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BACKGROUND: Cognitive-behavioral intervention techniques are increasingly demonstrating their efficacy in preventing relapses and managing problems in patients with schizophrenia. There is still variation in its effectiveness for negative symptoms, such as mood-related symptoms and motivation to engage socially. METHODS: A systematic search was conducted in PubMed, Web of Science for English literature on cognitive-behavioral therapy (CBT) interventions in patients with schizophrenia. The search included randomized controlled trials and nonrandomized controlled trials. The search period extended from the inception of the databases to September 30, 2022. Two researchers independently performed quality assessment and data extraction based on predefined inclusion and exclusion criteria. RESULTS: Discrepancies were resolved through discussion or consultation with a third researcher. Initially, 169 articles were retrieved through database searches and other means. After applying the inclusion and exclusion criteria, 10 randomized controlled studies were included in the final analysis. The intervention group comprised a total of 680 patients with schizophrenia, while the control group included 686 patients with schizophrenia. Meta-analysis results demonstrated a statistically significant difference in negative symptom reduction between the CBT intervention group (WMD = -1.19, 95% CI [-1.73, -0.66], P < .0001) and the control group. CONCLUSION: We have analyzed the effectiveness of CBT based on our previous research, CBT was found to effectively improve negative symptoms in individuals diagnosed with schizophrenia.

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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.

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BACKGROUND: Quality of life has emerged as a powerful indicator of therapeutic success. However, little research has been conducted to study potential factors that influence quality of life in persons with schizophrenia, particularly in low-income developing nations. AIM: This study aimed to investigate how insight and empathy impacted the quality of life and severity of symptoms in patients. METHODS: A descriptive cross-sectional research design was conducted on 168 patients with schizophrenia using the PANSS Scale, Schizophrenia Quality of Life Scale R4, the Interpersonal Reactivity Index, and the Birchwood Insight Scale. RESULTS: Our findings show that the mean score for quality of life was (70.9 ± 9.2), whereas the mean scores for empathy and insight were (60.8 ± 15.8) and (5.8 ± 1.9), respectively. Insight and empathy have predicted effects on QoL (adjusted r square = 0.035, sig = 0.009) and (adjusted r square = 0.012, sig = 0.027), respectively. On the other hand, the regression model also showed a substantial inverse relationship between the severity of the illness and both empathy and insight. CONCLUSION: The majority of the clients had poor quality of life, low insight, and low empathy. Insight and empathy play a role in anticipating the patient's perceptions of quality of life. They might affect how severe their illness is. Our findings highlight the importance of developing empathy and insight, and therapies that do so may aid patients with low quality of life.

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BACKGROUND: It is well established that individuals with schizophrenia experience deficits in emotional perception that can impact long-term social and occupational functioning. Understanding the factors that impact these impairments is important for targeting interventions to improve recovery. In the general population, compared with males, females tend to show greater perception of emotions. Whether this sex difference persists in schizophrenia is less clear. In contrast to males, females diagnosed with schizophrenia tend to have a higher age of disease onset and better premorbid functioning but do not necessarily have better outcomes. Effective treatments for social cognitive impairments are highly relevant to long-term functional rehabilitation. A greater understanding of the cognitive deficits in emotional perception within females and males living with schizophrenia may assist interventions to be better tailored to individuals. OBJECTIVE: This systematic review aims to collate, synthesize, and critically appraise evidence considering the influence of biological sex (female and male) on the emotional perception of individuals with schizophrenia. METHODS: This is a systematic review protocol based on the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. The electronic databases MEDLINE, Embase, CENTRAL, CINAHL, and PsycINFO will be systematically searched. To be included in this review, studies must compare the emotional perceptions of male and female participants older than 18 years who have a primary diagnosis of a schizophrenia spectrum disorder. Qualitative studies, case reports, case series, unpublished manuscripts, and studies not reported in English will be excluded. Key search strategies will include combinations of the following terms: "men," "male," "man," "female," "women," "woman," "sex," "gender," "emotional perception," "emotional processing," "schizophrenia," "schizophren," "psychotic disorders," "psychosis," "psychoses," "psychotic," "schizoaffective," "schizotypal personality disorder," and "schizotyp." Identified studies will be uploaded to the web-based Covidence systematic review management software. The risk of bias for individual studies will be assessed using the relevant Joanna Briggs Institute checklist tools. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system will also be used to evaluate the strength of the evidence base. Findings will be synthesized to provide a systematic summary of the existing literature. If sufficiently comparable data to permit meta-analysis emerges, a random-effects meta-analysis will be performed. RESULTS: This systematic review was registered with the PROSPERO (International Prospective Register of Systematic Reviews) in October 2023. The search and screening of study titles and abstracts are currently underway. Data are expected to be extracted and analyzed in July 2024. CONCLUSIONS: Results will contribute to an improved understanding of the social cognitive profiles of males and females with schizophrenia. This knowledge is expected to inform the adaptation of interventions to improve functional outcomes. TRIAL REGISTRATION: PROSPERO CRD42023463561; https://tinyurl.com/34sr3rnf. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56977.

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BACKGROUND: We report the final results of treatment with aripiprazole, blonanserin, and paliperidone from the Japan Useful Medication Program for Schizophrenia (JUMPs), a 104-week naturalistic study. METHODS: JUMPs was an open-label, three-arm, randomized, parallel-group, 104-week study. Patients aged ≥ 20 years with schizophrenia requiring antipsychotic treatment or a switch from previous therapy were enrolled. The primary endpoint was treatment discontinuation rate over 104 weeks. Secondary endpoints included remission rate, Personal and Social Performance (PSP), safety, Positive and Negative Syndrome Scale (PANSS), and quality of life (QOL; EuroQol-5 dimension). RESULTS: In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). Treatment discontinuation rates (aripiprazole, 80.5%; blonanserin, 81.2%; paliperidone, 71.4%) were not significantly different (p = 0.2385) among the treatment groups at 104 weeks; comparable outcomes were observed for endpoints, including remission (42.9%, 46.7%, and 45.8%), PANSS, and safety. In the overall cohort, while the improvement in the PSP total score at Week 104 was not significantly different from baseline, a significant improvement (p < 0.05) in QOL and total PANSS scores (including all subscales) was observed at Week 104 compared with baseline. Multivariable analysis identified a shorter disease duration and a higher chlorpromazine-equivalent antipsychotic dosage level (≥ 1000 mg) before switching to monotherapy as predictors of treatment discontinuation. CONCLUSIONS: The 104-week treatment outcomes were comparable between groups; the overall trend of improvement in remission rate, safety, and QOL suggests the importance of continued treatment. CLINICAL TRIAL REGISTRATION: UMIN-Clinical Trials Registry UMIN000007942 (public release date: 14/05/2012).

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Cognitive impairments affect functional capacity in individuals with schizophrenia (SZH), but their neural basis remains unclear. The Wisconsin Card Sorting Test (WCST), and the Stroop Task (SCWT), are paradigmatic tests which have been used extensively for examining executive function in SZH. However, few studies have explored how deficits on these tasks link to brain volume differences commonly seen in SZH. Here, for the first time, we tested associations between FreeSurfer-derived frontal brain volumes and performance on both WCST and SCWT, in a well-matched sample of 57 SZH and 32 control subjects. We also explored whether these associations were dissociable from links to symptom severity in SZH. Results revealed correlations between volumes and task performance which were unique to SZH. In SZH only, volumes of right middle frontal regions correlated with both WCST and Stroop performance: correlation coefficients were significantly different to those present in the control group, highlighting their specificity to the patient group. In the Stroop task, superior frontal regions also showed associations with Stroop interference scores which were unique to SZH. These findings provide important detail around how deficits on these two paradigmatic executive function tasks link to brain structural differences in SZH. Results align with converging evidence suggesting that neuropathology within right middle frontal regions (BA9 and BA46) might be of particular import in SZH. No volumetric associations with symptom severity were found, supporting the notion that the structural abnormalities underpinning cognitive deficits in SZH differ from those associated with symptomatology.

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Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.

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Social deficits in schizophrenia have been attributed to an impaired attunement to mutual interaction, or "interaffectivity". While impairments in emotion recognition and facial expressivity in schizophrenia have been consistently reported, findings on mimicry and social synchrony are inconsistent, and previous studies have often lacked ecological validity. To investigate interaffective behavior in dyadic interactions in a real-world-like setting, 20 individuals with schizophrenia and 20 without mental disorder played a cooperative board game with a previously unacquainted healthy control participant. Facial expression analysis was conducted using Affectiva Emotion AI in iMotions 9.3. The contingency and state space distribution of emotional facial expressions was assessed using Mangold INTERACT. Psychotic symptoms, subjective stress, affectivity and game experience were evaluated through questionnaires. Due to a considerable between-group age difference, age-adjusted ANCOVA was performed. Overall, despite an unchanged subjective experience of the social interaction, individuals with schizophrenia exhibited reduced responsiveness to positive affective stimuli. Subjective game experience did not differ between groups. Descriptively, facial expressions in schizophrenia were generally more negative, with increased sadness and decreased joy. Facial mimicry was impaired specifically regarding joyful expressions in schizophrenia, which correlated with blunted affect as measured by the SANS. Dyadic interactions involving persons with schizophrenia were less attracted toward mutual joyful affective states. Only unadjusted for age, in the absence of emotional stimuli from their interaction partner, individuals with schizophrenia showed more angry and sad expressions. These impairments in interaffective processes may contribute to social dysfunction in schizophrenia and provide new avenues for future research.

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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.

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OBJECTIVES: In schizophrenia, nonspecific lighting likely causes sleep timing disturbances, leading to distress and poorer clinical status. However, the effect of exposure to circadian lighting on psychopathology outcome in schizophrenia remains unknown. Hence, this study aimed to develop such an intervention and investigate its impact on schizophrenia. METHODS: Twenty schizophrenia patients at a psychiatric nursing institute were monitored over 10 weeks, with assessments using the Brief Psychiatric Rating Scale (BPRS) and Mini-Mental State Examination (MMSE) conducted at baseline, weeks 3 (T1), 7 (T2), and 10 (T3). RESULTS: Circadian lighting significantly improved BPRS scores between T1-T2 (p < .05) and T1-T3 (p < .001), with affectivity scores also showing significant enhancements postintervention. Notably, female participants exhibited substantial improvements in BPRS scores from T1 to T3 (p < .01), while male participants demonstrated significant gains in MMSE scores from T1 to T2 (p < .01). CONCLUSIONS: Circadian lighting presents a promising intervention for improving psychiatric outcomes in schizophrenia, with distinct benefits observed across different psychopathological aspects and genders. These findings underscore the potential of lighting chronotherapy in psychiatric clinical practice and warrant further exploration in related research.

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ABSTRACT: Schizophrenia is a debilitating mental health disorder that imposes profound economic, societal, and personal burdens. The negative symptoms of schizophrenia ( i.e. , blunted affect, alogia, anhedonia, asociality, and avolition) are highly prevalent and pervasive in the psychotic disorder and pose significant resistance to available treatment options. Traumatic childhood experiences are strongly linked with the risk of developing schizophrenia. Most prior studies have primarily focused on positive symptoms of schizophrenia ( e.g. , hallucinations and delusions), whereas less attention has been given to negative symptoms. The current study investigated the relationship between childhood trauma ( i.e. , physical abuse, sexual abuse, and emotional abuse and neglect) and negative symptoms in a sample of schizophrenia outpatients and healthy controls ( n = 159 participants, including 99 patients with schizophrenia). The observations from the current study revealed that schizophrenia patients experienced a significantly greater degree of childhood trauma and negative symptoms than the control individuals. The results of the current study also indicated that more severe experiences of total childhood trauma ( i.e. , summation of all trauma types), physical abuse, and emotional neglect may increase the risk of schizophrenia patients reporting negative symptoms. However, childhood sexual and emotional abuse was found to have no impact on the degree of negative symptoms experienced by schizophrenia patients. Implications and limitations of the current study are discussed. In conclusion, we found that the severity of overall childhood trauma, physical abuse, and emotional neglect may play an important role in increasing the likelihood of schizophrenia patients reporting negative symptoms.

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This publication presents an analysis of the psychological concepts, involved in the construction of clinical models of schizophrenia; in particular - the new clinical-biological paradigm of schizophrenia (reflecting the data of own psychometric studies). Based on the analysis, 3 modes of interaction between clinical and psychological constructs in the construction of models of schizophrenia were identified. The conceptualization of clinical models was carried out from the perspective of the contribution of psychological and psychometric constructs - allowing to expand theoretical ideas about the dynamics of views on the clinical construct of schizophrenia.

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OBJECTIVE: To develop a systematics of chronic delusional psychoses in schizophrenia and pathology of the schizophrenic spectrum that takes into account psychopathological structure (the mechanism of delusional formation) and the trajectories of the disease course (the ratio of negative/positive dimensions). MATERIAL AND METHODS: The study sample was recruited from the large Moscow psychiatric hospital in 2019-2024 and included 126 patients (94 male, 32 female, mean age 36.5±12.1 years) hospitalized with ICD-10 diagnosis of paranoid schizophrenia (F20.00) or delusional disorder (F22). A clinical-psychopathological method was used. RESULTS: The study identifies three variants of paranoid domains, the typology of which takes into account both the psychopathological structure and the trajectories of their development, which determine the dominance of predominantly negative or positive symptoms throughout the disease: 1) psychosis with delusional interpretations and predominant orientation of symptoms towards the negative pole of the schizophrenia psychopathology (n=37, 29.4%); 2) psychosis with hallucinatory delusions and predominant direction of symptoms towards the positive pole of the schizophrenia psychopathology (n=50, 39.7%); and 3) «combined¼ hallucinatory-delusional psychosis with a simultaneous orientation of symptoms to the negative/positive poles of the schizophrenia psychopathology (n=39, 30.9%). Detailed phenomenological characteristics of each of the three presented variants are given. CONCLUSION: The developed three-component taxonomy confirms, on the model of chronic delusional psychoses appearing in schizophrenia and the pathology of the schizophrenia spectrum, the concept of simultaneous representation of two relatively independent domains determined by neurobiological processes in the schizophrenia psychopathology positive and negative disorders.

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OBJECTIVE: To create a new taxonomy of schizophrenia spectrum disorders (SSD) based on the comparability of the design of SSD and borderline states. MATERIAL AND METHODS: The total sample consists of 205 patients with an established diagnosis of SSD (F21; F25; F22 according to ICD-10) collected from studies of the department of borderline mental pathology and psychosomatic disorders of the Federal State Budgetary Institution Mental Health Research Center and the Department of Psychiatry and Psychosomatics of Moscow State Medical University in the period 2014 to 2024. Clinical, psychometric, statistical methods were used. RESULTS: A new two-level model of schizotypal personality disorder (STPD) has been developed: the first level is psychopathic-like disorders of the «Ferschroben¼ type; the second level are psychopathological disorders (positive, negative, etc.), appearing under their «mask¼, constituting a «tracing paper¼ of manifestations of schizophrenia «in miniature¼. The two-level psychopathological model of STPD is a complex clinical phenotype, including independent but overlapping phenotypic formations: psychopathic-like - the «Ferschroben¼ type; and basic - schizophreniform disorders. CONCLUSION: The clinical classification of schizophrenia spectrum disorders has been developed; pseudoneuroses and stress-induced disorders of the endogenous circle are considered in the aspect of the dynamics of STPD.

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This review focuses on late-onset schizophrenia and schizophrenia-like psychosis with very late onset (VLOSLP) with focus on their psychopathologic, neuropsychologic, and neurobiologic aspects. A literature review on late-onset schizophrenia and VLOSLP was conducted based on publications from PubMed, Scopus, and Google Scholar databases up to December 2023. It may be noted that research into schizophrenia has largely focused on early-onset patients, and research into the mental health of older people has focused primarily on dementia and depression, with relatively little information on late-onset schizophrenia and VLOSLP. The nosology of late-onset functional psychoses is still poorly understood. There is currently no consensus on the diagnostic framework for psychosis labeled by the term VLOSLP. These deficiencies need to be addressed in order to understand the background of VLOSLP, the course and prognosis of the illness, and to develop successful management and treatment strategies for these patients, as older adults are more susceptible to the adverse effects of psychotropic medications. Therapy should be holistic, including not only medication but also psychotherapy, and the key role of caregivers of elderly schizophrenia patients should be taken into account. There should be judicious use of pharmacotherapy with an assessment of its risks and benefits.

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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.

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OBJECTIVE: The Corollary Discharge (CD) mechanism inhibits self-generated speech sound perception, appearing disrupted in schizophrenia and potentially contributing to Anomalous Self-Experiences (ASEs). However, it remains unclear if this alteration and its correlation with ASEs extend to other psychotic disorders. METHODS: Electroencephalography was used to study the N1 Event-Related Potential (ERP) as an index of CD-mediated suppression in the auditory cortex across thirty-five participants with schizophrenia, twenty-six with bipolar disorder, and thirty healthy controls. Auditory N1 was elicited by two conditions: real-time listening to self-pronounced vowels while speaking through connected microphone and earphones (listen/talk -or talk condition in previous literature-) and passive listening to the same previously recorded self-uttered vowels (listen/no talk -or listen condition-). RESULTS: N1 ERP amplitude was lower in the listen/talk condition compared to listen/no talk across all groups. However, N1 suppression was significantly reduced in schizophrenia, with bipolar patients showing intermediate attenuation between both groups (i.e., non-significantly different from controls). Furthermore, N1 suppression inversely correlated with ASEs severity only in schizophrenia. CONCLUSIONS: Dysfunction of the CD mechanism may be a defining feature of schizophrenia, where it is connected to ASEs. SIGNIFICANCE: These results corroborate previous findings linking auditory N1 ERP suppression with disrupted CD mechanism in schizophrenia, but not in bipolar disorder.

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