Background The diagnostic term schizophrenia is among the most stigmatizing labels in psychology and medicine. Public anti-stigma campaigns and efforts to replace the term with less pejorative terms have yielded mixed results. Importantly, patients' own preferences regarding diagnostic labels have been insufficiently explored. Methods In a cross-sectional online survey, 182 adults with a diagnosis of schizophrenia or schizoaffective disorder anonymously completed questionnaires assessing sociodemographic variables, psychopathology (CAPE), self-stigma, and were also asked if they would prefer a different term to “schizophrenia.” Associations between label preference and clinical as well as psychosocial variables were examined using group comparisons and logistic regression. Findings A relative majority of participants preferred retaining the label “schizophrenia” (48.9%), followed by “psychosis” (23.6%; various terms containing psychosis: 37.9%). Overall, nearly three quarters endorsed either “schizophrenia” or a variant using “psychosis”. Preference for retaining “schizophrenia” was associated with lower perceived stigma from others, less prior inpatient treatment on closed wards, lower self-esteem, and higher positive symptoms. Limitations The study relied on self-report data, was cross-sectional, and included only German-speaking participants, limiting generalizability. Interpretations Most patients favored the established diagnostic terms “schizophrenia” and “psychosis” over novel alternatives. This raises the question of whether current efforts to destigmatize the disorder might instead focus on balanced scientific and media communication that highlights the possibility of positive outcomes. Interventions should address both public stigma and self-stigma, potentially drawing on lessons from the U.S. civil rights movement, which reclaimed the term “Black” and stripped it of its earlier negative connotations.
AIM:Assess reasons individuals with chronic schizophrenia in rural communities of low- and middle-income countries (LMICs) often remain untreated. METHOD:Reported reasons for the non-treatment of 201 community-dwelling individuals with untreated chronic schizophrenia (mean duration of illness, 23.3 years) in rural China were obtained from patients and caregivers. After providing information about the illness and how to apply for free treatment, a follow-up telephone survey 25 months later assessed reasons for persistent non-treatment. RESULTS:Common reasons for non-treatment over the long course of the illness provided at baseline were family financial difficulties (40.8%), caregivers' failure to identify the mental illness (19.9%), and patients' refusal to take medication (14.9%). Among the 185 patients followed up, only 45 (24.3%) completed at least 1 month of treatment. Reasons for non-treatment included patients' refusal to take medication (18.4%); caregivers' forgetting to administer medication (15.1%) or inability to monitor medication (9.2%); caregivers' belief that the patient did not need treatment because they were elderly (14.1%), that the condition was incurable (7.0%), or that the symptoms were not severe (5.4%); medication side-effects or lack of immediate symptomatic improvement (11.4%); and financial difficulties (8.6%) or difficulty getting free medication (3.2%). CONCLUSIONS:Reasons for persistent non-treatment indicate that after 20-plus years of illness, some individuals with chronic, untreated schizophrenia in LMICs and their family caregivers may accommodate to the situation and have little hope or interest in changing the status quo. The expansion of mental health services to previously underserved communities and the provision of free treatment and follow-up services to these individuals must be accompanied by promotion efforts that improve public knowledge about mental illness and change patients' and caregivers' negative attitudes about treatment.
Background and hypothesis Clozapine is the only antipsychotic with protective effects against suicide in schizophrenia (SCZ). Newer dopamine partial agonist (DPA) antipsychotics have better tolerability and modulate serotonin, dopamine, and N-methyl-d-aspartate neurotransmission pathways implicated in suicide. We aim to investigate the effects of DPAs on suicide in SCZ. Methods We searched seven databases up to February 2026 for SCZ studies that reported suicide data. The primary outcome was suicide deaths and attempts; suicidal ideation was added as a secondary outcome. Random effects meta-analyses quantified suicide risk in randomized controlled trials (RCT) while single proportion meta-analyses assessed longitudinal suicide risk in open label extension trials (OLE). For RCTs, sensitivity analyses were conducted and subgroup analyses explored the impact of dose, drug type, and comparator arm. Study results Twenty articles were included; thirteen excluded higher suicide risk participants. Compared to placebo control, DPAs did not significantly change the risk of primary [RR = 0.65, p = 0.38] or secondary [RR = 0.63, p = 0.15] suicide outcomes. Subgroup and sensitivity analyses were not statistically significant. For OLEs, there was a significant increase in the incidence of primary [Ip = 0.004, p = 0.048] and secondary [Ip = 0.024, p = 0.0013] suicide outcomes, but there was marked study heterogeneity. Conclusion There is no current trial evidence to show that DPAs significantly impact suicide outcomes in SCZ. The signal from OLEs should be interpreted cautiously due to heterogeneity and requires replication. An effective clozapine alternative is needed for suicide prevention in SCZ.
BACKGROUND:The glymphatic system has been extensively implicated in neurodegenerative diseases as a key pathway responsible for cerebral metabolic waste clearance. However, its role in schizophrenia remains poorly understood. This study aimed to evaluate glymphatic system function in patients with schizophrenia through a systematic review and meta-analysis. METHODS:A systematic literature search was conducted to identify studies investigating glymphatic dysfunction in schizophrenia. Diffusion tensor image analysis along the perivascular space (DTI-ALPS) was used as a surrogate marker of glymphatic system function. PubMed, Web of Science, Scopus, and Embase were systematically searched for eligible studies published up to April 10, 2026. A total of eight high-quality studies were included in the final analysis. A random-effects model was applied to calculate pooled standardized mean differences (SMD) and corresponding effect sizes. RESULTS:Meta-analysis showed that the DTI-ALPS index in schizophrenia patients was significantly lower compared to healthy controls (SMD = -2.42, 95% CI: -4.06 to -0.79) suggesting potential glymphatic dysfunction. Sensitivity analysis confirmed the robustness of the findings, and no publication bias was detected. Subgroup analyses indicated that disease stage significantly influenced DTI-ALPS indices. CONCLUSION:The present findings indicate significant alterations in the DTI-ALPS index in schizophrenia, with disease stage closely associated with these alterations. These results suggest that alterations in the cerebral glymphatic system, as indexed by DTI-ALPS, may represent a potential neurobiological correlate underlying the pathological disturbances observed in schizophrenia.
Extrapyramidal symptoms (EPS) have been described as intrinsic to schizophrenia spectrum disorders (SSD), beyond medication-induced effects. Among EPS, parkinsonism is the most prevalent subtype and has been linked to poorer clinical and functional outcomes. We aimed to examine the relationships between parkinsonism and psychopathology and social functioning, as well as its demographic and pharmacological correlates, in a real-world sample of outpatients with schizophrenia receiving stable antipsychotic medication. Data were drawn from the PRISM project, an EU-funded, multicentre, cross-sectional, naturalistic study. Parkinsonism was assessed with the Extrapyramidal Symptoms Rating Scale (ESRS). Patients aged 18-45 years with a confirmed DSM-IV diagnosis of schizophrenia were included if clinically stable on unchanged antipsychotic dosage for ≥ 8 weeks and excluded if scoring > 22 on the PANSS-Positive subscale or ≥ 4 on the ESRS. Associations were analysed using correlation and regression models adjusted for relevant covariates, including antipsychotic exposure. Ninety patients were included (mean age 31.53 ± 6.64 years; 36.7% female; 27.8% "other than White"). Parkinsonism prevalence was 51% (ESRS≥1), higher among "other than White" participants (80% vs. 40%, χ2p < 0.001). Parkinsonism was not significantly associated with antipsychotic dose, route, or generation, nor with concomitant psychotropic use (all p > 0.05). Parkinsonism severity correlated with PANSS-Positive (rₛ = 0.228, p = 0.031), PANSS-Negative (rₛ = 0.278, p = 0.008), PANSS-General (rₛ = 0.210, p = 0.047), and PANSS-Total (rₛ = 0.283, p = 0.007). In adjusted regression models, associations remained significant for PANSS-Negative (β = 0.276, p = 0.019) and PANSS-Total (β = 0.234, p = 0.043). No significant associations were observed with social functioning. These findings suggest that parkinsonism is closely associated with clinical symptom severity and may reflect core illness-related features of schizophrenia.
BACKGROUND:Antipsychotics with a long-term favorable tolerability profile are needed to improve outcomes in patients with schizophrenia. A 1-year, open-label, Phase 3 study investigated long-term safety and efficacy of lumateperone 42 mg (a simultaneous modulator of serotonin, dopamine, and glutamate) in patients with stable schizophrenia. METHODS:Adult outpatients (≥18 years) with DSM-5-defined schizophrenia with stable pathology received lumateperone 42 mg orally once daily for 368 days. The primary endpoint was safety, assessed by adverse events (AEs) and changes in extrapyramidal symptoms (EPS), cardiometabolic and prolactin parameters, and vital signs. Secondary endpoints included change in Positive and Negative Syndrome Scale (PANSS) Total score and Calgary Depression Scale for Schizophrenia (CDSS). RESULTS:Of 602 patients treated with lumateperone 42 mg, 229 (38.0%) completed 1-year treatment. Treatment-emergent AEs (TEAEs) occurred in 390 patients (64.8%); the most common TEAEs (≥5%) were weight decreased (10.1%), diarrhea (7.6%), dry mouth (7.6%), and headache (7.3%). There were no notable changes in EPS-related scales. Significant improvements occurred for total and low-density lipoprotein cholesterol (P < .001), prolactin (P < .05), and triglycerides (P < .05) at Day 368. Weight, body mass index, and waist circumference significantly decreased throughout the study to Day 368 (P < .001). Lumateperone significantly improved PANSS Total score (mean change = -4.2; 95% CI = -5.6 to -2.8; effect size [ES] = -0.39; P < .001) and CDSS Total score (mean change = -0.6; 95% CI = -0.99 to -0.23; ES = -0.21; P < .01) at Day 368. CONCLUSION:Lumateperone 42 mg demonstrated a favorable safety profile with improvements in cardiometabolic and prolactin parameters and a low EPS risk and maintenance of stable symptoms of schizophrenia over 1-year treatment.
BACKGROUND:Findings regarding the efficacy of n-3 polyunsaturated fatty acid (PUFA) supplementation as an adjunct treatment for schizophrenia (SZ) have been inconsistent. This study investigated whether n-3 PUFA supplementation was associated with changes in niacin skin flush response (NSFR) and clinical symptoms in patients with SZ, and explored the value of baseline NSFR for patient stratification. METHODS:A total of 99 patients with SZ and 30 healthy controls (HCs) were enrolled. Patients with SZ were randomized in a 1:2 ratio to standard pharmacotherapy alone or standard pharmacotherapy plus n-3 PUFA supplementation for 21 days. NSFR and Positive and Negative Syndrome Scale (PANSS) assessments were performed at baseline and post-intervention. RESULTS:Patients with SZ showed significantly lower baseline NSFR than HCs (P = 7.097 × 10-6). Following intervention, total PANSS scores decreased in both groups, while significant NSFR improvement was observed only in the n-3 PUFA supplementation group. Adjusted linear mixed-effects models revealed a significant "group × time" interaction for NSFR (standardized β = 0.57, 95% CI: 0.08 to 1.06, P = 0.025). Exploratory stratified analysis showed that patients with blunted baseline NSFR who received n-3 PUFA supplementation exhibited the most favorable short-term response, reflected by the largest and statistically significant NSFR increase, with a directionally favorable change in PANSS total score. CONCLUSIONS:Baseline NSFR blunting may help identify a subgroup of SZ patients with greater short-term responsiveness to adjunctive n-3 PUFA supplementation. These findings support further investigation of NSFR as a candidate stratification marker for targeted adjunctive intervention in schizophrenia.
Background and hypothesis Schizophrenia profoundly affects the quality of life of individuals living with the disorder. Despite the availability of numerous measurement tools, there is no consensus which one should be used as standard. As a first step, systematic reviews about the measurement properties of the various scales are needed, but such reviews are not available. Study design We provide a systematic review of the Clinician-Rated Outcome Measure (ClinROM) Quality of Life Scale (QLS). We evaluated its measurement properties using the COnsensus-based Standards for the selection of health Measurement INstrument (COSMIN) guidelines. Study results Of 4331 papers identified by a search in PubMed and EMBASE, 15 met the inclusion criteria. The QLS demonstrated good inter-rater reliability, known-groups validity and convergent validity of certain subscales. However, major limitations were identified in its development and content validity, and both evidence for structural validity and convergent validity of total scores. Internal consistency could not be conclusively evaluated due to insufficient structural validity. Conclusion Given its substantial limitations, the QLS has been classified in COSMIN's recommendation category C. Following COSMIN's criteria, its use cannot be generally recommended.
OBJECTIVES:Visual impairment and broader visual-related abnormalities have been implicated in psychosis, but the consistency, specificity, and direction of this association remain unclear. We systematically reviewed evidence linking clinically defined visual impairment, visual-processing abnormalities, oculomotor/visuomotor abnormalities, higher-order visual dysfunction, and psychosis-related outcomes. METHODS:PubMed/MEDLINE, EMBASE, and PsycINFO were searched according to PRISMA guidelines. Studies were synthesized narratively by design and visual-related domain. An exploratory random-effects meta-analysis was conducted when sufficiently comparable cross-sectional estimates were available for clinically defined or functional visual impairment. RESULTS:Fifty-six unique studies were included and synthesized across longitudinal or genetically informed, case-control, cross-sectional, and case-report evidence. Longitudinal findings were heterogeneous, with positive, inverse, null, attenuated, and reverse-direction associations. Case-control studies reported abnormalities across retinal/ocular, central visual-system, electrophysiological, oculomotor, subjective, and higher-order visual-cognitive domains, whereas visual-acuity findings were mixed. Cross-sectional studies provided the most consistent evidence for an association between clinically defined or functional visual impairment and psychosis-related outcomes. In the primary meta-analysis of 12 cross-sectional estimates, visual impairment was associated with higher odds of psychosis-related outcomes (OR = 1.98, 95% CI 1.35-2.90). Sensitivity analyses remained positive under broader eligibility criteria and after exclusion of the largest effect estimate. Direction-stratified and hallucination-related analyses also supported a positive association, although smaller subgroups were less precise. CONCLUSIONS:Visual dysfunction is associated with psychosis-related outcomes, but interpretation depends on visual domain and study design. Current evidence supports a cautious, bidirectional, domain-based framework rather than a single causal pathway from visual impairment to psychosis.
INTRODUCTION:Although prior studies have observed speech alterations in schizophrenia, minimal research has focused on this in schizotypal personality disorder (SPD), despite impairments observed in social communication and function. SPD is a disorder within the schizophrenia spectrum, but individuals are typically antipsychotic naïve and lack a history of psychiatric hospitalizations. The current study examined acoustic features extracted from an open-ended interview in individuals with schizophrenia spectrum disorders and healthy controls. METHODS:Twenty-seven individuals with SPD, 36 individuals with schizophrenia or schizoaffective disorder, and 44 healthy controls (HCs) participated in the open-ended interview. Assessments included a structured diagnostic interview, clinical-symptom severity ratings, and social cognition tasks. Acoustic features of interest were extracted from audio recordings of the interviews using automated methods. RESULTS:Individuals with schizophrenia demonstrated alterations in articulatory control, spectral stability, and temporal coordination compared to individuals with SPD and HCs. The SPD group exhibited similar acoustic features to HCs. Within the clinical groups combined, lower acoustic features were associated with greater negative symptom severity and poorer social cognition. CONCLUSION:Results suggest that computerized analysis of acoustic alterations in the schizophrenia spectrum may aid in identifying subtle differences in speech that are related to symptom severity and social cognition. This study provides initial evidence to suggest that individuals with SPD are spared the acoustic speech alterations seen in schizophrenia, but future research is needed to examine these features in larger samples and in a variety of speech tasks.
Patients with schizophrenia exhibit a significantly elevated prevalence of overweight and obesity, which contribute to serious cardiometabolic disease and premature death. Although physical exercise is considered a promising add-on treatment, its specific impact on BMI and the most effective components of the intervention remain unclear. We conducted a systematic review and meta-analysis of randomised controlled trials to determine whether physical exercise reduces BMI in this population, and to examine how exercise prescription, delivery mode, and exercise dose (intensity and duration) influence outcomes. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to December 2025. Data were pooled using a random-effects model, and subgroup analyses were conducted for exercise prescription (aerobic, anaerobic, concurrent), mode (individual, group), intensity (low-to-moderate, moderate-to-vigorous), and duration (<20 weeks, ≥20 weeks). Nine trials with 356 participants were included. Physical Exercise interventions yielded a statistically significant, small-to-moderate reduction in BMI. Subgroup analyses showed a significant effect for aerobic exercise; however, no clear effect was observed for anaerobic or concurrent training. Meanwhile, higher-dose regimens of moderate-to-vigorous intensity and interventions lasting ≥20 weeks appeared to significantly influence BMI. Importantly, individual-based interventions demonstrated meaningful effects, whereas group-based interventions tended to have less pronounced results. Therefore, structured physical exercise, particularly moderate-to-vigorous aerobic training for ≥20 weeks, appears to be an effective intervention for reducing BMI in patients with schizophrenia. The findings indicate an interesting pattern: individually delivered protocols yielded statistical efficacy, whereas group formats showed descriptively lower dropout rates, suggesting potentially better feasibility for implementation.
OBJECTIVES:This study aimed to distinguish infections and infestations-related adverse events (IIAEs) linked to second-generation antipsychotics (SGAs) within distinct efficacy signals. METHODS:Ten-year data on the main SGAs were extracted from the FDA adverse event reporting system (FAERS) database for the period spanning from 2016 to 2025. SGAs were categorized by dosage as low, medium, or high. The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were used to quantify the signals. The Weibull distribution was used to evaluate the risk over time. RESULTS:The majority of these patients were female and aged 18 years or older. The primary outcomes for patients who experienced IIAEs included initial or prolonged hospitalization. Olanzapine (OLA) and quetiapine (QUE) had the shortest median onset times (30 days), whereas clozapine (CLO) exhibited the longest median onset time (2493 days). Further analysis using Weibull CDF modeling demonstrated an increasing hazard rate over time for the low- and medium-dose groups of ARI, the medium-dose group of OLA, and the high-dose group of RIS. Following disproportionality analysis, several positive signals (p‑IIAEs) were identified. Aspiration pneumonia was identified as the predominant p‑IIAE among CLO, OLA, QUE, RIS, and ARI, particularly for CLO. Additionally, the strong signal for sexually transmitted diseases associated with ARI also warrants attention. CONCLUSIONS:Through real‑world pharmacovigilance analysis, aspiration pneumonia associated with SGAs was identified as the most prominent p‑IIAE. The present findings are anticipated to offer valuable information to support the safe and rational use of SGAs in patients.
Aim Cognitive Behavioural Therapy for psychosis (CBTp) is a recommended psychosocial treatment for psychosis, yet a substantial proportion of individuals do not engage with therapy or fail to achieve meaningful treatment gains. Method A systematic review was conducted to summarise the existing literature regarding the predictors of treatment response to, and engagement with, CBTp across the psychosis continuum (i.e., Clinical High Risk for psychosis [CHR], First Episode Psychosis [FEP], and schizophrenia [SZ]). Results Twenty-three studies were included (N = 3241, FEP = 3; SZ = 20; CHR = 0). The review identified substantial heterogeneity in study design, outcome measures and findings. Some studies reported associations between lower delusional conviction and higher levels of insight with more favourable outcomes, while longer illness duration was associated with poorer outcomes in some studies, although none of these associations were consistently replicated. Symptom severity showed heterogeneous associations with CBTp response. Engagement findings were limited, with lower negative symptom severity associated with better uptake or engagement in some studies. Some evidence suggested that poorer engagement may be associated with behavioural and occupational difficulties. Evidence for associations with socio-demographic and medication-related factors, functioning, belief flexibility, depression/anxiety, and neurocognitive predictors was limited, inconsistent, or null. Conclusions The available evidence does not allow definitive conclusions about the factors associated with CBTp engagement and outcome. The findings suggest that these outcomes may be influenced by a combination of clinical factors and psychological processes. Further research is needed to establish robust and generalisable predictors, particularly in early psychosis.
BACKGROUND:Social anhedonia is an essential part of schizophrenia spectrum disorders (SSD), as well as a part of the negative symptom domain. Ecological momentary assessment (EMA) has emerged as a valuable method for assessing momentary emotional experiences in daily life of patients with negative symptoms, while minimizing retrospective reporting bias. However, few EMA studies have examined how patients with SSD and negative symptoms experience social contexts, and findings are inconsistent. The present study aimed to extend this line of research by examining associations between social context and positive affect, negative affect, and pleasure in patients with SSD and prominent negative symptoms. METHODS:Twenty-six participants with SSD completed one week of EMA assessments. Repeated momentary ratings of social context, affect, and pleasure were collected, and multilevel analyses were conducted to examine within-person associations between social context and emotional experience. RESULTS:Participants reported significantly greater positive affect in social contexts compared to non-social contexts. In contrast, social context was not significantly associated with negative affect or consummatory pleasure. Time lagged analyses of experienced affect following a social context were not significant, and social context did not moderate the association between anticipatory and consummatory pleasure. CONCLUSION:The findings suggest that patients with SSD and prominent negative symptoms experience greater positive affect in social contexts compared to being alone, without corresponding increases in consummatory pleasure, highlighting a potential dissociation between affective and hedonic processes in daily social experiences.
Psychiatric disability in schizophrenia may reflect the combined effects of clinical symptoms, cognitive impairment, individual resources, and environmental support rather than the influence of a single risk factor. This study used fuzzy-set qualitative comparative analysis to identify configurations associated with higher and lower psychiatric disability states among patients with stable-phase schizophrenia. A cross-sectional study was conducted among 482 patients with stable-phase schizophrenia. Psychiatric disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Seven conditions were examined: negative symptoms, depressive symptoms, neurocognition, social cognition, psychological resilience, family functioning, and social support. Necessary condition analysis showed that no single condition reached the necessity consistency threshold. Sufficiency analysis identified five configurations associated with higher psychiatric disability and five configurations associated with lower psychiatric disability. For higher psychiatric disability, the overall solution consistency was 0.935 and coverage was 0.724; for lower psychiatric disability, the overall solution consistency was 0.932 and coverage was 0.695. Low social cognitive functioning appeared in all higher-disability configurations, whereas the absence of negative symptoms and the presence of social cognitive ability appeared in all lower-disability configurations. These findings indicate equifinality and configurational asymmetry, suggesting that psychiatric disability in schizophrenia should be assessed and addressed through combined consideration of symptoms, cognition, especially social cognition, and resource conditions.
Social cognitive difficulties among those with schizophrenia and first episode psychosis (FEP) are well-documented, but less research has investigated the social cognitive construct of empathy. Empathy has been linked in schizophrenia samples to symptoms and functioning, but minimal work has examined empathy among those with FEP. This study examined associations between empathy, symptoms, and functioning in FEP participants, as well as whether empathy accounts for unique variance in these constructs over and above other social cognitive measures. Participants were 100 people with FEP who were taking part in a larger randomized controlled trial. Two empathy measures, the Interpersonal Reactivity Index (IRI) and Questionnaire of Cognitive and Affective Empathy (QCAE), were administered at baseline, along with measures of symptoms, functioning, and other social cognitive constructs. Results revealed that greater empathy, measured by the IRI, was linked to less severe negative symptoms across multiple domains, while fewer associations were evident for positive symptoms and functioning. Across tested domains, empathy significantly predicted clinical outcomes over and above other social cognitive constructs. However, both empathy measures displayed low internal consistency. Taken together, results suggest that empathy may be important to consider in FEP populations, particularly as it relates to negative symptoms, and empathy predicts unique variance in multiple clinical characteristics. Future work should focus on improving empathy measurement approaches and examining empathy in tandem with broader social cognitive batteries among FEP samples.
Adverse childhood experiences (ACEs) are associated with elevated risk for psychosis-spectrum outcomes, yet less is known about whether specific forms of adversity differentially relate to schizotypal traits as a function of gender. The present study examined whether gender moderates associations between individual ACE categories, particularly childhood sexual abuse (CSA), and multidimensional schizotypal traits in a non-clinical undergraduate sample. Participants (N = 864) completed the Adverse Childhood Experiences Questionnaire and the Schizotypal Personality Questionnaire-Brief Revised. Analyses were conducted in a matched sample (N = 302) equating men and women on exposure to CSA and physical abuse, and moderation models tested gender × ACE interactions across positive, negative, and disorganized schizotypy domains. Significant gender × CSA interactions emerged across multiple domains. Women with a history of CSA exhibited higher levels of negative (social anxiety, constricted affect, and no close friends) and select positive (ideas of reference) schizotypal traits compared to men with similar exposure. Other ACE categories demonstrated domain-specific main effects but weaker and less consistent moderation by gender. These findings indicate that CSA confers gender-dependent vulnerability to psychosis-spectrum traits, particularly within interpersonal and affective domains, even when exposure is controlled. Results highlight the importance of modeling specific adversities and moderation effects when examining psychosis risk and support the need for gender-sensitive, trauma-informed approaches to early identification and prevention.
