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Schizophrenia Research and Care—Advancements and Challenges

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (15 December 2022) | Viewed by 30117

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Special Issue Editor

Prof. Dr. Armida Mucci

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Guest Editor

Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
Interests: electrophysiological, brain imaging and neuropsychological correlates of negative symptom domains in schizophrenia; cognitive remediation in schizophrenia; clinical, biological and social aspects influencing schizophrenia real-life functioning

Special Issue Information

Dear Colleagues,

The diagnosis and care of people with schizophrenia has improved in the last several decades, but schizophrenia remains a leading cause of disability and premature mortality.

In more than 50% of affected individuals, currently available antipsychotics are poorly tolerated or ineffective in ameliorating positive psychotic symptoms (delusions and hallucinations).

The treatment of cognitive impairment and negative symptoms, which represent the main determinants of disability, remains an unmet need of schizophrenia care.

Finally, antipsychotics might worsen the highly prevalent physical health problems of people with schizophrenia, such as cardiovascular disease and metabolic syndrome, contributing to their disability and reduced life expectancy.

The progress In understanding the neurobiology of schizophrenia has fostered the development of novel dopaminergic and non-dopaminergic antipsychotics which hold promise for the improvement of treatment-resistant positive symptoms, negative symptoms and cognitive impairment. Furthermore, some new antipsychotics present a substantial reduction of liability to represent cardiovascular and metabolic risk factors.

Cognitive remediation has been shown to be an effective intervention to improve cognitive dysfunction in schizophrenia, and might ameliorate negative symptoms. Other psychosocial interventions have shown beneficial effects on negative symptoms, but it is not clear whether these effects are specific or reflect improvement in other dimensions.

Innovative non-pharmacological interventions are under scrutiny for treatment-resistant psychotic symptoms, such as those using virtual reality for hallucinations.

The integration of pharmacological and psychosocial interventions heavily depends on accurate and comprehensive assessment of psychopathology, cognitive profile, and physical health status, with the potential to improve the quality of life of people with schizophrenia.

This Special Issue of the Journal of Clinical Medicine on Schizophrenia Research and Care—Advancements and Challenges aims to collect reviews, original research articles, opinion papers, to provide updates, new findings and future perspectives of schizophrenia research and care.

Topics will include

1) Cognitive impairment associated with schizophrenia: the role of social and non-social deficits;

2) New perspectives of cognitive remediation in schizophrenia;

3) Biomarkers of cognitive dysfunction and negative symptoms;

4) Challenges and advancements in the assessment of negative symptoms;

5) Physical health in people with schizophrenia and antipsychotic treatment;

6) Virtual reality in the assessment and care of people with schizophrenia;

7) New dopaminergic and non-dopaminergic antipsychotics: from improved tolerability to improved efficacy.

Prof. Dr. Armida Mucci
Guest Editor

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Keywords

cognitive impairment
negative symptoms
treatment-resistant schizophrenia
non-dopaminergic antipsychotics
premature mortality
cognitive remediation
virtual reality

Published Papers (13 papers)

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Research

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12 pages, 271 KiB

Open AccessArticle

Correlation of Health-Related Quality of Life with Negative Symptoms Assessed with the Self-Evaluation of Negative Symptoms Scale (SNS) and Cognitive Deficits in Schizophrenia: A Cross-Sectional Study in Routine Psychiatric Care

by Jonas Montvidas, Virginija Adomaitienė, Darius Leskauskas and Sonia Dollfus

J. Clin. Med. 2023, 12(3), 901; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12030901 - 23 Jan 2023

Cited by 1 | Viewed by 1801

Abstract

(1) Background: Schizophrenia is a severe mental disorder characterized by various symptom groups that tremendously affect health-related quality of life (HRQoL). We aimed to specify whether negative symptoms and cognitive deficits of schizophrenia correlate and can predict HRQoL. (2) Methods: Patients diagnosed with paranoid schizophrenia were invited to participate in the study. Participants were evaluated using the Montreal Cognitive Assessment (MoCA) and the Brief Psychiatric Rating Scale (BPRS) and were asked to fill out the Self-evaluation of Negative Symptoms scale (SNS) and the Medical Outcomes Short Form Survey (SF-36). Pearson’s and Spearman’s correlations were used to calculate the correlations between cognitive deficits and negative symptoms. We performed the receiver operating characteristic (ROC) analysis for the variables correlated with SF-36 scores. (3) Results: HRQoL correlated significantly with the negative symptoms; however, it did not correlate with cognitive deficits. ROC analysis showed that the abulia subscore of the SNS showed the most significant predictive potential of HRQoL. (4) Conclusions: Negative symptoms correlate more significantly with the HRQoL than cognitive symptoms. The SNS offers the possibility of predicting the HRQoL of patients with schizophrenia and is useful as a screening tool in clinical practice. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

10 pages, 554 KiB

Open AccessArticle

Switching Antipsychotic Medications in People with Schizophrenia: A 4-Year Naturalistic Study

by Giammarco Cascino, Rossella Ceres, Alessio Maria Monteleone, Paola Bucci, Giulia Maria Giordano, Silvana Galderisi and Palmiero Monteleone

J. Clin. Med. 2022, 11(19), 5965; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195965 - 10 Oct 2022

Viewed by 1358

Abstract

Although generally effective in ameliorating the core manifestations of schizophrenia, antipsychotics (APs) may lead to only suboptimal responses or may be associated with a variety of treatment-related adverse events which require additional treatment strategies. Under such clinical circumstances, switching APs represents a rational treatment option. The present study aimed to identify the variables that predict AP switch and to quantify the frequency of this phenomenon in people with schizophrenia in real-life. A secondary analysis was conducted on the data collected at baseline and at a 4-year follow-up from a large sample of community-dwelling Italian people with schizophrenia. Demographic and clinical variables as well as information about AP treatment were recorded at two time points. Over the 4-year period, 34.9% of the 571 participants switched the AP; in particular, 8.4% of participants switched from first-generation APs (FGAs) to second-generation APs or vice versa, while 8.2% of them switched to clozapine. Logistic regression models showed that combination of APs at baseline was negatively associated with AP switch, while treatment with FGAs and the presence of extrapyramidal symptoms at baseline were associated with AP class switch. Although the aim of the present study was not to assess predictors of clinical relapse in people with schizophrenia, we might speculate that switching APs represents a surrogate indicator of treatment failure in some patients and could lead into relapse, which is a costly aspect of schizophrenia management in both economic and human terms. The sooner such a negative outcome can be predicted and managed, the sooner the treatment can be optimized to avoid it. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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17 pages, 329 KiB

Open AccessArticle

Relationship of Neuropeptide S (NPS) with Neurocognitive, Clinical, and Electrophysiological Parameters of Patients during Structured Rehabilitation Therapy for Schizophrenia

by Agnieszka Markiewicz-Gospodarek, Renata Markiewicz, Beata Dobrowolska, Mansur Rahnama and Bartosz Łoza

J. Clin. Med. 2022, 11(18), 5266; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11185266 - 06 Sep 2022

Cited by 3 | Viewed by 1280

Abstract

Introduction: Neuropeptide S is a biomarker related to various neuropsychiatric and neurocognitive functions. Since the need to improve cognitive functions in schizophrenia is unquestionable, it was valuable to investigate the possible relationships of plasma levels of NPS with neurocognitive, psychopathological and EEG parameters in patients with schizophrenia. Aim: Relationships between the serum NPS level and neurocognitive, clinical, and electrophysiological parameters were investigated in patients diagnosed with schizophrenia who underwent structured rehabilitation therapy. Methods: Thirty-three men diagnosed with schizophrenia were randomized into two groups. The REH group (N16) consisted of patients who underwent structured rehabilitation therapy, the CON group (N17) continued its previous treatment. Additionally, the reference NPS serum results were checked in a group of healthy people (N15). In the study several tests assessing various neurocognitive functions were used: d2 Sustained-Attention Test (d2), Color Trails Test (CTT), Beck Cognitive Insight Scale (BCIS), Acceptance of Illness Scale (AIS), and General Self-Efficacy Scale (GSES). The clinical parameters were measured with Positive and Negative Syndrome Scale (PANSS) and electrophysiological parameters were analyzed with auditory evoked potentials (AEPs) and quantitative electroencephalography (QEEG). The NPS, neurocognitive, clinical, and electrophysiological results of REH and CON groups were recorded at the beginning (T1) and after a period of 3 months (T2). Results: A decreased level of NPS was associated with the improvement in specific complex indices of d2 and BCIS neurocognitive tests, as well as the improvement in the clinical state (PANSS). No correlation was observed between the level of NPS and the results of AEPs and QEEG measurements. Conclusions: A decreased level of NPS is possibly related to the improvement in metacognition and social cognition domains, as well as to clinical improvement during the rehabilitation therapy of patients with schizophrenia. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

13 pages, 514 KiB

Open AccessArticle

Impaired Effort Allocation in Patients with Recent-Onset Schizophrenia and Its Relevance to Negative Symptoms Assessments and Persistent Negative Symptoms

by Ezgi Ince Guliyev, Sinan Guloksuz and Alp Ucok

J. Clin. Med. 2022, 11(17), 5060; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11175060 - 28 Aug 2022

Cited by 3 | Viewed by 1101

Abstract

(1) Background: Our aims in this study were (i) to compare effort allocation capacity measured between patients with recent-onset schizophrenia (SCZ) and healthy controls (HCs), (ii) within the SCZ, to investigate the association of effort allocation capacity with negative symptoms (NS), and (iii) to compare this association with the type of NS scale used. (2) Methods: Thirty-one patients with SCZ and 30 HCs participated in the study. The NS was examined using an older-generation (Scale for the Assessment of Negative Symptoms, SANS), a newer-generation (Brief Negative Symptoms Scale, BNSS), and a self-rated (Self-evaluation of Negative Symptoms Scale, SNS) negative symptom scale, as well as longitudinally by using persistent NS (PNS) distinction. (3) Results: The SCZ group was less willing to expend effort in high/moderate-probability and -magnitude conditions but more in low-probability and -magnitude conditions. A general reduction in effort allocation capacity was also present. Patients with PNS were less likely to choose hard tasks than non-PNS patients. Clinician-rated scales correlated with 50% probability and moderate-reward-magnitude conditions. Correlations with the SNS were minimal. (4) Conclusions: Our findings suggest that patients with SCZ may show a general reduction in effort allocation capacity and make inefficient choices, although they are not totally reward-insensitive. The effects of NS on effort expenditure can be more pronounced when the rewarding stimulus is vague. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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8 pages, 267 KiB

Open AccessArticle

Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition

by Verónica Romero-Ferreiro, Lorena García-Fernández, Ana Isabel Aparicio, Isabel Martínez-Gras, Mónica Dompablo, Luis Sánchez-Pastor, David Rentero, Miguel Ángel Alvarez-Mon, Juan Manuel Espejo-Saavedra, Guillermo Lahera, Paloma Marí-Beffa, José Luis Santos and Roberto Rodriguez-Jimenez

J. Clin. Med. 2022, 11(7), 2044; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11072044 - 06 Apr 2022

Cited by 1 | Viewed by 1925

Abstract

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the “Understanding Emotions” and “Managing Emotions” MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the “Managing Emotions” branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the “Managing Emotions” branch of the MSCEIT as part of the MCCB. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

9 pages, 294 KiB

Open AccessArticle

Impact of Negative Symptoms on Functioning and Quality of Life in First Psychotic Episodes of Schizophrenia

by Lorena García-Fernández, Verónica Romero-Ferreiro, Luis Sánchez-Pastor, Mónica Dompablo, Isabel Martínez-Gras, Juan Manuel Espejo-Saavedra, David Rentero, Ana Isabel Aparicio, Miguel Angel Alvarez-Mon, Guillermo Lahera, Jimmy Lee, Jose Luis Santos and Roberto Rodriguez-Jimenez

J. Clin. Med. 2022, 11(4), 983; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11040983 - 14 Feb 2022

Cited by 7 | Viewed by 2291

Abstract

Negative symptoms are not considered a unitary construct encompassing two different domains, diminished expression, and avolition-apathy. The aim of this study was to explore the relationships between each domain and psychosocial functioning and quality of life in people with a first psychotic episode of schizophrenia. In total, 61 outpatients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS), The Functioning Assesment Short Test (FAST) and The Quality of Life Scale (QLS). The mean global score for CAINS was 21.5 (SD: 15.6), with a CAINS Avolition-Apathy (MAP) score of 17.0 (SD: 11.8), and CAINS Diminished Expression (EXP) score of 4.5 (SD: 5.0). The mean FAST score was 31.9 (SD: 18.9), and 41.1 (SD: 17.9) for QLS. Linear regression analysis revealed a significant (F(4,53) = 15.65, p < 0.001) relationship between MAP and EXP CAINS’ score and FAST score. CAINS-MAP was more predictive of FAST scores (β = 0.44, p = 0.001) than CAINS-EXP (β = 0.37, p = 0.007). Linear regression analysis for QLS revealed a significant model (F(4,56) = 29.29, p < 0.001). The standardized regression weight for the CAINS-MAP was around three times greater (β = −0.63, p < 0.001) than for CAINS-EXP (β = −0.24, p = 0.024). The two different domains are associated differently with functionality and quality of life. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

18 pages, 2084 KiB

Open AccessArticle

Effect of Antipsychotic Treatment on Neutrophil-to-Lymphocyte Ratio during Hospitalization for Acute Psychosis in the Course of Schizophrenia—A Cross-Sectional Retrospective Study

by Bartosz Dawidowski, Grzegorz Grelecki, Adam Biłgorajski, Piotr Podwalski, Błażej Misiak and Jerzy Samochowiec

J. Clin. Med. 2022, 11(1), 232; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010232 - 31 Dec 2021

Cited by 9 | Viewed by 1909

Abstract

Background: Studies have shown that there are deviations in the results of peripheral blood counts, which lead to increased values of the neutrophils-to-lymphocytes ratio (NLR) in schizophrenia. Antipsychotic drugs have proven to lower the levels of pro-inflammatory cytokines and a growing number of studies indicate a similar effect on NLR values. Methods: We identified inpatients with schizophrenia and collected data of NLR at the beginning (NLR₁) and end (NLR₂) of hospitalization, the status of antipsychotic medication on admission and potential confounding factors. In the statistical analysis, we applied a linear mixed model. Results: After the inclusion and exclusion process the records of 40 patients (n_p = 40) and 71 hospitalizations (n_h = 71) were analyzed. We found that in the group of antipsychotics-naive patients, the NLR₁ were significantly higher than the NLR₂ values. Such a difference did not occur in the case of non-antipsychotics-naïve patients. Age and the diagnosis of hypothyroidism influenced the value of change in NLR from the beginning to the end of hospitalization in a given patient (ΔNLR). Conclusions: The study confirmed the lowering effect of antipsychotics on NLR values in psychosis. The NLR may potentially be a tool for assessing response to treatment with antipsychotics. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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16 pages, 817 KiB

Open AccessArticle

Investigating the Relationship between White Matter Connectivity and Motivational Circuits in Subjects with Deficit Schizophrenia: A Diffusion Tensor Imaging (DTI) Study

by Giulia M. Giordano, Pasquale Pezzella, Mario Quarantelli, Paola Bucci, Anna Prinster, Andrea Soricelli, Andrea Perrottelli, Luigi Giuliani, Michele Fabrazzo and Silvana Galderisi

J. Clin. Med. 2022, 11(1), 61; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010061 - 23 Dec 2021

Cited by 9 | Viewed by 2635

Abstract

Deficit schizophrenia is a subtype of schizophrenia presenting primary and enduring negative symptoms (NS). Although one of the most updated hypotheses indicates a relationship between NS and impaired motivation, only a few studies have investigated abnormalities of motivational circuits in subjects with deficit schizophrenia (DS). Our aim was to investigate structural connectivity within motivational circuits in DS. We analyzed diffusion tensor imaging (DTI) data from 46 subjects with schizophrenia (SCZ) and 35 healthy controls (HCs). SCZ were classified as DS (n = 9) and non-deficit (NDS) (n = 37) using the Schedule for Deficit Syndrome. The connectivity index (CI) and the Fractional Anisotropy (FA) of the connections between selected brain areas involved in motivational circuits were examined. DS, as compared with NDS and HCs, showed increased CI between the right amygdala and dorsal anterior insular cortex and increased FA of the pathway connecting the left nucleus accumbens with the posterior insular cortex. Our results support previous evidence of distinct neurobiological alterations underlying different clinical subtypes of schizophrenia. DS, as compared with NDS and HCs, may present an altered pruning process (consistent with the hyperconnectivity) in cerebral regions involved in updating the stimulus value to guide goal-directed behavior. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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17 pages, 1026 KiB

Open AccessArticle

Mismatch Negativity and P3a Impairment through Different Phases of Schizophrenia and Their Association with Real-Life Functioning

by Giulia M. Giordano, Luigi Giuliani, Andrea Perrottelli, Paola Bucci, Giorgio Di Lorenzo, Alberto Siracusano, Francesco Brando, Pasquale Pezzella, Michele Fabrazzo, Mario Altamura, Antonello Bellomo, Giammarco Cascino, Anna Comparelli, Palmiero Monteleone, Maurizio Pompili, Silvana Galderisi, Mario Maj and The Italian Network for Research on Psychoses

J. Clin. Med. 2021, 10(24), 5838; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245838 - 13 Dec 2021

Cited by 6 | Viewed by 2619

Abstract

Impairment in functioning since the onset of psychosis and further deterioration over time is a key aspect of subjects with schizophrenia (SCZ). Mismatch negativity (MMN) and P3a, indices of early attention processing that are often impaired in schizophrenia, might represent optimal electrophysiological candidate biomarkers of illness progression and poor outcome. However, contrasting findings are reported about the relationships between MMN-P3a and functioning. The study aimed to investigate in SCZ the influence of illness duration on MMN-P3a and the relationship of MMN-P3a with functioning. Pitch (p) and duration (d) MMN-P3a were investigated in 117 SCZ and 61 healthy controls (HCs). SCZ were divided into four illness duration groups: ≤ 5, 6 to 13, 14 to 18, and 19 to 32 years. p-MMN and d-MMN amplitude was reduced in SCZ compared to HCs, independently from illness duration, psychopathology, and neurocognitive deficits. p-MMN reduction was associated with lower “Work skills”. The p-P3a amplitude was reduced in the SCZ group with longest illness duration compared to HCs. No relationship between P3a and functioning was found. Our results suggested that MMN amplitude reduction might represent a biomarker of poor functioning in SCZ. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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Review

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13 pages, 446 KiB

Open AccessReview

Do Sex/Gender and Menopause Influence the Psychopathology and Comorbidity Observed in Delusional Disorders?

by Alexandre González-Rodríguez, Mary V. Seeman, Alexandre Díaz-Pons, Rosa Ayesa-Arriola, Mentxu Natividad, Eva Calvo and José A. Monreal

J. Clin. Med. 2022, 11(15), 4550; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154550 - 04 Aug 2022

Cited by 5 | Viewed by 2317

Abstract

Background: While sex differences and gonadal hormone levels are taken seriously in the understanding and treatment of schizophrenia, their influence in the psychopathology of delusional disorders (DD) remains unknown. Methods: Our strategy was to conduct a narrative review of the effects of (a) sex/gender difference and (b) menopause on delusional content, affective and anxiety-related comorbidity, substance use disorders, cognition, aggressivity, and suicide risk in DD. Results: Because the literature is scarce, our results are tentative. We found that erotomania was more prevalent in women than in men, and especially in women with premenopausal onset. In contrast, jealous and somatic delusions were more commonly seen in DD women with postmenopausal onset. With respect to depressive comorbidity, women with premenopausal onset appear more vulnerable to depression than those with later onset. Age at menopause is reported to correlate positively with intensity of suicidal ideation. Anxiety symptoms may be related to estrogen levels. Men present with higher rates of substance use disorders, particularly alcohol use. Conclusions: Many male/female differences in DD may be attributable to sociocultural factors but menopause, and, therefore, levels of female hormones, influence symptom expression in women and mediate the expression of psychiatric comorbidities. Further research in this area promises to lead to improved individualized treatment. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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28 pages, 378 KiB

Open AccessEditor’s ChoiceReview

Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders

by Michele Fabrazzo, Salvatore Cipolla, Alessio Camerlengo, Francesco Perris and Francesco Catapano

J. Clin. Med. 2022, 11(15), 4530; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154530 - 03 Aug 2022

Cited by 14 | Viewed by 3565

Abstract

Despite methodological limitations, real-world studies might support clinicians by broadening the knowledge of antipsychotics’ (APs) effectiveness and tolerability in different clinical scenarios and complement clinical trials. We conducted an extensive literature search in the PubMed database to evaluate the effectiveness and tolerability profiles of second-generation antipsychotics (SGAs) from real-world studies to aid clinicians and researchers in selecting the proper treatment for patients with schizophrenia and related disorders. The present review evidenced that SGAs demonstrated superior effectiveness over first-generation antipsychotics (FGAs) in relapse-free survival and psychiatric hospitalization rate and for treating negative symptoms. Persistence and adherence to therapy were higher in SGAs than FGAs. Most studies concluded that switching to long-acting injectables (LAIs) was significantly associated with a lower treatment failure rate than monotherapy with oral SGAs. Considerable improvements in general functionality, subjective well-being, and total score on global satisfaction tests, besides improved personal and social performance, were reported in some studies on patients treated with LAI SGAs. Clozapine was also associated with the lowest rates of treatment failure and greater effectiveness over the other SGAs, although with more severe side effects. Effectiveness on primary negative symptoms and cognitive deficits was rarely measured in these studies. Based on the data analyzed in the present review, new treatments are needed with better tolerability and improved effectiveness for negative, affective, and cognitive symptoms. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

Other

Jump to: Research, Review

22 pages, 439 KiB

Open AccessViewpoint

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects

by Laura Orsolini, Simone Pompili and Umberto Volpe

J. Clin. Med. 2022, 11(17), 5040; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11175040 - 27 Aug 2022

Cited by 5 | Viewed by 4192

Abstract

Although schizophrenia is currently conceptualized as being characterized as a syndrome that includes a collection of signs and symptoms, there is strong evidence of heterogeneous and complex underpinned etiological, etiopathogenetic, and psychopathological mechanisms, which are still under investigation. Therefore, the present viewpoint review is aimed at providing some insights into the recently investigated schizophrenia research fields in order to discuss the potential future research directions in schizophrenia research. The traditional schizophrenia construct and diagnosis were progressively revised and revisited, based on the recently emerging neurobiological, genetic, and epidemiological research. Moreover, innovative diagnostic and therapeutic approaches are pointed to build a new construct, allowing the development of better clinical and treatment outcomes and characterization for schizophrenic individuals, considering a more patient-centered, personalized, and tailored-based dimensional approach. Further translational studies are needed in order to integrate neurobiological, genetic, and environmental studies into clinical practice and to help clinicians and researchers to understand how to redesign a new schizophrenia construct. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

9 pages, 238 KiB

Open AccessOpinion

We Should Improve Personalization of Management in Patients with a Diagnosis of Schizophrenia

by Alfonso Tortorella

J. Clin. Med. 2022, 11(1), 184; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010184 - 30 Dec 2021

Cited by 7 | Viewed by 1430

Abstract

The current management of patients with schizophrenia is marked by a lack of personalization. After the diagnosis is made, a second-generation antipsychotic is usually prescribed based on the current clinician’s preferences, sometimes accompanied by a psychosocial intervention which is typically not evidence-based and not targeted to the specific needs of the individual patient. In this opinion paper, some steps are outlined that could be taken in order to address this lack of personalization. A special emphasis is laid on the clinical characterization of the patient who has received a diagnosis of schizophrenia. Considerations are put forward concerning the assessment of the negative dimension in ordinary clinical practice, which is often neglected; the evaluation of cognitive functioning using a simple test battery which requires limited professional training and takes no more than 15 min to administer; the evaluation of social functioning using a validated instrument focusing on personal care skills, interpersonal relationships, social acceptability, activities, and work skills; and the assessment of the unmet needs of the person (including practical, social, and emotional needs, and existential or personal recovery). The implications of the assessment of these domains for the formulation of the management plan are discussed. Full article

(This article belongs to the Special Issue Schizophrenia Research and Care—Advancements and Challenges)

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