Schizophrenia is a complex psychiatric disorder marked by positive and negative symptoms,leading to mood disturbances,cognitive impairments,and social withdrawal.While anti-psychotic medications remain the cornerstone...Schizophrenia is a complex psychiatric disorder marked by positive and negative symptoms,leading to mood disturbances,cognitive impairments,and social withdrawal.While anti-psychotic medications remain the cornerstone of treatment,they often fail to fully address certain symptoms.Additionally,treatment-resistant schizophrenia,affecting 30%-40%of patients,remains a substantial clinical challenge.Positive,negative symptoms and cognitive impairments have been linked to disruptions in the glutamatergic,serotonin,GABAergic,and muscarinic pathways in the brain.Recent advances using genome-wide association study and other approaches have uncovered a significant number of new schizophrenia risk genes that uncovered new,and reinforced prior,concepts on the genetic and neurological underpinnings of schizophrenia,including abnormalities in synaptic function,immune processes,and lipid metabolism.Concurrently,new therapeutics targeting different modalities,which are expected to address some of the limitations of anti-psychotic drugs currently being offered to patients,are currently being evaluated.Collectively,these efforts provide new momentum for the next phase of schizophrenia research and treatment.展开更多
Selecting the initial antipsychotic dose is a high-impact decision in acute schizophrenia.A randomized study found that starting lurasidone at 80 mg/day for 1 week(then flexible titration)produced earlier reductions i...Selecting the initial antipsychotic dose is a high-impact decision in acute schizophrenia.A randomized study found that starting lurasidone at 80 mg/day for 1 week(then flexible titration)produced earlier reductions in Positive and Negative Syndrome Scale positive symptoms than 40 mg/day,without higher discontinuations for adverse events or a metabolic penalty over 6 weeks.These data support an individualized approach:Start at 80 mg/day when rapid control of positive symptoms or agitation is needed and tolerance permits;start at 40 mg/day when akathisia risk or patient preference argues for caution,with a planned day-7 review for up-titration.The open-label design,dose convergence after week 1,and the lack of stratified randomization limit attribution of longer-term advantages to starting dose.Even so,the trial reframes initial dose as a modifiable lever for the early course rather than a one-size-fits-all rule and warrants confirmation in larger,double-blind randomized trials.展开更多
BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Resear...BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.展开更多
BACKGROUND Very late-onset schizophrenia-like psychosis(VLOSLP)is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60.The incidence o...BACKGROUND Very late-onset schizophrenia-like psychosis(VLOSLP)is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60.The incidence of VLOSLP shows a linear relationship with increasing age.However,no studies have reported alterations in spontaneous brain activity among VLOSLP patients and their correlation with cognitive function and clinical symptoms.AIM To explore VLOSLP brain activity and correlations with cognitive function and clinical symptoms using resting-state functional magnetic resonance imaging.METHODS This study included 33 VLOSLP patients and 34 healthy controls.The cognitive assessment utilized the Mini Mental State Examination,Montreal Cognitive Assessment,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Clinical characteristic acquisition was performed via the Positive and Negative Syndrome Scale(PANSS).All participants were scanned via resting-state functional magnetic resonance imaging,and the data were processed using amplitude of low-frequency fluctuations(ALFF),fractional ALFF(fALFF),regional homogeneity,and voxelmirrored homotopic connectivity(VMHC).RESULTS The VLOSLP group presented decreased ALFF values in the left cuneus,right precuneus,right precentral gyrus,and left paracentral lobule;increased fALFF values in the left caudate nucleus;decreased fALFF values in the right calcarine fissure and surrounding cortex(CAL)and right precuneus;increased regional homogeneity values in the right putamen;and decreased VMHC values in the bilateral CAL,bilateral superior temporal gyrus,and bilateral cuneus.In the VLOSLP group,ALFF values in the right precuneus were negatively correlated with Mini Mental State Examination score and PANSS positive subscale score,and VMHC values in the bilateral CAL were negatively correlated with the RBANS total score,RBANS delayed memory score,and PANSS positive subscale score.CONCLUSION The changes of brain activity in VLOSLP are concentrated in the right precuneus and bilateral CAL regions,which may be associated with cognitive impairment and clinically positive symptoms.展开更多
We read the impressive review article“Clozapine resistant schizophrenia:Newer avenues of management”with great enthusiasm and appreciation.The author believes that preventing clozapine resistance from developing may...We read the impressive review article“Clozapine resistant schizophrenia:Newer avenues of management”with great enthusiasm and appreciation.The author believes that preventing clozapine resistance from developing may be the most effective treatment strategy for patients with clozapine-resistant schizophrenia(CRS),and optimizing clozapine treatment is a key component.Disentangling the differences between treatment-resistant schizophrenia and CRS is important for studies addressing treatment strategies for these difficult-to-treat populations.展开更多
BACKGROUND The use of network pharmacology and blood metabolomics to study the patho-genesis of violent aggression in patients with schizophrenia and the related drug mechanisms of action provides new directions for r...BACKGROUND The use of network pharmacology and blood metabolomics to study the patho-genesis of violent aggression in patients with schizophrenia and the related drug mechanisms of action provides new directions for reducing the risk of violent aggression and optimizing treatment plans.AIM To explore the metabolic regulatory mechanism of olanzapine in treating patients with schizophrenia with a moderate to high risk of violent aggression.METHODS Metabolomic technology was used to screen differentially abundant metabolites in patients with schizophrenia with a moderate to high risk of violent aggression before and after olanzapine treatment,and the related metabolic pathways were identified.Network pharmacology was used to establish protein-protein interaction networks of the core targets of olanzapine.Gene Ontology functional analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were subsequently performed.RESULTS Compared with the healthy group,the patients with schizophrenia group presented significant changes in the levels of 24 metabolites related to the disruption of 9 metabolic pathways,among which the key pathways were the alanine,aspartate and glutamate metabolism and arginine biosynthesis pathways.After treatment with olanzapine,the levels of 10 differentially abundant metabolites were significantly reversed in patients with schizophrenia.Olanzapine effectively regulated six metabolic pathways,among which the key pathways were alanine,aspartate and glutamate metabolism and arginine biosynthesis pathways.Ten core targets of olanzapine were involved in several key pathways.CONCLUSION The metabolic pathways of alanine,aspartate,and glutamate metabolism and arginine biosynthesis are the key pathways involved in olanzapine treatment for aggressive schizophrenia.展开更多
BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyro...BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.展开更多
Historically,psychiatric diagnoses have been made based on patient’s reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders.The utilization of neuroimaging or biomarkers to...Historically,psychiatric diagnoses have been made based on patient’s reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders.The utilization of neuroimaging or biomarkers to make the diagnosis and manage psychiatric disorders remains a distant goal.There have been several studies that examine brain imaging in psychiatric disorders,but more work is needed to elucidate the complexities of the human brain.In this editorial,we examine two articles by Xu et al and Stoyanov et al,that show developments in the direction of using neuroimaging to examine the brains of people with schizo-phrenia and depression.Xu et al used magnetic resonance imaging to examine the brain structure of patients with schizophrenia,in addition to examining neurotransmitter levels as biomarkers.Stoyanov et al used functional magnetic resonance imaging to look at modulation of different neural circuits by diagnostic-specific scales in patients with schizophrenia and depression.These two studies provide crucial evidence in advancing our understanding of the brain in prevalent psychiatric disorders.展开更多
In this editorial,we comment on the recent article by Fei et al exploring the field of near-infrared spectroscopy(NIRS)research in schizophrenia from a bibliometrics perspective.In recent years,NIRS has shown unique a...In this editorial,we comment on the recent article by Fei et al exploring the field of near-infrared spectroscopy(NIRS)research in schizophrenia from a bibliometrics perspective.In recent years,NIRS has shown unique advantages in the auxiliary diagnosis of schizophrenia,and the introduction of bibliometrics has provided a macro perspective for research in this field.Despite the opportunities brought about by these technological developments,remaining challenges require multidi-sciplinary approach to devise a reliable and accurate diagnosis system for schizo-phrenia.Nonetheless,NIRS-assisted technology is expected to contribute to the division of methods for early intervention and treatment of schizophrenia.展开更多
This manuscript explores the recent study by Cui et al which assessed the interplay between inflammatory cytokines and brain-derived neurotrophic factor(BDNF)levels in first-episode schizophrenia patients.The study re...This manuscript explores the recent study by Cui et al which assessed the interplay between inflammatory cytokines and brain-derived neurotrophic factor(BDNF)levels in first-episode schizophrenia patients.The study revealed that higher levels of interleukin-6 and tumor necrosis factor-αcorrelated with reduced BDNF levels and poorer cognitive performance.Schizophrenia is a severe psy-chiatric disorder impacting approximately 1%of the global population,charac-terized by positive symptoms(hallucinations and delusions),negative symptoms(diminished motivation and cognitive impairments)and disorganized thoughts and behaviors.Emerging research highlights the role of BDNF as a potential biomarker for early diagnosis and therapeutic targeting.The findings from Cui et al’s study suggest that targeting neuroinflammation and enhancing BDNF levels may improve cognitive outcomes.Effective treatment approaches involve a com-bination of pharmacological and non-pharmacological interventions tailored to individual patient needs.Hence,monitoring cognitive and neuroinflammatory markers is essential for improving patient outcomes and quality of life.Conse-quently,this manuscript highlights the need for an integrated approach to schizo-phrenia management,considering both clinical symptoms and underlying neuro-biological changes.展开更多
Schizophrenia is a severely impacting serious mental illness that presents numerous difficulties to those who suffer from it, their families, and society. While much effort has been invested in understanding successfu...Schizophrenia is a severely impacting serious mental illness that presents numerous difficulties to those who suffer from it, their families, and society. While much effort has been invested in understanding successful treatments, it is still a major issue in public health. This review assesses the advances and issues in the management of schizophrenia in the 21st century, paying special attention to drugs, psychosocial techniques, and connected specialty care. Medications for antipsychotics and psychosocial procedures have shown potential to relieve symptoms and improve functioning, while Recovery-Oriented Care and Psychological Trauma Recovery focus on early diagnosis, combined treatment, and sustained attention. However, many questions remain that need to be answered, including access to care, unmet needs, and discrepancies. Today’s neuroscience research, along with genetic studies and novel therapy options, such as long-acting injectable antipsychotics or telepsychiatry, offers the possibility of further progress being made. Future research exploring fields such as neuroscience, genetics, and implementation science could lead to increasingly effective strategies for people with schizophrenia.展开更多
BACKGROUND Blonanserin,a novel antipsychotic,has demonstrated efficacy in treating both positive and negative symptoms.However,limited research exists on its dose-dependent effectiveness and safety in patients with an...BACKGROUND Blonanserin,a novel antipsychotic,has demonstrated efficacy in treating both positive and negative symptoms.However,limited research exists on its dose-dependent effectiveness and safety in patients with and without prominent nega-tive symptoms(PNS).AIM To evaluate the effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia in real-world clinical settings and to explore the efficacy and safety of different doses of blonanserin for patients with PNS and without PNS.METHODS A 12-week,multicenter,prospective post-marketing surveillance was conducted.In this study,we included patients with first-episode schizophrenia who received blonanserin monotherapy.Patients were divided into those with PNS and without PNS,based on the Brief Psychiatric Rating Scale(BPRS)negative symptoms subscale scores.Additionally,patients were labeled as high-dose and low-dose was evaluated through the incidence of adverse drug reactions(ADRs).RESULTS A total of 653 patients were included in the analysis,with 613 completing the study.The BPRS total score decreased significantly from 47.94±16.31 at baseline to 26.88±9.47 at 12 weeks(P<0.001).A significant interaction of PNS×dose×time was observed for BPRS total scores(F=3.47,P=0.040)and negative symptom subscale scores(F=6.76,P=0.002).In the PNS group,the high-dose group showed greater reductions in BPRS total scores(P=0.001)and negative symptom subscale scores(P=0.003)than the low-dose group in week 12.In the without PNS group,no significant difference was observed between the high-dose and low-dose groups at any visit.Most adverse reactions were mild or moderate,with extrapyramidal symptoms(9.3%)being most common;1.5%of patients gained≥7%body weight at 12 weeks.CONCLUSION Blonanserin effectively alleviated the clinical symptoms of first-episode schizophrenia with an acceptable safety profile.High-dose blonanserin is particularly beneficial for patients with PNS in the acute phase of first-episode schizophrenia.However,due to the limitation of ADR reporting the real world,the ADR incidence observed in this study may be underestimated.展开更多
This article reviews the concept of telemedicine,as well as the current status of its application in patients with schizophrenia,problems,and suggestions for improvement,with the aim of providing a reference for the a...This article reviews the concept of telemedicine,as well as the current status of its application in patients with schizophrenia,problems,and suggestions for improvement,with the aim of providing a reference for the application of telemedicine in patients with schizophrenia.展开更多
This minireview explores the role of acetylcholine and muscarinic receptors in the pathophysiology of schizophrenia and summarizes the latest data on xanomeline/trospium chloride,a novel antipsychotic approved by the ...This minireview explores the role of acetylcholine and muscarinic receptors in the pathophysiology of schizophrenia and summarizes the latest data on xanomeline/trospium chloride,a novel antipsychotic approved by the United States Food and Drug Administration in September 2024.Evidence suggests that cholinergic dysfunction,particularly an imbalance in the expression of the M1 and M4 muscarinic receptors,may contribute to the pathophysiology and symptoms of schizophrenia.Xanomeline/trospium chloride combines xanomeline,an M1 and M4 receptor agonist,with trospium chloride,a non-selective peripheral muscarinic receptor antagonist that reduces peripheral cholinergic side effects.Clinical trials have demonstrated significant reductions in the positive and negative symptoms of schizophrenia,with improvements in Positive and Negati-ve Syndrome Scale scores observed as early as two weeks.A post-hoc analysis of one trial revealed cognitive improvements in patients with baseline cognitive impairment.This medication was generally well-tolerated,with mild-to-moderate gastrointestinal symptoms being the most common adverse events.While these results are promising,further research is needed to better understand its effectiveness and safety in real-world clinical practice,and to define its optimal role in managing this complex psychiatric disorder.展开更多
BACKGROUND Schizophrenia(SZ),a chronic and widespread brain disorder,presents with complex etiology and pathogenesis that remain inadequately understood.Despite the absence of a universally recognized endophenotype,pe...BACKGROUND Schizophrenia(SZ),a chronic and widespread brain disorder,presents with complex etiology and pathogenesis that remain inadequately understood.Despite the absence of a universally recognized endophenotype,peripheral blood mononuclear cells(PBMCs)serve as a robust model for investigating intracellular alterations linked to SZ.AIM To preliminarily investigate potential pathogenic mechanisms and identify novel biomarkers for SZ.METHODS PBMCs from SZ patients were subjected to integrative transcriptomic and proteomic analyses to uncover differentially expressed genes(DEGs)and differentially expressed proteins while mapping putative disease-associated signaling pathways.Key findings were validated using western blot(WB)and real-time fluorescence quantitative PCR(RT-qPCR).RNAi-lentivirus was employed to transfect rat hippocampal CA1 neurons in vitro,with subsequent verification of target gene expression via RT-qPCR.The levels of neuronal conduction proteins,including calmodulin-dependent protein kinase II(caMKII),CREB,and BDNF,were assessed through WB.Apoptosis was quantified by flow cytometry,while cell proliferation and viability were evaluated using the Cell Counting Kit-8 assay.RESULTS The integration of transcriptomic and proteomic analyses identified 6079 co-expressed genes,among which 25 DEGs were significantly altered between the SZ group and healthy controls.Notably,haptoglobin(HP),lactotransferrin(LTF),and SERPING1 exhibited marked upregulation.KEGG pathway enrichment analysis implicated neuroactive ligand-receptor interaction pathways in disease pathogenesis.Clinical sample validation demonstrated elevated protein and mRNA levels of HP,LTF,and SERPING1 in the SZ group compared to controls.WB analysis of all clinical samples further corroborated the significant upregulation of SERPING1.In hippocampal CA1 neurons transfected with lentivirus,reduced SERPING1 expression was accompanied by increased levels of CaMKII,CREB,and BDNF,enhanced cell viability,and reduced apoptosis.CONCLUSION SERPING1 may suppress neural cell proliferation in SZ patients via modulation of the CaMKII-CREB-BDNF signaling pathway.展开更多
Schizophrenia is a complex neuropsychiatric disorder characterized by cognitive,emotional,and behavioral impairments.The microbiota-gut-brain axis is crucial in its pathophysiology,mediating communication between the ...Schizophrenia is a complex neuropsychiatric disorder characterized by cognitive,emotional,and behavioral impairments.The microbiota-gut-brain axis is crucial in its pathophysiology,mediating communication between the gut and brain through neural,immune,endocrine,and metabolic pathways.Dysbiosis,or an imbalance in gut microbiota,is linked to neuroinflammation,systemic inflam-mation,and neurotransmitter disruptions,all of which contribute to the symp-toms of schizophrenia.Gut microbiota-derived metabolites,such as short-chain fatty acids,influence brain function,including immune responses and neurotrans-mitter synthesis.These findings suggest that microbial imbalances exacerbate schizophrenia,providing a novel perspective on the disorder’s underlying mechanisms.Emerging microbiota-targeted therapies—such as probiotics,prebiotics,dietary interventions,and fecal microbiota trans-plantation—show promise as adjunctive treatments,aiming to restore microbial balance and improve clinical outcomes.While further research is needed,targeting the micro-biota-gut-brain axis offers an innovative approach to schizophrenia management,with the potential to enhance patient outcomes and quality of life.展开更多
BACKGROUND Schizophrenia,a complex group of mental disorders,is primarily managed with antipsychotic medications.The safety and efficacy of different initial doses of lurasidone for acute schizophrenia remain uncertai...BACKGROUND Schizophrenia,a complex group of mental disorders,is primarily managed with antipsychotic medications.The safety and efficacy of different initial doses of lurasidone for acute schizophrenia remain uncertain,particularly concerning discontinuation rates due to adverse events(AEs).AIM To compare the safety of two initial doses of lurasidone for the treatment of acute schizophrenia in Chinese patients.METHODS This 6-week,randomized,open-label,multicenter trial allocated participants to receive either 40 mg/day or 80 mg/day lurasidone initially,with dose adjustment allowed after a one-week fixed-dose period.Safety assessments included the primary endpoint of discontinuation due to AEs,as well as evaluations of AEs,weight changes,and laboratory parameters.Efficacy assessments included responder rates and changes in scores on the Positive and Negative Syndrome Scale(PANSS),Clinical Global Impression-Severity scale,and Calgary Depression Scale for Schizophrenia.RESULTS Among 197 participants,no significant difference was found in discontinuation rate due to AEs between groups(3.03% vs 5.10%,P=0.707).Treatment-emergent AEs were reported in 64.6%and 71.4%of participants in the 40 mg/day and 80 mg/day initiation groups,respectively.Response rates at weeks 1 and 2 showed no statistically significant differences.Both groups demonstrated significant improvements in PANSS total,Clinical Global Impression-Severity,and Calgary Depression Scale for Schizophrenia scores from baseline(all P<0.01).Notably,the 80 mg/day initiation group showed greater improvement in the PANSS positive subscale score at visits 1 and 2 compared to the 40 mg/day initiation group(P<0.05).CONCLUSION Initial doses of 40 mg/day and 80 mg/day lurasidone are safe and effective for acute schizophrenia,with no significant increase in AEs-related discontinuation rate at the higher dose.展开更多
This article summarizes recent advances in the understanding of RNA-binding proteins(RBPs),with a focus on their roles in exercise-induced mRNA regulation and their implications for schizophrenia(SZ).RBPs are critical...This article summarizes recent advances in the understanding of RNA-binding proteins(RBPs),with a focus on their roles in exercise-induced mRNA regulation and their implications for schizophrenia(SZ).RBPs are critical regulators of mRNA stability,splicing,transport,translation,and degradation,directly influencing gene expression through sequence-and structure-specific binding.In the nervous system,RBPs sustain synaptic plasticity,neural development,and neuronal homeostasis.Emerging evidence shows that exercise modulates the expression and activity of RBPs,thereby influencing mRNA translation and neurotransmitter signaling,which may underlie its beneficial effects on brain function.Dysregulation of specific RBPs has been identified in SZ,implicating them in disrupted synaptic transmission,impaired plasticity,and neuroinflammation.RBPs involved in memory and emotional regulation show marked dysfunction in SZ patients.Some RBPs have been proposed as potential biomarkers for early diagnosis and treatment monitoring.Moreover,therapeutic modulation of RBPs,through pharmacological or behavioral interventions such as exercise,may restore neuronal function by targeting post-transcriptional gene regulation.Exercise,as a non-invasive modulator of RBP expression,holds promise as an adjunctive strategy in SZ treatment,particularly in early stages.Further research into RBP-mediated pathways may offer novel insights into SZ pathophysiology and inform the development of targeted interventions.展开更多
Even if dissociation has various facets,it is clear that knowledge of dissociative psychosis and a dissociative schizophrenia-based viewpoint may provide new perspectives on mental disorders.Many researchers screening...Even if dissociation has various facets,it is clear that knowledge of dissociative psychosis and a dissociative schizophrenia-based viewpoint may provide new perspectives on mental disorders.Many researchers screening for comorbid symptoms of“childhood traumatic experiences”and“dissociation”,where specific characteristics are significant to the presence of psychosis and schizophrenia,may lead to an acceptable definition.In recent years,researchers have also reported crucial advances in the understanding of dissociative psychosis and dissociative schizophrenia.Although clinical studies in this area have been ongoing for a long time,research has not demonstrated that a clear and valid relationship exists between dissociation,childhood traumatic experiences,and schizophrenia or psychotic spectrum disorders.However,some results of statistical comparisons have supported the existence of the clinical manifestation known as dissociative psychosis and dissociative schizophrenia.Dissociation,childhood traumatic experiences,and positive psychotic symptoms may be a prominent part of dissociative psychosis and schizophrenia.The intense presence of negative symptoms may indicate classical schizophrenia.In research and clinical practice,researchers and clinicians may use psychometric tests to detect symptoms of dissociative psychosis.Psychotic persons with traumatic experiences likely benefit from treatment focused on trauma symptomatolgy.展开更多
BACKGROUND Pyoderma gangrenosum(PG)is one of the most severe extra-intestinal manifest-ations of ulcerative colitis(UC).The treatment of refractory UC combined with PG is challenging,particularly for patients with sch...BACKGROUND Pyoderma gangrenosum(PG)is one of the most severe extra-intestinal manifest-ations of ulcerative colitis(UC).The treatment of refractory UC combined with PG is challenging,particularly for patients with schizophrenia(SCZ)with a long-term history of risperidone use,and there have been no successfully treated patients reported in the literature.CASE SUMMARY A 36-year-old woman attended the gastroenterological clinic due to intermittent symptoms of diarrhea and mucous bloody stools.Prior to the emergence of these symptoms,the patient had a history of SCZ for 3 years.She had been receiving long-term risperidone treatment and had stable mental symptoms.In April 2023,she was diagnosed with UC E3 moderate and began taking mesalazine 3 g/day.In March 2024,her intestinal symptoms recurred and approximately 2 months later,PG developed in both lower limbs.Previous treatments with adalimumab and steroids were ineffective for PG and UC,and simultaneously,the patient experienced headache,confusion,and severe sleep disturbances.After switching to upadacitinib(UPA)45 mg/day,PG lesions showed complete healing and fecal calprotectin was<10μg/g after 7 weeks of treatment.Following approximately 12 weeks of UPA therapy,colonoscopy indicated that the patient had achieved mucosal healing.No adverse events occurred during UPA induction and main-tenance therapy for 6 months with risperidone.CONCLUSION UPA treatment led to successful resolution of both intestinal and extra-intestinal manifestations in this patient with new-onset UC who had a history of SCZ.No adverse effects were observed with concurrent UPA and risperidone use.展开更多
基金supported by the Ministry of Health National Medical Research Council (to JL)the National University of Singapore (to JJEC)
文摘Schizophrenia is a complex psychiatric disorder marked by positive and negative symptoms,leading to mood disturbances,cognitive impairments,and social withdrawal.While anti-psychotic medications remain the cornerstone of treatment,they often fail to fully address certain symptoms.Additionally,treatment-resistant schizophrenia,affecting 30%-40%of patients,remains a substantial clinical challenge.Positive,negative symptoms and cognitive impairments have been linked to disruptions in the glutamatergic,serotonin,GABAergic,and muscarinic pathways in the brain.Recent advances using genome-wide association study and other approaches have uncovered a significant number of new schizophrenia risk genes that uncovered new,and reinforced prior,concepts on the genetic and neurological underpinnings of schizophrenia,including abnormalities in synaptic function,immune processes,and lipid metabolism.Concurrently,new therapeutics targeting different modalities,which are expected to address some of the limitations of anti-psychotic drugs currently being offered to patients,are currently being evaluated.Collectively,these efforts provide new momentum for the next phase of schizophrenia research and treatment.
文摘Selecting the initial antipsychotic dose is a high-impact decision in acute schizophrenia.A randomized study found that starting lurasidone at 80 mg/day for 1 week(then flexible titration)produced earlier reductions in Positive and Negative Syndrome Scale positive symptoms than 40 mg/day,without higher discontinuations for adverse events or a metabolic penalty over 6 weeks.These data support an individualized approach:Start at 80 mg/day when rapid control of positive symptoms or agitation is needed and tolerance permits;start at 40 mg/day when akathisia risk or patient preference argues for caution,with a planned day-7 review for up-titration.The open-label design,dose convergence after week 1,and the lack of stratified randomization limit attribution of longer-term advantages to starting dose.Even so,the trial reframes initial dose as a modifiable lever for the early course rather than a one-size-fits-all rule and warrants confirmation in larger,double-blind randomized trials.
文摘BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.
基金Supported by Wuxi Municipal Health Commission Major Project,No.202107and Wuxi Taihu Talent Project,No.WXTTP 2021.
文摘BACKGROUND Very late-onset schizophrenia-like psychosis(VLOSLP)is a subtype of schizophrenia spectrum disorders in which individuals experience psychotic symptoms for the first time after the age of 60.The incidence of VLOSLP shows a linear relationship with increasing age.However,no studies have reported alterations in spontaneous brain activity among VLOSLP patients and their correlation with cognitive function and clinical symptoms.AIM To explore VLOSLP brain activity and correlations with cognitive function and clinical symptoms using resting-state functional magnetic resonance imaging.METHODS This study included 33 VLOSLP patients and 34 healthy controls.The cognitive assessment utilized the Mini Mental State Examination,Montreal Cognitive Assessment,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Clinical characteristic acquisition was performed via the Positive and Negative Syndrome Scale(PANSS).All participants were scanned via resting-state functional magnetic resonance imaging,and the data were processed using amplitude of low-frequency fluctuations(ALFF),fractional ALFF(fALFF),regional homogeneity,and voxelmirrored homotopic connectivity(VMHC).RESULTS The VLOSLP group presented decreased ALFF values in the left cuneus,right precuneus,right precentral gyrus,and left paracentral lobule;increased fALFF values in the left caudate nucleus;decreased fALFF values in the right calcarine fissure and surrounding cortex(CAL)and right precuneus;increased regional homogeneity values in the right putamen;and decreased VMHC values in the bilateral CAL,bilateral superior temporal gyrus,and bilateral cuneus.In the VLOSLP group,ALFF values in the right precuneus were negatively correlated with Mini Mental State Examination score and PANSS positive subscale score,and VMHC values in the bilateral CAL were negatively correlated with the RBANS total score,RBANS delayed memory score,and PANSS positive subscale score.CONCLUSION The changes of brain activity in VLOSLP are concentrated in the right precuneus and bilateral CAL regions,which may be associated with cognitive impairment and clinically positive symptoms.
文摘We read the impressive review article“Clozapine resistant schizophrenia:Newer avenues of management”with great enthusiasm and appreciation.The author believes that preventing clozapine resistance from developing may be the most effective treatment strategy for patients with clozapine-resistant schizophrenia(CRS),and optimizing clozapine treatment is a key component.Disentangling the differences between treatment-resistant schizophrenia and CRS is important for studies addressing treatment strategies for these difficult-to-treat populations.
基金Supported by Henan Provincial Science and Technology Research Project,No.242102310203.
文摘BACKGROUND The use of network pharmacology and blood metabolomics to study the patho-genesis of violent aggression in patients with schizophrenia and the related drug mechanisms of action provides new directions for reducing the risk of violent aggression and optimizing treatment plans.AIM To explore the metabolic regulatory mechanism of olanzapine in treating patients with schizophrenia with a moderate to high risk of violent aggression.METHODS Metabolomic technology was used to screen differentially abundant metabolites in patients with schizophrenia with a moderate to high risk of violent aggression before and after olanzapine treatment,and the related metabolic pathways were identified.Network pharmacology was used to establish protein-protein interaction networks of the core targets of olanzapine.Gene Ontology functional analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were subsequently performed.RESULTS Compared with the healthy group,the patients with schizophrenia group presented significant changes in the levels of 24 metabolites related to the disruption of 9 metabolic pathways,among which the key pathways were the alanine,aspartate and glutamate metabolism and arginine biosynthesis pathways.After treatment with olanzapine,the levels of 10 differentially abundant metabolites were significantly reversed in patients with schizophrenia.Olanzapine effectively regulated six metabolic pathways,among which the key pathways were alanine,aspartate and glutamate metabolism and arginine biosynthesis pathways.Ten core targets of olanzapine were involved in several key pathways.CONCLUSION The metabolic pathways of alanine,aspartate,and glutamate metabolism and arginine biosynthesis are the key pathways involved in olanzapine treatment for aggressive schizophrenia.
文摘BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.
文摘Historically,psychiatric diagnoses have been made based on patient’s reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders.The utilization of neuroimaging or biomarkers to make the diagnosis and manage psychiatric disorders remains a distant goal.There have been several studies that examine brain imaging in psychiatric disorders,but more work is needed to elucidate the complexities of the human brain.In this editorial,we examine two articles by Xu et al and Stoyanov et al,that show developments in the direction of using neuroimaging to examine the brains of people with schizo-phrenia and depression.Xu et al used magnetic resonance imaging to examine the brain structure of patients with schizophrenia,in addition to examining neurotransmitter levels as biomarkers.Stoyanov et al used functional magnetic resonance imaging to look at modulation of different neural circuits by diagnostic-specific scales in patients with schizophrenia and depression.These two studies provide crucial evidence in advancing our understanding of the brain in prevalent psychiatric disorders.
文摘In this editorial,we comment on the recent article by Fei et al exploring the field of near-infrared spectroscopy(NIRS)research in schizophrenia from a bibliometrics perspective.In recent years,NIRS has shown unique advantages in the auxiliary diagnosis of schizophrenia,and the introduction of bibliometrics has provided a macro perspective for research in this field.Despite the opportunities brought about by these technological developments,remaining challenges require multidi-sciplinary approach to devise a reliable and accurate diagnosis system for schizo-phrenia.Nonetheless,NIRS-assisted technology is expected to contribute to the division of methods for early intervention and treatment of schizophrenia.
基金Supported by Basic Science Research Program Through the National Research Foundation of Korea(NRF)Funded By the Ministry of Education,No.NRF-RS-2023-00237287.
文摘This manuscript explores the recent study by Cui et al which assessed the interplay between inflammatory cytokines and brain-derived neurotrophic factor(BDNF)levels in first-episode schizophrenia patients.The study revealed that higher levels of interleukin-6 and tumor necrosis factor-αcorrelated with reduced BDNF levels and poorer cognitive performance.Schizophrenia is a severe psy-chiatric disorder impacting approximately 1%of the global population,charac-terized by positive symptoms(hallucinations and delusions),negative symptoms(diminished motivation and cognitive impairments)and disorganized thoughts and behaviors.Emerging research highlights the role of BDNF as a potential biomarker for early diagnosis and therapeutic targeting.The findings from Cui et al’s study suggest that targeting neuroinflammation and enhancing BDNF levels may improve cognitive outcomes.Effective treatment approaches involve a com-bination of pharmacological and non-pharmacological interventions tailored to individual patient needs.Hence,monitoring cognitive and neuroinflammatory markers is essential for improving patient outcomes and quality of life.Conse-quently,this manuscript highlights the need for an integrated approach to schizo-phrenia management,considering both clinical symptoms and underlying neuro-biological changes.
文摘Schizophrenia is a severely impacting serious mental illness that presents numerous difficulties to those who suffer from it, their families, and society. While much effort has been invested in understanding successful treatments, it is still a major issue in public health. This review assesses the advances and issues in the management of schizophrenia in the 21st century, paying special attention to drugs, psychosocial techniques, and connected specialty care. Medications for antipsychotics and psychosocial procedures have shown potential to relieve symptoms and improve functioning, while Recovery-Oriented Care and Psychological Trauma Recovery focus on early diagnosis, combined treatment, and sustained attention. However, many questions remain that need to be answered, including access to care, unmet needs, and discrepancies. Today’s neuroscience research, along with genetic studies and novel therapy options, such as long-acting injectable antipsychotics or telepsychiatry, offers the possibility of further progress being made. Future research exploring fields such as neuroscience, genetics, and implementation science could lead to increasingly effective strategies for people with schizophrenia.
文摘BACKGROUND Blonanserin,a novel antipsychotic,has demonstrated efficacy in treating both positive and negative symptoms.However,limited research exists on its dose-dependent effectiveness and safety in patients with and without prominent nega-tive symptoms(PNS).AIM To evaluate the effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia in real-world clinical settings and to explore the efficacy and safety of different doses of blonanserin for patients with PNS and without PNS.METHODS A 12-week,multicenter,prospective post-marketing surveillance was conducted.In this study,we included patients with first-episode schizophrenia who received blonanserin monotherapy.Patients were divided into those with PNS and without PNS,based on the Brief Psychiatric Rating Scale(BPRS)negative symptoms subscale scores.Additionally,patients were labeled as high-dose and low-dose was evaluated through the incidence of adverse drug reactions(ADRs).RESULTS A total of 653 patients were included in the analysis,with 613 completing the study.The BPRS total score decreased significantly from 47.94±16.31 at baseline to 26.88±9.47 at 12 weeks(P<0.001).A significant interaction of PNS×dose×time was observed for BPRS total scores(F=3.47,P=0.040)and negative symptom subscale scores(F=6.76,P=0.002).In the PNS group,the high-dose group showed greater reductions in BPRS total scores(P=0.001)and negative symptom subscale scores(P=0.003)than the low-dose group in week 12.In the without PNS group,no significant difference was observed between the high-dose and low-dose groups at any visit.Most adverse reactions were mild or moderate,with extrapyramidal symptoms(9.3%)being most common;1.5%of patients gained≥7%body weight at 12 weeks.CONCLUSION Blonanserin effectively alleviated the clinical symptoms of first-episode schizophrenia with an acceptable safety profile.High-dose blonanserin is particularly beneficial for patients with PNS in the acute phase of first-episode schizophrenia.However,due to the limitation of ADR reporting the real world,the ADR incidence observed in this study may be underestimated.
文摘This article reviews the concept of telemedicine,as well as the current status of its application in patients with schizophrenia,problems,and suggestions for improvement,with the aim of providing a reference for the application of telemedicine in patients with schizophrenia.
文摘This minireview explores the role of acetylcholine and muscarinic receptors in the pathophysiology of schizophrenia and summarizes the latest data on xanomeline/trospium chloride,a novel antipsychotic approved by the United States Food and Drug Administration in September 2024.Evidence suggests that cholinergic dysfunction,particularly an imbalance in the expression of the M1 and M4 muscarinic receptors,may contribute to the pathophysiology and symptoms of schizophrenia.Xanomeline/trospium chloride combines xanomeline,an M1 and M4 receptor agonist,with trospium chloride,a non-selective peripheral muscarinic receptor antagonist that reduces peripheral cholinergic side effects.Clinical trials have demonstrated significant reductions in the positive and negative symptoms of schizophrenia,with improvements in Positive and Negati-ve Syndrome Scale scores observed as early as two weeks.A post-hoc analysis of one trial revealed cognitive improvements in patients with baseline cognitive impairment.This medication was generally well-tolerated,with mild-to-moderate gastrointestinal symptoms being the most common adverse events.While these results are promising,further research is needed to better understand its effectiveness and safety in real-world clinical practice,and to define its optimal role in managing this complex psychiatric disorder.
基金Supported by the Key R&D Projects of Hainan Province,No.ZDYF2022SHFZ295.
文摘BACKGROUND Schizophrenia(SZ),a chronic and widespread brain disorder,presents with complex etiology and pathogenesis that remain inadequately understood.Despite the absence of a universally recognized endophenotype,peripheral blood mononuclear cells(PBMCs)serve as a robust model for investigating intracellular alterations linked to SZ.AIM To preliminarily investigate potential pathogenic mechanisms and identify novel biomarkers for SZ.METHODS PBMCs from SZ patients were subjected to integrative transcriptomic and proteomic analyses to uncover differentially expressed genes(DEGs)and differentially expressed proteins while mapping putative disease-associated signaling pathways.Key findings were validated using western blot(WB)and real-time fluorescence quantitative PCR(RT-qPCR).RNAi-lentivirus was employed to transfect rat hippocampal CA1 neurons in vitro,with subsequent verification of target gene expression via RT-qPCR.The levels of neuronal conduction proteins,including calmodulin-dependent protein kinase II(caMKII),CREB,and BDNF,were assessed through WB.Apoptosis was quantified by flow cytometry,while cell proliferation and viability were evaluated using the Cell Counting Kit-8 assay.RESULTS The integration of transcriptomic and proteomic analyses identified 6079 co-expressed genes,among which 25 DEGs were significantly altered between the SZ group and healthy controls.Notably,haptoglobin(HP),lactotransferrin(LTF),and SERPING1 exhibited marked upregulation.KEGG pathway enrichment analysis implicated neuroactive ligand-receptor interaction pathways in disease pathogenesis.Clinical sample validation demonstrated elevated protein and mRNA levels of HP,LTF,and SERPING1 in the SZ group compared to controls.WB analysis of all clinical samples further corroborated the significant upregulation of SERPING1.In hippocampal CA1 neurons transfected with lentivirus,reduced SERPING1 expression was accompanied by increased levels of CaMKII,CREB,and BDNF,enhanced cell viability,and reduced apoptosis.CONCLUSION SERPING1 may suppress neural cell proliferation in SZ patients via modulation of the CaMKII-CREB-BDNF signaling pathway.
文摘Schizophrenia is a complex neuropsychiatric disorder characterized by cognitive,emotional,and behavioral impairments.The microbiota-gut-brain axis is crucial in its pathophysiology,mediating communication between the gut and brain through neural,immune,endocrine,and metabolic pathways.Dysbiosis,or an imbalance in gut microbiota,is linked to neuroinflammation,systemic inflam-mation,and neurotransmitter disruptions,all of which contribute to the symp-toms of schizophrenia.Gut microbiota-derived metabolites,such as short-chain fatty acids,influence brain function,including immune responses and neurotrans-mitter synthesis.These findings suggest that microbial imbalances exacerbate schizophrenia,providing a novel perspective on the disorder’s underlying mechanisms.Emerging microbiota-targeted therapies—such as probiotics,prebiotics,dietary interventions,and fecal microbiota trans-plantation—show promise as adjunctive treatments,aiming to restore microbial balance and improve clinical outcomes.While further research is needed,targeting the micro-biota-gut-brain axis offers an innovative approach to schizophrenia management,with the potential to enhance patient outcomes and quality of life.
文摘BACKGROUND Schizophrenia,a complex group of mental disorders,is primarily managed with antipsychotic medications.The safety and efficacy of different initial doses of lurasidone for acute schizophrenia remain uncertain,particularly concerning discontinuation rates due to adverse events(AEs).AIM To compare the safety of two initial doses of lurasidone for the treatment of acute schizophrenia in Chinese patients.METHODS This 6-week,randomized,open-label,multicenter trial allocated participants to receive either 40 mg/day or 80 mg/day lurasidone initially,with dose adjustment allowed after a one-week fixed-dose period.Safety assessments included the primary endpoint of discontinuation due to AEs,as well as evaluations of AEs,weight changes,and laboratory parameters.Efficacy assessments included responder rates and changes in scores on the Positive and Negative Syndrome Scale(PANSS),Clinical Global Impression-Severity scale,and Calgary Depression Scale for Schizophrenia.RESULTS Among 197 participants,no significant difference was found in discontinuation rate due to AEs between groups(3.03% vs 5.10%,P=0.707).Treatment-emergent AEs were reported in 64.6%and 71.4%of participants in the 40 mg/day and 80 mg/day initiation groups,respectively.Response rates at weeks 1 and 2 showed no statistically significant differences.Both groups demonstrated significant improvements in PANSS total,Clinical Global Impression-Severity,and Calgary Depression Scale for Schizophrenia scores from baseline(all P<0.01).Notably,the 80 mg/day initiation group showed greater improvement in the PANSS positive subscale score at visits 1 and 2 compared to the 40 mg/day initiation group(P<0.05).CONCLUSION Initial doses of 40 mg/day and 80 mg/day lurasidone are safe and effective for acute schizophrenia,with no significant increase in AEs-related discontinuation rate at the higher dose.
文摘This article summarizes recent advances in the understanding of RNA-binding proteins(RBPs),with a focus on their roles in exercise-induced mRNA regulation and their implications for schizophrenia(SZ).RBPs are critical regulators of mRNA stability,splicing,transport,translation,and degradation,directly influencing gene expression through sequence-and structure-specific binding.In the nervous system,RBPs sustain synaptic plasticity,neural development,and neuronal homeostasis.Emerging evidence shows that exercise modulates the expression and activity of RBPs,thereby influencing mRNA translation and neurotransmitter signaling,which may underlie its beneficial effects on brain function.Dysregulation of specific RBPs has been identified in SZ,implicating them in disrupted synaptic transmission,impaired plasticity,and neuroinflammation.RBPs involved in memory and emotional regulation show marked dysfunction in SZ patients.Some RBPs have been proposed as potential biomarkers for early diagnosis and treatment monitoring.Moreover,therapeutic modulation of RBPs,through pharmacological or behavioral interventions such as exercise,may restore neuronal function by targeting post-transcriptional gene regulation.Exercise,as a non-invasive modulator of RBP expression,holds promise as an adjunctive strategy in SZ treatment,particularly in early stages.Further research into RBP-mediated pathways may offer novel insights into SZ pathophysiology and inform the development of targeted interventions.
文摘Even if dissociation has various facets,it is clear that knowledge of dissociative psychosis and a dissociative schizophrenia-based viewpoint may provide new perspectives on mental disorders.Many researchers screening for comorbid symptoms of“childhood traumatic experiences”and“dissociation”,where specific characteristics are significant to the presence of psychosis and schizophrenia,may lead to an acceptable definition.In recent years,researchers have also reported crucial advances in the understanding of dissociative psychosis and dissociative schizophrenia.Although clinical studies in this area have been ongoing for a long time,research has not demonstrated that a clear and valid relationship exists between dissociation,childhood traumatic experiences,and schizophrenia or psychotic spectrum disorders.However,some results of statistical comparisons have supported the existence of the clinical manifestation known as dissociative psychosis and dissociative schizophrenia.Dissociation,childhood traumatic experiences,and positive psychotic symptoms may be a prominent part of dissociative psychosis and schizophrenia.The intense presence of negative symptoms may indicate classical schizophrenia.In research and clinical practice,researchers and clinicians may use psychometric tests to detect symptoms of dissociative psychosis.Psychotic persons with traumatic experiences likely benefit from treatment focused on trauma symptomatolgy.
文摘BACKGROUND Pyoderma gangrenosum(PG)is one of the most severe extra-intestinal manifest-ations of ulcerative colitis(UC).The treatment of refractory UC combined with PG is challenging,particularly for patients with schizophrenia(SCZ)with a long-term history of risperidone use,and there have been no successfully treated patients reported in the literature.CASE SUMMARY A 36-year-old woman attended the gastroenterological clinic due to intermittent symptoms of diarrhea and mucous bloody stools.Prior to the emergence of these symptoms,the patient had a history of SCZ for 3 years.She had been receiving long-term risperidone treatment and had stable mental symptoms.In April 2023,she was diagnosed with UC E3 moderate and began taking mesalazine 3 g/day.In March 2024,her intestinal symptoms recurred and approximately 2 months later,PG developed in both lower limbs.Previous treatments with adalimumab and steroids were ineffective for PG and UC,and simultaneously,the patient experienced headache,confusion,and severe sleep disturbances.After switching to upadacitinib(UPA)45 mg/day,PG lesions showed complete healing and fecal calprotectin was<10μg/g after 7 weeks of treatment.Following approximately 12 weeks of UPA therapy,colonoscopy indicated that the patient had achieved mucosal healing.No adverse events occurred during UPA induction and main-tenance therapy for 6 months with risperidone.CONCLUSION UPA treatment led to successful resolution of both intestinal and extra-intestinal manifestations in this patient with new-onset UC who had a history of SCZ.No adverse effects were observed with concurrent UPA and risperidone use.
