The identification of new genetic variants underlying psychosis is crucial to improve its molecular diagnosis and to determine the disease etiology, which is necessary to develop new therapeutic targets.

To identify novel rare genetic variants associated to mental disorders, using whole exome sequencing (WES).

Two families with high prevalence of mental disease were genotyped using WES. The first family has 5 members affected, the mother with a bipolar disorder, three sons, two with schizophrenia and one with schizoaffective disorder, and a cousin with major depression and psychotic symptoms. The second family is constituted by 38 members affected by major mental diseases in three generations. Key affected members of each family were genotyped by WES. Shared rare variants, with allelic frequencies below 0.5% in general population, were identified among the affected members of the family. The segregation of those variants was confirmed by Sanger sequencing.

In family 1, thirty-seven genetic variants related to neurodevelopment were identified. Two of those variants in the genes TRIP12 and RNF25 segregated with psychosis. In family 2, seven rare genetic variants contained in genes related to neurodevelopment were identified. A mutation in the gene ARHGAP19 segregated with psychosis.

Three new genes have been found to be associated with psychosis. TRIP12 and RNF25 encode two E3-ubiquitin ligases which modulate the Wnt pathway, mutations in which lead to neurodevelopmental defects. ARHGAP19 encodes a GTPase which regulates the RhoA protein, involved in the regulation of the cytoskeleton.

The authors have not supplied their declaration of competing interest.

According to the dopamine hypothesis functional brain abnormalities and neurochemical alterations may converge to cause psychosis through aberrant salience attribution. Indeed, resting-state functional magnetic resonance imaging (rs-fMRI) has revealed widespread brain disconnectivity across the psychotic spectrum.

To advance the understanding of the dopaminergic involvement in intrinsic functional connectivity (iFC) and its putative relationship to the development of psychotic disorders we aimed to investigate the link between L-Dopa, a dopamine precursor, and its modulation of striatal iFC in subthreshold psychosis, i.e. non-clinical psychosis.

We used a randomized, double-blind placebo controlled study design including in our sample 56 healthy, male, right-handed, subjects with no familiar risk factors for psychosis who were assessed with the Schizotypal Personality Questionnaire (SPQ) and underwent 10 minutes of rs-fMRI scanning. All subjects received either 250 mg of Madopar DR®(200 mg L-Dopa plus 50 mg benserazid, dual release form) or a placebo. We analysed resting-state iFC of 6 striatal seeds, known to evoke dopamine related networks.

The main effect of L-Dopa presented itself (FWE-corrected) as a significant decrease in iFC from the right ventral striatum to the cerebellum and the precuneus cortex, and an increase in iFC to the occipital cortex. Subjects with high SPQ positive symptom sub-scores showed a significant increase of L-Dopa induced connectivity.

We identified striatal functional connectivity being modulated by augmented dopamine availability, and in support of the dopamine hypothesis, we found that those iFC patterns are associated to high scores of psychotic like experiences.

The authors have not supplied their declaration of competing interest.

Outcome after first episode psychosis is heterogeneous, but knowledge about the distribution and predictive factors is limited.

To investigate medication and rehospitalizations for five years after first episode hospital treated psychosis.

Swedish population registers were used to select a nation-wide cohort of 962 cases (589 or 61% men) with a first hospitalization for psychosis at ages between 16–25 years. Cases were categorized year by year for 5 years after the initial hospitalization with regard to rehospitalizations and dispensations of antipsychotics and other medications.

The 5-years mortality was 4% (n = 39) with suicides in 16 cases (1.6%, 11 of which were men). Additionally, 139 cases (23% of women and 10% of men) had hospitalizations for suicide attempts within 5 years. A bimodal distribution of years with medication was found indicating two different trajectories of outcome. One peak was seen for cases with dispensations of antipsychotics 5 of 5 years (40% of the cohort). Another peak was seen at dispensations during at most 1 of 5 year (30%). During year 5, 514 (56% of 923 cases surviving 5 years) had dispensations of neuroleptics and 257 (28%) were hospitalized, whereas 356 cases (39%) had no dispensation of neuroleptics or hospitalization.

The population of young cases with first episode psychosis is heterogeneous with at least two clearly separable trajectories based on medication and hospitalizations. The high mortality and high incidence of suicide attempts during a five-year period demonstrate a need for careful monitoring of these patients.

The authors have not supplied their declaration of competing interest.

The study presents the construction of CSSS: a short screening scale intended for diagnosis of cognitive deficits among people with schizophrenia. The final version of the scale consist of 6 subscales which measure basic cognitive functions.

A total of 160 persons (124 with schizophrenia and 36 healthy controls) were tested using the initial version of the CSSS scale consisting of 11 subscales. Correlation analysis between the subscale results was carried out, as well as confirmatory factor analysis, internal consistency analysis of the scale, IRT (item response theory) analysis of the item's difficulty, and analysis of the scale's accuracy as a classifier.

One factor explains 37% of the variance of the subscales’ results. The scale has satisfactory internal consistency (0,83). Subjects with schizophrenia achieved significantly lower scores than healthy subjects. The area under the ROC curve (AUC) for discriminating between subjects with schizophrenia and healthy subjects was 0.83. Cut point of 16 raw points is 86% sensitive and has 70% specificity.

The form of the tool that has been achieved as a result of presented analyses suggests that this scale has a potential to fulfill the assumed goals, which will be tested during continuing validation studies.

The authors have not supplied their declaration of competing interest.

In subjects with schizophrenia (SCZ), the disorganization factor was found to be a strong predictor of real-life functioning. “Conceptual disorganization” (P2), “difficulties in abstract thinking” (N5) and “poor attention” (G11) are considered core aspects of the disorganization factor, as assessed by PANSS. The overlap of these items with neurocognitive functions is debated and should be further investigated.

Within the Italian network for research on psychoses study, electrophysiological and neurocognitive correlates of the disorganization factor and its component items were investigated.

Resting state EEGs were recorded in 145 stabilized SCZ and 69 matched healthy controls (HC). Spectral amplitude (SAmp) was averaged in nine frequency bands. MATRICS consensus cognitive battery (MCCB) was used for neurocognitive assessment. Band SAmp differences and correlations with psychopathology and MCCB scores were explored by global randomization statistics.

SCZ showed increased delta, theta, and beta1 and decreased alpha2 SAmp. A negative correlation between alpha1 and disorganization was observed in SCZ. At the item level, only N5 showed this correlation. MCCB neurocognitive composite was associated with P2 and N5 but not with alpha1 SAmp.

Our findings suggest an heterogeneity of the disorganization dimension and a partial overlap with neurocognitive domains. The N5, “difficulties in abstract thinking”, had a unique association with alpha1 SAmp, which is thought to be involved in the formation of conceptual maps.

The authors have not supplied their declaration of competing interest.

Previous data showed higher autistic traits in individuals with anorexia nervosa (AN) compared to healthy controls (CTL). It is not known, however, whether this characteristic is shared by other feeding and eating disorders (FEDs) or it is uniquely associated to AN.

To compare autistic traits among individuals with AN, bulimia nervosa (BN), binge eating disorder (BED) and CTL and to investigate which specific dimensions differentiate one group from another.

A total of 241 FED patients (53 AN, 41 BN, 42 BED) and 105 CTL were administered the autism-spectrum quotient (AQ), the adult autism subthreshold spectrum (AdAS Spectrum), the Ritvo autism and Asperger diagnostic scale 14-item (RAADS-14 Screen).

FED subjects reported higher AQ, AdAS spectrum and RAADS-14 total and subscales scores compared to CTL (all P < .001). No differences were found amongst AN, BN and BED subjects in questionnaires’ total scores. BN group scored higher than AN in the hyper-/hyporeactivity to sensory input domain of the AdAS spectrum (P < .001); AN group scored higher than BED in the attention switching domain of the AQ (P < .001), and BED group scored lower than both AN and BN in the mentalizing deficit domain of the RAADS-14 (all P < .001).

We reported for the first time that not only AN but also BN and BED patients show greater autistic traits compared to CTL. Longitudinal studies are needed to confirm this preliminary report and to elucidate whether autistic traits either precede, co-occur or follow FEDs.

The authors have not supplied their declaration of competing interest.

Both resilient coping strategies and the structural/functional characteristics of personal social networks are considered important factors when facing adversity and the challenges inherent to the aging process.

To analyze the association between the configurations of ego-centred networks and different levels of resilient coping in a sample of elderly people.

Quantitative, cross-sectional study comparing groups, with 512 participants, mostly women (n = 325; 63.5%), married (n = 264; 51.5%), with 76 years old in average (SD ± 7.6), and with basic education (n = 261; 51%). We used a socio-demographic questionnaire, the IARSP-Elderly (personal social network assessment tool) and the Brief Resilient Coping Scale for data collection.

We found different levels of resilient coping in our sample: low (50.4%); medium (38,7%); strong (10.9%). These three levels of coping were associated with the composition of ego-centred networks, namely the proportion of friends and colleagues (P < 0.05), different perceived emotional support, reciprocity and satisfaction with the network (P < 0.05), frequency of contacts and relationships’ durability (P < 0.05).

Higher levels of coping are associated with a larger proportion of friends in the network, whereas the familistic networks are associated with low coping. Although participants in our study revealed mainly kin comprised networks, these results reflect the relevance of resilient coping in the activation of non-kin relationships in old age.

The authors have not supplied their declaration of competing interest.

There is evidence suggesting that for some individuals self-generating compassion and being open to compassion from others can be difficult or aversive. To date, however, no study has explored how these fears of compassion are associated with early emotional memories, such as shame or safeness memories, and to symptoms of depression and anxiety in adulthood. The current study set out to investigate the mediator effect of fears of compassion on the relationship between the traumatic and centrality features of shame memories, early memories of warmth and safeness, and symptoms of depression and anxiety.

In this cross-sectional study, participants were 302 individuals (171 women; age M = 36.28; SD = 11.45) recruited from the general community population, who completed self-report measures of fears of compassion (for self, for others and from others), shame memories, safeness memories, depression and anxiety.

Path analysis showed that fears of compassion for self and of receiving compassion from others mediated the effects of shame traumatic memory, centrality of shame memory and early memories of warmth and safeness on depressive and anxiety symptoms. Fear of compassion for self was the best predictor of depression and anxiety.

Fears of compassion may render an individual more vulnerable to defeat and threat responses when faced with stressful life events, which can manifest as symptoms of depression or anxiety. Clinical implications might be derived from these findings as these fears, as well as the negative emotional memories fuelling them, may need to be addressed in therapy to assist patients in self-generating and receiving compassion.

The authors have not supplied their declaration of competing interest.

A better understanding of the genomics of mental illnesses allowed genetic counselling to be provided to individuals with severe mental illness and their families.

The present study was aimed at assessing the efficacy of genetic counselling for severe mental illnesses with high suicide risk.

Assessment was performed before and after genetic counselling session. Measures used were evaluation of traumatic events in childhood, multidimensional scale for perception of social support (SMSSP), positive and negative affect schedule (PANAS-X), Brief Psychiatric Rating Scale (BPRS), Paykel questionnaire and Genetic Counselling Outcome Scale (GCOS). Paykel's questionnaire consists of five questions about suicidal thoughts and attempts, including: life-weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts. Intervention and assessment lasted approximately one and a half hour. Data from 48 patients was analysed.

Mean age of participants was M = 38.4, SD = 9.7, and the group was batter represented by females (57%). The participants had various diagnoses, 22% had schizophrenia, 36% bipolar disorder and 42% recurrent depressive disorder. Forty percent of participants reported suicidal ideation and 22,5% had a past history of suicide attempt. Genetic counselling had a direct positive influence upon GCOS specific items and reduced the Paykel scores among participants presenting with suicidal ideation.

Genetic counselling offers information about the disorder, the role of genetics and the impact of environmental factors. Preliminary data suggest that providing genetic counselling decreases the suicidal ideation frequency.

The authors have not supplied their declaration of competing interest.

Schizophrenia is treated with antipsychotics and other psychotropic medications, many of which are substrates for the highly polymorphic CYP2D6 enzyme. The most frequent variant allele is CYP2D6*4- leading cause of poor metabolism (PM) phenotype. PM causes the reduction of therapeutic response, increase the risk of adverse drug reactions and increase the plasma concentration of both drug and its metabolites above the levels of toxicity.

Analysing CYP2D6*4 allele frequency among schizophrenic patients for further individualisation and rationalisation of therapy.

Research was conducted on 38 schizophrenic patients and 110 healthy individuals. CYP2D6*4 allele was detected with allele specific PCR.

Both wild type allele carriers are 55% of the schizophrenic patients, 45% are wild type/*4heterozygous, and *4/*4 homozygous are not identified. There is a statistically significant difference in the genotype distribution (P < 0.05) between schizophrenic patients and healthy individuals. Significantly higher *4 allele frequency (37%) comparing to healthy individuals (P < 0.0001) indicates the necessary caution in administration of CYP2D6 substrates. A lower frequency of PMs in schizophrenic patients than in healthy individuals could be explained with CYP2D6 neuroactive substrate metabolism. Forty-five percent of the schizophrenic patients are intermediate metabolisers carrying the higher risk of adverse response to CYP2D6 substrates comparing to wild type homozygous. As none of the analyzed patients was PM, exceeded plasma concentrations of medications above toxic levels are not expected when administrating the right dosage.

Altered CYP2D6 metabolism may contribute to the vulnerability, clinical severity and treatment outcome of schizophrenia.

The authors have not supplied their declaration of competing interest.

The candidate gene-environment interaction (cG × E) research field in psychiatry has traditionally been dominated by the diathesis–stress framework, where certain genotypes are assumed to confer increased risk for adverse outcomes in a stressful environment. In later years, theories of differential susceptibility or biological sensitivity have been presented, suggesting that cGs that interact with environmental events do not exclusively confer a risk for behavioural or psychiatric disorders but rather seem to alter the sensitivity to both positive and negative environmental influences.

The present study investigates the susceptibility properties of the 5HTTLPR gene in relation to depressive symptoms and delinquency in two separate adolescent community samples: n = 1457, collected in 2006; and n = 191, collected in 2001.

Two-, three- and four-way interactions between the 5HTTLPR, positive family environment, negative family environment, and sex were found in relation to both depressive symptoms and delinquency. However, the susceptibility properties of the 5HTTLPR gene were distinctly less pronounced in relation to depressive symptoms.

If the assumption that the 5HTTLPR gene induces differential susceptibility to both positive and negative environmental influences is correct, the previous failures to measure and control for positive environmental factors might be a possible explanation for former inconsistent findings within the research field.

The authors have not supplied their declaration of competing interest.

Anorexia nervosa (AN) is a severe psychiatric disorder. The epigenetic regulations are strongly suggested in AN. We and other groups have performed a whole-genome methylation study (methylome) in AN. We found that the differentially methylated CpG sites are located around genes involved in biological processes in link with embryonic morphogenesis, brain development and its plasticity, in particular adhesion and axon guidance. Here, we study an independent group of 40 AN patients. Furthermore, we have done a follow-up during more than one year, to compare the methylation profiles in subjects that evolve to the remission.

Our work is to replicate the methylome study in an independent AN cohort and to characterize profiles of methylation at two times for the same subjects to compare the AN patients that convert to remitters.

Our goal is to identify diagnostic and prognostic epigenetic signatures for AN.

Of the 40 AN patients, 18 evolved to remission. Furthermore, the blood samples of the subjects from the 2 times will be investigated, like this, each subject is its own control. Methylation of DNA is measured by using the Infinium HumanMethylation450 BeadChip technology.

Comparisons of AN to controls showed similar profiles of methylation involving the same biological processes as previously identified. We are comparing now the difference of methylation between the 18 remitters and the 18 actual AN, taking into account of the two times of samples.

We expect to characterize specific methylation signature of the prognostic of the AN remission.

The authors have not supplied their declaration of competing interest.

Bipolar disorder (BD) is characterized by unusual shifts in mood and energy and affects 1 to 3% of the general population. Lithium (Li) can prevent patients from depression and mania, as well as reduce the risk of suicide. Unfortunately, a high rate of patients do not respond positively to Li treatment. In line with various studies, Li treatment is also associated with potentially severe adverse reactions, including renal dysfunctions. Specifically, it has been reported that Li may induce reduction of glomerular filtration rate (GFR) in long-term treated BD patients.

The aim of our study was to evaluate the contribution of genetic variants in Li-induced reduction of the estimated GFR (eGFR) in bipolar patients, under long term Li therapy.

We screened the literature to identify genes previously shown to be associated with kidney function or Li mechanism of action and genotyped tag SNPs covering these genes.

The sample comprised 70 Sardinian bipolar patients genotyped for 46 SNPs, located in 33 genes, with Invader assay and Sanger sequencing.

Our results showed that a SNP (rs378448) located in Acid Sensing Ion Channel Neurona-1 (ACCN1) gene, significantly interacted with years of Li treatment in reducing eGFR (F = 4.166, P = 0.046).

Our preliminary findings suggest that ACCN1 (ASIC2) gene could be involved in modulating the susceptibility of BD patients to develop renal dysfunctions induced by chronic Li treatment.

The authors have not supplied their declaration of competing interest.

TAAR1 is a G protein-coupled receptor expressed broadly throughout the brain. Recently, TAAR1 has been demonstrated to be an important modulator of the dopaminergic, serotonergic and glutamatergic activity.

Assessment of the relation between two single-nucleotide polymorphisms of TAAR1 gene, suicide attempts and alcohol abuse.

A total of 150 Polish patients were included, 59 subjects after suicide attempt vs. 91 controls. The chosen SNPs (rs759733834 and rs9402439) were studied using RFLP-PCR methods. The Hardy-Weinberg equilibrium was tested in control group.

Chi2 or Yeates Chi2 Test were used.

The mean age of study subjects and controls was: 38 ± 12.3 and 42 ± 12.8 respectively; 49% study males vs. 54% male controls. We did not observe the association between the carriage of the genotypes GG, GA and AA of rs759733834 polymorphisms in either of the groups. The distribution of genotypes in respect to rs9402439 polymorphism (CC, CG, GG) was also insignificant. Among patients with alcohol dependence, the frequency G allele of rs9402439 polymorphism was lower compared to non-addicted ones (27 vs. 47%) P < 0.01.

TAAR1 polymorphisms rs759733834 and rs9402439 are not related to suicide attempts. The carriage of allele G of rs9402439 polymorphism is related to lower risk of alcohol addiction OR 0.40 95%Cl 0.20–0.81. To our knowledge, this is the first study on the TAAR1 receptor and the risk of suicide and it might offer a new insight into genetic etiology of TAAR1 receptor.

The authors have not supplied their declaration of competing interest.

Patients with a first episode psychosis (FEP) have repeatedly been shown to have gray matter (GM) volume alterations. Some of these neuroanatomical abnormalities are already evident in the at-risk mental state (ARMS) for psychosis. Not only GM alterations but also neurocognitive impairments predate the onset of frank psychosis with verbal learning and memory (VLM) being among the most impaired domains. Yet, their interconnection with alterations in GM volumes remains ambiguous.

To evaluate associations of different subcortical GM volumes in the medial temporal lobe with VLM performance in ARMS and FEP patients.

Data were collected within the prospective Früherkennung von Psychosen (FePsy) study, which aims to improve the early detection of psychosis. VLM was assessed using the California Verbal Learning Test (CVLT) and its latent variables Attention Span (AS), Learning Efficiency (LE), Delayed Memory (DM) and Inaccurate Memory (IM). Structural images were acquired using a 3 Tesla magnetic resonance imaging scanner.

Data from 59 ARMS and 47 FEP patients were analysed. Structural equation models revealed significant associations between the amygdala and AS, LE and IM; thalamus and LE and IM; and the caudate, hippocampus and putamen with IM. However, none of these significant results withstood correction for multiple testing.

Although VLM is among the most impaired cognitive domains in emerging psychosis, we could not find an association between low performance in this domain and reductions in subcortical GM volumes. Our results suggest that deficits in this domain may not stem from alterations in subcortical structures.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Socially-assistive robots have been used with older adults with cognitive impairment in residential care, and found to improve mood and well-being. However, there is little known about the potential benefits in adults with other neuropsychiatric symptoms.

The aim of this project was explore the utility and acceptability of a socially-assistive robot in engaging adults with a variety of neuropsychiatric symptoms.

Betty, a socially-assistive robot was installed in a unit which specialises in the assessment and diagnosis of adults presenting with neuropsychiatric symptoms. She is 39 cm tall, has a baby-face appearance and has the ability to engage individuals through personalised services which can be programmed according to individuals’ preferences. These include singing songs and playing games. Training for the nursing staff who were responsible for incorporating Betty into the unit activities was provided. The frequency, duration and type of activity which Betty was involved in was recorded. Patients admitted who could provide informed consent were able to be included in the project. These participants completed pre- and post-questionnaires.

Eight patients (mean age 54.4 years, SD 13.6) who had diagnoses ranging from depression and schizophrenia participated. Types of activities included singing songs, playing Bingo and reading the news. Participants reported that they were comfortable with Betty and did not feel concerned in her presence. They enjoyed interacting with her.

This pilot project demonstrated that participants found Betty to be acceptable and she was useful in engaging them in activities. Future directions would involve larger sample sizes and different settings.

The authors have not supplied their declaration of competing interest.

Behavioral disorders, such as conduct disorder, influence choice of treatment and its outcome. Less is known about other variables that may have an influence.

We aimed to measure the parent drug and metabolite plasma levels in risperidone-treated children and adolescents with behavioral disorders and investigate the role of drug dose and patients’ gender and age.

We recruited 115 children/adolescents with DSM-5 behavioral disorders (females = 24; age range: 5–18 years) at the Departments of Psychiatry of the Hospitals of Bolzano, Italy, and Innsbruck, Austria. We measured risperidone and its metabolite 9-hydroxyrisperidone plasma levels and the parent drug-to-metabolite ratio in the plasma of all patients by using LC-MS/MS. A subsample of 15 patients had their risperidone doses measured daily. We compared risperidone and 9-hydroxyrisperidone plasma levels, as well as risperidone/9-hydroxyrisperidone ratio, in males vs. females and in younger (≤ 14 years) vs. older (15–18 years) patients by using Mann-Whitney U test. We fitted linear models for the variables “age” and “daily risperidone dose” by using log-transformation, regression analysis and applying the R2 statistic.

Females had significantly higher median 9-hydroxyrisperidone plasma levels (P = 0.000). Younger patients had a slightly lower median risperidone/9-hydroxyrisperidone ratio (P = 0.052). At the regression analysis, daily risperidone doses and metabolite, rather than parent drug–plasma levels were correlated (R2 = 0.35).

Gender is significantly associated with plasma levels, with females being slower metabolizers than males. Concerning age, younger patients seem to be rapid metabolizers, possibly due to a higher activity of CYP2D6. R2 suggests a clear-cut elimination of the metabolite.

The authors have not supplied their declaration of competing interest.

Schizotypy refers to a set of temporally stable traits that are observed in the general population and that resemble, in attenuated form, the symptoms of schizophrenia. In a previous work, we identified volumetric patterns in thalamic subregions which were associated with disease status, and trained a random forests classifier, accounting for such thalamic volumetric patterns, that discriminated healthy controls (HC) from patients with schizophrenia (SCZ) (81% accuracy) [1].

i) to assess performance of random forests classifier developed by Pergola and coworkers [1], in an independent sample of healthy subjects; ii) to test whether false positives (FP), i.e. HC classified as SCZ based on such classifier would be associated with greater schizotypy compared with true negatives (TN), i.e. HC classified as such.

A total of 167 HC participated in the MRI study and filled the Schizotypal Personality Questionnaire (SPQ). We pre-processed MRI data with SPM8 and DARTEL. Then, we used thalamic grey matter volumes (GMV) as features in the random forests prediction of disease status at the single subject level. Finally, we tested SPQ scores differences between FP and TN with Mann-Whitney test.

The classification accuracy was 71%. FP had greater SPQ scores compared to TN (P = 0.007).

Classification accuracy of our classifier in an independent sample suggests that thalamic GMV patterns are reproducible markers of disease status. Furthermore, the present results also suggest that variability of thalamic GMV patterns in HC may have relevance for subclinical phenotypes related to schizophrenia spectrum.

The authors have not supplied their declaration of competing interest.

Recent studies suggest that most of schizophrenia's first-episode patients have the potential for long-term remission. Conversely, some meta-analysis estimate the actual median recovery rate to be 13.5% [1]. Relapses may contribute to the emergence of increased morbidity and treatment resistance.

To evaluate possible relationships between the numbers of previous admissions, years of diagnosed disease and hospitalization length.

A cross-sectional retrospective study on all patients (n = 202, 150 men and 52 women) admitted at an acute inpatient unit throughout the year of 2015, diagnosed with schizophrenia (ICD-9, 295). Collection of socio-demographic data, number of previous admissions (PA), years of diagnosed disease (YDD) and hospitalization length (HL). Descriptive statistical analysis, Spearman rank correlation and Mann-Whitney U test.

Overall, the sample's mean age was 44.3 years old (std 12.7), being lower in men (42.5 versus 49.7). The average of admissions was 1.2 per year. PA and YDD were significantly associated (P < 0.0001). Contrarily, there was no statistical association between the number of PA and HL (P > 0.1), as well as between YDD and HL (P > 0.1) was found.

This study provides additional evidence for schizophrenia's early onset in men. There seems to be no association between relapses and treatment resistance, considering PA, YDD and HL as valuable soft outcomes. Future understanding of relapses’ pathophysiological mechanisms is warranted in order to explain schizophrenia's low median recovery rate.

The authors have not supplied their declaration of competing interest.