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Efficacy and safety of antipsychotic treatments for schizophrenia: A systematic review and network meta-analysis of randomized trials in Japan.

J Psychiatr Res 2021 Apr 30;138:444-452. Epub 2021 Apr 30.

Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.

Background: We examined the efficacy and safety of using antipsychotic medication for schizophrenia using only randomized trials of antipsychotic for schizophrenia conducted in Japan to avoid the biological and environmental heterogeneities caused by pooling data from various races and ethnicities.

Methods: We searched for eligible studies on Embase, PubMed, and CENTRAL. Primary outcomes were improvement in Positive and Negative Syndrome Scale total score (PANSS-T) and all-cause discontinuation. Read More

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Brain dysfunction of methamphetamine-associated psychosis in resting state: Approaching schizophrenia and critical role of right superior temporal deficit.

Addict Biol 2021 May 6:e13044. Epub 2021 May 6.

Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.

Methamphetamine (MA)-associated psychosis (MAP) is highly debilitating and common among individuals who use the drug, yet the underlying neural mechanism is not clear. This study compared brain functions between patients with MAP and those with schizophrenia during resting state and investigated the effect of brain alteration on the association between MA use and psychosis in patients with MAP. Three groups, including 24 patients with MAP, 17 with schizophrenia in first-episode (SCZ) and 31 healthy controls (HCs), were included after receiving a resting-state functional MRI scan. Read More

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Decision making under ambiguity and risk in adolescent-onset schizophrenia.

BMC Psychiatry 2021 05 4;21(1):230. Epub 2021 May 4.

Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China.

Objective: Numerous studies have identified impaired decision making (DM) under both ambiguity and risk in adult patients with schizophrenia. However, the assessment of DM in patients with adolescent-onset schizophrenia (AOS) has been challenging as a result of the instability and heterogeneity of manifestations. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT), which are frequently used to evaluate DM respectively under ambiguity and risk, are sensitive to adolescents and neuropsychiatric patients. Read More

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Vitamin B6 deficiency hyperactivates the noradrenergic system, leading to social deficits and cognitive impairment.

Transl Psychiatry 2021 May 3;11(1):262. Epub 2021 May 3.

Project for Schizophrenia Research, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, 156-8506, Japan.

We have reported that a subpopulation of patients with schizophrenia have lower levels of vitamin B (VB6) in peripheral blood than do healthy controls. In a previous study, we found that VB6 level was inversely proportional to the patient's positive and negative symptom scale (PANSS) score for measuring symptom severity, suggesting that the loss of VB6 might contribute to the development of schizophrenia symptoms. In the present study, to clarify the relationship between VB6 deficiency and schizophrenia, we generated VB6-deficient (VB6(-)) mice through feeding with a VB6-lacking diet as a mouse model for the subpopulation of schizophrenia patients with VB6 deficiency. Read More

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Application of machine learning to predict reduction in total PANSS score and enrich enrollment in schizophrenia clinical trials.

Clin Transl Sci 2021 May 3. Epub 2021 May 3.

Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Clinical trial efficiency, defined as facilitating patient enrollment, and reducing the time to reach safety and efficacy decision points, is a critical driving factor for making improvements in therapeutic development. The present work evaluated a machine learning (ML) approach to improve phase II or proof-of-concept trials designed to address unmet medical needs in treating schizophrenia. Diagnostic data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial were used to develop a binary classification ML model predicting individual patient response as either "improvement," defined as greater than 20% reduction in total Positive and Negative Syndrome Scale (PANSS) score, or "no improvement," defined as an inadequate treatment response (<20% reduction in total PANSS). Read More

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Small Words That Matter: Linguistic Style and Conceptual Disorganization in Untreated First-Episode Schizophrenia.

Schizophr Bull Open 2021 Jan 15;2(1):sgab010. Epub 2021 Mar 15.

Robarts Research Institute, London, ON, Canada.

This study aimed to shed light on the linguistic style affecting the communication discourse in first-episode schizophrenia (FES) by investigating the analytic thinking index in relation to clinical scores of conceptual and thought disorganization (Positive and Negative Syndrome Scale, PANSS-P2 and Thought and Language Index, TLI). Using robust Bayesian modeling, we report three major findings: (1) FES subjects showed reduced analytic thinking, exhibiting a less categorical linguistic style than healthy control (HC) subjects (Bayes factor, BF > 1000), despite using the same proportion of function and content words as HCs; (2) the lower the analytic thinking score, the higher the symptoms scores of conceptual disorganization (PANSS-P2, BF = 22.66) and global disorganization of thinking (TLI, BF = 112. Read More

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January 2021

Perceived Stress and Life Events in Patients Affected by Schizophrenia and Schizoaffective and Bipolar Disorder: Is There a Role for Self-Reported Basic Symptoms?

Psychopathology 2021 Apr 28:1-8. Epub 2021 Apr 28.

Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy.

Introduction: The stress-diathesis model of psychotic disorders describes, in vulnerable individuals, the role of psychosocial stress in the onset and exacerbation of psychotic symptoms. Another interesting approach to the study of vulnerability in the development of psychosis is represented by the basic symptoms concept.

Objective: The present study aims at proposing an integration between these two models and investigating possible associations between psychotic symptoms, basic symptoms, perceived stress, and life events in a sample of patients affected by schizophrenia (SZ), schizoaffective (SA), and bipolar disorder with and without psychotic symptoms. Read More

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[Continuity of care and therapeutic adherence in young people at psychosis onset: the integrated intervention model of the Psychiatric Service of Bolzano].

Riv Psichiatr 2021 Jan-Feb;56(2):93-99

Sezione di Psichiatria, Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona.

Aim: To report on: 1) the modification process occurred within the Psychiatric Service of Bolzano toward an early, intensive, specific and multimodal system of care for patients experiencing their first psychotic episode and their family members; 2) the 12-month clinical and social course of a sample of patients referred to the "Early Intervention Project".

Methods: Longitudinal naturalist study evaluating the 12-month clinical and outcome of a cohort of first-episode psychosis patients consecutively referred to the "Early Intervention Project" implemented within the Psychiatric Service of Bolzano. Socio-demographic characteristics, housing situation and occupational status, interventions offered (medical intervention, psychotherapy, psychoeducation to family members, social intervention) and hospital admissions were drawn from electronic medical records. Read More

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The Relationship Between Different Aspects of Theory of Mind and Symptom Clusters in Psychotic Disorders: Deconstructing Theory of Mind Into Cognitive, Affective, and Hyper Theory of Mind.

Front Psychiatry 2021 9;12:607154. Epub 2021 Apr 9.

Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.

Several meta-analyses highlight pronounced problems in general Theory of Mind (ToM), the ability to infer other persons' mental states, in patients with psychosis in comparison to non-clinical controls. In addition, first studies suggest associations between Hyper-ToM, an exaggerated inference of mental states to others, and delusions. Research on different ToM subtypes (Cognitive ToM, Affective ToM, and Hyper-ToM) and symptom clusters of psychosis (positive, negative, and disorganized symptoms) have gathered conflicting findings. Read More

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Efficacy and safety of lurasidone in acutely psychotic patients with schizophrenia: A 6-week, randomized, double-blind, placebo-controlled study.

Psychiatry Clin Neurosci 2021 Apr 23. Epub 2021 Apr 23.

Japan Depression Center, Japan.

Aim: To evaluate the efficacy of lurasidone in acute schizophrenia in Japan and other countries.

Methods: Subjects, ages 18-74, diagnosed with schizophrenia were to be randomized to lurasidone 40 mg/day or placebo. The primary efficacy endpoint was change from baseline on the Positive and Negative Syndrome Scale (PANSS) total score at Week 6. Read More

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Early Improvement of Psychiatric Symptoms with Long-Acting Injectable Antipsychotic Predicts Subsequent Social Functional Remission in Patients with Schizophrenia.

Neuropsychiatr Dis Treat 2021 16;17:1095-1104. Epub 2021 Apr 16.

Research and Development Clinical Science Division, Janssen Pharmaceutical K.K., Tokyo, Japan.

Purpose: The aim of this study was to clarify whether early symptomatic improvement in response to a long-acting injectable antipsychotic (LAI) contributes to subsequent social functional remission in patients with schizophrenia using the previous clinical trial data (EudraCT registration number: 2011-004889-15). Associations between other factors and social functional remission were also explored.

Patients And Methods: We analyzed 428 patients with schizophrenia in which the personal and social performance scale (PSP) and the involvement evaluation questionnaire (IEQ) at the time of the base line were recorded. Read More

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Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-naïve schizophrenia.

Ann Gen Psychiatry 2021 Apr 21;20(1):26. Epub 2021 Apr 21.

CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.

Background: Schizophrenia is a complex mental illness with significant sex differences. Cognitive impairment is common in patients with schizophrenia, even in remission. This study was designed to examine the sex differences in the relationship between cognitive impairment and clinical correlations with first-episode drug-naïve (FEDN) schizophrenia. Read More

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Association of negative symptoms with cognitive impairment in Chinese Han patients with chronic schizophrenia.

Int J Psychiatry Clin Pract 2021 Apr 20:1-7. Epub 2021 Apr 20.

Institute of Psychology, Chinese Academy of Sciences, Beijing, China.

Objective: Cognitive impairment is an essential feature of schizophrenia; however, the relationship between clinical psychiatric symptoms with cognitive impairment is still unclear. Therefore, we aimed to assess cognitive deficits and the relationship between clinical symptoms and cognitive function in patients with chronic schizophrenia, which provide a reference guide for psychiatrists.

Methods: We compared the cognitive function in 312 schizophrenia inpatients and 397 healthy controls by using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Read More

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The type 2 diabetes mellitus susceptibility gene CDKAL1 polymorphism is associated with depressive symptom in first-episode drug-naive schizophrenic patients.

Hum Psychopharmacol 2021 Apr 15. Epub 2021 Apr 15.

Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China.

Background: Patients with schizophrenia have an increased prevalence of type 2 diabetes mellitus that has shown a significant association with the rs7754840 polymorphism in the gene encoding the cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated protein 1-like 1 (CDKAL1).

Objective: To examine whether this polymorphism was involved in the susceptibility in first-episode drug-naive schizophrenic patients (FDSP), and further influenced their clinical symptoms.

Methods: This polymorphism was genotyped in 239 FDSP and 368 healthy controls. Read More

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Neuronal Signatures of Negative and Positive Schemas towards the Self and Others in Patients with Early Stage Schizophrenia.

Psychiatry Investig 2021 Apr 15;18(4):284-294. Epub 2021 Apr 15.

Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea.

Objective: The present study investigated the functional neuroanatomy underlying negative and positive schemas towards the self and others in patients with early stage schizophrenia spectrum disorders (SSDs) using a task-based fMRI procedure.

Methods: This study included 50 patients with SSDs and 52 controls. The schema-evoking task consisted of four active conditions and neutral condition. Read More

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Clinical validation of ratings on the six-item Positive and Negative Syndrome Scale obtained via the Simplified Negative and Positive Symptoms Interview.

J Psychopharmacol 2021 Mar 28:269881121996890. Epub 2021 Mar 28.

Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.

Background: The six-item version of the Positive and Negative Syndrome Scale (PANSS-6) has shown promise as a brief measure of the severity of core symptoms of schizophrenia. However, since all prior analyses of the PANSS-6 were based on data extracted from studies using the full 30-item PANSS (PANSS-30), it remains unknown whether it is possible to obtain valid information for the PANSS-6 ratings via a brief interview, such as the Simplified Negative and Positive Symptoms Interview (SNAPSI).

Aims: We aimed to validate the PANSS-6 ratings obtained via the SNAPSI using the PANSS-6 scores extracted from the PANSS-30 ratings obtained via the comprehensive Structured Clinical Interview for PANSS (SCI-PANSS) as the gold-standard reference. Read More

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A Random Forest Model for Predicting Social Functional Improvement in Chinese Patients with Schizophrenia After 3 Months of Atypical Antipsychotic Monopharmacy: A Cohort Study.

Neuropsychiatr Dis Treat 2021 19;17:847-857. Epub 2021 Mar 19.

Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

Purpose: Impaired social functions contribute to the burden of schizophrenia patients and their families, but predictive tools of social functioning prognosis and specific factors are undefined in Chinese clinical practice. This article explores a machine learning tool to identify whether patients will achieve significant social functional improvement after 3 months of atypical antipsychotic monopharmacy and finds the defined risk factors using a multicenter clinical study.

Patients And Methods: A multicenter study on atypical antipsychotic (AAP) treatment in Chinese patients with schizophrenia (SALT-C) was conducted from July 2011 to August 2018. Read More

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Pharmacogenetic associations of NRG1 polymorphisms with neurocognitive performance and clinical symptom response to risperidone in the untreated schizophrenia.

Schizophr Res 2021 Mar 23;231:67-69. Epub 2021 Mar 23.

Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China.

Objective: To explore pharmacogenetic relationships of NRG1 genotypes with neurocognitive performance and clinical symptoms after 12 week treatment of risperidone in Chinese Han first-episode schizophrenia.

Methods: A cohort of 221 patients with schizophrenia were recruited for this research. Finally 177 untreated first-episode patients were clinically evaluated with the Positive and Negative Syndrome Scale (PANSS), Raven's Standard Progressive Matrices (RSPM), Digit Vigilance Test (DVT), Digit Span (DS), underwent genotyping for five polymorphisms of NRG1, and completed a 12-week prospective study of risperidone monotherapy. Read More

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Association Between Serum Insulin-Like Growth Factor 1 Levels and the Clinical Symptoms of Chronic Schizophrenia: Preliminary Findings.

Front Psychiatry 2021 3;12:653802. Epub 2021 Mar 3.

Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan.

Insulin-like growth factor 1 (IGF-1) is a trophic mediator that is regulated by growth hormone and associated with the proliferation, development, and growth of neural cells. IGF-1 may be associated with the pathophysiology of schizophrenia, but this association remains controversial. This study aimed to investigate the relationship between serum IGF-1 levels and psychiatric symptoms in patients with chronic schizophrenia. Read More

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Traditional Chinese Medicine Decoction Combined With Antipsychotic for Chronic Schizophrenia Treatment: A Systematic Review and Meta-analysis.

Front Pharmacol 2020 20;11:616088. Epub 2021 Jan 20.

Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China.

Despite several studies suggesting the effectiveness of traditional Chinese medicine (TCM) in schizophrenia, there is still a lack of systematic summary and analysis on the role of TCM as adjuvant therapy in chronic schizophrenia. For this purpose, we conducted a meta-analysis to study the efficacy of TCM as an adjuvant combined with antipsychotics in the treatment of chronic schizophrenia. Until April 2020, based on the review of six electronic databases, eight articles were selected. Read More

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January 2021

A network meta-analysis of the dose-response effects of lurasidone on acute schizophrenia.

Sci Rep 2021 Mar 10;11(1):5571. Epub 2021 Mar 10.

Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Si Phum, 110 Inthawarorot Road, Mueang, 50200, Chiang Mai, Thailand.

We compared the efficacy, safety, and acceptability of lurasidone at different doses to establish the dose-response relationships of lurasidone therapeutic and adverse effects in acute schizophrenia. Included trials were 4- to 16-week, fixed-dose, randomized controlled trials of lurasidone in adults with acute schizophrenia. Different doses of lurasidone, other antipsychotics, and placebo were considered as independent treatments. Read More

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Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders.

BMC Psychiatry 2021 03 10;21(1):147. Epub 2021 Mar 10.

School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.

Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. Read More

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Escape and absconding among offenders with schizophrenia spectrum disorder - an explorative analysis of characteristics.

BMC Psychiatry 2021 03 4;21(1):122. Epub 2021 Mar 4.

Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland.

Background: Escape and absconding, especially in forensic settings, can have serious consequences for patients, staff and institutions. Several characteristics of affected patients could be identified so far, albeit based on heterogeneous patient populations, a limited number of possible factors and basal statistical analyses. The aim of this study was to determine the most important characteristics among a large number of possible variables and to describe the best statistical model using machine learning in a homogeneous group of offender patients with schizophrenia spectrum disorder. Read More

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Clinical validation of the Symptom Self-rating Scale for Schizophrenia (4S) among inpatients.

Nord J Psychiatry 2021 Feb 25:1-11. Epub 2021 Feb 25.

Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.

Purpose: Self-reports of psychosis-related symptoms may be a valuable supplement to clinician-ratings, but more validation studies are required. The aim of this study was to conduct clinical validation for the Symptom Self-rating Scale for Schizophrenia (4S) in an inpatient setting.

Materials And Methods: Inpatients diagnosed with schizophrenia were invited to participate in the study. Read More

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February 2021

Emerging cycloid psychosis episodes during COVID-19 pandemic: a case series.

Nord J Psychiatry 2021 Feb 25:1-6. Epub 2021 Feb 25.

Psychiatry Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.

Aims: Cycloid psychosis (CP) is a clinical entity characterized by sudden onset of psychotic polymorphic symptomatology and fluctuant course. It has a reported rate of psychosocial precipitating factors ranging 30-65%. The aim of the study was to describe all cases of CP, admitted in our Psychiatry ward, during the first two months of the COVID-19 pandemic. Read More

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February 2021

Comparative study of effectiveness of augmentation with ECT in clozapine resistant schizophrenia (CRS) and non-clozapine resistant schizophrenia (Non-CRS).

Nord J Psychiatry 2021 Feb 25:1-17. Epub 2021 Feb 25.

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: There is limited evidence for different treatment strategies in patients with clozapine resistant schizophrenia (CRS).

Aim: To determine the effectiveness of ECT in patients with clozapine resistant schizophrenia and compare the same with a group of patients with non-clozapine resistant schizophrenia, receiving ECT.

Results: Out of a total of 68 patients with schizophrenia, 27 (38. Read More

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February 2021

Muscarinic Cholinergic Receptor Agonist and Peripheral Antagonist for Schizophrenia.

N Engl J Med 2021 02;384(8):717-726

From Karuna Therapeutics, Boston (S.K.B., S.S., A.C.M., S.M.P.); Columbia University Vagelos College of Physicians and Surgeons, New York (J.A.L.); and Indiana University School of Medicine, Indianapolis (A.B.).

Background: The muscarinic receptor agonist xanomeline has antipsychotic properties and is devoid of dopamine receptor-blocking activity but causes cholinergic adverse events. Trospium is a peripherally restricted muscarinic receptor antagonist that reduces peripheral cholinergic effects of xanomeline. The efficacy and safety of combined xanomeline and trospium in patients with schizophrenia are unknown. Read More

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February 2021

Long acting aripiprazole influences cognitive functions in recent onset schizophrenia.

Psychopharmacology (Berl) 2021 Feb 13. Epub 2021 Feb 13.

Department of Psychiatry, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia.

Rationale: Beneficial effects of aripiprazole on cognition in schizophrenia have been previously reported, but not in recent onset schizophrenia. Cognitive impairments have also been associated with catechol-O-methyltransferase (COMT), methylenetetrahydrofolate reductase (MTHFR), and serotonin transporter (SERT) gene polymorphisms which were earlier implicated in the pathophysiology of schizophrenia.

Objectives: This study examined the short-term influence of aripiprazole long-acting injectable (LAI) as well as of COMT, MTHFR, and SERT gene polymorphisms and their interactions on clinical features and cognitive functions in inpatients with recent onset schizophrenia. Read More

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February 2021

Standardized training in the rating of the six-item Positive And Negative Syndrome Scale (PANSS-6).

Schizophr Res 2021 Feb 9;228:438-446. Epub 2021 Feb 9.

Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark.

The six-item Positive And Negative Syndrome Scale (PANSS-6) allows for a brief assessment of the severity of core symptoms of schizophrenia. However, implementing the PANSS-6 in clinical practice requires that staff members' ratings are accurate and reliable. We aimed to investigate whether such accuracy and reliability can be obtained via a brief video-based training program. Read More

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February 2021