Background: 22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion disorder and represents one of the strongest known genetic risk factors for psychosis. Social cognition (SC) deficits are a core feature of schizophrenia and are strongly associated with functional outcomes. In individuals affected by 22q11.2DS and psychotic symptoms, SC impairments may emerge early; however, direct comparisons between patients with 22q11.2DS with psychotic symptoms and those with schizophrenia remain limited. Methods: In this case-control study, we investigated 21 patients with 22q11.2DS and active psychotic symptoms and 21 outpatients with schizophrenia and active psychotic symptoms recruited from the outpatient clinics of Sant'Andrea Hospital, Rome. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS), and cognitive and social cognitive functioning were evaluated using the Cognitive Assessment Interview. Results: Patients with schizophrenia showed significantly higher severity of positive, general, cognitive, excitement, and depression symptoms (all P < .05). In contrast, patients with 22q11.2DS exhibited more pronounced SC impairment (U = 81.00, P < .001). In the 22q11.2DS group, SC was associated with multiple cognitive and clinical domains, including working memory, attention/vigilance, processing speed, reasoning/problem solving, and PANSS total score. Correlation analyses further revealed stronger associations between negative symptoms and cognitive domains in 22q11.2DS group compared with schizophrenia group. Conclusions: In this study, patients with 22q11.2DS and patients with schizophrenia showed partially distinct profiles of psychopathology and SC. While schizophrenia was characterized by greater overall symptom severity, 22q11.2DS was associated with more pronounced social cognitive impairment.

Bipolar depression is often difficult to treat and needs a specific therapeutic approach. This systematic review and meta-analysis aimed to evaluate the efficacy of lumateperone to be inclusive of more recently published studies with this agent in depressive episodes of bipolar disorder. Three meta-analyses were conducted to determine whether the mean Montgomery-Asberg Depression Rating Scale (MADRS) values in the placebo groups differ significantly from the mean MADRS scale values in the group receiving lumateperone 42 mg and whether the mean of Clinical Global Impression Bipolar Version - Severity Scale (CGI-BP-S) – (depression subscore and overall bipolar illness) values in the placebo groups differ significantly from the mean CGI-BP-S scale values in the group receiving lumateperone 42 mg. The meta-analysis showed a statistically significant difference between patients treated with lumateperone 42 mg and those treated with placebo for the MADRS and CGI subscores. The clinical profile of lumateperone indicates that it is a established and highly efficacious treatment option for major depressive episodes associated with bipolar disorder.

BackgroundA suicide crisis represents a psychological state preceding a suicide behavior and occurs when an individual experiences intolerable emotions. Only a few instruments have been developed so far to assess cognitions and emotions associated with a specific interpretative model of the suicide crisis.ObjectivesWe aimed to (1) evaluate the psychometric properties of a new questionnaire (Suicidal Crisis Evaluation Scale, SCES) that could potentially assess cognitions and emotions relevant to the suicide crisis; (2) evaluate whether cognitions and emotions investigated with the SCES were characteristics of psychiatric patients at greater risk for suicide; (3) investigate whether the presence and severity of suicide-relevant cognitions and mental states could be associated with affective temperaments; and (3) study whether the severity of current depression at least partially mediated the association between affective temperaments and negative mental states.MethodsWe included 188 adult psychiatric inpatients admitted to the Sant'Andrea Hospital psychiatric inpatient unit in Rome. We administered the SCES and questionnaires to measure current depression, and affective temperaments.ResultsA common factor explained around 70% of SCES variance, and SCES scores were significantly higher in patients with a recent suicide attempt than in other patients. Part of the variance in common between some affective temperaments and SCES scores was explained by the presence and severity of current depressive symptoms.ConclusionPsychiatric patients need to be assessed for the presence and severity of cognitions and emotions present during the suicide crisis for a better understanding of the complex architecture of suicide risk. The SCES is a valid and reliable measure that could capture such mental states. More studies are necessary to confirm and expand our results in independent samples.

Recently, esketamine became availableas an intranasal formulation, proposed for treatment-resistant depression (TRD). Three cases of TRD are presented, two with features of a psychiatric emergency. The first case is a 35-year-old man with MDD onset at the age of 27 years, with five previous failed therapies. The second patient is a middle-aged man with a 21-year MDD onset and six previous antidepressant treatments discontinued for poor therapeutic effects and tolerability. He also presented suicidal ideation with intent and a history of a failed suicide attempt by self-cutting his forearms. The third case is a 28-year-old female with a first MDD episode in 2020, treated first with amitriptyline and then with intravenous clomipramine. She had a history of a previous suicide attempt by self-cutting and, by her admission, showed active suicidal ideation with intent. In all three cases, a rapid reduction of depressive symptoms was observed with a subsequent complete resolution of suicidal ideation and intent in the two patients with such risk. Intranasal esketamine treatment was carried out with concomitant oral antidepressant therapy. The third patient reported the only recorded side effect: dissociation 20 min after every esketamine administration. Our preliminary experience proved esketamine's effectiveness on TRD symptoms and successful outcomes in psychiatric emergencies such as suicide risk.

Introduction Only a few studies analyse the clinical and psychopathological characteristics of first-admitted inpatients regardless of diagnosis. Objectives Describing the psychopathological, demographic, and clinical characteristics of inpatients with acute symptomatology identifying groups with common features using factors extracted from the Brief Psychiatric Rating Scale (BPRS). Methods We selected 103 (48 F) inpatients from the psychiatric ward of the Sant’Andrea Hospital in Rome from January 2019 to December 2021. We assessed psychopathological characteristics and suicide risk with BPRS, Global Assessment of Functioning, and Columbia-Suicide Severity Rating Scale and gathered the anamnestic and demographic data. We conducted descriptive analyses and factor analysis on BPRS items. Then we used the BPRS factors as variables to perform a cluster analysis. Results Major Depressive Disorder (MDD) was the most frequent diagnosis. We obtained five factors: “Psychotic dimensions” (FI); “Anxiety” (FII); “Hostility and lack of cooperation” (FIII); “Depression” (FIV); “Flattening of affectivity” (FV). We identified two clusters (cluster 1 n=31; cluster 2 n=72). Patients in cluster 1 reported higher average scores in FI and FIII while the average scores of cluster 2 patients in FII and FIV were higher than patients in cluster 1. We called cluster 1 “psychotic and hostile patients compulsory admitted with a low risk of suicide”. Cluster 2 patients are “affective patients with a high risk of suicide”. The two clusters share an average age of 38-39 yo and an average GAF score indicating severe impairment and inability to function in almost all areas. They differ in the psychiatric diagnosis represented: respectively, Schizophrenia Spectrum Disorder and Bipolar Disorder with low suicidal risk, MDD, and Personality Disorders with a high suicidal risk. 39% of patients in cluster 1 were involuntarily admitted. Conclusions The results of our study show that patients admitted for the first time usually are admitted for psychotic symptoms and a high risk of suicide. Psychotic patients more often show hostility and lack of cooperativeness which can explain the higher rate of involuntary admissions. Patients with predominant affective symptoms show a higher risk of suicide. Our analyses do not consider categorical diagnosis highlighting that exist transdiagnostic groups of patients with specific needs. Disclosure of Interest None Declared

Bipolar Disorder (BD) and Attention Deficit and Hyperactivity Disorder (ADHD) are mental disorders with high degree of lifetime comorbidity. Both BD and ADHD are disorders with onset in childhood and early adolescence. Both disorders are often undiagnosed, misdiagnosed, and sometimes overdiagnosed, leading to high rates of morbidity and disability. The psychiatric and behavioral symptoms associated with ADHD and BD have significant overlap. Albeit the existence of a large body of literature, it is far from being clear whether comorbidity can be explained by the confounding overlap of operationally defined criteria or whether it reflects a genuine comorbidity of two biologically distinct disorders. The aim of this paper is to recognize and/or differentiate the pattern of ADHD across the course of BD from a nosological point of view, focusing on specific clinical and neurobiological dimensions. We found that some critical issues may help to fulfill the purpose of our perspective. We suggest that the relationship between ADHD and BD, based on clinical, developmental, and epidemiological commonalities, can be better clarified using four different scenarios.

BACKGROUND:Research on the influence of neurocognitive factors on suicide risk, regardless of the diagnosis, is inconsistent. Recently, suicide risk studies propose applying a trans-diagnostic framework in line with the launch of the Research Domain Criteria Cognitive Systems model. In the present study, we highlight the extent of cognitive impairment using a standardized battery in a psychiatric sample stratified for different degrees of suicidal risk. We also differentiate in our sample various neurocognitive profiles associated with different levels of risk.MATERIALS AND METHODS:We divided a sample of 106 subjects into three groups stratified by suicide risk level: Suicide Attempt (SA), Suicidal Ideation (SI), Patient Controls (PC) and Healthy Controls (HC). We conducted a multivariate Analysis of Variance (MANOVA) for each cognitive domain measured through the standardized battery MATRICS Consensus Cognitive Battery (MCCB).RESULTS:We found that the group of patients performed worse than the group of healthy controls on most domains; social cognition was impaired in the suicide risk groups compared both to HC and PC. Patients in the SA group performed worse than those in the SI group.CONCLUSION:Social cognition impairment may play a crucial role in suicidality among individuals diagnosed with serious mental illness as it is involved in both SI and SA; noteworthy, it is more compromised in the SA group fitting as a marker of risk severity.

ABSTRACT:Schizophrenia is characterized not only by psychopathological symptoms but also by medical comorbidities. Among the latter, there are limited data on dental health. We conducted a systematic review with the primary aim of clarifying the extent of the relationship between dental diseases and schizophrenia. The second aim was to delineate an intervention program based on illness-related factors that influence dental health. The preferred reporting items for systematic reviews and meta-analyses statement for reporting systematic reviews was used. Only articles published in English language peer-reviewed journals were considered; we excluded case reports, meta-analyses, and systematic reviews, as well as studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Twenty-one studies comprising 13,110 patients with schizophrenia and 9025 healthy controls were included. Negative symptomatology, long duration of illness, smoking habit, drug-induced xerostomia, and neuroinflammation are the most critical areas. We suggest an intervention program for prevention and treatment of dental diseases in schizophrenia.

We performed a retrospective study from January to May 2020 to establish the sociodemographic and clinical characteristics of patients with mental health problems who arrived at an Italian emergency department during the COVID-19 outbreak. We divided the sample into two groups taking as a watershed March 11, when the World Health Organization announced COVID-19 outbreak as a pandemic. Chi-square/t-tests, adjusted p values (Bonferroni method), and regression analysis were performed. Patients who arrived at the emergency department during the lockdown decreased by 56%; showed greater active suicidal ideation, more tension, and more severe psychopathological state; were living alone more frequently; and were taking home treatment mainly based on second-generation antipsychotics. According to our study, it seems that patients with mental disorders have consulted psychiatric services less frequently during the pandemic, but the economic, health, and social distress may be linked with an increase in suicidal risk and the severity of the psychopathological state.

Abstract Schizophrenia is characterized not only by psychopathological symptoms but also by medical comorbidities. Among the latter, there are limited data on dental health. We conducted a systematic review with the primary aim of clarifying the extent of the relationship between dental diseases and schizophrenia. The second aim was to delineate an intervention program based on illness-related factors that influence dental health. The preferred reporting items for systematic reviews and meta-analyses statement for reporting systematic reviews was used. Only articles published in English language peer-reviewed journals were considered; we excluded case reports, meta-analyses, and systematic reviews, as well as studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Twenty-one studies comprising 13,110 patients with schizophrenia and 9025 healthy controls were included. Negative symptomatology, long duration of illness, smoking habit, drug-induced xerostomia, and neuroinflammation are the most critical areas. We suggest an intervention program for prevention and treatment of dental diseases in schizophrenia.

Abstract Background The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. Methods Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. Results There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. Discussion Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

EDITORIAL article Front. Psychiatry, 05 October 2021 | https://doi.org/10.3389/fpsyt.2021.772307

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.

INTRODUCTION:Aberrant salience is the incorrect assignment of salience or significance to innocuous stimuli, and been hypothesized to be a central mechanism in the development of psychosis. In addition to aberrant salience, social-cognitive models of psychosis suggest that the way people process information about the self is important in all stages of psychosis. The aim of the present study is to explore the relationship between aberrant salience and emotion processing in schizophrenia patients with psychotic relapse.METHODS:A sample of 42 patients with relapse was recruited. Aberrant salience was measured with the Aberrant Salience Inventory (ASI). Assessment of social cognition was carried out using the Facial Emotion Identification Test (FEIT). Partial correlations were controlled for possible confounding variables.RESULTS:The ASI factors "increase in meaning" and "heightened cognition" positively correlated with impaired recognition of positive emotions, and ASI total score inversely correlated to time to response to task. Most of incorrect answers corresponded to misclassification of positive emotions.CONCLUSION:Our findings show that there is evidence for a relationship between aberrant salience and emotion processing during a psychotic episode; we propose that aberrant salience and alterations in emotion processing trigger the loss of modulating feedback from the external world to produce a self-referential mental state.

The aims of the present study were to 1) evaluate clinical differences between patients suffering from schizophrenia (SZ) with mild versus moderate/severe formal thought disorder (FTD); 2) explore relationships between dimensions of FTD, neuropsychological domains, and global functioning; and 3) compare clinical dimensions of FTD in early and late SZ. One hundred thirty-six individuals with schizophrenia were recruited and evaluated during a nonacute phase of illness. FTD was assessed with the Thought, Language, and Communication Scale. Partial correlations, t-tests, and stepwise regression were undertaken to address the study aims. Patients with moderate/severe FTD performed worse than those with mild FTD for processing speed, reasoning and problem solving, and social cognition, and demonstrated poorer global functioning. Early SZ did not differ from late SZ in terms of negative FTD and difficulty in abstract thinking (DAT). Negative FTD was correlated with reasoning and problem solving; DAT was correlated with social cognition. All clinical dimensions of FTD, regardless of neurocognitive impairment, accounted for a significant amount of variance in global functioning. FTD predicted global functioning, regardless of neurocognitive factors. Due to their stability in different phases of the course of the disease and their strong relationship with other core variables, Neg-FTD and DAT should be investigated as an intermediate phenotype of the illness.

Abstract Background The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

Improving real‐life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness‐related variables, personal resources, context‐related factors and real‐life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4‐year follow‐up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow‐up. In addition, we compared the network structure of patients who were classified as recovered at follow‐up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow‐up study. The network structure did not change significantly from baseline to follow‐up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow‐up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non‐recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self‐reinforcing networks of symptoms and dysfunctions in people with schizophrenia.