175. Emotional recognition deficits and the impact of pattern-based traditional chinese medicine intervention on diabetic comorbidity in early-stage schizophrenia

Abstract Background Clinical outcomes in early schizophrenia with type 2 diabetes mellitus (T2DM) are heterogeneous, and current treatments usually address psychosis and metabolic risk separately. Facial emotion recognition (FER) deficits and alexithymia, core features of social-cognitive impairment, may further hinder diabetes self-management and functional recovery, yet few interventions target these processes and metabolic control together. Emerging evidence suggests that pattern-based traditional Chinese medicine (TCM) can improve antipsychotic-related metabolic abnormalities, but its impact on FER remains unknown. To evaluate whether TCM syndrome differentiation intervention can simultaneously improve FER and glycemic control in individuals with early-stage schizophrenia and T2DM, this study assessed the effects of adding a 24-week TCM syndrome differentiation intervention to standard treatment on FER performance and metabolic indicators in this high-risk population. Methods This 24-week rater-blinded randomized controlled trial enrolled 120 patients aged 18-45 years with early-stage schizophrenia (illness duration ≤5 years) who also met the diagnostic criteria for T2DM, recruited from two psychiatric specialty centers. Participants were randomly assigned in a 1:1 ratio to either a control group or a TCM group. Both groups received standard antipsychotic pharmacotherapy and guideline-based diabetes management, while the TCM group additionally received pattern-based TCM treatment. Statistical analyses followed the intention-to-treat principle, and mixed-effects models were used to evaluate time-by-group interaction effects. Results The intervention effects on the primary outcomes are summarized in Table 1. As shown in Table 1, FER accuracy increased by 11.80% in the TCM group, whereas the control group exhibited an increase of only 4.20%, yielding a between-group difference of 7.60%, which was statistically significant (p<.001). In terms of metabolic control, HbA1c decreased by 0.92% in the TCM group and by 0.31% in the control group, resulting in a between-group difference of -0.61 percentage points (p<.001). Moreover, improvements in all primary outcome measures were greater in the TCM group than in the control group, indicating that over the 24-week follow-up period, pattern-based TCM intervention was significantly superior to standard treatment in enhancing emotion recognition, improving glycemic control, and reducing body weight. Discussion The findings indicate that, among patients with early-stage schizophrenia and comorbid T2DM, a 24-week course of pattern-based TCM intervention combined with emotion-recognition training, compared with standard treatment, not only improved facial emotion recognition but also enhanced glycemic control and overall metabolic status, and further optimized psychiatric symptoms and social functioning. Constructing an integrated intervention framework that simultaneously targets “pattern-specific mind–body dysregulation” and “social cognitive deficits” may offer additional advantages for the comprehensive management of psychometabolic comorbidity. Future studies are needed to replicate and extend these results; this model has the potential to evolve into a culturally contextualized, mechanism-informed integrative pathway for early psychosis intervention, fostering coordinated care across psychiatry, endocrinology, and TCM services.