Schizophrenia is often associated with impaired functioning abilities due to its disabling symptoms.

to determine the clinical factors that impact the functioning in stabilized patients withschizophrenia and schizoaffective disorder.

We conducted a cross-sectional, descriptive and analytical study. It was carried out on an outpatient population with schizophrenia or schizoaffective disorder diagnosis. We used the Functional Assessment Staging Scale (FAST) to measure the functional capacity, the PANSS to assess psychosis symptom severity and the Calgary scale to screen for comorbid depression.

Seventy-five patients were included with 61 males (81.3%).The mean age was 39.81 ± 9.96 years. The mean sore of the Fast scale was 33 ± 14.95. 90% of our patients scored higher than 11 on the FAST scale revealing a functioning deficiency. 18.7% scored higher than 6 on the Calgary scale revealing a comorbid depression .No significant correlations were found between the FAST score and the age of patient, the gender,the age of onset of psychosis, the duration of untreated psychosis and the number of life-time episodes. Scores of PANSS were significantly higher among patients with a functioning deficiency (p<0.00).No significant correlation was found between the FAST score and the Calgary score.

Our study suggests that the severity of residual positive and negative symptoms affects negatively the functioning of patients with schizophrenia or schizoaffective disorder. Thus, targeting those symptoms in the treatment may have significant functional benefits.

No significant relationships.

Psychotic disorders usually come with diagnosis difficulties, especially when the clinical presentation is recent or if there are organic factor associated. Regarding this, we propose the clinical case of a man 47 years old without psychiatric history, who is brought to the hospital after being run over by the subway. At his arrival, he verbalizes delirious thoughts of persecution and harm.

The objective is to emphasize the importance of making an appropriate somatic study in psychosis cases, especially when we don’t know the time of setting or we can’t make a psychiatric interview in optimal conditions.

The study included a blood test including methemoglobine, cranial tomography, serologies and a heavy metals test. We reviewed the scientific literature in Pubmed and Web of Science about the possible association between the psychiatric and the dermatological symptoms.

During his admission, the patient recognizes delusional thoughts of harm since he was young and he was so frightened because of this that he tried to commit suicide in the subway. Moreover, he also thinks that silver can heal any disease, so he has licked silver coins for years. The final diagnosis was schizophrenia, and argyria due to a chronic silver intoxication.

Heavy metals intoxications can be associated to acute psychotic disorders, so we must take them into account. As well, schizophrenia can cause bizarre believes which can lead to the intoxication.

No significant relationships.

Despite pharmacological advances in the treatment of schizophrenia, significant number of patients are still treatment-resistant. Clozapine is recommended as first-line treatment for treatment-resistant schizophrenia (TRS) in guidelines. Despite the greater efficacy of clozapine over other antipsychotics in the management of TRS, a significant number of patients fail to attain adequate response or develop adverse effects, and more interventions are needed.

To describe a clinical case of treatment-resistant schizophrenia patient with prominent negative symptoms treated with combination of clozapine, cariprazine and fluoxetine, and to review the literature.

Clinical case presentation through review of the clinical file and non-systematic review on PubMed and ResearchGate.

A 41 year old female patient presented to inpatient clinic with low mood, occasional commanding and commenting verbal hallucinations, occasional suicidal thoughts, blunted affect, anhedonia, asociality, she was apathetic, lacked motivation to get up from bed, had night’s sleep disturbance. Patient was diagnosed with Schizophrenia in 2009, she has been hospitalized in Psychiatric wards for 16 times. She has received treatment with combinations of several antipsychotic drugs and antidepressants, had side-effects and have not reached full remission. During treatment with clozapine (up to 175mg per day) in combination with cariprazine (up to 4.5mg per day) and fluoxetine (up to 20mg per day), gradually negative symptoms decreased, patient became more active, showed interest in daily and rehabilitation activities, night’s sleep improved.

Patient with treatment-resistant schizophrenia benefited from combination of clozapine, cariprazine and fluoxetine. Further research is necessary on treatment combination strategies for TRS.

No significant relationships.

There is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS.

This study aims to investigate socio-demographic and clinical correlates of late-onset of TRS.

Using data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics.

We observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS.

Our findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance.

DFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp

Despite the efficacy of antipsychotics, up to about 30% of schizophrenia patients do not respond adequately to treatment and are called treatment-resistant schizophrenia (TRS) patients. The treatment of choice in these patients is clozapine, which is used last due to the adverse effects it can cause. However, it has been shown that half of TRSs are also resistant to clozapine, leading to ultra-resistant schizophrenia.

We present a clinical case corresponding to a 33-year-old man, single, residing in a community residence, undergoing psychiatric follow-up from the age of 7, receiving during this period the diagnoses of schizotypal personality disorder and paranoid schizophrenia.

As of 2015, he began to make autolytic attempts, the last being this year, 2021. Moment in which he manifests for the first time presenting imperative, sporadic auditory pseudo-hallucinations, which incite self-harm. These sensory-perceptual alterations appeared from 2015, together with the worsening of the negative symptoms.

The patient has been treated with numerous antipsychotics, without complete remission, so since 2019 treatment with Clozapine 200mg was started. As the symptoms did not subside, the dose was increased to 400mg, at which point some of its side effects began to appear; urinary incontinence, sedation, sexual impotence … so the patient abandoned the treatment, suffering a relapse of his mental pathology.

Despite the arrival of atypical antipsychotics, it remains a challenge that there is a complete remission of symptoms in some patients with schizophrenia, for which we consider that psychopharmacological research in this group of patients is of the utmost importance.

No significant relationships.

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

No significant relationships.

Electroconvulsive therapy (ECT) is one of the oldest psychiatric treatments used to this day. It is particularly useful in cases of schizophrenia resistant to treatment with antipsychotics. 49% of patients with schizophrenia experience little or no response with one trial of antipsychotics, 71% do not achieve remission and up to 20% of patients are also resistant to clozapine.

Description of a clinical case where ECT is used in the treatment of resistant schizophrenia and review of the literature.

Description of a clinical case. Non systematic review of the literature, searching the terms “treatment resistant”; “schizophrenia”; “ect” in the databases Pubmed, Medline, Cochrane and Uptodate.

Male, 38-year-old patient, diagnosed with schizophrenia for 20 years, with history of multiple hospitalizations, institutionalized for 9 years. Treated with risperidone 50 mg intramuscular fortnightly, clozapine 750 mg daily, aripiprazol 30 mg daily and diazepam 10 mg daily. He presented with increased delusional intensity for a year. Hospitalized for treatment with ECT, submitted to 12 sessions with bitemporal stimuli, with effective convulsions. MoCA, PANSS and BPRS were applied before and after treatment, with an increase of 25% in MoCA and a decrease of 47.3% and 57.9% respectively, in the psychotic symptoms scales.

We present a case of schizophrenia resistant to treatment with multiple antipsychotics, including clozapine. ECT was used, with clinically demonstrated efficacy. In the future, it might be interesting to study in detail the mechanism of action of this treatment with the goal of deepening the knowledge of the neurobiology of schizophrenia.

No significant relationships.

Epilepsy is a common and severe neurologic condition, with a high prevalence of psychiatric comorbidity. Epilepsy surgery has been used for its treatment, resulting in remission or significant reduction of crisis. An improvement of previously existing psychopathology has been more frequently described, however its exacerbation or de novo psychopathology post-surgery has also been reported. The prevalence rate for post-surgery psychosis is 1.1%. There are no clear risk factors associated to this condition, or a proposed pathological mechanism. However, most cases described in the literature are of patients submitted to temporal lobectomy.

Description of a clinical case of a first-episode psychosis post-epilepsy surgery and review of the literature.

Description of a clinical case. Non systematic review of the literature, searching the terms “psychiatric”; “psychosis”; “epilepsy surgery” in the databases Pubmed, Medline and Cochrane.

Male, 29-year-old patient, diagnosed with refractory temporal lobe epilepsy. Neuropsychiatric history of mixed adaptation disorder, treated with escitalopram 10 mg daily. Submitted to anterior temporal lobectomy with no complications. On the 6th day post-surgery, he developed persecutory and self-referent delusions. There’s no evidence of other causal factors. Treated with paliperidone 3 mg daily with symptom remission after one week. The diagnosis of brief psychotic disorder was made.

We present a case of a de novo psychotic disorder, a rare complication of epilepsy surgery. In the future, it might be interesting to study this association in detail, with the goal of deepening the knowledge of the neurobiology of psychosis, particularly the involvement of temporal circuits.

No significant relationships.

Cognitive insight is a relatively recent concept referring to the ability, not only to reassess unusual experiences objectively after corrective feedback but also to distance oneself from them and it seems to be specifically altered in schizophrenia. Yet, despite its importance in the understanding of psychotic symptoms, this process has never been studied in the North African population.

Therefore, this paper aims to compare cognitive insight performances between two Tunisian psychiatric populations and to explore its relationship with other cognitive processes.

The study population comprised 17 participants with schizophrenia, 9 with bipolar disorder, and 30 healthy controls. The groups were paired for age, education level, and socioeconomic status. We assessed depression, global executive functioning, verbal episodic memory, metamemory (online and offline), and cognitive insight. The latter was evaluated by the Beck Cognitive Insight Scale.

The results showed that, compared to the other groups, participants with schizophrenia obtained a lower self-reflectiveness score and a higher self-certainty score, resulting in a significantly lower composite index. These findings seem to indicate the alteration of cognitive insight in schizophrenia. However, no significant differences were found between the other two groups. Moreover, correlational analyses showed that cognitive insight components were only associated with metamemory indices which proved to be the best predictors of this ability, along with the global executive score.

In conclusion, our data seems to corroborate the international literature reporting a cognitive insight deficit in schizophrenia. However, further research is needed in order to better understand the specific processes underlying this metacognitive function.

No significant relationships.

Multifamily interventions have shown to reduce the risk of relapse of psychotic symptoms in first episodes of psychosis (FEPs) but are not frequently implemented in specific treatment programs. We have develop a pilot study for the implementation of the interfamily therapy in FEPs within a Mental Health Centre in the Community of Madrid.

The aims were to examine: relapses (measured as re-hospitalization), duration of re-hospitalizations and voluntary versus involuntary re-hospitalizations during participation in MFG compared with the previous year.

21 subjects participated in a MFG during 12 months, 11 participants with a diagnosis of psychosis and 10 family members. Interfamily therapy works as a new model of interactive psychoeducation among families where they share their own experiences and look for comprehension and solutions all together.

Our clinical experience in an interfamily therapy intervention over 12 months has led us to identify a high degree of participation and acceptance by users and their families, and we have observed a lower relapse rate, with fewer of psychiatric admissions and of shorter duration among patients during the year of participation in the MFG compared to the year before treatment.

MFG has been well accepted by both patients and their families, with a high degree of participation.The results observed in our experience of MFG treatment are consistent with the findings of previous studies that support the reduction of the relapse rate, the number of hospitalizations and their duration when family interventions are incorporated into treatment in recent-onset psychosis, especially in a multi-family group format.

No significant relationships.

The author demonstrates the psychodynamic understanding of schizophrenia and describes the ensuing personality-structural psychotherapy. Schizophrenia from a psychodynamic understanding is a disease in the core of the identity with disturbances of the personality functions of identity, ego-demarcation, aggression, fear, narcissism, perception, cognitive abilities and the body- ego. It is the concern of the author to investigate how schizophrenically structured patients and their family members experience the group dynamic field in which the patients grew up and its relations to the illness. The following five topics: contact and experiences within the family of childhood, body care and physical contact, kindergarden and school life, puberty, and contacts outside the family have been investigated.

The aim is to show how the family settings and backgrounds are conducive to developing schizophrenia

The author chosed for her investigation the method of biographical interviews, introduced by Witzel (1985). This method of interviewing is problem centered, object and process oriented. The analysis of the exhaustive tape-recorded interviews was made by using the method of qualitative analysis based on the grounded theory.

Schizophrenia from psychodynamic understanding is a disease in the core of the identity with disturbances of the personality functions of identity, ego-demarcation, aggression, fear, narcissism, perception, cognitive abilities and the body- ego.

It is the concern of the author to investigate how schizophrenically structured patients and their family members experience the group dynamic social energetic field in which the patients grew up and its relations to the illness

No significant relationships.

Psychiatric care for persons suffering from chronic mental disorders and unable to live independently involves an assessment of their need for a certain form of social service. In Russia patients with schizophrenia account for over 40 % of all persons living in residential facilities for persons with mental disability (Kekelidze, 2020). Their clinical picture is most often determined by negative symptoms, which makes it advisable to use the BNSS scale (Kirkpatrick, 2011).

Pilot testing of the BNSS scale in patients, living in residential facilities for persons with mental disability.

With Russian-language version of the BNSS scale (Mucci, 2019; Papsuev, 2020); CGI-S; Standardized protocol of forensic psychiatric examination in cases of deprivation, restriction, restoration of legal capacity (Kharitonova, 2021) we examined 15 persons (Age: M=54,2; SD=8,6) suffering from schizophrenia and living in residential facilities.

In three subjects the BNSS survey was not possible. The remaining 12 had a total score from 6 to 61 (M = 29.08; Med = 25; Std.Dev. = 17.98) with maximum score in the Asociality subscale (Item 6: M = 3.25; Med = 4; Std.Dev. = 1.76). CGI-S significantly correlated with indicators on the scales «Avolition: inner experience» (r = 0.68, p <0.05), «Blunted affect : vocal expression» (r = 0.64, p <0.05). According to full examination community-based services were recommended for two women with BNSS overall score 6 and 11.

Our pilot study demonstrated that the BNSS can be successfully used as one of methods in comprehensive examination to determine the form of social services.

No significant relationships.

Social media networks are becoming omnipresent in our lives, and more and more available to everyone including patients with mental illnesses.

Our study aimed to examine the prevalence of social media use in individuals with schizophrenia and schizoaffective disorder, and to examine the association of severity of symptoms with social media use.

A total of 38 patients with schizophrenia or schizoaffective disorder were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax, Tunisia. Socio-demographic information as well as details about their social media use were collected from all the patients. Severity of schizophrenia symptoms was assessed on the Positive and Negative Syndrome Scale (PANSS). A logistic regression was used to explore the association between social media use and clinical characteristics of the participants.

Of the 38 study participants, 23.7% used social media. Facebook was the most popular social media site. The number of social media users were highest among participants aged 21–30 years old, married participants, residents of an urban region, employed participants and patients with a tertiary education level. Age and PANSS negative score were significantly and negatively associated with social media use.

Less than one fourth of patients with schizophrenia and schizoaffective disorder use social media and may be suitable candidates for treatment programs supported by social media platforms , especially those of a young age and a low severity of negative symptoms .

No significant relationships.

Patients with Polycystic ovary syndrome (PCOS) have increased vulnerability to psychiatric disorders, particularly a tendency to depression and anxiety, as well as schizophrenia. The association between PCOS and psychiatric disorders is a topic of research given the possibility of common potential mechanisms as well as the clinical similarity between the adverse effects of atypical antipsychotics and the symptoms of PCOS.

We proposed to investigate the etiopathogenic relationship between schizophrenia and PCOS as well as the therapeutic particularities.

We report a case of schizophrenia occurring in a patient with PCOS. Then, we conducted a literature review using “PubMed” database and keywords “psychosis”, “schizophrenia”, “Polycystic ovary syndrome” and “antipsychotic drugs”.

She was an 18-year-old patient, diagnosed with PCOS since 2018. She has been followed in the psychiatry outpatient department since 8 months for psychotic symptoms (hallucinatory syndrome with thoughts of self-aggressiveness, delusional syndrome with mental automatism…). She was prescribed olanzapine (5 then 10 mg/day). However, after a weight gain (4 kg per month), this drug was switched by Risperidone (2 then 4 mg/day). The evolution was marked by the appearance of galactorrhea. Thus, the Risperidone was switched to Aripiprazole. Then, we noted a significant improvement on the psychiatric features and a better clinical tolerance.

For women with PCOS and psychosis, treatment with antipsychotic drugs can worsen PCOS symptomatology and lead to negative consequences for a woman’s reproductive potential and her quality of life. Therefore, the psychosis management must take these particularities into account, in order to improve the prognosis of both diseases.

No significant relationships.

Suicide is one of the most frequent causes of death in schizophrenia patients, but the low insight in this pathology makes it difficult to identify persons at risk. The clinical picture of schizophrenia includes a wide variety of signs and symptoms, which make it hard to properly assess suicidal ideation.

Our study was aimed at comparing tendencies among the clinical presentation and sociodemographic factors of schizophrenic patients with and without suicide attempts in their medical history.

We analysed the clinical data of 60 patients admitted to the Psychiatry Clinic of Timisoara with the diagnosis of Schizophrenia during 2020-2021. The PANNS-R scale was used for every patient, and each item was compared to the clinical data gathered.

A positive history of suicide attempts was corelated to blunted affect, stereotyped thinking, lack of spontanety and flow of conversation, somatic concern, tension, unsual tought content, lack of judgment and insight. Total negative symptoms were correlated with psychiatric family history.

Considering a history of suicide attempts is a risk factor for suicide, more studies are needed to evaluate patients with such a history in order to identify the constelation of risk factors with a high predictibility value for suicide. This could help implement prophylactic measures in clinical practice that would decrease suicidal behaviour in schizophrenia.

No significant relationships.

The prevalence of depressive disorders in patients with schizophrenia is estimated at 25%. Nevertheless, depressive symptoms occurring during the acute decompensation of schizophrenia have rarely been studied.

The aim of our study was to assess depressive symptoms in hospitalized patients suffering from schizophrenia.

We conducted a cross-sectional, descriptive and analytical study, including 30 schizophrenic patients, hospitalized in the psychiatry B “department of the Hedi Chaker university hospital in Sfax. The assessment of clinical severity of schizophrenia was performed by the Positive and Negative Syndrome Scale (PANSS), that of depressive symptoms by the “Calgary Depression Scale for Schizophrenia” (CDSS).

The mean age of patients was 41.2. Most of patients were male (86.7%) and unemployed (83.3%). Only 13.3% of them were married. Patients were hospitalized 8.83 times in average. A personal history of suicide attempts was found in 16.70% of cases. The mean score in the CDSS scale was 5.12. According to the CDSS score, a depressive state was diagnosed in 36.7% % of patients. Depression was associated with significantly more frequent history of suicide attempts (p=0.028), as well as significantly higher scores in the positive dimension of the PANSS (p=0.03).

Our results show that depressive symptoms are common during the acute decompensation phase of schizophrenia. They are associated with impaired functioning of patients, as well as a higher risk of suicide. Screening for depressive symptoms in patients hospitalized for schizophrenia is therefore essential in order to ensure better management.

No significant relationships.

More than half patients with schizophrenia are smokers. Heavy smoking has been correlated to more severe positive symptoms, a higher number of hospitalizations and a less efficiency of antipsychotics. Unfortunately, abstinence is difficult to achieve in these patients, therefore it is importance of understanding the link between smoking and psychosis.

Analyzing the complex relationship between schizophrenia and nicotine’s effects on the human brain.

The study was a review of literature over the past 10 years based on the pubmed database.

Smoking might be a precipitating factor in the development of schizophrenia since it preceded the onset of this illness for several years.Shared genetic background was also emphasized establishing a complex biological link between nicotine and schizophrenia.

In another approach, the “self-medication hypothesis” has been proposed suggesting a beneficial effect of nicotine on both cognitive impairment and negative symptoms in schizophrenia, related to the regulation of the dopamine and nicotinic receptor systems. But this conclusion is controversial since other studies concluded to a more neurocognitive impairment in smokers compared to controlled population.

Smoking in schizophrenia is a complex “phenomenon” that remains, so far, misunderstood. Greater differences might exist between heavy and light smokers making it more difficult to point out the exact effect of nicotine on the brain. Smoking cessation therapies taking into account the specificity of patients with schizophrenia should be more developed.

No significant relationships.

Paraphrenia consists on a syndrome of insidious development with a chronic delirium of great phenomenological richness, predominating productive or delusional-hallucinatory forms and with time it evolves to pure fabulation. Delusions appear in 100% of cases predominating persecution, reference and false identifications. It is a classic term that disappeared with DSM-III, but is still useful for the description of certain clinical cases.

Presentation of a case that clearly defines the classic term paraphrenia, which is now a days lost in new classifications.

We carried out a literature review of the term paraphrenia and presented a real case of a patient interned in our psychiatric ward.

A 55-year-old woman, was without treatment or attendance to her psychiatrist for years, admitted to the hospital due to public disturbance. Even the lack of treatment did not repercuss greatly emotionally or behaviorally. During our interviews, she showed an expansive discourse rich in delirious content, as well as thought transmission and reading, auditive hallucinations and corporal influence. As we can see, this case exposes what would have classical been classified as a case of paraphrenia, nowadays we cannot find a better term to name this group of symptoms with the current classifications.

We can conclude that paraphrenia is halfway between schizophrenic disorganization and paranoic structuring. The personal deterioration is significantly lower than in schizophrenia and the expression of delirium differs from paranoia. Even though actual classifications provide simplicity and pragmatism, we risk losing the semiological and phenomenological richness of classic terminology.

No significant relationships.

Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with decreased gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC).

We hypothesize that greater ARI will be associated with reduced right posterior CMFG and rACC GMVs.

Data were collected at baseline as part of the North American Prodrome Longitudinal Study. Counties where participants resided during childhood were geographically coded using the US Censuses to area-level factors. ARI was defined as the percentage of residents living in a different house five years ago. Generalized linear mixed models tested associations between ARI and GMVs.

This study included 29 HC and 64 CHR-P individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = -0.258; 95% CI = -0.502 – -0.015) and right rACC volumes (adjusted β = -0.318; 95% CI = -0.612 – -0.023). The interaction terms (ARI X diagnostic group) in the prediction of both brain regions were not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs.

Like urban upbringing, ARI may be an important social environmental characteristic that adversely impacts brain regions related to schizophrenia.

No significant relationships.

The appearance of inhibitory symptoms encompassed in what are known as negative symptoms is part of the usual symptoms of schizophrenia. Sometimes this inhibition reaches a significant severity, so it is essential to know its approach.

Case report and literature review regarding the treatment of resistant schizophrenia with a predominance of negative symptoms

We present the clinical case of a 28-year-old man diagnosed with schizophrenia at 23 years old, whose onset was characterized by delusional ideas of harm (poisoning) and delusions with a mystic-religious theme that lead him to reduce his intake until requiring a first admission for severe desnutrition. Subsequently, after two more admissions, the patient presents selective reduction in food intake, decrease in daily activity and apathy without positive symptoms.

Throughout the treatment, several lines of antipsychotic treatments have been tried at the maximum tolerated dose (haloperidol, oral paliperidone and depot, aripiprazole and clozapine up to a dose of 600 mg). Clozapine resistance required testing various augmentation strategies (Venlafaxine, Lamotrigine and Electroconvulsive therapy) with low results. Finally, to complement the treatment, the patient was transferred to a mid-stay unit where psychosocial treatment with a multidisciplinary approach was started. This has allowed more continuous follow-up and thus a partial improvement of the clinic.

Numerous studies describe numerous augmentation strategies for clozapine-resistant schizophrenia with negative symptoms. However, the results are still inconclusive, needing more research. Meanwhile, we want to highlight the importance of complementing the treatment with psychosocial approaches.

No significant relationships.