Psychosis refers to symptoms that are positive, disorganised,or negative and affects 3% of the population yet little information on long-term cognition is available.

To determine association between symptom severity,duration of disease and cognitive impairment.

50 adult patients suffering from psychosis(DSM-5) for minimum 1 year and currently on at least 1 antipsychotic drug whose cognition and severity of symptoms were assessed by Montreal Cognitive Assessment test(MoCA) and Positive and Negative Syndrome Scale (PANSS) respectively were included in this cross sectional,cohort study.

Mean age of population was 41.5±12.33 years.Disorganised behaviour and speech were the prevalent core symptoms and risperidone was the choice of drug.

Symptom severity was mild and more negative symptoms were prominent (composite score: -1.48±6.47) (Table 1 PANSS Score) and an overall moderate cognitive impairment(16.5±4.46, table 2) was seen in population. Females showed a significantly lower MoCA score as compared to males (14.9±4.8 vs 17.65 ± 3.78, p=0.03) implying more cognitive decline (image 3).There is a strong, negative, linear correlation between MoCA and PANSS scores (r= -0.688, p<0.001) wherein all domains(image 1)except memory were negatively correlated to PANSS. Duration of illness showed a moderate, positive,linear and weak, negative, linear correlation with PANSS( r= 0.417, p =0.003) and MoCA(r = -0.314, p= 0.026) respectively. PANSS items were negatively correlated to MoCA in positive, negative and generalised items except delusions, blunted effect and tension(image 2).

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Image 3:

We conclude that cognitive function significantly declines( executive function was the most and memory was not significantly impacted) with respect to increasing disease severity and duration of illness in long term psychosis.Most positive symptoms, excluding delusions,and negative symptoms (apart from blunted affect) and general symptoms (except tension), were significantly linked to cognitive decline.

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An influential current theory suggests that auditory verbal hallucinations (AVH) result from abnormal activity in the auditory cortex. Against this, however, Fuentes-Claramonte et al (Sci Rep 2021; 11 18890) recently found that AVH did not activate the primary or secondary auditory cortex, although there were activations in other areas including Broca’s area. At the level of brain structure, sulcal depth has been increasingly linked to brain function (Natu et al Cereb Cortex 2021; 31 48-61; De Vareilles et al Dev Cogn Neurosci 2023; 61 101249 ). Accordingly, exploring brain structural-functional associations for AVH may provide new insights in their biological basis.

To assess the relationship between sulcal depth and brain activity during AVH and perception of real speech.

Functional (fMRI) and structural (sMRI) 3T scans were obtained from 14 patients with schizophrenia who experienced near-continuous AVH. During fMRI, participants pressed a button when they experienced AVH or heard real speech similar in form to their AVH. Standard fMRI analysis was conducted with FSL, while sMRI images were processed using Freesurfer’s recon-all pipeline to measure sulcal depth. Cross-modal registration aligned whole-brain fMRI activation maps to corresponding structural data and correlations between sulcal depth and brain activity were calculated for each vertex; age, sex and estimated premorbid IQ were covaried for. Cluster-based correction was applied for multiple comparisons.

During real speech, a positive correlation was found between brain activations and sulcal depth in the left superior temporal sulcus (STS, BA 22), and negative correlations in the middle temporal (BA 21), frontal (BA 46), and parietal cortex. On the right, positive correlations were seen in the superior and middle temporal cortex (BA 38, 20, 42), while negative correlations were found in the STS (BA 22), pars triangularis (BA45), and precentral (figure a). During AVH, there was a negative correlation in the left pars triangularis (BA 45) only, including Broca’s area, with no significant correlations in the right hemisphere (figure b).

Image 1:

The left STS, along with frontal and temporoparietal areas, appear structurally and functionally linked to perception of real speech. In contrast, AVH primarily engages Broca’s area and adjacent left inferior frontal regions.

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Schizophrenia is often characterized by chronic progression and frequent relapses. However, recent evidence suggests that many patients can achieve symptoms remission and functional recovery through integrated pharmacological and psychosocial interventions. Despite treatment advances, up to 34% of patients are resistant to standard antipsychotic treatments, with clozapine being the gold standard for treatment-resistant schizophrenia (TRS). However, up to 60% of TRS patients may not respond adequately to clozapine due to its adverse effects and lack of compliance. Recently, the use of two long-acting injectable (LAI) antipsychotics has emerged as a potential strategy for managing TRS, particularly in patients with poor adherence to oral therapies.

The objective is to provide clinical insights into this novel pharmacological approach consisting in the administration of two LAI antipsychotics in patients with treatment resistant schizophrenia.

This case report describes the clinical management of a 62-year-old woman with a 20-year history of treatment-resistant paranoid schizophrenia, characterized by multiple hospitalizations, delusions, auditory hallucinations, disorganized behavior, and non-adherence to oral medications.

Due to the patient’s poor response to prior treatments, including clozapine, a novel therapeutic strategy was adopted during her hospitalization in March 2023. Two LAI antipsychotics, haloperidol decanoate (100 mg/28 days) and aripiprazole (400 mg/28 days), were administered alternately to optimize symptom control while minimizing adverse effects. Over 8 weeks, the patient demonstrated significant improvements in psychotic symptoms, mood, and functioning. Importantly, adherence to treatment improved.

This case highlights the potential efficacy and safety of combining two LAI antipsychotics in TRS patients, particularly those with poor adherence to oral therapies. The alternating administration of haloperidol and aripiprazole may exploit the synergistic effects of first- and second-generation antipsychotics, offering a promising alternative for managing complex cases of schizophrenia. Further studies are needed to confirm these findings and establish guidelines for dual LAI use in TRS patients.

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The role of emotional regulation (ER) has emerged as a key mechanism associated with psychosis with important implications for its onset and maintenance. However, knowledge about ER in psychosis has been predominantly quantitative, often neglecting patients’ own perceptions of the difficulties they experience when dealing with their emotions.

To address this gap, we have undertaken a qualitative study to investigate ER in individuals with schizophrenia and schizoaffective disorder using semi-structured interviews. Given the qualitative nature of the study, we have no specific hypotheses. Instead, we aim to explore the stages of emotional regulation and the factors that influence ER in people with schizophrenia and schizoaffective disorder, aligning our investigation with existing theoretical models.

Patient recruitment and data collection are in progress. Thematic analyses will be carried out.

Results will be presented during the European Congress of Psychiatry.

We expect that this study will provide a deeper understanding of ER from the individuals’ perspectives and enrich ER literature and theoretical models related to clinical populations. Ultimately, this research aims to contribute to the development of quantitative studies to test new hypotheses and design individual-tailored psychological interventions aimed at improving ER in patients with schizophrenia and schizoaffective disorder.

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Cannabis is the most widely used psychoactive substance among youth, and its use has been increasingly linked to psychiatric disorders, particularly psychosis. THC, the psychoactive component of cannabis, has the potential to trigger or worsen schizophrenia. Cannabis use is associated with an earlier onset of schizophrenia and is more prevalent among males with first-episode psychosis, which may contribute to an earlier onset of schizophrenia observed in men. With increasing cannabis legalization, understanding gender differences in cannabis use in schizophrenia patients is essential for personalized treatment approaches.

To examine the gender-specific impact of cannabis use on schizophrenia or other psychotic disorders, focusing on pre-onset use and discontinuation following antipsychotic (AP) treatment.

A retrospective study was conducted including personal interviews and medical history reviews of inpatients and outpatients. Inclusion criteria were age between 18 and 65 years, diagnosis of schizophrenia or schizoaffective disorder, and use of AP therapy, both for at least 5 years. Statistical analysis was performed using the Jamovi statistical analysis software.

136 patients being treated at University Medical Centre Maribor’s Department of Psychiatry were included in the study. 38.2% of patients were females and 61.1% were males. The mean age of all participants was 49.2±11.8 years. The mean age at the time of diagnosis was statistically significantly higher in females compared to males (30.4±8.9 versus 26.0±7.9 years; Mann Whitney U test: p<0.001). Before the onset of psychosis, 23.1% females and 56.0% males used cannabis, while 76.9% females and 44.0% males did not (Image 1). A chi-squared test showed a significant gender difference in cannabis use (p<0.001), indicating higher prevalence among males. After introduction of the AP treatment 58.3% females and 57.4% males discontinued cannabis use (Image 2). A chi-squared test indicated no significant association between sex and cannabis discontinuation (p=0.956), with similar rates for both genders.

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Our study reveals significant gender differences in cannabis use before psychosis onset, with males showing higher prevalence and potentially earlier diagnosis. However, cannabis discontinuation rates after AP treatment were similar across genders, suggesting comparable responses to treatment. As cannabis legalization increases, the need for customized interventions that consider gender-specific factors in managing psychotic disorders is emphasized. Further research is necessary to investigate the long-term effects of cannabis use on treatment outcomes in both males and females.

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Ekbom syndrome, also known as delusional parasitosis, is a psychiatric disorder in which the affected person is firmly convinced that their body is infested with parasites, insects, or any other microorganism, despite the lack of medical evidence to support it.

A 56-year-old woman presents to the emergency department, referred by her primary care physician, due to a sensation of worms in her vagina and rectum. She reports that larvae are coming out of her nostrils, ears… and she feels them settling in her kidney. She is accompanied by her husband, who mentions that on some occasions, she has shown him the supposed parasite.

The objectives of this clinical case are to understand whether Ekbom syndrome can be related to any secondary organic pathology, as well as to identify the conditions with which the differential diagnosis should be made, and to determine the most effective treatments.

Examination: Sensory-perceptual disturbances in the form of cenesthetic hallucinations. High levels of anxiety with functional impact on her daily life.

Complementary tests: A referral was made to Internal Medicine to rule out the presence of parasites, and to Neurology for an MRI with contrast, which revealed a white matter lesion in the brainstem. Tests for anti-AQP4 and anti-MOG antibodies were also conducted, and both were negative. After these studies, it was concluded that the criteria for secondary Ekbom syndrome due to organic pathology were not met.

The differential diagnosis should be made with other psychiatric disorders such as schizophrenia, major depression, or substance-induced psychosis. Neurological diseases, such as dementia, multiple sclerosis, or meningoencephalitis, should also be ruled out. Lastly, it is advisable to rule out dermatological conditions, such as scabies.

Treatment was initiated with Risperidone and Alprazolam, with good response and improvement in delusional ideation.

Treatment with atypical antipsychotics is effective for this syndrome, reducing delusional ideas and significantly improving the psychiatric symptoms that accompany the delusion, such as anxiety, depression, and insomnia.

Good collaboration between different medical professionals is essential to rule out associated secondary pathology.

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While it is known that of those people who experience psychotic experiences, approximately 75% of them do so for the first time between the ages of 15 and 30 and that the majority are male, there has recently been increasing interest in the incidence of psychosis in other population groups.

The present study aims to analyse the sociodemographic data collected over a period of ten months in a First-Episode Psychosis Programme in a third level hospital, such as the Hospital Clínico Universitario de Valladolid.

It is a retrospective observational study. Patients have been recruited during ten months and those who presented an episode of the psychosis spectrum for the first time (according to DSM-V diagnostic criteria) were included. Different socio-demographic data regarding their age, sex, marital status and employment status have been collected at the time of their inclusion in the programme.

A sample of 23 patients was recruited, of which 26% were women (n=6) and 74% were men (n=17).

The mean age was 29.95 years.

Regarding marital status, 70% of the patients in the sample were single (n=16), 17% were married (n=4), and 13% were living with a partner (n=3). There were no divorced or widowed patients.

In terms of employment, 36% (n=8) of the patients were in employment at the time of admission to the programme. 26% (n=6) were studying, 21% (n=5) were unemployed, 13% (n=3) were on sick leave and 4% (n=1) were receiving a pension.

Socio-demographic data, in general, are as expected in a programme of these characteristics. However, it should be noted that the mean age of the patients recruited is above that most frequently described in the literature. However, we believe that it would be necessary to increase the sample size to be able to offer more robust results.

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Clozapine is an atypical and complex antipsychotic that appears to benefit from actions on multiple neurotransmitter systems. While its mechanisms of action are not fully understood, this broad spectrum of activity accounts for clozapine’s superior efficacy in treating refractory schizophrenia and other conditions.

The aim of this paper is to review the main indications of clozapine and its applications in clinical practice, as well as to highlight key considerations for its safe and effective management.

A systematic review of the scientific and clinical literature on clozapine was conducted. The review included databases such as PubMed and Cochrane, covering articles from the past 20 years. The scientific evidence obtained was analyzed and synthesized.

Findings indicate that clozapine remains the treatment of choice for patients with treatment-resistant schizophrenia, showing a superior response rate compared to other antipsychotics. Additionally, its effectiveness in reducing suicidal behaviors in patients with schizophrenia and related disorders has been identified. The indications also extend to psychosis in Parkinson’s disease, substance use disorders, and a wide range of psychiatric and neurological disorders.

Clozapine is essential in the treatment of refractory schizophrenia and in reducing suicide risk. Its broad mechanism of action, affecting multiple neurotransmitters, allows its use in secondary psychotic disorders and complex comorbidities, such as Parkinson’s disease. However, its use is associated with significant risks, necessitating rigorous monitoring of adverse effects.

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Suicide is a significant concern among individuals with schizophrenia, yet it often receives insufficient attention in clinical settings. Understanding the specific risk factors associated with suicide in this population is critical for implementing targeted and effective prevention strategies, enhancing patient care, and ultimately reducing this substantial risk.

To identify suicide risk factors within a population of patients with schizophrenia.

This was a descriptive retrospective study conducted at the Psychiatry Department D of Razi Hospital in Tunisia. Clinical records of patients diagnosed with schizophrenia according to DSM-5 criteria, aged over 18 years, without substance-related disorders or somatic pathology explaining psychiatric symptoms, were reviewed. Patients were followed in the department for ten years (2013-2023) and identified as having at least one suicide attempt during their follow-up. Data collected included sociodemographic information (age, education level, residence, socioeconomic status, marital status, offspring, profession) and clinical details (number and nature of suicide attempts, clinical scores at the time of suicide attempt using PANSS and CDS scales, current antipsychotic treatment, family history of suicide and psychosis, and treatment adherence).

We collected data from 60 patients, with a mean age of 42 ± 12.02 years; 66% (n=40) were male. Regarding education and employment, 60% (n=36) had primary education, and 55% (n=33) were employed. 65% (n=39) were unmarried, and 80% (n=48) had a low socioeconomic status. The average number of suicide attempts per patient was 3.52 ± 1.02, with the most common methods being medication ingestion (60%) and strangulation (20%). Approximately 70% (n=42) of patients had a family history of mental disorders, and 40% (n=24) had a family history of suicide. During suicide attempts, mean scores on PANSS-positive, PANSS-negative, and CDS subscales were 25.4 ± 4.7, 18.6 ± 3.2, and 12.8 ± 2.5, respectively.

We found that male gender (p=0.03; OR=3.33; 95% CI [1.12 - 9.89]), low socioeconomic status (p=0.002; OR=2.25; 95% CI [1.04 - 4.86]), family history of suicide (p=0.04; OR=2.90; 95% CI [1.15 - 7.32]), high PANSS-positive scores (p=0.0019; OR=1.98; 95% CI [1.42 - 3.51]), and high CDS scores (p=0.005; OR=2.50; 95% CI [1.32 - 4.72]) were suicide risk factors in our study participants.

The identified factors, including male gender, low socioeconomic status, family history of suicide, and elevated clinical symptomatology, highlight specific areas that warrant focused attention when evaluating and managing patients with schizophrenia.

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Schizophrenia is a multifaceted psychiatric disorder characterized by disturbances in thinking, emotions, and behavior. It exhibits a diverse spectrum of clinical presentations influenced by various factors, among which gender plays a significant role.

To determine the differences in clinical profile and therapeutic response among schizophrenia patients according to gender.

We conducted a descriptive, cross-sectional, comparative study over a three-month period from January to March 2024, among patients in the post-care service of Psychiatry Department D at Razi Hospital diagnosed with schizophrenia based on DSM-5 criteria. Sociodemographic and clinical data were initially collected from patients’ medical records and then verified and supplemented during direct interviews using a pre-established information sheet. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity in participants.

We enrolled 80 participants, of whom 50 were male (62.5%) and 30 were female (37.5%). The mean age of participants was 42.5 years. Men had higher mean scores on the positive symptoms subscale (75.6±12.05) and negative symptoms subscale (64.8±8.69), while women had higher mean scores on the general symptoms subscale (69.3±15.86). Male patients exhibited a higher prevalence of auditory hallucinations (80%) compared to women (55%), with a statistically significant difference (χ² = 4.32, p < 10-3). Similarly, a higher prevalence of delusional ideas (72%) was observed in men compared to women (45%), also statistically significant (χ² = 5.87, p = 0.02). Regarding therapeutic response, men showed a statistically more significant improvement in positive symptoms like hallucinations and delusional ideas, with an average reduction of 15 points on the PANSS scale compared to 10 points in women (p = 0.02). Conversely, women demonstrated a more favorable response to negative symptoms such as social withdrawal and apathy, with an average reduction of 12 points on the PANSS negative symptoms subscale compared to 8 points in men (p = 0.04).

The observed differences in clinical profiles and therapeutic responses between male and female patients underscore the necessity for tailored treatment approaches aimed at optimizing outcomes and enhancing patient care.

None Declared

Treatment-resistant schizophrenia remains a major challenge in psychiatry due to its resistance to conventional therapeutic interventions, leading to persistent symptoms and functional impairment. Efforts to address it focus on exploring alternative approaches, including novel medications, psychosocial interventions, and neurostimulation techniques.

To determine the sociodemographic and clinical profile of patients with treatment-resistant schizophrenia.

We conducted a retrospective descriptive study involving patients diagnosed with treatment-resistant schizophrenia at Psychiatry Service D of Razi Hospital in Tunisia over a five-year period (2019-2023). Data collection was conducted retrospectively by initially referring to medical records and subsequently verifying and supplementing information through patient or family interviews. Sociodemographic variables included age, gender, educational level, socioeconomic status, marital status, and occupation. Clinical data of interest comprised age at onset of mental disorder, duration of untreated psychosis, illness duration, family history of mental illness, previous treatments and their dosages, medical and psychiatric comorbidities, therapeutic adherence, and clinical scores using the Positive and Negative Syndrome Scale (PANSS).

The sample size is 30 patients.

We identified a distinct demographic and clinical profile among patients diagnosed with treatment-resistant schizophrenia. The cohort exhibited a notable male predominance, constituting 60% (n=18) of the study population, with a mean age of 39 ± 14.58 years. The majority of patients were unmarried (70%, n=21) and belonged to a lower socioeconomic status (80%, n=24).

In terms of clinical characteristics, patients experienced an early onset of the disorder at 18 ± 3.58 years, coupled with a prolonged duration of untreated psychosis averaging 8 ± 2.65 years. There was a substantial prevalence of family history of mental illness among the cohort (80%, n=24).

The initial psychiatric assessment, based on PANSS scores obtained from the first hospitalization, revealed elevated symptomatology levels: Positive subscale score averaged 28 ± 5.23, Negative subscale score averaged 20 ± 4.53, and General psychopathology score averaged 65 ± 10.02.

Comprehensive clinical and sociodemographic profiling of individuals with treatment-resistant schizophrenia is essential for enhancing clinical outcomes and tailoring treatment strategies. This approach allows clinicians to better understand the unique challenges these patients face, enabling the development of more targeted and effective interventions to improve their quality of life.

None Declared

Psychosis encompasses a complex spectrum of psychiatric manifestations that can arise from diverse organic etiologies, such as severe head trauma (1), epilepsy, systemic diseases, and tumors. While brain tumors are typically considered neurological conditions primarily affecting cognitive and motor functions, they can also present with psychiatric symptoms that exhibit clinical and evolutionary atypicality. This interplay between organic pathologies and psychiatric symptomatology underscores the intricate nature of mental health disorders originating from physiological disruptions.

To describe a case of chronic psychotic disorder with intermittent exacerbations secondary to a neurological tumor and discuss the diagnostic and therapeutic challenges.

We report the case of a 46-year-old male patient who was admitted to Razi Hospital for aggressive behavior, delusional syndrome, and auditory hallucinations in 2023. The case report is followed by a discussion reviewing relevant literature on the subject.

A 46-year-old Caucasian man with no significant medical history was referred to our psychiatry service due to recent behavioral disturbances marked by hetero-aggressive outbursts. During evaluation, the patient was conscious, well-oriented in time and space, but anxious and attentive. He reported auditory hallucinations with religious content, persecutory delusions, and mystical-religious ideas. According to the patient’s history, auditory hallucinations began at age 16, with exacerbations at 25, 34, and 42 years.

Psychometric evaluation using the Positive and Negative Syndrome Scale (PANSS) yielded scores of 39 for positive symptoms and 16 for negative symptoms. Neurological examination revealed no abnormalities. Brain MRI showed a tumor in the splenium of the corpus callosum measuring 18 x 14 x 8 mm, with mild hypointensity on T1, hyperintensity on T2 and FLAIR, and minimal contrast enhancement suggesting a glial origin.

The patient was treated with risperidone (4 mg/day) and diazepam (5 mg/day). Over six weeks, PANSS scores decreased (positive: 23 points, negative: 7 points).

After consultation with the neurosurgery team, surgical intervention was not pursued due to the absence of tumor growth and neurological symptoms.

The observed partial remission of psychotic symptoms with pharmacological intervention highlights the potential efficacy of such treatments in ameliorating psychiatric manifestations of organic brain pathologies.

Reference

(1) Khouloud Razki, Uta Ouali, Sofiene Ben Aissa, Chaima Najar, Amina Aissa, Raba Jomli, Journal of the Neurological Sciences, Volume 455, Supplement, December 2023, 122512, ISSN 0022-510X DOI : https://doi.org/10.1016/j.jns.2023.122512

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Qualitative studies of the connection between overweight/ obesity, medicine adherence and symptoms of psychosis are lacking. The project Home-based Intervention with Semaglutide Treatment of Neuroleptica-Related Prediabetes, HISTORI, was a blinded, randomized control trial where people with schizophrenia and prediabetes were randomized to either Semaglutide og placebo injections.

The research question in HISTORI Experience focused on the patients´ mindset while participating in HISTORI, their experiences and thoughts regarding weight and exercise, eating behaviors, psychotic symptoms and their interactions with HISTORI staff.

19 qualitative, semi structured interviews were conducted. 11 Semaglutide interviews (6 female, 5 male) and 9 placebo interviews (5 female, 3 male). The interviews were analyzed with a reflexive thematic analysis (Braun & Clarke, 2022).

Patient and Public Involvement: One person with lived experience who could not be included in the HISTORI project, joined HISTORI Experience as a co-researcher. She was involved in creating a phenomenological interview guide. She was then introduced to the coding process and participated in the development of themes. A didactic relationship model was applied as an overall framework for the involvement (Hiim & Hippe, 2007). This model is learning-oriented and takes different factors that might influence the coorporation into account. Factors such as setting, learners´ abilities, learning process, content, goal and evaluation. To ensure a sustainable and active involvement the Involvement Matrix (Smits et al. Research Involvement and Engagement; 2020) was used both prospective and retrospective throughout the involvement process.

The results from both HISTORI and HISTORI Experience provides us with new knowledge that can be implementet in treatment with Semaglutide for patients with schizophrenia.

Results and conclusion are expected in April 2025 and will be represented at the EPA conference.

None Declared

Schizophrenia is a chronic, frequent, and disabling psychiatric condition. The prognosis is more severe in the absence of treatment.

The aims of our study were to evaluate the quality of treatment adherence and the Impact of the age of onset and duration of schizophrenia on the quality of treatment adherence and to assess the implication of these factors as predictors of poor adherence.

We conducted a cross-sectional and analytical study. We recruited 150 patients with schizophrenia treated at Razi Hospital of Manouba, divided into 113 patients with good adherence compared to 37 patients with poor adherence. We used the Medical Adherence Report Scale (MARS) to assess the quality of therapeutic adherence.

The average age of onset of the illness was 22.91 ± 4.6 years, with extremes ranging from 13 to 36 years.

The average duration of the illness in the patients in our series was 17 years, with extremes ranging from two to 42 years.

The average duration of untreated psychosis was two years, with a median of 12 months and extremes ranging from one month to 20 years.

A statistically significant association was found between the duration of untreated psychosis and the quality of treatment adherence (p=0.003).

Neither the age of onset of the illness nor its duration had any influence on the quality of patient adherence.

To prevent poor treatment adherence, a systematic screening for predictive factors and adequate management of schizophrenia would be imperative.

None Declared

Cycloid psychosis, first described by Kleist and further developed by Leonhard, is characterized by a cyclic course of acute psychotic episodes, marked by delusions, hallucinations, affective and motor disturbances. It lies at the intersection of affective and schizophreniform disorders, presenting a diagnostic challenge due to its episodic nature and inter-episodic remission. Currently, no diagnostic category clearly encompasses such clinical pictures, and these patients are usually diagnosed with brief psychotic disorders.

This report aims to describe a case of cycloid psychosis, highlighting the nosological and treatment limitations of this entity.

Consultation and review of the patient’s clinical records and articles referenced on the PubMed platform.

This case report presents a 37-year-old male admitted to the emergency department with delusions of persecution and reference, auditory hallucinations, decreased need for sleep, and increased goal-directed activity, alongside a lack of insight into his condition. No significant mood disturbances were observed. Symptoms had progressively worsened over two weeks, and upon examination, the patient exhibited psychomotor agitation, incoherent speech, perplexity, and marked distress. Initial laboratory work and brain imaging were unremarkable. The patient was hospitalized for involuntary treatment, where antipsychotic therapy with risperidone (up to 4mg/day) was initiated but later switched to olanzapine (10mg/day) due to significant extrapyramidal symptoms. He was also started on valproic acid, titrated up to 1000mg/day. During hospitalization, the patient showed progressive behavioral organization, resolution of delusions and auditory hallucinations, improved sleep, and restored insight.

Upon review of his psychiatric history, it was discovered that he had experienced two previous psychotic episodes in 2018 and 2021, diagnosed as bouffées délirantes while residing in France. Both episodes were successfully treated with olanzapine, with restituto ad integrum within one month, and no signs of personality changes or biographical disruption. Based on these recurrent psychotic episodes and his current presentation, a diagnosis of cycloid psychosis was made, following the criteria proposed by Perris and Brockington.

The patient was discharged after two weeks of inpatient care, and at his one-week follow-up, showed complete remission of psychotic symptoms.

Cycloid psychosis presents significant diagnostic challenges due to its ambiguous nosological status. It does not fit neatly into conventional categories such as schizophrenia or bipolar disorder, as it shares characteristics with both while maintaining a distinct clinical course marked by episodic, self-limiting psychotic phases with full remission. This diagnostic ambiguity also poses difficulties in treatment, as no specific guidelines exist, and current literature is sparce.

None Declared

Schizophrenia is a severe, chronic mental disorder, with about one-third of patients failing to achieve remission. Its multifactorial etiology includes a strong genetic component that remains insufficiently understood. Dysregulation of dopaminergic and glutamatergic neurotransmitter pathways has been implicated in the development of schizophrenia, as revealed through neuromorphological, molecular, pharmacological, and pharmacogenetic studies. Recent research has expanded this focus to include neuroinflammatory mechanisms and metabolic pathways, emphasizing the fine regulation of these neurotransmitter systems. Among these, adenosine has gained attention for its potential role in the pathophysiology of schizophrenia.

This literature review aims to explore the role of adenosine in schizophrenia, its connection to dopaminergic and glutamatergic hypotheses, and broader implications for the development of symptoms and complications.

A comprehensive review of studies investigating adenosine’s neuroregulatory, inflammatory, and neuromodulatory functions.

The adenosine hypothesis suggests that reduced adenosine activity plays a critical role in the development of schizophrenia symptoms. Adenosine regulates dopaminergic and glutamatergic neurotransmission via ADORA A1 and ADORA A2 receptors. Studies have shown changes in adenosine receptors, transporters, and enzymes involved in adenosine metabolism in individuals with schizophrenia. Moreover, adenosine’s neuroprotective role, particularly in stress and inflammation, connects it to the dopaminergic/glutamatergic systems and the broader neurodevelopmental “two-hit” hypothesis, suggesting that schizophrenia develops through a combination of genetic vulnerability and environmental factors. A study by Ary Gadelha and colleagues proposed a link between hypo-adenosine states and the increased risk of sudden cardiac death in schizophrenia patients, indicating the broader systemic importance of adenosine dysregulation in these individuals.

Adenosine appears to be a potential modulator in the pathophysiology of schizophrenia, connecting various neurotransmitter pathways and influencing genetic vulnerabilities, neuroinflammation, and cardiovascular risks. Further research into adenosine-related mechanisms could offer valuable insights into early interventions, improving treatment outcomes and potentially reducing complications such as treatment resistance and sudden cardiac death in schizophrenia patients.

References

Lara DR, Souza DO. Schizophrenia: a purinergic hypothesis. Med Hypotheses. 2000;54(2):157-166. doi:10.1054/mehy.1999.0003

Boison D. Adenosine as a neuromodulator in neurological diseases. Curr Opin Pharmacol. 2008;8(1):2-7. doi:10.1016/j.coph.2007.09.002

Fredholm BB, Chen JF, Cunha RA, Svenningsson P, Vaugeois JM. Adenosine and brain function. Int Rev Neurobiol. 2005;63:191-270. doi:10.1016/S0074-7742(05)63007-3. PMID: 15797469

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Patients with schizophrenia spectrum disorders continue to face societal stigma. This stigma contributes to their loneliness and marginalization, acting as a significant barrier to recovery and clinical stabilization. While medication and clinical follow-up are essential for treatment, social factors are also crucial for individuals to achieve a functional and fulfilling life. It is necessary to explore these factors in this this study.

To explore the social factors affecting the recovery and clinical stabilization of patients with schizophrenia spectrum disorders.

• - To identify the support needs of these patients to enhance their functional and fulfilling lives.

• - To assess the impact of societal stigma on the well-being and integration of individuals with schizophrenia.

• - To examine the role of mental health professionals and family involvement in reducing stigma and improving social functioning.

• - To highlight the importance of vocational interventions and supportive environments in facilitating the integration of patients into society.

For the purpose of conducting the non-systematic narrative review on the topic, we performed a search for articles in the PubMed database.

Improvements in the effectiveness of antipsychotics and earlier intervention are enabling more patients to reach a cognitive level that supports a functional life, including maintaining interpersonal and occupational relationships. Thematic analysis has identified four key support needs: skill development, vocational intervention, support and encouragement, and a supportive work environment.

The involvement of mental health professionals with the patient’s family is also crucial for addressing and reducing the stigma associated with the illness, thereby enhancing understanding of the individual within the context of their condition.

Social anhedonia, which impairs social functioning, is a significant concern. Additionally, the risk of suicide is notably higher during the initial phase of schizophrenia compared to the general population.

After achieving clinical stabilization with antipsychotics and other psychotropic medications, intervention in the social sphere becomes crucial for the patient’s well-being and functionality. Having a professional occupation, when feasible, is a positive indicator of patients’ integration and their role in society.

To support this integration, psychiatry services and civil society must enhance their efforts. This includes developing occupational services, establishing partnerships with local businesses, and improving public awareness about schizophrenia.

None Declared

Paraphrenia is a chronic psychotic disorder characterized by persistent delusions, with preservation of cognitive function and personality, which distinguishes it from schizophrenia, where cognitive decline is more pronounced. Although initially defined by Kraepelin, paraphrenia has been excluded from current diagnostic systems, complicating its distinction from schizophrenia and delusional disorders. Over time, experts like Mayer-Gross, Roth, and Munro have debated whether paraphrenia constitutes a distinct diagnostic entity, raising questions about its relevance in contemporary psychiatry.

To present a case that resembles paraphrenia and explore the clinical presentation and diagnostic process, particularly in the context of the disorder’s exclusion from diagnostic systems.

This study is based on a case report, supported by a non-systematic review of relevant literature. Clinical data was collected throughout the patient’s treatment, and articles on paraphrenia were reviewed to provide historical and diagnostic context.

A 60-year-old woman, single, household cleaner, was brought by her sibling to the emergency department for presenting persecutory delusions, and auditory hallucinations in the prior four months. She believed her downstairs neighbors had installed cameras in her house, controlling her every move. She presented a depressed mood and difficulty falling asleep. Toxicology screening, blood work, and head-CT showed no changes. Due to treatment refractoriness, Clozapine was started. A formal neuropsychological assessment was carried out, which did not show cognitive deterioration. The patient revealed less preoccupation with delusions and hallucinations and was discharged two months after admission.

In this case, the patient exhibited a chronic psychotic disorder marked by persecutory delusions and auditory hallucinations, without encapsulated delusional thinking. These symptoms had persisted for four months, during which the patient maintained personality stability and interpersonal functionality, displaying appropriate emotional responses and no cognitive decline. The onset occurred in middle age, with no psychiatric family history or evidence of premorbid issues. Significant stressors before symptom onset were identified as a likely trigger. This case highlights the persistence of psychotic symptoms with preserved cognitive and emotional stability, aligning with the diagnostic characteristics of paraphrenia. Despite exclusion from modern classification systems, the clinical presentation supports considering paraphrenia as distinct from other psychotic disorders, particularly in terms of its preserved functionality and absence of cognitive decline. This case underscores the need to continue the study on paraphrenia, and possibly rethinking its role in diagnostic frameworks, particularly in cases of late-onset psychosis.

None Declared

The use of antipsychotic medications in individuals with epilepsy has been studied extensively. Starting neuroleptic therapy in patients with epilepsy is complicated due to the potential for these drugs to lower the seizure threshold. Consequently, both psychiatrists and neurologists must collaborate to develop personalized treatment plans for these patients.

To evaluate various therapeutic options for patients experiencing both psychotic symptoms and seizures, aiming to select the most appropriate treatment for each individual.

This case report describes a 47-year-old male patient who is presented with a diagnosis of symptomatic focal epilepsy in the left temporoparietal malacic area post traumatic brain injury. Following a traffic accident at the age of 14, after which he suffered a temporoparietal hematoma, the patient has presented numerous epileptic seizures. Initially, he abandoned treatment and follow-up with neurology, which he resumed in 2021. Additionally, the patient was referred to psychiatry after verbalizing delusional ideation of persecution with affective repercussions (tendency towards irritability) and behavioral repercussions (tendency towards social isolation and difficulties in the work environment) as well as auditory hallucinations with derogatory content. Neurology initiated treatment with eslicarbazepine 800mg, with cessation of epileptic seizures. After considering different treatment options and taking into account interactions with antiepileptic treatment, risperidone 1mg was initiated.

Following the initiation of risperidone, the patient experienced a reduction in irritability and has not presented further epileptic seizures. Due to potential drug interactions, the risperidone dose was gradually titrated upwards, resulting in a decrease in delusional ideation and improved overall functioning.

Patients with epilepsy and comorbid psychotic symptoms require a multidisciplinary approach, including individualized treatment. Neuroleptic medications can significantly improve quality of life in these patients. Therefore, it is essential to carefully select the appropriate antipsychotic, starting at low doses and gradually titrating upwards, with close monitoring to ensure patient safety and drug efficacy.

None Declared

Schizophrenia is a common diagnosis among individuals with mental health disorders, characterized by chronic mental illness that affects perception, volition, and emotions. Numerous studies have demonstrated that schizophrenia significantly reduces global functioning and impairs function. Motivation deficit, a core symptom in individuals with schizophrenia, directly or indirectly impacts their functioning and disease outcomes. Currently, there are limited assessment tools available for measuring motivation, especially in Chinese. The fourth edition of the Volitional Questionnaire in Chinese (VQ-C), developed based on the Model of Human Occupation (MOHO), assesses motivation levels in individuals. It is scored through activity observations of clients, providing a simple and clinically feasible evaluation method. The English version of the VQ has proven to be a reliable and valid tool for individuals with mental illnesses. However, the psychometric properties of the VQ-C have not been extensively discussed in the literature.

This study aims to test the reliability of the VQ-C in patients with schizophrenia.

We recruited 45 patients with chronic schizophrenia. The VQ-C assesses clients’ motivation by observing their participation in various activities within their environment. The VQ-C consists of fourteen items, each rated on a 4-point scale, with higher scores indicating higher levels of motivation. Two raters independently observed participants’ engagement in two different types of activities (static and dynamic) over one week and scored their motivation levels based on their performance. Two testers simultaneously observed participants’ performance and provided scores.

In the data analysis, we used descriptive statistics to analyze demographic data of the participants, such as age, gender, and length of illness. Internal consistency was assessed using Cronbach’s alpha.

We recruited 45 participants with schizophrenia for the study, with 43 completing the test. The mean age was 43.02 years, and the mean duration of illness was 21.93 years. Each participant was assessed in two different activity contexts, allowing for independent analysis of scores in the sports and art contexts. The analysis of scores in the sports context revealed a Cronbach’s alpha of 0.95, indicating high reliability. Similarly, the assessment scores in the art context showed a Cronbach’s alpha value of 0.96.

This study investigated the internal reliability of the VQ-C in patients with schizophrenia, demonstrating strong reliability. Based on these results, it is suggested that the VQ-C can be used to assess the motivational state of patients with schizophrenia, facilitating the design and implementation of treatment interventions.

None Declared