Tobacco smoking and nicotine vaping in persons with first episode psychosis.

Tobacco smoking is highly prevalent in persons with psychosis and is the leading cause of preventable mortality in this population. Less is known about tobacco smoking in persons with first episode psychosis (FEP) and there have been no estimates about the prevalence of nicotine vaping in FEP. This study reports rates of tobacco smoking and nicotine vaping in young people with FEP enrolled in Coordinated Specialty Care programs in Pennsylvania and Maryland. Using data collected from 2021 to 2023, we examined lifetime and recent smoking and vaping and compared smokers and vapers to nonusers on symptoms, functioning, and substance use. The sample included 445 participants aged 13-35 with recent psychosis onset. Assessments were collected by program staff. Overall, 28 % of participants engaged in either smoking or vaping within 30 days of the admission assessment. Smokers and vapers were disproportionately male, cannabis users, and had lower negative symptom severity than non-smokers. Vapers had higher role and social functioning. Both smoking and vaping were related to a longer time from psychosis onset to program enrollment. We compare these findings to previous studies and suggest steps for addressing smoking and vaping in this vulnerable population.

Parental perceptions of second opinion consultations for recent onset schizophrenia.

AIM: Correct early diagnosis and intervention for schizophrenia is associated with improved outcomes. This study sought to determine the potential value of specialized consultations for individuals thought to have a recent-onset schizophrenia spectrum disorder who were not receiving specialized care. METHODS: 121 consecutive one-time consultations were performed in a clinic specializing in recent-onset schizophrenia. Parents of 79 patients were questioned about the process and the value of the consultation. RESULTS: Consultations were perceived by parents as both positive and helpful experiences. 85% of parents were somewhat or very happy with the consultation experience, and 86% found the consultation to be moderately or very helpful. A third of parents viewed the consultation as contributing to the long-term improvement of the patient's condition. CONCLUSIONS: The findings demonstrate the potential value of consultations for individuals with possible schizophrenia spectrum disorders not receiving specialized treatment, and provide rationale for comprehensive studies investigating the widespread implementation of such consultations.

Hearing Voices and Seeing Things: Symptoms of Anxiety Misconstrued as Evidence of Schizophrenia in an Adolescent.

A patient's complaint of "hearing voices" or "seeing things" or of similar perceptual abnormalities leaves the clinician with 2 decisions: (1) Is the patient actually experiencing a hallucination, or does the complaint reflect a different mental experience, ranging from outright fabrication to the misinterpretation or mislabeling of vivid thoughts and emotions? (2) How should the experience reported by the patient, whether determined to be a hallucination or not, be understood in the context of the patient's entire history and mental state? We report the case of a 16-year-old whose cartoon-like hallucinations had led to the diagnosis of schizophrenia and had directed attention of the patient, her parents, and her clinicians away from critical issues of anxiety, depression, learning difficulties, and traumatic school experiences. This case illustrates how the diagnosis of schizophrenia can be driven by the prominence and vividness of psychotic-like symptoms reported by a patient, the expectation that patients' chief complaints must be directly and immediately addressed, insufficient attention to collateral information, and the distortions of a "checklist" approach to psychiatric diagnosis driven by the criteria in the Diagnostic and Statistical Manual of Mental Disorders, insurers, and the properties of electronic medical records. Given the consequences of either underdiagnosing or overdiagnosing schizophrenia, and the current lack of validated objective tests to assist with this diagnosis, clinicians are obligated to perform a thorough clinical assessment of such patients, including a probing exploration of the patient's mental state and a systematic collection of collateral information.

Specialized Consultation for Suspected Recent-onset Schizophrenia: Diagnostic Clarity and the Distorting Impact of Anxiety and Reported Auditory Hallucinations.

Early detection of psychotic disorders is now recognized as vital in reducing dysfunction, morbidity, and mortality. However, making the diagnosis of a psychotic disorder, especially earlier in the course of disease, can be challenging, and an incorrect diagnosis of a psychotic disorder may also have significant consequences. We therefore, conducted a retroactive chart review of 78 patients referred to a specialty early psychosis consultation clinic to examine the role of specialty clinics in clarifying the diagnosis of early psychosis, especially potential schizophrenia. Of the 78 patients, 43 (55%) had a primary diagnosis at referral of a schizophrenia spectrum disorder. The primary diagnosis in the consultation clinic was different in 22 (51%) of these 43 cases, and 18 (42%) of these patients were not diagnosed with any form of primary psychotic disorder. These patients were more likely to report anxiety and less likely to report thought disorder than patients with a consultation diagnosis of schizophrenia or schizoaffective disorder. Clinicians may therefore overdiagnose schizophrenia, demonstrating the value of second opinions from clinics specializing in the diagnosis of recent-onset psychosis.

Risk of Hospitalization Due to Medication Nonadherence Identified Through EMRs of Patients With Psychosis.

OBJECTIVE: This study examined whether outpatients with a psychotic disorder who are at risk of hospitalization can be identified by using data from electronic medical records (EMRs). METHODS: Data from EMRs of outpatients enrolled in two clinics for treatment of psychotic disorders were abstracted. Monthly data were collected for 75 patients over two years. The study examined the association of medication nonadherence, substance use, participation in psychiatric rehabilitation, and long-acting injectable antipsychotic use in any given month with the risk of hospitalization in the subsequent month by using generalized estimating equations. RESULTS: The only variable found to increase the relative risk of future hospitalization was recorded medication nonadherence (adjusted relative risk=7.19, p<.001). CONCLUSIONS: Results suggest that recording medication nonadherence in EMRs is feasible and that these data may be used to identify patients at high risk of future hospitalization, who may require more intensive intervention.

Heterokaryon technique for analysis of cell type-specific localization.

A significant number of proteins are regulated by subcellular trafficking or nucleocytolasmic shuttling. These proteins display a diverse array of cellular functions including nuclear import/export of RNA and protein, transcriptional regulation, and apoptosis. Interestingly, major cellular reorganizations including cell division, differentiation and transformation, often involve such activities. The detailed study of these proteins and their respective regulatory mechanisms can be challenging as the stimulation for these localization changes can be elusive, and the movements themselves can be quite dynamic and difficult to track. Studies involving cellular oncogenesis, for example, continue to benefit from understanding pathways and protein activities that differ between normal primary cells and transformed cells. As many proteins show altered localization during transformation or as a result of transformation, methods to efficiently characterize these proteins and the pathways in which they participate stand to improve the understanding of oncogenesis and open new areas for drug targeting. Here we present a method for the analysis of protein trafficking and shuttling activity between primary and transformed mammalian cells. This method combines the generation of heterokaryon fusions with fluorescence microscopy to provide a flexible protocol that can be used to detect steady-state or dynamic protein localizations. As shown in Figure 1, two separate cell types are transiently transfected with plasmid constructs bearing a fluoroprotein gene attached to the gene of interest. After expression, the cells are fused using polyethylene glycol, and protein localizations may then be imaged using a variety of methods. The protocol presented here is a fundamental approach to which specialized techniques may be added.

Fisheries: deep-sea fishes qualify as endangered.

Criteria from the World Conservation Union (IUCN) have been used to classify marine fish species as endangered since 1996, but deep-sea fish have not so far been evaluated--despite their vulnerability to aggressive deepwater fishing as a result of certain life-history traits. Here we use research-survey data to show that five species of deep-sea fish have declined over a 17-year period in the Canadian waters of the northwest Atlantic to such an extent that they meet the IUCN criteria for being critically endangered. Our results indicate that urgent action is needed for the sustainable management of deep-sea fisheries.

Disturbed visual processing contributes to impaired reading in Alzheimer's disease.

The relationship between visual processing dysfunction and oral reading impairment was investigated in 17 patients with probable or possible Alzheimer's disease (AD). When dementia severity was controlled, a significant relationship was found between single word oral reading impairments and difficulties discriminating words written in different fonts and photographs of objects in different orientations, which are all functions believed to be dependent on the integrity of left ventral temporal-occipital visual association regions. By contrast, there was no significant relationship between reading performance and the score on a test of spatial localization, believed to be more dependent on parietal lobe function. There was also no relationship between reading ability and discrimination of unfamiliar faces, a function thought to engage right inferotemporal lobe structures. In contrast to the significant association between impaired reading and certain visual processes, when dementia severity was controlled, there was no relationship between reading and lexical semantic impairment. These results highlight the contribution of visual processing deficits to impaired oral reading in AD and further suggest that this association may derive from neuropathological changes in areas of the left temporal occipital lobes specialized for high-level visual processing.