The rapid change a variety of the clinical picture in case of autoimmune encephalitis remain a diagnostic challenge.

Diagnostics and therapeutic process as of the atypical psychosis.

A 40-year-old woman, since 2 weeks she expressed catastrophic delusions and dysphoria. Next she revealed tinnitus, psychosensory disturbances, disorganization of thinking and behavior and the first grand mal seizure occurred. In the neurology ward were described psychogenic disorders and she was referred to the psychiatric ward, where catatonic schizophrenia was diagnosed. She was disoriented, with periodic episodes of arousal and freezing, negativism and command automatism. She was hallucinating visually, auditorily, olfactorily, and cenesthetically, expressed delusions of catastrophe, influence, and persecution. Despite modifications of treatment (aripiprazole, haloperidol, olanzapine, quetiapine, clozapine, valproate) she didn’t improve. In the 4th week of hospitalization, an episode of fever of unknown etiology occurred and she was transferred to a higher referral psychiatric ward. Next fluctuating disturbances of consciousness, myoclonus, bilateral palmomental and Babinski’s sign and swallowing disorders were observed. Due to the lack of therapeutic effect tiapride was administer with slight improvement.

Laboratory tests: CRP, VDRL, anti-HIV antibodies - absent, ceruloplasmin, ANA, anti-TPO, anti-TSHR antibodies, tumor markers – normal range.

No changes in contrast-enhanced MRI head. In EEG moderate-grade, extensive changes in the fronto-central and frontotemporal leads bilateral.

CSF examination – normal range, negative result for 14-3–3 protein

In a panel for antibodies typical of autoimmune encephalitis - presence of anti-NMDA antibodies. Then autoimmune encephalitis was diagnosed. She was initially treated with immunoglobulins, with slight effects. Subsequently, effective immunosuppressive treatment with mycophenolate mofetil and methylprednisolone was administered. Further, the psychosis resolved, with the normalization of the neurological signs. The patient’s in stable mental and somatic condition was discharged without further psychopharmacology.

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In anti NMDA receptor encephalitis affective symptoms, psychosis, catatonia, consciousness disorders, as well as neurological symptoms occurred. In majority of cases no changes are observed in brain imaging. EEG examination shows non-specific changes in 90% of cases. About 80% of patients recover without functional impairment, but in 7% disease is lethal. Crucial is to determine the etiology of atypical symptoms in order to implement adequate therapy as soon as possible.

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Correlation between cannabis decriminalization and some psychotic disorders, specifically Acute and transient psychotic disorders (ATPD), Schizophrenia, and Psychotic disorder with delusions due to known physiological condition. It will cover overview of these disorders, challenges in differential diagnoses and the effects of drug abuse on mental health.

Impact of cannabis decriminalization on selected psychotic disorders: Acute and transient psychotic disorders (ATPD), Schizophrenia, and Psychotic disorder with delusions due to known physiological condition.

• - Quantitative, Retrospective Analysis: Analysis of archived medical records from 2013 to 2023 at “Center for Mental Health and Prevention of Addiction” in Tbilisi.

• - Examination of Prevalence Changes: Focus on ATPD, Schizophrenia, and Psychotic Disorder with Delusions due to Known Physiological Condition.

• - Statistical Comparisons: Comparison between pre-decriminalization (2013-2018) and post-decriminalization (2019-2023) periods.

• - Analysis of Drug User Patient Cases: Assessment of the increase in drug user cases within the mentioned diagnoses.

• - ATPD Cases: Increased significantly by threefold (from 195 to 594).

• - Schizophrenia Cases: Decreased slightly by 21% (from 2068 to 1627).

• - Psychotic Disorder with Delusions due to Known Physiological Condition: Remained relatively stable with a 14% decrease (from 473 to 408).

• - Drug User Patients: Increased dramatically by about 3.5 times following cannabis decriminalization.

• - The findings suggest a potential link between increased substance use, including cannabis, and the rise in ATPD cases.

• - Decriminalization may have indirectly influenced accessibility and use of various narcotics.

• - The lack of public education about the potential mental health risks of narcotic use could be a contributing factor.

• - The observed decrease in Schizophrenia and Psychotic Disorder with Delusions due to Known Physiological Condition cases might be due to other factors requiring further investigation.

• - These findings highlight the need for comprehensive research on the long-term consequences of cannabis decriminalization on mental health.

• - Targeted public health interventions and mental health support services are crucial to address the challenges of rising narcotic use in Georgia.

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Psychotic disorders have a negative impact on people’s lives, including their financial situation. Limited studies indicate that people with psychosis also have lower subjective evaluations of their financial situation, such as perceived financial needs.

This study aimed 1) to examine differences in unmet financial needs between people with psychosis, parents, siblings, and controls, 2) to examine whether family clustering contributes to unmet financial needs, and 3) to examine to what extent substance use, demographic, economic, psychiatric, functional, and cognitive characteristics predict unmet financial needs in people with psychosis.

Data of the first assessment of people with psychosis (n=956), siblings (n=889), parents (n=858), and controls (n=496) of the Genetic Risk and Outcome of Psychosis study were used. Group differences were assessed with Kruskal-Wallis tests (aim 1). We performed mixed-effect logistic regression analysis and explorative and confirmative ordinal logistic regression analyses for aim 2 and 3, respectively.

People with psychosis reported significantly higher levels of unmet financial need (24%) compared to siblings, parents, and controls (all <10%; table 1). We found no evidence of familial clustering in unmet financial needs. Cannabis and tobacco use significantly and consistently predicted higher levels of unmet financial needs in people with psychosis. Demographic, economic, psychiatric, functional, and cognitive characteristics were no significant predictors.Table 1.

Levels of meeting financial needs of people with psychosis, siblings, parents, and controls.

Relatively high levels of unmet financial needs occur in a heterogeneous group of people with psychosis, especially when they use cannabis or tobacco. Unmet financial needs can have serious consequences for mental health, leisure time, and social activities. Thus, it is pivotal to recognize unmet financial needs, especially combined with substance use, as a stressor for people with psychosis.

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Patients with schizophrenia frequently have difficulties in defecation which may lead to adverse health consequences. Many interventions have been proposed to resolve the problems but not usually effective. Kombucha tea has been advocated for their effects on gut microbiota and thought to improve the stool passage in healthy population. However, the relevant evidence was insufficient in patients with schizophrenia. In this study, the research team tried to evaluate the effectiveness of Kombucha tea in the clinical settings.

This study aimed to evaluate both subjective and objective amelioration of stool passage in constipated patients with schizophrenia.

Schizophrenic inpatients who took laxative medications or had subjective difficulties in stool passage were eligible for the study. The protocol was approved by the IRB of Tsao-Tun Psychiatric Center and registered on the trial registry of Clinicaltrial.gov. After obtaining consents and initial screening, the recruited participants were randomly allocated into either the control or intervention groups. Participants in the control group were provided with flavored lemon tea while those in the intervention group drank commercial Kombucha tea. Every morning during 8-week period, participants in both groups were provided with the drinks bottled in opaque plastic bottles filled with the same volume (200ml) and similar taste.

The multidisciplinary team collected the demographic profiles, clinical details, kinesiological data, cognitive condition (measured with the MoCA) and psychiatric status (measured with the BPRS). The outcome data were collected through interview and medical record review by the researchers independent from allocation of the groups, and were computed with the statistical software JASP with the statistical significance at the 5% level (p<0.05).

79 schizophrenic patients were enrolled in the study, and the key data were illustrated at the attached Table. All the variables at the baseline showed no statistical significance between groups. In terms of the outcomes, the means of objective measurement of stool passage showed no statistical significance between groups. In contrast, the subjective measurement showed the ease of defecation difficulties, trending towards ‘smoother and easier defecation’ (p<0.05).

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Our preliminary analyses indicated that Kombucha tea improved the subjective outcome of stool passage in schizophrenic patients with constipations after taking Kombucha tea drinks while no statistical significance was observed in the objective measurements. To the best of our knowledge, this study is one of the very few studies exploring the effectiveness of Kombucha tea in ameliorating difficulties in stool passage in the patients with schizophrenia and it shed the light of future research.

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Schizophrenia is a severe psychiatric disorder characterized by disturbances in perception, thinking, affect, behavior, and negative symptoms. Depression in patients with schizophrenia worsens disease outcomes by increasing suicide risk, complicating the clinical picture, and reducing social functioning quality. Treatment is challenging, as monotherapy with modern antipsychotics is not always successful. Adding antidepressants may improve outcomes, but the effectiveness of such augmentation often requires further evidence.

This study aimed to examine the effects of combining second-generation antipsychotics (SGA) with vortioxetine, a novel multimodal serotonergic antidepressant, on various aspects, including quality of life, anhedonia, cognitive function, and overall symptom improvement in schizophrenia patients.

We conducted a comprehensive search of PubMed, Embase, Cochrane and Web of Science databases up to September 2024 for studies using Vortioxetine with standard treatments for schizophrenia.

We screened 371 studies and our review included six studies gathering 508 patients. Study type, sample sizes, and follow-up time varied across studies (Figure 1). All studies involved adding Vortioxetine to existing antipsychotic treatments, with dosages ranging from 5-20 mg/day. Study durations varied from eight to 48 weeks. Common scales across multiple studies included: PANSS (Positive and Negative Syndrome Scale), WHOQOL-BREF (World Health Organization Quality of Life Assessment), CDSS (Calgary Depression Scale for Schizophrenia), and various cognitive function tests (e.g., WCST, Verbal Fluency Test, Stroop Task). Overall, the studies reported positive effects of vortioxetine in schizophrenia patients (Figure 2): Improved quality of life, Reduced anhedonia, Enhanced cognitive function, Improved depressive symptoms, Reduced negative symptoms. Most studies reported good tolerability of vortioxetine with minimal side effects.

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The findings suggest that Vortioxetine may be a promising adjunctive treatment for schizophrenia, potentially improving various domains including quality of life, cognitive function, negative symptoms, and depressive symptoms. However, larger and more robust studies are needed to confirm these findings.

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The efficacy of yoga as an adjunctive treatment for schizophrenia spectrum disorders (SSD) has garnered interest, however, meta-analytic findings exhibit heterogeneity. While yoga may positively influence various symptom domains, further investigation is needed due to the limited number, quality, and generalizability of studies. Yoga-based Group Intervention (YoGI) was specifically developed together with persons with SSD through a participatory approach and its mechanisms and processes were explored within qualitative studies.

This pre-registered randomized controlled trial (RCT) assessed the acceptability and feasibility as well as preliminary outcomes of YoGI compared to a commprehensive treatment as usual (TAU) in an inpatient setting.

Fifty inpatients with SSD received either treatment as usual (TAU, n = 25) or YoGI+TAU (n = 25) for four weeks. Preliminary analyses examined rater-blinded positive and negative symptoms, self-rated depressive and anxiety symptoms, body mindfulness, mindfulness, psychological flexibility, subjective cognition, social functioning, quality of life, and medication regime at baseline and post-intervention.

Outcomes showed a 95% protocol adherence, feasibility and retention rates of 91% and 94%, respectively, and a dropout rate of 6%. ANCOVA revealed significant between-group post-intervention improvements for YoGI+TAU in positive symptoms, depression, cognitive fusion, and a mindfulness subscale. Medium-to-large pre-to-post intervention effects were found for body-mindfulness, positive, negative, and general symptomatology, depression, anxiety, stress, cognitive fusion, attention, and quality of life in YoGI+TAU, while within-group changes were consistently smaller in TAU. No severe adverse events were reported.

This trial contributes to the growing evidence supporting the feasibility and acceptability of yoga for persons with SSD in an inpatient setting. Furthermore, preliminary evidence suggests that YoGI may provide additional benefits beyond TAU alone, across various self- and rater-based outcomes. These outcomes include improvements in body mindfulness, mindfulness, and psychiatric symptomatology, including positive and negative symptoms, subjective cognition, depression, anxiety, stress, social functioning, and quality of life. Additional fully powered RCTs are warranted to further elucidate the efficacy and potential mechanisms of action of YoGI for SSD, which should also assess the cost-efficiency of YoGI and explore longitudinal changes associated with the intervention. Such comprehensive research endeavours will not only enhance our understanding of the therapeutic potential of YoGI but also inform clinical practice and intervention strategies for persons with SSD.

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Schizophrenia is a severe mental illness manifested by various symptoms. Negative symptoms (NS) are associated with disability and poor function of patients. The study of NS neurobiology is complicated by their heterogeneity. Factor analysis revealed two distinct NS subdomains with different pathophysiological mechanisms: volitional pathology, including avolition and apathy (AA), and diminished expression (DE). Inflammation is one mechanism that may underlie NS, including their heterogeneity.

To investigate the differentiated associations between polymorphisms of interleukin genes IL-1β (rs16944), IL-4 (rs2243250), and IL-10 (rs1800872, rs1800896) and adverse childhood experiences (ACE) with NS of schizophrenia, specifically the factors of AA and DE. We hypothesize that genetic variants, which may aggravate the inflammatory response, are associated with higher NS and NS factors scores.

Data from 564 patients diagnosed with schizophrenia or schizoaffective disorder were included in the study. NS factors were calculated based on the Positive and Negative Syndromes Scale. The two-way ANOVA (sex, genotype) with Bonferroni post hoc test was used to examine the effect of the genotypes on the PANSS-derived NS subdomains.

The high-expressive allele of IL-1β and low-expressive alleles of IL-4 and IL-10 are associated with more severe NS. However, a differentiated association with the AA and DE factors was found only for the IL-10 rs1800872 polymorphism. Among carriers of the low-expressive AA allele with ACE, there is a trend towards increased ED scores, but not AA scores.

The findings confirm that the imbalance between pro-inflammatory and anti-inflammatory cytokines may be a key mechanism influencing the severity and heterogeneity of NS.

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Charles Bonnet syndrome, first described by Charles Bonnet in 1760, is characterized by visual hallucinations in cognitively normal patients who are typically elderly and often visually impaired.

This case has been evaluated as a typical Charles Bonnet syndrome characterized by multisensory hallucinations (visual, auditory, olfactory hallucinations) observed in a patient with NF-2 diagnosis. In this respect, this case analysis might make an important contribution to the literature, as it might expand the understanding of CBS in the context of complex neurological disorders. Consideration must be put into the possibility of associating the patients’ multisensory hallucinations with organic pathology due to the presence of occipital and temporal meningiomas.

In this section, data obtained from our own case will be included. Additionally, a literature review was conducted using PubMed, restricting the search to studies published between 2014 and 2024. The search term “Charles Bonnet Syndrome” was used to identify relevant articles. Furthermore, a detailed anamnesis of the disease process was obtained from the patient’s mother.

A 31-year-old female first presented to our psychiatry outpatient clinic in July 2024, with her relative reporting a diagnosis of neurofibromatosis type 2. It was documented that the patient underwent surgery in November for diffuse meningiomas (both supra- and infratentorial, involving the temporal and occipital regions). Also, the patient experienced total hearing loss due to vestibular schwannomas in the right region and suffered from visual loss during the pre-operating period. She reported a distressing increase in the acute perception of the smell and taste of food and beverages. Her first psychiatric examination was conducted postoperatively. Olanzapine 2.5mg/day was commenced as a treatment for relative auditory and olfactory hallucinations, and the dose of the drug was gradually increased to 10mg/day. The final examination was conducted on August 26, 2024. According to reports from the patient’s relatives, there was a noted decrease in the frequency and intensity of the hallucinations. Throughout the medical examinations, communication with the patient was partially facilitated using tactile cues.

A typical Charles Bonnet syndrome is a disorder characterized by visual loss accompanied by visual hallucinations. In this case, olfactory, auditory and alpha-factor hallucinations that developed after visual and hearing loss were detected and resulted in the involvement of more than one sensory organ, shedding light on the current literature. In this case, the fact that the person already had neurofibromatosis type 2 disease further complicates the etiology of these symptoms and requires detailed follow-up and treatment.

None Declared

Psychosis has long been known to have an association with epilepsy. Slater’s 1963 descriptive case series provided the first modern definition of epilepsy-related psychosis, described as psychotic symptoms developing after the onset of epilepsy and occurring in clear consciousness, not exclusively during or right after a seizure. Up to 7% of individuals with epilepsy have a co-morbid psychotic illness. Consensus guidelines by the International League of Epilepsy recommend treating epilepsy-related psychosis similarly to other categories of psychosis. Despite the widespread consensus that the prescription of an antipsychotic is possible without risk in an epileptic patient treated with AEDs, there have always been special considerations about prescribing antipsychotics for seizure-related psychosis. Furthermore, a review article by Adachi et al. specifically warns that concerns regarding seizure threshold can lead to the undertreatment of this particular type of psychosis.

Case report.

Case report.

Case presentation: Our patient has generalized epilepsy, with several incomes due to generalized tonic-clonic seizure and mild diffuse encephalopathy since childhood. By the age of 15 years, he started developing suspicion, self-reference, persecutory and damage delusions, visual hallucinations and episodes of aggressiveness towards people surrounding him. He had been treated with multiple antiepileptics and antipsychotics drugs, without achieving a long-term stabilisation until now. While the seizures were controlled in his early ages; ever since the onset of the psychosis both the psychotic symptoms and the seizures got impossible to handle, mainly because of his lack of tolerance to almost every antipsychotic used. Our primary hypothesis is that these antipsychotics lowered the seizure threshold, triggering new episodes of tonic-clonic seizures and arousing the patient’s desire of abandon the treatment -the latter has been confirmed by the patient-. At this point, we considered the recently released brexpiprazol as a potentially efficient treatment. After a proper explanation of our clinical reasons to prescribe this new drug, especially its unique pharmacodynamics, we adquired the patient’s consent to start with it. So far, the response is being excellent, which is particularly impressive given the fact that he is taking the maximum daily dose of brexpiprazol (4mg). Not only the psychotic symptoms are restrained, but also he has not experienced any seizure since the introduction. As a key outcome, the patient has developed a significant insight regarding his condition and the need of treatment.

The treatment of epilepsy-related psychosis is a really delicate subject. Brexpiprazol is a modern drug, with an innovative pharmacodynamics and an excellent side-effect profile, and should be taken into consideration in every patient with seizure-related psychosis.

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Numerous studies have highlighted the unmet needs in intimate and sexual relationships among patients with schizophrenia. Although research shows that patients with schizophrenia express a desire for romantic and sexual connections, they encounter difficulties in forming and sustaining these relationships. However, the underlying causes of deficits in sexual and romantic functioning remain unknown and unexplored.

The study aims to assess whether difficulties in forming intimate relationships could be connected to a decreased ability to interpret courtship signals.

49 male participants (36 patients, 13 controls) and 27 female participants (14 patients, 13 controls) were exposed to our experiment „Does she like me?” task. The task involves a video stimuli that depicts a woman/man displaying different nonverbal behaviors (rejection, courtship, and neutral attitude). Each participant evaluated the woman’s sexual interest/ man’s sexual interest on a nine-point scale. In addition, eye movements and pupil dilation were measured using the eye-tracking device Eyelink 1000plus. Patients and controls were compared on subjective report and psychophysiological eye tracking markers. For data analysis, we used Repeated measures ANOVA.

There was no statistically significant difference between the control group and patients in their assessment of women´s interest (F (2, 94) = 1.28, p = 0.28, ηp2= 0.03) or men’s interest (F (2,50) = 0.24, p = 0.79, ηp2= 0.01). Also, there was no difference in average pupil size. However, while both groups correctly identified the nonverbal cues and responded accordingly (with the greatest assessments of interest for positive stimuli, lesser for neutral stimuli, and the least for negative stimuli), male patients on average tended to overestimate women’s interest in all conditions (positive, neutral, negative) compared to the control group.

According to our results, the ability to interpret courtship signals does not differ significantly between patients and controls. However, male patients tend to overestimate women’s sexual interest on average, which may be one of the reasons why they face challenges in intimate relationships. Further research is needed to explore this.

The study was supported by the Czech Health Research Council, no. NU21J-04-00024 and by the Charles University, Fac Med1, GAUK no. 56123.

None Declared

Melatonin is a neurohormone plays a role in the development and course of schizophrenia.Melatonin also has an important role in regulating circadian rhythms, so melatonin secretions have been suggested as markers for circadian dysfunctions in schizophrenic patients. Some studies have assessed the circadian profiles of melatonin secretion in schizophrenic patients, showing that the nocturnal circadian rhythm of plasma melatonin secretion was disrupted in medicated chronic schizophrenics (Jiang H. K. & Wang J. Y. Diurnal melatonin and cortisol secretion profiles in medicated schizophrenic patients. Journal of the Formosan Medical Association. Taiwan yi zhi 1998 97(12), 830–837). Nocturnal plasma melatonin secretion was also reduced in the drug-free schizophrenic patients (Monteleone P. et al. Depressed nocturnal plasma melatonin levels in drug-free paranoid schizophrenics. Schizophrenia research 1992;7(1), 77–84). These findings could suggest the presence of abnormal melatonin rhythm in schizophrenics, which may be related to the pathophysiologic process itself. However, it is not known whether there are melatonin secretion significant differences in acute phase and clinical stabilization phase of schizophrenic patients.

The aim of this study is to assess the melatonin secretion profile in acute phase and clinical stabilization phase of schizophrenic patients to know if exists circadian rhythm and to compare both measures.

Our sample consists in 48 patients that have been study in two clinic phases: acute phase and after discharge,clinically stabilized. Blood samples were collected in the morning (12:00 hours) and at night (00:00 hours) by venipuncture in reclined position with mask that covers the eyes. Serum levels of Melatonin were measured in acute phase and stabilized phase, after discharge. Melatonin was measured by means of ELISA (Enzyme-linked immunosorbent assay) techniques. The relationship between quantitative variables at two times of the same marker were analyzed by T-Student test.

All comparisons reach a degree of statistical significance, which we can interpret as meaning that there is a circadian rhythm at the two moments measured. Furthermore there significant difference between acute phase of the schizophrenia respect control phase, three months after discharge.

In this study we can hypothesize that Melatonin has circadian rhythm when the patients are in acute psychosis and when are stabilized. MLT levels increase at control, a fact that we can interpret as there is an increase in antioxidants levels in the clinical stabilization phase, this increase being even greater at the three-month control, which may be attributable to the treatment due to its antioxidant properties or to the disease itself. The results of this biomarker could be interpreted as is useful variable for the prognosis.

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Shared psychotic disorder (folie à deux) is a rare mental health condition where delusions are transmitted from one person to another within a close relationship. Understanding these complex dynamics is crucial for effective diagnosis and treatment.

To present two cases of shared psychosis involving close relatives diagnosed with schizophrenia, aiming to open discussion on the complex dynamics of familial relationships and their impact on mental illness.

2 case reports.

We present two cases of shared psychosis involving close family members. The first case involves two sisters, aged 43 and 48, both diagnosed with paranoid schizophrenia. The 43-year-old sister was admitted following a suicide attempt and exhibited active psychosis with paranoid delusions. During her hospitalization, the older sister displayed identical delusions and refused her sibling’s treatment, leading to her own admission. Both sisters, previously untreated and highly educated, were managed with antipsychotic medications. While the delusions were encapsulated during treatment, concerns remain about their shared living environment and its potential influence on their ongoing recovery.

The second case involves a 33-year-old woman with a decade-long history of schizophrenia who was brought to the emergency room malnourished and uncommunicative, having not eaten for over a week. She was fed via a nasogastric tube during her lengthy hospitalization and placed on a regimen of Clozapine. The patient exhibited severe negative symptoms and behaviors suggestive of auditory hallucinations. Her mother, also of low educational and socioeconomic status, was present throughout her stay but displayed delusional beliefs that interfered with her daughter’s treatment. Following restrictions on the mother’s access to the patient, the daughter showed slight improvement and began eating independently.

These cases highlight the significant impact that familial relationships and shared psychosis can have on the progression and management of schizophrenia. The challenge in treating shared delusions lies not only in addressing the symptoms but also in mitigating the interpersonal dynamics that may perpetuate them. Further investigation into family-based psychosis and its treatment is warranted.

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Most of the validated Italian scales for assessing psychotic symptoms don’t analyze specific symptoms like delusions and hallucinations in detail, but rather measure a wide range of experiences and behaviors in a general way. Scales such as PANSS, SAPS, and Sistema3 include only a few items on delusions and hallucinations, without considering the multidimensional characteristics of these symptoms, such as the degree of conviction, distress, duration, and perceived reality of the hallucinations. The Psychotic Symptom Rating Scales (PSYRATS) is the most widely used scale globally for measuring the severity of hallucinations and delusions through a semi-structured interview, but it has never been translated into Italian.

The aim of this study is to conduct a preliminary evaluation of the psychometric properties of the Italian version of the PSYRATs.

The participants were recruited from among adult patients who were able to communicate fluently in Italian and were admitted to the Psychiatry Department of the Cesena Hospital. Eligibility depended on the presence of persistent delusions or auditory hallucinations in the week prior.

The hospitalized patients were assessed using the Italian version of the PSYRATS, the Positive And Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS). The reliability of the scales was assessed using Cronbach’s Alpha, and the relationship between the variables was analyzed using Spearman’s correlation.

The sample consisted of 25 participants (5 female, 20 male), with a mean age of 43 years and an average educational level of 11 years. A good internal consistency was observed for the “Auditory Hallucinations” scale (Alpha = .92) and for the “Delusions” scale (Alpha = .97). Spearman’s correlation analysis revealed that the “Total PSYRATs” scale has strong correlations with the “Auditory Hallucinations” scale (Rho = .93; p = .001) and the “Delusions” scale (Rho = .45; p = .02). Valid correlation indices were also noted between the “Total PSYRATs” and “Total BPRS” scales (Rho = .62; p = .001) and the PANSS scale (Rho = .45; p = .02).

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The preliminary data demonstrate good internal consistency and convergent validity of the Italian version of the PSYRATS; therefore, this instrument appears to be a valid measure for the assessment of hallucinations and delusions. The results of this study are limited by the relatively small sample size, making it essential to repeat the analyses on a larger population.

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For patients with schizophrenia, effective treatment of early episodes may improve long-term outcomes, reduce the risk of relapse, and limit functional impairment.

To evaluate the efficacy and safety of brexpiprazole versus placebo in adult and adolescent patients with early-episode schizophrenia.

Data were analyzed from four Phase 3, 6-week, randomized, double-blind, placebo-controlled trials: three in adults (Clinical Trials.gov: NCT01396421 [Vector], NCT01393613 [Beacon], NCT01810380 [Lighthouse]), and one in adolescents (NCT03198078 [Study 331-10-234]). For the trials in adults, patients aged 18–65 were randomized to placebo (total N=531), brexpiprazole (total N=1,093; 0.25, 1, 2 or 4 mg/day, or 2–4 mg/day, depending on the trial), or quetiapine extended-release (N=154; active reference in one trial). For the trial in adolescents, patients aged 13–17 were randomized to placebo (N=104), brexpiprazole 2–4 mg/day (N=110), or aripiprazole (N=102; active reference). Mean baseline Positive and Negative Syndrome Scale (PANSS) Total scores indicated that adult and adolescent patients were of similar disease severity. In all four trials, the primary efficacy endpoint was change from baseline to Week 6 in PANSS Total score. In this post hoc analysis, early-episode schizophrenia was defined as age 13–35, and ≤5 years’ duration of illness. Data from the four trials were pooled and compared between brexpiprazole 2–4 mg/day (FDA-recommended target dose in adults and adolescents) and placebo. Efficacy outcomes were analyzed using least squares (LS) mean change from baseline (mixed model for repeated measures). Safety was also evaluated.

The post hoc early-episode schizophrenia sample comprised 292 patients treated with brexpiprazole 2–4 mg, and 190 treated with placebo (analyzed for safety), of whom 289 and 187 were analyzed for efficacy, respectively. The post hoc efficacy sample comprised 19.3% of the corresponding efficacy sample of the adult trials (pooled), and 98.1% of the corresponding efficacy sample of the adolescent trial. In the post hoc efficacy sample, mean (standard deviation) baseline age was 22.4 (6.6) in the brexpiprazole group and 20.5 (6.6) in the placebo group, and baseline PANSS Total scores were 97.9 (13.5) and 100.4 (14.2), respectively. The LS mean (standard error) change from baseline to Week 6 in PANSS Total score was -21.4 (1.1) with brexpiprazole, and -17.8 (1.4) with placebo (p=0.042). The overall incidence of treatment-emergent adverse events (TEAEs) was 50.7% with brexpiprazole, and 46.3% with placebo. The TEAE with the highest incidence in the brexpiprazole group was akathisia (6.5%; placebo, 2.1%).

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In this post hoc analysis of patients with early-episode schizophrenia, brexpiprazole was associated with greater improvement in schizophrenia symptoms than placebo. No new safety observations were made.

None Declared

Individuals with schizophrenia (SZ) are known to be impaired in their social and communication abilities. However, these impairments are not well characterized. More specifically, little is known about how SZ individuals take into account their interlocutor during conversation. Verbal backchannels (e.g., okay, yes) have been described as crucial cues that contribute to conversation coordination by allowing the updating of knowledge shared between interlocutors (Gravano & Hirschberg, 2011, Comput. speech lang., 25, 601-634). They could reflect the ability of interlocutors to take into account their partner’s perspective during conversation.

The aim of the present study was to explore how SZ individuals manage conversation coordination with their interlocutor.

Thirty-one SZ participants and 30 healthy control (HC) participants matched for age and educational level performed a referential communication task with a partner (i.e., a collaborative game; Champagne-Lavau et al., 2009, Cogn. Neuropsychiatry, 14, 217-239.). During this game, they played either the role of Director (condition 1) or the role of Addressee (condition 2) with an experimenter. In condition 1, we performed prosodic analyses on the cues known to predict the production of a backchannel (i.e., backchannel-inviting cues, Gravano & Hirschberg, 2011) by the Addressee (e.g., duration and intonational contour of the Director’s utterance produced before the backchannel). In condition 2, we performed phonetic analyses (e.g., f0min, f0max, pitch span, duration) on the backchannels (i.e., yes) produced by the Addressee. SZ participants’ severity of symptoms was measured using the PANSS. Participants were also assessed on their theory of mind abilities with the Hinting task.

Data from 22 SZ and 17 HC participants were analyzed. The main results did not show any difference between SZ and HC participants regarding the production of backchannel-inviting cues (condition 1) and regarding the number of backchannels produced (condition 2). However, phonetic analyses in condition 2 showed that SZ participants produced backchannels with a shorter duration (222 ms ± 85) and a reduced pitch span (0.443 ± 0.301) compared to HC participants (duration: 265 ms ± 91; pitch span: 0.586 ± 0.367). We also found a correlation between pitch span and PANSS (general score) (r = -0.467, p = 0.029) and a correlation marginally significant between pitch span and theory of mind abilities (r = 0.395, p = 0.069).

This exploratory study seems to show that SZ participants’ production of backchannels (reflecting their role in conversation coordination) is related to their theory of mind abilities and to their symptoms.

None Declared

The emergence of psychotic symptoms induced by antidepressants is an uncommon phenomenon, though it has been documented in isolated cases. Psychosis induced by serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Venlafaxine, is particularly rare. This case presents a patient who developed psychotic symptoms after starting treatment with Venlafaxine, highlighting his capacity for self-criticism and the egodystonic nature of his delusions.

To describe a case of a depressive episode with psychotic symptoms secondary to antidepressant treatment, emphasizing the importance of differential diagnosis, therapeutic management, and the patient’s notable awareness of the unreality of his psychotic symptoms.

A 40-year-old male with a history of depressive disorder and substance abuse experienced high levels of anxiety following the death of his father, with whom he had a conflicted relationship. He started treatment with Venlafaxine, which he had previously taken with good results. Shortly after, he developed euphoria, persecutory thoughts, and delusions, such as the belief that there were cameras watching him, that his food was poisoned, and that he was being followed. No substance use was reported during this period, although he had a history of significant abuse in the past. Due to the worsening of his symptoms, he voluntarily admitted himself for further evaluation at a hospital in Barcelona.

During his hospital stay, Venlafaxine was discontinued due to its association with the psychotic symptoms. Antipsychotics such as Olanzapine, Invega, Aripiprazole, and Depakine were introduced, but these were poorly tolerated. After being transferred to Madrid, Cariprazine was reintroduced, leading to partial improvement, although referential thinking persisted. In private follow-up care, Anafranil was later added, which further improved his mood, although residual psychotic symptoms, particularly referential thinking, remained. A key aspect of this case is the patient’s good insight and egodystonic experience of his psychotic symptoms from the onset. He has recently started group therapy in a Multifamily Psychotherapy Group.

This case highlights the importance of differential diagnosis between antidepressant-induced psychosis and primary psychotic disorders. It also underscores the patient’s egodystonic experience of his delusions, with good insight, which facilitated clinical management. The literature on antidepressant-induced psychosis, particularly with drugs like Venlafaxine, is limited, indicating the need for further study of this rare but significant side effect.

None Declared

Shared psychotic disorder (Folie à Deux) is a phenomenon in which one person adopts the delusions of another with whom they have a close relationship. This case is particularly interesting because the delusions primarily developed through telephone conversations between two sisters and were notably exacerbated when they reunited in person. The telephone-based relationship between the sisters raises questions about the psychological influence from a distance in the development of shared psychosis.

To describe a clinical case of Folie à Deux in which delusion transmission occurred predominantly through telephone communication, highlighting the role of physical contact in the exacerbation of psychotic symptoms.

We present the case of a 59-year-old woman hospitalized for shared psychosis. Her sister, with whom she maintained a close relationship through frequent phone calls, had previously developed persecutory delusions related to a complicated divorce. Over the course of five years, the patient began to share the same delusions of persecution and surveillance that her sister transmitted over the phone. However, following a visit from her sister to Madrid in July 2024, the patient’s psychotic symptoms intensified, leading to psychiatric hospitalization in the brief hospitalization unit (UHB), where antipsychotic and antidepressant treatment was initiated.

The patient was admitted with persecutory delusions centered on alleged surveillance related to her sister’s divorce, delusions that her sister initially developed and which they shared after years of phone conversations. During hospitalization, antipsychotic treatment was effective, leading to remission of the active psychotic symptoms. The patient demonstrated insight into her delusions, linking them to her sister’s influence. As contact with her sister decreased and treatment was introduced, the psychotic symptoms subsided. Since discharge, the patient has remained stable, though a medication adjustment was required due to reported side effects.

This case of Folie à Deux highlights how a telephone relationship can be sufficient to transmit and maintain shared psychotic delusions. While physical contact exacerbated the symptoms, emotional exchange from a distance can also be a potent medium for perpetuating delusions. This case suggests that proximity, whether physical or emotional, directly influences the severity of shared psychosis.

None Declared

In Spain, approximately 4% of the prison population suffers from severe mental disorders, with schizophrenia being more prevalent in this group compared to the general population. Although violent behavior is infrequent among individuals with schizophrenia, it holds significant clinical importance. Reoffending rates are low, and crimes are typically less severe. Comorbid substance abuse is also common.

This study examines the case of a man with schizophrenia who committed homicide under the influence of drugs, highlighting the complex relationship between schizophrenia and violence.

We present the case of a 30-year-old man with no prior medical or legal history, sentenced to five years and nine months in prison for homicide (of his sister), resisting arrest, and minor injuries. The homicide occurred after the consumption of MDMA. The initial forensic report revealed no severe psychopathy and a preserved sense of reality, while the defense argued moderate impairment of cognitive and volitional faculties due to intoxication and extreme fatigue.

After spending a few months in prison, he attempted suicide by hanging, which did not require admission and was considered reactive to a stressful life situation. During his incarceration, the patient exhibited progressive thought disorganization, eccentric behaviors, hallucinations, and delusional ideation unrelated to substance use. He also engaged in severe self-harm, requiring bilateral orchiectomy. Following this, he was diagnosed with schizophrenia and treated in a psychiatric unit. Since 2022, he has been included in the Integrated Care Program for Severe Mental Illnesses in Prison (PAIEM) and treated with extended-release paliperidone. After release, he was incorporated into the Continuity of Care Program, maintaining regular consultations with psychiatry, nursing, and social work. He has integrated well into the psychosocial rehabilitation center, showing no behavioral disturbances. He reports almost complete amnesia of the offenses for which he was convicted and exhibits some indifference towards them. He continues to receive treatment and is diagnosed with schizophrenia, predominantly with negative symptoms.

This case underscores the need to adequately assess negative symptoms of schizophrenia and their impact on violent behavior. The successful transition of the patient from prison to a specialized center highlights the importance of continuous treatment and monitoring in cases of severe mental disorders. Effective management of treatment and post-prison follow-up is crucial for minimizing risks and promoting successful community integration.

None Declared

A specific attitude towards death is an important marker of suicidal risk. A freely written text can be considered as a variant of a projective test and can assess implicit attitudes toward death and suicide.

The objective was to identify the psychological characteristics of the subjects using the theme of death in the texts.

91 patients with schizophrenic and affective spectrum disorders (43 men and 48 women). The control N=98 (40 men and 58 women). All the subjects wrote a short essay “Me, others, the world”, the presence of words from the thematic group “death” was assessed, Big Five Inventory (BFI) and SCL-90R were used. The question about the presence of suicidal thoughts was measured on a Likert scale.

Control and clinical groups did not differ in the frequency of the topic of death (13.3% of the control and 16.5% in clinical group). However, patients wrote more often about themselves, while in control «death» was more often encountered when discussing problems of humanity, ecology, loneliness. The subjects from the clinical group showed low: “Extraversion” (48,86±10,07 and 44,72±10,44 for the control and clinical groups) (due to low “Activity”, “Excitement seeking” and “Gregariousness”), “Conscientiousness” (“Neat” and “Decisiveness”), “Emotional Stability” (50,58±12,21 and 54,88±11,42) (due to “Tension”, “Depression” and “Self-punishing”). Сcomparison of the subgroups that mentioned «death» (control and clinical subgroups) revealed no statistical differences in BFI (clinical subgroup demonstrated a more pronounced “insensitivity”). In general, all subjects (both healthy and clinic patients) with the topic of death differed from the group of subjects who did not touch death vocabulary: “Introversion” (47.66±9.77 and 40.58±13.45 for the subgroup without «death» and with the topic of death), “Attachment” (53,25 ±10,06 and 60,25± 7,03), high “Emotionality” (48,85±11,87 and 56,91± 10,88). A similar pattern is observed when comparing the subgroups “control without the theme of death” and “control with the theme of death”. In the clinical group, it was shown that the topic of death is associated with a higher suicidal risk (the question about the severity of the intention to commit suicide, the average values are 0.30±0.57 and 1.16±1.60 for the “clinical subgroup without the topic of death” and “clinical subgroup with the topic of death”, respectively).

The topic of death in control group indicates a conflict between introversion and social orientation, as well as an inability to control their emotions and impulsive drives and low self-esteem. In the clinical group, almost all of whose subjects differ from the healthy group by increased introversion and emotionality, mentioning the topic of death may be a marker of increased suicidal risk.

None Declared

Studies shows a connection between hostility and the severity of psychopathological symptoms. When psychopathological symptoms (mainly depressive) are expressed, hostility towards one’s own “I”, other people, and generalized impersonal hostility in the form of a sense of injustice, ill will of the surrounding world, and a negative assessment of the subjective future are combined. the connection between hostility and a negative assessment of the future requires empirical confirmation.

The aim of the study was to analyze the connection between hostility and a negative assessment of the future.

N=37 people hospitalized in the clinic of the Mental Health Research Center (16 men and 21 women) with a diagnosis of schizophrenia and affective spectrum. Methods: SCL-90R, BPAQ-24 (Buss, Perry), All the subjects wrote a short essay “Me, others, the world”, attitude to the future was assessed by a group of answers in the modified Sentence Completion Test (Sacks, Levy). The subjects were divided into three subgroups: “positive expectations of the future” (N=16, mean age 24.87±8.20), “neutral future” (N=10, mean age 21.89±8.08), “negative assessment of the future” (N=11, mean age 21.45±4.82). The presence of a trend in changing parameters depending on the attitude to the future - Jonckheere-Terpstra Test, comparison of subgroups by parameters of qualitative assessment of the essay - Chi-Square Tests were used.

The analysis showed an increase in “hostility” (BPAQ-24) with a change in attitude to the future from negative to neutral and positive. With a negative attitude towards the future, there were the highest rates of “hostility” (24.82 ± 4.26, 17.60 ± 5.58, 16.40 ± 4.63, Std. J–Tstat. = -3.44, p = .001). It was revealed that negative expectations of the future are associated with the presence of problems in interpersonal relationships in the present, “Interpersonal Sensitivity” (SCL-90) is increased (10.82 ± 7.37, 7.00 ± 6.88, 4.87 ± 6.81, Std. J–Tstat. = -2.348, p = .019), individuals with high rates are distinguished by negative expectations regarding interpersonal interaction and any communications with other people. The analysis of the parameters of the qualitative analysis of the essays in the subgroups showed that only with a negative attitude towards the future there is a mention of the fragility and instability of the world (36%, p=.007), statistically more often mention the topic of suicide, death, “no place in this world” (80% compared to 16% and 22%, p=.049), the topic of “rejection” (p=.025), the frequency of expectation of a negative assessment of oneself by other people (, p=.004).

Results confirm the hypothesis about the relationship between hostility and a negative attitude towards the future and allow to assume that a common factor for both hostility and a negative attitude towards the future in mental pathology are problematic interpersonal relationships.

None Declared