Peripersonal Space Plasticity in Relation to Psychopathology and Anomalous Subjective Experiences in Individuals With Early-Onset and Adult-Onset Schizophrenia.

INTRODUCTION: Individuals with schizophrenia present anomalies in the extension and plasticity of the peripersonal space (PPS), the section of space surrounding the body, shaped through motor experiences. A weak multisensory integration in PPS would contribute to an impairment of self-embodiment processing, a core feature of the disorder linked to specific subjective experiences. In this exploratory study, we aimed at: (1) testing an association between PPS features, psychopathology, and subjective experiences in schizophrenia; (2) describing the PPS profile in individuals with early-onset schizophrenia. MATERIALS AND METHODS: Twenty-seven individuals with schizophrenia underwent a task measuring the PPS size and boundaries demarcation before and after a motor training with a tool. The Positive And Negative Syndrome Scale (PANSS), the Examination of Anomalous Self Experience scale (EASE) and the Autism Rating Scale (ARS) were used to assess psychopathology. Subsequently, participants were divided into two subgroups, early and adult-onset schizophrenia. The two groups were compared in regard to their PPS and psychopathological profiles. RESULTS: PPS patterns were associated with psychopathology, particularly positively with PANSS negative scale score, and negatively with subjective experiences of existential reorientation (EASE Domain 5 scores) and of social encounters (ARS scores). Only PPS parameters and ARS scores differentiated between early and adult-onset participants. CONCLUSIONS: Our results, although preliminary and exploratory, can suggest a link between PPS patterns, negative symptoms, and disturbances of the subjective experience, particularly in the intersubjective domain, in schizophrenia. Moreover, they seem to suggest that specific PPS profiles and schizophrenic autism traits could be markers of early-onset schizophrenia.

[Melatonergic antidepressant agomelatine: augmentation of antipsychotic drugs in treatment of post-schizophrenic depression]. / Melatoninergicheskii antidepressant agomelatin: augmentatsiya antipsikhotikov v terapii postshizofrenicheskikh depressii.

The article presents an analytical review of the data on the effectiveness of agomelatine as an augmentation of antipsychotics in the treatment of post-schizophrenic depression (PSD). The results of 5 published studies with a total sample size of 137 patients, the duration of therapy from 28 to 180 days with the appointment of agomelatin in combination with antipsychotics, including cases of additional use of drugs of other classes (normotimics, antidepressants, anxiolytics, anticholinergic correctors) were used. As a result, a pronounced effect was established in the indicators of respondents and patients in remission, combined with a favorable tolerability and safety profile, determining the prospects for the use of agomelatin in the therapy of PSD. Certain limitations in the methodology, including open and uncontrolled research design and small sample sizes, determine the relevance of systematic controlled trials to confirm the results obtained.

Preparation and release pattern study of long-term controlled release Blonanserin microspheres.

To prepare a PLGA microsphere loaded with the antipsychotic Blonanserin without release leg period and released in a near-zero model for long time, in this study, 15 kDa and 75 kDa PLGA were chosen to be mixed with different ratios, and Blonanserin microspheres (Bn-MS) without significant differences in the particle size, drug loading capacity, and encapsulation rate were prepared by microfluidics. The release kinetic model was fitted to the release behavior by monitoring the changes in particle size and morphology during the Bn-MS release to investigate microspheres' in vitro release pattern. The results showed that the addition of appropriate ratios of mixed molecular weights to Bn-MS could eliminate the release hysteresis period. When the ratio of 15 kDa and 75 kDa was 1:9 (F3), the Bn-MS had a low burst release rate, moderate release rate, no release hysteresis period, a long release period of up to 35 days, and a stable release pattern close to the zero level. The results of the release mechanism study indicated that the hybrid PLGA improved the release behavior of the microspheres by adjusting the dissolution degradation rate of Bn-MS, which in turn affected the release mechanism of the microspheres.

[Schizophrenia spectrum disorders (aspects of psychopathology and clinical taxonomy)]. / Rasstroistva shizofrenicheskogo spektra (aspekty psikhopatologii i klinicheskaya sistematika).

OBJECTIVE: To create a new taxonomy of schizophrenia spectrum disorders (SSD) based on the comparability of the design of SSD and borderline states. MATERIAL AND METHODS: The total sample consists of 205 patients with an established diagnosis of SSD (F21; F25; F22 according to ICD-10) collected from studies of the department of borderline mental pathology and psychosomatic disorders of the Federal State Budgetary Institution Mental Health Research Center and the Department of Psychiatry and Psychosomatics of Moscow State Medical University in the period 2014 to 2024. Clinical, psychometric, statistical methods were used. RESULTS: A new two-level model of schizotypal personality disorder (STPD) has been developed: the first level is psychopathic-like disorders of the «Ferschroben¼ type; the second level are psychopathological disorders (positive, negative, etc.), appearing under their «mask¼, constituting a «tracing paper¼ of manifestations of schizophrenia «in miniature¼. The two-level psychopathological model of STPD is a complex clinical phenotype, including independent but overlapping phenotypic formations: psychopathic-like - the «Ferschroben¼ type; and basic - schizophreniform disorders. CONCLUSION: The clinical classification of schizophrenia spectrum disorders has been developed; pseudoneuroses and stress-induced disorders of the endogenous circle are considered in the aspect of the dynamics of STPD.

Changes in brain-derived neurotrophic factors in schizophrenic patients with spiritual psychoreligious therapy.

Objectives: To examine the effect of Spiritual Quranic Emotional Freedom Technique therapy on the level of brain-derived neurotrophic factor in schizophrenic patients. METHODS: The quasi-experimental study was conducted from August to December 2021 at the Polytechnic of Health, Kendari, Indonesia, and comprised patients of either gender aged >20 years who had been diagnosed with schizophrenia by psychiatrists using the text-revised version of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, had Brief Psychiatric Rating Scale score 50-60, and were part of the treatment programme at the polyclinic. They were divided into experimental group A and control group B. Patients in group A were given 30 days of Spiritual Quranic Emotional Freedom Technique therapy, while those in group B received only education about the spiritual therapy with the recommendation to listen to the Quran verses. A set of healthy controls memorizing the Quran was enrolled from the Islamic Boarding School, Kendari, and placed in group C. They were given education about the need to keep reading and learning the Quran. The intervention was done 2 times per week for 4 weeks. Serum brain-derived neurotrophic factor level for all groups and the Brief Psychiatric Rating Scale score for groups A and B were assessed at baseline and post-intervention. Data was analysed using SPSS 22. RESULTS: Of the 30 subjects, 16(53.3%) were females and 14(46.7%) were males. There were 11(36.7%) subjects aged 31-40 years. Each of the 3 groups had 10(33.3%) subjects. There was a significant decrease in Brief Psychiatric Rating Scale scores in groups A and B post-intervention (p<0.000). There was a significant increase in serum brain-derived neurotrophic factor levels post-therapy in groups A and C (p<0.001), while in group B it was not significant (p=0.500). CONCLUSIONS: Spiritual Quranic Emotional Freedom Technique therapy could enhance clinical improvement and brain function in schizophrenic patients.

Combining mHealth Technology and Pharmacotherapy to Improve Mental Health Outcomes and Reduce Human Rights Abuses in West Africa: Intervention Field Trial.

Background: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses.

Efficacy and safety of low-dose amisulpride versus olanzapine-fluoxetine combination in post-schizophrenic depression: A randomized controlled trial.

Post-schizophrenic depression (PSD) increases the morbidity, mortality, and health burden in patients with schizophrenia. However, treatment of PSD is challenging due to the lack of substantial evidence of standard clinical practice. This study was aimed at comparing the efficacy and safety of low-dose amisulpride versus olanzapine-fluoxetine combination (OFC) in PSD. This was a randomized controlled trial conducted in sixty patients with PSD fulfilling the eligibility criteria. Recruited patients were randomized to receive either amisulpride at low dose (i.e., 100-300 mg/day) or OFC (5/10 mg + 20 mg) for eight weeks. The Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression-Severity (CGI-S) and serum BDNF levels were assessed at baseline and after eight weeks of treatment. The change in the CDSS scores from baseline over eight weeks was significant in both the amisulpride and OFC groups. However, the changes were not significant when compared between the groups. Similarly, the changes in CGI-S scores and serum BDNF levels were significant in each group; but non-significant between the groups. A significant negative correlation was found between the changes in the CDSS scores and the serum BDNF levels in each group. No significant adverse events were noted in either group. Thus, to conclude, low-dose amisulpride can be a potential monotherapy in PSD with a favourable clinical outcome and safety profile (ClinicalTrials.gov ID: NCT04876521).

Neuropsychological dimensions related to alterations of verbal self-monitoring neural networks in schizophrenic language: systematic review.

Although schizophrenia has traditionally been interpreted as a disorder of thought, contemporary perspectives suggest that it may be more appropriate to conceptualize it as a disorder of language connectivity. The linguistic anomalies present in schizophrenia possess distinctive characteristics that, despite certain connections, are not comparable to aphasic disorders. It is proposed that these anomalies are the result of dysfunctions in verbal self-monitoring mechanisms, which may influence other neuropsychological dimensions. This study set out to examine the neuropsychological dimensions associated with alterations in the neural networks of verbal self-monitoring in schizophrenic language, based on the scientific evidence published to date. Exhaustive searches were conducted in PubMed, Web of Science, and Scopus to identify magnetic resonance studies that evaluated verbal self-monitoring mechanisms in schizophrenia. Of a total of 133 articles identified, 22 were selected for qualitative analysis. The general findings indicated alterations in frontotemporoparietal networks and in systems such as the insula, amygdala, anterior cingulate cortex, putamen, and hippocampus. Despite the heterogeneity of the data, it is concluded that language plays a fundamental role in schizophrenia and that its alterations are linked with other neuropsychological dimensions, particularly emotional and perceptual ones.

Delusión de «dog-gras¼: reporte de caso y revisión breve de la literatura / "Dog-gras" delusion: case report and brief literature review

RESUMEN El síndrome de Capgras forma parte de los síndromes delusionales de identificación errónea o falsa, y es el más frecuente de este grupo. Consiste en la convicción delusional de que una o más personas cercanas, mascotas u objetos inanimados han sido reemplazados por alguien o algo idéntico que es considerado como un sustituto o impostor. Son escasas las descripciones de este fenómeno con relación a los animales. En este reporte, se presenta, junto con una breve revisión de la literatura, el caso de un varón de 29 años, con diagnóstico de esquizofrenia paranoide, que acude al servicio de emergencia de un establecimiento psiquiátrico y que muestra delusiones de Capgras relacionadas a su mascota. El curso clínico mostró respuesta favorable al uso de un antipsicótico atípico. Se examinan varias teorías que intentan explicar el síndrome de Capgras vinculado a animales que tienen un significado emocional y relevante para el paciente. Este caso es el decimoprimero reportado en la literatura con respecto al síndrome de Capgras relacionado a mascotas. Una exploración adecuada en los pacientes psicóticos permitirá el reconocimiento de esta infrecuente entidad nosológica.

ABSTRACT Capgras Syndrome is one of the delusional misidentification syndromes, the most frequent in this group. It is characterized by the delusional conviction that one or more known people, pets, or inanimate things have been replaced by someone or something identical, that is considered a substitute or impostor. A few cases have been published about this phenomenon involving animals. The case of a 29-yearold male and a non-systematic review of relevant bibliography are reported. The patient had the diagnosis of paranoid schizophrenia and was seen in the emergency department of a mental health institution; psychotic symptoms and Capgras delusions related to his pet were evidenced. His clinical course showed a favorable response to an atypical antipsychotic. Different theories that attempt to explain the Capgras Syndrome extended to animals that have emotional and relevant significance for the patient, are examined. This is the eleventh case reported in the literature of Capgras Syndrome associated with pets. An appropriate exploration in psychotic patients will enable the recognition of this uncommon nosological entity.

A comparative study of interhemispheric functional connectivity in major depression and schizophrenia.

BACKGROUND: Major depressive disorder (MDD) and schizophrenia (SZ) are serious psychiatric disorders that, despite exhibiting different diagnostic criteria, exhibit significant overlap regarding the biological and clinical features of affected patients. While prior evidence has shown that interhemispheric functional connectivity (FC) is abnormal in MDD and SZ, the particular similarities and differences that unify and characterize MDD and SZ regarding these interhemispheric FC patterns remain to be characterized. This study was thus designed to conduct an in-depth analysis of MDD- and SZ-related patterns of interhemispheric FC. METHODS: This study enrolled MDD patients, SZ patients, and normal control (NC) individuals (n = 36 each). Resting-state functional MRI (rs-fMRI) studies of these patients were conducted, after which voxel-mirrored homotopic connectivity (VMHC) was used to analyze the preprocesses rs-fMRI data. The VMHC values in these different values were then compared through one-way ANOVAs and post hoc analyses. RESULTS: Significant differences were observed in both the striatum and middle frontal gyrus (MFG) when comparing these three groups. Through pairwise comparisons, MDD patients but not SZ patients exhibited reduced MFG VMHC values relative to the NC individuals. Conversely, striatum VMHC values significantly increased in SZ patients relative to NC individuals and MDD patients. CONCLUSION: These results support the interhemispheric functional disconnection hypothesis as a basis for the pathogenesis of MDD and SZ. The observed differences in interhemispheric FC in the MFG and striatum of MDD and SZ patients will offer a neuroimaging basis that can aid in the differential diagnosis of these debilitating conditions.

The Autism Rating Scale for Schizophrenia - Revised English Version: An Instrument to Characterize Schizophrenia Spectrum Disorders Phenotype.

Dis-sociality (DS) reflects the impairment of social experience in people with schizophrenia; it encompasses both negative features (disorder of attunement, inability to grasp the meaning of social contexts, the vanishing of social shared knowledge) and positive features (a peculiar set of values, ruminations not oriented to reality), reflecting the existential arrangement of people with schizophrenia. DS is grounded on the notion of schizophrenic autism as depicted by continental psychopathology. A rating scale has been developed, providing an experiential phenotype. Here we present the Autism Rating Scale for Schizophrenia - Revised English version (ARSS-Rev), developed on the Italian version of the scale. The scale is provided by a structured interview to facilitate the assessment of the phenomena investigated here. ARSS-Rev is composed of 16 distinctive items grouped into 6 categories: hypo-attunement, invasiveness, emotional flooding, algorithmic conception of sociality, antithetical attitude toward sociality, and idionomia. For each item and category, an accurate description is provided. Different intensities of phenomena are assessed through a Likert scale by rating each item according to its quantitative features (frequency, intensity, impairment, and need for coping). The ARSS-Rev has been able to discriminate patients with remitted schizophrenia from euthymic patients with psychotic bipolar disorder. This instrument may be useful in clinical/research settings to demarcate the boundaries of schizophrenia spectrum disorders from affective psychoses.

Prescribing pattern of antipsychotics for patients with schizophrenia using the total daily dose online tool.

This study aimed to investigate the prescribing pattern of antipsychotic medications for schizophrenia using the British National Formulary total daily dose (TDD) online tool. We analysed data from the electronic medical records at King Khalid University Hospital (KKUH) of 272 patients diagnosed with schizophrenia who were prescribed both typical and atypical antipsychotic medications. The results showed that aripiprazole was the most commonly prescribed antipsychotic drug, followed by haloperidol then risperidone. The TDD online tool was used to calculate the TDD of each prescribed antipsychotic medication. Most patients were prescribed doses within the recommended range for each medication, although some were prescribed doses above or below the recommended range. Moreover, a high recommended TDD was associated with the combined use of antipsychotics rather than monotherapy. Additionally, high TDD levels were associated with the following antipsychotics: haloperidol, olanzapine, paliperidone, and quetiapine. Our findings highlight the importance of using evidence-based tools such as the TDD online tool to guide prescribing practices and ensure optimal dosing of antipsychotic medications for patients with schizophrenia.

Schizophrenia: jinn, magic or disease? Experiences of family caregivers of patients with schizophrenia in Baloch ethnicity.

BACKGROUND: Cultural and religious beliefs are effective on people's attitudes towards schizophrenia and their help-seeking behaviors. This study aimed to explain the experiences of family caregivers of patients with schizophrenia in Baloch ethnicity. METHODS: This is a qualitative study with conventional content analysis approach. Purposive sampling was used and 21 participants, including family caregiver for patients with schizophrenia, a psychologist, a prayer-writer, and a normal person were interviewed in Sistan and Balochistan province in the southeast of Iran. Qualitative data were analyzed by Granheim and Lundman method. RESULTS: One main theme, three categories, and 10 Sub-categories were extracted from analysis of interviews. "Immersion in the cultural beliefs" was the main theme of the study with categories of "Belief in the superstitious and supernatural nature of the psychological disease", "Superstitious beliefs, an attempt to free the patient", and "Conflict between cultural beliefs and science". CONCLUSIONS: Help-seeking behaviors of family caregivers in Baloch ethnicity are influenced by their religious, superstitious, and cultural beliefs. Psycho-education should be part of all mental health education programs in these communities, as delays in treatment worsen the prognosis of people with schizophrenia. Training the medical staff to consider the culture, religion and therapeutic preferences of the Baloch people can be effective in advancing the goals. In addition, local influencers should stress the importance of health care alongside harmless local remedies.

Markers of schizophrenia at the prosody/pragmatics interface. Evidence from corpora of spontaneous speech interactions.

The speech of individuals with schizophrenia exhibits atypical prosody and pragmatic dysfunctions, producing monotony. The paper presents the outcomes of corpus-based research on the prosodic features of the pathology as they manifest in real-life spontaneous interactions. The research relies on a corpus of schizophrenic speech recorded during psychiatric interviews (CIPPS) compared to a sampling of non-pathological speech derived from the LABLITA corpus of spoken Italian, which has been selected according to comparability requirements. Corpora has been intensively analyzed in the Language into Act Theory (L-AcT) frame, which links prosodic cues and pragmatic values. A cluster of linguistic parameters marked by prosody has been considered: utterance boundaries, information structure, speech disfluency, and prosodic prominence. The speech flow of patients turns out to be organized into small chunks of information that are shorter and scarcely structured, with an atypical proportion of post-nuclear information units (Appendix). It is pervasively scattered with silences, especially with long pauses between utterances and long silences at turn-taking. Fluency is hindered by retracing phenomena that characterize complex information structures. The acoustic parameters that give rise to prosodic prominence (f0 mean, f0 standard deviation, spectral emphasis, and intensity variation) have been measured considering the pragmatic roles of the prosodic units, distinguishing prominences within the illocutionary units (Comment) from those characterizing Topic units. Patients show a flattening of the Comment-prominence, reflecting impairments in performing the illocutionary activity. Reduced values of spectral emphasis and intensity variation also suggest a lack of engagement in communication. Conversely, Topic-prominence shows higher values for f0 standard deviation and spectral emphasis, suggesting effort when defining the domain of relevance of the illocutionary force. When comparing Topic and Comment-prominences of patients, the former consistently exhibit higher values across all parameters. In contrast, the non-pathological group displays the opposite pattern.

Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence.

Objective: To explore the pattern of empathy characteristics in male patients with schizophrenia (SCH) and to examine whether empathy deficit is associated with impulsivity and premeditated violence. Methods: One hundred and fourteen male SCH patients were enrolled in this study. The demographic data of all patients were collected and the subjects were divided into two groups, namely, the violent group, including 60 cases, and the non-violent group, comprising 54 cases, according to the Modified Overt Aggression Scale (MOAS). The Chinese version of the Interpersonal Reactivity Index-C (IRI-C) was used to evaluate empathy and the Impulsive/Predicted Aggression Scales (IPAS) was employed to assess the characteristics of aggression. Results: Among the 60 patients in the violent group, 44 patients had impulsive aggression (IA) and 16 patients had premeditated aggression (PM) according to the IPAS scale. In the violent group, the scores of the four subfactors of the IRI-C, i.e., perspective taking (PT), fantasy (FS), personal distress (PD), and empathy concern (EC), were significantly lower than in the non-violent group. Stepwise logistic regression showed that PM was independent influencing factor for violent behaviors in SCH patients. Correlation analysis revealed that EC of affective empathy was positively correlated with PM but not with IA. Conclusion: SCH patients with violent behavior had more extensive empathy deficits compared with non-violent SCH patients. EC, IA and PM are independent risk factors of violence in SCH patients. Empathy concern is an important index to predict PM in male patients with SCH.

Association between polymorphism rs2421943 of the insulin-degrading enzyme and schizophrenia: Preliminary report.

BACKGROUND: Insulin-degrading enzyme (IDE) is an important gene in studies of the pathophysiology of type 2 diabetes mellitus (T2DM). Recent studies have suggested a possible link between type 2 diabetes mellitus (T2DM) and the pathophysiology of schizophrenia (SZ). At the same time, significant changes in insulin-degrading enzyme (IDE) gene expression have been found in the brains of people with schizophrenia. These findings highlight the need to further investigate the role of IDE in schizophrenia pathogenesis. METHODS: We enrolled 733 participants from the Czech Republic, including 383 patients with schizophrenia and 350 healthy controls. Our study focused on the single nucleotide polymorphism (SNP) rs2421943 in the IDE gene, which has previously been associated with the pathogenesis of Alzheimer's disease. The SNP was analyzed using the PCR-RFLP method. RESULTS: The G allele of the rs2421943 polymorphism was found to significantly increase the risk of developing SZ (p < 0.01) when a gender-based analysis showed that both AG and GG genotypes were associated with a more than 1.55 times increased risk of SZ in females (p < 0.03) but not in males. Besides, we identified a potential binding site at the G allele locus for has-miR-7110-5p, providing a potential mechanism for the observed association. CONCLUSION: Our results confirm the role of the IDE gene in schizophrenia pathogenesis and suggest that future research should investigate the relationship between miRNA and estrogen influence on IDE expression in schizophrenia pathogenesis.

Capturing the variety of clinical pathways in patients with schizophrenic disorders through state sequences analysis.

BACKGROUND: Care pathways are increasingly being used to enhance the quality of care and optimize the use of resources for health care. Nevertheless, recommendations regarding the sequence of care are mostly based on consensus-based decisions as there is a lack of evidence on effective treatment sequences. In a real-world setting, classical statistical tools were insufficient to consider a phenomenon with such high variability adequately and have to be integrated with novel data mining techniques suitable for identifying patterns in complex data structures. Data-driven techniques can potentially support empirically identifying effective care sequences by extracting them from data collected routinely. The purpose of this study is to perform a state sequence analysis (SSA) to identify different patterns of treatment and to asses whether sequence analysis may be a useful tool for profiling patients according to the treatment pattern. METHODS: The clinical application that motivated the study of this method concerns the mental health field. In fact, the care pathways of patients affected by severe mental disorders often do not correspond to the standards required by the guidelines in this field. In particular, we analyzed patients with schizophrenic disorders (i.e., schizophrenia, schizotypal or delusional disorders) using administrative data from 2015 to 2018 from Lombardy Region. This methodology considers the patient's therapeutic path as a conceptual unit, composed of a succession of different states, and we show how SSA can be used to describe longitudinal patient status. RESULTS: We define the states to be the weekly coverage of different treatments (psychiatric visits, psychosocial interventions, and anti-psychotic drugs), and we use the longest common subsequences (dis)similarity measure to compare and cluster the sequences. We obtained three different clusters with very different patterns of treatments. CONCLUSIONS: This kind of information, such as common patterns of care that allowed us to risk profile patients, can provide health policymakers an opportunity to plan optimum and individualized patient care by allocating appropriate resources, analyzing trends in the health status of a population, and finding the risk factors that can be leveraged to prevent the decline of mental health status at the population level.

H-bond-type thermo-responsive schizophrenic copolymers: The phase transition correlation with their parent polymers and the improved protein co-assembly ability.

Schizophrenic copolymers are one type of the popular smart polymers that show invertible colloidal structures in response to temperature stimulus. However, the lack of principles to predict the phase transition temperature of a schizophrenic copolymer from its corresponding parent thermo-responsive polymers limits their development. Additionally, studies on their applications remain scarce. Herein, a series of schizophrenic copolymers were synthesized by polymerization of a RAFT-made polymer precursor poly(acrylamide-co-N-acryloxysuccinimide-co-acrylic acid) (P(AAm-co-NAS-co-AAc)) with the mixture of N-isopropylmethacrylamide (NIPAm) and acrylamide (AAm) in varying molar ratios. In aqueous solution, the block P(AAm-co-NAS-co-AAc) and the block poly(NIPAm-co-AAm) exhibited upper and lower critical solution temperature (UCST and LCST) behavior, respectively. The schizophrenic copolymers featured either UCST-LCST, LCST-UCST, or only LCST thermo-responsive transition. A preliminary correlation of phase transition between the schizophrenic copolymers and their parent polymers was summarized. Furthermore, the co-assembly of the schizophrenic copolymers and proteins were conducted and the kinetics of protein loading and protein activity were investigated, which showed that the schizophrenic copolymers were efficient platforms for protein co-assembly with ultra-high protein loading while preserving the protein bioactivities. Additionally, all the materials were non-toxic towards NIH 3T3 and MCF-7 cells. This work offers the prospects of the schizophrenic polymers in soft colloidal and assembly systems, particularly in guiding the design of new materials and their use in biomedical applications.

Selfhood and alterity: schizophrenic experience between Blankenburg and Tatossian.

This paper presents a critical comparison between two phenomenological accounts of schizophrenic experience: on the one side, Blankenburg's seminal work on the basal disturbance (Grundstörung) of schizophrenia as loss of natural self-evidence (Natürlichen Selbstverständlichkeit); on the other side, Tatossian's insight, briefly elaborated in a lecture presented in Heidelberg in 1994 and largely forgotten by the relevant literature. Whereas the former mainly develops an intersubjective reading of schizophrenia, the latter suggests an intrasubjective understanding. Indeed, for Blankenburg, schizophrenic experience can be broadly characterized as a progressive impoverishment of our rootedness in the social world, leading to derealization and depersonalization. In this respect, Tatossian takes schizophrenic autism not as the effect of a loss of originary sociality but as the result of a deeper disproportion. For Tatossian, schizophrenia is characterized, ultimately, by a basic self-disorder or alteration that consists in the breakdown of the twofold dimension of transcendental subjectivity, encompassing both constituting consciousness and phenomenologizing onlooker. In this sense, his interpretation of schizophrenic disorders is closer to the ipseity-disturbance model. I show that while Blankenburg and Tatossian share a dialectical understanding of schizophrenia by pointing to basic modifications of the "transcendental organization" of experience, their divergence originates from a different reading of the phenomenological epoché. Except for the clinical perspective, the point of contention between Blankenburg and Tatossian seems to concern their use of internal resources of the Husserlian phenomenology. By presenting the philosophical presuppositions of their analyses, I discuss two key figures of phenomenological psychopathology by showing how their debate on the meaning of schizophrenic experience can be reframed by looking at the relationship between transcendental subjectivity and intersubjectivity in Husserl's phenomenology.