Approximately a third of patients with schizophrenia show limited response to antipsychotic medication. As several studies have been suggesting new classifications to schizophrenia, our aim is to review different hypothesis and seek a new way of approaching patient's treatment in day-to-day practice.

The methods we used consisted on reviewing several papers that have recently been published on the area of classification and treatment of schizophrenia, considering an approach to the findings that enables a practical and clinical advantage in the area.

New studies suggest that neuroimaging measures of dopamine and glutamate function might provide a means of stratifying patients with psychosis according to their response to treatment. Some of those studies associate treatment response with the anterior cingulate level of glutamate and striatal dopamine synthesis capacity. Other study identified three biotypes with different outcomes to psychosis, reaching a stronger association between biotypes as predictors of illness severity than the DSM-V classification. If a correlation between these studies was found, we would be able, in theory, to predict the response to treatment using simple and affordable neurobiological measures.

Associating the anterior cingulate glutamate levels, the striatal dopamine synthesis capacity and biotypes hypothesis in schizophrenia, one can expect to be possible to predict the degree of response to treatment, based on more affordable methods to day-to-day clinicians than the measure of neurotransmitter levels, enabling the regular clinicians to narrow their pharmacological options for patients, achieving better results in the approach to schizophrenia.

The authors have not supplied their declaration of competing interest.

Koro syndrome has traditionally been considered a culturally bound syndrome, characterized by the delusional belief that one's genitalia are retracting and the anxiety caused by the perception of imminent death. Although it is widely regarded as an epidemic in South-east Asia, there are some isolated cases in other cultures as well.

We present a Koro case study and a systematic review, focusing on the presentation and its treatment, in order to make visible this syndrome to Western culture and provide the tools to identify it.

To provide an overview of Koro's presentation, phenomenology and treatment. We also want to clarify the nosology classification of this syndrome and its influence in the reported cases.

We begin describing a new case of Koro syndrome: a Spanish male presented an acute psychosis, the patient had an intellectual disability and a family history of mental illness. A systematic review was done based on articles published in Pubmed following the PRISMA guidelines.

From 117 studies, only 29 met the inclusion criteria. Data were analyzed on several epidemiological and clinical characteristics. We found that Koro syndrome is more often presented as a result of intoxication or as a part of a previous known psychotic disorder. Cases involving patients sharing their delusion have been only reported in Asia.

No specific data could be obtained about epidemiology and pathogenesis, as our conclusion about Koro syndrome was based mainly on few case studies. Pharmacotherapy and social support may be effective in ameliorating the symptoms.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Subjective Memory Complaints (SMC) are common in clinical practice. the clinical significance of these subjective complaints among older individuals is not well understood.

To study and discuss the association between SMC and MCI, underlining the importance of an adequate clinical assessment of SMC in the elderly.

Review of the literature.

There is no consistent definition of SMC in the literature. Some prospective studies showed an association with objective memory impairments, conceptualizing SMC as a Pre-Mild Cognitive Impairment. SMC are also currently considered to be a core feature of Mild Cognitive Impairment (MCI). Cross-sectional studies and longitudinal studies showed conflicting results concerning the association between SMC and MCI.

The understanding of the predictive value of SMC in cognitive decline is still poorly understood. It is important to define criteria aimed to increase specificity of memory complaints, allowing an earlier identification of populations with higher risk of MCI. Future research on this complex association is important to identify SMC individuals at increased risk of conversion to MCI and dementia.

Even though cigarette smoking is a leading cause of preventable mortality, worldwide tobacco is consumed by approximately 22% of population. Smoking is also one of the risk factors for cardiovascular disease and it impacts our brain processing as well as being one of the recognised risk factors for Alzheimer's disease. The tobacco toxins may cause these disorders, e.g., nicotine at high levels, which are inhaled, resulting in preclinical brain changes. Researchers suggest that there are differences in brain volume between smokers and non-smokers. This review examines these differences on the brain grey matter volume (GMV).

In March/April 2015: MedLine, Embasse and PsycInfo were searched using terms: “grey matter”, “voxel based”, “smoking” and “cigarette”.

Studies found brain GMV decreases in smokers compared to non-smokers. Furthermore, gender specific differences were found, while thalamus and cerebellum was affected in both genders decrease in olfactory gyrus was found only in male smokers. Age group differences were also found and these may suggest pre-existing abnormalities that lead to nicotine dependence in younger individuals. Only one study found positive correlation between number of pack-years and GMV.

Smoking decreases the volume of grey matter in most brain areas. This decrease may be responsible for the cognitive impairment and difficulties with emotional regulation in smokers compared with non-smokers.

The authors have not supplied their declaration of competing interest.

To estimate the prevalence of eating disorders (EDs) and associated risk factors in a sample of undergraduate students.

This is a cross-sectional study. We used a questionnaire consisting of the following sections: demographics, SCOFF questionnaire for screening EDs, the Achievement Anxiety Test (AAT) and the Depression, Anxiety and Stress Scale (DASS). Our sample was selected randomly. Sample size was 535 students (44% men, 56% women), and 33% of students were between 18 and 20 years old (age range 16–28).

SCOFF's reliability measured by Cronbach's alpha was 0.542; AAT's alpha for its facilitating scale was 0.682 and debilitating scale 0.821; finally, DASS's depression, anxiety and stress sections’ alpha were 0.923, 0.896 and 0.876 respectively. The prevalence of EDs was 42.2%. The associated factors with the presence of EDs was gender (62% women, 38% men; X2 = 5.007, p = 0.025) and personal family status (X2 = 18.862, p = 0.002), while having divorced parents was a borderline association (OR = 1.53, 95% CI 0.97–2.42). Mann-Whitney’s U test showed that there was a significant difference in the scale of stress between those with an ED and those without (p = 0.026) but not for depression and anxiety. According to multiple logistic regression, risk factors for having an eating disorder were depression, stress, female gender, being married and searching for a romantic relationship (overall model fit p < 0.0001).

This is the first study on EDs from Greece. Depression and stress were significant predictors of EDs, which shows the importance of these two factors in the pathogenesis of EDs.

The effects of long-term antipsychotic medication on cognition in schizophrenia are unclear (Husa A.P. et al., Schizophr. Res. 2014).

Understanding how long-term antipsychotic treatment affects cognition is crucial for the development of safe, evidence-based treatment of schizophrenia.

To analyse the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia at age 43 years in a general population sample.

Sixty (33 males) schizophrenia spectrum subjects from the Northern Finland Birth Cohort 1966 were assessed at age 43 years by California Verbal Learning Test, Visual Object Learning Test, Abstraction Inhibition and Working Memory task, Verbal fluency, Visual series, Vocabulary, Digit Span and Matrix reasoning. Cumulative lifetime antipsychotic dose-years were collected from treatment records and interviews. A factor analysis based on the cognitive tests resulted in one cognitive factor. The association between this cognitive composite score and antipsychotic dose-years was analysed by linear regression.

Higher lifetime antipsychotic dose-years were statistically significantly associated with poorer cognitive composite score at age 43 years (B=-0.32, p>0.001), also when adjusted for gender, onset age, remission and number of hospital treatment days (B=-0.42, p=0.008).

To our knowledge, this is the first report of an association between cumulative lifetime antipsychotic dose and cognition in midlife in schizophrenia. Based on this data, the use of high antipsychotic doses may relate to poorer cognitive functioning in schizophrenia after twenty years of illness. These results do not support the view that antipsychotics prevent cognitive decline or promote cognitive recovery in schizophrenia.

The present study evaluated the association between the WHO (Ten) Well-being index and major depression assessed by the Major Depression Inventory (MDI) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN). The main aim was to examine how well the WHO (Ten) Well-being index worked as a screening instrument for depression in a population-based sample.

A questionnaire including the WHO (Ten) Well-being index and the MDI was sent out to a randomly selected adult Swedish population and 10 441 persons participated. Psychiatrists using SCAN interviewed a selected sample. Sensitivity, specificity, Receiver Operating Characteristics (ROC) and Area Under the Curve (AUC) were calculated.

When a cut-off score ≤ 8 for the Well-being scale was used and depression according to SCAN was the index of validity the sensitivity was 0.81 and the specificity 0.81. When depression according to the algorithm of the MDI was used the sensitivity was 0.89 and the specificity was 0.86 at a cut-off score of ≤ 12. There were no age or gender differences between true positive persons versus false negative persons. The AUC was good (0.86) when using SCAN and when using the DSM-IV algorithm of the MDI excellent (0.93).

The WHO (Ten) Well-being scale can be used as s simple screening instrument for depression in population-based studies. However, the scale needs to be further evaluated in order to examine if the recommended cut-off score in the present study could be replicated in other surveys.

Alexithymic characteristics have been observed in antisocial personality disorder (APD). On the other hand, aggression is a particular problem commonly observed in personality disorders, especially in APD. We investigated the alexithymic features and aggression levels in outpatients diagnosed with APD in a military hospital setting.

71 male subjects diagnosed with APD and 81 sex and age matched normal subjects with no known medical or psychiatric disorder were assessed with an assessment battery using a sociodemographic data form, APD section of SCID-II, the Toronto Alexithymia Scale (TAS)-20 items, and Aggression Questionnaire.

The subjects with APD have showed significantly higher rates of unemployment, lower educational and socioeconomic status. The APD group also displayed significantly higher scores on alexithymia and aggression than control group. APD subjects with higher scores of aggression revealed significantly higher scores of alexithymia.

Use of action to express emotions, a commonly observed feature of APD, was once considered to be a part of alexithymia. The subjects with APD may have less developed cognitive skills which lead to a failure in communicating their feelings. This may result in immature methods of communicating distress. Our study indicate that alexithymia may contribute to aggressive behavior in patients with APD. To draw a more definitive conclusion on this issue, larger community based studies that compares APD subjects with sociodemographically matched patient control groups are necessary.

Autism Spectrum Disorder and Social Anxiety Disorder are mental illnesses characterized by a dysfunction in social behavior (SB); a phenomenon largely mediated by the medial prefrontal cortex (mPFC). Clinical studies have demonstrated that lysergic acid diethylamide (LSD), a partial agonist of the 5-HT2A receptor, can promote SB. However, its mechanism of action on SB is unknown.

To assess the effects of repeated LSD administration on social behavior in mice and to identify which mPFC receptors mediate LSD’s behavioral effects.

Eight-week-old C57BL/6J male mice received vehicle or repeated LSD (30 μg/kg/day i.p. for 7 days) as well the selective 5-HT2A receptor antagonist MDL, or the AMPA receptor antagonist NBQX. Twenty-four hours following the last injection, mice underwent the Direct Social Interaction Test and the Three-Chamber Test (TCT) to assess sociability and preference for social novelty. in vivo electrophysiological recordings were performed in mice treated with vehicle or LSD using multi-barrelled electrodes for microiontophoretic ejections of the selective 5-HT2A receptor agonist DOI or the selective AMPA receptor agonist quisqualate on mPFC pyramidal neurons.

Repeated treatment with low doses of LSD increased the interaction time in the DSI as well as sociability and social novelty indices in the TCT. These pro-social effects were blocked by the intra-PFC administration of both 5-HT2A and AMPA antagonists. LSD also potentiated, in a current-dependent manner, the excitatory response of mPFC neurons to 5-HT2Aand AMPA agonists.

Repeated, low doses of LSD increases social behavior via a mechanism of action that is mediated by 5-HT2A and AMPA in the mPFC.

The medical and scientific communities are continually reporting that night work can increase the risk of certain disorders and have a negative impact on the overall well-being of employees.

This study wanted to examine the impact of night work on physical and psychological well-being of hospital staff.

We carried out a cross-sectional study about a representative sample of hospital staff. We used validated self-reporting instruments: the Perceived Stress Scale (PSS) and the Subjective Well-being Scale (SWS). Data were analyzed using SPSS-20.

Our study concerned 519 hospital staffs. More than half were male (53%) and 83.1% had worked in the same position for more than two years. More than half of the participants (51. 3%) considered themselves in very good health. Also 41.5% of participants had a well-being index reduced and 26% of personal had high perceived stress. Correlation analysis had shown that more than one guard at week was associated with high levels of perceived stress (P = 0.004) and well-being index reduced (P = 0.000). After adjusting for categories, more than one shift work at week was associated to well-being index reduced with odds ratios of 1.57 (confidence interval 95% [1.07 to 2.30]).

There is a clear correlation between night work, perceived stress and subjective well-being of different categories of hospital staff. Shift work interferences on health and well-being are complex and multifaceted in their origins and time manifestations, dealing with several aspects of personal characteristics, and working and living conditions.

The authors have not supplied their declaration of competing interest.

The traditional diathesis-stress model states that cognitive vulnerabilities in interaction with stressors predict the increase of depression. However, the relationships between these variables can be much more complex, with each variable influencing each other.

The present study is based on the transactional cognitive vulnerability to stress model (Hankin & Abramson, 2001) and assesses the bidirectional relationships between cognitions, depression and stressors over time.

To understand the dynamics between stress, depression, and cognitions.

1350 adolescents (47% girls & 53% boys; Age Mean = 15.86) were assessed at the beginning of the school year and at follow-up 6 months later. They completed measures of three cognitive vulnerabilities (maladaptive schemas, negative inferential style, and rumination), negative life events and depressive symptoms. A fully cross-lagged design panel was carried out.

Stressors and all cognitive vulnerabilities but rumination predicted the increase in depression at T2. Both initial levels of depression and cognitive vulnerabilities predicted the increase in dependent stressors. Initial levels of stressors predicted an increase in rumination, hopelessness inferences, and maladaptive schemas over time. Finally, initial level of depression predicted the increase in hopelessness inferences and maladaptive schemas. the bidirectional relationships between variables were very similar for boys and girls.

The study supports not only the role of some cognitive styles as vulnerabilities for depression, but also the stress generation and the scar hypothesis. the findings support a transactional model with reciprocal relationships between stress, depression and cognitive vulnerabilities.

Some studies have shown that more than 40% of patients with first episode psychosis (FEP) are nonadherent and treatment with long – acting antipsychotics (LAIs) could increase their compliance. However, studies on efficacy of LAIs versus oral antipsychotics for preventing relapse among schizophrenia patients have produced conflicting results.

With this study we want to asses if patients with FEP in treatment with LAIs have a decreased incidence of readmission compared with patients in treatment with oral antipsychotics over 6 month follow – up.

188 FEP patients were consecutively admitted to Hospital del Mar since January 2008 to September 2014. The included evaluation was, among others: sociodemographic data, duration of untreated psychosis (DUP), diagnosis, substance use and clinical data at baseline. Later, antipsychotic treatment and number of admissions and of emergencies over 6 months were also recorded. We studied difference sin readmission, number of emergencies between patients on LAI and oral treatment.

We found a significative decreased incidence of readmission (p=0,000) and a lower number of emergencies (p=0,017) in the group of FEP patients treated with LAIs versus the group treated with oral antipsychotics.

In our sample, treatment with LAIs is associated with a reduced readmission rate and a lower number of emergencies in patients with FEP. This finding are agree with the results of other studies that show a significantly reduced relapse and a lowest risk of rehospitalization in FEP patients treated with LAIs.

Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from 2 Phase III, randomized, double-blind (6-week), placebo-controlled trials of fixed-dose cariprazine (3mg/d and 6mg/d, NCT01104766) and flexible-dose cariprazine (3–6mg/d and 6–9mg/d, NCT01104779) in adults with acute exacerbation of schizophrenia.

Evaluate the efficacy, safety, and tolerability of cariprazine in schizophrenia.

Primary and secondary efficacy parameters were change from baseline to Week 6 in Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 617 (NCT01104766; 153 placebo, 155 cariprazine 3mg/d, 157 cariprazine 6mg/d, 152 aripiprazole) and 446 (NCT01104779; 147 placebo, 151 cariprazine 3–6mg/d, 148 cariprazine 6–9mg/d). Improvement from baseline to Week 6 on PANSS total scores was significantly greater with cariprazine vs placebo: least square mean difference (LSMD) was −6.0 (3mg/d, P=.0044), −6.8 (3–6mg/d, P=.0029), −8.8 (6mg/d, P<.0001), and −9.9 (6–9mg/d, P<.0001). Cariprazine was significantly superior to placebo on CGI-S: LSMD was −0.4 (3mg/d, P=.0044), −0.3 (3–6mg/d, P=.0115), −0.5 (6mg/d, P<.0001), and −0.5 (6–9mg/d, P=.0002). Aripiprazole (active control, NCT01104766) was superior to placebo on both measures (LSMD: PANSS=−7.0, P=.0008; CGI-S=−0.4, P=.0001). The only common cariprazine-related TEAE (≥5% and twice rate of placebo) that occurred in both studies was akathisia. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of schizophrenia.