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”.
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”.
Previous research has indicated that individuals expressing high schizotypal traits and patients with Schizotypal Personality Disorder (SPD), show deficits in facial emotion recognition, compared to low schizotypal or control groups. On the other hand, non-significant findings also exist and the association of facial emotion recognition deficits with the different schizotypal dimensions is not well defined, thus limiting any conclusive outcomes. Therefore, the aim of this systematic review was to further clarify this relationship. To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
In 2016 NICE updated its guidance, extending the age to which early intervention in psychosis (EIP) services treat patients following their first episode of psychosis, to 65 years, from the previous cut-off of 35 years. The aim of this service evaluation was to identify differences in the demographic details, diagnoses, and treatments between patients below and above 35 years to identify any unmet needs in the latter age category.To read the full article, choose Open Athens “Institutional Login” and search for “Midlands Partnership”.
Antipsychotic-induced weight gain is associated with alterations to the composition of the gut microbiota. The purpose of this study was to determine the effect of probiotics plus dietary fiber on antipsychotic-induced weight gain.
In a complex world, gathering information and adjusting our beliefs about the world is of paramount importance. The literature suggests that patients with psychotic disorders display a tendency to draw early conclusions based on limited evidence, referred to as the jumping-to-conclusions bias, but few studies have examined the computational mechanisms underlying this and related belief-updating biases. Here, we employ a computational approach to understand the relationship between jumping-to-conclusions, psychotic disorders, and delusions.
Quantitative models of psychopathology can empirically guide subclassification of heterogeneous clinical presentations such as psychosis; they are particularly well-equipped to capture the nuanced symptomatology observed in first-episode psychosis. As well, components may be better aligned with biological variables. The current study sought to confirm and extend knowledge of the hierarchical structure of psychosis symptoms in first-episode psychosis. Based on past hierarchical work, we hypothesized that a 4 component level would be most closely associated with longitudinal disability.
A consensus definition of clinical recovery in first-episode psychosis (FEP) is required to improve knowledge about recovery rates in this population. To propose criteria for a future consensus definition, this study aims to investigate rates of clinical recovery when using a standard definition (full psychotic symptom remission and adequate functioning for minimum one year) across both affective and nonaffective FEP groups (bipolar spectrum and schizophrenia spectrum disorders).
Most voice hearers report childhood trauma. Many voice hearers report comorbid post-traumatic stress symptoms and that the content of their voices (auditory verbal hallucinations) is directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. The factors that maintain trauma-related voices are unknown, and there is limited research in this area. This study aimed to identify potential maintaining factors of trauma-related voices by reviewing models of post-traumatic stress disorder (PTSD) and positive symptoms of psychosis. Open access article- no login required
This study provides definitive evidence that the gameChange intervention is safe and can be effective for treating avoidance of social situations in people diagnosed with a psychotic disorder, particularly for those with more severe avoidance. As most clinicians would probably not have used VR for treatment before, or perhaps never even heard of it, the results provide assurance that this novel approach is not going to harm the people they work with and may provide an effective adjunct to usual care for improving social difficulties in psychosis populations.
Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. To read the full article, log in using your NHS OpenAthens details.
This study specifically examined how mental health professionals assess the difficulties faced by caregivers in the Greek context. However, prior research suggests that the caregiving burden may be impacted by income and race or culture (Do et al., 2014). Therefore, it would be beneficial to replicate this research and examine how mental health professionals perceive informal caregivers’ needs in different countries, to see if they assess them differently.
The prevalence and significance of schizophrenia-related phenotypes at the population level is debated in the literature. Here, the authors assessed whether two recently reported neuroanatomical signatures of schizophrenia—signature 1, with widespread reduction of gray matter volume, and signature 2, with increased striatal volume—could be replicated in an independent schizophrenia sample, and investigated whether expression of these signatures can be detected at the population level and how they relate to cognition, psychosis spectrum symptoms, and schizophrenia genetic risk.. To read the full article, log in using your MPFT NHS OpenAthens details.
People presenting with first-episode psychosis (FEP) have heterogenous outcomes. More than 40% fail to achieve symptomatic remission. Accurate prediction of individual outcome in FEP could facilitate early intervention to change the clinical trajectory and improve prognosis. We aim to systematically review evidence for prediction models developed for predicting poor outcome in FEP. To read the full article, log in using your MPFT NHS OpenAthens details.
Determining the extent to which relationships between duration of untreated psychosis (DUP) and outcome endure longitudinally across the lifetime course of psychotic illness requires prospective, systematic studies of epidemiologically representative incidence cohorts across decades. Transience, persistence, or heterogeneity in associations between DUP and distinct outcome domains are yet to be investigated over such time frames. To read the full article, log in using your MPFT NHS OpenAthens details.