To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses. Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder. Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.

Background Despite the progress in treatment and clinical outcomes, schizophrenia remains a highly stigmatized disease and imposes a challenge to families and patients towards recovery. Stigma can debilitate individuals as much as the disease itself, representing one of the most relevant obstacles to overcome the illness: it hinders the pursuit of autonomy and achievement of life goals. Stigma is complex and multilayered and its research usually focus on patients and society, but a lower number of studies address health professionals stigma. Even fewer investigate stigma of researchers. Thus, our objective is to analyze how the most cited research papers published in 2018 addressing schizophrenia depict the disease to identify putative stigma among researchers. Methods In this exploratory study, we conducted a search using Web of Science (WoS) with the following terms: (“patients with schizophrenia”) OR (“schizophrenia patients”). We restricted the search to articles published in 2018 and selected the 20 studies with the highest total number of citations. We identified how the authors defined schizophrenia and then categorized the definition in three groups: (1) negative perspective, in which depreciative words were used to define the disease; (2) neutral definition, in which emphasis is given to the description of epidemiological data; and (3) neutral to positive definition, when negative outcomes were listed as possibilities, not certainties. Two independent authors (G.K. and M.M.) categorized each article and eventual conflicts were solved by a third author (A.G.) Results 25% of the studies depicted a clearly negative perspective of schizophrenia. In these studies, the disease was described with words such as “devastating” and “highly disabling”. Most studies (60%) were coded as neutral, being mainly descriptive of current epidemiological data. Only 3 studies (15%) were identified as more favorable, since they acknowledged the possibility of better outcomes among patients with schizophrenia. Discussion In the current schizophrenia scientific literature, negative views of the disease are still largely common. Considering the role of highly cited papers as opinion formers, we suggest that as occurred in other fields, such as the change in address of suicide by the media, some orientation should be adopted to avoid further contributions to the schizophrenia stigma.

Background Negative symptoms are associated with a range of poor clinical and real-life functioning outcomes in people with schizophrenia. The division of negative symptoms into two separate factors, named “expressive deficits” and “social amotivation” could enable more accurate analysis and the development of new therapeutic tools. We aim to investigate whether the different symptoms that make up the negative dimension at baseline differently predict treatment response in first episode psychosis (FEP) antipsychotic naïve patients. Methods Patients with FEP (n=80), without previous use of antipsychotics, were recruited at an emergency service in São Paulo, Brazil, between 2014 and 2019. Individuals were assessed at admission and after 10 weeks of follow-up. Patients with schizophrenia, schizoaffective disorder and schizophreniform disorder were included. The diagnosis was confirmed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I). Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at the baseline and after 10 weeks of treatment. The “expressive deficits” factor was defined as the sum of the six following items of the PANSS: N1 (blunted affect), N3 (poor rapport), N6 (lack of spontaneity and flow of conversation), G5 (mannerisms and posturing), G7 (motor retardation), G13 (disturbance of volition). The “social amotivation” factor was defined as the sum of N2 (emotional withdrawal), N4 (passive/apathetic social withdrawal) and G16 (active social avoidance). To evaluate treatment response, we used the difference between the PANSS score at baseline and after ten weeks of follow-up (delta-PANSS). We performed three linear regressions, one using the “expressive deficits” factor, one using the “social amotivation” factor and another using the total negative symptom score at baseline. Results The mean age was 26.01 years old (SD ± 7.2), and the majority was male (58.75%). “Expressive deficits” (p=0.005, R-squared=0.084, F-test=8.28, β=8.24, df=78), “social amotivation” (p=0.009, R-squared=0,072, F-test=7.14, β=5.59, df=78); and negative symptoms (p=0.002, R-squared=0.105, F-test=10.23, β=9.08, df=78) at baseline behaved similarly in relation to delta-PANSS. All measures of negative symptoms are highly correlated to PANSS total at both time points. Discussion The results were different from our initial hypothesis of worse outcome for patients with higher expressive negative symptoms. We found that negative symptoms overall and both subdomains are highly correlated to PANSS total in acute phase in early stages, what can explain the association to better outcomes with antipsychotic treatment. Longer follow-up can help us to investigate whether differences between the subdomains of negative symptoms can be observed in more stable patients.

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