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To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP).
A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies.
One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49–58]) over a mean follow-up period of 43.57 months (SD = 51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27–36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found.
Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years.
Empirically derived dietary patterns are useful to describe food consumption habits within population groups. The aim of the study was to analyse dietary patterns as well as changes of these patterns within the last decade among German adolescents.
Dietary patterns were analyzed for 12 to 17 years old participants of two waves of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Baseline (2003–2006) N = 5.197 and KiGGS Wave 2 (2014–2017) N = 5.199). KiGGS is part of the nationwide health monitoring in Germany. Food consumption was assessed by a semi-quantitative food frequency questionnaire. Based on this information, dietary patterns were derived using principal component analysis in a former analysis for KiGGS Baseline(1) and in this new analysis for KiGGS Wave 2. In KiGGS Baseline three major dietary patterns were identified (‘western’, ‘traditional’, and ‘healthy’) among boys and two among girls (‘western/traditional’, and ‘healthy’).
In KiGGS wave 2 the ‘traditional’ pattern could not be identified anymore among boys and a new pattern, the ‘sandwich’ pattern was identified among girls and boys. The ‘sandwich’ pattern was positively correlated with the intake of bread, processed meat, cheese, butter/margarine, jam, cake/cookies, and among boys also confectionary. Compared to the former ‘traditional’ dietary pattern among boys, the new ‘sandwich‘ pattern shows similarities (bread, processed meat and butter/margarine) but the former warm meal components are missing (meat and potatoes).There were only slight differences in the food groups associated with the ‘western’, ‘western/traditional’ or ‘healthy’ pattern between both surveys.
Within the past decade dietary patterns changed among German adolescents. In 2014–2017 a new ‘sandwich’ pattern was identified among boys and girls, and the ‘traditional’ dietary pattern was not found any more among boys. This change could be associated with more frequent food consumption out of home among adolescents. Within the past decade, the school system in many German federal states was restructured from half-day schools towards whole-day schools and the utilization of meal supply within schools almost doubled among adolescents. These changes may have influenced the food consumption habits among adolescents.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
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