Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness.

Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm.

Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16–72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from ‘external’ cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE.

A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

The balance between neurotoxic and neuroprotective effects of kynurenine pathway (KP) components has been recently proposed as a key element in the pathophysiology of bipolar disorder (BD) and related mood episodes. This comprehensive overview explored the link of KP with symptom severity and other clinical features of BD.

We searched Medline, Embase, and PsycInfo electronic databases for studies assessing the association of peripheral and/or central concentrations of KP metabolites with putative clinical features, including symptom severity and other clinical domains in BD.

We included the findings of 13 observational studies investigating the possible variations of KP metabolites according to symptom severity, psychotic features, suicidal behaviors, and sleep disturbances in BD. Studies testing the relationship between KP metabolites and depression severity generated mixed and inconsistent findings. No statistically significant correlations with manic symptoms were found. Moreover, heterogeneous variations of the KP across different clinical domains were shown. Few available studies found (a) higher levels of cerebrospinal fluid kynurenic acid and lower of plasma quinolinic acid in BD with psychotic features, (b) lower central and peripheral picolinic acid levels in BD with suicide attempts, and (c) no significant correlations between KP metabolites and BD-related sleep disturbances.

An imbalance of KP metabolism toward the neurotoxic branches is likely to occur in people with BD, though evidence on variations according to specific clinical features of BD is less clear. Additional research is needed to clarify the role of KP in the etiopathogenesis of BD and related clinical features.

Previously, environmental vulnerability for schizophrenia assessed through exposome score for schizophrenia (ES-SCZ) was associated with the risk for psychosis development.

The current study aims to investigate the longitudinal association between ES-SCZ and symptom severity in individuals with first episode psychosis (FEP) to understand how environmental exposures affect illness course.

Baseline and 1-month follow-up assessments were available for 225 individuals with FEP from the Athens FEP Research Study. The Positive and Negative Syndrome Scale (PANSS) was used to measure clinical features. In accordance with previous reports, the ES-SCZ was calculated by summing log-odds weighted environmental exposures (childhood adversities, winter birth, and cannabis use). To model the course of clinical features over time the effects of the ES-SCZ-by-time interaction, ES-SCZ, and time were analyzed with multilevel regression analyses. Age, sex, and education were added as covariates

The analyses of change of PANSS total score over time indicated that clinical features decreased from baseline to the 1-month follow-up assessment. The association between ES-SCZ and PANSS total score were not statistically significant. The analyses of the PANSS total score over time indicated an ES-SCZ-by-time interaction (B = 2.82 [95% CI 0.28; 5.35], P-value = 0.029), meaning the decrease of the PANSS total score over time were dependent on ES-SCZ and individuals with high ES-SCZ showed less improvement

The findings show that the total environmental predisposition to schizophrenia (ES-SCZ) not only increases the risk for psychosis development but may also influences the illness course.

No significant relationships.

Neuronal intranuclear inclusion disease (NIID) is a rare slowly progressive neurodegenerative disorder that is characterized pathologically by the presence of eosinophilic intranuclear inclusions. NIID is a heterogeneous disease with diverse clinical manifestations, making diagnosis difficult. Here, we analyzed the clinical, pathological, and radiological features of Chinese NIID patients to improve our understanding of NIID.

A total of 17 patients with sporadic NIID were recruited from the Ruijin Hospital Database between 2014 and 2021. Clinical patient information and brain MRI data were collected. All of the patients underwent standard skin biopsy procedures.

The average age of onset for symptoms was 60.18 years, and the average duration of illness was 4.06 years. All patients were diagnosed with NIID due to the presence of intranuclear inclusions confirmed by skin biopsy. Tremor was the most common initial symptom. The average ages at onset and at diagnosis were both lower in patients with tremor than in patients without tremor. NIID may be a systemic disease that affects multiple organs, for one patient had a history of chronic renal insufficiency for more than 10 years. In addition to high-intensity U-fibers signals on diffusion-weighted imaging, there were several other MRI findings, such as focal leukoencephalopathy and cortical swelling. Encephalitic episodes followed by reversible leukoencephalopathy was another important imaging feature of NIID.

The clinical manifestations of NIID are highly variable. Tremor may be the most common initial symptom in certain cohorts. Encephalitic episodes followed by reversible asymmetric leukoencephalopathy may also indicate this disease.

Bipolar female patients have clinical and evolutionary features wich involve different factors related to the women specifities.

Establish clinical and evolutionary features in a population of bipolar female patients attending to Gabes psychiatry department.

A retrospective descriptive and analytical study was undertaken including female patients referred to psychiatry department of Gabes regional hospital, for the first time in a 6-year period (January 1st, 2010 to December 31, 2016) and who were already diagnosed with bipolar disorder (BD). Sociodemographic, clinical and evolutionary data were assessed. Patients were divised into two groups according to gender. The collected data were compared between the two groups. The statistical analysis was executed on the software SPSS (20th edition).

From the 193 bipolar patients, 103 were women. The mean age of the disorder’s onset amongst Female patients was 32.4 years old [14 - 63]. The mean duration of the disorder was 7.6 years [2 - 30]. The polarity of the first episode was a depressive one in 74.7% of cases. It was associated to psychotic features in 43.7% of cases. Seasonal pattern was noted in 10.6% amongst female patients and rapid cycling bipolar disorder in 6.2% of cases. Analytical study showed that women began the BD more often with a depressive episode (p=0.004) and were more frequently diagnosed with BD type 2 (p<0.001). Men had significantly more auditory (p=0.002) and visual hallucinations (p=0.019).

There were clinical specifities of women with BD from which important to be considered.

Familial co-aggregation studies of eating disorders (EDs) and schizophrenia reveal shared genetic and environment factors, yet their etiological and clinical relationship remains unclear. We evaluate the influence of schizophrenia family history on clinical outcomes of EDs.

We conducted a cohort evaluation of the association between family history of schizophrenia and ED clinical features, psychiatric comorbidities, and somatic and mental health burden in individuals born in Sweden 1977–2003 with anorexia nervosa (AN) or other EDs (OED: bulimia nervosa, binge-eating disorder, and ED not otherwise specified).

Of 12 424 individuals with AN and 20 716 individuals with OED, 599 (4.8%) and 1118 (5.4%), respectively, had a family history of schizophrenia (in up to third-degree relatives). Among individuals with AN, schizophrenia in first-degree relatives was significantly associated with increased comorbid attention-deficit/hyperactivity disorder (ADHD) [HR(95% CI) 2.26 (1.27–3.99)], substance abuse disorder (SUD) [HR (95% CI) 1.93 (1.25–2.98)], and anxiety disorders [HR (95% CI) 1.47 (1.08–2.01)], but higher lowest illness-associated body mass index (BMI) [1.14 kg/m2, 95% CI (0.19–2.10)]. Schizophrenia in any relative (up to third-degree) in AN was significantly associated with higher somatic and mental health burden, but lower ED psychopathology scores [−0.29, 95% CI (−0.54 to −0.04)]. Schizophrenia in first-degree relatives in individuals with OED was significantly associated with increased comorbid ADHD, obsessive-compulsive disorder, SUD, anxiety disorders, somatic and mental health burden, and suicide attempts.

We observed different patterns of ED-related outcomes, psychiatric comorbidity, and illness burden in individuals with EDs with and without family histories of schizophrenia and provide new insights into the diverse manifestations of EDs.