Schizophrenia Bulletin最新文献

{"title":"A First-Person Account: Living with Chronic Epistemic Invalidation.","authors":"Joyce M G Vromen","doi":"10.1093/schbul/sbag029","DOIUrl":"https://doi.org/10.1093/schbul/sbag029","url":null,"abstract":"","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Childhood and Adolescent Loneliness in First-Episode Psychosis: Synergistic Polygenic Effects and Functional Outcomes.","authors":"Álvaro Andreu-Bernabeu, Javier González-Peñas, Miguel Bernardo, Silvia Amoretti, Julio Bobes, Manuel Arrojo, Mara Parellada, Michael O'Donovan, Jim van Os, Bart P F Rutten, Robin M Murray, Marta Di Forti, Evangelos Vassos, Celso Arango, Covadonga M Díaz-Caneja","doi":"10.1093/schbul/sbag107","DOIUrl":"10.1093/schbul/sbag107","url":null,"abstract":"<p><strong>Background: </strong>Prolonged childhood and adolescent loneliness (CAL) may mark an early socio-emotional vulnerability relevant to psychosis and interact with genetic liability. We examined whether CAL increases odds of first-episode psychosis (FEP), relates to diagnostic subtype and functioning, and interacts with polygenic risk scores (PGS) for schizophrenia (SCZ), bipolar disorder (BIP), and major depression (MDD).</p><p><strong>Study methods: </strong>We analyzed 2565 participants (1084 FEP, 1481 controls) from European Gene-Environment Interactions in Schizophrenia (EU-GEI) study. CAL was assessed retrospectively before age 12 (LNL12) and at 12-16 years (LNL12-16). Functioning was rated with a modified Global Assessment of Functioning (GAF). Genome-wide PGS for SCZ, BIP, and MDD were calculated using polygenic risk score-continuous shrinkage. Mixed-effects logistic and linear regression models tested associations of CAL with FEP, subtype, and functioning, including sex-stratified analyses. Additive gene-environment interaction was examined using dichotomized PGS and the Relative Excess Risk due to Interaction.</p><p><strong>Study results: </strong>Both LNL12 (OR = 2.90, 95% CI, 2.30-3.66) and LNL12-16 (OR = 2.34, 95% CI, 1.94-2.84) were associated with FEP, independent of premorbid social isolation. CAL increased FEP odds in both sexes. LNL12-16, but not LNL12, was associated with affective versus non-affective psychosis (OR = 1.37, 95% CI, 1.02-1.83), more clearly in females (OR = 1.79, 95% CI, 1.16-2.77). CAL was also associated with poorer functioning, with 3-4-point lower GAF Disability scores. Significant additive interactions were observed between LNL12-16 and SCZ-PGS, and between LNL12 and MDD-PGS, although the latter did not replicate in European-ancestry sensitivity analyses.</p><p><strong>Conclusions: </strong>Prolonged CAL is linked to higher risk of FEP, preferentially affective psychosis in females, poorer functioning, and developmental potentiation of polygenic liability.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning to Expect Less: An Ecological Momentary Assessment Study of Prediction Errors, Reward Anticipation, and Negative Symptoms in Daily Lives of People with Schizophrenia.","authors":"Matthias Pillny, Dilge N Durlanik, Tania M Lincoln, Matteo Cella, Til Wykes, Clementine J Edwards","doi":"10.1093/schbul/sbag125","DOIUrl":"10.1093/schbul/sbag125","url":null,"abstract":"<p><strong>Background and hypotheses: </strong>The brain continuously generates predictions about future experiences. When outcomes deviate from expectations, positive (+RPE) and negative (-RPE) reward prediction errors recalibrate predictions. Neuroimaging evidence indicates that amotivation in schizophrenia-spectrum disorders (SSD) is linked to blunted processing of +RPEs. Yet the nature of RPEs and their processing in the everyday lives of people with SSD remains unknown.</p><p><strong>Study design: </strong>This preregistered analysis pooled data from two studies (N = 147; SSD = 68, healthy controls [HC] = 79) to quantify daily-life +RPEs and -RPEs and test their association with subsequent updating of anticipatory pleasure. Participants completed six days of ecological momentary assessment capturing current and anticipated pleasure. +RPEs were defined as EMA assessments in which current pleasure exceeded anticipated pleasure at the previous prompt, -RPEs were defined as occasions in which current pleasure fell short of prior anticipation. Linear mixed-effects models tested group differences in RPE frequency and magnitude; time-lagged models assessed updating of anticipatory pleasure.</p><p><strong>Study results: </strong>Individuals with SSD reported fewer +RPEs (β = -0.05, p = .025), with no group difference in -RPEs or RPE magnitude. Within SSD, higher baseline amotivation was associated with smaller +RPEs (β = -0.08, p = .019). Time-lagged analyses revealed that in SSD, larger +RPEs predicted reduced subsequent anticipatory pleasure (β = -.171, p < .001), unlike in HCs (β = -.038, p = .26).</p><p><strong>Conclusions: </strong>Findings indicate that in everyday life, individuals with SSD experience fewer positive surprises and show maladaptive updating of reward expectations, potentially driving negative symptoms.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis and Other Substance Use, Experiences of Ethnoracial Discrimination, and Psychotic-Like Experiences.","authors":"Zeeshan M Huque, Thomas M Olino, Jason Schiffman, Vijay A Mittal, Lauren M Ellman","doi":"10.1093/schbul/sbaf183","DOIUrl":"10.1093/schbul/sbaf183","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Cannabis use has been linked to increased positive psychotic-like experiences (PLEs) and found to act additively with stressful/traumatic events to increase risk for psychosis. Emerging evidence suggests that experiencing ethnoracial discrimination is a chronic stressor associated with increased substance use and positive PLEs. We hypothesized that ethnoracial discrimination would be associated with increased positive PLEs through the indirect effect of increased cannabis use.</p><p><strong>Study design: </strong>Community individuals (n = 7,429) aged 16-30 ascertained from the Multi-site Assessment of Psychosis-risk (MAP) study completed self-report assessments of ethnoracial discrimination, cannabis and substance use, and positive PLEs. Statistical analyses using an indirect effects framework examined direct effects from ethnoracial discrimination to specific positive PLEs (non-persecutory ideation, persecution ideation, and perceptual abnormalities), and indirect effects through cannabis use. To test the specificity of cannabis, supplementary analyses examined indirect effects through other substance.</p><p><strong>Study results: </strong>Across Asian, Black, Hispanic, and non-Hispanic White participants, significant direct effects were found from ethnoracial discrimination to each positive PLE (all p < 0.01). Significant indirect effects were found through cannabis use and through other substance use among Asian, Black, and Hispanic individuals, and via other substance use in non-Hispanic White individuals (all 95% CIs excluded zero).</p><p><strong>Conclusions: </strong>Results suggest that any substance use, including but not limited to cannabis use, may be a common pathway by which exposure to stressful experiences of ethnoracial discrimination may contribute to increased positive PLEs. Findings have implications for targeting substance use in individuals who may be at increased risk for psychotic experiences and who have experienced ethnoracial discrimination.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145392594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dimensional and Network Architecture of Catatonia in Schizophrenia Spectrum Disorders and Mood Disorders: Evidence from a Large, Deeply Phenotyped Sample.","authors":"Stefan Fritze, Sebastian Volkmer, Stephanie Lefebvre, Dilsa Cemre Akkoc Altinok, Anastasia Pavlidou, Katharina Stegmayer, Andreas Meyer-Lindenberg, Sebastian Walther, Dusan Hirjak","doi":"10.1093/schbul/sbag118","DOIUrl":"10.1093/schbul/sbag118","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Catatonia is a transdiagnostic syndrome in schizophrenia spectrum disorders (SSD) and mood disorders (MOD), but both its empirical structure and the frequency of its signs and symptoms remain insufficiently understood.</p><p><strong>Study design: </strong>We examined 465 patients with SSD or MOD from Mannheim (Germany) and Bern (Switzerland) using the 40-item Northoff Catatonia Rating Scale (NCRS); 336 patients were additionally assessed with the Bush-Francis Catatonia Rating Scale (BFCRS). We examined the frequency of catatonia signs and symptoms across subthreshold and syndromal presentations (ICD-11, DSM-5) and analyzed the relationships between signs and symptoms using network analysis.</p><p><strong>Study results: </strong>84.1% of patients exhibited at least 1 catatonia sign or symptom, and 65.8% 3 or more on the NCRS, with 86 patients (18.5%) meeting ICD-11 criteria and 26 (5.6%) fulfilling DSM-5 criteria based on overlapping NCRS items. In the BFCRS subsample, 26.8% of patients showed at least 1 sign or symptom, and 14.6% 3 or more signs and/or symptoms. The most frequent signs/symptoms were flat affect, autism/withdrawal (>40%), staring, and rigidity (>20%), whereas severe motor signs/symptoms such as stupor, mutism, catalepsy, and waxy flexibility were less frequent (5%-10%). The NCRS network revealed weak to moderate associations among affective, behavioral, and motor signs and symptoms. The BFCRS network demonstrated comparable interrelations, supporting the NCRS findings, whereas the network in the ICD-11 subgroup was unstable.</p><p><strong>Conclusions: </strong>Catatonia emerges as a dimensional syndrome with frequent subthreshold manifestations. While syndromal catatonia aligns with ICD-11 psychomotor domains, subthreshold presentations do not, highlighting the need for systematic screening and refined dimensional models beyond categorical diagnosis.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Motor Trajectories and 2-Year Cognitive and Functional Outcomes in First-Episode Psychosis.","authors":"Eloi Giné-Servén, Gustavo J Gil-Berrozpe, Alejandro Ballesteros, Silvia Amoretti, Maria Florencia Forte, Joaquín Galvañ, Gisela Mezquida, Eduard Vieta, Renzo Abregú-Crespo, Ana Sánchez-Torres, Amira Trabsa, Elena de la Serna, Javier Labad, Miquel Bernardo, Manuel J Cuesta, PEPs Group","doi":"10.1093/schbul/sbag128","DOIUrl":"10.1093/schbul/sbag128","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Motor abnormalities (MAs) are intrinsic features of the psychosis spectrum, but their longitudinal associations with cognition and functioning remain unclear. We hypothesized that Positive and Negative Syndrome Scale (PANSS)-derived hypokinetic and hyperkinetic motor dimensions would be associated with cognitive and functional outcomes and that distinct longitudinal motor trajectories would capture clinically relevant heterogeneity in first-episode psychosis (FEP).</p><p><strong>Study design: </strong>In a multicenter naturalistic FEP cohort, 159 patients completed clinical, functional, and neurocognitive assessments at 2 months and 2 years. PANSS-derived motor dimensions were assessed longitudinally. Cross-sectional and longitudinal associations with cognition and functioning were examined using correlational, mixed-effects, and trajectory-based analyses, including growth mixture modeling.</p><p><strong>Study results: </strong>At 2 months, hypokinetic severity was associated with poorer verbal memory (r = -0.252, p = .002), whereas hyperkinetic severity was associated with poorer vocabulary (r = -0.260, p = .001) and verbal memory (r = -0.237, P = .003). Prospectively, higher 2-month hyperkinetic severity was associated with poorer vocabulary (r = -0.282, P < .001), verbal memory (r = -0.366, P < .001), and global cognition (r = -0.309, P = .001) at 2 years. Mixed-effects analyses confirmed associations between hyperkinetic severity and poorer longitudinal verbal memory trajectory (β = -0.295, P = .019). Higher-severity hyperkinetic trajectories remained associated with poorer 2-year verbal memory (β = -0.858, P = .003) and functional outcome (β = 10.209, P = .005).</p><p><strong>Conclusions: </strong>PANSS-derived motor dimensions capture meaningful longitudinal heterogeneity in FEP. Sustained hyperkinetic severity was consistently associated with poorer verbal memory and functional outcome over time, supporting the relevance of MAs as longitudinal correlates of cognitive and functional variability in early psychosis.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Hospitalization Outcomes after Enrollment in Coordinated Specialty Care for First-Episode Psychosis: Findings from the Early Psychosis Intervention Network (EPINET) in the United States.","authors":"Sümeyra N Tayfur, Zhiqian Song, Fangyong Li, Iruma Bello, Melanie E Bennett, Monica E Calkins, John A Cosgrove, Lisa Dixon, John Hsu, John M Kane, Molly A Lopez, Piper Meyer-Kalos, Tara A Niendam, Dost Öngür, Delbert Robinson, Alejandro Szmulewicz, Sophia Vinogradov, Jenifer L Vohs, Alan Breier, Vinod H Srihari","doi":"10.1093/schbul/sbag101","DOIUrl":"10.1093/schbul/sbag101","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric hospitalization is a key outcome in first-episode psychosis (FEP). Coordinated Specialty Care (CSC) is increasingly implemented across the United States, but hospitalization outcomes in real-world CSC settings remain uncertain.</p><p><strong>Study design: </strong>This cohort study used data from the Early Psychosis Intervention Network. The sample included 2951 individuals across six networks (87 clinics in 15 states), assessed at admission and every 6 months for 2 years. Outcomes included psychiatric hospitalization, number of admissions, and total nights hospitalized. Logistic, Poisson, and negative binomial regression models were used.</p><p><strong>Study results: </strong>At admission, 71.2% had been hospitalized in the prior 6 months. Older age was associated with lower hospitalization risk (odds ratios [OR], 0.95; 95% confidence intervals [CI], 0.92-0.98; P < .001), fewer admissions (incidence rate ratios [IRR], 0.98; 95% CI, 0.96-0.99; P = .003), and fewer nights hospitalized (risk ratios [RR], 0.96; 95% CI, 0.94-0.99; P = .002). Prior hospitalization predicted higher risk (OR, 1.52; 95% CI, 1.18-1.98; P = .001), more admissions (IRR, 2.89; 95% CI, 2.49-3.36; P < .001), and more nights hospitalized (RR, 3.04; 95% CI, 2.47-3.71; P < .001). Shorter duration of untreated psychosis (DUP) was associated with more admissions (IRR, 0.93; 95% CI, 0.89-0.96; P < .001) and more nights hospitalized (RR, 0.92; 95% CI, 0.88-0.96; P = .001).</p><p><strong>Conclusions: </strong>Hospitalizations decreased substantially after CSC admission and remained low over 2 years in this large national FEP cohort. Prior hospitalization and markers of earlier illness course (younger age and shorter DUP) were associated with higher hospitalization burden, highlighting targets for CSC care refinement.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosis Polyrisk Score and Polygenic Risk Score to Improve Detection and Prognosis in Individuals at Clinical High Risk for Psychosis: Model Development and Internal Validation.","authors":"Dominic Oliver, Maite Arribas, Yanakan Logeswaran, Laura Fusar-Poli, Matthew J Kempton, Emily P Hedges, Clara Albinaña, Evangelos Vassos, Amir Sariaslan, William Pettersson-Yeo, Lucia Valmaggia, Mark van der Gaag, Lieuwe de Haan, Barnaby Nelson, Patrick McGorry, Anita Riecher-Rössler, Erich Studerus, Rodrigo Bressan, Neus Barrantes-Vidal, Marie-Odile Krebs, Merete Nordentoft, Stephan Ruhrmann, Gabriele Sachs, Bart Rutten, Jim van Os, Daniel Stahl, Philip McGuire, Paolo Fusar-Poli","doi":"10.1093/schbul/sbag088","DOIUrl":"10.1093/schbul/sbag088","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Psychosis prevention can be supported by tools that facilitate the early detection of individuals at clinical high risk (CHR-P) and predicting their clinical outcomes. We aimed to use clinical, genetic, and environmental data to: (1) predict case-control status as a proof-of-concept for CHR-P detection, and (2) predict transition to psychosis.</p><p><strong>Study design: </strong>We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions: a multicenter cohort study comprising 344 CHR-P individuals and 67 healthy controls. To predict CHR-P status, we used environmental (Psychosis Polyrisk Score [PPS]) and genetic (polygenic risk score for schizophrenia [PRS]) measures with logistic regression (LR) and random forest (RF). To predict transition to psychosis, we used clinical, environmental, and genetic measures with Cox proportional hazards model and random survival forest. Primary outcomes were discrimination (C-index) and calibration (intercept and slope) in repeated nested cross-validation. Clinical utility was assessed with decision curve analysis.</p><p><strong>Study results: </strong>For detection of CHR-P, both PPS (LR:C = 0.91, 95% CI, 0.87-0.94, intercept = 1.46, slope = 0.73; RF:C = 0.77, 95% CI, 0.61-0.90, intercept = -0.53, slope = 0.42) and PPS + PRS (LR:C = 0.89, 95% CI, 0.85-0.92, intercept = 1.45, slope = 0.73; RF:C = 0.78, 95% CI, 0.65-0.89, intercept = -0.24, slope = 0.44) had excellent discrimination performance, whereas PRS performed substantially worse (LR:C = 0.60, 95% CI, 0.52-0.67, intercept = 1.63, slope = 0.81; RF:C = 0.57, 95% CI, 0.41-0.72, intercept = -0.84, slope = 0.10). All models over-estimated risk in individuals with low observed risk. Prognosis model performance was poor (C ≤ 0.65).</p><p><strong>Conclusions: </strong>CHR-P detection may be improved by using the PPS, though evidence is needed from more representative detection settings. However, we did not find evidence that baseline clinical, environmental and/or genetic data enhanced the prediction of psychosis onset.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Prodromal Questionnaire-16 for Screening and Prediction of Psychosis in Autistic Adults: Cross-Sectional and Longitudinal Findings From a National Cohort.","authors":"Djordje Basic, Sander Begeer, Tim Ziermans","doi":"10.1093/schbul/sbag160","DOIUrl":"10.1093/schbul/sbag160","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Autistic individuals are at elevated risk for psychosis, yet attenuated psychotic symptoms may go undetected due to overlapping features and limited validation of screening tools in autistic populations. This study evaluated the performance of the Prodromal Questionnaire-16 (PQ-16) in autistic adults, including its longitudinal predictive value for schizophrenia-spectrum diagnoses, and examined demographic and clinical correlates of attenuated psychotic symptoms.</p><p><strong>Study design: </strong>Using data from a large longitudinal cohort (the Netherlands Autism Register), we analyzed self-reported PQ-16 symptom and distress scores alongside demographic variables, age at autism diagnosis, autistic traits (AQ-28), and depressive symptoms (PHQ-Dep-4). Descriptive analyses characterized PQ-16 score distributions. Linear regression models examined predictors of PQ-16 symptom severity. Logistic regression and ROC analyses evaluated whether PQ-16 scores predicted self-reported new-onset schizophrenia-spectrum diagnoses at follow-up.</p><p><strong>Study results: </strong>Among 1686 autistic adults (mean age = 46.04), 34.1% exceeded the PQ-16 cutoff (≥6), indicating a substantially higher prevalence of attenuated psychotic symptoms than reported in non-autistic populations. In the fully adjusted model, higher PQ-16 scores were independently associated with greater autistic trait severity and depressive symptoms. New-onset schizophrenia-spectrum diagnoses based on self-report occurred in 1.4% of participants with longitudinal data (5/361) and were observed exclusively among individuals above the PQ-16 cutoff (3.2% vs 0.0%, P = .015). ROC analyses suggested apparent discrimination for PQ-16 total, distress, and combined scores, although estimates should be interpreted cautiously given the very small number of incident cases.</p><p><strong>Conclusions: </strong>The PQ-16 identifies meaningful patterns of attenuated psychotic symptoms in autistic adults. Findings support brief screening as part of a 2-step assessment approach.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the At-Risk Mental State: Metastability and Hybrid States of Reality in Emerging Psychosis.","authors":"Philippe Nuss, Maharajah Ponnaiah, Vince Calhoun","doi":"10.1093/schbul/sbag126","DOIUrl":"10.1093/schbul/sbag126","url":null,"abstract":"<p><p>The ultra-high-risk (UHR) and at-risk mental state (ARMS) constructs were originally developed to identify individuals at imminent risk of transition to psychosis. However, declining transition rates, limited predictive value, and the persistence of significant non-psychotic morbidity increasingly challenge the view of ARMS as a brief, transitional stage along a linear continuum from health to illness.Here, we propose here an alternative conceptualization of ARMS/UHR as a relatively enduring clinical configuration. Clinically, this state is characterized by persistent experiences in which unusual perceptions or beliefs are layered onto ordinary reality, maintaining a sense of coherence. From this perspective, symptoms are not only markers of pathology, but can be understood as coherence-seeking responses when the self is destabilized. At the neurobiological level, we argue that this clinical configuration is paralleled by brain dynamics operating in a metastable regime. The brain is viewed as a dynamic system that flexibly reorganizes large-scale networks, balancing integration and segregation while minimizing energetic costs. Within this framework, ARMS may be understood as a self-sustaining, non-stationary network configuration that accommodates psychotic-like experiences without necessarily progressing to psychosis. Integrating phenomenological accounts of lived experience with systems-level models of brain dynamics, this perspective moves beyond risk prediction alone. It supports clinical approaches aimed at strengthening flexibility and reducing neural and cognitive effort while preserving adaptive functioning, and motivates research paradigms capable of capturing individual-level, time-varying brain dynamics in real-world contexts.</p>","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"52 5","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}