Introduction

The treatment study of patients with Schizophrenia Spectrum Disorders in the first five years of the disease is very important for the development of quality treatment programs and the prevention of recurrence of the disease. Schizophrenic patients often have symptoms of depression and they are forced to take antidepressants besides antipsychotics.

Objectives

Purpose: to study the antidepressant pharmacotherapy features of patients with Schizophrenia Spectrum Disorders within first five years after onset of disease.

Methods

Materials and Methods: Medical records of patients diagnosed with a list of Schizophrenia Spectrum Disorders were analyzed (ICD-10 headings: F20.0-3, F20.5-6, F20.8-9, F21.1-5, F22.02-03, F23.x3-x4, F25.01, F25.11, F25.21-22, F25. 8-9). 1520 patients were used in the analyses: 54,8 % – men, 45,2 % – women (mean age – 33,7±10,1 years).

Results

Results: In 55.2% of cases, besides neuroleptics, patients took other psychotropic drugs. Selective serotonin reuptake inhibitors (58.9% of all antidepressant use cases) prevailed among antidepressants, tricyclic antidepressants were used less frequently (25.9%), selective serotonin and noradrenaline reuptake inhibitors (8.1%) and antidepressants with other chemical structures and mechanisms of action (7.1%) were used even less frequently.

Picture. Frequency of antidepressants using

Conclusions

Conclusion: Symptoms of depression can effect the course of schizophrenia significantly. The obtained data will serve as a basis for the development of treatment programs for patients with Schizophrenia Spectrum Disorders.

Introduction

The idea of the gender differences effect on the schizophrenia course is ambiguous.

Objectives

The study of the gender influence on the social functioning of patients with paranoid schizophrenia.

Methods

100 patients with paranoid schizophrenia were examined (age 18-50 years, total score on the PANSS <120, duration of mental disorders for at least 5 years). Clinical and socio-demographic characteristics have been analyzed using scales: PANSS, BACS, WHOQOL, PSP, the "Compliance Level" questionnaire, SOMO (Subjective Assessment of Interpersonal Relations) test, "Emotional Intelligence" test and "Dembo-Rubinstein Self-Evaluation Test". Characteristics of patient’s nearest social environment (main caregivers) were assessed by the FACES-3 and LSI scale.

Results

The indicator of social functioning (total PSP score) correlated in men: with passport age (R = -0.356), the duration of the disease (R = -0.384), the number of hospitalizations (R = -0.538), a duration of hospitalization (R = -0.352), negative symptoms (R = -0.661), a quality of life (R = 0.311); in women: with passport age (R = -0.270), negative symptoms (R = -0.463), quality of life (R = 0.440), cognitive indicator (R = 0.313). Logite-regression analysis showed that gender associated with social functioning (B0 = -3.289, R1 = 0.055, χ2 = 20.569, p = 0.00001), but gender didn't associate with a cognitive indicator (B0 = -0.591, R1 = 0.018 , χ2 = 1.522, p = 0.217) and quality of life (B0 = -2.037, R1 = 0.010, χ2 = 2.852, p = 0.091).

Conclusions

Received data indicates the effect of gender differences on the social functioning of patients with paranoid schizophrenia significantly.

Introduction

Social cognitive dysfunctions contribute to the deficits of psychosocial functioning of people on the Schizophrenia Spectrum. Recently, the focus has turned to the area of affective disorders, with respect to social cognition and alexithymia.

Objectives

Evaluation of abilities and potential differences in alexithymia and the capacity of facial emotion recognition in individuals suffering with disorders on the schizophrenia or the affective (unipolar depressive) spectrum.

Methods

We evaluated two groups of 26 participants each, diagnosed with either a Schizophrenia Spectrum Disorder (SDD) or Recurrent Depressive Disorder (RDD) hospitalized in the Psychiatry Clinic of Timisoara, Romania. The analyzed parameters were: socio-demographic, clinical, alexithymia (Toronto Alexithymia Scale), and the ability to identify emotions (Reading the Mind in the Eye Test).

Results

We established that 57.69% of SSD subjects had alexithymia, while 19.23% had possible-alexithymia and 23.07% were non-alexithymic. Most of the subjects had a low ability to identify emotions (84.61%). In regards to the RDD group, all 26 participants had alexithymia, while almost 74% of them had a lower than normal ability to correctly identify emotions.

Conclusions

The SSD participants showed clear deficits describing and identifying emotions. Overall, the RDD group had similar results, but slightly better abilities of recognizing others’ emotions in the eyes. Our results suggest that difficulties recognising facially expressed emotions and alexithymia could possibly be linked in both spectra. These populations may benefit from tailored social skills training and intervention programs that offer service users more accurate recognition of relapse signs leading to timelier help-seeking.

Introduction

Tinnitus can be described as a nonspecific symptom without a clear clinical origin or presentation, in our specialty they have been linked to a wide variety of mental disorders.

Objectives

We intended by the presentation of a clinical case to highlight the importance of nonspecific symptoms as cardinal symptoms of psychotic episodes in order to perform an early intervention in patients at risk of psychosis and to improve their prognosis. A review of the literature on this subject is carried out.

Methods

Describing the case of a 67-year-old patient with no previous psychiatric history who presented at the moment he consulted, tinnitus of 5 months of evolution with important repercussion at affective and behavioral level. the patient developped insomnia and behavioural changes. In the psychopathological examination, verbiage, suspiciousness and a delusional idea of ​​harm were observed. Literature referring to psychosis and nonspecific symptoms as tinnitus as a cardinal symptoms is reviewed.

Results

After ruling out an organic cause for the tinnitus, a careful examination of the patient is performed highlighting a certain particularity in relation to these, which with the rest of the symptoms and the clear repercussion at different functional levels led us to consider him within the risk group to suffer a psychosis. He received treatment with low doses of atypical antipsychotic with favorable clinical evolution.

Conclusions

Psychotic episodes with nonspecific symptoms such as tinnitus as cardinal symptoms in patients with or without psychiatric history have been described in literature. In most cases, symptoms improved after treatment with atypical antipsychotic.

Introduction

Childhood trauma (CT) has been proposed as a risk factor for schizophrenia. Moreover, it has been related to brain abnormalities associated with cognitive functions, including social cognition (SC). Suffering repeated traumatic events could give rise to a threatening interpretation of the environment and affect SC, facilitating psychotic symptoms. Our research draws from the premise that different CT exposure might affect to distinct aspects of SC.

Objectives

The aims of this study are i) to assess the relations between general and social cognition in schizophrenia patients and ii) to assess the possible relations between childhood adverse experiences and SC deficits.

Methods

55 schizophrenia patients and 33 controls (aged 17-67) were included. CT was evaluated using CTQ. GEOPTE scale was used to assess personal perception about SC comparing it to information provided by a relative. General intelligence quotient was taken as a measure of general cognition.

Results

Sample was composed by 66.6% males and 33.3% females. Mean of age was 36.47 years old. CTQ scores were higher for patients in emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse. Patients showed higher GEOPTE scores than controls.Patients who have suffered emotional neglect or emotional abuse obtained higher levels of GEOPTE, and therefore worse social cognition than patients who did not suffer it. An association between emotional intelligence and general intelligence scores was found in patients.

Conclusions

Patients with schizophrenia score worse in social cognition and general cognition than controls. Emotional neglect and emotional abuse could be considered as risk factors for developing worse social cognition in schizophrenia

Introduction

Ophthalmological disorders in patients with schizophrenia to date have not been sufficiently researched or documented. In most cases these disorders are related to dry eye symptoms and tear film dysfunction.

Objectives

The objectives of this research was to investigate the subjective indicators regarding tear film dysfunction in schizophrenic patients. The intention was to prove that long-term use of antipsychotics in these patients may cause damage to tear film quality.

Methods

The study was conducted on a sample of 160 participants with one group consisting of 80 schizophrenic patients taking antipsychotics and other group including 80 healthy controls. The study gruops did not differ in the parameters considered as risk factors for tear film dysfunction. Both groups were subjected to ophthalmologic examination and filled out the Ocular Surface Disease Index (OSDI) questionnaire related to subjective symptoms of dry eye. The questionnaire consisted of three parts realted to symptoms, visual function and environmental impact.

Results

Obtained results showed statistical significant differences in all subjective measurements and indicators between the two groups. All tested variables showed higher average values in patients with schizophrenia taking antipsychotic therapy compared to healthy controls.

Conclusions

This research shows that long-term use of antipsyhotic drugs in patients with schizophrenia is correlated to tear film dysfunction and may cause subjective ocular symptoms similar to those experienced in patients with dry eye syndrome.

Introduction

Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safe-
ty.(1) Limited data on clinicians’ reasoning suggest various motivations for this strategy, including attempts to increase/speed up efficacy, treat residual positive symptoms, or reduce adverse effects allowing dose reduction of the first antipsychotic(2). Antipsychotic polypharmacy has been reported as a common clinical practice (3).

Objectives

The aim is to adress the motives clinicians have to use antipsychotic augmentation vs monotherapy.

Is there a reduction of symptoms in patients with antipsychotic augmentation vs monotherapy

Methods

Retrospective study in a group of patients in a subacute unit during 2019.

Results

Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction.

Conclusions

Response is greater in the antipsychotic polypharmacy group. This finding suggests that expectation and salience biases, also present inclinical care, may underlie observed improvements and decision making when augmenting one antipsychotic with a second one.

Introduction

Schizophrenic patients could attemp suicide. Social cognition might be one an importat factor that could improve suicide risk.

Objectives

Our study aims to compare the neurocognitive profile of two groups of schizophrenia patients that differ in the presence or absence of suicidal risk; find a correlation between the presence of suicidal ideation/attempt and specific neurocognitive deficits.

Methods

98 patients with Schizophrenic Disorder (SZ) according to DSM 5-TR were enrolled. Neurocognitive functions were evaluated by means of Measurement Research and Treatment to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Clinical data were assessed through the Brief Psychiatric Rating Scale (BPRS). The existence of suicidal ideation and actual suicide attempts have been investigated through the Columbia-Suicide Severity Rating Scale (C-SSRS). Based on the results on the C-SSRS scale, subjects were dichotomized in suicidal risk patients and non-suicidal risk patients. Suicidal patients had at least 1 on the scale that investigates the severity of the suicidal ideation.

Results

Suicidal patients had a significantly (p=0,006) worse performance on the test that explores the cognitive domain of social cognition (42,43 (mean 46,04)) than patients who did not have a suicidal risk (31,75(mean 40,40)) . The two groups did not differ in other cognitive domains. (Table 2). Instead verbal learning (22,36(mean 5,04)) or speed of processing (42,44(mean 54,13)) were slightly greater in suicidal patients.

Conclusions

Our analysis has shown a significant relationship between social cognitive impairment and suicidal risk in schizophrenia patients. It’s conceivable that social cognitive impairment is an endophenotype of schizophrenia and a risk trait for suicide

Introduction

Schizophrenia is a chronic psychiatric disorder during whom most of patients experiencing multiple relapses. Relapses prevention is a major concern in patient’s care.

Objectives

Evaluate the effectiveness of therapeutic strategies set up after a relapse.

Methods

A retrospective observational study was conducted. Every patient with schizophrenia hospitalized in 2016 for relapse were included. Patient medical records and prescription software were used to collect different parameters. Effectiveness of the strategies implemented during the hospitalization was assessed via the relapse caused re-hospitalization rate within one year of discharge. Links between the variables collected were studied by ANOVA performed with R software.

Results

A total of 102 patients were included. The cause of relapse was mainly non-adherence to antipsychotic medication(56%). Three types of strategies have been identified: maintenance of treatment (same molecule, dosage and route of administration, n=26); optimization (same molecule, change in dosage or route, n=37); change of molecule (n=39). Thirty-five percent of patients were re-hospitalized for relapse within one year of discharge. No statistically significant association was found between the strategy implemented, the class of antipsychotic, the route of administration and the occurrence of a re-hospitalization during the year. Relapsed patients were those who had the most history of relapses.

Conclusions

Non adherence to treatment is a major problem in schizophrenia. The lack of association between antipsychotic management and relapse occurrence shows significance of non-pharmacological therapies such as therapeutic patient education or psychoeducation. Each treatment has to be individualized started as early as possible, and education practices has to be establish to improve treatment adherence.

Introduction

Assessment of depression is schizophrenia is clinically important due to high risk for suicidality, distress and impact on functioning. Limited numbers of studies have evaluated depression in patients with schizophrenia in clinical remission.

Objectives

To assess the prevalence of depression in patients with chronic schizophrenia who are currently in remission.

Methods

Two hundred and fifty patients with schizophrenia, who were in clinical remission, were assessed for depression using Calgary depression rating scale for schizophrenia (CDSS) and Global Assessment of Functioning (GAF) Scale. CDSS score of ≥7 was considered cut-off for depression.

Results

The mean age of the sample was 35.14 (SD: 10.01) years and the mean duration of formal education was 10.4 (SD: 4.52) years. Majority of the participants were males (66.4%), married (56.4%), unemployed (53.2%), and hailed from nuclear family (59.6%). The mean age of onset of illness was 27.17 (SD: 9.37) years and duration of untreated illness was 4.40 (SD: 1.79) months, the mean duration of illness was 98.35 (SD: 71.78) months and the mean duration of remission at the time of assessment was 8.4 (SD: 5.45) months and mean GAF score of the sample was 78.44 (SD: 7.59). The prevalence of depression in the study sample was 18.8%.

Conclusions

Present study suggests that one in five patients of schizophrenia, currently in clinical remission has depression.

Introduction

In recent years, cognitive involvement in first-episode psychosis (FEP) is becoming more important, with multiple publications in this regard, with generally heterogeneous results due to different methodologies. The solider data point to impairment in verbal and working memory, processing speed and executive function,and being them all related with negative symptoms

Objectives

Preliminary results regarding cognitive function in patients with FEP are presented

Methods

A longitudinal and prospective case-control study will be performed during a year.FEP patients with cannabis-use are identified as cases and FEP patients with no cannabis-use as controls.The sample will be constituted by all the patients, diagnosed of first psychotic episode,admitted during a year at the Psychiatry Unit of the HUPHM.Three evaluations will be made.The first of them will be administered on the days before the discharge, the second 6 months after and the third a year a head.Each evaluation will include different scales, cognitive impairment is assessed by SCIP-S

Results

We present preliminary result of cognitive impairment in 32 consecutive FEP admitted to our center. We included 23 cases (71.8%) and 9 controls (28.1%).Result regarding SCIP percentile on the different areas were the following: all of them except verbal fluency were higher among controls (IMAGE-1).Differences regarding processing speed were significant (p<0.1)(IMAGE-2).7 subjects had a second evaluation after 6 months.Regarding total-SCIP percentil,cases suffered greater improvement compared with controls (p=0.05)(IMAGE-3)

Conclusions

First cognitive evaluation in FEP can be substantially altered in cannabis-users,however,we highlight changes occurring during follow-up, being specially this group the one suffering greater total improvement in cognitive functions,compared with non-consumers

Introduction

The use of antipsychotic combinations in patients diagnosed with schizophrenia is an extended intervention in our daily clinical practice. It is estimated that 10-30% of patients with this diagnosis have used more than one antipsychotic concurrently.

Objectives

The aim of this study was to evaluate the clinical evidence that support the use of antipsychotic polypharmacy against monotherapy in Treatment-resistant schizophrenia (TRS) in terms of long-term efficacy and efficiency, as well as of safety and tolerability.

Methods

A non-systematic review of the literature was conducted by searching in the Pubmed database the keywords: “antipsychotic combinations”, “antipsychotic polypharmacy” and “Schizophrenia”. The authors only selected papers published within the last 5 years.

Results

During the last years, different studies including meta-analyses and systematic reviews have been published, yielding to conflicting results. While in some cases the use of combination of antipsychotics showed higher outcomes in reduction of symptoms and risk of rehospitalization -in particularly for Clozapine and Aripiprazole combination-, others concluded that polytherapy predicts an earlier relapse as well as higher risk of discontinuation followed from a worst side effects profile.

Conclusions

Although several publications of high level of evidence have been carried out, the results obtained are generally contradictory and of low consistency. Nevertheless, some recent long-term studies show encouraging results with some antipsychotic combinations in particular. Further investigations are needed in order to elucidate the efficacy and risks of this therapeutic option.

Introduction

Theory of mind along with alexithymia, represent two important factors involved in an adecvate social functioning of any patients diagnosed with a psychotic disorder, therefore, also in the schizoaffective disorder.

Objectives

The purpose of this study is to evaluate the alexithymia and theory of mind in patients diagnosed with schizoaffective disorder, that are in remission and under treatment.

Methods

22 subjects diagnosed with schizoaffective disorder (according to ICD10 criteria) have been included in our study. The subjects have been selected using inclusion and exclusion criteria. The analized parameters were: socio-demographical data , alexithymia ( Toronto Alexithymia Scale) and Theory of Mind (“Reading the Mind in the Eyes test”). The data obtained was analyzed statistically.

Results

The socio-demographical data revealed that the median age of onset of the disorder was 28,2 years, the median education level was 11,2 years (highschool), the median evolution of the disorder is 10,8 years and all of them are now retired due to sickness or disability. The analyzed data showed that the ability of reading the mind in the eyes in 82% of the patients, as well as the alexithymia (79% of the patients) were impaired. Also, there is a direct correlation between these two; a lower ability to express emotions correlates to a lower ability to identify emotions (r=-0.524324317).

Conclusions

In the schizoaffective disorder, theory of mind, as well as alexithymia are impaired and there is a direct correlation between them.

Introduction

Parry fractures,a fracture in the forearm usually consequence of protecting the face against aggressive attacks, are known to be an indicator of interpersonal violence.They are frequently used in bioarcheological studies.Studies on violence and schizophrenia are mainly focused on the violent behaviors of patients while lacking the violence the patients are exposed to.Radiologically shown parry fracture could be a sign to detect victimization in patients with schizophrenia.

Objectives

To shed light on this issue we present two schizophrenic patients with parry fractures.

Methods

Exposure to violence in these patients was assessed by radiological examination.

Results

Case 1: 28-year old male with schizophrenia and inhalant use disorder,was treated in an inpatient clinic because of a psychotic attack.He had surgical scars on his left forearm and elbow.He said that he was attacked by his friends 5 years ago.The left ulna and humerus were broken due to that assault.

Case 2: 40-year old female patient with schizophrenia,was seen in an outpatient clinic and she was in remisson clinically.When questioned whether she has been subjected to physical violence in the past,she said that she was attacked by her ex-husband.Although she was under pain in her forearm,she didn’t apply to hospital back then.Radiological imaging revealed the old fracture.

Conclusions

It is known that autobiographical memory is reduced in patients with schizophrenia.Therefore,physical examination and therapeutic alliance may reveal the victimization of the patients.Furthermore,some specific bone fractures and wounds could be used to detect victimization even after plenty of time passes.

Introduction

Sialorrhea is one of the most common side effect of neuroleptics treatment. It can be unconfortable and could be a reason for therapeutic non-compliance. Botulinum toxin has been effective in the treatment of hypersalivation in Parkinson disease, infant cerebral palsy and amyotrophic lateral sclerosis.

Objectives

To illustrate the utility of botulinum-A toxin as a treatment of antipsychotic-induced sialorrhea through a case report.

Methods

We report the clinical history of a young male diagnosed as treatment-refractory schizophrenia in treatment with clozapine and paliperidone and a severe pharmachological induced hypersalivation.

Results

After onset treatment with botulinum-A toxin inyections in both parotid glands, sialorrhea decreased.

Conclusions

Botulinum-A toxin may be a good therapeutic option for the treatment of neuroleptic-induced sialorrhea.

Introduction

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can affect multiple organs.

Neuropsychiatric manifestations occur in two-thirds of patients with SLE, but psychosis is rare.

Corticosteroids are the cornerstone treatment in those cases, but can also induce psychosis themselves.

Objectives

To describe a case depicting psychotic symptoms in a patient with SLE, highlighting the importance of a correct diagnosis and its implications on the treatment.

Methods

Clinical case report and brief review of relevant literature.

Results

M, a 40-year old female, with a background of SLE for 30 years and psychiatric history of depressive episode 2 years earlier, checks in the emergency room with persecutory delusional ideation initiating 3 months prior. M had a SLE-related nephrological relapse 6 months earlier, with a proteinuria peak of 2g/day.

M was found medicated with sertraline 100mg; mirtazapine 15mg; hydroxychloroquine 400mg; enalapril 20mg; losartan 50mg; prednisolone 5mg (on tapering phase) and mycophenolate mofetil 400mg 2id (maintenance dose).

No significant signs or changes were found either at objective examination or on blood analyses. Brain CT revealed brain groove accentuation. Brain MRI showed unspecific signs. Lumbar puncture was refused by the patient.

M was diagnosed with organic delusional disorder secondary to SLE, and started prednisolone 40mg/day and risperidone 2mg 2id.

M was discharged one month after, maintaining residual delusional ideation but with reduced expressed emotion towards it.

Conclusions

The differential diagnosis of psychotic symptoms in a patient with SLE is fundamental, since it will determine the treatment strategy adopted.

Introduction

Sometimes it is necessary to perform an organic screening before referring a patient to mental health. A basic study can avoid therapeutic problems.

Objectives

34-year-old woman with no previous history in mental health. No family history in mental health. Married and mother of a daughter.After a car accident of some neighbors in his village, she starts abruptly with fear of damaging herself. This leads him to confine himself at home and limit his social activities, needing continuous supervision by his mother and daughter. Her mother says that in previous days she was tired.

Methods

Psychopathological examination: Conscious, oriented, collaborative. Hypotymic mood. Overrated ideas about hurting herself, afraid of going to the act. In the background, delusional ideas of harm. Floating anxiety, feeling of associated asthenia.

Results

Antidepressant and antipsychotic treatment is started. By not giving up the symptomatology, analytics that demonstrate hypothyroidism are requested. A computed axial tomography is also requested, and it doesn’t show significant alterations for the patient’s age. She is derived to endocrinology and by supplementing with thyroid hormone, symptoms improve, achieving psychopathological stability.

Conclusions

When referring to mental health in a case of sudden onset of symptoms, organic pathology must be ruled out previously, since the response to treatment may not be effective and the patient is being damaged.

Introduction

Creutzfeldt - Jakob disease (CJD) is an extremely rare and devastating disease characterized by rapid neurological deterioration in a healthy individual. The classic clinical presentation of CJD includes rapidly progressive dementia, myoclonus, pyramidal, extrapyramidal and cerebellar signs. Although it is less frequent that the disease begin with non-specific psychiatric signs.

Objectives

describe the psychiatric symptoms of CJD

Methods

retrospective study of a patient diagnosed with CJD

Results

We reported the case of a 66-year-old woman without personal or familial psychiatric history. Initial symptoms included delusions of persecution, depressed mood, memory loss, and a strange sensation

His sons stated that his cognitive problems had worsened significantly in the previous two weeks and associated with visual, auditory and sensory hallucinations. The physical examination was significant for perseverance, agnosia and apraxia associated with depressed mood and loss of vital momentum. His muscle tone was normal at all four extremities. Magnetic resonance imaging (MRI) showed high signal intensity in the bilateral caudate, putamen and left frontotemporal cortex in T2-weighted and diffusion-weighted imaging. Studies on cerebrospinal fluid (CSF) were also performed. The number of cells, glucose and proteins were within normal limits its 14-3-3 protein level was positive.

Conclusions

Our patient was diagnosed with probable CJD, based on internationally-agreed diagnostic criteria. This fatal neurological disease occurs in sporadic, familial and acquired forms. Psychiatric symptoms are considered rare; in early stages of the disease they are found in up to 40% of the cases. However, presentation as a pure psychotic condition over so many months of development is not typical.

Introduction

Schizophrenia and other psychotic disorders have a great impact on the socio-health framework worldwide. Its onset in the young adult prevails, and these disorders can be detected at both earlier and later ages, requiring an adequate diagnostic-therapeutic approach.

Objectives

The case of a 19-year-old female patient is presented, with follow-up by a Mental Health Unit from the age of 12 for presenting psychotic symptoms, who was admitted to the Acute Inpatient Psychiatry Unit after going to the Emergency Department due to an exacerbation of her psychotic symptoms along with behavioural disturbances and low mood. Upon admission, the patient verbalized delusional ideas of persecution, as well as overvalued ideas and delusional perceptions, in which she felt persecuted on the street, as well as observed in the bathroom, mostly by men known to the patient, and in occasions by her deceased father. She also referred being suffering olfactory hallucinations (in differential diagnosis with delusional perceptions).

Methods

Complete analytics, cranial CT and electroencephalogram revealed no pathological findings.

Results

Differential diagnosis was established among between schizophrenia, delusional disorder, schizoaffective disorder, major depressive disorder with psychotic symptoms and dissociative disorder.

The patient was treated with oral Aripiprazole at a dose of 15mg per day resulting in an adequate therapeutic response, a decrease in psychotic symptoms, as well as mood and behavioural stability.

Conclusions

Adequate anamnesis and psychopathological exploration are necessary to achieve a correct diagnosis of the psychotic symptoms.

Aripiprazole may be an effective therapeutic option in the treatment of psychotic symptoms in young patients.

Introduction

First-time presence of schizophrenic symptoms in 40-year old persons is rare. The complex symptomatology of shizoaffective disorder makes a misdiagnosis highly likely.

Objectives

To present a case of schizoaffective disorder.

Methods

Medline search and review of the clinical history and the related literature.

Results

We present the case of a 40-year-old man who suffered psychotic symptoms for the first time. According to the psychiatric history, this patient has needed emergency psychiatric examination half year before hospitalization due to deregulated behaviour in relation to persecutory delusions triggered by the regular use of cannabis. Before hospital treatment there was a two years history of persecutory, reference and erotic delusions, auditory hallucinations, sleeping disturbances and during hospital time elevated mood. Laboratory results and brain imaging were unremarkable. He was diagnosed with schizoaffective disorder and cannabis abuse. During the following month he was treated with an atypical antipsychotic and a mood stabiliser and his psychotic and manic symptoms improved. With these drugs and cannabis abstinence, he almost enjoyed normal life and work.

Conclusions

Late onset psychosis is due to a wide range of clinical conditions. The evolution and presentation of psychotic and affective symptoms in this patient made us think of schizoaffective disorder as main diagnosis.

Introduction

First-time presence of schizophrenic symptoms in 40-year old person is rare. The complex symptomatology of shizoaffective disorder makes a misdiagnosis highly likely.

Objectives

To present a case of schizoaffective disorder.

Methods

Medline search and review of the clinical history and the related literature.

Results

We present the case of a 40-year-old who suffered psychotic symptoms for the first time. According to the psychiatric history, this patient has needed emergency psychiatric examination half year before hospitalization due to deregulated behaviour in relation to persecutory delusions triggered by the regular use of cannabis. Before hospital treatment there was a two year history of persecutory, reference and erotic delusions, auditory hallucinations, sleeping disturbances and during hospital time elevated mood. Laboratory results and brain imaging were unremarkable. He was diagnosed with syhizoaffective disorder and cannabis abuse. During the following month he was treated with atypical antipsychotic and mood stabiliser and his psychotic and manic symptoms improved. With these drugs and cannabis abstinence, he almost enjoyed normal life and work.

Conclusions

Late onset psychosis is due to a wide range of clinical conditions. The evolution and presentation of psychotic and afective symptoms in this patient made us think of schizoaffective disorder as main diagnosis.

Introduction

Amongst psychotic disorders, late-onset schizophrenia is rare. It debuts after 40 years of age and is associated with forthcoming psychosocial factors, higher relacional, educational and laboral achievement, female and paranoid subtype preponderance, lower rates of substance use, and weaker family history of schizophrenia. Phenomenologically, auditory hallucinations predominate but there is a higher proportion of other modalities.

Objectives

Succeed in the understanding of the course of late-onset schizophrenia, which could go unnoticed for a long time, resulting in delay in diagnosis and in torpid recovery.

Methods

Presentation of a case and review of the scientific literature.

Results

We report the case of a 57-year-old man with two previous referrals to Mental Health due to psychotic sintomatology, which apparently started eleven years prior, never being evaluated. Up until the debut of the disease he had been married and held various jobs, having isolating himself from the family, coming to live in unsanitary conditions and being completely invaded by the experience of being influenced by an otherworldly force, generating insidious changes in his personality and behaviour. Eventually, he filed a complaint against “the power of the dead” and the forensic specialist requested a psychiatric report, so he was evaluated and admitted involuntarily to the psychiatric unit, staying two months. He was diagnosed with paranoid schizophrenia and treated with antipsychotics, currently being monitored.

Conclusions

We illustrate late-onset schizophrenia in men and the relevance of a proper and early diagnosis; highlighting the risks of overlooking these patients, with the potential repercussions in their own means to function in society.

Introduction

Amongst delusional disorders, delusional parasitosis or Ekbom’s syndrome is relatively infrequent. These patients report an unwavering false belief of skin infestation due to sensoperceptive hallucinations, despite the absence of any medical evidence. There are two forms of delusional parasitosis: in the primary form the delusion of parasitic infection is the only symptom present, whereas in the secondary form it occurs alongside another psychiatric disorder, such as schizophrenia, drug abuse or an organic cause. Antipsychotics are the most usen treatment.

Objectives

Presentation of a case and discussion of first approach to delusional parasitosis.

Methods

Presentation of a case and a small review of the scientific literature available in PubMed.

Results

Caucasian, 49-year-old woman reported a not-confirmed toe nail fungic infection one year prior, progressing with the subjective sensation of spreading to the rest of the body. Consequently, she employed diverse topical and oral remedies without medical supervision. One month prior she got medical assessment in a different medical centre, being evaluated by Dermatology and Psychiatry, getting the diagnosis of delusional parasitosis despite a lack of a battery of tests. She is given treatment, with no adherence. She escalated into more aggresive compulsions of cleasing, resulting in excoriations and scaldings, with increasing difficulties to lead her life.

Conclusions

We illustrate the relevance of close multidisciplinary cooperation and the use of an adequate battery of tests to rule out an organic cause. An early diagnosis is key, as a therapeutic alliance prevents the patients from isolation and the development of depression symptoms, or else, of self-harm.

Introduction

Identifying people at clinical high-risk (CHR) for psychosis facilitates the development of intervention strategies aimed to prevent the onset of a full-blown psychosis. There is evidence linking attachment adversity and poor mentalization to the risk for developing psychosis.

Objectives

In this study we aimed at: (1) investigating attachment patterns in a clinical sample of adolescent/young adult help-seekers and comparing the distribution of attachment patterns in CHR vs non-CHR subjects; (2) exploring the association between reflective functioning and subclinical psychotic symptoms; and (3) longitudinally examining the predictivity of attachment patterns, reflective functioning, and the interaction between them, with respect to transition to psychosis.

Methods

57 CHR outpatients were compared with 53 other outpatients who did not meet the high-risk criteria. A multi-method diagnostic assessment was implemented, including the Structured Interview for Prodromal Syndromes (SIPS). Adult Attachment Interview was also administered, and the transcripts were further assessed using the Reflective Functioning (RF) Scale. Participants were followed-up over a mean period of 14 months.

Results

CHR status was negatively associated to secure attachment patterns and positively associated to dismissing attachment patterns (χ2= 6.98, p = 0.03). The RF scores were significantly lower in the CHR sample (t=3.99; p<.001) and significant correlations between RF and SIPS subscales were found. Moreover, we found a significant effect of RF on the probability of transit in psychosis (β=.75, p=.03; OR=.473, 95% CI: .242, .924).

Conclusions

Our results suggest that attachment-informed and mentalization-based psychotherapies may be effective preventive treatments for CHR patients.

Introduction

Psychotic disorders have been described as a comorbidity in epilepsy. Psychotic syndromes associated with epilepsy are normally defined based on their chronological relation to the seizures ( interictal, posictal). They are more frequent in patients with long-standing history of seizures, family antecedents of psychosis, and invovelment of temporal lobe.

Objectives

We describe a case case of a patient with a diagnosis of secundary epilepsy, who developed psychotic symthoms in a stability period and suitable control of seizures.

Methods

Data are obtained at medical history, physical examination, complete analysis, CT, magnetic resonance and electroencephalogram.

Results

A 54 year old female patient was atended at hospital because of subacute behavioral disturbances, auditory and visual hallucinations, paranoid ideation, spacetime disorientaion.

She has a secundary epilepsy diagnoses since she was 19 years old, neurocysticercosis (parenchymal nodular calcificated involved and subarachnoid alteration) and chronic hydrocephalus stabilized. She was treated with levetiracetam, lacosamide and valproate. Last time that she had suffered one episode of partial complex seizure was 4 months earlier.

When acute organic causes of psychiatric symthoms were discarded, she was hospitalized at psychiatry department of our hospital and neuroleptic treatment was iniciated. During hospitalization we also noticed several symthoms of mild cognitive impairment. She was succesfuly treated and discharged home with low doses of neuroleptics.

Conclusions

The diagnosis of psychotic states associated with epilepsy could be difficoult because of the very different clinical manifestations and. It is important to consider the high prevalence of psychiatric comorbility in patients with epilepsy to administer them a multidisciplinary treatment.

Introduction

Psychosis is a rare sequela of TBI that occurs in a range between 0.9% to 8.5% of patients. Besides, a maniac episode occurs in approximately 9% of patients in this group.

Objectives

We describe a case of a 29-year-old woman who presented psychotic and manic symptomatology after a TBI, as well as the diagnostic process and treatment.

Methods

In this poster, we report a case of post-TBI severe mental illness.

Results

Our patient hospitalized because of psychotic and maniform symptoms, appeared after a polytrauma involving a TBI. This clinical picture had been progressing for years, consisting of abrupt humour changes, irritability, impulsivity, self-referentiality and verbalization of megalomaniac and persecutory ideas. Occasionally, these delusional symptoms had a greater emotional and behavioural impact in the form of aggressive and uninhibited conduct, which coincided with a reduction of sleep needs, an increase of activity and remarkable dysphoria, this being the situation of the patient when she arrived at the hospital. After several weeks of observation and treatment in our hospitalization unit, the patient was diagnosed with schizoaffective disorder and organic personality disorder.

Conclusions

It is essential for all kind of specialists to think about mental illness as a possible sequela of TBI to reach an early diagnostic.

Introduction

A program of First Episodes Psychosis has been implemented in Navarra

Objectives

To describe the baseline sociodemographic and clinical characteristics of patients attending the PEPsNa.

Methods

We present the baseline results of the sample

Results

To date, 211 patients have been treated.

Mean age: 29.9 years (SD: 10.5).

Gender: 67.8% male.

Ethnicity: 73% Caucasian, 15.2% Latin American, 5.7% African and 3.8% Arab.

Marital status: 70% were single.

Housing: 49.5% live with their parents or family.

Employment and occupation: 42.7% of patients have a job or carry out standardised studies. 33.5% are long-term unemployed.

DUP: The duration of untreated psychosis is 19.5 months (SD 46.9).

The premorbid GAF score is 71.5 and the GAF score of the episode is 30.35.

Referrals: 56.7% of patients are referred from the acute psychiatric hospitalization unit and a 30% from Mental Health Centres.

Substance abuse: only 20% of patients do not consume any substance. The most consumed drugs are alcohol (75%), cannabis (57.8%) and stimulants (37%).

Baseline diagnosis: brief psychotic disorder (42.9%), unspecified psychotic disorder (20%), schizophrenia (14.6%) and substance-induced psychotic disorder (11.7%).

Psychopathology: CASH (global rating) for psychotic syndrome: 3.7 (SD 1.1); disorganised syndrome: 2.2 (SD 1.5); negative syndrome: 1.2 (SD 1.3).

Treatment: 15.5% of patients received no antipsychotic treatment. The most frequent antipsychotic is risperidone (40.8%).

Basal metabolic syndrome: 4% of patients meet criteria.

Conclusions

We highlight data such as a short dup that may be related early intervention, substance use is very frequent and Metabolic Syndrome is present from the beginning of the disease

Introduction

Childhood trauma is the main non-hereditary factor that has proved a strong link to schizophrenia development in adulthood. All kinds of interpersonal childhood trauma have been linked to psychosis. Young age and poly-victimisation increase likelihood for trauma-related psychosis onset.

Objectives

1) Describe childhood traumatic experiences of patients with schizophrenia, 2) Assess relationship between trauma and suicidal history in these patients.

Methods

Retrospective study including adult patients diagnosed with schizophrenia spectrum disorders. Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ-SF), which includes 28 items grouped into 5 specific factors (physical, emotional and sexual abuse, physical and emotional neglect).

Results

Forty-five patients (55.5% men, mean age: 41.1 years) were included. 77.8% had experienced childhood trauma, with no significant gender differences (48.9% emotional abuse, 28.9% physical abuse, 40.0% sexual abuse, 55.6% emotional neglect, 46.7% physical neglect). 31.1% reported severe poly-victimisation (≥4 types of trauma). Childhood trauma was significantly related with lifetime suicidal history for patients with any sort of abuse (p=0.001), emotional abuse (p=0.017) and physical neglect (p=0.028). Likelihood of suicidal behaviour was doubled in patients who had been sexually abused during childhood (p=0.063).

Conclusions

More than 3/4 of schizophrenia spectrum patients were abused during childhood and 3 out of 10 patients suffered from more than 3 types of abuse. Childhood trauma is a risk factor for lifetime suicidal behaviour. Systematic inquiry on childhood abuse in these patients is recommended.

Introduction

The gastrointestinal system is colonized by a large number of bacteria, known as microbioma, that can play a significant role in the interaction between the brain and the gastrointestinal tract. It has been proposed that microbiota may be involved in the pathogenesis of various neurological and psychiatric disorders, involving the immune response, and in the treatment resistance of those disorders.

Objectives

The aim of this study is to review the possible relationships between microbiota, schizophrenia and treatment resistance.

Methods

We review the clinical case of a 45-year-old patient who was admitted to our hospital, diagnosed with schizophrenia, and the treatment difficulties we had, which could be related to the ulcerative colitis he had. We also review some literature about this topic.

Results

Some studies have recognized the importance of interactions between the brain and the gut, mediated by microbiota, in the pathogenesis of psychiatric disorders, such a schizophrenia. In addition, it has been proposed an immune hypothesis of schizophrenia, and a genomic relationship has been suggested between schizophrenia and some autoimmune disorders, such as Crohn’s disease, multiple sclerosis, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, type I diabetes, and ulcerative colitis.

Conclusions

There is a close relationship between microbiota alterations and schizophrenia, including its resistant forms. This may provide the basis for future studies on immune system modulation and microbiota as a target for the treatment for schizophrenia.

Introduction

Potomania is defined as the desire to drink large amounts of liquid compulsively with a pleasuring feeling. It is not included in the psychiatric classifications with a specific diagnosis and it is remarkable the lack of studies and the little scientific evidence on it.

Objectives

Presenting the case of a patient diagnosed with potomania, describing its management during admission to Psychiatry

Methods

A 35-year-old male admitted to the Psychiatry plant after hyponatremia due to water intake. Psychiatric history of Schizophrenia with multiple decompensation episodes, alcoholism and Cannabis consumption. Admitted 3 months ago to the ICU for severe hyponatremia. In treatment with Quetiapine and Risperidone.

He referred to drinking 8 liters of water a day due to a sensation of dry mouth and to "purify". Three years ago, fluid intake increased progressively until several hyponatremia occurred. A scan impoverished discourse, residual, affective flattening, no
no positive psychotic symptoms. Initially multiple demands and no control over water intake.

Results

Behavioral measures applied at admission: strict surveillance, closed bath, water restriction, chewing gum. Valproic acid treatment started up to 1500mg/d. Progressively improvement over impulse control and decrease the desire to water intake until sodium is in range. After discharge, he moves to mid-stay to continue care.

Conclusions

The most frequent diagnosis for potomanian patients is Schizophrenia. Apart from being a vital danger due to the risk of hyponetremia, it is related to chronicity, deficit symptoms and less response to treatment. It would be necessary to continue with investigations in order to improve the approach of these patients.

Introduction

Cognitive impairment is a key feature in patients with psychotic disorders. The Montreal Cognitive Assessment (MoCA) is a brief tool that has been shown to be effective in identifying mild cognitive impairment and early dementia.

Objectives

This study explores the usefulness of this instrument to detect cognitive impairment in long-term psychotic disorders.

Methods

One hundred-forty stabilized patients were re-evaluated more than 15 years after a First Episode of Psychosis (FEP). Patients were psychopathologically assessed, and the MoCA test and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery were administered. Two cut-off scores for cognitive impairment using the MATRICS battery were applied (T score <40 and <30).

Results

Concurrent validation was found between the total scores of the MoCA and MATRICS. We also found significant associations between 5 out of 7 MoCA subtests (visuospatial-executive, attention, language, abstraction and delayed recall) and MATRICS subtests but not for the naming and orientation MoCA subtests. Receiver operating characteristic (ROC) analysis suggested a <25 cut-off for cognitive impairment instead of the original <26.

Conclusions

Our results suggest that the MoCA test is a useful screening instrument for assessing cognitive impairment in psychotic patients and has some advantages over other available instruments, such as its ease-of-use and short administration time.

Introduction

Cognitive impairments in psychotic disorders have been reported as a continuum in severity, from schizophrenia spectrum disorders (more severe) to affective disorders (less severe) (Hill et al 2013). However, findings to date have been inconsistent (Reichenberg et al 2019).

Objectives

To establish the cognitive profiles in the MATRICS Consensus Cognitive Battery (MCCB) of a sample of patients with psychotic disorders, according to their diagnosis.

Methods

172 outpatients with psychosis were assessed with the MCCB. Patients were grouped considering their diagnosis: Schizophrenia spectrum disorders (SSD, n=69); Affective disorders (AD, n=46), Schizoaffective disorders (SAD, n=39), Other psychoses(OP, n=18), including patients with one or more psychotic episodes in the past which remitted and do not meet diagnostic criteria for a current psychotic disorder.

Results

Patients with SSD showed worse performance on attention, verbal and visual learning, and combined score of the MCCB, with respect to the OP group. They also underperformed AD group in verbal learning and social cognition. AD patients showed worse performance than OP patients in processing speed and visual learning tasks. SAD patient only showed significant differences in attention scores, with respect to OP patients (Table 1, Fig. 1).

Conclusions

SSD patients showed the most severe cognitive impairment with respect to OP patients. These results suggest a similar profile of impairment in SSD, SAD and AD, and significant differences in severity regarding OP patients. OP patients as a group showed average performance in all the cognitive functions explored.

Introduction

Network analysis represents a promising approach to study the relationships between clinical and cognitive variables in psychiatric disorders. However, only one study to date has studied cognition in patients with psychosis using network analysis (Chang et al 2019).

Objectives

To examine the relationships between a set of neuropsychological variables using the network analysis in a sample of patients with first episode psychosis (FEP)

Methods

266 patients with a FEP were assessed with a set of neuropsychological tests, including measures of premorbid IQ, attention, working memory, verbal memory, processing speed, executive functions and social cognition. Network analysis was applied using the qgraph package of R-Studio software, to obtain the relationships among cognitive scores controlling for the influence of all the other variables in the network.

Results

The interrelations between the nodes in the cognitive network of this sample of patients with FEP showed a strong association between the measures of each neuropsychological test. Cognitive domains established a priori were validated by the network only in those measures that belonged to the same test (verbal memory and social cognition). However, measures corresponding to processing speed and executive function showed different interconnection patterns, according to the tests and not to the cognitive domains.

Conclusions

The network shows strong relationships between the variables of each test. However, the strength of some of the connections do not correspond with ‘a priori’ cognitive domains when different tests are involved. Further research is needed to ascertain whether this structure is replicated.

Introduction

Negative symptoms are a core feature of schizophrenia. The CAINS (Clinical Assessment Interview for Negative Symptoms) is an empirically-developed “second generation” scale for the assessment of negative symptoms.

Objectives

We examined the psychometric properties of the CAINS scale and their comparative value regarding the Scale for the Assessment of Negative Symptoms (SANS) for predicting psychosocial outcome

Methods

A total of 98 consecutive admissions with schizophrenia spectrum psychosis were administered the SANS at admission and discharge times, and the CAINS at discharge time. The Global Assessment of Functioning (GAF) and World Health Organization Disability Assessment Schedule (WHODAS) were used for the assessment of psychosocial functioning.

Results

The CAINS motivation/pleasure and expression subscales correlated significantly with all of the SANS subscales, both for admission and discharge, with the exception of attention.
The CAINS motivation/pleasure score was significantly associated with other psychopathological dimensions at discharge, such as positive, disorganized and illness unawareness dimensions but inversely with mania dimension. And the CAINS expression subscale was only inversely and significantly associated with mania dimension at admission.
Factor analysis of CAINS items revealed a two-dimensional structure that explained the 81.62% of the variance.
Both CAINS and SANS subscales were strongly associated with WHODAS and GAF psychosocial functioning scores.

Conclusions

These findings suggest that the CAINS Spanish version is a valid tool for measuring negative symptoms in schizophrenia. And despite both high scores on both CAINS and SANS scales showed significant associations with poor functioning, it seems that the associations of CAINS scores were less strong than those of SANS scale.

Introduction

Gender differences have an impact on the course of schizophrenia. Earlier age of onset, worse premorbid functioning, more severe negative symptoms and cognitive impairment are reported in males and might be associated with poor functioning.

Objectives

Within the Italian Network for Research on Psychoses, we investigated, in a sample of 280 females (F) and 641 males (M) with chronic schizophrenia, the frequency of negative symptoms and their impact on real-life functioning, controlling for the major causes of secondary negative symptoms and neurocognitive impairment.

Methods

BNSS assessed negative symptom domains: anhedonia, asociality, avolition, blunted affect and alogia. Linear regression analyses investigated the predictors of real-life functioning domains (assessed with the SLOF): interpersonal relationships (IR), everyday life activities (AC) and work skills (WS). Depression, parkinsonism, positive and disorganization dimensions, neurocognitive composite score and BNSS domains were used as independent variables.

Results

M showed a greater impairment in functioning and higher frequency of negative symptoms than F. Impairment in IR was predicted by asociality, alogia and disorganization in M; by asociality, positive dimension and anhedonia in F. In M, deficit in AC was predicted by disorganization, alogia, neurocognitive impairment, avolition and positive dimension. In F, disorganization and neurocognitive impairment predicted the deficit in AC. WS deficit was predicted by disorganization, neurocognitive impairment, anhedonia, positive dimension and parkinsonism in M; by disorganization, avolition and neurocognitive impairment in F.

Conclusions

Our results support the higher frequency of negative symptoms in M and demonstrate gender-related differences in factors associated with poor functioning, suggesting the importance of individualized gender-specific rehabilitation programs.

Introduction

It is widely known that the exposure to stressful life events can trigger psychosis in vulnerable individuals. There are several models proposing the possible mechanisms underlying this relationship. Stress increases the cortisol level in the brain and therefore it could increase the level of dopamine receptors. On the other hand, it has been proposed that social disadvantage could increase the sensitivity to dopamine in the brain. Psychosis may also be explained as an exacerbated defense mechanism (“hyperconsciousness”) in changing environments.

Objectives

To present a case of a first-psychotic episode during an Erasmus Program and to review the literature about stressful life events and psychosis.

Methods

We will present a case report and a literature review.

Results

We report a case of a 21-year-old woman, with no psychiatric nor substance abuse history. Erasmus student, living in a foreign European city for a month and a half. Her symptoms started after 3 weeks living abroad with confusion, thought blocking and persecutory and referential delusions. Physical exam, blood analysis and cerebral CT scan were normal. We started treatment with aripiprazole 20 mg and lorazepam 3 mg daily with clinical improvement in two weeks.

Conclusions

Changing environments can work as stressful life events that can trigger psychosis in vulnerable individuals. There is evidence in favor that stressful events in adult life may be involved in the onset of psychosis and our study supports these findings.

Introduction

The degree of acceptance of long-term injectable medication is still controversial. Could this trend change as patients know the existence of a quarterly formulation?

Objectives

The present study attempts to test whether the introduction of injectable PILP injection medication on a quarterly basis implies a change in acceptance and attitudes toward injectable medication.

Methods

It is a descriptive study that collects data from patients with an initial negative attitude towards an injectable treatment and who changes when they know the existence of a quarterly formulation.

Results

In our study we used the ICD scale (N = 50), finding a difference mayor of 3 positive points when starting treatment with quarterly PILP suggests a good predisposition and a change of attitude of the patients when knowing the existence of a quarterly injectable formulation

Conclusions

Acceptance of treatment by the patient is of great importance as an integral part of their recovery process.
Limitations:
- Scarce total number of cases and need for validation with more detailed scales
- Need a longer study since it is done in an outpatient setting
Strengths:
- Reflects the "real" attitude of patients with regard to injectable medication
- Allows the patient to make decisions regarding their treatment

In this study, we observed that the treatment with quarterly PILP is a benefit for the patient perceived by the patient, with a more adequate attitude and a better acceptance of an injectable treatment, which leads to a substantial improvement in their quality of life and the prognosis of her illness

Introduction

Cannabis use, due to its influence on the developmentn and prognosis of the disease, has become a target for the prevention and treatment of FEP patients.

Cannabis use in FEP is correlated with poor adherence treatment, the severity of psychotic symptoms, the risk of relapse and poorer functional outcome at follow-up.

It has been shown that psychoeducation, as an adjuvant to pharmacological treatment, is effective in improving negative symptoms and functionality. However, there is a need to develop effective specific interventions to reduce cannabis use as part of comprehensive treatment programs for patients with psychosis.

Objectives

The objective of the study was to assess the comparative efficacy of a cognitive-behavioral treatment program for cannabis use cessation (experimental group) in relation to Psychoeducation (standard group) in FEP patients.

Methods

Patients were randomly assigned to one of the two treatment groups (experimental/standard group) and were assessed with an assessment protocol for gathering data on clinical, functional and cannabis variables (baseline, post-treatment, 3, 6 and 12 months of follow-up).

The effectiveness of both interventions was compared by models of repeated measures and logistic regression.

Results

Experimental group patients showed a greater reduction in use of cannabis compared to the control group (B=.-3,367; p=,000), less psychotic symptoms (t= -2.808, p= 0.007), and better functionality (t= -2.721, p= 0.008) in the post-treatment. No differences were found in depressive, anxious or manic or symptomatology.

Conclusions

The intervention focused on the management of cannabis use is essential to prevent relapses and to improve the prognosis of FEP patients.

Introduction

Early psychosocial interventions adjunctive to pharmacotherapy may contribute to symptomatic and functional recovery of first episode psychosis patients (FEP). Therefore, individuals who receive early intervention including guidance on how to improve their adherence to treatment, insight into their illness and self-management, have a better course and, hence, these factors are associated with a better prognosis.

Objectives

The objective of the study was to assess the efficacy of a psychoeducation programme versus treatment as usual in improving the symptomatology and functionality of patients (pre/post-treatment).

Methods

This is a single-blind randomised clinical trial in which FEP patients were randomly assigned to one of two treatment groups: 1) the control group, receiving pharmacotherapy together with regular sessions with a psychiatrist (treatment as usual), and 2) the intervention group receiving integrated treatment, namely treatment as usual plus a psychoeducational intervention. The psychoeducational programme has 14 sessions focused on improving patient insight into their illness, treatment adherence, prodromal identification, early intervention to prevent relapses, healthy lifestyles, techniques for managing anxiety, social skills and problem solving. Patients can also call a telephone helpline between sessions.

The improvemente in adherence (Morisky Green Medication Adherence Scale), psychotic (Positive and Negative Syndrome Scale), and functionality (Functioning Assessment Short Test) was analyzed using bivariate analysis, linear and logistic regression models.

Results

The intervention group presented better functionality (B=11,024; p=0,000) and adherence (B =3,128; p=0,001) and fewer psychotic symptoms (B=-2,002; p=0,0037) than control group in the post-treatment.

Conclusions

Psychoeducation is effective as a complementary therapy to pharmacological treatment, improving the evolution of FEP.

Introduction

Hyperprolactinemia is a frequent but neglected adverse effect observed in patients treated with antipsychotic-drugs. The prevalence of hyperprolactinemia among psychiatric patients receiving antipsychotic medications was estimated to be between 30% and 70%. An English study showed that 18% of men and 47% of women treated with antipsychotics for severe mental illness had a prolactin level above the normal range (Besnard et al. 2014).

Objectives

Hyperprolactinemia is in fact more frequent in women than in men. Sometimes it is asymptomatic, but the higher the prolactin level is, the more patients have clinical manifestations.

Methods

The sample consisted of 119 consecutively acute admitted women, aged 18 to 45 years with recurrent schizophrenia diagnosed on bases of DSM-5 criteria. Assessment for all the enrolled subjects comprised a psychiatric evaluation and blood draw to determine the prolactin level. Hyperprolactinemia was defined as a level of prolactin above the upper limit of normal (>23.00 µg/L for females).

Results

Hyperprolactinemia was detected in 74.79% patients (n=89), whereas the group without hyperprolactinemia comprised 25.21% of the sample.

Conclusions

The percentage of hyperprolactinemia of 74,79% in this study can be attributed to the fact that the sample consisted of women with recurrent schizophrenia who were receiving antipsychotic medication for a period of time. Our findings may support a possible role of hyperprolactinemia in recurrent episodes of schizophrenia in female patients (taking into account the total number of subjects with elevated prolactin levels), but further research is required to confirm these results.

Introduction

Facing extreme life experiences can impoverish the ability to narrate experience and self. Descriptive psychiatry's model of psychoeducation focusing insight in psychosis may fail its purpose and threaten the already damaged patient’s identity.

Through the process of accepting illness, a value-bearing individual can end up being considered dysfunctional and worthless and experience guilt, shame, hopelessness, demoralization and helplessness. Elseway, denying illness would be considered proof of anosognosia. Both situations may lead to illness narratives introjection, agency loss, own beliefs and competency mistrust and stagnation.

Objectives

The aim is to show narrative therapy as an advantageous complement or alternative to objective psychiatry psychoeducation in psychosis clinical practice.

Reintegrate one’s life narratives and retrieve recovery agency is one of the most powerful, adaptative and healing a person can accomplish.

Methods

Narrative model encourages the patient to build and tell coherent and desirable stories in which recovery is promoted, from a personal point of view, and validates these.

A non-pathologizing speech, normalization, externalization, empathy, respect and kindness are recomended. It is fostered to embrace different truths and alternative versions of self, promoting dialogue and cooperation between selves to dynamize identity narratives and allow choosing a preferred self in each situation. Exploiting personal resources is encouraged.

Results

The person feels reauthorized in the direction of life and recovery, starts narrating personal life stories and recover the possibility of social interaction.

Conclusions

Through recovery process, the person regain an integrated sense of identity, separated from illness and develop an author-narrator-protagonist role in his own life story and the recovery process.

Introduction

Narrative therapy in psychotic patients shows recovery as an adaptative process: the personal recovery journey.

Myths have always brought cultural and institutional cohesion and bind all human beings in any era or country. Hero’s Journey is a myth that appeals to any person who faces life challenges. The hero is an example of courage, strength, and resilience who resist setbacks and obstacles and in doing so experiences an identity transformation. The victory of the heroine is the victory of all mankind. When he returns from the journey he shares knowledge with the rest of the inhabitants of the "ordinary world". In Myth, this knowledge transcends intrahistory, and becomes part of popular culture outside the tale.

Objectives

The aim of this work is to adapt Hero’s Journey scheme to narrative psychotherapy in psychosis.

Methods

The person is invited to his own-Hero’s Journey and encouraged to try identities and coping strategies through narrative approach, methaphors and hope speech that normalizes recovery.

The therapist doesn’t show the way but motivates the individual to undertake a journey towards well-being and develop his potential overcoming difficulties along the way.

Results

The journey teaches that challenges can be embraced and profitable. Narrative processing systems steered and blocked by illness are now dynamized, promoting desirable identity narratives and integrating them in one’s self.

Conclusions

Recovery journey is an adaptation, growth and self-rediscovery journey whose goal is individual fulfillment and wellbeing. The “psychotic” person puts himself into a position to start high personal value trips and to become the author-narrator-hero of his life story.

Introduction

Studies have shown that up to 40% with a diagnose of schizophrenia have hearing hallucinations after optimal pharmacological treatment. Experience shows that patients who hear voices can develop and improve their relationship with the voices and manage his voices in a better way.

Objectives

We wish to evaluate the Auditory vocal hallucination treatment.

Methods

The hearing voices therapy is a supplement to existing treatment and is done with understanding and interpretation of the voices in order to reduce anxiety for the voices as well as to master and interpret the voices so that they become "useful" to the patient. The professional attitude is accommodating, non-confrontational and not requiring the patient to change relationship with his voices.

Purpose of group treatment:

To share the experience of hearing voices.

To gain better acceptance and knowledge of hearing voices.

To achieve better cooperation with their voices in an equal relationship.

Learning to interpret their voices and break isolation.

Measures: Auditory Vocal Hallucination Rating Scale (AVHRS). Sleep (Pittsburgh Sleep Quality Index).

Results

21 patients participated. On average they scored high on AVHRS. The patients had very bad sleep quality. The women had a decrease in AVHRS (2.1; p= 0.03) after 1 years.

Conclusions

The group treatment was acceptable for the patients and the study found positive outcomes for female sex. The study can be followed by a larger RCT.

Introduction

Nowadays, suicide and attempted suicide set up a major impact on individuals’ life; studies show that every year around 800.000 people die due to suicide. Needless to highlight the importance of identifying correctly the population at risk, even more when we discuss about psychiatric patients. One of the psychiatric disorders that goes hand in hand with high mortality through suicide is schizophrenia.

Objectives

The following presentation case reveals the situation of a 26 years old subject, Caucasian male, intellectual, without any somatic or psychiatric records, who came to the emergency room after an attempted suicide by defenestration.

Methods

As time went on, the patient’s evolution was towards schizophrenia.

Results

Among other risk factors, on long-term, suicide attempts may be consider a significant agent for the development of schizophrenia.

Conclusions

Therefore, a patient with suicide attempt/s must be carefully evaluated, counseled, observed and treated for a long period of time, as this event/s opens the door for various mental illnesses (including schizophrenia).

Introduction

Patients with serious mental illness (SMI) reduced life expectancy by up to 20 years. Smoking is the main preventable risk factor in relation to reducing mortality. Developing new tools to motivate patients towards cessation of smoking is a priority.

Objectives

The objective is to evaluate the effectiveness to quit smoking of an intensive antitobacco intervention on lung damage and possibilities of prevention in patients with schizophrenia or bipolar disorder to quit smoking.

Methods

It is a 12-month follow-up, multicenter study to evaluate an intensive motivational tool based on the individual risk of pulmonary damage and prevention opportunities. A minimum of 204 smokers will be included, aged over 40 years old, all of whom are patients diagnosed with either schizophrenia or bipolar disorder (BD). Chronic obstructive pulmonary disease (COPD) will be evaluated using spirometry, and the diagnosis will then be validated by a pneumologist and the lung age estimated. Based on this value, a motivational message about prevention will be issued for the intervention group, which will be reinforced by individualized text messages over a period of 3 months.

Results

231 subjets were screening but only 160 signed the consent to participated and completed the intervention. 100 completed the follow-up in the intervention group and 97 in the control group.

Conclusions

In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking.

Introduction

Patients with schizophrenia or bipolar disorder (BD) continue with tobacco rates similar to the general population were in the 50th. Antitobacco strategies were starting to use in different countries but not always was applied to serious mental illness (SMI). There are two forms to measure the motivation bases in the Prochaska and DiClemente Transtheoretical Model (TTM), the Stage of Change (SOC) or the continuous Readiness to Change (RTC).

Objectives

Evaluate the predictive capacity of the 2 indices for measuring motivation described in the TTM. SOC and RTC.

Methods

75 adult patients were included in a Multicomponent Smoking Cessation Program (9 months follow-up). At the end of the preparation stage, the patients completed the URICA Scale to measure the SOC and the RTC. Regression analyses were carried out to identify the predictors of the efficacy outcomes: reduction of at least 50% of the cigarettes per day or abstinence or reduction of the carbon monoxide.

Results

We find differences in the measurement of motivational levels independently, but this difference disappeared during the follow-up. In a linear mixed-effects model, the reduction of the CO was significatively associated with the reduction of the CO at the end of the active treatment and during the follow-up (b: -1.51; SD: 0.82; p<0.01).

Conclusions

The level of RTC predicts the reduction of CO at the end of the active phase and at the end of the follow-up. So, clinical practice and research in SMI could consider using the continuous form to examine the level of motivation.

Introduction

Poor adherence has also been associated with an increased risk and rate of relapse, increased number of voluntary and involuntary admissions, greater levels of residual positive symptoms, and poor quality of life, social relations, and activities of daily living. The rate of medication nonadherence varies from 26% to 53% for complete discontinuation at the end of the one year to 33%–63% of inadequate medication adherence.

Objectives

To determine the prevalence of non-adherence in a cohort of patients with first episode psychosis and the sociodemographic and clinical factors associated with non-adherent behaviour.

Methods

The sample included 216 consecutive patients from 2016 to 2018 diagnosed with schizophrenia spectrum disorder or an affective psychosis using ICD-10. Sociodemographic variables, duration of untreated psychosis, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no-adherence, partial adherence and regular adherence.

Results

In their first year in the program 31% were non-adherent, 17% partial adherent, and 52% adherent. Non-adherent patients demonstrated more positive symptoms, more relapses, more psychoactive substance use disorder, reduced insight, and poorer quality of life. They were younger, had an earlier age of onset and lesser family support in treatment.

Conclusions

Results for this group are similar to those reported in the literature. Correlates are often the consequence of non-adherence. Non-compliance has to be anticipated and relationships maintained with patients and families to intervene as soon as possible to minimize the consequence of non-compliance.

Introduction

150 women, patients with paranoid schizophrenia and their families were examined in a comprehensive manner. The examined patients were divided into 4 groups depending on the model of family interaction.

Objectives

1. Analyze the peculiarities of the clinical psychopathological symptoms of schizophrenia of women in different models of family interaction.

Methods

Research methods: clinical, clinical psychopathological, clinical anamnestic, psychodiagnostic, socio-demographic and statistical.

Results

Group psychoeducational and behavioral impacts first (general orientation), then taking into account the necessity of the restoration skills of family roles' performance, defined by a model family interaction, backed up by the further %tage of the elements of family psychotherapy

Conclusions

.Use of these approaches to medical and psych rehabilitation work with PSH female patients and members of their families, proved their effectiveness compared with specified measures of the standard care given to patients according to their quality of life, social functioning and patients' compliance with supportive therapy.

Introduction

Recent works have highlighted the role of the glutamatergic model in the pathophysiology of schizophrenia.

Objectives

This narative revue aims at reviewing current knowledge of alterations in glutamatergic neurotransmission in schizophrenia.

Methods

We used the following keywords « schizophrenia » AND « glutamate » OR « ketamine » OR « NMDA » in PubMed. From the 5600 results, we have selected only those published from 2010 to 2019. Articles were selected according to their relevance.

Results

The 16 selected articles bring large evidence concerning the glutamatergic model in schizophrenia. This model explains negative and cognitive symptoms by an excess of inhibition of the mesocortical pathway by GABA interneurons, directly stimulated by glutamatergic pathways. NMDA antagonists induce schizophrenia-like symptoms in disease-free subjects. Evidences were brought by brain imaging, genetic, post-mortem, and Mismatch Negativity studies. Antipsychotics currently used have only a limited effect on glutamatergic neurotransmission. Clozapine seems to have the largest effect on glutamatergic pathways. NMDA co-agonists, like sarcosine and D-serine, might be interesting in treatment of negative symptoms. Molecules targeting other glutamatergic pathways might also be interesting in schizophrenia treatment.

Conclusions

Those studies support the link between schizophrenia and hypofunction of NMDA receptors. This model brings new perspectives in treatment development. The potential of molecules targeting glutamatergic pathways as treatment needs to be investigated at larger scale.

Introduction

Schizophrenia affects people’s well-being and participation in everyday activities through, among others, a mechanism of cognitive impairments. Cognitive remediation (CR) has promising evidence for its effectiveness among people with schizophrenia. However, its feasibility and effectiveness in inpatient settings are evasive. Virtual Reality (VR) technology provides a platform for CR in ecological environments and tasks having a potential to overcome previously reported limitations.

Objectives

Test the effectiveness of VR-based CR for improvement of cognition, functional capacity and participation in daily-life activities among inpatients with schizophrenia.

Methods

Twenty-four inpatients (male: N=19, 79.2%; Age: M=33.8, SD=8.7) were enrolled into the pre-post designed study using convenience sampling. The participants completed 10 sessions of 20 minutes using the Functional Brain Trainer (Intendu©), a body-controlled, interactive adaptive tool for training of inhibition, response planning, working and reverse memory, shifting, self-initiation, persistence, and attention in functional tasks and environments. Evaluation procedure includes assessments of cognition, functional capacity, schizophrenia symptoms and dimensions of participation using standard tools.

Results

Improvement was found in visual-motor skills, processing speed and shifting (-2.44<Z<-2.89, p<.05), schizophrenia symptoms (positive, negative and general: -3.9<Z<-3.2 p<.001), functional capacity (Z=-3, p<.01) and participation diversity (t(22)= -2.9, p<.05).

Conclusions

This preliminary study provides initial evidence for effectiveness and ecological validity of the short VR-based cognitive training in inpatient acute settings suggesting its contribution to daily-life reintegration after discharge and well-being of individuals with schizophrenia. Larger, controlled studies are needed to provide a clearer evidence of the effectiveness of this tool in these population.

Introduction

Negative symptoms in schizophrenia can persist despite remission of positive symptoms, and even during periods of clinical stability. It is known they can have great impact on normal functions. Currently approved atypical antipsychotics treatment have efficacy on positive symptoms, but they have still limited improvement on primary negative symptoms.

Objectives

The aim of the current paper is to provide an updated comprehensive perspective on the treatment of negative symptoms in psychosis.

Methods

Literature review related to the topic

Results

Negative symptoms such as blunted affect, anhedonia, alogia or asociality can be categorized as primary negative symptoms, related to the onset of psychosis. We might consider that they can also be described in relation with others psychiatric symptoms, such as depression, and secondary to positive symptoms or side-effects of antipsychotic treatments and long term antipsychotic treatment side effects. Primary negative psychotic symptoms have been related to poor social and occupational functioning. They also commonly have great impact on patient´s daily life and decreases global recovery. There are some recent studies focus on new antipsychotic treatments, as well as some specific psychological interventions.

Conclusions

Specific treatments for primary negative symptoms in psychosis are still limited. Early intervention and integral approach of primary negative symptoms could provide a significant improvement in patient recovery. Combined treatment, including antipsychotics drugs and psychological and psychosocial intervention might also be considered, although further studies would be necessary.

Introduction

Even though antipsychotic treatment is usually effective in suppressing psychotic symptoms there are about a 20% of cases which doesn’t respond to an otherwise adequate treatment even after prescribing clozapine, that is why it’s necessary to redefine some terms and reach a consensus about how to deal with these cases.

Objectives

The aim of this study is to analyze the different therapeutic alternatives and combinations available for the treatment of ultra-resistant schizophrenia

Methods

We proceed to review the recent bibliography on this subject, with regard to the case of a 41 year old female diagnosed of Paranoid Schizophrenia since its first episode in 1998, followed by 8 more episodes that required hospitalization. While she has experimented clear improvement after each stance in the psychiatric ward the affection has evolved worse than expected even though she has had a correct compliance and adherence to every prescribed treatment. Psychopathologically the patient experimented intense psychotic symptoms including auditory hallucinations that had a strong impact on her and her physical state leading to a huge loss of weight after she stopped eating properly due to the voices contents, these symptoms kept evolving even after increasing the daily dose of clozapine.

Results

After maintaining the treatment with clozapine at higher doses and not seeing improvement, we finally achieved improvement by adding aripiprazole.

Conclusions

Even though clozapine has proved to be an effective treatment there are some cases when it’s not enough and we need to rely on polytheraphy , being one of those aripiprazole.

Introduction

In Pamplona, Spain, there is an Early Intervention Program that has been providing assistance for First Psychotic Patients for the last two years.

Objectives

To analyze the longitudinal effects of the different interventions in clinical variables applied to 211 patients during two years of follow-up: CASH dimensions, substance abuse, antipsychotic type and dosage, remission rates, re-hospitalization rates and all-cause-of-treatment-dropout and DSM 5 diagnoses

Methods

We apply a standarized evaluation protocol to every patient at different times: premorbid, initial time, and every three months during follow up.

Results

The CASH positive dimension (delusions and hallucinations) had a mean score at baseline of 3.77, showing an evident decline during the follow-up. The same happened with the disorganized dimension. We found no significant differences in the negative, motor and affective dimensions.

Regarding remission rates from the 6 to the 24 months we found a decline in the rates, accordingly to the increase in re-hospitalization rates. Some of these cases were due to treatment dropout. The doses of antipsychotic treatment are lower at the end of follow-up

Substance abuse rates are lower within the first six months, but after this time the percentage of non-consumers declines.

The most frequent DSM 5 basal diagnosis is Brief Psychotic Episode, but during follow-up the diagnosis of Schizophrenia increase from 14.6% at baseline up to 46.2% at month 24.

Conclusions

The Early Intervention Services improve, psychopathological dimensions and decrease re-hospitalization rates.

Introduction

Erotomania is defined as a condition in which the patient believes that some celebrity or person of higher status is in love with her, and interprets his words and actions as unequivocal signs of love. The father of this concept, Clerambault, described erotomania as a clinical syndrome, with a chronic or transitory course, sometimes a premonitory syndrome or as an independent entity.

Objectives

Describe a case of a female patient with erotomanic delusions with no remission under therapy and to review the links between erotomania and other psychiatric disorders.

Methods

Literature review and a case report. The databases Pubmed and Medline have been consulted and the most appropriate articles were examined.

Results

We report the case of a 70-year-old white woman diagnosed with having schizoaffective disorder for the previous 56 years. She had multiple hospitalizations, most of them with maniac symptoms associated with mystical, megalomaniac and erotomanic delusions. Clinical remissions were minimal, despite various treatment modalities, the patient remain entrapped by their erotomaniac delusions.

Conclusions

Erotomania is described as a rare entity, usually listed under other syndromes and neglected in the recent literature. There are a few studies with schizoaffective and schizophrenic patients that conclude, like our case-report, that erotomanic delusions have a chronic course and are relatively refractory to treatment. However, there is still lack of systematic description, assessment and diagnosis and there is a need for further enhanced epidemiological study.

Introduction

Schizophrenia is a frequent and severe group of mental disorders without pathognomonic signs.

Symptoms may include disfunctional perception, cognition, behavior. Individuals seek public health system referring their thoughts, feelings, acts are felt/ shared/ influenced by external forces. Humor accompany inertia, negativism, lethargy.

Studies have shown symptoms occur firstly in patients younger than 25 years old.

Objectives

To assess the impact of schizophrenia with gender and ages most affected in public health system of Brazil.

Methods

Assess patients by age and gender in Brazilian public system of health and expenses created due to schizophrenia. Data were collected and analyzed from SIH/SUS including all public health institutions in Brazilian states.

Results

Conclusions

According to records in SIH/SUS database in 10 years, ages most affected by schizophrenia and correlations are 20-29 and 30-39. Total expenses were BRL2.104.780.862,51, approximately USD5.045.159,7.

Results found agree with previous studies that most common age of onset was around 25 years. Schizophrenia and correlations are a concern for public health, because underdiagnosis increase the burden and create further expenses, along with discomfort for patients and families.

Introduction

Noonan síndrome (NS) is a relatively common genetic syndrome caused by mutations affecting a cellular signaling pathway known as the Ras-map kinase (RAS-MAPK) pathway, which is essential for the typical growth and development of multiple systems. NS is estimated to occur in approximately 1:100 to 1:2500 births. Clinically, NS is associated with cardiovascular abnormalities, growth and endocrine disorders, hematologic symptoms, as well as neuropsychological features including cognition, language, memory, attention, adaptive behaviour, social skills and anxiety. Most of these symtoms are associated with psycosis.

Objectives

To expose the importance of the higher incidence of psychosis in NS.

Methods

This is a systematic review in UpToDate.

Results

Intellectual disabilities in children with NS are increased to the general population. Lower inteligence has shown to be a risk factor for attention difficulties. Also, it has shown that NS patients has slowed processing speed, which is linked to developmental and behavioral disorders. There have been found some differences in frontal lobe-subcortical circuitry, which is critical for working memory, response inhibitiom and cognitive flexibility. Anxiety and depression were present in almost three times greater tan de community.

All these features added to the physical limitations, make it reasonable to expect higher rates of psychosis in these individuals, although studies that determine the extent to which they are increased are lacking.

Conclusions

The review of the physical and neuropsychological features suggest that in NS there is an increased risk for anxiety, social cognition and adaptative behabiour, which could increase the risk of psychotic symptoms.

Introduction

The rates of mortality among people with psychotic disorders are a major public health concern. Little is known about clinical and social factors that can predict these differences in mortality rates with respect to general population and to those patients who don’t have anticipated death (Reininghaus et al., 2015).

Objectives

To study mortality in a cohort of patients with a first episode of psychosis (FEP) and to examine clinical and social variables which are associated with an increase in early death in psychotic disorders.

Methods

This is a retrospective observational study of a cohort of 523 patients, who were hospitalized in the Psychiatric Department of the Complejo Hospitalario de Navarra between 1990 and 2009 with a FEP, and a mean follow-up of 18 years. Mortality rate of this cohort is reported, and clinical and demographic variables are examined.

Results

The mortality in this cohort was of 83 patients (15.87%). First cause of death was natural death (36.14%) followed by suicide (18.07%) and cancer (16.87%) (Fig. 1)

When comparing demographic, clinical and functionality variables, we found that both groups only showed significant differences in age at illness onset and education (Table 1)

Conclusions

A late illness onset and low educational attainments resulted in two differential factors in our sample of FEP patients who were followed up after a mean of 18 years. Although the first cause of death was natural death, a deeper analysis of the high rates of suicide is needed.

Introduction

The inaugural stages of psychotic conditions are a critical period, during which patient involvement and adherence to treatment are essential, as delaying the institution of psychosis treatment is associated with long-term negative consequences. About two thirds of patients have a suboptimal response to antipsychotics, and these results are further aggravated when substance use disorders are present. Studies have shown that there has been a somewhat limited impact of psychosocial therapy, suggesting little or no benefit from using psychotherapeutic interventions in these individuals.

Objectives

Evaluate the use of Cannabidiol as an adjunctive treatment for inaugural (or already established) psychosis in order to improve adherence to antipsychotic therapy in patients with cannabis abuse.

Methods

Narrative literature review by performing a search on MedLine for English-written articles. The query used was “(CBD OR Cannabidiol) AND (Schizophrenia OR Psychosis) AND (Psychiatric OR Psychiatry)”.

Results

Increasing attention has recently emerged towards the endocannabinoid system as a potential therapeutic target for these disorders. CBD, unlike THC, is devoid of adverse psychoactive effects and its clinical interest in psyhchiatry derives from its antipsychotic, anxiolytic, anti-inflammatory and neuroprotective properties. CBD appears to counteract psychotic symptoms and cognitive impairment associated with cannabis use and may lower the risk for developing psychosis that is related to cannabis use.

Conclusions

Cannabidiol is nowadays an emerging therapeutic agent that has shown potential efficacy in the treatment of psychotic disorders, substance use disorders, and coexistence of these disorders. Cannabidiol may thus represent a more easily acceptable and tolerable therapeutic agent for this particularly vulnerable population.

Introduction

Schizophrenia is a severe mental disorder leading to patients’ functional deterioration, compromising their daily life.

Objectives

Investigate the potential impact that a long-acting injectable such as aripiprazole once-monthly (AOM) has in the course of schizophrenia by evaluating patients’ functionality and overall clinical outcome, in the psychiatric clinic of a general hospital in Greece.

Methods

Five patients are included in the current report, two males and three females, 25 to 45 years old. CGI-S (Clinical Global Impression- Severity) and GAF (Global Assessment of Functioning) scales were evaluated at hospital admission, upon discharge and once monthly for a period of at least 6 months. Functional improvement was set as a treatment goal for these patients for the first time after diagnosis.

Results

CGI-S score at baseline was >5 and GAF score was ≥40. All five patients, previously stabilized with aripiprazole per os, responded to AOM 400 mg treatment and experienced improvement in daily functioning. Clinical improvement was observed in 6-8 months’ time with a reduction in the CGI-S score >1 point and functionality improvement was evident by almost doubling the GAF score, possibly increasing the expectations for better disease progression. More specifically, in 6 months’ time patients experienced “no more than slight impairment in social, occupational or school functioning”, a description based on the GAF score.

Conclusions

Treatment with an atypical long-acting injectable antipsychotic such as AOM 400mg, improved the aforementioned patients’ functionality and overall treatment outcome in a real-life clinical setting.

Introduction

Synthetic catinones are

Objectives

We present a case report of psychotic symptoms resulting from mephedrone use.

Methods

A 32-year-old male consults at the emergency department for psychotic symptoms present three days after consuming mephedrone.

There is no prior psychiatric history. He refers occasional use of drugs for recreational purposes: cocaine, amphetamines, GHB, mephedrone. Although he has never consulted, he admits previous psychotic experiences, in the context of drug use, specifically by mephedrone.

At the moment he reports threats and noises coming from his neighbours’ home for the last three days, describing fear for his safety. He also presents insomnia and hyporexia. He confirms mephedrone use, in the context of chemsex.

Results

Drug-induced psychotic disorder is diagnosed. Aripiprazole 5mg is indicated and the patient is referred for follow-up.

Conclusions

Chemsex is a psychosocial phenomenon growing in Spain, involving the use of psychoactive substances to seek pleasant sensations and facilitate certain sexual practices. Mephedrone is one of the drugs used, and can lead to psychotic symptomatology.

Introduction

Anti–N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome that presents with complex neurologic symptoms, like memory deficits, alterations in level of consciousness, seizures, abnormal movements, as well as psychiatric manifestations. Patients can develop psychotic symptoms, anxiety, agitation or bizarre behavior. Occasionally, psychiatric manifestations are the most prominent symptoms, and clinicians may initially suspect psychiatric illness, resulting in an inaccurate diagnostic approach and delay in correct treatment.

Objectives

We here present a case of a young woman admitted in the Psychiatry ward for acute onset psychotic symptoms, suspecting a psychotic or dissociative disorder.

Methods

A 28 year-old-woman is brought to the Emergency department presenting with agitation, hallucinations, disorganized speech, delusions and insomnia.

She has a history of a mixed anxiety disorder that had been treated with SSRIs and benzodiazepines. At the moment she was not taking any psychiatric medications.

Initially, she was treated with antipsychotic drugs and benzodiazepines, resulting in rapid remission of the psychotic symptoms. She presented excessive drowsiness, this believed secondary to treatment. Moreover, cognitive alterations displayed: short-term memory deficits, errors in nomination and repetition, semantic paraphasias, echolalia and bradypsychia.

Brain MRI found no remarkable alterations. Electroencephalogram was normal. Analisys of cerebrospinal fluid finds anti–N-methyl-D-aspartate antibodies in 1:16 proportion.

Results

Anti-NMDAR Encephalitis is diagnosed. Patient is transferred to the Neurology ward and starts immunotherapy. Further studies are carried out for the detection of teratoma.

Conclusions

For patients presenting psychotic or other psychiatric symptoms associating cognitive or memory alterations, anti–N-methyl-D-aspartate receptor encephalitis should be considered in the differential diagnosis.

Introduction

First episode psychosis is one of the most challenging subjects in Psychiatry because the symptoms can be complex, they are not specific, the prodrome varies and the consequences can be devastating if the patients don’t receive the right treatment as fast as possible.

Objectives

The main goal was to evaluate the relationship between the symptomatology and the way of addressability at mental health services of a group of patients diagnosed with First Episode Psychosis.

Methods

We observed 22 patients hospitalised in our Clinic of Psychiatry during September-December 2018 who were at the first contact with any Psychiatric Service and had the diagnosis of Acute and transient psychotic disorders( F23 on ICD 10). The following parameters were analyzed by us: gender, age, urban/rural, education, profession, marital status, way of addressability and clinic symptomatology. We divided the subjects in two groups: A – patients brought by their families and B – patients brought by ambulance and police.

Results

The majority of subjects( 68,18%) were brought at the Hospital by ambulance and police but still at the initiative of their families. Subjects from group A showed: paranoid delusions(100%), hallucinations( 71,43%), delusion of control(71,43%) and expansive delusions(85,81%). Subjects from group B showed: paranoid delusions(93.33%), hallucinations(80%), delusion of control(73,33%) and expansive delusions(73,33%). Statistically there are no major differences between the two groups regarding the symptomatology.

Conclusions

The majority of subjects with First Episode Psychosis reach the Psychiatric Facilities brought by ambulance and police and less brought by their families. The dominant symptoms are paranoid delusions, hallucinations and expansive delusions.

Introduction

There are few studies comparing samples of schizophrenic and delusional patients hospitalized for first time in their life.

Objectives

- Determine the prevalence of both diseases in a sample of first-time hospitalized patients.

- Determine the differences between the two groups comparing multiple variables collected during their first hospitalization.

Methods

We selected all patients who were first-time hospitalized in our psychiatric unit between 1996 and 2018 and diagnosed according to DSM-IV with Schizophrenia or Delusional Disorder.

Through the SPSS program we compared different clinical and sociodemographic variables collected during basal hospitalization between diagnostic groups.

Results

117 patients were diagnosed with Schizophrenia and 107 with Delusional Disorder, representing 4.9% and 4.5% of the total number (2370) of first-time hospitalized patients. The variables that significantly differentiated delusional patients were: female gender (53% vs. 22% , P<0.000), higher age (average of 56 vs. 38, P<0.00), more involuntary admissions (26% vs 11% , P<0.005), more organic comorbidity (49% vs 24%, P<0.000), shorter duration of illness (10% more 20 years vs 27%, P<0.004), less antecedents of previous cannabis use (15% vs. 35% P<0.002). After a logistic regression analysis, higher age, more percentage of involuntary admission and shorter duration of illness remained significantly associated with Delusional Disorder.

Conclusions

- Schizophrenics and delusional patients represent 4.9% and 4.5% respectively of all first-time hospitalized patients.

- Delusional patients are significantly older, have a significantly shorter duration of illness and are involuntarily hospitalized in a larger percentage than schizophrenics.

Introduction

Impairment in different social cognition domains has been found across different phases of schizophrenia spectrum disorders. There is growing evidence showing that they are linked with worse functional outcomes, which raises the question whether they remain stable over time. To date, few studies have tried to establish a comparison between social cognition performance in early and chronic psychosis and mixed findings have arised

Objectives

The aim of the current study is to compare social cognition performance between samples of early and chronic psychosis.

Methods

Data from 81 patients: 53 chronic (>5y) psychotic patients and 28 early psychosis (<5y) was collected. Patients were assessed on different Social Cognition tasks: Reading the mind in the eyes test (RMET), Ambiguous Intentions Hostility Questionnaire (AIHQ) and Hinting Task Test (HT).

Results

Compared with chronic SSD patients, Early Psychosis group had better performance on some social cognition tasks: HT, Mean Difference (MD): -1,593 CI 95% -2,551 to -0,634 p:0.02; and RMET MD: -3,142 CI95% -5.490 to -0,794 p:0.01. Although no differences were found on global AIHQ performance, Early Psychosis patients tended to display more aggression attributions (AIHQ-AB MD: -,24080 CI95% -,474 to -,007 p: 0,044), and Chronic SSD patients more hostility attributions (AIHQ-HB MD: 0,303 CI95% 0,002 to 0,603)

Conclusions

Social Cognition decline in psychotic population is a largely unexplored field, although it can be an important factor explaining functional decline in patients not attending psychosocial treatments focusing on this field. Clinical significance of the results and limitations of the study are discussed.

Introduction

Introduction: Non-adherence to antipsychotic therapy is an important problem in the management of schizophrenia. Long-acting injectable (LAI) antipsychotics favor treatment compliance, improving disease prognosis and reducing associated health care costs. Recent reviews seem to suggest that the optimal time to start LAI therapy would be just before hospital discharge once patients are stabilized after an acute episode.

Objectives

Objectives: To evaluate and describe the treatment persistence-related factors in patients initiated in aripiprazole once-monthly (AOM) during the first 6 months after an acute schizophrenia relapse.

Methods

Methods: Observational, retrospective, non-interventional study not interfering with normal clinical practice (retrospective inclusion).

Results

Results: 140 patients enrolled in 12 Spanish sites, 91 included in the Full Analysis Set (FAS) population. Demographics for persistent and non-persistent patients (table 1) and clinical results (table 2):

Table 1. Patient demographics

** p<0.001

Table 2. Clinical results

* p<0.003, ** p<0.001, ***p<0.0001

Mean persistence (days) in the first 6 months for persistent vs non-persistent was of 182.0 vs 48.5 (Fig. 1).

There were no serious AE/ADRs.

Conclusions

Conclusions: Fewer years since schizophrenia diagnosis (p=0.003) and fewer concomitant medication (p=0.02) at initiation are associated with a decrease of risk of AOM discontinuation (Multivariate Cox regression model).

Introduction

Quality of life (QoL) and functionality are some of the most important outcomes for patients with chronic, debilitating diseases such as schizophrenia.

Objectives

The aim of our study was to evaluate the effects of depression on functionality and QoL in schizophrenia patients.

Methods

This was a prospective non-interventional study assessing QoL in chronic stable schizophrenia patients. We evaluated schizophrenia patients admitted for re-evaluation between October 2010-October 2012 in the “Obregia” Psychiatric Hospital, Bucharest. We assessed depression using the Positive and Negative Symptoms Scale (PANSS) G6 item, QoL - measured through the World Health Association – Quality of Life (WHO-QOL) and functionality (evaluated with the Global Assessment of Functioning Scale - GAFS). We analyzed (linear regression) the influence of depressive symptoms on QoL and functionality while controlling for positive and negative symptoms (evaluated with PANSS).

Results

We included 110 patients, 45 (40.9%) of which were males. The mean age was 40.2 (±10.37). The mean PANSS G6 score was 3, meaning most patients presented with mild to moderate depression. More depression symptoms are associated with lower QoL, especially in the physical (F(1,108)=10.559, p=.002, R²=.089), social relationships (F(1,108)=4.911, p=.029, R²=.043) and psychological domains (F(1,108)=8.553, p=.004, R²=.073) of the WHO-QOL. From a clinician point of view (measured through GAF), depression had no impact on the functionality of these patients (mean GAF score 75.13, ±9.17, p=.259).

Conclusions

Patients with schizophrenia experience depressive symptoms which lower their QoL. It is important to diagnose and treat these symptoms in order to provide prompt interventions which may improve QoL in schizophrenia patients.

Introduction

Psychiatrists must always keep in mind the variety of organic mental disorders. Alterations in thyroid hormones are a common cause of psychiatric symptoms, most of them related to mood disorder. However, psychosis is not as well defined as a part of this disorders.

Objectives

The aim of this review is to bring closer to professionals this kind of manifestations, with a clinical example with a wide range of symptoms.

Methods

We conducted a review of the scientific literature on Pubmed, following a clinical case registered in our center. The search was focused on symptoms, its relation with blood levels of thyroid hormones and treatment.

Results

Thyroid disfunction are common and affect almost 5% of the general population, with a female predominance. After Asher (1949) created the concept of “myxedema madness”, number of cases in literature has increased. Etiopathogenesis is still unknown, although several theories are defended. There is no correlation between the degree of thyroid dysfunction and the severity of the psychiatric symptoms manifested.

Conclusions

- Organic diseases can cause classic psychotic symptoms: hypothyroidism is one of them.

- Etiopathogenesis of psychotic symptoms in hypothyroidism is still unknown.

- Correlation was not found between the degree of thyroid dysfunction and the severity of the psychiatric symptoms.

- Treatment consist on hormone replacement therapy, although some symptoms can remain in some cases.

- Further investigations, as well as systematized reviews, are required to get a better knowledge of cases and get an earlier diagnosis.

Introduction

Creutzfeldt - Jakob disease (CJD) is an extremely rare and devastating disease characterized by rapid neurological deterioration in a healthy individual. The classic clinical presentation of CJD includes rapidly progressive dementia, myoclonus, pyramidal, extrapyramidal and cerebellar signs. Although it is less, frequent that the disease begin with non-specific psychiatric signs.

Objectives

Describe the different psychiatric aspects of CJD

Methods

retrospective study of a single case diagnosed CJD

Results

We reported the case of a 66-year-old woman without personal or familial psychiatric history. Initial symptoms included delusions of persecution, depressed mood, memory loss, and a strange sensation.

His sons stated that his cognitive problems had worsened significantly in the previous two weeks and associated with visual, auditory and sensory hallucinations. The physical examination was significant for perseverance, agnosia and apraxia associated with depressed mood and loss of vital momentum. His muscle tone was normal at all four extremities. Magnetic resonance imaging (MRI) showed high signal intensity in the bilateral caudate, putamen and left frontotemporal cortex in T2-weighted and diffusion-weighted imaging. Studies on cerebrospinal fluid (CSF) were also performed. The number of cells, glucose and proteins were within normal limits its 14-3-3 protein level was positive.

Conclusions

Our patient was diagnosed with probable CJD, based on internationally-agreed diagnostic criteria. This fatal neurological disease occurs in sporadic, familial and acquired forms. Psychiatric symptoms are considered rare; in early stages of the disease they are found in up to 40% of the cases. However, presentation as a pure psychotic condition over so many months of development is not typical

Introduction

Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by facial capillary malformations and / or ipsilateral cerebral and ocular vascular malformations, which give rise to varying degrees of ocular and neurological abnormalities.
Prevalence at birth in Europe is estimated at around 1 / 20,000 and 1 / 50,000.
Cerebral vascular malformations are also present. Babies usually have leptomeningeal angiomatosis in the first year of life, responsible for the existence of complex focal or partial epileptic seizures, early manual laterality and preferences in the direction of the gaze. With the progression of the disease, and depending on the severity of the seizures, patients may develop hemiparesis, hemiplegia and varying degrees of intellectual disability.

Objectives

The objective of this communication is to present an unusual and unusual case of Sturge Weber Sindrme with psychotic symptoms with behavioral disorders.

Methods

Description and analysis of the clinical case and review of the state of the art.

Results

A 45-year-old patient diagnosed with Sturge-Weber syndrome (encephalotrigeminal angiomatosis). In 2019, it begins with a delusional idea of damage by livestock farm employees, generating multiple conflicts with them. He disappears from his city and the police place him in France, he suffers an epileptic crisis after leaving the treatment and the family locates him in the immediate vicinity of the hospital, after which he is transferred to Spain to enter his reference hospital in the area of psychiatry

Conclusions

The patient is treated with amisulpride and antiepileptic drugs, improving behavior and the delusional idea of harm.

Introduction

The coexistence of obsessive compulsive symptoms (OCS) and psychotic symptoms has been reported since the 19th century, with low prevalence rates (1-3.5 %). However, more contemporary studies have shown a much higher prevalence of OCS (25%) and OCD (12%) in schizophrenia. Schizo-obsessive disorder has been proposed to clasify these patients.

Objectives

Here we present a case report of a patient who has presented a wide range of OCS, both in the acute and in the chronic phase. We describe the main characteristics of the schizo-obsessive spectrum, the patient´s disease progression and his treatment.

Methods

Description of a clinical case and literature review.

Results

A 28 year-old-male, previously diagnosed with schizophrenia and OCD, was admitted to the psychiatric rehabilitation unit. He had a long history of hospital admissions and had received a multitude of psychopharmacological treatments. Since the first psychotic episode, the content of the obsessions and compulsions wasn´t interrelated with the content of delusions. Althought OCS worsened after the introduction of certains antipsychotics, mainly clozapine, these symptoms were present before receiving any type of drug. Also, his clinical presentation changed over time, from the predominance of paranoid delusions and contamination obsessions, to becoming particularly disorganized and with extravagant time-consuming compulsive rituals.

Conclusions

There is enough evidence in the literature showing the clinical importance of the schizo-obsessive spectrum disorders. However, little is known about the treatment strategies and there is a great dificulty in categorizing these disorders, because, sometimes, in clinical practice, the borders between obsessive and delusional thoughts are diffuse and arbitrary.

Introduction

Carboplatin-liposomal doxorubicin is a widely used chemotherapy combination against ovarian cancer. Very few cases of new-onset psychosis have been reported during treatment with platinum-containing antineoplastic drugs. Anxiety, depression and insomnia have been reported with doxorubicin; but there are no reports of acute psychosis so far.

Objectives

The aim is to expose a clinical case in order to provide further evidence on this topic.

Methods

We present a 67-year-old woman without previous psychiatric history, diagnosed with ovarian high-grade serous carcinoma stage IIIB. She received three cycles of carboplatin-paclitaxel, which was later changed to carboplatin-liposomal doxorubicin due to peripheral neurotoxicity associated to paclitaxel. Behavioural disturbances, persecutory delusions, insomnia and aggressiveness appeared two weeks after receiving the second cycle of the new antineoplastic combination. She was hospitalized and assessed for organic etiologies, although no evidence of metastasis in Central Nervous System was found.

Results

She was diagnosed with brief psychotic disorder and started on paliperidone up to 12 mg per day and quetiapine 50 mg per day. The following days she recovered to her basal mental state and one week after she was discharged. No psychotic relapse occurred after two more cycles of chemotherapy.

Conclusions

This case reports the possible association between chemotherapy and the development of a psychotic episode. The timing of symptomatology onset suggests doxorubicin was responsible for the psychiatric complication. Behavioural disturbances in patients receiving chemotherapy should lead to psychiatric evaluation, as long as organic pathology has been discarded.

Introduction

Psychotic disorders in childhood and early adolescence often progress to more serious illness, but in many instances, there are underlying diagnosable medical causes. Careful clinical examinations are warranted to detect any signs of a possibly treatable disease.

Objectives

To report a case of a 14-year-old male with behavioural changes.

Methods

Case report based on clinical records. Brief literature review.

Results

A 14-year-old male was first evaluated in an outpatient clinic. 5 months earlier, he began presenting slight behavioural changes, mainly disinhibition, with increasing severity, alongside parasomnias (agitation, repetitive incoherent speech and subsequent amnesia). By the time he was evaluated, psychomotor restlessness and disinhibition was marked. He also presented pressured speech with loose associations and some speech perseverance. No delusional content was detected. There was a significant impact in the familial and school domains. A diagnosis of probable hypomanic episode was prompted and the patient derived to a specialized program. Blood workup, serum and cerebrospinal fluid autoimmunity study, MRI and electroencephalogram wielded no relevant results. He showed limited response to olanzapine. Aripiprazole wielded better behavioural response and valproate add-on led to added benefit, although incomplete. Later, a polysomnography revealed right temporal dysfunction with very frequent epileptiform activity and occasional left temporal activity. Eslicarbazepine was added with remission of parasomnia episodes and behavioural improvement.

Conclusions

This case highlights the importance of thorough diagnostic workup when dealing with manic/psychotic symptoms in very young patients. Considering a possible underlying structural substratum is paramount as it may affect the treatment and the prognosis.

Introduction

Based on the work carried out with more than a hundred and fifty patients who have participated in the Art Therapy activity at the Puerta de Hierro Majadahonda Psychiatric Day Hospital since 2002, and the analysis of its expressive and communicative processes, a paradigmatic case has been selected.

Objectives

To identify which characteristics of verbal language hinder its expressive and communicative function in schizophrenic patients, and determine what the differential contribution of artistic language could be.

Methods

Analysis of the art therapy process of a 55-year old male, diagnosed with schizophrenia since the age of 24, with persecutory delusions and sensoperception alterations, whose most dysfunctional symptomatology was a disorganized, prolix, circumstantial verbal language that did not allow him to communicate. This frustrated him as well as the rest of the patients and therapists.

The differences between the way of constructing the verbal and de artistic language are analyzed.

Results

The written logical verbal language recorded over a year of treatment in the HDP does not present relevant changes in terms of its expressive and/or communicative functionality.

The discourse developed from the plastic language is perceived by the patient as egosyntonic, endowed with meaning and effective in terms of social connectivity.

Conclusions

Opposed to the continued dysfunctionality of written verbal logical language as and expressive and communicative route, plastic language can facilitate the construction of a structured narrative that is meaningful to the patient and comprehensible to his or her environment.

Introduction

Corticosteroids are commonly used to treat collagen tissue diseases.However,they are associated with various neuropsychiatric disorders including depression,hypomania and mania,frank psychosis,delirium and etc.In the literature,there are many case reports about corticosteroid-induced psychosis when high doses have been used.

Objectives

Our aim is to present a case of psychotic exacerbation occurring at a low dose of corticosteroids with delusional disorder,in contrast with the literature.

Methods

History:Mr.O.A. is a 64 year-old patient diagnosed with delusional disorder, who was admitted to our inpatient service in 2019 due to a three month history of delusions of reference,persecutory delusions and delusions of passivity and delusional misinterpretation.His history revealed that he was diagnosed with delusional disorder in 2013,was presented with delusion of jealousy and agitation.During this period, he also experienced a worsening of his psoriatic arthropathy and the immunologist therefore increased his prednisolone dose from 5mg to 10mg daily.The delusions of reference,persecutory delusions and delusions of passivity then resurfaced after this medication increase.

Results

Discussion:To date, many studies have discussed the link between corticosteroids and neuropsychiatric disorders.There is no agreed cut-off dose for corticosteroid treatment for patients with psychiatric diagnoses, nor any information about the effect of delusion’s types.In our case,symptoms added after increasing corticosteroid dose to 10mg totally disappered after decreasing prednisolone dose to 5mg again.

Conclusions

Corticosteroid is an important and effective treatment for collagen tissue diseases.However,corticosteroids cause many psychiatric disorders or symptoms.There is no recognised cut-off limit for corticosteroid therapy when is administered to a patient with a psychiatric disorder.Further research and attention in this area are required.

Introduction

The phenomenon of infantilism and puerelism are considered as parallel in the framework of «age identity disorders» (AID). However, the comparative clinical pathway of infantilism and puerilism in schizophrenia remains poorly understood.

Objectives

The aim of study - psychopathological, psychometric analysis of AID on the model of schizophrenia.

Methods

Research summarize the results of the study in a sample of 45 patients with schizophrenia, following with the detectable signs of AID in clinical course of the disease (23 - infantilism; 22 – puerilism).

Psychometric evaluation was carried out using SANS, DES and “Methods for diagnostics of personal maturity” (MDPM). Statistical processing was carried out using Mann-Whitney test and Spearman correlation analysis.

Results

The differentiation between infantilism and puerilism in schizophrenia is not limited by differences in the indicators of age-related immaturity (Tab.1):

Tab.1. Psychometric scores by groups

1) Infantilism forms in childhood and shows an affinity to the dimensional structures of the negative symptoms - avolition disorders (Tab.2).

2) Puerilism forms in adulthood, manifests in the framework of dissociative psychosis and, conversely, shows the affinity to the positive symptoms - dissociative psychopathological formations.

Tab 2. Correlation between MDPM and SANS/DES scores by groups

Conclusions

Infantilism and puerilism are associated with polar dimensional structures (positive-negative symptoms) and can be regarded as psychopathologically heterogeneous formations.

Introduction

Meningioma is a slow-growing benign tumor arising from meninges, usually asymptomatic. Meningiomas may be primarily present with mood disorders, psychosis, memory disturbances, personality changes, anxiety or anorexia nervosa, but frequently it presented with neurologic signs due to mass effect.

Prevalence rates for meningiomas are variable and range from 50.4/100,000 to 70.7/100,000. Female incidence is about three-fold the male incidence, with the largest difference observed between 30 and 59 years.

Although there may be an association between some tumor locations and psychiatric symptoms, it is difficult to predict the symptoms based on the location or vice versa.

Objectives

Show the importance of complementary test due to discard organic anomalies that could justify symptomatology.

Methods

A 53 years old single woman with no history of psychiatric disorder or drug abuse. The patient came to urgencies with his family due to behavior disorder, anxiety and insomnia in the last month. In the examination presents disorganized behavior with rituals, and thoughts abnormalities, including though blocking and irrational laughers inconsistent with the mood. Strange speech behaving suspiciously and hyperalert. Hyporexia and weight loss of 10kg

Results

Blood tests, serologies, drug screening shows no abnormalities

Craneal MRI: pineal/ tentorial border meningioma

BDI: 9

IPDE: correlation to histrionic behavior

We decide an involuntary hospitalization due to lack of diagnosis and patient unconsciousness of her mental condition. We initiate treatment with paliperidone 6mg/24h , lorazepam 1mg/8h and lormetazepam 2mg/24h.

Conclusions

The posibility of cerebral tumours as the cause of developing first psychotic episode and the importance of cerebral scaner in middle ages.

Introduction

The term chemsex refers to sex intentionally had under the influence of psychoactive drugs, mostly among men who have sex with other men. When drugs are administered by intravenously, it is know as slamming or slamsex. Mephedrone is the most commonly used drug to this practice, in combination with other as amphetamines. This practice has been associated with some psychiatric and organic complications.

Objectives

Describe a case about drug-induced psychosis, one of chemsex complications. Moreover, show the multiple medical complications associated with its consumption.

Methods

Patient’s data is obtained from medical history, psychiatric interviews carried out during his hospitalizations and his psychological follow-up in center for comprehensive drug addiction care.

Results

45 year-old man patient was admitted into psychiatric unit due to delusional ideation, behavioral disturbances and heteroaggressiveness after mephedrone, amphetamines and other drugs intoxication in the context of slamsex practice. He has a history of two previous autolytic attempts but no psychotic episodes, and a consumption of intravenous mephedrone since two years ago with great emotional impact. After one week of hospitalization and antipsychotic treatment psychotic symptoms disappear. Concerning his medical history, he was infected for HIV, syphilis, hepatitis A and visceral Leishmania.

Conclusions

It is necessary to be aware of the increased in chemsex and slamsex rates and therefore of the comorbidities that have associated. Rapid detection is important in order to reduce and control the severe addiction they entail (especially intravenous consumption).

Introduction

Sensibility to other people’s opinion about oneself varies from apathetic to hypersensitive states. As first described by Kretschmer, when the sensitive disposition is exaggerated occurring simultaneously with some endogenous and exogenous pathogenic factors, it may lead to sensitive delusions of reference. The sensitive character is defined as shy, hyper-emotive and sensitive individuals, with a tendency to self-criticism.

Objectives

Presentation of a scientific poster discussing a case of sensitive delusion of reference in a 40 years old male.

Methods

Case report is presented. Bibliographic research conducted using the search engine Pubmed®.

Results

A 40 year old male with premorbid obsessive traits, seeks psychiatric help due to feelings of prejudice and people looking at him “strangely, specifically staring at his pubic region”. He also refers having the perception “people talking about him behind his back”. Characterwise, its an individual with anancastic personality traits, highly demanding with himself and very competitive. Diagnosis was initially complex, however later he revealed that symptoms started since he once used a penis enlargement device and felt that someone must have noticed it.

Conclusions

The symptomatology of sensitive delusions of reference is the exaggerated effect of the sensitive character traits. This often starts after a traumatic event that reveals the subject own failure and/or humiliates him/her. Their ideas of reference, hypochondriacal fears and self accusations all lead to one central experience. The course of all sensitive delusions of reference is comparative benign although severer forms may take a course of several years.

Introduction

With the growing of global aging population, psychosis arising for the first time in older people is becoming more common. Presently, the diagnostic boxes on the subject of late onset psychosis remain controverse. As Bleuler once described “the science of late onset psychosis is the most obscure field of psychiatry”. The observation of psychotic symptoms in individuals over 60 years old with no psychiatric premorbility has suggested that late paraphrenia (LP) is nosologically different from schizophrenia. Recently, LP has been classified as very late-onset schizophrenia-like psychosis.

Objectives

Our goal is to present a scientific poster discussing a case of late onset psychosis in a 68 years old male and its diagnostic challenges.

Methods

Case report. Bibliographic research was conducted using the search engine Pubmed® and the keywords: “Late onset psychosis”.

Results

A 68 years old male presented himself at the emergency service with persecutory delusions and hallucinations in the visual and auditory modalities. He had been hospitalized in the previous year for similar symptoms. However, the diagnosis became challenging as hospitalization progressed.

Conclusions

This condition can be a form of presentation of late onset schizophrenia, or it may constitute a distinct condition. Late paraphrenia does share some similarities with schizophrenia, such as delusional beliefs and possible hallucinations (mostly auditory), but is distinguished by the well preserved personality and affect. It has been suggested that the older the patient the greater the similarities between LP and late onset schizophrenia in respect of neuropathology, treatment and prognosis.

Introduction

Cannabis is the most commonly used recreational drug in the world, and its use has been associated with increased risk of psychosis. Nonetheless, despite the hypothesis that cannabis use is a contributory cause of schizophrenia, other possibilities have been formulated to explain the replicated association between cannabis use and psychosis: (a) persons with schizophrenia may use cannabis as a form of self-medication; (b) cannabis use is a confounder of use of other psychotogenic drug use or (c) there is a common genetic vulnerability between cannabis use and psychosis.

Objectives

Analyse difference in reason to use cannabis between cases and controls

Methods

Using data from the multicentric EUGEI case-control study of First-Episode Psychosis, we examined differences in reasons to start use of cannabis, using the Cannabis Experiences Questionnaire. Descriptive comparisons between groups were made with Chi² and associations were explored using multinomial logistic regression models.

Results

Around 85% of controls started using cannabis because either friends or family were using it, 68% of cases attributing starting due to this reason. Significantly higher percentage of cases started using cannabis to feel better (18% of cases vs 5% of controls). Regression models showed that being a case was positively associated with starting use in order to feel better (RRR 4.67, z=7.58, p>0.001), remaining significant when adjusted.

Conclusions

A higher proportion of patients with psychosis than controls start using cannabis as a way to make them feel better; this raises the possibility that in a minority of cases, self-medication may be relevant.

Introduction

The negative symtoms and metabolic syndrom are a very frecuent phemomena with hard treatment.

Objectives

Find the differences in the improving of negative symtoms and the metabolic rates in patients with change of neuroleptic (oral to paliperidone palmitate injection).

Methods

Observational longitudinal study during 18 months. We incluided all the patients with the diagnosis of schizophrenia, in which we done a change from oral neurolepic to Palmitate of Paliperidone and age of 18 years o more.

We used SANSS and CGI-Scale for negative symtoms and metabolic rates (weight, IMC, Glucose, Colestherol, TG and prolactin) and abdominal perimeter.

Results

40 patients was incluided. 60% are male. Average age 42.48 years. 22% has metabolic disease, 32% with axis IV disease and 28% with toxic sustances Average dosis of palmate of paliperidone 105 mg/28 days.

The reason of change to injection was: No response 38% to oral neuroleptic treatment and side effects 28%. Rest patients wish.

Metabolic rates improved: Less in weight, IMC, Glucose, Colestherol, TG and prolactin and abdominal perimeter.

The SANSS scale improved, All of them were statadistical significative (p<0,05) and CGI scale results improved.

Conclusions

The change from oral neuroleptic to palmitate of paliperidone improved metabolic rates and abdominal perimeter . Also improved SANSS and CGI Scale.

The palmitate of paliperidone is useful in schizophrenic patients and with less incidence of metabolic side efects and improved of negative symptoms.

Introduction

Risperidone long-acting injection and Paliperidone Palmitate one month are value in the treatment of Schizophrenia.

Objectives

The assess the long term efficacy of Risperidone vs Paliperidone to preveting relapse. Risperidone long-acting injection and Paliperidone Palmitate are a valuable strategy for the treatment of the schizophrenia. More studies are necessary to assess the efectiveness to preventing relapse.

Methods

30 patients with diagnosis of schizophrenia was treated with Risperidone and 30 patients with diagnosis of schizophrenia with Palmitate of paliperidone. We Follow 30 months PANSS, PSMQ are performed at the begin and de end of study, We defined Relapse: Rehospitalization or 25% base lane PANSS.

Results

The 56,6 % patients with Risperidone long-acting injection no relapse and 83,3% with Paliperidone Palmitate. The 63,3 % patients with Risperidone long-acting injection are satisfied or very satisfied while 86,6% oatients with Paliperidone Palmitate are satisfied or very satisfied . Also his famly member. The improved of de CGI scale global patients with Risperidone long-acting injection was 2,8 points, and patients with Paliperidone Palmitate was 3,9.

Conclusions

We observed higher percentage of relapse free in patients treated with Paliperidone Palmitate than treated with Risperidone long-acting injection. Patients treated with Paliperidone Palmitate apperars to have greter acceptance and in her family than patients treated with Risperidone long-acting injection.

Introduction

People who experience a trauma may react differently, such as depression, anxiety, agitation.

Objectives

In this case, patient was dismissed on charges of terrorism and reacted with childish behaviors.

Methods

CASE:

42 years old male, married with three children; suspended on charges of terrorism. For this reason, he is introverted, rarely going out. He returned to work 5 months later, but he was restless, unhappy and felt excluded from the business environment. Two months after starting work, patient had high fever and 2-hour loss of consciousness following diarrhea without any organic pathology. His mental state examination revealed visual and auditory hallucinations and persecutory delusions. Preliminary diagnosis was hysterical psychosis. He started to walk and talk childishly; his age gets smaller and smaller. Sertraline (50 mg/daily), alprazolam (2*0.5 mg) was started. In the event of advancing regression like starting to crawling and fear of falling when walking; the dose of Sertraline doubled (100 mg/daily), per day.

Results

Four months after his discharge the idea that he was being followed lasts. He was still talking lispingly. Quetiapine(100 mg/daily), was added to the treatment. After 6 months his nightmares continue. Dissociative episodes are reduced but still last. The dose of Quetiapine is increased to 250 mg/daily. After 9 months, lispingly speech improved and functionality almost returned to normal.

Conclusions

Psychoanalytic explanation: the desire to escape the pressures and responsibilities of adult life. In this case, it is interesting that the regression progresses to crawling. The diagnosis of adult baby syndrome is becoming increasingly worthy of discussion.

Introduction

Both childhood adversity (CA) (i.e., household discord (HD), bullying and abuse) and cannabis use increase the risk of developing psychosis, nevertheless little is known about the mechanisms underlying their association.

Objectives

Using data from the EU-GEI case-control study of First-Episode Psychosis (FEP), we examined whether cannabis use mediated the relationship between CA and psychosis.

Methods

853 FEP patients and 1,174 controls were recruited as part of the EUGEI study. The Cannabis Experience Questionnaire was used to collect detailed history of cannabis use. The Childhood Experience of Care and Abuse was used to assess exposure to HD, sexual, physical, emotional abuse and bullying Early (when exposure occurred in childhood: between birth and age 12), and Late (in adolescence: between ages 12 and age 17). We performed mediation analyses to test whether the relationship between CA, Early and Late, was mediated by (1) lifetime cannabis use, (2) cannabis potency, and (3) frequency of use in adolescence.

Results

Results (see Table 1) indicated that the relationship between HD and psychosis was mediated by lifetime cannabis use, cannabis potency, and frequency of use. When the analyses were restricted to Early HD, both lifetime cannabis use, and cannabis potency mediated the association with psychosis. In addition, both sexual abuse, and late bullying relationships with psychosis were mediated by lifetime cannabis use.

Conclusions

The mediational role of cannabis use was particularly robust for experiences of HD relative to other types of trauma. For that reason, children and adolescents exposed can benefit from psychosocial interventions aiming at preventing cannabis misuse.

Introduction

Cognitive impairment has been found to be a more significant predictor of noncompliance than the severity of positive symptoms or attitude to treatment. Patients with the first episode of schizophrenia are characterized by high probability of exacerbations after the first attack, which is .associated with the ack of drug compliance.

Objectives

The purpose of this study was to explore the relationship betweens cognitive functioning and compliance characteristics in patients with the first episode of schizophrenia.

Methods

50 patients with the first episode of schizophrenia (F20.0 "Paranoid schizophrenia") in stable remission were . assessed by PANSS, BACS, DAI. Statistical analysis was performed in the R programming environment, version 3.6.1.

Results

The data obtained indicate that compliant patients have better indicators of auditory speech memory. In addition, patients with a satisfactory compliance, unlike non-compliant patients, have a higher level of motor skills, as well as higher speed of information processing and better planning. Executive functioning (Tower of London) had a statistically significant positive correlation with the degree of adherence to therapy (r=0,32, p=0,022).

Conclusions

88% of patients had neurocognitive impairment, 38% of which were characterized by low adherence to therapy. The severity of neurocognitive deficiency in certain areas, particularly planning, of cognitive functioning may be predictive in terms of the risk of violation of the treatment regimen and relapse of the disease.

Introduction

Among various neurobiological models of schizophrenia,much attention is paid to structure and microstructure disturbances in brain white matter. The aim of this study is to research the most important pyramid pathway of the brain responsible for impulse transduction during motion regulation - corticospinal tract (CST) - using method of diffusion tensor imaging (DTI).

Objectives

The study was done in accordance to the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. All participants signed an informed consent.

13 young (17 -27) male patients with schizophrenia (F20, ICD-10) and 15 mentally healthy age- and sex-matched subjects were analyzed.

Methods

MRI data were obtained on Achieva 3.0T scanner (Philips) with DualQuasar gradient system and 8-channel radio-frequency receiver coil for the head. DT-images were acquired in the axial plane using echoplanar impulse sequence. Diffusion gradient were applied in 32 non-collinear directions.

Functional anisotropy (FA) and diffusion coefficient (DC) were measured in the following parts of CST in left and right hemispheres: motor area, radiate crown, posterior limb of internal capsule, cerebral peduncle, pyramids of the medulla oblongata.

Results

A decrease in the coefficient of fractional anisotropy in the posterior limb of the internal capsule and an increase in diffusion coefficient in the radiate crown and motor cortex were observed.

Conclusions

The results reflect different mechanisms of changes in water diffusion in various areas of the corticospinal tract: changes in nerve fiber microstructure in internal capsule (left hemisphere) and density decrease in motor cortex and radiate crown.

Introduction

Metabolic features of neuronal systems controlling movement are poorly studied in schizophrenia despite revealed motor disorders.

Objectives

Aim of this study was to analyze dynamics of motor cortex metabolism in norm and in early stage of schizophrenia in period of BOLD response to event related single stimulus.

Methods

Patient group comprised 9 males aged from 16 to 28 years who met the criteria of schizophrenia (F20, ICD-10). Study was performed on Phillips Achieva 3.0 T MRI scanner. VOI in motor cortex was localized on the base of fMRI study (EPI FFE, TR = 3000 ms, TE = 30 ms).

Results

BOLD signal in both groups demonstrated maximum at the 6th s after target stimulus, however its value was reliably lover in schizophrenia in comparison with the control group.The only [NAA] in normal motor cortex was changed after the stimulation. In schizophrenia [NAA], [Cr] and [Cho] were constant. [NAA] in normal cortex statistically significantly decreased at the 12th s after stimulus presentation and returned to initial value at the 15th s.

Conclusions

The reversible decrease of NAA observed for the norm in the study could provide a short-term activation of neuronal Krebs cycle through a synthesis of AcCoA using acetate obtained in ASPA reaction. Different behavior of [NAA] in the norm and schizophrenia might be related with a difference in location (or activity) of ASPA. Decreased expression of glutamate transporters in schizophrenia could also reduce consumption of NAA as a source of acetate in synthesis of AcCoA which is used for restoration of ATP.

Introduction

Antipsychotics have been recognized as weight-inducing agents. Weight gain seems to result from increased food intake and reduced energy expenditure. Schizophrenia(SZ) patients are more likely to stay indoors and have reduced exposure to sunlight. Vitamin D(VitD) deficiency has been linked with SZ. It is unclear the effect of VitD supplementation on psychiatric and nutritional status in patients with chronic SZ who present obesity and being at risk of inadequacy VitD levels.

Objectives

Presenting a case-report, and reviewing the association between VitD and schizophrenia.

Methods

A research was conducted using Pubmed^® and the key-words: schizophrenia, vitamin D, nutritional status, selecting an English literature.

Results

Female, 38 years old, single, referred to the nutrition consultation due to obesity, with a BMI ≥ 30.0 kg/m²(42.3kg/m²) using the cut-offs of the WHO criteria. Psychiatric evaluation was characterized by positive and negative symptoms of SZ (according to ICD-10 diagnostic criteria), received antipsychotics (risperidone 2mg, cyamemazine 100mg) medication. Medical history, obesity-related complications, medication use and blood samples were obtained. Inadequate levels of VitD(17.0 ng/mL), using the IOM cut-off points was observed. Oral supplement of 2668 U.I./day VitD was started. A tailored diet was also performed. After twelve months of follow-up improvements in the BMI(39.7kg/m2) and on psychiatric symptoms were found reducing the antipsychotic (risperidone 2mg, cyamemazine 25mg SOS) medication. Current investigations show that there is a direct association between VitD levels and the symptoms of schizophrenia, suggesting that treatment should include assessment of patients` VitD levels.

Conclusions

Vitamin D status should be evaluated in patients`with schizophrenia.

Introduction

Treatment effects in patients with severe mental disorders are often limited by poor treatment adherence. A large body of evidence concerning non-compliance with antipsychotic medication revealed average dropout rates of about 42% within 6 months of treatment. A significantly lower number of studies examined dropout rates of psychosocial treatments (e.g. cognitive behavioral therapy, cognitive remediation) and their predicting factors. Reported dropout rates range up to 50% with a mean of 13% depending on characteristics of the study (e. quality), the therapy (e.g. duration) as well as the patient. While male gender, higher age and a longer duration of illness were often found to be associated with premature dropout from treatment, other factors like severity of negative symptoms, poor functioning and poor working memory only inconsistently impacted treatment adherence.

Objectives

We aimed at investigating patient related characteristics associated with dropping out from 6 months cognitive remediation programs.

Methods

Predictive value of age, gender, education, occupational status, migration, duration of illness and psychosocial functioning on dropout status are analysed in 2x90 patients with schizophrenia. Patients participate in an ongoing RCT comparing social cognitive vs. neurocognitive remediation (ISST-study).

Results

Interim analysis in n=110 patients completing (74%) or noncompleting (26%) the treatment period so far did not reveal significant association between investigated predictors and dropout status.

Conclusions

The results show that 6 months outpatient cognitive remediation is feasible, in general well received, and suitable for all patients with schizophrenia without special groups at increased risk for non-adherence.

Introduction

Cognitive remediation (CR) aims to improve social- or neuro-cognitive processes with the ultimate goal of enhancing functioning and recovery. However, sufficient intensity and consistency over a period of time is required to produce cognitive gains (Wykes & Spaulding 2011), while nonadherence is likely to minimize the effectiveness of CR (Dillon et al. 2016). Though integration of CR in rehabilitative settings is preferable and benefitious (Wykes et al. 2011), the outpatient setting and longer duration of treatment usually associated with this requirement is also prone for more non-adherence in schizophrenia patients.

Objectives

We aimed at investigating the feasibility of 6 months outpatient cognitive remediation in schizophrenia patient with respect to adherence and safety parameters.

Methods

Attendance in treatment and assessment sessions, reasons for discontinuation, and safety parameters (suicidal crisis, rehospitalisation) are analysed in 2x90 patients with schizophrenia. Patients participate in ongoing RCT comparing social cognitive vs. neurocognitive remediation (ISST-study). Both CR-conditions comprise 18 sessions each within a treatment period of 6 months.

Results

Interim analysis in n=81 patients completing and n=29 patients discontinuing the treatment period so far revealed very high rates of attendance in treatment sessions in completers (94%) as well as in the entire sample including discontinuing patients (74%). Safety events were transient and occurred in total in only about 15% of patients during the treatment period.

Conclusions

The results show that 6 months outpatient cognitive remediation is feasible, in general well received, and save for patients with schizophrenia.

Introduction

The findings of the previous study clearly indicated higher levels of subjective well-being among older age groups than younger ones, and females than males in Japanese adults (Shimai et al). However, little is known about these factors for people living with mental illness.

Objectives

This study aims to describe factors associated with subjective well-being in patients with endogenous psychosis in the psychiatric hospital and community, and especially the effect of age and gender.　

Methods

A comparative cross-sectional study was conducted with clinically stable persons diagnosed with endogenous psychosis. A convenience sample of 29 participants(15 participants: fifty years old and above, 14: under 50 years old) was drawn from the inpatients、the psychiatric day care and the sheltered workshop settings. They were evaluated by the Subjective Well-Being under Neuroleptic drug treatment Short form -Japanese Version (SWNS-J) as a specific well-being measure. The Japanese version of the Brief Psychiatric Rating Scale (BPRS) was used to assess symptom severity. Man-Whitney U test was used to analysis the differences between two groups.

Results

The SWNS-J score in participants of 50 years old and above was significantly higher, compared with that in participants under 50 years old (P<0.02).　The largest correlations were obtained between the SWNS-J score and age, particularly in males (P<0.05).　

Conclusions

We conclude that these data of our report provide the valuable information for future research in mental health area, especially in the area of interventions to promote subjective well-being of people living with mental illness.

Introduction

30 — 60% of patients have treatment-resistant schizophrenia (TRS). The most frequently used overcoming methods are high therapeutic doses of clozapine or augmentation strategy. Although these methods are widely adopted, their effectiveness is often insufficient, the number of patients not responding to clozapine is estimated between 40 – 70%. Alternatively, electroconvulsive therapy (ECT) can be used, with no positive response only in 10%. Despite this, the ECT is highly stigmatized, and its safety needs an objective verification.

Objectives

Objective verification of safety of ECT by analysis of biological markers and rating scales of patients with TRS.

Methods

The study included 98 patients with TRS divided into 2 groups: receiving only psychopharmacotherapy (PPT) and psychopharmacotherapy in combination with ECT (ECT+PPT). The condition of patients and venous blood were tested and evaluated before the experiment and after 4 weeks of therapy. The following biomarkers were used: BDNF, NSE, S100B, CK-MB, as well as the PANSS and UKU scales.

Results

Patients receiving ECT and PPT after 4 weeks of therapy showed significantly lower level of positive, negative and general psychopathology symptoms on the PANSS scale, (p<0.001). Patients receiving ECT with pharmacotherapy did not have an increase in the severity of side effects on the UKU scale, some of them reduced (especially neurological and mental), (p<0.001). There was no statistically significant increase in NSE, S100B, CK-MB and slight increase in BDNF levels in patients receiving ECT and PPT.

Conclusions

ECT is an effective and safe therapy method of treatment-resistant schizophrenia that doesn't cause structural damage to the brain.

Introduction

Mounting evidence suggests strong relationship between emotion recognition impairments and limited social functioning (SF) in both Schizophrenia (SZ) and Alzheimer´s Disease (AD) patients. However, the specific profile of deficits may differ in both and are likely to have a relationship with the deficits observed in emotional recognition processes in both patient populations.

Objectives

This study aimed to investigate SF of these disorders and its influence on facial emotion recognition.

Methods

Four groups were recruited: SZ (n = 57, 71.93% men; m = 30.72 years, sd = 6.34), AD (n = 46, 56.52% men; m = 68.83 years, sd = 7.05) and two age-matched control groups (CG1: n = 31, 58.06% men; m = 28.55 years, sd = 7.18; CG2: n = 28, 53.57% men; m = 67.07 years, sd = 7.03). Participants completed some scales on SF, loneliness and depression symptoms. Facial emotion recognition was assessed by the Facial Emotion Recognition Task (FERT), and general cognition by the Digit Symbol Substitution Test (DSST).

Results

As a result, SZ participants showed higher levels of loneliness and lower levels of social engagement (p < .01); than those from CG1. FERT performance was predicted by general cognition (all outcomes). Poor social engagement and interpersonal behaviour was related with worse accuracy to detect negative emotions. Finally, higher levels of loneliness were associated with lower misclassification of negative emotions. These results were independent of study group.

Conclusions

Higher levels of social deficit insight in SZ patients and a systematic bias in negative facial emotion decoding could explained these results.

Introduction

The presence of negative symptoms in early psychosis is variable. However, its persistence has been associated with a worsening prognosis and impaired functionality.

Objectives

To determine the influence of negative symptoms on functional outcomes, in the early stages of psychosis.

Methods

An observational study was designed on a sample of 41 outpatients, aged between 18 and 45 years, who had presented a first episode of psychosis, without a substance use disorder, during the last three years. A semi-structured interview collected the main sociodemographic characteristics and negative symptoms were explored using the Positive and Negative Syndromes Scale (PANSS). The Functioning Assessment Short Test (FAST) was applied, focusing on six areas (autonomy, occupational and cognitive functioning, financial issues, leisure) to quantify the functionality. Statistical analysis was performed using SPSS v21.0 (statistical significance p <0.05).

Results

The patient profile was a male (55%), with a mean age of 30.5 years (SD = 7.2), single (87.5%), student (47.5%), living in urban areas (82,5%) with the family (60%). The average age of psychotic debut stood at 25.8 years (SD = 6.9). Standardized PANSS-Negative scores were positively correlated significantly with the standardized results of FAST-Total (r= 0.385; p= 0.015) and FAST-Cognitive (r= 0.478; p= 0.002), respectively. Negative symptoms explained 12% of the variance of total functioning (R2= 0.115) and 20% of the variance of cognitive functioning (R2= 0.196; p= 0.005).

Conclusions

The presence of negative symptoms in early stages of psychosis appears to increase the impairment of psychosocial functioning and cognition.

Introduction

Dysmorfofobia is a pathological discontent with one's own appearance, which is most common at a young age. It can occur in relatively mild mental illness-depression, hypochondria, personality disorders, and schizophrenic spectrum disorders. At the same time, the nosological specificity of dysmorphophobia is noted.

Objectives

To study the clinical manifestations, dynamics and outcomes of dysmorphophobia syndrome in patients with schizophrenia.

Methods

115 patients (70 men and 45 women of young age) with the established diagnosis "pseudoneurotic schizophrenia" were examined. The pathological dissatisfaction with the appearance (syndrome of dysmorphophobia) was revealed in the clinical findings of the abovementioned patients. The Research Methods: clinical-and-psychopathological, catamnestic, psychometric, and statistical methods.

Results

The following features of dysmorphophobia in patients with schizophrenia were revealed: mostly delusional pathological dissatisfaction with appearance, dysmorphophobic ideas related to several parts of the body; actual physical disabilities of patients were ignored; delusions of reference and the relentless pursuit for the correction of physical disability and were expressed.

Conclusions

Schizophrenia with dysmorphophobia syndrome occurs predominantly in low - and average progredience, accompanied by severe social exclusion, isolation, and loss of the ability to work. Dysmorphophobia in patients with schizophrenia is very difficult to treat.

Introduction

Substance abuse is the most prevalent comorbid psychiatric condition associated with schizophrenia, and contributes to an unfavourable disease course. Cannabis is the illicit drug most often abused.

Objectives

The aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, compared with those without a history of cannabis use.

Methods

This retrospective cohort study included schizophrenics admitted to the psychiatric ward of Mahdia University Hospital over the period from 2015 to 2018. We divided our sample into two groups: a first group consisting of patients with a tetra-hydro-cannabinol positive toxicology dosage and a second group with a negative toxicological dosage.

Results

58 case of schizophrenia were included in this study, of which 40 had a positive tetrahydro-cannabinol dosage. Among schizophrenia patients with a history of cannabis use, the mean age of the first hospitalization was earlier (27.27 vs 33.58, p = 0.04), the number of hospital days was higher (29.33 vs 24.67, p = 0.02). Also, they required a higher-dose antipsychotic in chlorpromazine equivalent (732 vs 603, p = 0.04). No statistically significant difference was found for the psychometric scales between the two groups.

Conclusions

Our results indicate that the course and prognosis of schizophrenic with cannabis use may be more severe than schizophrenia cases in general. These findings bring attention on the importance of preventing and treating addictive behavior among these patients.

Introduction

Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes.

Objectives

Our study is aimed to describe the therapeutic adherence and to identify the factors associated with poor adherence among schizophrenic patients.

Methods

This was a cross-sectional study conducted at psychiatry consultation of the university medical center of Mahdia, Tunisia. Data collection occurred between the months of January and March 2018, including patients suffering from schizophrenia. The evaluation of adherence was performed using the MARS scale (Medication Adherence Rating Scale).

Results

In our sample of 131 schizophrenic patients, there is a male predominance (76%), as well as unmarried status (58.7%), unemployed (72%). The rate of non compliance treatment was 73%. Low levels of education, poor insight and polytherapy were associated to poor adherence. Although patients aged more than 40 years, who were married and diagnosed with undifferentiated schizophrenia were good compliant to treatment (p<0.05).

Conclusions

We suggest a proper treatment strategy for each patient based on the identification of non adherence risk factors.

Introduction

In assessing a first psychotic episode it is necessary to discard possibilities of other underlying medical pathologies that may cause the psychiatric symptoms.

Objectives

To illustrate the warning signs that must be considered in the assessment of a first psychotic episode.

Methods

We present the case of a 24-year-old male, without psychiatric history, treated in the emergency department for behavioral disturbances evolving over the course of 5 days. Auditory and visual hallucinations, echolalia, episodes of self-aggression and psychomotor agitation are described. Fever had been described for 3 days before the consultation.

Results

No analytical alterations are observed, nor in the imaging tests (Rx thorax, cranial CT). Lumbar puncture is normal. Serologies and drug test are negative. Empirical treatment is initiated with Aciclovir and Haloperidol. Subsequently, EEG and NMR are performed that are within normality. With this data it seems very unlikely to be infectious encephalitis, therefore treatment is suspended after 10 days. The patient evolves favorably without presenting any neurological deficit, being finally diagnosed with neurological functional disorder possibly reactive to systemic infection.

The data that guide our patient towards secondary psychosis are: fever of unknown origin, fluctuations in symptomatology and state of consciousness, visual hallucinations and absence of personal or family psychiatric history.

Conclusions

It is essential to conduct a regulated study of the patient prior to the first psychotic episode, by means of a complete history, a careful clinical examination, and regulated complementary tests.