BACKGROUND:Thought disorder (TD) is a core feature of severe mental illnesses such as schizophrenia, characterized by disruptions in speech, language, and communication. People with TD face unique barriers that hinder their involvement in research, both as participants and as partners. Their systematic underrepresentation in psychiatric research is driven by pervasive assumptions about their decisional capacity, willingness to participate, and ability to engage in research. This perpetuates a biased evidence base, likely hindering the therapeutic progress toward addressing this core problem. METHODS:This review, informed by professional (clinical and research) and lived (bottom-up and phenomenological) experience of TD, examines how flawed assumptions regarding capacity, engagement, and participatory abilities serve as active barriers to inclusion. RESULTS:We argue for a shift toward supported inclusion through tailored capacity assessments, enhanced informed consent procedures, targeted training of research personnel, and systemic institutional practices. Incorporating lived experiences of those with TD as research partners is integral to this approach, fostering co-production of research that is more valid, inclusive, and applicable. CONCLUSIONS:Without these inclusion-focused changes, the development of treatments for TD is likely to have very slow progress and a critical segment of the severely unwell population will continue to be underrepresented from the scientific process, undermining both the utility and generalizability of psychiatric research.

BACKGROUND:Formal thought disorder (FTD) is a key determinant of social functioning in schizophrenia. However, existing syntheses have not differentiated positive versus negative FTD dimensions, which have distinct trajectories, mechanisms, and treatment implications. We examined the differential associations of positive and negative FTD with social functioning. METHODS:A comprehensive systematic review with stricter inclusion criteria to update prior meta-analyses, searching Scopus and PubMed for publications up to 31 January 2026. Bayesian random-effects meta-analyses were performed separately for negative FTD (k = 7 studies, N = 1226) and positive FTD (k = 24, N = 4072). Bias was assessed using a modified Newcastle-Ottawa Scale. Robust Bayesian methods assessed publication bias. Protocol pre-registered with OSF: 10.17605/OSF.IO/WMT3X. RESULTS:Both dimensions showed negative associations with social functioning. Positive FTD demonstrated a robust pooled effect (r = -0.31, 95% CrI: -0.40 to -0.20) with extreme evidence (BF10 > 100, posterior probability ~100%). Negative FTD showed a smaller effect (r = -0.21, 95% CrI: -0.38 to 0.000) with moderate evidence (BF10 = 7.97, posterior probability = 88.9%). Positive FTD accounts for more variance in functioning than negative FTD, but this difference is not robust due to paucity of negative FTD studies. High heterogeneity (I2 > 76%), unexplained by known moderators, indicates substantial variation across study settings. CONCLUSIONS:Both FTD dimensions link to poorer social functioning, with stronger evidence for positive FTD due to more studies and larger samples. Positive FTD may affect social functioning by disrupting communicative competence, highlighting a need for interventions targeting communication deficits.

Background and objectives : Patients with Borderline Personality Disorder (BPD) often struggle in social interactions, exhibiting altered empathy and biased emotion recognition. Understanding how these aspects intertwine and relate to BPD symptoms remains unclear. This study aims at evaluating the ability to perceive both psychological and physical pain from a third-person and first-person perspective in BPD people and healthy controls, as well as to explore the interplay with childhood traumas, subjective empathy, alexithymia, emotion dysregulation and severity of symptoms. Methods : We utilized the 'Social Interaction Empathy Task' on an Italian sample (49 BPD patients, 52 healthy controls) to explore empathy for physical and psychological pain. We also evaluated emotion recognition alongside traits like alexithymia, childhood trauma, parenting style, dissociation, and impulsivity. Results : BPD patients perceived psychologically painful and neutral social situations as more distressing than controls, especially in the first-person perspective. A linear regression analysis revealed that 'Difficulty Describing Feelings' (DDF) subscale of the Toronto Alexithymia Scale (TAS-20) predicted ratings for psychologically painful images from a third-person view. Additionally, BPD patients frequently misinterpreted happy and neutral faces. We also observed correlations between emotion recognition and adverse childhood experiences, parenting style, and symptom severity. Conclusion : These findings suggest altered empathy for psychological pain in BPD patients, partly influenced by challenges in articulating emotions.

Serotonergic psychedelics are re-emerging as therapeutic candidates across psychiatry, particularly for treatment-resistant depression. Their rapid and sustained antidepressant effects, alongside evidence for neuroplastic, dopaminergic, and glutamatergic modulation, have prompted interest in whether they could address depressive and negative symptoms in schizophrenia spectrum disorders (SSDs). This narrative review summarizes mechanistic, preclinical, and early clinical findings relevant to psychedelic use in SSDs. Schizophrenia and major depressive disorder share disturbances in dopamine, glutamate, and neuroplasticity, and both involve large-scale network abnormalities. Schizophrenia is associated with widespread dysconnectivity, mesocortical hypodopaminergia, and striatal hyperdopaminergia linked to NMDA receptor hypofunction. Depression is characterized by fronto-limbic and default mode network hyperconnectivity, mesolimbic hypodopaminergia, and reduced cortical glutamatergic tone. Depressive symptoms within SSDs may reflect an intermediate phenotype combining depressive-like hyperconnectivity with schizophrenia-related global dysconnectivity, suggesting that psychedelics' capacity to transiently increase network flexibility and recalibrate maladaptive connectivity may be clinically relevant. Preclinical studies show increased dendritic spine density, enhanced BDNF expression, restored reward sensitivity, and modulation of network dynamics after psychedelic administration. Clinically, uncontrolled exposure appears associated with increased psychosis-related presentations, whereas limited case reports suggest controlled administration may be tolerated in carefully selected, clinically stable individuals with SSDs. To date, only one early-phase trial (MDMA in schizophrenia) is ongoing, and no randomized trials have evaluated psilocybin or LSD in SSDs. Overall, psychedelics are biologically and mechanistically plausible but remain unproven for depressive and negative symptoms in SSDs, which partially overlap. Carefully designed, safety-focused early-phase studies in clinically stable patients are therefore a prerequisite for broader clinical application.

Schizophrenia (SCZ) and frontotemporal dementia (FTD) are characterized by widespread neuroanatomical, neurophysiological and cognitive abnormalities and a progressive course leading to disability. Despite being two distinct clinical entities, SCZ and FTD present overlapping clinical features and neurobiological underpinnings, as highlighted by growing evidence. Both disorders are characterized by cognitive impairment, behavioral alterations, and substantial phenotypic heterogeneity. Parallel pathophysiological alterations include dopaminergic and glutamatergic dysfunction, particularly involving NMDA receptors, excitatory/inhibitory imbalance in the prefrontal cortex, and neuroimmune alterations. Additionally, dysregulation of the kynurenine pathway, driven by chronic inflammation, further contributes to cognitive decline in both conditions. Although SCZ is not conventionally classified as neurodegenerative, subtle neurodegenerative mechanisms may contribute to cognitive decline, complicating differential diagnosis with FTD. This narrative review explores biological systems and molecular pathways affected across both conditions, highlighting the potential for identifying transdiagnostic biomarkers and therapeutic targets. Recognizing the partial overlap in pathophysiology and symptomatology between SCZ and FTD may enhance diagnostic accuracy in atypical or early-stage presentations and support the development of mechanism-based transdiagnostic interventions targeting cognitive and behavioral domains. An integrated perspective on psychiatric and neurodegenerative disorders may inform both clinical practice and translational research.

BackgroundTobacco use is significantly more prevalent among individuals with schizophrenia spectrum disorders (SSD) compared to the general population, contributing to elevated rates of premature mortality from smoking-related diseases. Despite a decline in smoking prevalence in the general population, individuals with SSD continue to smoke at persistently high rates, driven by biological, psychological, and social factors. Standard smoking cessation approaches yield markedly poorer outcomes in this group compared to non-psychiatric populations. This scoping review aimed to map the emerging evidence on the use of e-cigarettes among individuals with SSD or serious mental illness (SMI).MethodsThis scoping review was conducted in accordance with the Population–Concept–Context (PCC) framework and reported following the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines. The review focused on studies published between January 2020 and February 2026, searched on PubMed and EMBASE, providing an up-to-date synthesis of emerging evidence on e-cigarette use in this vulnerable population.ResultsThree studies reported across four publications were included (total N = 323); one research group (Pratt et al.) contributed two separate publications reporting distinct outcomes from the same study cohort. Findings suggest that e-cigarette-based interventions are feasible and acceptable in individuals with SSD and SMI, with preliminary evidence of smoking reduction and decreased exposure to tobacco-related carcinogens. However, sustained harm reduction appeared dependent on a combined approach considering that device provision was empowered in its efficacy to sustain harm reduction over time when integrated with behavioral support.ConclusionsThe available evidence, while preliminary and limited by the small number of included studies, should be interpreted with caution regarding generalizability to patients with Schizophrenia Spectrum Disorders exclusively, as three of the four included publications recruited participants with broader SMI diagnoses of which SSD represents only a subset. Further research, including larger adequately powered trials with standardized outcome measures and longer follow-up, is needed to establish the generalizability and long-term impact of these interventions.

AIMS:This study investigates whether the melatonin (MLT) system modulates the behavioral, neurophysiological and neurochemical effects of fecal microbiota transplantation (FMT) from individuals with schizophrenia (SCZ), highlighting the role of the tryptophan (Trp) to MLT and kynurenine (Kyn) pathways. MATERIALS AND METHODS:FMT was performed using fecal samples from individuals with SCZ, characterized by distinct clinical, cognitive and metabolic profiles (severe vs mild SCZ), into antibiotic-treated MLT-deficient (C57BL/6) and MLT-proficient (C3H/HeJ) mice. Post-FMT evaluations included locomotor activity assessment (open field test), working memory testing (T-maze), in-vivo electrophysiological recordings from ventral tegmental area (VTA) dopamine (DA) neurons, and quantification of peripheral cytokines and central and peripheral Trp metabolites. KEY FINDINGS:In MLT-deficient mice, FMT from severe SCZ induced hyperlocomotion and altered peripheral inflammatory markers (decreased IL-1β, increased keratinocyte-derived cytokine) compared to FMT from mild SCZ. Conversely, in MLT-proficient mice, severe SCZ FMT induced persistent spatial working memory deficits and a significant reduction in overall VTA DA neuronal firing, specifically driven by the high-firing subpopulation. Furthermore, MLT-proficient mice receiving severe SCZ FMT selectively exhibited increased brain Trp levels alongside a decreased Kyn/Trp ratio. SIGNIFICANCE:Our findings identify the MLT system as a key biological switch that gates the impact of SCZ-associated microbiota on brain and behavior, dissociating behavioral from cognitive, neurophysiological and neurochemical outcomes. This work links circadian biology to microbiota-driven effects and points to the Trp-Kyn-MLT axis as a critical interface. This work provides a conceptual framework for targeting circadian-microbiome interactions, as a novel strategy to modulate disease-relevant phenotypes in SCZ.

Abstract Individuals with schizophrenia show well-documented impairment in metaphor comprehension, often exhibiting a bias toward concrete, literal interpretations. While this tendency has traditionally been linked to psychopathological and cognitive factors, the contribution of perceptual processes remains underexplored. Here, we tested the hypothesis that figurative language impairment reflects altered perceptual processing, whereby the visual representations evoked by metaphors remain abnormally active and hinder abstraction. A sample of 143 individuals with schizophrenia and healthy controls was administered a novel paradigm where metaphors (e.g., Wisdom is a flashlight ) served as primes for target words related to the metaphor vehicle based on visual (e.g., microphone ), action (e.g., remote ), or semantic features (e.g., lamp ). While in healthy participants metaphors activated semantically associated words, individuals with schizophrenia showed sustained visual priming, emerging 1000 ms after metaphor presentation and persisting up to 1400 ms, with both groups showing reverse priming for action targets. Critically, greater visual priming predicted lower metaphor comprehension in patients, whereas greater semantic priming was correlated with better metaphor skills in controls. These results suggest that visual-perceptual representations are not only overactivated in patients compared to controls during metaphor processing but may also interfere with figurative comprehension. We argue that concretism arises from an imbalance between bottom-up sensory signals and top-down contextual priors, leading to the persistence of the visual representations and impaired abstraction. More broadly, these results support multimodal and predictive accounts of metaphor processing and point to altered perceptual dynamics as a previously unappreciated mechanism contributing to pragmatic impairment in schizophrenia.

QuestionWhat is the global evidence on climate-related and nature-based mental health interventions?FindingsAlthough psychosocial interventions are currently recommended in treatment guidelines worldwide to reduce the adverse mental health effects of climatic impact drivers, this umbrella review found the credibility of the evidence basis for this recommendation to be very low. Nature-based interventions were associated with favorable mental health outcomes generally but evidence specifically for climatic impact drivers was lacking.MeaningGuidelines and policies for mental health interventions in the context of climate change need to be largely informed by global evidence from contexts other than climate change. This umbrella review and meta-analysis evaluates associations of climate-related and nature-based mental health interventions with mental health outcomes. ImportanceClimate change is associated with increasing mental health morbidity and mortality. However, an umbrella review to classify and quantify the global evidence on climate-related and nature-based mental health interventions is lacking.ObjectiveTo assess associations of climate-related and nature-based mental health interventions with mental health outcomes.Data SourcesPubMed, PsycINFO, Web of Science, and Cochrane databases were searched from inception to November 17, 2024.Study SelectionSystematic reviews with meta-analyses (SRMAs) with controlled climate-related or nature-based mental health interventions and mental health outcomes were included.Data Extraction and SynthesisStandardized mean differences (SMDs; intervention vs control) and 95% CIs were synthesized, evidence was stratified according to the level of credibility, and associations were assessed using meta-regression.Main Outcomes and MeasuresOutcomes were mental disorders, psychiatric symptoms, and positive mental health.ResultsTwenty-eight SRMAs were included that examined 344 studies and 91 associations between psychosocial or nature-based interventions and outcomes. Of the 91 associations, 10 (11%) had a moderate credibility of evidence and 81 (89%) had low or very low credibility. Psychosocial interventions addressing climatic impact drivers were associated with very low credibility, based on limited data. Nature-based interventions were associated with reductions in tension (SMD, -0.87; 95% CI, -1.31 to -0.43), fatigue (SMD, -0.80; 95% CI, -1.16 to -0.44), confusion (SMD, -0.65; 95% CI, -1.12 to -0.19), and negative affect (SMD, -0.51; 95% CI, -0.85 to -0.16), as well as increases in positive affect (SMD, 0.98; 95% CI, 0.65 to 1.30), vigor (SMD, 0.83; 95% CI, 0.37 to 1.28), and well-being (SMD, 0.40; 95% CI, 0.07 to 0.73), with moderate credibility of evidence and not addressing climatic impact drivers. Older participants and study locations with lower tree cover, better health care access and quality, and lower systemic vulnerability to climate change were associated with stronger improvements in negative affect following nature-based interventions.Conclusions and RelevanceThere is limited evidence for mental health interventions to reduce adverse mental health impacts of climatic impact drivers, but there is promising potential for future research in this field based on evidence from contexts other than climate change. Currently, strategies for mental health interventions in the context of climate change, such as those for implementing and scaling interventions, need to rely largely on global evidence from contexts other than climate change.

Serotonergic psychedelics are increasingly investigated as treatments for affective disorders. Concerns persist regarding their potential to induce hypomania or mania, particularly in individuals with bipolar spectrum vulnerability. Whether these substances precipitate transient mood switches or contribute to persistent bipolar illness or diagnostic transition remains unclear. We conducted a systematic review of human studies examining manic or hypomanic symptoms following exposure to serotonergic psychedelics (psilocybin, LSD, mescaline, DMT/ayahuasca) or MDMA (CRD420251160656). Databases and trial registries were searched through January 26, 2026. Eligible designs included randomized and non-randomized clinical studies, registry-based cohorts, cross-sectional surveys, and longitudinal observational studies. Outcomes included dysphoria/euphoria, manic or hypomanic symptoms and transition to bipolar disorder. Risk of bias was assessed using ROBINS-I, ROB2 or NIH tools. Twenty-three studies met inclusion criteria, four contributing to meta-analysis. Rates of psychedelic-associated dysphoria/euphoria, hypomania or mania ranged from 5.8% in controlled trials of psilocybin-assisted psychotherapy for major depressive disorders to 30% in naturalistic studies of individuals with bipolar disorder. When present, manic symptoms were typically acute and self-limited. Observational studies identified higher risks among individuals with bipolar I disorder, familial vulnerability, polysubstance use, and unsupervised or illegal use. Registry-based cohorts examining diagnostic transitions showed a prevalence of subsequent transition to bipolar disorder of 4% (95% CI 2-8%; N = 7478; I² = 32.1%), with little evidence for a hallucinogen-specific signal. Overall, serotonergic psychedelics appear to pose a low but clinically meaningful relative risk of transient mood-related symptoms in susceptible individuals while remaining relatively safe in controlled clinical settings. Long-term outcomes and repeated exposure remain insufficiently studied, underscoring the need for rigorous longitudinal research.

Background Clinical evaluation of language abilities is central to diagnosing impairments in neurological and neuropsychiatric conditions, such as brain injuries, Parkinson’s disease, or schizophrenia. However, assessment tools predominantly target structural and semantic aspects of language, while pragmatic and communicative abilities remain underrepresented, despite consistent evidence of their vulnerability across clinical populations. This gap is largely due to the scarcity of standardized and rapid tools for pragmatic assessment and the inherent difficulty of measuring context-dependent communicative abilities Aim This study aimed to develop and validate the German adaptation of the Assessment of Pragmatic Abilities and Cognitive Substrates Brief (APACS Brief-De), a 10-minute screening tool originally created in Italian, assessing discourse production and comprehension of non-literal language, to enable reliable and time-efficient evaluation of pragmatics in German-speaking contexts. Methods Adopting a culturally sensitive translation approach, a standard and a multiple choice APACS Brief-De were developed, each with an alternate form to allow for repeated assessments, which were administered remotely in a sample of healthy German-speaking adults. Results The APACS Brief-De Multiple Choice showed good consistency, reliability, validity, and equivalence between forms. Age and global cognitive performance significantly influenced pragmatic scores. The comparisons with the Italian standard form confirmed statistical equivalence, underscoring the robustness of the tool across languages. Age- and education-adjusted normative cut-off scores are provided for clinical interpretation. Conclusions APACS Brief-De offers a rapid and valid tool for assessing the global pragmatic profile, well-suited for integration into routine clinical practice, and represents a significant step toward crosslinguistic standardization of pragmatic assessment.

Difficulties in figurative language understanding are largely documented as part of a broader pragmatic impairment, especially in psychosis. Among figurative domains, metaphor stands out as a significant predictor of functioning, in addition to exhibiting meaningful associations with psychopathological and cognitive features. Yet, the assessment of metaphor comprehension remains a niche area, also due to the lack of reliable and valid tools. Here, we examined the psychometric properties of a rapid test of metaphor comprehension, the Physical and Mental Metaphors (PMM) task, involving a sample of 143 patients with schizophrenia and 57 controls. Findings provide robust support for the PMM reliability and validity. First, internal consistency was satisfactory, and the factorial structure aligned with theoretical assumptions. Second, the PMM demonstrated good validity, being strongly correlated with the pragmatic profile of patients as measured with a standard tool such as the Assessment of Pragmatic Abilities and Cognitive Substrates (APACS) test, showing also relevant associations with symptomatology, in particular abstract thinking and the broader domains of disorganization and negative symptoms, as well as weakly with Theory of Mind and global cognition. Third, the PMM task proved highly effective both in discriminating between individuals with and without pragmatic deficit, as detected via APACS, and in distinguishing patients from healthy controls. Taken together, these results indicate that the PMM task captures the specific impairment in figurative language and the general pragmatic vulnerability characteristic of schizophrenia, as well as their interface with symptoms. As such, it represents a valuable tool for detecting communicative disorders, characterizing symptoms and complementing the diagnostic process.

Importance:Climate change is associated with increasing mental health morbidity and mortality. However, an umbrella review to classify and quantify the global evidence on climate-related and nature-based mental health interventions is lacking. Objective:To assess associations of climate-related and nature-based mental health interventions with mental health outcomes. Data Sources:PubMed, PsycINFO, Web of Science, and Cochrane databases were searched from inception to November 17, 2024. Study Selection:Systematic reviews with meta-analyses (SRMAs) with controlled climate-related or nature-based mental health interventions and mental health outcomes were included. Data Extraction and Synthesis:Standardized mean differences (SMDs; intervention vs control) and 95% CIs were synthesized, evidence was stratified according to the level of credibility, and associations were assessed using meta-regression. Main Outcomes and Measures:Outcomes were mental disorders, psychiatric symptoms, and positive mental health. Results:Twenty-eight SRMAs were included that examined 344 studies and 91 associations between psychosocial or nature-based interventions and outcomes. Of the 91 associations, 10 (11%) had a moderate credibility of evidence and 81 (89%) had low or very low credibility. Psychosocial interventions addressing climatic impact drivers were associated with very low credibility, based on limited data. Nature-based interventions were associated with reductions in tension (SMD, -0.87; 95% CI, -1.31 to -0.43), fatigue (SMD, -0.80; 95% CI, -1.16 to -0.44), confusion (SMD, -0.65; 95% CI, -1.12 to -0.19), and negative affect (SMD, -0.51; 95% CI, -0.85 to -0.16), as well as increases in positive affect (SMD, 0.98; 95% CI, 0.65 to 1.30), vigor (SMD, 0.83; 95% CI, 0.37 to 1.28), and well-being (SMD, 0.40; 95% CI, 0.07 to 0.73), with moderate credibility of evidence and not addressing climatic impact drivers. Older participants and study locations with lower tree cover, better health care access and quality, and lower systemic vulnerability to climate change were associated with stronger improvements in negative affect following nature-based interventions. Conclusions and Relevance:There is limited evidence for mental health interventions to reduce adverse mental health impacts of climatic impact drivers, but there is promising potential for future research in this field based on evidence from contexts other than climate change. Currently, strategies for mental health interventions in the context of climate change, such as those for implementing and scaling interventions, need to rely largely on global evidence from contexts other than climate change.

Precision psychiatry aims to improve routine clinical practice by integrating biological, clinical, and environmental data. Many studies have been performed in different areas of research on major depressive disorder, bipolar disorder, and schizophrenia. Neuroimaging and electroencephalography findings have identified potential circuit-level abnormalities predictive of treatment response. Protein biomarkers, including IL-2, S100B, and NfL, and the kynurenine pathway illustrate the role of immune and metabolic dysregulation. Circadian rhythm disturbances and the gut microbiome have also emerged as critical transdiagnostic contributors to psychiatric symptomatology and outcomes. Moreover, advances in genomic research and polygenic scores support the perspective of personalized risk stratification and medication selection. While challenges remain, such as data replication issues, prediction model accuracy, and scalability, the progress so far achieved underscores the potential of precision psychiatry in improving diagnostic accuracy and treatment effectiveness.

Physical Restraint (PR) is a coercive procedure used in emergency psychiatric care to ensure safety in life-threatening situations. Because of its traumatic nature, studies emphasize the importance of considering the patient’s subjective experience. We pursued this aim by overcoming classic qualitative approaches and innovatively applying a multilayered semiautomated language analysis to a corpus of narratives about PR collected from 99 individuals across seven mental health services in Italy. Compared to a reference corpus, PR narratives were characterized by reduced fluency and lexical density, yet a greater use of emotional and cognitive terms, verbs, and first-person singular pronouns. Sadness was the most represented emotion, followed by anger and fear. One-third of the PR narratives contained at least one metaphor, with Animals and War/Prison as the most distinctive source domains. The quality and length of the PR experience impacted both the structure and the sentiment of the narratives. Findings confirm the distressful nature of PR but also point to the use of various linguistic mechanisms which might serve as an early adaptive response toward healing from the traumatic experience. Overall, the study highlights the importance of Natural Language Processing as an unobtrusive window into subjective experience, offering insights for therapeutic choices.

Lack of abstract thinking, known as concretism, is a well-known psychopathological feature of schizophrenia, reflecting the tendency to adhere to concrete aspects of stimuli and figurative language comprehension difficulties. Inspired by the similarity between 'concretism' as defined in psychopathology and 'concreteness' as defined in linguistics, namely a semantic dimension linked to perceptual experience, we tested the novel hypothesis that impairment in deriving figurative meanings is related to impairment at the semantic level, involving concreteness. We analysed speech samples from 63 individuals with schizophrenia and 47 controls, who were asked to verbalise the meaning of idioms, metaphors, and proverbs. By automatically extracting linguistic features from speech, we observed that answers in the schizophrenia group exhibited higher word concreteness and the related measure of word imageability, especially in proverbs, while not differing from controls' ones in lexical richness and speech-time composition. Concreteness in verbalisations produced by individuals with schizophrenia negatively predicted their ability to understand proverbs and their global pragmatic and cognitive profile. This study supports the idea that concretism is rooted in semantics, linking the tendency to concrete figurative interpretations and a bias towards concrete words. In this view, impairment in figurative language understanding can be seen as a difficulty in abstracting away from perceptual-related properties associated with linguistic inputs, in the broader context of multisensory integration disruption. The study discloses new areas of interest for the automated analysis of speech in psychosis, pointing to the importance of considering concreteness for better characterising linguistic profiles and identifying clinically relevant linguistic dimensions.

Pragmatics is key to communicating effectively, and its assessment in vulnerable populations is of paramount importance. Although tools exist for this purpose, they are often effortful and time-consuming, with complex scoring procedures, which hampers their inclusion in clinical practice. To address these issues, we present the Brief Assessment of Pragmatic Abilities and Cognitive Substrates (APACS Brief), a rapid (10 min), easy-to-use and freely distributed tool for evaluating pragmatics in Italian, inspired by the existing APACS test and already validated in the remote version (APACS Brief Remote). The APACS Brief test measures–with a simplified scale–the domains of discourse production and figurative language understanding and is developed in two parallel forms, each including novel items differing from APACS. Psychometric properties, cut-off scores, and thresholds for change were computed on 287 adults. The analysis revealed satisfactory internal consistency, good test–retest reliability, and strong concurrent and construct validity. Moreover, APACS Brief showed excellent discriminant validity on a sample of 56 patients with schizophrenia, who were also cross-classified consistently by APACS Brief and APACS cut-off values. Overall, APACS Brief is a reliable tool for evaluating pragmatic skills and their breakdown, with brief administration time and simple scoring making it well-suited for screening in at-risk populations.

Schizophrenia is a highly polygenic disease, and several genetic variants associated with the disease converge on altered synaptic homeostasis. In particular, the gene encoding complement component 4 (C4) showed the strongest association with schizophrenia, and this protein is involved in complement-dependent and microglia-mediated synaptic pruning. As a matter of fact, microglia are overactive in schizophrenia, and reduced synaptic arborization, especially in the prefrontal cortex (PFC), is an established hallmark of schizophrenia, likely associated with gray matter loss, cortical thinning, hypofrontality, and deficit syndrome. The recent development of a new radioligand targeting the synaptic vesicle glycoprotein 2A (SV2A) demonstrated in vivo lower synaptic density at the PFC level in individuals with schizophrenia, corroborating the synaptic hypothesis of thedisease first proposed by Feinberg in 1982. Interestingly, robust preclinical evidence (in vitro and animal models) showed the ability of psychedelics to promote neuroplasticity and synaptogenesis, potentially counteracting the excessive synaptic loss, restoring volume loss, and possibly explaining improvements in negative and cognitive symptoms described by old clinical studies. Overall, microdoses should be explored first as a possible treatment in a selected sample of patients affected by deficit schizophrenia, followed by low and full doses if encouraging results were to emerge.