Objectives: This study aimed to examine the association between anticholinergic burden, cognitive function, and clinical severity in elderly patients with schizophrenia to suggest safer medication treatment strategies. Methods: A cross-sectional study was conducted with 60 patients aged 60-90 years diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria at the National Center for Mental Health. Participants with Clinical Global Impression-Severity (CGS-S) scores ≤4 were included. The Korean Version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment Packet, the 2nd Edition (CERAD-K), CGI-S, and total Anticholinergic Cognitive Burden (ACB) scores were assessed. Statistical analyses included Mann-Whitney tests, Bootstrap analysis of covariance, and Spearman correlations. Results: The mean age was 69.52±6.33 years, with 66.67% female participants. The mean total ACB score was 4.30±2.42, with 80% of patients having scores ≥3. High ACB group (n=48) showed significantly higher CGI-S scores (3.13±0.73 vs. 2.67±0.49, p=0.030) and lower performance in Word List Memory, Constructional Praxis, and Constructional Recall domains. After adjusting for education year, age, and sex, high ACB group showed significantly lower CERAD-K total score I than the low ACB group (F=5.947, p=0.018). Total ACB score also showed significant negative correlations with CERAD-K total score I (r=-0.32, p=0.011). Conclusion High anticholinergic burden in elderly schizophrenia patients was significantly associated with cognitive impairment and symptom severity. These findings suggest the need for careful medication adjustment in this population.

Objectives: This study compared treatment persistence between aripiprazole once-monthly (AOM) and paliperidone palmitate 1-month (PP1M) in patients with schizophrenia spectrum disorders using long-term real-world data from a single university hospital. Methods: This retrospective cohort study analyzed electronic medical records of patients treated with long-acting injectable antipsychotics. To reduce structural bias, only patients receiving 1-month formulations, AOM or PP1M, were included. Discontinuation was defined as the absence of an additional injection for more than 60 days after the scheduled date. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate treatment persistence. Results: A total of 308 patients were analyzed (AOM, n=145; PP1M, n=163). The AOM group had a significantly higher proportion of patients without treatment discontinuation than the PP1M group (52.4% vs. 29.5%, p＜0.001). PP1M was associated with a significantly higher hazard of treatment discontinuation than AOM (hazard ratio=1.93, 95% confidence interval=1.40-2.65, p＜0.001). The distribution of discontinuation reasons did not differ significantly between groups (p=0.705). Conclusion AOM was associated with significantly longer treatment persistence than PP1M. These findings suggest that long-acting injectable agent selection may meaningfully influence long-term treatment continuity and should be considered when individualizing maintenance treatment strategies for schizophrenia spectrum disorders.

Objectives: This pilot study examined the preliminary findings associated with a cognitive-load-controlled structured psychodrama program on affect, fear of negative evaluation, and general psychopathology in long-term psychiatric inpatients, most of whom had schizophrenia spectrum disorders. Methods: A single-group pre-post design was used. A total of 125 stabilized long-term psychiatric inpatients participated in a 25-session structured psychodrama program. To enhance measurement validity in consideration of participants’ cognitive characteristics, self-report measures were administered in small-group sessions with individualized explanation. Primary outcomes (Positive and Negative Affect Schedule [PANAS], Affect Balance Scale [ABS], and Brief Fear of Negative Evaluation [BFNE]) were assessed in 125 participants, and the secondary outcome (Brief Psychiatric Rating Scale [BPRS]) was assessed in a randomly selected subgroup of 53 participants. Results: After the intervention, positive affect significantly increased, whereas negative affect significantly decreased on both the PANAS and ABS (all p＜0.001). BFNE scores significantly decreased from 43.14 to 28.94 (p＜0.001). Total BPRS scores also significantly decreased from 47.49 to 34.76 (p＜0.001), with notable improvements in depressive mood, anxiety, tension, somatic concern, and emotional withdrawal. Conclusion A structured psychodrama program may be a feasible and potentially beneficial psychosocial intervention for long-term psychiatric inpatients. However, given the single-group pre-post design and other methodological limitations, the magnitude of the observed changes should be interpreted cautiously. These findings may serve as preliminary data for future controlled trials.

Objectives: This study investigated medication perceptions, adherence patterns, self-discontinuation experiences, and information sources among psychiatric outpatients to provide evidence for improving adherence strategies. Methods: A cross-sectional survey was conducted with 79 outpatients from a University Hospital, Department of Psychiatry. Self-administered questionnaires assessed diagnostic awareness, medication perceptions, adherence behaviors, discontinuation experiences, side effects, and information sources. Results: Overall, 89.7% knew their psychiatric diagnosis and 88.2% perceived medication as effective. While 73.1% rarely forgot medication, 35.9% had previously self-discontinued treatment. Medication adherence was significantly associated with previous discontinuation experience (p=0.006), whereas diagnostic awareness and efficacy perception were not. Primary discontinuation reasons were symptom improvement (53.6%) and physical discomfort (35.7%). Common side effects included weight gain (n=31), daytime drowsiness (n=26), memory impairment (n=24), and concentration problems (n=22). Patients primarily obtained side effect information from TV/internet (27.8%) rather than healthcare providers (20.3%). Most patients desired additional information about side effects (57.0%) and medication effects (54.4%). Conclusion Daily medication-taking behaviors were more predictive of treatment discontinuation than cognitive factors in this outpatient sample. Discontinuation due to symptom improvement and reliance on non-medical information sources highlights the need for enhanced patient education regarding relapse risks and systematic provision of accurate medication information.

Objectives: We aimed to characterize the effect of electroconvulsive therapy (ECT) on mismatch negativity (MMN), an event-related potential suggested as a biomarker of cortical dysfunction and illness progression in psychosis, and its association with improvement in positive symptoms. Methods: MMN was calculated from electroencephalogram recorded during a passive auditory oddball paradigm before and after ECT in psychosis patients receiving both ECT and medication, at matched intervals in patients receiving medication only, and at baseline in healthy controls (HCs). In patient groups, group-time interaction on MMN amplitudes was analyzed using mixed models for repeated measures. In the ECT group, correlations between MMN amplitude and Positive and Negative Syndrome Scale (PANSS) subscales were assessed. Results: Data from 26 ECT-treated patients, 23 medication-only patients, and 50 HCs were analyzed. At baseline, MMN amplitude and latency differed among groups. A significant group-time interaction indicated differential MMN amplitude change between the ECT group and the medication-only group. In the ECT group, a positive repeated-measure correlation was observed between MMN amplitude and PANSS positive score. Conclusion Our results demonstrate a normalizing effect of ECT on MMN amplitude and its relationship with improvement of positive symptoms. They imply that ECT modulates neurophysiological mechanisms underlying MMN generation.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

The mechanism of electroconvulsive therapy (ECT) in schizophrenia remains unclear, with limited research available. Previous studies have reported ECT-induced changes in protein markers, including neurotrophic factors, inflammatory markers, and signaling proteins, but findings have been inconsistent. This study reviews existing literature on protein changes associated with ECT and explores potential molecular mechanisms underlying its effects. Additionally, we present pilot findings from 34 patients with schizophrenia or schizoaffective disorder who underwent ECT at Seoul National University Hospital. Blood samples collected before and after ECT were analyzed via liquid chromatography-tandem mass spectrometry (LC-MS/MS) to identify differentially expressed proteins (DEPs), with Pearson’s correlation analysis examining their association with symptom changes. Talin 2 emerged as a potential biomarker linked to clinical improvement. However, given the small sample size, these findings require cautious interpretation. Further research is needed to clarify the molecular mechanisms underlying ECT’s therapeutic effects in schizophrenia.

This review synthesizes research findings on the structural and functional brain changes observed after electroconvulsive therapy (ECT) in patients with schizophrenia. Structural neuroimaging studies suggest that the hippocampus, amygdala, and right insular cortex are the most critical areas implicated in ECT-related changes for these patients. Functional neuroimaging studies also highlight the involvement of the hippocampus, amygdala, and insular cortex, along with the prefrontal cortex, default mode network, and thalamostriatal system. We examine and discuss the potential implications of these incorporated findings. Given the relative scarcity of related studies, further research is needed to elucidate the mechanisms underlying the effects of ECT in patients with schizophrenia.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment for schizophrenia. However, its clinical utilization has been declining due to advancements in antipsychotic medications and the persistent stigma associated with the treatment. Clinical guidelines differ in their recommendations regarding the applications of ECT in schizophrenia treatment. Existing studies demonstrated that ECT is effective for treatment-resistant schizophrenia, clozapine-resistant schizophrenia, acute psychotic exacerbations, and patients at high risk of suicide, with enhanced efficacy when combined with antipsychotic medications. Despite its clinical benefits, concerns regarding cognitive impairment, social stigma, and limited accessibility have led to its underutilization. Addressing these challenges requires expanding educational efforts for clinicians, increasing public awareness, promoting further research into its long-term efficacy and cognitive effects, and implementing policy changes to improve accessibility. This review emphasizes the essential role of ECT in schizophrenia treatment and the need to reintegrate it as a viable and necessary treatment option for suitable patients.

The mechanism of electroconvulsive therapy (ECT) in schizophrenia remains unclear, with limited research available. Previous studies have reported ECT-induced changes in protein markers, including neurotrophic factors, inflammatory markers, and signaling proteins, but findings have been inconsistent. This study reviews existing literature on protein changes associated with ECT and explores potential molecular mechanisms underlying its effects. Additionally, we present pilot findings from 34 patients with schizophrenia or schizoaffective disorder who underwent ECT at Seoul National University Hospital. Blood samples collected before and after ECT were analyzed via liquid chromatography-tandem mass spectrometry (LC-MS/MS) to identify differentially expressed proteins (DEPs), with Pearson’s correlation analysis examining their association with symptom changes. Talin 2 emerged as a potential biomarker linked to clinical improvement. However, given the small sample size, these findings require cautious interpretation. Further research is needed to clarify the molecular mechanisms underlying ECT’s therapeutic effects in schizophrenia.