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• LGBTQA+ people face challenges in accessing and engaging with psychosis services. • Experiencing intersecting sources of stigma can lead to unique barriers to care. • Gender-affirming care is a crucial facet of mental health support for trans people. • LGBTQA+/psychosis competencies must be improved in psychosis/LGBTQA+ services. LGBTQA+ individuals are at increased risk of experiencing psychosis and face barriers in accessing appropriate and timely mental health support. This scoping review maps the existing literature to identify barriers and facilitators to access and engagement to care for LGBTQA+ people across the psychosis spectrum. Select databases and grey literature were searched up to May 2024. Following screening according to pre-determined eligibility criteria, 37 papers were included in this review. A total of 89 barriers and 63 facilitators to mental health care were identified. Using inductive thematic analysis, five themes were developed to synthesise these items: (1) service-related factors, (2) stigma, (3) social networks, (4) personal factors, and (5) psychosis-related factors. These findings illustrate the complex interplay of factors affecting pathways to care in this population and highlight the significance of intersectionality. Improving LGBTQA+ and psychosis competencies in the public and in services that support these populations may enable earlier detection of psychosis and provision of effective care. Scoping review registration: This protocol is registered in Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/AT6FC). [ABSTRACT FROM AUTHOR]

• Scant research had studied cognition and non-auditory hallucinations. • Two investigations had studied cognition and multisensory hallucinations. • Olfactory identification deficits were not related to olfactory hallucinations. • Non-auditory and multisensory hallucinations were related to misattribution biases. • Significant advances are needed to explore cognition across sensory modalities. Multisensory hallucinations refer to unusual perceptual events in the absence of corresponding stimuli, experienced in two or more sensory modalities. Within the schizophrenia-spectrum disorder literature, the cognitive correlates of multisensory and non-auditory hallucinations remain largely unknown. This scoping review aimed to map and synthesise research that explored relationships between cognition and non-auditory and multisensory hallucinations in schizophrenia-spectrum disorders. Published, peer-reviewed, empirical research studies were sought through three databases: Web of Science, Scopus, and PubMed. Studies that had explored visual, olfactory, tactile, and gustatory hallucinations, or multisensory hallucinations, and their relationships to any basic cognitive mechanisms were included. Of 2218 records identified, a total of 17 studies met inclusion criteria. Visual hallucinations were the most frequently explored (13 studies); followed by olfactory hallucinations (five studies), tactile hallucinations (two studies) and multisensory hallucinations (two studies). Several cognitive mechanisms were studied, yet the majority were only explored in individual studies across the sensory modalities, limiting conclusions that could be drawn. Exploring the potential mechanistic drivers for hallucinations across multiple sensory modalities would advance the field significantly and allow for development of aetiological models that better capture the full gamut of hallucinatory experiences. [ABSTRACT FROM AUTHOR]

• Congress created NIMH to do clinical and basic research, especially on severe mental illnesses. • For its first 4+ decades NIMH did this. • For the 3 most recent decades, NIMH has massively decreased clinical research, especially on severe mental illnesses. • We recommend that NIMH reestablish its original priorities. In 2024, NIMH is celebrating its 75th anniversary. At the Congressional hearings preceding its initial funding in 1949, witnesses stressed the need for NIMH to carry out clinical and basic research to find the causes and better treatments for severe mental illnesses. Patients with schizophrenia alone were said to occupy one quarter of all hospital beds in the U.S. We therefore sought to ascertain the relative importance of clinical and basic research funded by NIMH over the life of the institute, using schizophrenia as our primary example. We used information of published studies, from the NIMH website, and from NIMH employees both past and present. During its first 40 years, NIMH funded clinical and basic research approximately equally. That changed in the 1990s when the funding of the Human Genome Project started a shift in research resources from clinical to basic. By 2015, clinical research at NIMH had been reduced to 10 % of the research portfolio. This decline has continued and been well documented. For example, between 2006 and 2023, NIMH-funded extramural drug trials for schizophrenia and bipolar disorder decreased by 95 %. To clearly illustrate the decline of schizophrenia research at NIMH, research for the 5-year period from 1984 to 1988 was compared with research from 2018 to 2022. In summary, data suggests that over the past 3 decades NIMH has reduced clinical research on severe mental illnesses by at least 90 %. We therefore recommend that NIMH re-establish clinical research on severe mental illnesses as a priority, as originally intended by Congress; that NIMH spend at least 50 % of all disease-related research dollars on clinical research; and that this distribution be documented in an existing and publicly available database. [ABSTRACT FROM AUTHOR]

• Real-Life Paradigm (RLP) assesses JTC with social scenarios akin to daily life. • Prior results on JTC and delusions may be artifacts of method effects. • RLP shows excellent construct validity and boosts participant engagement. • Differential JTC effects noted with neutral vs. social task information. • Social tasks vary in impact based on visual vs. verbal information processing. • The RLP is available for clinicians and researchers. The Jumping to Conclusions bias (JTC), characterized by hasty decision-making with insufficient information, is associated with delusion development. The beads task, a standard measure for JTC, assesses information-gathering behaviour but may yield inconsistent results due to comprehension difficulties and limited engagement. To address these shortcomings, we developed the Real-Life Paradigm —two novel tasks simulating social scenarios, tested alongside the beads task under three experimental conditions (baseline, time pressure and cost-benefit), along with measures of psychotic experiences, emotional states, and task appraisal. Using Confirmatory Factor Analysis with a multitrait-multimethod approach in a non-clinical sample (N = 253), the Real-Life Paradigm demonstrated strong convergent and discriminant validity, reflecting distinct but related JTC patterns across different scenarios. The type of information (neutral vs. social) and presentation (visual vs. verbal) influenced JTC patterns, with no correlation between positive psychotic experiences and any task. Participants found the new scenarios, particularly under cost-benefit conditions, more realistic and engaging than the beads task. These findings provide initial support for the Real-Life Paradigm as a method for assessing JTC. This paradigm addresses limitations of traditional JTC measures and offers a more ecologically valid approach to studying decision-making processes related to delusion formation. [Display omitted] [ABSTRACT FROM AUTHOR]

What is already known about the topic?. • Schizophrenia spectrum disorder is a serious psychotic disorders that affects adult patients worldwide. • Although antipsychotic medicine, and electroconvulsive therapy (ECT) may be effective for the treatment of patients with schizophrenia spectrum disorders, some researchers found that these treatments had a negative impact on cognition and memory. What this paper adds. • Mindfulness-based intervention (MBIs) had significantly moderate effects to reduce psychotic symptoms, increase global functioning, insight, and mindfulness compared to controls. • Mean age of patients, length of MBIs, MBIs format, home assignment, blinded collectors, intention-to-treat, and attrition rate were moderators influencing the ES. • MBIs might be used as alternative to conventional treatment for patients with schizophrenia spectrum disorders. Mindfulness refers to the practice of consciously attending to the present moment without judgement. Although mindfulness-based intervention have been extensively researched. Less is known about the effect of this intervention on psychotic symptoms in patients with schizophrenia spectrum disorders. Thus, we synthesized the effects of mindfulness-based interventions (MBIs) on psychotic symptoms, global functioning, insight, and mindfulness in patients with schizophrenia spectrum disorders. Nine electronic databases were searched from inception to March 2024 including Academic Search Complete, CINAHL, Cochrane, Ovid APA InFo, ProQuest, PubMed, Scopus, Mindfulness Journal and Web of Science. We reviewed studies on outcomes for patients with schizophrenia spectrum disorders receiving mindfulness-based interventions. We only reviewed all experimental and quasi-trials studies written in English. A random-effects model was used to compute the effect size. We used Funnel plot, Q statistics, and I2 to test the heterogeneity across studies. Also, we examined moderators to explore sources of heterogeneity. Across 24 included studies (N = 1,632), 796 schizophrenia patients participated in mindfulness interventions; 836 served as controls. Most schizophrenia patients were males (69 %, s = 7). Mean age ranged from 24.4 to 59.5 years. Overall, mindfulness-based interventions showed reduced psychotic symptoms (g = 0.70, 95 %CI 0.04, 1.36, I2 = 96 %), increased global functioning (g = 1.28, 95 %CI 0.50, 2.05), insight (g = 1.21, 95 %CI 0.88, 1.55) and mindfulness (g = 0.56, 95 %CI 0.15, 0.97) compared to control groups, but with substantial heterogeneity. With subgroup analysis, every one-year of mean age of patients with schizophrenia increased, psychotic symptom worsened (slope = -0.071, tau2 = 0.77, Q between = 166.3, p =.016). Additionally, for every day of MBIs practice increased, psychotic symptoms improved (Slope = 0.012, tau2 = 1.37, Q between = 251.6, p =.033), patients' functioning improved (slope = 0.013, tau2 = 0.69, Qbetween = 142.1, p =.017) and patients' insight improved (slope = 0.001, tau2 = 0.012, Q between = 8.6, p =.043). Providing MBIs as a mixed format (individual plus group intervention) had a greater effect (g = 1.538) on improving patients' insight than providing MBIs only to individuals (g = 0.889). Also, providing MBIs with a home assignment had a greater effect (g = 1.517) on improving patients' insight than providing MBIs without a home assignment (g = 0.787). No primary studies reported the adverse effects. MBIs significantly improved psychotic symptoms, global functioning, insight, and mindfulness among patients with schizophrenia spectrum disorders, especially MBIs with home assignment. Clinicians and health providers should consider using MBIs as alternative complementary treatment for improving psychotic symptoms and increasing global functioning, insight and mindfulness. [ABSTRACT FROM AUTHOR]

• A varied number of approaches to reduce self-stigma in psychosis has been tested. • The effect of self-stigma reduction interventions appears moderate to strong. • Effective interventions combine psychoeducation, social, and cognitive approaches. • Studies at lower risk of bias reported smaller effects of interventions. The burden of self-stigma in psychosis has been widely studied, leading to the development and implementation of self-stigma reduction programmes to ameliorate its impact. In order to successfully improve self-stigma in psychosis, we must evaluate the effect of available interventions to help clinicians select the most appropriate approach for their patients. This systematic review and meta-analysis aimed to evaluate the effect of self-stigma reduction interventions in people with psychosis while considering the interventions' characteristics as an important moderator of their effect. The results from this systematic review suggest that interventions involving more than one component, particularly those combining psychoeducation, social skills training and cognitive approaches, were most effective at reducing self-stigma in people with psychosis. Additionally, shorter interventions were found best reduced self-stigma at post-treatment evaluation. A meta-analysis mirrored these results, finding an overall favourable effect of interventions but high heterogeneity in the sample. Subgroup analyses found larger self-stigma reductions following multi-component interventions compared to single-component interventions. An analysis of risk of bias revealed a trend suggesting studies with lower risk of bias produced smaller effects. The results of this review can inform practitioners select and develop interventions to reduce self-stigma in psychosis. [ABSTRACT FROM AUTHOR]

• Guided discontinuation of APs in FEP patients led to fewer relapses and a longer time to relapse. • Voluntary withdrawal of APs resulted in a higher risk of relapse. • One relapse was prevented for every seven patients who continued with APs (NNT=7). • One relapse was reported for every four who voluntarily discontinued APs (NNH=4). The predictors of clinical evolution after nonaffective first-episode psychosis (NAFEP) have yet to be fully elucidated. It is important to weigh the long-term benefits of maintained antipsychotic (AP) treatment against the risks of relapse upon discontinuation. Between January 2017 and December 2022, we recruited 211 NAFEP patients from the Programa de Primeros Episodios Psicóticos de Navarra (PEPsNa) who achieved clinical remission within two years and continued follow-up. Clinicians recommended discontinuation of antipsychotics for 47 participants, resulting in significantly fewer relapses (10.6%, p ≤ 0.05) and a longer relapse-free survival time (95% confidence interval= 16.9 to 18.2 months). For every four individuals out of 72 who voluntarily discontinued APs (in contrast to those who were advised to discontinue APs), there was one more relapse (number needed to harm= 4; p ≤ 0.01). Moreover, one additional relapse was prevented for every seven individuals who continued APs instead of voluntarily discontinuing APs (number needed to treat= 7; p ≤ 0.05). Lower premorbid risk factors and better clinical profiles, such as shorter DUP, shorter time to remission, good real-world performance, better neurocognitive functioning, lack of a schizophrenia spectrum diagnosis, and a lower average dose of APs led clinicians to recommend AP discontinuation after achieving remission from NAFEP. This guided discontinuation of APs did not lead to a higher risk of relapse, but participants who voluntarily withdrew from treatment had a higher risk of relapse. [ABSTRACT FROM AUTHOR]

• Auditory-based targeted cognitive training (ATCT) is an emerging therapeutic. • EEG biomarkers collected at the start of ATCT can identify eventual responders. • Participant perspectives related to EEG-informed ATCT is lacking. • We conducted qualitative interviews to gain feedback related to EEG-informed ATCT. • Results generated actionable feedback to optimize EEG-informed ATCT effectiveness. Auditory-based targeted cognitive training (ATCT) is an emerging adaptive neuroplasticity-based intervention. Previous studies have shown that electroencephalographic (EEG) biomarkers of auditory information processing assessed at the start of ATCT have predicted cognitive, clinical, and functional gains from a full 30–40 hour ATCT program, but participant attitudes related to coupling EEG to ATCT are not well-known. This study assessed stakeholder feedback related to EEG biomarker collection as part of ATCT to optimize future EEG-informed ATCT studies. Semi-structured interviews assessed attitudes of ATCT-naïve participants (n =50) living with a range of psychiatric disorders and cognitive function who underwent EEG assessment associated with a 1 hour ATCT exercise. A deductive approach was used to code the data and an iterative approach was employed to identify key emerging themes. Interview data yielded 62 unique themes related to EEG biomarker collection and ATCT. Qualitative analysis identified positive and negative elements of participants' experience of EEG-informed ATCT as well as ways to streamline the EEG experience. Results suggest EEG-informed ATCT studies may be optimized using actionable improvements to current protocols leveraged from themes identified. [ABSTRACT FROM AUTHOR]

• Cognitive remediation leads to significant improvements in executive functions. • Cognitive remediation leads to significant improvements in visual memory. • Engagement in group cognitive remediation remains a challenge in this population. • Perceived competency and enjoyment influences engagement in cognitive remediation. Social anxiety disorder (SAD) is a frequent comorbidity in first-episode psychosis (FEP) and may increase cognitive impairments. Cognitive remediation (CR) is an effective treatment for cognition, particularly in a group format. This study aims to assess the efficacy, acceptability and engagement of group CR on cognitive outcomes in FEP+SAD compared to group cognitive-behavioral therapy (CBT). Participants with FEP+SAD were randomized to group CR (n = 45) or CBT-SAD (n = 51). They were assessed for cognition at baseline, post-therapy and 3- and 6-month follow-up. The CR group additionally completed scale to assess perceived competency and enjoyment in CR. Linear mixed models for repeated measures were used for cognitive scores. Descriptive statistics and t -tests were used to summarize acceptability, perceived competency, and enjoyment, for CR completers and non-completers. The CR group performed significantly better than CBT on executive functions and visual memory at post-therapy compared to baseline. Twenty participants completed CR (44 %; mean 5.5 sessions). At week 1, CR non-completers presented higher levels of perceived competency. Completers reported higher enjoyment scores at the last session compared to the first session. Group CR is effective for cognitive outcomes in FEP+SAD, but acceptability and engagement present a challenge. Future studies are necessary to explore approaches promoting engagement. [ABSTRACT FROM AUTHOR]

• Schizophrenia spectrum disorders (SSD) weight substantially on healthcare systems. • Direct healthcare costs were analyzed in a sample of 276 individuals with SSD. • A mean direct cost of 16477.23 (±32856.47) € per patient per year was identified. • Cost predictors were psychosocial functioning, age of onset and symptom severity. • Socially useful activities and negative symptoms outranked other scale items. The economic burden of schizophrenia amounts for 1.5-3 % of healthcare expenses in developed countries, and ∼50 % derives from direct costs: 81 % of these are due to hospitalization, residential facilities and semi-residential facilities. Therefore, a better characterization of variables that influence direct costs represents a relevant issue. A total of 276 individuals with schizophrenia spectrum disorders receiving treatment from the Community Mental Health Centers of Brescia (Italy) were included in the study: for each participant socio-demographic, clinical and functional characteristics were assessed, and data related to the use of services in 2022 (then converted to costs) were collected. Regression analyses were performed to identify predictors of costs. A direct healthcare expenditure of 16477.23 (±32856.47) € per patient per year was identified. The main cost predictor was the PSP total score (p=0.005), followed by age of onset (p=0.020), and PANSS total score (p=0.033). Including PANSS sub-scales scores and PSP single items as potential predictors, the main predictor was the "socially useful activities" PSP item (p=0.002), followed by age of onset (p=0.011), and PANSS negative scale score (p=0.027). Our findings underline the need to implement rehabilitative intervention focused on the improvement of psychosocial functioning and negative symptoms, also to reduce healthcare expenses. [ABSTRACT FROM AUTHOR]

• Individuals at risk for mania or psychosis experience substantial sleep difficulties. • For individuals at-risk for psychosis, sleep disturbances were linked to cognitive deficits, neural abnormalities, and attenuated psychotic symptoms, with the latter displaying strong associations with insomnia and sleep efficiency. • Among individuals at-risk for mania, sleep problems were associated with prodromal affective symptoms. Sleep difficulties are highly prevalent among individuals with schizophrenia and bipolar disorder (BD), playing key roles in the onset, clinical presentation, and course of psychotic and manic episodes. However, less is known about sleep difficulties and their sequelae among individuals at-risk for psychosis and mania. Therefore, we conducted a scoping review of sleep disturbances among individuals at-risk for psychosis or mania. Employing PRISMA guidelines, 38 articles were identified documenting associations with clinical, neurocognitive, neurobiological and functional indicators. Specifically, individuals at-risk for psychosis and mania experience greater sleep disruptions compared to healthy controls characterized by increased nighttime activity, sleep variability, delayed onset of rapid eye movement sleep, and poorer sleep quality. For individuals at-risk for psychosis, sleep disturbances were linked to cognitive deficits, neural abnormalities, and attenuated psychotic symptoms, with the latter displaying strong associations with insomnia and sleep efficiency. Among individuals at-risk for mania, sleep problems manifested early in life and were associated with prodromal affective symptoms, with a bidirectional relationship between sleep and affective symptoms. Overall, results highlight the crucial role sleep difficulties play in both at-risk populations. We discuss the implications of these findings to the development of preventive interventions for individuals at-risk for psychosis and mania. [ABSTRACT FROM AUTHOR]

• People with schizophrenia report experiencing stigma related to cognitive impairment. • People with schizophrenia and greater cognitive decline report more cognitive stigma. • Cognitive stigma experiences in schizophrenia are associated with depressive symptoms. Schizophrenia is the most strongly stigmatized psychiatric diagnosis, with negative stereotypes including assumptions of incompetence and inability to recover. Individuals with cognitive impairment associated with schizophrenia (CIAS) have reported stigma experiences, suggesting that CIAS carries stigma in addition to the stigma associated with schizophrenia as a diagnostic label. While research has established that mental illness stigma more generally is linked with poor psychiatric and functional outcomes, no research has explored correlates of CIAS stigma. This study evaluated cognitive, psychiatric, and functional correlates of CIAS stigma among 54 individuals with schizophrenia spectrum disorders participating in a cognitive remediation trial. Participants with greater estimated cognitive decline reported higher levels of CIAS stigma experiences. Participants who reported higher levels of CIAS stigma also scored higher on a measure of depressive symptom severity. No significant associations were found between CIAS stigma and positive and negative psychosis symptoms or general psychopathology ratings. CIAS stigma was not associated with performance-based functional capacity or ratings of community functioning. Findings suggest that CIAS stigma is linked with the degree of cognitive decline and depressive symptom severity among individuals with schizophrenia spectrum disorders. Additional research is needed to elucidate directionality and the relationship between CIAS stigma and functioning outcomes. [ABSTRACT FROM AUTHOR]

• Findings of bioenergetic abnormalities require re-conceptualization of schizophrenia. • These abnormalities are present in the brain and in the periphery at first episode. • Central and systemic impairments during the disease course need to be reconciled. • We propose that schizophrenia is a disease of impaired dynamic metabolic flexibility. • This theoretical framework and testable hypothesis open the way to novel treatment. Schizophrenia is a chronic, neurodevelopmental disorder with unknown aetiology and pathophysiology that emphasises the role of neurotransmitter imbalance and abnormalities in synaptic plasticity. The currently used pharmacological approach, the antipsychotic drugs, which have limited efficacy and an array of side-effects, have been developed based on the neurotransmitter hypothesis. Recent research has uncovered systemic and brain abnormalities in glucose and energy metabolism, focusing on altered glycolysis and mitochondrial oxidative phosphorylation. These findings call for a re-conceptualisation of schizophrenia pathophysiology as a progressing bioenergetics failure. In this review, we provide an overview of the fundamentals of brain bioenergetics and the changes identified in schizophrenia. We then propose a new explanatory framework positing that schizophrenia is a disease of impaired dynamic metabolic flexibility , which also reconciles findings of abnormal glucose and energy metabolism in the periphery and in the brain along the course of the disease. This evidence-based framework and testable hypothesis has the potential to transform the way we conceptualise this debilitating condition and to develop novel treatment approaches. [ABSTRACT FROM AUTHOR]

• The usage of psychiatric rehabilitation services (PRS) for people with schizophrenia was associated with double time-to-readmission. • People who used PRS (any kind) had lower mean annual rehospitalization days. • More intensive residential services were associated with larger reductions in re-hospitalization days. • Supported employment and sheltered workshops were the vocational services associated with the largest decrease in re-hospitalization days. • Providing both vocational and residential PRS had a synergistic effect on the reduction of re-hospitalization days. Psychiatric rehabilitation is essential for the recovery of individuals with schizophrenia. However, re-hospitalization is sometimes inevitable. This study examined the association between varied community psychiatric rehabilitation services (PRS) and long-term re-hospitalization parameters. National registries provided data on 5163 adults diagnosed with schizophrenia and schizoaffective disorder. Patients with recurrent hospitalizations were tracked over three periods: before rehabilitation legislation (1991–2000), during rehabilitation implementation (2001–2009), and follow-up (2010–2017). Associations between PRS types and annual re-hospitalization days (ARHD) during follow-up were analyzed. Findings revealed that the rehabilitation group had a median time-to-readmission of 757 days, while the non-rehabilitation group had 321 days. Combined residential and vocational rehabilitation was associated with a 20-day decrease in ARHD, while residential or vocational rehabilitation alone were associated with reductions of 2 and 5 days, respectively. Higher levels of residential support were linked to reduced ARHD. Of the vocational rehabilitation types, supported-employment and sheltered-workshops showed association with the greatest reductions in ARHD (17 days). Overall, community-based PRS is linked to prolonged time-to-readmission and reduced re-hospitalization days. A combination of vocational and residential services is related to a synergistic decrease in re-hospitalization days. This suggests that recurrent hospitalization for patients who are using PRS is shorter and may be part of their recovery pathway. [ABSTRACT FROM AUTHOR]

• Child and adolescent PLEs increase the risk of psychosis onset by young adulthood. • A third of psychotic disorder diagnoses are attributed to child or adolescent PLEs. • Interview-based assessments of PLEs better identify psychosis prone trajectories. • Further work is needed to improve and standardize the assessment of PLEs. Psychotic-like experiences (PLEs) are common in the general population. Child and adolescent PLEs are the most prevalent and linked with future psychotic disorders. Significant heterogeneity in PLE assessment has obscured its clinical utility to identify psychosis-prone trajectories and improve clinical outcomes. This meta-analysis aimed to assess i) PLE prevalence in children and adolescents and ii) their relationship with subsequent psychotic disorder while exploring sources of heterogeneity. PubMed, Embase, PsycINFO, and CINAHL databases were searched in August 2023 for population-based longitudinal studies that assessed child or adolescent PLEs and early adulthood psychotic outcomes. Six studies were included (n = 16,560), showing a pooled PLE prevalence of 17.3 %. Child and adolescent PLEs were associated with an increased risk of psychotic disorder in early adulthood (unadjusted OR = 3.80, 95 % CI: 2.31–6.26), with a population attributable fraction of 32.6 %. Significant heterogeneity in the strength of this relationship (I2 = 70 %, p =.01) was related to assessment type (self-report vs. interview). This review contends that interview-based PLE assessments could more accurately identify children or adolescents on a path towards psychosis and are better suited for psychotic risk identification. Further research is needed to elucidate interactions between PLEs and other psychotic risk factors. [ABSTRACT FROM AUTHOR]

• Alterations in GABA production due to gut dysbiosis might impact mental health. • Microbial imbalances could contribute to the pathophysiology of schizophrenia through the modulation of neurotransmitter levels and immune system interactions. • The endo-cannabinoid system is a crucial component interacting with the microbiome. This system is involved in regulating mood, stress response, and cognitive functions, and its interplay with the microbiome may have significant implications for mental health disorders, including schizophrenia. The microbiome has been linked to numerous neurological and psychiatric diseases, including schizophrenia. Nevertheless, correlating microbial perturbations to pathophysiological aspects of schizophrenia remains elusive, as study participants are typically medicated when sampled, complicating mechanistic investigation. Here we explored specific microbial and metabolic alterations in schizophrenia patients, while explicitly considering their medications. We recruited 30 patients and 14 healthy controls. Fecal and serum samples were collected for microbiota and (untargeted) metabolome characterization, respectively. While significant differences were detected between microbiome of controls and schizophrenia patients overall, patients not taking GABA-enhancing drugs had profiles similar to the control group. This pattern was preserved, but to a lesser extent, when comparing metabolomes. Several key metabolic pathways differed between patients and controls, even after filtering out those directly related to pharmaceuticals and their metabolism, and the citric acid cycle and amino acid biosynthesis pathways were enriched in the group prescribed antipsychotics without GABA-enhancers. Administration of exogenous GABA affected overall patient homeostasis, not just disease course, supporting our hypothesis that microbiota play a part in cognitive, emotional, and mental function, and that this role must be considered in the full context of an individual's state, including medication. [Display omitted] [ABSTRACT FROM AUTHOR]

• Patients with severe mental disorders have high comorbidity with metabolic disorders. • We explored shared genetic factors between these traits considering the effect of sex. • We observed extensive genetic overlap between severe mental disorders and BMI. • A large part of the identified genetic variants showed sex differences. • Our findings highlight potential sex differences in the genetic liability to metabolic comorbidities in patients with severe mental disorders. High rates of metabolic risk factors contribute to premature mortality in patients with severe mental disorders, but the molecular underpinnings of this association are largely unknown. We performed the first analysis on shared genetic factors between severe mental disorders and metabolic traits considering the effect of sex. We applied an integrated analytical pipeline on the largest sex-stratified genome-wide association datasets available for bipolar disorder (BD), major depressive disorder (MDD), schizophrenia (SZ), and for body mass index (BMI) and waist-to-hip ratio (WHR) (all including participants of European origin). We observed extensive genetic overlap between all severe mental disorders and variants associated with BMI in women or men and identified several genetic loci shared between BD, or SZ and BMI in women (24 and 91, respectively) or men (13 and 208, respectively), with mixed directions of effect. A large part of the identified genetic variants showed sex differences in terms of location, genes modulated in adipose tissue and/or brain regions, and druggable targets. By providing a complete picture of disorder specific and cross-disorder shared genetic determinants, our results highlight potential sex differences in the genetic liability to metabolic comorbidities in patients with severe mental disorders. [ABSTRACT FROM AUTHOR]

• Question Are antipsychotic formulations associated with sudden cardiac death (SCD) in patients with schizophrenia? • Findings In patients with schizophrenia, the risk of SCD with different antipsychotic formulations is ranked from high to low as follows: long-acting injectable antipsychotic (LAI) and oral-daily antipsychotic (OAP) combination, LAI monotherapy, OAP monotherapy, and non-antipsychotic use within the observation period. In addition, cardiovascular comorbidities are associated with an increased risk of SCD. • Meaning Physicians should obtain the history of cardiovascular disease before prescribing LAIs to patients with schizophrenia. They should also minimize prescribing combined antipsychotics and closely monitor their patients' cardiovascular condition after prescribing LAIs. The aim of this study was to clarify the association between various antipsychotic formulations—oral-daily antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs), and their combination—and the risk of sudden cardiac death (SCD). We conducted a nationwide population-based case–control study using data from 2011 to 2020 from the National Health Insurance Research Database and multiple-cause-of-death data from Taiwan. The study included patients with a new diagnosis of schizophrenia who were followed for SCD occurrence until 2020. Cases and controls were frequency-matched at a 1:4 ratio by age, sex, and year of new schizophrenia diagnosis. Compared with the use of OAP monotherapy, the use of LAI and OAP combination (OR = 1.91) and LAI monotherapy (OR = 1.45) were associated with an increased risk of SCD. Additionally, cardiovascular comorbidities (adjusted OR = 11.15) were identified as a significant risk factor for SCD. This study revealed the following hierarchy of SCD risk associated with antipsychotic formulations (listed from lowest to highest risk): nonuse of antipsychotics, OAP monotherapy, LAI monotherapy, and their combination. These findings underscore the importance of assessing cardiovascular disease history before LAIs are prescribed to patients with schizophrenia and indicate that physicians should avoid prescribing combined antipsychotics when using LAIs. [ABSTRACT FROM AUTHOR]

Schizophrenia is associated with higher cancer-related mortality, perhaps due to delayed diagnosis and limited access to treatment. The study aimed to compare patients diagnosed with cancer with and without schizophrenia to determine whether these groups differ in terms of oncological variables and survival outcomes. This was a retrospective, observational cohort study that included 30.990 patients diagnosed with cancer between 1997 and 2021. We performed univariate and bivariate analyses for the sociodemographic and clinical variables, and constructed Kaplan-Meier survival curves and used the log-rank test to perform the comparisons. All variables were compared for each cancer type. One hundred and sixty-two (0.52 %) patients had a confirmed diagnosis of schizophrenia (ICD-9 criteria). The mean age at diagnosis was significantly lower in the schizophrenia group. A significantly higher proportion of the schizophrenia group was diagnosed with cancer through the emergency department and a lower percentage through scheduled appointments. A smaller percentage of patients in the schizophrenia group received radical treatment for cancer. The mortality rate was higher in the schizophrenia group and median survival was lower. These findings suggest that cancer patients with schizophrenia have worse outcomes than patients without schizophrenia in terms of oncological variables and survival., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

• Some patients with schizophrenia do not respond favorably to antipsychotics. • Childhood trauma types may influence antipsychotic effectiveness in schizophrenia. • Sexual abuse predicted increased positive psychosis symptoms following treatment with antipsychotics. • Physical neglect predicted general psychopathology symptoms following treatment with antipsychotics. • Childhood trauma predicted AP treatment response in schizophrenia spectrum disorders. Treatment with antipsychotics (APs) for schizophrenia spectrum disorders (SSDs) is generally effective, however, a significant proportion does not respond favorably. Childhood trauma (CT) subtypes (physical, sexual, and emotional abuse, physical and emotional neglect) could influence treatment effectiveness; however, research is scarce. Heterogeneity in AP response could be explained by differentiating by CT subtype. The present study was based on the Bergen-Stavanger-Trondheim-Innsbruck (BeSt InTro) study. CTQ-SF assessed CT subtypes in SSDs (n = 98). CT subtypes were examined in relation to psychosis symptoms measured by PANSS during one year of treatment with APs, by means of linear mixed effects (LME) models. Results were significant for CT subtypes, where increased levels of sexual abuse and physical neglect were associated with increased mean levels of psychosis symptoms throughout the course of treatment from baseline to 52 weeks. AP effectiveness may thus be influenced by CT subtype in SSDs. The results support clinical guidelines recommending a focus on assessment and treatment of trauma in SSDs. [ABSTRACT FROM AUTHOR]

• Large language models (GPT-3.5, GPT-4, and Llama3) could predict human-generated ratings of coherence, content, and tangentiality in clinical speech samples with moderate accuracy. • GPT-4 and Llama3 predictions were more accurate to the human ratings than GPT-3.5. • Using default parameters, both GPT models showed high levels of inconsistency in their predicted ratings, while Llama3 was relatively consistent. • Inconsistency in large language model predictions could be mitigated by controlling the temperature parameter. • Ensemble methods which combined multiple sets of model-predicted ratings improved predictive accuracy. Natural Language Processing (NLP) methods have shown promise for the assessment of formal thought disorder, a hallmark feature of schizophrenia in which disturbances to the structure, organization, or coherence of thought can manifest as disordered or incoherent speech. We investigated the suitability of modern Large Language Models (LLMs - e.g., GPT-3.5, GPT-4, and Llama 3) to predict expert-generated ratings for three dimensions of thought disorder (coherence, content, and tangentiality) assigned to speech samples collected from both patients with a diagnosis of schizophrenia (n = 26) and healthy control participants (n = 25). In addition to (1) evaluating the accuracy of LLM-generated ratings relative to human experts, we also (2) investigated the degree to which the LLMs produced consistent ratings across multiple trials, and we (3) sought to understand the factors that impacted the consistency of LLM-generated output. We found that machine-generated ratings of the level of thought disorder in speech matched favorably those of expert humans, and we identified a tradeoff between accuracy and consistency in LLM ratings. Unlike traditional NLP methods, LLMs were not always consistent in their predictions, but these inconsistencies could be mitigated with careful parameter selection and ensemble methods. We discuss implications for NLP-based assessment of thought disorder and provide recommendations of best practices for integrating these methods in the field of psychiatry. [ABSTRACT FROM AUTHOR]

• Cognitive impairment is recognized as a core feature of Schizophrenia. • "Primary" and "secondary" cognitive impairment can be hypothetically distinguished. • Primary cognitive impairment stems from essential neurobiological alterations. • Secondary cognitive impairment is the consequence of other source issues. • Primary and secondary cognitive impairment require different/specific treatments. Cognitive impairment represents one of the core features of schizophrenia, involves both neurocognition and social cognition domains, and has a significant negative impact on real-world functioning. The present review provides a framework for the conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. In this conceptualization, primary cognitive impairment can be defined as a consequence of the neurobiological alterations that underlie psychopathological manifestations of the disorder, while secondary cognitive impairment can be defined as the results of a source issue that has a negative impact on cognitive performance. Sources of secondary cognitive impairment are frequent in people with schizophrenia and include several different factors, such as positive and negative symptoms, depressive symptoms, autistic symptoms, pharmacotherapy, substance abuse, metabolic syndrome, social deprivation, and sleep disorders. It can be hypothesized that secondary cognitive impairment may be improved by effectively resolving the source issue, while primary cognitive impairment may benefit from dedicated treatment. Further research is required to confirm this hypothesis, to better characterize the distinction between primary and secondary cognitive impairment in a clinical and in a neurobiological perspective, and to evaluate the impact of systematically assessing and treating secondary cognitive impairment. [ABSTRACT FROM AUTHOR]

• Literature gap exists for FGA-LAIs in acute psychosis; few old studies compare FGA-LAIs, none against SGA-LAIs or placebo. • Second-generation LAIs (SGA-LAIs) outperform placebo in reducing acute symptoms in SSDs. • SGA-LAIs demonstrate higher acceptability compared to placebo, supporting their use in acute phases. • Different LAI formulations show efficacy in short-term symptom reduction, irrespective of oral supplementation. • SGA-LAIs are evidence-based choices for managing acute psychopathology and enhancing adherence in acutely ill patients. To assess the effect of Long-acting injectable (LAI) antipsychotics in acutely ill patients, we systematically searched major databases for randomized controlled trials (RCTs) comparing LAIs with other LAIs, oral antipsychotics, or placebo in acutely symptomatic adults with schizophrenia-spectrum disorders. Data were analyzed with a random-effects network meta-analysis. Co-primary outcomes were efficacy (mean change in psychopathology rating scales) and acceptability (all-cause discontinuations) at study endpoint. Of 25 RCTs, 19 studies tested second-generation LAIs (SGA-LAIs) and six first-generation LAIs (FGA-LAIs). Due to a disconnected network, FGA-LAIs were analyzed separately, with poor data quality. The SGA-LAIs network included 8,418 individuals (males=63%, mean age=39.3 years). All SGA-LAIs outperformed placebo in reducing acute symptoms at study endpoint (median follow-up=13 weeks). They were more acceptable than placebo with the only exception of olanzapine, for which no differences with placebo emerged. Additionally, we distinguished between different LAI formulations of the same antipsychotic to explore potential pharmacokinetic differences. Most formulations outperformed placebo in the very short-term (2 weeks or less), regardless of the need for initial oral supplementation. SGA-LAIs are evidence-based treatments in acutely ill individuals with schizophrenia-spectrum disorders. Findings support the use of SGA-LAIs to manage psychopathology and improve adherence right from the acute phases of illness. [ABSTRACT FROM AUTHOR]

• There were significant regional differences in cognitive and functional capacity performance in healthy controls. • However, the performance disadvantage for people with schizophrenia was consistent across site-related differences in healthy controls' performance. • Variation in regional performance on the part of healthy people does not appear to influence performance differences between participants with schizophrenia and healthy people on indices cognition and functional capacity. Cognitive performance manifests regional differences, correlated with education. There is less information available about regional differences in performance-based measures of functional capacity. In multi-national trials focused on cognitive enhancement, it may be impossible to validate every measure in all locations. It is unknown if regional differences in healthy controls' (HC) performance affects relative levels of impairment in participants with schizophrenia (SCZ). A multi-site study comparing SCZ and HC administered the MATRICS Consensus Cognitive Battery (MCCB) and Virtual Reality Functional Capacity Assessment Tool (VRFCAT) to 164 HC participants and 164 with SCZ across three sites (Columbia, SC, Miami, and San Diego) and a representative sample of HC (n = 390) completed the VRFCAT in Durham, NC. Performance was compared between HC and SCZ participants at the validation sites. There were statistically significant cross-site differences in HC performance on both the MCCB and VRFCAT. Differences between HC and SCZ on MCCB and VRFCAT were substantial at all three sites, indicating that regional variations in HC performance did not induce reduced differences from SCZ participants. Regional differences were smaller than diagnostic group differences, suggesting that relative impairments of participants with SCZ is consistently preserved across performance differences in HC. [ABSTRACT FROM AUTHOR]

• High engagement rates observed, indicating the appeal of online social networking (OSN) for individuals with psychosis. • Higher quality and longer-term studies did not support effectiveness of current OSN interventions in reducing social isolation or improving quality of life of people with psychosis. • Limited effectiveness may be linked to the use of purpose-built platforms; exploring pre-existing mainstream OSN platforms could offer wider social connections. • Outdated OSN technologies in some interventions highlight the need for future research to focus on developing and testing interventions with updated technology. Social isolation is frequent in people with psychosis, contributing to negative health outcomes. Interventions including online social networking (OSN) may overcome some psychosis-related barriers and facilitate social interactions. However, evidence is currently sparse and needs to be collated in a systematic review to better understand effectiveness. Following PRISMA guidelines, this review yielded 9835 results. Eleven publications, reporting data from five RCTs and six non-controlled studies, met the inclusion criteria. Two independent reviewers undertook data extraction and quality assessment, with results narratively synthesised. This review looked broadly at interventions including either purpose-build platforms for peer-to-peer interactions or existing OSN tools. Yet, we only identified interventions utilising purpose-designed platforms. Early small-scale studies suggested OSN interventions reduced social isolation, but larger effectiveness studies did not confirm these effects. No improvements in quality-of-life outcomes were identified. Higher quality and longer-term studies did not support effectiveness of current OSN interventions in reducing social isolation or improving quality of life of people with psychosis. These interventions used purpose-built platforms and encouraged OSN between selected individuals, which may explain these outcomes. Future research may explore promoting safe use of mainstream OSN platforms to expand the social networks of individuals with psychosis. [ABSTRACT FROM AUTHOR]

• Sleep disturbances are linked to impaired socio-occupational functioning in serious mental illness (SMI) populations. • Need for systematic integration of sleep assessment and intervention in SMI treatment protocols for improved socio-occupational functioning. • Highlights the need for further research on the mechanistic links between sleep parameters and socio-occupational outcomes in SMI for targeted interventions. Sleep is a crucial factor influencing mental health and quality of life. Individuals with serious mental illness (SMI) often experience significant sleep problems. This can further exacerbate their symptoms and impact their socio-occupational functioning (SOF) (the extent to which a person is able to engage in 'self-care and activities of daily living, communication, interpersonal relations, instrumental living skills, and work'). Despite the well-established bidirectional relationship between sleep and mental health, the specific association between sleep and SOF in the context of SMI remains underexplored. A systematic review was conducted. Comprehensive searches in PubMed and PsycNet yielded 832 results. After applying inclusion criteria, 24 studies were included in the narrative synthesis. Study characteristics and key findings were extracted for analysis. Collectively, studies investigated sleep quality, satisfaction, duration, disturbance, specific disorders, and objectively-recorded sleep parameters across various study designs. Studies included a total population of 10,938, utilising a range of sleep and SOF outcome measures. Nearly all studies indicated that worsened sleep was associated with reduced SOF in SMI populations. The review supports the potential role of improved sleep as a route to improved SOF in SMI populations. This has clear implications for research and clinical care for patients with SMI. [ABSTRACT FROM AUTHOR]

• Polygenic risk for schizophrenia was associated with inner retinal layer thinning. • Polygenic risk for schizophrenia was not related to retinal microvascular features. • Retinal thinning in schizophrenia may reflect a neurodegenerative process. • Retinal microvascular abnormalities may be secondary consequences of schizophrenia. We examined the relationship between genetic risk for schizophrenia (SZ), using polygenic risk scores (PRSs), and retinal morphological alterations. Retinal structural and vascular indices derived from optical coherence tomography (OCT) and color fundus photography (CFP) and PRSs for SZ were analyzed in N = 35,024 individuals from the prospective cohort study, United Kingdom Biobank (UKB). Results indicated that macular ganglion cell-inner plexiform layer (mGC-IPL) thickness was significantly inversely related to PRS for SZ, and this relationship was strongest within higher PRS quintiles and independent of potential confounders and age. PRS, however, was unrelated to retinal vascular characteristics, with the exception of venular tortuosity, and other retinal structural indices (macular retinal nerve fiber layer [mRNFL], inner nuclear layer [INL], cup-to-disc ratio [CDR]). Additionally, the association between greater PRS and reduced mGC-IPL thickness was only significant for participants in the 40–49 and 50–59 age groups, not those in the 60–69 age group. These findings suggest that mGC-IPL thinning is associated with a genetic predisposition to SZ and may reflect neurodevelopmental and/or neurodegenerative processes inherent to SZ. Retinal microvasculature alterations, however, may be secondary consequences of SZ and do not appear to be associated with a genetic predisposition to SZ. [ABSTRACT FROM AUTHOR]

• Violence risk is increased in patients with schizophrenia. • Our understanding of the nature of that link is limited. • The HCR-20v3 represents one of the best structured ways of assessing that risk. • The HCR-20 should be re-evaluated every 6 months. • The HCR-20v3 is most effective at identifying those at low risk of violence. Aggression and violence are common day to day problems in psychiatric settings. However, the optimal means of assessing that risk remains unclear. In the context of that uncertainty many tools have evolved, among which the HCR-20 is one of the most globally accepted, though many questions remain about its performance, how and when it should be deployed and how it can be most effectively used. In this 12 month follow up study of 210 forensic psychiatric inpatients with a diagnosis of a schizophrenia spectrum disorder we explored these issues. We found that the performance of the HCR-20v3, especially its Total score, performed well up to 6 months after it was rated but its performance deteriorated after that. Repeating the HCR-20v3 at 6 months stabilised the risk assessment and led to improved performance in the second months over and above the first rating. The HCR-20v3 was good at identifying those subjects at low risk of violence over 6 months of follow up in a forensic inpatient setting. The real-world implications of this study are that the HCR-20v3 is an effective means of identifying patient at low risk of violence, but it should be reassessed every 6 months. [ABSTRACT FROM AUTHOR]

• Plasma NfL protein shows a differential relationship with age in TRS and BPAD compared to controls. • TRS individuals have an accelerated increase in NfL with age. • BPAD individuals have an attenuated increase in NfL with age. Accelerated brain ageing has been observed in multiple psychiatric disorders. This study examined whether relationships between age and plasma neurofilament light (NfL) protein differed in individuals with psychiatric disorders (major depressive disorder (n = 42), bipolar affective disorder (n = 121), treatment-resistant schizophrenia (TRS, n = 82)) compared to two healthy control (HC) groups (n = 1,926 and n = 59). Compared to two independent HC samples, individuals with TRS demonstrated a stronger positive relationship between age and NfL levels. Individuals with BPAD had a stronger negative relationship between age and NfL levels compared to the large normative HC cohort, but not locally-acquired HCs. These findings show that plasma NfL levels are differentially associated with age in individuals with TRS and BPAD compared to healthy individuals. [ABSTRACT FROM AUTHOR]

• The psychological interventions were superior to the control groups (active-, inactive-, TAU- and waitlist-control group) in the reduction in overall symptoms in treatment-resistant schizophrenia. • The less active the control group (e.g. waitlist- or treatment as usual control group) is, the bigger is the effect of the psychological intervention. • All control groups were associated with a symptomreduction from the pre- to post-measurement point, with the greatest reduction in the inactive control group. Control groups used in randomised controlled trials investigating psychological interventions for depression and anxiety disorders have effects of their own. This has never been investigated for schizophrenia, in particular treatment-resistant schizophrenia. This systematic review and meta-analysis aimed to examine how control groups in randomised controlled trials on psychological interventions for treatment-resistant schizophrenia behave in their effects on general symptomatology. In a search of various databases until July 2023, 31 eligible studies with 3125 participants were found whose control groups were assigned to four categories: active, inactive, treatment as usual and waitlist. The analyses showed that psychological interventions had a greater effect on symptom reduction to all control groups combined. When separating the control groups, only compared to TAU and waitlist controls the psychological interventions were superior. The difference was larger when less active control groups (e.g. waitlist – or treatment as usual control groups) were used. All control groups were associated with an improvement in symptoms from pre- to post-measurement point, with the greatest improvement observed in the inactive control group. The results are preliminary, but they suggest that the choice of the control group has a considerable impact on study effects as it has been shown in other psychiatric diagnoses. [ABSTRACT FROM AUTHOR]

• Precise diagnosis of psychosis facilitates early intervention, and supports recovery. • The lack of specific biomarkers limits early diagnosis and intervention. • Circulating and brain-derived exosomes are potential blood biomarkers of psychosis. • Future investigations need to consider the multifactorial context of psychosis. Due to its reliance on heterogeneous symptomatology, the accurate diagnosis of psychotic disorders remains a challenging task in clinical practice. Precise and early diagnosis of psychotic disorders facilitates early intervention, which has been shown to have substantial benefits for long-term outcomes. Still, the lack of specific biomarkers is an important limitation in early diagnosis and intervention. Exosomes, which act as messengers between cells, including brain cells, contain a vast array of molecules that hold promise for unveiling disorder-specific abnormalities. In this review, we discuss recent evidence highlighting the potential of circulating exosomes and brain-derived exosomes as valuable tools for the identification of accessible, non-invasive, and blood-based biomarkers of psychotic symptomatology and risk. We discuss current limitations in biomarker discovery studies focusing on exosomes. To enhance diagnosis specificity and treatment response, we also provide guidance for future investigations that need to target biomarkers of risk and relapse, as well as consider duration of untreated psychosis, biological sex, and other factors in the multifactorial biosignature of psychosis. [ABSTRACT FROM AUTHOR]

• The positive effects of resilience on psychological distress has been found in previous studies however this has not yet been investigated in the seriously mentally ill. • In this study we investigated the course of psychological distress and resilience in the first two years of the Covid-19 pandemic in patients with severe mental illness (SMI; schizophrenia spectrum disorder, bipolar disorder, major depressive disorder with psychotic features) and major depressive disorder without psychotic features (MDD) compared to healthy control subjects. • The findings of this study show that MDD patients are a particularly vulnerable group in the face of crises. • Our findings suggest that more focus should be laid on strategies to improve resilience in this group as they would profit the most in terms of reducing psychological distress and one can speculate that this may improve quality of life and hence outcomes in the long run. The positive effects of resilience on psychological distress has been found in previous studies in samples not including the seriously mentally ill. The present study aimed to investigate the course of psychological distress and resilience in the first two years of the Covid-19 pandemic in patients with severe mental illness (SMI) and major depressive disorder without psychotic features (MDD) compared to healthy control subjects. 141 patients with SMI or MDD who had been admitted to a psychiatric ward in Tyrol (Austria) or South Tyrol (Italy) in 2019 and 584 community controls participated in a longitudinal online survey. Next to collecting sociodemographic data, psychological distress was evaluated using the Brief Symptom Checklist (BSCL) and resilience by the 13-Item Resilience Scale (RS-13). Psychological distress was consistently significantly higher while resilience was consistently significantly lower among both patient groups compared to healthy controls. In the patient samples, those with MDD consistently exhibited a significantly higher prevalence and level of psychological distress and significantly lower resilience. Resilience had a moderating effect on psychological distress especially in the MDD group. Our results suggest that MDD patients represent a particularly vulnerable group and findings imply that these patients would profit the most from trainings fostering resilience. [ABSTRACT FROM AUTHOR]

• This longitudinal cohort study aimed to identify the predictors of better function following psychiatric hospitalization for psychosis. • Following hospitalization, the participants' function either decreased, remained stable, or improved. • A more severe baseline presentation along with better socioeconomic status was associated with a better functional prognosis. • Symptomatic improvements were seen in both improving and stable individuals, showing discrepancies between functional and symptomatic recovery. • These results highlight the importance of studying the predictors of functioning rather than solely focusing on relapse prevention. Psychotic disorders can be severely enabling, and functional recovery is often difficult to achieve. Admission to a psychiatric unit represents a key opportunity to implement strategies that will improve functional outcomes. In the current literature, there is a lack of consensus on which factors influence functional recovery. Therefore, the present longitudinal cohort study aimed to identify factors associated with functional trajectories following hospital admission for acute psychosis. A sample of 453 individuals with acute psychosis was extracted from the Signature Biobank database. Participants were followed for up to a year following admission. Various clinical indicators were documented over time. Functional trajectories were calculated based on the World Health Organization Disability Assessment Schedule 2.0. Three groups were identified: "improving", "stable", and "worsening" function. Individuals with a more severe symptomatic presentation at baseline were found to have better functional improve more over time. Over time, individuals in the "improving" and "stable" groups had significant improvements in their psychiatric symptoms. Finally, individuals following a "worsening" functional trajectory initially improved in terms of psychotic symptoms, but it did not persist over time. These results highlight the importance of studying function as a key component of recovery rather than solely focusing on relapse prevention. [ABSTRACT FROM AUTHOR]

• The risk of physical violence is significantly higher in patients with schizophrenia compared to the general population. • Several biological, psychological, and socioeconomic features have been identified as risk factors for violence. • We formulated a predictive model that significantly predicts certain violence trajectories in schizophrenia based on sex and stressful life events. The risk of violence is higher in schizophrenia spectrum disorders (SSD) compared to the general population and it is a pressing and understudied issue. Several dispositional and environmental factors have been previously correlated with violence, however, there has been little success in assessing their ability to predict violence patterns across the life span. This study aims to assess violence prediction based on personality traits, psychological resilience, and life-course adversities in a non-forensic population of SSD patients. In a sample of 231 patients with SSD, we assessed violence using the Brown-Goodwin History of Lifetime Aggression Scale and conducted cross-sectional assessments of possible predictors such as childhood trauma, personality traits and resilience scores. We then utilized a logistic regression classification algorithm to predict different violence trajectories based on the proposed risk factors. Our model significantly predicted individuals with violence in both childhood and adulthood, as well as childhood-only violence (p < 0.001). However, the model did not show significance for adult-only violence (p = 0.604). In all given trajectories, female sex appeared to be protective against violence, while stressful life events appeared to contribute to it. These results suggest that distinct factors can better inform risk assessment of lifespan violence patterns for personalized interventions in SSD. [ABSTRACT FROM AUTHOR]