Alysis Reliability Study: Rearranging Phenomenology into Etiology in Mental Disorders

‘Alysis’ )abbreviation of Neuroanalysis(, - is the chosen definition for the rearrangement of psychiatric phenomology to approximate the hypothesized etiology of mental disorders. Currently the relevant scales such as Positive and Negative Symptoms Scale (PANSS) for schizophrenia and the Hamilton scales for depression and anxiety, and Mania Rating Scale have no specific guiding principle in the order of items. ‘Alysis’ is a reorganization of multiple known scales to fit a future brain-related diagnostic approach to mental disorders. Due to the regrouping of items from different scales and reorganizing them according to a brain-related hypothetic order, it is necessary to reassess the reliability of the new ‘Alysis’ rearrangement. In this work the new ‘Alysis’ format is described and then using t-scores analysis, compared to the widely-used Brief Psychiatric Rating Scale (BPRS) scale for mental disorders. It is shown that ‘Alysis’ is reliable thus can be a good diagnostic platform to go ahead and generate personalized testable-predictions about brain-related diagnostics for psychiatric patients.

Correlation between Post-Acute Electroconvulsive Therapy Alpha-Band Spectrum Power Increase and Improvement of Psychiatric Symptoms

The results of quantitative electroencephalography (qEEG) studies on electroconvulsive therapy (ECT) have been inconsistent, and indicators of the efficacy of ECT have not been clearly identified. In this study, we examined whether qEEG could be used as an indicator of the effect of ECT by measuring it during the course of treatment. We analyzed qEEG data before and after acute-phase ECT in 18 patients with schizophrenia, mood disorders, and other psychiatric disorders. We processed the qEEG data and compared the spectral power between the data acquired before and after ECT. The spectral power increased significantly after ECT in the delta, theta, and alpha bands. There was a strong significant correlation between the increase in the spectral power of the alpha band after acute ECT and improvement in the Brief Psychiatric Rating Scale score. Our results suggest that an increase in the alpha-band spectral power may be useful as an objective indicator of the treatment effect of acute ECT.

Sleep Disturbances and the Speed of Multimorbidity Development in Old Age

Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The goal of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N=3363). The study included a subsample (n=1189) without multimorbidity at baseline (<2 chronic diseases). Baseline sleep disturbances were assessed using the Comprehensive Psychiatric Rating Scale, and categorized as none, mild, moderate-severe. The number of chronic conditions throughout the nine-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic diseases accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, and musculoskeletal diseases as the outcome. Moderate-severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year=0.142, p=0.008), regardless of potential confounders. Significant positive associations were also found between moderate-severe sleep disturbances and neuropsychiatric (ß/year=0.041, p=0.016) and musculoskeletal (ß/year=0.038, p=0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.

The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services

Aims: Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. Methods: We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. Results: Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. Conclusion: These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.

The Course of Psychiatric Symptoms During Remand Imprisonment

Imprisonment may pose a risk for unintended effects such as deterioration of psychiatric symptoms. Therefore, it is pivotal to understand the relation between imprisonment and the course of psychiatric symptoms, but previous studies are inconclusive. The current study followed up the psychiatric symptoms of newly admitted remand prisoners to one Dutch remand prison using the Brief Psychiatric Rating Scale (BPRS) and also studied possible related pre-existing variables. On average we found an overall slight—yet clinically marginal—improvement of psychiatric, in particular affective symptoms. One in three prisoners deteriorated and prisoners with psychotic disorders less often deteriorated. Other variables were not related. Overall, psychiatric symptoms remain stable over time during early remand imprisonment independent of most psychiatric disorders. The context in the Dutch prison studied appears to be adequately organized in terms of handling psychiatric stability, but we notice that prison contexts may vary to a large extend.

Awareness of illness moderates self-assessment of psychotic symptoms

Objective: Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). Methods: A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. Results: A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings ( r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = –0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high ( r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients ( r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = –0.129, p = 0.897; disorganization: U = 2986.5, z = –0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = –1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. Conclusions: Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.

BDNF, GDNF, NGF and Klotho levels and neurocognitive functions in acute term of schizophrenia

Background Klotho and its relationship with neurotrophic factors and cognition in schizophrenia has not yet been investigated. In this study, the hypothesis that the blood serum levels of BDNF, GDNF, NGF and Klotho in schizophrenia patients and healthy controls would be related to cognitive functions was investigated. Methods In this study, two groups were assessed: schizophrenia patients (case group) who were hospitalised in the Psychiatry Clinic of Sakarya University Training and Research Hospital and healthy volunteers (control group). The patients were evaluated on the 1st and 20th days of their hospitalisation with the Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), the General Assessment of Functioning Scale (GAF) and the Clinical Global Impression Scale (CGI). For cognitive assessment, both groups were evaluated with the Wechsler Memory Scale-Visual Production Subtest (Wechsler Memory Scale III-Visual Reproduction Subtest) and the Stroop test. Results BDNF, GDNF, NGF and Klotho levels were lower in schizophrenia patients than in healthy controls. In the schizophrenia patients, on the 20th day of treatment, there was a statistically significant increase in BDNF compared to the 1st day of treatment. BDNF, GDNF and Klotho showed positive correlations with some cognitive functions in the healthy controls. BDNF, GDNF, NGF and Klotho levels were intercorrelated and predictive of each other in both groups. Conclusion This study suggests a relationship between cognitive functions, neurotrophic factors and Klotho. Most of the results are the first of their kind in the extant literature, while other results are either similar to or divergent from those generated in previous studies. Therefore, new, enhanced studies are needed to clarify the role of Klotho and neurotrophic factors in schizophrenia.

Validity and reliability of a Persian version of the self- evaluation of negative symptoms (SNS)

Aim The Self-evaluation of Negative Symptoms (SNS) has been developed to allow schizophrenia patients to evaluate themselves in five dimensions of negative symptoms. The present study aimed to examine psychometric properties of the Persian version of SNS. Methods A group of 50 patients with schizophrenia and a group of 50 healthy controls received the Persian-SNS. Severity of negative symptoms were evaluated by the Scale for Assessment of Negative symptoms (SANS) and the Brief Psychiatric Rating Scale (BPRS). Results The results showed that the Cronbach’s alpha for the Persian SNS was 0.95. The Persian-SNS and its subscales showed significant positive correlations with the total SANS score and SANS subscales as well as BPRS negative subscale, thus confirming the validity of the scale. Finally, the Persian-SNS showed the ability to discriminate patients with schizophrenia from healthy controls. Conclusion The acceptable properties of the Persian version of SNS demonstrated that it is a practical tool for screening negative symptoms in Persian-speaking schizophrenia patients.

Do Leptin Play a Role in Metabolism–Related Psychopathological Symptoms?

Objectives: Leptin is a crucial regulator of energy balance and is associated with obesity. In recent years, it has also been recognized as involved in the psychopathological mechanism. Our study aimed to elucidate the relationships between serum leptin levels, body mass index (BMI), and psychopathology symptoms in patients with schizophrenia.Methods: A cross-sectional assessment of 324 inpatients with schizophrenia was conducted. Schizophrenia symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). Serum leptin levels were assessed by the Enzyme-Linked Immunosorbent Assay (ELISA).Results: Significant differences in sex, BMI, and negative symptom subscale (PANSS-N) scores were found between the groups with high and low leptin levels in the study. Leptin levels were positively correlated with BMI (B = 2.322, t = 9.557, P &lt; 0.001) and negatively correlated with PANSS-N scores (B = −0.303, t = −2.784, P = 0.006).Conclusions: Our results suggest that the increase in leptin levels is responsible for antipsychotic-induced weight gain and improved psychopathological symptoms.

Clinical Utility of Wearable Sensors and Patient-Reported Surveys in Patients With Schizophrenia: Noninterventional, Observational Study

Background Relapse in schizophrenia may be preceded by early warning signs of biological, sensory, and clinical status. Early detection of warning signs may facilitate intervention and prevent relapses. Objective This study aims to investigate the feasibility of using wearable devices and self-reported technologies to identify symptom exacerbation correlates and relapse in patients with schizophrenia. Methods In this observational study, patients with schizophrenia were provided with remote sensing devices to continuously monitor activity (Garmin vivofit) and sleep (Philips Actiwatch), and smartphones were used to record patient-reported outcomes. Clinical assessments of symptoms (Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale) were performed biweekly, and other clinical scales on symptoms (Clinical Global Impression-Schizophrenia, Calgary Depression Scale), psychosocial functioning, physical activity (Yale Physical Activity Survey), and sleep (Pittsburgh Sleep Quality Index) were assessed every 4 weeks. Patients were observed for 4 months, and correlations between clinical assessments and aggregated device metrics data were assessed using a mixed-effect model. An elastic net model was used to predict the clinical symptoms based on the device features. Results Of the 40 patients enrolled, 1 patient relapsed after being stable with evaluable postbaseline data. Weekly patient-reported outcomes were moderately correlated with psychiatric symptoms (Brief Psychiatric Rating Scale total score, r=0.29; Calgary Depression Scale total score, r=0.37; and Positive and Negative Syndrome Scale total score, r=0.3). In the elastic net model, sleep and activity features derived from Philips Actigraph and Garmin vivofit were predictive of the sitting index of the Yale Physical Activity Survey and sleep duration component of the Pittsburgh Sleep Quality Index. On the basis of the combined patient data, a high percentage of data coverage and compliance (>80%) was observed for each device. Conclusions This study demonstrated that wearable devices and smartphones could be effectively deployed and potentially used to monitor patients with schizophrenia. Furthermore, metrics-based prediction models can assist in detecting earlier signs of symptom changes. The operational learnings from this study may provide insights to conduct future studies. Trial Registration ClinicalTrials.gov NCT02224430; https://www.clinicaltrials.gov/ct2/show/NCT02224430