The clinical symptoms and signs of methamphetamine-associated psychosis (MAP) and schizophrenia are highly similar, but the situation is completely different when MAP and schizophrenia patients need to be assessed for criminal responsibility after they comitted a harmful behavior. Therefore, the distinction between the two psychoses is very important in forensic psychiatry. At present, the identification of these two psychoses is mainly dependent on the corresponding criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Chinese Classification of Mental Disorders Version 3 (CCMD-3). It's challenging to diagnose and distinguish between the two in practical cases due to their similar clinical symptoms and the lack of effective objective indexes. Different from the limitations of single omics, integrative omics intergrates data from multiple dimensions and has been extensively studied in the field of schizophrenia and has achieved some preliminary results. In view of the correlation between MAP and schizophrenia and the potential application value of integrative omics, this paper proposes an integrative omics strategy for MAP pathogenesis and forensic identification, aiming to improve the further understanding of the relationship between the two psychoses and the corresponding pathogenesis. It also provides references for the future exploration of integrative omics in forensic precise identification and effective monitoring and early warning methods.
Humans ; Methamphetamine/adverse effects* ; Psychoses, Substance-Induced/etiology* ; Psychotic Disorders/genetics* ; Schizophrenia/genetics* ; Diagnosis, Differential

OBJECTIVE: Suicide is the leading cause of death in 10–39-year-olds in South Korea, and the second highest rate among the OECD countries. However, few studies have investigated the particularity of completed suicide in South Korea. METHODS: Study subjects consisted of 2,838 suicide cases and 56,758 age and sex matched living controls from a national representative sample of 1,025,340 South Koreans. They were obtained from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) with follow-up up to 12 years. We obtained information on primary diagnosis of any ICD-10 disorder along with suicide cases during their lifetime. RESULTS: Among ICD-10 disorders, depression was the most common disorder (19.10%, n=542), found in victims of completed suicides except for common medical disorders such as hypertensive crisis, respiratory tract infection or arthropathies. After adjusting for sex, age, economic status, disability, and disorders, schizophrenia showed the strongest association with suicide (AOR: 28.56, 95% CI: 19.58–41.66) among all ICD-10 disorders, followed by psoriasis, multiple body injury, epilepsy, sleep disorder, depression, and bipolar disorder. For age groups, ≤19 years was associated with anxiety disorder (AOR=80.65, 95% CI: 13.33–487.93), 20–34 years with epilepsy (AOR=134.92, 95% CI: 33.69–540.37), both 35–49 years (AOR=108.57, 95% CI: 37.17–317.09) and 50–65 years (AOR=189.41 95% CI: 26.59–1349.31), with schizophrenia, and >65 years (AOR=44.7, 95% CI: 8.93–223.63) with psoriasis. CONCLUSION: Psychiatric and physical disorders carried greatly increased risks and numbers of suicides in South Korea. Schizophrenia was the strongest risk factor, especially 35–65 years, and depression was the most common in suicide victims among ICD-10 disorders in South Korea.
Anxiety Disorders ; Bipolar Disorder ; Case-Control Studies ; Cause of Death ; Cohort Studies ; Depression ; Diagnosis ; Epilepsy ; Follow-Up Studies ; Humans ; Insurance, Health ; International Classification of Diseases ; Korea ; National Health Programs ; Organisation for Economic Co-Operation and Development ; Psoriasis ; Respiratory Tract Infections ; Risk Factors ; Schizophrenia ; Sleep Wake Disorders ; Suicide

OBJECTIVE: Whether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral anti-psychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days. METHODS: We performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after. RESULTS: The mean number of admissions fell from 0.83 to 0.17 per patient (p < 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p < 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points. CONCLUSION: Our results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.
Antipsychotic Agents ; Diagnosis ; Hospitalization ; Humans ; Paliperidone Palmitate ; Psychotic Disorders ; Retrospective Studies ; Schizophrenia

OBJECTIVE: In this study, we aimed to evaluate the serum hepcidin levels in attention deficit hyperactivity disorder (ADHD) patients that were newly diagnosed with no history of psychotropic drugs. METHODS: A total of 70 ADHD patients and 69 healthy controls were enrolled in our study. During the diagnosis, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version were applied. The sociodemographic data form, Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale, and Conners’ Rating Scales-Revised: Long Form were used for the clinical evaluation. Serum hepcidin levels were measured and compared between the groups. RESULTS: No significant difference between the groups in terms of age (p=0.533) and gender (p=0.397) was determined. In addition, the groups did not differ significantly for the other sociodemographic variables recorded. Serum hepcidin levels were found to be significantly higher in the patients with ADHD than healthy controls (p=0.019). CONCLUSION: To the best of our knowledge, this study is the first to evaluate the total serum hepcidin levels in ADHD patients. Our study findings may suggest that high levels of hepcidin may cause iron dysregulation in ADHD patients. However, further studies are required to establish a definite conclusion.
Adolescent Behavior ; Adolescent ; Appointments and Schedules ; Attention Deficit Disorder with Hyperactivity ; Child ; Diagnosis ; Hepcidins ; Humans ; Iron ; Mass Screening ; Mood Disorders ; Psychotropic Drugs ; Schizophrenia

OBJECTIVES: In this preliminary study, we investigated the clinical characteristics of patients who were first diagnosed with psychotic disorder and explored the impact of the adherence to antipsychotics on long-term medical use. METHODS: All national health insurance claims related to psychotic disorders including gender, age, income, and drug compliance, from January 1, 2008 to December 31, 2015, were examined. With trend test using Medication Possession Ratio (MPR), we compared the medical use between the compliant group (MRP≥0.8) and the comparative non-compliant group (0.2≤MPR<0.8). RESULTS: Among 28,095 participants in total, 16,239 patients (57.8%) were diagnosed as schizophrenia; the 30s were the most common (n=7,151, 25.5%). Drug compliance was generally low regardless of the diagnosis and was the lowest among 20s with the 40–60% range of income. The compliant group showed lower psychiatric and medical use than the comparative group in the following years (p<0.0001). CONCLUSION: These findings suggest that patients in the 20s and 30s with the 40–60% range of income, who are diagnosed with schizophrenia at the first psychiatric visit, may need more clinical and political attention. The results also emphasize the importance of initial drug adherence to antipsychotics in reducing long-term psychiatric costs.
Antipsychotic Agents ; Compliance ; Diagnosis ; Humans ; National Health Programs ; Psychotic Disorders ; Schizophrenia

Neurocognitive deficits are frequently observed in patients with schizophrenia and major depressive disorder (MDD). The relations between cognitive features may be represented by neurocognitive graphs based on cognitive features, modeled as Gaussian Markov random fields. However, it is unclear whether it is possible to differentiate between phenotypic patterns associated with the differential diagnosis of schizophrenia and depression using this neurocognitive graph approach. In this study, we enrolled 215 first-episode patients with schizophrenia (FES), 125 with MDD, and 237 demographically-matched healthy controls (HCs). The cognitive performance of all participants was evaluated using a battery of neurocognitive tests. The graphical LASSO model was trained with a one-vs-one scenario to learn the conditional independent structure of neurocognitive features of each group. Participants in the holdout dataset were classified into different groups with the highest likelihood. A partial correlation matrix was transformed from the graphical model to further explore the neurocognitive graph for each group. The classification approach identified the diagnostic class for individuals with an average accuracy of 73.41% for FES vs HC, 67.07% for MDD vs HC, and 59.48% for FES vs MDD. Both of the neurocognitive graphs for FES and MDD had more connections and higher node centrality than those for HC. The neurocognitive graph for FES was less sparse and had more connections than that for MDD. Thus, neurocognitive graphs based on cognitive features are promising for describing endophenotypes that may discriminate schizophrenia from depression.
Adult ; Algorithms ; Depressive Disorder, Major ; classification ; diagnosis ; Endophenotypes ; analysis ; Female ; Humans ; Machine Learning ; Male ; Markov Chains ; Neuropsychological Tests ; Schizophrenia ; classification ; diagnosis ; Young Adult

OBJECTIVES: Dopamine dysregulation has been regarded as one of the core pathologies in patients with schizophrenia. Since dopamine synthesis capacity has found to be inconsistent in patients with schizophrenia, current classification of patients based on clinical symptoms cannot reflect the neurochemical heterogeneity of the disease. Here we performed new subtyping of patients with first-episode psychosis (FEP) through biotype-based cluster analysis. We specifically suggested basal ganglia structural changes as a biotype, which deeply involves in the dopaminergic circuit. METHODS: Forty FEP and 40 demographically matched healthy participants underwent 3T T1 MRI. Whole brain parcellation was conducted, and volumes of total 6 regions of basal ganglia have been extracted as features for cluster analysis. We used K-means clustering, and external validation was conducted with Positive and Negative Syndrome Scale (PANSS). ResultsZZK-means clustering divided 40 FEP subjects into 2 clusters. Cluster 1 (n = 25) showed substantial volume decrease in 4 regions of basal ganglia compared to Cluster 2 (n = 15). Cluster 1 showed higher positive scales of PANSS compared with Cluster 2 (F = 2.333, p = 0.025). Compared to healthy controls, Cluster 1 showed smaller volumes in 4 regions, whereas Cluster 2 showed larger volumes in 3 regions. RESULTS: K-means clustering divided 40 FEP subjects into 2 clusters. Cluster 1 (n = 25) showed substantial volume decrease in 4 regions of basal ganglia compared to Cluster 2 (n = 15). Cluster 1 showed higher positive scales of PANSS compared with Cluster 2 (F = 2.333, p = 0.025). Compared to healthy controls, Cluster 1 showed smaller volumes in 4 regions, whereas Cluster 2 showed larger volumes in 3 regions. CONCLUSIONS: Two subgroups have been found by cluster analysis, which showed a distinct difference in volume patterns of basal ganglia structures and positive symptom severity. The result possibly reflects the neurobiological heterogeneity of schizophrenia. Thus, the current study supports the importance of paradigm shift toward biotype-based diagnosis, instead of phenotype, for future precision psychiatry.
Basal Ganglia* ; Brain ; Classification ; Cluster Analysis ; Diagnosis ; Dopamine ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging ; Pathology ; Phenotype ; Polytetrafluoroethylene ; Population Characteristics ; Psychotic Disorders* ; Schizophrenia ; Weights and Measures

The ability to identify students at ultra-high risk (UHR) for psychosis in school settings is crucial for enabling appropriate referral to a clinician and positive therapeutic results. The aim of this study was to examine school counselors' recognition of the diagnosis and appropriate treatment recommendations for students at UHR for psychosis. In total, 132 school counselors completed surveys, including questions relating to a vignette about a student at UHR for psychosis. In total, 12.4% of the sample provided the correct diagnosis, much lower than that for other schizophrenia spectrum disorders and non-psychotic disorders, including depressive disorder. Although most school counselors preferred psychiatrists as the first-line treatment for students at UHR for psychosis, counseling centers were also mentioned as potential treatment options. In terms of medication, antipsychotics were preferred over other medication classes. It is necessary to design appropriate educational and training programs for school counselors to promote identification and effective referral of those at UHR for psychosis.
Antipsychotic Agents ; Counseling ; Depressive Disorder ; Diagnosis ; Education ; Humans ; Psychiatry ; Psychotic Disorders* ; Referral and Consultation ; Schizophrenia

Early detection is a crucial milestone in the prevention and treatment of schizophrenia spectrum psychosis, which might alter the course of schizophrenia. Currently, there are two complementary approaches to characterizing the clinical-high risk state of psychosis : the ultra-high risk (UHR) and basic symptoms criteria. Individuals at UHR have two phase-specific problems : heightened risk for the potential pathology of schizophrenia spectrum psychosis and the symptoms, distress and psychosocial functional impairment, which make them seek help. The clinical characteristics of UHR are similar to those of overt psychotic disorders in terms of psychopathological symptoms dimensions, psychosocial disability, neurocognitive and socio-cognitive impairments, history of trauma and abuse experience, lack of protective factors and dysfunctional metacognitive beliefs, and the comorbidity of psychiatric illness. Regarding the risk, the pretest risk probability of a psychotic disorder in each high-risk clinic is considered an important factor for predicting the power of an early detection strategy. For the distress and psychosocial disability, the strategies of the therapeutic intervention will be a focus of clinical attention. On the follow-up, one of third of the UHR individuals have sufficient positive symptom to fulfil the at-risk criteria. Most of the UHR individuals have suffered from comorbid psychiatric illness at the times of both baseline and follow-up, and there is no improvement of psychosocial functioning. Currently, it is essential to optimize the early detection and intervention strategy according to the referring and recruitment characteristics of each high-risk clinic in Korean practice situations.
Comorbidity ; Diagnosis* ; Follow-Up Studies ; Pathology ; Protective Factors ; Psychotic Disorders* ; Schizophrenia

PURPOSE: The purpose of this study was to construct an acceptance-commitment therapy (ACT)-based stress management program for inpatients with schizophrenia and to examine its effects on hospitalization stress, self-efficacy, and psychological well-being. METHODS: A non-equivalent control group pretest-posttest design was used. Participants were 44 inpatients with a diagnosis of schizophrenia. The experimental group (n=22) received the ACT-based stress management program twice a week for a total of four weeks. The control group (n=22) received the usual care from their primary health care providers. The study was carried out from August 7 to September 1, 2017, and data were analyzed using IBM SPSS/WIN 22.0 with a Chi-square test, Fisher's exact test, and an independent t-test. RESULTS: The experimental group showed a significant decrease in hospitalization stress (t=5.09, p < .001) and an increase in self-efficacy (t=2.44, p=.019). However, there was no significant difference in psychological well-being between the two groups (t=0.13, p=.894). CONCLUSION: The results of this study suggest that the ACT-based stress management program can be used as an effective mental health nursing intervention for hospitalization stress and self-efficacy for inpatients with schizophrenia.
Acceptance and Commitment Therapy ; Diagnosis ; Hospitalization* ; Humans ; Inpatients* ; Primary Health Care ; Psychiatric Nursing ; Schizophrenia* ; Self Efficacy ; Stress, Psychological