Aggression is common and a major behavioral problem in patients with intellectual disability (ID). Antipsychotics are frequently used for psychosis or challenging behavior. There is little literature regarding utilization of clozapine in patients with ID for aggressive behavior.

The aims of the study were the evaluation of efficacy and safety of clozapine in treatment of aggression in patients with ID.

A longitudinal naturalistic study including a cohort of 225 consecutive patients with intellectual disability admitted to an acute psychiatric unit between 1 January 2014 and 31 December 2015. Severity of symptoms was assessed at admission with Modified Overt Aggression Scale (MOAS) and Global Assessment of Functioning Scale (GAFS). The data included: demographics, main psychiatric diagnosis, IQ, alcohol/smoking, institutionalization, antipsychotics and another psychotropics, restraint, readiness to discharge (RDQ), side-effects and length of stay.

Of 225 potentially eligible individuals, 205 (92.7%) were treated with antypschotics and 110 male (53.56%) with mean age 32.37 (SD = 9.9). Thirty-seven patients (18%), 18 male (48.65%) were treated with clozapine, mean dose 309.45 mg/day (range 100–450 mg/day). Clozapine reduced need for restraint and duration of hospitalization compared with haloperidol (P < 0.05).

Clozapine was efficient and safety for treating persistent aggression in patients with intellectual disability. There were no seizures, myocarditis or agranulocytosis during study. Larger and randomized trials are needed to fully explore the anti-aggressive benefit of clozapine.

The authors have not supplied their declaration of competing interest.

Childhood trauma exposure is associated with the risk of eating disorders (EDs) in adulthood. The biological basis of this link may involve a persistent dysregulation of the endogenous stress response system, in particular the hypothalamic-pituitary-adrenal (HPA) axis, as a consequence of early life maltreatment.

Adult patients with EDs and history of childhood trauma may have a dysregulation of the HPA axis that could be different from EDs patients without childhood trauma exposure.

In order to assess the effects of childhood trauma experiences on HPA-axis activity in EDs, we compared the salivary cortisol response to the Trier Social Stress Test (TSST) of adult patients with EDs according to their history of childhood trauma.

Twenty-seven EDs patients and 13 healthy women participated in the study. Salivary cortisol responses during exposure to the TSST was measured. Participants also completed the childhood trauma questionnaire (CTQ) and eating-related psychopathological rating scales.

According to CTQ, 15 individuals with EDs reported childhood maltreatment whereas 12 EDs patients and all the healthy women did not experience childhood maltreatment. Compared with the control group, non-maltreated EDs patient group exhibited a slightly enhanced cortisol response to TSST, whereas the group of non-maltreated EDs patients showed a normal cortisol response. Moreover, EDs patients with childhood maltreatment exhibited statistically significant blunting of cortisol compared to non-maltreated ones.

The present findings support the evidence that, in patients with EDs, there is a dysregulation of HPA-axis activity and that childhood trauma exposure may contribute to this dysregulation.

The authors have not supplied their declaration of competing interest.

Anorexia nervosa (AN) is a lethal psychiatric disease with only narrow treatment possibilities. Recent study results point out, that gut microbiota might be a contributing factor in the development and persistence of AN through effects on the gut-brain-axis.

We used 16SRNA sequencing to characterize the composition and diversity of the gut microbiota of 18 AN patients, 19 normal weight controls and 19 athletes matched by age using stool samples. The QIIME-pipeline was used to assess the sequencing result. All participants completed an activity-questionnaire (IPAQ) and inventories to measure depression (BDI, HAMD).

Kruskal-Wallis test identified significant differences in alpha-diversity (Chao-1-estimator [P = 0.013], number of observed species [P = 0.027]) between groups. Spearman-Correlation revealed a significant correlation of number of observed species (r = 0.366, P = 0.006) Chao-1-estimator (r = 0.352, P = 0.008) and BMI (Fig. 1). Furthermore, a higher BMI was related to lower depression scores (r = 0.351, P < 0.001). Although there was a tendency of a negative correlation of BDI-scores and alpha-diversity (r = –0.180, P = 0.059), correlations with depression scores and IPAQ-scores did not reach significance level (Fig. 1).

Our preliminary data demonstrate correlations of alpha-diversity and BMI. Further studies are needed to provide further insights in AN gut microbiota and its influence factors.

The authors have not supplied their declaration of competing interest.

Childhood trauma (CT) is a relevant environmental stressor for bipolar disorder (BP). Amygdala and hippocampus are key areas involved both in the pathophysiology of BP and in mediating the biological response to stress.

Structural neuroimaging studies help clarifying neural correlates of the relationship between BP diagnosis and CT.

To verify the impact of CT on amygdala and hippocampus and hippocampal subfields volumes in BP patients and healthy control (HC).

We assessed 105 outpatients, diagnosed with BPI or BPII according to DSM-IV-TR criteria, and 113 HC subjects. History of CT was obtained using the childhood trauma questionnaire (CTQ). High-resolution magnetic resonance imaging was performed on all subjects and volumes of amygdala, hippocampus, nucleus accumbens, caudate, pallidum, putamen, thalamus and hippocampal subfields were measured through FreeSurfer.

All deep gray matter structures were smaller in BP than HC. CT modulated the impact of the diagnosis on bilateral amygdala and hippocampus, in particular on subiculum, presubiculum and cornu ammonis CA1. It was associated with bilateral decreased volumes in HC and increased volumes in patients with BP.

Childhood trauma impacts on the amygdala and hippocampus, brain areas involved in response to stress and emotion processing, and specifically on the hippocampal subfields most implicated in learning trough positive/negative reinforcement.

The authors have not supplied their declaration of competing interest.

Despite increasing awareness of high prevalence of psychiatric disorders in people with intellectual disability (ID), diagnostic tools are few and scarcely used in daily practice. SPAID-G (psychiatric instrument for the intellectually disabled adult-general version) is the first Italian for carrying out psychiatric diagnostic orientations in adults with ID. It was designed to be easy and quick instrument for daily clinical practice.

The present study was aimed at evaluating psychometric and psychodiagnostic characteristics of the SPAID-G and at supplying new data on the prevalence rate of psychiatric disorders in a multicentric Italian sample of people with ID living in different settings.

The SPAID-G was consecutively administered to more than 800 persons with ID attending residential, rehabilitative or clinical services across Italy. A part of the sample was also assessed for psychopathology through the use of DASH-II, PDD-MRS and clinically diagnosed in accordance to DSM-IV-TR and DSM-5 criteria.

SPAID internal consistency, inter-rater reliability and concordance with DASH-II and PDD-MRS resulted to be good. Around 40% of the sample was assessed to have a cluster of psychopathological symptoms that could be consistent with a psychiatric diagnosis. Autism, impulse control disorder and personality disorder resulted to be the most frequent over threshold scores.

The SPAID-G seems to be a valid and cost-effective screening tool for the psychiatric assessment within the Italian population with ID.

The authors have not supplied their declaration of competing interest.

Patients affected by bipolar disorder type I (BD-I) show a significant emotional impairment during both acute and euthymic phases of the illness, but the influence of negative life experiences is not yet fully understood.

Aim of the present study was to investigate the role of previous traumatic events on negative emotion processing in euthymic BD-I patients.

Eighteen euthymic BD-I patients, 7 reporting past traumatic events (T-BD-I), but free of post-traumatic stress disorder (PTSD) symptoms at the moment of the evaluation and 11 never exposed to traumas (NT-BD-I), were compared to 24 not traumatized controls (NC). All participants performed a IAPS-based emotional task: they were required to identify vegetable items (targets) among neutral or negative pictures. Accuracy (percentage of correct responses) and mean reaction times (RT) were recorded.

T-BD-I performed similarly to NC and significantly better than NT-BD-I in terms of accuracy (Fig. 1). No significant between-group effects were observed for mean RT.

A previous history of traumatic events, without current PTSD symptoms, may significantly impact the negative emotion processing in euthymic BD-I. Interestingly, traumatized patients showed a better accuracy when processing both neutral and negative images, thus suggesting that paying more attention to external stimuli may be a successful compensatory mechanism to cope with potential environmental threats.

The authors have not supplied their declaration of competing interest.

Clinician-patient communication is a major factor in influencing outcomes of healthcare. Complexity increases if an individual has multiple health needs requiring support of different clinicians or agencies.

To develop and evidence a simple dynamic computerised tool to capture and communicate outcomes of intervention or alteration in clinical need in patients with multiple chronic health needs.

A MS Excel algorithm was designed for swift capture of clinical information discussed in an appointment using pre-designed set of evidenced based domains. An instant personalized single screen visual is produced to facilitate information sharing and decision-making. The display is responsive to compare changes across time. A prototype was conceptually tested in an epilepsy clinic for people with Intellectual disability (ID) due to the unique challenges posed in this population.

Evidence across 300 patients with ID and epilepsy showed the tool works by enhancing reflective communication, compliance and therapeutic relationship. Medication and appointment compliance was 95% and patient satisfaction over 90%.

To discuss all influencing health factors in a consultation is a communication challenge esp. if the patient has multiple health needs. A picture equals 1000 words and helps address the cognitive complexity of verbal information. The radar offers an evidenced based common framework to host care plans of different health conditions. It provides individualised easy view person centred care plans to allow patients to gain insight on how the different conditions impact on their overall well being and be active participants. The tool will be practically demonstrated.

The authors have not supplied their declaration of competing interest.

Lurasidone, an atypical antipsychotic, demonstrated efficacy and safety in adults with schizophrenia.

To evaluate the efficacy and safety of lurasidone in adolescent patients with schizophrenia.

Adolescents (13–17 years old) with schizophrenia were randomly assigned to six weeks of double-blind treatment with lurasidone 37 mg/day, 74 mg/day or placebo. An ANCOVA using an LOCF approach was performed to assess change from baseline on secondary study endpoints: Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) and Children's Global Assessment Scale (CGAS).

Patients were randomized to lurasidone 37 mg/d (n = 108), 74 mg/day (n = 106), or placebo (n = 112). Placebo-adjusted LS mean improvement at week 6 on the PQ-LES-Q was 5.3 (P = 0.001) and 5.8 (P < 0.001) for the 37 mg/day and 74 mg/day groups, respectively; and, on the CGAS was 4.6 (P = 0.002) and 4.9 (P < 0.001) for the 37 mg/day and 74 mg/d groups, respectively. The most common adverse events occurring at ≥ 5% in either lurasidone group and at least twice the rate of placebo were: nausea, somnolence, akathisia, vomiting and sedation. Mean change in weight at week 6 for placebo, 37 mg/day, and 74 mg/day groups was 0.05 kg, 0.17 kg, and 0.49 kg, respectively. Lurasidone treated patients did not show clinically meaningful differences from placebo on laboratory measures of cholesterol, triglycerides, glucose, and prolactin.

Adolescent patients with schizophrenia treated with lurasidone demonstrated significant improvement in quality of life and function. Lurasidone was generally well-tolerated and associated with minimal changes in weight and metabolic parameters. Sponsored by Sunovion Pharmaceuticals Inc. ClinicalTrials.gov identifier: NCT01911429.

Dr. Findling receives or has received research support, acted as a consultant and/or served on a speaker's bureau for Alcobra, American Academy of Child & Adolescent Psychiatry, American Physician Institute, American Psychiatric Press, Bracket, CogCubed, Cognition Group, Coronado Biosciences, Dana Foundation, Elsevier, Forest, Guilford Press, Ironshore, Johns Hopkins University Press, Jubilant Clinsys, KemPharm, Lundbeck, Merck, NIH, Neurim, Novartis, Otsuka, Oxford University Press, Pfizer, Physicians Postgraduate Press, Purdue, Rhodes Pharmaceuticals, Roche, Sage, Shire, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Tris, Validus, and WebMD. Drs. Goldman, Cucchiaro, Deng, and Loebel are employees of Sunovion Pharmaceuticals Inc.

Bipolar disorder (BD) is a chronic, highly disabling condition, associated with a high burden of morbidity and mortality, often secondary to suicidal behaviors. In previous reports, different variables have been associated with a higher risk of suicidal acts, with variable effect.

To evaluate which socio-demographic and clinical variables correlate with suicide attempts in bipolar patients.

To enrich literature data about suicidal behaviour in BD.

A sample of 362 BD patients (DSM IV-TR) was retrospectively collected and divided in two subgroups, in relation to the presence of a previous suicide attempt. Socio-demographic and clinical variables were compared between attempters and non-attempters using Corrected multivariate analysis of covariance (MANCOVA).

A total of 26,2% of analyzed patients attempted suicide in their lifespan, and approximately one third of them had multiple suicide attempts (i.e. ≥ 2; 31%). Depressive polarity at index mood episode, higher number of psychiatric hospitalizations, comorbidity with alcohol abuse, eating disorders and psychiatric poly-comorbidity were significantly associated with suicide attempt. Additionally, treatment with lithium, poly-pharmacotherapy (≥ 4 current drugs) and higher recurrence of psychosocial rehabilitation were significantly more frequent in patients who attempted suicide.

The present paper reported a correlation with some specific clinical variables and the lifetime presence of suicide attempt in patients with BD. Although these retrospective findings did not address the causality issue, they may be of clinical relevance in order to better understand suicidal behavior in BD and to adopt proper strategies to prevent suicide in higher risk patients.

The authors have not supplied their declaration of competing interest.

Burnout is constantly becoming more exhaustively researched topic. It is assumed there is strong relationship between burnout and work-stress. The aim of this study was to investigate the relationship between burnout and work-stress in order to test the hypothesis that there is an association between these two variables.

The study sample comprised of economically active Czech population, that was a representative sample. Data was gained through combination of interviews and questionnaires depending on the age of the participants. Data was then analyzed using multiple linear regressions.

The total sample comprised of 1027 participants; 675 persons aged 25–50 years and 352 persons aged 51–65 years. The sample contained roughly equal number of men (52.8%) and women (47.2%) The full model explained 59,79% variance and was highly significant F (18,1008) = 85,76, P = 001. Some factors that participants feel like could help them reduce the stress in workplace and subsequently reduce the burnout are longer holidays, lowering the administration burden, better work place conditions and lastly increasing the authority a person has in a given work place.

The study has shown an association between work-stress and burnout and thus in order to prevent burnout with it related job absence certain precaution steps should be made. The reoccurring theme that would seem to improve the situation is decreasing the administrative work that is unrelated to the profession as well as increasing the powers the employees have in their position.

The authors have not supplied their declaration of competing interest.

The first time when people attempt suicide first contact is critical. Psychiatrists must decide to hospitalize them or follow-up in mental health units and the bases of a doctor-patient relationship are formed.

An analysis of referrals to psychiatry from the emergency room (ER) was developed. Our objective was to discover if there was a statistical correlation between gender and other variables, especially repeated visits and admissions.

Our sample was composed of patients who visited the ER for suicidal tendencies for 20 months. We carried out an observational retrospective study. The variables collected were: age, gender, cause, repeated visit (visit to the ER in the following two months), previous attempts, previous follow-up, method used, use of toxic substances during the attempt, intentionality, referral from the ER, later follow-up and diagnostic impression at the ER.

A total of 620 patients were sampled. The relationship between gender and repeated visit, previous attempts, dysfunctional personality traits, use of substances and later follow-up was found (Chi2). Although the relationship between admissions and gender were not statistically significant, influence by gender (over all in males) can be observed in logistic regression models. As well as, in patients who visited the ER several times, dysfunctional personality traits seem to be the most common but gender marks significant differences between groups.

The data obtained is consistent with those reported in previous studies. To know who the riskier groups are can allow professionals to plan protocols and unify admission criteria.

The authors have not supplied their declaration of competing interest.

Higher risk of mental health problems has been linked with problems in relationships, including the experience of relational conflict with significant others and peers. Conversely, positive relations with others have been established as a key factor of psychological well being.

We hypothesized that psychological maladjustment will be related to the number, nature and severity of relational stressors. Furthermore, there would be a higher likelihood of risk of mental disorders for those who experience more relational hardships and of greater severity. Positive relations with others will protect from risk of mental health problems.

A total of 4461 university students completed a health and well-being survey, including the GHQ-12 (centesimal and 3-point cut-off scores), Ryff psychological well-being scale and a scale of 25 life stressors. Indexes of number and severity of difficulties in relationships were calculated with 10 items including romantic partners, friends, family, and classmates.

Correlations were significant. Logistic regression showed a risk effect for all stressors with OR values above 1.32. Overall perceived severity had the highest value (OR = 2.38, 95% CI = 2.16–2.61) and amongst the 10 stressors, gender related abuse/violence was also the highest (OR = 1.90, 95% CI = 1.73–2.09). Positive relations showed a protective effect (OR = 0.60, 95% CI = 0.56–0.54).

Findings can inform health promotion, prevention and therapeutic interventions so as to improve the quality of personal relationship and conflict management skills, and to strengthen well-being associated with positive relations with others. Academic institutions committed to student welfare and the promotion of healthy environments should play a major role in young adults’ mental health.

The authors have not supplied their declaration of competing interest.

Suicide is a major concern for those afflicted by schizophrenia. Identifying patients at the highest risk for future suicide attempts remains a complex problem for psychiatric intervention. Machine learning models allow for the integration of many risk factors in order to build an algorithm that predicts which patients are likely to attempt suicide. Currently, it is unclear how to integrate previously identified risk factors into a clinically relevant predictive tool to estimate the probability of a patient with schizophrenia for attempting suicide.

We conducted a cross-sectional assessment on a sample of 345 participants diagnosed with schizophrenia spectrum disorders. Suicide attempters and non-attempters were clearly identified using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Suicide Ideation Scale (BSS). We developed two classification algorithms using a regularized regression and random forest model with sociocultural and clinical variables as features to train the models.

Both classification models performed similarly in identifying suicide attempters and non-attempters. Our regularized logistic regression model demonstrated an accuracy of 66% and an area under the curve (AUC) of 0.71, while the random forest model demonstrated 65% accuracy and an AUC of 0.67.

Machine learning algorithms offer a relatively successful method for incorporating many clinical features to predict individuals at risk for future suicide attempts. Increased performance of these models using clinically relevant variables offers the potential to facilitate early treatment and intervention to prevent future suicide attempts.

The authors have not supplied their declaration of competing interest.

Wellness self-management is an adaptation and expansion of the illness management and recovery, an internationally recognized best practice. WSM is a recovery-oriented, curriculum-based practice designed to help adults with severe mental health problems make decisions and take action to manage symptoms and improve their quality of life.

In the present study, the Italian translation of the WSM was implemented and validated. Moreover, the impact of its application in a day hospital setting on cognitive functions, psychopathology, personal resources and real-life functioning with respect to treatment as usual (TAU) was investigated.

The study was aimed at assessing the effectiveness of a semi-structured version of WSM in a day hospital setting in patients with severe mental illness.

Fourteen patients with a diagnosis of severe mental illness were recruited and randomly assigned to either WSM or TAU. WSM participants attended four 2-hour sessions per week for 1 month, including lessons selected on the basis of the goals of participants. Both groups received weekly planned treatment in the day-hospital setting and continued their pharmacotherapy.

The two groups of patients were comparable for age, education, cognitive functioning and psychopathological severity. WSM produced a significantly greater improvement in neurocognition, psychopathology, personal resources and real-life functioning with respect to TAU.

Our results offer promising preliminary evidence that the use of WSM provides an effective complement to current mental health treatment.

The authors have not supplied their declaration of competing interest.

An impairment of premorbid adjustment (PA) has been regarded among poor prognostic indicators of schizophrenia. Some discrepancies in the literature suggest the usefulness of further characterizations of its impact on different aspects of the disease.

The present study aimed to investigate the association of poor PA with psychopathology, neurocognition and real-life functioning in patients with schizophrenia recruited within the multicenter study of the Italian network for research on psychoses. functioning during childhood and adolescence (early adjustment) was assessed also in a group of healthy controls (HC) and one of unaffected relatives of patients (UR).

Group comparisons were performed between patients with poor and those with good PA. Differences in frequency of poor early adjustment were investigated among patients, HC and UR.

Patients with poor PA, as compared to those with good PA, showed earlier age of onset, more severe negative symptoms and disorganization, greater impairment on all cognitive domains with the exception of attention/vigilance and worse real-life functioning in the considered areas (interpersonal relationships, community activities and work abilities). The pattern of poor early adjustment was more frequent in patients with respect to UR and HC and, to a less degree, in UR with respect to HC.

Our findings confirm that poor PA in schizophrenia is associated with poorer illness outcome, and offer a further characterization of PA impact on different psychopathological and cognitive domains. They also suggest that poor early adjustment is a candidate endophenotype of schizophrenia, occurring in patients and their unaffected relatives.

The authors have not supplied their declaration of competing interest.

Negative symptoms are a core feature of schizophrenia but their pathophysiology remains elusive. They cluster in a motivation-related domain, including apathy, anhedonia, asociality and in an expression-related domain, including alogia and blunted affect.

Our aim was to investigate the different neurobiological underpinnings of the two domains using the brain electrical microstates (MS), which reflect global patterns of functional connectivity with high temporal resolution.

We recorded multichannel resting EEGs in 142 schizophrenia patients (SCZ) and in 64 healthy controls (HC), recruited to the Italian network for research on psychoses study. Four microstates (MS) classes were computed from resting EEG data using the K-Mean clustering algorithm. Pearson's coefficient was used to investigate correlations of microstates measures with negative symptom domains, assessed by the Brief Negative Symptoms Scale (BNSS).

SCZ, in comparison to HC, showed increased contribution and duration of MS-C. Only the avolition domain of BNSS correlated with the contribution and occurrence of MS-A. Within the same domain, anticipatory anhedonia, apathy and asociality, but not consummatory anhedonia, were positively correlated with contribution and occurrence of microstate A. Asociality was also negatively correlated with contribution and occurrence of MS-D.

Our findings support different neurobiological underpinnings of the negative symptom domains, avolition and expressive deficit. Furthermore, our results lend support to the hypothesis that only anticipatory anhedonia is linked to the avolition domain of the negative symptoms. Mixed results in the literature concerning the presence of MS-A and D abnormalities in schizophrenia might be related to the syndrome heterogeneity.

The authors have not supplied their declaration of competing interest.

Relapse prevention during early stages after psychosis onset is a key factor for long term outcome. While factors associated with first relapse have been widely studied, factors associated with subsequent relapses are poorly described.

To determine predictive factors of first and subsequent relapses among patients recruited from a cohort of PAFIP Early Intervention Program.

We analyzed socio-demographic and clinical data of a cohort of 393 first episode psychosis (FEP) patients that were recruited since February 2001 to May 2011. Of these, 341 achieved clinical remission and were, therefore, considered to be at risk of relapse. They were followed-up for 3 years. A wide range of potential factors were included as possible predictors of relapse. Test univariate, analysis logistics of regression, regression of Cox and analysis of survival of Kaplan-Meier were carried out.

Poor adherence to medication was the main predictor associated to first relapse (ExpB: 2.979; P < 0.001). After the first relapse, only 56 patients (33.9%) underwent a second relapse, being the diagnosis (ExpB: 1.975; P = 0.074), the age of onset, (ExpB: 1.078; P = 0.003) and a low level of positive symptomatology (ExpB: 0.863; P = 0.03) the predictors of associated with a second relapse.

After a FEP, non-adherence to medication is the main predictor of first relapse. Second and subsequent relapses relate with non-modifiable factors such as age of onset or schizophrenia diagnosis. This subgroup of patients could have greater predisposition to relapse related with the severity of the disease itself.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Tobacco smoking is common in schizophrenia. Some characteristics are usually associated to tobacco smoking in schizophrenia, such as younger age, earlier onset of the disease, number of hospitalizations or higher treatment doses. However, little is known about positive symptoms or aggressiveness, as well as trauma history.

to study the relationship between smoking status and clinical characteristics in patients with schizophrenia.

A total of 474 patients with were consecutively included in the network of FondaMental Expert Center (FACE) for schizophrenia and assessed with the structural clinical interview for DSM-IV axis 1 disorders (SCID), validated scales for psychotic symptomatology and childhood trauma questionnaire. Tobacco abuse or dependence was defined according to the SCID. Ongoing antipsychotic treatment was recorded. Aggressiveness was measured with Buss-Perry Aggression Questionnaire (BPAQ).

A sample of 474 patients with schizophrenia was included in this study (non-smokers, n = 215; non-smokers, n = 259). Mean age at tobacco onset was 17.19 years old (SD = 3.93). In multivariate analysis, smoking was associated with SGA use (P = 0.028), with higher scores of physical aggressiveness (P = 0.042), with current alcohol-dependence (P = 0.002). However, no association was observed with sex, age of onset, trauma history, global functioning, observance or psychotic symptomatology.

Tobacco smoking was associated with physical aggressiveness, but not with earlier onset of the disease nor traumas or psychotic symptomatology. Besides, the results of the present study are in favor of a superior efficacy of second-generation antipsychotics in the treatment of comorbid tobacco use. These results need further investigation in longitudinal studies.

The authors have not supplied their declaration of competing interest.

The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. Cognitive abilities are nuclear for the social recovery. Stress impairs higher cognitive processes, dependent on the prefrontal cortex (PFC) and that involve maintenance and integration of information over extended periods, including working memory and attention. Different mechanism are involved such as HPA-Axis hyperactivity, affecting PFC. Recently, investigations show the different evolution of cognitive abilities between different sex in WM.

A sample of 41 FEPs and 39 healthy subjects were evaluated. The variables assessed were verbal and visual memory, attention, working memory, processing speed, mental flexibility, verbal fluency, motor coordination, planning ability and intelligence.

We found an interaction between age (< 16 years and > 16 years) and group (psychosis vs. controls) in working memory (P = 0.04). There were no difference in men < 16 years old control group and men with same age plus psychosis (5.87 ± 1.57 vs. 5.83 ± 1; P = 0.1) in WM. However, this work was found to be significantly different in the univariant analysis of working memory in the group < 16 years old women control (7.30 ± 1.56) and women psychosis group (5.61 ± 1.91).

Social cognition and stress seem to be directly relation. Some studies show that stress enhance cognition performance in men while impairing it in women. Stress affect a variety of cognitive processes such attention and working memory. Deficit in social cognition are present in the prodromal phases of psychosis.

The authors have not supplied their declaration of competing interest.