The Importance of Cerebrospinal Fluid Investigation in First-episode Psychosis

Despite being a reliable first-hand source of data on neuronal pathology, cerebrospinal fluid (CSF) analysis remains an often-overlooked evaluation method in first-episode psychosis (FEP). In this paper, we begin by discussing the current role of CSF testing during FEP evaluation in clinical practice. Given that anti-N-methyl-D-aspartate receptor encephalitis presents with a clinical picture indistinguishable from FEP in >85% of cases, we debate the importance of testing for CSF neuronal antibodies in at least a subset of patients. Then, we continue by reviewing the most important recent studies which sought to identify potential CSF biomarkers in FEP caused by a primary psychiatric disorder. By circumventing traditional psychiatric classifications, characteristic biomarker profiles have the potential to become integral components of early diagnosis, disease stratification, treatment choice, and outcome prediction. Along these lines, we aim to provide an updated perspective on the importance of CSF investigation in FEP.

Current State of Application of Formal Thought Disorder Screening Methods in First-Degree Relatives of Patients With Schizophrenia: A Narrative Review

Abstract:

Historically, formal thought disorder (FTD) has been considered one of the distinctive key symptoms of schizophrenia and is still regarded as an important early warning sign and a marker of illness severity with solid predictive value. Recent studies found that the presence of FTD is predictive of the subsequent diagnosis of schizophrenia and often precedes the frank clinical picture by several months. Much effort has been put into developing scales that can reliably detect FTD and can be readily applied in routine clinical practice. This narrative review investigated the use of FTD as a screening tool to assess risk in first-degree relatives of patients with schizophrenia. The results show that the use of these scales in first-degree relatives of schizophrenic individuals during clinical contact and counseling is still an exception, despite their uniquely heightened vulnerability profile. To our knowledge, this is the first time that the application of FTD screening methods in first-degree relatives of schizophrenic individuals has been reviewed in a structured way.

Response Shift as a Possible Obstacle in Assessing Perceived Quality of Life and Burden of Care in Informal Caregivers of Individuals with Schizophrenia: A Narrative Review

Abstrtact:

Schizophrenia is one of the most common and devastating mental disorders. Due to the possibility of relatively robust control over clinical symptoms, the focus of care for schizophrenia patients has shifted from institutionalized to community-based outpatient treatment options. While this change in paradigm allows affected individuals to socialize and take part in everyday activities, it has also increased the burden on family caregivers. At the same time, the interpretation of self-reported quality of life scores can be challenging due to known influencing factors like changes in internal standards, values, and goals. We present the theory of response shift as an adaptive mechanism that summarizes these complex changes and explains the seemingly contradicting long-term findings regarding quality of life ratings in informal caregivers. This state-of-the-art narrative review was undertaken to give an overview of the most critical factors that negatively impact the quality of life of caregivers and to summarize the current evidence, if any, of the response shifts in nonprofessional family caregivers. To our knowledge it is the first time that response shift and its impact on quality of life in family caregivers of patients is reviewed in this way.

An overview of the Quality of Life in Patients with Schizophrenia

Abstract:

Schizophrenia is one of the most common and devastating mental disorders. While control of positive clinical symptoms can be achieved relatively robustly, other clinical signs such as negative symptoms or cognitive problems can be more difficult to treat. This narrative review was undertaken to give an overview of how these and other factors impact a patient’s quality of life. Ample evidence shows that clinical symptoms of any kind have a negative impact on quality of life. Numerous factors, however, play an important role in the overall wellbeing of the patients in such a way that a mere focus on clinical symptom control is not enough to improve quality of life. These factors include psychological traits of the patient, socioeconomic factors such as education and employment status, gender ethnicity, medication side effects, stigma, and psychiatric comorbidities. Maximizing quality of life as the main treatment focus should, therefore, include a comprehensive approach that keeps all these factors and their complicated interplay in mind in order to deliver the best possible treatment.

Current perspectives in treating negative symptoms of schizophrenia: A narrative review (Review)

The negative symptoms of schizophrenia are an unmet treatment target as currently approved treatments mostly control positive symptoms. The persistence of these symptoms holds back the patient's reinstatement in society, making them incapable of fulfilling their social, professional, or family roles. There is overwhelming research evidence suggesting that the negative symptoms of schizophrenia are associated with poorer functioning and lower quality of life than positive symptoms, confirming the need for developing new treatments for this particular category of symptoms. This present review aims to review clinical trials addressing novel pharmacological approaches addressing primary negative symptoms of schizophrenia. We overview both monotherapies, first-generation and second-generation antipsychotics, and add-on therapies, including psychostimulants, anti-inflammatory drugs, antidepressants, molecules targeting glutamatergic, cholinergic or serotonergic systems and hormones. Our findings suggest that the primary negative symptoms of schizophrenia may be mitigated by adjunctive therapies, and we highlight the pharmacological agents that have proven superior efficacy. Novel compounds such as cariprazine and MIN-101, to date, show promising results, but large clinical trials are needed to test their efficacy and safety.