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The Brief Psychiatric Rating-Scale
... The Brief Psychiatric Rating Scale (BPRS), developed by Overall & Gorham (1962), was used to evaluate the severity of psychiatric symptoms [30]. This instrument comprises two assessments for negative symptoms, specifically depression-anxiety (somatic concern, anxiety, guilty feelings, and depressive mood), and lack of vitality, as well as three assessments for positive symptoms, including thought disturbance, activation (tension, mannerism-posturing, and excitement), and hostile suspicion. ...
... The Brief Psychiatric Rating Scale (BPRS), developed by Overall & Gorham (1962), was used to evaluate the severity of psychiatric symptoms [30]. This instrument comprises two assessments for negative symptoms, specifically depression-anxiety (somatic concern, anxiety, guilty feelings, and depressive mood), and lack of vitality, as well as three assessments for positive symptoms, including thought disturbance, activation (tension, mannerism-posturing, and excitement), and hostile suspicion. ...
Background
As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical.
Objective
To investigate the factors associated with a high level of suicide risk among patients with LLD.
Methods
A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses’ Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD.
Results
The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p<0.001), activation of the BPRS (β=-0.29, 95% CI=-1.22, -0.35, p<0.001), normal cognitive function of the Mini-Mental State Examination (MMSE) (β = 0.21, 95% CI = 0.50, 3.48, p<0.05), involuntary admission (β = 0.20, 95% CI = 0.44, 3.43, p<0.05), and objective support of the Social Support Rating Scale (SSRS) (β = 0.21, 95% CI = 0.08, 0.66, p<0.05) were statistically associated with a high level of suicide risk in patients with LLD.
Conclusion
This study found that LLD patients with severe depression-anxiety, low activation, normal cognitive function, involuntary admission, and strong objective support exhibited a high level of suicide risk. These patients should receive intensified monitoring and comprehensive measures should be implemented to prevent the occurrence of suicidal behaviors during hospitalization.
... The use of various instruments to measure clinical outcomes makes comparing clinical outcomes across studies somewhat difficult. In some ACT studies the Brief Psychiatric Rating Scale (BPRS) with 18 or 24 items or the Health of the Nation Outcome Scale has been used to measure the severity of psychiatric symptoms and problems, and the level of functioning has often been measured using the Global Assessment of Functioning Scale (GAF) [10][11][12][13]. ...
... The sample consisted of 142 patients treated by the first 12 ACT teams in Norway, with a median of 13 patients per team (range [6][7][8][9][10][11][12][13][14][15][16][17]. Patient characteristics at the start of treatment are shown in Table 1. ...
Background
Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams.
Methods
Our explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment.
Results
After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start.
Conclusions
ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.
... Before reviewing specific MoAs and medications, we begin with a brief overview of the negative symptoms rating scales used for the studies included in this review, which we hope will provide context for the reader interpreting the studies. The Positive and Negative Syndrome Scale (PANSS) [37] and the Brief Psychiatric Rating Scale (BPRS) [38] are older, comprehensive scales that assess both positive and negative symptoms. The PANSS is used by a majority of clinical trials, both with its originally defined negative subscale and in alternative groupings developed using factor analysis [39]. ...
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.
... The schizophrenia part of the dataset contains categorical information on the presence of the paranoid subtype based on DSM-IV criteria. The present symptomatic state of the patients were rated on the Brief Psychiatric Rating Scale (BPRS) 59 , a frequently used rating scale for measuring the overall psychopathology of individuals diagnosed with schizophrenia. The BPRS consists of 18 items rated from 1 to 7, and higher sum scores indicate a more severe condition 60 . ...
Mental health is vital to human well-being, and prevention strategies to address mental illness have a significant impact on the burden of disease and quality of life. With the recent developments in body-worn sensors, it is now possible to continuously collect data that can be used to gain insights into mental health states. This has the potential to optimize psychiatric assessment, thereby improving patient experiences and quality of life. However, access to high-quality medical data for research purposes is limited, especially regarding diagnosed psychiatric patients. To this extent, we present the OBF-Psychiatric dataset which comprises motor activity recordings of patients with bipolar and unipolar major depression, schizophrenia, and ADHD (attention deficit hyperactivity disorder). The dataset also contains data from a clinical sample diagnosed with various mood and anxiety disorders, as well as a healthy control group, making it suitable for building machine learning models and other analytical tools. It contains recordings from 162 individuals totalling 1565 days worth of motor activity data with a mean of 9.6 days per individual.
... In individuals with epilepsy, cycloserine is contraindicated and should be used with caution in those with a history of depression because of an increased risk of suicide. Cycloserine has also been reported to exacerbate symptoms in chronic schizophrenia and can induce delirium [7]. ...
... Demographic data, medical history, and comorbid disorders were collected. Symptoms severity and socio-occupational functioning were assessed using the Brief Psychiatric Rating Scale (BPRS) [72], the Positive and Negative Syndrome Scale (PANSS) [73], the Scale for the Assessment of Negative Symptoms (SANS) [60], the Scale for the Assessment of Positive Symptoms (SAPS) [74], and the Global Assessment of Functioning (GAF) [75]. ...
Citation: Samoud, S.; Mtiraoui, A.; Zamali, I.; Galai, Y.; Hannachi, N.; Manoubi, W.; Nakhli, J.; Louzir, H.; Kissi, Y.E. Comparative Analysis of Serum BAFF and IL-17 Levels Pre-and Post-Antipsychotic Treatment for Acute Schizophrenia. Int. J. Mol. Sci. 2025, 26, 385. https://doi. Abstract: The interplay between the cytokine network and antipsychotic treatment in schizophrenia remains poorly understood. This study aimed to investigate the impact of psychotropic medications on serum levels of IFN-γ, IL-4, TGF-β1, IL-17, and BAFF, and to explore their relationship with psychopathological features. We recruited 63 patients diagnosed with schizophrenia in the acute phase, all of whom were either drug-naïve or had been drug-free for at least three months. Serum levels of IL-4, IFN-γ, TGF-β1, IL-17, and BAFF were measured at baseline and after six months of antipsychotic treatment. The severity of symptoms was assessed using the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), and the Scale for the Assessment of Negative Symptoms (SANS). Fifty-two patients completed the six-month follow-up for immunoassay analysis. Antipsychotic treatment led to a significant decrease in serum levels of IFN-γ, TGF-β1, and IL-17, alongside a significant increase in BAFF levels. Changes in IFN-γ were positively correlated with SANS scores and negatively correlated with Global Assessment of Functioning (GAF) scores. Changes in TGF-β1 were negatively correlated with GAF scores. Changes in BAFF were negatively correlated with SAPS scores. Multivariable regression models were used to explore the association between cytokine level changes (IL-17, BAFF, IFN-γ, and TGF-β1) and independent variables, including demographic (gender, age), behavioral (tobacco use), clinical (schizophrenia type, disease course, date of onset, prior treatment), and biological (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) factors, as well as standardized assessment scores. No significant associations were found, except for a significant negative correlation between TGF-β1 changes and GAF scores, as well as a positive correlation with age. Interestingly, advanced statistical analyses revealed that only changes in IL-17 and BAFF levels were significantly associated with antipsychotic treatment. Our findings suggest that antipsychotic drugs exert both pro-and anti-inflammatory effects on the cytokine network. The observed modulation of IL-17 and BAFF highlights their potential as future therapeutic targets in schizophrenia.
... Psychosis: Psychosis was assessed at baseline using four items from the Brief Psychiatric Rating Scale (BPRS), (25) a semi-structured clinical interview where interviewers rated 24 different symptoms, from 1 (not present) to 7 (extremely severe). These four items (hallucinations, unusual thought content, suspiciousness, and conceptual disorganization) composed the BPRS psychosis subscale (25). ...
Objective
Previous research has found that social anxiety and depression are associated with occupational impairment, including unemployment and decreased productivity. However, longitudinal studies are limited to depression and only examine effects of anxiety cross‐sectionally. Furthermore, prior studies only measured occupational impairment dichotomously as either employed or unemployed. The present secondary data analysis sought to build upon these gaps and investigate bidirectional relationships between hours worked, measured continuously, and symptoms of social anxiety and depression over the course of 48 weeks following a brief intervention for job‐seekers with social anxiety disorder, many of whom reported elevated levels of depression. Employment was operationalized as the average number of hours spent working in a given week.
Methods
Two cross‐lagged panel models were tested to investigate these relationships in 250 diverse job‐seeking individuals (59.2% female, 40.8% Black or African‐American, and 16.4% Hispanic/Latine).
Results
In partial support of initial hypotheses, social anxiety and depression symptoms both negatively predicted subsequent hours worked. Hours worked did not predict subsequent social anxiety or depression symptoms.
Conclusions
This was the first study to investigate relationships among depression, social anxiety, and employment that operationalized employment as a continuous variable. The findings contribute novel information about the longitudinal impact of both social anxiety and depression on hours worked and suggest that symptoms of social anxiety or depression may serve as a barrier to seeking or maintaining employment. Interventions for unemployment should consider incorporating simultaneous treatment of social anxiety and depression.
... The BPRS was developed to characterise psychopathology and assess its severity among individuals diagnosed with psychosis (33). It is clinician-rated and comprises 18 items assessing various psychiatric symptoms, rated on a severity scale from 1 (not present) to 7 (extremely severe). ...
Background: A considerable number of schizophrenia patients still require long-term hospital care despite psychiatric deinstitutionalisation, especially in developing nations. Prolonged hospitalisation is associated with greater impairment in psychosocial functioning. This study aimed to determine the level of psychosocial functioning and its predictors among long-stay schizophrenia patients in a Malaysian mental institution. Methods: This cross-sectional study included 138 patients selected through universal sampling. Data on socio-demographics, illness characteristics such as psychopathology and illness severity [measured using the Brief Psychiatric Rating Scale (BPRS)], and cognitive function [assessed using the Montreal Cognitive Assessment (MoCA)] were collected. The Personal and Social Performance (PSP) scale was used to evaluate psychosocial functioning. Pearson correlation coefficients and multiple linear regression analyses were applied to identify the correlates and predictors of psychosocial functioning. Results: This study found that 47.8% and 16.7% of the patients had moderate and severe cognitive impairments, respectively. The mean PSP score was 69.68 (standard deviation (SD) = 15.48). Female gender, previous unemployment and more severe cognitive impairments were significantly associated with poorer psychosocial functioning. Meanwhile, negative symptoms and age of onset were negatively correlated with psychosocial functioning. By contrast, the duration of illness was positively correlated with psychosocial functioning. The regression model indicated that being female (β = –7.32, p < 0.001), previously unemployed (β = –3.67, p < 0.047), having negative symptoms (β = –4.18, p < 0.001), experiencing a longer illness duration (β = –0.60, p = 0.004), and the presence of severe cognitive impairment (β = –9.80, p < 0.001) significantly predicted poorer psychosocial functioning. Conclusion: Long-stay schizophrenia patients experience substantial difficulties in psychosocial functioning. Factors such as gender, last employment status, negative symptoms, illness duration, and cognitive function affect psychosocial functioning.
... The patient factors assessed included the duration of schizophrenia and the frequency of relapses (defined as the number of relapses in one year). The Brief Psychiatric Rating Scale (BPRS) was used to measure the severity of psychiatric symptoms, such as depression, anxiety, hallucinations, and unusual behavior (Hofmann et al., 2022;Overall & Gorham, 1962). The BPRS consists of 18 items, completed by a physician based on the patient's condition. ...
Introduction: Families play a critical role in the care and support of individuals with schizophrenia. However, this responsibility often leaves caregivers with significant physical and psychological burdens. Objective: The study aimed to evaluate the family caregiver, patient, environmental factors, and family function as predictors of family caregiver burden in schizophrenia patients. Methods: This study used a cross-sectional design. The population consisted of family caregivers of schizophrenia patients who had experienced at least one episode in the past year, lived in the same house, and had been caregivers for at least one year. We recruited 220 family caregivers of schizophrenia patients. The variables in this study were family caregiver, patient, environmental factors, family function, and caregiver burden. The data was collected using a self-report questionnaire and analyzed using partial least squares. Results: Most respondents were predominantly between the ages of 46 and 65. The model showed that caregiver burden was influenced by the patient factor (t= 4.259, path coefficient: 0.088), environment factor (t= 6.540, path coefficient: 0.288), and family function (t= 10.977, path coefficient: 0.497). These findings showed that family function was the dominant factor in caregiver burden. Conclusion: Patient factors, environmental factors, and family function significantly affected the family caregiver burden, except for the family caregiver factor. This model can help family caregivers decrease their burden by managing family functioning.
... The scale is widely used in clinical research [32]. It was developed in its original English version as a 16-item version [33] and has subsequently been replaced by an 18-item version [31]. We used the German version of the scale [34]. ...
Background
This study investigated socio-demographic, psychiatric, and psychological characteristics of patients with high versus low utilization of psychiatric inpatient services. Our objective was to better understand the utilization pattern and to contribute to improving psychiatric care.
Methods
One-hundred and twenty inpatients of the University Psychiatric Clinics (UPK) Basel, Switzerland, participated in this cross-sectional study. All patients were interviewed using different clinical scales. As target variables we investigated the number of days of psychiatric inpatient treatment within a 30-month period.
Results
Despite including multiple relevant patient variables and using elaborate statistical models (classic univariate und multiple regression, LASSO regression, and non-linear random forest models), the selected variables explained only a small percentage of variance in the number of days of psychiatric inpatient treatment with cross-validated R² values ranging from 0.16 to 0.22. The number of unmet needs of patients turned out to be a meaningful and hence potentially clinically relevant correlate of the number of days of psychiatric inpatient treatment in each of the applied statistical models.
Conclusions
High utilization behavior remains a complex phenomenon, which can only partly be explained by psychiatric, psychological, or social/demographic characteristics. Self-reported unmet patient needs seems to be a promising variable which may be targeted by further research in order to potentially reduce unnecessary hospitalizations or develop better tailored psychiatric treatments.
... Long research visits occurred at baseline (Week 1), Weeks 5, 9 and 13 and at follow-up 4 weeks following the end of medication (Week 19). Additional safety measures were administered at these visits to screen for psychosis (Brief Psychiatric Rating Scaling psychosis and hostility items [24], suicidality (Columbia Suicide Severity Rating Scale) [25] and cardiac adverse events [electrocardiogram (ECG)]. Participants were reimbursed with a supermarket voucher at screening and Weeks 1, 5, 9, 13 and 19. ...
Aims
This study tested the efficacy and safety of a 12‐week course of lisdexamfetamine in reducing methamphetamine use, an outcome which is associated with improvements in health and wellbeing, in people dependent on methamphetamine.
Design, setting and participants
This study was a randomised double‐blind placebo‐controlled trial conducted in six specialist outpatient clinics in Adelaide, Melbourne, Newcastle and Sydney, Australia (2018–2021). Participants were164 adults with methamphetamine dependence, reporting at least 14 use days out of the previous 28 days (62% male, 38% female, < 1% other; mean age 39 years).
Interventions
Participants were randomly allocated 1:1 to a 15‐week regimen of lisdexamfetamine (1‐week induction to 250 mg, 12‐week maintenance regimen, 2‐week reduction; n = 80) or matched placebo ( n = 84), followed‐up to Week 19.
Measurements
The primary efficacy measure was past 28‐day methamphetamine use at Week 13. Safety was assessed by adverse event rates. Secondary measures included methamphetamine use during the 12‐week treatment period and treatment satisfaction.
Findings
Nine randomized participants did not start treatment (five were allocated to lisdexamfetamine and four allocated to placebo) and were excluded from the analyses. Fifty‐seven per cent of participants were retained on study medication to primary end‐point. There was only weak evidence of a lisdexamfetamine benefit at 13 weeks [adjusted difference in days of methamphetamine use = 2.2, 95% confidence interval (CI) = –0.5 to 5.0; P = 0.49]. However, throughout the whole 12‐week treatment maintenance phase, the lisdexamfetamine group had fewer days of methamphetamine use in total (difference = 8.8, 95% CI = 2.7–15.0; P = 0.005). The lisdexamfetamine group reported greater self‐reported treatment effectiveness [odds ratio (OR) = 2.89, 95% CI = 1.67–5.02; P < 0.001] and treatment satisfaction (OR = 3.80, 95% CI = 1.93–7.47; P < 0.001). Adverse events with lisdexamfetamine included nausea. Serious adverse events occurred in four (5%) of participants who received lisdexamfetamine.
Conclusions
Lisdexamfetamine appears to reduce methamphetamine use over a 12‐week treatment period, although there is only weak evidence that reduced use is maintained during the last 4 weeks.
... 3. Previously diagnosed with schizophrenia (minimum 2 years before inclusion in the study). 4. Hospitalized or outpatient patients currently in the phase of exacerbation of psychotic symptoms who, on the BPRS (Brief Psychiatric Rating Scale) (13), have scores of 4 or more on two of the four items (9, 10, 11, and 15). 5. Sexually active participants in the study who have committed to using medically acceptable forms of contraception during the duration of the study. 6. Stable social environment for patients treated on an outpatient basis, including the presence of a person from the environment in order to obtain reliable data. ...
Olanzapine is an atypical antipsychotic that serves as the first line of schizophrenia treatment. The metabolism of olanzapine takes place with the leading participation of two enzymes, CYP1A2 and CYP2D6. The CYP450 enzyme activity can be changed under the influence of many drugs, which results in potentially significant interactions in which one drug can increase the toxicity (inhibition of cytochrome) or reduce the second drug's therapeutic effect. The aim of this study was to examine the frequency of certain genetic polymorphisms and their impact on the therapeutic response of patients treated with olanzapine. This research was conducted according to the design of a prospective, interventional, clinical study of phase IV by type of case series, where the stratification of the subjects was performed according to the obtained types of tested genotypes. Patients (N=120) were recruited at the Clinic of Psychiatry, University Clinical Center Kragujevac, in Serbia. The primary endpoint to assess the therapeutic response in this study was PANSS. In our study, the presence of the investigated gene variations (UGT1A4, CYP1A2, FMO3, and CYP2D6) does not affect the clinical response to olanzapine therapy in patients suffering from schizophrenia, compared to patients who are carriers of the wild-type gene. The presence of genes of CYP1A2*1C (rs2069514, −3860G>A), CYP1A2 (rs2472297, 74735539C>T), FMO3 E158K (rs2266782, 15167G>A), FMO3 V257M (rs1736557, 18281G>A), FMO3 E308G (rs2266780, 21443A>G), CYP2D6*3 (rs35742686, 2549delA), CYP2D6*4 (rs3892097, 1846G>A), CYP2D6*6 (rs5030655, 1707delT) does not change the clinical response to olanzapine therapy in patients suffering from schizophrenia, compared to patients who are carriers of the wild-type gene.
... For each report, we extracted the following information related to the patient sample: 1) gender (% of male participants); 2) mean age; 3) mean years of education; 4) smoking history (% smoker participants); 5) hospitalization status (i.e., inpatient, outpatient, or mixed sample); 6) medication status (coded as "Yes" if more that 50 % of the sample was medicated, otherwise coded as "No"); 7) mean disease duration (years); 8) olfactory test type (i.e., odor identification, discrimination, or threshold); 9) tool used to detect olfactory abilities among the three different test types, such as the University of Pennsylvania Smell Identification Test (UPSIT; Doty et al., 1984), the Sniffin' Sticks test (Hummel et al., 1997), the Munich Olfaction Test (MOT; Kruggel, 1989), or others; 10) assessment method (either birhinal or unirhinal presentation); 11) general psychiatric symptoms rating scores, assessed through the Brief Psychiatric Rating Scale (BPRS; Overall and Gorham, 1962); and 12) positive and negative symptoms rating scores, standardized through the conversion to z-scores across the diverse psychological tests used, including the Scales for the Assessment of Negative Symptoms (SANS; Andreasen, 1983) and the previously mentioned SAPS, and PANSS. These coded data were used as moderators for the meta-regressions. ...
... The secondary outcomes like Hamilton Anxiety Rating scale (HARS) [28], UKU Side effect scale [29], Brief Psychotic Rating Scale (BPRS) [30], WHO quality of life -BREF (WHOQOL-BREF) [31], Pittsburgh Sleep Quality Index (PSQI) [32] and Clinical Global Impression {Severity (CGI-S), Global Improvement (CGI-GI), Efficacy Index (CGI-EI)} [33] were assessed at all the time points. Blood parameters like Haemoglobin, serum creatinine and liver function tests like bilirubin total, bilirubin direct, bilirubin indirect, Aspartate Amino transferase, Alanine Amino transferase, Alkaline phosphatase, total protein, albumin were assessed at pre and post interventions. ...
Background
Role of Ayurveda medications in the management of Major depressive disorder (MDD) is explored.
Objective
To evaluate the effect of Brahmi vati and Aswagandarista in the management of MDD.
Methods
Study was a Randomized, Controlled, parallel group comparative clinical trial. Fifty patients meeting the MDD (DSM V) diagnostic criteria from teaching hospital were recruited in the study. They were divided in two 2 groups. Control group were administered with Escitalopram 10 mg twice a day. Ayurveda group were intervened with tablet Brahmi vati 500 mg thrice a day and Liquid Aswagandarista 10 ml thrice a day. Interventions were for 60 days. Assessments were done on every 15th day. Assessments criteria included Hamilton Depression Rating scale (HDRS), Hamilton Anxiety Rating scale (HARS), UKU Side effect scale (UKU), Brief Psychotic Rating Scale (BPRS), WHO quality of life -BREF (WHOQOL-BREF), Pittsburgh Sleep Quality Index (PSQI) and Clinical Global Impression scales (CGI) were assessed at all the time points. Blood parameters like Haemoglobin, Serum creatinine and Liver function tests were evaluated at pre and post study.
Results
Between group comparison showed significant improvements in WHOQOL-Bref (p < 0.001), UKU (p = 0.04) favouring Ayurveda group and PSQI (p = 0.02) improvements in control group. Improvements in other parameters were comparable. Within group assessment showed significant (p < 0.001) improvement in HDRS, HARS, BPRS, CGI-S, CGI-GI in both the groups. Liver function tests and serum creatines were within normative limits.
Conclusion
Ayurveda medications produced significant improvements comparable to escitalopram with additional advantages in quality of life and side effects profile.
... The Structured Clinical Interview for DSM-5 (First, 2015) confirmed assignment of MDD and/or co-morbid anxiety diagnosis in the MDD group (and absence of exclusionary diagnoses in both groups, online Supplementary S.I. section 1), as well as whether participants were currently depressed (or in partial or full remission). Depression symptoms were assessed using the Hamilton Depression Rating Scale (HAMD, Hamilton, 1960), Brief Psychiatric Rating Scale (Overall & Gorham, 1962), MGH Cognitive and Physical Functioning Questionnaire (Fava, Iosifescu, Pedrelli, & Baer, 2009), Patient Heath Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001), Generalized Anxiety Disorder-7 (Spitzer, Kroenke, Williams, & Lowe, 2006), Snaith-Hamilton Pleasure Scale (Nakonezny et al., 2010), Apathy Motivation Index (Ang et al., 2017), Adult Temperament Questionnaire Effortful Control subscale (Evans & Rothbart, 2007), and Need for Cognition scale (Cacioppo, Petty, & Kao, 1984, online Supplementary S.I. section 4, Table S.I. S1). ...
Background
Individuals with major depressive disorder (MDD) can experience reduced motivation and cognitive function, leading to challenges with goal-directed behavior. When selecting goals, people maximize ‘expected value’ by selecting actions that maximize potential reward while minimizing associated costs, including effort ‘costs’ and the opportunity cost of time. In MDD, differential weighing of costs and benefits are theorized mechanisms underlying changes in goal-directed cognition and may contribute to symptom heterogeneity.
Methods
We used the Effort Foraging Task to quantify cognitive and physical effort costs, and patch leaving thresholds in low effort conditions (reflecting perceived opportunity cost of time) and investigated their shared versus distinct relationships to clinical features in participants with MDD ( N = 52, 43 in-episode) and comparisons ( N = 27).
Results
Contrary to our predictions, none of the decision-making measures differed with MDD diagnosis. However, each of the measures was related to symptom severity, over and above effects of ability (i.e. performance). Greater anxiety symptoms were selectively associated with lower cognitive effort cost (i.e. greater willingness to exert effort). Anhedonia and behavioral apathy were associated with increased physical effort costs. Finally, greater overall depression was related to decreased patch leaving thresholds.
Conclusions
Markers of effort-based decision-making may inform understanding of MDD heterogeneity. Increased willingness to exert cognitive effort may contribute to anxiety symptoms such as worry. Decreased leaving threshold associations with symptom severity are consistent with reward rate-based accounts of reduced vigor in MDD. Future research should address subtypes of depression with or without anxiety, which may relate differentially to cognitive effort decisions.
... The Brief Psychiatric Rating Scale, BPRS (Overall and Gorham) [30] is a widely used instrument for assessing the positive, negative, and affective symptoms of individuals who have psychotic disorders, especially schizophrenia. The BPRS consists of 18-symptom constructs and takes 20-30 min for the interview and scoring. ...
Background
Current evidence supports the idea that neurocognitive deficits (NCD) constitute a core dimension of schizophrenia. Studies on longitudinal changes in neurocognition among neuroleptic-naive first-episode schizophrenia (FES) from Africa are uncommon. We aimed to highlight the prevalence of, and changes in NCD among FES on naturalistic treatment follow-up for 8 weeks, and the relationship with psychopathological and psychosocial outcomes.
Methods
Consecutive FES and Healthy Control (HC) were recruited. Diagnosis of schizophrenia was based on ICD-10 criteria. The HC (n = 86) consisted of nursing students in the same facility, recruited purposely to match the cases in age and gender. After the baseline assessment, 82 FES were followed up 4-weekly for changes in NCD, psychopathological and psychosocial ratings for a period of 8 weeks, using the 3 alternate forms of the Screen for Cognitive Impairment in Psychiatry (SCIP), the Wisconsin Card Test, the Mini Mental State Examination, as well as the Brief Psychiatric Rating Scale, the WHO Disability Assessment Scale, and the Global Assessment of Functioning scale. The control group was tested only once, and their scores were utilized for comparison with the patients’ scores only at week 8. The prevalence of neurocognitive deficits in the two groups was described using percentages and 95% confidence interval. Predictors of cognitive function was determined using multivariate linear regression.
Results
The prevalence of any NCD among FES at 8 weeks and HC was 62.9% (95% CI: 51.5%, 74.2%) and 1.2% (95% CI: 0.0%, 6.6%), respectively. With treatment, there was a significant improvement in cognitive function at each interval of follow-up. At week 8, the prevalence of any NCD among patients in remission was 55.1%. Total SCIP scores at week 8 had significant inverse moderate relationship with the dimensions of psychopathology. Conversely, total SCIP score was strongly positively correlated with functioning (rhos= 0.71, p < 0.001) at week 8. At week 8, the baseline predictors of total SCIP score were, duration of untreated psychosis (β = -0.33, p = 0.01, variance = 19.8%), negative symptoms (β = -0.35, p = 0.03, variance = 4.9%) and positive symptoms (β = -0.43, p = 0.01, variance = 4.8%).
Conclusion
The high prevalence of NCD when patients were in remission indicates that they are enduring and merit consideration as a domain of psychopathology.
... Data were available to analyze the differences between "long" DUP and "short" DUP at baseline in the following outcomes: Brief Psychiatric Rating Scale 43 At baseline, "long" DUP was associated with significantly higher PANSS negative scale scores (ES = 0.45, 95%CI 0.16 to 0.74) and SANS scale scores (ES = 0.29, 95%CI 0.11 to 0.47), (Figures 1 and 2), without significant differences in the other outcomes ( Supplementary Figures 2-10). ...
Background and Hypothesis: Duration of untreated psy-chosis (DUP) has been linked to worse mental health outcomes in psychotic disorders. We meta-analytically studied the relationship between "long" vs. "short" DUP and mental health outcomes.
Study Design: This PRISMA/MOOSE-compliant meta-analysis searched for nonoverlapping individual studies from database inception until November 01, 2023, reporting data from author-defined "short"/"long" DUP (ac-cording to author's definition) in patients with first-episode psychosis (FEP). We compared differences between "short"/"long" DUP groups at baseline and/or follow-up in continuous and binary outcomes. We conducted random-effects meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO: CRD42023479321).
Study Results: From 16,055 citations, 34 studies were included (n = 6,425, age = 27.5 ± 7.1 years, males = 60.4%, white = 70.2%, DUP: mean = 60.8 ± 43.8 weeks, median = 52.5, interquartile range = 31.3, 68.0 weeks, follow-up = 19.2 ± 35.0 months). The definition of "short"/"long" varies significantly between the studies. Compared to "short" DUP (mean = 10.2 ± 11.2 weeks), "long" DUP (mean = 58.8 ± 76.4 weeks) was associated with higher baseline Positive and Negative Syndrome Scale (PANSS) negative (k = 14, ES = 0.45, 95%CI = 0.16, 0.74) and Scale for the Assessment of Negative Symptoms (k = 7, ES = 0.29, 95%CI = 0.11, 0.47) scores, lower remission (k = 7, OR = 0.40, 95%CI = 0.24, 0.67) and more suicide attempts (k = 4, OR = 2.01, 95%CI = 1.36, 2.96). At follow-up, compared to "short" DUP, "long" DUP was associated with lower Global Assessment of Functioning (k = 4, ES = −0.63, 95%CI = −0.83, −0.43) and higher PANSS negative subscale scores (k = 5, ES = 0.66, 95%CI = 0.05, 1.27).
Conclusions: In FEP, longer DUP is related to greater baseline negative symptoms, less remission, and more suicide attempts, as well as greater postbaseline negative symptom severity and functional disability. To what degree longer DUP contributes to poorer outcomes or whether DUP only correlates with these outcomes requires further study. A greater consensus on the definition of long DUP is needed to make comparisons between studies more feasible.
... Identifier: NCT02034253, NCT03442101) clinical observations over several months of follow up were used to establish a final diagnosis. The Brief Psychiatric Rating Scale (BPRS) was used to assess symptom severity [49]. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) [50] at the beginning of the study. ...
Background
Previous studies have implicated hippocampal abnormalities in the neuropathology of psychosis spectrum disorders. Reduced hippocampal volume has been reported across all illness stages, and this atrophy has been hypothesized to be the result of glutamatergic excess. To test this hypothesis, we measured hippocampal subfield volumes and hippocampal glutamate levels in antipsychotic naïve first episode psychosis patients (FEP) and the progression of volume decline and changes in glutamate levels over a 16-week antipsychotic drug (APD) trial. We aimed to determine if subfield volumes at baseline were associated with glutamate levels, and if baseline glutamate levels were predictive of change in subfield volumes over time.
Methods
We enrolled ninety-three medication-naïve FEP participants and 80 matched healthy controls (HC). T1 and T2 weighted images and magnetic resonance spectroscopy (MRS) data from a voxel prescribed in the left hippocampus were collected from participants at baseline and after 6 and 16 weeks of APD treatment. Hippocampal subfield volumes were assessed using FreeSurfer 7.1.1., while glutamate levels were quantified using jMRUI version 6.0. Data were analyzed using linear mixed models.
Results
We found regional subfield volume deficits in the CA1, and presubiculum in FEP at baseline, that further expanded to include the molecular and granule cell layer of the dentate gyrus (GC/ML/DG) and CA4 by week 16. Baseline hippocampal glutamate levels in FEP were not significantly different than those of HC, and there was no effect of treatment on glutamate. Glutamate levels were not related to initial subfield volumes or volume changes over 16 weeks.
Conclusion
We report a progressive loss of hippocampal subfield volumes over a period of 16 weeks after initiation of treatment, suggestive of early progression in neuropathology. Our results do not suggest a role for glutamate as a driving factor. This study underscores the need to further research the mechanism(s) underlying this phenomenon as it has implications for early intervention to preserve cognitive decline in FEP participants.
... Evaluation of symptoms according to the PANSS and BPRS scales [50,51] ...
Background: Schizophrenia is a complex disorder characterized by positive symptoms (e.g., hallucinations), negative symptoms (e.g., social withdrawal), and disorganized symptoms (e.g., thought disorder). Alongside these, cognitive and depressive symptoms often emerge, with depressive symptoms sometimes dominating the clinical picture. Understanding the factors that influence the development of depressive symptoms in schizophrenia could clarify the dynamics between depressive and psychotic symptoms and guide clinical interventions. Methods: A total of 105 patients with schizophrenia (66 women, 39 men) were assessed using several clinical scales: PANSS, BPRS, DOCS, DES, HAM-D, and the Luria-Nebraska Neuropsychological Battery for cognitive evaluation. Statistical analyses, including correlation and regression, were conducted using SPSS to determine the significance of associations. Results: Disorganized and obsessive-compulsive symptoms were identified as primary factors associated with depressive symptoms in patients with schizophrenia. Conversely, a longer duration of untreated psychosis was linked to a lower severity of depressive symptoms, suggesting that early intervention may alter the depressive symptom trajectory. Conclusions: Here, we suggest a complex interaction between psychotic and depressive symptoms, possibly indicating a biological antagonism. The association of depressive symptoms with disorganized and obsessive-compulsive features may reflect an adaptive psychological response, attempting to stabilize amidst the disintegration of schizophrenia. These insights support a more integrated approach to treatment, addressing both psychotic and depressive symptoms to improve patient outcomes.
... (a) Eight parameters from the Brief Psychiatric Rating Scale (BPRS) [10], were included in the assessments: tension, anxiety, mannerisms and posturing, hostility, suspiciousness, motor retardation, uncooperativeness and excitement. These parameters were chosen because they can be quantified in video recordings. ...
Violence risk is a major challenge among acute psychiatric inpatients. The study aimed to predict violent behavior risk in an acute psychiatric ward using video recordings from the emergency department. 69 videos of the emergency department recording the first ten minutes following patients’ arrivals were included. Psychiatrists watched the videos, completed relevant Brief Psychiatric Rating Scale items and answered intuitive questions about each patient’s risk of violence. Demographic and clinical data were also collected. Motoric mannerisms as rated in the BPRS significantly differed between violent and non-violent patients (p < 0.05). Additionally, we found a significant correlation between intuitive prediction of violence and actual violence (p = 0.008). Violent behavior was predicted in 42.1% of the cases by the intuitive evaluation compared to 11.5% mistakenly evaluated patients. Logistic regression revealed that the intuitive question and the BPRS items regarding tension and motoric mannerism created a successful model for predicting violence with 88.2% sensitivity and 72.5% specificity. We sought to define the factors that most accurately predict violence in the acute psychiatric ward, based solely on behavior in the emergency department. Intuitive impressions of clinicians and motoric mannerisms should be considered when evaluating patients for potential violent behavior.
... The psychotomimetic effects were assessed using the four positive symptom items of psychosis from the Brief Psychiatric Rating Scale (BPRS+) [25], which include hallucinations, suspiciousness, unusual thought content, and conceptual disorganization. ...
Background
Chronic treatment-resistant depression (TRD) poses a major challenge for clinicians. Ketamine has shown a rapid but short-lived antidepressant effect in several studies involving TRD patients with different demographic and clinical profiles. Our study aimed to assess the antidepressant effect of serial infusion sessions of ketamine in patients with chronic TRD and evaluate the severity of symptoms after relapse and the general psychiatric health of the responding patients.
Methods
In this single arm open-label study, six infusions of ketamine at 0.5 mg/kg were administered to chronic TRD patients for approximately two weeks. Response and remission rates, side effects, adverse events and after-relapse symptoms were evaluated, and patients were followed for three months.
Results
23 patients underwent at least one infusion session, and 18 patients completed the six sessions. Twelve (66.67%) patients responded to the treatment at some point, and 11 (61.11%) patients maintained response after the end of the treatment protocol. One infusion was not sufficient to achieve a response (P > 0.9999, z = 1.81), and more than half of the responders met the response criteria after the third infusion. Only one patient (5.56%) achieved remission at the end of the infusion phase. All but one ketamine responders relapsed within one month after the end of the treatment. There was no statistical difference between baseline and after-relapse MADRS scores (P = 0.7886, 95% CI=-5.512-4.312, R² = 0,008411). However, a high incidence of serious adverse events related to suicidality was evident; one of the non-responding patients attempted suicide and several attempts to sedate this patient with benzodiazepines failed. Two responding patients ended up with a suicidal attempt or severe suicidal thoughts.
Conclusions
Introducing rapid-acting antidepressant to manage TRD patients in clinical practice demands further investigation, and the benefit-to-harm ratio should be assessed in the light of the increased risk of suicidality.
Background and Hypothesis
Formal thought disorder (FTD), studied even before the inception of the concept of schizophrenia, remains a deeply isolating experience for patients as well as a difficult one for their interlocutors, including clinicians.
Study Design
The views on language, paralinguistic, and extralinguistic features exhibited by patients with severe mental ill health are reviewed, including the contributions from 19th-century European authors to the last third of the 20th century.
Study Results
Stages in the construction of FTD are described, including its merging with Dementia Praecox, and its subsequently being shaped by notions such as primitive archaic thinking, paralogical or autistic thinking, concretism, overinclusive thinking, and the return of the efforts to describing it with increased reliability.
Conclusions
It appears that some features of communication in schizophrenia, but not others, have been selected at different points in time for clinical and research use without realizing that by carrying out that selection, the phenomenon under study itself is changed. Remarkably, some theories of FTD remained in use, despite being empirically disproved (eg, word association disorder, concrete thinking, paralogical thinking) or despite its highly problematic and discriminatory nature. We would suggest that studies of FTD should explicitly consider which and why some of its features are included or excluded when assessing it. Furthermore, we would suggest that the study of FTD should incorporate the complexity of human communication, including the pragmatic, paralinguistic, non-verbal, and cognitive dimensions of the localized and unique situation where it takes place.
A basic screening of the patient’s mental and functional status is part of the diagnostic assessment of dementia. Some of the same assessment measures used clinically are used as outcomes in clinical trials. Cognitive deficits are both core features of the dementia syndrome and progress over time. It is therefore important for both clinicians and clinical investigators to be able to quantify this change over time as well as possible improvements with treatment.
Over the past 35 years, surrogate endpoints, to be used in lieu of so-called true endpoints, have become increasingly important as potential shortcuts for the development of medicinal products. In various therapeutic areas, current-day endpoints once were surrogates that underwent favorable evaluation, such as progression-free survival in colorectal cancer, or simply replaced a former true endpoint out of necessity, such as CD4 counts and then viral load in HIV/AIDS. Of course, a surrogate endpoint will never exactly capture the same information as the endpoint it is designed to replace, and the relationship between both may change when there are drastic changes in, for example, the therapies applied. In any case, meticulous evaluation of candidate surrogates is in order. To this end and over time, a variety of approaches have been proposed to evaluate candidate surrogate endpoints, starting from the seminal work of Prentice (Stat Med 8; 431–440, 1989) and that of Freedman et al. (Stat Med 11; 167–178, 1992). The earliest work focused on a single trial, while at the turn of the century, focus shifted to the meta-analytic approach. The framework was developed for different outcome types and permits the distinction between individual-level and trial-level surrogacy. It also enables examination of the predictive power of the treatment effect on the surrogate to the treatment effect on the true endpoint. Surrogates have also entered the regulatory framework for clinical trials. More recently, causal inference methodology has entered surrogate endpoint evaluation. In this setting, a counterfactual pair of endpoints is considered for every patient, under control and experimental conditions, for the true endpoint and perhaps also for the surrogate. The lack of identification that results is addressed via sensitivity analysis. A case study in psychiatry completes the overview.
Background
Almost 40% of individuals at ultra-high risk (UHR) for psychosis experience persistent attenuated psychotic symptoms (APS) yet it is unclear (1) whether they share overlapping clinical and functional outcomes compared to individuals who transition to psychosis, (2) when symptom and functioning trajectories begin to diverge between UHR individuals with different clinical outcomes, and (3) whether non-remission (persistent APS or transition) can be predicted using baseline and/or longitudinal data.
Study Design
Participants were drawn from 2 randomized clinical trials: Neurapro (n = 220; discovery sample) and STEP (n = 180; external validation sample). First, 12–24 month symptoms and functioning were compared between UHR individuals with persistent APS, sustained remission, or transition to psychosis. Next, short-term changes in symptoms and functioning were compared between groups to determine timepoints at which trajectories began to diverge. Finally, we used support vector machines to predict non-remission (persistent APS or transition) vs sustained remission using data from baseline, 6-month follow-up, and combined baseline and 6-month follow-up.
Results
Individuals with persistent APS had substantially poorer outcomes compared to those who remitted, and more closely resembled individuals who later transitioned to psychosis. Despite few baseline differences between groups, clinical and functional trajectories of the persistent APS and transition groups rapidly diverged from those who remitted. Prediction of non-remission was poor using baseline data but improved substantially when using 6-month follow-up or combined baseline-6-month data.
Conclusions
Ultra-high-risk individuals with persistent APS display similar clinical and functional trajectories to transitioned cases, suggesting that more intensive and sustained intervention is required for this subgroup. However, prospective identification of individuals with poor clinical outcomes (ie, persistence or deterioration of attenuated psychotic symptoms) may require longitudinal monitoring of symptom and functioning trajectories for several months.
Editorial: This paper examines the historical and contemporary understanding of Functional Neurological Disorder (FND) through the case of "Villa de las Niñas," a boarding school in Mexico where 66 students presented FND symptoms. The study highlights the complex interplay of medical, psychiatric, and social factors in diagnosing and managing FND within vulnerable populations. Comprehensive assessments revealed high comorbidities, including depressive and anxiety disorders. The findings underscore the urgent need for biopsychosocial approaches to treatment, recognizing the importance of addressing the biological, psychological, and social aspects of FND. Policies addressing institutional environments' role in mental health are also crucial. The case exemplifies FND's complex nature, emphasizing interdisciplinary collaboration in research and practice to mitigate its impact.
Objectives
Managing symptoms, notably psychiatric symptoms, in dementia with Lewy bodies (DLB) is complex, affecting both patients and caregivers. People with DLB often react poorly to antipsychotics, limiting treatment options. Although electroconvulsive therapy (ECT)'s potential for DLB is acknowledged, evidence is scarce owing to limited studies. This study investigated ECT's effectiveness and safety for DLB and prodromal DLB with antecedent psychiatric symptoms.
Methods
This retrospective study investigated people with DLB ( N = 12) and mild cognitive impairment (MCI) with LB ( N = 13), a prodromal form of DLB, who underwent ECT for psychiatric symptoms and had abnormal findings confirmed using dopamine transporter single‐photon emission computed tomography and ¹²³ I‐metaiodobenzylguanidine myocardial scintigraphy. We reviewed these patients' medical records and determined the severity of psychotic symptoms before and 1 week after the final ECT session with the Clinical Global Impressions Severity Scale (CGI‐S). Improvement in psychotic symptoms was evaluated approximately 1 week after the final ECT session using the CGI Improvement Scale (CGI‐I). Additionally, we assessed cognitive function and dementia severity before and after ECT, as well as any adverse events caused by ECT.
Results
ECT significantly improved psychiatric symptoms, as assessed using the CGI‐S, with CGI‐I reports in the order of 60% “very much improved,” 20% “much improved,” 16% “minimally improved,” and 4% “no change.” Parkinsonism improved (Hoehn and Yahr: 1.76 ± 1.2 before vs. 1.04 ± 0.7 after, p < 0.001) as did dementia severity (Clinical Dementia Rating, p = 0.037). Adverse events included delirium in 24% of patients and amnesia in 4% of patients. ECT did not worsen cognitive function.
Conclusions
ECT for DLB and MCI with LB with antecedent psychiatric symptoms appears safe and effective in managing psychiatric symptoms and Parkinsonism. Further large‐scale multicenter studies are warranted to conclusively establish its effectiveness and safety.
Background: Combined behavioral- and pharmacological-based tobacco cessation interventions are effective for adults with serious mental illness; yet, they continue to smoke at alarming rates. Materials and Methods: A pilot two-arm randomized controlled trial of the program consisted of 50 minutes of game-based groups 3×/week, for 12 weeks alongside counseling and pharmacotherapy. The intervention group engaged in game-based group physical activity (PA), while the control group engaged in sedentary games. Results: Multilevel regression analyses were used to examine the primary aims. Mean number of cigarettes smoked per week (cig/wk) for the sample (n = 48) at enrollment was 56.3 cigarettes. The linear change was significant at 2.9 fewer cig/wk. The average psychiatric symptom score at enrollment for the PA group was 41.5 points with a significant predicted linear decrease in scores. Conclusion: Both study groups showed a significant reduction in cig/wk. The combination of counseling and pharmacotherapy offered in groups may have aided with cessation and cigarette reduction while also providing a benefit to mental health.
Background and Hypothesis
Understanding perceptual alterations in mental disorders can help uncover neural and computational anomalies. In schizophrenia, perceptual alterations have been reported for many visual features, including a deficit in contrast sensitivity, a key measure of visual function. The evidence supporting this deficit, however, has not been comprehensively synthesized.
Study Design
We conducted a systematic review and meta-analysis of studies measuring contrast sensitivity in individuals with schizophrenia and healthy controls. Our search identified 46 studies, of which 43 focused on chronic patients.
Study Results
We found that patients with chronic schizophrenia have reduced contrast sensitivity (g = 0.74; 95% CI, 0.55 to 0.93; P = 8.2 × 10−10). However, we found evidence that the deficit could be driven by medication. Additionally, none of the studies estimated attentional lapses, leaving it uncertain whether a potentially higher frequency of lapses in patients contributes to the observed deficit. Furthermore, only two studies comprehensively assessed visual acuity, complicating the understanding of the role of spatial frequency in the observed deficit.
Conclusions
While we identified a robust deficit in contrast sensitivity among chronic schizophrenia patients, the influence of attentional lapses and medication on this impairment remains unclear. We make several suggestions for future research to clarify the underlying mechanisms contributing to this deficit.
Schizophrenia is a major mental disorder that affects approximately 0.5% of the population worldwide. Persistent negative symptoms and cognitive impairments associated with schizophrenia (CIAS) are key features of the disorder and primary predictors of long-term disability. At the neurochemical level, both CIAS and negative symptoms are potentially attributable to dysfunction or dysregulation of N-methyl-d-aspartate receptor (NMDAR)-mediated neurotransmission within cortical and subcortical brain regions. At present, there are no approved treatments for either CIAS or persistent negative symptoms. Development of novel treatments, moreover, is limited by the lack of biomarkers that can be used translationally across preclinical and early-stage clinical investigation. The present chapter describes the use of mismatch negativity (MMN) as a pharmacodynamic/response (PD/R) biomarker for early-stage clinical investigation of NMDAR targeted therapies for schizophrenia. MMN indexes dysfunction of early auditory processing (EAP) in schizophrenia. In humans, deficits in MMN generation contribute hierarchically to impaired cognition and functional outcome. Across humans, rodents, and primates, MMN has been linked to impaired NMDAR function and resultant disturbances in excitatory/inhibitory (E/I) balance involving interactions between glutamatergic (excitatory) pyramidal and GABAeric (inhibitory) local circuit neurons. In early-stage clinical trials, MMN has shown sensitivity to the acute effects of novel pharmacological treatments. These findings support use of MMN as a pharmacodynamic/response biomarker to support preclinical drug discovery and early-stage proof-of-mechanisms studies in schizophrenia and other related neuropsychiatric disorders.
Background
A prolonged first episode of psychosis (FEP) without adequate treatment is a predictor of poor clinical, functional, and health outcomes and significant economic burden. Team-based “coordinated specialty care” (CSC) for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery. However, California’s CSC program implementation has been unsystematic and could benefit from standardizing its processes and data collection infrastructure. To address this, we established a consortium of EP clinics across the state via a Learning Health Care Network (LHCN) framework to develop the Early Psychosis Intervention Network of California (EPI-CAL). EPI-CAL’s LHCN developed a core battery of evidence-based measures for service users and family members and linked them together using a unique data collection and visualization application, Beehive.
Methods and objectives
EPI-CAL’s LHCN collects, visualizes, and aggregates data at the individual and clinic level for EP programs across California via Beehive. Beehive was designed to: (1) collect outcomes data from service users receiving care at EP programs and their support persons, (2) provide the data to providers on a secure web-based dashboard to support measurement-based care, and (3) allow data to be used for program or research analysis. We will (1) determine the feasibility of implementing an LHCN across a diverse, decentralized network of early psychosis programs, (2) determine if the implementation of an LHCN increases the delivery of measurement-based care, and (3) determine if the implementation of measurement-based care is associated with significant improvements in key service user outcomes. EPI-CAL’s network will contribute data to the Early Psychosis Intervention Network (EPINET) program.
Discussion
The current study aims to establish an LHCN of EP clinics in California that implements harmonized data collection using Beehive and assesses the feasibility of establishing such a network. Our goal is for this harmonized data collection approach to be used to inform decisions and develop learning opportunities for service users, staff, and administrators, and to improve outcomes for service users and their supporters in CSC care. Further, the data will enable programs and research teams to examine what elements of care lead to program success and improved treatment outcomes for service users.
Clinical trials registration
www.ClinicalTrials.gov, identifier NCT04007510; registered 07/05/2019.
Background and hypothesis:
Probiotic augmentation offers a promising treatment for bipolar disorder (BD) and schizophrenia spectrum disorder (SSD). By targeting microbiome deviations, they may improve both gut and brain health.
Study design:
In this double-blind, randomized, placebo-controlled trial with the multi-strain probiotic formulation Ecologic BARRIER, we aimed to improve psychiatric and cognitive symptoms, intestinal permeability, and gastrointestinal symptoms in patients with BD or SSD. A total of 131 patients were randomized 1:1 to receive either the probiotic supplement (n = 67) or a placebo (n = 64) for 3 months, in addition to treatment-as-usual. The primary outcomes were symptom severity assessed by the Brief Psychiatric Rating Scale and cognitive functioning by the Brief Assessment of Cognition in Schizophrenia.
Study results:
No significant effect of probiotics was observed on psychiatric symptoms, but borderline significant improvement was observed in the cognition category of verbal memory (Linear Mixed Model (LMM) 0.33; adjusted P = .059). Probiotics beneficially affected markers of intestinal permeability and inflammation, including zonulin (LMMserum = -18.40; adjusted P = .002; LMMfecal = -10.47; adjusted P = .014) and alpha-1 antitrypsin (LMM 9.26; adjusted P = .025). Indigestion complaints significantly decreased in male participants in the probiotics group (LMM = -0.70; adjusted P = .010). Adverse events were similar between groups.
Conclusions:
Our study observed significant advantages of probiotics for gut health in BD and SSD, with excellent safety and tolerability. A borderline effect on verbal memory was also indicated. These results underscore the need for further research into microbiome-targeted interventions for patients with complex brain disorders.
Background and Hypothesis
The number of clinical efficacy trials of Cognitive Remediation (CR), a behavioral intervention consisting of cognitive task practice and/or strategy training to improve cognitive skills in schizophrenia, has increased substantially over the past 25 years. While recent reviews have highlighted the effects of CR on cognition and function, CR effects on negative symptoms remain understudied. Given the overlap between negative symptoms and cognition, CR effects might be expected.
Study Design
Electronic databases were evaluated up to September 2023 using a broad range of search terms. Sixty-nine unique, controlled trials that used negative symptoms as an outcome were meta-analyzed. Data were independently extracted with excellent (>98%) reliability. Random effects models assessed the effects of CR on summary and expressive vs. experiential negative symptoms. Moderator analyses evaluated a broad array of treatment and participant factors.
Study Results
The meta-analysis (5319 participants) revealed that CR produced a small effect size improvement on summary negative symptoms (Hedge’s g = 0.179). Sample differences in age, duration of illness, symptoms, and antipsychotic dosage did not serve as a barrier to treatment benefit. CR also produced small-to-moderate improvements in alogia (Hedge’s g = 0.312) but not experiential negative symptoms. Programs of CR that utilized bridging activities that relate training of cognitive skills to activities of daily living produced greater improvement in negative symptoms (g = 0.281 vs 0.055). Longer CR programs also produce larger effects on negative symptoms.
Conclusions
CR produces small, consistent reductions in negative symptoms in people with schizophrenia. Variations in CR effects may be linked to different treatment ingredients.
A reanalysis of previously presented data (Shawver et al, 1959) was done to determine what personality factors, as measured by the Lorr Multi-dimensional Scale for Rating Psychiatric Patients (1953), changed over a period of 6 months of hospitalization. Factor analysis of change scores (6-month ratings subtracted from initial) on the 42-item scale resulted in 6 independent factors. Change was reflected in factors of: mental disorganization, thought guilt, depression, and anxiety. Mental disorganization was seen to be the central factor or primary process in schizophrenic.
An evaluation of imipramine, isocarboxazide, dextroamphetamine‐amobarbital, and placebo was carried out in 204 patients with depressive syndromes in thirty‐two Veterans Administration Hospitals. Treatment with a fixed dosage schedule was followed for 3 weeks, the dosage becoming flexible during an ensuing 9 week period. Evaluation of responses was made by three rating scales specially derived for depressed patients.
After 3 weeks of treatment, imipramine was significantly more effective than the other three treatments as measured only by a thirty‐one item expert clinician's scale derived from the Inpatient Multidimensional Psychiatric Scale. Favorable responses to imipramine were often prompt, leading to loss of such patients from the study before the full 12 week treatment period had been completed. After 12 weeks of treatment, the patients who remained in all four treatment groups were significantly improved when each group was compared with its pretreatment level, but there were no statistically reliable differences between treatments at the end of the study. These results emphasize the need for controlled studies in depressive syndromes subject to spontaneous improvement.
Multidimensional Scale for Rating Psychiatric Patients
- M Low
- R L Jenkins
- J Q Holsopple
LOW. M., JENKINS, R. L., & HOLSOPPLE, J. Q. Multidimensional Scale for Rating
Psychiatric Patients. V. A. Tech. Bull., 1953, No. 10-507.
A confirmation of nine postulared psychotic syndromes Basic dimensions of change in symptomatology of chronic schizophrenics. I. abnorn. ~ o c
- M Low
- D M Mcnair
- C J Klett
- J J Lasky
- Abstract
- J E Overall
- D R Gorham
- J R Shawver
LOW, M., MCNAIR, D. M., KLETT, C. J., & LASKY, J. J. A confirmation of nine postulared psychotic syndromes. Amer. Psychologist, 1960, 15, 495. (Abstract) OVERALL, J. E., GORHAM, D. R., & SHAWVER, J. R. Basic dimensions of change in symptomatology of chronic schizophrenics. I. abnorn. ~ o c. Psychol., 1961, 62, 597-602.
Chemotherapy of depression: a controlled comparison of imipramine, isocarboxazid, dexcroampheramine and placebo
- J E Overall
- L E Hollister
- A D Pokorny
- J F Casey
- G Katz
OVERALL, J. E., HOLLISTER, L. E., POKORNY, A. D., CASEY, J. F., & KATZ, G. Chemotherapy of depression: a controlled comparison of imipramine, isocarboxazid,
dexcroampheramine and placebo. Clin. Phamacol. Therapearics, 1962, in press.
A confirmation of nine postulared psychotic syndromes
- M Low
- D M Mcnair
- C J Klett
- J J Lasky
LOW, M., MCNAIR, D. M., KLETT, C. J., & LASKY, J. J. A confirmation of nine
postulared psychotic syndromes. Amer. Psychologist, 1960, 15, 495. (Abstract)
Multidimensional Scale for Rating Psychiatric Patients
- M Lorr
- R L Jenkins
- J Holsopple