Incidence of crime victimization and perpetration is higher in severely mentally ill people than in general population. In the literature, fewer papers investigate the risk of being a victim than the risk of perpetrating violence in psychiatric patients.

To study incidence of self-reported crime victimisation or perpetration in 2 multicentric database of patients suffering from schizophrenia or related psychoses who are admitted involuntarily to hospital.

Included involuntarily admitted patients with ICD-10 diagnosis of F20-F29, age 18–65, giving informed consent. Univariable and multivariable logistic regression to estimate odds ratios. Structured interview and BPRS by trained operators.

Three hundred and eighty-three and 543 cases for each database. Victims: 37.8% and 28.0%. Accused: 25.6% and 11.6%. Victims had higher BPRS subscale of Mania, were unemployed and had fewer social contacts. Accused had higher mania in one of the 2 sample. Sociodemographic predictors included unemployment and homelessness, younger age and male gender.

Sociodemographic factors are important predictors of being accused of a crime. Higher symptoms of mania are associated with higher odds of being victim of violence in 2 multicentric samples, after correction for other variables. Rates of both victimisation and perpetration rates are higher than in samples of people from general population or from outpatients settings. Accused and victims have a strong association with consideration on the context of life.

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

Despite multiple clinical and preclinical studies investigating schizophrenia, the neurobiological basis of this disease is still unknown. The dysregulation of the serotonergic system, in particular the 5-HT2A receptor and the endocannabinoid system have been postulated as possible causes of schizophrenia.

The aim of this study is to evaluate the expression of CB1-5-HT2A receptor heteromers in primary cultures of pro-neurons from the olfactory epithelium in schizophrenia patients and control subjects.

We recruited a group of 10 healthy volunteers and 10 patients diagnosed with schizophrenia, who were treated with atypical antipsychotics, were clinically stable and had an illness duration range from 1 up to 15 years. The patients were diagnosed with schizophrenia from the medical record and confirmed by the structured clinical interview for DSM disorders. The expression of CB1-5-HT2A receptor heteromers in primary cultures of pro-neurons from the olfactory epithelium was quantified using proximity ligation assays and confocal microscopy.

Olfactory epithelium pro-neurons were viable and expressed the neuronal marker, III-β tubulin. We also established the presence and the functionality of CB1-5-HT2A receptor heteromers in these cells using the proximity ligation and cAMP activity assays, respectively. Heteromer expression was significantly increased in schizophrenia patients with respect to controls.

This highly innovative methodology will allow the noninvasive, low-cost study of new biomarkers for schizophrenia in a model closely related to the central nervous system.

The authors have not supplied their declaration of competing interest.Acknowledgments

This work was supported by grants from DIUE-Generalitat-de Catalunya (2014SGR 680), Instituto de Salud Carlos III (PI14/00210) and (PI10/01708) FIS-FEDER-Funds. LG is supported by the Instituto-de Salud Carlos III through a “Río Hortega” (CM14/00111).

Several scientific studies support the relation between pulmonary embolism and antipsychotic treatment (acute or chronic). We present a case of possible association of venous thromboembolism (VTE) and ziprasidone.

Man, 55-year-old, with mild hypertension. He has neither toxics habits nor allergies. He does exercise every day. He started with behavioral and perception disorders during 9 months before being diagnosed of paranoid schizophrenia in 2002. He began with risperidone 3 mg per day and amisulpride 25 mg per day as hypnotic. It allowed a good development and he keeps stable since then. The treatment produced sedation and weight increase, so it was changed to ziprasidone 60 mg per day and later 40 mg per day. A few months ago, he was hospitalized with breathelessness that started suddenly two days before. After all diagnostic tests, he was diagnosed with pulmonary embolism and right leg VTE. His medical development was very positive and he must begin with acenocumarol (doses–depend) and support stockings.

As we know, since last 10 years, antipsychotic exposure significantly increases the risk of pulmonary embolism. Due to the lack of risk related factor in this case, it would point that reason. The increase related is about 50% of developing VTE and this increased risk similarly applies to first and second generation antipsychotics drugs. Despite that, there are more cases in olanzapine, clozapine and haloperidol treatments due to antiaggregatory action and antithrombotic effects. We present this case probably closely related with ziprasidone.

The authors have not supplied their declaration of competing interest.

It is well known about relation between skin and mind, not only due to their mutual origin, but also by their illness expression parallelism. We report a case to show that reciprocity.

Woman, 42-year-old, single. She only suffers from a skin disease; mild psoriasis guttata placed in both elbows and knees. She treated it with local treatment (cortisone cream) during seasonal prutius and the lesions did not grow or expand. She was hospitalized due to psychotic symptoms (paranoid delusions with her colleagues) and started antipsychotics treatment (risperidone 12 mg per day and olanzapine 10 mg per night). By the same time, she suffered a psoriasis crisis. Her psoriatic plaques increased their sizes and her chest and both thighs were affected too. She complained about grave pruritus. All her medical test results were normal. After that, the patient improved her psychotics’ symptoms, but she started with agoraphobic signs and seclusion at home. Psoriasis were even worse than before and she needed metrotexate to treat it. Being introduced to escitalopram 15 mg per day, anxiety and depression symptoms disappeared and her grave psoriasis became the mild one that she knew.

Schizophrenia was associated with a greater variety of autoimmune diseases than was anticipated. Studies found evidence for a shared genetic etiology between schizophrenia and psoriasis. Despite that, we think that the study of psychopathology can amplify our understanding about the etiopathogenesis of psoriasis and associated mental disorders.

The authors have not supplied their declaration of competing interest.

Frontotemporal dementia (FTD) encompasses a group of clinical features that include personality and behavior changes (disinhibition, social isolation, antisocial behavior, compulsion) and executive dysfunction (poor planning, loss of judgment and loss of insight). These features may lead to an incorrect diagnosis of a primary psychiatric disorder.

To emphasize the difficulties in making a clinical distinction between early frontotemporal dementia and other psychiatric diseases.

We describe 11 patients who suffered from FTD, while initially had diagnosed with primary psychiatric disorders. The correct diagnosis was achieved by psychiatric and neuropsychological evaluations (WAIS SCALE, ACE-R, MMSE), neuroimaging studies (MRI 7/11, SPECT 8/11) and applying the international consensus criteria for FTD.

All patients (5 males and 6 females) were initially diagnosed with psychiatric disorders: schizophrenia (2/11), bipolar disorders (4/11), depression (5/11), schizoaffective disorder (1/11), somatization disorder (1/11), personality disorders (2/11), malingering (1/11), alcohol dependence (1/11), while 5 patients had more than one diagnosis. The age of onset varied from 19 to 53 years old. Final diagnosis of FTD was delayed on average 6,5 years from the onset of symptoms.

Clinicians should be familiar with the clinical entity of FTD and its difficult distinction from other psychiatric disorders. A possible hospitalization of a patient with FTD in a psychiatric department and the social impact that it brings may be avoided. On the other hand, the proper care of FTD patients (pharmacological and psychosocial) improves the quality of life of patients and their caregivers.

The authors have not supplied their declaration of competing interest.

Tackling stigma and discrimination is a major concern worldwide as demonstrated e.g. in the European Mental Health Action Plan. We need valid and feasible indicators to assess the stigma of mental illness. In Portugal, validated scales focused on mental health consumers’ personal experiences of stigma are scarce. The consumer experiences of stigma questionnaire (CESQ) (Wahl, 1999), developed in collaboration with the National Alliance for the Mentally Ill, focuses on users’ real life experiences. Although it was validated in different countries, some psychometric properties (e.g. test-retest reliability) are to be tested.

To further assess CESQ psychometric properties and to validate its Portuguese translation.

The CESQ Portuguese translation was developed in collaboration with the author (Otto Wahl), using standard translation and back-translation procedures. The acceptability of items was assessed in pilot studies and discussed in groups also involving health professionals. The measure was then used in a convenience sample of 122 persons with severe mental illness. Assessments included test-retest reliability (n = 48). A factor analysis was also conducted.

Overall, the CESQ translation proved acceptable and missing items were few, not compromising the analysis. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.83 [95% CI 0.71–0.90] and Cronbach's alpha for internal consistency was 0.80 [95% CI 0.75–0.85]. In the principal component analysis, factor loadings confirmed the two originally reported domains: stigma and discrimination.

The CESQ Portuguese version demonstrated good validity and reliability, replicating research using the original version and adding to the documentation of its psychometric properties.

The authors have not supplied their declaration of competing interest.

Early recognition of the signs and symptoms of psychiatric illnesses is important as the delay would predict worse prognosis.

To study the help-seeking behavior and sociodemographic factors of psychiatric patients presenting to Psychiatric Unit Teaching Hospital, Karapitiya.

A descriptive cross sectional study. Sample drawn from patients presenting for the first time to Psychiatric Unit Teaching Hospital, Karapitiya. An interviewer administered questionnaire was used to collect data.

Age ranged from 13 to 76 years (n = 50). Males 34 (68%). Duration from onset of symptoms to first presentation ranged from 2 days to nine years, mean 2 years. Twenty-five (50%) had symptoms for more than one year. Sixteen (32%) stated to have attributed illness to supernatural courses as the reason to delay seeking medical help. None gave difficulty in accessing a psychiatric unit as reason for the delay. Twenty-six (52%) referred by nonpsychiatric medical professionals. Regarding alternative treatment engaged in prior to presentation to a psychiatric unit, eighteen (36%) tried to dispose of evil spirits with the help of yakaduru or kattadi, seven (14%) sought help from indigenous medical practitioners and twenty (40%) engaged in religious rituals. Thirteen (26%) sought nonpsychiatric medical treatment.

A substantial number of patients suffering from psychiatric disorders present to psychiatric units delayed. As the majority were referred by nonpsychiatric medical professionals, alerting them regarding importance of early identification of psychiatric illnesses could help in reducing the delay.

The authors have not supplied their declaration of competing interest.

Neurocognitive and social cognitive impairments are central characteristics of schizophrenia and, to a lesser extent, of bipolar disorder. Birth cohorts and familial high risk studies have described cognitive impairments in subjects before onset of diagnosis as well as in children with increased genetic risk for development of the disorders.

To our knowledge, this is the first study to investigate the correlations between neurocogntion and social cognition in parents and offspring simultaneously and with the same methodology. We will divide the parents into subgroups (cognitive impairment and good cognitive functioning) and use these subgroups to describe correlations with their offspring. Identifying associations between parents and offspring can add important clues to risk factors for schizophrenia and bipolar disorder and, on the long-term, help the development of more effective and potentially preventive treatments.

This study is part of the Danish high risk and resilience study–VIA7. The VIA7 cohort consists of 522 children age 7 with zero, 1 or 2 parents diagnosed with schizophrenia or bipolar disorder and both of their biological parents. We assessed neurocognition and social cognition with a comprehensive test battery including: intelligence (RIST), executive functions (WAIS-IV, D-KEFS, CANTAB), verbal memory (TOMAL2), attention, emotion recognition, decision making and response control (CANTAB), theory of mind (animated triangles) and social perception (TASIT). Parental subgroups were based on the 95% CI of the controls (cognitive impairment < 95%CI and good cognitive functioning > 95% CI).

Data analysis is ongoing and results will be presented at the conference.

The authors have not supplied their declaration of competing interest.

Twenty-one percent of women with first episode of psychosis in the south Granada between 2008 and 2014 went to hospital emergency during the duration of untreated psychosis (DUP) aiming a gynecological consultation caused by psychotic symptoms. Only one in five was referred to mental health services.

To improve difficulties detecting cases during the prodromal phase, we aim to analyze the patient's profile and reasons for consultation and study whether there are variables that facilitate referral to specialist intervention.

A retrospective clinical–cases review of medical histories was made searching for sociodemographic variables, drug consumption, emergency services consultations and psychotic prodromal outcomes.

They were single women between 18–32 years. Sixty percent reported cannabis consumption. All of them live with family. Eighty percent were studying or unemployed. Three types of emergency consultations were reported with a similar incidences: order the emergency-contraception-pill, a pregnancy test or “a scan to check virginity/a nonconsensual relationship”. During the initial exploration, about 40% were under the influence of drugs. Most of them had nonspecific symptoms of anxiety, emotional lability, irritability, etc. In half of the cases were reported weight loss, insomnia and several variations of the usual behavior in recent days.

The most important variable is to analyze the reason for consultation. Moreover, substance abuse and a combination of prodromal symptoms including positive and other nonspecific are detected. Furthermore, at the profile with possible demands, we believe it is appropriate not to delay mental health assessment after making the appropriate intervention.

The authors have not supplied their declaration of competing interest.

The acute psychotic episode have often a dramatic expression. Although it is easily diagnosed, it is not easy to predict the evolution and much less the prognosis that are of concern both for the therapist and the patients’ families.

To describe the profile of a population of patients with a first psychotic episode. To identify factors correlated with evolution to schizophrenia.

This is a retrospective study conducted among 55 patients hospitalized for a first acute psychotic episode, in the psychiatry B department during the period extending between January 2010 and December 2015.

The average age of patients was 26.5. The majority was single male. The prodromal phase was present with predominantly psychotic symptoms (80%). Schizophrenia was the most frequently encountered scalable diagnosis (38%). Some factors are associated with the evolution to schizophrenia. We can mention male gender (P = 0.004) and premorbid schizoid personality (P = 0.047). About correlated clinical factors, we have found an initial symptomatology dominated by loss of interest (P = 0.05), withdrawal and isolation (P = 0.017), impulsivity (P = 0.011), breaking with the usual functioning (P = 0.04), mental automatism (P = 0.033), the delusions of persecution (P = 0.025) and intuitive mechanism (P = 0.023).

When a first acute delusional experience occurs in a young adult, it is always a test of uncertain outcome. However, schizophrenia remains the most feared evolutionary. A better understanding of poor prognosis and early and appropriate management seem paramount to reduce the prevalence of this dreaded evolution.

The authors have not supplied their declaration of competing interest.

Treatment resistance is considered a challenging problem of antipsychotic pharmacotherapy in schizophrenia, especially, when it is associated with other factors, such as cultural aspects, diverse clinical presentation, furthermore functional impact. Then, combination approaches are commonly used, for instance, the add-on of aripiprazole to clozapine; which allows increasing of efficacy and safety.

Assess the response to clozapine–aripiprazole combination treatment in the management of resistant schizophrenia.

Treatment of resistant schizophrenia.

Analysis of a clinical case.

A 27-year-old male resident in an Iberian country two years ago, is from a Latin American country, lives with his mother, his sister and his nephew. Their parents were separated. Eight years ago, his father died and shortly thereafter, he started impaired behavior, auditory and visual hallucinations, delusions about referentiality, persecution and prejudice, which required a brief hospitalization in their country. Upon arrival, he is included in the network of Mental Health, with positive symptoms, significant behavioral and cognitive disorganization and he needed hospitalization again. Then, treatment is instituted in different lines with risperidone, quetiapine, olanzapine, haloperidol, amisulpride, without results. Then, combined clozapine therapy is initiated up to 400 mg/day, more aripiprazole 20 mg/day, which switch after to pattern injectable depot, with informed consent. Six months after, he presents encapsulated delirium and improvement of disorganization, allowing the patient to retake studies.

Clozapine–aripiprazole combination was associated with 22% reduction of clozapine dose. There was improvement in positive and negative symptoms, social functions and amelioration in their metabolic profile.

The authors have not supplied their declaration of competing interest.

Diabetes type 2 is 2–3 fold more common in patients with schizophrenia compared to the general population. A lifestyle with focus on diet, exercise and medication is required to prevent complications from diabetes type 2.

Patients may have trouble complying with a well-structured and healthy lifestyle because of factors related to their illness e.g. cognitive disturbances, negative/positive symptoms and treatment with psychotropic medication.

To measure and reduce diabetes type 2 risk factors in patients and examine characteristics associated with a positive outcome.

A naturalistic intervention study through 30 months of clinical work with individual guidance, group sessions and treatment as usual.

At index, the newly diagnosed patients had a high consumption of soft drinks and low physical activity. Over time, the newly diagnosed patients worsened their physical profile with increased weight, waist circumference, visceral adiposity index (P = 0.030) and HbA1c (P = 0.010). HbA1c increased for newly diagnosed male patients with 0.24 m.mol/L (P = 0.007). The long-term patient's physical activity level was low. After the intervention, they improved in consumption of soft drinks (P = 0.001) and fast food meals (P = 0.009). Furthermore, the long-term patients lowered their weight and waist circumference while becoming more physically active. There were no changes in HbA1c in the intervention period.

Our study showed being long-term ill and female gender was associated with positive outcome of lifestyle intervention into improving physical health and reducing diabetes type 2 risk, meanwhile being newly diagnosed and being male showed a negative outcome despite intervention.

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

The authors have not supplied their declaration of competing interest.

Clinical benefits of antipsychotic treatment depend on the efficacy and on the patients’ tolerability and compliance. To reduce patient initiated treatment discontinuation, timely detection of treatment emergent side effects is essential. The Glasgow Antipsychotic Side-effects scale for clozapine (GASS-C) is a recently developed instrument to measure subjectively experienced clozapine side effects.

Timely detection of unreported clozapine related side-effects.

Documenting the prevalence of side-effects in schizophrenia or chronic psychotic disorder with the Serbian version of the GASS-C.

The sample included 95 in and outpatients with schizophrenia or chronic psychotic disorder. All subjects filled out the Serbian version of the GASS-C and a sociodemographic questionnaire.

The median age was 46.1 years; 53.7% of subjects were male. Clozapine doses ranged from 25 to 423 mg. Drowsiness (78%) was the most commonly reported side-effect. Overall, 16.8% of the patients added other complaints, such as headache, pain, hand or leg numbing or nightmares. According to GASS-C total score categorization [2], only 4.2. % of subjects were rated with severe side-effects, while 14% of themselves rated their symptoms as severe or distressing. More side effects were reported by female patients and by inpatients. Only a weak positive correlation was found between the severity of the side effects and clozapine dosage.

We found the GASS-C to be a useful instrument that elicits both unknown side-effects and patients rating of their severity. Side effects did not clearly relate to the prescribed dose. Future research should include the relation of clozapine plasma levels with side effects assessed with GASS-C.

The authors have not supplied their declaration of competing interest.

Antipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.

To evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.

This was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.

In basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.

The authors have not supplied their declaration of competing interest.

A long-acting form of risperidone is now broadly available for the treatment of schizophrenia and closely related psychiatric conditions. It combines the advantage of previously available depot formulations for first-generation drugs with the favorable characteristics of the modern “atypical” antipsychotics, namely higher efficacy in the treatment of the negative symptoms of schizophrenia and reduced motor disturbances [1].

During this study, we observed side effects that appear in patients that are treated with risperidone depot. Patients were observed for a period of 3 months (October–December 2015) and the side effects were evaluated with Glasgow Antipsychotic Side-effect Scale (GASS). The data obtained were analyzed with SPSS, trying to prove the impact of variables such as: gender, age, diagnosis, dose and duration of treatment on the occurrence of side effects.

Through statistical processing, we reached the conclusion that there is a statistically significant correlation between duration of treatment and side effects (P value was 0.0001). Between two variables has a strong positive correlation (Kendall value was 0.766). Has a statistically significant correlation between the drug dose and side effects (P value was 0.026). Between two variables has a moderate positive correlation (Kendall value was 0.504). No statistically significant correlation between these variables: gender-side effects, diagnose-side effects and age-side effects.

The authors have not supplied their declaration of competing interest.

People with psychotic disorders have increased mortality compared to the general population. The mortality is mostly due to natural causes and it is disproportionately high compared to the somatic morbidity of people with psychotic disorders.

We aimed to find predictors of mortality in psychotic disorders and to evaluate the extent to which sociodemographic and health-related factors explain the excess mortality.

In a nationally representative sample of Finns aged 30–70 years (n = 5642), psychotic disorders were diagnosed in 2000–2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk.

Adjusting for age and sex, diagnosis of nonaffective psychotic disorder (NAP) (n = 106) was statistically significantly associated with all-cause mortality (HR 2.99, 95% CI 2.03–4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85–4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10–4.05) for all-cause and to 1.98 (95% CI 0.94–4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07–0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07–11.69).

The elevated mortality risk associated with NAP is only partly explained by socioeconomic factors, lifestyle, cardiometabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic conditions in people with psychotic disorders.

Jaakko Keinänen owns shares in pharmaceutical company Orion.

In the Czech Republic, research of the schizophrenia spectrum suffers from a lack of standardized measuring instruments. The community assessment of psychic experiences (CAPE) has been used internationally to quantify positive, negative and affective symptoms associated with the spectrum and to screen individuals who may be in risk of developing a spectrum disorder.

This study aimed to develop a Czech version of the CAPE and to examine its psychometric properties in a nonclinical population.

An author with an expertise in the field and a subject-naïve author translated the CAPE into the Czech language. After a professional back-translation, the instrument's most suitable version was agreed upon. Lie-scale items were added to allow for an online circulation. The CAPE was administered to a large sample of participants alongside the Beck depression inventory (BDI-II).

Internal consistency was assessed using the Cronbach's alpha. Internal structure was evaluated using confirmatory factor analysis and compared to the structure of the original. Criterion validity was examined through correlation analyses of the BDI-II scores and the total and subtotal CAPE scores.

It is determined whether the Czech version of the CAPE has sufficient reliability and validity to be recommended for research purposes. It is expected that further study of the CAPE as well as the introduction of additional tools will motivate the standardization of research, diagnosis and prevention of schizophrenia spectrum disorders in the Czech Republic.

The authors have not supplied their declaration of competing interest.

Patients with schizophrenia suffer from cognitive deficits in seven domains in addition to social cognition. P300 latency and amplitude have been linked in these patients to the basic cognitive deficits.

Comparing patients suffering from schizophrenia with matched healthy subjects as regards auditory event related potential tests as measured by P300.

Fifty-two subjects were divided into 2 groups: group (A): 27 patients with schizophrenia according to the diagnostic and statistical manual of mental disorders-text revised (DSM-IV TR). Those with current substance use, psychiatric disorders or organic disorders were excluded. Group (B): 25 healthy control subjects with negative history of substance and psychiatric disorders. Patients were assessed using Positive and Negative Symptom Scale (PANSS) for severity of psychotic symptoms, Addenbrook's Cognitive Examination Revised (ACE-R) for basic cognitive, reading the mind in the eye test for social cognition, P300 and electro-encephalography (EEG)

The two groups were different significantly in ACE total and its subtests measuring attention-orientation, memory, language, visuospatial and reading the mind in the eye test for social cognition scores with patients showing lower scores (P = 0.000, 0.012, 0.000, 0.038, 0.041 and 0.001 respectively). Control group had higher amplitude of P300 and shorter latency than patients (P = 0.003 and 0.005 respectively). P300 amplitude correlated positively with visuospatial memory (P = 0.015). PANSS general pathology scale correlated positively with duration of untreated psychosis (P = 0.029) and with fluency (P = 0.047).

Patients with schizophrenia differ from controls in P300.

The authors have not supplied their declaration of competing interest.

Clozapine is one of the most effective drugs for the treatment resistant schizophrenia (TRS). It was reported that modified electroconvulsive therapy (mECT) may be an effective clozapine augmentation strategy in TRS.

The objective of this study was to investigate the influence of clozapine to mECT in the TRS.

Forty-seven patients were recruited in this study, but eight patients were excluded because clozapine was discontinued by reason of side effects. Ultimately, 39 patients were enrolled.

Seventeen patients received mECT before clozapine therapy. Two patients continued mECT after starting clozapine therapy. There was a significant difference between before–after clozapine therapy (χ2 test, P< 0.01). Intermittent mECT was performed for 3 patients before clozapine and for one patient after starting clozapine.

This result suggests that clozapine therapy reduces mECT. In Japan, the first-line treatment for TRS is CLO. mECT is recommended for clozapine resistant schizophrenia patients. Prescription of CLO is limited in the part of medical facility because all physicians who prescribe clozapine must be registered with the clozaril patient monitoring service in Japan. It is considered that mECT is more readily selected than clozapine therapy. Therefore, the number of mECT is not reduced generally.

Clozapine therapy reduces the necessity of mECT.

The authors have not supplied their declaration of competing interest.