this study contributes to the growing evidence-base which suggests that ACT could be another treatment option for people with psychosis. Further studies of ACT for people with psychosis are required to continue building upon the evidence-base.
Within healthcare services, we facilitate ACT-based groups for people with mental health difficulties. We have an opportunity here to set up ACT-based groups specifically for people with psychosis and conduct service evaluation studies to evaluate their feasibility in services.
"I believe this study has one major implication for clinical practice – it highlights the urgent need to improve the survival rates of patients with psychosis.
It is unacceptable that 13-14% of people with a FEP in this study passed away by the 20-year follow-up, especially given the average age for these patients was just 46. This rate is likely to be the result of multiple factors, including death by suicide (3.5%). We know that the main cause of death in these patients is cardiovascular-related, and more research is needed to investigate why this is the case, and what to do about it."
Based on a number needed to assess (NNA) of 18 for clinically relevant abnormalities, Blackman et al. (2023) conclude that their findings “support the use of MRI as part of the initial clinical assessment of all patients with FEP.” However, due to the authors’ liberal definition of clinical relevance together with the exclusion of patients with a suspected non-psychiatric cause of psychosis in most of the included studies, it remains debatable whether routine screening is warranted for all patients with FEP. Given recent evidence about the prevalence of autoimmune encephalitis as a potential cause of FEP (Scott et al., 2018), there may be other diagnostic procedures that are better warranted than routine neuroimaging in FEP depending on clinical presentation.
This study is important because it raises awareness of available resources, such as HVGs and peer support, from which people who hear voices can access care outside mental health services. The findings can be used to inform further training for professionals working in secondary care mental health services (i.e., CMHTs) and/or those supporting people who hear voices. Healthcare professionals should be aware of the benefits of HVGs and other groups and encourage collaborations between HVGs and the NHS (i.e., via signposting or community referrals).
This study evaluated the relationship between negative symptoms, daily time use (productive/non-productive activities, PA/NPA), and negative emotions in schizophrenia-spectrum disorders (SSDs): 618 individuals with SSDs (311 residential care patients [RCPs], 307 outpatients) were surveyed about socio-demographic, clinical (BPRS, BNSS) and daily time use (paper-and-pencil Time Use Survey completed twice/week) characteristics.
This systematic review aimed to review neuroimaging studies comparing clozapine-resistant schizophrenia patients with clozapine-responding patients, and with first-line antipsychotic responding (FLR) patients.
Vitamin D deficiency is prevalent in people with established psychotic disorders, but less is known about vitamin D levels in people with first-episode psychosis (FEP). This study aimed to determine the prevalence of vitamin D deficiency in people with FEP and identify the factors associated with vitamin D status.
The quality of life in people with psychosis has been consistently demonstrated to be lower than those without, with self-stigma contributing greatly to this impairment. Hence, it is imperative to address this gap in order to facilitate recovery-oriented and other outcomes. This study investigates the potential of religiosity in moderating the effects of self-stigma on quality of life among those with psychosis. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Schizophrenia is associated with increased risk of cardiovascular disease (CVD), although there is variation in risk among individuals. There are indications of shared genetic etiology between schizophrenia and CVD, but the nature of the overlap remains unclear. The aim of this study was to fill this gap in knowledge. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Identification of robust biomarkers that predict individualized response to antipsychotic treatment at the early stage of psychotic disorders remains a challenge in precision psychiatry. The aim of this study was to investigate whether any functional connectome-based neural traits could serve as such a biomarker. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes.
Although research has documented the marked disparities in rates of psychosis-spectrum diagnoses in various socially marginalized populations, there is limited research addressing the needs of gender expansive individuals in the context of psychosis-spectrum illnesses using a minority stress lens. As clinical high-risk for psychosis (CHR-p) assessment and treatment becomes accessible to increasingly diverse populations, there is a need for clinicians to demonstrate greater clinical competency working with individuals across diverse social backgrounds and identities. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Clinical guidelines recommend providing physical activity interventions (PAIs) to people with schizophrenia or bipolar disorder for weight management. However, the cost-effectiveness of PAIs is unknown. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Fractures are common accidents for long-term hospitalized patients with schizophrenia (SZ) in psychiatric hospitals, and once they occur, patients usually endure the pain of fractures for a long time. Accumulating evidence has supported the implementation of dance/movement therapy (DMT) as a promising intervention for patients with SZ. However, no research has been conducted to investigate its role in balance ability in SZ. This study was designed to investigate the efficacy of a 12-week DMT intervention in bone mineral density and balance ability in patients with SZ using a randomized, controlled trial design. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Loneliness is prevalent among individuals with mental illnesses. This cross-sectional survey study examined the moderating effects of self-esteem and perceived support from families and friends on the association of loneliness with suicide risk and depression in individuals with schizophrenia. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Aripiprazole is recommended for routine use in schizophrenia patients. However, the biological mechanism for the adverse drug reactions (ADRs) among schizophrenia patients with the antipsychotic drug aripiprazole is far from clear. To explore the potential genetic factors that may cause movement-related adverse antipsychotic effects in patients, we conducted an association analysis between movement-related ADRs and SNPs in schizophrenia patients receiving aripiprazole monotherapy.
To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Negative symptoms of schizophrenia are linked with poor functioning and quality of life. Therefore, appropriate measurement tools to assess negative symptoms are needed. The NIMH-MATRICS Consensus defined five domains for negative symptoms, which The Brief Negative Symptom Scale (BNSS) covers. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
VR may be an effective environment for psychosis patients with agoraphobia. Although patients are aware that VR environments are not real, they very closely match real-world experiences and allow for greater engagement with treatment (Lambe et al., 2020). Psychosis patients are more likely to enter situations within VR that they would otherwise find incredibly distressing in the real world and this allows a safe space for experimentation (Lambe et al., 2020).
The authors argue that there is something about a person’s natural inclination to seek contact with other people that helps stave off the risk – or at least the speed – of developing psychosis, in the face of particular stressors. There are many reasons why this might be, but specifically highlighting residential instability is useful in terms of improving early interventional and risk reduction approaches. Clinicians may wish to be particularly proactive in bolstering social opportunities and support for people who are less extravert, and are currently facing a move of residency.
The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period.
The aim of this qualitative study is to explore patients' perspectives on Acceptance and Commitment Therapy for early stages of psychosis. Therefore, we interviewed participants of the INTERACT study, that quantitatively investigated Acceptance and Commitment Therapy in Daily Life (ACT-DL) in combination with treatment as usual, for early stages of psychosis, comparing it to treatment as usual.
Early intervention services are the established and evidence-based treatment option for individuals with first-episode psychosis. They are time-limited, and care pathways following discharge from these services have had little investigation. We aimed to map care pathways at the end of early intervention treatment in England to determine common trajectories of care.
Ultra-high risk (UHR) is considered a forerunner of psychosis, but most UHR individuals do not later convert, yet remain symptomatic, disabled and help-seeking. Thus, there is an increased recognition of the UHR phenotype as a syndrome in itself, rather than merely a risk syndrome. It is therefore essential to investigate outcomes other than transition to psychosis. For this purpose, perceptual aberration appears to be a distinct, as well as a stable and less state-specific vulnerability indicator. We aimed to investigate perceptual aberration and associations with functional, neuro and social cognitive risk factors in an UHR sample.
Negative symptoms are an important symptom dimension in schizophrenia that are often least responsive to antipsychotic medications. We revisit the current practice of identifying ‘primary’ negative symptoms and suggest that its concept would benefit from a further elaboration of their timing of emergence in relation to the dynamic neurobiological changes to enhance their utility in clinical decision-making and research. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Cognitive remediation is currently recommended to treat cognitive and functional impairments in patients with schizophrenia. Recently, treatment of negative symptoms has been proposed as a new target for cognitive remediation. Evidence of reductions in negative symptoms has been described in different meta-analyses. However, treating primary negative symptoms is still an open question. Despite some emerging evidence, more research focused on individuals with primary negative symptoms is indispensable. In addition, more attention to the role of moderators and mediators and the use of more specific assessments is necessary. Nevertheless, cognitive remediation could be considered as one promising option to treat primary negative symptoms.To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Negative symptoms are core symptoms of schizophrenia which are common throughout the course of the illness. We outline their functional impact, before reviewing the latest research and guidelines on their assessment and treatment. Finally, we discuss conceptual issues related to measurement of negative symptoms and approaches to address these. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Although clozapine is the most efficacious medication for treatment-refractory schizophrenia, not all patients will have an adequate response. Optimising clozapine dose using therapeutic drug monitoring could therefore maximise response. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Medication adherence of schizophrenic patients is a growing public health problem. We conducted a meta-analysis on the influencing factors of medication compliance in schizophrenic patients.
The risk of psychosis hospitalization was lower during antidepressant use as compared to non-use (adjusted Hazard Ratio, aHR, 0.93, 95% CI 0.92–0.95). Antidepressants were associated with a decreased risk of mortality (aHR 0.80, 95% CI 0.76–0.85) and a slightly increased risk of non-psychiatric hospitalization (aHR 1.03, 95% CI 1.01–1.06). In conclusion, these results indicate that antidepressants might be useful and relatively safe to use in this population.
Syntax, the grammatical structure of sentences, is a fundamental aspect of language. It remains debated whether reduced syntactic complexity is unique to schizophrenia spectrum disorder (SSD) or whether it is also present in major depressive disorder (MDD). Furthermore, the association of syntax (including syntactic complexity and diversity) with language-related neuropsychology and psychopathological symptoms across disorders remains unclear.
Prospection refers to the ability to simulate and pre-experience future events. Schizophrenia patients have difficulty in anticipating pleasure in future events, but previous studies examined prospection deficits in chronic schizophrenia patients. This study aimed to investigate prospection deficits in first-episode schizophrenia patients.
New-onset psychosis is always disconcerting and alarming for patients, families, and clinicians. Although some acute psychotic disorders are brief and resolve in a short period of time, others progress to schizophrenia or bipolar disorder and have a long-term impact on people’s mental health and quality of life. Substance-induced psychotic disorders are brief psychotic syndromes triggered by substance use that persist for days or weeks after intoxication has resolved. Abundant evidence suggests that individuals presenting to mental health services with substance-induced psychotic disorders have a significant risk of later transition to schizophrenia or, more zgenerally, to a chronic psychotic disorder. A recent meta-analysis (1) of 25 studies providing substance-specific estimates of transition to schizophrenia spectrum disorders among more than 34,000 individuals with substance-induced psychotic disorder estimated a pooled transition rate of 25% across all substances, with differential rates depending on the substance.
Psychosis spectrum disorders continue to rank highly among causes of disability. This has resulted in efforts to expand the range of treatment targets beyond symptom remission to include other recovery markers, including social and occupational function and quality of life. Although the efficacy of psychosocial interventions in early psychosis has been widely reported, the acceptability of these interventions is less well-known. This study explores the participant perspective on a novel, psychosocial intervention combining cognitive remediation and social recovery therapy.
Disengagement from Early Intervention in Psychosis (EIP) services is pronounced in individuals from racially minoritized or diverse ethnic backgrounds, lesbian, gay, bisexual, transgender, and queer or questioning individuals, and individuals from some religious or spiritual backgrounds. The Early Youth Engagement in first episode psychosis study (EYE-2) is a cluster randomized controlled trial that tests a new engagement intervention.
The authors investigated transitions to schizophrenia spectrum or bipolar disorder following different types of substance-induced psychosis and the impact of gender, age, number of emergency admissions related to substance-induced psychosis, and type of substance-induced psychosis on such transitions. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Consistent with the current literature, this study indicates that standard antipsychotic dosing is best for relapse prevention. Clinicians should resist the urge to utilise low-dose antipsychotic therapy in the early years of schizophrenia requiring hospitalisation.
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”.