Suicide risk is elevated among individuals at clinical high risk for psychosis (CHR-P). The current study examined variability in suicidal ideation during treatment for individuals at CHR-P.
Cannabis is used by one third of youth in Early Psychosis Intervention (EPI) programs and high dose consumption of the primary constituent Δ-9 tetrahydrocannabinol (THC) is associated with higher risk for relapse in this group. Cannabidiol (CBD) is a secondary cannabis constituent that may have antipsychotic properties, though its health risks are only beginning to be understood. Little is known about the views of youth in EPI programs toward CBD, including their reasons for use and perceptions of risk.
To review and evaluate the evidence from meta-analytic studies of psychosocial and behavioural interventions for the negative symptoms of schizophrenia. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Childhood-onset schizophrenia (COS) is a rare and severe form of schizophrenia with an estimated prevalence of 1/10,000. Schizophrenia and Autism spectrum disorder (ASD) have shared phenotypic features and shared genetic etiology. There is growing research surrounding the co-occurrence of psychomotor syndromes like catatonia with neurodevelopmental disorders like ASD or psychiatric disorders like schizophrenia. In 2013, Shorter and Wachtel described a phenomenon of the ‘Iron Triangle’ where COS, ASD, and catatonia often co-occur. The Iron Triangle theory is based on observation of historical case literature, which showed that all three diagnoses in the Iron Triangle were routinely assigned to children and adolescents. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
For people living with psychosis, cognitive impairment is common and can have significant impacts for functional recovery, impacting engagement with treatment and quality of life more broadly. There is now strong evidence for the effectiveness of cognition-focused treatments, such as cognitive remediation to improve clinical and functional outcomes for people with psychosis. However, engagement with treatment has been a long-standing issue in mental health care, including for people with psychosis, who often experience difficulties with motivation. While research on clinical effectiveness of cognition-focused treatment is growing, to date there has been little research focused on the implementation of such treatments and it is not clear how best to support uptake and engagement across diverse mental health settings
Schizophrenia onset in the developmental age has a strong neurodevelopmental burden and is associated with a poorer prognosis. The approach to diagnosis is still based on symptomatic description without objective validation. In this study, we aimed to compare the peripheral blood levels of hypothesized biomarker proteins: brain-derived neurotrophic factor (BDNF), proBDNF, p75 neurotrophin receptor (p75NTR) and S100B between early-onset schizophrenia-spectrum adolescents (n = 45) and healthy controls (n = 34). To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Early intervention in people with an at-risk mental state (ARMS) for psychosis can prevent the onset of psychosis. Clinical guidelines recommend that ARMS are referred to triage services, and then to Early Intervention (EI) teams in secondary care for assessment and treatment. However, little is known about how ARMS patients are identified and managed in UK primary and secondary care. This study explored patients' and clinicians' views of ARMS patients' care pathways.
Youth at clinical high risk (CHR) for psychosis have high rates of early life trauma, but it is unclear how trauma exposure impacts later negative symptom severity in CHR. The current study examined the association between early childhood trauma and the five domains of negative symptoms (anhedonia, avolition, asociality, blunted affect, alogia).
It is clear from the results that participants were uncertain about how to support their family members with reducing or stopping antipsychotics and the harms and benefits of doing so. Thus, it might be beneficial for clinicians to provide family members with sufficient information about the above, so they can make an informed decision about the best options for support. Continued monitoring might ensure that the family member does not need to increase their dosage, change antipsychotics, or take antipsychotics again.
This study aimed to establish a prediction model of quetiapine concentration in patients with schizophrenia and depression, based on real-world data via machine learning techniques to assist clinical regimen decisions. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Understanding the evolution of negative symptoms in first-episode psychosis (FEP) requires long-term longitudinal study designs that capture the progression of this condition and the associated brain changes. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
There are communities in which hearing voices frequently is common and expected, and in which participants are not expected to have a need for care. This paper compares the ideas and practices of these communities. We observe that these communities utilize cultural models to identify and to explain voice-like events—and that there are some common features to these models across communities......To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Approximately one-third of patients with a psychotic disorder experience visual hallucinations (VH). While new, more targeted treatment options are warranted, the pathophysiology of VH remains largely unknown. Previous studies hypothesized that VH result from impaired functioning of the vision-related networks and impaired interaction between those networks, including a possible functional disconnection between the primary visual cortex (V1) and higher-order visual processing regions. Testing these hypotheses requires sufficient data on brain activation during actual VH, but such data are extremely scarce. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Partial agonists of dopamine receptors are used in combination with full antagonists in treating psychosis, either to mitigate side-effects or in the hope of increasing effectiveness. We examine how combinations may affect the occupancy of D2/D3 dopamine receptors and explore how these can explain the outcomes in the light of the dopamine hypothesis of psychosis. The combinations considered here are from published studies combining aripiprazole with amisulpride, with risperidone in people with hyperprolactinaemia and with olanzapine to mitigate weight gain. We discuss possible worsening of symptoms by the addition of a partial agonist or switching. We also examine the potentially adverse interaction with a full antagonist such as haloperidol given during a subsequent relapse to control severe agitation. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Clozapine dose assessment in treatment-refractory schizophrenia is complicated. There is a narrow margin between an effective and a potentially toxic dose and wide inter-individual variation in clozapine metabolic capacity. Moreover, factors such as changes in smoking habit, infection/inflammation, co-prescription of certain drugs, notably fluvoxamine, and age alter the dose requirement within individuals. Therapeutic drug monitoring (TDM) of plasma clozapine and N-desmethylclozapine (norclozapine) can help assess adherence, guide dosage and guard against toxicity. This article gives an overview of clozapine pharmacokinetics and factors affecting clozapine dose requirements. It then outlines the procedures and processes of clozapine TDM, from taking the blood sample for laboratory assay or point-of-contact (finger-prick) testing (POCT) to interpreting and acting on the results. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Family history is an established risk factor for mental illness. The authors sought to investigate whether polygenic scores (PGSs) can complement family history to improve identification of risk for major mood and psychotic disorders. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Negative symptoms are a primary cause of disability in schizophrenia for which there are no established pharmacotherapies. This study evaluated a novel psychosocial intervention that combined two evidence-based practices—motivational interviewing and cognitive-behavioral therapy (MI-CBT)—for the treatment of motivational negative symptoms. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Guidance on clozapine dosing in treatment-resistant schizophrenia is based largely on data from White young adult males. This study aimed to investigate the pharmacokinetic profiles of clozapine and N-desmethylclozapine (norclozapine) across the age range, accounting for sex, ethnicity, smoking status, and body weight. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Medication self-management (MSM) is considered an important aspect of pharmacotherapy and plays an essential role in the treatment of various illnesses. To date, research into the willingness and attitude of psychiatric healthcare providers toward MSM in patients diagnosed with schizophrenia or bipolar disorders during hospitalization is lacking. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
The study aimed to evaluate the efficacy, and explore carers' experience, of a brief carer focussed intervention in an Early Intervention in Psychosis (EIP) service using a mixed methods approach.
Dropping out of psychological interventions is estimated to occur in up to a third of individuals with psychosis. Given the high degree of attrition in this population, identifying predictors of attrition is important to develop strategies to retain individuals in treatment. We observed a particularly high degree of attrition (48%) in a recent randomized controlled study assessing cognitive health interventions for first-episode psychosis participants with comorbid social anxiety. Due to the importance of developing interventions for social anxiety in first episode psychosis, the aim of the present study was to identify putative predictors of attrition through a secondary analysis of data. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
This study examines associations between premorbid adjustment and comorbid disorders in individuals at ultra-high risk (UHR) for psychosis. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Many individuals with schizophrenia discontinue initially prescribed antipsychotics. Knowledge on reasons for discontinuation among individuals with first-episode schizophrenia is sparse. We aimed to describe reasons for discontinuation and continuation, differences between individuals discontinuing and continuing, and factors predicting reasons for discontinuation or continuation.
Evidence suggests that both childhood trauma and perceived stress are risk factors for the development of psychosis, as well as negative symptoms such as anhedonia. Previous findings link increases in perceived stress to anhedonia in individuals at clinical high risk for psychosis (CHR) and depression; however, the role of childhood trauma in this relationship has not yet been explored, despite consistent evidence that it is associated with sensitisation to later stress. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
People with severe mental ill health (SMI) experience some of the largest health inequalities of any sector within society. For these inequalities to be reduced, an understanding of the behavioural determinants of health in this population is needed. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
The authors present an interesting study that attempts to support clinical decision-making in important patient subgroups. Overall, they show that the data do not support an individualised treatment approach, where treatment is matched to a patient subtype.
Psychosis and related disorders are a major public health issue. Early identification and prevention for those at high risk (at-risk-mental-state, ARMS) is important. General practitioners (GPs) are often the first point of contact for health services. In this review we aim to identify (1) the most common methods for identifying individuals with an ARMS in primary care, (2) the methods for improving identification of individuals with an ARMS in primary care, and (3) the most common barriers that prevent GPs from screening for individuals with an ARMS.
There is growing interest in early intervention in psychotic disorders. However, gender differences in the outcomes of such treatment have not been studied in a randomized clinical trial. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Negative symptoms of schizophrenia manifest as reduced motivation and pleasure (MAP) and impaired emotional expressivity (EXP). These can occur as primary phenomena, but have also been suggested to occur secondary to other clinical factors, including antipsychotic-induced sedation. However, this relationship has not been established formally. Here, we examined the effect of antipsychotic-induced sedation (assessed via the proxy of total daily sleep duration) on MAP and EXP in a cohort of 187 clozapine-treated patients with schizophrenia followed for over 2 years on average, using multilevel regression and mediation models.
Complex schizophrenia symptoms were recently conceptualized as interactive symptoms within a network system. However, it remains unknown how a schizophrenia network changed during acute antipsychotic treatment. The present study aimed to evaluate the interactive change of schizophrenia symptoms under seven antipsychotics from individual time series. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Throughout the life stages of women with schizophrenia-spectrum disorders (SSD), lower estrogen levels are associated with more severe disease course. At perimenopause in the mid-forties, estrogen levels decline to remain persistently low after menopause. This period is hypothesized to increase relapse risk and reduce antipsychotic effectiveness in preventing relapse.
Although maintenance treatment with antipsychotics protects against psychotic relapse, high doses may hamper recovery. Therefore, dose reduction or discontinuation may be considered in patients with chronic schizophrenia. Here, we identified risk factors for psychotic relapse when doses are reduced. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
There have been concerns that clozapine treatment may undermine the capacity of the body to fight infection and increase the vulnerability to contracting COVID-19. This review of recent cohort studies investigated (1) whether people with a severe psychiatric disorder are at increased risk of COVID-19 and complications, (2) the immunological response of clozapine-users who contract COVID-19, and (3) patients’ perspectives on COVID-19 and the pandemic response.
The study is consistent with previous research in finding that IHT reduced the amount of time spent in hospital for people experiencing an acute mental health crisis. The average reduction of 24.55 days in hospital over 12 months seems clinically significant, especially as this study was performed in a modern crisis care system with a greater number of other care options than in previous studies. Therefore, the findings should be disseminated to clinicians and service users, to show that home treatment is an effective alternative to hospital admission. Importantly for those who might be worried about the risks of IHT, the study did not find any increase in adverse events or later compulsory admission, although there might not have been a big enough sample size to detect a difference.
Whether ACT-DL is beneficial in the long-term for only a sub-group of people experiencing symptoms of early psychosis or all of them seems a question of secondary importance when preliminary evidence shows that it is effective for negative symptoms. Furthermore, the confirmation that providing therapeutic intervention in combination with ACT components is likely to help delay or manage the negative symptoms of early psychosis is imperative for clinicians and health care providers.
Personal recovery literature has been influential in the conceptualisation of emotional distress and service provision. While personal recovery in psychosis has been well-studied, voice hearing literature has not been reviewed to elucidate recovery processes. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Childhood disturbances in social, emotional, language, motor and cognitive functioning, and schizotypy have each been implicated as precursors of schizophrenia-spectrum disorders. We investigated whether relationships between early childhood developmental vulnerabilities and childhood schizotypy are mediated by educational underachievement in middle childhood.
Psychotic disorders and schizotypal traits aggregate in the relatives of probands with schizophrenia. It is currently unclear how variability in symptom dimensions in schizophrenia probands and their relatives is associated with polygenic liability to psychiatric disorders. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Developing effective treatment options for negative symptoms of psychotic disorders remains a major unmet treatment need and area for further research. In a recent uncontrolled study by Swanson et al., (2021), Metacognition Training (MCT) for negative symptoms was found to lead to fewer negative symptoms, less stigma and increased self-rated reflective ability. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Conclusions
Auditory, visual, somatic, olfactory, and tactile hallucinations were experienced by deaf people with psychosis, with audio-visual being the most prevalent type of hallucination
The content of hallucinations was religious, paranoid, and/or sexual in nature
It appears that clinicians and researchers need to consider both individual sensory experiences and preferred communication style (e.g., sign, lip-reading, hearing-aid, using or not using their voice) when assessing voice hearing in prelingually deaf people with psychosis.
Based on the number needed to treat for the main study outcome, the authors concluded that 'for every 3 individuals continuing antipsychotic treatment at standard doses, one additional individual will avoid relapse compared to stopping antipsychotic treatment, which can be regarded as a large effect magnitude according to commonly used thresholds.'
Despite the emphasis shifting over the past century from institutional (asylum) care to community treatment and integration, including a focus on occupational functioning, this study did not find that the gap in educational attainment is narrowing for people with schizophrenia (compared to those without). In fact, in low and middle-income countries, this gap may be widening....
....it is important to note that disengagement from education systems often happens far earlier in life than the onset of schizophrenia, pointing to the fact that we cannot simply rely upon First Episode Psychosis services to address this problem. In fact, recent research suggests that cognitive deficits in people with schizophrenia begin to emerge more than a decade before the onset of psychosis itself (Jonas et al., 2022)
For me, the key implication of the study is that people accessing CAMHS, particularly people who experienced inpatient care in adolescence, should be considered for regular review. Once reaching adulthood, screening and assessment for bipolar and psychosis should be available in the adult mental health services. Hopefully, these measures will limit the duration of non-treatment.
Negative content in hearing voices (i.e., auditory verbal hallucinations) has been associated with adverse clinical outcomes including voice-related distress. Voice appraisals and responding mindfully to voices are theorized to reduce voice-related distress. This study aimed in examine mediators of the negative content voice-related distress relationship in clinical (those who recently received input from mental health services) and non-clinical voice-hearers.
The authors sought to determine whether antipsychotic use, compared with nonuse, is associated with lower work disability in first-episode nonaffective psychosis, and if so, for how long. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
There is a strong association between stress and psychotic symptoms, and this study examined the bidirectional nature of this relationship in parents with psychosis, with negative affect as a mediator and a range of other psychosocial factors included as covariates. It also examined whether stress from parenting had a larger impact on psychosis than non-parenting stress.
Patients with schizophrenia have a significant risk of self-harm. We aimed to explore the dynamic relationship between symptomatology, functioning and deliberate self-harm (DSH) and evaluate the feasibility of developing a self-harm risk prediction tool for patients with first-episode schizophrenia (FES). To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Schizophrenia-spectrum disorder (SSD) is associated with increased premature death, with emerging data suggesting early illness course as a high-risk period for excess mortality. This study aimed to examine mortality rate in patients with incident SSD and differential mortality risk between inpatient-diagnosed and outpatient-diagnosed subsamples within 5 years of first diagnosis. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
A. Laenen, T. Vangeneugden, H. Geys, and G. Molenberghs. The British journal of mathematical and statistical psychology, 59 (Pt 1):
113-31(May 2006)Mesures de concordància; Online; ICC; Psiquiatria.