These data suggest that olanzapine has some superior cognitive benefits relative to haloperidol and risperidone. A larger sample replication study is necessary to confirm and generalize the observations of this study and begin evaluation of the implications of this change to cerebral function and quality of life for people with schizophrenia.

Computers, video games, and technological devices are part of young people’s everyday lives. Hikikomori is a Japanese word describing a condition that mainly affects adolescents or young adults who live isolated from the world, cloistered within their parents’ homes, locked in their bedrooms for days, months, or even years on end, and refusing to communicate even with their family. These patients use the Internet profusely, and only venture out to deal with their most imperative bodily needs. Although first described in Japan, cases have been described from around the world. This is the first published report from Canada. The disorder shares characteristics with prodromal psychosis, negative symptoms of schizophrenia, or Internet addiction, which are common differential or comorbid diagnoses. However, certain cases are not accompanied by a mental disorder. Psychotherapy is the treatment of choice although many cases are reluctant to present. The exact place of hikikomori in psychiatric nosology has yet to be determined. We searched Medline up to 12th May, 2015 supplemented by a hand search of the bibliographies of all retrieved articles. We used the following search terms: Hikikomori OR (prolonged AND social AND withdrawal). We found 97 potential papers. Of these 42 were in Japanese, and 1 in Korean. However, many of these were cited by subsequent English language papers that were included in the review. Following scrutiny of the titles and abstracts, 29 were judged to be relevant. Further research is needed to distinguish between primary and secondary hikikomori and establish whether this is a new diagnostic entity, or particular cultural or societal manifestations of established diagnoses.

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These data will be useful for developing Web-based psychoeducation tools and cognitive remediation video games for youth with FEP.

Background: Long-acting injectable antipsychotics (LAI-AP) for patients with schizophrenia (SCZ) have saved significant healthcare costs. However, the cost effectiveness of LAI-AP for patients with other mental disorders has yet to be established. The goal of this study was to evaluate the impact of early initiation of LAI-AP medications on healthcare resource utilization (HRU). Drawing on the Quebecois universal healthcare program (RAMQ), we conducted a nationwide prospective cohort study of LAI-AP under real-world conditions. Methods: This study was performed using a representative sample of patients newly treated with LAI-AP (n = 3957) who were covered by the Québec Health Insurance Plan. The index date was defined as the date of the first prescription for LAI-AP between 1 January 2008 and 31 March 2012. We collected (a) the demographics and patient characteristics; (b) the treatment characteristics index drug, speciality of the principal prescriber, prescriptions of LAI-AP; and (c) HRU and costs. Two comparisons were made between (a) non-SCZ users of LAI-AP and SCZ users of LAI-AP; and (b) patients with SCZ using first-generation antipsychotic LAI-AP (FGA-LAI) and second-generation antipsychotic LAI-AP (SGA-LAI). Results: In the people with SCZ group, 976 patients were on an SGA-LAI, and 1020 patients were on an FGA-LAI; 41.9% of all users were on risperidone LAI-AP during this period and 17.9% were on zuclopenthixol decanoate. The number of hospitalizations was reduced by half. Durations were also significantly reduced. The total healthcare cost savings for all users were C$29,876 per patient/per year. Younger patients tended to receive more SGA-LAI than FGA-LAI: 29% versus 13%. The percentage of general practitioners who prescribe LAI-AP is higher in the FGA-LAI group than in the SGA-LAI group: 19% versus 13%. For psychiatrist prescribers, it is the opposite: 86% (SGA-LAI) versus 79% (FGA-LAI). The concomitant use of oral antipsychotics (OAP) in the year following index date is higher in the FGA-LAI group: 75% versus 43%. The number of hospitalization days was reduced by 31.5 days in the FGA-LAI group and 38.8 days in the SGA-LAI group. Cost savings were of C$31,924 in the FGA-LAI group and of C$39,100 in the SGA-LAI group. Conclusion: The initiation of LAI-AP saved significant costs to the province of Québec compared with the previous year. Initiation of a LAI-AP resulted in lower resource use. Higher medication costs were offset by lower inpatient and outpatient costs.Keywords: antipsychotics, compliance, healthcare resource utilization, long-acting injection formulations of antipsychotics, relapse prevention, schizoaffective disorder, schizophrenia. [4][5][6][7] In a recent study, we illustrated that healthcare costs in the year following LAI-AP initiation in SCZ were associated with significant healthcare cost savings compared with the previous year. [8][9][10][11] Drawing on the Québec universal healthcare program (RAMQ) that covers physician services and hospitalizations for the entire provi...

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Our objective was to assess the generalizability, across sites and cognitive contexts, of schizophrenia classification based on functional brain connectivity. We tested different training-test scenarios combining fMRI data from 191 schizophrenia patients and 191 matched healthy controls obtained at 6 scanning sites and under different task conditions. Diagnosis classification accuracy generalized well to a novel site and cognitive context provided data from multiple sites were used for classifier training. By contrast, lower classification accuracy was achieved when data from a single distinct site was used for training. These findings indicate that it is beneficial to use multisite data to train fMRI-based classifiers intended for large-scale use in the clinical realm.

16p11.2 and 22q11.2 Copy Number Variants (CNVs) confer high risk for Autism Spectrum Disorder (ASD), schizophrenia (SZ), and Attention-Deficit-Hyperactivity-Disorder (ADHD), but their impact on functional connectivity (FC) remains unclear. Here we report an analysis of resting-state FC using magnetic resonance imaging data from 101 CNV carriers, 755 individuals with idiopathic ASD, SZ, or ADHD and 1,072 controls. We characterize CNV FC-signatures and use them to identify dimensions contributing to complex idiopathic conditions. CNVs have large mirror effects on FC at the global and regional level. Thalamus, somatomotor, and posterior insula regions play a critical role in dysconnectivity shared across deletions, duplications, idiopathic ASD, SZ but not ADHD. Individuals with higher similarity to deletion FC-signatures exhibit worse cognitive and behavioral symptoms. Deletion similarities identified at the connectivity level could be related to the redundant associations observed genome-wide between gene expression spatial patterns and FC-signatures. Results may explain why many CNVs affect a similar range of neuropsychiatric symptoms.