Introduction: Tardive dyskinesia (TD) is a known adverse drug reaction (ADR) of first-generation and second-generation antipsychotics. While second-generation antipsychotics are believed to pose a lower TD risk, evidence remains mixed. This study compares TD risk between first- and second-generation antipsychotics using postmarket ADR data. Study Type: Observational cross-sectional pharmacovigilance analysis. Methods: We conducted a disproportionality analysis of the FAERS database from 2012 to 2024, calculating the reporting odds ratio (OR) for TD in antipsychotic users. Individual drug ORs were pooled via meta-analysis with stratification by age and sex. Results: Significant variation in TD risk was observed across drugs; second-generation antipsychotics were not uniformly safer than first-generation agents. Stratified analyses revealed further variability by demographic factors. Notably, clozapine exhibited a lower OR compared with other antipsychotics. Conclusions: These findings challenge the assumption of uniformly decreased TD risk of second-generation antipsychotics and underscore the importance of individualized risk assessment when prescribing antipsychotics.
AIM:The popularity of the Clock Drawing Test (CDT) is paralleled by the multitude of scoring systems ranging from brief and subjective to complex. METHODS:To compare the properties and classification accuracy of different scoring approaches, the CDT was scored using 14 published scoring systems and one simplistic four-point scale using a military veteran sample. RESULTS:Among the scoring approaches, eight displayed acceptable discrimination between profiles classified as cognitively intact versus cognitively impaired based on neuropsychological test scores, with areas under the receiver operating characteristic curve (AUCs)=.709 to .797. Analyses within individual cognitive domains revealed excellent discrimination for the Framingham (visuospatial: AUC=.850, and executive: AUC=.808) and Shulman (language: AUC=.811) scoring approaches. CONCLUSIONS:Simpler and even subjective approaches were on par with highly detailed procedures for scoring the CDT. With many scoring approaches being capable of detecting overall impairment, a total score may be most useful as a screening indicator.
INTRODUCTION:This study examined risk factors for schizophrenia spectrum disorder (SSD)-related hospitalization among children, adolescents, and transitional-age-youth (TAY). METHODS:A cross-sectional analysis of the nationwide inpatient sample included 618,495 inpatients aged 6-24, divided into SSD and other psychiatric illness cohorts. RESULTS:SSD accounted for 15% of psychiatric hospitalizations. Most SSD inpatients were ages 18-24 (91%), male (68.9%), and identified as Caucasian (37.7%) or African American (35.8%). Higher odds of SSD hospitalization were seen in TAY (OR=17.2), males (OR=2.5), African American (OR=2.8), and Hispanic (OR=2.06) individuals. Stimulant-related disorders (OR=1.36) and epilepsy (OR=1.24) increased risk, especially in children 6-11. Adolescents 12-17, cannabis-related disorders increased SSD hospitalization odds (OR=1.21). CONCLUSIONS:Children under 11 are more likely to be hospitalized for SSD due to stimulant-related disorders and epilepsy, while adolescents face higher risks linked to cannabis-related disorders, highlighting the need for targeted inpatient treatment.
Aim:Activation syndrome, a possible consequence of antidepressant treatment, has been linked to suicidal ideation, yet its definition remains debated. This study investigated the frequency and risk factors of activation syndrome in patients with first-episode major depressive disorder.Methods:Two hundred six patients were assessed at baseline, week 2, and week 4. Baseline measures included the Hypomania-Checklist-32, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire, and evaluations of anxious distress, mixed features, and atypical depression. Follow-up interviews assessed activation syndrome.Results:Activation Syndrome occurred in 33% (n = 68). It was associated with younger age, atypical depression, higher Hypomania-Checklist-32 scores, anxious distress, cyclothymic/irritable temperaments, and suicidal ideation. Logistic regression showed past hypomania and atypical depression as significant predictors. Associations remained after excluding mania/hypomania cases.Conclusions:In first-episode major depressive disorder, past hypomania symptoms and atypical depression increase activation syndrome risk, highlighting the need for close monitoring given implications for bipolarity and suicidality.
Introduction:This study examined risk factors for schizophrenia spectrum disorder (SSD)-related hospitalization among children, adolescents, and transitional-age-youth (TAY).Methods:A cross-sectional analysis of the nationwide inpatient sample included 618,495 inpatients aged 6-24, divided into SSD and other psychiatric illness cohorts.Results:SSD accounted for 15% of psychiatric hospitalizations. Most SSD inpatients were ages 18-24 (91%), male (68.9%), and identified as Caucasian (37.7%) or African American (35.8%). Higher odds of SSD hospitalization were seen in TAY (OR=17.2), males (OR=2.5), African American (OR=2.8), and Hispanic (OR=2.06) individuals. Stimulant-related disorders (OR=1.36) and epilepsy (OR=1.24) increased risk, especially in children 6-11. Adolescents 12-17, cannabis-related disorders increased SSD hospitalization odds (OR=1.21).Conclusions:Children under 11 are more likely to be hospitalized for SSD due to stimulant-related disorders and epilepsy, while adolescents face higher risks linked to cannabis-related disorders, highlighting the need for targeted inpatient treatment.
Aim:Researchers have studied mechanisms underlying social motivation in schizophrenia, including reward learning, hostile attribution bias, and defeatist performance beliefs. Yet, existing work is limited by the use of laboratory paradigms and/or trait-level measures.Methods:This study used ecological momentary assessment (EMA) to determine factors that influence daily social motivation. Eighty-two Veterans with psychosis completed four electronic surveys per day for one week. Social activity, including appraisals of interactions, experienced enjoyment, and desire for future socialization, was collected.Results:Increases in social rewards and performance appraisals predicted desire for social interactions, but did not predict the number of subsequent interactions. Hostile attributions were not associated with desire nor subsequent interactions.Conclusions:Results support the value of EMA to measure state-level changes in motivation and suggest positive experiences and performance appraisals are important, malleable determinants of social motivation. Yet, these factors may not entirely determine future social behavior. Other influences should be considered.
Introduction: The primary goal in randomized clinical trials (RCTs) is to estimate the causal effects of interventions. Since prognostic factors can also affect outcomes, RCTs often employ covariate-adjusted analyses. It is important to review reasons for adjustment, advantages and disadvantages of adjustments, and reiterate best practices. Methods: We reviewed guidelines and recommendations for covariate adjustment from authoritative sources, including the European Medicines Agency and the US Food and Drug Administration, as well as recent studies and meta-analyses. Results: While post hoc adjustments for baseline covariates may lead to bias, unadjusted analyses and prespecified adjusted analyses are valid approaches for RCTs. Adjustment for highly prognostic variables can enhance precision and power. Direct adjustment methods and more complex methods, such as inverse probability of treatment weighting, can be applied. Conclusions: Covariate adjustments should be prespecified, theoretically justified, and transparently reported. This approach aligns with the CONSORT 2025 guidelines, emphasizing methodological rigor and transparency.
AIM:Aripiprazole is one of the few pharmacological agents approved for managing irritability in children and adolescents with autism spectrum disorder (ASD). METHODS:Randomized controlled trials comparing oral aripiprazole with placebo or active drugs in participants under 18 years were systematically searched in major databases through September 2025 (last search: September 15, 2025). The primary outcome was change in Aberrant Behavior Checklist-Irritability (ABC-I) scores; data were synthesized using random-effects models. RESULTS:Eleven trials ( N = 1,135) were included. Aripiprazole significantly reduced irritability (mean difference = -5.18; 95% CI = -6.72 to -3.64; I 2 = 0%) and improved global ratings versus placebo. Common adverse effects were weight gain, sedation, and extrapyramidal symptoms, though discontinuation rates were comparable to placebo. CONCLUSIONS:Aripiprazole effectively and safely reduces irritability in pediatric ASD. Although adverse effects are frequent, they are generally manageable, supporting individualized dosing and long-term monitoring.
AIM:Activation syndrome, a possible consequence of antidepressant treatment, has been linked to suicidal ideation, yet its definition remains debated. This study investigated the frequency and risk factors of activation syndrome in patients with first-episode major depressive disorder. METHODS:Two hundred six patients were assessed at baseline, week 2, and week 4. Baseline measures included the Hypomania-Checklist-32, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire, and evaluations of anxious distress, mixed features, and atypical depression. Follow-up interviews assessed activation syndrome. RESULTS:Activation Syndrome occurred in 33% ( n = 68). It was associated with younger age, atypical depression, higher Hypomania-Checklist-32 scores, anxious distress, cyclothymic/irritable temperaments, and suicidal ideation. Logistic regression showed past hypomania and atypical depression as significant predictors. Associations remained after excluding mania/hypomania cases. CONCLUSIONS:In first-episode major depressive disorder, past hypomania symptoms and atypical depression increase activation syndrome risk, highlighting the need for close monitoring given implications for bipolarity and suicidality.
AIM:This pilot RCT evaluated the feasibility, acceptability, and preliminary effects of Metacognitive Interpersonal Group Therapy for Adolescents (MIT-GA) compared with waiting list plus treatment-as-usual (WL+TAU). METHODS:One hundred adolescents (14-18 years) meeting DSM-IV criteria for PDs (excluding antisocial PD) were randomized to MIT-GA or WL+TAU for 4 months. Primary outcomes included treatment acceptability, psychosocial functioning (CGAS, IIP-64), and symptom severity (SCL-90-R GSI). Secondary outcomes were depression (Y-BDI), caregiver stress (PSS), and parental self-efficacy (BPSES). Mechanisms of change included metacognition (MAS-A), alexithymia (TAS-20), and impulsivity (BIS-11). RESULTS:MIT-GA participants showed greater improvements in psychosocial functioning ( d = 0.80) and parental stress ( d = 0.65) versus WL+TAU. No significant between-group differences were found in overall symptom severity. MIT-GA also improved metacognition, alexithymia, and attentional impulsivity. No adverse events were reported. CONCLUSIONS:These findings support the feasibility and potential utility of MIT-GA for adolescents with PDs.
Aim:Mental illness significantly influences national development by reflecting a nation's socioeconomic well-being. This study compares mental illness trends in developing countries in Asia and Africa.Methods:Secondary data from the mental health depression disorder data set (2000-2017) were analyzed for Bangladesh, India, Nigeria, and Ghana. Key disorders examined include depression, schizophrenia, anxiety, substance use disorder, and bipolar disorder.Results:Schizophrenia, anxiety, and bipolar disorder remained relatively stable across countries. Schizophrenia was highest in Bangladesh, while bipolar disorder was more prevalent in Nigeria and India. Depression declined in Bangladesh and India but increased steadily in Nigeria and Ghana. Anxiety correlated strongly with depression in Bangladesh and Nigeria. In Ghana, anxiety and bipolar disorder together increased depression. In India, all mental illnesses except bipolar disorder were linked to increased depression.Conclusions:Understanding mental illness in a global context is vital for developing targeted mental health interventions and restructuring the systems in developing countries.
INTRODUCTION:Although researchers have extensively studied expectations, we know little about their associations with individuals' perceptions of illness. In this study, we explored whether individuals' expectations of psychotherapy were associated with their mental illness attributions. METHODS:Participants ( N =291) completed the Mental Illness Attribution Questionnaire (MIAQ) and the Expectations of Active Processes in Psychotherapy Scale (EAPPS). We utilized linear regressions to evaluate their associations while adjusting for potential confounders. RESULTS:The belief that mental illness originated in biology was associated with most change process expectations ( p <0.007, .16< b <.27). Social/stress attributions were associated with the expectation that psychotherapy would foster resilience and sharing sensitive contents openly and securely ( b =.31, p =0.000; b =.34, p =0.000). Supernatural attributions were associated with the expectation that psychotherapy would focus on exploring therapist-patient relations ( b =.28, p =0.003). CONCLUSIONS:Results suggest that individuals' perceptions about the origins of mental illness are related to their psychotherapy change process expectations.
Aim:The role of mental disorders as risk factors for mild cognitive impairment (MCI) remains underexplored. Previous studies often focused narrowly on mental disorders, overlooking comorbidities among psychiatric patients.Methods:Utilizing a nationwide cohort from 2009 to 2020, this study analyzed 2,717,131 individuals aged 40 years and above. Cox proportional hazards regression analysis was used to determine associations of mental disorders (depressive disorders, bipolar and related disorders, schizophrenia, anxiety disorders, insomnia) and the risk of MCI.Results:Any mental disorder was associated with a 50% increased risk of MCI (HR: 1.50; 95% CI: 1.48-1.51), except for schizophrenia, which did not significantly alter the MCI risk (HR: 1.08; 95% CI 0.92-1.25). Individuals with a single diagnosis exhibited heightened MCI risk even when participants with multiple diagnoses were excluded (HR: 1.43; 95% CI: 1.41-1.45).Conclusions:Our findings advocate for a comprehensive approach addressing both disorder types and further cognitive deterioration.
AIM:Mental illness significantly influences national development by reflecting a nation's socioeconomic well-being. This study compares mental illness trends in developing countries in Asia and Africa. METHODS:Secondary data from the mental health depression disorder data set (2000-2017) were analyzed for Bangladesh, India, Nigeria, and Ghana. Key disorders examined include depression, schizophrenia, anxiety, substance use disorder, and bipolar disorder. RESULTS:Schizophrenia, anxiety, and bipolar disorder remained relatively stable across countries. Schizophrenia was highest in Bangladesh, while bipolar disorder was more prevalent in Nigeria and India. Depression declined in Bangladesh and India but increased steadily in Nigeria and Ghana. Anxiety correlated strongly with depression in Bangladesh and Nigeria. In Ghana, anxiety and bipolar disorder together increased depression. In India, all mental illnesses except bipolar disorder were linked to increased depression. CONCLUSIONS:Understanding mental illness in a global context is vital for developing targeted mental health interventions and restructuring the systems in developing countries.
Introduction: Social exclusion affects patients with schizophrenia (SCZ) both because of a fundamental disposition to introversion and through social discrimination. Here, we explore the emotional and cardiac autonomic responses to ostracism using a ball-tossing experiment. Methods: Through a cross-sectional design, 30 patients with SCZ and 30 healthy controls (HC) performed the Cyberball task. We measured respiratory sinus arrhythmia (RSA) at baseline, immediately after each gameplay (inclusion and ostracism) and after 10 minutes (reflective stage), as well as self-reported ratings of threats toward one’s fundamental need to belong. Results: Participants with SCZ showed reduced RSA at baseline, which remained low for the task’s entire duration, regardless of the experimental condition. When excluded, they self-reported a lower sense of threat to fundamental needs, as compared with HC. Conclusions: Patients with SCZ showed a persistent defensive autonomic state and displayed a blunted emotional response to experimental ostracism, suggesting difficulties in activating social engagement strategies.
INTRODUCTION:The relationship between violence and schizophrenia spectrum disorders (SSDs) is complex and poorly understood. Moreover, violence takes different trajectories, depending on its onset relative to that of the illness. However, the effect of such trajectories on the illness is not fully understood in nonforensic populations. METHODS:Two hundred twenty-three participants with SSD were recruited and divided into different violence subgroups using the Brown-Goodwin scale. Psychotic, affective, cognitive, and functional outcomes were measured. RESULTS:Subgroups only significantly differed in psychotic outcomes, such as paranoia (p=.044), measured by the Symptoms Checklist Scores (SCL-90). Pair-wise analysis revealed that those with childhood and adulthood violence displayed significantly higher paranoia, compared with the nonviolent group (p=.015). However, this was not significant after correcting for multiple comparisons. CONCLUSIONS:Different violence trajectories are associated with different symptomatic outcomes in SSD. This suggests an interplay between violence and psychosis, which is important for comprehensive treatment approaches.
The prevalence of PTSD in individuals who suffer traumatic brain injury (TBI) or spinal cord injury (SCI) following road traffic accidents (RTAs) has not been comprehensively reviewed. A systematic search was conducted in Cochrane, PubMed, Scopus, CINAHL, ProQuest, PsycARTICLES, and PsycINFO, and the meta-analyses were performed by the comprehensive meta-analysis (CMA). JBI checklists were utilized for critical appraisal. The pooled prevalence of PTSD in TBI and SCI survivors of RTAs was 29.4% (95% CI: 22.7% – 37.3%). The rate of PTSD in adults was 29.3% (95% CI: 23.8% – 35.5%), and it was 30.9% (95% CI: 4.4% – 81.3%) in the children subgroup. Coping styles, previous employment, acute stress disorder, and reduced awareness are some of the reported risk factors. Future longitudinal studies should further investigate the prevalence and predictors of PTSD in RTAs to identify early diagnosis and prevention strategies.
