A person with “high-risk mental status (HRMS)” indicates that the person, usually young people between the ages of 14 and 25, is more likely to develop psychosis. These people have attenuated psychotic symptoms without reaching the intensity or frequency of a frank psychotic episode. It is suggested that psychological trauma could favor neurochemical and psychopathological changes in a vulnerable individual. It would be interesting to study the role of psychotherapeutic interventions in the course of high-risk mental states and their possible evolution to a psychotic disorder. We present the case of an 18-year-old adolescent whose diagnosis was high risk of psychosis.

This work has several objectives. On the one hand review current information on high-risk mental status (EMAR). On the other hand, develop a discussion about whether the EMAR category should be a diagnostic entity or just a condition.

A bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed in order to expose its own experience in this field, defining specific interventions as well as results.

The case presented is of an 18-year-old female patient.

She states that the main reason for consultation is something that happened last Sunday, at which time he had “an identity crisis” in which he did not know if he was a girl or a boy. The reasoning behind this fact is that “as Pablo Alborán likes him, perhaps he is a boy”. Given the bizarreness of the explanation and the patient’s particular contact, I explore a previous psychopathological situation. She says that since last year she feels more insecure, with diffuse fear that it is difficult to specify or nominate something specific: “in class and that is very difficult for me, public presentations”, she says that “everything scares me”, she says that she has a non-specific fear that has been maintained even increasing over the months and that has led him to have greater anguish. Even though the patient dates the beginning of the picture on Sunday, it is noteworthy that the previous Thursday she had requested a consultation with psychology in the private circuit that although she does not know how to specify the reason “because of fears” it seems that the anguish resulting from this fear had been increasing, having greater difficulties for the presentations in class. The contact is psychotic and the situation that the patient describes is typical of a “treme” situation, cataloged in the current literature as a High-Risk Mental State.

High-risk mental states are not a diagnostic category according to current classifications, although it is necessary to reach a consensus on what the diagnosis implies and what would be the way to proceed when a patient presents these symptoms.

None Declared

Schizophrenia, a chronic and complex psychiatric pathology, can be isolated. However, it may have other comorbidities and thus be accompanied by addictive behaviors complicating their management.

to estimate the prevalence and identify the characteristics of addictive behavior among patients with schizophrenia.

A retrospective study of 151 patients with schizophrenia and hospitalized in the psychiatry department of the Taher Sfar university hospital in Mahdia from January 2017 to December 2021.

The mean age of the patients was 39.8 ± 11.23 years with a predominance of age group 36-45 years (38.4%). All of the patients were males . Three quarters of patients (75.5%) were users of psychoactive substances (PSA): nearly three quarters (72.8%) dependent on tobacco, more than a third (39.7%) dependent on alcohol, more a quarter (29.1%) dependent on cannabis and almost a quarter (26.5%) dependent on other SPA. In more than half of the cases (54.4%), the age at which SPA consumption began was between 16 and 25. SPA use preceded the onset of schizophrenia in 62.3% of case. The relationship with the entourage was marked by hetero-aggressiveness in 77.5% of the patients, a withdrawal from the entourage for 16.6% of the patients and a conflict for 5.3% of the patients. The impact on the relationship with oneself was marked by self-aggressiveness in 18.5% of patients. Regarding professional impact, three quarters of patients (76.1%) had to stop working. The majority of patients (84.1%) continued their usual treatment, while 15.2% of patients stopped it. In only one patient increased doses were necessary.

Subjects suffering from schizophrenia are particularly vulnerable to addictions, mainly to tobacco and alcohol. They are therefore a group at greater risk of harmful effects of psychoactive substances and at worsening the clinical course of their psychiatric illness. Screening and treatment measures their addictive behaviors early on, even before schizophrenia sets in, should be offered.

None Declared

Schizophrenia is a debilitating and mutilating mental illness, generally progressing in a Chronic way . It is at the origin of a limitation of social autonomy and source of psychological distress .

evaluate the effective social autonomy of schizophrenic patients.

it is a cross-sectional study carried out at the EPS psychiatry consultation in Mahdia during a period of 3 months, with schizophrenic patients meeting the DSM 5 criteria, having an age varying from 19 to 65 years and whose duration of evolution was at least of one year. Have been excluded those in a state of decompensation, presenting a severe organic disease or having a major cognitive impairment. Information was collected from patients and fromtheir medical records using a pre-established questionnaire. The scale of social autonomy (EAS) of Legay with 17 items grouped into 5 dimensions was used for the evaluation.

The general characteristics of the 360 schizophrenic patients who met the inclusion criteria, revealed an average age of 40.2 years, a sex ratio of 2.33, a majority of single (55.8%), a low level of education(66.7%), an absence of professional activity (67.3%) and a deteriorated socioeconomic level (68.6%).Clinical Characteristics noted an average onset age of the disorder of 26 years, an average duration of evolution of 14 years and a preponderance of the residual type and of the episodic evolutionary course with residual symptoms between episodes respectively in 40.6 and 76.4%. The average of EAS scores were 39.08. Three quarters of the population (75.7%) had a score below 59. 24.3% of patients had scores between 60 and 108 signifying impaired social autonomy.

The evaluation of effective social autonomy is essential for any therapeutic project considering psychosocial integration and rehabilitation of schizophrenic patients.

None Declared

Schizophrenia is a severe mental illness but especially important in terms of its impact on the subject. The stigmatization of these patients is major, leading to a significant decrease in their quality of life. This is partly due to the media coverage of the rare cases of hetero-aggression.

The aggressiveness of schizophrenic subjects remains poorly known and little studied.

The objectives of our study are to determine whether the prescription of second-generation antipsychotics is associated with lower levels of aggression than the prescription of first-generation antipsychotics and to identify aggravating factors.

Materials and methods: We used an anonymous questionnaire based on, in addition to individual status and conditions, a self-administered questionnaire to assess the degree of aggression (the Buss and Perry Aggression Questionnaire (BPAQ)).

Our study demonstrated superiority of second-generation antipsychotics in preventing aggression in subjects with schizophrenia, as well as an association between increased aggression and low insight, low compliance and low social support. In addition, younger age, male gender, and lower education were associated with increased aggression.

The prevention of aggression would then begin with the management of psychotic symptoms and comorbid disorders, as well as work on the compliance and insight of these patients. However, the aggressive dimension persists in some of them.

None Declared

Catatonia is a transnosographic and potentially fatal syndrome, most often associated with mood disorders or schizophrenia, but can also develop in autistic disorders, dementia, as well as in general medical conditions such as epilepsy, autoimmune encephalitis, hypercalcemia, hepatic encephalopathy, or diabetic ketoacidosis.

the objective is to understand the semiology and treatment of catatonic syndrome in a clinical case

Clinical case

The work we present is based on a clinical case of a patient with schizophrenia presenting a catatonic syndrome, of which a neurological cause was first evoked but after clinical investigations the diagnosis of schizophrenia was retained and currently the patient is stabilized on Clozapine. It is imperative to recognize a catatonic syndrome in order to treat it quickly, as some of the etiologies that cause this syndrome and the consequences of the syndrome itself can be life-threatening.

Catatonia remains a subject of research for centuries, the diagnosis is clinical, based on a set of criteria grouped in the DSM5, its etiologies are psychiatric and organic including neurological. Rapid diagnostic and therapeutic management is essential to avoid life-threatening complications.

None Declared

Schizophrenia is a severe, common, chronic mental disorder with a prolonged and disabling course, having a high social impact.

Mortality is two to three times higher in schizophrenic patients than in the general population.

Suicide is the main cause of death in patients with schizophrenia. In spite of great efforts in preventing such deaths, suicide rates have remained alarmingly high, highlighting the need for a better understanding of the phenomenon.

The objective of this work is to determine the prevalence of suicide in schizophrenic patients, to investigate the main risk factors in these patients and the characteristics of suicide and the therapeutic management of the patients.

This is a retrospective study on medical records about 43 patients (32 men / 11 women) who were admitted to the Arrazi Hospital in Salé, from september 2021 to september 2022, using an operating form grouping socio-demographic criteria of the patients, personal and family history, characteristics of the suicide attempt and management.

In this study, 75% were male and 25% were female with an average age of 34.5 years. The existence of a personal history of suicidal ideation, plans and attempts is a major risk factor for suicide. The lethality of the means used reflects a higher degree of suicidal intentionality. Clozapine, in particular, plays a protective role by reducing the rate of suicides and suicide attempts.

Despite therapeutic progress, the prevalence of suicide among patients suffering from schizophrenia is still high.

The prevention of suicide in these patients remains fundamental, as does the reduction of positive or negative symptoms, the improvement of quality of life, the reduction of the handicap caused by this illness and the fight against the stigmatization of patients.

None Declared

Substance use disorders among individuals with psychotic disorders are a common. This is generally linked to more symptoms, worsened illness and high rates of treatment non-adherence. Long acting injections offer reliable drug delivery, reduce relapse risk and mortality (Khan et al 2016, Correll et al 2020) and can be used in individuals using illicit substances (Coles et al 2021, Erdogan et al 2021).

Aim was to look at literature comparing morbidity and mortality between oral versus long acting antipsychotics in patients with Schizophrenia and psychotic disorders who are currently using illicit drugs.

A literature search was conducted using keywords long acting antipsychotic injection / depot and substance use on databases EMBASE, Psychinfo, Medline and CINAHL.

A review of psychopharmacological properties of first and second generation LAI (Taylor 2009) noted that use is complicated by adverse effects and confusion over dose response relationships. Atypical antipsychotics may induce direct cardiovascular alterations, probably through apoptotic effect of dopamine receptor D2 (DRD2) blockade. A cross sectional study (Dehelan et al 2021) looked at cardiac ejection fraction (EF) in 123 patients with Schizophrenia or Schizoaffective disorder on Aripiprazole, Olanzapine, Paliperidone and Risperidone Long acting injections. A trend was observed indicating that patients treated with an antipsychotic associated with a lower affinity for the DRD2, such as Olanzapine, have higher EF values than patients treated with antipsychotics with a stronger binding to the DRD2, such as Paliperidone and Risperidone. Patients receiving Aripiprazole, which has the strongest affinity for the DRD2 from all four antipsychotics but is also a partial DRD2 agonist, display higher EF values than those on Paliperidone and Risperidone.

A critical systematic review and meta-analysis of randomised long term trials looking at oral vs depot antipsychotic drugs for Schizophrenia (Leucht, Claudia et al 2011) included 10 studies. Relapse was significantly reduced in patients on long acting injections. There was limited data on non-adherence, drop outs and adverse events. This data revealed no significant differences. There is concern with methodological issues in trials and possibility of bias.

Another systematic meta review of randomised controlled trials of long acting antipsychotic injections (Adams Clive et al 2001), found no difference in adverse effects in long acting injections vs oral medications but small benefit on global outcome measure (relapse).

Larger studies of populations of patients who are using illicit substances and are on long acting antipsychotic injections are required to discern differences in long term adverse effects in this population .

None Declared

The Living Through Psychosis (LTP) programme at St Patrick’s Mental Health Services, Ireland (SPMHS) is heavily informed by the Compassion Focus Therapy (CFT) for Psychosis model. LTP offers an opportunity for service users to develop compassion skills to cope with emotional and psychological challenges relating to living with psychosis; and to develop their capacity to for a mindful, non-judgemental and compassionate awareness of distressing thoughts and images.

This (ongoing) online survey explores both service user and clinician attitudes towards the CFT-informed LTP group. We also aim to identify any potential concerns that might demotivate referrals to LTP and similar programmes, and to explore what are judged to be its benefits. The study also provides an opportunity to develop and improve the LTP programme to best fulfil service users’ needs.

The online survey is concise and responses are anonymous. Clinicians and service users complete similar-but-separate sets of questions that are adapted for relevancy and wording. The survey mainly consists of Likert Scale questions in relation to potential participation in, or referral to, LTP (after a visually-aided description of LTP is provided online within the survey). Using convenience sampling, the survey has been distributed among clinicians and service users through email and Internet advertisements within SPMHS and psychosis organisations such as Psychosis Ireland. Descriptive analysis is used for quantitative questions, while thematic analysis covers qualitative questions.

Data collection is currently ongoing and will finish in December 2022. Preliminary results will be presented at the conference.

Conclusions will be derived from the results. It is anticipated that the findings will be helpful in further developing the LTP programme and similar CFT programmes for psychosis.

None Declared

6-monthly paliperidone palmitate features an initiation regimen through 1-monthly paliperidone palmitate or 3-monthly paliperidone palmitate. Some patients don´t have sufficient adherence to treatment and it is necessary at the clinical level to start directly with 6-monthly paliperidone palmitte. There is une little clinical experience with these alternative initiations and throuht this work those that have been carried out for 12 months at the Rey Juan Carlos Hospital are exposed.

The main objective of the study is to describe the alternative initations performed with 6-monthly paliperidone palmitate in routine clinical practice, having opted for a regimen different from the standard for clinical reasons.

A retrospective selection of patiens will be made throuht non-probabilistic consecutive sampling, including all patients who have benn administered 6-monthly paliperidone palmitate with a stard different form the standard during the last 6 months. To do his, the electronic medical record will be used, first selecting the patients who have started 6-monthly paliperidone palmitate through the anonymized digital records and, later, including in the study only those who have followed and alternative initiation pattern. The variables studied will be the following: age, sex, diagnosis, dose of paliperidone palmitate, initiation regimen, consumption of toxic substances, absenteeism from 6-monthly paliperidone palmitate, visits to the emergency room and admissions.

The study included a total of 5 patients ( n:5). 80% of the patients were male and 20%were female. The mean age was 39.7 years. 80% of the patients had an associated substance use disorder. The following alternate sarting schedules were with biannual paliperidone palmitate: monthly paliperidone palmitate 150 mg together with semi-annual paliperidone palmitate both on day 1 ( n: 2) or monthly paliperidone palmitate 150 mg on day 1, monthly paliperidone palmitate 100 mg on day 5 and semi-annual paliperidone palmitate on day 12 ( n: 3 ).

A total of 0 visits to the emergency department and 0 admissions were observed after the 6-monthly paliperidone palmitate regimen.

Alternative initations with 6-monthly paliperidone palmitate may be a useful and safe clinical alternative in patients with very low adherence who, due to clinical needs, require startin 6-monthly paliperidone palmitate earlier in order to guarantee adherence .

None Declared

Schizophrenia is a highly debilitating disorder afflicting more than 24 million individuals worldwide. In Mexico, the Ministry of Health estimates that it affects more than 1 million people. Suicide is one of the main causes of death among people diagnosed with schizophrenia, their risk is 12 times higher than in. the general population

To evaluate the clinical characteristics of schizophrenic patients at risk of suicide in the Latino population.

We included 130 patients recruited from genetics studies in Latino patients with schizophrenia from the outpatient and inpatient psychiatric ward of the University Hospital “Dr José E. González” in Monterrey, Nuevo Leon, Mexico. Beck Depression Inventory (BDI-II), the Convergent Functional Information for Suicidality (CFI-S) were applied to all participants. We compared the sociodemographic and clinical characteristics of patients with suicidal risk (measured by history of suicidal attempt or current suicidal risk) and present depressive episode.

Of the 130 participants, 66.9% were male, the median age was 38 years. We found 11(14.3%) patients with suicidal risk and 119 (91.5%) without suicidal risk. Sociodemographic and clinical characteristics of the study population at risk of suicide are described in graphic 1. Patients with a history of suicide attempt scored higher on the CFI-S scale with a median of 0.5 (q1=0.45; q3=0.54) vs. 0.31 (q1=0.22; q3=0.45) (p= 0.004)(Graphic 2). Based on the BDI-II we found 2.30% patients showed a mild depression, 20.0% moderate depression and 4.61% severe depression (graphic 3). Schizophrenic patients with a previous suicide attempt and depressive episode had higher score range in CFI-S, median .65 (q1=.65; q2=.59, p=0.000). Also, 63.60% were severely depressive (p=0.000) when they compared with patients with low risk of suicide. Schizophrenic patients with suicidal risk were characterized by: age >=60 years old, unemployment, no children, single, without religion, family history of suicide, previous suicide attempt, depressive episodes, substance abuse, auditory hallucinations and referential delusions.

Image:

Image 2:

Image 3:

In our study with Latino population, we observed similar clinical characteristics predictive of suicide risk described in the international studies. Our study is relevant to applied preventive measures in groups of schizophrenic patients with risk factors and their relatives.

None Declared

Substance abuse is common among patients with schizophrenia, is related toworse course and outcome of illness. Unfortunately, little is known about how substanceabuse affects the cognitive function of schizophrenia patients, whose cognitive function isoften already comprised. Neurocognitive functioning includes inhibition control and decision-making, and both schizophrenia and substance use disorder are related to impairmentsof inhibition control. However, the influence of substance abuse on inhibition capacitiesamong schizophrenia patients is unclear

This study measured the influence of substance use disorder on inhibition capacities and risky decision-making in a group of 39 schizophrenia patients that were evaluated using a socio-demographic questionnaire and clinical assessment using the Positive and Negative Syndromes Scale for Schizophrenia. To assess inhibition control we utilized the Matching Familiar Figure Test (MFFT) and the Stroop task, and to evaluate decision-making we used the Iowa Gambling Task (IGT) and self-report questionnaire, the Barratt Impulsiveness Scale

Univariate analysis found significant differences between the groups with regard to criminal history (v2¼5.97, p¼.015), smoking status (v:12.30, p<.001), and total BIS score (t: 2.69, df¼37, p¼.01). Our model did not find a significant effect of substance abuse on the first response time and number of errors on the MFFT or in the total interference index of Stroop performance and net score on risky decision-making in the IGT.

The two groups did not differ significantly either in first response time or in number of errors on the MFFT (F¼0.54, p¼.47, d¼0.24, 95% CI [-0.4, 0.88]; F¼0.28, p¼.60, d¼0.61, 95% CI [0, 1.26], respectively), nor did they differ in the total interference index of the Stroop task (F(1)¼0.49, p¼.49, d¼0.25, 95% CI [-0.38, 0.88]).

The analyses did not detect any statistically significant effect of substance abuse on inhibition control or risky decision-making processes in outpatients diagnosed with schizophrenia, despite increased impulsivity, criminal history and smoking status. These results neither support nor disprove previous findings.

None Declared

Patients’ cooperation, especially in medication taking, constitutes a significant challenge in psychiatric care. Psychiatric patients are often reluctant to take a specific pharmacological treatment because of side effects. Akathisia and other extra pyramidal symptoms are side effects that could result into real danger and are thought to be the main reasons of discontinuing pharmacological treatment. Despite this, some gaps in research knowledge exist on the rate of psychiatric patients that suffer from Akathisia. For example, Clozapine treatment, despite its efficacy, is often disqualified due to side effects concern. The research literature barely refers to the development of extrapyramidal symptoms, and more specifically Akathisia. There are few reports about Akathisia when taking Clozapine. It results into a lack of objective studies and knowledge based only on subjective clinical evaluations.

This study aims at comparing Clozapine and Risperidone in general, with or without polypharmacy and more especially, in terms of Akathisia.

This research was carried out in Abarbanel Mental Health Center over a period of six months. The study population included 100 patients, including hospitalized and ambulatory patients. They were equally divided into two groups: 50 patients who received Clozapine, and 50 patients who received Risperidone. It should be noted that due to polypharmacy, 17 patients in the Clozapine group and 6 patients in the Risperidone group received additional anti-psychotic treatment. Akathisia was evaluated using Barnes Akathisia Scale (BAS).

The demographic and clinical data was found identical in both groups. We found that Akathisia symptoms appeared 1.4 times more in patients who took Risperidone only, compared to those who took Clozapine only (p < 0.05). This research emphasizes the irrelevance of existing data on anti-psychotics’ treatments, while 24% of the patients treated with Clozapine and 34% of the patients treated with Risperidone showed Akathisia symptoms.

Akathisia symptoms are very common in patients who take anti-psychotic treatment as Clozapine and Risperidone. Previous research revealed that Akathisia is very common for Risperidone patients, however the symptoms are often neglected in patients taking Clozapine. We show in our research that the rate of Akathisia is high in both treatments. Therefore, the importance of diagnosing akathisia should be emphasized in patients treated with Clozapine. Moreover, Akathisia should receive much more importance when choosing anti-psychotic treatment.

None Declared

l’actualité de la recherche en psychiatrie se focalise sur la possibilité de nouvelles pistes de prise en charge notamment celles qui sont basées sur la chimiothérapie, et ce, en dépassant le spectre de la prescription des neuroleptiques.

L’actualité de la recherche en psychiatrie se focalise sur la possibilité de nouvelles pistes deprise en charge notamment celles qui sont basées sur la chimiothérapie, et ce, en dépassant lespectre de la prescription des neuroleptiques.

la place des anti-inflammatoires dans la prise en charge de la schizophrénie

Une étude publiée dans l’American Journal of Psychiatry suggère qu’une plus grande activité microgliale peut être un signe de schizophrénie. Ainsi, la détecter et la réduire pourrait être un élément de prévention de cette maladie. Une étude publiée dans l’American Journal of Psychiatry suggère qu’une plus grandeactivité microgliale peut être un signe de schizophrénie. Ainsi, la détecter et la réduire pourraitêtre un élément de prévention de cette maladie.

Il a été constaté qu’une activité microgliale élevée coïncide avec la réduction du volume de la matière grise chez les sujets atteints ou à risque de développer la schizophrénie. Ce paramètre est aussi un signe de gravité symptomatique chez les patients atteints de cette maladie.

Il a été constaté qu’une activité microglialeélevée coïncide avec la réduction du volume de la matière grise chez les sujets atteints ou à risquede développer la schizophrénie. Ce paramètre est aussi un signe de gravité symptomatique chezles patients atteints de cette maladie.

Cette étude ouvre une nouvelle voie dans le traitement de la schizophrénie, par l’ajout au traitement de molécules ayant des propriétés anti-inflammatoires chez les patients présentant une résistance au traitement antipsychotique.

None Declared

Substance misuse increases the risk of developing psychosis in vulnerable people. However, patients with substance use disorders’ attributes and their effect on first-episode psychosis (FEP) are still unclear.

To describe and compare inpatient admissions for FEP with substance misuse and its impact on clinical outcomes.

We conducted an observational and retrospective study, analyzing sociodemographic determinants and clinical data regarding the patients hospitalized for FEP, between January 2019 and June 2022, in the psychiatric unit at our hospital in Bragança, Portugal. We used logistic regression to estimate the effect of social determinants and other clinical data regarding the patients hospitalized for FEP with substance abuse.

We included 78 patients in this study. Of these patients, 30% (n=23) reported substance (drugs or alcohol) misuse prior to hospital admission. Regarding only the patients with substance misuse, 96% were male and the median age was 31 years. Cannabis was the most often reported substance of abuse (83%). Most of these patients were unmarried (OR:10.794; 95%CI:2.855-40.805;P=0.001), lived in a rural setting (OR:0.263; 95%CI:0.094-0.731;P=0.009) and had no previous psychiatric history (OR:1.022; 95%CI:0.386-2.709;P=0.964).Regarding hospital admission, 70% were involuntary admitted (OR:4;95%CI:1.408-11.366;P=0.007) and the median time of hospitalization was 17 days. At the time of discharge, 48% of these set of patients still didn’t have insight into their mental illness (OR:1.737;95%CI:0.646-4.679;P=0.272). During the evaluation period of this study, 13% of the patients were readmitted to the hospital (OR:1.029;95%CI:0.241-4.383;P=0.970) and 35% missed outpatient appointments (OR:3.133;95%CI:1.003-9.791;P=0.044). The diagnoses at the time of discharge were: substance-induced psychosis (52%), schizophrenia (22%), affective psychosis (17%), and acute and transient psychotic disorder (9%).

This analysis indicates substance misuse predates and is prevalent in FEP. Many of these patients fail to recognize and accept that they are suffering from a mental illness and drop out of outpatient psychiatric care. Further, substance-induced psychoses are associated with a significant risk for transition to schizophrenia particularly following cannabis-induced psychosis. Thus, it is crucial to optimize adherence to the therapeutic regimen and outpatient follow-up.

None Declared

Long-acting injectable antipsychotics (LAIAs) are currently the most effective alternative for patients with schizophrenia who exhibit poor adherence. LAIAs can lead the course of treatment with the potential to increase adherence in schizophrenia treatment.

Present the results of a network metaanalysis on the comparative efficacy of LAIs in schizophrenia.

Included trials of adults with schizophrenia compared the efficacy of LAI vs LAI or placebo through the Positive and Negative Syndrome Scale (PANSS). Efficacy was evaluated through the standarized mean differences (SMD) from baseline to endpoint in the PANSS total scores.

Results from 15 studies reported usable results for PANSS score (five antipsychotics compared) are shown in Figure 1. In hierarchical order, haloperidol, aripiprazole, risperidone, and paliperidone reduced the PANSS score significantly more than other drugs.

Image:

Most LAIAs are equally efficient at reducing overall symptoms, and differences between individual LAIAs are non-significant.

None Declared

Chronic mental illnesses are long-lasting and recurring, require continuous care as well as an integrated and collaborative approach to organize the care. This study sought to examine whether family center collaborative care is an acceptable treatment option for individuals with chronic mental illness.

Is the family-centered collaborative care suitable for patients with chronic mental illness?

From the years 2000 to 2021, ten electronic databases relating to family-centered collaborative care for mental illness were searched adopting PRISMA’s checklist

After systematic search, 27 articles and a thesis were found. According to moderate to high quality qualitative research, family-centered collaborative care was considered acceptable intervention, though a few studies supporting it.

This study examines theoretical, methodological, and practical considerations as a basis for more robust data collection based on individual experiences and evidence-based practice.

1. 1. Wittchen, H.-U., et al., The size and burden of mental disorders and other disorders of the brain in Europe 2010. European neuropsychopharmacology, 2011. 21(9): p. 655-679.

2. 2. CUTLER, J.L., Kaplan and Sadock’s synopsis of psychiatry. 2016, LWW.

3. 3. Thornicroft, G., et al., The personal impact of schizophrenia in Europe. Schizophrenia research, 2004. 69(2-3): p. 125-132.

4. 4. Vigo, D., G. Thornicroft, and R. Atun, Estimating the true global burden of mental illness. The Lancet Psychiatry, 2016. 3(2): p. 171-178.

None Declared

We present the case of a 19-year-old patient who experienced a nonexisting moving sensation, increasing size and painful sensation on tongue, jaw and skull bones. Likewise, the patient showed high anguish, psychomotor restlessness and low mood, in relation to somatic symptomatology; which severely interfered in his life, dropping his university studies and his social life. He also presented thoughts of being victim of a complot of his classmates.

To present a case report and to review the literature of coenesthetic schizophrenia.

Literature review of scientific articles searching in EMBASE and Pubmed. We considered articles in English and Spanish.

Treatment with oral aripiprazole and sertraline was started, with progressive clinical improvement, decreasing somatic sensations until they disappeared, as well as mood improvement and remission of anxiety and psychomotor restlessness.

Coenesthetic schizophrenia was first described in 1957 by Gerd Huber. It is characterized by bodily sensations often combined with affective disturbances. Other symptoms that occur frequently are affective, vegetative, motor and sensory alterations. Typical schizophrenic symptoms are limited to brief psychotic episodes.

We consider knowledge of this entity important, given the differential clinical characteristics regarding to other presentations of schizophrenia, as well as the need to do a differential diagnosis with other disorders such as body dysmorphic disorder or hypochondriasis.

None Declared

In spite of the progress observed in the last decade particularly in the field of the neurosciences, areas of controversy and incomplete concepts still remain in psychiatry. One relates to the study the heterogeneous group of schizophrenic spectrum functional psychosis that arise along the neurophysiological aging process. Kraepelin first used the term paraphrenia in 1912, to describe a psychotic disorder with much lighter impairment of emotion and volition, minimal to no cognitive deterioration (dementia) and personality preservation compared to dementia praecox. However, since its first descriptions, late-onset psychoses have received different descriptions and definitions.

Brief review of the evolution of paraphrenia concept, focusing not only on pioneering currents, but also articulating it with recent conclusions on late-onset psychoses.

Systematic revision of literature.

After Kreapelin pioneerism, Bleuler and Mayer-Gross would contribute to the weakening and disruption of the Kraepelinian concept of paraphrenia. In the first half of the 20th century, psychiatry was moving towards the dissolution of this concept. British psychiatrists would later rehabilitate the concept of paraphrenia but to designate a very late-onset variant of schizophrenia - late paraphrenia. This influenced the International Diseases Classifications (ICD), and the 8th edition was the first to consider paraphrenia as a subtype of paranoid schizophrenia.

By the end of the 20th century, both ICD-10 and various editions of DSM since DSM-III-TR (inclusive) omitted the category of paraphrenia, allowing the super-inclusiveness of the schizophrenia category and discouraging research on the theme.

In the late 20th century, late paraphrenia was conceived as a group of heterogeneous disorders that included paranoid and organic psychosis. To date, the term very late onset schizophrenia-like psychosis is the term used to replace late paraphrenia.

The nosological consecration of paraphrenia suffered several misfortunes over the last century. The schizophrenic psychosis “black-hole” conceived at the same time contributed to this concealment. In addition, modern pharmacology also allowed the neuroleptization and homogenization of disorders with psychotic symptoms which led to the devaluation of some diagnostic possibilities in the “neighborhood” of schizophrenia.

We propose a nosological frame composed of two distinct entities: one based on a neurodevelopment disorder - schizophrenia - with insidious onset at a younger age, with a hereditary background and greater global deterioration, an the other, with a neurodegenerative basis - paraphrenia - with an abrupt and later onset, less contribution of genetic factors, greater preservation and lower probability of dementia development.

None Declared

Psychosis is a frequent complication in patients diagnosed with Parkinson’s Disease (PD). Characterized mainly by visual hallucinations and paranoid delusions, it occurs most frequently, but not exclusively, as an adverse effect of antiparkinson medications. Nevertheless, cognitive impairment and dementia, as a frequent feature of PD, needs to be considered for differential diagnosis.

Our main objective is to report a case of PD Psychosis, its diagnosis and management and complement it with a non-systematic review of literature.

Patient file consultation and an additional research, based on the key words “Psychosis” and “Parkinson’s Disease”, using Pubmed as database.

A 53-year-old female, diagnosed with Juvenile Parkinson’s Disease since age 45 and, as expected, polimedicated with antiparkinson medication. Without any relevant psychiatric background, she was admitted to the emergency department for disorganized behaviour, with 2 weeks of evolution. There, it was also possible to determine the presence of auditive hallucinations and persecutory delusions, associated with marked anguish.

After exclusion of any underlying cause for this symptomatology, inpatient treatment was proposed and accepted by the patient. In collaboration with the Neurology Department, a gradual reduction and optimization of antiparkinson drugs was conducted, associated with introduction of low doses of antipsychotic drugs, in this case Olanzapine. With this medication adjustments, clinical improvement was accomplished, with eventual fading and cessation of psychotic symptoms. Additionally, an irregularly intake of antiparkinson drugs was considered the most probably cause of this clinical decompensation.

As present in literature, due to the chronicity and complexity of PD, stopping all antiparkinson drugs is not an option, even when psychotic symptoms, that could be a consequence of these drugs, are present. Therefore, a rigorous evaluation and management are mandatory, including the exclusion of other underlying causes and a careful therapeutic adjustment, with gradual reduction of antiparkinson drugs, addressing an eventual temporal relationship between the beginning of a specific drug and the onset of symptoms, and verification of therapeutic compliance, including an involuntary overdose. In cases of refractory symptoms, and after a risk-benefit assessment, pharmacologic treatment directed at these symptoms, low doses of anti-psychotics, may be necessary.

None Declared

Proper nutrition with fats has a protective effect on the functioning of the nervous system. However, a disturbed ratio of essential polyunsaturated fatty acids supply is nowadays a common phenomenon. A diet overloaded with saturated fats and a shortage of those essential ones in the company with possibly some unfavorable genetic endowment could lead to the release of psychosis from the framework of diet defined by nature for thousands of years.

The study aims to review the literature to assess the influence of supplementation with polyunsaturated fatty acids in the occurrence of psychotic disorders prevention, as well as their impact on remission prolongation.

Literature review in PubMed, Google Scholar, and Web of Science using the keywords [psychosis] OR [psychotic] OR [schizophrenia] OR [unipolar] OR [bipolar] OR [schizoaffective] OR [depression] OR [manic] OR [hypomanic] OR [mania] OR [hypomania] OR [first episode psychosis] OR [ultra-high risk] OR [UHR] AND [polyunsaturated fatty acids] OR [PUFA] OR [prostaglandin] OR [phospholipid] OR [phospholipase A2] OR [arachidonic acid] OR [linoleic acid] OR [alpha-linolenic acid] OR [omega-3] OR [omega-6] OR [nutrition] OR [diet]. The review included original articles, reviews, systematic reviews, meta-analyses, and case reports from 1977-2022 in Polish and English.

86 articles devoted to diet and nutrition in psychotic disorders were analyzed. Patients with schizophrenia, bipolar disorder, and schizoaffective disorders exhibit deficiencies in polyunsaturated fatty acids. Such results may indicate compliance with David Horrobin’s theory of the psychotic disorders development in predisposed individuals.

Supplementation with polyunsaturated fatty acids may be a chance for a selected group of patients to prolong remission but also hope to prevent the occurrence of psychotic disorders in particularly vulnerable individuals.

None Declared