Distinct alterations in probabilistic reversal learning across at-risk mental state, first episode psychosis and persistent schizophrenia.

We used a probabilistic reversal learning task to examine prediction error-driven belief updating in three clinical groups with psychosis or psychosis-like symptoms. Study 1 compared people with at-risk mental state and first episode psychosis (FEP) to matched controls. Study 2 compared people diagnosed with treatment-resistant schizophrenia (TRS) to matched controls.

The role of psychosis and clozapine load in excessive checking in treatment-resistant schizophrenia: longitudinal observational study.

Background: A significant proportion of people with clozapine-treated schizophrenia develop 'checking' compulsions, a phenomenon yet to be understood.

Aims: To use habit formation models developed in cognitive neuroscience to investigate the dynamic interplay between psychosis, clozapine dose and obsessive-compulsive symptoms (OCS).

Method: Using the anonymised electronic records of a cohort of clozapine-treated patients, including longitudinal assessments of OCS and psychosis, we performed longitudinal multi-level mediation and multi-level moderation analyses to explore associations of psychosis with obsessiveness and excessive checking.

Should vaccination status be a consideration during secondary triage?

The rapid development of widely available and effective vaccines has been integral to the international response to the COVID-19 pandemic. However, a significant minority of those offered vaccination have refused, often due to their adherence to 'anti-vax' beliefs. These beliefs include that vaccines are dangerous, render the recipient magnetic or contain government microchips.

Negative symptoms and cognitive impairment are associated with distinct motivational deficits in treatment resistant schizophrenia.

Background: Motivational deficits are a central feature of the negative syndrome in schizophrenia. They have consistently been associated with reduced willingness to expend physical effort in return for monetary rewards on effort based decision making (EBDM) paradigms. Nevertheless, the mechanisms underlying such altered performance are not well characterised, and it remains unclear if they are driven purely by negative symptoms, or also in part by cognitive impairment, antipsychotic treatment or even positive symptoms.

Postoperative risks of stoma formation in patients with dementia.

Stoma formation for patients with dementia presents an increasing problem in a global ageing population. While potentially lifesaving, stomas impose significant, long-term postoperative burdens on patients, and may particularly challenge those with cognitive impairment.In this case, a patient was considered for colostomy to manage a colovesical fistula.

Surgical interventions in adult upper limb spasticity management: a systematic review.

Upper limb spasticity following upper motor neuron lesion is a key cause of long-term disability in adults, causing functional loss, pain, and reduced quality of life. Surgical management is an under-utilized intervention, and little work has been performed to collate and evaluate the evidence for these interventions. We undertake the first, PRISMA-compliant systematic review synthesizing the evidence for surgical management of spasticity in adults.

Clozapine-related obsessive-compulsive symptoms and their impact on wellbeing: a naturalistic longitudinal study.

Background: Obsessive-compulsive symptoms (OCS) are commonly associated with clozapine treatment but are frequently overlooked by clinicians despite their potential impact on patients' quality of life. In this study, we explored whether OCS severity impacted subjective wellbeing and general functioning, independently of depressive and psychotic symptoms.

Methods: We used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine and assessed annually for OCS, wellbeing, general functioning, and psychopathology using standardised scales as part of routine clinical practice.

Mechanisms Underlying Motivational Dysfunction in Schizophrenia.

Negative symptoms are a debilitating feature of schizophrenia which are often resistant to pharmacological intervention. The mechanisms underlying them remain poorly understood, and diagnostic methods rely on phenotyping through validated questionnaires. Deeper endo-phenotyping is likely to be necessary in order to improve current understanding.

Longitudinal effects of clozapine concentration and clozapine to N-desmethylclozapine ratio on cognition: A mediation model.

Previous cross-sectional studies have found clozapine to N-desmethylclozapine (CLZ:NDMC) ratio to be negatively correlated with cognition in clozapine-treated patients with schizophrenia. However, no work has examined the association between CLZ:NDMC ratio and cognition using a within-subjects design. Here, we investigate the longitudinal effects of changes in the clozapine load and the CLZ:NDMC ratio on cognition whilst controlling for a range of independent factors.

The influence of negative and affective symptoms on anhedonia self-report in schizophrenia.

Background: Anhedonia, a symptom prevalent in schizophrenia patients, is thought to arise either within negative symptomatology or from secondary sources, such as depression. The common co-occurrence of these diseases complicates the assessment of anhedonia in schizophrenia.

Method: In a sample of 40 outpatients with chronic schizophrenia, we explored both the validity of the Snaith-Hamilton Pleasure Scale (SHAPS) self-report for anhedonia assessment and those factors influenced its scoring.