Schizophrenia is a severe debilitating condition, with elevated level of aggressiveness reaching 33% in a large sample of patients. Unaffected biological relatives of schizophrenia patients share similar though less severe neurocognitive and behavioral abnormalities seen in their affected relatives. Recent findings demonstrates that first degree relatives of schizophrenia patients are at increased risk of violence and aggressive behavior, especially during adolescence, with poor outcome. Besides, adolescents aged from 12 to 18 years old, may experience aversive and overwhelming emotions difficult to regulate due to immaturity of neuronal networks. There are evidence of an association of emotion dysregulation and violent conduct among youth. However, to our knowledge, studies among first degree relatives of psychotic patients were not performed.

The aim of this study was to evaluate the aggressiveness and emotion dysregulation among unaffected adolescents with fist degree family history of schizophrenia and to investigate the association linking these two entities.

In this purpose wo conducted a cross sectional descriptive study in Razi hospital during three months: from July to September 2022. Unaffected adolescents aged 12 to 18 whom first-degree relatives were diagnosed with schizophrenia according to DSM-5 criteria were included. Adolescents with psychiatric conditions or medical affections associated with psychiatric presentation were not included. Sociodemographic data were collected on a preestablished questionnaire and the following scales were used: The Life History of Aggression LHA, an 11 items self-reported tool, in the Arabic version, The Aggression Questionnaire AQ which is a 29 items self-reported scale in Arabic version and the The Emotion Regulation Questionnaire (ERQ), a 10 items self-reported measure rated on a likert scale, in the validated Arabic version. Written informed consent was obtained from the legal tutor of each adolescent.

Results of this survey are ongoing.

Results of this survey are ongoing.

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Violence is a common behavioral and health concern among adolescents, aged 12 to 18 years old. In fact, aggressiveness may result in severe outcome in a critical age characterised by biological, psychological, and social changes. Schizophrenia is a severe and chronic condition, with elevated level of aggressiveness. Since unaffected biological relatives of schizophrenia patients share similar though less severe neurocognitive and behavioral abnormalities seen in their affected relatives, they are at increased risk of violence mainly during adolescence. However, studies including adolescents with schizophrenia first degree history are scarce.

The aim of this survey was to evaluate the aggressiveness among unaffected adolescents with fist degree family history of schizophrenia and in a control group of adolescents with no family psychiatric history.

In this purpose wo conducted a case-control cross sectional study in Razi hospital during three months: from July to September 2022. Unaffected adolescents aged 12 to 18 whom first-degree relatives were diagnosed with schizophrenia according to DSM-5 criteria were included. Adolescents with psychiatric conditions or medical affections associated with psychiatric presentation were not included. Control group was selected amongst the population. Sociodemographic data were collected on a preestablished questionnaire and the following scales were used: The Life History of Aggression LHA, an 11 items self-reported tool, in the Arabic version, The Aggression Questionnaire AQ which is a 29 items self-reported scale in Arabic version. Written informed consent was obtained from the legal tutor of each adolescent.

Results of this survey are ongoing.

Results of this survey are ongoing.

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There is a modest but consistent association between violent behavior and schizophrenia. Persons with schizophrenia are at a modestly increased risk of committing violence ,with approximately half of victims being relatives

Our study examined the factors attributed to violent behaviour within the relationship patient-caregiver in schizophrenia according to caregivers.

This is a cross-sectional study among caregivers of patients with schizophrenia during the period from June to August 2022.Patients who attended our department of psychiatry at the Razi.

The questionnaire was divided into three sections. The first section contained items regarding patient- and caregiver-related information.

In the second section, caregivers were asked questions about their experience of violence perpetration and victimization involving their relative with schizophrenia in the past 12 months.

Beyond frequency, caregivers were also asked to specify, the causes of the violence perpetrated and suffered

The third section contained two measures, i.e. the Depression Anxiety and Stress Scales (DASS-21) and the abridged version of the Zarit Burden Interview (ZBI), assessing psychological distress and caregiving burden, respectively. The protocol of the study was approved by the ethics committee of the Razi Psychiatric Hospital.

The majority of caregivers were females (63.6%), and consisted of patients’ parents (50.9%).

The most endorsed causes of violence victimization were symptoms of illness (57.3%), followed by refusal to adhere to treatment (49.1%), drug reaction (23.6%), and negative events; while the most reported causes of violence perpetration were refusal to adhere to treatment (42.7%), Symptoms of illness (37.3%), and limitation of patients’ activities and/or liberty (32.7%).

Bivariate analysis showed that lower patients’ economic status (p=.042), tobacco (p=.015) and alcohol use (p=.014) as well as taking Trihexyphenidyl (p=.001) were significantly and positively associated with violence perpetration by caregivers against their relatives with schizophrenia.

Multivariable analysis (Logistic regression) revealed that caregivers’ levels of burden remained significantly associated with violence victimization occurrence (p=.026; OR=1.48), while only having other person in charge of caring represented a significant factor associated with perpetration of any form of violence against patients (p=.007; OR=.17).

It is important for medical staffs to provide caregivers with professional knowledge about patients’ real motivation for violence in order to improve their skills of problem-solving.

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Antipsychotics (AP) are used as the primary pharmaceutical treatment for schizophrenia. Randomised clinical trials (RCT) show that the initiation of AP treatment often induces side effects such as substantial weight gain and metabolic disturbances, including an increased risk of type-2 diabetes (DM). However, the limitations of RCTs are often small cohorts that only represent a minority of patients with schizophrenia seen in everyday clinical settings leading to selection bias. Many RCTs are also limited by a short follow-up time, as evaluation of metabolic disturbances requires months to years of observation.

Within a large cohort of real-world patients with long-term follow-up, we aim to study the differential metabolic side effects of specific antipsychotic drugs.

We performed a retrospective cohort study using the electronic patient record system “MidtEPJ”, which contains data from blood samples and medication usage from all patients registered with a schizophrenia diagnosis (ICD-10 code DF20) in the central region of Denmark from 2016-2022. Patients were followed from September 2016 (for patients with a schizophrenia diagnosis before this date) or their first schizophrenia diagnosis. The exposure is treatment with AP medication. Outcomes of interest are the development of DM, defined as a diagnosis of DM or usage of anti-diabetic medication, and changes in HbA1c, glucose, and cholesterol levels (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol and triglycerides). We performed cox regression analyses to study the associations between specific AP compounds with the differential risk for developing DM and changes in metabolic markers.

We identified 4909 individual patients with a schizophrenia diagnosis from October 1st, 2016, to September 30th, 2022. AP was subscribed to 4609 of these patients. The results will be presented at the 2023 EPA Congress.

Our results will be discussed at the conference.

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In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.

We present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.

Bibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.

We present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.

It is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.

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One of the promising methods for optimizing treatment in order to achieve high-quality remissions is a personalized approach to prescribing therapy in the form of pharmacogenetic testing, the feasibility of which has already been substantiated and proven in a number of clinical guidelines. By the beginning of 2022, several influential regulatory and expert organizations recommend considering the results of genetic testing when prescribing therapy. Thus, personalization of antipsychotic therapy is being introduced in the world practice.

To establish the significance of pharmacogenetic markers that determine the efficacy and safety of antipsychotic therapy in patients with schizophrenia in clinical practice.

The study included 264 patients (141 men, 123 women; 27.3 ± 4.5 years) from among the first hospitalized in a psychiatric hospital in the period 2018-2020, meeting the inclusion criteria (psychosis within the schizophrenia spectrum disorders; consent to participate in research). Non-inclusion criteria - signs of organic brain damage; alcohol or substance abuse; somatic pathology in the stage of decompensation). The examination took place in three stages - in the first days of hospitalization at the peak of the acute condition and during the formation of remission - after 6 and 12 months. Genetic analysis was performed using high-density biochips from Illumina CoreExome Bead (Illumina Inc, USA). During the follow-up observation, some patients dropped out due to refusal to undergo examination, change of diagnosis or change of place of residence. After 6 and 12 months, it was possible to trace the dynamics of the state of 91 patients (50 men, 41 women; 24.9 ± 4.6 years).

Based on the follow-up results, two types of schizophrenia dynamics were identified - with a relatively favorable and unfavorable course. The formation of a relatively stable remission corresponding to the criteria proposed by the working group was noted in 47 patients (51.6%), carriers of gene polymorphisms: DRD2 rs1799732 (del); COMT rs4680(GG); BDNF rs6265 (CC); ANKK1 rs1800497 (GG); MC4R rs489693 (AA); ABCB1 rs1045642 and ABCC1 rs212090 (GG). An unfavorable course with the ineffectiveness of antipsychotics was found in 48.4% of cases in patients with DRD2 rs1799732 (G/del) carriers; COMT rs4680(AA); BDNF rs6265 (TT); ANKK1 rs1800497 (AA); MC4R rs489693 (GG); ABCB1 rs1045642 and ABCC1 rs212090 (AA).

After analyzing the results of genetic testing and clinical and dynamic characteristics of the course of schizophrenia, we can talk about the relationship between the establishment of high-quality remission in the presence of polymorphisms in the genotype, whose role has been proven in terms of the effectiveness and safety of antipsychotics.

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We present the case of a 34-year-old female patient, 35 weeks pregnant and previously diagnosed with delusional disorder.

Somatic personal history: NAMC. intrinsic asthma. Cutaneous psoriasis.

Personal psychiatric history: In psychiatric follow-up since childhood, due to eating problems. Subsequently by adaptive pictures, with anxiety and dysfunctional personality traits intermittently. She resumes contact again in February 2017 presenting frank delusional clinic. Father diagnosed with schizophrenia.

Personal data: 34-year-old woman, married, with a 6-year-old son.

Current illness: The patient presents active delusional symptoms of about 3 years of evolution, she reports that she knows that there are people in her neighborhood who want to harm her and have guns with which they are constantly shooting to kill her "I hear the shots every day, I have the windows covered with metal plates and I cannot go out with my son, nor to the park, nor to do the shopping”. When she began the delusional symptoms, she was prescribed treatment with olanzapine without response, later with paliperidone palmitate, without response, and then with oral aripiprazole and depot 400mg once a month, with partial response. Prior to the current pregnancy, treatment with clozapine was considered, which the patient accepted but did not tolerate and had to be withdrawn.

Evolution: The patient then remains in treatment with depot aripiprazole, with a partial response and less behavioral repercussion of the delusional content, but with a torpid evolution and tending to chronicity. During this course the patient accidentally becomes pregnant again. The doses of benzodiazepines that she was previously taking to control anxiety and sleep were lowered, maintaining treatment with depot aripiprazole, reducing the dose to 300mg monthly. The pregnancy has proceeded normally to date, with close controls by the gynecology service and monthly visits to psychiatry clinics.

Clinical judgment: Persistent delusional disorder.

In this case, the need arises to maintain depot antipsychotic treatment in a patient with a severe mental disorder during pregnancy, given the serious consequences of delusional content on the patient’s functioning and thus be able to preserve stability at this level during pregnancy.

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Late-onset psychosis appears in people over the age of 40. Some preliminary studies show that LOP has fewer severe positive symptoms, more systematic persecutory delusions, more bizarre-type delusions, less affective flattening, and more social withdrawal than early onset psychosis.

There are some studies that consider late-onset and very late-onset psychosis as prodromes of neurodegenerative disease. There are some differences in neuropsychological profiles and specific cognitive function alterations discovered. More evidence, however, is required to make an accurate diagnosis.

The objective of this study was to reflect the difficulties in differentiating between late-onset psychosis and dementia by reporting the case of a 77-year-old woman who presented with mystical-religious delusions and hallucinations during her hospitalization.

We present the case of a 77-year-old woman who was hospitalized because of a stroke. During her stay, she began receiving follow-up from the mental health team because she verbalized some mystical-religious delusional ideas. During the psychiatric interview, the patient verbalized mystical-religious ideas and oscillated between coherent, organized, and disaggregated speech. No problems were detected with orientation, or florid affective symptoms that could point to a delirium or affective disorder. The premorbid personality was extravagant, with interpersonal difficulties and magical thinking. Nonetheless, she had no prior contact with the mental health system or hospitalization. We could approximate the beginning of the symptomatology at around 60 years old, thanks to her relatives. Prior to this age, she maintained good function by working as a chef on a regular basis. She gradually isolated herself due to her lack of mobility. Similarly, she decreases her self-care activities, begins hoarding items around the house, and gradually develops more psychotic symptoms.A brain scan was performed, and no acute pathology was found. A neuropsychological test was not executed due to a lack of collaboration from the patient.

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This case reflects the complexity of differentiating between dementia and late-onset psychosis. Supplementary testing and follow-up are essential for establishing a diagnosis. Related to that, more research is needed to identify the differential characteristics between the two disorders and the temporal correlation between them.

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Regarding the diagnosis of schizophrenia, a peak of onset of symptoms is considered at 25 years. The debut after 60 years is considered late onset and is rare, generating controversies in the diagnosis

We present the case of a 58-year-old patient with no personal or family history of mental health, who came to the emergency room for the first time, reporting feeling in danger. He comments itching on his skin, verbalizing seeing bugs running through it, relating this phenomenon to “witchcraft by my brothers”, he also refers to feeling like “they watch my thoughts and block it through a mobile application, they enter through my eye right and this gives me less vision and a headache. He also refers to having the ability to listen to how his brothers talk about how they are going to “hurt me.” Psychopathologically, we highlight that she is oriented in the three spheres, presenting delusional ideation with an experience of harm, a phenomenon of thought theft and auditory and tactile hallucinations.

Analytical and imaging tests, as well as toxins in urine, were negative.

Diagnosis of psychotic episode is made to see evolution. The clinic partially yields to treatment with atypical antipsychotics. At this time, the patient has no awareness of the disease.

Despite being a diagnosis that is scarcely prevalent, once organic disease has been ruled out.

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Patients with schizophrenia have deficits in contextual vision. However, results are often very mixed. In some paradigms, patients do not take the context into account and therefore act more veridically than healthy controls. In other paradigms, context impairs performance in patients more strongly than in healthy controls. These mixed results may be explained by differences in paradigms, as well as by small or biased samples, given the large heterogeneity of the disease.

To understand if there are general contextual deficits in schizophrenia.

17 schizophrenia patients and 16 age-matched controls were tested with a combined crowding and uncrowding paradigm.

Schizophrenia patients show qualitatively similar crowding performance as controls. In the uncrowding condition, however, patientsimproved less than controls. We suggest that performance in the various paradigms depends on idiosyncratic aspects of the paradigm in addition to the heterogeneity of the disease.

There are no general impaired mechanisms in schizophrenia. Deficits depend strongly on idiosyncrasies of the specific stimuli.

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The Default Mode Network (DMN) is a brain system with physiological and cognitive properties that make it a major pillar of cortical integration. It has been a subject of increased research on different psychiatric conditions such as schizophrenia. It was hypothesized that alterations in the brain connectivity of the DMN, at the level of its functional connectivity (FC) and structural connectivity (SC), may be at the basis of this pathology. Thus, the DMN has been associated with several clinical variables such as symptom severity, disease prognosis and response to antipsychotic treatment, making this system a potential future tool in the study of these variables for better clinical guidance in patients with schizophrenia.

The aim of this study is to review the role of DMN in the pathophysiological mechanisms underlying schizophrenia, as well as its potential role as a future biomarker in detecting patients at high risk of developing a first psychotic episode and predicting therapeutic response to antipsychotics.

Systematic review of the literature published on Pubmed using the terms: “Default Mode Network”, “Schizophrenia”, “First Psychotic Episode” and “Antipsychotics”.

A myriad of studies revealed the presence of dysfunctional DMN brain activity in patients with schizophrenia. However, increased FC of the DMN is the predominant outcome reported by literature in patients with and without chronic exposure to antipsychotic therapy, at high risk of developing psychosis and on both early and advanced disease stages, suggesting that the DMN may have a meritorious role on the pathophysiology of schizophrenia. Some studies have found SC changes associated with altered FC on patients at early stages of the disease without exposure to prolonged antipsychotic therapy. Regarding the relationship between DMN and antipsychotic therapy, studies suggested that DMN is shaped by antipsychotic therapy by regulating FC activity.

This work helped us to understand the importance of the future study of the connectivity of the DMN in a longitudinal perspective of the course of schizophrenia in order to potentiate the creation of brain signatures that might translate the alterations of the connectivity of the DMN in early stages of the disease, which in turn could work as potential future biomarkers for the detection of patients at high risk of developing a first psychotic episode but also work on predicting the therapeutic response to antipsychotics, allowing us to direct our clinical orientation towards a better prognosis of the disease.

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The Capgras syndrome, also known as the delusion of doubles, is a delusional misidentification syndrome, defined in 1923 by Joseph Capgras, who referred to it as “l’illusion des sosies”, which means “the illusion of look-alikes”. In this syndrome, people falsely believe that someone significant to them has been replaced by an identical-looking impostor.

To review the evolution of the conceptualization of Capgras syndrome and its relationship with neurological disorders, such as dementia.

Non-systematic review of the literature with selection of scientific articles published in the last 10 years, using PUBMED as database and the following keywords: «Capgras syndrome» and «dementia». 11 studies were included.

Originally, Capgras syndrome was seen exclusively as a psychiatric disorder: a delusional disorder, which can be associated to schizophrenia, bipolar or schizoaffective disorder. Since 1980, when organic brain lesions were identified in patients with Capgras syndrome, it started to be understood as a neuropsychiatric disorder. Previous studies revealed that in Capgras syndrome there is damage in the bifrontal, temporal cortex and the limbic system, structures that are involved in emotional arousal to familiar faces. In fact, Capgras Syndrome can be experienced in neurological conditions, including Alzheimer’s disease, dementia with Lewy body, Parkinson’s disease, epilepsy, cerebrovascular disease, subarachnoid hemorrhage, pituitary tumors and head injury. A 2014’s study showed that 73% of Capgras syndrome cases had comorbid diagnosis of schizophrenia, 26,4% had dementia and 16,7% had mood disorders. The prevalence of Capgras syndrome in neurodegenerative disorders is well known, and it is higher in dementia with Lewy body than in Alzheimer’s disease and frontotemporal dementia. In patients without a neurodegenerative disease, Capgras syndrome typically occurs at a younger age and is associated with psychiatric disease, cerebrovascular events, or illicit drug use. To date, it is unclear whether there are differences between Capgras syndrome as it occurs in neurodegenerative compared with non-neurodegenerative diseases.

Currently, it is believed that Capgras syndrome can be associated not only with psychiatric diseases (a delusional syndrome, when belief evaluation is affected) but also with neurological diseases, such as neurodegenerative disorders. Therefore, when addressing a Capgras syndrome it is necessary to rule out these neurological conditions. Also, correct early identification of the Capgras syndrome in dementia cases will improve the clinical management, outcome and quality of life of patients and caregivers.

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Because of their mechanism of action, treatments used in Parkinson’s disease can lead to the development of non-motor symptoms, including neuropsychiatric manifestations such as psychotic symptoms and mood disturbances such as depression. Cariprazine is a new atypical antipsychotic, D3 receptor antagonist, with lower affinity for the 5HT2A receptor and higher affinity for alpha 1B adrenergic receptors than any other antipsychotic, which has been shown in preclinical studies that play an important role in ameliorating levodopa-induced psychotic symptoms in patients with Parkinson’s disease.

A case of a patient with psychosis related to Parkinson’s Disease and depressive symptoms is presented followed by a theoretical review on the topic.

A case is presented with a bibliographic review.

A 66-year-old male was hospitalized in the psychiatric unit of short hospitalization with psychotic symptomatology and presence of depressive symptoms.

The patient presented in his medical history two previous hospitalizations with depressive clinic with psychotic symptomatology in 2018 and February 2022, the last one after been diagnosed with Parkinson’s disease in January 2022. The introduction of Parkinson’s Disease treatment with levodopa/benserazide caused a secondary worsening of his psychotic symptomatology. In addition to this, the patient was being treated with quetiapine, desvenlafaxine and clonazepam.

During the hospitalization, the dose of desvenlafaxine was increased and quetiapine treatment was replaced by cariprazine because of no clear improvement in symptomatology. After 24 hours, the patient showed a clear clinical improvement: better mood, delirious ideas decreased as well as the hearing of voices. No adverse events related with this medication were observed. After 20 days of hospitalization, the patient was discharged with favorable evolution.

Although most of the studies available so far propose quetiapine as the antipsychotic treatment of choice for levodopa-induced psychosis in patients with Parkinson’s disease, the case report presented strengthens the recent data described in the literature on cariprazine in the treatment of psychosis related to Parkinson’s Disease. However, additional long-term studies including a larger number of patients with long-term follow-up will be necessary to confirm the efficacy of this drug in this type of patients with this pathology.

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Therapeutic Alliance (TA) is a fundamental aspect of clinical practice, in particular with psychotic patients. In this population, TA has been associated with better clinical outcomes, such as symptomatic and functional impairment reduction and greater life quality. Several aspects have been suggested to negatively interfere with this patient-therapist relationship, including different beliefs about mental health/disease, the role of mental health systems or mental disease-associated stigma. Showing empathy, stimulating metacognition, searching for shared meaning and working as a team seem to be an adequate way to surpass these obstacles - just like we do when we enter an escape room.

To understand the importance of TA in the successful clinical management of psychotic patients; and to propose an original hierarchical framework of TA with these patients.

Review of the scientific literature on the subject and proposal of an original framework of TA with psychotic patients doing an analogy with escape room dynamics.

In an escape room, a team works together to solve a series of mysteries, each leading to another, thus accomplishing one final goal. To do such, every element must agree on the solution to proceed; and there is no access to one level without successfully completing the former.

In a clinical environment with a psychotic patient, such rules may also apply. Although the starting level in each patient-therapist relationship may vary, it is here proposed that proceeding to the next level without at least partial agreement in the previous one may be inefficacious or even counterproductive for the intentions of the therapist.

So, shall we begin?

Level 0 - Who am I? Prior to the encounter with the patient, it is important that the therapist knows himself reasonably well, specially regarding his beliefs, shortcomings and biases in his clinical practice.

Level 1 - What is this? The teamwork starts here. Both therapist and patient must discover why this encounter is happening, what does it mean to be in this medical facility or to be mentally ill, in general.

Level 2 - What is wrong? Trying to understand what is detrimental in the patient’s mental health.

Level 3 - What to do? Tailoring a therapeutic intervention to the impairments of the patient.

Level 4 - How to do it? Finding a way to suit the therapeutic intervention to patient’s personal preferences and availability.

Level 5 - The way out. Helping the patient escape this room and fulfill his maximum potential in all of the other “rooms” of his life.

TA is indispensable to therapeutic success when dealing with psychotic patients.

There is a need for shared meaning and understanding in multiple aspects of the therapist-patient relationship; an approach that only focus some of these aspects while ignoring others may be ineffective or even detrimental to clinical outcomes.

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Sleep disturbances are commonly observed in schizophrenia and are associated with worse psychotic symptoms and poorer clinical outcomes. This has generated considerable interest in characterizing the relationship between disturbed sleep and schizophrenia.

The aim of this study is to assess sleep quality in patients recently diagnosed with schizophrenia that are antipsychotic-naïve and to analyze their association with sociodemographic and clinical data in the same patient group.

We conducted a cross-sectional, descriptive and analytical study among patients in the psychiatry department "G" at Razi Hospital, over a period of six months. Three scales were used: the Global Assessment of Functioning (GAF) Scale, the Positive and Negative Syndrome Scale (PANSS) and the Pittsburgh Sleep Quality Index (PSQI).

The mean age of patients was 26.8 years and 65% were male. The mean age of onset of the disease in patients included in our study was 24.8 years. The majority of patients (96.3%, n=52) were considered poor sleepers (PSQI threshold value >5). We objectified a negative and statistically significant association between patient functioning (total GAF score) and sleep quality (r= -0.277, p=0.043). The PSQI total score was positively and significantly correlated with the negative scale scores (r=0.315, p=0.021), the general psychopathology scale scores (r=0.411, p=0.002) and the PANSS total score (r=0.378, p=0.005); while no significant association was objectified with scores of the positive scale.

Our study has demonstrated a high prevalence of sleep disorders during the first episode of schizophrenia, as well as their association with the severity of symptoms.

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Resting state electroencephalogram (EEG) abnormalities in schizophrenia (SCZ) suggest alterations in neural oscillatory activity. However, few studies have examined EEG coherence in this population.

Therefore, this study investigated whether these electrophysiological characteristics differentiate schizophrenic patients from healthy controls.

This was a cross-sectional, descriptive, and analytical case-control study. The selected patients were followed for SCZ at the psychiatry "C" department at the Hedi Chaker hospital of Sfax. Patients were assessed by the Positive and Negative Schizophrenia scale (PANSS) and the Treatment Adherence Scale (MARS). They all benefited from an EEG at the service of functional explorations in Sfax. Student’s test was performed to compare the coherence values between groups.

Thirty men including 15 schizophrenic patients and 15 age- and sex-matched controls were included. The average age was 40 years ±12.72 years for schizophrenics and 47.93 ± 15.61 years for healthy controls. Schizophrenics had an average PANSS of 64.6±22.7, and an average MARS score of 5.8 ± 3.09.

In terms of intra-hemispheric coherence, Schizophrenic patients generally exhibited higher coherence at the Delta band compared to healthy controls. In contrast, schizophrenic patients appeared to have decreased intra-hemispheric connectivity for other frequency bands, particularly between the frontal and other brain lobes bilaterally.

In this study, we found that the schizophrenic patients had significantly higher coherence in the delta frequency band compared to the normal controls. These findings suggest that EEG can be a sensitive measure for diagnosing SCZ.

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Schizophrenia (SCZ) is a common and disabling psychiatric condition. Its diagnosis is entirely clinical. Many researchers have looked into electroencephalogram (EEG) power spectrum analysis for SCZ to find specific abnormalities.

The objective of this study was to analyze the EEG of patients with SCZ using power spectral density and to compare them with those of healthy controls, in order to look for specificities.

This was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for SCZ in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Healthy controls were included. Patients were assessed by the Positive and Negative schizophrenia scale (PANSS). All participants benefited from an EEG at rest condition at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. We have measured the powers of each band using Welch power spectral density method called absolute power (AP). Statistical analyses were carried out.

Fifteen schizophrenics and 15 controls, all male, were included. The average age of schizophrenics and healthy controls was 40 years ±12.72 years and 47.93 ± 15.61 years respectively. There were no significant differences in age between patients and controls. Schizophrenics had a mean PANSS of 64.6±22.7.

At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for the alpha band particularly in the parietal and occipital lobes in schizophrenics (53,16 ± 48,83 μV2 and 75,17 ± 56,28 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). There was also an overall decrease in AP for the different frequency bands in schizophrenics compared to controls. However, values persisted high in the temporal lobe for all frequency bands.

In conclusion, this decrease in AP for the alpha band in the parietal and occipital lobes in schizophrenics can be a sensitive biomarker for diagnosing SCZ.

None Declared

The construct of a clinical high-risk (CHR) state of psychosis has been established to describe potentially prodromal symptoms which typically appear during adolescence and young adulthood. This is a very sensitive developmental period and the clinical high risk (CHR) is associated with increased functional impairment. To address the specialities in the care for this patient population a specialized outpatient care unit for early intervention in psychosis at the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, of the University Zürich (CAPS) is established. The interdisciplinary team (psychiatrists and psychologists) supports children and adolescents with psychotic disorders or at clinical high risk for developing psychosis. The early intervention service offers specialized assessment, treatment and case management for minors with a first psychosis or CHR-state in an outpatient or inpatient setting as well as by day clinic care.

The evaluation main objective was to get a better understanding about this vulnerable patient group. Therefore we analysed the clinical data about CHR-state, comorbid diagnosis, treatment, medication and hospitalisation of the patients who entered the service for early intervention in psychosis.

Participants who entered the service for early intervention in psychosis were followed up in the years 2017-2021 and descriptive analysis was used to summarize the data. For the evaluation of the risk construct the participants have been classified in “no increased risk”, “CHR” or “early onset psychosis” (EOP). Additionally, ICD diagnosis, demographics and treatment (medication, psychotherapy, treatment setting) were assessed. Therapy was either psychotherapy and/or group training called DBT2P (Dialectical behavioral group training for adolescents, to prevent psychiatric disorders). Additionally, the use of a smartphone application “Robin Z”(add-on treatment tool to support the patients between the sessions) was assessed.

In the last five years we saw 300 patients (112 female, mean age 15.7) who sought the care unit for early intervention. The evaluation of the risk showed that 44 patients had no increased risk, 205 were classified with a CHR and 51 fulfilled the criteria of an early onset psychosis (18.5%). Most of the patients showed comorbid diagnosis, mainly depressive disorders (42%). The data about the treatment will be analyzed for the congress.

Despite clinical implications, there is little data about early detection and early intervention in psychosis for children and adolescent. Therefore, the evaluation of the clinical data of the CAPS is of clinical importance and expected to add essential information in the fields of prevention and early intervention in psychosis.

None Declared

Schizophrenia is a heterogeneous disease that is strongly influenced by genetic predisposition. A large variety of candidate genes have been identified, each of which, however, explains only a small proportion of the genetic risk for schizophrenia. Due to the complexity of psychiatric diseases, endophenotypes are of primary interest in psychiatric research. Endophenotypes are stable markers in-between the genotype and the phenotype and are thought to be associated with a small number of genes involved in the pathophysiology of the disease.

To characterize a very sensitive candidate endophenotype of schizophrenia spectrum disorders, based on visual backward masking.

We tested first: Schizophrenia patients, their non-affected siblings, healthy controls and second: various populations of the schizophrenia continuum (bipolar and schizoaffective patients), as well as adolescents with psychosis, abstinent alcoholics, and depressive patients with a very sensitive masking technique.

Schizophrenia patients and their siblings show strong performance deficits. Masking performance of relatives was significantly in between the one of patients and controls. Moreover, deficits were stable throughout one year. The shine-through paradigm distinguishes with high sensitivity and specificity between schizophrenic patients, first-order relatives, and healthy controls. Patients with first episode of psychosis, as well as adolescents with psychosis, have shown clear performance deficit. Deficits are specific to the psychosis spectrum and not evident in depressive patients and abstinent alcoholics.

Our results suggest that the shine-through masking paradigm is a potential endophenotype of the schizophrenia spectrum disorders.

None Declared

Persistent delusional disorder has some features similar to schizophrenia, although the functionality of patients with this diagnosis is usually higher and is diagnosed at an older age. Although the pharmacological treatment of schizophrenia has been studied extensively, there is not much data on the treatment of persistent delusional disorder. Regarding the use of clozapines specifically in persistent delusional disorders, there are some case reports with encouraging results. Electroconvulsive therapy is not generally used as a treatment for persistent delusional disorder.

To reflect on the relevance of using electronvulsive therapy in the treatment of persistent delusional disorder.

Through the description of a clinical case in which there was evidence of remission of resistant psychotic symptoms after clozapine-induced epileptic seizures, the authors hypothesize the existence of a direct relationship between the crisis and the resolution of a persistent delusional disorder.

A.F., 78 years old, male. No personal history of psychiatric or medical-surgical illness. Admitted for psychotic decompensation framed in persistent delusional disorder. The patient underwent pharmacological treatment with resistance to three lines of antipsychotics. With the introduction of clozapine 100mg/day, the patient had two epileptic seizures, followed by complete remission of psychotic symptoms.

The clinical case described refers to a patient diagnosed with resistant persistent delusional disorder, with almost immediate resolution of the condition after epileptic seizures induced by clozapine. Taking into account the clinical response in our patient to two spontaneous epileptic seizures, we hypothesize that electroconvulsive therapy may be effective in the treatment of persistent delusional disorder.

None Declared