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The 10th International Yakult Symposium was held in Milan, Italy, on 13–14 October 2022. Two keynote lectures covered the crewed journey to space and its implications for the human microbiome, and how current regulatory systems can be adapted and updated to ensure the safety of microorganisms used as probiotics or food processing ingredients. The remaining lectures were split into sections entitled “Chances” and “Challenges.” The “Chances” section explored opportunities for the science of probiotics and fermented foods to contribute to diverse areas of health such as irritable bowel syndrome, major depression, Parkinson’s disease, immune dysfunction, infant colic, intensive care, respiratory infections, and promoting healthy longevity. The “Challenges” section included selecting appropriate clinical trial participants and methodologies to minimise heterogeneity in responses, how to view probiotics in the context of One Health, adapting regulatory frameworks, and understanding how substances of bacterial origin can cross the blood–brain barrier. The symposium provided evidence from cutting-edge research that gut eubiosis is vital for human health and, like space, the microbiota deserves further exploration of its vast potential.

BackgroundThis study aims to empirically identify profiles of functioning, and the correlates of those profiles in a sample of patients with stable schizophrenia in a real-world setting. The second aim was to assess factors associated with best profile membership.MethodsThree hundred and twenty-three outpatients were enrolled in a cross-sectional study. A two-step cluster analysis was used to define groups of patients by using baseline values for the Heinrichs-Carpenter Quality of Life Scale (QLS) total score. Logistic regression was used to construct models of class membership.ResultsOur study identified three distinct clusters: 50.4% of patients were classified in the “moderate” cluster, 27.9% in the “poor” cluster, 21.7% in the “good” cluster. Membership in the “good” cluster versus the “poor” cluster was characterized by less severe negative (OR = .832) and depressive symptoms (OR = .848), being employed (OR = 2.414), having a long-term relationship (OR = .256), and treatment with second-generation antipsychotics (SGAs) (OR = 3.831). Nagelkerke R2 for this model was .777.ConclusionsUnderstanding which factors are associated with better outcomes may direct specific and additional therapeutic interventions, such as treatment with SGAs and supported employment, in order to enhance benefits for patients, as well as to improve the delivery of care in the community.

Social cognition (SC) refers broadly to the domains of cognitive functions that are employed in socially relevant situations. These disturbances have been found to be strongly related to disorganized and negative symptoms in schizophrenia. Each of the disorganization symptoms suggests a diminishment or absence of organization. There seems to be a loss of the ability to be directed toward or committed to a particular focal topic or goal. Such conditions are likely to impact patients’ drives or motivations to initiate goal-directed activities that could yield pleasurable opportunities. Moreover, it has been suggested that disorganized symptoms are an integral link in cognitive pathways, with connections between cognitive processes weakening as disorganized symptoms increase. Thus, it seems that when disorganized symptoms are present, people with schizophrenia are no longer able to effectively utilize the neurocognitive abilities necessary for performing social cognitive or metacognitive tasks. It is also in line with models of disorganization in schizophrenia (Bleuler, 1911) that a “loosening of associations”—similar to current conceptualizations of disorganized symptoms—is at the core of these cognitive disruptions. Previous research has linked disorganization to cognition (neurocognition and SC) and cognition to social functioning, although in separate studies. The present study was conducted to explore a model, where disorganization predicted social functioning both directly both through indirect effects on other determinants (neurocognition, SC and negative symptoms) in a large, and well-characterized sample of patients with schizophrenia recruited in the context of a multi-center study of the Italian Network for Research on Psychoses (NIRP).Disclosure of interestThe author declares that he has no competing interest.

Social cognition (SC) refers broadly to the domains of cognitive functions that are employed in socially relevant situations. These include three primary domains (i.e., emotion perception, Theory of Mind-TOM-, and attributional style), as well as more complex and developing concepts such as social metacognition.Patients with schizophrenia demonstrate significant deficits across multiple dimensions of SC and throughout all phases of the illness.The correlation between SC and real-life functioning ranged from small to large, mainly depending on the examined aspect of SC, with largest effects observed for TOM. Indeed, it has been suggested that TOM difficulties may lead to social misperceptions that influence how an individual reacts to others, which in turn may lead to maladaptive social patterns and/or social withdrawal, which both may influence real-life vocational outcome more than neurocognition (NC) abilities. Moreover, SC appears to act as a mediator between nonsocial basic NC and community functioning.The goals of this study are to analyze the pattern of SC variables in schizophrenia using cluster analysis, to examine the relationship of real-life functioning with cluster membership, and to identify cut-offs that best discriminate among clusters in a large sample of patients with schizophrenia recruited to the Italian Network for Research on Psychoses (NIRP). A full assessment of different aspects of SC was carried out, including emotional intelligence, recognition and theory of mind (TOM).Disclosure of interestThe author has not supplied his declaration of competing interest.

IntroductionAn impairment of premorbid adjustment (PA) has been regarded among poor prognostic indicators of schizophrenia. Some discrepancies in the literature suggest the usefulness of further characterizations of its impact on different aspects of the disease.AimsThe present study aimed to investigate the association of poor PA with psychopathology, neurocognition and real-life functioning in patients with schizophrenia recruited within the multicenter study of the Italian network for research on psychoses. functioning during childhood and adolescence (early adjustment) was assessed also in a group of healthy controls (HC) and one of unaffected relatives of patients (UR).MethodsGroup comparisons were performed between patients with poor and those with good PA. Differences in frequency of poor early adjustment were investigated among patients, HC and UR.ResultsPatients with poor PA, as compared to those with good PA, showed earlier age of onset, more severe negative symptoms and disorganization, greater impairment on all cognitive domains with the exception of attention/vigilance and worse real-life functioning in the considered areas (interpersonal relationships, community activities and work abilities). The pattern of poor early adjustment was more frequent in patients with respect to UR and HC and, to a less degree, in UR with respect to HC.ConclusionsOur findings confirm that poor PA in schizophrenia is associated with poorer illness outcome, and offer a further characterization of PA impact on different psychopathological and cognitive domains. They also suggest that poor early adjustment is a candidate endophenotype of schizophrenia, occurring in patients and their unaffected relatives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe inter-relationships of neurocognition, social cognition, residual psychopathology and real-life functioning are poorly understood. A large multicenter study was carried out by the Italian Network for Research on Psychoses to model relationships between neurocognitive deficits, psychopathology and real-life functioning, taking into account the role of functional capacity and social cognition.MethodsA structural equation model was used to investigate direct and indirect effects of neurocognition and psychopathology on real-life functioning. Social cognition and functional capacity were modeled as mediators.ResultsIn 921 patients with schizophrenia, neurocognition had both direct and indirect effects, through functional capacity and social cognition, on real-life functioning. Neurocognition predicted to a large extent social cognition on which depression and disorganization had a modest effect. Social cognition showed a significant direct impact on real-life functioning.ConclusionOur results support a strong link between neurocognition and functional outcome, independent of psychopathology. Social cognition accounted for unique incremental variance in real-life functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Negative symptoms have been associated with functional outcome of patients with schizophrenia by a large body of literature. However, in previous studies negative symptoms were regarded as a unitary construct, while recent literature data suggest that they include at least two factors, ‘Avolition” and ‘Poor Emotional Expression” (EE), that might show different relationships to functional outcome; moreover, the inter-relationships of negative symptoms, neurocognition, social cognition and real-life functioning are poorly understood. Objectives A large multicenter study was carried out by the Italian Network for Research on Psychoses to model relationship between the negative symptom domains and real-life functioning, taking into account the role of other psychopathological dimensions including depression, neurocognition, functional capacity and social cognition. Methods A structural equation model was used to investigate direct and indirect effects of the 2 negative symptoms domains, other psychopathological dimensions, including depression, and neurocognition on real-life functioning. Social cognition and functional capacity were modeled as mediators. Results In 921 patients with schizophrenia we found that the considered variables explained about 50% of real-life functioning variance. Avolition and functional capacity were the strongest independent predictors, followed by positive and disorganization dimensions, neurocognition and social cognition. EE had only a modest indirect effect on functioning. Neurocognition strongly predicted functional capacity and social cognition, which mediated its effects on functioning. Conclusion Our results support the heterogeneity of the two negative symptom domains. Only avolition is a strong predictor of functioning in real-life of patients with schizophrenia independent of social cognition, neurocognition and functional capacity. Acknowledgements The study was carried out within the project ‘Multicenter study on factors influencing real-life social functioning of people with a diagnosis of schizophrenia” of the Italian Network for Research on Psychoses.

Introduction The Brief Negative Symptom Scale (BNSS) was designed to address the main limitations of the existing scales for the assessment of negative symptoms in schizophrenia. The first validation of the scale by the same group involved in its development showed good convergent and discriminant validity, and a factor structure which confirmed the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). Nevertheless, the investigated samples of patients with schizophrenia were relatively small. Objectives The present study aimed at providing a further independent validation of the BNSS in a large clinical sample to promote a wider diffusion of the scale in clinical research. Methods The inter-rater reliability, convergent/discriminant validity and factor structure of the Italian version of the BNSS were evaluated in 912 outpatients with schizophrenia recruited within an Italian multicenter study. Results Our results confirmed the strong inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the whole sample (N=912) and in a smaller group of patients without clinically significant levels of depression and extrapyramidal symptoms (N=496). The BNSS factor structure was supported in both groups. Conclusions According to our results the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies. Acknowledgements The study was carried out within the project 'Multicenter study on factors influencing real-life social functioning of people with a diagnosis of schizophrenia” of the Italian Network for Research on Psychoses.