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gondii compared to controls. Thus, this study adds to previous research questioning the asymptomatic aspect of chronic toxoplasmosis and the etiology of schizophrenia.The cortisol response in patients with obsessive-compulsive disorder (OCD) during exposure with response prevention (ERP), a stressful but very effective psychotherapeutic treatment, has shown contradictory findings in three prior studies with low sample sizes. In a larger cohort of 51 patients with OCD we repeatedly measured subjective units of distress (SUD) and the adrenocortical stress hormones cortisol, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) in saliva during the very first session of ERP and on the day before. Expectedly, SUD were increased on the ERP day before the session and further rose during ERP, but salivary cortisol and DHEA were statistically indistinguishable from the comparison condition. Interestingly, DHEA-S was significantly elevated throughout the ERP versus the comparison day, but did not further increase in acute response to ERP. According to an explorative analysis in a subsample, hormone levels on the comparison or the ERP day did not predict anti-OCD treatment response one month later. These results corroborate our prior findings of cortisol non-response despite considerable subjective stress in ERP. The role of DHEA-S in anticipatory anxiety and the effects of augmentative cortisol therapy in ERP need further study.Transcranial magnetic stimulation (TMS) can be used to evaluate the effects of pharmacological interventions. The aim of this study was to assess the impact of the selective serotonin reuptake inhibitor, sertraline, and the atypical antipsychotic drugs quetiapine and olanzapine, on cortical excitability in unmedicated patients with major depressive disorder (MDD). The study included 45 medication-free MDD patients diagnosed according to DSM V. They were divided randomly into three groups who received a single oral dose of one of the three drugs sertraline (50 mg), quetiapine (100 mg) and olanzapine (10 mg). Psychological evaluation was conducted using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory Scale (BDI). Resting and active motor thresholds (rMT and aMT) together with contralateral and ipsilateral cortical silent periods (cSP, and iSP) were measured for each participant before and at the time of maximum concentration of drug intake. There was significant increase in excitability of motor cortex after sertraline without changes in GABAB neurotransmission. Quetiapine and olanzapine potentiated inhibitory GABAB neurotransmission (prolongation of cSP); olanzapine additionally prolonged the iSP. Thus TMS can differentiate between the impact of different psychotropic drugs on excitatory and inhibitory transmission in motor cortex.The present study examined clinician outreach efforts to families and family engagement; and predictors of engagement in a coordinated specialty care (CSC) for first episode psychosis. From 2015 to 2019, 211 clients experiencing their first episode of psychosis and their family members received services from New Journeys, a network of CSC programs in the United States. Analyses examined the association between race/ethnicity, insurance type, referral source, housing stability, and outreach efforts and family attendance. Overall, 70% of client family members attended at least one psychoeducation appointment and in the first month of treatment 40% of family members attended family psychoeducation. Outreach efforts including phone attempts (β=1.09; p = 0.02) and phone contact (β=1.10; p = 0.02) were significantly higher for Black families relative to White families; whereas Black families were scheduled less often for a family psychoeducation (β=-0.28; p = 0.02) compared to Whites families. Significant differences in family attendance based on insurance type were also found (p less then 0.01). Referral source and housing stability were not significant predictors of outreach or attendance. These findings suggest that alternative engagement efforts that extend beyond in-person contact may be needed to continuously engage families, specifically Black families and those with public and no insurance.Cognitive impairments are core features of schizophrenia and the best predictor of functional outcome. Cholinergic system and alpha-7 nicotinic acetylcholine (α7nACh) receptors are strongly implicated in the pathophysiologic mechanisms associated with cognitive impairments in schizophrenia. IOX2 research buy Galantamine is not only a reversible, competitive inhibitor of acetylcholinesterase but also a type I positive allosteric modulator of α7nACh receptors. The objective of this meta-analysis was to examine the efficacy of galantamine for cognitive symptoms of schizophrenia. In the meta-analysis that included six randomized controlled trials (RCTs, N=226), cognitive impairments significantly improved with galantamine compared to placebo, with a small Hedges' g effect size of 0.233. This finding is consistent with other RCTs in schizophrenia with medications with a similar mechanism of action. On the basis of the results from all the failed (although some efficacy has been shown) RCTs to date in schizophrenia, targeting only one pathophysiologic mechanism may be insufficient to detect a clinically meaningful signal. Nicotinergic medications, like any other add-on medications, are unlikely to be effective as stand-alone medications. Hence, these medications may have to be combined with other medications with complementary mechanisms such as glutamatergic/N-methyl-D-aspartate systems to detect a meaningful effect size for the three domains of psychopathology.The association between Attention Deficit Hyperactivity Disorder (ADHD) and suicidal ideation has been the focus of recent research interest among youths and young adults. However, the role perceived stress plays in this association is unclear. We investigated whether perceived stress accounts for the association between ADHD and subsequent suicidal ideation among French students enrolled in the i-Share cohort. The associations between ADHD symptoms, perceived stress at baseline, and suicidal ideation during follow-up were investigated using logistic regression models, and Structural Equation Modeling was used to estimate the indirect effect via perceived stress. In total 4333 participants (median age 20.3 years; [interquartile range 18.7-21.8]) were included in the main analyses. ADHD was associated with suicidal ideation (adjusted Odds Ratio = 1.15 [95% Confidence Interval 1.04-1.26]). Perceived stress partially accounts for the association between ADHD and suicidal ideation (proportion explained 49%). Our study suggests that ADHD and perceived stress represent mental health targets for suicide prevention programs.Results of studies on peripheral blood levels of homocysteine (Hcy) in children with autism spectrum disorder (ASD) are inconsistent, and conclusions from two previous meta-analyses on this subject published in 2012 are already outdated. Therefore, we conducted an updated systematic review and meta-analysis to quantitatively summarize the peripheral blood Hcy data in children with ASD compared with healthy controls (HC). We searched PubMed, EMBASE, PsycINFO, PsycARTICLES, Web of Science, and Cochrane Library databases from inception to September 2019 for eligible studies, with no language restriction. Using random-effects model, we computed summary statistics. Thirty-one studies (3304 participants including 1641 cases) were included. The pooled results showed that the peripheral blood Hcy levels were significantly elevated in children with ASD when compared to HC (Hedges's g = 0.56, 95% CI = 0.36 to 0.76, P less then 0.001). By sensitivity analyses, we confirmed that our results were quite robust. Additionally, no publication bias was observed in this meta-analysis. In conclusion, our study support the association of increased circulating Hcy levels with ASD in children, and the involvement of Hcy in the occurrence of ASD. However, in view of the significant between-study heterogeneity, the conclusions should be interpreted cautiously and more investigation is required.Individuals with schizophrenia are over three times more likely to have problem and pathological gambling (PPG) than the general population (Cunningham-Williams et al., 1998; Desai and Potenza, 2009), but little is known about this co-occurrence and how PPG relates to specific symptom dimensions of psychotic disorders. Although cognitive distortions in PPG have been linked to gambling motivations (e.g., distorted thoughts about odds of winning), how psychotic symptoms in schizophrenia or related disorders relate to gambling motivations have not been examined systematically to date. Individuals with schizophrenia or schizoaffective disorder (n = 170) completed structured face-to-face interviews regarding problem-gambling severity, gambling motivations, and five symptom factors of psychosis (Positive, Negative, Disorganized/Concrete, Depressed, and Excited). Different symptom dimensions of psychosis showed distinct patterns of relationships with motivations to gamble and gambling onset. PPG in schizophrenia was associated with elevated scores on the Depressed factor. Psychotic symptom severity was associated with increased motivation to gamble for financial reasons and decreased motivations to gamble for service, and possibly social or interpersonal, reasons. Age of gambling onset was inversely associated with psychotic symptom severity, particularly positive features. Our findings suggest that motivations for gambling may differ in the context of schizophrenia and relate to specific symptom clusters.Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.Although prolonged exposure (PE) and SSRI antidepressants are effective in treating posttraumatic stress disorder (PTSD), previous studies have shown that some symptoms tend to persist. The current study compared sertraline hydrochloride plus enhanced medication management (EMM), PE plus placebo, or PE plus sertraline hydrochloride in the likelihood of each individual PTSD symptom persisting in veterans with a PTSD diagnosis. We compared the likelihood of individual PTSD symptoms persisting in those with versus without a PTSD diagnosis at posttreatment. We found no significant differences across conditions in which symptoms were likely to persist posttreatment. Among those without a PTSD diagnosis at posttreatment, sleeping difficulties (63.0%), hypervigilance (47.3%), and nightmares (45.0%) were most likely to persist. Findings indicate no consistent differences in residual symptoms between PE and medications, and shared decision making with patients is encouraged in selecting treatments. Gold standard treatments (e.