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Sleep and rest-activity-rhythm (RAR) abnormalities are commonly reported in schizophrenia spectrum disorder (SSD) patients
an in-depth characterization of sleep/RAR alterations in SSD
including patients in different treatment settings
and the relationship between these alterations and SSD clinical features (e.g.
N = 79 residential and N = 58 outpatients) and healthy control (HC) subjects (N = 113) were recruited for the DiAPAson project
Participants wore an ActiGraph for seven consecutive days to monitor habitual sleep-RAR patterns
IS) were computed in each study participant
Negative symptoms were assessed in SSD patients with the Brief Negative Symptom Scale (BNSS)
Both SSD groups showed lower M10 and longer sleep/rest duration vs
while only residential patients had more fragmented and irregular rhythms than HC
residential patients had lower M10 and higher beta
residential patients had worse BNSS scores relative to outpatients
and higher IS contributed to between-group differences in BNSS score severity
residentials and outpatients SSD had both shared and unique abnormalities in Sleep/RAR measures vs
which also contributed to the patients’ negative symptom severity
Future work will help establish whether improving some of these measures may ameliorate the quality of life and clinical symptoms of SSD patients
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Dataset referring to this manuscript is published with restricted access on Zenodo platform and accessible at this link: https://doi.org/10.5281/zenodo.7738228
The data analysis scripts used in this study are available from the corresponding author upon reasonable request
Diagnostic and statistical manual of mental disorders
Sleep abnormalities in schizophrenia: state of the art and next steps
Sleep and circadian rhythm disturbance in remitted schizophrenia and bipolar disorder: a systematic review and meta-analysis
Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries
Life expectancy and cardiovascular mortality in persons with schizophrenia
Pathophysiological mechanisms of increased cardiometabolic risk in people with schizophrenia and other severe mental illnesses
Associations between sedentary behaviour and metabolic parameters in patients with schizophrenia
Effects of aerobic exercise on metabolic syndrome
and symptoms in schizophrenia include decreased mortality
Evaluating the links between schizophrenia and sleep and circadian rhythm disruption
Relationships between rest-activity rhythms
and clinical symptoms in individuals at clinical high risk for psychosis and healthy comparison subjects
Sleep abnormalities in individuals at clinical high risk for psychosis
Disturbed circadian rest-activity cycles in schizophrenia patients: an effect of drugs
Actigraphic registration of motor activity reveals a more structured behavioural pattern in schizophrenia than in major depression
Sleep–wake cycles and cognitive functioning in schizophrenia
Sleep–wake patterns in schizophrenia patients compared to healthy controls
Variations of rest–activity rhythm and sleep–wake in schizophrenic patients versus healthy subjects: An actigraphic comparative study
Quantitative psychomotor dysfunction in schizophrenia: a loss of drive
Quality of life and physical activity levels in outpatients with schizophrenia
Nonlinear analysis of motor activity shows differences between schizophrenia and depression: a study using Fourier analysis and sample entropy
A pilot study: comparative research of social functioning
and cognitive function among institutional inpatients
and outpatients with chronic schizophrenia and healthy elderly people
Physical exercise for negative symptoms of schizophrenia: Systematic review of randomized controlled trials and meta-analysis
Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up
Pharmacological treatment of negative symptoms of schizophrenia: therapeutic opportunity or Cul‐de‐sac
Activity monitoring using a mHealth device and correlations with psychopathology in patients with chronic schizophrenia
Actigraphic monitoring of activity and rest in schizophrenic patients treated with olanzapine or risperidone
Actigraphy studies and clinical and biobehavioural correlates in schizophrenia: a systematic review
Diagnostic and statistical manual of mental disorders: DSM-5
American psychiatric association Washington
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
Traduzione italiana della Brief Psychiatric Rating Scale
Rivista di riabilitazione Psichiatrica e Psicosociale
in Social Work Research and Abstracts 19 9-21 (Oxford University Press
The Specific Level of Functioning Scale: construct validity
internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community
quality of care and interpersonal relationships in patients with Schizophrenia spectrum disorders (DiAPASon): an Italian multicentre study
Next-generation negative symptom assessment for clinical trials: validation of the Brief Negative Symptom Scale
The Brief Negative Symptom Scale (BNSS): independent validation in a large sample of Italian patients with schizophrenia
‘nparACT’package for R: a free software tool for the non-parametric analysis of actigraphy data
Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patients by application of nonparametric methods
Automatic sleep/wake identification from wrist activity
Real-time mobile monitoring of the dynamic associations among motor activity
Nonparametric methods in actigraphy: an update
Stability and fragmentation of the activity rhythm across the sleep-wake cycle: the importance of age
In-and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis
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We thank the Italian Ministry of Health for the funding received for this research project
We thank all members of the DiAPAson Consortium who actively worked to make this project possible: DMH
Zarbo); Dept of Molecular and Translational Medicine
Rota); RF Centro Ippocrate CRA Macchiareddu
Schiavo); Fatebenefratelli Sant’Ambrogio e Sacro Cuore di Gesù
Rufelli); Fatebenefratelli Beata Vergine Consolata
Pogliaghi); RF CTRP Associazione Don Giuseppe Girelli
The DiAPAson project was funded by the Italian Ministry of Health (Bando per la Ricerca Finalizzata 2018: RF-2018-12365514)
The Ministry of Health has no role in analyzing and interpreting study findings
The corresponding author was supported by the National Institute of Mental Health (NIMH) grant
These authors contributed equally: Ahmad Mayeli
Unit of Epidemiological Psychiatry and Evaluation
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli
Manuel Zamparini & Giovanni de Girolamo
Department of Mental Health and Dependence
Department of Molecular and Translational Medicine
IRCCS Centro San Giovanni di Dio Fatebenefratelli
Department of Clinical and Experimental Sciences
Conceptualized and designed the research: AM
All authors contributed to the interpretation of the results
The authors declare no competing interests
The study has been approved by the ethical committees (Ecs) of the three main participating centers: EC of IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli (31/07/2019; no
EC of Area Vasta Emilia Nord (25/ 09/2019; no
20190075685) and by the Ecs of all participating sites
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliation
a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law
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DOI: https://doi.org/10.1038/s41380-023-02050-x
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26/3/23 - Marché de l’art - Paris - Mardi 28 mars (et le 29 mars également pour l’une d’elles)
trois ventes à l’hôtel Drouot présenteront quelques œuvres notables
en prolongement de celles que nous avons décrites cette semaine et dont nous reparlerons abondamment en raison des nombreuses préemptions ou achats de musées qui y ont eu lieu (dont deux du Musée d’Orsay dans la vente Ader de dessins anciens et modernes de vendredi dernier que nous n’avions pas eu le temps d’évoquer)
Chez Daguerre (catalogue)
où la vente du portrait du comte d’Argenson présenté dans le catalogue a finalement été reportée
nous retiendrons un petit album de dessins (ill
1 et 2) par le peintre crémonais Bernardino Campi (qui ne semble pas avoir de liens familiaux avec les autres Campi de la même ville
Les seize compositions représentent des scènes de la vie de saint Bruno
S’agit-il de projets pour un cycle de peintures ou de fresques effectivement réalisées
probablement parce que les conditions de création de ce carnet sont inconnues
Notons cependant que Bernardino Campi travailla au moins une fois pour les Chartreux dans l’oratoire du château de San Colombano al Lambro
mais il y avait représenté des scènes de la vie de sainte…
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+ 6 Photos+ 6 PhotosPreviousNextA brand-new 1990 Peugeot 205 hatchback – with just 65km on its odometer – is going under the hammer in Europe
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This study evaluated the relationship between negative symptoms
daily time use (productive/non-productive activities
and negative emotions in schizophrenia-spectrum disorders (SSDs): 618 individuals with SSDs (311 residential care patients [RCPs]
307 outpatients) were surveyed about socio-demographic
BNSS) and daily time use (paper-and-pencil Time Use Survey completed twice/week) characteristics
also underwent ecological monitoring of emotions (8 times/day for a week) through Experience Sampling Method (ESM)
RCPs spent significantly less time in PA than outpatients
Patients with more negative symptomatology spent more time in NPA and less in PA compared to patients with milder symptoms
Higher time spent in NPA was associated with negative emotions (p < 0.001 during workdays) even when correcting for BNSS total and antipsychotic polypharmacy (p = 0.002 for workdays
Future studies are needed to explore in more detail the relationship between negative emotions
providing opportunities for more informed and personalised clinical treatment planning and research into interactions between different motivational
saliency and behavioural aspects in individuals with SSDs
the investigation of negative emotions may enrich the established neurocognitive paradigm of negative symptoms and related functional outcomes
in a subsample of patients who underwent ecological monitoring assessments with ESM
We hypothesised that patients would spend more time in NPA and less time in PA than healthy controls
and that more negative symptomatology would be associated with more time spent in NPA and less time in PA
we hypothesised that less NPA would be associated with more negative daily negative emotions
over and above the adverse effect of negative symptomatology severity and antipsychotic polypharmacy
The DiAPASon multisite project (DAily time use
and interpersonal relationships in patients with Schizophrenia spectrum disorders) involved 20 Departments of Mental Health (DMHs) and 17 residential facilities (RFs) located in various regions of Italy
The participating DMHs recruited both outpatients and residential patients
while RFs only enroled residential care patients
with an average number of 12.8 (±5.7) residents
which together recruited an average of 3.5 (±2.6) patients per RF (approximately 27% of patients in each RF)
treating clinicians invited eligible patients under their care to participate in the study
outpatients (who were community-dwelling patients with SSDs) were recruited from consecutively evaluated patients at the DMHs until the desired target sample was achieved
facility directors prepared an alphabetical list of patients with SSDs who were present on an index day: based on this list
patients were consecutively invited to participate in the study until the required target sample was achieved
Healthy controls were recruited by public advertisement and snowball sampling procedures
participants from a selected number of sites were invited to take part to the ESM monitoring; logistic and financial limitations prevented the implementation of the ESM study in all sites
The ESM monitoring was preceded by a briefing session in which RAs gave instructions about the procedures and how to effectively perform them
The monitoring was followed by a debriefing session in which the same RAs collected information on study acceptability and feasibility
outpatients and healthy controls received € 25.00 for travel expense reimbursement
The study was approved by the ethical committee of the local institutions (see section below)
or history of clinically significant head injury or cerebrovascular/neurological disease
a 13-item clinician-administered instrument designed to evaluate anhedonia
Each subscale is rated on a scale from 0 (not present) to 6 (severe deficit)
with higher values indicating greater symptom severity
each column indicated the daily hour (from 12 a.m
each participant had to answer the question “What are you doing right now?”
selecting one or more of the 15 possible activity categories
The TUS was completed by both people with SSD and the unaffected control group
and each selection in the TUS corresponded to a “count” of about 60 min
The TUS was completed by each participant twice during a week
on a working day (Monday-Friday) and on Sunday
The participants were invited to complete the survey at different times during the day or at latest in the evening
in order to minimise recall biases as much as possible
the NPA macro-category did not include “watching TV or listening to the radio” to separate those activities that can be considered entirely passive (e.g.
doing nothing) and those that may involve an active cognitive effort (i.e.
Daily emotions were assessed with a brief questionnaire on a smartphone-based application for ESM which was developed ad hoc for the project
The ESM assessment included three sections: current activities
The main objective of this repository is to collect items used in several ESM studies in order to facilitate the selection of good assessment measures and the exchange of researchers’ experiences
this section asked the participant how he/she felt that emotion at that current moment
The participant had to select the amount of that emotion on a visual bar from 0 to 100 (from 0
Positive emotions were computed as mean of the following items: happy
were computed as mean of the following ESM items: sad
Emotions were calculated for both weekdays and weekends
Participants received notifications 8 times a day
The notifications were semi-randomised (i.e.
randomly sent within eight scheduled time slots)
and a reminder was sent after 15 minutes if the participant did not respond to the initial prompt
Participants had a maximum of 30 min to respond
673 eligible patients (340 residential patients
333 outpatients) and 114 healthy controls were recruited
17 residential patients (2.5%) were excluded for severe cognitive impairment (i.e.
36 patients (10 residential patients and 26 outpatients
5.3%) dropped out from the study after providing initial consent to participate
whereas 2 residential patients and 2 healthy controls did not complete the TUS
the final sample for the first (paper-and-pencil) phase of this study included 618 patients (311 residential care patients
121 patients (66 residential care patients
55 outpatients) and 112 healthy controls (matched for age and sex) participated in the TUS and the ESM
Table 1 shows the socio-demographic and clinical characteristics of the sample
Groups were homogeneous regarding sex distribution and mean age
Both residential care patients and outpatients were more frequently single (86.8% and 85.7%
respectively) compared to healthy controls (25.0%)
had a higher mean education level and were more likely to work compared to both patient groups
Unemployment was more common among residential care patients compared to outpatients
Outpatients (28.6 ± 6.0) had a higher body mass index (BMI) compared to both residential patients (26.9 ± 4.9; p < .001) and healthy controls (24.2 ± 3.7; p < .001)
and residential care patients had a higher BMI compared to controls (p < .001)
Residential care patients had a higher frequency of psychiatric comorbidities (36.0% vs 20.9%; p < 0.001) and received a higher number of current antipsychotic (1.8 ± 0.8 vs 1.4 ± 0.7; p < 0.001) and non-antipsychotic (1.6 ± 1.2 vs 1.0 ± 1.1; p < 0.001) medications compared to outpatients
Residential care patients also had significantly higher BNSS total scores (26.3 ± 16.6 vs 19.3 ± 13.9; p < 0.001) and sub-scores than outpatients
We also shown the socio-demographic and clinical characteristics of the ESM sample, and between-group differences (Supplementary Table 5s)
Table 1 also shows between-group differences for daily time use
We did not find any statistically significant difference between outpatients and residential care patients regarding the amount of time spent in NPA (p = 0.459 for Sundays; p = 0.091 for work days)
outpatients spent significantly more time performing PA than residential care patients
both on work days (4.4 ± 3.3 vs 2.4 ± 2.4; p < 0.001) and on Sundays (2.9 ± 3.1 vs 1.8 ± 2.3; p < 0.001)
and more time in PA than both patient populations
As shown in Table 2
there were significant positive relationships between BNSS total scores
and the amount of time spent in NPA during working days – both among residential care patients (r = 0.18; p = 0.001) and outpatients (r = 0.13; p = 0.030)
non-significant negative relationships were found between BNSS total scores
and the amount of time spent in PA during work days – both among residential care patients (r = −0.11; p = 0.090) and outpatients (r = −0.10; p = 0.096)
A significant relationship between BNSS total score and time use on Sundays was found only for residential care patients
Residential care patients showed similar trends for BNSS asociality
outpatients mainly showed significant associations between time use during work days and the BNSS avolition subscale
The avolition subscale displayed the highest effect sizes (r ranging from −0.25 to 0.20) for both residential care and outpatients
This result held true both for individuals living in residential facilities and for outpatients
residential care users reported being less engaged in PA
These findings indirectly reflect the differential degrees of autonomy at different intensities and settings of psychiatric care
the cross-sectional nature of the study prohibits drawing conclusions about the directionality of the relationship between time use and clinical outcomes
and – more specifically – it does not allow to detect a putative causal role of negative emotions or symptoms with regard to time use
Future research should address these limitations in prospective studies
Dataset referring to this manuscript is published with restricted access on Zenodo platform and accessible at this link: https://doi.org/10.5281/zenodo.6867888
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Thanks are due to the large number of colleagues in all Italy who have actively collaborated
listed below by alphabetical order of the location: DMH
The DiAPAson project is funded by the Italian Ministry of Health (Bando per la ricerca Finalizzata 2018: RF-2018-12365514)
The Ministry of Health has no role in the analyses and interpretation of study findings
These authors contributed equally: Giulio D’Anna
Unit of Epidemiological and Evaluation Psychiatry
Department of Psychiatry and Molecular Medicine
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Department of Child and Adolescent Psychiatry
Department of Mental Health and Pathological Addiction
AOUI Verona; IRCCS Fatebenefratelli San Giovanni di Dio
and F.S.: supervision and writing (review and editing)
has been a consultant and/or advisor to or has received honoraria from: AbbVie
He provided expert testimony for Janssen and Otsuka
He served on a Data Safety Monitoring Board for Compass Pathways
He has received grant support from Janssen and Takeda
He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics
The other authors declare that they have no competing interests
The study has been approved by the ethical committees (ECs) of the three main participating centres: EC of IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli (31/07/2019; no
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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DOI: https://doi.org/10.1038/s41537-023-00372-x
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Il verdetto delle elezioni amministrative 2019
126 comuni della provincia di Pavia hanno rinnovato il consiglio comunale ed eletto il nuovo sindaco
vince al primo turno ed è il nuovo sindaco di Pavia
Il centrodestra (Fracassi è sostenuto da Lega
Pavia Ideale) si riprende dunque palazzo Mezzabarba 5 anni dopo la sconfitta di Cattaneo ad opera di Depaoli
[[(gele.Finegil.StandardArticle2014v1) Fabrizio Fracassi fa il botto al primo turno, è lui il nuovo sindaco: «Devo cambiare Pavia, non ci sono scuse»]]
è esponente di lungo corso della Lega Nord (è iscritto dal 1990): a palazzo Mezzabarba è già stato consigliere comunale e assessore nella giunta Cattaneo
è stato inoltre consigliere regionale per una legislatura e dal 2012 siede nel consiglio del Parco del Ticino
Le liste. Lega primo partito con il 26,5%, il Pd si è fermato al 22,9. Forza Italia (11,8) è il solo altro partito ad avere superato il 10 per cento. I risultati
I candidati consiglieri più votati: Bobbio Pallavicini (il più votato in assoluto)
Arcuri (Forza Italia) Niutta (Pavia Prima)
Dopo 30 anni il centrodestra torna al potere in città: Alessandro Cantù
ha battuto di 205 voti il sindaco uscente Piergiorgio Maggi
A Casteggio Vigo supera il 50% e batte i tre avversari
Lodigiani è il primo sindaco di Colli Verdi
il nuovo comune nato dalla fusione di Ruino
In diversi centri la contesa è finita sul filo di lana: a Spessa (vittoria per soli 6 voti)
Arena Po e Valle Salimbene la differenza percentuale tra i primi due arrivati è stata minima
CASTELLETTO DI BRANDUZZO: Antonio Lo Verso
MONTEBELLO DELLA BATTAGLIA: Andrea Mariani
SANTA MARIA DELLE VERSA: Stefano Riccardi
primo discorso da leader della Lega�L’euro � un crimine contro l’umanit�
Il nuovo segretario: �Insieme contro il boia di Bruxelles �E ai giornalisti: �Parassiti
Matteo Salvini � il nuovo segretario della Lega Nord
il congresso federale del Carroccio riunito a Torino per alzata di mano