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The emerging adulthood represents a vulnerable and critical turning point for the beginning of mental illnesses and is therefore of particular interest for the study of risk and resilience. The present survey investigated the impact of sex on the associations between resilience and the perception of social support and stress in students. The Resilience Scale was used to assess resilience. Stress perception and social support perception were measured using the Perceived Stress Scale and the Social Support Questionnaire FSozU k-22, respectively. Between the ages of 18 and 30, 503 subjects (59.6% female) were included into the study. We detected a significant effect of sex with markedly lower resilience and a more pronounced perception of stress and social support among females. Significant correlations between resilience, stress perception, and social support perception were found in both sexes with women showing a stronger interrelationship between stress perception and both resilience and social support perception. Mediation analysis revealed that the relationship between the perception of social support and stress was fully mediated by resilience among men and partly mediated by resilience among women. Of note, the mediation of resilience on the interrelationship between the perception of social support and stress was much stronger in women than in men. These findings suggest that sex-specific, customized interventions focusing on the strengthening of resilience and the claiming of social support are needed to promote mental health in emerging adults.

Low self-esteem is regarded as a barrier to recovery from schizophrenia and the identification of factors affecting this psychological characteristic may help to implement effective therapeutic interventions. To this end, the present study aimed to assess whether residual symptoms of the disorder and performance on a comprehensive neuropsychological test battery might differently impact self-esteem among 70 stabilized outpatients with chronic schizophrenia from public outpatient mental health services. Self-esteem inter-correlated with the severity of overall symptomatology, affective and negative symptoms, with premorbid intelligence, and with performance in the domains of verbal learning and memory, visual memory, working memory, and verbal fluency. Residual affective symptoms, premorbid intelligence, and female sex predicted poorer self-esteem in multiple linear regression analysis. The findings of this study implicate that next to psychological interventions therapeutic strategies that specifically target affective symptoms of schizophrenia may have a beneficial impact on patients’ self-esteem.

BackgroundThis analysis evaluated potential differences in subjective well-being (SW) among patients with early-phase schizophrenia (SZ) randomized to treatment with either long-acting injectable (LAI) or oral aripiprazole or paliperidone within the “European Long-acting Antipsychotics in Schizophrenia Trial” (EULAST).MethodsA total of 478 patients were followed for up to 19 months. SW was measured using the Subjective Well-being under Neuroleptic Treatment scale (SWN). Linear mixed-effects models assessed treatment differences. Comprehensive analyses included age, sex, symptomatology (Positive and Negative Syndrome Scale [PANSS]), and side effects (Systematic Monitoring of Adverse Events Related to Treatments [SMARTS] and St. Hans rating scale [SHRS] for extrapyramidal syndromes) on SWN changes.ResultsOverall, SW improved over the course of the study. No significant differences emerged between LAI and oral administration (p = 0.1533) or between aripiprazole and paliperidone (p = 0.2008). Similarly, age and sex were not relevant in this regard. In contrast, negative, positive, and affective symptoms (all p < 0.0001) as well as the overall side effect burden (SMARTS sum-score, p < 0.0001) showed significant inverse associations with SW. Certain SHRS subscales correlated with SW in partial models, but associations disappeared in the fully adjusted model.ConclusionsPatients with SZ initiating LAI or oral treatment with aripiprazole or paliperidone reported comparable SW improvements. Findings emphasize that treatment choice should be guided less by formulation or substance and more by individual patient needs, prioritizing symptom control while minimizing adverse effects. A patient-centered approach remains essential to optimize both clinical outcomes and subjective well-being in early-phase SZ.

Driving motorized vehicles is an integral part of individual mobility and a key parameter for employment and social integration. This naturalistic, cross-sectional study investigated the associations between driving fitness, residual symptomatology, olanzapine equivalent, and extrapyramidal symptoms (EPS) in long term stable outpatients with schizophrenia. Beside sociodemographic data, and driving habits, residual symptoms, and EPS were assessed using the Positive and Negative Syndrome Scale (PANSS), and the Modified Simpson Angus Scale (MSAS). PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. MSAS cut-off scores ≥3 were defined as positive for EPS. Driving skills were assessed using the Vienna Test System and an expert evaluation. 50 patients were included into the study. Mean PANSS total scores indicated mild residual symptomatology and EPS were not present in 48% of study participants. 44% passed the driving fitness assessment and were considered as competent to drive, 20% were judged to be partially competent and 36% to be incompetent to drive. With the exception of disorganization (r = −0·287, p = 0·048) residual symptoms of schizophrenia did not correlate with driving fitness. However, moderate negative correlations were detected between driving fitness and the severity of EPS (r = −0·554, p = 0·000), age (r = −0·413, p = 0·003) as well as olanzapine equivalent doses (r = −0·432, p = 0·002). These results were not corrected for multiple comparison. The present findings indicate that up to two thirds of clinically stable outpatients with chronic schizophrenia may be (partially) competent to drive. Both the presence of EPS as well as the dosage of antipsychotic medication seem to be of particular relevance in this regard. •We conducted a correlation and regression analysis to investigate predictors for driving fitness in schizophrenia.•Antipsychotic dose, disorganization and extrapyramidal symptoms were associated with a reduced driving performance.•We found that up to two thirds of people with schizophrenia who are clinical stable are at least partially able to drive.

•The ACC has a role in conscientiousness through resting-state networks.•Sexes differ in metabolite correlates of personality traits in the pCC and the ACC.•The ACC metabolites are linked to the so-called Alpha-factor of personality.•The ACC is involved in stress processes as part of the limbic system.•The pCC is co-involved in stress processes with self-esteem and hopelessness. Personality traits have been linked with both brain structure and function. However, the exact relationship between personality traits and other behavioural measures with neurometabolites, measured with proton magnetic resonance spectroscopy, is not clear. Here we investigated the association between behavioural measures (i.e., personality traits, resilience, perceived stress, self-esteem, hopelessness, psychological distress) and metabolite ratios (i.e., of choline-containing compounds [Cho], creatine and phosphocreatine [Cr], and N-acetyl-aspartate [NAA]) in the posterior cingulate cortex (pCC) and the dorsal anterior cingulate cortex (dACC) and surrounding white matter (WM) regions in healthy emerging adults (N = 57, 26 women, mean age=23.40 years, SD=2.50). The pCC and the dACC were selected for their known involvement as important brain network hubs and their association to five factor personality dimensions and other psychological measures. Spectral analysis as well as statistics for demographic, clinical, and imaging data were performed. Correlation and multiple regression analyses were used to test the relationship between metabolite ratios and behavioural scores in the entire sample as well as in female and male participants separately. The entire sample showed significant (p<0.05) negative correlates of stress with the NAA/Cr ratio in the pCC, and of extraversion with WM metabolite ratios. In regards of sex differences, a significantly higher NAA/Cho ratio in the pCC (p<0.05), the dACC (p<0.01), and in the left and right posterior WM matter (p<0.05), and a lower Cho/Cr ratio in the dACC (p<0.01) was detected in women. Moreover, the two sexes differed in regards of metabolite correlates of openness, conscientiousness, extraversion, agreeableness, neuroticism, stress, hopelessness, and self-esteem, and in multiple regression model predictions. Our results point to a role of the ACC in conscientiousness through its involvement in higher-order cognitive control as part of the salience network and internally directed thoughts as part of the default mode network (DMN). Furthermore, the two sexes differ in terms of metabolite correlates of openness and conscientiousness in the pCC, suggesting mental process involvement through the DMN, and of agreeableness in the dACC, possibly through involvement in social cognitive processes, particularly in women. Additionally, our results suggest that the ACC is linked to the so-called Alpha-factor of personality. Our findings on stress correlates contribute to the existing literature of the involvement of the ACC as part of the limbic system. In addition, our results suggest a possible role of the pCC in stress-regulatory processes through a possible co-involvement of stress, hopelessness, and self-esteem in the pCC in men, where higher self-esteem may help to cope with stress.

We need easy-to-use, valid biomarkers for diagnosing Alzheimer's disease (AD). Blood biomarkers are a promising option, especially as there is a good correlation with beta-amyloid and tau biomarkers measured by positron emission tomography or in the cerebrospinal fluid. We investigated the added value of measuring these markers in the blood of patients who have already been diagnosed, and how cut-off values can be set in clinical routine. Plasma pTau 181 and pTau 217 levels were analyzed using Lumipulse G600II in 132 memory clinic outpatients with different forms of dementia and in 43 cognitively intact controls (CIC). Linear discriminant analysis was used to determine the diagnostic accuracy of pTau 181, pTau 217, and the pTau 217/181 ratio in plasma. The Youden index (YI) was calculated to determine optimal cut-points. The diagnostic performance of pTau levels to distinguish between dementia patients and CIC yielded an AUC of 0.724 (95% CI: 0.635-0.813) with a cut point (YI) of 1.46 pg/mL for pTau 181 and an AUC of 0.845 (95% CI: 0.763-0.927) with a cut point (YI) of 0.23 pg/mL for pTau 217. The pTau217/181 ratio showed slightly better discriminatory performance (AUC of 0.858 [95% CI: 0.769-0.946]) at a cut point (YI) of 0.18. We suggest that the combined use of pTau217 and pTau181 as a ratio may serve as a valuable method to differentiate AD from non-AD dementia and from cognitively healthy individuals. However, plasma pTau217 outperforms pTau181 and the ratio due to its greater stability and marginally higher sensitivity compared to the 217/181 ratio. Plasma pTau217 levels above the cut-off point could indicate the need for further investigation of biomarkers.

Many studies have implicated extracellular signal-regulated kinase (ERK) in drug-rewarding properties. Yet, only few investigated if ERK also mediates the naturally rewarding stimuli. In this study, we compared ERK activation in the nucleus accumbens (NAc) after cocaine reward and after positive social interaction with a partner-reward in male rats. With our protocol, ERK phosphorylation in the NAc was not increased after cocaine reward. In addition, the interaction with a social partner did not alter ERK activation in the NAc. These results suggest that ERK in the NAc may not be involved in natural reward learning. Social interaction (SI) in an alternative context to the one associated to drugs of abuse can abolish drug preference. Given that intra-NAc core-ERK inhibition impaired the expression of cocaine preference, we wanted to investigate if the protective effects of SI when an individual is allowed to interact with a social partner in an alternative context to the one associated to drugs during the learning phase are enhanced by ERK inhibition. For that, U0126 was bilaterally infused into the NAc core of rats conditioned with cocaine in one context and with social interaction in the opposite context before assessing the expression of reward-related learning. Intra-NAc core ERK inhibition was ineffective to impair the expression of drug reward as previously demonstrated, when a social partner was available in an alternative context. Thus, the effects of the pharmacological manipulations based on decreasing ERK activity are not cumulative to other treatments for drug addiction based on social interaction.

Impairments in social and nonsocial cognition have been demonstrated in both patients suffering from bipolar disorder (BD) and their unaffected relatives and might therefore represent a heritable marker of risk. This study investigated the relevance of emotional intelligence (EI) as part of the emotion processing domain of social cognition in this regard. A total of 54 outpatients suffering from BD, 54 unaffected siblings, and 80 control subjects were investigated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the Brief Assessment of Cognition in Schizophrenia (BACS). Analyses of covariance (ANCOVAs) were performed with adjustment for the BACS composite score. The three groups were compared by one-way analysis of variance or chi-square test, depending on the variable type. As the three groups differed significantly in their level of education, additional ANCOVAs with adjustment for education were performed. Patients achieved significantly lower levels of overall EI and overall nonsocial cognitive functioning compared to unaffected siblings and controls, whereas performance of the latter two groups was comparable in both domains. Due to comparable levels of EI in unaffected siblings of patients suffering from BD and control subjects, EI assessed by means of the MSCEIT does not represent an endophenotype for BD.

Pharmacological treatment options for patients with dementia owing to Alzheimer's disease are limited to symptomatic therapy. Recently, the US Food and Drug Administration approved the monoclonal antibody lecanemab for the treatment of amyloid-positive patients with mild cognitive impairment (MCI) and early Alzheimer´s dementia. European approval is expected in 2024. Data on the applicability and eligibility for treatment with anti-amyloid monoclonal antibodies outside of a study population are lacking. This study examined eligibility criteria for lecanemab in a real-world memory clinic population between 1 January 2022 and 31 July 2023. We conducted a retrospective, single-centre study applying the clinical trial eligibility criteria for lecanemab to out-patients of a specialised psychiatric memory clinic. Eligibility for anti-amyloid treatment was assessed following the phase 3 inclusion and exclusion criteria and the published recommendations for lecanemab. The study population consisted of 587 out-patients. Two-thirds were diagnosed with Alzheimer's disease (probable or possible Alzheimer's disease dementia in 43.6% of cases, = 256) or MCI (23%, = 135), and 33.4% ( = 196) were diagnosed with dementia or neurocognitive disorder owing to another aetiology. Applying all lecanemab eligibility criteria, 11 (4.3%) patients with dementia and two (1.5%) patients with MCI would have been eligible for treatment with this compound, whereas 13 dementia (5.1%) and 14 (10.4%) MCI patients met clinical inclusion criteria, but had no available amyloid status. Even in a memory clinic with a good infrastructure and sufficient facilities for dementia diagnostics, most patients do not meet the eligibility criteria for treatment with lecanemab.

Background Non-adherence to medication remains a major challenge in the long-term management of patients with schizophrenia. Next to lack of insight into the illness, adverse effects of antipsychotic drugs, cognitive deficits, poor therapeutic alliance, reduced quality of life, missing social support, and negative attitudes toward medication are predictors of non-adherence. This study examined potential correlations between attitudes toward antipsychotic drug therapy, subjective well-being, and symptom change in patients with chronic schizophrenia. Methods 30 patients with schizophrenia starting monotherapy with a new-generation antipsychotic were included into the study. The Drug Attitude Inventory (DAI) and the Subjective Well-being under Neuroleptic Treatment Scale, short form (SWN-K), were administered after 2, 4, and 12 weeks of treatment. At the same points in time and at baseline, psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS), and functioning was assessed by means of the Global Assessment of Functioning Scale (GAF). Antipsychotic induced side effects were evaluated by using the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. Results Study participants had a mean age of 37.5 ± 9.7 years, baseline symptoms were mild. The PANSS total score improved significantly from baseline to weeks 4 ( p  = .003) and 12 ( p  = .001), respectively. Neither the DAI total score nor the SWN-K total score changed significantly over the course of time. The severity of symptoms was not correlated with drug attitude at any time point but was negatively correlated with wellbeing at weeks 2 ( r  = −.419, p  = .021) and 4 ( r  = −.441, p  = .015). There was no significant correlation between DAI and SWN-K total scores at any time point. Conclusions Next to showing that the DAI and the SWN-K measure different aspects of subjective experiences during antipsychotic treatment these findings emphasize the use of both instruments to optimize adherence to medication.