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
The temporal course of antipsychotic drug action in schizophrenia remains poorly understood. We aimed to explore how different symptom domains of schizophrenia improve over time. Such knowledge has important implications for treatment decisions and for understanding the mechanisms of action of antipsychotic drugs.
METHODS
We analysed individual patient data from an existing repository comprising six antipsychotic drug trials of 6-12 months' duration in patients with acute schizophrenia (n=2079; 1328 [64%] men, 751 [36%] women; 1577 [76%] White, 502 [24%] non-White; mean age 34·72 years [range 16-73]). We used descriptive statistics to examine improvement trajectories across five PANSS symptom domains according to an established five-factor model (positive symptoms, negative symptoms, hostility and excitement, anxiety and depression, and cognitive and disorganisation). Time-to-response analyses were conducted using a threshold of at least 50% symptom reduction to define response within each domain. We used path analysis to explore whether improvements in negative, positive, and cognitive symptoms were mediated by changes in other symptom domains. People with lived experience were not involved in the project.
FINDINGS
All five symptom domains showed substantial improvements during the first weeks of treatment, which slowly plateaued from week 15 onwards. While the factors improved in parallel, some improved more than others. Within the first 6 months, on average, hostility and excitability symptoms decreased by 76% (95% CI -80·5 to -71·1) from baseline, positive symptoms by 64% (-68·0 to -60·5), anxiety and depression symptoms by 57% (-61·2 to -53·2), cognitive and disorganisation symptoms by 61% (-64·0 to -57·2), and negative symptoms by 50% (-53·9 to -46·4). Median time to response adjusted for baseline symptom severity, age, and sex, was 3 weeks (95% CI 3 to 3, restricted mean survival time [RMST] 6·60, SE 0·20)) for hostility and excitement and 4 weeks for positive symptoms (4 to 4, RMST 7·76, SE 0·20) and anxiety and depression symptoms (4 to 4, RMST 8·71, SE 0·22), compared with 8 weeks for negative symptoms (6 to 9, RMST 12·45, SE 0·25) and cognitive and disorganisation symptoms (6 to 9, RMST 12·06, SE 0·25). Exploratory investigations using path analysis suggested that only a small proportion of the improvement in negative symptoms was mediated by improvements in cognitive and disorganisation and anxiety and depression domains.
INTERPRETATION
Clinicians should be aware of earlier attainment of substantial response of hostility and excitement, then positive symptoms, before substantial reductions in other domains. Treatment changes should not be made prematurely when negative and cognitive and disorganisation symptoms persist, as improvement in these domains lags behind. Researchers should consider these temporal patterns when investigating the mechanisms of action of antipsychotic drugs.
FUNDING
None.
S. Leucht, Mathias Harrer, S. Illing et al.· Lancet psychiatry· 2 citations
Lived experience narratives provide a rich account of how individuals interpret and organize their mental health, capturing dimensions of meaning and context that are often missed by structured assessments and traditional language-based features. Despite their importance, the unstructured nature of these data has limited their systematic use. Recent advances in large language models (LLMs) enable scalable analysis of narrative data, allowing for the extraction of thematic and structural features across large datasets. These approaches position lived experience as a promising digital biomarker, with the potential to capture early, ecologically valid signals and complement existing clinical measures. However, challenges related to validation, interpretability, bias, and data governance remain. We outline emerging methodological frameworks and discuss how LLMbased approaches can support more scalable, longitudinal, and person-centered models of mental health.
Jenna M. Reinen, Cheryl M. Corcoran, René S. Kahn et al.· International Conference on...· 0 citations