Introduction:Stigma can be a barrier to early intervention of severe mental illnesses, especially schizophrenia, which further leads to poor outcomes. Mental health campaigns were designed to educate the general public about signs for early identification of psychosis, but the line between schizophrenia and attenuated psychosis was not well demarcated. We wonder if people would generalize their stigmas towards schizophrenia to subjects with subthreshold psychotic symptoms. Methods:A cross-sectional survey was employed which used a structured questionnaire, comprised of four case vignettes describing attenuated psychosis syndrome (APS), schizophrenia, psychotic-like experiences (PLE), or depression, and was followed by two sets of questions using the 4-point Likert scale to measure discrimination and prejudices. Participants were chosen by convenience sampling of laypersons from different backgrounds. Results:A total of 268 subjects completed this survey. A gradient of stigmas, highest toward schizophrenia, followed by APS/depression, and lowest toward PLE was apparent across gender, all age groups, and education levels. Participants who were younger and had higher education revealed a trend of lower prejudice and discrimination. People who have visited a psychiatric hospital showed higher discrimination toward schizophrenia, APS, and depression. People who have seen mentally ill persons in public places showed lower stigma toward PLE. Discussion:Our respondents posed a differentiable attitude towards PLE, APS, and schizophrenia, while exhibiting no difference between APS and depression. Certain personal attributes were correlated with stigma levels. Further investigation about mental health literacy and attitudes towards subjects with psychotic symptoms in the general public is warranted. K E Y W O R D Sattenuated psychosis syndrome, depression, psychotic-like experience, schizophrenia, stigma

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BackgroundAntipsychotic drugs are the standard treatment for schizophrenia; however, the treatment outcomes vary. Different treatment outcomes may be attributed to the genetic and molecular heterogeneity of patients, which may be represented in the white matter structures of the brain. In the present study, we assessed the association between white matter tract integrity and treatment outcomes in patients with schizophrenia.MethodsWe evaluated 96 patients with schizophrenia (remitted, 53; non-remitted, 43) and 50 healthy controls through diffusion spectrum imaging with a 3 Tesla magnetic resonance imaging scanner. Patients were categorized into the remission and non-remission groups according to the criteria proposed by The Remission in Schizophrenia Working Group (RSWG) on the basis of PANSS scores. White matter tract integrity was assessed through an automatic tract-specific analysis method to determine the mean generalized fractional anisotropy (GFA) values of the 76 white matter tract bundles in each participant.ResultsAnalysis of covariance revealed that 7 tracts, namely the bilateral fornices, the bilateral uncinate fasciculi, and the callosal fibers (CFs) of the bilateral temporal poles, bilateral hippocampi, and bilateral amygdalae, had significantly different GFA values among the 3 groups. Posthoc between-groups analysis showed that the non-remission group had lower GFA values in all 7 tracts than the control group; the remission group had lower GFA values than the control group only in 4 tracts, namely the bilateral fornices and the CFs of the bilateral temporal poles, and bilateral hippocampi. Compared with the remission group, the non-remission group had lower GFA values in all 7 tracts.DiscussionAll 7 tracts that were altered in the non-remission group are a part of the limbic system, which supports various functions, including emotions, memory, and learning. Our results suggest that patients who had poor outcomes to antipsychotic treatments might have more severe disruptions in the limbic system. The 7 altered tracts in the non-remission group are compatible with those reported in previous studies on white matter or gray matter alterations. In a cross-sectional tractography-based study on 3 pairs of association fibers (i.e., the cingulum, superior longitudinal fasciculus, and uncinate fasciculus), Luck et al reported that compared with patients with good outcomes, patients with poor outcomes had reduced FA in the uncinate fasciculus and superior longitudinal fasciculus. Marques et al performed a longitudinal study using tract-based spatial statistics and reported that non-responders had more tracts with a significantly lower FA than did the responders, particularly in the uncinate fasciculus and corpus callosum. In addition to the uncinate fasciculus, we also observed reduced fiber integrity in the bilateral fornices and the CFs of the bilateral temporal poles, bilateral hippocampi, and bilateral amygdalae; these tracts connect the gray matter in the limbic system. Jääskeläinen et al reveale...