Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019

Synergistic insights into positive allosteric modulator and agonist using Gaussian accelerated and tau random acceleration simulations in the metabotropic glutamate receptor 2

Schizophrenia is a severe brain disorder that usually produces a lifetime of disability. Related research shows activating metabotropic glutamate receptors holds therapeutic potential. Agonist-positive allosteric modulations (ago-PAMs) not only activate metabotropic glutamate receptors but also enhance glutamate-induced responses, offering a promising treatment strategy. However, the molecular mechanisms by which ago-PAM enhances glutamate-induced responses remain unclear, as does the potential influence of glutamate on ago-PAM. In this study, Gaussian accelerated molecular dynamics and tau random acceleration molecular dynamics simulations were employed to investigate the molecular mechanism between ago-PAM and glutamate in full-length mGlu2. Results suggest that the ago-PAM JNJ-46281222 enhances the binding affinity and residence time of glutamates in the Venus flytrap (VFT) domains by initiating a variant reverse communication from the heptahelical transmembrane (7TM) domains to VFTs via the cysteine-rich domains. Meanwhile, glutamate facilitates the interaction between Trp676 and Glu701 to further induce the relaxation of TM5, promoting the opening of the PAM-binding pocket. Glutamate can also promote the upward rotation of the cyclopropylmethyl group of the JNJ-46281222 to bring the TM6-TM6 distance closer. Nevertheless, it remains uncertain how the binding between mGlu2 and G protein differs when induced by small molecules binding in allosteric sites, orthosteric sites, or both. In conclusion, this study shed new light on the positive coordination relationship between ago-PAM and glutamate in the full-length mGlu2 receptor, which could help develop novel and more effective ago-PAM to treat schizophrenia.

Association between serum bilirubin and type 2 diabetes mellitus risk: Findings from a schizophrenia cohort

BACKGROUND

The relationship between serum bilirubin levels and type 2 diabetes mellitus (T2DM) in individuals with schizophrenia (SCZ) remains poorly understood. This study investigated associations between total, conjugated, and unconjugated bilirubin (TB, CB, and UCB) and T2DM risk, while exploring the potential role of inflammatory pathways.

METHODS

The study included 862 SCZ patients from Baiyun Jingkang Hospital, Guangzhou, the People's Republic of China. Cox proportional hazards model assessed baseline bilirubin and T2DM risk, while causal mediation analysis explored inflammatory markers. Latent class trajectory model and logistic regression model evaluated the association between multi-timepoint trajectories of bilirubin and T2DM prevalence.

RESULTS

Over a median 3.19-year follow-up, 63 T2DM cases were diagnosed. Adjusted hazard ratios per 1 μmol/L increase were 0.88 (95 % CI: 0.82-0.95) for TB, 0.71 (0.57-0.89) for CB, and 0.86 (0.78-0.95) for UCB. Compared to the lowest tertile, the highest tertiles of TB, CB, and UCB were associated with 63 %, 74 %, and 63 % reduced T2DM risks, respectively. Lymphocyte count mediated TB (8.77 %), CB (11.68 %), and UCB (8.34 %); CRP mediated TB (3.33 %) and UCB (4.60 %) with T2DM. Persistently high TB and UCB levels were associated with lower T2DM prevalence (OR = 0.22 and 0.30, respectively).

CONCLUSION

Elevated bilirubin levels are associated with reduced T2DM risk in SCZ patients, with lymphocyte count and CRP partially mediating the bilirubin-T2DM relationship. And persistently high levels of TB and UCB linked to a lower prevalence of T2DM. These findings suggest that moderately elevated serum bilirubin may reduce T2DM risk among SCZ patients.

INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia

Schizophrenia is a mental illness involving multiple symptom domains and is often associated with substantial physical health comorbidities. Guidelines exist, but these tend to be country-specific and are often missing a concise yet comprehensive algorithmic approach. From May 1, 2023, to Jan 1, 2025, International Guidelines for Algorithmic Treatment (INTEGRATE) authors from all UN regions collaborated to develop a consensus guideline focused on the pharmacological treatment of schizophrenia. Following an umbrella review of the literature, input from expert workshops, a consensus survey, and lived experience focus groups, a consensus algorithmic guideline and associated digital tool were developed. Key recommendations include a focus on metabolic health from treatment initiation, timely assessment and management of non-response, symptom domain-specific interventions, mitigation of side-effects, and the prompt use of clozapine in cases of treatment resistance.

Global evaluation of the impact of food fortification with folic acid on rates of schizophrenia

BACKGROUND

Low folate status is one of the multiple factors thought to contribute to the development of schizophrenia. As of 2023, over 70 countries have implemented mandatory fortification of foods with folic acid, a public health measure aimed at reducing neural tube defects; however, the impact of such policy on schizophrenia has not been comprehensively investigated.

METHOD

We assessed the impact of mandatory folic acid fortification on changes in the schizophrenia rates in 194 jurisdictions between 1990 and 2019 using publicly available data. We used weighted regression models adjusted for sociodemographic and sociopolitical factors, experience of natural disasters, and baseline schizophrenia rate.

RESULTS

Age-adjusted prevalence and incidence of schizophrenia increased marginally between 1990 and 2019. In all geographic regions, schizophrenia prevalence and incidence per 100,000 positively correlated with countries' sociodemographic index and were lower with fortification. Schizophrenia burdens were higher among males compared to females. Lower prevalence and incidence of schizophrenia were associated with having mandatory fortification with modest magnitudes. Duration of fortification or the fortification dose did not appear to have a strong impact. However, in the 15-39 year age-group, both mandatory fortification (β = -13·14 (-22·60, -3·68)) and duration of fortification (β = -0·82 (-1·40, -0·23)) were significantly associated with lower schizophrenia with larger magnitude in both sexes. The highest dose tertile was reported to have the lowest incidence and the smallest increase in prevalence in this age-group.

CONCLUSION

Folic acid fortification may be a beneficial intervention in lowering schizophrenia among adolescents and young adults.

Analysis of differentially expressed genes in schizophrenia based on bioinformatics and corresponding mRNA expression levels

OBJECTIVE

This study aimed to use bioinformatics analysis to identify differentially expressed genes (DEGs) involved in the pathogenesis of schizophrenia and validate their mRNA expression levels through real-time quantitative PCR (qPCR).

MATERIAL/METHODS

Datasets from the publicly available Gene Expression Omnibus (GEO) database were analyzed using R software to identify DEGs. Functional enrichment analyses, including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, were conducted. A protein-protein interaction (PPI) network was constructed using Cytoscape software to identify key genes with notable expression changes. The expression levels of these key genes were subsequently validated in schizophrenia patients using qPCR to assess potential susceptibility genes.

RESULTS

In total, 813 DEGs were identified, with six key genes highlighted through GO analysis and PPI network screening. Among these, HDAC1, UBA52, and FYN demonstrated statistically significant differences in mRNA expression between schizophrenia patients and healthy controls (P < 0.05).

CONCLUSIONS

This study identified several DEGs potentially linked to the pathogenesis of schizophrenia, suggesting that HDAC1, UBA52, and FYN could serve as candidate susceptibility genes and diagnostic biomarkers. These findings provide new insights and directions for future schizophrenia research.

New pharmacological approaches in the treatment of schizophrenia

Schizophrenia is a primary health concern, imposing a significant burden on both patients and healthcare systems globally. It is a disease with a complex etiology in which both genetic and environmental factors are involved. Despite numerous studies, the mechanism of its origin is still not fully understood. The hypotheses are synaptic, serotonergic, muscarinic, dopaminergic, microRNA-related, and neurodegenerative theories. Treatment to date is mainly based on antipsychotic drugs that act on the dopaminergic system. Although they are effective in reducing positive symptoms, their effect on negative and cognitive symptoms is limited, and their use is often associated with numerous side effects. A breakthrough in the treatment of schizophrenia came with the approval of the first drug with a non-dopaminergic mechanism of action, which opens up new therapeutic possibilities. As a result, there is intensive research into innovative substances that could increase the effectiveness of treatment and improve the quality of life of patients. In this review, we present the current state of knowledge about schizophrenia, its prevalence, risk factors, and its impact on patients' functioning. We pay special attention to new therapeutic directions, including drugs that affect systems other than the dopaminergic one, which could open up new prospects for treating the condition.

Do biological alterations precede the onset of psychosis? A systematic review and meta-analysis of immune, cardiometabolic, prolactin and HPA axis alterations in clinical high-risk for psychosis

First episode psychosis (FEP) individuals show biological abnormalities preceding antipsychotic treatment. However, it remains unclear whether such alterations are also present before the onset of psychosis. We aim to provide estimates of standardized mean differences for immune, cardiometabolic, prolactin, and HPA axis parameters in individuals at clinical high-risk for psychosis (CHR-P) compared to healthy controls (HC) and FEP individuals, and between CHR-P transitioning to psychosis (CHR-T) compared non-transitioning (CHR-NT). A multistep literature search was performed from database inception until September 25, 2023. PRISMA/MOOSE-compliant and pre-registered (PROSPERO: CRD42024507670) systematic review identified studies reporting on immune, cardiovascular or endocrine parameters in CHR-P samples compared with HC or FEP samples or comparing CHR-T vs CHR-NT. Inter-group differences in magnitude of effect were estimated using Hedges g and estimates were pooled using random-effects meta-analysis. Heterogeneity was high for most outcomes. 37 studies were included, total sample 2509 CHR-P, 710 FEP, and 1444 HC individuals. A statistically significant elevation of pro-inflammatory proteins was found among CHR-P compared with HC (k = 12; N = 1710; g = 0.16; p < 0.01) and FEP (k = 7; g = 0.15; p = 0.04) subjects. Interleukin-6 (IL-6) was increased in CHR-P compared to HC (k = 9; N = 1243; g = 0.54; p < 0.01), and interleukin-4 (IL-4) was increased in CHR-T compared with CHR-NT (k = 2; N = 318; g = 0.36; p < 0.01). CHR-P exhibited stronger cortisol awakening response than FEP subjects (k = 3; N = 173; g = 0.51; p = 0.01). CHR-P and FEP individuals did not show statistically significant differences in terms of prolactin levels. An inflammatory state (particularly marked by elevated IL-6 and IL-4 levels) and HPA axis alterations are present in CHR-P individuals.

Microstructural imaging of brain changes in schizophrenia via quantitative T1 (qT1): a preliminary comparison of two acquisition protocols

Schizophrenia spectrum disorders (SSD) are a complex group of illnesses, and their pathophysiology remains unclear. Recent developments in neuroimaging techniques provided useful quantitative measures, such as quantitative T1 mapping (qT1) that is susceptible to tissue-level, microscopic changes. However, it is important to identify the most sensitive, accurate, and reliable imaging protocol, given the complex nature of SSD. We compared structural brain changes in a pilot sample of 15 SSD patients and 7 healthy controls, cross-sectionally, and using two different qT1 mapping protocols. Our findings showed a global elevation in qT1 values in SSD patients, that was statistically significant in the lateral ventricles, thalamus, caudate, and hippocampus (p < 0.01). Moreover, the two acquisition protocols were differently modulated by demographic factors, such as age, sex, and education, which further illustrates the importance of protocol selection. In conclusion, this investigation revealed microstructural tissue changes in subcortical regions in SSD patients, providing further insights into the pathophysiology of the illness.

Disrupted default mode network connectivity and its role in negative symptoms of schizophrenia

Schizophrenia is a complex mental disorder characterised by positive symptoms, negative symptoms, and cognitive deficits, with recent studies suggesting that disruptions in the default mode network (DMN) may underlie many of these symptoms. In this study, we used graph theory analysis of resting-state functional magnetic resonance imaging data to investigate differences in the topological organisation and functional connectivity of the DMN in patients with schizophrenia, using two independent datasets of patients and healthy controls. The findings revealed significant group differences in the DMN of patients with schizophrenia, particularly within the core-medial temporal lobe (MTL) subsystem, characterised by lower shortest path length, clustering coefficient, and small-worldness, indicating less efficient network organisation. Weaker functional connectivity in the core-MTL subsystem was correlated with higher avolition-apathy scores, highlighting the role of DMN connectivity patterns in negative symptoms. These results, validated across two independent datasets, emphasise the robust and generalisable association between schizophrenia and DMN network features, less efficient topological properties, and weaker functional connectivity. This underscores the importance of targeting DMN connectivity to alleviate negative symptoms, improve clinical outcomes, and potentially serve as a biomarker for monitoring symptom severity and guiding treatment.

Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021

BACKGROUND

Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented.

METHODS

This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years.

RESULTS

In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years.

CONCLUSIONS

The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).

Elimination of the clozapine risk evaluation and mitigation strategy (REMS) - Improving access to care for those with treatment-refractory schizophrenia

A variety of pharmacological treatment options exist for schizophrenia, although as many as 20 % to 40 % of individuals with schizophrenia experience treatment-refractory symptoms. Typically defined by non-response to at least two sequential, adequate trials of antipsychotics, treatment-refractory schizophrenia represents a significant clinical challenge. Currently, clozapine (Clozaril) is the only evidence-based treatment strategy available for treatment-refractory schizophrenia. Nonetheless, clozapine has long remained underutilized due to administrative barriers such as the Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) program, a historical requirement for clozapine prescribing. The FDA has eliminated the clozapine REMS program effective February 2025. This editorial provides an update on clozapine and recognizes that elimination of the clozapine REMS program will reduce barriers to clozapine prescribing.

Effects of sulforaphane on negative symptoms and cognitive impairments in chronic schizophrenia patients: A randomized double-blind trial

BACKGROUND

The pathological mechanisms of negative symptoms and cognitive impairment in schizophrenia may involve oxidative stress and neuroinflammation. Sulforaphane is an organosulfur compound with antioxidant and anti-inflammatory properties. This study aimed to evaluate its efficacy in ameliorating negative symptoms and cognitive impairments in chronic schizophrenia patients.

METHOD

This 24-week double-blind randomised trial (NCT04521868) recruited schizophrenia patients with significant negative symptoms. Participants were randomly assigned to receive either sulforaphane or placebo and were required to complete at least one post-intervention assessment to evaluate changes in negative symptoms and cognitive functioning. Existing antipsychotic medication treatment regimens remained unchanged throughout the study.

RESULTS

A total of 42 patients were included in the statistical analysis, with 28 receiving sulforaphane and 14 assigned to placebo. Sulforaphane significantly reduced the Negative Symptom Score from the PANSS 5-Factor model between groups (p = 0.007) and exhibited a significant time-by-group interaction (p = 0.023), with more pronounced group differences observed after 12 weeks compared to 24 weeks of treatment. Sulforaphane also demonstrated a significant reduction in the original PANSS Negative Symptom Score between groups (p = 0.029). However, sulforaphane showed no significant effects on the MATRICS Consensus Cognitive Battery composite score or its subscores.

CONCLUSION

The significant improvements in the Negative Symptom Score from the PANSS 5-Factor model and the original PANSS Negative Symptom Score in the sulforaphane group suggest the potential of sulforaphane as an adjunctive treatment for ameliorating negative symptoms in chronic schizophrenia. Further research is warranted to explore the effects of sulforaphane on cognitive function.

Forty years of research trends in long-acting injectable antipsychotics: A bibliometric analysis

BackgroundUsing long-acting injectable (LAI) antipsychotics is crucial for treating psychiatric illnesses, particularly those within the schizophrenia spectrum. Through bibliometric analysis, our study aimed to provide an understanding of the changes in research trends related to LAIs over the past 40 years.MethodsWe collected the publications from 1983 to 2023 related to research studies on LAIs included in the Web of Science database. Two thousand four hundred and twelve publications were selected based on specific criteria and analyzed using the VOSviewer software and the Biblioshiny app. We obtained and presented data on institutional analysis, country analysis, author and co-authorship analysis, journal analysis, funding agencies, and keyword citation numbers.ResultsFrom the period 1983-1992 to 2014-2023, the number of total publications showed a significant growth of 4.91. The majority (approximately 90%) of publications were produced in high-income countries. The private sector may play a significant role in research. The most crucial keywords were schizophrenia and risperidone.ConclusionsThe trend in LAI research is currently dynamic and ongoing. There seems to be an increasing connection between studies and LAIs that contain second-generation antipsychotics. The number of studies relating to the private sector is noteworthy.

Connecting the dots: Understanding and addressing the metabolic impact of antipsychotic and antidepressant medications

Serious mental disorders such as schizophrenia and major depression are associated with considerable morbidity and mortality, resulting in much shorter life expectancies in those affected. The discovery of antipsychotic medications ushered in improved health outcomes for people with serious mental disorders but also brought about increased morbidity due to their metabolic side effects, including obesity and diabetes mellitus. Antidepressant medications have a more favorable metabolic side effect profile, but some can still cause weight gain and hyperglycemia. In this narrative review, we discuss antipsychotic and antidepressant medications' mechanisms of action, their respective effectiveness in treating psychosis and depression, and their metabolic side effects. In addition, we present therapeutic strategies for minimizing cardiometabolic health risks in patients treated with these medications by applying a comprehensive, biopsychosocial approach.

Research metrics of Australian eating disorders researchers

Building the research capacity and capability of Australia's eating disorder (ED) research workforce has been identified as a key strategy to respond to the increasing prevalence of EDs. However, there is currently a limited understanding of the research strengths and scope of this workforce and this is a barrier to capacity building efforts and to evaluating the impacts of these efforts. This study sought to understand and summarise the current research metrics of the top 50 research experts in Australia identified through Expertscape. Publicly available publication, citation and funded research grants metrics, were extracted from Expertscape, Scopus, SciVal, Dimensions.ai and researcher profiles and summarised. The results indicate that Australian Feeding and Eating Disorder (FED) researchers are competitive internationally, and are spread across professional disciplines with the highest representation from psychology. Expertscape researcher rank was associated with higher numbers of publications in feeding and eating disorders overall, but not to total outputs, field-weighted citation impact (FWCI), or number of publications in top percentile journals. Publications were heavily focused on Anorexia Nervosa. Public grants awarded to the identified ED researchers in Australia over the past 10 years were largely National Health and Medical Research Council (NHMRC) project grant schemes, targeting innovative and creative research across any area of health and medical research. Cumulative dollars awarded over the 10-year period up to 2023 were approximately $23.9 million AUD, roughly 6 times less than that awarded to Schizophrenia research. These results summarise the current state of Australian FED research, comprised of a productive high performing research workforce limited by inadequate research funding.

Resting-state EEG and MEG gamma frequencies in schizophrenia: a systematic review and exploratory power-spectrum metanalysis

The hypoactivity of parvalbumin-containing interneurons (PV-interneurons) is a pathogenetic mechanism of schizophrenia according to the glutamatergic theory, and PV-interneurons are necessary for the generation of EEG/MEG gamma-frequencies (30-100 Hz). The present study aims to a literature synthesis on resting-state gamma-frequency changes in patients with schizophrenia vs healthy controls, and to examine the relationship between these changes and severity of symptoms. A protocol was enregistered in PROSPERO and a systematic search was conducted in PubMed, PsycINFO and Cochrane Database of Systematic Reviews, following PRISMA guidelines. An exploratory metanalysis was realized. Out of 1391 records, 43 were included for a qualitative synthesis (N = 2133 [11-185], females 37.4%, age 33.9 ± 9.2). Results on power spectra were heterogeneous: in 12 studies gamma power was increased, involving the whole brain (N = 3), multiple regions (N = 6) or only frontal (N = 1), central (n = 1) and temporal (N = 1) areas; in 3 studies gamma power was reduced, involving multiple areas (N = 2) or the right temporal region (N = 1); one study revealed mixed results and 13 studies showed no differences. The meta-analysis on 4 studies (N = 211) showed non-significant differences between patients and controls and a large heterogeneity. The functional connectivity picture consists of sparse patterns of decreases and/or increases, widespread to multiple regions. Relationships emerged between gamma power and connectivity and severity of psychotic and cognitive symptoms. Theta-gamma coupling was increased in patients, with limited evidence for other changes in phase-amplitude coupling. Resting-state gamma-frequencies alterations in schizophrenia were inconsistent across studies; the heterogeneity of patients and methods could partially explain this outcome.

Neuroimage Analysis Methods and Artificial Intelligence Techniques for Reliable Biomarkers and Accurate Diagnosis of Schizophrenia: Achievements Made by Chinese Scholars Around the Past Decade

BACKGROUND AND HYPOTHESIS

Schizophrenia (SZ) is characterized by significant cognitive and behavioral disruptions. Neuroimaging techniques, particularly magnetic resonance imaging (MRI), have been widely utilized to investigate biomarkers of SZ, distinguish SZ from healthy conditions or other mental disorders, and explore biotypes within SZ or across SZ and other mental disorders, which aim to promote the accurate diagnosis of SZ. In China, research on SZ using MRI has grown considerably in recent years.

STUDY DESIGN

The article reviews advanced neuroimaging and artificial intelligence (AI) methods using single-modal or multimodal MRI to reveal the mechanism of SZ and promote accurate diagnosis of SZ, with a particular emphasis on the achievements made by Chinese scholars around the past decade.

STUDY RESULTS

Our article focuses on the methods for capturing subtle brain functional and structural properties from the high-dimensional MRI data, the multimodal fusion and feature selection methods for obtaining important and sparse neuroimaging features, the supervised statistical analysis and classification for distinguishing disorders, and the unsupervised clustering and semi-supervised learning methods for identifying neuroimage-based biotypes. Crucially, our article highlights the characteristics of each method and underscores the interconnections among various approaches regarding biomarker extraction and neuroimage-based diagnosis, which is beneficial not only for comprehending SZ but also for exploring other mental disorders.

CONCLUSIONS

We offer a valuable review of advanced neuroimage analysis and AI methods primarily focused on SZ research by Chinese scholars, aiming to promote the diagnosis, treatment, and prevention of SZ, as well as other mental disorders, both within China and internationally.

Advances in MRI Research for First-Episode Schizophrenia: A Selective Review and NSFC-Funded Analysis

BACKGROUND AND HYPOTHESES

The causes of schizophrenia remain unclear, and research has been hindered by the lack of quantifiable standards. However, magnetic resonance imaging (MRI) is addressing these challenges, revealing critical neurobiological details and emphasizing its importance in both evaluation and treatment.

STUDY DESIGN

First, we reviewed the progress of research on structural MRI (sMRI), functional MRI (fMRI), multimodal/multiomics analysis, artificial intelligence, and neuromodulation in first-episode schizophrenia (FES) over the past 5 years. Second, we summarize the current state of schizophrenia research funded by the National Natural Science Foundation of China (NSFC) to facilitate academic exchange and cooperation both domestically and internationally.

STUDY RESULTS

sMRI has identified early neurodevelopmental biomarkers in FES patients, and fMRI has highlighted functional abnormalities across disease stages. Multimodal/multiomics analysis has revealed complex brain-neurobiology interactions. Neuromodulation techniques, which directly modulate neural activity in specific brain regions, offer promising long-term benefits for stabilizing conditions and enhancing patients' quality of life. NSFC-funded analysis shows China is increasing its funding for schizophrenia research, though funding distribution remains uneven. The research focus has shifted from a single perspective on brain structure and function to multichannel, multimodal comprehensive analysis methods. This progress has driven the integration of machine learning-driven multiomics research, aiming to construct disease classification models, explore disease mechanisms, and guide treatment from multidimensional and interdisciplinary perspectives.

CONCLUSIONS

MRI technology has provided new perspectives for the diagnosis and treatment of schizophrenia, especially the neurobiological foundations of the disease. Support from the NSFC provides a scientific and financial basis for future research and treatment, heralding scientific discoveries and technological innovations in this field and bringing hope to schizophrenia patients.

Brain Cytochrome P450: Navigating Neurological Health and Metabolic Regulation

Human cytochrome P450 (CYP) enzymes in the brain represent a crucial frontier in neuroscience, with far-reaching implications for drug detoxification, cellular metabolism, and the progression of neurodegenerative diseases. The brain's complex architecture, composed of interconnected cell types and receptors, drives unique neuronal signaling pathways, modulates enzyme functions, and leads to distinct CYP gene expression and regulation patterns compared to the liver. Despite their relatively low levels of expression, brain CYPs exert significant influence on drug responses, neurotoxin susceptibility, behavior, and neurological disease risk. These enzymes are essential for maintaining brain homeostasis, mediating cholesterol turnover, and synthesizing and metabolizing neurochemicals, neurosteroids, and neurotransmitters. Moreover, they are key participants in oxidative stress responses, neuroprotection, and the regulation of inflammation. In addition to their roles in metabolizing psychotropic drugs, substances of abuse, and endogenous compounds, brain CYPs impact drug efficacy, safety, and resistance, underscoring their importance beyond traditional drug metabolism. Their involvement in critical physiological processes also links them to neuroprotection, with significant implications for the onset and progression of neurodegenerative diseases. Understanding the roles of cerebral CYP enzymes is vital for advancing neuroprotective strategies, personalizing treatments for brain disorders, and developing CNS-targeting therapeutics. This review explores the emerging roles of CYP enzymes, particularly those within the CYP1-3 and CYP46 families, highlighting their functional diversity and the pathological consequences of their dysregulation on neurological health. It also examines the potential of cerebral CYP-based biomarkers to improve the diagnosis and treatment of neurodegenerative disorders, offering new avenues for therapeutic innovation.

Disentangling the effects of various risk factors and trends in lung cancer mortality

Lung cancer is a leading cause of mortality in oncological classifications, yet the impact of various risk factors on lung cancer mortality (LCM) in non-smokers remains unclear. This study aims to weigh out the diverse impact of multiple risk factors on LCM rates and identify trends in LCM rates worldwide. We initially employed Random Forest Tree (RFT) and Gradient Boosting Regression (GBR) to identify common primary factors influencing LCM. After eliminating four common primary factors, a comparative analysis between partial and Pearson correlations was conducted to filter out significant factors in the correlations between risk factors and LCM rates across 204 countries from 2005 to 2019. The findings show that excluding the impacts of occupational exposure to arsenic, smoking, residential radon, occupational exposure to silica, occupational exposure to asbestos, high systolic blood pressure, secondhand smoke, child wasting, and alcohol use had a considerably greater impact on LCM than particular matter pollution (PM2.5). Furthermore, a Multiple Joinpoint Regression analysis identified increasing trends of LCM rates in the 142 countries (e.g., China and India); decreasing trends in 38 countries (e.g., Denmark and Norway), and stable trends in 24 countries (e.g., Sudan, Mali, and Australia). This research suggests that in addition to considering the effects of occupational exposure to arsenic, smoking, residential radon, and occupational exposure to silica on LCM rates, occupational exposure to asbestos, high systolic blood pressure, secondhand smoke, child wasting, and alcohol use should be considered in lung cancer prevention strategies, especially in countries with increasing trends of LCM rates.

A new model to study season-of-conception effects on child neurodevelopment based on maternal history of seasonal affective disorder

Season of birth/conception has been used to study neurodevelopmental risk in hundreds of studies, however the translational impact of this work remains limited. We propose a new model to study season-of- conception effects on neurodevelopment using maternal fall-winter seasonality as a key moderating variable, and provide initial empirical data to support this new approach. In an ongoing pregnancy cohort study we evaluated associations between season-of conception and maternal history of fall-winter Seasonal Affective Disorder (SAD) on child executive functioning in 520 children at age 54 months. Executive functioning was measured using computerized administration of the Flanker test (a measure of attention) and the Dimensional Change Card Sort (a measure of cognitive flexibility). Results indicated that sixty-four mothers (12.3 %) met criteria for historical fall-winter SAD. MANCOVA found a significant season of conception (fall-winter vs. spring-summer) by maternal SAD (yes/no) by sex (female/male) interaction predicting the two child outcomes (F = 4.11, df= 2,509, p=.017). In the subgroup of children in the SAD group, girls conceived in the fall-winter vs. spring-summer months had significantly lower scores on the Dimensional Change Card Sort. No significant effects related to season of conception and/or maternal SAD were found in boys. Similar results were found after controlling for maternal depressive symptoms during pregnancy. In summary, season-of-conception was associated with impaired child executive functioning at age 54 months, but only in girls of mothers with a history of fall-winter SAD. The use of maternal seasonality and sex as moderating variables may be critical to early neuro- developmental research based on pregnancy timing, particularly at more northern latitudes.

Leveraging deep neural network and language models for predicting long-term hospitalization risk in schizophrenia

Early warning of long-term hospitalization in schizophrenia (SCZ) patients at the time of admission is crucial for effective resource allocation and individual treatment planning. In this study, we developed a deep learning model that integrates demographic, behavioral, and blood test data from admission to forecast extended hospital stays using a retrospective cohort. By utilizing language models, our developed algorithm efficiently extracts 95% of the unstructured electronic health records data needed for this work, while ensuring data privacy and low error rate. This paradigm has also been demonstrated to have significant advantages in reducing potential discrimination and erroneous dependencies. By utilizing multimodal features, our deep learning model achieved a classification accuracy of 0.81 and an AUC of 0.9. Key risk factors identified included advanced age, longer disease duration, and blood markers such as elevated neutrophil-to-lymphocyte ratio, lower lymphocyte percentage, and reduced albumin levels, validated through comprehensive interpretability analyses and ablation studies. The inclusion of multimodal data significantly improved prediction performance, with demographic variables alone achieving an accuracy of 0.73, which increased to 0.81 with the addition of behavioral and blood test data. Our approach outperformed traditional machine learning methods, which were less effective in predicting long-term stays. This study demonstrates the potential of integrating diverse data types for enhanced predictive accuracy in mental health care, providing a robust framework for early intervention and personalized treatment in SCZ management.

ECT-induced primary open-angle glaucoma in a patient with unstable thyroid function: a case report

Background

Schizophrenia is a prevalent and severe psychiatric disorder for which electroconvulsive therapy (ECT) is frequently utilized as a treatment modality. Although ECT can transiently elevate intraocular pressure, the incidence of ECT-related adverse ophthalmic events in patients with coexisting hyperthyroidism is not well documented.

Case report

In this report, we describe an elderly woman with schizophrenia and hyperthyroidism. Before undergoing ECT, she had no previous history of glaucoma, and her thyroid function was in an unstable state. After three sessions of ECT, the patient exhibited conjunctival congestion and was subsequently diagnosed with primary open-angle glaucoma, which was not treated. Her intraocular pressure normalized prior to and following the fourth ECT session, and she experienced no further ocular discomfort during subsequent treatments (fifth through eighth sessions).

Conclusions

Although ECT has been used in patients with coexisting psychiatric and thyroid dysfunction, there is a lack of reports addressing the risk of inducing or exacerbating glaucoma in the context of unstable thyroid function. This case emphasizes the necessity of monitoring intraocular pressure in patients with unstable thyroid function during ECT, to mitigate the risk of ocular complications.

Unraveling the potential of neuroinflammation and autophagy in schizophrenia

Schizophrenia (SCZ) is a complex and chronic psychiatric disorder that affects a significant proportion of the global population. Although the precise etiology of SCZ remains uncertain, recent studies have underscored the involvement of neuroinflammation and autophagy in its pathogenesis. Neuroinflammation, characterized by hyperactivated microglia and markedly elevated pro-inflammatory cytokines, has been observed in postmortem brain tissues of SCZ patients and is closely associated with disease severity. Autophagy, a cellular process responsible for eliminating damaged components and maintaining cellular homeostasis, is believed to play a pivotal role in neuronal health and the onset of SCZ. This review explores the roles and underlying mechanisms of neuroinflammation and autophagy in SCZ, with a particular focus on their intricate interplay. Additionally, we provide an overview of potential therapeutic strategies aimed at modulating neuroinflammation and autophagy, including nutritional interventions, anti-inflammatory drugs, antipsychotics, and plant-derived natural compounds. The review also addresses the dual effects of antipsychotics on autophagy. Our objective is to translate these insights into clinical practice, expanding the therapeutic options available to improve the overall health and well-being of individuals with SCZ.

Triangulating evidence from the GALENOS living systematic review on trace amine-associated receptor 1 (TAAR1) agonists in psychosis

BACKGROUND

Trace amine-associated receptor 1 (TAAR1) agonists offer a new approach, but there is uncertainty regarding their effects, exact mechanism of action and potential role in treating psychosis.

AIMS

To evaluate the available evidence on TAAR1 agonists in psychosis, using triangulation of the output of living systematic reviews (LSRs) of animal and human studies, and provide recommendations for future research prioritisation.

METHOD

This study is part of GALENOS (Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis). In the triangulation process, a multidisciplinary group of experts, including those with lived experience, met and appraised the first co-produced living systematic reviews from GALENOS, on TAAR1 agonists.

RESULTS

The animal data suggested a potential antipsychotic effect, as TAAR1 agonists reduced locomotor activity induced by pro-psychotic drug treatment. Human studies showed few differences for ulotaront and ralmitaront compared with placebo in improving overall symptoms in adults with acute schizophrenia (four studies, n = 1291 participants, standardised mean difference (SMD) 0.15, 95% CI -0.05 to 0.34). Large placebo responses were seen in ulotaront phase three trials. Ralmitaront was less efficacious than risperidone (one study, n = 156 participants, SMD = -0.53, 95% CI -0.86 to -0.20). The side-effect profile of TAAR1 agonists was favourable compared with existing antipsychotics. Priorities for future studies included (a) using different animal models of psychosis with greater translational validity; (b) animal and human studies with wider outcomes including cognitive and affective symptoms and (c) mechanistic studies and investigations of other potential applications, such as adjunctive treatments and long-term outcomes. Recommendations for future iterations of the LSRs included (a) meta-analysis of individual human participant data, (b) including studies that used different methodologies and (c) assessing other disorders and symptoms.

CONCLUSIONS

This co-produced, international triangulation examined the available evidence and developed recommendations for future research and clinical applications for TAAR1 agonists in psychosis. Broader challenges included difficulties in assessing the risk of bias, reproducibility, translation and interpretability of animal models to clinical outcomes, and a lack of individual and clinical characteristics in the human data. The research will inform a separate, independent prioritisation process, led by lived experience experts, to prioritise directions for future research.

Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates

Studies demonstrated increased obstetric and neonatal complications in women with schizophrenia-spectrum disorder (SSD), but most inadequately addressed confounders and rarely considered antipsychotic effects. We conducted a meta-analysis and a population-based cohort study evaluating associations of adverse obstetric/neonatal outcomes with SSD and prenatal antipsychotic use. In the meta-analysis, we searched four databases from inception to October-31-2023 and generated pooled risk estimates using random-effect models. In the cohort study, we identified women aged 15-50 years with SSD-diagnosis from electronic-heath-record database of public healthcare-services who delivered first/singleton children between 2003 and 2018 in Hong Kong. Propensity-score weighted regression-analyses incorporating important confounders including maternal pre-existing and gestational morbidities, substance/alcohol abuse, and psychotropic use, were performed to assess risk of adverse obstetric/neonatal outcomes in SSD-women versus non-SSD-women, and subsequently treated-SSD and untreated-SSD subgroups to disentangle effects of SSD from antipsychotic exposure. The meta-analysis (studies = 18, women = 37,214,330, including 42,926 SSD-women) found significant associations of SSD with 12 of 17 analyzed negative obstetric/neonatal outcomes (with pooled relative risk ranged:1.12-2.10), including placental complications, induced labor, Caesarean delivery, fetal distress, stillbirth, preterm birth, small-for-gestational-age, low birth weight, low APGAR scores, neonatal and post-neonatal deaths. However, the cohort study (466,358 women, including 804 SSD-women) revealed that elevated risk of most study outcomes in unadjusted-models were markedly-attenuated or became non-significant in propensity-score weighted adjusted-models, except index-delivery hospitalization ≥7 days (odds ratio [OR] = 1.76 [95% CI = 1.33-2.34]), preterm birth (OR = 1.48 [95% CI = 1.09-2.00]) and neonatal special-care admission (OR = 1.65 [95% CI = 1.35-2.01]). Apart from higher neonatal special-care admission in treated-SSD than untreated-SSD women (OR = 1.75 [95% CI = 1.23-2.52]), no significant between-group differences emerged in other outcomes. In sum, elevated risk of most obstetric/neonatal complications reported in SSD-women might largely be explained by maternal physical comorbidities, substance/alcohol use disorders and other confounders. Interventions targeting modifiable maternal risk factors should be incorporated in prenatal care for SSD-women to minimize avoidable adverse outcomes.

Uncovering convergence and divergence between autism and schizophrenia using genomic tools and patients' neurons

Autism spectrum disorders (ASDs) are highly heritable and result in abnormal repetitive behaviors and impairment in communication and cognitive skills. Previous studies have focused on the genetic correlation between ASDs and other neuropsychiatric disorders, but an in-depth understanding of the correlation to other disorders is required. We conducted an extensive meta-analysis of common variants identified in ASDs by genome-wide association studies (GWAS) and compared it to the consensus genes and single nucleotide polymorphisms (SNPs) of Schizophrenia (SCZ). We found approximately 75% of the GWAS genes that are associated with ASD are also associated with SCZ. We further investigated the cellular phenotypes of neurons derived from induced pluripotent stem cell (iPSC) models in ASD and SCZ. Our findings revealed that ASD and SCZ neurons initially follow divergent developmental trajectories compared to control neurons. However, despite these early diametrical differences, both ASD and SCZ neurons ultimately display similar deficits in synaptic activity as they mature. This significant genetic overlap between ASD and SCZ, coupled with the convergence towards similar synaptic deficits, highlights the intricate interplay of genetic and developmental factors in shaping the shared underlying mechanisms of these complex neurodevelopmental and neuropsychiatric disorders.

Comorbid health outcomes in patients with schizophrenia: an umbrella review of systematic reviews and meta-analyses

There is no comprehensive umbrella review exploring the connection between schizophrenia and various health outcomes. Therefore, we aimed to systematically review existing meta-analyses about schizophrenia-associated comorbid health outcomes and validate the evidence levels. We performed an umbrella review of meta-analyses of observational studies to explore comorbid health outcomes in individuals with schizophrenia. Searches were conducted across PubMed/MEDLINE, EMBASE, ClinicalKey, and Google Scholar up to September 5, 2023, targeting meta-analyses of observational studies related to comorbid health outcomes in individuals with schizophrenia. We applied AMSTAR2 for data extraction and quality assessment, adhering to PRISMA guidelines. Evidence credibility was evaluated and categorized by evidence quality. Our protocol was registered with PROSPERO (CRD42024498833). Risk and protective factors were analyzed and presented through equivalent odds ratios (eRR). In this umbrella review, we analyzed 9 meta-analyses, including 88 original articles, covering 21 comorbid health outcomes with over 66 million participants across 19 countries. Patients with schizophrenia showed significant associations with multiple health outcomes, including asthma (eRR, 1.71 [95% CI, 1.05-2.78], class and quality of evidence [CE] = non-significant), chronic obstructive pulmonary disease (1.73 [1.25-2.37], CE = weak), pneumonia (2.63 [1.11-6.23], CE = weak), breast cancer of female patients (1.31 [1.04-1.65], CE = weak), cardiovascular disease (1.53 [1.12-2.11], CE = weak), stroke (1.71 [1.30-2.25], CE = weak), congestive heart failure (1.81 [1.21-2.69], CE = weak), sexual dysfunction (2.30 [1.75-3.04], CE = weak), fracture (1.63 [1.10-2.40], CE = weak), dementia (2.29 [1.19-4.39], CE = weak), and psoriasis (1.83 [1.18-2.83] CE = weak). Our study underscores the imperative for an integrated treatment approach to schizophrenia, highlighting its broad impact across respiratory, cardiovascular, sexual, neurological, and dermatological health domains. Given the predominantly non-significant to weak evidence levels, further studies are needed to reinforce our understanding.

Inhibition of striatal indirect pathway during second postnatal week leads to long-lasting deficits in motivated behavior

Schizophrenia is a neuropsychiatric disorder with postulated neurodevelopmental etiology. Genetic and imaging studies have shown enhanced dopamine and D2 receptor occupancy in the striatum of patients with schizophrenia. However, whether alterations in postnatal striatal dopamine can lead to long-lasting changes in brain function and behavior is still unclear. Here, we approximated striatal D2R hyperfunction in mice via designer receptor-mediated activation of inhibitory Gi-protein signaling during a defined postnatal time window. We found that Gi-mediated inhibition of the indirect pathway (IP) during postnatal days 8-15 led to long-lasting decreases in locomotor activity and motivated behavior measured in the adult animal. In vivo photometry further showed that the motivational deficit was associated with an attenuated adaptation of outcome-evoked dopamine levels to changes in effort requirements. These data establish a sensitive time window of D2R-regulated striatal development with long-lasting impacts on neuronal function and behavior.

IUPHAR review: Drug repurposing in Schizophrenia - An updated review of clinical trials

There is an urgent need for mechanistically novel and more efficacious treatments for schizophrenia, especially those targeting negative and cognitive symptoms with a more favorable side-effect profile. Drug repurposing-the process of identifying new therapeutic uses for already approved compounds-offers a promising approach to overcoming the lengthy, costly, and high-risk process of traditional CNS drug discovery. This review aims to update our previous findings on the clinical drug repurposing pipeline in schizophrenia. We examined studies conducted between 2018 and 2024, identifying 61 trials evaluating 40 unique repurposed drug candidates. These encompassed a broad range of pharmacological mechanisms, including immunomodulation, cognitive enhancement, and hormonal, metabolic, and neurotransmitter modulation. A notable development is the combination of the muscarinic modulators xanomeline, a compound with antipsychotic properties, and trospium, included to mitigate peripheral side effects, now approved by the FDA as the first antipsychotic drug in decades with a fundamentally novel mechanism of action. Moving beyond the traditional dopaminergic paradigm of schizophrenia, such findings highlight opportunities to improve treatment-resistant symptoms and alleviate adverse effects. Overall, the evolving drug repurposing landscape illustrates a significant shift in the rationale for schizophrenia drug development, highlighting the potential of in silico strategies, biomarker-based patient stratification, and personalized treatments that align with underlying pathophysiological processes.

Efficacy, tolerability, and safety of xanomeline-trospium chloride for schizophrenia: A systematic review and meta-analysis

The United States Food and Drug Administration approved xanomeline-trospium combination for schizophrenia on September-26-2024. We conducted a PRISMA 2020-compliant systematic review with random-effects meta-analysis on the efficacy and safety of xanomeline-trospium in randomized controlled trials in patients with schizophrenia (MEDLINE, EMBASE, Cochrane, PsycINFO, October-01-2024). Co-primary outcomes were Positive And Negative Syndrome Scale (PANSS) total score (standardized mean difference=SMD), and all-cause discontinuation (risk ratio=RR). Cochrane's Risk of Bias (RoB) Tool 2 and GRADE were used. Xanomeline-trospium (k = 3, schizophrenia acute exacerbation, RoB=low, baseline N = 690, males=75.5 %, age=44.3 + 11.0, duration=5 weeks) outperformed placebo on PANSS total (SMD=-0.56, 95 % confidence interval/CI=-0.72/-0.40), positive (SMD=-0.59, 95 %CI=-0.75/-0.43), negative (SMD=-0.33, 95 %CI=-0.49/-0.17), and Marder Factor negative symptom score (SMD=-0.36, 95 %CI=-0.60/-0.13), Clinical Global Impression-Severity (SMD=-0.54, 95 %CI=-0.71/-0.37) (GRADE=moderate), and response (≥30 % reduction from baseline: RR=2.13, 95 %CI=1.66-2.75). Risk of ≥7 % weight gain (RR=0.46, 95 %CI=0.25-0.87, NNT=19), low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol levels were reduced, while risk was increased for vomiting, hypertension, nausea, dry mouth, dyspepsia, constipation (RR=7.60, 95 %CI=1.50-38.57 to RR=2.72, 95 %CI=1.63-4.55), any adverse event (RR=1.33, 95 %CI=1.18-1.51, NNT=6), triglyceride levels and supine heart rate (GRADE=moderate to high). Conversely, the risk was not increased for any other, serious, or severe adverse events or all-cause discontinuation. In post-hoc analyses, xanomeline-trospium outperformed placebo regarding response (≥20 % and ≥30 % threshold) starting at week 2, negative symptoms in patients with prominent negative symptoms, and cognitive symptoms in patients ≥1 standard deviation below the general population norm. Further, pro-/anti-cholinergic side effects were mild-moderate and mostly transient. Xanomeline-trospium is an effective treatment for schizophrenia with a unique tolerability profile, potentially addressing unmet needs.

Diagnostic role of circulating cell-free DNA in schizophrenia and neuro-degenerative disorders

Over the past few years, circulating cell-free DNA (cfDNA) research has grown exponentially. Several studies have associated the release of cfDNA in the bloodstream, cerebrospinal fluid, and other body fluids with increased apoptosis and cell death. Therefore, their possible use as biomarkers for cancer and other diseases has emerged. The diagnosis of pathological entities such as schizophrenia and neurodegenerative diseases involves many challenges and requires ruling out conditions with similar symptoms. In this context, cfDNA could serve as a valuable diagnostic biomarker. This study encompasses the recent bibliography and research regarding the utilization of circulating cfDNA for diagnostic purposes in schizophrenia, Alzheimer's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, and Huntington's disease. This minimally invasive method has provided important evidence regarding the diagnosis of the aforementioned diseases although further research is necessary.

Deep multimodal representations and classification of first-episode psychosis via live face processing

Schizophrenia is a severe psychiatric disorder associated with a wide range of cognitive and neurophysiological dysfunctions and long-term social difficulties. Early detection is expected to reduce the burden of disease by initiating early treatment. In this paper, we test the hypothesis that integration of multiple simultaneous acquisitions of neuroimaging, behavioral, and clinical information will be better for prediction of early psychosis than unimodal recordings. We propose a novel framework to investigate the neural underpinnings of the early psychosis symptoms (that can develop into Schizophrenia with age) using multimodal acquisitions of neural and behavioral recordings including functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG), and facial features. Our data acquisition paradigm is based on live face-toface interaction in order to study the neural correlates of social cognition in first-episode psychosis (FEP). We propose a novel deep representation learning framework, Neural-PRISM, for learning joint multimodal compressed representations combining neural as well as behavioral recordings. These learned representations are subsequently used to describe, classify, and predict the severity of early psychosis in patients, as measured by the Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores to evaluate the impact of symptomatology. We found that incorporating joint multimodal representations from fNIRS and EEG along with behavioral recordings enhances classification between typical controls and FEP individuals (significant improvements between 10 - 20%). Additionally, our results suggest that geometric and topological features such as curvatures and path signatures of the embedded trajectories of brain activity enable detection of discriminatory neural characteristics in early psychosis.

Striatal dopamine D2/D3 receptor regulation of human reward processing and behaviour

Signalling at dopamine D2/D3 receptors is thought to underlie motivated behaviour, pleasure experiences and emotional expression based on animal studies, but it is unclear if this is the case in humans or how this relates to neural processing of reward stimuli. Using a randomised, double-blind, placebo-controlled, crossover neuroimaging study, we show in healthy humans that sustained dopamine D2/D3 receptor antagonism for 7 days results in negative symptoms (impairments in motivated behaviour, hedonic experience, verbal and emotional expression) and that this is related to blunted striatal response to reward stimuli. In contrast, 7 days of partial D2/D3 agonism does not disrupt reward signalling, motivated behaviour or hedonic experience. Both D2/D3 antagonism and partial agonism induce motor impairments, which are not related to striatal reward response. These findings identify a central role for D2/D3 signalling and reward processing in the mechanism underlying motivated behaviour and emotional responses in humans, with implications for understanding neuropsychiatric disorders such as schizophrenia and Parkinson's disease.

Reduced temporal variability of cortical excitation/inhibition ratio in schizophrenia

Altered neural excitation/inhibition (E/I) balance has long been suspected as a potential underlying cause for clinical symptoms in schizophrenia (SZ). Recent methodological advancements linking the spectral slope (β) of neurophysiological recordings - such as them electroencephalogram (EEG) - to E/I ratio provided much-needed tools to better understand this plausible relationship. Importantly, most approaches treat E/I ratio as a stationary feature in a single scaling range. On the other hand, previous research indicates that this property might change over time, as well as it can express different characteristics in low- and high-frequency regimes. In line, in this study we analyzed resting-state EEG recordings from 30 patients with SZ and 31 healthy controls (HC) and characterized E/I ratio via β separately for low- (1-4 Hz) and high- (20-45 Hz) frequency regimes in a time-resolved manner. Results from this analysis confirmed the bimodal nature of power spectra in both HC and SZ, with steeper spectral slopes in the high- compared to low-frequency ranges. We did not observe any between-group differences in stationary (i.e., time-averaged) neural signatures, however, the temporal variance of β in the 20-45 Hz regime was significantly reduced in SZ patients when compared to HC, predominantly over regions corresponding to the dorsal attention network. Furthermore, this alteration was found correlated to positive clinical symptom scores. Our study indicates that altered E/I ratio dynamics are a characteristic trait of SZ that reflect pathophysiological processes involving the parietal and occipital cortices, potentially responsible for some of the clinical features of the disorder.

Sleep duration and its associated factors in schizophrenia patients: a large-scale cross-sectional survey

BACKGROUND

Sleep disturbance is a common condition in patients with schizophrenia. Studies have shown that insufficient sleep and excessive sleep lead to adverse health outcomes. This study aimed to identify the factors associated with short and long sleep duration, as well as the prevalence of somatic comorbidities in schizophrenia patients.

METHODS

This study was conducted in 24 mental health institutes of Guangdong Province using a multistage-stratified and random sampling method. All information was collected by face-to-face interview with a structured questionnaire. The association of sleep duration with sociodemographic and clinical factors was determined using multinomial logistic regressions. Subgroup analysis was performed in the various source of patients.

RESULTS

A total of 6 024 schizophrenia patients were enrolled in this study, among whom 8.6% (n = 521) reported short sleep duration and 47.2% (n = 2 850) had long sleep duration. The most common comorbid chronic diseases in the entire cohort were hypertension (8.0%), diabetes (6.8%) and hyperlipidemia (3.2%). Factors such as, current smoker, outpatients, benzodiazepines (BZDs), side effects, comorbidities, age of onset, and illness duration were positively associated with short sleep duration. On the other hand, personal annul income < 10 000 yuan, personal annul income ≥ 40 000 yuan, chronic patients, first-generation antipsychotics (FGAs) and side effects were positively associated with long sleep duration. In outpatient settings, overweight was associated with long sleep duration, whereas in inpatient settings, being female positively correlated with long sleep duration.

CONCLUSION

Disruption of sleep duration and somatic comorbidities are highly prevalent in patients with schizophrenia. This study demonstrates the complex relationships among socioeconomic information, clinical factors and sleep duration in schizophrenia, highlighting the need for developing targeted interventions and management strategies for sleep duration.

CLINICAL TRIAL NUMBER

Not applicable.

Population pharmacokinetics of brexpiprazole in Japanese healthy subjects and patients with schizophrenia

Brexpiprazole, widely approved for the treatment of schizophrenia, is an atypical antipsychotic that modulates serotonin-dopamine activity. To better understand the pharmacokinetics (PK) of brexpiprazole in Japanese patients, a population PK model was constructed and used to estimate steady state PK profiles and parameters as well as dopamine D2/D3 receptor occupancy profiles after repeated oral administrations of brexpiprazole at 1 and 2 mg/day. Nonlinear mixed effects modelling was used to analyse data from a total of 398 healthy subjects and patients with schizophrenia who received brexpiprazole in three Japanese clinical trials. The PK of brexpiprazole were well described by a two-compartment disposition model with transit absorption compartments. Estimated glomerular filtration rate, age and cytochrome P450 2D6 phenotype were identified as significant covariates on CL/F only. The model predicted that, at a dose of 2 mg/day, trough plasma concentration (90 % prediction interval) of brexpiprazole is 77.1 (22.4-173) ng/mL and that dopamine D2/D3 receptor occupancy is >80 % over one day for most patients at steady state. This suggests the recommended maintenance dose of 2 mg/day of brexpiprazole leads to clinically useful dopamine D2/D3 receptor occupancy at steady state in Japanese patients.

Efficacy of identifying Treatment-Resistant and non-Treatment-Resistant Schizophrenia using niacin skin flushing response combined with clinical feature

Treatment-resistant schizophrenia (TRS) is a serious mental disease and early identification of this disease is necessary for timely initiation of treatment strategies and management measures. This study aimed to investigate the potential of niacin skin flushing response (NSFR) combined with clinical features in recognizing TRS and non-TRS (NTRS). A total of 269 patients with schizophrenia (99 TRS and 170 NTRS) were included in this study. We conducted NSFR test on 269 participants. Positive and negative syndrome scale (PANSS), repeatable battery for the assessment of neuropsychological status (RBANS) and insight and treatment attitudes questionnaires (ITAQ) were used to assess the patients' psychiatric symptoms, cognitive function, and attitude towards illness and treatment, respectively. Differences in NSFR and clinical features between TRS and NTRS were assessed and the relation was evaluated using Spearman correlation. The efficacy of NSFR and clinical features in identifying TRS was assessed using the receiver operating characteristic (ROC) curve. Patients with TRS have enhanced NSFR compared to patients with NTRS, and NSFR was positively correlated with the course of the disease. PANSS total score was negatively correlated with the age of first onset, RBANS total score, and ITAQ score and positively correlated with the course of disease. Age of first onset, course of disease, RBANS total score, and NSFR were poor indicators for identifying TRS and NTRS. The ITAQ score has better diagnostic validity for TRS compared to the above indicators. Among the clinical features, the ITAQ has an important role in recognizing TRS. The NSFR has poor efficacy in recognizing TRS.

Optimising Aripiprazole Long-Acting Injectable: A Comparative Study of One- and Two-Injection Start Regimens in Schizophrenia with and Without Substance Use Disorders and Relationship to Early Serum Levels

Aripiprazole as a long-acting injectable (LAI) is initiated in oral aripiprazole-stabilised patients and needs, after first injection, 14 days supplementation of oral aripiprazole (one-injection start, OIS). Recently, an alternative two-injection start (TIS) was advanced, involving two 400 mg injections with a single 20 mg oral supplementation of aripiprazole. We tested the two regimens in patients with schizophrenia (SCZ, n = 152, 90 men and 62 women) with (SUD+; n = 93) or without (SUD-; n = 59) substance use disorders (SUDs), comparing OIS (n = 66) with TIS (n = 86) and SUD+ vs. SUD-. For 26 patients, we measured weekly for one month, aripiprazole + dehydroaripiprazole (active moiety) levels. Patients were followed for three months after LAI with psychopathology and quality-of-life scales (BPRS, CGI-S, ACES, BIS-11, and WHOQOL). All groups improved in psychopathology with no differences between OSI and TIS and between SCZ-SUD+ and SCZ-SUD-. The TIS group was associated with serum blood levels of the active moiety within the therapeutic window, while the OIS group showed peaks above the window, possibly exposing patients to toxicity. Treatments were well-tolerated. Here we showed no disadvantages for TIS vs. OIS and possibly increased safety. Shifting the initiation of aripiprazole LAIs to the TIS modality may be safe and pharmacokinetically advantageous.

Lack of Clinically Meaningful Effect of Cariprazine on the Pharmacokinetics of a Combined Oral Contraceptive

INTRODUCTION

Cariprazine (CAR) is a potent dopamine receptor partial agonist antipsychotic approved by the EMA and the FDA. To address the uncertainty regarding the effectiveness of hormonal contraceptives during CAR co-administration and whether a second barrier method is necessary, a drug-drug interaction study with an oral contraceptive was conducted post-approval.

METHODS

The phase I, fixed-sequence multicenter study involved two periods with 24 patients with schizophrenia, aiming to evaluate the effect of CAR on the pharmacokinetics (PK) of a combined oral contraceptive (COC) containing 30 μg ethinylestradiol (EE) and 150 μg levonorgestrel (LNG). In period A, a single dose of COC alone was administered on day 1. In period B, the highest therapeutic dose of 6 mg CAR was administered once daily from day 4, and a second dose of COC was given concomitantly on day 31.

RESULTS

Overall, CAR had no clinically meaningful effect on the PK of the COC. The terminal half-life and the time of maximum plasma concentration of EE and LNG were not altered by CAR co-administration. The highest difference observed was a decrease of 14% in the maximum plasma concentration of EE, with only slight deviation of the 90% confidence interval (CI) of the test/reference ratio (77.09-96.81) from the generally accepted bioequivalence range of 80-125%, which is not considered clinically relevant. Confidence intervals of all other exposure measures were within the 80-125% range for both EE and LNG.

CONCLUSIONS

According to these results, hormonal contraceptives can be considered effective during CAR treatment.

TRIAL REGISTRATION

Trial registration number (EudraCT) 2018-003722-80.

Ferroptosis in schizophrenia: Mechanisms and therapeutic potentials (Review)

Schizophrenia, a complex psychiatric disorder, presents with multifaceted symptoms and important challenges in treatment, primarily due to its pathophysiological complexity, which involves oxidative stress and aberrant iron metabolism. Recent insights into ferroptosis, a unique form of iron‑dependent cell death characterized by lipid peroxidation and antioxidant system failures, open new avenues for understanding the neurobiological foundation of schizophrenia. The present review explores the interplay between ferroptosis and schizophrenia, emphasizing the potential contributions of disrupted iron homeostasis and oxidative mechanisms to the pathology and progression of this disease. The emerging evidence linking ferroptosis with the oxidative stress observed in schizophrenia provides a compelling narrative for re‑evaluating current therapeutic strategies and exploring novel interventions targeting these molecular pathways, such as the glutathione peroxidase 4 pathway and the ferroptosis suppressor protein 1 pathway. By integrating recent advances in ferroptosis research, the current review highlights innovative therapeutic potentials, including N‑acetylcysteine, selenium, omega‑3 fatty acids and iron chelation therapy, which could address the limitations of existing treatments and improve clinical outcomes for individuals with schizophrenia.

Xanomeline-Trospium for Adults with Schizophrenia Experiencing Acute Psychosis: A Systematic Review and Meta-analysis of Safety and Tolerability Outcomes

The United States Food and Drug Administration approved the xanomeline-trospium combination in September 2024 for treating schizophrenia, based in part on three double-blind, randomized placebo-controlled trials in adults with schizophrenia experiencing acute psychosis. This random-effects model pairwise meta-analysis of those three trials found that xanomeline-trospium was comparable to placebo in terms of all-cause discontinuation, discontinuation rate due to adverse events, Simpson-Angus Scale score change, Barnes Akathisia Rating Scale score change, body weight change, body mass index change, blood pressure change, serum total cholesterol change, blood glucose change, QTc interval changes, and the incidence of headache, somnolence, insomnia, dizziness, akathisia, agitation, tachycardia, gastroesophageal reflux disease, diarrhea, increased weight, and decreased appetite. However, xanomeline-trospium was associated with a higher incidence of at least one adverse event, dry mouth, hypertension, nausea, vomiting, dyspepsia, and constipation, and increased serum triglyceride compared with placebo. Notably, xanomeline-trospium demonstrated superior efficacy than placebo in improving the Positive and Negative Syndrome Scale (PANSS) total score, PANSS positive subscale score, and PANSS negative subscale score.

Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies

BACKGROUND

Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality.

OBJECTIVE

This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia.

METHODS

Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (≥12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies.

RESULTS

Of the enrolled participants, 94% (46/49) and 86% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71%, 35/49; study 2: 80%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2.

CONCLUSIONS

A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312.

Exploring genetic associations and drug targets for mitochondrial proteins and schizophrenia risk

Numerous observational studies have highlighted associations between mitochondrial dysfunction and schizophrenia (SCZ), yet the causal relationship remains elusive. This study aims to elucidate the causal link between mitochondria-associated proteins and SCZ. We used summary data from a genome-wide association study (GWAS) of 66 mitochondria-associated proteins in 3,301 individuals from Europe, as well as a GWAS on the large, multi-ethnic ancestry of SCZ, involving 76,755 cases and 243,649 controls. We conducted bidirectional two-sample Mendelian randomization (MR) analyses, with inverse variance weighting (IVW) as the primary method. To account for multi-directionality and ensure robustness, we included MR-Egger, weighted median (WM), weighted mode, and simple mode methods as supplementary sensitivity analyses. Moreover, we explored the GWAS catalog and the Drug-Gene Interaction Database (DGIdb) to identify and evaluate potential therapeutic targets. MR analysis revealed significant genetically determined causal associations between ETHE1 (OR: 1.06), SOD (OR: 0.97), CALU3 (OR: 1.03), and C1QBP (OR: 1.05) and SCZ. According to the reverse MR analysis, a causal relationship was shown between SCZ and CA5A (OR: 1.09), DLD (OR: 1. 08), AIF1 (OR: 0.93), SerRS (OR: 0.93) and MULA of NFKB1 (OR: 0.77). After conducting the gene-drug analysis, HRG, F12, GPLD1, C1R, BCHE, CFH, PON1, and CA5A were identified as promising therapeutic targets. This present study reveals a significant causal relationship between mitochondria-associated proteins and SCZ, offering valuable insights into the disease's pathogenicity and identifying potential therapeutic targets for drug development.

Medication adherence and needs among patients with schizophrenia in China: a qualitative study

OBJECTIVES

To explore the factors influencing medication adherence and the medication needs of patients with schizophrenia when living in a community in China.

DESIGN

A qualitative study.

SETTING

Community and psychiatric ward in Zhuhai city, Guangdong province.

PARTICIPANTS

Patients with schizophrenia and (or) their primary caregivers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Facilitators and barriers of medication adherence and the medication needs.

RESULTS

A total of 20 patients with schizophrenia and 12 primary caregivers participated in the study. Based on the Health Ecology Model, the analysis identified four levels of factors influencing medication adherence, categorised as individual (facilitators: effective treatment, positive expectation, establishing a routine and assistive tools; barriers: side effects, inadequate knowledge, forgetfulness and irregular daily schedule), interpersonal (facilitators: caregiver assistance and psychiatrist's recommendation; barriers: lack of social support), community (facilitators: community mental health services and reducing medication use frequency; barriers: limited medication accessibility and affordability) and policy and culture related (facilitators: collectivist culture and social security policy; barriers: stigma). Additionally, five medication needs (managing side effects, applying for social security, improving medication accessibility, transitioning to long-acting injections and getting health education) were recognised.

CONCLUSIONS

These findings offer valuable insights for healthcare providers and policymakers, underscoring the need for targeted interventions to enhance medication adherence among patients with schizophrenia in China.

Factors associated with the revolving door phenomenon in patients with schizophrenia: results from an acute psychiatric hospital in Romania

Background

The revolving door phenomenon refers to patients with frequent hospital admissions and emerged after deinstitutionalization reforms have been implemented. Schizophrenia is a severe and debilitating mental disorder and has frequently been identified as one of the most prevalent disorders among revolving door patients. Therefore, this research aimed to identify socio-demographic and clinical factors associated with the revolving door phenomenon in patients with schizophrenia.

Methods

We conducted an observational and retrospective cohort study and collected data from the medical records of individuals admitted to the largest psychiatric hospital in Romania during a 2-year period. Patients with three or more admissions during a 12-month period were identified as revolving door.

Results

Of the total of 635 patients included in this study, 108 met the criteria for revolving door. Patients had a mean age of 44.55±12.83 years and most of them were single (81.7%) and receiving a disability pension (68.7%) and had an illness duration of more than 5 years (81.9%). Male gender (p=0.000), younger age (p<0.05), presence of psychiatric comorbidity (p<0.05), substance use disorder (p=0.000) and alcohol use disorder (p<0.01) were associated with the revolving door patients. A binary linear logistic regression revealed that male gender (OR=1.92, 95%CI:1.21-3.08), shorter hospitalization (OR=0.982, 95%CI:0.964-1.000), substance use disorder (OR=2.47, 95%CI:1.16-5.26), verbal (OR=1.44, 95%CI:1.05-1.98) and physical (OR=1.331, 95%CI:1.017-1.744) aggression were predictive factors for frequent use of inpatient services.

Conclusions

The results may facilitate development of future reform policies aimed at reducing the revolving door phenomenon, including implementing transitional care interventions between hospital and community services.

A multidimensional assessment of adverse events associated with paliperidone palmitate: a real-world pharmacovigilance study using the FAERS and JADER databases

OBJECTIVE

Paliperidone palmitate is a second-generation antipsychotic that has undergone extensive investigation in clinical trials. However, real-world studies assessing its safety in large populations are lacking. As such, this study aimed to comprehensively evaluate real-world adverse drug events (ADEs) linked to paliperidone palmitate by employing data mining techniques on the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database and the Japanese Adverse Drug Event Report (JADER) database.

METHODS

The study retrieved ADE reports from the FAERS database covering the period from 2009 through the third quarter of 2024, and from the JADER database covering the period from 2013 through the second quarter of 2024. Utilizing disproportionality analyses such as the reporting odds ratios (ROR), proportional reporting ratios (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item Poisson shrinkage (MGPS), significant associations between ADEs and paliperidone palmitate were evaluated.

RESULTS

A total of 27,672 ADE reports related to paliperidone palmitate were identified in FAERS, with 285 significantly disproportionate preferred terms (PTs) identified by all four algorithms. Paliperidone palmitate-associated ADEs encompassed 27 System Organ Classes (SOCs). The top three PTs with the highest reported cases were off-label use, drug ineffective, and hospitalization. Common ADEs included increased blood prolactin, galactorrhea, and schizophrenia, which was consistent with drug label. Noteworthy, unexpected signals not listed in the drug label were also identified, such as psychosexual disorders, prolactin-producing pituitary tumors, suicide attempt, and sudden death. The median onset time for all ADEs was 40 days. Furthermore, gender-based difference in risk signals was detected. Females are more likely to experience elevated blood prolactin and weight increase, whereas males are more prone to sexual dysfunction. Among the 1,065 ADE reports from the JADER database, we identified 51 positive signals, 35 of which overlapped with those found in FAERS, including schizophrenia, hyperprolactinemia, and erectile dysfunction.

CONCLUSION

The study findings from two independent databases serve as crucial references for ensuring the safe of paliperidone palmitate. Additionally, the gender-specific monitoring references provided can enhance clinical surveillance efforts and facilitate more effective risk identification.

Correlation analyse between thyroid hormone levels and severity of schizophrenia symptoms

BACKGROUND

The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia, especially thyroid hormones.

AIM

To study the relationship between triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH) and schizophrenia.

METHODS

In this study, 100 schizophrenia patients were selected from our hospital between April 2022 and April 2024. Their clinical data were analyzed retrospectively. Based on the Positive and Negative Syndrome Scale (PANSS) score, patients were divided into mild (1-3 points, n = 39), moderate (4 points, n = 45), and severe groups (5-7 points, n = 16). Additionally, 55 healthy individuals served as a control group. Venous blood samples were collected to measure T3, T4, FT3, FT4, TSH, and cortisol concentrations, analyzing their relationship with PANSS scores.

RESULTS

The serum levels of T3, FT3, FT4, TSH and cortisol in the schizophrenia group were lower than those in the control group (P < 0.05). With the increase of the severity of the disease, the concentrations of T3 and T4 decreased, while the concentrations of TSH and cortisol increased (P < 0.05). The concentrations of TSH and cortisol were positively correlated with the PANSS score, while T3 and T4 were negatively correlated with the PANSS score (P < 0.05). The receiver operating characteristic curve results showed that T3, T4, TSH, and cortisol had good efficacy in the diagnosis of schizophrenia. Logistic results showed that decreased T3 level, decreased T4 level, decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.

CONCLUSION

Thyroid hormone levels are associated with the severity of schizophrenia symptoms, which can provide new solutions for the diagnosis and treatment of schizophrenia.

Evaluation of the impact of refined nursing care on schizophrenia patients

This study evaluates the impact of refined nursing interventions on patients with schizophrenia, focusing on disease severity, cognitive function, medication adherence, quality of life, and medication-related complications. The aim is to provide evidence for enhancing future clinical treatments. From January 2022 to January 2024, 201 schizophrenia patients were enrolled based on specific inclusion and exclusion criteria. Patients were allocated into 2 groups using propensity score matching: an experimental group that received refined nursing care and a control group that received routine care. Outcome measures included Positive and Negative Syndrome Scale scores, cognitive assessments (Mini-Mental State Examination and Nurses' Observation Scale for Inpatient Evaluation), medication adherence, quality of life, relapse rates, and medication-related side effects. After propensity score matching, baseline characteristics of the experimental and control groups were comparable. Following nursing interventions, the experimental group demonstrated significant improvements in Positive and Negative Syndrome Scale scores, cognitive assessments (Mini-Mental State Examination and Nurses' Observation Scale for Inpatient Evaluation), medication adherence, and quality of life compared to the control group. The experimental group also showed lower relapse rates and fewer medication side effects, confirming the enhanced effectiveness of refined nursing interventions. Refined nursing care significantly improved disease outcomes, cognitive function, medication adherence, and quality of life in schizophrenia patients, while reducing relapse rates and medication-related complications, highlighting its clinical value in psychiatric care.

Investigating resting-state functional connectivity changes within procedural memory network across neuropsychiatric disorders using fMRI

BACKGROUND

Cognitive networks impairments are common in neuropsychiatric disorders like Attention Deficit Hyperactivity Disorder (ADHD), bipolar disorder (BD), and schizophrenia (SZ). While previous research has focused on specific brain regions, the role of the procedural memory as a type of long-term memory to examine cognitive networks impairments in these disorders remains unclear. This study investigates alterations in resting-state functional connectivity (rs-FC) within the procedural memory network to explore brain function associated with cognitive networks in patients with these disorders.

METHODS

This study analyzed resting-state functional magnetic resonance imaging (rs-fMRI) data from 40 individuals with ADHD, 49 with BD, 50 with SZ, and 50 healthy controls (HCs). A procedural memory network was defined based on the selection of 34 regions of interest (ROIs) associated with the network in the Harvard-Oxford Cortical Structural Atlas (default atlas). Multivariate region of interest to region of interest connectivity (mRRC) was used to analyze the rs-FC between the defined network regions. Significant differences in rs-FC between patients and HCs were identified (P < 0.001).

RESULTS

ADHD patients showed increased Cereb45 l - Cereb3 r rs-FC (p = 0.000067) and decreased Cereb1 l - Cereb6 l rs-FC (p = 0.00092). BD patients exhibited increased rs-FC between multiple regions, including Claustrum r - Caudate r (p = 0.00058), subthalamic nucleus r - Pallidum l (p = 0.00060), substantia nigra l - Cereb2 l (p = 0.00082), Cereb10 r - SMA r (p = 0.00086), and Cereb9 r - SMA l (p = 0.00093) as well as decreased rs-FC in subthalamic nucleus r - Cereb6 l (p = 0.00013) and Cereb9 r - Cereb9 l (p = 0.00033). SZ patients indicated increased Caudate r- putamen l rs-FC (p = 0.00057) and decreased rs-FC in subthalamic nucleus r - Cereb6 l (p = 0.000063), and Cereb1 r - subthalamic nucleus r (p = 0.00063).

CONCLUSIONS

This study found significant alterations in rs-FC within the procedural memory network in patients with ADHD, BD, and SZ compared to HCs. These findings suggest that disrupted rs-FC within this network may related to cognitive networks impairments observed in these disorders.

CLINICAL TRIAL NUMBER

Not applicable.