Schizophrenia Bulletin最新文献

{"title":"A Scoping Review of Methods, Guidelines, and Protocols Used for Dose Reduction or Discontinuation of Antipsychotic Medication in People Affected by Psychotic Disorders.","authors":"Isabelle Jeffares, Dara Friars, Helena Plapp, Kelly Allott, Cathal Cadogan, Dolores Keating, Catherine Mooney, Karen O'Connor, Brian O'Donoghue","doi":"10.1093/schbul/sbaf181","DOIUrl":"10.1093/schbul/sbaf181","url":null,"abstract":"<p><strong>Background: </strong>Individuals affected by psychotic disorders often decide to have a trial of dose reduction or discontinuation of their antipsychotic medications; however, there is a lack of evidence-based guidance for this practice. There is limited knowledge on the different methods for dose reduction or discontinuation of antipsychotic medications in which methods might be the safest and most effective. This scoping review aims to identify methods of antipsychotic dose reduction and discontinuation, to develop a comprehensive inventory of tapering strategies.</p><p><strong>Study design: </strong>A systematic search was performed in PubMed, EMBASE, PsycINFO, and Cochrane to identify publications involving antipsychotic dose reduction or discontinuation. We included primary studies, systematic reviews, theoretical papers, and guidelines.</p><p><strong>Study results: </strong>A total of 9005 unique articles were identified, and full text screening was conducted on 459 of these. Thirty-two articles were included in the final analysis: 28 related to oral antipsychotic medications and 4 to long acting injectables. Three broad categories of dose reduction/discontinuation were identified-immediate, rapid (<4 weeks), and gradual (short 4-26 weeks and long≥26 weeks). Further subtypes were identified, with reduction based on either the original starting dose or the most recent dose after the last reduction. The hyperbolic method estimates the dose reduction based on a gradual reduction in the D2 receptor occupancy.</p><p><strong>Conclusions: </strong>A wide range of antipsychotic tapering methods have been implemented internationally with no consensus on the best approach. The results of this scoping review could help to inform research on establishing the most effective methods of antipsychotic discontinuation.</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/PMC13645659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145378677","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":"Reconceptualizing Schizophrenia through a Patient-Oriented Perspective: a Systematic Review and Qualitative Meta-Synthesis.","authors":"Sofia Francesca Aprile, Alessandro Rodolico, Djordje Basic, Kerem Böge, Markus Bühner, Christoph U Correll, Cristiano Cutuli, Peter Falkai, Gerhard Gründer, Alkomiet Hasan, Stefania Lanzafame, Josef Priller, Christian Nikolaus Schmitz, Maria Salvina Signorelli, Irene Bighelli, Filippo Caraci, Stefan Leucht","doi":"10.1093/schbul/sbag122","DOIUrl":"10.1093/schbul/sbag122","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Schizophrenia spectrum disorders are typically described using positive and negative symptoms, yet standard diagnostic systems may not reflect the full range of how individuals experience the disorder. We hypothesized that synthesizing first-person accounts would yield a broader, clinically useful symptom framework that better represents lived experience.</p><p><strong>Study design: </strong>We performed a systematic review and qualitative meta-synthesis following Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines (PROSPERO: CRD420251069446). PubMed, PsycINFO, and Scopus were searched up to January 2026. Eligible studies used qualitative or mixed methods and reported first-person accounts from individuals with schizophrenia spectrum disorders. We included 52 peer-reviewed studies (2856 participants). We conducted two thematic syntheses: (1) general illness experience and (2) symptom experience organized using the Manual for Assessment and Documentation of Psychopathology in Psychiatry framework.</p><p><strong>Study results: </strong>Across illness experience, five themes emerged: pervasive effects on physical, psychological, social, and relational life; stigma and isolation; interactions with medication, clinicians, and services; disruption and fragmentation of self, reality, and meaning; and coping strategies, including the protective role of social support. Across symptom experience, fear recurred across psychotic and non-psychotic domains, and participants often described psychosis as a transformed experience of reality rather than discrete symptoms. Accounts spanned disturbances in consciousness, perception, thinking, cognition, affect, and behavior.</p><p><strong>Conclusions: </strong>Lived experience highlights marked heterogeneity that extends beyond traditional symptom dichotomies and is only partly captured by current diagnostic frameworks. Incorporating patient-reported perspectives may support more nuanced, person-centered assessment and evaluation of treatment response.</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/PMC13612232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040564","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":"Cognitive Behavior Therapy for Psychosis in People with Intellectual Disability—A Scoping Review","authors":"S R Vogels,A B P Staring,J de Jager","doi":"10.1093/schbul/sbag115","DOIUrl":"https://doi.org/10.1093/schbul/sbag115","url":null,"abstract":"Abstract Background and Hypothesis Cognitive behavior therapy for psychosis (CBTp) is effective in reducing psychiatric symptoms. Most CBTp trials have excluded patients with intellectual disabilities, even though intellectual disabilities are associated with an at least 3 times higher psychosis prevalence. More understanding of evidence-based approaches for this population is needed. The aim of this review was to assess the current state of knowledge about CBTp for people with both intellectual disabilities and psychosis. Specifically, the interests were the efficacy and feasibility of CBTp for this population and possible adaptations in clinical practice. Study Design A scoping review on CBTp for people with both psychosis and intellectual disabilities was performed using Cochrane library, EMbase, PUBMED, and PsycINFO, on October first, 2025. Study Results A total of 185 unique articles were identified; full text screening was conducted on 50 of these. Eighteen studies were included. Four case study publications, together describing nine patients, tentatively showed efficacy of CBTp despite intellectual disability. Further, patients with intellectual disability seemed able to understand key elements of CBTp. Preliminary evidence showed that core CBTp components can be kept in place, with only practical adjustments necessary. An overview of these CBTp adjustments is presented. Additionally, 6 trials looking at CBTp outcome moderation showed that cognitive impairments generally do not reduce benefits. Conclusion Cognitive behavior therapy for psychosis seems feasible for people with psychosis and intellectual disabilities, with only practical adjustments necessary. Randomized controlled trials are needed to study the efficacy of CBTp for this population.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"51 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deletion of Bmal1 in the Prelimbic Cortex Glutamatergic Neurons Triggers Schizophrenia-Like Behaviors in Mice.","authors":"Yi-Qin Yao, Bo-Wei Guo, Zhi-Yi Xu, Cun Wang, Hao Hong, Zhi-Gang Chen, Su-Su Tang","doi":"10.1093/schbul/sbag090","DOIUrl":"10.1093/schbul/sbag090","url":null,"abstract":"<p><strong>Background: </strong>While circadian disturbances are commonly comorbid with schizophrenia (SCZ), whether deficits in clock genes can induce SCZ-like behaviors in mice remains poorly understood. Brain and muscle Arnt-like protein 1 (Bmal1, also known as Mop3 or Arntl), a core circadian clock gene, is implicated in the regulation of circadian rhythms, and its single nucleotide polymorphism rs1982350 has been linked to the pathogenesis of SCZ.</p><p><strong>Study design: </strong>In the present study, we employed global or conditional Bmal1 knockout mouse models to explore the effects of Bmal1 deficiency on SCZ-like phenotypes.</p><p><strong>Study results: </strong>We found that global Bmal1 deletion resulted in hyperactivity, social impairment, anhedonia-like behavior, impaired pre-pulse inhibition, and cognitive deficits in mice, all of which recapitulate the core behavioral abnormalities characteristic of SCZ. Furthermore, enhanced excitability of glutamatergic neurons was identified in the prelimbic cortex (PrL) of Bmal1 knockout mice. Importantly, conditional Bmal1 deletion that specifically triggers localized circadian disruption in PrL glutamatergic neurons replicated the negative symptoms and cognitive deficits associated with SCZ, in the absence of hyperactivity and anhedonia-like behaviors. Mechanistically, Bmal1 in PrL glutamatergic neurons mediates SCZ-related negative symptoms and cognitive deficits via the glutamatergic projection from the PrL to the striatum.</p><p><strong>Conclusions: </strong>Together, these results reveal a previously unidentified role for Bmal1 deficiency in the PrL in driving SCZ-relevant negative symptoms and cognitive dysfunction. Our findings provide experimental evidence supporting a putative role for dysregulated circadian clock gene expression in the pathogenesis of SCZ.</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/PMC13502898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813870","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":"Coping Style as a Predictor of Relapse and Functioning in First Episode Psychosis.","authors":"Anna Georgiades, Ryan Hammoud, Shangqing Liu, Maria Chiara Del Piccolo, Aljawharah Almuqrin, Alina Jorovat, Nandinee Rajkhowa, Stefania Tognin, Andrea Mechelli","doi":"10.1093/schbul/sbag079","DOIUrl":"10.1093/schbul/sbag079","url":null,"abstract":"<p><strong>Background: </strong>Compromised coping responses to life stressors may influence the development, maintenance, and recovery of psychosis.</p><p><strong>Study design: </strong>A longitudinal design assessed 269 First Episode Psychosis (FEP) patients at baseline, 4, 8, and 12 months. Linear/logistic regressions and machine learning techniques evaluated whether baseline coping styles predicted clinical and functional outcomes.</p><p><strong>Study results: </strong>Relapse occurred in 22 (9%), 35 (14%), and 50 (20%) participants within 4, 8, and 12 months, respectively. Maladaptive coping was associated with higher odds of relapse within 12 months (OR = 1.06, 95% CI: 1.00-1.12), hallucinations (OR = 1.07, 95% CI: 1.01-1.13) and delusions (OR = 1.07, 95% CI: 1.02-1.13), and with poorer Global Assessment of Functioning symptom and disability scores across follow-up. Adaptive coping was significantly associated with lower odds of hallucinations (OR = 0.96, 95% CI: 0.92-1.00) and delusions (OR = 0.95, 95% CI: 0.91-0.99) and with better functioning at 4 months (B = 0.35, SE = 0.13). Machine learning indicated that maladaptive (AUC = 0.770, accuracy [ACC] = 0.750) and adaptive coping (AUC = 0.729, ACC = 0.696) were significantly associated with relapse within 12 months, with maladaptive coping showing stronger predictive accuracy. Key contributors included self-distraction and substance use for maladaptive coping, and spiritual/religious coping and active problem-solving for adaptive coping.</p><p><strong>Conclusions: </strong>Baseline coping styles were associated with clinical and functional outcomes in FEP. These findings suggest that targeting maladaptive coping, particularly self-distraction and substance use, while promoting active problem-solving and spiritual/religious coping, may inform future intervention development aimed at improving symptom trajectories and long-term functional recovery.</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/PMC13502908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813841","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":"Advancing Generative Artificial Intelligence for Clinical Assessment: Commentary on Chen, Horga, and Escola 2026.","authors":"George Chatzisofroniou, Alex S Cohen","doi":"10.1093/schbul/sbag174","DOIUrl":"10.1093/schbul/sbag174","url":null,"abstract":"<p><p>Chen et al. provide proof-of-concept evidence that a general-purpose LLM, using zero-shot training, can derive clinical ratings from transcripts of semi-structured interviews in the AMP-SCZ. In this commentary, we complement this line of research with three considerations. First, the psychometric evaluation strategy would benefit from explicit \"use case\" specifications, since acceptable performance thresholds differ substantially across various uses. In the Chen et al., data, there is relatively compressed symptom-severity distribution in the data that may obscure its reliability and validity for some, but not all, use cases. Second, defining benchmarks requires consideration. The reliability benchmark used in this study are defensible but may not be ideal for CHR populations and may not fully account for information asymmetries (e.g., evaluating nonverbal behavior from transcripts) between human and LLM raters. Involving consensus or multi-rater benchmarks might better establish ground truth and help evaluate the scientific value of these technologies. Third, involves reproducibility, as single-prompt and single-system validation leaves open how results may be idiosyncratically tied to a specific prompt wording of a specific LLM model. This is a particular issue given the rapid deprecation and change associated with LLM models. To advance the authors ambitious and important research agenda, we recommend fixed annotated validation sets with consensus benchmarks tied to pre-specified use-cases and validation protocols. Additionally, multi-model and ensemble approaches may be important for generalizing results beyond specific LLM technologies. Addressing these issues would strengthen confidence in deploying LLM-derived ratings as a scalable, multilingual tool for schizophrenia research and clinical practice.</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/PMC13563661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945498","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":"Seven Times Stronger.","authors":"","doi":"10.1093/schbul/sbaf182","DOIUrl":"10.1093/schbul/sbaf182","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/PMC13644812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128474","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":"What Kurt Schneider Also Said: The Primacy of Subjective Experience in the Concept of First Rank Symptoms.","authors":"Luis F Varela, Pablo López-Silva","doi":"10.1093/schbul/sbag123","DOIUrl":"10.1093/schbul/sbag123","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/PMC13644876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128550","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":"Stress Sensitivity and the Extended Psychosis Phenotype: Results from the Experience Sampling Method Study.","authors":"Tomasz Grąźlewski, Jerzy Samochowiec, Hanna Gelner, Łukasz Gawęda, Patryk Piotrowski, Błażej Misiak","doi":"10.1093/schbul/sbaf196","DOIUrl":"10.1093/schbul/sbaf196","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Individuals with psychosis might show heightened sensitivity to minor daily stressors. However, it is unclear if this sensitivity extends to the broader population with subclinical psychopathology, reflected in psychotic-like experiences (PLEs). This study examined whether individuals with PLEs show increased symptom and cortisol responses to minor daily stressors.</p><p><strong>Study design: </strong>Altogether, 99 individuals with PLEs and 102 controls without PLEs were enrolled from the general population (aged 18-35 years). Using the experience sampling method over 7 days, participants reported PLEs, negative affect, threat anticipation, aberrant salience, and stress across different categories: area-related, activity-related, event-related, and social stress. Saliva samples for cortisol measurement were collected after each prompt.</p><p><strong>Study results: </strong>Participants with PLEs demonstrated significantly greater symptom and threat anticipation responses to all stress categories compared to controls. Aberrant salience responses to stress showed sex differences; females with PLEs exhibited stronger aberrant salience responses to most stress categories compared to males, a pattern not observed in controls. Elevated salivary cortisol levels were found among participants with PLEs (Cohen's d = 0.265) regardless of stress exposure, though this effect varied across stress categories in different models.</p><p><strong>Conclusions: </strong>The extended psychosis phenotype might be linked to elevated salivary cortisol and heightened responses to minor stressors in affective symptoms and threat anticipation, supporting the presence of increased stress sensitivity in people with PLEs. The observed sex-specific differences indicate that aberrant salience may play a distinct and nuanced role in stress sensitivity among individuals with PLEs, especially in females.</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/PMC13645662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422622","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":"Psychosocial Interventions for Older Adults With Severe Mental Illness: A Systematic Scoping Review and Meta-analysis.","authors":"Macarena Sánchez-Izquierdo, Ignacio Echegoyen, Ellen Lee, Vanesa Peinado, Francisco López-Arroyo, Rocío Caballero","doi":"10.1093/schbul/sbaf169","DOIUrl":"10.1093/schbul/sbaf169","url":null,"abstract":"<p><strong>Background: </strong>Older adults with severe mental illness (SMI) experience complex rehabilitative needs that are often neglected in clinical and research settings. Psychosocial interventions are key to supporting recovery; however, evidence specific to this population remains fragmented. This scoping review and meta-analysis aims to synthesize available research on psychosocial interventions designed for older adults with SMI and evaluate their effectiveness.</p><p><strong>Study design: </strong>Following the Arksey and O'Malley framework and PRISMA-ScR guidelines, we conducted a comprehensive search across PubMed, PsycINFO, and Scopus for studies published between 2000 and 2023. Eligibility was based on the PICO framework, focusing on adults aged ≥ 50 with SMI. Data were extracted and analyzed using descriptive synthesis and meta-analytic techniques.</p><p><strong>Study results: </strong>Sixteen studies met the inclusion criteria, encompassing 884 participants. Interventions primarily targeted clinical recovery, with limited focus on aspects of personal recovery. Meta-analysis indicated a moderate overall effect size (ES = 0.366, P < .0001) with low heterogeneity (I2 = 18.81%). Quality assessment revealed that 62.5% of studies had medium to high risk of bias.</p><p><strong>Conclusions: </strong>While psychosocial interventions show promise in improving clinical outcomes for older adults with SMI, there is a significant gap in addressing personal recovery dimensions. Future research should emphasize holistic, long-term interventions to enhance both clinical and personal recoveries.</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/PMC13645829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150437","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}