There is a substantial body of literature on environmental risk associated with schizophrenia. Most research has largely been conducted in Europe and North America, with little representation of the rest of the world; hence generalisability of findings is questionable. For this reason, we performed a mapping review of studies on environmental risk for schizophrenia spectrum disorders, recording the country where they were conducted, and we linked our findings with publicly available data to identify correlates with the uneven global distribution. Our aim was to evaluate how universal is the ‘common knowledge’ of environmental risk for psychosis collating the availability of evidence across different countries and to generate suggestions for future research identifying gaps in evidence.

We performed a systematic search and mapping of studies in the PubMed and PsycINFO electronic databases reporting on exposure to environmental risk for schizophrenia including obstetric complications, paternal age, migration, urbanicity, childhood trauma, and cannabis use and subsequent onset of schizophrenia spectrum disorders. This search focused on articles published from the date of the first available publication until 31 May 2023. We recorded the country where they were conducted. We downloaded publicly available data on population size, measures of wealth, medical provisions, research investment, and of quality research outputs per country and performed regression analyses of each predictor with the number of studies and recruited cases in each country.

We identified 308 publications that included a sample size of 445,000 patients with schizophrenia spectrum disorders. The majority were conducted in northern Europe and North America, with large parts of the world totally unrepresented. In the associations between the number of environmental risk studies for schizophrenia with potential predictors, we found that neither population nor wealth or research investment were strong predictors of research outputs in the field. Interestingly, the stronger correlations were found for number of researchers per population and for indicators of top-end scientific achievements, such as number of Nobel laureates per country.

Our results demonstrate a gap of knowledge due to the underrepresentation of studies on environmental risk of schizophrenia spectrum disorders in large parts of the world. This has implications not only in the generalisability of any findings from research conducted in the Northern hemisphere but also in our ability to progress in efforts to make causal inferences about biological pathways to schizophrenia. These findings reinforce the need to focus research on populations that are underrepresented in research and underserved in health care.

Antimicrobials are frequently prescribed to hospice patients despite limited data on their utility.1–3 The Palliative Performance Scale (PPS) has been used for survival prediction among cancer patients and further generalized to end-of-life (EOL) diagnoses.4 This study aims to identify characteristics associated with antimicrobial usage within 30 days of EOL in non-hospitalized outpatient hospice patients from a single center in the United States (US).

We analyzed data on 1,111 hospice deaths from 2019. From these data, patients were divided into two groups: those who received antimicrobials at EOL (n = 212) and equally randomly computer-generated control group who did not. Fisher’s exact test and Wilcoxon rank sum test were used for analysis. PPS was recorded and used to determine functional status; higher PPS equates to higher functional status. Multivariable logistic regression correlated patient characteristics with EOL antimicrobial status.

Higher PPS scores were significantly associated with increased likelihood of antimicrobial use (Odds Ratio [OR] 1.40, 95% Confidence Interval [CI] 1.16–1.70). Male patients (OR 0.60, 95% CI 0.40–0.90) and patients with cancer (OR 0.61, 95% CI 0.39–0.96) were associated with lower odds of receiving antimicrobials. No significant association was found with age, race/ethnicity, residence, illness, or code status.

The study identifies an association between PPS and antimicrobial prescribing near EOL. Tailoring antimicrobial use based on individual patient characteristics and goals may better align with hospice care objectives and aid in stewardship endeavors. Further research is needed to explore PPS as a potential tool to guide prescribing.

Psychosocial interventions for people with mental illness are increasingly focusing on facilitating recovery and self-care. Despite evidence from Europe on the short-term effects of recovery self-planning programs for people discharged from crisis resolution teams, similar programs and supporting evidence in other countries or healthcare contexts are lacking, particularly regarding cultural adaptation and long-term assessment. This randomized controlled trial compared a 4-month peer-facilitated, recovery-focused self-illness management (Peer-RESIM) program for Chinese adults with first-episode psychosis with psychoeducation (PE) and treatment as usual (TAU).

Patients (N = 198) were recruited from four Integrated Community Centres for Mental Wellness in Hong Kong and randomly assigned to the Peer-RESIM, PE, or TAU group (66/group). The primary outcomes were recovery and functioning levels; the secondary outcomes were psychotic symptoms, problem-solving ability, rehospitalization rate, and service satisfaction. Assessments were conducted at baseline and immediate, 9, and 18 months postintervention.

The generalized estimating equation test revealed that the Peer-RESIM group reported significantly greater improvements in recovery, functioning, problem-solving ability, psychotic symptoms, average duration of rehospitalizations, and service satisfaction (p = 0.01–0.04, small to large effect sizes) than the TAU group at all three posttests and the PE group at 18 months postintervention.

The Peer-RESIM can enhance long-term recovery and self-care in adults with early-stage psychosis.

To determine the frequency and outcomes of early follow-up blood cultures (BCs) collected within 48 hours of patients being investigated for bacteremia in the emergency department (ED), as well as the number of new pathogens isolated.

Retrospective observational study of patients who had BCs collected in the ED between October 2019 and July 2020.

This study was conducted in a large, metropolitan ED with annual census of over 82,000 adult presentations. ED patients who had BCs collected during the study period were identified, and those who had BCs recollected within 48 hours were identified as having early follow-up BCs. The characteristics of these patients were compared to those without early follow-up BC collection. Logistic regression analyses were conducted to determine relationships between specific pathogens in EDBCs and early follow-up BC collection.

During the study period, 68,330 patients were treated in the ED, and BCs were collected from 1821 (2.7%). Of these, 449 (24.7%) had BCs recollected within 48 hours of their initial ED workup (early follow-up BCs) and were re-cultured 789 times across their collective stays. Five patients (1.1%) grew pathogens not isolated in EDBCs, all of which were susceptible to concurrent antimicrobials. No new pathogens were isolated in BCs taken >48 hours post ED workup.

Collection of early follow-up BCs was common. However, the rate of new pathogen growth was low and contributed minimally to patient management. Given associated costs and patient discomfort, the practice should be discouraged unless to clarify potential false positive results in ED BC.

Although current prescribing guidelines suggest continuation of psychotropic drugs in pregnant women, population-based evidence supporting their safety is limited.

This study aims to clarify the plausible causal links between maternal psychotropic drug exposures and obstetric complications.

This cohort study investigated all births by Hong Kong residents ≥18 years of age in public hospitals between 2004 and 2022. Birth episodes were classified according to whether they were unexposed to psychotropic drugs, exposed but discontinued before conception or exposed during pregnancy. Firth’s penalised logistic regression was employed in all analysis, and negative control analysis was conducted to assess causality. False discovery rate correction and sensitivity analyses were performed.

Among 587 419 births, 7182 episodes involved psychotropic prescriptions (antipsychotics, antidepressants, anticonvulsants, benzodiazepines) during pregnancy. In broad drug class analysis, all significant associations observed in the exposed group were also observed in negative control analysis (psychotropics discontinued before conception), suggesting that elevated risks could be attributed to unmeasured confounders. Nevertheless, in subclass analyses, certain psychotropic drugs showed increased risks of obstetric complications, i.e. significant associations between atypical antipsychotics and genito-urinary infection (odds ratio 2.70, 95% CI 1.46–4.83), and between valproate and low birth weight (odds ratio 1.68, 95% CI 1.16–2.37). These associations became non-significant in negative control analysis, and the high E-values (atypical antipsychotics and genito-urinary infection, 4.84; valproate and low birth weight, 2.75) suggested that the results were unlikely to have been driven by unmeasured confounders. Maternal diagnoses of schizophrenia and depression were independently associated with increased risk of obstetric complications, after controlling for the effects of psychotropics.

The population-based data and meticulous analyses did not support any clear causal link between broad-class psychotropic exposure during pregnancy and increased risk of obstetric/neonatal complications. However, some psychotropic subclasses may increase obstetric/neonatal complications. The limited number of episodes involving discontinuation of some psychotropic subclasses may have resulted in false negative findings in the negative control analysis.