Schizophrenia is a major mental illness with a progressive course. Thirty percent of cases of patients with schizophrenia do not respond to adequate trials of at least 2 different groups of antipsychotics are currently classified as having treatment resistant schizophrenia (TRS). Clozapine remains the gold standard, treatment of choice for TRS. However, clozapine does not come without its own challenges. Its risk profile, particularly agranulocytosis, reported in 1% of cases, has led to the necessity of weekly blood counts within the first 18 weeks of treatment and subsequently every month with slow dose titration. Clinically, sedation, weight gain and hypersalivation may further hamper the compliance of patients. Non-compliance has been reported to cause rebound psychosis. Recent studies have raised questions as to which antipsychotic is most efficacious for TRS. Thus, we conducted a systematic review of high dose olanzapine treatment for people with TRS.

A systematic review of prospective studies found through search of PubMed, Scopus and hand-searched key papers which included randomized controlled trials and open-label studies which looked at high dose of olanzapine treatment response for TRS.

The study is currently ongoing and preliminary results will be presented at the conference in April 2017.

The gravity of burden TRS brings to patients extends itself to their families, carers and clinicians. Further evidence on which antipsychotic is more efficacious for patients with TRS would have huge implications in terms of health benefits for the patients, better informed clinical decisions and also health economics in general.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a chronic mental illness associated with several functional impairments. There has been an increasing interest in the impact of schizophrenia on functioning. The development of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for schizophrenia, a shortlist of 97 ICF categories that are relevant for describing functioning and disability of people living with schizophrenia, has derived from this interest.

This study aims to explore the content validity of this core set from the perspective of psychiatrists.

In a 3-round Delphi survey, psychiatrists experienced in schizophrenia treatment were asked about patients’ problems, resources and environmental factors they treat in patients with schizophrenia.

A total of 352 psychiatrists from 65 countries representing all six World Health Organization regions completed the first round questionnaire. The response rate at the third round was 86%. Answers were linked to 422 ICF categories. Of all these, 109 ICF categories reached consensus (≥ 75% agreement) at the third round. Eighty-seven out of the 97 ICF categories that form the comprehensive ICF core set for schizophrenia were represented in this list. All the comprehensive ICF core set for schizophrenia categories reached consensus except five categories.

The content validity of the comprehensive ICF core set for schizophrenia from the perspective of psychiatrists was largely supported. However, further research is needed including other health professionals (e.g., psychologists, nurses and occupational therapists) to further obtain new content validity evidences.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Improved insight level among schizophrenia patients is predictive for better illness prognosis.

Explore factors connected to insight.

Evaluate the insight level and clinical characteristics of first time hospitalized schizophrenia spectrum patients.

All consecutive first time hospitalized schizophrenia spectrum patients in a psychiatric hospital from 01.01.2016–26.09.2016. Patients were interviewed upon hospitalization and at the discharge with Scale for the assessment of positive symptoms (SAPS) and negative symptoms (SANS), Schedule of assessment of insight-extended (SAI-E), The Calgary depression scale for schizophrenia (C-sch), sociodemographic and clinical data were collected. All participants signed written informed consent and the study was approved by the Riga Stradins University Ethics committee.

From 45 first episode patients, 38 met the inclusion criteria. Mean age was 37.66 years (SD: 11.48 years), the average duration of untreated illness (DUI) was 40.5 months (SD: 57.35 months). Psychopathologic symptoms and insight levels evaluated in scores in the 1st and 2nd interviews were as follows: SAPS 69.11 (SD: 20.78) and 33.61 (SD: 18.04), SANS 63.21 (SD: 25.30) and 40.95 (SD: 24.47), SAI-E 15.50 and 27.24 (SD: 13.24), P < 0.001, C-sch 8.50 (SD: 5.31) and 4.27 (SD: 2.86), P < 0.05. There was no statistically significant correlation between DUI and insight level. A higher level of insight at hospitalization correlated with higher levels of depression: r = 0.569, P < 0.001.

We noticed a tendency that lower insight levels might correlate with longer periods of untreated illness. We found that higher insight levels correlated with higher symptoms of depression.

The authors have not supplied their declaration of competing interest.

Only 21% of patients included in the South of Granada's First Episodes Program in the year 2014 were women. Studies do not use to focus on sex differences at first-episode samples and it can be masking some relevant variables in this population.

In this exploratory study, we aim to focus on gynaecological consultations during the period of untreated psychosis (DUP) at first episodes of psychosis in women.

A retrospective clinical-cases review of medical histories was made searching for sociodemographic variables, consultations during DUP and psychotic prodromal outcomes.

The average age of the sample was 23 years. The average of DUP was one to three months. Sixty percent of referees to mental health services were from primary care and 20% from emergency services. The main symptom was persecutory or prejudice delusions. Thirty-six percent of them were related to sexuality or pregnancy. In most cases, the demands were not bizarre. When a wide history was made and they were properly explored, a delusional theme was appreciated and the reason for consultation was not justified. Eg. Postcoital pill order for not taking precautions, in a telepathic relationship. Forty percent of claims were made in primary care. Half of them were assessed by a gynecologyst. Sixty percent were treated in the emergency room.

We conclude that these data are relevant for specialists. Both for efficient resource management and for early detection of incipient psychosis. Gynecological abnormal demands are common in consultations to health services for specific malaise during the period of untreated psychosis.

The authors have not supplied their declaration of competing interest.

There are many jobs that offer advantages of treatment with long-acting injectable in psychosis.

To know the changes in the different variables after the start of paliperidone palmitate (PP).

We performed a descriptive and retrospective study. Were evaluated patients who received maintenance therapy with PP during 48 months.

The sample was composed of 29 patients: 72.4% men and 27.6% women. Average age of 46.21 years. In Figures 1, 2 and 3 show data obtained in relation to compliance with treatment, relapse, maintenance dose, number of admissions and visits to emergency departments respectively.

The administration of PP is associated with a higher level of compliance with treatment. The patients presented a lower number of relapses, hospitalizations and visits to the emergency room. The maintenance dose more used is 150 mg.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Both 1st and 2nd generation of antipsychotics are associated with prolonged QTc interval. Prolonged QTc can lead to ventricular tachycardia and Torsade's de pointes, ultimatime resulting to cardiac arrest and sudden death. Prolonged QTc interval due to increased DDD has not yet been investigated.

To investigate whether increased DDD of antipsychotics, causes further prolonged QTc, by patients diagnosed with schizophrenia.

To learn more about antipsychotics impact on the QTc interval in patients diagnosed with schizophrenia.

An observational study of unselected patients diagnosed with schizophrenia. Enrolled from January 2013 through March 2015 with follow-up until June 2015 in the region of central Denmark. Data was collected from ECG records and patient journals.

ECGs were available in 58 patients. We observed no relation between increased DDD of antipsychotics and prolonged QTc. There were no differences in average QTc interval for the whole sample of patients receiving different DDD of antipsychotics.

We do not recommend increased attention to patients treated with higher DDD of antipsychotics.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Recent evidence points to a critical role of redox dysregulation induced oxidative stress in the pathophysiology of early phases of schizophrenia. An add-on trial with n-acetyl-cysteine (NAC) led to a reduction in negative symptoms in chronic schizophrenia patients. Aim of this study was to explore impact of addition of NAC to standard treatment in early psychosis (EP) patients.

Double-blind, randomized, placebo-controlled trial of addition of NAC, 2700 mg daily, to antipsychotic treatment over 6 months. Monthly assessment of PANSS, GAF, SOFAS and antipsychotics treatment; quantification of brain glutathione levels (GSHmPFC) by 1H-magnetic-resonance-spectroscopy and of blood cells glutathione (GSHBC) and glutathione peroxidase activity (GPxBC) as marker of oxidation status at the beginning and end of treatment.

Overall, 63 patients were included. Spectroscopy data showed that GSHmPFC increased by +23% in the NAC group, while it tended to decrease by −5% in the placebo group (P = 0.005). No significant difference between NAC and placebo was observed on global changes in negative symptoms, positive symptoms or functional outcome. However, in patients with high-baseline oxidation status (GPxBC>22.3U/gHb), subgroup explorations revealed an improvement of positive symptoms over time compared to patients with low-baseline GPx (P = 0.02).

While addition of NAC induced an increase of brain GSH, it had no impact on symptomatic and functional outcome in EP patients. However, in patients with high oxidation status, addition of NAC leads to significantly greater improvement in positive symptoms. Future studies on antioxidant interventions in EP should consider biomarker-guided treatment.

The authors have not supplied their declaration of competing interest.

Peripersonal space has been defined as the area immediately surrounding the body in which interactions with a person or an object can occur. Larger peripersonal space may reflect discomfort in close interpersonal situation or cognitive deficit. Individuals with schizophrenia are more sensitive to social stimulation. The capacity to provide accurate judgments of peripersonal space boundaries depend on the capacity to create an organized and structured mental representation that integrates signals from different sensory modalities and brain regions.

We conducted a study on personal space in patients with schizophrenia using a paradigm that was not affected by emotional and social interference.

We aimed to investigate the characteristics of personal space in patients with schizophrenia.

We recruited 20 schizophrenic patients according to DSM-V criterion and 20 healthy volunteers, matched by gender and age. Schizophrenic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Participants performed the peripersonal space (PPS) task. Collected data underwent statistical analyses.

Schizophrenic patients demonstrate a stronger/weaker need for personal space, than the comparison group, depending on the score of negative and positive symptom, as assessed by using the PANSS even without emotional and social interference.

Interpersonal interactions between the individual with schizophrenia and people in their immediate environment can lead to increased symptomatology. Social isolation is one of the most primary causes of poor quality of life in mental illnesses. Better understanding of the mechanisms for abnormal interactive behavior could provide significant valid guidelines for innovating intervention programs.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is growing evidence about the importance of motor symptoms in psychosis. Motor abnormalities have been observed in naive-drugs, first-episode patients. Clinical assessment of motor abnormalities normally relies upon subjective observer-based ratings. Kinematic analysis of handwriting has proved to be an objective measure of motor symptoms, but it has not been used in clinical settings.

In the present work, the geometrical analysis of handwriting patterns is proposed as a new tool to evaluate motor symptoms in psychosis.

Overall, 35 healthy participants and 43 patients with psychosis from San Agustín Hospital (Linares, Spain) participed in the study. Participants were asked to write with a pen on a white paper (see patterns in the Figure 1). In order to analyze the heterogeneity of handwriting pattterns, we employed lacunarity, a nonlinear measure previously used in the analysis of biomedical images. Lacunarity measures the distribution of gap sizes in a geometrical space. A large value implies large gaps and clumping of points, whereas a small value suggests a uniform distribution with shorter gaps.

Lacunarity was significantly higher in handwritten patterns from patients than in controls. In addition, we found a higher heterogeneity in patients with motor symptoms in comparison with patients without motor symptoms.

Our results suggest that analysis of handwritten patterns can be a valuable method in the evaluation of motor symptoms.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a serious disorder that influences all life aspects of the patients. The most important goals in schizophrenia are remission, recovery, improving psychosocial functioning and quality of life, which can be influenced by different factors, especially insight.

To evaluate the awareness of illness in Romanian patients diagnosed with schizophrenia and to determine the predictive role of insight.

This study wants to highlight the importance of the evaluation of insight in psychotic patients, taking into account that awareness leads to compliance with treatment, decreased rate of relapses and rehospitalization and a better prognosis.

Overall, 80 patients (44 males and 36 females) recruited from first and second psychiatric clinic Cluj-Napoca, diagnosed according to ICD-10 and DSM-V criteria with schizophrenia and acute psychotic disorder participated in this study. A semi-structured interview collected demographical data. Psychotic symptoms were evaluated using PANSS, severity of the disease using CGI and insight using SUMD.

Our results showed that the most important predictive factors for the evolution were: level of insight (r = −0.41 P < 0.01), presence of family history (r = 0.24 P < 0.05) and belonging to urban areas (r = 0.23 P < 0.05). The level of insight explained 16% of variance of improving psychotic symptoms during hospitalization.

The awareness of illness is one of the predictive factors for long-term schizophrenia and the best predictive model of disease progression is composed of variables SUMD total and PANSS total on admission.

The authors have not supplied their declaration of competing interest.

The dimensional approaches regard delusions as a continuum of the daily beliefs, not being limited to the clinical population and it can also be found in the general population. Due to the multifaceted conceptualization of delusions, the analysis of the dimensions of distress, preoccupation and conviction may be more revealing than the content of the belief itself, whereby an evaluation that incorporates these dimensions is fundamental.

Translation, adaptation and study of the psychometric properties of the Peters et al. delusions inventory (PDI-21) for the Portuguese population.

Assessing the multidimensionality of the delusional ideation in the community.

The sample consists of 249 adults from the general population, aged between 18 to 65. The brief symptom inventory, the social desirability scale of the eysenck personality questionnaire and the World Health Organization quality of life–bref were used in this study beyond the PDI-21.

The Portuguese version of the PDI-21 has shown good psychometric properties regarding its internal consistency and test-retest reliability. It demonstrated significant positive correlations with the psychopathological symptoms and negative associations with social desirability and with the quality of life, confirming its divergent and convergent validity. The analysis of the frequency of delusional ideas for the total of the sample and on the basis of gender has revealed prevalence rates very similar to the ones found in previous studies.

The Portuguese version of the PDI-21 has adequate psychometric properties and it can be used to assess the delusional ideation in the general population.

The authors have not supplied their declaration of competing interest.

Although there is no cure, schizophrenia is highly treatable disease. Successful first episode schizophrenia (FES) treatment is crucial to minimize personal, vocational and social deterioration. Quetiapine is atypical, second generation antipsychotic, serotonin-dopamine antagonist. Quetiapine is potent blocker of D2, 5HT2A and 5HT1A receptors.

To estimate efficacy of quetiapine in treatment of first episode schizophrenia.

This study included 70 patients with FES diagnosed by ICD-10 criteria, who are divided into haloperidol (H) 35 patients and quetiapine (Q) group 35 patients. Patients were observed for 6 months in hospital and extra hospital conditions, according to protocol which included Positive and Negative Symptom Schedule Scale (PANSS) and the number of withdrawals attributed to adverse event (AE). Control group was treated with haloperidol 5–20 mg/24 h and experimental group was treated with quetiapine 400–800 mg/24 h.

Average pretrial PANSS score was 110.1 in quetiapine and 108.5 in haloperidol group. Average PANSS score after 180 days was 50.6 in Q and 60.4 in H group. There is no statistical difference in pretrial scores between groups for PANSS score (P = 0.647). There is significant statistical difference in PANSS score reduction after 180 days in both groups (P < 0.001). There is significant statistical difference in PANSS score reduction between Q and H group after 180 days (P < 0.001). Overall, 8.6% AEs occurred in Q, and 25.8% in H group.

Quetiapine has shown better efficacy in treatment of FES comparing to haloperidol, with statistically significant lower adverse effects rate.

The authors have not supplied their declaration of competing interest.

Methods of assessment of medicated compliance are based upon preceding experience of taking therapy and cannot be applied at the first admission.

To investigate premorbid characteristics in schizophrenic patients and reveal the factors indicating noncompliance.

We used medical record background, interview, Medical Compliance Prediction Scale for Psychiatry for evaluation of the level of compliance, program STATISTICA10 for identification of the average level of compliance in the subgroups of each factor by Kruskal–Wallis test and revealing those subgroups for each factor where the average level of compliance was statistically significantly lower (P < 0.05).

We examined 120 patients (status corresponded to the ICD-10 diagnostic criteria for schizophrenia, age–18 and older, duration of the disease–5 years and more, patients taking typical or atypical antipsychotics or combined therapy) according to factors of premorbid period such as gender, family history of mental disorders, personality traits, nurture in the family, education level, marital status; substance use, age at the onset of disease.

Level of compliance was lower in subgroups of men, patients having several relatives with mental disorders, patients having personality with predominance of irritable and impulsive traits, patients with neglect in parental families, patients with education level lower than high school and with education level higher than bachelor; patients not working or studying to onset of disease; patients who were divorced or widowed; patients living alone; patients using psychoactive substances; patients aged 21 years and older to the onset of disease.

The authors have not supplied their declaration of competing interest.

The basic role of cerebellar dysfunctions in schizophrenia pathophysiology is already well-known. Importantly, cerebellar signs such as gait and balance coordination deficits are objectively manifested and measurable. However, both early detection and treatment monitoring of the illness are still-based mainly on subjective psychopathological symptoms.

To introduce an objective and quantitative approach to the cerebellar gait and balance disorders in schizophrenia.

An original (internationally patented) method for objective equilibriometric quantification of stepping locomotion (a kind of motion analysis system) was developed and then applied repetitively in 230 schizophrenic patients and 230 well-matched healthy controls.

Subclinical but objectively measurable equilibriometric locomotor ataxia (ELA) was identified in a large proportion of the investigated patients. Its severity fluctuated along with the changes in the clinical state. As a rule, the degree of ELA transiently increases during psychotic exacerbation and gradually returns to its prepsychotic level during therapeutic remission. Data analysis revealed that the basic (prepsychotic and postpsychotic) ELA could be viewed as a new schizotaxic biomarker (trait-marker) for schizophrenia, while the degree of its severity could serve as a new objectively measurable state-marker for psychosis. Besides, its dynamics during antipsychotic treatment might be used as an objective measure of the therapeutic response (a kind of surrogate pharmacodynamic biomarker).

Objective quantification of the ELA allows for early detection of subclinical signs of cerebellar ataxia (or schizotaxia) in individuals at high-risk for schizophrenia, whereas in psychotic patients it permits their objective antipsychotic-treatment monitoring.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.