Research on the Etiology and Intervention Effects of Breakthrough Psychosis in Schizophrenia

Objective: To investigate the etiology and intervention effects of Breakthrough Acute Mental Manifestations (BAMM) in schizophrenia. Methods: Seventeen patients with BAMM from Shanghai Civil Affairs Second Mental Health Center between January 2018 and August 2025 were selected as the observation group. A control group was randomly selected from patients with schizophrenia. No significant differences were found in age, gender, or disease course between the two groups (P > 0.05). Variables including season, predisposing factors, menstruation, inflammatory factors (white blood cell count（WBS）, neutrophil percentage（NEUT%）), Mini-Mental State Examination (MMSE), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS), electroencephalogram (EEG), and medication use were recorded to analyze influencing factors. The observation group first underwent a one-month intervention involving an increased dosage of their antipsychotic medication, after which previously identified statistically significant influencing factors were compared. Subsequently, some patients in the observation group received sertraline intervention, and the influencing factors were compared again at the end of 3 months and 6 months. Results: The occurrence of BAMM in schizophrenia was significantly correlated with specific medication use (clozapine), HAMA scores, and Y-BOCS scores (P < 0.05). After one month of increased antipsychotic dosage, the Y-BOCS scores showed a significant negative correlation (P < 0.05). After three months of sertraline intervention, HAMD scores changed significantly (P < 0.05). After six months of sertraline intervention, both HAMD and Y-BOCS scores showed statistically significant differences (P < 0.05). Conclusion: BAMM in schizophrenia patients may be associated with the use of specific antipsychotics, such as clozapine, and its essence might be a special form of obsessive-compulsive symptoms. Blindly increasing the dosage of antipsychotics may worsen the condition, while adjunctive sertraline may be an effective intervention strategy.