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A recent study showed that individuals in a stable phase of schizophrenia tend to be more likely to have a deficit in facial emotion recognition than healthy individuals.

“Negative emotions were found to have a worse impact in comparison to positive emotions, with happiness emotions being the least impacted,” wrote investigators, led by Shaily Mina, MD, from the department of psychiatry at VMMC and Safdarjung Hospital, in India.

Facial emotion recognition plays a significant role in social interactions, and a deficit in recognizing facial emotions can impair an individual’s judgment toward others. Many studies have examined the deficit in facial emotion recognition among patients with schizophrenia.2 In a cross-sectional study, investigators sought to assess the facial emotion recognition deficits in individuals with schizophrenia compared with healthy individuals.1 They also aimed to evaluate the association between deficits in facial emotion recognition and clinical and demographic profiles.

The study included participants aged 18 – 50 years with a schizophrenia diagnosis based on the DSM-5. Participants were clinically stable, defined as item scores of ≤ 3 in each category of the Positive and Negative Syndrome Scale (PANSS), and on a stable medication dose for ≥ 6 weeks if on oral treatment or 12 weeks if on injections. Moreover, participants had schizophrenia for ≥ 1 year (mean duration: 84 months) with no hospitalization or electroconvulsive therapy received in the previous 12 weeks.

The mean age of illness onset was 31.70 ± 7.12 years among patients with schizophrenia. Approximately 83.3% of participants had a continuous course of illness and 16.7% had an episodic course. Most (83.3%) had no medical comorbidity, although 16.7% had hypothyroidism and type 2 diabetes.

Among individuals with schizophrenia, 96.7% did not report any positive symptoms, 20% reported negative symptoms (reduced social interaction), and 36.7% reported cognitive symptoms (forgetfulness). The mean PANSS total score was 32.20 ± 1.40, with scores of 7.47 ± 0.86 for the positive symptom dimension, 7.70 ± 1.17 for the negative symptom dimension, and 17.03 ± 0.80 for general psychopathology dimension. All participants with schizophrenia were on monotherapy, either olanzapine (n = 8), risperidone (n = 16), lurasidone (n = 1), clozapine (n = 2), aripiprazole (n = 2), or cariprazine (n = 1).

Investigators compared participants with schizophrenia (n = 30; mean age: 39.30 ± 5.39 years) with age, gender, and education-matched healthy controls (n = 30; mean age: 39.30 ± 5.19 years) who were recruited from an outpatient clinic and screened for the absence of any psychiatric illness. Most participants were male (57%), belonged to a Hindu nuclear family, and were from an urban community. Participants were excluded from either group if they had a comorbid substance use disorder (excluding nicotine and caffeine) within the last year, a history of neurological disease, any uncontrolled medical condition, any significant visual or hearing impairment, or intellectual disability.

The research took place at a tertiary care hospital in North India from September 2023 to March 2024. Assessments included the Addenbrooke’s Cognitive Examination (ACE-III), All India Institute of Medical Sciences (AIIMS) Facial Toolbox for Emotion Recognition (AFTER), the Positive and Negative Syndrome Scale (PANSS), and Medication Adherence Rating Scale (MARS).

The schizophrenia arm performed significantly worse than healthy controls at identifying positive and negative emotions, excluding happiness for which both arms got 100% recognition:

Individuals with schizophrenia also took significantly longer to recognize emotion than the controls. Additionally, females with schizophrenia took longer to recognize disgust (disgust recognition time: t = 3.21, df = 25.35;

 = .004, mean difference [MD], 8.94; 95% CI, 14.68–3.20) and sadness (t = 1.95, df = 28, 

= .03; MD, 2.48; 95% CI, 5.08–0.11) than males. No other gender differences were observed in either the schizophrenia or healthy arms.

Investigators saw anger recognition negatively correlated with PANSS positive symptoms, total scores, and ACE-III fluency. Disgust recognition positively correlated with PANSS negative symptoms but negatively with general psychopathology. Surprise recognition negatively correlated with PANSS total scores.

“We found a mild correlation of negative emotions (anger, disgust, and surprise) to PANSS scores that could indicate that psychopathology and severity of the disorder might have some role in the identification of facial emotions even in the stable phase of illness with more impact of severity of illness on negative emotions,” investigators wrote.

Mina S, Chaudhary S. Facial Emotion Recognition Ability in Individuals with Remitted Schizophrenia in Comparison to Healthy Population: A Cross-Sectional Study. Indian J Psychol Med. 2025 Jan 2:02537176241299371. doi: 10.1177/02537176241299371. Epub ahead of print. PMID: 39759442; PMCID: PMC11694268.

Gao Z, Zhao W, Liu S, Liu Z, Yang C, Xu Y. Facial Emotion Recognition in Schizophrenia. Front Psychiatry. 2021 May 4;12:633717. doi: 10.3389/fpsyt.2021.633717. PMID: 34017272; PMCID: PMC8129182.

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Individuals with stable schizophrenia exhibit significant deficits in facial emotion recognition compared to healthy controls, particularly with negative emotions like sadness, disgust, and fear. Happiness recognition remains unaffected. The study involved clinically stable schizophrenia patients and matched healthy controls, revealing that females with schizophrenia took longer to recognize certain emotions. Correlations were found between emotion recognition and PANSS scores, suggesting that psychopathology and disorder severity may influence emotion recognition even in stable phases. The study underscores the impact of schizophrenia on social cognition and interaction.

Individuals with stable schizophrenia struggle to recognize facial emotions such as sadness, disgust, and anger—but not happiness—which may impact social interactions.

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Patients with Stable Schizophrenia Struggle to Recognize Negative Facial Emotions

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Pain coping skills training (PCST) may offer a viable approach to addressing and managing chronic pain in patients with 

 receiving maintenance hemodialysis, according to findings from a recent study.

Results from the HOPE Consortium Trial showed 24 weeks of a PCST intervention improved pain interference, quality of life, and several other patient-reported outcomes in patients receiving hemodialysis with self-reported chronic pain, suggesting the cognitive behavioral intervention may provide a low-risk, scalable approach for pain management in this patient population.

According to the American Kidney Fund, an estimated 35.5 million people in the US have kidney disease and about 808,000 are living with kidney failure. There are not enough donor kidneys available for everyone with kidney failure to receive a transplant. As a result, most people who develop kidney failure will require treatment with dialysis, which is frequently associated with burdensome side effects leading to an impaired quality of life.

“Behavioral approaches for chronic pain such as cognitive behavioral therapy are appealing alternatives or complements to pharmacologic therapies but have not been well studied among people with dialysis-dependent kidney failure,” Laura Dember, MD, a professor of medicine and epidemiology at the University of Pennsylvania, and colleagues wrote.

To evaluate the effectiveness of PCST on pain interference, investigators conducted a multicenter randomized clinical trial across 16 academic centers and 103 outpatient dialysis facilities in the US. For inclusion, patients were required to be ≥ 18 years of age; receive in-center treatment with maintenance hemodialysis for ≥ 90 days; be fluent in English or Spanish; and self-report moderate or severe chronic pain, defined as pain on most days or every day during the past 3 months and a score of ≥ 4 on the Pain, Enjoyment of Life, and General Activity scale.

A total of 643 participants were included in the study. Among the cohort, the mean age was 60.3 (Standard deviation [SD],12.6) years, 44.8% of patients were female, and 47.9% self-identified as Black.

Participants were randomly assigned to PCST or usual care in a 1:1 ratio using random permuted blocks of 2, 4, and 6 with stratification by enrolling site and presence or absence of opioid use. Participants randomized to PCST (n = 319) had weekly coach-led sessions lasting 45-50 minutes via video or telephone conferencing for 12 weeks, followed by an additional 12 weeks of automated interactive voice response (IVR) sessions. Participants randomized to usual care (n = 324) had no trial-driven pain intervention.

Investigators followed trial participants for 36 weeks, with in-person or telephone visits conducted every 4 weeks. The primary outcome was pain interference measured with the Brief Pain Inventory (BPI) Interference subscale. Secondary outcomes included pain intensity, pain catastrophizing, quality of life, depression, and anxiety.

The median number of coach-led PCST sessions attended by the 319 participants randomized to PCST was 12.0 (interquartile range [IQR], 10.0 to 12.0) out of a maximum of 12. Most (61.9%) were conducted by video conferencing and took place during dialysis (63.2%). Of the 21,034 daily automated telephone contacts initiated during the 12-week IVR intervention period, 11,206 (53.3%) were accepted by the participants, and the per-participant median completion was 59.8% (IQR, 19.1% to 86.9%).

At week 12, the PCST group had a larger reduction in the BPI Interference score than the usual care group (between-group difference, −0.49; 95% CI, −0.85 to −0.12; 

 = .009). The effect persisted at week 24 (between-group difference, −0.48; 95% CI, −0.86 to −0.11) but was diminished at week 36 (between-group difference, −0.34; 95% CI, −0.72 to 0.04).

Investigators noted a larger proportion of participants in the PCST group, compared with the usual care group, had a decrease in BPI Interference score > 1 point at week 12 (50.9% vs 36.6%; odds ratio [OR], 1.79; 95% CI, 1.28 to 2.49) and at week 24 (55.0% vs 42.8%; OR, 1.59; 95% CI, 1.13 to 2.24) but not at week 36 (48.2% vs 42.4%; OR, 1.26; 95% CI, 0.89 to 1.79).

Positive changes with PCST were also evident for secondary outcomes of pain intensity, quality of life, depression, and anxiety at weeks 12 and/or 24, as well as for pain catastrophizing at weeks 24 and 36.

Investigators acknowledged multiple limitations to these findings, including the fact that participants and members of the site research teams were not masked to treatment assignments; ascertainment of the PROs could not be performed for approximately 10% of participants at week 12 and approximately 20% of participants at later time points, largely due to participant death; and the lack of a cost-effectiveness analysis to assess the economic implications of adopting the intervention.

“This randomized clinical trial of PCST showed benefits on pain interference, quality of life, and several other PROs among individuals undergoing maintenance hemodialysis and experiencing chronic pain,” investigators concluded.

 “Centrally administered PCST may provide a low-risk, scalable approach for people with dialysis-dependent kidney failure, a population with limited options for managing pain.”

Dember LM, Hsu JY, Mehrotra R, et al. Pain Coping Skills Training for Patients Receiving Hemodialysis: The HOPE Consortium Randomized Clinical Trial. 

American Kidney Fund. Quick kidney disease facts and stats. July 19, 2024. Accessed January 8, 2025. https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

Pain coping skills training (PCST) has shown promise in managing chronic pain for patients with kidney failure undergoing hemodialysis. A study from the HOPE Consortium Trial demonstrated that a 24-week PCST intervention improved pain interference, quality of life, and other patient-reported outcomes. The trial involved 643 participants, with PCST sessions conducted via video or phone. Results indicated significant reductions in pain interference at weeks 12 and 24, though effects diminished by week 36. Despite some limitations, PCST offers a scalable, low-risk pain management option for this patient population.

Findings from the HOPE Consortium Trial suggest PCST can help pain interference and quality of life in patients on hemodialysis experiencing chronic pain.

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Pain Coping Skills Training Aids Pain Management for Dialysis-Dependent Kidney Failure

New research is sounding the alarm on increasing rates of 

 among adolescents and young adults, additionally highlighting notable sex disparities for long-term liver-related outcomes.

Findings from the population-based study of more than 3000 patients 13-39 years of age in Canada suggest rapid increases in the rates of AH in this patient population over the past 2 decades, especially among women. Despite numerically more males being affected by AH, females had greater rates of liver-related mortality and were at an approximately 50% increased risk of developing cirrhosis.

According to alcohol-associated liver disease practice guidance from the American Association for the Study of Liver Diseases, women have a greater risk of liver injury compared with men for any level of drinking. Additionally, while rates of alcohol use disorder and high-risk drinking have risen in the US in recent years, some of the greatest increases have been observed among women.

“Given the surging rates of AH among adolescents and young adults, there is an urgent need to identify risk groups and short- and long-term outcomes to facilitate targeted interventions and chronic disease management plans,” Jennifer Flemming, MD, an associate professor of medicine and public health sciences at Queen's University, and colleagues wrote.

 “The influence of sex on the development of major liver-related outcomes, such as cirrhosis and decompensation, among adolescents and young adults with AH is understudied.”

To define the sex-specific epidemiology of AH in adolescents and young adults as well as the association between female sex and liver-related outcomes, investigators conducted a population-based retrospective cohort study in Ontario, Canada, using data from ICES, an independent, nonprofit research institute that houses an electronic repository of datasets for all Ontario residents eligible for the province’s single-payer health care system.

Data on adolescents and young adults 13-39 years of age with an incident diagnosis of alcohol-associated hepatitis without a history of cirrhosis and/or decompensation were identified through inpatient hospital admissions and emergency department records and included in the analysis. Incident diagnoses were captured from January 1, 2002, to December 31, 2021.

Sex was the primary exposure obtained from the Registered Persons Database. The outcomes of interest included all-cause mortality with death date obtained from the Registered Persons Database up to December 31, 2022.

A total of 3340 adolescents and young adults with alcohol-associated hepatitis were identified and included in the analysis. Among the cohort, the median age was 33 (interquartile range [IQR], 28-36) years and 64% of patients were male. The median follow-up was 5 (IQR, 2-10) years, during which time most participants required hospitalization (74%) with a median length of stay of 4 (IQR, 3-8) days.

Investigators noted rates of alcohol-associated hepatitis increased by 8% per year (rate ratio [RR], 1.08; 95% CI, 1.07-1.09; 

 <.001), with yearly rates increasing faster among females (RR, 1.11; 95% CI, 1.09-1.12) than males (RR, 1.07; 95% CI, 1.06-1.07).

The cumulative incidence of death was 6.9% at 1 year (95% CI, 6.2%-7.9%); 18.9% at 5 years (95% CI, 17.4%-20.3%); 29.4% at 10 years (95% CI, 27.5%-31.4%); and 47.7% at 20 years (95% CI, 43.5%-51.8%). However, when stratified by sex, investigators did not observe any association with overall mortality. Additionally, in competing risks regression, there was no association between female sex and overall mortality (subdistribution hazard ratios [sHR], 1.10; 95% CI, 0.95-1.27).

A total of 2374 individuals (71%) were alive without cirrhosis 6 months after their initial alcohol-associated hepatitis presentation. Of those, 527 (22%) developed incident cirrhosis and/or decompensation after a median follow-up of 4 (IQR, 2-9) years (37% females vs 29% males; 

Further analysis revealed female sex was independently associated with a 47% greater subhazard of cirrhosis and/or decompensation (sHR, 1.47; 95% CI, 1.23-1.76; 

 <.001). Investigators also pointed out the cumulative incidence of liver-related mortality at 10 years was higher among females (11.0%; 95% CI, 8.3%-14.2%) than males (6.9%; 95% CI, 5.4%-8.6%; 

They acknowledged multiple limitations to these findings, including the use of ICD codes to define AH; the inability to account for AH treatment and how this may affect outcomes in the present study; and the lack of data available regarding the treatment of alcohol use disorder, quantity of alcohol consumption, obesity, race and ethnicity, marital status, or social supports, which may be associated with the development of AH and study outcomes.

“These data support the need to develop early identification and treatment for those at risk for AH and multidisciplinary management after their first presentation,” investigators concluded.

 “Furthermore, the increase of AH among adolescents and young adults highlights the need to develop clinical trials and observational studies with a sex or gender approach to best support this younger vulnerable population.”

Flemming JA, Djerboua M, Chapman O, Ayonrinde O, Terrault NA. Epidemiology and Outcomes of Alcohol-Associated Hepatitis in Adolescents and Young Adults. 

Crabb DW, Im GY, Szabo G, et al. Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. 

Rising rates of alcohol-associated hepatitis (AH) among adolescents and young adults, particularly women, are concerning. A Canadian study of over 3000 patients aged 13-39 revealed rapid increases in AH rates over two decades, with women facing higher liver-related mortality and a 50% increased risk of cirrhosis. Despite more males being affected, females showed faster yearly rate increases. The study underscores the need for targeted interventions and sex-specific research, given the significant sex disparities in liver-related outcomes and the growing prevalence of AH in younger populations.

Study findings highlight increasing rates of AH among adolescents and younger adults, with women facing worse long-term liver-related outcomes.

Hepatology

Young Women Face Worse Long-Term Alcohol-Associated Hepatitis Outcomes Than Men

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

 polypill, comprised of a statin and multiple half-standard dose anti-hypertensives, could be a high-value intervention, and reduce health disparities among a low-income, majority-Black population, according to a new economic evaluation.

Data from the Southern Community Cohort Study (SCCS) Polypill Trial reported the value of a polypill in addressing 

 risk factors among those with limited access to preventive healthcare.

 This evaluation on a computer simulation model revealed the high value of the polypill if priced at ≤$463 yearly.

“The polypill would be highly cost-effective among individuals eligible for the SCCS Polypill Trial identified opportunistically,” wrote the investigative team, led by Ciaran N. Kohli-Lynch, PhD, department of preventive medicine, Feinberg School of Medicine, Northwestern University. “However, it may be challenging for health systems to reach underserved populations.”

Race and ethnicity, as well as income level, are notable patient factors impacting CVD rates across the US.

 CVD risk elevations are observed in both non-Hispanic Black and lower-income cohorts, compared with non-Hispanic White and higher-income peers. These disparities are attributed to reasons such as clinical inertia, little access to healthcare, and issues with medication adherence.

Cardiovascular polypills potentially dissolve these barriers and benefit patient adherence more effectively than traditional treatment using multiple pills. The SCCS Polypill trial involved half doses of 4 preventive agents: atorvastatin 10 mg, amlodipine 2.5 mg, losartan 25 mg, and hydrochlorothiazide 12.5 mg.

After 12 months, those treated with a polypill reported a mean reduction of 7 mmHg in systolic blood pressure (SBP) and 11 mg/dL in LDL-C level, compared with the control arm. For this trial analysis, a discrete-event simulation version of the CVD policy model replicated clinical and economic outcomes from a healthcare perspective, with a time horizon of 10 years.

Polypill treatment was granted an annual cost of $463 in the base case analysis. Two cohorts were analyzed, including an SCCS Polypill trial cohort of 100,000 participants and all trial-eligible non-Hispanic Black adults in the US. The analysis’ primary outcome was direct health care costs and quality-adjusted life-years (QALYs), discounted 3% annually, and the incremental cost per gain in QALYs.

Projections centered on the trial-representative cohort found polypill treatment could yield an estimated 1190 additional QALYs versus usual care, with a cost of approximately $10,152,000. Overall, at the base-case price, Kohli-Lynch and colleagues estimated polypill treatment at $8560 per QALY gained compared with usual care. It was estimated at high value (<$50,000 per QALY) in nearly all (99%) simulations.

Estimates suggested polypill treatment was high-value priced at ≤$559 per year and cost-saving at ≤$443 per year. Most sensitivity analyses confirmed polypill treatment remained high-value. From a secondary analysis of 3,602,427 trial-eligible non-Hispanic Black US adults, Kohli-Lynch and colleagues estimated polypill treatment remained high-value, with estimates at $13,400 per gained QALY.

“Our results may be particularly relevant to other patient groups with low rates of treatment persistence and adherence, including community-dwelling older adult patients with chronic polypharmacy and younger adults with elevated cardiovascular risk factors,” Kohli-Lynch and colleagues added.

An accompanying editorial by Clyde W. Yancy, MD, MSc, division of cardiology, Northwestern University, cited a 2014 recommendation by the US Food and Drug Administration (FDA) concluding that, although outcomes trials are unnecessary for polypill approval, a fixed-dose product requires ≥1 new molecular entity.

Irrespective of the low-risk profile of half-dose therapy, concerns surround the need for titration, adverse effects, and overtreatment of the polypill. However, Yancy indicated that this regulatory question and issues in implementation are not insurmountable, suggesting the results of the SCCS cohort are game-changing for the polypill.

“The cohort in SCCS definitively recalibrates the argument,” Yancy wrote. “There is no social determinant of health more compelling than poverty, and in many US communities, poverty is pervasive, and CVD is epidemic. The resultant but unmeasurable societal costs are incalculable. A disruptive solution is needed.”

Kohli-Lynch CN, Moran AE, Kazi DS, et al. Cost-Effectiveness of a Polypill for Cardiovascular Disease Prevention in an Underserved Population. JAMA Cardiol. Published online January 08, 2025. doi:10.1001/jamacardio.2024.4812

Muñoz D, Uzoije P, Reynolds C, et al. Polypill for Cardiovascular Disease Prevention in an Underserved Population. 

. 2019;381(12):1114-1123. doi:10.1056/NEJMoa1815359

Jacobs JA, Addo DK, Zheutlin AR, et al. Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020 [published correction appears in JAMA Cardiol. 2023 Jul 1;8(7):710. doi: 10.1001/jamacardio.2023.1358]. 

. 2023;8(5):443-452. doi:10.1001/jamacardio.2023.0228

Yancy CW, Fonarow GC. Genius and the CVD Polypill—A Step Toward Achieving Health Equity? JAMA Cardiol. Published online January 08, 2025. doi:10.1001/jamacardio.2024.4820

A cardiovascular polypill, combining a statin and multiple half-dose antihypertensives, shows promise as a cost-effective intervention for reducing health disparities in low-income, majority-Black populations. The Southern Community Cohort Study (SCCS) Polypill Trial demonstrated significant reductions in systolic blood pressure and LDL-C levels. Economic evaluations suggest the polypill is highly cost-effective, especially when priced at or below $463 annually. Despite potential challenges in reaching underserved populations, the polypill could improve adherence and treatment outcomes, offering a high-value solution for cardiovascular disease prevention in vulnerable groups.

An economic analysis highlights a cardiovascular polypill's potential to lower healthcare costs and address income-based health disparities.

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Panelists discuss major risk factors for COPD development, including smoking, long-term exposure to environmental pollutants, and genetics, while noting that a history of asthma, early bronchitis, respiratory infections, and sex (with higher prevalence in men) may also influence disease onset and progression.

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Patients in this post-hoc analysis with elevated CRP were found to have a higher BMI and more severe hidradenitis suppurativa.

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C-Reactive Protein Effective as Biomarker for HS Treated with Adalimumab

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From 2000 to 2021, primary liver cancer incidences and deaths in the US increased by more than 100%, driven by rapid growth in ALD and MASLD.

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Alcohol-Associated Liver Disease, MASLD Drive Growing Liver Cancer Burden in the US

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The biosimilars month in review highlights a newly approved ustekinumab biosimilar and a look into the field in 2024.

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This analysis using worldwide data from GBD 2021 indicates that the global burden of eczema in children has gradually risen and has been projected to continue increasing.

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Global Atopic Dermatitis Among Children Projected to Rise Over 50 Years

The designation follows positive topline data from the phase 2a trial of CNP-104 in PBC, which were presented at AASLD’s The Liver Meeting

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Patients with Stable Schizophrenia Struggle to Recognize Negative Facial Emotions

Pain Coping Skills Training Aids Pain Management for Dialysis-Dependent Kidney Failure

Young Women Face Worse Long-Term Alcohol-Associated Hepatitis Outcomes Than Men

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