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L'hôpital public est nécessaire aux patients présentant les souffrances psychiques les plus graves. Au sein d'une institution, les symptômes des uns impactent le fonctionnement collectif, entre contre-attitudes, projections scissionnelles, etc. Nous savons depuis Jean-Étienne Esquirol que l'hôpital peut être soignant en lui-même, s'il est investi par des soignants « habiles ». À l'heure d'une restructuration de l'hôpital public, les outils issus du champ de la psychothérapie institutionnelle peuvent-ils participer à « soigner l'hôpital pour qu'il devienne soignant », selon l'aphorisme d'Hermann Simon ? Nous proposons d'articuler des savoirs psychopathologiques aux concepts institutionnels, afin de questionner un possible soin des singularités via le travail collectif. Nous présentons une élaboration théorico-clinique à partir de vignettes cliniques qui tentent de rendre compte de la pratique quotidienne d'un service de psychiatrie publique orienté par la psychothérapie institutionnelle et du soin psychothérapique possible, en institution, de sujets psychotiques. Les concepts issus de la psychothérapie institutionnelle s'appuient sur des psychopathologies psychanalytiques et phénoménologiques qui font l'épreuve de la clinique : notamment les questions d'espace, d'ambiance et de transfert, au cœur de la psychopathologie des psychoses. Ces concepts peuvent être discutés et affinés au regard de l'actualité de la recherche et des pratiques et soutiennent des prises en soins créatives adossées à la logique de secteur. Les outils institutionnels semblent soutenir les équipes soignantes dans leurs accueils de la souffrance psychique. S'ils ne font pas l'objet de positionnements dogmatiques, ils favorisent une alliance thérapeutique au plus près de la subjectivité des acteurs, et permettent une théorisation performative de la pratique quotidienne. Une attention conjointe portée à la psychopathologie et à la clinique institutionnelle contribue à proposer des prises en soin individualisées et à soutenir la singularité et de la subjectivité des patients les plus fragiles et des équipes qui les accompagnent. Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by "skilled" caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to "heal the hospital so that it can heal", in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work. We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects. Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors. Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice. Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them. [ABSTRACT FROM AUTHOR]

Henri Grivois has posited that psychosis involves the subjective experience of oneself as the center or focal point of the world. In this experience, the world that is typically unrelated to oneself becomes incomprehensible, and in its place is the sense that all life events are directly related to oneself or that one is perpetually at the center of all noteworthy activity. We suggest that this experience of centrality can be understood through the lens of the integrated model of metacognition. Specifically, we explore the idea that the metacognitive domain of decentration, or the ability to form ideas about the larger community one is a part of, can be used to operationalize and measure centrality. We propose a three-phase approach to addressing centrality within an integrative psychotherapy focused on subjective and experiential aspects of recovery. These phases focus on the patient's experience of centrality and include (1) inviting the therapist to join one's centrality, (2) acknowledging others as different from oneself, and (3) recognizing alternative perspectives in the world. We provide case examples and explore the metacognitive tasks and potential barriers associated with each phase. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Results Conclusions The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans‐diagnostically assessed the prevalence and co‐occurrence of at‐risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr.This cross‐sectional and observational‐prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16–35 who were referred for various kinds of non‐psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities.Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED‐consistent and ED‐inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference.From a trans‐diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co‐morbid ED in other kinds of psychopathology is being overlooked. [ABSTRACT FROM AUTHOR]

Background: Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well‐known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. Methods: As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self‐Report, Family Assessment Device, and an in‐house measure, respectively. Results: Multi‐group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. Conclusions: OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high‐risk youth. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Cognitive control deficits are prominent in individuals with psychotic psychopathology. Studies providing evidence for deficits in proactive control generally examine average performance and not variation across trials for individuals—potentially obscuring detection of essential contributors to cognitive control. Here, we leverage intertrial variability through drift-diffusion models (DDMs) aiming to identify key contributors to cognitive control deficits in psychosis. Study Design People with psychosis (PwP; N  = 122), their first-degree biological relatives (N  = 78), and controls (N  = 50) each completed 120 trials of the dot pattern expectancy (DPX) cognitive control task. We fit full hierarchical DDMs to response and reaction time (RT) data for individual trials and then used classification models to compare the DDM parameters with conventional measures of proactive and reactive control. Study Results PwP demonstrated slower drift rates on proactive control trials suggesting less efficient use of cue information. Both PwP and relatives showed protracted nondecision times to infrequent trial sequences suggesting slowed perceptual processing. Classification analyses indicated that DDM parameters differentiated between the groups better than conventional measures and identified drift rates during proactive control, nondecision time during reactive control, and cue bias as most important. DDM parameters were associated with real-world functioning and schizotypal traits. Conclusions Modeling of trial-level data revealed that slow evidence accumulation and longer preparatory periods are the strongest contributors to cognitive control deficits in psychotic psychopathology. This pattern of atypical responding during the DPX is consistent with shallow basins in attractor dynamic models that reflect difficulties in maintaining state representations, possibly mediated by excess neural excitation or poor connectivity. [ABSTRACT FROM AUTHOR]

Aim: Lithium, even at low doses, appears to offer neuroprotection against a wide variety of insults. In this controlled pilot, we examined the safety (i.e., side‐effect profile) of lithium in a sample of young people identified at ultra‐high risk (UHR) for psychosis. The secondary aim was to explore whether lithium provided a signal of clinical efficacy in reducing transition to psychosis compared with treatment as usual (TAU). Methods: Young people attending the PACE clinic at Orygen, Melbourne, were prescribed a fixed dose (450 mg) of lithium (n = 25) or received TAU (n = 78). The primary outcome examined side‐effects, with transition to psychosis, functioning and measures of psychopathology assessed as secondary outcomes. Results: Participants in both groups were functionally compromised (lithium group GAF = 56.6; monitoring group GAF = 56.9). Side‐effect assessment indicated that lithium was well‐tolerated. 64% (n = 16) of participants in the lithium group were lithium‐adherent to week 12. Few cases transitioned to psychosis across the study period; lithium group 4% (n = 1); monitoring group 7.7% (n = 6). There was no difference in time to transition to psychosis between the groups. No group differences were observed in other functioning and symptom domains, although all outcomes improved over time. Conclusions: With a side‐effect profile either comparable to, or better than UHR antipsychotic trials, lithium might be explored for further research with UHR young people. A definitive larger trial is needed to determine the efficacy of lithium in this cohort. [ABSTRACT FROM AUTHOR]

Aim: Validated assessment tools are needed to identify clinically high risk for psychosis. This study aimed to validate the early recognition inventory ERIraos, which consists of the ERIraos Checklist for risk screening and the ERIraos Symptom List for a more thorough risk assessment in the Estonian language to detect psychotic prodromal symptoms. Methods: A prospective cohort study provided an opportunity to evaluate the characteristics of the ERIraos instrument in predicting the increased risk of a psychotic disorder in the future. The 177 study participants, aged 13–42 years old, were divided into groups without an increased risk and three risk groups with different risk severity levels based on the ERIraos Symptom List assessment. Results: The results indicated excellent inter‐rater reliability for the ERIraos Symptom List total score. The ability of the ERIraos checklist to screen persons with an elevated psychosis risk was very good (ROC‐AUC = 0.86). The capability of the ERIraos Symptom List scores to predict the probability of transitioning to psychosis within 2 years was very good (ROC‐AUC = 0.83). Brief limited intermittent psychotic symptoms and observable behavioural and affective symptoms were statistically significant predictors of transition to psychosis. There were strong and statistically significant correlations between the ERIraos Symptom List scores and other clinical measures assessing functioning and psychopathology. Conclusions: The results of this study demonstrate the reliability and validity of the Estonian version of the ERIraos instrument and support the usability of ERIraos as a two‐step tool for the early recognition of psychosis risk. [ABSTRACT FROM AUTHOR]

Both syndromic and subsyndromal episodes of psychiatric disorders are common during and after pregnancy and are associated with adverse consequences for the mother and her baby. Despite remarkable opportunities for the detection of at-risk women, the prevention and treatment of peripartum recurrences of psychiatric disorders remain a challenge for physicians, and allied professionals This brief report discusses the importance of subsyndromal symptoms and offers suggestions to improve the assessment, diagnosis, and treatment of perinatal psychiatric disorders. [ABSTRACT FROM AUTHOR]

In many everyday decisions, individuals choose between trialling something novel or something they know well. Deciding when to try a new option or stick with an option that is already known to you, known as the "explore/exploit" dilemma, is an important feature of cognition that characterises a range of decision-making contexts encountered by humans. Recent evidence has suggested preferences in explore/exploit biases are associated with psychopathology, although this has typically been examined within individual disorders. The current review examined whether explore/exploit decision-making represents a promising transdiagnostic target for psychosis, depression, and anxiety. A systematic search of academic databases was conducted, yielding a total of 29 studies. Studies examining psychosis were mostly consistent in showing that individuals with psychosis explored more compared with individuals without psychosis. The literature on anxiety and depression was more heterogenous; some studies found that anxiety and depression were associated with more exploration, whereas other studies demonstrated reduced exploration in anxiety and depression. However, examining a subset of studies that employed case-control methods, there was some evidence that both anxiety and depression also were associated with increased exploration. Due to the heterogeneity across the literature, we suggest that there is insufficient evidence to conclude whether explore/exploit decision-making is a transdiagnostic target for psychosis, depression, and anxiety. However, alongside our advisory groups of lived experience advisors, we suggest that this context of decision-making is a promising candidate that merits further investigation using well-powered, longitudinal designs. Such work also should examine whether biases in explore/exploit choices are amenable to intervention. [ABSTRACT FROM AUTHOR]

Objective: This mixed methods study examined depictions of spirituality among people with psychosis in influential television programming. Spirituality is a central strength for many people with psychosis. Yet, despite the important role media plays in shaping perceptions, little research has examined the intersection between spirituality and psychosis in the popular media. Methods: To address this gap, we conducted a content analysis of the 50 most viewed primetime fictional television shows over a 10-year period as determined by the Nielsen rating organization. Characters with psychosis were identified via keyword searches of online sources (Wikis, IMDb, etc.) and subsequently independently coded by two individuals. Characters were rated on 18 items in three domains related to demographics, life status, and character framing. Inter-rater reliability ranged from good to excellent across variables. Results: Of 120 identified characters with psychosis, just 16% (n = 19) had a spiritual identity. Analysis revealed few differences between spiritual and secular characters on demographic and life status variables. Conversely, an examination of framing variables revealed spiritual characters were comparatively less attractive, exhibited a greater negative impact on society, and were more likely to be referred to pejoratively (as a psychopath) and engage in criminal activity. Trend analysis indicated portrayals of spiritual characters decreased over time. Conclusions: The results suggest media depictions of spirituality contribute to the stigmatization of spirituality among people with psychosis, potentially preventing access to important coping resources and discouraging professional help-seeking. Primary care physicians should consider incorporating a spiritual assessment into care to determine spiritual coping assets and then support these. [ABSTRACT FROM AUTHOR]

In this paper I explore Walter Benjamin's complex thoughts about the concept of experience to illuminate a central paradox when thinking about madness. This paradox concerns the need to hold together constellations of concepts that appear to be diametrically opposed. On the one hand there is the realm of the psychopathological; a psychiatric thinking of madness as mental illness that refers to suffering, loss of existence, and dysfunction. On the other hand, there is a thinking about madness as a diverse and different experience, as possibility, illumination, and difference. Benjamin's writings on experience can be particularly fertile here because he acknowledges the contradictions in experience, at certain points emphasising the loss of experience and at other points focussing on the possibilities of a new experience even within a destruction of experience. I will explore three aspects of Benjamin's reflections on experience and their relationship to an experience of psychosis; the loss of experience in modernity and the possibilities that lie within such a loss, the turn towards the object in Benjamin's account of experience, and finally the concept of the limit-experience. I conclude by considering Benjamin's idea of the dialectical image and apply this idea to the experience of madness. [ABSTRACT FROM AUTHOR]

This study investigates the development of concepts of psychosis in the Jewish Hospital in Warsaw, within the context of social and historical processes to which the hospital was the subject and a broader scope of European concepts of psychosis. In the years 1898–1909, the first chief physician of the psychiatric ward, Adam Wizel, focused mainly on hysteria. The interest in psychoses was initiated by Maurycy Bornsztajn, who started to promote psychoanalytic ideas. The second decade of the functioning of the Jewish Hospital's psychiatric ward was marked by issues concerning the classification of psychoses. In the third decade, after Poland regained independence, psychosis became the main focus of the hospital's staff. Newly appointed psychiatrists, Gustaw Bychowski and Władysław Matecki, contributed substantially to the psychoanalytic understanding of psychosis. Bornsztajn continued to develop his psychoanalytically based concept of psychosis. Wizel changed his attitude toward psychoanalysis and acknowledged the importance of Freud's discoveries. Władysław Sterling contributed to the biological understanding of schizophrenia. In the last period, 1931–1943, the Jewish Hospital in Warsaw struggled with the consequences of the economic crisis in Poland, Wizel's death, and Bychowski's departure, which resulted in the reduced number of publications in the field of psychosis. Nevertheless, Bornsztajn managed to further develop his concept of somatopsychic schizophrenia and Matecki introduced the category of pseudo‐neurotic schizophrenia. The psychoanalytic approach developed by Wizel, Bornsztajn, Bychowski, and Matecki was supplemented with other influences, especially phenomenology. Wizel, Bychowski, and Matecki were advocates of the psychoanalytic psychotherapy of psychotic patients. [ABSTRACT FROM AUTHOR]

Psychiatric literature about when instances of voice hearing should be regarded as religiously inflected psychopathology and when they should be regarded as religious experiences sometimes presupposes that a person's experience can only be either psychopathological, or else a genuine religious experience. In this paper I will consider an alternative: the possibility of a both–and account. A both–and account might involve the idea that a religious experience causes psychopathology, or is psychopathology, or that people open to religious experiences may also be susceptible to psychopathology. After arguing that these are either problematic or under-evidenced, I will argue for another version of a both–and account: that genuine religious experience can arise out of situations involving psychopathology. I will also point to some of the clinical and pastoral implications of my view. [ABSTRACT FROM AUTHOR]

Although psychotic disorders are characterized by an impaired ability to discriminate internal and external worlds, the role of interoceptive and exteroceptive perceptions in determining this alteration is still unclear. This observational study aimed at investigating (a) increases/decreases in interoceptive and exteroceptive perceptions in patients with psychosis (PSY) compared to healthy controls (HC); (b) the association between interoception and exteroception in HC and PSY. Two hundred and ten HC and 72 PSY completed the Multidimensional Assessment of Interoceptive awareness (MAIA, 8 domains) and the Adolescent-Adult Sensory Profile (AASP, 4 domains). MAIA/AASP differences were evaluated with MANOVA, Kruskal–Wallis and Mann–Whitney tests. MAIA and AASP scores were correlated to quantify the interoceptive–exteroceptive coupling as Spearman's rho coefficients. Subgroup analyses were performed dividing PSY in schizophrenia/schizoaffective versus other psychosis. Compared to HC, PSY showed increased mean scores in four MAIA and two AASP domains (Bonferroni-p < 0.01). The interoceptive–exteroceptive coupling followed two correlation patterns in HC. A first pattern displayed negative correlations between MAIA not-worrying and AASP sensory sensitivity/sensation avoidance, while the second pattern highlighted positive correlations between MAIA scores and AASP sensation seeking. The two correlation patterns between HC and other-PSY subgroup were similar. However, schizophrenia/schizoaffective PSY did not show positive correlations in the second pattern, rather displaying negative correlations between MAIA scores and AASP domains related to passive behavioral responses. Correlation values were more extreme in PSY subgroups, indicating stronger interoceptive–exteroceptive coupling compared to HC. This study demonstrates that interoception and exteroception are atypical and excessively coupled in psychosis compared to the general population. Clinical Trials Registration: Protocol Number 20210003663 (Pavia, Ethical Committee IRCCS Policlinico San Matteo). [ABSTRACT FROM AUTHOR]

Background: Repetitive transcranial magnetic stimulation (rTMS) has recently gained relevance in treating different psychiatric disorders. Limited evidence suggests that the beneficial effects of rTMS on psychopathology could be at least partly mediated through changes in inflammatory response. This systematic review summarizes the literature on whether rTMS can modulate inflammatory markers and thus positively influence the course of psychiatric illnesses. Materials and methods: A systematic review of rTMS and inflammatory markers in psychiatric diseases was conducted according to PRISMA guidelines. Information on the association between rTMS treatment response and changes of inflammatory markers was extracted. The quality of the studies was assessed using the National Heart, Lung, and Blood Institute for human studies and the Systematic Review Center for Laboratory Animal Experimentation for animal studies. Results: This review includes 17 studies (2 animal and 15 human studies) on the relationship between rTMS treatment response and changes of inflammatory markers. Positive changes in microglial activity and anti-inflammatory effects were associated with behavioral improvement in animal models of depression. However, these findings have not been consistently replicated in human studies focusing on treatment-resistant depression. While several studies reported rTMS-induced alterations in peripheral inflammatory markers, only two could demonstrate their association to clinical treatment response. Notably, most studies showed poor or moderate quality in the bias assessment. Conclusions: While certain human studies suggest an association between rTMS-induced anti-inflammatory effects and improvement in psychopathology, heterogeneity, and underpowered analyses constrain the generalizability of these results. The discrepancy between animal and human findings highlights the need for larger, standardized human studies. Trial registration: (PROSPERO Registration: CRD42023492732). [ABSTRACT FROM AUTHOR]

Karl Jaspers' assertion of the un-understandability of schizophrenic psychosis, which rests on a division between what is psychologically understandable and what must be explained via natural causation, has faced numerous challenges from within phenomenological psychopathology. But despite significant developments in the phenomenology of schizophrenia, I suggest that this dichotomy, between psychological understandability and naturalistic explanation, is still present in some phenomenological research on schizophrenia today, even in work that explicitly critiques the limitations of empathic understanding and the purported incomprehensibility of schizophrenic delusions. Other theories of subjectivity, particularly those in the Lacanian tradition, offer one way to recognize the impossibility of understanding without turning to naturalistic explanation. These theories may encourage us to better integrate other key insights in phenomenology, most clearly articulated in the work of Merleau-Ponty, that look beyond "conscious" awareness—those that allow for a renewed appreciation of the un-understandable in schizophrenia, and indeed in all human experience. [ABSTRACT FROM AUTHOR]

We reevaluated HiTOP's existing factor analytic evidence-base for a Psychosis (P) superspectrum as encompassing two psychosis-relevant subfactors ("spectra")—Thought Disorder (TD) and Detachment (D). We found that their data did not support P as a superspectrum with TD and D subfactors. Instead, TD contained both positive and negative symptoms of psychosis and emerged at the subfactor level. D did not target negative symptoms but, largely, disorders unrelated to psychosis and should not be placed under P. Determining if P is truly a superspectrum with psychosis TD and D subfactors will require factor analyses whose items are symptom-based and span the full range of psychopathology. Secondly, HiTOP authors state that TD and D provide a "nearly 2-fold" improvement in reliability over schizophrenia diagnoses but, after aligning the comparative study methodologies, this 2-fold improvement disappears. Finally, HiTOP's use of the term thought disorder is inconsistent with the ICD-11 and psychosis literature, in which it refers to formal thought disorder. We recommend that HiTOP (a) refer to P as a subfactor with positive and negative symptoms of psychosis until research indicates otherwise, (b) regularly rely on formal systematic reviews, (c) use appropriate reliability comparisons, (d) deconflate D with negative symptoms, and (e) rename TD. [ABSTRACT FROM AUTHOR]

Background Class and social disadvantage have long been identified as significant factors in the etiology and epidemiology of psychosis. Few studies have explicitly examined the impact of intersecting social disadvantage on long-term employment and financial independence. Methods We applied latent class analysis (LCA) to 20-year longitudinal data from participants with affective and non-affective psychosis (n = 256) within the Chicago Longitudinal Research. LCA groups were modeled using multiple indicators of pre-morbid disadvantage (parental social class, educational attainment, race, gender, and work and social functioning prior to psychosis onset). The comparative longitudinal work and financial functioning of LCA groups were then examined. Results We identified three distinct latent classes: one comprised entirely of White participants, with the highest parental class and highest levels of educational attainment; a second predominantly working-class group, with equal numbers of Black and White participants; and a third with the lowest parental social class, lowest levels of education and a mix of Black and White participants. The latter, our highest social disadvantage group experienced significantly poorer employment and financial outcomes at all time-points, controlling for diagnosis, symptoms, and hospitalizations prior to baseline. Contrary to our hypotheses, on most measures, the two less disadvantaged groups did not significantly differ from each other. Conclusions Our analyses add to a growing literature on the impact of multiple forms of social disadvantage on long-term functional trajectories, underscoring the importance of proactive attention to sociostructural disadvantage early in treatment, and the development and evaluation of interventions designed to mitigate ongoing social stratification. [ABSTRACT FROM AUTHOR]

Identifying phenotypes at high risk of suicidal behaviour is a relevant objective of clinical and translational research and can facilitate the identification of possible candidate biomarkers. We probed the potential association and eventual stability of neuropsychological profiles and serum BDNF concentrations with lifetime suicide ideation and attempts (LSI and LSA, respectively) in individuals with schizophrenia (SCZ) and schizoaffective disorder (SCA) in a 2-year follow-up study. A secondary analysis was conducted on a convenience sample of previously recruited subjects from a single outpatient clinic. Retrospectively assessed LSI and LSA were recorded by analysing the available longitudinal clinical health records. LSI + LSA subjects consistently exhibited lower PANSS-defined negative symptoms and better performance in the BACS-letter fluency subtask. There was no significant association between BDNF levels and either LSI or LSA. We found a relatively stable pattern of lower negative symptoms over two years among patients with LSI and LSA. No significant difference in serum BDNF concentrations was detected. The translational viability of using neuropsychological profiles as a possible avenue for the identification of populations at risk for suicide behaviours rather than the categorical diagnosis represents a promising option but requires further confirmation. [ABSTRACT FROM AUTHOR]

Background: Individuals presenting with first episode psychosis (FEP) constitute a population with high admission rates. Across psychiatric services, community based treatment is aimed for where appropriate. Therefore, further knowledge on predictors of admission is required. Purpose: The objectives were to: (i) determine the proportion of individuals with FEP admitted at time of presentation (voluntarily and involuntarily) (ii) identify associated demographic and clinical factors. Methods: This study included all young people (aged 15–24) who presented with FEP to the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia from 01.01.11 to 31.12.16. Binary logistic regression was used to determine unadjusted and adjusted odds ratios. Results: Of 1208 participants, 58.6% were male and the median age was 20 years (I.Q.R.17–22). At time of presentation, 50.2% were admitted. On multivariate analysis, the following factors predicted admission: being a migrant (OR = 1.75, 95% CI [1.17, 2.62]), aggression (OR = 1.42, 95% CI [1.02, 1.99]), and more severe psychotic symptoms. Longer duration of untreated psychosis was associated with lower admission rates. 70.1% of admissions were involuntary (33.7% of the cohort). Risk factors for involuntary admission were consistent with any admission, other than aggression, and with the addition of older age and male sex. Conclusion: There remains a high admission rate for FEP, even in an established early intervention service, with severity of psychopathology being the strongest predictive factor. There is an independent association between migrancy and admission. Potential reasons for these findings are discussed, and initiatives to reduce admission rates including (i) interventions to prevent admission and (ii) alternative care pathways. [ABSTRACT FROM AUTHOR]

Background The role of duration of untreated psychosis (DUP) as an early detection and intervention target to improve outcomes for individuals with first-episode psychosis is unknown. Study Design PRISMA/MOOSE-compliant systematic review to identify studies until February 1, 2023, with an intervention and a control group, reporting DUP in both groups. Random effects meta-analysis to evaluate (1) differences in DUP in early detection/intervention services vs the control group, (2) the efficacy of early detection strategies regarding eight real-world outcomes at baseline (service entry), and (3) the efficacy of early intervention strategies on ten real-world outcomes at follow-up. We conducted quality assessment, heterogeneity, publication bias, and meta-regression analyses (PROSPERO: CRD42020163640). Study Results From 6229 citations, 33 intervention studies were retrieved. The intervention group achieved a small DUP reduction (Hedges' g  = 0.168, 95% CI = 0.055–0.283) vs the control group. The early detection group had better functioning levels (g  = 0.281, 95% CI = 0.073–0.488) at baseline. Both groups did not differ regarding total psychopathology, admission rates, quality of life, positive/negative/depressive symptoms, and employment rates (P  > .05). Early interventions improved quality of life (g  = 0.600, 95% CI = 0.408–0.791), employment rates (g  = 0.427, 95% CI = 0.135–0.718), negative symptoms (g  = 0.417, 95% CI = 0.153–0.682), relapse rates (g  = 0.364, 95% CI = 0.117–0.612), admissions rates (g  = 0.335, 95% CI = 0.198–0.468), total psychopathology (g  = 0.298, 95% CI = 0.014–0.582), depressive symptoms (g  = 0.268, 95% CI = 0.008–0.528), and functioning (g  = 0.180, 95% CI = 0.065–0.295) at follow-up but not positive symptoms or remission (P  > .05). Conclusions Comparing interventions targeting DUP and control groups, the impact of early detection strategies on DUP and other correlates is limited. However, the impact of early intervention was significant regarding relevant outcomes, underscoring the importance of supporting early intervention services worldwide. [ABSTRACT FROM AUTHOR]

The widespread use of novel psychoactive substances (NPSs)—defined as new narcotic or psychotropic agents not classified under the Single Convention on Narcotic Drugs of 1961 or the Convention on Psychotropic Substances of 1971—poses a significant challenge to contemporary mental health paradigms due to their impact on psychiatric disorders. This study revisits and expands upon the theory of mental automatism as proposed by Gaëtan Gatian de Clérambault, aiming to elucidate the psychopathological mechanisms underlying substance-induced psychoses (SIP) and their distinction from non-induced psychoses (schizophrenia and related disorders). Through a phenomenological and clinical investigation, we explore the relevance of mental automatism in the development of toxic psychoses, drawing upon the historical and contemporary literature. This research highlights the psychopathological distinctions between induced and non-induced psychoses and the transition mechanisms from acute to chronic psychosis states. De Clérambault's theory, supplemented by Janet, Jackson, and Bonhoeffer's contributions, provides a foundational framework for understanding the genesis of SIP. Our findings suggest that NPS consumption, particularly among adolescents and psychiatric patients, significantly correlates with increased risks of SIP, marked by a transition to chronicity influenced by biological lesions triggered by substance use. Furthermore, we propose a comprehensive framework for SIP, integrating mental automatism, psychopathological distinctions, and transition mechanisms. This framework aims to refine diagnostic criteria and therapeutic approaches, addressing gaps in clinical practice and research. The study underscores the need for a nuanced understanding of SIP, advocating for a paradigm shift in psychiatric assessment and treatment approaches to better address the complexities of substance-induced mental health disorders. [ABSTRACT FROM AUTHOR]

A traditional view in psychiatry concerns the intimate relationship between personality disorders and primary mental disorders in a spectral model. Psychic functions with common roots might play a role in personality and psychosis or other disorders, not only in terms of deficits but also of balance or proportions among them. Personality characteristics in connection with endogenous or functional psychoses have been described, such as the sensitive and melancholic types. Concepts derived from psychopathology, namely schizoidism and syntony which involve psychosis and personality, seem related to pivotal frameworks in the cognitive sciences comprising the so-called 4E cognition. When adopting a continuum view of mental disorders, they behave in a unitary or systemic configuration, corresponding to endogenous-functional dispositions interacting with the milieu and shaping personality. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is associated with hypoactivation of reward sensitive brain areas during reward anticipation. However, it is unclear whether these neural functions are similarly impaired in other disorders with psychotic symptomatology or individuals with genetic liability for psychosis. If abnormalities in reward sensitive brain areas are shared across individuals with psychotic psychopathology and people with heightened genetic liability for psychosis, there may be a common neural basis for symptoms of diminished pleasure and motivation. Methods: We compared performance and neural activity in 123 people with a history of psychosis (PwP), 81 of their first-degree biological relatives, and 49 controls during a modified Monetary Incentive Delay task during fMRI. Results: PwP exhibited hypoactivation of the striatum and anterior insula (AI) during cueing of potential future rewards with each diagnostic group showing hypoactivations during reward anticipation compared to controls. Despite normative task performance, relatives demonstrated caudate activation intermediate between controls and PwP, nucleus accumbens activation more similar to PwP than controls, but putamen activation on par with controls. Across diagnostic groups of PwP there was less functional connectivity between bilateral caudate and several regions of the salience network (medial frontal gyrus, anterior cingulate, AI) during reward anticipation. Conclusions: Findings implicate less activation and connectivity in reward processing brain regions across a spectrum of disorders involving psychotic psychopathology. Specifically, aberrations in striatal and insular activity during reward anticipation seen in schizophrenia are partially shared with other forms of psychotic psychopathology and associated with genetic liability for psychosis. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning. Study Design The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N  = 59), bipolar disorder (N  = 61), unipolar depression (N  = 60), remitted unipolar depression (N  = 51), and nonclinical comparisons (N  = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life. Study Results Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F (4,284) = 28.00, P  < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = −0.44, t  = 6.40, P  < .001). Furthermore, passive sensing measures showed that greater movement (β = −0.56, t  = −3.29, P  = .02) and phone calls (β = −0.22, t  = 12.79, P  = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life. Conclusions These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Exercise therapy has been shown to be an effective complementary treatment for patients with psychotic disorders. However, the specific impacts of different training modalities remain poorly understood. This article aims to quantitatively review the moderating influence of different exercise modalities, hypothesizing that higher exercise intensity as well as utilization of mindfulness-based exercise (MBE) components, will improve intervention outcomes. Study Design PubMed, Web of Science, and PsycINFO were searched from 2010 to March 2022 for randomized controlled trials investigating exercise interventions in patients with psychotic disorders (preregistration: https://doi.org/10.17605/OSF.IO/J8QNS). Outcomes considered were positive/negative symptoms, Positive and Negative Syndrome Scale (PANSS) General Psychopathology/Total scores, depressive symptoms, psychosocial functioning, quality of life, cardiorespiratory fitness, and body mass index. Separate meta-analyses, including moderator analyses, were performed to evaluate the moderating influence of different training modalities. Study Results Of 6653 studies, 40 (n  = 2111 patients) were included in the meta-analysis. The effects of moderate-intensity exercise exceed low-intensity approaches for PANSS Total scores (P  = .02) and depressive symptoms (P  = .04). The presence of MBE components was associated with improvements in positive symptoms (P  = .04) and PANSS General Psychopathology subscores (P  = .04) but also with higher error and between-study heterogeneity. Our analysis also shows improved intervention effects on depression in younger patients (P  = .012) and improved psychosocial functioning scores following more frequent sessions (P  < .01). Conclusions A minimum of moderate intensity should be considered. More frequent training sessions per week also seem to be beneficial. While adding mindfulness elements is promising, it increases heterogeneity and requires caution in terms of generalization. [ABSTRACT FROM AUTHOR]

Background and hypothesis Childhood adversity (CA) increases the risk for several adult psychiatric conditions. It is unclear why some exposed individuals experience psychotic symptoms and others do not. We investigated whether a syndemic explained a psychotic outcome determined by CA. Study design We used self-reported cross-sectional data from 7461 British men surveyed in different population subgroups. Latent class analysis (LCA) identified categorical psychopathological outcomes. LCs were tested by interaction analysis between syndemic factors derived from confirmatory factor analysis according to CA experiences. Pathway analysis using partial least squares path modeling. Results A 4-class model with excellent fit identified an LC characterized by both psychotic and anxiety symptoms (class 4). A syndemic model of joint effects, adducing a 3-component latent variable of substance misuse (SM), high-risk sexual behavior (SH), violence and criminality (VC) showed synergy between components and explained the psychotic outcome (class 4). We found significant interactions between factor scores on the multiplicative scale, specific only to class 4 (psychosis), including SM × SH, SH × VC, and SM × VC (OR > 1, P  < .05); and on the additive scale SM × SH (relative excess risk due to interaction >0, P  < .05), but only for men who experienced CA. Conclusion Multiplicative synergistic interactions between SM, SH, and VC constituted a mechanism determining a psychotic outcome, but not for anxiety disorder, mixed anxiety disorder/depression, or depressive disorder. This was specific to men who had experienced CA along direct and syndemic pathways. Population interventions should target SM and VC in adulthood but prioritize primary prevention strategies for CA. [ABSTRACT FROM AUTHOR]

The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium's transdiagnostic dimensional model of psychopathology has considerable support; however, this model has been underresearched in individuals at clinical high risk for psychosis (CHR-P), a population that may advance the model. CHR-P individuals not only have attenuated psychotic symptoms that vary in severity, but also have many comorbid diagnoses and varied clinical outcomes, including disorders with uncertain relations to HiTOP (e.g., obsessive-compulsive disorder). The present study used self-report and interview data from North American Prodrome Longitudinal Study-3 (710 CHR, 96 controls) to replicate the HiTOP model and test specific hypotheses regarding disorders with uncertain relations to its dimensions. Additionally, the present study examined the HiTOP model in relation to childhood trauma, declines in social functioning, and development of full psychosis. Confirmatory factor analysis indicated that the HiTOP model's fit was nearly adequate (e.g., comparative fit index =.89), though several theory-relevant modifications were indicated. Additionally, specific tests were conducted to gain a more fine-grained perspective on how disorders with less clear prior evidence were related to the HiTOP model. Notable findings from these analyses include bipolar spectrum disorders relating to the psychosis super spectrum (i.e.,.39 loading), and obsessive-compulsive disorder showing a complex pattern of loadings (e.g., internalizing and psychosis). The final model parsimoniously accounted for childhood trauma (e.g., super spectra rs =.22–.32), associations with current functioning, and predicted future conversion to a psychotic disorder (e.g., super spectra R2 =.13). Overall, these results inform the HiTOP model and suggest its promise for CHR-P research. General Scientific Summary: Individuals at risk of developing psychosis often have multiple psychiatric diagnoses; however, existing diagnostic frameworks poorly describe the reality of the symptoms experienced by individuals at risk for psychosis. The present study supported the validity and utility of an alternative framework for describing psychiatric symptoms—the Hierarchical Taxonomy of Psychopathology—by showing its relevance to both psychosis risk factors and clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: N‐acetylcysteine (NAC) augmentation of antipsychotic medication has been studied in psychotic disorders but the results are inconsistent. This meta‐analysis aimed to evaluate the efficacy and acceptability of NAC as an augmentation strategy for psychotic disorders. Methods: PubMed, Web of Science, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov were searched until the date of November 28, 2022. The inclusion criteria were randomized controlled trials (RCTs) comparing NAC and placebo in patients with psychotic disorders. The outcomes were the psychotic symptoms measured by the Positive and Negative Syndrome Scale (PANSS) and drop‐out rates. Results: A total of 594 patients from eight trials were included. The results showed that no difference was found in score changes of PANSS total, positive, negative, or general psychopathology scale scores between the NAC group and placebo group in both time points (≤24 weeks and >24 weeks). There was also no statistical difference in drop‐out rates between the two groups. Conclusion: For the moment, it is not appropriate to recommend NAC as an augmentation of antipsychotic medication to treat psychotic disorders in routine clinical practice. [ABSTRACT FROM AUTHOR]

This article explores the philosophical questions surrounding the experience of recovering from psychosis and regaining a sense of self and agency. The author discusses the limitations of understanding the self and agency as inner experiences and argues that they are instead shaped by external factors and the endorsement of beliefs supported by external facts. The article proposes that recovery from psychosis involves committing to the transparency condition, which entails finding and endorsing facts in the external world. This perspective offers a non-psychological account of recovery and provides a comprehensive orientation for psychiatrists to facilitate recovery. The article also raises questions about the accuracy and potential oppressiveness of this process, as well as its applicability to healing in psychopathology more generally. [Extracted from the article]

Mental health and substance use conditions are prevalent among perinatal individuals. These conditions have a negative impact on the health of perinatal individuals, their infants, and families, yet are underdiagnosed and undertreated. Populations that have been marginalized disproportionately face barriers to accessing care. Integrating mental health into obstetric care could address the perinatal mental health crisis. We review perinatal mental health conditions and substance use, outline the impact associated with these conditions, and describe the promise and potential of integrating mental health into obstetric settings to improve outcomes for patients receiving obstetric and gynecologic care. [ABSTRACT FROM AUTHOR]

Background Research suggests that effort-cost decision-making (ECDM), the estimation of work required to obtain reward, may be a relevant framework for understanding motivational impairment in psychotic and mood pathology. Specifically, research has suggested that people with psychotic and mood pathology experience effort as more costly than controls, and thus pursue effortful goals less frequently. This study examined ECDM across psychotic and mood pathology. Hypothesis We hypothesized that patient groups would show reduced willingness to expend effort compared to controls. Study Design People with schizophrenia (N  = 33), schizoaffective disorder (N  = 28), bipolar disorder (N  = 39), major depressive disorder (N  = 40), and controls (N  = 70) completed a physical ECDM task. Participants decided between completing a low-effort or high-effort option for small or larger rewards, respectively. Reward magnitude, reward probability, and effort magnitude varied trial-by-trial. Data were analyzed using standard and hierarchical logistic regression analyses to assess the subject-specific contribution of various factors to choice. Negative symptoms were measured with a clinician-rated interview. Study Results There was a significant effect of group, driven by reduced choice of high-effort options in schizophrenia. Hierarchical logistic regression revealed that reduced choice of high-effort options in schizophrenia was driven by weaker contributions of probability information. Use of reward information was inversely associated with motivational impairment in schizophrenia. Surprisingly, individuals with major depressive disorder and bipolar disorder did not differ from controls. Conclusions Our results provide support for ECDM deficits in schizophrenia. Additionally, differences between groups in ECDM suggest a seemingly similar behavioral phenotype, reduced motivation, could arise from disparate mechanisms. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation and behavior, and psychopathology in schizophrenia. We explored associations between sleep problems, suicidal ideation, and psychopathology in a cohort of patients with first-episode psychosis. Study Design We performed a secondary analysis of data for n = 403 subjects with data from the Recovery After an Initial Schizophrenia Episode study using regression models. Study Results The prevalence of sleep problems and suicidal ideation at baseline was 57% and 15%, respectively. After controlling for potential confounders, in the study baseline sleep problems were associated with increased odds of suicidal ideation with evidence of a dose-dependent relationship (OR = 2.25, 95% CI 1.15–4.41, P =.018). Over 24 months, sleep problems at any time point were associated with an over 3-fold increased odds of concurrent suicidal ideation (OR = 3.21, 95% CI 1.45–7.14, P =.004). Subjects with persistent sleep problems were almost 14 times more likely to endorse suicidal ideation at least once over the study than those without sleep problems (OR = 13.8, 95% CI 6.5–53.4, P <.001). Sleep problems were also a predictor of higher Positive and Negative Syndrome Scale total (β = 0.13–0.22), positive (β = 0.14–0.25), and general (β = 0.16–0.27) subscale scores at baseline and multiple follow-up visits (P <.01 for each). Conclusions Sleep problems are highly prevalent and associated with suicidal ideation and greater psychopathology in first-episode psychosis. Formal assessment and treatment of insomnia appear relevant to the clinical care of patients with psychosis as a predictor of suicidal ideation and symptom severity. [ABSTRACT FROM AUTHOR]

Aim: The prognostic prediction of outcomes in individuals at clinical high‐risk for psychosis (CHR‐P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta‐analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR‐P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR‐P individuals with more severe psychopathology and worse prognostic trajectories along a 1‐year follow‐up period. Methods: This research was settled within the 'Parma At‐Risk Mental States' program. Baseline and 1‐year follow‐up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR‐P individuals who were taking AP medications at entry were included in the CHR‐P‐AP+ subgroup. The remaining participants were grouped as CHR‐P‐AP‐. Results: Hundred and seventy‐eight CHR‐P individuals (aged 12–25 years) were enrolled (91 CHR‐P‐AP+, 87 CHR‐P‐AP‐). Compared to CHR‐P AP‐, CHR‐P AP+ individuals had older age, greater baseline PANSS 'Positive Symptoms' and 'Negative Symptoms' factor subscores and a lower GAF score. At the end of our follow‐up, CHR‐P‐AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non‐planned visits compared to CHRP‐ AP‐ individuals. Conclusions: In agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR‐P individuals and should be included in risk calculators. [ABSTRACT FROM AUTHOR]

Disengagement of youth with psychosis from Early Psychosis Intervention (EPI) services continues to be a significant barrier to recovery, with approximately one-third prematurely discontinuing treatment despite the ongoing need. The current pilot trial sought to evaluate the preliminary efficacy and feasibility of a weekly short message service (SMS) intervention to improve engagement in EPI services. This was a longitudinal single-blinded randomized control trial in which participants were assigned to receive either an active or sham SMS intervention over nine months. Sixty-one participants with early psychosis between the ages of 16 and 29 were enrolled, randomized, and received at least part of the intervention. Primary outcomes consisted of participant clinic attendance rates over the course of the intervention and clinician-rated engagement. Secondary measures included patient-rated therapeutic rapport, attitude toward medication, psychopathology, cognition, functioning, and intervention feedback from participants. Compared to the sham group, participants receiving the active intervention did not show improved appointment attendance rates; however, did exhibit some improvements in aspects of engagement, including improved clinician-rated availability, attitude toward medication, positive symptoms, avolition-apathy and social functioning. Thus, contrary to our hypotheses, digitally augmented care did not result in enhanced engagement in EPI services, as measured by clinic attendance, although with some indication that it may contribute to improved attitude toward medication and, potentially, medication adherence. Weekly SMS text messaging appeared to result in a pattern of engagement whereby individuals who were improving clinically attended appointments less often, possibly due to inadvertent use of the intervention to check in with clinicians. ClinicalTrials.gov (NCT04379349). [ABSTRACT FROM AUTHOR]

In 20th century psychiatry, various disturbances of imagination were discussed in the context of schizophrenia. Today, these notions have almost completely vanished from mainstream psychopathology. However, recent work has suggested that specific phenomena within this area have a relevance for differential diagnosis and early detection of psychosis. This paper first provides an overview of 20th century psychopathological literature, as well as more recent neurocognitive studies, addressing disturbances of imagination and their role for symptom formation in schizophrenia. It then discusses recent empirical investigations of subjective anomalies of imagination in schizophrenia-spectrum disorders and suggests a clinical-phenomenological account of their role in the development of psychotic symptoms. Empirically and conceptually, these subjective anomalies are linked with disturbances of basic self. Patients' descriptions of the development of their anomalous experiences and symptoms indicate that increased spatial (object-like) articulation and instability of the first-personal manifestation of imaginative experience can be involved in the emergence of delusions and hallucinatory phenomena. Finally, a potential link between subjective anomalies of imagination and the neurocognitive construct of source monitoring deficits is discussed. [ABSTRACT FROM AUTHOR]

The authors take inspiration from a case of hysterical psychosis to illustrate a typical condition of this evocative disease: the symbolic language of hysteria, conjurer of archetypical images. The authors encourage the clinician not to decode such aspects in rational analytical terms, rather to have a more wide-open approach that promotes the emergence of the individual unconscious, reconnecting with the collective imagination. This approach could help psychiatrists better understand a subject's inner experiences and interpersonal behavior. [ABSTRACT FROM AUTHOR]

The book review discusses "Reconceptualizing schizophrenia: The phenomenology of urhomelessness" edited by Kamens, S. The book explores the role of culture in the development of schizophrenia experiences and investigates whether there is a common underlying structure to these experiences across cultures. The author, Sarah Kamens, uses diverse methods and participants to examine the concept of schizophrenia as a profound sense of vulnerability and alienation called "urhomelessness." The book offers a culturally sensitive perspective on schizophrenia and has implications for phenomenological psychopathology. The review praises Kamens' work for providing a compassionate framework that deepens understanding of individuals with schizophrenia and their experiences of alienation. [Extracted from the article]

Child poly-victimization is a risk factor for psychopathology in adulthood, such as anxiety and depression. Despite that, there is minus investment regarding psychotic symptoms and the mechanisms explaining the relationship between poly-victimization and psychoticism. The purpose of this study is to investigate these variables and explain how they might be associated. A sample of 246 adults participated in this study, aged between 18 and 68 years (M = 37.5, SD = 12.5) and mostly females (76.8%). The results revealed a significant mediating effect of anxiety and depression in the relationship between childhood victimization and psychoticism (b =.12, p =.011), but not a significant moderating effect of gender, Δχ2(5) = 3.87, p =.568. The affective pathway was supported by our findings. These results suggest the need of additional efforts on prevention of child victimization, as well as of intervention programs aiming to prevent its cumulative effect. [ABSTRACT FROM AUTHOR]

Psychiatry is currently negotiating several challenges that are typified by (but are not unique to) schizophrenia: do periodic refinements in operational diagnostic algorithms (a) resolve intricacies and subtleties within and between psychotic and non-psychotic disorders that are authentic and impactful, or (b) constitute arbitrary and porous boundaries that should be complemented, or even replaced, by dimensional-continuum concepts of abnormality and dysfunction. Critically, these issues relate not only to apparent boundaries between diagnoses but also to those between 'health' and 'illness'. This article considers catatonia within evolving dimensional-continuum approaches to the description of impairment and dysfunction among psychotic and non-psychotic disorders. It begins by considering the definition and assessment of catatonia vis-à-vis other disorders, followed by its long-standing conjunction with schizophrenia, relationship with antipsychotic drug treatment, transdiagnostic perspectives and relationships, and pathobiological processes. These appear to involve dysfunction across elements in overlapping neural networks that result in a confluence of psychopathology and intrinsic hypo- and hyperkinetic motor dysfunction. It has been argued that while current diagnostic approaches can have utility in defining groups of cases that are closely related, contemporary evidence indicates categorical diagnoses to be arbitrary divisions of what is essentially a continuous landscape. Psychotic and non-psychotic diagnoses, including catatonia, may reflect arbitrary areas around points of intersection between orthogonal dimensions of psychopathology and intrinsic movement disorder in a poly-dimensional space that characterises this continuous landscape of mental health and dysfunction. [ABSTRACT FROM AUTHOR]

The long-term stability of neuromotor domains assessed at the first episode of psychosis (FEP) and their ability for predicting a number of outcomes remains largely unknown, and this study addressed these issues. This was a longitudinal study of 243 participants with FEP who were assessed at baseline for background variables and parkinsonism, dyskinesia, neurological soft signs (NSS) and catatonia, and reassessed 21 years later for the same neuromotor variables, psychopathology, functioning, personal recovery, cognitive performance and medical comorbidity. Stability of neuromotor ratings was assessed using the intraclass correlations coefficient and associations between the predictors and outcomes were examined using univariate and multivariate statistics. Baseline dyskinesia and NSS ratings showed excellent stability over time whereas that for parkinsonism and catatonia was relatively low. Neuromotor dysfunction at follow-up was independently predicted by a family history of schizophrenia, obstetric complications, neurodevelopmental delay, low premorbid IQ and baseline ratings of dyskinesia and NSS. Moreover, baseline dyskinesia and NSS ratings independently predicted more positive and negative symptoms, poor functioning and less personal recovery; catatonia predicted less personal recovery and more medical comorbidity. Baseline neuromotor ratings explained between 4% (for medical comorbidity) and 34% (for neuromotor dysfunction) of the variance in the outcomes. Lastly, neuromotor dysfunction at baseline highly predicted clinical staging at follow-up. Baseline neuromotor domains show variable stability over time and relate distinctively to very long-term outcomes. Both baseline dyskinesia and NSS are trait markers of the disease process and robust predictors of the outcomes. [ABSTRACT FROM AUTHOR]

Background. In patients with a psychotic disorder, rates of substance use (tobacco, cannabis, and alcohol) are higher compared to the general population. However, little is known about associations between substance use and self-reported aspects of social functioning in patients with a psychotic disorder. Methods. In this cross-sectional study of 281 community-dwelling patients with a psychotic disorder, linear regression models were used to assess associations between substance use (tobacco, cannabis, or alcohol) and self-reported aspects of social functioning (perceived social support, stigmatization, social participation, or loneliness) adjusting for confounders (age, gender, and severity of psychopathology). Results. Compared to nonsmokers, both intermediate and heavy smokers reported lower scores on loneliness (E = -0.580, SE = 0.258, p = 0.025 and E = -0.547, SE = 0,272, p = 0.046, respectively). Daily cannabis users reported less social participation deficits than non-cannabis users (E = -0.348, SE = 0.145, p = 0.017). Problematic alcohol use was associated with more perceived social support compared to non-alcohol use (E = 3.152, SE = 1.102, p = 0.005). Polysubstance users reported less loneliness compared to no users (E = -0.569, SE = 0.287, p = 0.049). Conclusions. Substance use in patients with psychosis is associated with more favorable scores on various self-reported aspects of social functioning. [ABSTRACT FROM AUTHOR]

Mixed depressive states are defined by the co-presence of depressive and manic symptoms. They represent extremely variable conditions from the point of view of clinical expressiveness and are difficult to recognize, ranging from clear schizophrenic-like psychoses and pseudodemented pictures to subsyndromal psychopathology. At the basis of the extreme variability of depressive pictures with mixed features are the different combinations that depressive and manic symptoms can assume. Furthermore, the intensity of depressive symptoms and manic symptoms, combined, can be variable, a factor that contributes to making the picture even more variable. Each form of mixed depressive state therefore presents its own specific symptomatic characteristics and specific difficulties in differential diagnosis and each form requires a different therapeutic strategy. In this work we have distinguished four possible specific subtypes of mixed depressive states, describing their specific clinical presentation and the therapeutic options most supported by the literature with the aim of contributing to a better recognition of mixed depressive states, to avoid incorrect diagnoses at patient and treatments that are useless if not worsening. [ABSTRACT FROM AUTHOR]

Conditions of chronic psychosis such as schizophrenia and mania are likely to result in several salient changes in the patient‟s personality and result in several cognitive changes. Clinical psychological testing specialization constitutes a specialized form of testing that focuses on differentiating individuals based on the nature and degree of psychopathology. The critical role of psychological assessment in treatment planning has been increasingly recognized in recent years because of its significant role in diagnostic and psychotherapeutic intervention strategies. The HFDT is designed to enhance the time-honored projective analytics aspects of human figure drawing analysis. The aim of the present study was to understand the HFDT profile of Indian patients with Psychotic conditions. The sample consisted of 80 patients with Psychosis diagnosed according to the ICD 10 DCR (1993) criterion, drawn from IPD and OPD of Gwalior Mansik Arogyshala, Gwalior, M.P., India. The sample included people of both sexes and in the age range of 18-50 years. Materials: Human figure drawing test (HFDT) by Mitchell et al. (1993). Results indicated that Indian patients with psychosis drew several specific features such as a small-sized figure, left placement, gross disproportion, unequal arms, heavy lines, genderless figures, developmentally indistinguishable features, naked without genitalia, and omissions of various parts. The authors concluded that there are several qualitative and quantitative variations on Human Figure Drawing test features in Indian patients with psychosis. [ABSTRACT FROM AUTHOR]

The Somatic Inkblot Test- online version (SIT) was taken by a 32-Year-old married male, working as an executive in the private sector, living in an urban Indian joint family. He complains about insomnia, excessive worrying, having sad mood, irritability, decreased interest in work, and decreased sexual appetite. The SIT images helped in understanding psychopathology of the symptoms and brought on the surface many unpleasant memories such as bullying in the school, conflicting relationship with father and dissatisfied intimate relationship. He felt much relieved after the discussion with the therapist. A few sessions of psychotherapy helped with positive results. His responses projected on the Somatic Inkblot Test have been analyzed using content analysis and psychoanalytic interpretation and discussed in this case study. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Schizotypy provides a framework for understanding the developmental nature of psychotic disorders and a means of identifying "at-risk" individuals early in the lifespan. However, there is a lack of prospective longitudinal research examining the relationship between schizotypy in childhood and later psychotic and other mental disorders. We hypothesized that distinct profiles of schizotypy in childhood would be differentially associated with psychotic and other mental disorders emerging later in adolescence. Study Design In a large population cohort of Australian young people (n = 26 837), we prospectively examined the relationship between person-centered profiles of schizotypy identified in middle childhood (age ~11 years) and adolescent diagnoses (age ~13–18 years) across 7 types of mental disorders using multinomial logistic regression. Results Membership in any of 3 childhood schizotypy profiles (true schizotypy , affective schizotypy , or introverted schizotypy) was associated with an increased likelihood of being diagnosed with any type of mental disorder in adolescence; effects were strongest for the true schizotypy group (aOR = 3.07, 95% CI = 2.64, 3.57), followed by the introverted (aOR = 1.94, 95% CI = 1.75, 2.15) and affective (aOR = 1.29, 95% CI = 1.13, 1.47) schizotypy groups. Six of the 7 types of mental disorders measured (including psychotic disorders) were associated with at least 1 schizotypy group. Conclusions Schizotypy in middle childhood is an important correlate of mental disorders in adolescence; however, it does not appear to be specifically associated with psychotic disorders in this age group. [ABSTRACT FROM AUTHOR]

Introduction: The Aberrant Salience Inventory (ASI) is a useful tool to measure salience abnormalities among the general population. There is strong clinical and scientific evidence that salience alteration is linked to psychosis. To the present day, no meta‐analysis evaluating ASI's psychometric properties and screening potential has been published. Materials and Methods: PubMed, Google Scholar, Scopus, and Embase were searched using terms including "psychosis," "schizophrenia," and "Aberrant Salience Inventory." Observational and experimental studies employing ASI on populations of non‐psychotic controls and patients with psychosis were included. ASI scores and other demographic measures (age, gender, ethnicity) were extracted as outcomes. Individual patients' data (IPD) were collected. Exploratory factor analysis (EFA) was performed on the IPD. Results: Eight articles were finally included in the meta‐analysis. ASI scores differ significantly between psychotic and non‐psychotic populations; a novel three‐factor model is proposed regarding subscales structure. Theoretical positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and presented together with different cutoff points depending on preselected specific populations of interest. Discussion: PPV and NPV values reached levels adequate for ASI to be considered a viable screening tool for psychosis. The factor analysis highlights the presence of a novel subscale that was named "Unveiling experiences." Implications regarding the meaning of the new factor structure are discussed, as well as ASI's potential as a screening tool. [ABSTRACT FROM AUTHOR]

Background : The purpose of the present review was to summarize the main literature contribution on the relationship between borderline personality disorder (BPD) and early psychosis. While retracing the historical path of the term "borderline", specific attention was paid to psychotic and psychotic-like symptoms in BPD. Its relationship with At Risk Mental State was evaluated, as well. Methods : This search was conducted on PUBMED/MEDLINE and PsycInfo, looking for "Borderline personality disorder, First Episode Psychosis, Early Psychosis, Ultra-High Risk AND/OR Clinical High Risk" for psychosis. Results : Eight pertinent papers were identified on this topic. Their main findings were then discussed. The term "borderline" has undergone different changes in meaning and use, despite always referring to states considered on the fence between neurosis and psychosis. However, considering the history of psychopathology and its relationship with diagnostic manuals, little attention has been given to its psychotic features. Being those symptoms highly burdensome, this neglect has often led to misdiagnosis and under-treatment. Conclusions : Psychotic symptoms in BPD can be severe and distressing. Nonetheless they can be easily neglected, and when found they challenge clinicians in defining a differential diagnosis to distinguish between BPD and Psychosis Spectrum Disorders. Given specific needs and interventions for these different conditions, a dimensional, rather than categorical, approach should be considered, as well as specific care pathways and monitoring should be advised. [ABSTRACT FROM AUTHOR]

Childhood adversity is associated with psychopathology. First evidence in adults suggests that threat anticipation, i.e., an enhanced anticipation of unpleasant events creating an enduring sense of threat, may be a putative mechanism linking childhood adversity to psychopathology. This study aimed to test the indirect effect of childhood adversity on psychopathology via threat anticipation in a large community sample of adolescents. We measured childhood trauma and bullying victimization (as indicators of childhood adversity), threat anticipation, general psychopathology and prodromal psychotic symptoms in adolescents aged 12–16 years (full sample size N = 1682; minimum sample size in the complete case sample N = 449) in wave I of the SIGMA study. We found strong evidence that childhood adversity (e.g. childhood trauma, adj. β (aβ) = 0.54, p <.001) and threat anticipation (e.g. aβ = 0.36, p <.001) were associated with general psychopathology and prodromal psychotic symptoms. Moreover, there was evidence that the association between childhood adversity, general psychopathology and prodromal psychotic symptoms is mediated via pathways through threat anticipation (e.g. childhood trauma, aβindirect effect = 0.13, p <.001). Threat anticipation may be a potential mechanism linking childhood adversity and psychopathology in adolescents. [ABSTRACT FROM AUTHOR]

Background: Increased reactivity to minor stressors is considered a risk factor for psychosis, especially in vulnerable individuals. In the present study, we investigated affective and psychotic stress reactivity as well as its link with psychotic symptoms and psychopathology in youths with 22q11.2 deletion syndrome (22q11DS), a neurogenetic condition associated with a high risk for psychosis. Methods: A 6-day ecological momentary assessment protocol was used to assess perceived daily-life stress as well as affective and psychotic reactivity to stress in participants with 22q11DS (n = 38, age = 18.4) and healthy controls (HC; n = 53, age = 19.1). Psychotic symptoms, general psychopathology, and coping strategies were also assessed through clinical interviews and questionnaires. Results: Participants with 22q11DS reported higher levels of perceived social stress (b = 0.21, p = 0.036) but lower levels of activity-related stress (b = −0.31, p = 0.003) in their daily lives compared to HC. The groups did not differ in affective or psychotic reactivity to stress, but individuals with 22q11DS who reported increased affective reactivity to social stressors showed more severe positive psychotic symptoms (r s = 0.505, p = 0.008). Finally, avoidance coping strategies moderated the association between stress and negative affects. Conclusions: Our results suggest an increased vulnerability for daily social stress in youths with 22q11DS, and link elevated social stress reactivity to heightened psychotic symptom severity. Given the high risk for psychosis in 22q11DS, interventions should focus on reducing social stress and developing adaptive coping strategies. [ABSTRACT FROM AUTHOR]