Deep Multimodal Representations and Classification of First-Episode Psychosis via Live Face Processing

Schizophrenia is a severe psychiatric disorder associated with a wide range of cognitive and neurophysiological dysfunctions and long-term social difficulties. Early detection is expected to reduce the burden of disease by initiating early treatment. In this paper, we test the hypothesis that integration of multiple simultaneous acquisitions of neuroimaging, behavioral, and clinical information will be better for prediction of early psychosis than unimodal recordings. We propose a novel framework to investigate the neural underpinnings of the early psychosis symptoms (that can develop into Schizophrenia with age) using multimodal acquisitions of neural and behavioral recordings including functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG), and facial features. Our data acquisition paradigm is based on live face-toface interaction in order to study the neural correlates of social cognition in first-episode psychosis (FEP). We propose a novel deep representation learning framework, Neural-PRISM, for learning joint multimodal compressed representations combining neural as well as behavioral recordings. These learned representations are subsequently used to describe, classify, and predict the severity of early psychosis in patients, as measured by the Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores to evaluate the impact of symptomatology. We found that incorporating joint multimodal representations from fNIRS and EEG along with behavioral recordings enhances classification between typical controls and FEP individuals (significant improvements between 10 - 20%). Additionally, our results suggest that geometric and topological features such as curvatures and path signatures of the embedded trajectories of brain activity enable detection of discriminatory neural characteristics in early psychosis.

Individuals with First Episode Psychosis (FEP) have a higher risk of compulsory admission, but evidence on its prognostic role on outcomes and its baseline predictors is poor. The aims of this investigation were to calculate incidence rate of compulsory admission in FEP individuals treated within an Italian "Early Intervention in Psychosis" (EIP) service across 2years of follow-up, and to compare clinical and sociodemographic characteristics between FEP patients with and without compulsory admission during the follow-up. 500 FEP patients were recruited within the "Parma-Early Psychosis" program and completed a socio-demographic chart, the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale. For inter-group comparisons, Mann-Whitney and Chi-square tests, Kaplan-Meier survival analysis, Cox and binary logistic regression, and mixed-design ANOVA were performed. 30 (6%) FEP participants were compulsory admitted. At baseline, they were likely to be males and to have a diagnosis of schizophrenia and lower GAF scores. Longitudinally, they had higher risk of service disengagement, new attempted suicide, and functioning impairment, and showed significant group effects in terms of more severe positive symptoms, negative symptoms, uncooperativeness, and GAF scores (0.023<ƞ2<0.100). At baseline, the most robust predictor for compulsory treatment was uncooperativeness (HR=1.460), while the strongest protective factor was family history of psychosis in first-degree relatives (HR=5.790). A not negligible part of FEP participants were compulsory admitted across the follow-up. This was longitudinally associated with poor outcomes and worse treatment response. Implementing initiatives to improve the skills of professionals to increase treatment motivation from presentation is crucial to promote positive outcomes.

Hippocampal Volumes in First-Episode Psychosis

Hallucinations are considered one of the primary symptoms of psychosis; however, their neural basis remains unclear. Voxel-based morphometry (VBM)1 studies have associated hallucinations with gray matter (GM) volume reduction in the superior temporal gyrus in schizophrenia.2 Although hallucinations are associated with brain connectivity,3 few studies have investigated their relationship with white matter (WM) volume. Moreover, these studies have shown inconsistent results.4, 5 The chronicity of illness and long-term medications for schizophrenia may limit the interpretation of previous findings.2 Thus, hallucination studies in clinical high risk for psychosis (CHR) and first-episode psychosis (FEP) are required, with minimal effects of chronicity of illness and medication. However, no VBM study has examined the relationship between hallucinations and WM volume in CHR and FEP. Therefore, we aimed to investigate the regional GM and WM volumes associated with hallucinations in CHR and FEP. We enrolled 57 individuals with CHR, 50 individuals with FEP, and 33 healthy controls (HCs). The Comprehensive Assessment of At-Risk Mental States-Japanese version6 was used to confirm whether ultra-high risk criteria7 were met. Table S1 summarizes the demographic and clinical data of the patients. Hallucination severity was assessed using the Positive and Negative Syndrome Scale (PANSS)8 P3 score. Fig. S1 shows the distribution of the severity of hallucinations. Some of those with a PANSS P3 score of 3 or higher were classified as having CHR because of the low frequency and duration of hallucinations. Magnetic resonance imaging (MRI) data were acquired with a 1.5-T Philips scanner. We examined the association of GM and WM volume with hallucination severity in the group that combined patients with CHR and FEP (CHR/FEP combined group) and performed group comparisons of GM and WM volume between the CHR/FEP combined and HC groups. Age, sex, and intracranial volume were entered as nuisance covariates for each analysis. VBM analysis was conducted using DARTEL9 in SPM12 (https://www.fil.ion.ucl.ac.uk/spm/software/spm12/) with standard smoothing of 8-mm full width at half maximum (FWHM). The initial statistical threshold was set at P < 0.001, uncorrected at the voxel level. The extent threshold for cluster size was set based on the expected number of voxels per cluster provided by SPM. Familywise error (FWE) correction at the cluster level (P < 0.05) was applied to identify significant clusters. Appendix S1 provides detailed information on these methods. This study was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Tohoku University Graduate School of Medicine and Tohoku University Hospital. Written informed consent was obtained from participants aged 18 years or older and from the parents of those under 18 years of age, with written assent from the participants. The anonymity of participants was preserved. WM volume was not significantly correlated with hallucination severity in the CHR/FEP combined group after FWE correction at the cluster level. Reanalysis with 15-mm or 20-mm FWHM filtering did not show significant associations. Additionally, there was no significant difference in the GM and WM volumes between the CHR/FEP combined and HC groups. No regional GM volume abnormalities were significantly correlated with hallucination severity in the CHR/FEP combined group. Appendix S1, Figs. S2–S5, and Tables S2–S5 provide uncorrected results and detailed information regarding these results. To the best of our knowledge, this is the first VBM study to investigate WM volume related to hallucinations in CHR and FEP. We found no significant correlation between WM volume and hallucination severity. In contrast to previous studies in schizophrenia,2, 4, 5 this study examined the brain volume association of hallucinations in CHR and FEP. CHR and FEP are heterogeneous groups in the early stages of mental illness and do not necessarily convert to schizophrenia. Our results indicate that brain disturbances involved in hallucinations in CHR and FEP may be more subtle and/or inconsistent with those in schizophrenia. Diffusion tensor imaging, a neuroimaging method applied to CHR,10 may be suitable for examining structural abnormalities in the development of hallucinations. This study has some limitations. First, information regarding hallucinations is not detailed. Second, the cross-sectional design limited the interpretation of our findings. Third, we used an MRI scanner with a lower field strength than that of recent studies.4 Fourth, there were significant age differences between the groups. Fifth, automatic quality assurance for MRI scans was not performed. In conclusion, advanced neuroimaging studies are needed to reveal the mechanism of hallucinations. This work was supported by JSPS KAKENHI (grant number 18K07586). We thank the participants, staff of the SAFE clinic, and radiological technologists. The authors declare no conflicts of interest. Appendix S1. Supporting information Figure S1. Distribution of hallucination severity. CHR, clinical high risk for psychosis; FEP, first-episode psychosis; PANSS, Positive and Negative Syndrome Scale. Figure S2. Brain regions with lower gray matter volume in the CHR/FEP group compared to the HC group. Statistical threshold was set at P < 0.001, uncorrected at the voxel level. The threshold extent for cluster size was set to k = 117 based on the expected number of voxels per cluster provided by SPM. The full width at half maximum was set to 8-mm. CHR, clinical high risk for psychosis; FEP, first-episode psychosis; HC, healthy controls; SPM, Statistical Parametric Mapping Figure S3. Brain regions with lower white matter volume in the CHR/FEP group compared to the HC group. Statistical threshold was set at P < 0.001, uncorrected at the voxel level. The threshold extent for cluster size was set to k = 129 based on the expected number of voxels per cluster provided by SPM. The full width at half maximum was set to 8-mm. CHR, clinical high risk for psychosis; FEP, first-episode psychosis; HC, healthy controls; SPM, Statistical Parametric Mapping Figure S4. Positive correlation between gray matter volume and hallucination severity in the patients at clinical high risk for psychosis. Statistical threshold was set at P < 0.001, uncorrected at the voxel level. The threshold extent for cluster size was set to k = 101 based on the expected number of voxels per cluster provided by the SPM. The full width at half maximum was set to 8-mm. SPM, Statistical Parametric Mapping Figure S5. Negative correlation between white matter volume and hallucination severity in the patients at clinical high risk for psychosis. Statistical threshold was set at P < 0.001, uncorrected at the voxel level. The threshold extent for cluster size was set to k = 121 based on the expected number of voxels per cluster provided by the SPM. The full width at half maximum was set to 8-mm. SPM, Statistical Parametric Mapping Table S1. Demographic and clinical characteristics of the participants. †Educational level, CP-equivalent dose on MRI scan, PANSS positive, PANSS negative, PANSS general, PANSS total, PANSS P3: hallucinatory behavior, and days from enrollment to MRI scan were analyzed using the t-test. Age and intracranial volume were analyzed using one-way analysis of variance. Sex and antipsychotic use were analyzed using the chi-squared test. Significant results are shown in bold. CHR, clinical high risk for psychosis; CP-equivalent, chlorpromazine equivalent; FEP, first-episode psychosis; HC, healthy controls; PANSS, Positive and Negative Syndrome Scale. Table S2. Between-group comparison of regional gray matter volume. CHR/FEP < HC (extent threshold: 117 voxels). † Uncorrected p-value at voxel level. ‡ familywise error-corrected p-value at the cluster level. k, cluster size at P < 0.001 (uncorrected); CHR, clinical high risk for psychosis; FEP, first-episode psychosis; HC, healthy controls; L/R, left/right hemisphere; MNI, Montreal Neurological Institute. The extent threshold for cluster size was set based on the expected number of voxels per cluster provided by the SPM. The full width at half maximum was set to 8-mm. Table S3. Between group comparison of regional white matter volume. CHR/FEP < HC (extent threshold: 129 voxels). † Uncorrected P-value at voxel level. ‡ familywise error-corrected p-value at the cluster level. k, cluster size at P < 0.001 (uncorrected); CHR, clinical high risk for psychosis; FEP, first-episode psychosis; HC, healthy controls; L/R, left/right hemisphere; MNI, Montreal Neurological Institute. The extent threshold for cluster size was set based on the expected number of voxels per cluster provided by the SPM. The full width at half maximum was set to 8-mm. Table S4. Correlation between gray matter volume and hallucination severity in the patients with CHR. Positive correlation (extent threshold: 101 voxels). † Uncorrected p-value at voxel level. ‡ familywise error-corrected p-value at the cluster level. k, cluster size at P < 0.001 (uncorrected); CHR, clinical high risk for psychosis; L/R, left/right hemisphere; MNI, Montreal Neurological Institute. The extent threshold for cluster size was set based on the expected number of voxels per cluster provided by the SPM. The full width at half maximum was set to 8-mm. Table S5. Correlation between white matter volume and hallucination severity in the patients with CHR. Negative correlation (extent threshold: 121 voxels). † Uncorrected p-value at voxel level. ‡ familywise error-corrected p-value at the cluster level. k, cluster size at P < 0.001 (uncorrected); CHR, clinical high risk for psychosis; L/R, left/right hemisphere; MNI, Montreal Neurological Institute. The extent threshold for cluster size was set based on the expected number of voxels per cluster provided by the SPM. The full width at half maximum was set to 8-mm. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

ObjectiveAlthough previous studies have reported impaired performance in the reading the mind in the eyes test (RMET), which measures complex emotion recognition abilities, in patients with schizophrenia, reports regarding individuals at clinical high risk (CHR) for psychosis have been inconsistent, mainly due to the interacting confounding effects of general cognitive abilities and age. We compared RMET performances across first-episode psychosis (FEP) patients, CHR individuals, and healthy controls (HCs) while controlling for the effects of both general cognitive abilities and age.MethodsA total of 25 FEP, 41 CHR, and 44 HC subjects matched for age participated in this study. RMET performance scores were compared across the groups using analysis of variance with sex and intelligence quotient as covariates. Exploratory Pearson’s correlation analyses were performed to reveal the potential relationships of RMET scores with clinical symptom severity in the FEP and CHR groups.ResultsRMET performance scores were significantly lower among FEP and CHR participants than among HCs. FEP patients and CHR subjects showed comparable RMET performance scores. RMET scores were negatively correlated with Positive and Negative Syndrome Scale (PANSS) positive symptom subscale scores in the FEP patients. No significant correlation was identified between RMET scores and other clinical scale scores.ConclusionImpaired RMET performance is present from the risk stage of psychosis, which might be related to positive symptom severity in early psychosis. Longitudinal studies are necessary to confirm the stability of complex emotion recognition impairments and their relationship with social functioning in early psychosis patients.

Childhood trauma (CT), in the form of abuse and neglect, and altered social cognition (SC) are both linked to poorer clinical and functional outcomes in psychosis. The impact of CT and its subtypes on SC in early psychosis has been underexplored, with mixed findings from previous studies. The current study investigated the effects of CT and its subtypes on SC in at-risk mental state (ARMS) for psychosis and first episode psychosis (FEP) individuals. One hundred and seventeen individuals were included (ARMS [n = 51], FEP [n = 66]). History of CT was assessed using the composite score of the Childhood Trauma Questionnaire. SC abilities were tested with the Reading the Mind in the Eyes Test for Theory of Mind (ToM) and Emotion Expression Multimorph Task for Emotion Recognition (ER). Linear regression, ANCOVA, and repeated-measures ANOVA were performed to investigate main and interaction effects. FEP individuals performed significantly worse than ARMS participants in ER sensitivity. Composite CT was not associated with SC in either cohort. Physical neglect was a strong predictor of poorer ToM in FEP individuals ( = 0.082). Physical abuse was negatively associated with overall ER sensitivity in ARMS participants versus FEPs ( = 0.079), particularly anger (p < 0.001), disgust (p = 0.019), and sadness (p = 0.004). Results highlight the importance of investigating effects of CT subtypes on SC performance in early psychosis as specific subtypes may impact differentially on SC. These associations can guide further investigation of underlying mechanisms and inform personalised interventions for early psychosis targeting specific SC deficits linked to CT in future research.

People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes. To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP. This multisite, double-blind, placebo-controlled, parallel-group randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686 declined participation or were excluded, 149 were randomized, and 104 were followed up at 6 months. The study recruited participants from January 19, 2016, to June 14, 2019, with the final follow-up (after the last dose) completed on December 20, 2019. Monthly augmentation with 120 000 IU of cholecalciferol or placebo. The primary outcome measure was total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included total PANSS score at 3 months; PANSS positive, negative, and general psychopathology subscale scores at 3 and 6 months; Global Assessment of Function scores (for symptoms and disability); Calgary Depression Scale score, waist circumference, body mass index, and glycated hemoglobin, total cholesterol, C-reactive protein, and vitamin D concentrations at 6 months; and a planned sensitivity analysis in those with insufficient vitamin D levels at baseline. A total of 149 participants (mean [SD] age, 28.1 (8.5) years; 89 [59.7%] male; 65 [43.6%] Black or of other minoritized racial and ethnic group; 84 [56.4%] White [British, Irish, or of other White ethnicity]) were randomized. No differences were observed in the intention-to-treat analysis in the primary outcome, total PANSS score at 6 months (mean difference, 3.57; 95% CI, -1.11 to 8.25; P = .13), or the secondary outcomes at 3 and 6 months (PANSS positive subscore: mean difference, -0.98; 95% CI, -2.23 to 0.27 at 3 months; mean difference, 0.68; 95% CI, -0.69 to 1.99 at 6 months; PANSS negative subscore: mean difference, 0.68; 95% CI, -1.39 to 2.76 at 3 months; mean difference, 1.56; 95% CI, -0.31 to 3.44 at 6 months; and general psychopathology subscore: mean difference, -2.09; 95% CI, -4.36 to 0.18 at 3 months; mean difference, 1.31; 95% CI, -1.42 to 4.05 at 6 months). There also were no significant differences in the Global Assessment of Function symptom score (mean difference, 0.02; 95% CI, -4.60 to 4.94); Global Assessment of Function disability score (mean difference, -0.01; 95% CI, -5.25 to 5.23), or Calgary Depression Scale score (mean difference, -0.39; 95% CI, -2.05 to 1.26) at 6 months. Vitamin D levels were very low in the study group, especially in Black participants and those who identified as another minoritized racial and ethnic group, 57 of 61 (93.4%) of whom had insufficient vitamin D. The treatment was safe and led to a significant increase in 25-hydroxyvitamin D concentrations. In this randomized clinical trial, no association was found between vitamin D supplementation and mental health or metabolic outcomes at 6 months. Because so few patients with FEP were vitamin D replete, the results of this study suggest that this group would benefit from active consideration in future population health strategies. isrctn.org Identifier: ISRCTN12424842.

Borderline personality disorder vs. mood disorders: clinical comparisons in young people treated within an “Early Intervention” service for first episode psychosis

IntroductionDepression is common in schizophrenia and is correlated with suicide risk and poor long-term outcomes. However, the presence of depressive symptoms is often underestimated in both research and treatment, particularly at the illness onset.ObjectivesThe goals of this study were: (a) to longitudinally observe anxious-depressive symptom levels in patients with First Episode Schizophrenia (FES) during a 24 months of follow-up period, and (b) to examine their associations with other psychopathology and the intervention patients received in an “Early Intervention in Psychosis” (EIP) program during the follow-up period.MethodsThe Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 159 FES patients both at baseline and across the follow-up. Data were analyzed by linear regression analysis and Spearman’s coefficients.ResultsAnxious-depressive symptoms had significant longitudinal associations with GAF deterioration and PANSS “Positive Symptoms”, “Negative Symptoms” and “Disorganization” subscores. During the follow-up period, FES participants significantly improved the level of anxious-depressive symptoms. This was significantly associated with the number of case management and individual psychotherapy meetings the patient engaged in, as well as with lower antipsychotic doses prescribed during the follow-up period.ConclusionsIn conclusion, anxious-depressive symptoms are prominent in FES and at the initial entry into EIP programs. Anxious-depressive symptom severity tends to diminish overtime, especially with the provision of specialized EIP treatments. However, since we did not have a control population studied in parallel, we cannot say whether these results are specific to the protocols of EIP programs or just to the intensity of engagement in care.Disclosure of InterestNone Declared

Effects of Fish-Oil Consumption on Psychological Function Outcomes in Psychosis: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials.

There's a general lack of knowledge about autism attributes in early psychosis, although little initial evidence showed that having autistic features contributes to poorer recovery over time. The main aim of this examination was to compare sociodemographic and clinical variables between FEP patients with or without autistic characteristics treated within an "Early Intervention in Psychosis" (EIP) service both at entry and across 2years of follow-up. We also examined the longitudinal course of autism severity levels in FEP to investigate whether they truly represented trait-like attributes. FEP participants completed the AQ-spectrum Questionnaire (AQ), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) at baseline and over time. Inter-group comparisons were examined using Chi-Squared or Mann-Whitney test, Kaplan-Meyer survival analysis, mixed-design ANOVA, and binary logistic regression. AQ score longitudinal stability was explored using Wilcoxon test for repeated measures and Spearman correlation coefficient. 132 subjects were recruited (28 [21.20%] scored above the AQ cut-off score of≥26). At presentation, they showed younger age and higher severity in psychopathology (especially negative symptoms). Across the follow-up, the AQ+ subsample had lower incidence rates of service disengagement, PANSS symptomatic remission, and GAF functional remission. AQ scores showed longitudinal stability over time. The AQ represents a valid instrument to assess "trait-like" autistic features in FEP subjects. Specifically, it captures a distinct FEP subgroup characterized by more severe clinical presentation, poorer clinical and functional outcomes, and specific therapeutic needs.

Background: The Duration of Untreated Psychosis (DUP) is the time between the first-episode psychosis (FEP) and the initiation of antipsychotic treatment. It is an important predictor of several disease-related outcomes in psychotic disorders. The aim of this manuscript is investigating the influence of cannabis on the DUP and its clinical correlates. Methods: During years 2014–2019, sixty-two FEP patients with and without cannabis use disorder (CUD) were recruited from several Italian psychiatric hospitals. The subjects were then divided into two groups based on the duration of the DUP and assessed at the beginning of the antipsychotic treatment and after 3 and 6 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale, and the Dissociative Experiences Scale (DES-II). Results: As expected, a longer DUP was associated with worse symptoms and cannabis use did not seem to affect the DUP, but both were related with more dissociative symptoms at onset and over time. Discussion: According to our study, cannabis use can be a predictor of FEP and DUP, and of disease outcome. However, several factors might influence the relationship between cannabis use and DUP. Preventing cannabis use and early diagnosis of psychotic disorders might impact the disease by reducing the persistence of symptoms and limiting dissociative experiences.

BackgroundExecutive control over low-level information processing is impaired proximal to psychosis onset with evidence of recovery over the first year of illness. However, previous studies demonstrating diminished perceptual modulation via attention are complicated by simultaneously impaired perceptual responses. The present study examined the early auditory gamma-band response (EAGBR), a marker of early cortical processing that appears preserved in first-episode psychosis (FEP), and its modulation by attention in a longitudinal FEP sample.MethodsMagnetoencephalography was recorded from 25 FEP and 32 healthy controls (HC) during active and passive listening conditions in an auditory oddball task at baseline and follow-up (4–12 months) sessions. EAGBR inter-trial phase coherence (ITPC) and evoked power were measured from responses to standard tones. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS).ResultsThere was no group difference in EAGBR power or ITPC. While EAGBR ITPC increased with attention in HC, this modulation was impaired among FEP. Diminished EAGBR modulation in FEP persisted at longitudinal follow-up. However, among FEP, recovery of EAGBR modulation was associated with reduced PANSS negative scores.ConclusionFEP exhibit impaired executive control over the flow of information at the earliest stages of sensory processing within auditory cortex. In contrast to previous work, this deficit was observed despite an intact measure of sensory processing, mitigating potential confounds. Recovery of sensory gain modulation over time was associated with reductions in negative symptoms, highlighting a source of potential resiliency against some of the most debilitating and treatment refractory symptoms in early psychosis.

BackgroundMismatch negativity (MMN) is an event-related potential component when a sequence of relatively standard stimuli is interrupted by the infrequent presentation of deviant stimuli. MMN is known to be associated with neuro-cognition and functional outcomes. Also, abnormally decreased MMN has often been reported in schizophrenia. Remission and recovery rates are related to the neuro-cognition of patients with schizophrenia. The present study explored the relationship of MMN with remission in patients with schizophrenia.MethodsForty patients with schizophrenia were recruited and divided into two groups, with or without remission, according to the Remission in Schizophrenia Working Group criteria (RSWGcr). For assessments of symptom severity, cognitive function and functional outcome, scale such as Positive and Negative Syndrome Scale (PANSS), K-WAIS-IV, and Global Assessment of Functioning (GAF) were measured. MMN of the patients were evaluated at the frontocentral site. A regression analysis was used to identify the factors that significantly predicted symptom improvement and remission including MMN at frontal site assessed at baseline, and anticipated clinical variables as predictive factors.ResultsMMN amplitudes in frontal sites were further decreased in the groups without remission compared to the groups with remission. MMN amplitude was significantly correlated with measures of symptom change and functional outcome measurements in patients with schizophrenia. Regression analysis revealed that symptom severity and MMN significantly predicted remission in patients with schizophrenia. Symptom improvement significantly predicted PANSS at baseline, illness duration, and antipsychotic dose, as did MMN amplitude at frontal site.DiscussionThis study explored the relationship of MMN with remission in patients with schizophrenia. The remitted patients with schizophrenia showed larger MMN amplitude in frontal electrode site than those of non-remitted patients. MMN in frontal sites was correlated with symptom improvement and functional outcomes through PANSS and GAF scales. The present study found that MMN was significantly correlated with variables related to remission such as PANSS and GAF evaluated at 6 months later. MMN indexes appears to be a promising candidate for predicted factor of remission of schizophrenia.

Increase in serum HDL level is associated with less negative symptoms after one year of antipsychotic treatment in first-episode psychosis