The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a performance-based measure developed to assess functional capacity through simulations of daily activities. This study examined its psychometric properties in a Spanish sample, including individuals with first-episode psychosis (FEP), schizophrenia, and healthy controls.

A total of 370 participants (99 FEP, 116 schizophrenia, and 155 controls) completed the VRFCAT in a multicenter study. Internal consistency (McDonald’s omega), discriminative validity (group comparisons and ROC curves), and convergent validity via correlations with cognitive performance and clinical symptoms were examined. Reference percentiles were calculated from the healthy control sample using quantile regression, stratified by age and education.

Item-level VRFCAT completion times showed acceptable to good internal consistency overall and in controls and schizophrenia samples, but poor in FEP. Differences in VRFCAT performance emerged (χ2 = 108.88, p < .001), with controls performing best, schizophrenia worst, and FEP in between. ROC analyses indicated good discriminative accuracy in distinguishing patients from controls (area under the curve [AUC] = 0.779, sensitivity = 80.0%, specificity = 64.2%); but limited discrimination between schizophrenia and FEP. Age and education, but not sex, significantly affected performance. VRFCAT showed small-to-moderate correlations with cognitive performance, and no significant associations with symptom severity.

The VRFCAT is a reliable and valid tool for assessing functional capacity in Spanish-speaking individuals with psychotic disorders. Its ecological validity, objectivity, psychometric properties, brief administration time, and ease of use support its potential use in clinical and research settings for evaluating functional recovery and treatment outcomes.

Cognitive impairment is central to psychosis and strongly linked to functional outcomes. The Brief Assessment of Cognition (BAC) app is a tablet-based, automated tool for assessing key cognitive domains but has not been validated in Spanish-speaking populations or across illness stages.

A total of 402 participants (117 with first-episode psychosis [FEP], 125 with schizophrenia, and 160 controls) completed the BAC app along with clinical and functional assessments. We evaluated internal consistency, group differences, convergent and discriminant validity, and the effects of sex, age, and education. Normative percentiles were derived from controls.

The BAC app showed good internal consistency across groups (α = 0.76–0.87) and effectively differentiated individuals with psychosis from controls (area under the curve [AUC] = 0.862), with performance declining from controls to FEP to schizophrenia. Discrimination between FEP and schizophrenia was limited (AUC = 0.649). BAC App correlated positively with estimated intelligence quotient and functional capacity, and negatively with symptom severity, particularly in FEP. Performance varied by age, sex, and education, supporting the need for stratified normative data.

The BAC app showed strong reliability and validity for cognitive assessment in Spanish-speaking individuals with psychosis. Its brevity, automated scoring, and normative data support its clinical and research applications for cognitive screening, monitoring, and treatment evaluation.

Recent meta-analyses support the inclusion of cognitive behavioral therapy (CBT) in schizophrenia treatment. Metacognitive Training (MCT) for psychosis is a psychoeducational program derived from CBT, with most meta-analyses showing favorable results. Although meta-analyses are commonly used in clinical practice to guide evidence-based decision-making, the grading system provides complementary results by offering a structured approach for assessing the strength and reliability of evidence and deriving grades of recommendations accordingly.

Our research applies the guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) to propose grades of recommendation for MCT for psychosis, analyzing 38 randomized controlled trials (RCTs) (n = 1942) and 10 meta-analyses. The primary outcome was positive symptoms, with secondary measures including negative symptoms, general psychopathology, self-esteem, functioning, insight, and cognitive function.

Our findings are primarily based on the risks of bias attributed to RCTs (11 high, 19 moderate, 6 low) and, when necessary, on the overall confidence attributed to meta-analyses (3 low, 7 critically low). According to the WFSBP guidelines, strong recommendations should be made for using MCT for psychosis to improve post-treatment positive symptoms, delusions, and total psychotic symptoms (WFSBP-grade 1). Limited recommendations (WFSBP-grade 2) could be made for using MCT to improve post-treatment visuospatial abilities and to maintain benefits over time in psychopathology, functioning, self-esteem, episodic memory, and attention.

MCT for psychosis is an evidence-based program, especially for positive symptoms, with long-lasting clinical benefits. These recommendations should be interpreted with caution given potential residual biases and heterogeneity among studies.

Sex differences in symptomatology in people with psychosis have been studied extensively in recent decades. Although studies have pointed to such differences, to date there is no review that has performed a systematic search and quantitative synthesis. In this paper, we describe the protocol for a pairwise meta-analysis comparing a range of symptom outcome measures between men and women diagnosed with a psychotic spectrum disorder at different stages of the disorder (PROSPERO registration number CRD42021264942). In August 2021 we conducted systematic searches of PsychInfo, PubMed, Web of Science, Scopus and Dialnet to identify observational studies that report data on symptoms for males and females separately. Two independent reviewers will conduct literature searches, select studies, extract data, assess the risk of bias and assess outcome quality. To assess the effect size of all outcome measures, we will conduct pairwise meta-analysis using random-effects models. The quality of studies will be evaluated using a National Heart, Lung and Blood Institute's quality assessment tool and the confidence in the results will be evaluated using the GRADE tool. Meta-regression and sensitivity analyses will be conducted to assess the robustness of the findings. No ethical problems are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.

The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally.

This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group.

1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001].

The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.

Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.

We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.

Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = −0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.

Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

Schizophrenia research based on traditional assessment measures for negative symptoms appears to be, to some extent, unreliable. The limitations of the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS) have been extensively acknowledged and should be taken into account. The aim of this study is to show how the PANSS and the SANS conflate negative symptoms and cognition and to offer alternatives for the limitations found.

A sample of 117 participants with schizophrenia from two independent studies was retrospectively investigated. Linear regression models were computed to explore the effect of negative symptoms and illness duration as predictors of cognitive performance.

For the PANSS, the item “abstract thinking” accounted for the association between negative symptoms and cognition. For the SANS, the “attention” subscale predicted the performance in verbal memory, but illness duration emerged as a stronger predictor than negative symptoms for outcomes of processing speed, verbal and working memory.

Utilizing alternative models to the traditional PANSS and SANS formats, and accounting for illness duration, provide more precise evidence on the relationship between negative symptoms and cognition. Since these measures are still extensively utilized, we recommend adopting more rigorous approaches to avoid misleading results.