BackgroundChildhood trauma may influence clinical presentation in first-episode schizophrenia (FES), but its specific associations with cognitive function and clinical symptoms remain unclear.MethodsSeventy-one FES participants and 62 healthy controls were assessed using the Childhood Trauma Questionnaire (CTQ-SF), MATRICS Consensus Cognitive Battery (MCCB), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale (CDSS). Group comparisons, Spearman correlations, hierarchical regression, and mediation analyses (PROCESS macro) were performed.ResultsFES participants reported significantly higher childhood trauma (except physical abuse) and performed worse on all MCCB domains (all *p* < 0.00625). Within the clinical group, those with childhood trauma (71.8%) showed nominally lower MCCB total scores (*p* = 0.042) and a trend toward higher negative symptoms (*p* = 0.083). Exploratory analyses indicated that physical neglect was associated with attention/vigilance (r = -0.54) and overall cognition (*r* = -0.69); physical abuse with social cognition (*r* = -0.54); sexual abuse with general psychopathology (*r* = 0.56). No independent associations of trauma subtypes were found in regression analyses. Attention/vigilance was significantly associated with negative symptoms (β = -0.43, *p* = 0.002) but did not mediate the trauma-symptom relationship.ConclusionFES participants report more childhood trauma and exhibit widespread cognitive impairment, with physical neglect most strongly linked to attentional deficits. Attention/vigilance was associated with negative symptoms, suggesting that trauma-informed cognitive rehabilitation may have potential value.

This study explored the objective effectiveness of treatment and the subjective experiences of patients with schizophrenia spectrum disorders (SSD) and mood disorders (MD) in a day rehabilitation ward. A mixed-methods design was employed. Patients meeting the ICD-10 criteria for SSD or MD were enrolled. Standardised scales (BPRS, HAMD, MRSS) were used to assess symptom and functional changes in 377 patients; semi-structured interviews were conducted with 27 purposively sampled patients, and the data were analyzed using content analysis. Quantitative findings showed that, after treatment, patients with SSD had significantly lower BPRS total scores (Z=-2.929, P = 0.003), including lower factor scores for hostile suspiciousness (Z=-3.225, P = 0.001) and thought disturbance (Z=-2.412, P = 0.016). The MRSS total score (Z=-2.031, P = 0.042) and dependency subscale score (Z=-2.045, P = 0.041) were also significantly lower. For patients with MD, HAMD total score (Z=-4.188, P < 0.001) and the factor scores for anxiety/somatisation (Z=-3.604, P < 0.001), cognitive disturbance (Z=-3.385, P < 0.001), retardation (Z=-4.208, P < 0.001), sleep disturbance (Z=-2.842, P = 0.004), and hopelessness (Z=-2.448, P = 0.014) were significantly reduced. MRSS total score (Z=-2.294, P = 0.022) and inactivity subscale score(Z=-2.276, P = 0.023) were likewise significantly lower. Qualitative findings indicated that patients perceived positive changes in symptoms and illness status, personal growth, interpersonal communication, life fulfillment, and social integration. Reported challenges included difficulty in keeping up with and integrating into the courses, rehabilitation plateaus, and insufficient social support. Our findings suggest that patients with both SSD and MD experienced symptomatic improvement after treatment in the day rehabilitation ward. Changes in social functioning require further investigation. In addition, patients continued to face difficulties and challenges during day treatment.

This case report describes the implementation and observed outcomes of an empowerment-oriented case management approach in a patient with treatment-resistant schizophrenia (TRS), addressing the limitations of conventional approaches that often neglect patient autonomy and subjective agency. Through the implementation of a multidisciplinary, four-dimensional empowerment framework—comprising pathological treatment, psychological cognition, social engagement, and family care—a 34-year-old male TRS patient received targeted intervention over a three-year period. Quantitative assessments, including PANSS, HRSD, SDSS, CGI, MRSS, and FAES II-CV, demonstrated substantial improvements: PANSS total score decreased from 90 to 61, CGI severity score reduced from 6 to 3, and MRSS dependency subscale declined from 29 to 14. Qualitative interviews further revealed enhanced medication adherence, symptom self-monitoring, and social functioning, alongside increased daily autonomy, reduced stigma, and improved family dynamics. These preliminary observations from a single case suggest potential benefits that warrant systematic investigation through controlled studies. The temporal associations observed between the intervention and improvements cannot establish causality but provide hypotheses for future research.

OBJECTIVES:Working memory impairments represent fundamental cognitive deficits in schizophrenia (SZ). Although transcranial direct current stimulation (tDCS) has demonstrated potential in enhancing working memory in SZ, its neural mechanisms and optimized strategies remain to be elucidated. This study explored the effects of tDCS with concurrent cognitive performance targeting the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex (PPC) on electroencephalography (EEG) microstates in SZ. METHODS:This analysis is based on a randomized, double-blind clinical trial of tDCS with concurrent cognitive performance in SZ. Sixty participants were assigned to three groups: active DLPFC, active PPC, and sham stimulation groups. tDCS was administered concurrently with a visual working memory task. The spatial span test was used to assess working memory at baseline, week 1, and week 2, with resting-state EEG data collected at each time point. RESULTS:No significant differences were detected in the characteristics of the four microstates (A, B, C, and D) at baseline. Compared with the sham stimulation group, the active DLPFC and PPC groups exhibited significant improvements in the duration, occurrence, and coverage of microstate B at week 2. However, the changes in the parameters of microstate B at week 2 were not significantly correlated with working memory improvement. CONCLUSIONS:This study suggests that neuromodulation targeting different nodes within the task-induced network may influence the same subnetworks in SZ. This work provides new insights into network-based interventions and contributes to the development of multitarget intervention strategies under task conditions.

Cognitive dysfunction is a defining characteristic impairing social functioning in schizophrenia (SZ). N-methyl-D-aspartate receptor (NMDAR) hypofunction may underlie these impairments. This study explored the association between peripheral blood levels of the NMDAR subunits NR1 and NR2 and cognitive improvement in SZ, evaluating their potential as biomarkers for the efficacy of cognitive intervention. This secondary analysis of a randomized controlled trial included 60 clinically stable SZ patients and 30 healthy controls (HCs). Patients received five-day transcranial direct current stimulation (tDCS) during cognitive tasks across three groups: the active dorsolateral prefrontal cortex (DLPFC), the active posterior parietal cortex (PPC), and the sham stimulation group. Cognition was evaluated, and blood samples were collected at baseline, week 1, and week 2. Baseline blood samples were also obtained from HCs. NR1 and NR2 concentrations were quantified using enzyme-linked immunosorbent assay (ELISA). We found that baseline NR1 concentration was significantly lower in the patient group than in HCs, with no NR2 differences observed. Compared to the other two groups, the active PPC group demonstrated significant working memory improvements. In the active PPC group, baseline NR1 and NR2 concentrations were negatively correlated with working memory improvements at week 1. Moreover, changes in NR1 at weeks 1 and 2, and NR2 at week 1, were positively associated with working memory improvements at week 1 in the active PPC group. Peripheral NR1 and NR2 levels may serve as biomarkers for predicting cognitive improvement in SZ, supporting the role of NMDAR dysfunction in SZ-related cognitive deficits.

Background: Delta-band (1-4 Hz) oscillation contributes to speech recognition and may be impaired in schizophrenia. This study primarily aimed to investigate the impairment of the 2.5-Hz auditory steady-state response (ASSR) and its correlation with other auditory cognitive indicators, clinical symptoms, and multidomain cognition in individuals with schizophrenia. Methods: In this cross-sectional study, 30 patients with schizophrenia and 30 healthy controls underwent 2.5- and 40-Hz ASSR and mismatch negativity (MMN) assessment. The Positive and Negative Syndrome Scale (PANSS) was utilized to assess the patients' clinical symptoms, and the MATRICS consensus cognitive battery (MCCB) was used to evaluate cognitive function. Results: The 2.5-Hz ASSR inter-trial coherence (ITC) was significantly lower among patients with schizophrenia than among healthy controls (P = 0.012, Cohen's d = 0.66). The 2.5-Hz ASSR ITC alone distinguished these groups, with 53.3 % sensitivity, 70.0 % specificity, and 61.7 % accuracy. In the schizophrenia group, the 2.5-Hz ASSR ITC did not correlate significantly with the MMN amplitude or any clinical symptoms or cognitive measurement. In healthy controls, the 2.5-Hz ASSR ITC correlated positively with verbal learning (r = 0.381, P = 0.038), although this correlation was not significant after Bonferroni correction. Conclusion: The evoked activity maintaining delta-band oscillation entrainment in the auditory system reveals a deficit in schizophrenia and is valuable for the objective diagnosis of this disorder.

Working memory deficits are linked to irregularities in the dorsolateral prefrontal cortex (DLPFC) and the posterior parietal cortex (PPC) in schizophrenia, effective intervention strategies are lacking. We evaluated the differential efficacy and underlying neuromechanisms of targeting transcranial direct current stimulation (tDCS) at the DLPFC and the PPC with concurrent cognitive performance for working memory in schizophrenia. In a randomized and double-blind clinical trial, sixty clinically stable schizophrenic patients with below-average working memory were randomly assigned to active DLPFC, active PPC, and sham tDCS groups. Two sessions of tDCS during N-back task were delivered daily for five days. The primary outcome was changes in spatial span test scores from baseline to week 1. The secondary outcomes included changes in scores of color delay-estimation task, other cognitive tasks, and mismatch negativity (biomarker of N-methyl-d-aspartate receptor functioning). Compared with the active DLPFC group, the active PPC group demonstrated significantly greater improvement in spatial span test scores (p = 0.008, d = 0.94) and an augmentation in color delay-estimation task capacity at week 1; the latter sustained to week 2. Compared with the sham tDCS group, the active PPC group did not show a significant improvement in spatial span test scores at week 1 and 2; however, significant enhancement was observed in their color delay-estimation task capacity at week 2. Additionally, mismatch negativity amplitude was enhanced, and changes in theta band measures were positively correlated with working memory improvement in the active PPC group, while no such correlations were observed in the active DLPFC group or the sham tDCS group. Our results suggest that tDCS targeting the PPC relative to the DLPFC during concurrent cognitive performance may improve working memory in schizophrenia, meriting further investigation. The improvement in working memory appears to be linked to enhanced N-methyl-d-aspartate receptor functioning.

Abstract Background Recurrent observations have indicated the presence of deficits in mismatch negativity (MMN) among schizophrenia. There is evidence suggesting a correlation between increased dopaminergic activity and reduced MMN amplitude, but there is no consensus on whether antipsychotic medications can improve MMN deficit in schizophrenia. Methods We conducted clinical assessments, cognitive function tests, and EEG data collection and analysis on 31 drug-naïve patients with schizophrenia. Comprehensive evaluation tools such as PANSS and MCCB. MMN amplitude was analyzed by event-related potential (ERP) approaches, evoked theta power was analyzed by event-related spectral perturbation (ERSP) approaches. Results Our findings indicate that antipsychotic treatment significantly improved clinical symptoms, as evidenced by reductions in PANSS positive, negative, general symptoms, and total scores (all p < 0.001). Cognitive function improvements were observed in language learning, working memory, and overall MCCB scores (p < 0.05), although other cognitive domains showed no significant changes. However, no significant improvements were noted in MMN amplitude and evoke theta power after four weeks of antipsychotic treatment (p > 0.05). Conclusion These results suggest that while antipsychotic medications effectively alleviate clinical symptoms, their impact on MMN amplitude and evoke theta power deficit is limited in the short term. Moreover, the amelioration of cognitive impairment in individuals with schizophrenia is not readily discernible, and it cannot be discounted that the enhancement observed in language acquisition and working memory may be attributed to a learning effect. These findings underscore the complexity of the neurobiological mechanisms involved and highlight the need for further research to optimize individualized treatment strategies for schizophrenia. Trial Registration ChiCTR2000038961, October 10, 2020.

This article presents three detailed case reports of refractory schizophrenia with varying degrees of improvement in psychiatric symptoms,cognitive function,and insight after 16 sessions of group metacognitive training(MCT)across an 8-week period,and aims to explore the curative effect of group MCT in patients with refractory schizophrenia,thus to provide references for improving symptoms in refractory schizophrenia.

BACKGROUND Cognitive reserve (CR) and the catechol-O-methyltransferase (COMT ) Val/Met polymorphism are reportedly linked to negative symptoms in schizophrenia. However, the regulatory effect of the COMT genotype on the relationship between CR and negative symptoms is still unexamined. AIM To investigate whether the relationship between CR and negative symptoms could be regulated by the COMT Val/Met polymorphism. METHODS In a cross-sectional study, 54 clinically stable patients with schizophrenia underwent assessments for the COMT genotype, CR, and negative symptoms. CR was estimated using scores in the information and similarities subtests of a short form of the Chinese version of the Wechsler Adult Intelligence Scale. RESULTS COMT Met-carriers exhibited fewer negative symptoms than Val homozygotes. In the total sample, significant negative correlations were found between negative symptoms and information, similarities. Associations between information, similarities and negative symptoms were observed in Val homozygotes only, with information and similarities showing interaction effects with the COMT genotype in relation to negative symptoms (information, β = -0.282, 95%CI: -0.552 to -0.011, P = 0.042; similarities, β = -0.250, 95%CI: -0.495 to -0.004, P = 0.046). CONCLUSION This study provides initial evidence that the association between negative symptoms and CR is under the regulation of the COMT genotype in schizophrenia.

INTRODUCTION:A previous meta-analysis indicated stable progress in cognitive functions in early psychosis, assessed through various tools. To avoid assessment-related heterogeneity, this study aims to examine the longitudinal cognitive function changes in early psychosis utilizing the MATRICS Consensus Cognitive Battery (MCCB). METHODS:Embase, PubMed, and Scopus were systematically searched from their inception to September 26th 2023. The inclusion criteria were longitudinal studies that presented follow-up MCCB data for individuals experiencing first-episode psychosis (FEP) and those with ultra-high risk for psychosis (UHR). RESULTS:Twelve studies with 791 participants (566 FEP patients and 225 healthy controls) were subjected to analysis. Suitable UHR studies were absent. Over time, both FEP patients and healthy controls showed significant improvements in MCCB total scores. Furthermore, FEP patients demonstrated improvements across all MCCB domains, while healthy controls only showed augmentations in specific domains such as speed of processing, attention, working memory, and reasoning and problem-solving. Visuospatial learning improvements were significantly greater in FEP patients compared to healthy controls. Subgroup analyses suggested that neither diagnostic type nor follow-up duration influenced the magnitude of cognitive improvement in FEP patients. CONCLUSION:The magnitude of cognitive improvement for MCCB domains was not significantly different between FEP and healthy controls other than visuospatial learning. This underscores visuospatial learning as a potentially sensitive cognitive marker for early pathologic state changes in psychotic disorders.

Both the brain-derived neurotrophic factor (BDNF) valine (Val)/methionine (Met) polymorphism and mismatch negativity (MMN) amplitude are reportedly linked to working memory impairments in schizophrenia. However, there is evident scarcity of research aimed at exploring the relationships among the three factors. In this secondary analysis of a randomized, controlled, double-blind trial, we investigated these relationships. The trial assessed the efficacy of transcranial direct current stimulation for enhancing working memory in clinically stable schizophrenia patients, who were randomly divided into three groups: dorsolateral prefrontal cortex stimulation, posterior parietal cortex stimulation, and sham stimulation groups. Transcranial direct current stimulation was administered concurrently with a working memory task over five days. We assessed the BDNF genotype, MMN amplitude, working memory capacity, and interference control subdomains. These assessments were conducted at baseline with 54 patients and followed up post-intervention with 48 patients. Compared to BDNF Met-carriers, Val homozygotes exhibited fewer positive and general symptoms and increased working memory capacity at baseline. A correlation between MMN amplitude and working memory capacity was noted only in BDNF Val homozygotes. The correlations were significantly different in the two BDNF genotype groups. Furthermore, in the intervention group that showed significant improvement in MMN amplitude, BDNF Val homozygotes exhibited greater enhancement in working memory capacity than Met-carriers. This study provides in vivo evidence for the interaction between MMN and BDNF Val/Met polymorphism for working memory capacity. As MMN has been considered a biomarker of N-methyl-D-aspartate receptor (NMDAR) function, these data shed light on the complex interactions between BDNF and NMDAR in terms of working memory in schizophrenia.

工作记忆缺陷是精神分裂症神经认知障碍的一个主要方面,有研究显示重复经颅磁刺激(rTMS)可明显改善精神分裂症患者的工作记忆缺陷,但不同研究的结果缺乏一致性.本文拟介绍精神分裂症的工作记忆缺陷及其相关重要脑区,综述rTMS治疗精神分裂症工作记忆缺陷的临床试验新进展,并提出下一步的研究方向.

Background: Post-traumatic stress disorder (PTSD) is highly prevalent in the individuals at clinical-high risk for psychosis (CHR). The aim of this study was to examine the efficacy and safety of Eye Movement Desensitization and Reprocessing (EMDR) in individuals at CHR with comorbid PTSD or subthreshold PTSD in a randomized controlled trial. Methods: Fifty-seven individuals at CHR with PTSD or subthreshold PTSD formed the study sample. The eligible participants were randomly assigned to a 12 weeks EMDR treatment (N = 28) or a waiting list condition (WL, N = 29). The structured interview for psychosis risk syndrome (SIPS), the clinician administered post-traumatic stress disorder scale (CAPS) and a battery of self-rating inventories covering depressive, anxiety and suicidal symptoms were administered. Results: Twenty-six participants in the EMDR group and all the participants in the WL group completed the study. The analyses of covariance revealed greater reduction of the mean scores on CAPS (F = 23.2, Partial 72 = 0.3, P < 0.001), SIPS positive scales (F = 17.8, Partial 72 = 0.25, P < 0.001) and all the self-rating inventories in the EMDR group than in the WL group. Participants in the EMDR group were more likely to achieve remission of CHR compared to those in the WL group at endpoint (60.7 % vs. 31 %, P = 0.025). Conclusions: EMDR treatment not only effectively improved traumatic symptoms, but also significantly reduced the attenuated psychotic symptoms and resulted in a higher remission rate of CHR. This study highlighted the necessity of adding a trauma-focused component to the present approach of early intervention in psychosis.

Depression is a common mood disorder with a high recurrence rate and a considerable proportion of patients with residual symptoms. It was found that the traumatic symptoms of patients with depression were significantly correlated with their residual symptoms and recurrence. Therefore, the intervention of trauma in patients with depression may be an effective means to improve the symptoms and prognosis of the disease. Eye movement desensitization and reprocessing（EMDR） is a commonly used psychological therapy to intervene in trauma. This article reviews the application of EMDR in depression with traumatic symptoms.

Background Non-suicidal self-injury (NSSI) is more common in adolescents and its occurrence may be influenced by personality traits. Children and adolescents are a high-risk group for NSSI. Although there are some studies on the prevalence of NSSI, however, there are fewer studies on the factors associated with the severity of NSSI and the specific causes of the influence of NSSI and personality traits. Methods Participants of this study were junior high school students enrolled in three different schools of a Chinese province. NSSI was evaluated using the Adolescents Self-Harm Scale and their personality traits were assessed using the Neuroticism Extraversion Openness Five-factor Inventory (NEO-FFI). Results 2376 junior high school students participated, and the annual incidence of NSSI was 37.1% (n=881). The mean age of the NSSI-detected individuals was 13.61 years (SD=1.017). Out of total number of detections, 56.6% (n=499) were female and 67.4% (n=594) were individuals who self-injured using multiple means. Hair pulling, scratching the skin, and whacking harder objects with the hand were the most common modes of NSSI, with incidences of 51.0%, 43.0%, and 42.8% respectively in the NSSI-detected population. There was a negative association between grade and NSSI severity (p < 0.05), and NSSI was more severe in females. The scores in the Neuroticism dimension were higher in the group with NSSI than in the group without NSSI, while the scores in the extraversion, openness, agreeableness and conscientiousness dimensions were lower than in the group without NSSI (p < 0.01). Neuroticism and openness were significantly positively correlated with NSSI severity, and extraversion, agreeableness, conscientiousness were significantly negatively correlated with NSSI severity (p < 0.01). Conclusion The severity of NSSI was relatively higher in lower grades among junior grades and females, and the number of self-injury using multiple means was significantly higher; hair pulling, skin scratching and whacking harder objects with hands were the most common NSSI modalities. Among the personality traits, for the incidence of NSSI, high neuroticism was a risk factor, and high extraversion, openness, agreeableness, and conscientiousness were protective factors. For the severity of NSSI, high neuroticism and high openness were risk factors, and high extraversion, high agreeableness, and high conscientiousness were protective factors.

创伤后应激障碍(PTSD)常与精神病性障碍共病.共病精神病性障碍的PTSD患者常有病程长,症状重及社会功能差等特点.眼动脱敏与再加工(EMDR)治疗是PTSD的推荐治疗方法之一.但大多数EMDR治疗PTSD患者的研究都未纳入合并精神病性障碍患者,本文总结了至今为止EMDR治疗精神病性障碍的研究,为更好地在精神病性障碍患者中应用EMDR治疗提供参考.

AbstracObjectives This study aimed to preliminarily and exploratorily examine the associations between childhood trauma (CT), its subtypes, and personality traits among unaffected first-degree relatives (FDR, children, or siblings) of patients with major depressive disorder (MDD). Methods The study sample included three subgroups: MDD patients (N = 85), Patients' FDRs (N = 35), and healthy control individuals (HC, N = 89). The Childhood Trauma Questionnaire (CTQ) was used to assess childhood trauma and the Eysenck Personality Questionnaire was used to assess personality traits. Results Significant differences were found in a few personality traits (p < 0.05 for extraversion, neuroticism, and psychoticism) among MDD patients, FDR, and HC, and there were no significant differences between HC and FDR. In the FDR group, compared with those without CT, participants with CT scored significantly higher for neuroticism (N) (F = 3.246, p = 0.046). CT was significantly associated with N, psychoticism (P) and Lie (L), and the strongest association was between CT total score and N. Significantly positive correlations were found between N and sexual abuse (SA) (r = 0.344, p = 0.043), emotional neglect (EN) (r = 0.394, p = 0.019), physical neglect (PN) (r = 0.393, p = 0.019), and CTQ total score (r = 0.452, p = 0.006); between P and CTQ total score (r = 0.336, p = 0.049); and significant negative correlations were found between L and EN (r = -0.446, p = 0.007), CTQ total score (r = -0.375, p = 0.027). Conclusion In unaffected FDRs, there were significant associations between childhood trauma and a few personality traits, including neuroticism, psychoticism, and lie, and emotional neglect was significantly associated with neuroticism.

High-risk populations of schizophrenia can be mainly identified as genetic high-risk based on putative endophenotypes or ultra-high-risk (UHR) based on clinically manifested symptoms. Previous studies have consistently shown brain structural abnormalities in both genetic high-risk and UHR individuals. In this study, we aimed to disentangle the convergent and divergent pattern of gray matter alterations between UHR and unaffected first-degree relatives from genetic high-risk individuals. We used structural MRI scans and voxel-based morphometry method to examine gray matter volume (GMV) differences among 23 UHR subjects meeting the Structured Interview for Prodromal Syndromes (SIPS) criteria, 18 unaffected first-degree relatives (UFDR), 26 first-episode schizophrenia patients (FES) and 54 healthy controls (CN). We found that a number of brain regions exhibited a monotonically decreasing trend of GMV from CN to UFDR to UHR to FES. Compared with CN, the UHR subjects showed significant decreases of GMV similar to the patients in the inferior temporal gyrus, fusiform gyrus, middle occipital gyrus, insula, and limbic regions. Moreover, the UHR transformed subgroup had significantly lower GMV than UHR non-transformed subgroup in the right inferior temporal/fusiform gyrus. On the other hand, the UFDR subjects only showed significant GMV decreases in the inferior temporal gyrus and fusiform. Moreover, we found GMV in the occipital lobe was negatively correlated with the UHR subjects' composite positive symptom of SIPS, and GMV in the cerebellum was positively correlated with FES subjects' symptom severity. Our results suggest that GMV deficits and regional dysfunction are evident prior to the onset of psychosis and are more prominent in the UHR than the UFDR individuals.