Meanwhile, these symptoms are closely linked to anxiety and depression, further complicating prognosis. The mechanisms underlying these relationships remain unclear. This study aims to identify the factors influencing negative symptoms in schizophrenia and examine their relationship with anxiety and depression to guide more effective interventions and improve patient outcomes. Methods This study recruited 300 inpatients with schizophrenia from October 2022 to May 2023. Sociodemographic data and clinical characteristics were collected via a self-designed questionnaire. Negative symptoms, depression, and anxiety were assessed using the SANS, HAMD, and HAMA scales, respectively. Results Multiple regression analysis indicated that familial support (β = -1.285, P = 0.005), friend support (β = -0.797, P = 0.032), sleep quality (β = 2.307, P < 0.001), anxiety (β = 0.264, P = 0.004), and depression (β = 0.324, P = 0.007) were the main factors influencing negative symptoms. After adjusting for the duration of psychiatric disorder and type of antipsychotic medication as covariates, the above factors remained primary contributors to negative symptoms. Conclusion Enhancing familial support, friend support, and addressing emotional health and sleep disturbances are strategies that may alleviate negative symptoms in patients with schizophrenia.
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Affiliation(s)
- Gang Zeng
- Geriatric Neuroscience Center, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Rongyu Liang
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Lingxian Xiao
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Department of Nursing, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Weiye Cao
- School of Nursing, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Wenqing Zhou
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Adult Psychiatry Department, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Wen Wang
- School of Nursing, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Cuixia Liu
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Chronic Psychiatry Department, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Huarong Zhou
- Geriatric Neuroscience Center, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Xiaolei Shi
- Geriatric Neuroscience Center, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Ben Chen
- Geriatric Neuroscience Center, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Wanhua Chen
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Department of Nursing, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
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12
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Abdel Samie M, Nasreldin M, Shahin M, Amer DA, Mohamed RM, Taher DB, Sayed T, Ahmed N, Mabrouk A, Mamdouh J, Gohar SM. Association between suicidal ideation, negative symptoms and theory of mind in first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2025; 60:353-361. [PMID: 39014044 DOI: 10.1007/s00127-024-02709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Suicidal thoughts are common among patients with first episode psychosis (FEP). The impact of symptoms' severity and social cognition on suicidal risk should be a focus of attention. This study aimed at assessment of the severity of suicidal ideation in patients with FEP and its potential association with the theory of mind (ToM) impairment and symptoms' severity. METHODS Ninety-six participants were recruited consecutively and subdivided into three equal groups: FEP, schizophrenia, and healthy controls (HC). The symptoms' severity was assessed using Positive and Negative Syndrome Scale (PANSS) and Beck Depression Inventory (BDI). Suicidal ideation was evaluated using Beck Scale for Suicidal Ideation (BSSI). Reading the Mind in the Eyes revised version (RMET) was used to assess ToM. RESULTS Suicidal ideation was significantly higher only in FEP compared to HC (p = 0.001). Both FEP and schizophrenia had substantially lower performance than HC on RMET (p < 0.001). Higher depression (β = 0.452, p = 0.007) and negative symptoms (β = 0.433, p = 0.027) appeared to be significantly associated with increased suicidal ideation severity in FEP while RMET did not. CONCLUSION Patients with FEP and chronic schizophrenia have comparable deficits in theory of mind dimension of social cognition. The severity of negative and depressive symptoms potentially contributes to the increased risk of suicide in FEP.
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Affiliation(s)
- Mai Abdel Samie
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Mohamed Nasreldin
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Mostafa Shahin
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Dalal A Amer
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Rania Mamdouh Mohamed
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Dina Badie Taher
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Talha Sayed
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Nadine Ahmed
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Ali Mabrouk
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Joseph Mamdouh
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt
| | - Sherif M Gohar
- Department of Psychiatry, Faculty of Medicine, Cairo University, El Saraya Street, El Manyal, Cairo, 11956, Egypt.
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.
- Faculty of Health Sciences, Network for Medical Sciences, University of Stavanger, Stavanger, Norway.
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13
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Métivier L, Dollfus S. Systematic Review of Self-Assessment Scales for Negative Symptoms in Schizophrenia. Brain Sci 2025; 15:148. [PMID: 40002481 PMCID: PMC11852625 DOI: 10.3390/brainsci15020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 01/17/2025] [Accepted: 01/23/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Negative symptoms (NSs) significantly impair the outcome of schizophrenia, primarily due to their effect on quality of life and their resistance to pharmacological treatments. Several scales have been developed to assess the various dimensions of NSs, including avolition, anhedonia, alogia, social withdrawal, and blunted affect. While observer-rated scales are the most commonly used, self-assessment tools remain underutilized. However, self-assessments offer a promising approach for gaining insights into the personal experiences of individuals. The objective of this review was to identify and report the psychometric properties of self-assessment scales for NSs that are relevant for both research and clinical practice, with a focus on tools that assess multiple domains of NSs in order to support comprehensive evaluations and tailored therapeutic strategies. Methods: We conducted an exhaustive literature review following PRISMA guidelines to identify self-evaluation scales that evaluate several domains of NSs in the MEDLINE and Web of Science databases. The COSMIN checklist was used to assess the methodological quality of each tool. Results: Our review identified five self-assessment scales. Among these, two scales received a Grade A recommendation for use in clinical or research practice: the Self-evaluation Negative Symptom (SNS), which assesses the five domains of NSs, and the Motivation And Pleasure Scale Self-report (MAP-SR), which evaluates anhedonia, avolition, and social withdrawal. Conclusions: The SNS and the MAP-SR are the only tools with sufficient psychometric properties, making them reliable for use in both research and clinical practice. Despite the development of self-assessment tools for NSs, their integration into research and clinical settings remains limited, highlighting the need for increased utilization to enhance the understanding and management of these symptoms.
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Affiliation(s)
- Lucie Métivier
- UMR-S 1237, Neuropresage Team, GIP Cyceron, 14000 Caen, France;
- Department of Health (UFR Santé), University of Caen Normandy (UNICAEN), 14000 Caen, France
- Academic and Medical Research Federation (FHU A2M2P), University of Caen Normandy (UNICAEN), 14000 Caen, France
| | - Sonia Dollfus
- UMR-S 1237, Neuropresage Team, GIP Cyceron, 14000 Caen, France;
- Department of Health (UFR Santé), University of Caen Normandy (UNICAEN), 14000 Caen, France
- Academic and Medical Research Federation (FHU A2M2P), University of Caen Normandy (UNICAEN), 14000 Caen, France
- Department of Psychiatry, Esquirol Center, University Hospital Center (CHU), 14000 Caen, France
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14
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Romm KL, Skoge M, Barrett EA, Berentzen LC, Bergsager D, Fugelli P, Bjella T, Gardsjord ES, Kling K, Kruse SH, Kværner KJ, Melle I, Mork E, Ihler HM, Rognli EB, Simonsen C, Værnes TG, Aminoff SR. A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability. JMIR Form Res 2025; 9:e57614. [PMID: 39823632 PMCID: PMC11786142 DOI: 10.2196/57614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 10/28/2024] [Accepted: 11/06/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. OBJECTIVE This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. METHODS We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. RESULTS To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. CONCLUSIONS iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.
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Affiliation(s)
- Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mari Skoge
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elizabeth Ann Barrett
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lars-Christian Berentzen
- Section for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Dagfinn Bergsager
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Pål Fugelli
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Thomas Bjella
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend Strand Gardsjord
- Section for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristine Kling
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sindre Hembre Kruse
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kari Jorunn Kværner
- Centre for Connected Care (C3), Oslo University Hospital, Oslo, Norway
- BI Norwegian Business School, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Clinical Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend Mork
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Henrik Myhre Ihler
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Eline Borger Rognli
- Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tor Gunnar Værnes
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sofie Ragnhild Aminoff
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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15
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Mucci A, Leucht S, Giordano GM, Giuliani L, Wehr S, Weigel L, Galderisi S. Assessment of Negative Symptoms in Schizophrenia: From the Consensus Conference-Derived Scales to Remote Digital Phenotyping. Brain Sci 2025; 15:83. [PMID: 39851450 PMCID: PMC11764445 DOI: 10.3390/brainsci15010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/13/2025] [Accepted: 01/15/2025] [Indexed: 01/26/2025] Open
Abstract
The assessment of negative symptoms in schizophrenia has advanced since the 2006 NIMH-MATRICS Consensus Statement, leading to the development of second-generation rating scales like the Brief Negative Symptom Scale and the Clinical Assessment Interview for Negative Symptoms. These scales address the limitations of first-generation tools, such as the inclusion of aspects that are not negative symptoms and the lack of assessment of the subject's internal experience. However, psychometric validation of these scales is still in progress, and they are not yet recommended by regulatory agencies, thus limiting their use in clinical trials and settings. Complementing these traditional methods, remote digital phenotyping offers a novel approach by leveraging smartphones and wearable technology to capture real-time, high-resolution clinical data. Despite the potential to overcome traditional assessment barriers, challenges remain in aligning these digital measures with clinical ratings and ensuring data security. Equally important is patient acceptance, as the success of remote digital phenotyping relies on the willingness of patients to use these technologies. This review provides a critical overview of both second-generation scales and remote digital phenotyping for assessing negative symptoms, highlighting future research needs.
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Affiliation(s)
- Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, School of Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80135 Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaningerstrasse 22, 81675 Munich, Germany
| | - Giulia M. Giordano
- Department of Mental and Physical Health and Preventive Medicine, School of Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80135 Naples, Italy
| | - Luigi Giuliani
- Department of Mental and Physical Health and Preventive Medicine, School of Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80135 Naples, Italy
| | - Sophia Wehr
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaningerstrasse 22, 81675 Munich, Germany
| | - Lucia Weigel
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaningerstrasse 22, 81675 Munich, Germany
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, School of Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80135 Naples, Italy
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16
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Nibbio G, Calzavara-Pinton I, Barlati S, Necchini N, Bertoni L, Lisoni J, Stanga V, Deste G, Turrina C, Vita A. Well-Being and Mental Health: Where Do We Stand After COVID-19 Pandemic? J Nerv Ment Dis 2025; 213:28-33. [PMID: 39693599 DOI: 10.1097/nmd.0000000000001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
ABSTRACT Mental health encompasses the ability to cope with important stresses of life and to realize one's abilities in the community, and the COVID-19 pandemic represented a very stressful event for people with mental illnesses. Our aim was to assess mental well-being in people living with different mental disorders, comparing results obtained in 2016 with those observed after the COVID-19 pandemic. Ninety-six participants were assessed using the Mental Health Continuum Short Form and classified as "flourishing," "moderately mentally healthy," and "languishing." Overall, a significant increase in the prevalence of "flourishing" and "moderately mentally healthy" subjects and a reduction of "languishing" subjects ( p = 0.003) were observed. However, a significant improvement in well-being ( p = 0.005) was observed only in the schizophrenia spectrum disorder group. Moreover, only subjects that never contracted SARS-CoV-2 showed a significant ( p = 0.019) increase in positive well-being states. Lockdowns may have led caregivers to spend more time with the participants, also increasing treatment adherence, resulting in an improvement of overall well-being in several participants.
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Affiliation(s)
- Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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17
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Giuliani L, Pezzella P, Mucci A, Palumbo D, Caporusso E, Piegari G, Giordano GM, Blasio P, Mencacci C, Torriero S, Galderisi S. Effectiveness of a social cognition remediation intervention for patients with schizophrenia: a randomized-controlled study. Ann Gen Psychiatry 2024; 23:52. [PMID: 39732701 DOI: 10.1186/s12991-024-00535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 12/05/2024] [Indexed: 12/30/2024] Open
Abstract
This randomized-controlled study evaluates the effectiveness of a newly developed social cognition rehabilitation intervention, the modified Social Cognition Individualized Activity Lab (mSoCIAL), in improving social cognition and clinical and functional outcomes of persons with schizophrenia recruited in two Italian sites: University of Campania "Luigi Vanvitelli" in Naples and ASST Fatebenefratelli-Sacco in Milan. mSoCIAL consists of a social cognitive training module focusing on different domains of social cognition and of a narrative enhancement module. We assessed changes in social cognition, clinical characteristics and functional variables in patients with schizophrenia who participated in 10 weekly sessions of mSoCIAL or received treatment as usual (TAU). A paired-sample t test and a repeated-measures MANOVA were used to investigate respectively within and between-group differences. Twenty people with schizophrenia were blindly assigned to mSoCIAL and 20 to TAU. After 10 weeks, mSoCIAL significantly improved disorganization, emotion recognition, functional capacity and real-life functioning. As compared to TAU, the mSoCIAL group showed a significant improvement in minimal and enriched social inference domain of theory of mind, and in key domains of real-life functioning (interpersonal relationships, everyday life skills, and work skills). mSoCIAL improved social cognition and real-life functioning of people with schizophrenia. These results highlight the importance of social cognition deficit treatment in schizophrenia and the necessity for these interventions to be multifaced and personalized. Such an approach ensures that improvements in social cognition translate into enhanced functional outcomes.Trial registration NCT05130853, registered on 24 November 2021.
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Affiliation(s)
- Luigi Giuliani
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Pasquale Pezzella
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Armida Mucci
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
| | - Davide Palumbo
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Edoardo Caporusso
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Giuseppe Piegari
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | | | - Pietro Blasio
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Claudio Mencacci
- Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
| | - Sara Torriero
- Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
| | - Silvana Galderisi
- University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
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18
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Weigel L, Wehr S, Galderisi S, Mucci A, Davis JM, Leucht S. Clinician-Reported Negative Symptom Scales: A Systematic Review of Measurement Properties. Schizophr Bull 2024; 51:3-16. [PMID: 39422706 DOI: 10.1093/schbul/sbae168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
BACKGROUND Negative symptoms of schizophrenia are correlated with reduction of normal function and lower quality of life. They were newly defined by the NIMH-MATRICS Consensus in 2005, dividing the rating tools to assess them into first-generation scales, developed before the Consensus, and second-generation scales, based on the recently introduced definitions. METHODS The COnsensus-based Standards for the selection of health Measurement Instrument (COSMIN) guidelines for systematic reviews were used to evaluate the quality of psychometric data of the first-generation scales that cover the 5 negative symptom domains of the NIMHS Consensus: the Scale for the Assessment of Negative Symptoms (SANS), the High Royds Evaluation of Negativity Scale (HEN), and the Negative Symptom Assessment-16 (NSA-16). RESULTS The search strategy resulted in the inclusion of a total of 13 articles, 7 for the SANS, 4 for the NSA-16, and 2 for the HEN. For the SANS and the NSA-16, the overall results of the scales' measurement properties are mostly insufficient or indeterminate. The quality of evidence for the HEN is poor, due to a small number of validation studies/included patients. CONCLUSIONS After applying the COSMIN guidelines, we do not recommend the usage of these first-generation scales to rate negative symptoms. At the minimum they require further validation.
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Affiliation(s)
- Lucia Weigel
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Sophia Wehr
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago (mc912), Chicago, IL 60612, United States
- Maryland Psychiatric Research Center, Baltimore, MD 21228, United States
| | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
- German Center for Mental Health, partner site Munich, Germany
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19
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Fedotov IA, Pavlichenko AV, Chumakov EM, Leonova AV, Sorokin MY, Bogoyavlenskaya VY, Vlasova VA, Kuznetsova AR, Petrova NN. Results of a Multicenter Clinical Study on Adaptation and Validation of the Russian Version of the Clinical Assessment Interview for Negative Symptoms (CAINS). V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY 2024; 58:107-119. [DOI: 10.31363/2313-7053-2024-971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2025]
Abstract
The aim of the study is to adapt and validate the Russian version of the Clinical Assessment Interview for Negative Symptoms (CAINS).Material and methods. From 2018 to 2024, 89 people were examined: 42 men (47.2%) and 47 women (52.8%), average age 37±9.8 years. Among them, 82 patients (92.1%) were diagnosed with F20.0 according to ICD-10, 5 patients (5.6%) with F21, and 2 patients (2.3%) with F23.1. The mean duration of the mental disorder was 18 [1-42] years, with an average number of hospitalizations of 12 [1-28] times. The CAINS manual and questionnaire text, translated into Russian by a group of young psychiatrists from the RSP YPC, were utilized for assessment.Results: The Cronbach’s alpha for the total score of the questionnaire was 0.91. Convergent validity was demonstrated by a significant positive correlation between CAINS scores and the Marder PANSS factor. Confirmatory factor analysis indicated the preservation of the questionnaire’s two-factor model, explaining 55.8% of the total variance. Discriminant validity was evidenced by the more frequent absence of correlations between CAINS scores and positive and general psychopathological PANSS ratings. Inter-rater reliability was established by a sufficient level of agreement, with Cohen’s kappa coefficient, among independent raters for the majority (91%) of clinical assessments using the CAINS questionnaire.Conclusion: The obtained results demonstrate that the Russian adaptation of the Clinical Assessment Interview for Negative Symptoms (CAINS) is a valid and effective psychometric clinical interview. It can be utilized for both clinical research and everyday clinical practice when working with patients suffering from psychotic disorders within the schizophrenia spectrum.
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Affiliation(s)
| | | | | | | | - M. Yu. Sorokin
- V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology
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20
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Qu K, He Y, Zhang Z, Cao Y, Qin Q, Zhou Z, Zhen L. Association Study Between DRD2, DRD3 Genetic Polymorphisms and Adverse Reactions in Chinese Patients on Amisulpride Treatment. PHARMACOPSYCHIATRY 2024; 57:283-289. [PMID: 39187246 DOI: 10.1055/a-2375-3859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
OBJECTIVE To determine if the cardiac function and "endocrinium" of Chinese patients are associated with dopamine D2 (DRD2) (rs6276) and DRD3 (rs6280, rs963468) genetic polymorphisms when treated with amisulpride. METHODS This study enrolled 148 patients with schizophrenia who took amisulpride orally for 8 weeks. DRD2 (rs6276) and DRD3 (rs6280, rs963468) genetic polymorphisms were detected with TaqMan-MGB allelic discrimination. RESULTS Analysis by multivariate covariance analysis (MANCOVA) showed that after adjusting for age, gender, and the baseline level, the increase in the level of aspartate aminotransferase (AST) and creatine kinase (CK) in the rs6276 AG group was higher than that in the AA and GG groups. Similarly, the changed estradiol (E2) level in rs6276 GG and rs963468 GG groups was higher than that in the other two groups. Adjusting for covariates, the increased triglyceride (TG) level in rs6276 GG and rs963468 GG groups was the highest among their different genotype groups. The increase in the level of "AST" in the rs6280 TT group was higher than that in the CC and CT groups upon adjusting for covariates. Similarly, MANCOVA showed that the increase in the level of "CK" in the rs6280 CT group was higher than that in the CC and CT groups. Besides, the increased level of "PRL" in the rs6280 CC group and rs963468 GG group was higher than that in their other two genotypes groups. CONCLUSION DRD2 (rs6276) and DRD3 (rs6280, rs963468) polymorphisms can affect amisulpride tolerability since they are associated with the observed adverse reactions, including cardiac dysfunction and endocrine disorders in Chinese patients with schizophrenia.
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Affiliation(s)
- Kankan Qu
- The affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Yanan He
- The affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Zhongdong Zhang
- The affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Yeli Cao
- The affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Qiyun Qin
- Genenexus Technology Corporation, Shanghai, China
| | - Zhenhe Zhou
- The affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Lili Zhen
- The affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
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21
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Calzavara Pinton I, Nibbio G, Bertoni L, Cicale A, Necchini N, Zardini D, Bosco Ubertino U, Cerati C, Deste G, Barlati S, Vita A. The economic burden of schizophrenia spectrum disorders: clinical and functional correlates and predictors of direct costs. A retrospective longitudinal study. Psychiatry Res 2024; 342:116240. [PMID: 39488944 DOI: 10.1016/j.psychres.2024.116240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 10/16/2024] [Accepted: 10/19/2024] [Indexed: 11/05/2024]
Abstract
The economic burden of schizophrenia amounts for 1.5-3 % of healthcare expenses in developed countries, and ∼50 % derives from direct costs: 81 % of these are due to hospitalization, residential facilities and semi-residential facilities. Therefore, a better characterization of variables that influence direct costs represents a relevant issue. A total of 276 individuals with schizophrenia spectrum disorders receiving treatment from the Community Mental Health Centers of Brescia (Italy) were included in the study: for each participant socio-demographic, clinical and functional characteristics were assessed, and data related to the use of services in 2022 (then converted to costs) were collected. Regression analyses were performed to identify predictors of costs. A direct healthcare expenditure of 16477.23 (±32856.47) € per patient per year was identified. The main cost predictor was the PSP total score (p=0.005), followed by age of onset (p=0.020), and PANSS total score (p=0.033). Including PANSS sub-scales scores and PSP single items as potential predictors, the main predictor was the "socially useful activities" PSP item (p=0.002), followed by age of onset (p=0.011), and PANSS negative scale score (p=0.027). Our findings underline the need to implement rehabilitative intervention focused on the improvement of psychosocial functioning and negative symptoms, also to reduce healthcare expenses.
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Affiliation(s)
- Irene Calzavara Pinton
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ughetta Bosco Ubertino
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Caterina Cerati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Psychiatric Unit, ASST Valcamonica, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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22
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Lisoni J, Nibbio G, Baglioni A, Dini S, Manera B, Maccari A, Altieri L, Calzavara-Pinton I, Zucchetti A, Deste G, Barlati S, Vita A. Is It Possible to Combine Non-Invasive Brain Stimulation and Evidence-Based Psychosocial Interventions in Schizophrenia? A Critical Review. Brain Sci 2024; 14:1067. [PMID: 39595830 PMCID: PMC11591595 DOI: 10.3390/brainsci14111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/24/2024] [Accepted: 10/26/2024] [Indexed: 11/28/2024] Open
Abstract
In schizophrenia, it was suggested that an integrated and multimodal approach, combining pharmacological and non-pharmacological interventions, could improve functional outcomes and clinical features in patients living with schizophrenia (PLWS). Among these alternatives, evidence-based psychosocial interventions (EBPIs) and Non-Invasive Brain Stimulation (NIBS) represent feasible treatment options targeting the clinical features that are unmet needs of PLWS (especially negative and cognitive symptoms). As no clear evidence is available on the combination of these non-pharmacological approaches, this review aimed to collect the available literature on the combination of EBPIs and NIBS in the treatment of PLWS. We demonstrated that the field of combining EBPIs and NIBS in schizophrenia is in its infancy, as only 11 studies were reviewed. In fact, only a few trials, with divergent results, combined these non-pharmacological modalities; while emerging evidence is available on the combination of cognitive remediation and rTMS/iTBS, inconclusive results were obtained. Conversely, albeit preliminary, more solid findings are available on the combination of HF-rTMS and family intervention. Moreover, despite the fact that cognitive activation could not be considered an EBPI, promising results are available in combination with tDCS to improve the working memory domain. To overcome these limitations, we considered several methodological issues to promote research in this field.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Antonio Baglioni
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Simona Dini
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Bianca Manera
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Alessandra Maccari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Luca Altieri
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Irene Calzavara-Pinton
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
| | - Andrea Zucchetti
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
- Department of Mental Health and Addiction Services, ASST Vallecamonica, 25040 Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
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23
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Vita A, Nibbio G, Barlati S. Conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. Psychiatry Res 2024; 340:116126. [PMID: 39128169 DOI: 10.1016/j.psychres.2024.116126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
Cognitive impairment represents one of the core features of schizophrenia, involves both neurocognition and social cognition domains, and has a significant negative impact on real-world functioning. The present review provides a framework for the conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. In this conceptualization, primary cognitive impairment can be defined as a consequence of the neurobiological alterations that underlie psychopathological manifestations of the disorder, while secondary cognitive impairment can be defined as the results of a source issue that has a negative impact on cognitive performance. Sources of secondary cognitive impairment are frequent in people with schizophrenia and include several different factors, such as positive and negative symptoms, depressive symptoms, autistic symptoms, pharmacotherapy, substance abuse, metabolic syndrome, social deprivation, and sleep disorders. It can be hypothesized that secondary cognitive impairment may be improved by effectively resolving the source issue, while primary cognitive impairment may benefit from dedicated treatment. Further research is required to confirm this hypothesis, to better characterize the distinction between primary and secondary cognitive impairment in a clinical and in a neurobiological perspective, and to evaluate the impact of systematically assessing and treating secondary cognitive impairment.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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24
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Hao J, Tiles-Sar N, Habtewold TD, Liemburg EJ, Bruggeman R, van der Meer L, Alizadeh BZ. Shaping tomorrow's support: baseline clinical characteristics predict later social functioning and quality of life in schizophrenia spectrum disorder. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1733-1750. [PMID: 38456932 PMCID: PMC11464570 DOI: 10.1007/s00127-024-02630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE We aimed to explore the multidimensional nature of social inclusion (mSI) among patients diagnosed with schizophrenia spectrum disorder (SSD), and to identify the predictors of 3-year mSI and the mSI prediction using traditional and data-driven approaches. METHODS We used the baseline and 3-year follow-up data of 1119 patients from the Genetic Risk and Outcome in Psychosis (GROUP) cohort in the Netherlands. The outcome mSI was defined as clusters derived from combined analyses of thirteen subscales from the Social Functioning Scale and the brief version of World Health Organization Quality of Life questionnaires through K-means clustering. Prediction models were built through multinomial logistic regression (ModelMLR) and random forest (ModelRF), internally validated via bootstrapping and compared by accuracy and the discriminability of mSI subgroups. RESULTS We identified five mSI subgroups: "very low (social functioning)/very low (quality of life)" (8.58%), "low/low" (12.87%), "high/low" (49.24%), "medium/high" (18.05%), and "high/high" (11.26%). The mSI was robustly predicted by a genetic predisposition for SSD, premorbid adjustment, positive, negative, and depressive symptoms, number of met needs, and baseline satisfaction with the environment and social life. The ModelRF (61.61% [54.90%, 68.01%]; P =0.013) was cautiously considered outperform the ModelMLR (59.16% [55.75%, 62.58%]; P =0.994). CONCLUSION We introduced and distinguished meaningful subgroups of mSI, which were modestly predictable from baseline clinical characteristics. A possibility for early prediction of mSI at the clinical stage may unlock the potential for faster and more impactful social support that is specifically tailored to the unique characteristics of the mSI subgroup to which a given patient belongs.
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Affiliation(s)
- Jiasi Hao
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Natalia Tiles-Sar
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Edith J Liemburg
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands.
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25
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Vita A, Barlati S, Cavallaro R, Mucci A, Riva MA, Rocca P, Rossi A, Galderisi S. Definition, assessment and treatment of cognitive impairment associated with schizophrenia: expert opinion and practical recommendations. Front Psychiatry 2024; 15:1451832. [PMID: 39371908 PMCID: PMC11450451 DOI: 10.3389/fpsyt.2024.1451832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/22/2024] [Indexed: 10/08/2024] Open
Abstract
A considerable proportion of patients with schizophrenia perform below population norms on standardized neuropsychological tests, and the performance of those performing within normal range is lower than predicted based on parental education. Cognitive impairment predates the onset of psychosis, is observed during symptom remission and in non-affected first-degree relatives of patients. At the present time, cognitive deficits are regarded as key features of schizophrenia, important determinants of poor psychosocial outcome and targets for both pharmacological and non-pharmacological treatment strategies. A group of eight key opinion leaders reviewed and discussed latest advances in scientific research and current good clinical practices on assessment, management, and treatment of CIAS. In the present paper they summarize the current evidence, identify main gaps between current knowledge and mental health services clinical practice, and provide practical recommendations to reduce the gap.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili of, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili of, Brescia, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco A. Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Biological Psychiatry Unit, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Paola Rocca
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L’Aquila, L’Aquila, Italy
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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26
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Margariti MM, Vlachos II, Mpourazana D, Aristotelidis P, Selakovic M, Ifanti M, Papageorgiou C. Psychotic Arousal and the Psychopathology of Acute Schizophrenia: An Exploratory Study of the Experiential Emotional State in Acute Psychosis. J Clin Med 2024; 13:5477. [PMID: 39336964 PMCID: PMC11432037 DOI: 10.3390/jcm13185477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/08/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Increasing research data suggest that the dysfunction of emotional brain systems may be an important contributor to the pathophysiology of schizophrenia. However, contemporary psychopathology consistently underestimates the role of emotions in the phenomenology of the disease. Psychotic arousal (PA) is a conceptually defined psychopathological construct aiming to portray the experiential emotional state of acute psychosis. The concept provides an explanatory model for the emergence of psychosis, and the formation and maintenance of delusions based on neurobiological models on the formation of core consciousness and subjectivity. This is the first exploratory study of the major assumptions, endorsed in the project summarized as follows: (1) psychotic arousal is a discrete state, eligible for investigation; (2) abnormal experiential feelings are an integral part of this state; and (3) the state is responsive to antipsychotic intervention during the first weeks of treatment. Methods: We developed the Psychotic Arousal Scale (PAS) accordingly, explored its first psychometric properties and tested its relation to other psychopathological measures. Fifty-five acute schizophrenia patients were evaluated with the PAS, the Positive and Negative Syndrome Scale, the Brown Assessment of Beliefs Scale, the Hamilton Anxiety Scale, and the Calgary Depression Scale. Cronbach α coefficients, t-test analysis, correlations and mixed linear regression models were applied for testing the internal reliability of the scale, associations between parameters and sensitivity to change in three time periods during therapeutic intervention. Results: The results of the study support that (PA) is eligible for investigation as a discrete psychopathological state. Abnormal experiential feelings are an integral part of this state, presenting high affinity with other affective measures; their degree of severity relates to the delusions' conviction and are amenable to antipsychotics early in treatment during the acute psychotic episode. Conclusions: The findings of this exploratory study are connotative of the presence of an emotional arousal permeated by abnormal experiential feelings during acute psychosis, largely overlooked by contemporary psychopathology.
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Affiliation(s)
- Maria M Margariti
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Ilias I Vlachos
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitra Mpourazana
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Panagiotis Aristotelidis
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mirjana Selakovic
- Department of Psychiatry, "Sismanogleio" General Hospital, 15126 Athens, Greece
| | - Maria Ifanti
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
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27
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Liu Z, Lv D, Li J, Li F, Zhang Y, Liu Y, Gao C, Qiu Y, Ma J, Zhang R. The potential predictive value and relationship of blood-based inflammatory markers with the clinical symptoms of Han Chinese patients with first-episode adolescent-onset schizophrenia. Front Psychiatry 2024; 15:1431350. [PMID: 39290303 PMCID: PMC11405196 DOI: 10.3389/fpsyt.2024.1431350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Background Inflammation is associated with the pathophysiology of schizophrenia. The blood markers for systemic inflammation include neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), lymphocyte-monocyte ratio (LMR), system inflammation response index (SIRI), and platelet-lymphocyte ratio (PLR). However, these inflammation markers and their relationships with clinical phenotypes among Han Chinese patients with first-episode adolescent-onset schizophrenia (AOS) is unclear. This investigation aimed to elucidate the impact of inflammation on Han Chinese AOS patients as well as the association of blood-based inflammation markers with clinical symptoms. Methods Altogether, 203 Han Chinese individuals participated in this study, 102 first-episode AOS patients and 101 healthy controls. The assessment of inflammatory indices was based on complete blood cell count. Furthermore, schizophrenia-related clinical symptoms were evaluated using the five-factor model of the Positive and Negative Syndrome Scale (PANSS). Results In Han Chinese first-episode AOS patients, levels of SIRI, PLR, SII, and NLR were significantly increased (p < 0.001), while LMR decreased (p < 0.001) compared to healthy controls. Furthermore, multivariate logistic regression showed that LMR, NLR, SII, and SIRI (all p < 0.05) were independently associated with AOS. Moreover, Receiver operating characteristics assessment indicated that NLR, SIRI, LMR, and SII could effectively distinguish AOS patients from healthy controls. Their areas under the curves were 0.734, 0.701, 0.715, and 0.730 (all p < 0.001). In addition, Correlation analysis revealed that LMR was negatively correlated with the PANSS total, negative, and cognitive factor scores (all p < 0.05); NLR was positively correlated with the cognitive factor score (p < 0.01); SII was negatively correlated with the positive factor score and positively with the negative and cognitive factor scores (all p < 0.05); SIRI was positively correlated with the PANSS total and cognitive factor scores (all p < 0.01). Conclusions This research established the involvement of peripheral blood inflammatory markers (LMR, NLR, SII, and SIRI) with the clinical manifestations and pathophysiology of schizophrenia, and these can serve as screening tools or potential indices of the inflammatory state and AOS symptoms severity.
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Affiliation(s)
- Zhihua Liu
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Dali Lv
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Jianfeng Li
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Fuwei Li
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Yanhua Zhang
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Yongjie Liu
- Department of Psychiatry, The Fifth People's Hospital of Luoyang, Luoyang, Henan, China
| | - Chao Gao
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Yafeng Qiu
- Department of Psychiatry, The Fourth People's Hospital of Nanyang, Nanyang, Henan, China
| | - Jun Ma
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Ruiling Zhang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
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Ricci C, Leuci E, Quattrone E, Palmisano D, Pellegrini P, Menchetti M, Pupo S, Pelizza L. Persistent negative symptoms in young people at clinical high risk of psychosis treated with an Italian early intervention program: a longitudinal study. Eur Arch Psychiatry Clin Neurosci 2024; 274:1311-1326. [PMID: 38668766 PMCID: PMC11362215 DOI: 10.1007/s00406-024-01808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/02/2024] [Indexed: 08/30/2024]
Abstract
Negative symptoms in CHR-P people are generally not responsive to treatments and commonly related to poorer functional outcome. However, less research attention has been dedicated to Persistent Negative Symptoms (PNS), defined as clinically stable negative symptoms of moderate severity evident for at least 6 months. This study aims to (a) determine the prevalence of PNS in a sample of young people at CHR-P; (b) investigate any association of PNS with functioning and clinical features; (c) examine longitudinal course of PNS across 2 years of follow-up and changes in PNS severity levels with specialized treatments. One Hundred Eighty CHR-P participants were recruited and were divided into CHR-P/PNS + and CHR-P/PNS- subgroups. The clinical assessments were based on the PANSS and the GAF and were conducted at baseline and every 12 months during the follow-up. Twenty four participants showed PNS at entry. Of them, 21 concluded the 2-year follow-up period. At baseline, the CHR-P/PNS + participants showed more educational and employment deficits, and more social and functioning impairment. During the follow-up, the CHR-P/PNS + subgroup had a significant longitudinal decrease in negative symptoms, which was specifically related to antidepressant treatment. CHR-P/PNS + subjects also showed a higher incidence of new hospitalization and a lower functional recovery over time. Our findings support that the persistence of negative symptoms in CHR-P people is longitudinally related to worse daily functioning and more severe clinical conditions that are at higher risk of hospitalization and are less responsive to specialized treatments.
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Affiliation(s)
- Camilla Ricci
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Derna Palmisano
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy.
- "Paolo Ottonello" Psychiatry Institute, Via Pepoli 5, 40123, Bologna, BO, Italy.
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Lucarini V, Grice M, Wehrle S, Cangemi F, Giustozzi F, Amorosi S, Rasmi F, Fascendini N, Magnani F, Marchesi C, Scoriels L, Vogeley K, Krebs MO, Tonna M. Language in interaction: turn-taking patterns in conversations involving individuals with schizophrenia. Psychiatry Res 2024; 339:116102. [PMID: 39089189 DOI: 10.1016/j.psychres.2024.116102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/15/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024]
Abstract
Individuals with schizophrenia generally show difficulties in interpersonal communication. Linguistic analyses shed new light on speech atypicalities in schizophrenia. However, very little is known about conversational interaction management by these individuals. Moreover, the relationship between linguistic features, psychopathology, and patients' subjectivity has received limited attention to date. We used a novel methodology to explore dyadic conversations involving 58 participants (29 individuals with schizophrenia and 29 control persons) and medical doctors. High-quality stereo recordings were obtained and used to quantify turn-taking patterns. We investigated psychopathological dimensions and subjective experiences using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Examination of Anomalous Self Experience scale (EASE), the Autism Rating Scale (ARS) and the Abnormal Bodily Phenomena questionnaire (ABPq). Different turn-taking patterns of both patients and interviewers characterised conversations involving individuals with schizophrenia. We observed higher levels of overlap and mutual silence in dialogues with the patients compared to dialogues with control persons. Mutual silence was associated with negative symptom severity; no dialogical feature was correlated with anomalous subjective experiences. Our findings suggest that individuals with schizophrenia display peculiar turn-taking behaviour, thereby enhancing our understanding of interactional coordination in schizophrenia.
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Affiliation(s)
- Valeria Lucarini
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team: Pathophysiology of psychiatric disorders: development and vulnerability, Paris 75014, France; GHU Paris Psychiatrie et Neurosciences, CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, Hôpital Sainte Anne, Paris 75014, France; CNRS GDR 3557-Institut de Psychiatrie, France.
| | - Martine Grice
- IfL-Phonetics, University of Cologne, Cologne, Germany
| | - Simon Wehrle
- IfL-Phonetics, University of Cologne, Cologne, Germany
| | | | - Francesca Giustozzi
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Amorosi
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Rasmi
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nikolas Fascendini
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Magnani
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Marchesi
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy
| | - Linda Scoriels
- GHU Paris Psychiatrie et Neurosciences, CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, Hôpital Sainte Anne, Paris 75014, France
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany; Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Marie-Odile Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team: Pathophysiology of psychiatric disorders: development and vulnerability, Paris 75014, France; GHU Paris Psychiatrie et Neurosciences, CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, Hôpital Sainte Anne, Paris 75014, France; CNRS GDR 3557-Institut de Psychiatrie, France
| | - Matteo Tonna
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy
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Zhang H, Zhang L, Liu Z, Ma J. Prevalence and Clinical Correlates of Autistic Features in Patients with Initial-Treatment and Drug-Naive Schizophrenia. ALPHA PSYCHIATRY 2024; 25:611-616. [PMID: 39553488 PMCID: PMC11562552 DOI: 10.5152/alphapsychiatry.2024.241626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/03/2024] [Indexed: 11/19/2024]
Abstract
Objective A distinct subtype of schizophrenia (SCZ) is the one accompanied with autistic features (AF). This study aimed to determine the prevalence of AF in initial-treatment and drug-naive (ITDN) patients with SCZ and investigate its influencing factors. Methods The study recruited 710 ITDN patients with SCZ. Their sociodemographic data and general clinical information were collected, and a clinical psychological assessment was performed to quantify their psychopathology and disease severity. The severity of AF was calculated based on psychopathology scores. Results Overall, 19.01% (135/710) patients with SCZ showed AF. Patients with AF exhibited higher levels of thyroid-stimulating hormone (TSH) (t = -4.54, P < .001) and lower levels of free triiodothyronine (FT3) and free tetraiodothyronine (FT4) (t = 2.38, P = .018; t = 3.19, P = .002) than those with AF. Binary logistic regression analysis revealed waist circumference (B = 0.03, P = .022, odds ratio (OR) = 1.03) and TSH level (B = 0.54, P < .001, OR = 1.71) as risk factors for AF, and deemed low-density lipoprotein cholesterol (B = -0.43, P = .025, OR = 0.65), fasting blood glucose (B = -0.72, P = .013, OR = 0.49), FT3 (B = -0.32, P = .034, OR = 0.73), and FT4 (B = -0.08, P = .025, OR = 0.93) levels as protective factors. Multiple linear regression analysis identified FT3 level (B = -0.85, t = -2.22, P = .028, 95%, Confidence Intervals (CI): -1.61- -0.09) as a protective factor influencing AF severity. Conclusion This study reports the prevalence of AF in the target SCZ population and identifies factors associated with its development and severity. The discernment of these distinctive clinical features may facilitate formulation of tailored prevention strategies and interventions for this precise subset of SCZ patients.
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Affiliation(s)
- Hong Zhang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Lin Zhang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Zhihua Liu
- Department of Psychiatry, The Fourth People’s Hospital of Nanyang, Nanyang, Henan, China
| | - Jun Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Li Y, Ang MS, Yee JY, See YM, Lee J. Predictors of functioning in treatment-resistant schizophrenia: the role of negative symptoms and neurocognition. Front Psychiatry 2024; 15:1444843. [PMID: 39301219 PMCID: PMC11411185 DOI: 10.3389/fpsyt.2024.1444843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/05/2024] [Indexed: 09/22/2024] Open
Abstract
Introduction Predictors of functioning are well-studied in schizophrenia, but much less so in treatment-resistant schizophrenia (TRS). In this study, we aim to investigate contributions of schizophrenia symptom domains and neurocognition to predict functioning in a TRS population (n = 146). Methods Participants were assessed on the Positive and Negative Syndrome Scale (PANSS), to calculate scores for five symptom factors (Positive, Negative, Cognitive, Depressive and Hostility) and two negative symptom constructs (Diminished Expressivity (DE), and Social Anhedonia (SA) as part of the Motivation and Pleasure-related dimension), based on a previously validated model, modified in accordance with EPA guidelines on negative symptoms assessment. Neurocognition was assessed with symbol coding and digit sequencing tasks from the Brief Assessment of Cognition in Schizophrenia (BACS). Functioning was assessed with the Social and Occupational Functioning Assessment Scale (SOFAS), employment status and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Multiple regression analyses were performed on psychopathology scores and BACS scores against all three measures of functioning, controlling for age and sex. For WHODAS, regression with PANSS scores of significant symptom factors were also performed. Results A lower severity of negative symptoms in the SA dimension was the strongest predictor of higher functioning across all three functioning measures. Neurocognition, in particular processing speed and attention assessed on the symbol coding task, predicted employment. A lower severity of somatic concerns and depressive symptoms was associated with lesser self-reported disability on WHODAS. Discussion This study represents a first attempt at elucidating significant predictors of functioning in TRS. We highlight negative symptoms and neurocognition as important treatment targets to improve functioning in TRS, consistent with previous studies in general schizophrenia.
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Affiliation(s)
- Yanhui Li
- North Region, Institute of Mental Health, Singapore, Singapore
| | - Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jie Yin Yee
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yuen Mei See
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- North Region, Institute of Mental Health, Singapore, Singapore
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Lee KH, Yu CH. Reexamination of the relationships among neurocognition, self-defeatist beliefs, experiential negative symptoms, and social functioning in a sample of patients diagnosed with chronic schizophrenia and schizoaffective disorder. BMC Psychiatry 2024; 24:559. [PMID: 39138483 PMCID: PMC11323583 DOI: 10.1186/s12888-024-06003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE This study proposed and evaluated a theoretical model for exploring the relationships between neurocognition, self-defeatist beliefs, experiential negative symptoms, and social functioning in individuals with chronic schizophrenia. METHOD The study recruited 229 individuals given a diagnosis of schizophrenia and schizoaffective disorders from outpatient clinics and the day ward of a mental health hospital. After informed consent was obtained, the participants underwent assessments using the backward digit span, the digit symbol, and measures of self-defeatist beliefs, experiential negative symptoms, and social functioning. A structural equation model was applied to assess the fitness of the hypothesized model, with indices such as the goodness-of-fit index, comparative fit index, root mean square error of approximation, and standardized root mean square residual being used for model evaluation. RESULTS The hypothesized model had an adequate fit. The study findings indicated that neurocognition might indirectly influence self-defeatist beliefs through its effect on experiential negative symptoms. Contrary to expectations, the study did not observe a direct influence of neurocognition, self-defeatist beliefs, or negative symptoms on social functioning. The revised model revealed the role of experiential negative symptoms in mediating the association between neurocognition and social functioning. However, self-defeatist beliefs did not significantly affect social functioning. DISCUSSION Before modifying negative thoughts, enhancement of self-awareness ability can help improve negative symptoms and thereby improve the performance of social functions. Future research should develop a hierarchical program of negative symptoms, from cognition rehabilitation to enhancement of self-awareness, and end with modifying maladaptive beliefs.
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Affiliation(s)
- Kun-Hua Lee
- Department of Educational Psychology and Counseling, National Tsing Hua University, 521 Nan-Da Road, Hsinchu City, 30014, Taiwan.
| | - Chuan-Hsun Yu
- Department of General Psychiatry, Yuli Hospital, Ministry of Health and Welfare, Hualien County, Taiwan
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Giuliani L, Pezzella P, Giordano GM, Fazio L, Mucci A, Perrottelli A, Blasi G, Amore M, Rocca P, Rossi A, Bertolino A, Galderisi S, Maj M. Illness-related variables and abnormalities of resting-state brain activity in schizophrenia. Front Psychiatry 2024; 15:1458624. [PMID: 39165501 PMCID: PMC11333936 DOI: 10.3389/fpsyt.2024.1458624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/17/2024] [Indexed: 08/22/2024] Open
Abstract
Background The development of neuroimaging biomarkers in patients with schizophrenia (SCZ) requires a refined clinical characterization. A limitation of the neuroimaging literature is the partial uptake of progress in characterizing disease-related features, particularly negative symptoms (NS) and cognitive impairment (CI). In the present study, we assessed NS and CI using up-to-date instruments and investigated the associations of abnormalities in brain resting-state (rs)-activity with disease-related features. Methods Sixty-two community-dwelling SCZ subjects participated in the study. Multiple regression analyses were performed with the rs-activity of nine regions of interest as dependent variables and disease-related features as explanatory variables. Results Attention/vigilance deficits were negatively associated with dorsal anterior cingulate rs-activity and, together with depression, were positively associated with right dorsolateral prefrontal cortex rs-activity. These deficits and impairment of Reasoning/problem-solving, together with conceptual disorganization, were associated with right inferior parietal lobule and temporal parietal junction rs-activity. Independent of other features, the NS Expressive Deficit domain was associated with the left ventral caudate, while the Motivational Deficit was associated with the dorsal caudate rs-activity. Conclusion Neurocognitive deficits and the two negative symptom domains are associated with different neural markers. Replications of these findings could foster the identification of clinically actionable biomarkers of poor functional outcomes.
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Affiliation(s)
- Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Leonardo Fazio
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, Bari, Italy
- Department of Medicine and Surgery, Libera Università Mediterranea Giuseppe Degennaro, Casamassima, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L’Aquila, L’Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Wehr S, Weigel L, Davis J, Galderisi S, Mucci A, Leucht S. Clinical Assessment Interview for Negative Symptoms (CAINS): A Systematic Review of Measurement Properties. Schizophr Bull 2024; 50:747-756. [PMID: 37951838 PMCID: PMC11283189 DOI: 10.1093/schbul/sbad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Negative symptoms are very important for the overall loss of functioning observed in patients with schizophrenia. There is a need for valid tools to assess these symptoms. STUDY DESIGN We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review guideline to evaluate the quality of the clinical assessment interview for negative symptoms (CAINS) as a clinician-rated outcome measurement (ClinROM). STUDY RESULTS The search strategy resulted in the retrieval of 13 articles, 11 of which were included in this evaluation. In terms of risk of bias, most articles reported on measures of internal consistency and construct validity, which were overall of good quality. Structural validity, reliability, measurement error, and cross-cultural validity were reported with less than optimum quality. There was a risk of bias in ClinROM development. According to the updated criteria of good measurement properties, structural validity, internal consistency, and reliability showed good results. In contrast, hypothesis testing was somewhat poorer. Results for cross-cultural validity were indeterminate. According to the updated GRADE approach from the COSMIN group the scale received a moderate grade. CONCLUSIONS The COSMIN standard allows a judgment of the CAINS as an instrument with the potential to be recommended for use, but which requires further research to assess its quality, in particular in the domains of content validity, internal consistency, and cross-cultural validity.
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Affiliation(s)
- Sophia Wehr
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucia Weigel
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL
- Maryland Psychiatric Research Center, Baltimore, MD
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Perrottelli A, Giordano GM, Koenig T, Caporusso E, Giuliani L, Pezzella P, Bucci P, Mucci A, Galderisi S. Electrophysiological Correlates of Reward Anticipation in Subjects with Schizophrenia: An ERP Microstate Study. Brain Topogr 2024; 37:1-19. [PMID: 37402859 PMCID: PMC11199294 DOI: 10.1007/s10548-023-00984-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
The current study aimed to investigate alterations of event-related potentials (ERPs) microstate during reward anticipation in subjects with schizophrenia (SCZ), and their association with hedonic experience and negative symptoms. EEG data were recorded in thirty SCZ and twenty-three healthy controls (HC) during the monetary incentive delay task in which reward, loss and neutral cues were presented. Microstate analysis and standardized low-resolution electromagnetic tomography (sLORETA) were applied to EEG data. Furthermore, analyses correlating a topographic index (the ERPs score), calculated to quantify brain activation in relationship to the microstate maps, and scales assessing hedonic experience and negative symptoms were performed. Alterations in the first (125.0-187.5 ms) and second (261.7-414.1 ms) anticipatory cue-related microstate classes were observed. In SCZ, reward cues were associated to shorter duration and earlier offset of the first microstate class as compared to the neutral condition. In the second microstate class, the area under the curve was smaller for both reward and loss anticipation cues in SCZ as compared to HC. Furthermore, significant correlations between ERPs scores and the anticipation of pleasure scores were detected, while no significant association was found with negative symptoms. sLORETA analysis showed that hypo-activation of the cingulate cortex, insula, orbitofrontal and parietal cortex was detected in SCZ as compared to HC. Abnormalities in ERPs could be traced already during the early stages of reward processing and were associated with the anticipation of pleasure, suggesting that these dysfunctions might impair effective evaluation of incoming pleasant experiences. Negative symptoms and anhedonia are partially independent results.
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Affiliation(s)
- A Perrottelli
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G M Giordano
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - T Koenig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - E Caporusso
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Giuliani
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Pezzella
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Bucci
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Mucci
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Galderisi
- University of Campania "Luigi Vanvitelli", Naples, Italy
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Bielecki M, Tyburski E, Plichta P, Samochowiec J, Kucharska-Mazur J, Podwalski P, Rek-Owodziń K, Waszczuk K, Sagan L, Michalczyk A, Rudkowski K, Karabanowicz E, Świątkowska K, Misiak B, Bąba-Kubiś A, Mak M. Impulsivity and inhibitory control in deficit and non-deficit schizophrenia. BMC Psychiatry 2024; 24:473. [PMID: 38937731 PMCID: PMC11209995 DOI: 10.1186/s12888-024-05918-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND There is conflicting evidence on impulsivity and its potential relationship with inhibitory control in schizophrenia. This study therefore aimed to identify differences in impulsivity and cognitive and motor inhibition between patients with deficit (DS) and non-deficit (NDS) schizophrenia and healthy controls (HC). We also explored the relationships between impulsivity and different dimensions of inhibitory control in all studied groups. METHODS The sample comprised 28 DS patients, 45 NDS patients, and 39 age-matched HC. A neuropsychological battery was used. RESULTS DS patients scored lower in venturesomeness, while those with NDS scored higher in impulsiveness compared to HC. In addition, both groups of patients scored higher on measures of cognitive and motor inhibition, including those relatively independent of information processing speed (although the results were slightly different after adjusting for IQ and/or years of education). Correlations between impulsivity and cognitive inhibition emerged in DS patients, while links between impulsivity and motor inhibition were observed in HC. CONCLUSIONS Our results suggest the presence of deficits in experimentally assessed inhibitory control in schizophrenia patients, with predominant impulsivity in the NDS population. In addition, impulsivity may affect the cognitive control of inhibition in deficit schizophrenia. Nevertheless, due to the preliminary nature of these findings, they require further empirical verification in future research.
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Affiliation(s)
- Maksymilian Bielecki
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Ernest Tyburski
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland.
| | - Piotr Plichta
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Piotr Podwalski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Katarzyna Rek-Owodziń
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anna Michalczyk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Krzysztof Rudkowski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ewa Karabanowicz
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Katarzyna Świątkowska
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Błażej Misiak
- Department of Consultation Psychiatry and Neuroscience, Wrocław Medical University, Wrocław, Poland
| | - Agata Bąba-Kubiś
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Mak
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
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Dragasek J, Dombi ZB, Acsai K, Dzurilla V, Barabássy Á. The management of patients with predominant negative symptoms in Slovakia: A 1-year longitudinal, prospective, multicentric cohort study. Eur Psychiatry 2024; 67:e44. [PMID: 38778040 PMCID: PMC11441340 DOI: 10.1192/j.eurpsy.2024.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Predominant negative symptoms (PNSs) in schizophrenia can affect the patients' psychosocial functioning immensely and are less responsive to treatment than positive symptoms. AIMS The aim of the study was to observe negative symptoms and psychosocial functioning in PNS schizophrenia patients and to understand whether PNS can be improved and with what treatment strategies. METHODS This was a 1-year, prospective, multicentric cohort study conducted in Slovakia. Adult outpatients with diagnosis of schizophrenia according to ICD-10 and PNS evaluated using the criteria by the European Psychiatric Association's (EPA) guidance were included. Change in negative symptoms, functionality, and treatment patterns were observed. Treatment effectiveness was evaluated using the modified Short Assessment of Negative Domain (m-SAND), the Self-evaluation of Negative Symptoms (SNS) scale, the Personal and Social Performance (PSP) scale, and the Clinical Global Impression - Severity (CGI-S) and the Clinical Global Impression - Improvement (CGI-I) scales. Least-squares (LS) means were calculated for the change from baseline to final visit for the outcomes. RESULTS The study included 188 patients. Functionality improved as, by the end of the study, fewer patients were unemployed (53%) and more worked occasionally (21%). PNS improved significantly according to both physicians and patients (LS mean change from baseline in m-SAND total score: -10.0 (p-value <0.0001)). Most patients received polytherapy throughout the study. Cariprazine was utilized most (20% monotherapy and 76% polytherapy). Only a few patients discontinued treatment due to adverse drug reactions. CONCLUSIONS With the right treatment strategy, it is possible to achieve improvement in PNS and everyday functioning in schizophrenia outpatients.
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Affiliation(s)
- Jozef Dragasek
- 1st Department of Psychiatry, Pavol Jozef Safarik University, Faculty of Medicine and University Hospital of Louis Pasteur, Košice, Slovakia
| | | | - Károly Acsai
- Global Medical Division, Gedeon Richter Plc., Budapest, Hungary
- Ceva Animal Health, Ceva-Phylaxia, Budapest, Hungary
| | | | - Ágota Barabássy
- Global Medical Division, Gedeon Richter Plc., Budapest, Hungary
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Selvan P, Devkare P, Shetty A, Dharmadhikari S, Khandhedia C, Mane A, Mehta S, Andrade C. A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia. Front Psychiatry 2024; 15:1385925. [PMID: 38711874 PMCID: PMC11071166 DOI: 10.3389/fpsyt.2024.1385925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.
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Affiliation(s)
- Panneer Selvan
- Department of Psychiatry, Sneka Mind Care Hospital, Tirunelveli, Tamil Nadu, India
| | - Prashant Devkare
- Medical Affairs and Clinical Research, Sun Pharmaceutical Industries Limited, Mumbai, India
| | - Arthik Shetty
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Shruti Dharmadhikari
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chintan Khandhedia
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Amey Mane
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Suyog Mehta
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Ma K, Zhou T, Pu C, Cheng Z, Han X, Yang L, Yu X. The Bidirectional Relationship between Weight Gain and Cognitive Function in First-Episode Schizophrenia: A Longitudinal Study in China. Brain Sci 2024; 14:310. [PMID: 38671962 PMCID: PMC11048552 DOI: 10.3390/brainsci14040310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with schizophrenia often encounter notable weight gain during their illness, heightening the risk of metabolic diseases. While previous studies have noted a correlation between obesity and cognitive impairment in schizophrenia, many were cross-sectional, posing challenges in establishing a causal relationship between weight gain and cognitive function. The aim of this longitudinal study is to examine the relationship between weight gain and cognitive function in patients with first-episode schizophrenia (FES) during the initial 6-month antipsychotic treatments. Employing linear and logistic regression analyses, the study involved 337 participants. Significantly, baseline scores in processing speed (OR = 0.834, p = 0.007), working memory and attention (OR = 0.889, p = 0.043), and executive function (OR = 0.862, p = 0.006) were associated with clinically relevant weight gain (CRW, defined as an increase in body weight > 7%) at the 6-month endpoint. On the other hand, CRW correlated with improvements in the Brief Visuospatial Memory Test (p = 0.037). These findings suggest that patients with lower baseline cognitive performance undergo more substantial weight gain. Conversely, weight gain was correlated with cognitive improvements, particularly in the domain of visual learning and memory. This suggested a potential bidirectional relationship between weight gain and cognitive function in first-episode schizophrenia patients.
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Affiliation(s)
- Ke Ma
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Tianhang Zhou
- Peking University Sixth Hospital, Beijing 100191, China
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
| | - Chengcheng Pu
- Peking University Sixth Hospital, Beijing 100191, China
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
| | - Zhang Cheng
- Peking University Sixth Hospital, Beijing 100191, China
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
| | - Xue Han
- Peking University Sixth Hospital, Beijing 100191, China
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
| | - Lei Yang
- Peking University Sixth Hospital, Beijing 100191, China
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
| | - Xin Yu
- Peking University Sixth Hospital, Beijing 100191, China
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing 100191, China
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
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Misiak B, Pawlak E, Rembacz K, Kotas M, Żebrowska-Różańska P, Kujawa D, Łaczmański Ł, Piotrowski P, Bielawski T, Samochowiec J, Samochowiec A, Karpiński P. Associations of gut microbiota alterations with clinical, metabolic, and immune-inflammatory characteristics of chronic schizophrenia. J Psychiatr Res 2024; 171:152-160. [PMID: 38281465 DOI: 10.1016/j.jpsychires.2024.01.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/31/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
The present study had the following aims: 1) to compare gut microbiota composition in patients with schizophrenia and controls and 2) to investigate the association of differentially abundant bacterial taxa with markers of inflammation, intestinal permeability, lipid metabolism, and glucose homeostasis as well as clinical manifestation. A total of 115 patients with schizophrenia during remission of positive and disorganization symptoms, and 119 controls were enrolled. Altogether, 32 peripheral blood markers were assessed. A higher abundance of Eisenbergiella, Family XIII AD3011 group, Eggerthella, Hungatella, Lactobacillus, Olsenella, Coprobacillus, Methanobrevibacter, Ligilactobacillus, Eubacterium fissicatena group, and Clostridium innocuum group in patients with schizophrenia was found. The abundance of Paraprevotella and Bacteroides was decreased in patients with schizophrenia. Differentially abundant genera were associated with altered levels of immune-inflammatory markers, zonulin, lipid profile components, and insulin resistance. Moreover, several correlations of differentially abundant genera with cognitive impairment, higher severity of negative symptoms, and worse social functioning were observed. The association of Methanobrevibacter abundance with the level of negative symptoms, cognition, and social functioning appeared to be mediated by the levels of interleukin-6 and RANTES. In turn, the association of Hungatella with the performance of attention was mediated by the levels of zonulin. The findings indicate that compositional alterations of gut microbiota observed in patients with schizophrenia correspond with clinical manifestation, intestinal permeability, subclinical inflammation, lipid profile alterations, and impaired glucose homeostasis. Subclinical inflammation and impaired gut permeability might mediate the association of gut microbiota alterations with psychopathological symptoms and cognitive impairment.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
| | - Edyta Pawlak
- Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Krzysztof Rembacz
- Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Marek Kotas
- Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Paulina Żebrowska-Różańska
- Laboratory of Genomics & Bioinformatics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Dorota Kujawa
- Laboratory of Genomics & Bioinformatics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Łukasz Łaczmański
- Laboratory of Genomics & Bioinformatics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Bielawski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Agnieszka Samochowiec
- Department of Clinical Psychology, Institute of Psychology, University of Szczecin, Poland
| | - Paweł Karpiński
- Laboratory of Genomics & Bioinformatics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, Wroclaw, Poland
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Giordano GM, Pezzella P, Mucci A, Austin SF, Erfurth A, Glenthøj B, Hofer A, Hubenak J, Libiger J, Melle I, Nielsen MØ, Rybakowski JK, Wojciak P, Galderisi S, Sachs G. Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia. Front Psychiatry 2024; 15:1333711. [PMID: 38356912 PMCID: PMC10864497 DOI: 10.3389/fpsyt.2024.1333711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction In this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia. Methods The Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome. Results One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome. Conclusions Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Stephen F. Austin
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, Vienna, Austria
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Innsbruck, Austria
| | - Jan Hubenak
- Department of Psychiatry, Charles University, Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Jan Libiger
- Department of Psychiatry, Charles University, Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Ingrid Melle
- NORMENT Centre, Institute of Clinical Psychiatry, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Ø. Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janusz K. Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Bartoli F, Calabrese A, Moretti F, Castiglioni M, Prestifilippo L, De Pietra A, Gazzola M, Camera P, Crocamo C, Carrà G, NOMIAC Investigators. Exploring depression in people with schizophrenia spectrum disorders: A cross-sectional analysis of the clinical relationship with Positive and Negative Syndrome Scale dimensions. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2024; 46:e20233418. [PMID: 38281311 PMCID: PMC11189112 DOI: 10.47626/1516-4446-2023-3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Evidence on the relationship between depression and clinical dimensions of schizophrenia remains limited. This cross-sectional study investigated the association between depression and Positive and Negative Syndrome Scale (PANSS) dimensions in people with schizophrenia spectrum disorders. METHODS Trained assessors administered the PANSS to measure symptoms of schizophrenia and the Calgary Depression Scale for Schizophrenia to measure depression. The association of depression with overall PANSS score and related dimensions was investigated in multiple logistic regression analyses. RESULTS We included 231 inpatients with schizophrenia spectrum disorders (mean age: 42.4 (SD: 12.9) years; men: 58.9%; mean overall PANSS score: 82.5 (SD: 20.1); drug-free or naïve: 39.3%), including 78 (33.8%) with clinically significant depressive symptoms. Depression was associated with higher overall (regression coefficient, SE: 0.029, 0.008; p < 0.001) and general psychopathology (regression coefficient, SE: 0.118, 0.023; p < 0.001) PANSS scores. We found an inverse relationship between depression and positive symptoms (regression coefficient, SE: -0.088, 0.028; p = 0.002). No association between depression and negative symptoms was found. CONCLUSION Despite some limitations, our study shows that people affected by schizophrenia spectrum disorders with depression are likely to show more overall and general psychopathology symptoms but lower positive symptoms. Additional studies are needed to explore the generalizability of our findings.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marta Castiglioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca Prestifilippo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Aldo De Pietra
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Gazzola
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Camera
- Department of Mental Health and Addiction Services, ASST Nord Milano, Sesto SG Hospital, Milano, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, UK
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Perrottelli A, Marzocchi FF, Caporusso E, Giordano GM, Giuliani L, Melillo A, Pezzella P, Bucci P, Mucci A, Galderisi S. Advances in the understanding of the pathophysiology of schizophrenia and bipolar disorder through induced pluripotent stem cell models. J Psychiatry Neurosci 2024; 49:E109-E125. [PMID: 38490647 PMCID: PMC10950363 DOI: 10.1503/jpn.230112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 08/04/2023] [Accepted: 01/08/2024] [Indexed: 03/17/2024] Open
Abstract
The pathophysiology of schizophrenia and bipolar disorder involves a complex interaction between genetic and environmental factors that begins in the early stages of neurodevelopment. Recent advancements in the field of induced pluripotent stem cells (iPSCs) offer a promising tool for understanding the neurobiological alterations involved in these disorders and, potentially, for developing new treatment options. In this review, we summarize the results of iPSC-based research on schizophrenia and bipolar disorder, showing disturbances in neurodevelopmental processes, imbalance in glutamatergic-GABAergic transmission and neuromorphological alterations. The limitations of the reviewed literature are also highlighted, particularly the methodological heterogeneity of the studies, the limited number of studies developing iPSC models of both diseases simultaneously, and the lack of in-depth clinical characterization of the included samples. Further studies are needed to advance knowledge on the common and disease-specific pathophysiological features of schizophrenia and bipolar disorder and to promote the development of new treatment options.
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Affiliation(s)
| | | | | | | | - Luigi Giuliani
- From the University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Melillo
- From the University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Paola Bucci
- From the University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Armida Mucci
- From the University of Campania "Luigi Vanvitelli", Naples, Italy
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Pezzella P, Caporusso E, Mucci A, Bucci P, Giordano GM, Amore M, Rocca P, Rossi A, Bertolino A, Ventura J, Galderisi S, Maj M. Interview Versus Performance Assessment of Cognition as Predictors of Real-World Outcomes in a Large-Scale Cross-Sectional Study in Schizophrenia. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae020. [PMID: 39221412 PMCID: PMC11362673 DOI: 10.1093/schizbullopen/sgae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). It is approved as a coprimary measure of performance-based instruments, such as the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Recent research highlights negative symptoms, social cognition, and functional capacity as mediators of cognitive impairment's impact on functioning. This study compared mediation analysis outcomes using CAI or MCCB scores, providing insights into the utility of interview-based tools in research and clinical practice. The study included 618 individuals diagnosed with schizophrenia, recruited from 24 Italian psychiatric clinics. Neurocognitive assessments utilized both CAI and MCCB. Mediation analyses explored negative symptoms, social cognition, and functional capacity as mediators of the impact of neurocognition on real-life functioning domains. The study's results extend the validation of the CAI as a coprimary measure that provides valid information on the impact of cognitive impairment on real-life functioning and its possible mediators, complementing the information obtained using the MCCB. Interview-based cognitive assessment might be essential for understanding schizophrenia complexity and its impact on various cognitive and functional domains for clinicians, patients, and caregivers.
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Affiliation(s)
- Pasquale Pezzella
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Edoardo Caporusso
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Paola Bucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Giulia M Giordano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L’Aquila, L’Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Mario Maj
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”Naples, Italy
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De Pieri M, Berg X, Georgiadis F, Brakowski J, Burrer A, Sabé M, Kaliuzhna M, Vetter S, Seifritz E, Homan P, Kaiser S, Kirschner M. Negative Symptoms and Their Associations With Other Clinical Variables and Working Memory Across the Schizophrenia Spectrum and Bipolar Disorder. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae024. [PMID: 39430551 PMCID: PMC11487101 DOI: 10.1093/schizbullopen/sgae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
Negative symptoms (NS) of schizophrenia spectrum disorders (SSD) are also prevalent in bipolar disorder I (BD-I) and show associations with impaired working memory (WM). However, empirical work on their relationship to other clinical factors across SSD and BD-I is sparse. Here, we characterized the associations of NS with key clinical variables and WM capacity across a combined sample of SSD and BD. We included 50 outpatients with SSD and 49 with BD-I and assessed NS domains using SANS global scores for avolition-apathy, anhedonia-asociality, alogia, and blunted affect. We assessed the transdiagnostic relationship between NS and other clinical variables, including positive symptoms, disorganization, depressive symptoms, and antipsychotic medication, using multiple regressions. The strength of these associations was further determined through dominance analyses. Finally, we used multiple regression to assess the relationship between NS domains and WM. To assess the generalizability of transdiagnostic associations, analyses were repeated in each diagnostic group separately. Across SSD and BD-I, disorganization was associated with avolition-apathy and anhedonia-asociality and depressive symptoms additionally predicted anhedonia-asociality. Antipsychotic dose was associated with blunted affect while group differences only predicted alogia. Higher avolition-apathy was related to impaired WM transdiagnostically, partially mediated by the severity of disorganization, whereas only in BD-I higher anhedonia-asociality was associated with better WM capacity. This study demonstrated transdiagnostic associations of both avolition-apathy and anhedonia-asociality with disorganization and identified avolition-apathy as a potential transdiagnostic predictor of WM impairments. Overall, our findings highlight the importance of understanding the relationship between NS domains and other clinical factors with cognitive function across SSD and BD.
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Affiliation(s)
- Marco De Pieri
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals Geneva, Geneva, Switzerland
| | - Xaver Berg
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
| | - Foivos Georgiadis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
| | - Janis Brakowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
| | - Achim Burrer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
| | - Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals Geneva, Geneva, Switzerland
| | - Mariia Kaliuzhna
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals Geneva, Geneva, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zürich, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals Geneva, Geneva, Switzerland
| | - Matthias Kirschner
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals Geneva, Geneva, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Zürich, Switzerland
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Giordano GM, Sanmarchi F, Mucci A, Rucci P, Brando F, Caporusso E, Giuliani L, Melillo A, Pezzella P, Bucci P, Rocca P, Rossi A, Bertolino A, Rossi R, Pergola G, Galderisi S, Maj M, Italian Network for Research on Psychoses. External validation of the five domains of negative symptoms: Focus on cognition, functional capacity, and real-world functioning. Eur Psychiatry 2023; 67:e3. [PMID: 38097401 PMCID: PMC10964270 DOI: 10.1192/j.eurpsy.2023.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The conceptualization of negative symptoms (NS) in schizophrenia is still controversial. Recent confirmatory factor-analytic studies suggested that the bi-dimensional model (motivational deficit [MAP] and expressive deficit [EXP]) may not capture the complexity of NS structure, which could be better defined by a five-factor (five NS domains) or a hierarchical model (five NS domains as first-order factors, and MAP and EXP, as second-order factors). A validation of these models is needed to define the structure of NS. To evaluate the validity and temporal stability of the five-factor or the hierarchical structure of the brief negative symptom scale (BNSS) in individuals with schizophrenia (SCZ), exploring associations between these models with cognition, social cognition, functional capacity, and functioning at baseline and at 4 years follow-up. METHODS Clinical variables were assessed using state-of-the-art tools in 612 SCZ at two-time points. The validity of the five-factor and the hierarchical models was analyzed through structural equation models. RESULTS The two models had both a good fit and showed a similar pattern of associations with external validators at the two-time points, with minor variations. The five-factor solution had a slightly better fit. The associations with external validators favored the five-factor structure. CONCLUSIONS Our findings suggest that both five-factor and hierarchical models provide a valid conceptualization of NS in relation to external variables and that five-factor solution provides the best balance between parsimony and granularity to summarize the BNSS structure. This finding has important implications for the study of pathophysiological mechanisms and the development of new treatments.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Melillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P, Menchetti M. Longitudinal evaluation on negative symptoms in young people at Ultra-High Risk (UHR) of psychosis: results from a 2-year follow-up study in a real-world care setting. Eur Arch Psychiatry Clin Neurosci 2023; 273:1761-1771. [PMID: 37029806 DOI: 10.1007/s00406-023-01600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Negative Symptoms (NS) severely affect real-world functioning also in young people at UHR for developing psychosis. However, longitudinal research on beneficial effects of specialized treatments for NS in UHR people is still relatively scarce and inconclusive, especially in real-world care settings. The aims of the present research were: (1) to evaluate the longitudinal stability of NS levels in young UHR subjects treated within a specialized "Early Intervention in Psychosis" (EIP) program across a 2-year follow-up period, and (2) to investigate any relevant association of NS changes with the specific treatment components offered within the EIP program. One hundred UHR individuals (aged 12-25 years) completed the Positive And Negative Syndrome Scale (PANSS). A multiple linear regression analysis was conducted to examine significant associations between longitudinal changes in NS severity levels and the EIP treatment components. Across the follow-up, a significant decrease in NS clinical severity was observed. This reduction was associated with the intensity of individual psychotherapy sessions provided in the first year of treatment, a shorter duration of untreated illness at entry and the 2-year longitudinal decrease in positive symptom levels. In conclusion, NS are relevant in UHR people, but decrease over time together with the delivery of specialized EIP interventions. Specifically, our results showed that individual psychotherapy may reduce the clinical severity of NS at least during the first year of treatment.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Università Degli Studi Di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42100, Reggio Emilia, RE, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Simona Pupo
- Division of Pain Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Università Degli Studi Di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
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48
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Wang D, Xia L, Zhang Z, Camkurt MA, Issac A, Wu E, Xiu M, Chen D, Zhang XY. Sex difference in association between cognitive and P50 deficits in patients with chronic schizophrenia. Arch Womens Ment Health 2023; 26:793-801. [PMID: 37673838 DOI: 10.1007/s00737-023-01367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
A large number of studies have reported that sensory gating disorders represented by P50 inhibition may be involved in the pathophysiological process of schizophrenia. However, few studies have explored the relationship between sensory gating disorders and cognitive dysfunction in patients with schizophrenia. This study aimed to explore sex differences in the relationship between cognitive and P50 deficits in patients with chronic schizophrenia, which has not been reported. A total of 183 chronic schizophrenia patients (128 males and 55 females) and 166 healthy controls (76 males and 90 females) participated in this study. The MATRICS Consensus Cognitive Battery (MCCB) was measured for cognitive function and P50 components for the sensory gating in all participants. The Positive and Negative Syndrome Scales (PANSS) was used to assess the psychopathological symptoms in patients. Female patients performed significantly better than male patients in several cognitive domains of MCCB (all p < 0.01). There were no significant differences in P50 components between male and female patients (all p > 0.05). Further analysis showed that in female patients, latency of S2 was negatively correlated with reasoning and problem-solving domain of MCCB (p < 0.05), and P50 ratio was negatively correlated with social cognition domain of MCCB (p < 0.05). In male patients, there was no any correlation between P50 and cognitive domains of MCCB. Our results suggest that there is a sex difference in the association between P50 deficiency and cognitive impairment in Chinese Han patients with schizophrenia.
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Affiliation(s)
- Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, 100101, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Luyao Xia
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, 100101, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhiqi Zhang
- Department of Psychology, Barnard College, Columbia University, New York, NY, USA
| | - Mehmet A Camkurt
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aaron Issac
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, 100101, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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49
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Sklar AL, Matinrazm S, Ren X, Chlpka L, Curtis M, Coffman BA, Salisbury DF. Longitudinal Investigation of Auditory Dynamic Range Deficits in Early Psychosis and its Relationship to Negative Symptoms. Schizophr Bull 2023; 49:1508-1517. [PMID: 37260356 PMCID: PMC10686334 DOI: 10.1093/schbul/sbad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND HYPOTHESIS Despite accounting for significant disease morbidity in schizophrenia, the neuropathological basis of negative symptoms remains poorly understood and options for treatment limited. Our recent study identified robust associations between diminished auditory cortex (AC) dynamic range and social functioning impairments and negative symptoms in first episode psychosis (FESz). The current investigation examined the progression of these relationships 4-8 months from baseline testing. STUDY DESIGN Twenty-six FESz and 38 healthy controls (HC) were tested at baseline and follow-up. Magnetoencephalography (MEG) was recorded during binaural presentation of tones (75, 80, and 85 dB). Assessments included the MATRICS cognitive consensus battery (MCCB) and Global Functioning: Role and Social scales (GFR/GFS) and the Positive and Negative Syndrome Scale. STUDY RESULTS Overall, FESz exhibited a blunted response to increasing tone intensity relative to HC. While this deficit did not change over time at the group level, recovery of right hemisphere AC dynamic range (85-75 dB response) among FESz individuals was associated with reductions in negative symptoms (ρ = -0.50). Diminished dynamic range was also associated with impaired GFS (ρ = 0.65), GFR (ρ = 0.51), and MCCB (ρ = 0.49) at baseline and increased negative symptoms at baseline (ρ = -0.53) and follow-up (ρ = -0.51). CONCLUSION Despite persistent dynamic range impairment in FESz as a group, individual recovery of this AC response property was associated with significant reduction in negative symptoms. Identification of a functional neural deficit that tracts progression of negative symptoms during a critical period for disease modification is essential to the management of these devastating and historically treatment refractory symptoms.
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Affiliation(s)
- Alfredo L Sklar
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
| | - Sayna Matinrazm
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
| | - Xi Ren
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
| | - Lydia Chlpka
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
| | - Mark Curtis
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
| | - Brian A Coffman
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
| | - Dean F Salisbury
- University of Pittsburgh School of Medicine, Department of Psychiatry Pittsburgh, PA
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50
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Melillo A, Caporusso E, Giordano GM, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Mucci A, Galderisi S. Correlations between Negative Symptoms and Cognitive Deficits in Individuals at First Psychotic Episode or at High Risk of Psychosis: A Systematic Review. J Clin Med 2023; 12:7095. [PMID: 38002707 PMCID: PMC10672428 DOI: 10.3390/jcm12227095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The present review aims to identify correlations between negative symptoms (NS) and deficits in neurocognition and social cognition in subjects with first-episode psychosis (FEP) and at-high-risk populations (HR). A systematic search of the literature published between 1 January 2005 and 31 December 2022 was conducted on PubMed, Scopus, and PsycInfo. Out of the 4599 records identified, a total of 32 studies met our inclusion/exclusion criteria. Data on a total of 3086 FEP and 1732 HR were collected. The available evidence shows that NS correlate with executive functioning and theory of mind deficits in FEP subjects, and with deficits in the processing speed, attention and vigilance, and working memory in HR subjects. Visual learning and memory do not correlate with NS in either FEP or HR subjects. More inconsistent findings were retrieved in relation to other cognitive domains in both samples. The available evidence is limited by sample and methodological heterogeneity across studies and was rated as poor or average quality for the majority of included studies in both FEP and CHR populations. Further research based on shared definitions of first-episode psychosis and at-risk states, as well as on more recent conceptualizations of negative symptoms and cognitive impairment, is highly needed.
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Affiliation(s)
| | | | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie, 80138 Naples, Italy
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