Investigating the effects of age, IQ, dosing, and anthropometric measures on the treatment persistence in long-term methylphenidate use.

OBJECTIVES: This study aimed to determine anthropometric and clinical correlates of persistence to methylphenidate (MPH) treatment in Turkish youth with attention-deficit hyperactivity disorder (ADHD). METHODS: Data from medical records of 518 children and adolescents with ADHD were recorded between March 2012 and January 2022. Clinical variables of patients persistent to MPH ≥ 2 years were compared with those of the non-persistent group. Children and adolescent age groups were compared using Kaplan-Meier estimates for treatment drop-outs. Cox regression analysis until the treatment drop-out was implemented to calculate hazard ratios (HRs) for gender, age, full-scale IQ, and anthropometric measures. Weight, height, and body mass index (BMI) z-scores were calculated per national guidelines. RESULTS: Persistent and non-persistent study groups had similar full-scale IQ, weight, height, and BMI z-scores at treatment onset. The mean MPH dose was significantly higher in the persistent group compared to the non-persistent counterparts (31.43 ± 10.70 vs. 24.28 ± 9.60 mg/d, p < 0.001, d = 0.70). Compared to children, the adolescents showed earlier treatment drop-outs in males (p < 0.001) but not in females (p = 0.110). Younger age showed a positive effect on treatment persistence. Conversely, baseline BMI and IQ scores were not associated with long-term persistence. DISCUSSION: Our study demonstrated lower daily doses and older age-onset were associated with early drop-outs in MPH treatment. These findings supported the notion that effective dosing strategies at younger ages could increase the sustainability of the treatment with MPH in the Turkish population.

Electroconvulsive therapy or clozapine for adolescents with treatment-resistant schizophrenia: an explorative analysis on symptom dimensions.

OBJECTIVE: This study sought to compare pre-intervention patient characteristics and post-intervention outcomes in a naturalistic sample of adolescent inpatients with treatment-resistant psychotic symptoms who received either electroconvulsive therapy (ECT) or clozapine. METHODS: Data of adolescents with schizophrenia/schizoaffective disorder receiving ECT or clozapine were retrospectively collected from two tertiary-care psychiatry-teaching university hospitals. Subscale scores of the Positive and Negative Symptom Scale (PANSS) factors were calculated according to the five-factor solution. Baseline demographics, illness characteristics, and post-intervention outcomes were compared. RESULTS: There was no significant difference between patients receiving ECT (n = 13) and clozapine (n = 66) in terms of age, sex, and the duration of hospital stay. The ECT group more commonly had higher overall illness and aggression severity. Smoking was less frequent in the clozapine group. Baseline resistance/excitement symptom severity was significantly higher in the ECT group, while positive, negative, affect, disorganisation, and total symptom scores were not. Both interventions provided a significant reduction in PANSS scores with large effect sizes. CONCLUSION: Both ECT and clozapine yielded high effectiveness rates in adolescents with treatment-resistant schizophrenia/schizoaffective disorder. Youth receiving ECT were generally more activated than those who received clozapine.

Minor physical anomalies in schizophrenia and first-degree relatives in comparison to healthy controls: A systematic review and meta-analysis.

Minor physical anomalies (MPAs) are anatomical variations that are markers of aberrant early neurodevelopment. Schizophrenia is associated with increased MPA frequency, however, the frequency and distribution of MPAs exhibit substantial heterogeneity in schizophrenia and are not exclusive to this disorder. MPAs at different localizations might represent different developmental origins and might be related to latent genetic predisposition or vulnerability to develop full-blown psychosis. Therefore, we conducted a thorough review of minor physical anomalies (MPAs) in schizophrenia (Sch) and first-degree relatives (SchRel). Analyzing 52 studies published from January 1980 to October 2023, the meta-analysis compared MPA scores between 3780 schizophrenia patients and 3871 controls, as well as 1415 SchRel and 1569 controls. The total MPA score was significantly increased in schizophrenia compared to controls (g = 0.78 [0.63-0.93], p<0.001). In regional MPA meta-analyses, effect sizes ranged from 0.56 to 0.78. The difference between SchRel and controls was moderate (g = 0.44 [0.28-0.61], p<0.001). When individual MPA items were analyzed separately, fine electric hair, malformed ear, asymmetrical ear, curved 5th finger were anomalies that were shared between both schizophrenia and SchRel. Also, direct comparisons of the frequency of MPAs in schizophrenia and their relatives were conducted. Additionally, the early age of onset of schizophrenia was associated with mouth anomalies (Z=-2.13, p = 0.03), and ear anomalies were associated with a higher percentage of males in the schizophrenia group (Z = 2.64, p = 0.008). These findings support the notion that different MPAs might be associated with genetic susceptibility as well as vulnerability to developing full-blown psychosis. Studies investigating clinical and neurobiological correlates of MPAs in schizophrenia might be helpful in characterizing subtypes of psychoses that are associated with different developmental processes.

Computational analysis of linguistic features in speech samples of first-episode bipolar disorder and psychosis.

BACKGROUND: In recent years, automatic analyses using novel NLP methods have been used to investigate language abnormalities in schizophrenia. In contrast, only a few studies used automated language analyses in bipolar disorder. To our knowledge, no previous research compared automated language characteristics of first-episode psychosis (FEP) and bipolar disorder (FEBD) using NLP methods. METHODS: Our study included 53 FEP, 40 FEBD and 50 healthy control participants who are native Turkish speakers. Speech samples of the participants in the Thematic Apperception Test (TAT) underwent automated generic and part-of-speech analyses, as well as sentence-level semantic similarity analysis based on SBERT. RESULTS: Both FEBD and FEP were associated with the use of shorter sentences and increased sentence-level semantic similarity but less semantic alignment with the TAT pictures. FEP also demonstrated reduced verbosity and syntactic complexity. FEP differed from FEBD in reduced verbosity, decreased first-person singular pronouns, fewer conjunctions, increased semantic similarity as well as shorter sentence and word length. The mean classification accuracy was 82.45 % in FEP vs HC, 71.1 % in FEBD vs HC, and 73 % in FEP vs FEBD. After Bonferroni correction, the severity of negative symptoms in FEP was associated with reduced verbal output and increased 5th percentile of semantic similarity. LIMITATIONS: The main limitation of this study was the cross-sectional nature. CONCLUSION: Our findings demonstrate that both patient groups showed language abnormalities, which were more severe and widespread in FEP compared to FEBD. Our results suggest that NLP methods reveal transdiagnostic linguistic abnormalities in FEP and FEBD.

Comparison of social cognition and neurocognition in schizophrenia and autism spectrum disorder: A systematic review and meta-analysis.

BACKGROUND: This report aimed to compare group differences in social and non-social cognition in autism spectrum disorders (ASD) and schizophrenia, and examine the influence of age and other factors on group differences. METHODS: Literature searches were conducted in Pubmed and Web of Science from January 1980 to August 2022. Original research articles reporting objective measures of cognition were selected. RESULTS: 57 articles involving 1864 patients with schizophrenia and 1716 patients with ASD have been included. Schizophrenia was associated with more severe non-social-cognitive impairment, particularly in fluency (g=0.47;CI[0.17-0.76]) and processing speed domains (g=0.41;CI[0.20-0.62]). Poorer performance in social cognition (Z = 3.68,p = 0.0002) and non-social cognition (Z = 2.48,p = 0.01) in schizophrenia were significantly related to older age. ASD was associated with more severe social cognitive impairment when groups were matched for non-social-cognition (g=-0.18, p = 0.04) or reasoning/problem solving (g=-0,62; CI [-1,06-(-0.08)]. DISCUSSION: While both disorders present with social and non-social cognitive impairments, the pattern and developmental trajectories of these deficits are different. The limitations included heterogeneity of the cognitive measures, and the lack of sufficient information about antipsychotic use.

Choroidal structural analysis in ultra-high risk and first-episode psychosis.

Both structural and functional alterations in the retina and the choroid of the eye, as parts of the central nervous system, have been shown in psychotic disorders, especially in schizophrenia. In addition, genetic and imaging studies indicate vascular and angiogenesis anomalies in the psychosis spectrum disorders. In this ocular imaging study, choroidal structure and vascularity were investigated using enhanced depth imaging (EDI) optical coherence tomography (OCT) in first-episode psychosis (FEP), ultra-high risk for psychosis (UHR-P), and age- and gender- matched healthy controls (HCs). There were no significant differences between groups in central choroidal thickness, stromal choroidal area (SCA), luminal choroidal area (LCA) and total subfoveal choroidal area. The LCA/SCA ratio (p<0.001) and the choroidal vascularity index (CVI) (p<0.001) were significantly different between FEP, UHR-P and HCs. CVI and LCA/SCA ratio were significantly higher in patients with FEP compared to help-seeking youth at UHR-P. CVI and LCA/SCA ratio were not different between UHR-P and HCs. However, CVI was higher in UHR-P compared to HCs after excluding the outliers for the sensitivity analysis (p = 0.002). Current findings suggest that choroidal thickness is normal, but there are abnormalities in choroidal microvasculature in prodromal and first-episode psychosis. Further longitudinal studies are needed to investigate oculomics, especially CVI, as a promising biomarker for the prediction of conversion to psychosis in individuals at clinical high-risk.