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Fusar-Poli L, Panariello F, Berry K, Rocchetti M, Casiraghi L, Malvezzi M, Starace F, Zamparini M, Zarbo C, de Girolamo G. Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities. Br J Clin Psychol 2024; 63:156-177. [PMID: 38115200 DOI: 10.1111/bjc.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. METHODS Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. RESULTS Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (β = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (β = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (β = -.10, p = .002) and WAI-P ratings (β = -.19, p < .001). Better functioning level positively foresaw WAI-T (β = .14, p < .001) and WAI-P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. CONCLUSIONS This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Fabio Panariello
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Katherine Berry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Research and Innovation, Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matteo Rocchetti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Letizia Casiraghi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Matteo Malvezzi
- Department of Biostatistics, University of Parma, Parma, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Browne J, Wu WC, Jiang L, Singh M, Bozzay ML, Kunicki ZJ, Bayer TA, De Vito AN, Primack JM, McGeary JE, Kelso CM, Rudolph JL. Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data. J Psychiatr Res 2024; 173:58-63. [PMID: 38489871 DOI: 10.1016/j.jpsychires.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Jennifer M Primack
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
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Penadés R, Almodóvar-Payá C, García-Rizo C, Ruíz V, Catalán R, Valero S, Wykes T, Fatjó-Vilas M, Arias B. Changes in BDNF methylation patterns after cognitive remediation therapy in schizophrenia: A randomized and controlled trial. J Psychiatr Res 2024; 173:166-174. [PMID: 38537483 DOI: 10.1016/j.jpsychires.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
Although cognitive remediation therapy (CRT) produces cognitive benefits in schizophrenia, we do not yet understand whether molecular changes are associated with this cognitive improvement. A gene central to synaptic plasticity, the BDNF, has been proposed as one potential route. This study assesses whether BDNF methylation changes following CRT-produced cognitive improvement are detected. A randomized and controlled trial was performed with two groups (CRT, n = 40; TAU: Treatment as Usual, n = 20) on a sample of participants with schizophrenia. CRT was delivered by trained therapists using a web-based computerized program. Mixed Models, where the interaction of treatment (CRT, TAU) by time (T0: 0 weeks, T1: 16 weeks) was the main effect were used. Then, we tested the association between the treatment and methylation changes in three CpG islands of the BDNF gene. CRT group showed significant improvements in some cognitive domains. Between-groups differential changes in 5 CpG units over time were found, 4 in island 1 (CpG1.2, CpG1.7, CpG1.10, CpG1.17) and 1 in island 3 (CpG3.2). CRT group showed increases in methylation in CpG1.2, CpG1.7 and decreases in pG1.10, CpG1.17, and CpG3.2. Differences in the degree of methylation were associated with changes in Speed of Processing, Working Memory, and Verbal Learning within the CRT group. Those findings provide new data on the relationship between cognitive improvement and changes in peripheral methylation levels of BDNF gene, a key factor involved in neuroplasticity regulation. Trial Registration: NCT04278027.
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Affiliation(s)
- Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain; Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Carmen Almodóvar-Payá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain; Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Victoria Ruíz
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Rosa Catalán
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain; Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Sergi Valero
- ACE Alzheimer Center Barcelona, Barcelona, Spain; Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London & Maudsley NHS Foundation Trust, London Hospital, London, United Kingdom
| | - Mar Fatjó-Vilas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Bárbara Arias
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
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Mikkelsen TJ, Agerskov H, Jensen DM, Stenager E, Rothmann MJ. Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study. J Clin Nurs 2024; 33:1862-1874. [PMID: 38356190 DOI: 10.1111/jocn.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIM To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care. DESIGN The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews. METHODS Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. RESULTS Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment. CONCLUSION Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. IMPLICATIONS FOR PATIENT CARE The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.
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Affiliation(s)
- Tanja Juhl Mikkelsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
| | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Psychiatric Research Unit, Aabenraa, Department of Regional Health Services Research, University of Southern Denmark, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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de la Salle S, Choueiry J, Payumo M, Devlin M, Noel C, Abozmal A, Hyde M, Baysarowich R, Duncan B, Knott V. Transcranial Alternating Current Stimulation Alters Auditory Steady-State Oscillatory Rhythms and Their Cross-Frequency Couplings. Clin EEG Neurosci 2024; 55:329-339. [PMID: 37306065 PMCID: PMC11020127 DOI: 10.1177/15500594231179679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023]
Abstract
Auditory cortical plasticity deficits in schizophrenia are evidenced with electroencephalographic (EEG)-derived biomarkers, including the 40-Hz auditory steady-state response (ASSR). Aiming to understand the underlying oscillatory mechanisms contributing to the 40-Hz ASSR, we examined its response to transcranial alternating current stimulation (tACS) applied bilaterally to the temporal lobe of 23 healthy participants. Although not responding to gamma tACS, the 40-Hz ASSR was modulated by theta tACS (vs sham tACS), with reductions in gamma power and phase locking being accompanied by increases in theta-gamma phase-amplitude cross-frequency coupling. Results reveal that oscillatory changes induced by frequency-tuned tACS may be one approach for targeting and modulating auditory plasticity in normal and diseased brains.
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Affiliation(s)
- Sara de la Salle
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Joëlle Choueiry
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mark Payumo
- School of Psychology, Carleton University, Ottawa, ON, Canada
| | - Matt Devlin
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Chelsea Noel
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Ali Abozmal
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Molly Hyde
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Renée Baysarowich
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Brittany Duncan
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Verner Knott
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, Carleton University, Ottawa, ON, Canada
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Zhu Y, He S, Liu Y, Chen C, Ge X, Zhang W, Zhu Y, Zhou Q, Jiang Y, Zhang Y, Xu W, Wang N, Cai J, Xie B. Shanghai Community-Based Schizophrenia Cohort (SCS): a protocol for establishing a longitudinal cohort and research database of patients with schizophrenia receiving community-based mental health treatment. BMJ Open 2024; 14:e079312. [PMID: 38594189 PMCID: PMC11015296 DOI: 10.1136/bmjopen-2023-079312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Drivers for remission, relapse and violence-related behaviour among patients with schizophrenia are the most complicated issue. METHODS AND ANALYSIS This study aims to recruit a longitudinal cohort of patients with schizophrenia. Two suburban districts and two urban districts were randomly selected according to health service facilities, population, geographical region and socioeconomic status. Individuals (>18 years old) who received a diagnosis of schizophrenia following the International Classification of Diseases (10th edition) criteria within the past 3 years will be invited as participants. Assessments will be carried out in local community health centres. Data will be used to (1) establish a community-based schizophrenia cohort and biobank, (2) prospectively determine the course of multidimensional functional outcomes of patients with schizophrenia who are receiving community-based mental health treatment, and (3) map the trajectories of patients with schizophrenia and prospectively determine the course of multidimensional outcomes based on the differential impact of potentially modifiable moderators. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of Shanghai Mental Health Center (2021-67). Results of the study will be disseminated through peer-reviewed journals. If effective, related educational materials will be released to the public.
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Affiliation(s)
- Youwei Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Siyuan He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yanli Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chunmei Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaolei Ge
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Weibo Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, People's Republic of China
- Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yi Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qing Zhou
- Shanghai Xu Hui Mental Health Center, Shanghai, China
| | - Yihua Jiang
- Shanghai Min Hang Mental Health Center, Shanghai, China
| | - Yanping Zhang
- Shanghai Jin Shan Mental Health Center, Shanghai, China
| | - Weiyun Xu
- Shanghai Hong Kou Mental Health Center, Shanghai, China
| | - Na Wang
- Fudan University, Shanghai, Xuhui District, China
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Bin Xie
- Forensic Psychiatry, Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center, Shanghai, China
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Qin K, Yu Y, Cai H, Li J, Zeng J, Liang H. Effectiveness of mindfulness-based intervention in schizophrenia: A meta-analysis of randomized controlled trials. Psychiatry Res 2024; 334:115808. [PMID: 38402743 DOI: 10.1016/j.psychres.2024.115808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Schizophrenia poses significant societal challenges, including interpersonal tension, an increased risk of suicide, and soaring medical costs. Although antipsychotics can prevent relapses, they often give rise to adverse effects and do not provide lasting relief. Mindfulness-based interventions (MBI) emerge as a hopeful avenue for improving outcomes. However, existing research and meta-analyses of the efficacy of MBI in schizophrenia remain limited. This study aimed to evaluate the efficacy of MBI as an adjunctive therapy for schizophrenia. Relevant randomized controlled trials (RCTs) were searched across PubMed, Embase, Web of Science, and Cochrane Library from inception dates up to January 12, 2023. Statistical analyses were conducted using Stata software (version 15.0) and Review Manager 5.4. The quality of the included RCTs was assessed using the revised Cochrane risk of bias tool. A total of 18 RCTs were included, with 675 patients and 704 health controls. Our meta-analysis revealed that MBI significantly improved psychosocial function, insight, and mindfulness in individuals with schizophrenia. The quality of the included RCTs had a low to moderate risk of bias. These findings suggest that MBI holds promise for improving the mental health of individuals with schizophrenia.
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Affiliation(s)
- Keke Qin
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Yong Yu
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China.
| | - Huiling Cai
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jiahong Li
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jingyuan Zeng
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Huolan Liang
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
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Xue T, Sheng J, Gao H, Gu Y, Dai J, Yang X, Peng H, Gao H, Lu R, Shen Y, Wang L, Wang L, Shi Y, Li Z, Cui D. Eight-month intensive meditation-based intervention improves refractory hallucinations and delusions and quality of life in male inpatients with schizophrenia: a randomized controlled trial. Psychiatry Clin Neurosci 2024; 78:248-258. [PMID: 38318694 DOI: 10.1111/pcn.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/10/2023] [Accepted: 12/25/2023] [Indexed: 02/07/2024]
Abstract
AIM This study investigated the impact of an 8-month daily-guided intensive meditation-based intervention (iMI) on persistent hallucinations/delusions and health-related quality of life (QoL) in male inpatients with schizophrenia with treatment-refractory hallucinations and delusions (TRHDs). METHODS A randomized controlled trial assigned 64 male inpatients with schizophrenia and TRHD equally to an 8-month iMI plus general rehabilitation program (GRP) or GRP alone. Assessments were conducted at baseline and the third and eighth months using the Positive and Negative Syndrome Scale (PANSS), 36-Item Short Form-36 (SF-36), and Five Facet Mindfulness Questionnaire (FFMQ). Primary outcomes measured PANSS reduction rates for total score, positive symptoms, and hallucinations/delusions items. Secondary outcomes assessed PANSS, SF-36, and FFMQ scores for psychotic symptoms, health-related QoL, and mindfulness skills, respectively. RESULTS In the primary outcome, iMI significantly improved the reduction rates of PANSS total score, positive symptoms, and hallucination/delusion items compared with GRP at both the third and eighth months. Treatment response rates (≥25% reduction) for these measures significantly increased in the iMI group at the eighth month. Concerning secondary outcomes, iMI significantly reduced PANSS total score and hallucination/delusion items, while increasing scores in physical activity and mindfulness skills at both the third and eighth months compared with GRP. These effects were more pronounced with an 8-month intervention compared with a 3-month intervention. CONCLUSIONS An iMI benefits patients with TRHDs by reducing persistent hallucinations/delusions and enhancing health-related QoL. Longer iMI duration yields superior treatment outcomes.
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Affiliation(s)
- Ting Xue
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Jialing Sheng
- The First Minzheng Mental Health Center, Shanghai, China
| | - Hui Gao
- The First Minzheng Mental Health Center, Shanghai, China
| | - Yan Gu
- The First Minzheng Mental Health Center, Shanghai, China
| | - Jingjing Dai
- The First Minzheng Mental Health Center, Shanghai, China
| | - Xianghong Yang
- The First Minzheng Mental Health Center, Shanghai, China
| | - Hong Peng
- The First Minzheng Mental Health Center, Shanghai, China
| | - Hongrui Gao
- The First Minzheng Mental Health Center, Shanghai, China
| | - Ruping Lu
- The First Minzheng Mental Health Center, Shanghai, China
| | - Yi Shen
- The First Minzheng Mental Health Center, Shanghai, China
| | - Li Wang
- The First Minzheng Mental Health Center, Shanghai, China
| | - Lijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yuan Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Hotte-Meunier A, Penney D, Mendelson D, Thibaudeau É, Moritz S, Lepage M, Sauvé G. Effects of metacognitive training (MCT) on social cognition for schizophrenia spectrum and related psychotic disorders: a systematic review and meta-analysis. Psychol Med 2024; 54:914-920. [PMID: 37772399 DOI: 10.1017/s0033291723002611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Individuals with schizophrenia spectrum and related psychotic disorders (SSD) experience significant impairments in social cognition that impede functioning. Social cognition is a multidimensional construct consisting of four domains: 1. theory of mind, 2. emotion processing, 3. attributional style and 4. social perception. Metacognitive training (MCT) is an intervention designed to target cognitive biases in psychosis containing two modules addressing social cognition. METHODS A systematic review and meta-analysis was conducted to investigate the effects of MCT on social cognition and two of its domains: theory of mind and emotion processing. Ten electronic databases were scoured from 2007 to 1 February 2022 for MCT studies reporting social cognition outcomes for people with SSD (1050 identified, 282 assessed). Effect sizes were calculated using Cohen's d in R. RESULTS Nine studies were included in the meta-analysis (nMCT = 212, ncontrol = 194). MCT had a small but positive effect on global social cognition (d = 0.28 [95% CI 0.07-0.49]) and theory of mind (d = 0.27 [95% CI 0.01-0.52]). MCT showed no evidence of an effect on emotion processing (d = 0.03 [95% CI -0.26 to 0.32]). CONCLUSION MCT has a small but significant effect on social cognition for people with SSD. Our results add to other recent meta-analyses showing significant effects of MCT on clinically relevant outcomes such as positive symptoms, cognitive biases and cognitive insight. We recommend that future studies on MCT report outcomes on all four domains of social cognition. TRIAL REGISTRATION PROSPERO (in the process of registration) available at https://www.crd.york.ac.uk/prospero/#recordDetails.
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Affiliation(s)
- Adèle Hotte-Meunier
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Danielle Penney
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Daniel Mendelson
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Élisabeth Thibaudeau
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg, Hamburg, Germany
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Geneviève Sauvé
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Education and Pedagogy, Université du Québec à Montréal, Montreal, Canada
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Caiada M, Felix S, Guionnet S, Valery KM, Bonilla-Guerrero J, Destaillats JM, Prouteau A. Promoting Intimate Relationships in Mental Illness: A Systematic Review of Interventions. Community Ment Health J 2024; 60:536-551. [PMID: 38015269 DOI: 10.1007/s10597-023-01204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Although persons with Serious Mental Illness (SMI) express a need for intimate relations with others, they still suffer from a severe lack of social participation in this domain. However, these unmet needs have received little attention until recently. This study reviews interventions that aim to facilitate the development and the maintenance of intimate relationships (IR) of persons with schizophrenia, bipolar disorder and major depression. A systematic review following PRISMA guidelines was conducted. Studies published in Scopus, PubMed, EBSCO (Psych INFO, Psych ARTICLES, Psychology and Behavioral Sciences Collection) from January 1, 2000, to December, 2021, were screened. The search using terms referring to "schizophrenia", "bipolar disorder", "major depression", "IR" and "interventions" revealed 11 studies. Among them, 10 reported interventions for persons with depression, including 9 for couple therapy. Most interventions targeted satisfaction with couple relationships as the main therapeutic objective. Heterogeneity in study design precludes any firm conclusions about their efficacy. Interestingly, only one intervention focused on single persons interested in developing IR. The results highlight the lack of interventions: (i) aimed at promoting IR, (ii) designed for single persons, and (iii) targeting persons with psychotic disorders. This result may reflect the persisting stigmatization of persons with psychotic disorders, and the taboo associated with the IR and sexuality of persons with mental illness. Further studies are needed to develop inclusive interventions promoting the development of IR in persons with mental illness.
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Affiliation(s)
- Meryl Caiada
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France.
| | - Simon Felix
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Sarah Guionnet
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | - Kevin-Marc Valery
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | | | | | - Antoinette Prouteau
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
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11
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Slot MIE, van Hell HH, Rossum IWV, Dazzan P, Maat A, de Haan L, Crespo-Facorro B, Glenthøj B, Lawrie SM, McDonald C, Gruber O, van Amelsvoort T, Arango C, Kircher T, Nelson B, Galderisi S, Weiser M, Sachs G, Maatz A, Bressan RA, Kwon JS, Mizrahi R, McGuire P, Kahn RS. A naturalistic cohort study of first-episode schizophrenia spectrum disorder: A description of the early phase of illness in the PSYSCAN cohort. Schizophr Res 2024; 266:237-248. [PMID: 38431986 DOI: 10.1016/j.schres.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND We examined the course of illness over a 12-month period in a large, international multi-center cohort of people with a first-episode schizophrenia spectrum disorder (FES) in a naturalistic, prospective study (PSYSCAN). METHOD Patients with a first episode of schizophrenia, schizoaffective disorder (depressive type) or schizophreniform disorder were recruited at 16 institutions in Europe, Israel and Australia. Participants (N = 304) received clinical treatment as usual throughout the study. RESULTS The mean age of the cohort was 24.3 years (SD = 5.6), and 67 % were male. At baseline, participants presented with a range of intensities of psychotic symptoms, 80 % were taking antipsychotic medication, 68 % were receiving psychological treatment, with 46.5 % in symptomatic remission. The mean duration of untreated psychosis was 6.2 months (SD = 17.0). After one year, 67 % were in symptomatic remission and 61 % were in functional remission, but 31 % had been readmitted to hospital at some time after baseline. In the cohort as a whole, depressive symptoms remained stable over the follow-up period. In patients with a current depressive episode at baseline, depressive symptoms slightly improved. Alcohol, tobacco and cannabis were the most commonly used substances, with daily users of cannabis ranging between 9 and 11 % throughout the follow-up period. CONCLUSIONS This study provides valuable insight into the early course of a broad range of clinical and functional aspects of illness in FES patients in routine clinical practice.
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Affiliation(s)
- Margot I E Slot
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Hendrika H van Hell
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America.
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark 458 Hill, London SE5 8AF, United Kingdom.
| | - Arija Maat
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Psychiatry, Department Early Psychosis, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, University of Sevilla. Hospital Universitario Virgen del Rocio, IBiS-CSIC, Sevilla, Spain.
| | - Birte Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Dept. of Clinical Medicine, Copenhagen, Denmark.
| | - Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Mondriaan Mental Health Centre, Maastricht, the Netherlands.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, D-35039 Marburg, Germany.
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville, Victoria, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Silvana Galderisi
- University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Anke Maatz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - Rodrigo A Bressan
- Department of Psychiatry, Interdisciplinary Lab for Clinical Neurosciences (LiNC), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, 101 Dahakno, Jongno-gu, Seoul, Republic of Korea.
| | - Romina Mizrahi
- Department of Psychiatry, McGill University, Montreal, Canada.
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
| | - René S Kahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America.
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12
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Miley K, Bronstein MV, Ma S, Lee H, Green MF, Ventura J, Hooker CI, Nahum M, Vinogradov S. Trajectories and predictors of response to social cognition training in people with schizophrenia: A proof-of-concept machine learning study. Schizophr Res 2024; 266:92-99. [PMID: 38387253 PMCID: PMC11005939 DOI: 10.1016/j.schres.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/15/2023] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Social cognition training (SCT) can improve social cognition deficits in schizophrenia. However, little is known about patterns of response to SCT or individual characteristics that predict response. METHODS 76 adults with schizophrenia randomized to receive 8-12 weeks of remotely-delivered SCT were included in this analysis. Social cognition was measured with a composite of six assessments. Latent class growth analyses identified trajectories of social cognitive response to SCT. Random forest and logistic regression models were trained to predict membership in the trajectory group that showed improvement from baseline measures including symptoms, functioning, motivation, and cognition. RESULTS Five trajectory groups were identified: Group 1 (29 %) began with slightly above average social cognition, and this ability significantly improved with SCT. Group 2 (9 %) had baseline social cognition approximately one standard deviation above the sample mean and did not improve with training. Groups 3 (18 %) and 4 (36 %) began with average to slightly below-average social cognition and showed non-significant trends toward improvement. Group 5 (8 %) began with social cognition approximately one standard deviation below the sample mean, and experienced significant deterioration in social cognition. The random forest model had the best performance, predicting Group 1 membership with an area under the curve of 0.73 (SD 0.24; 95 % CI [0.51-0.87]). CONCLUSIONS Findings suggest that there are distinct patterns of response to SCT in schizophrenia and that those with slightly above average social cognition at baseline may be most likely to experience gains. Results may inform future research seeking to individualize SCT treatment for schizophrenia.
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Affiliation(s)
- Kathleen Miley
- HealthPartners Institute, Minneapolis, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, MN, USA.
| | - Michael V Bronstein
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, MN, USA
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, MN, USA
| | - Hyunkyu Lee
- Department of Research and Development, Posit Science Inc., San Francisco, CA, USA
| | - Michael F Green
- VA Greater Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Christine I Hooker
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mor Nahum
- School of Occupational Therapy, Hebrew University of Jerusalem, Israel
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, MN, USA
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13
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Gurusamy J, Gandhi S, Damodharan D, Palaniappan M, Ganesan V. Effect of lifestyle modification intervention (LMI) on metabolic syndrome in schizophrenia in a residential mental health care setting-A mixed method study. Schizophr Res 2024; 266:75-84. [PMID: 38377870 DOI: 10.1016/j.schres.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/18/2023] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Jothimani Gurusamy
- College of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Dinakaran Damodharan
- Center for Psychosocial Support and Disaster Management, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Marimuthu Palaniappan
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Venkatasubramanian Ganesan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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14
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Lee J, Huh S, Park K, Kang N, Yu HS, Park HG, Kim YS, Kang UG, Won S, Kim SH. Behavioral and transcriptional effects of repeated electroconvulsive seizures in the neonatal MK-801-treated rat model of schizophrenia. Psychopharmacology (Berl) 2024; 241:817-832. [PMID: 38081977 DOI: 10.1007/s00213-023-06511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024]
Abstract
RATIONALE Electroconvulsive therapy (ECT) is an effective treatment modality for schizophrenia. However, its antipsychotic-like mechanism remains unclear. OBJECTIVES To gain insight into the antipsychotic-like actions of ECT, this study investigated how repeated treatments of electroconvulsive seizure (ECS), an animal model for ECT, affect the behavioral and transcriptomic profile of a neurodevelopmental animal model of schizophrenia. METHODS Two injections of MK-801 or saline were administered to rats on postnatal day 7 (PN7), and either repeated ECS treatments (E10X) or sham shock was conducted daily from PN50 to PN59. Ultimately, the rats were divided into vehicle/sham (V/S), MK-801/sham (M/S), vehicle/ECS (V/E), and MK-801/ECS (M/E) groups. On PN59, prepulse inhibition and locomotor activity were tested. Prefrontal cortex transcriptomes were analyzed with mRNA sequencing and network and pathway analyses, and quantitative real-time polymerase chain reaction (qPCR) analyses were subsequently conducted. RESULTS Prepulse inhibition deficit was induced by MK-801 and normalized by E10X. In M/S vs. M/E model, Egr1, Mmp9, and S100a6 were identified as center genes, and interleukin-17 (IL-17), nuclear factor kappa B (NF-κB), and tumor necrosis factor (TNF) signaling pathways were identified as the three most relevant pathways. In the V/E vs. V/S model, mitophagy, NF-κB, and receptor for advanced glycation end products (RAGE) pathways were identified. qPCR analyses demonstrated that Igfbp6, Btf3, Cox6a2, and H2az1 were downregulated in M/S and upregulated in M/E. CONCLUSIONS E10X reverses the behavioral changes induced by MK-801 and produces transcriptional changes in inflammatory, insulin, and mitophagy pathways, which provide mechanistic insight into the antipsychotic-like mechanism of ECT.
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Affiliation(s)
- Jeonghoon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seonghoo Huh
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungtaek Park
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Nuree Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sook Yu
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hong Geun Park
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Ung Gu Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungho Won
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program of Bioinformatics, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- RexSoft Inc., Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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15
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Wang T, Yu M, Gu X, Liang X, Wang P, Peng W, Liu D, Chen D, Huang C, Tan Y, Liu K, Xiang B. Mechanism of electroconvulsive therapy in schizophrenia: a bioinformatics analysis study of RNA-seq data. Psychiatr Genet 2024; 34:54-60. [PMID: 38441120 DOI: 10.1097/ypg.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The molecular mechanism of electroconvulsive therapy (ECT) for schizophrenia remains unclear. The aim of this study was to uncover the underlying biological mechanisms of ECT in the treatment of schizophrenia using a transcriptional dataset. METHODS The peripheral blood mRNA sequencing data of eight patients (before and after ECT) and eight healthy controls were analyzed by integrated co-expression network analysis and the differentially expressed genes were analyzed by cluster analysis. Gene set overlap analysis was performed using the hypergeometric distribution of phypfunction in R. Associations of these gene sets with psychiatric disorders were explored. Tissue-specific enrichment analysis, gene ontology enrichment analysis, and protein-protein interaction enrichment analysis were used for gene set organization localization and pathway analysis. RESULTS We found the genes of the green-yellow module were significantly associated with the effect of ECT treatment and the common gene variants of schizophrenia ( P = 0.0061; family-wise error correction). The genes of the green-yellow module are mainly enriched in brain tissue and mainly involved in the pathways of neurotrophin, mitogen-activated protein kinase and long-term potentiation. CONCLUSION Genes associated with the efficacy of ECT were predominantly enriched in neurotrophin, mitogen-activated protein kinase and long-term potentiation signaling pathways.
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Affiliation(s)
| | - Minglan Yu
- Medical Laboratory Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province
| | - Xiaochu Gu
- Clinical Laboratory, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu Province
| | | | | | | | - Dongmei Liu
- Department of Psychiatry, Yibin Fourth People's Hospital, Yibin
| | - Dechao Chen
- Department of Psychiatry, Yibin Fourth People's Hospital, Yibin
| | | | - Youguo Tan
- Department of Psychiatry, Zigong Mental Health Center, Zigong, Sichuan Province, China
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16
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Isayeva U, Manchia M, Collu R, Primavera D, Deriu L, Caboni E, Iaselli NM, Sundas D, Tusconi M, Pinna F, Paribello P, Scherma M, Pisanu C, Meloni A, Zai CC, Congiu D, Squassina A, Fratta W, Fadda P, Carpiniello B. Symptomatic remission and recovery in major psychosis: Is there a role for BDNF? A secondary analysis of the LABSP cohort data. Schizophr Res 2024; 266:197-204. [PMID: 38422890 DOI: 10.1016/j.schres.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Remission, relapse prevention, and clinical recovery are crucial areas of interest in schizophrenia (SCZ) research. Although SCZ is a chronic disorder with poor overall outcomes, years of research demonstrated that recovery is possible. There are considerable data linking brain-derived neurotrophic factor (BDNF) to SCZ, however, evidence on the role of BDNF in remission in SCZ is scarce. This secondary analysis of the Longitudinal Assessment of BDNF in Sardinian patients (LABSP) data aimed to investigate the relationship between serum BDNF levels and symptomatic remission, simultaneous clinical and functional remission, and recovery in patients with SCZ. A total of 105 patients with SCZ or schizoaffective disorder were recruited for a longitudinal assessment of BDNF levels over 24 months. Longitudinal data were analyzed using mixed-effects linear regression models. The study found significant associations between use of long acting injectables (χ2 = 7.075, df = 1, p = 0.008), baseline serum BDNF levels (U = 701, z = -2.543, p = 0.011), and "childhood" (U = 475, z = -2.124, p = 0.034) and "general" (U = 55, z = -2.014, p = 0.044) subscales of the Premorbid Adjustment Scale (PAS) with patients maintaining remission and recovery. The diagnosis of SCZ was significantly associated with lower BDNF levels for patients with simultaneous clinical and functional remission (Z = 2.035, p = 0.0419) and recovery (Z = 2.009, p = 0.0445) compared to those without. There were no significant associations between remission in the entire sample and longitudinal serum BDNF levels or genetic variants within the BDNF gene. These findings provide further insight into the complex relationship between BDNF and SCZ.
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Affiliation(s)
- Ulker Isayeva
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Roberto Collu
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Deriu
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Edoardo Caboni
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Novella Maria Iaselli
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Davide Sundas
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Massimo Tusconi
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Maria Scherma
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Claudia Pisanu
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Anna Meloni
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Institute of Medical Science, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donatella Congiu
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Alessio Squassina
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Walter Fratta
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Dependence", University of Cagliari, Cagliari, Italy
| | - Paola Fadda
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Dependence", University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
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Williams MJ. Problems Translating Cognitive Enhancement Therapy From the Laboratory to the Real World. Psychiatr Serv 2024; 75:397. [PMID: 38557134 DOI: 10.1176/appi.ps.20230417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
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18
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Varese F, Sellwood W, Pulford D, Awenat Y, Bird L, Bhutani G, Carter LA, Davies L, Aseem S, Davis C, Hefferman-Clarke R, Hilton C, Horne G, Keane D, Logie R, Malkin D, Potter F, van den Berg D, Zia S, Bentall RP. Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings. Psychol Med 2024; 54:874-885. [PMID: 37882058 DOI: 10.1017/s0033291723002532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. METHODS A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. RESULTS Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. CONCLUSIONS The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Daniel Pulford
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Leanne Bird
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Gita Bhutani
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Lesley-Anne Carter
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Saadia Aseem
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Claire Davis
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | | | - Claire Hilton
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Georgia Horne
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - David Keane
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Robin Logie
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Debra Malkin
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Fiona Potter
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | | | - Shameem Zia
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Richard P Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Smith LC, Mateos AC, Due AS, Bergström J, Nordentoft M, Clemmensen L, Glenthøj LB. Immersive virtual reality in the treatment of auditory hallucinations: A PRISMA scoping review. Psychiatry Res 2024; 334:115834. [PMID: 38452499 DOI: 10.1016/j.psychres.2024.115834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND A large group of psychiatric patients suffer from auditory hallucinations (AH) despite relevant treatment regimens. In mental health populations, AH tend to be verbal (AVH) and the content critical or abusive. Trials employing immersive virtual reality (VR) to treat mental health disorders are emerging. OBJECTIVE The aim of this scoping review is to provide an overview of clinical trials utilizing VR in the treatment of AH and to document knowledge gaps in the literature. METHODS PubMed, Cochrane Library, and Embase were searched for studies reporting on the use of VR to target AH. RESULTS 16 papers were included in this PRISMA scoping review (ScR). In most studies VR therapy (VRT) was employed to ameliorate treatment resistant AVH in schizophrenia spectrum disorders. Only two studies included patients with a diagnosis of affective disorders. The VRT was carried out with the use of an avatar to represent the patient's most dominant voice. DISCUSSION The research field employing VR to treat AH is promising but still in its infancy. Results from larger randomized clinical trials are needed to establish substantial evidence of therapy effectiveness. Additionally, the knowledge base would benefit from more profound qualitative data exploring views of patients and therapists.
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Affiliation(s)
- Lisa Charlotte Smith
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Department of Clinical Medicine (DK), University of Copenhagen, Denmark.
| | - Ana Collados Mateos
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Anne Sofie Due
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Joanna Bergström
- Department of Computer Science (DK), University of Copenhagen, Denmark
| | - Merete Nordentoft
- Department of Clinical Medicine (DK), University of Copenhagen, Denmark; Research Unit (CORE), Capital Region (DK), Mental Health Center Copenhagen, Denmark
| | - Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Louise Birkedal Glenthøj
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Department of Psychology (DK), University of Copenhagen, Denmark
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20
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Chu M, Li S, Wang Y, Lui SSY, Chan RCK. The effect of noninvasive brain stimulation on anhedonia in patients with schizophrenia and depression: A systematic review and meta-analysis. Psych J 2024; 13:166-175. [PMID: 38151800 PMCID: PMC10990806 DOI: 10.1002/pchj.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Anhedonia is a transdiagnostic symptom found in patients with schizophrenia and depression. Current pharmacological interventions for anhedonia are unsatisfactory in a considerable proportion of patients. There has been growing interest in applying noninvasive brain stimulation (NIBS) to patients with anhedonia. However, evidence for the efficacy of NIBS for anhedonia remain inconsistent. This study systematically identified all studies that measured anhedonia and applied NIBS in patients with schizophrenia or depression. We conducted a search using the various databases in English (PubMed, EBSCOHost (PsycInfo/PsycArticles), Web of Science) and Chinese (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform) languages, and reviewed original research articles on NIBS published from January 1989 to July 2023. Our search had identified 15 articles for quantitative synthesis, with three concerning schizophrenia samples, 11 concerning samples with depression, and one concerning both clinical samples. We conducted a meta-analysis based on the 15 included studies, and the results suggested that NIBS could improve anhedonia symptoms in schizophrenia patients and patients with depression, with a medium-to-large effect size. Our findings are preliminary, given the limited number of included studies. Future NIBS research should measure anhedonia as a primary outcome and should recruit transdiagnostic samples.
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Affiliation(s)
- Min‐yi Chu
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuai‐biao Li
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience LaboratoryCAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Simon S. Y. Lui
- Department of Psychiatry, School of Clinical MedicineThe University of Hong KongHong KongChina
| | - Raymond C. K. Chan
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
- Neuropsychology and Applied Cognitive Neuroscience LaboratoryCAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
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21
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Chiang HI, Lo SC, Beckstead JW, Yang CY. Effects of Baduanjin Qigong in Individuals With Schizophrenia: A Preliminary Quasi-Experimental Pilot Study. J Psychosoc Nurs Ment Health Serv 2024; 62:41-48. [PMID: 37751581 DOI: 10.3928/02793695-20230920-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
The current quasi-experimental study explored the effects of Baduanjin qigong on body mass index (BMI) and five metabolic indexes in people with schizophrenia. Inclusion criteria were body mass index >25 kg/m2 or metabolic syndrome. Twenty-two service users were recruited from a psychiatric center and were assigned to the experimental group (EG) or control group (CG) using blocked randomization. The EG performed Baduanjin qigong lasting 1 hour for 12 weeks three times per week, whereas the CG received routine care. Generalized estimating equations showed that the EG achieved a greater decrease in BMI and waist circumference (WC) than the CG post-intervention. Baduanjin qigong may provide an effective nonpharmacological approach to reducing BMI and WC in people with schizophrenia. This study showed that performing Baduanjin qigong for 12 weeks is a feasible and effective strategy for improving the body shape of individuals with chronic schizophrenia, thus providing results that can serve as a reference for health professionals working in psychiatry departments. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 41-48.].
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22
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Le TP, Ventura J, Subotnik KL, Nuechterlein KH. Intrinsic motivation predicts cognitive and functional gains during coordinated specialty care for first-episode schizophrenia. Schizophr Res 2024; 266:249-255. [PMID: 38442522 DOI: 10.1016/j.schres.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/01/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
Coordinated Specialty Care (CSC) and embedded group therapeutic interventions have been effective in improving outcomes for individuals experiencing recent first-episode schizophrenia, including cognitive performance and functioning. Treatment response varies substantially, with some patients experiencing limited or no improvement. Motivation has emerged as a key determinant of treatment engagement and efficacy. However, the impact of intrinsic and extrinsic aspects of motivation has not been directly examined with treatment outcomes in first-episode schizophrenia. This study investigated whether baseline levels of intrinsic and extrinsic motivation predicted cognitive and functional gains over 6 and 12 months in CSC. Forty participants with first-episode schizophrenia completed a 12-month CSC treatment period. Baseline measures of intrinsic and extrinsic motivation were obtained for group therapeutic interventions and work/school, as well as measures of cognition and functioning (role and social) at baseline, 6 months, and 12 months. Results revealed that higher baseline scores of intrinsic motivation for group therapeutic interventions were significantly predictive of greater cognitive gains at 12 months, and a similar tendency was observed at 6 months. Additionally, baseline scores of intrinsic motivation for work/school predicted role gains at 6 months, with a similar tendency observed at 12 months. Extrinsic motivation did not consistently impact treatment outcomes, except for work/school-related extrinsic motivation, which was linked to greater social functioning gains at 12 months. These findings provide insight into the factors influencing treatment outcomes for individuals with first-episode schizophrenia and highlight the importance of intrinsic motivation as a modifiable personal variable that can enhance response to CSC.
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Affiliation(s)
- Thanh P Le
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Department of Psychology, University of California, Los Angeles, CA, USA
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23
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Cui W, Liu Z, Liang C, Zhao Z. Comparative efficacy of different types of exercise modalities on psychiatric symptomatology in patients with schizophrenia: a systematic review with network meta-analysis. Sci Rep 2024; 14:7019. [PMID: 38528063 DOI: 10.1038/s41598-024-57081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
This network meta-analysis investigated the effects of 8 types of physical exercises on treating positive symptoms, negative symptoms, general psychopathology, and the Positive And Negative Syndrome Scale (PANSS) total score in patients with schizophrenia. The methods adhered to PRISMA guidelines and used the Cochrane risk of bias tool for quality assessment, and Stata software for data analysis. Data were sourced from PubMed, Embase, Web of Science, and the Cochrane database up to August 15, 2023, following PICOS principles. A total of 25 studies including 1441 participants were analyzed. Results showed that resistance exercise seems to be effective for improving positive symptoms, while Yoga was more effective for negative symptoms. Low-intensity aerobic exercise was optimal for general psychopathology, and Yoga was effective in improving the PANSS total score. The study concluded that yoga and aerobic exercise demonstrated superior performance, but the impact of exercise on patients with schizophrenia is also influenced by individual factors and intervention dosages. Therefore, a pre-assessment of patients considering factors such as interests, hobbies, and physical capabilities is crucial for selecting appropriate exercise modalities.
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Affiliation(s)
- Wenlai Cui
- Graduate School, Capital University of Physical Education and Sports, Beijing, China
| | - Zhitao Liu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
| | - Cheng Liang
- Graduate School, Capital University of Physical Education and Sports, Beijing, China
| | - Zhizhi Zhao
- Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China.
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24
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Kumar P, Roy RN, Prajapati S. Labyrinthine and Neuroscientific Impact of Schizophrenia in the Criminal Justice System. Int Tinnitus J 2024; 27:231-237. [PMID: 38507639 DOI: 10.5935/0946-5448.20230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Schizophrenia, a complex neuropsychiatric condition, manifests with severe neurobiological and psychosocial symptoms, including psychosis, cognitive dysfunction, and social withdrawal. Neuroscience links these symptoms to synaptic malfunctions and neurotransmitter dysregulation, leading to a profound disconnection from reality. The disorder significantly affects cognitive, affective, and behavioral functions, causing considerable neuropsychological distress and functional impairments. The interplay of schizophrenia with the criminal justice system is complex, often exacerbating psychiatric stigma and introducing challenging neuroethical dilemmas. From neuroscientific perspective, schizophrenia symptoms are classified into 'positive' (hyperfunctioning or distortion of normal mental processes) and 'negative' (reduction or loss of mental functions). Each category presents distinct medico-legal challenges. Studies, including those from the Clinical Antipsychotic Trials of Intervention Effectiveness, highlight the importance of identifying neurobiological and psychosocial factors that increase the risk of criminal justice involvement, stressing the necessity of addressing concurrent disorders like substance use disorders. This convergence underscores the need for a delicate balance between therapeutic interventions and legal responsibility, advocating for policy reforms and neuroscience-based research initiatives. Such efforts are crucial for improving the management of schizophrenia within the criminal justice system, focusing on both the medical and societal aspects of the disorder.
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Affiliation(s)
- Prashant Kumar
- MATS Law School, MATS University, Raipur, Chhattisgarh (India)
| | - Rana Navneet Roy
- Hidayatullah National Law University, Raipur, Chhattisgarh (India)
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25
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Daliri DB, Laari TT, Abagye N, Afaya A. Exploring the experiences of mental health nurses in the management of schizophrenia in the Upper East Region of Ghana: a qualitative study. BMJ Open 2024; 14:e079933. [PMID: 38503418 PMCID: PMC10952925 DOI: 10.1136/bmjopen-2023-079933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Schizophrenia is a chronic condition, of which the diagnosis and management require comprehensive care. The role mental health nurses play in this management cannot be overemphasised. In an effort to give their best, several challenges confront them which need to be sought and addressed. This study aimed to explore the factors that influence the management of schizophrenia by mental health nurses in the Upper East Region. DESIGN AND PARTICIPANTS A descriptive phenomenology design was used in this study. Individual in-depth interviews were conducted among 18 purposively sampled mental health nurses using a semistructured interview guide. Audio-recorded interviews were transcribed verbatim and analysed thematically using Colaizzi's approach. SETTING The study was conducted in five primary and secondary-level health facilities in the Upper East Region of Ghana. FINDINGS Five themes were deduced from the theoretical framework, which were as follows: individual factors, interpersonal factors, organisational factors, community-level factors, and policy-level factors. At the individual level, factors such as the condition of the patient at presentation, medication side effects, inadequate knowledge, and poor adherence were identified. Interpersonal factors identified were poor communication, lack of mutual respect, and poor communication, while organisational factors such as inadequate staff, inadequate infrastructure and logistics, and unavailability of antipsychotics were reported. Moreover, the study identified community-level factors such as stigma and cultural beliefs, while policy-level factors such as laws regarding suicide, patient rights, and non-inclusion of mental health services into the National Health Insurance Scheme were reported as factors influencing the management of schizophrenia by mental health nurses. CONCLUSIONS Addressing these factors is essential to ensure sustainable improvements and the effective management of schizophrenia. It is imperative to consider these factors when designing interventions and policies to optimise the management of schizophrenia by mental health nurses in Ghana.
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Affiliation(s)
- Dennis Bomansang Daliri
- Presbyterian Psychiatric Hospital, Bolgatanga, Ghana
- Department of International and Global Health, University for Development Studies, Tamale, Ghana
| | | | - Nancy Abagye
- Department of Midwifery, University of Ghana, Legon, Ghana
| | - Agani Afaya
- Department of Nursing, University of Health and Allied Sciences, Ho, Ghana
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Ruffalo ML, Kottapalli M, Anbukkarasu P. Empathy in the Care of Individuals With Schizophrenia: A Vital Element of Treatment. Am J Psychother 2024; 77:30-34. [PMID: 38093661 DOI: 10.1176/appi.psychotherapy.20230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
Although therapist empathy has long been recognized as one of the most important ingredients of successful psychotherapy, its role in the treatment of schizophrenia has been neglected, relative to the treatment of other psychiatric disorders. In this article, the authors aimed to explore historical and modern conceptions of the use of empathy in work with patients with schizophrenia, review the research on empathy as applied generally in psychotherapy and as it pertains to this population, and offer a case study demonstrating empathy's instrumental role in the management of schizophrenia. Empathic understanding of patients with schizophrenia has relevance across treatment settings: in psychotherapy, on inpatient psychiatric units, in the emergency department, and at home with family or caregivers. An empathic understanding of the psychological process occurring in schizophrenia is a vital component of effective treatment.
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Affiliation(s)
- Mark L Ruffalo
- Department of Psychiatry, University of Central Florida College of Medicine, Orlando (all authors); Department of Psychiatry, Tufts University School of Medicine, Boston (Ruffalo)
| | - Manjula Kottapalli
- Department of Psychiatry, University of Central Florida College of Medicine, Orlando (all authors); Department of Psychiatry, Tufts University School of Medicine, Boston (Ruffalo)
| | - Preethashree Anbukkarasu
- Department of Psychiatry, University of Central Florida College of Medicine, Orlando (all authors); Department of Psychiatry, Tufts University School of Medicine, Boston (Ruffalo)
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27
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Lisoni J, Nibbio G, Baldacci G, Zucchetti A, Cicale A, Zardini D, Miotto P, Deste G, Barlati S, Vita A. Improving depressive symptoms in patients with schizophrenia using bilateral bipolar-nonbalanced prefrontal tDCS: Results from a double-blind sham-controlled trial. J Affect Disord 2024; 349:165-175. [PMID: 38199388 DOI: 10.1016/j.jad.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Treating depressive symptoms in patients with schizophrenia is challenging. While transcranical Dicrect Current Stimulation (tDCS) improved other core symptoms of schizophrenia, conflicting results have been obtained on depressive symptoms. Thus, we aimed to expand current evidence on tDCS efficacy to improve depressive symptoms in patients with schizophrenia. METHODS A double-blind RCT was performed with patients randomized to 2 mA active-tDCS or sham-tDCS (15 daily sessions) with a bilateral bipolar-nonbalanced prefrontal placement (anode: left Dorsolateral prefrontal cortex; cathode: right orbitofrontal region). Clinical outcomes included variations of Calgary Depression Scale for Schizophrenia total score (CDSS) and of Depression-hopelessness and Guilty idea of reference-pathological guilt factors. Analysis of covariance was performed evaluating between-group changes over time. The presence/absence of probable clinically significant depression was determined when CDSS > 6. RESULTS As 50 outpatients were included (both groups, n = 25), significant improvements following active-tDCS were observed for CDSS total score (p = 0.001), Depression-hopelessness (p = 0.001) and Guilty idea of reference-pathological guilt (p = 0.03). Considering patients with CDSS>6 (n = 23), compared to sham, active-tDCS significantly improved CDSS total score (p < 0.001), Depression-hopelessness (p = 0.001) but Guilty idea of reference-pathological guilt only marginally improved (p = 0.051). Considering response rates of clinically significant depression, important reductions of CDSS score were observed (78 % of the sample scored ≤6; active-tDCS, n = 23; sham-tDCS, n = 16; p = 0.017). Early wakening item did not significantly change in any group. LIMITATIONS The study lacks a follow-up period and evaluation of tDCS effects on psychosocial functioning. CONCLUSIONS Bilateral bipolar-nonbalanced prefrontal tDCS is a successful protocol for the treatment of depressive symptoms in patients with schizophrenia.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Paola Miotto
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
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28
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Chen WY, Pan CH, Su SS, Yang TW, Chen CC, Kuo CJ. Incidence and Risk Profiles for Suicide Mortality in Patients With Schizophrenia Receiving Homecare Case Management in Taiwan. Schizophr Bull 2024; 50:295-303. [PMID: 37163678 PMCID: PMC10919775 DOI: 10.1093/schbul/sbad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan's National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case-control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population.
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Affiliation(s)
- Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Shiang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tien-Wei Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Dai J, Sun D, Li B, Zhang Y, Wen M, Wang H, Bi H. Mixed-Mode Mindfulness-based cognitive therapy for psychological resilience, Self Esteem and Stigma of patients with schizophrenia: a randomized controlled trial. BMC Psychiatry 2024; 24:179. [PMID: 38439012 PMCID: PMC10913446 DOI: 10.1186/s12888-024-05636-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND People with schizophrenia often face challenges such as lower psychological resilience, reduced self-worth, and increased social stigma, hindering their recovery. Mindfulness-Based Cognitive Therapy (MBCT) has shown promise in boosting psychological resilience and self-esteem while diminishing stigma. However, MBCT demands professional involvement and substantial expenses, adding to the workload of professionals and the financial strain on patients. Mixed-mode Mindfulness-Based Cognitive Therapy (M-MBCT) integrates both "face-to-face" and "self-help" approaches to minimize staff effort and costs. This study aims to assess the impact of M-MBCT on the psychological resilience, self-esteem, and stigma in schizophrenia patients. METHODS This randomized, controlled, parallel-group, assessor-blinded clinical trial enrolled 174 inpatients with schizophrenia. Participants were randomly assigned to either the experimental or control group. The experimental group underwent an 8-week M-MBCT intervention, while the control group received standard treatment. Data collection employed the Connor-Davidson Resilience Scale (CD-RISC), Internalized Stigma of Mental Illness Scale (ISMI), and Rosenberg Self-Esteem Scale (RSES) before and after the intervention. Post-intervention, significant differences in ISMI, CD-RISC, and RSES scores were observed between the experimental and control groups. RESULTS In the experimental group, ISMI scores notably decreased, while CD-RISC and RSES scores significantly increased (P < 0.05). Multiple linear regression analysis identified age, education, and family history of mental illness as significant factors related to stigma (P < 0.05). Additionally, correlation analysis indicated a significant negative relationship between the reduction in CD-RISC scores and the reduction in ISMI scores (P < 0.05). CONCLUSION M-MBCT effectively enhanced psychological resilience and self-esteem while diminishing stigma in individuals with schizophrenia. M-MBCT emerges as a promising treatment option for schizophrenia sufferers. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 03/06/2023 ( www.chictr.org.cn ; ChiCTR ID: ChiCTR2300069071).
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Affiliation(s)
- Jiali Dai
- Department of geriatric Psychiatry, The Third Hospital of Daqing, Daqing, China
| | - Dawei Sun
- Department of geriatric Psychiatry, The Third Hospital of Daqing, Daqing, China
| | - Bohui Li
- Clinical laboratory, The Third Hospital of Daqing, Daqing, China
| | - Yang Zhang
- Department of geriatric Psychiatry, The Third Hospital of Daqing, Daqing, China
| | - Meiling Wen
- Second Psychiatric Ward, The Third Hospital of Daqing, Daqing, China
| | - Haina Wang
- Department of Psychological counseling, The Third Hospital of Daqing, Daqing, China
| | - Hongsheng Bi
- Second Psychiatric Ward, The Third Hospital of Daqing, Daqing, China.
- Second Psychiatric Ward, the Third Hospital of Daqing, 163712, Daqing, China.
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Yin J, Sun Y, Zhu Y, Alifujiang H, Wang Y, An S, Huang H, Fu X, Deng H, Chen Y. Effects of yoga on clinical symptoms, quality of life and social functioning in patients with schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2024; 93:103959. [PMID: 38342034 DOI: 10.1016/j.ajp.2024.103959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Yoga is gradually being explored as a potential complementary intervention in addition to psychiatric drugs for schizophrenia. However, there are conflicts on the efficacy of yoga for schizophrenia. This meta-analysis was aimed to evaluate the association of yoga intervention with reductions on clinical symptoms and improvements in quality of life (QoL) as well as social functioning among schizophrenia. METHOD Systematic literature search was undertaken to identify all RCTs that compared yoga with active or passive controls for patients with schizophrenia from inception to July 2023. The outcomes were measurements of positive symptoms, negative symptoms, QoL and social functioning. Random-effects models were performed to calculate the effect sizes in the standardized mean differences reporting as Hedges' s g statistic. RESULTS 19 studies enrolling 1274 participants with schizophrenia were included. Yoga had a medium effect on positive symptoms in the short term (Hedges's g = 0.31) and small effect in the long term (Hedges's g = 0.18). Medium significant effects were also found on negative symptoms in both the short term (Hedges's g = 0.44) and the long term (Hedges's g = 0.35). Yoga had a significant impact on improving both total QoL (Hedges's g = 0.34) and social functioning (Hedges's g = 0.45) with medium effect sizes. CONCLUSIONS Yoga was associated with significant reductions on negative and positive symptoms, and significant improvements in QoL as well as social functioning in patients with schizophrenia. Future research should explore the long-term efficacy of yoga for schizophrenia, encompassing more diverse populations.
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Affiliation(s)
- Jingyu Yin
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yuqi Sun
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yikang Zhu
- Shanghai Mental Health Center, Shanghai, China
| | | | - Yi Wang
- Mianyang Central Hospital, Mianyang, China
| | - Siyao An
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Huiqun Huang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Fu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Deng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
| | - Ying Chen
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
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Alfi-Yogev T, Kivity Y, Atzil-Slonim D, Paz A, Igra L, Lavi-Rotenberg A, Hasson-Ohayon I. Transdiagnostic effects of therapist self-disclosure on diverse emotional experiences of clients with emotional disorders and schizophrenia. J Clin Psychol 2024; 80:678-691. [PMID: 38265356 DOI: 10.1002/jclp.23648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/20/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Despite the clinical significance of emotional diversity, also known as emodiversity, there has been limited investigation into the therapeutic interventions that influence this construct. In the current study we examined the association between immediate therapist self-disclosure (TSD) and emodiversity among two diagnostic groups who tend to experience emotional difficulties: people with schizophrenia and people with emotional disorders (i.e., depression and/or anxiety). METHOD The sample comprised 74 clients (37 diagnosed with schizophrenia and 37 with emotional disorders) treated by 45 therapists in a university clinic setting. Following each session, clients self-reported their emotions, and therapists completed a measure of frequency and centrality of their immediate TSD during the session. RESULTS Longitudinal multilevel models indicated that immediate TSD was positively associated with clients' global emodiversity, both at the within- and the between-client levels, as well as with clients' negative emodiversity at the between-client level. Moreover, clients with emotional disorders and clients with schizophrenia did not differ in the association between immediate TSD and emodiversity. In addition, across groups, clients treated by therapists who used more immediate TSD on average showed greater increases in global emodiversity during treatment. CONCLUSIONS immediate TSD is associated with clients' ability to experience rich and diverse emotional experiences across different disorders. The theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Tal Alfi-Yogev
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Adar Paz
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
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Grammeniati A, Mantziou A, Peritogiannis V. First-contact patients with a community mental health service in rural Greece: A 3-year prospective study of treatment attendance and its co-relations. Int J Soc Psychiatry 2024; 70:355-363. [PMID: 38193429 DOI: 10.1177/00207640231212097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Treatment continuation is essential for the optimal management of patients with mental disorders in the community, but treatment and outcome are often undermined by the high rates of service disengagement and treatment non-adherence across all psychiatric diagnoses. The phenomenon may be even more relevant in rural settings. AIMS The aim of the present study was to explore attendance to treatment in first-contact patients in a community-based treatment setting in rural Greece and to explore the associations of treatment attendance with demographic and clinical factors. METHOD Data were collected prospectively over a 3-year period, with 1-year follow-up interval. All first-contact cases with the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T), Northwest Greece were considered, but only clinical cases were processed. RESULTS The sample size consisted of 446 patients, with a mean age 65.4 ± 18.8 years. The rate of 12-month attendance to mental health treatment was 13.5% (60 out of 446 patients). Treatment attendance was found to be correlated with younger age, the diagnosis of schizophrenia-spectrum disorder, and patients' referral by other psychiatric services. First examination over the year 2019 had been significantly inversely associated with treatment engagement. CONCLUSION Rates of subsequent attendance after initial assessment in a rural community mental healthcare setting were rather low in the present study. Several variables that have been previously associated with service engagement were found to be related in this study too, whereas other were not. Research on treatment engagement in rural treatment settings should be ongoing to reveal all associated factors.
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Affiliation(s)
- Aikaterini Grammeniati
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Alexandra Mantziou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
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Elgudin J, Johnsen C, Westermair AL, Trachsel M. Palliative psychiatry for a patient with treatment-refractory schizophrenia and severe chronic malignant catatonia: case report. Ann Palliat Med 2024; 13:433-439. [PMID: 38509645 DOI: 10.21037/apm-23-586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/17/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Palliative psychiatry is an emerging field that suggests a role for palliative interventions in the management of severe and persistent mental illness (SPMI). Current literature describes using a palliative approach for patients with severe anorexia nervosa. To our knowledge, this is the first case report describing end-of-life care in a patient with treatment-refractory catatonic schizophrenia. CASE DESCRIPTION We describe the case of a 49-year-old man with schizophrenia and severe chronic agitated/malignant catatonia who was hospitalized for ten months. Multiple treatment trials including medication such as neuroleptics and benzodiazepines, electroconvulsive therapy, and empiric interventions such as intravenous immunoglobulins were either not tolerated or did not result in clinically significant improvement. The patient continued to intermittently require intubation and sedation to control intractable behavioral and psychiatric disturbances. Ultimately, with collaboration of psychiatry, neurology, ethics, intensive care, and palliative care teams, the patient's parents decided to forgo further diagnostic testing and life-sustaining treatments. The patient died weeks later of aspiration pneumonia with good symptom control. CONCLUSIONS This case permits discussion of palliative interventions in patients with SPMI such as treatment-refractory psychotic disorders who likely cannot achieve a quality of life that is acceptable to them. Here, it can be justified to prioritize relief of suffering and prevention of further burdensome interventions over treatment of the SPMI symptoms such as catatonia and even over keeping the patient alive.
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Affiliation(s)
- Junona Elgudin
- Department of Psychiatry, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Clark Johnsen
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Anna Lisa Westermair
- Clinical Ethics Unit, University Hospital Basel (USB), University Psychiatric Clinics (UPK) Basel, University Children's Hospital Basel (UKBB), Geriatric University Medicine Felix Platter (UAFP), Basel, Switzerland; Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich (UZH), Zurich, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit, University Hospital Basel (USB), University Psychiatric Clinics (UPK) Basel, University Children's Hospital Basel (UKBB), Geriatric University Medicine Felix Platter (UAFP), Basel, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
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Yi S, Wang Q, Wang W, Hong C, Ren Z. Efficacy of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms and cognitive functioning in schizophrenia: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res 2024; 333:115728. [PMID: 38232567 DOI: 10.1016/j.psychres.2024.115728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/19/2024]
Abstract
Negative symptoms and cognitive dysfunction are core characteristics of schizophrenia that profoundly impact daily function and quality of life. As a noninvasive brain stimulation, repetitive transcranial magnetic stimulation (rTMS) has been proposed as a relatively new treatment for ameliorating negative symptoms and cognitive dysfunction in schizophrenia. However, there is controversy over the treatment methods and efficacy. We aimed to provide a quantitative integration of the published evidence regarding the efficacy of rTMS and analyze the feasibility of rTMS for treating negative symptoms and cognitive dysfunction in schizophrenia. A total of twenty reviews were ultimately selected and divided into thirty-three latitudes. Twenty-six analyses showed that rTMS significantly decreased the negative symptom score, and seventeen analyses were performed. Six analyses showed that rTMS treatment can increase working memory scores, and two of them had significant effects. Two analyses from the same review showed that rTMS had a long-term significant effect on treating language function. Only one analysis showed that rTMS had a significant effect on treating executive function. The analyses showed that rTMS had no significant effect on attention function and processing speed. Most reviews indicate that rTMS has an effect on negative symptoms, executive function, working memory, and language function in patients with schizophrenia. Although the quality of evidence was not high, these results are still positive and worthwhile for further study.
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Affiliation(s)
- Shuwei Yi
- Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province, China; Mental Health Center of Zhejiang Province, No. 1 Xianlin East Road, Yuhang District, Hangzhou, Zhejiang Province, China
| | - Qing Wang
- Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province, China; Mental Health Center of Zhejiang Province, No. 1 Xianlin East Road, Yuhang District, Hangzhou, Zhejiang Province, China
| | - Wenjie Wang
- Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province, China
| | - Chaokun Hong
- School of Public Health, Faculty of Medicine, Imperial College, London, Sherfield Building, Prince Consort Rd, South Kensington Campus, South Kensington, London SW7 2BB, UK
| | - Zhibin Ren
- Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province, China; Mental Health Center of Zhejiang Province, No. 1 Xianlin East Road, Yuhang District, Hangzhou, Zhejiang Province, China.
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Chen Y, Li Z, Yan C, Zou L. Is it more effective for anhedonia and avolition? A systematic review and meta-analysis of non-invasive brain stimulation interventions for negative symptoms in schizophrenia. CNS Neurosci Ther 2024; 30:e14645. [PMID: 38432851 PMCID: PMC10909625 DOI: 10.1111/cns.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) techniques are a promising tool for treating the negative symptoms of schizophrenia. Growing evidence suggests that different dimensions of negative symptoms have partly distinct underlying pathophysiological mechanisms. Previous randomized controlled trials (RCTs) have shown inconsistent impacts of NIBS across dimensions. OBJECTIVE This systematic review and meta-analysis evaluated the effects of NIBS on general negative symptoms, and on specific domains, including blunted affect, alogia, asociality, anhedonia, and avolition. DATA SOURCES PubMed, Web of Science, Embase, Cochrane CENTRAL, PsycINFO, OpenGrey, and Clinicaltrials.gov from the first date available to October, 2023. RESULTS Among 1049 studies, we identified eight high-quality RCTs. NIBS significantly affects general negative symptoms (SMD = -0.54, 95% CI [-0.88, -0.21]) and all five domains (SMD = -0.32 to -0.63). Among dimensions, better effects have been shown for improvement of avolition (SMD = -0.47, 95% CI [-0.81, -0.13]) and anhedonia (SMD = -0.63, 95% CI [-0.98, -0.28]). Subgroup analyses of studies that applied once daily stimulation or >10 sessions showed significantly reduced negative symptom severity. CONCLUSION NIBS exerts distinct effects across multiple dimensions of negative symptom, with treatment effects related to stimulation frequency and total sessions. These results need to be confirmed in dedicated studies.
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Affiliation(s)
- Yuying Chen
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public HealthSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zhuofeng Li
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public HealthSouthern Medical UniversityGuangzhouGuangdongChina
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), School of Psychology and Cognitive ScienceEast China Normal UniversityShanghaiChina
| | - Laiquan Zou
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public HealthSouthern Medical UniversityGuangzhouGuangdongChina
- Department of Psychiatry, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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Wong DFK, Cheung YCH, Oades LG, Ye SS, Ng YNP. Strength-based cognitive-behavioural therapy and peer-to-peer support in the recovery process for people with schizophrenia: A randomised control trial. Int J Soc Psychiatry 2024; 70:364-377. [PMID: 38032017 DOI: 10.1177/00207640231212096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIMS Dysfunctional cognition and negative symptoms in schizophrenia are associated with persistently low social functioning and quality of life (QoL). Recovery interventions report only a modest effect in improving social functioning and QoL. This study examined the therapeutic effects and pathways of interventions using strength-based cognitive-behavioural therapy (SBCBT) and peer-to-peer support (PSP) approaches. METHODS A randomised control trial compared SBCBT, PSP and TAU (treatment-as-usual) by recruiting 127 individuals with schizophrenia spectrum disorders and low social functioning. RESULTS The three-group comparison found SBCBT produced improved social functioning and social support at post-intervention and 6-month follow-up while PSP reported improved social QoL and defeatist beliefs, but none remained at 6-month follow-up. Unsurprising, no improvement was found in any areas for TAU, both at post-test and 6-month follow-up. Regarding mechanisms of change, improvements in hope and personal recovery consistently and significantly accounted for improvements in social functioning and many aspects of QoL of participants, thus indicating the important contribution of hope and personal recovery in strength-based interventions for people with schizophrenia. CONCLUSION This rigorously designed study provides the first few solid empirical evidence on the effectiveness of SBCBT and PSP in recovery from schizophrenia and provides initial evidence of the linkage between dysfunctional cognition, hope and recovery in schizophrenia.
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Affiliation(s)
- Daniel Fu Keung Wong
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Yves Cho Ho Cheung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Lindsay G Oades
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, Victoria, Australia
| | - Shengquan Sam Ye
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Yat-Nam Petrus Ng
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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Jolley S, Grice S. State of the art in psychological therapies for psychosis: Family interventions for psychosis. Psychol Psychother 2024; 97:19-33. [PMID: 37515432 DOI: 10.1111/papt.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE It is a half-century since the coalescence of social psychiatry and systemic family therapy approaches started to inform condition-specific therapeutic work with families to reduce relapse and hospital readmission for people with schizophrenia. Today, family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent. Few, if any, psychological therapies, have so powerful a framework to drive widespread implementation. Nevertheless, delivery in clinical services is variable, often lagging behind that of individual cognitive behavioural therapy, notwithstanding its considerably weaker implementation framework. Our aim in this article is to formulate this translation failure and offer potential solutions. METHOD We summarise the model/intervention and supporting evidence, then consider why delivery remains problematic. RESULTS We highlight the inter-linked issues of conceptual confusion between and conflation of, different approaches to working with families; of addressing diagnostic uncertainty, complex comorbidity and adapting interventions for specific populations; and of translation from gold-standard research trial practice, through educational curricula and training programmes, to routine delivery in frontline services. CONCLUSION We present our view of clinical, research and workforce development priorities to address these issues and continue the collective effort, moving into the next half-century, to work more effectively with people with psychosis and their families, to further improve outcomes.
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Affiliation(s)
- Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - Sarah Grice
- South London and Maudsley NHS Foundation Trust, London, UK
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Kos C, Bais L, Klaasen N, Opmeer E, Liemburg E, Wardenaar KJ, van Tol MJ, Knegtering H, Aleman A. Effects of right prefrontal theta-burst transcranial magnetic stimulation or transcranial direct current stimulation on apathy in patients with schizophrenia: A multicenter RCT. Psychiatry Res 2024; 333:115743. [PMID: 38271887 DOI: 10.1016/j.psychres.2024.115743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
Apathy is a core negative symptom associated with an unfavorable functional outcome. Noninvasive brain stimulation has shown promise in the treatment of schizophrenia but has not been tested specifically for apathy. We conducted a randomized controlled trial of intermittent theta-burst (iTBS) transcranial magnetic stimulation and transcranial direct current stimulation (tDCS) targeted at the right dorsolateral prefrontal cortex (DLPFC) in patients diagnosed with a psychotic disorder suffering from apathy. The study was a multicenter, randomized, placebo-controlled, and rater-blinded trial. Patients (N = 88) were randomized into active iTBS, active tDCS, sham iTBS or sham tDCS treatment, daily for two weeks (excluding weekends). Effects were measured post-treatment and at four week and ten week follow-up. Primary outcome was apathy severity (Apathy Evaluation Scale, clinician-rated). Additional measures included assessment of negative symptoms, depression, anhedonia and quality of life. No significant difference in improvement of apathy or negative symptoms was observed for real versus sham treatment with either iTBS or tDCS, though all groups improved to a small extent. We conclude that two weeks of brain stimulation over the right DLPFC with either iTBS or tDCS is not effective for improving apathy or negative symptoms. Longer and more intensive protocols may yield different results.
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Affiliation(s)
- Claire Kos
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; ZorgfocuZ, Groningen, The Netherlands
| | - Leonie Bais
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; Lentis Research, Lentis Center for Mental Health Care, Hereweg 80, Groningen 9725 AG, The Netherlands
| | - Nicky Klaasen
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Esther Opmeer
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Edith Liemburg
- Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - Klaas J Wardenaar
- Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Henderikus Knegtering
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; Lentis Research, Lentis Center for Mental Health Care, Hereweg 80, Groningen 9725 AG, The Netherlands; Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands.
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Ma CC, Lin YY, Chung YA, Park SY, Huang CCY, Chang WC, Chang HA. The two-back task leads to activity in the left dorsolateral prefrontal cortex in schizophrenia patients with predominant negative symptoms: a fNIRS study and its implication for tDCS. Exp Brain Res 2024; 242:585-597. [PMID: 38227007 DOI: 10.1007/s00221-023-06769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
Transcranial direct current stimulation (tDCS) over left dorsolateral prefrontal cortex (DLPFC) has shown some potential as an adjunctive intervention for ameliorating negative symptoms of schizophrenia, but its efficacy requires optimization. Recently, 'functional targeting' of stimulation holds promise for advancing tDCS efficacy by coupling tDCS with a cognitive task where the target brain regions are activated by that task and further specifically polarized by tDCS.The study used 48-channel functional near infra-red spectroscopy (fNIRS) aiming to determine a cognitive task that can effectively induce a cortical activation of the left DLPFC in schizophrenia patients with predominant negative symptoms before running a tDCS trial. Sixty schizophrenia patients with predominant negative symptoms completed measures of clinical and psychosocial functioning characteristics and assessments across cognitive domains. Hemodynamic changes during n-back working memory tasks with different cognitive loads (1-back and 2-back) and verbal fluency test (VFT) were measured using fNIRS. For n-back tasks, greater signal changes were found when the task required elevated cognitive load. One sample t-test revealed that only 2-back task elicited significant activation in left DLPFC (t = 4.23, FDR-corrected p = 0.0007). During VFT, patients failed to show significant task-related activity in left DLPFC (one sample t-test, t = -0.25, FDR-corrected p > 0.05). Our study implies that 2-back task can effectively activate left DLPFC in schizophrenia patients with predominant negative symptoms. This neurophysiologically-validated task is considered highly potential to be executed in conjunction with high-definition tDCS for "functional targeting" of the left DLPFC to treat negative symptoms in a double-blind randomized sham-control trial, registered on ClinicalTrials.gov Registry (ID: NCT05582980).
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Affiliation(s)
- Chin-Chao Ma
- Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, Taiwan
| | - Yen-Yue Lin
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Life Sciences, National Central University, Taoyuan, Taiwan
| | - Yong-An Chung
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sonya Youngju Park
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, Taiwan.
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Das M, Saxena A, Samantaray S, Kumar S, Raj Pc J, Goyal N. Intermittent Theta Burst Stimulation Using H7 Coil for Management of Negative Symptoms and Cognitive Dysfunction in Chronic Schizophrenia: A Case Report. J ECT 2024; 40:61-62. [PMID: 37561931 DOI: 10.1097/yct.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Manul Das
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
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Muto T, Kyono H. A woman with schizophrenia who died due to Takotsubo cardiomyopathy occurring after electroconvulsive therapy. BMC Psychiatry 2024; 24:139. [PMID: 38373994 PMCID: PMC10877909 DOI: 10.1186/s12888-024-05593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered one of the minor complications. Several cases of patients developing Takotsubo cardiomyopathy during a course of ECT have been reported, but none have died. We present a case of post-ECT Takotsubo cardiomyopathy that became fatal. CASE PRESENTATION We experienced a case of a 67-year-old woman who had delusions and catatonic symptoms due to schizophrenia but was resistant to several medications. Her symptoms improved by conducting ECT, but she had difficulty maintaining her improvement, which caused her to receive multiple courses of ECT. 3 weeks after her 6th course of ECT, the patient was diagnosed with Takotsubo cardiomyopathy and had a fatal outcome. CONCLUSION Our patient had numerous cases of aspiration pneumonia and malnutrition before ECT was performed, which might have made this case fatal. In conclusion, appropriate supplementation of nutrition and reduction of physical stressors are important to avoid death from Takotsubo cardiomyopathy caused by ECT. Prescribing clozapine was a solution in the present case, but there are some difficulties, such as the restriction against prescribing this drug in Japan.
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Affiliation(s)
- Takahiro Muto
- Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
| | - Hotsumi Kyono
- Yokohama City Minato Red Cross Hospital, Yokohama, Japan
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Rabasco A, Arias S, Benz MB, Weinstock LM, Miller I, Boudreaux ED, Camargo CA, Kunicki ZJ, Gaudiano BA. Longitudinal risk of suicide outcomes in people with severe mental illness following an emergency department visit and the effects of suicide prevention treatment. J Affect Disord 2024; 347:477-485. [PMID: 38065475 PMCID: PMC10872614 DOI: 10.1016/j.jad.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/29/2023] [Accepted: 12/02/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Individuals with severe mental illness (SMI), including bipolar disorder (BD) and schizophrenia-spectrum disorders (SSD), are at high risk for suicide. However, suicide research often excludes individuals with SMI. The current research examined differences in suicide outcomes (i.e., suicide attempt or death) for adults with and without BD and SSD diagnoses following an emergency department (ED) visit and investigated the efficacy of the Coping Long Term with Active Suicide Program (CLASP) intervention in reducing suicide outcomes among people with SMI. METHODS 1235 adults presenting with recent suicidality were recruited from 8 different EDs across the United States. Using a quasi-experimental, stepped wedge series design, participants were followed for 52-weeks with or without subsequent provision of CLASP. RESULTS Participants in the SSD group and the BD group had significantly shorter time to and higher rate of suicide outcomes than participants with other psychiatric diagnoses in all study phases and in non-CLASP phases, respectively. Participants with BD receiving the CLASP intervention had significantly longer time to suicide outcomes than those not receiving CLASP; these differences were not observed among those with SSD. LIMITATIONS Study limitations include self-reported psychiatric diagnosis, exclusion of homeless participants, and small sample size of participants with SSD. CONCLUSIONS Participants with SMI were at higher risk for suicide outcomes than participants with other psychiatric diagnoses. CLASP was efficacious among those participants with BD. Psychiatric diagnosis may be a key indicator of prospective suicide risk. More intensive and specialized follow-up mental health treatment may be necessary for those with SSD.
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Affiliation(s)
- Ana Rabasco
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
| | - Sarah Arias
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Madeline B Benz
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | | | - Ivan Miller
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | | | - Carlos A Camargo
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brandon A Gaudiano
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
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Xie Y, Li C, Guan M, Zhang T, Ma C, Wang Z, Ma Z, Wang H, Fang P. Low-frequency rTMS induces modifications in cortical structural connectivity - functional connectivity coupling in schizophrenia patients with auditory verbal hallucinations. Hum Brain Mapp 2024; 45:e26614. [PMID: 38375980 PMCID: PMC10878014 DOI: 10.1002/hbm.26614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Auditory verbal hallucinations (AVH) are distinctive clinical manifestations of schizophrenia. While low-frequency repetitive transcranial magnetic stimulation (rTMS) has demonstrated potential in mitigating AVH, the precise mechanisms by which it operates remain obscure. This study aimed to investigate alternations in structural connectivity and functional connectivity (SC-FC) coupling among schizophrenia patients with AVH prior to and following treatment with 1 Hz rTMS that specifically targets the left temporoparietal junction. Initially, patients exhibited significantly reduced macroscopic whole brain level SC-FC coupling compared to healthy controls. Notably, SC-FC coupling increased significantly across multiple networks, including the somatomotor, dorsal attention, ventral attention, frontoparietal control, and default mode networks, following rTMS treatment. Significant alternations in SC-FC coupling were noted in critical nodes comprising the somatomotor network and the default mode network, such as the precentral gyrus and the ventromedial prefrontal cortex, respectively. The alternations in SC-FC coupling exhibited a correlation with the amelioration of clinical symptom. The results of our study illuminate the intricate relationship between white matter structures and neuronal activity in patients who are receiving low-frequency rTMS. This advances our understanding of the foundational mechanisms underlying rTMS treatment for AVH.
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Affiliation(s)
- Yuanjun Xie
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
- Department of Radiology, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Chenxi Li
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Muzhen Guan
- Department of Mental HealthXi'an Medical CollegeXi'anChina
| | - Tian Zhang
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Chaozong Ma
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Zhongheng Wang
- Department of Psychiatry, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Zhujing Ma
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Huaning Wang
- Department of Psychiatry, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Peng Fang
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
- Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent PerceptionXi'anChina
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Casetta C, Santosh P, Bayley R, Bisson J, Byford S, Dixon C, Drake RJ, Elvins R, Emsley R, Fung N, Hayes D, Howes O, James A, James K, Jones R, Killaspy H, Lennox B, Marchant L, McGuire P, Oloyede E, Rogdaki M, Upthegrove R, Walters J, Egerton A, MacCabe JH. CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings. BMC Psychiatry 2024; 24:122. [PMID: 38355533 PMCID: PMC10865566 DOI: 10.1186/s12888-023-05397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.
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Affiliation(s)
- C Casetta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - P Santosh
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Bayley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C Dixon
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - R J Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Fung
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | - O Howes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - K James
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Jones
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - H Killaspy
- Division of Psychiatry, University College London, London, UK
| | - B Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - L Marchant
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - E Oloyede
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Rogdaki
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - J Walters
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - A Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Li X, Dai J, Liu Q, Zhao Z, Zhang X. Efficacy and safety of non-invasive brain stimulation on cognitive function for cognitive impairment associated with schizophrenia: A systematic review and meta-analysis. J Psychiatr Res 2024; 170:174-186. [PMID: 38150769 DOI: 10.1016/j.jpsychires.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
Based on existing evidence of the effects of the most commonly used non-invasive brain stimulation (NIBS), which includes transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), we conducted a meta-analysis to investigate the cognitive improvement and safety of NIBS on schizophrenia-related cognitive impairment. PubMed, EMBASE, Cochrane Library, and Web of Science were searched. The Cochrane Risk of Bias tool was used to assess the risk of bias of the included RCTs; Review Manager, version 5.4.1, was used to perform the statistical analysis. Twenty double-blind, randomized, sham-controlled trials involving 997 patients were included. As a result, no significant improvement in cognitive function was observed after NIBS treatment. However, the overall treatment effect of the two main NIBS modes (i.e., rTMS and tDCS) was associated with significantly larger improvements in negative symptoms and good tolerability in patients with schizophrenia compared to sham-controls (SMD = -0.56, 95% CI [-1.03, -0.08], p = 0.02, I2 = 88%). NIBS model and stimulus parameters influenced the effect of NIBS. More favorable effects were observed in patients who received rTMS stimulation (SMD = 0.25, 95% CI [0.01, 0.49], p = 0.04, I2 = 0%) in the left dorsolateral prefrontal cortex with a stimulation intensity of 20 Hz (p = 0.004) for a period longer than 1 month (p < 0.05). Yet, due to the limited number of included studies and heterogeneity in both study design and target population, the results of this analysis need to be interpreted with caution.
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Affiliation(s)
- Xueyan Li
- Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China.
| | - Jie Dai
- Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China
| | - Qingran Liu
- Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China
| | - Zhenying Zhao
- Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China
| | - Xiaofeng Zhang
- Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China
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Raffard S, de Connor A, Freeman D, Bortolon C. [Recent developments in the modeling and psychological management of persecutory ideation]. Encephale 2024; 50:99-107. [PMID: 37748987 DOI: 10.1016/j.encep.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/05/2023] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular "Feeling Safe" intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.
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Affiliation(s)
- Stéphane Raffard
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France; Laboratoire Epsylon, EA 4556, université Paul-Valéry-Montpellier, 3, route de Mende, 34199 Montpellier cedex 5, France.
| | - Alexandre de Connor
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, Royaume-Uni; Oxford Health NHS Foundation Trust, Oxford, Royaume-Uni; NIHR Oxford Health Biomedical Research Centre, Oxford, Royaume-Uni
| | - Catherine Bortolon
- Départment de psychologie, université de Grenoble-Alpes, université Savoie-Mont-Blanc, LIP/PC2S, Grenoble, France; Département de psychologie, institut universitaire de France, Paris, France
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Su Y, Pan X, Li H, Zhang G. Effects of mind-body therapies on schizophrenia: A systematic review and network meta-analysis. Schizophr Res 2024; 264:236-247. [PMID: 38185028 DOI: 10.1016/j.schres.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/09/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The objective of this meta-analysis is to evaluate and compare the effectiveness of different mind-body therapies in reducing the symptoms of schizophrenia. METHODS A systematic search was performed using databases such as PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Randomized controlled trials that assessed the effects of mind-body therapies on patients with schizophrenia were included. The search covered the period between the inception of each database and November 17th, 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool. A network meta-analysis was conducted to compare the effects of various mind-body therapies, including Yoga, Mindfulness, Tai Chi, Baduanjin, and Yijinjing. RESULTS The analysis included 22 randomized controlled trials involving a total of 2064 subjects. The network meta-analysis revealed that Yoga and Mindfulness interventions were more effective than other mind-body therapies in reducing the symptoms of schizophrenia. Specifically, Yoga improved PANSS-positive symptom scores (SUCRA: 74.8 %) and PANSS-negative symptom scores (SUCRA: 80.4 %), whereas Mindfulness improved PANSS-positive symptom scores (SUCRA: 85.6 %). CONCLUSION The findings of this study indicate that Yoga may be a promising intervention for the treatment of schizophrenia. However, the small sample size and the low quality of the included studies have limited the generalizability of our findings Therefore, this study must be understood with caution, and further investigation is warranted when more relevant studies emerge.
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Affiliation(s)
- Yuqin Su
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China; College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China.
| | - Xiaoli Pan
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China
| | - Hansen Li
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China
| | - Guodong Zhang
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China.
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48
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Zhou D, Xie H, Chen L, Zhu Z, Zhang C, Jiang J. The cognitive improvement in patients with schizophrenia following low-intensity repetitive transcranial magnetic stimulation could last for 6 months: A randomized controlled trial. Psychiatry Res 2024; 332:115672. [PMID: 38150811 DOI: 10.1016/j.psychres.2023.115672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
Cognitive impairments are a core symptom of schizophrenia. Although low-intensity repetitive transcranial magnetic stimulation (rTMS) also has cognitive improving effect like the commonly used high-intensity rTMS, it has not been applied in schizophrenia yet. To fill this gap, inpatients with schizophrenia were randomized to receive 20 sessions of daily adjunctive active low-intensity rTMS in 4 weeks, or sham treatment. At baseline, 4 weeks, and 6 months, the Positive and Negative Syndrome Scale (PANSS) was used to assess psychotic symptom severity, while the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Stroop Color and Word Test (SCWT) were used to assess cognitive functions. Compared to the sixty-nine patients receiving sham treatment, those fifty-nine patients receiving active rTMS performed better in all cognitive domains at post-treatment with small to large effect sizes. This superiority of active rTMS over sham treatment remained significant at 6-month follow-up, with small to large effect sizes, except for visuospatial function and delayed memory. The reduction in PANSS scores were not correlated with cognitive improvements. Our findings provide evidence for using low-intensity rTMS to ameliorate cognitive impairments in schizophrenia. More research are needed to determine the optimal intensity for each domain of cognitive functions.
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Affiliation(s)
- Dan Zhou
- Shanghai Putuo Mental Health Center, 211 Zhi Dan Road, 200065 Shanghai, China
| | - Hongtao Xie
- Shanghai Putuo Mental Health Center, 211 Zhi Dan Road, 200065 Shanghai, China
| | - Liqun Chen
- Shanghai Putuo Mental Health Center, 211 Zhi Dan Road, 200065 Shanghai, China
| | - Zhipei Zhu
- Shanghai Putuo Mental Health Center, 211 Zhi Dan Road, 200065 Shanghai, China
| | - Chunyan Zhang
- Shanghai Putuo Mental Health Center, 211 Zhi Dan Road, 200065 Shanghai, China
| | - Jiangling Jiang
- Department of Psychiatry, Tongji Hospital of Tongji University, 389 Xincun Road, 200065 Shanghai, China.
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Patterson C, Roberts M, Yousiph T, Robson G, Lewer K, Jay EK, Moxham L. Connection and recovery in the COVID-19 age: An analysis of changes in goal-setting throughout the pandemic by consumers living with enduring mental illness. Int J Ment Health Nurs 2024; 33:166-174. [PMID: 37743556 DOI: 10.1111/inm.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
Goal-setting is a tool that empowers consumer recovery. Though the pandemic has affected consumer goal-setting, the nature and extent of this impact have not been examined in a recovery setting. The aim of this study is to assess whether the recovery goals of individuals with serious mental illness changed in association with the COVID-19 pandemic. In this mixed-methods design, data were collected from a purposeful sample of consumers (nTOTAL = 355) aged 19-67 years (MAGE = 44.56, SD = 13.05) attending Recovery Camp, a 5-day therapeutic-recreation programme for individuals living with severe mental illness (e.g., PTSD, schizophrenia). Consumer-set goals were examined across 5 programmes prior to March 2020 (nPRE = 126) and 11 following (nPOST = 229). Goals were set on day one, with attainment self-scored on day five. Chi-squared goodness-of-fit tests compared goal proportions per domain; tests of independence assessed changes in goals pre- and post-pandemic. Six goal domains were identified: Approach-Based Recovery, Avoidance-based Recovery, Novel Physical Activities, Relationships, Health, and Recreation/Relaxation. Irrespective of the pandemic, goal attainment was consistently high across all programmes (86.56%). Approach-based Recovery goals were predominant pre-pandemic, but were significantly reduced post-pandemic (p = 0.040). Goals related to Relationships and Novel Physical Activities took precedence throughout the pandemic. Post-COVID-19, consumer recovery goals reveal increased desire for connection, novelty-seeking, and positive behavioural change.
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Affiliation(s)
- Christopher Patterson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle Roberts
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Taylor Yousiph
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgia Robson
- Faculty of the Arts, Social Science & Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lewer
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elissa-Kate Jay
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lorna Moxham
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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50
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Ostuzzi G, Barbui C. Combining randomised and observational evidence in schizophrenia: how real is the real world? Lancet Psychiatry 2024; 11:82-83. [PMID: 38215785 DOI: 10.1016/s2215-0366(23)00428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy.
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy
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