Models of mild cognitive deficits in risk assessment in early psychosis.

BACKGROUND: Mild cognitive deficits (MCD) emerge before the first episode of psychosis (FEP) and persist in the clinical high-risk (CHR) stage. This study aims to refine risk prediction by developing MCD models optimized for specific early psychosis stages and target populations. METHODS: A comprehensive neuropsychological battery assessed 1059 individuals with FEP, 794 CHR, and 774 matched healthy controls (HCs). CHR subjects, followed up for 2 years, were categorized into converters (CHR-C) and non-converters (CHR-NC). The MATRICS Consensus Cognitive Battery standardized neurocognitive tests were employed. RESULTS: Both the CHR and FEP groups exhibited significantly poorer performance compared to the HC group across all neurocognitive tests (all p < 0.001). The CHR-C group demonstrated poorer performance compared to the CHR-NC group on three sub-tests: visuospatial memory (p < 0.001), mazes (p = 0.005), and symbol coding (p = 0.023) tests. Upon adjusting for sex and age, the performance of the MCD model was excellent in differentiating FEP from HC, as evidenced by an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.895 (p < 0.001). However, when applied in the CHR group for predicting CHR-C (AUC = 0.581, p = 0.008), the performance was not satisfactory. To optimize the efficiency of psychotic risk assessment, three distinct MCD models were developed to distinguish FEP from HC, predict CHR-C from CHR-NC, and identify CHR from HC, achieving accuracies of 89.3%, 65.6%, and 80.2%, respectively. CONCLUSIONS: The MCD exhibits variations in domains, patterns, and weights across different stages of early psychosis and diverse target populations. Emphasizing precise risk assessment, our findings highlight the importance of tailored MCD models for different stages and risk levels.

Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis.

OBJECTIVE: The argument surrounding the safety and effectiveness of interventions for the population of individuals at a clinical high risk of developing psychosis has been ongoing for the past 30 years. However, few studies have assessed the needs of this special young population, who are struggling with the recent onset of psychotic symptoms. METHOD: The sample consisted of 171 family members of 108 clinical high-risk individuals included from the ShangHai at Risk for Psychosis research programme. A 'WeChat' group was established to provide mutual support. There were 22,007 valid messages sent within the group between 1 April 2015 and 27 June 2016. Chat records were subsequently analysed to determine the needs of families during intervention at the early stages of psychosis. RESULTS: Families of clinical high-risk individuals were highly involved in the entire medical process, and the major concerns of the families of clinical high-risk individuals focused on both functional recovery and medication. The themes of 'take medication', 'go to school' and 'study in school' were often discussed within the group. CONCLUSION: A family-focused intervention targeting functional recovery and real-time professional explanations of medication would meet the major needs of families of Chinese clinical high-risk individuals.

The MacArthur Competence Assessment Tools for assessing decision-making capacity in schizophrenia: A meta-analysis.

OBJECTIVE: This meta-analysis aimed to examine the decisional capacity measured by the MacArthur Competence Assessment Tools (MacCAT) in schizophrenia. METHOD: English (PubMed, PsycINFO, Embase, Cochrane Library databases and the Cochrane Controlled Trials Register) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from 1995 until August 1, 2016. Weighted and standardized mean differences were calculated. The random effects model was used in all cases. RESULTS: Altogether 10 studies were identified, with 7 studies using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) and 3 studies using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). The meta-analysis showed that there was significant impairment in decision-making capacity in schizophrenia patients compared to the healthy control group in terms of Understanding (SMD=-0.81, 95% CI: -1.06 to -0.56, P<0.001), Reasoning (SMD=-0.57, 95% CI: -0.80 to -0.34, P<0.001), Appreciation (SMD=-0.87, 95% CI: -1.20 to -0.53, P<0.001), and Expression a choice (SMD=-0.24, 95% CI: -0.43 to -0.05, P=0.01). CONCLUSION: Compared to the control group, schizophrenia patients are more likely to have impaired decision-making capacity in clinical research and treatment as measured by the MacCAT instruments. Researchers and clinicians need to consider the impaired decisional capacity in schizophrenia patients providing informed consent.

[Coupling situation of agriculture-ecology-economic system in Zhifanggou watershed of Loess hilly and gully region].

Based on the investigations in the Zhifanggou Watershed of Loess hilly and gully region from 1938 to 2007, and the establishment of eco-environmental and socio-economic comprehensive evaluation indices and coupling model, this paper analyzed the coupling situation of the agriculture-ecology-economic system in the watershed. During the study period, the agriculture-ecology-economic system in the watershed had gone through the coupling processes of economic system vs. ecosystem initial regenesis-consumption-promotion-coordination, and of ecosystem vs. economic system primary response-lag behind-recovery-coordination. According to the coupling degree fitting curves and the coupling type classification, the current agriculture-ecology-economic system in the watershed was still in the situation of coupling, and would be well coordinated.

[Interactive relations between agroecosystem and economic system in Loess Hilly Region--a case of Zhifanggou small watershed, Ansai County].

Based on the investigation data in 1938-2007 and by using the evaluation method of ecosystem service value and the ecological footprint theory, the ecosystem service value and ecological footprint in Zhifanggou watershed of Loess Hilly Region were calculated, with the interactive relations between agroecosystem and economic system in the watershed analyzed. From 1938 to 2007, Zhifanggou watershed experienced three development stages, i.e., ecological environment destruction with backwardness of economy (1938-1975), eco-environment restoration with rapid development of economy (1975-2000), and well-maintained ecological environment with stable growth of economy (2000-2007). The interactive relations of the eco-economic systems manifested as ecological deterioration, eco-economic adaptive regulation, and eco-economic benign interaction.

[Agricultural eco-economic system coupling in Zhifanggou watershed in hilly-gully region of Loess Plateau].

Agricultural eco-economic system coupling is an organic unit formed by the inherent interaction between agricultural ecosystem and economic system, and regulated and controlled by mankind moderate interference. Its status can be expressed by the circular chain-net structure of agricultural resources and agricultural industry. The agricultural eco-economic system in Zhifanggou watershed has gone through the process of system coupling, system conflict, system coupling, and partial conflict in high leverage, which is caused by the farmers' requirement and the state's macro-policy, economic means, and administrative means. To cope with the problems of agricultural eco-economics system coupling in Zhifanggou watershed, the optimal coupling model should be established, with tree-grass resources and related industries as the core.