Schizophrenia Bulletin最新文献

{"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":"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":"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}

{"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":"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":"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}