Abstract Purpose Negative symptoms remain a primary driver of functional disability in schizophrenia spectrum disorders. This article presents the official Danish Multidisciplinary Psychiatry Group’s (DMPG) national clinical guideline for the assessment and treatment of negative symptoms in psychotic disorders across the lifespan. Materials and methods A systematic literature search for systematic reviews and meta-analyses published between 2019 and 2024 was conducted in PubMed and PsycInfo. Studies were screened and extracted by independent reviewers using Covidence. To ensure clinical utility, recommendations were formulated by synthesizing the evidence base with expert consensus, which included extrapolating adult data to formulate guidance for children and adolescents where primary evidence is scarce. Results The consensus process yielded 21 specific clinical recommendations. The guideline mandates the assessment of five distinct domains (anhedonia, asociality, alogia, avolition, and blunted affect) using dedicated scales like the BNSS. It provides clear guidance on pharmacological strategies, including a conditional endorsement of modafinil augmentation and a recommendation against cannabinoids. Evidence-based psychosocial interventions, such as cognitive behavioral therapy and cognitive remediation, are also recommended. Conclusions The guideline establishes a comprehensive, clinically actionable framework for managing negative symptoms in children, adolescents, and adults. Furthermore, it emphasizes that advancing the field requires future research to utilize domain-specific tools to accurately distinguish primary from secondary negative symptoms.
Sofie Norlin Mølgaard, L. Glenthøj, R. Arendt et al.· Nordic Journal of Psychiatry· 0 citations
Abstract Background and Hypothesis Sleep disturbance is a well-established risk factor for suicide, though few studies to date have examined whether sleep disturbance contributes to suicide risk among individuals at clinical high risk for psychosis (CHR). The current study addressed this gap in the literature. We hypothesized that sleep disturbance would have a unique relationship with suicidal ideation/attempts when accounting for other variables in the model. We also hypothesized that the interaction between sleep disturbance/attenuated positive symptoms and sleep disturbance/stress would be related to suicidal ideation/attempts in CHR. Study Design The current study used data generated by the Accelerating Medicines Partnership® Schizophrenia Observational Study. The total sample included 1,048 participants (827 CHR and 221 community controls). Participants completed measures of suicidal ideation/attempts, attenuated positive symptoms, depressive symptoms, perceived stress, and sleep disturbance. Study Results Results supported a relationship between sleep disturbance and suicidal ideation/attempts in CHR, with participants who had lifetime ideation and attempts experiencing more sleep disturbance than those with no ideation or attempts. We also found small, but significant positive correlations between sleep disturbance and suicide risk in CHR. When accounting for other variables in the model, the effect of sleep disturbance remained significant for past month ideation, but not lifetime ideation or attempts. Both interaction models were non-significant. Conclusions Our findings highlight the potential value of sleep measures in early identification and treatment of suicide risk in CHR. Further research in this area is warranted.
H. Wastler, Aubrey M. Moe, Alexandra M Blouin et al.· Schizophrenia Bulletin Open· 0 citations
BACKGROUND
Avatar therapy is a virtual reality-based intervention designed to reduce the distress and severity of persistent auditory verbal hallucinations (AVHs) in schizophrenia spectrum disorders. Despite promising initial evidence, methodological limitations and implementation barriers have prevented widespread adoption. This study evaluated the feasibility and preliminary effectiveness of an enhanced VR-Avatar therapy in a Hungarian cohort as part of an international multi-site trial.
METHODS
In a non-randomized, waitlist-controlled pre-post design study, 30 outpatients with schizophrenia spectrum disorders and persistent AVHs received seven sessions of individual VR-Avatar therapy following a 12-week waiting period. Assessments were conducted at baseline, pre-intervention, and post-intervention by blinded raters, using measures of symptom severity, comorbid symptoms, and well-being. Piecewise linear mixed-effects models examined changes in slopes between waitlist and therapy phases.
RESULTS
Regarding primary outcomes, VR-Avatar therapy was associated with significant reductions in AVH severity (PSYRATS Hallucinations: Δslope = -0.36, p = 0.02, partial η2 = 0.09, PANSS hallucination: Δslope = -0.04, p = 0.02, partial η2 = 0.17) The PANSS positive symptoms subscale, the third primary outcome, showed a marginal improvement (Δslope = -0.09, p = 0.05, partial η2 = 0.056). The secondary outcome (BAVQ-R) showed trends toward reduction in voice malevolence (Δslope = -0.12, p = 0.16) and omnipotence (Δslope = -0.11, p = 0.09). Among exploratory outcomes, trait anxiety improved significantly (STAI-Trait: Δslope = -0.47, p = 0.02, partial η2 = 0.17). Dropout was low (2.85%). Therapy produced heterogeneous responses, where 43.3% (N = 13) achieved ≥6-point PSYRATS-AH reduction. Older age significantly predicted stronger outcomes (p = 0.028).
CONCLUSION
VR-Avatar therapy demonstrated good feasibility and high acceptability in a Hungarian clinical setting, with preliminary evidence suggesting potential benefits in reducing the severity of AVH and related distress.
L. Egervári, G. Csukly, Lilla Gerlinger et al.· Acta Psychologica· 0 citations
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