Sexual violence is considered to be one of the most traumatic, pervasive, and common human rights violations. In Tunisia, there is limited research about this issue.

The present study aims to explore the relationship between sexual violence and mental health in Tunisia, with a focus on understanding the prevalence and types of mental health problems experienced by victims, as well as different factors related to it.

This is a descriptive cross-sectional study that took place over six months from September 2022 to March 2023. Data collection was carried out using an online self-administered questionnaire distributed online. It is composed of 24 questions with “restricted” answers in the form of propositions. Each participant was invited to fill out the sociodemographic and clinical data form, the Harvard trauma questionnaire and the Hopkins symptoms questionnaire.

86.1% of our participants reported that they were subjected to a form of sexual aggression. Including 95.5% female, 4% male, and 0.5% non-binary. The median reported age of the first sexual aggression was 14 years. Our study found no significant correlation between age and trauma outcomes. Participants who reported sexual aggression were more likely to have scores above the cutoff for both the Harvard PTSD score and the Hopkins Symptoms Checklist scores. No statistically significant difference was found in the comparison of scores across genders. Participants with a past medical psychiatric history had a significantly higher average Harvard PTSD score as well as Hopkins symptoms checklist scores compared to those without this history. 35.5% of our participants chose not to disclose their traumatic experience to anyone. Notably, 34% of disclosures were made to friends and 22% to family members. The study found no statistically significant difference in the scores for post-traumatic stress disorder (PTSD), anxiety, or depression between participants who disclosed the assault and those who kept it a secret. The aggressor’s identity is mostly unknown (34.7%). Higher scores were reported by those who identified their partner as the aggressor. Our participants reported that they were victims of more than one episode of sexual assault in 67.3% of cases, with a mean age of revictimization of 19 years. A lower age of first sexual aggression was a significant risk factor for subsequent revictimization. 3.8% of our participants took legal action against their aggressor, and they had significantly higher average scores on all measured items and total scores. 30.8% of our participants seek psychiatric help. And the main reason for that would be a lack of awareness and knowledge.

The cultural context of Tunisia, intricately woven into the fabric of our study, emphasizes the need for targeted and culturally sensitive approaches to addressing the aftermath of sexual violence.

None Declared

The Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) is a brief battery to screen for cognitive impact of schizophrenia in outpatient settings. The EPICOG-SCH includes well-known subtests available worldwide that cover key cognitive domains demonstrated to be related to a variety of functional outcomes. Novel composite scores are modelled to predict patient’s functionality in daily life at short, mid and long term.

We want to progress in the elaboration of specific algorithms first episodes of schizophrenia at different follow up periods by modelling cognitive performance to predict short, mid and long term functionality.

Data for the present investigation were obtained from an the epidemiological and three-year longitudinal intervention program of first-episode psychosis (PAFIP) conducted at the outpatient clinic and the inpatient unit at the University Hospital Marques de Valdecilla, Spain. The cohort is composed by 167 patients with a diagnose of Schizophrenia and 160 healthy controls recruited between February 2001 to February 2014. For all analyses, a subset of measures was selected corresponding to the EPICOG-SCH domains with the Rey Auditory Verbal Learning Test (RAVLT) task ifor Logical Memory. Functional outcomes were measured by the Disability Assessment Scale (DAS) and the General Assessment for Function (GAF) scales. Functional measurements were conducted regarding premorbid, baseline set at clinical stabilization and 1, 3 year follow-up, and cognitive assessments where conducted at baseline and 1, 3 years of follow up.

A cohort of 122 patients and 114 Controls completed the study with a 3-year follow up were included in the analysis. Changes across evaluations is tested in patients and controls. A regression analysis including the different EPICOG-SCH subtests at baseline as predictors of functionality at the different time points to explore the best predictive algorithms at 1 and 3 years of patient’s functionality in daily life following a first-episode.

The EPICOG-SCH brief battery is modelled to be a useful first to screen for the cognitive impact of schizophrenia in daily functionality daily life. This research work will validate the composite scores for a context of use of first-episodes schizophrenia and follow up. To date it has not been described an efficient and straightforward way for clinicians working with schizophrenia to transfer quantitative information about patient cognitive profile into real life. The EPICOG-SCH global composite score provides valuable information to clinicians which can facilitate disease management, drawing a roadmap for cognitive rehabilitation, and planning of supportive resources from the community and health care system.

None Declared

The World Health Organization defines non-adherence to treatment as “a situation where an individual’s medication-taking behavior diverges from the agreed recommendations of healthcare professionals”. Individuals with psychiatric disorders frequently encounter challenges in adhering to their prescribed treatments, which is due amon other factors to a lack of insight. The non-adherence can lead to increased relapse rates, diminished treatment efficacy over time, and adverse effects on both the individual and the broader community.

This study’s objectives were towfold : (1) to investigate medication adherence among patients with schizophrenia and bipolar disorders under antipsychotics, and (2) to identify various factors associated with non-adherence to antipsychotic treatments.

A cross-sectional study was conducted at Razi Hospital, Tunisia, between December 2023 and January 2024. Were included patients who attended the outpatient clinic during the study period, who were in remission for at least one month and who were receiving antipsychotic medication. The Brief Adherence Rating Scale, the Positive and Negative Syndrome Scale and the Glasgow Antipsychotic Side-effects Scale were administered to all patients.

The study included 35 male patients with a mean age of 39 years ± 11 years. Schizophrenia was diagnosed in 86% (N=30) of the participants. Of these, 49% were prescribed first-generation antipsychotics (N=17), while 51% (N=18) were prescribed second-generation antipsychotics. More than half of the patients (63%) demonstrated non-adherence to their treatment regimen. Among these, 65% exhibited moderate to severe lack of insight into their illness, and 66% had not received psychoeducation about their condition. A significant association was found between non-adherence and moderate to severe lack of insight (p=0.000, OR=4, 95% CI [1.4-10]), lack of psychoeducation for the patient (p=0.02, OR=2, 95% CI [1-4.3]), and lack of psychoeducation for the caregiver (p=0.05, OR=1.7, 95% CI [0.9-3.2]). Binary logistic regression analysis indicated that lack of insight (p=0.01, OR=3.6) remained a significant risk factor for non-adherence.

This study underscores significant association between lack of insight and non-adherence to antipsychotic medications. Enhancing insight through early psychoeducational interventions could potentially improve medication adherence and positively influence long-term clinical and functional outcomes for patients.

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Delusions in schizophrenia have been theoretically linked to probabilistic reasoning bias (‘jumping to conclusions’, JTC), although experimental support has been mixed (Garety et al BJP 2013; 203 327-333). Ward and Garety (Schiz Res 2019; 203 80-87) recently proposed a reformulation of the theory in terms of Kahneman’s concepts of ‘fast’ and ‘slow’ thinking. This proposes that decision-making involves two cognitive processes: a fast, heuristic-based approach which is prone to errors, and a slow, deliberate process that carefully evaluates all the relevant evidence. According to this view, an overreliance on fast thinking and/or reduced engagement of slow thinking underlies the initial development of delusional interpretations of everyday events and also makes them harder to be corrected.

Our aim was to develop a novel task to investigate the fast and slow thinking hypothesis of delusions in patients with schizophrenia, for use in behavioural and functional imaging studies. As a preliminary step, we tested this task on healthy participants.

A battery of 137 experimental questions (where fast thinking leads to incorrect answers) was generated from multiple sources, including examples of the base rate and conjunction fallacies, the cognitive reflection test (CRT), trick questions, and syllogisms. Example questions included: If it takes 5 machines 5 minutes to make 5 widgets, how long would it take 100 machines to make 100 widgets? [Correct answer = 5 minutes; intuitive answer = 100 minutes; category: cognitive reflection] A farmer had 15 sheep and all but 8 died. How many are left? [intuitive answer: 7; correct answer: 8, category: trick question]. 137 control questions (where both fast and slow thinking give the correct answer) were adapted from the experimental questions. The questions were administered online to 176 healthy volunteers using PsychoPy software, with 15 experimental and 15 control questions randomly assigned to each participant.

The sample had a mean age of 40.3 years (range 17-77 years); 55.1% were female and 65.9% had a university education. Correct answers to experimental questions were markedly fewer than answers to control questions in all categories (overall p < 0.001). Response latency for the experimental questions was slightly higher than for the control questions, apart from in one category (CRT) (overall p = 0.004).

Results from a large sample of healthy participants indicate that a battery of questions can be feasibly developed to reliably detect fast thinking.

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Schizophrenia is a disorder associated with significant morbidity, largely due to poor treatment outcomes with existing interventions. Emerging evidence demonstrates that stem cell therapy using either patient-derived induced pluripotent stem cells (iPSCs) or mesenchymal stem cells (MSCs), may offer an effective alternative for treating schizophrenia by promoting the restoration of excitatory interneurons. However, given the variability in the therapeutic potential of iPSCs and MSCs, adopting a progressive computational approach to predict the clinical outcomes of these therapies might be an effective strategy.

The objective was to evaluate the efficacy of stem cell therapy in schizophrenia and to explore the role of computational models in predicting the outcomes of this therapy.

We conducted a systematic search of clinical trials and studies published (since 2015) in PubMed, SCOPUS, and EMBASE. The review included all randomized controlled trials involving iPSC or MSCs-based interventions and studies that incorporated computational models to predict outcomes. A total of 22 studies including 1436 individuals were included in the review. Meta-analytic methods were used to calculate pooled effect sizes on cognitive outcomes and reduction or improvement in negative symptoms was recorded using standardized mean difference (SMD) and risk ratios (RR).

This involved 979 patients with schizophrenia from four studies that met quality review criteria, revealing that MSC-based therapies using positive controls significantly improved negative symptoms with a standardized mean difference (SMD) of 0.52 (95% CI, 0.32–0.73; P < 0.001). Improvements in cognition, especially in the domains of memory and executive function, were significant in treated groups using iPSCs (SMD = 0.61, 95% CI, 0.40–0.82; P < 0.0001). The predictive models that classified interneuron (PV and SST) restoration in terms of sensitivity (83.4%) and specificity (78.2%) enhanced the ability to predict responder treatment effects. Ultimately, computational modeling reduced predictive variance in therapeutic efficacy by 18.7% (p = 0.006).

Our meta-analysis revealed that stem cell therapies, particularly MSCs and iPSCs, significantly improved both negative and cognitive symptoms associated with schizophrenia. Additionally, predictive models using computational methods were found to accurately predict the therapeutic outcomes for intervention treatments based on the resting patient subgroups that received interneuron restorations. We conclude that stem-cell-based therapies especially when used alongside computational models have tremendous potential to provide precise and personalized psychiatric care.

None Declared

Schizophrenia is a severe psychiatric disorder characterized by positive (delusions and hallucinations), negative and disorganization symptoms. According to the influential dopamine hypothesis, positive symptoms of schizophrenia are linked to increased dopamine transmission in subcortical regions, particularly the striatum. Kapur’s aberrant salience theory further suggests that hyperdopaminergia leads to increased and disorganized reward prediction error signalling, leading to the misattribution of significance to irrelevant stimuli, which contributes to the development of delusions. Negative symptoms have been argued to reflect reduced reward prediction error signalling.

To design an optimized monetary incentive delay (MID) task for use in fMRI studies of schizophrenia patients. For this, a pilot study was conducted in order to test the effects of monetary incentives on task performance in schizophrenia patients and healthy controls.

Nine healthy controls and seven patients with DSM-5 schizophrenia completed the MID task, including a training and test phase. This task evaluates reward processing by presenting cues that predict either rewarding or non-rewarding outcomes before a target that requires a speeded response. We investigated the effect of these cues on task performance (accuracy and reaction times) through a repeated measures ANOVA that compared rewarding and non-rewarding cues with a between-subjects factor for diagnosis.

The patients with schizophrenia exhibited slower RT and lower accuracy compared to healthy controls (main effect of group, RT p = 0.008, accuracy p = 0.047). There was also a significant main effect of condition, with better accuracy and shorter RT in the rewarded condition in both the patients and controls (accuracy p = 0.01, RT p = 0.003). However, there was no significant group*condition interaction. Both the patients and the controls showed significant improvements in task performance when rewards were offered, compared to when no rewards were provided.

Our MID task shows expected performance effects in patients with schizophrenia, producing effects comparable to those observed in healthy controls. This MID task design is therefore suitable for examining and understanding symptom profiles associated with reward processing, such as delusions and negative symptoms.

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Individuals diagnosed with schizophrenia experience a 2- to 3-fold higher mortality rate compared to the general population, with cardiovascular disease being the primary cause. On average, they lose about 15 years of potential life. Additionally, up to 15% of individuals with schizophrenia develop type 2 diabetes, further exacerbating their health challenges.

This study aimed to evaluate the efficacy of Semaglutide, a glucagon-like peptide-1 receptor agonist, as an adjunctive treatment to antipsychotic therapy in patients with schizophrenia spectrum disorders, prediabetes and overweight.

We conducted an investigator-initiated, randomized, placebo-controlled, double-blind trial across two clinical sites in Denmark. Out of 402 possible eligible participants, 154 were enrolled. Participants were receiving second-generation antipsychotic treatment, were overweight or obese, and had prediabetes (HbA1c 39-47 mmol/mol). Data collection spanned from January 1, 2022, to May 1, 2024. The primary outcome measure was changes in HbA1c, with secondary outcomes including psychotic symptoms, quality of life, BMI, and cardiometabolic parameters. A pre-specified statistical analysis plan was registered with ClinicalTrials.gov prior to unblinding the treatment arms.

The trial is spear-headed by Odense University Hospital with recruitment from community psychiatry settings in the Region of Southern Denmark and Region Zealand.

The last patient visit was May 1, 2024 and unblinding occurred primo September 2024. Results will be analyzed in Q4, 2024 and primary and secondary results presented at the conference.

Semaglutide holds potential as a novel therapeutic option for individuals with schizophrenia who experience prediabetes and antipsychotic-induced weight gain.

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Public perceptions of mental illness, particularly in the context of marriage, are shaped by a myriad of factors, including cultural beliefs, media representations, and personal experiences. These perceptions often involve misconceptions and negative stereotypes leading to social stigma and discrimination. For individuals with schizophrenia, stigma can result in significant challenges in forming and maintaining marital relationships.

To explore these perceptions we performed a qualitative analysis of public attitudes toward marriage in individuals with schizophrenia. By examining these perceptions, we aimed to identify common themes, misconceptions, and areas where public education might be most effective.

A cross-sectional study was conducted among general population. A survey was proposed via social networks. It included, additionally to socio-demographic and clinical variables, a detailed description of clinical symptoms and outcomes of schizophrenia along with open-ended questions assessing the perceptions of potential benefits and disbenefits of being an intimate partner of an individual with schizophrenia. Answers were arranged and the commonly reported themes in public opinion were identified.

A total of 304 participants majoritively aged between 20 and 30 years old were included, 80.9% among them were women. The most of them were graduated from university. Family psychiatric history was reported by 35.6% of the participants and 23.35% of them stated that they were living with a person with a psychiatric disorder. About 87% of the participants admitted that they had seen a psychiatrist at least once in their lives. Responses regarding potential disbenefits of being married to a patient with schizophrenia included 8 themes, the most representative ones were 1) the fear of dealing with the exacerbations (16.4%); 2) the risk of being attacked physically (10.9); 3) the impossibility of maintaining a stable relationship (10.9%); 4) the lack of communication (6.6%); and 5) the risk of separation (5.6%). Other themes included concerns about 6) dealing with an irresponsible partner (4.6%); 7) the risk of suicide and 8) the possibility of transmitting the pathology to descendants (2.3%).

About 23% of the participants stated that they were willing to get married with a schizophrenic patient in order to help him survive his illness.

This study has shed light on the complex and multifaceted perceptions held by the general population regarding marriage with a schizophrenic person. However, the study also revealed a glimmer of hope in the form of empathy and a growing recognition of the need for accurate information and support. As public awareness of mental health issues continues to rise, there is potential to challenge and change these negative perceptions.

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Marriage is widely regarded as an important part of social life, providing emotional support and stability. However, public perceptions of marriages involving individuals with psychiatric conditions like schizophrenia and bipolar disorder are not well understood. Stigma likely plays a crucial role in shaping these perceptions and affects societal attitudes toward such unions.

This study aimed to explore and compare public perceptions of marriage in individuals with schizophrenia and in individuals with bipolar disorder, and to examine how these views affect their marital prospects.

A cross-sectional survey was conducted using an online form to gather data from the general population. It covered socio-demographic and clinical variables, as well as detailed descriptions of schizophrenia and bipolar disorder symptoms and outcomes. The survey also included questions on public attitudes toward marriage involving individuals with schizophrenia and bipolar disorder. Participants answered 13 questions about the right of individuals with these conditions to marry, their capacity to maintain a stable relationship, and whether they would personally consider or recommend marrying someone with these disorders. This study was inspired by the article of Kumar et al., 2019).

The study involved 304 participants, mostly young adults, with 246 being women. Around 35.6% had a family history of psychiatric illness, and 23.35% lived with someone with a psychiatric disorder. The findings revealed significant differences in public perceptions of marriage for individuals with schizophrenia versus bipolar disorder. Participants were more strongly opposed to marriage as a cure, especially for schizophrenia (p<10^-3), and more had never considered finding a partner for someone with schizophrenia compared to bipolar disorder (p<10^-3). Reluctance to marry someone with schizophrenia was also significantly higher, even if compatibility was present (p<10^-3).

Regarding bipolar disorder, concerns about marriage exacerbating symptoms were more prevalent compared to schizophrenia (p=0.001). Despite these concerns, the stigma around marriage with individuals affected by bipolar disorder appeared less severe, as indicated by participants’ greater openness toward the possibility of such a union in individuals with schizophrenia (p<10^-3).

Results emphasize the need for targeted awareness and educational initiatives to address misunderstandings and support the marriage goals of individuals with mental health conditions. Future studies should examine the factors shaping these perceptions and develop approaches to promote a more inclusive perspective on marriage and mental health, tackling stigma and challenging widespread stereotypes.

None Declared

The perception of marriage involving individuals with schizophrenia remains critical in understanding the broader societal attitudes towards mental illness. Stigma and misconceptions often shape public views. Few studies have been conducted on this subject and the perceptions regarding this topic have not been thoroughly investigated.

This study aimed to explore perceptions of the general public regarding marriage in individuals with schizophrenia and to assess the relationships between these perceptions and affirming attitudes.

A cross sectional study was conducted via an online survey. It included a detailed description of clinical symptoms and outcomes of schizophrenia. Thirteen open-ended questions, adopted from the study of Kumar et al., 2019, and assessing various aspects of marriage in individuals with schizophrenia were asked.

A battery for measurement of affirming attitudes about mental illness was used, comprising the Empowerment scale(ES) to assess people’s beliefs about the social worth of people with mental illness, the Recovery scale (RS) to evaluate people’s beliefs about potential of recovery from serious mental illness and the self-discrimination scale (SDS) to assess people’s expectations about a person with mental illness successfully pursuing his life goals.

A total of 304 participants took part in the study, most of whom were between 20 and 30 years old, 80,9 were women. Additionally, 23.35% mentioned living with someone diagnosed with a psychiatric disorder. Results revealed that the majority of participants held reservations about marriage for individuals with schizophrenia. Over 50% believed that marriage neither cures nor improves symptoms, and more than 60% were reluctant to marry someone with schizophrenia or agreed to a marriage match involving a schizophrenic person. However, 53% agreed that individuals with schizophrenia have the right to make their own decisions about marriage, though concerns remain regarding their ability to manage family responsibilities. Regarding perceptions of schizophrenia, individuals who believed that marriage is not a cure for the illness and those who stated they would never consider marrying someone with schizophrenia exhibited significantly higher RS scores (p=.009 and p<10^-3, respectively). Participants who disagreed with the fact that individuals with schizophrenia have the right to marry showed significantly higher RS (p=.023), ES (p=.03), and SDS (p=.033) scores.

This study highlights the ongoing challenge of stigma towards individuals with schizophrenia, particularly about their perceived suitability for marriage. While there are encouraging signs of changing attitudes, broader efforts are needed to foster a more inclusive and supportive societal perspective on mental health and marriage.

None Declared

Understanding patient attitudes toward psychoactive substances is essential for improving treatment outcomes in psychotic disorders. Substance use complicates these disorders, worsening symptoms and hindering recovery. Despite known risks, many individuals with psychotic disorders engage in substance use influenced by various factors. The debate over the legalization, decriminalization, and normalization of psychoactive substances, including marijuana and psychedelics, is growing. Legalization removes legal restrictions, decriminalization reduces penalties, and normalization involves societal acceptance of these substances. Alcohol, a culturally embedded substance, is also highly harmful despite its legal status. Recently, there has been increased interest in cannabis for therapeutic use, though its role in psychotic disorders remains contentious. While some evidence suggests the benefits of cannabidiol (CBD), excessive use of high-THC cannabis may elevate the risk of psychosis or exacerbate symptoms.

To examine the attitudes and perceptions of patients with psychotic disorders toward alcohol, marijuana, and psychedelics, and to assess the prevalence of psychoactive substance use among individuals with psychotic disorders.

For this descriptive study, data were collected from September 2023 to September 2024 through a questionnaire distributed to patients during their hospitalization at the University Hospital of Split in the Psychiatry Department. Inclusion criteria included adult patients with ICD diagnoses from F20-F29 who agreed to participate in the study; exclusion criteria included patients with F21 (unless they also have F23) and those who declined to participate.

This study examined the attitudes and behaviors of 62 patients with psychotic disorders regarding alcohol and psychoactive substance use. The sample consisted of 37 men (59.7%) and 25 women (40.3%). Alcohol consumption was reported by 34 respondents (54%) in socially acceptable quantities, while 7 respondents (11.3%) admitted to combining alcohol with medications. Additionally, 8 respondents (12.9%) reported using other psychoactive drugs. Regarding perceptions, 6 respondents (9.7%) believed that marijuana helps their health, and an equal number expressed a similar belief about psychedelics.

Despite therapeutic cooperation, many patients continue to consume alcohol due to its availability and social acceptance. Some patients use marijuana, believing that it improves their mental state, while others use psychedelics; however, fewer patients engage with these substances compared to alcohol. These findings reveal significant variability in substance use and perceptions among patients with psychotic disorders, highlighting the need for further investigation into the factors influencing these behaviors to develop effective treatment strategies and support systems tailored to this population.

None Declared

A large proportion of patients with schizophrenia do not have a sufficient response even to clozapine. Very little is known if any pharmacological augmentation treatment can improve the long-term outcome of these patients.

We studied the comparative effectiveness of oral risperidone, olanzapine, quetiapine, and aripiprazole augmentation of clozapine treatment on the risk of hospitalization due to psychotic episode as a marker for severe relapse among patients with schizophrenia.

In this population-based study, patients with schizophrenia or schizoaffective disorder using clozapine were included from Finnish (years 1996-2017) and Swedish (years 2006-2021) nationwide registers of inpatients care, specialized outpatient care, sickness absence, and disability pension. The risk of hospitalization associated with periods of antipsychotic augmentation vs. clozapine monotherapy (expressed as adjusted hazard ratio, aHR) was assessed by a within-individual design, using each individual as his/her own control, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately, and then results were combined using a random-effect meta-analysis. Secondary outcomes were somatic hospitalization and composite outcome of psychosis/ somatic hospitalization.

In the meta-analysis of 23,206 clozapine users, medium dose (9-16.5 mg/day) aripiprazole augmentation was associated with the lowest risk of relapse among patients with low-dose (< 180 mg/day) (meta-analysis aHR 0.67, 95% CI 0.46-0.97, p=0.03), medium-dose (180-330 mg) (0.79, 0.70-0.91, p= 0.0006), and high-dose (>330 mg) clozapine (0.68, 0.62-0.75, p<0.0001), compared with the same clozapine dose as monotherapy. Augmentation with higher dose of aripiprazole or with other antipsychotics was associated with less favorable outcome. Only aripiprazole augmentations were associated with decreased risk of psychosis/somatic hospitalization, and the lowest risk was observed for medium-dose aripiprazole plus high-dose clozapine (0.70, 0.58-0.84, p=0.0001). Medium-dose aripiprazole plus high-dose clozapine was not associated with the risk of somatic hospitalization (0.66, 0.30-1.44, p=0.29), when compared with clozapine monotherapy in the same dose category.

This meta-analysis of two nation-wide cohorts totaling over 23,000 clozapine using patients indicates that 10-15 mg/day aripiprazole augmentation of clozapine treatment is associated with about 20-30% decreased risk of relapse compared with clozapine monotherapy periods within the same individuals.

J. Tiihonen Grant / Research support from: Janssen, Consultant of: Healthcare Global Village, HLS Therapeutics, Janssen, Orion, Teva, WebMD Global, Speakers bureau of: Janssen, Lundbeck, Otsuka, A. Tanskanen Grant / Research support from: Janssen, E. Mittendorfer-Rutz Grant / Research support from: Janssen, H. Taipale Grant / Research support from: Janssen, Speakers bureau of: Gedeon Richter, Lundbeck, Otsuka

The therapeutic alliance (TA) is increasingly acknowledged as a fundamental quality of care indicator. Numerous guidelines advocate TA awareness in practice, but lack specifics on building a strong TA. Yet, previous studies have found independent associations between levels of self-esteem, the quality of TA and severity of clinical symptoms in people with schizophrenia and other psychotic disorders. It suggests that the TA possibly mediates the relationship between self-esteem and psychotic symptoms. The present study therefore examined the relationships between these three factors in people with psychotic disorders.

Investigating the mediating effect of TA on the relationship between self-esteem and psychotic symptom severity.

The short forms of the Self-Esteem Rating Scale and the Working Alliance Inventory, respectively, were used to assess self-esteem and TA. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale. Linear regression models were applied, followed by a mediation-model when appropriate.

A higher self-esteem significantly predicted less severe psychotic symptoms (B = -.312; β = -.46, p <.001) and better TA (B = .123, β = .255, p = .009). There was no significant relation between TA and psychotic symptom severity (B = -.161; β = -0.109, p = .289), therefore no mediation-analysis was performed.

We found no association between TA and psychotic symptoms, which may be explained by the mild psychotic symptoms and overall high satisfaction scores on TA in our chronic sample. Another factor might be that current measurements assume a one-on-one relationship between a client and a professional, while nowadays multiple professionals are involved. We recommend re-evaluating the definition and assessment of the TA within chronic psychiatric populations. Our study results also offer practical guidelines for clinicians to improve their quality of care, such as the recommendation to focus on enhancing self-esteem in people with psychosis.

None Declared

Negative symptoms pose a significant challenge for the treatment and management of schizophrenia. They refer to the loss or diminishment of normal emotional and behavioural functions, which profoundly impact one’s quality of life and socio-occupational outcomes. They are often persistent and difficult to treat.

To explore and assess different treatment strategies for addressing negative symptoms of schizophrenia, including pharmacological, psychosocial, and non-invasive neurostimulation interventions. The goal is to provide an overview of current evidence and recommendations for enhancing the quality of life and functional outcomes in individuals with schizophrenia.

We conducted a review of the extant literature to determine treatment strategies for negative symptoms in schizophrenia. We incorporated findings from randomised controlled studies, meta-analyses and systematic reviews.

We have identified several treatment strategies for negative symptoms in schizophrenia. The literature indicates that second generation antipsychotics such as Cariprazine and Amisulpride are associated with better functional outcomes with lower cognitive impairment. Adding on an anti-depressant, particularly to first-generation antipsychotics, has demonstrated positive effects. Psychosocial interventions including Cognitive Remediation (CR), Social Skills Training (SST) and exercise programs also alleviate negative symptoms. Additionally, non-invasive neurostimulation intervention such as rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) has shown encouraging results in reducing negative symptoms.

The findings highlight the important of comprehensive and holistic treatment approach integrating both pharmacotherapy and non-pharmacotherapy strategies to address the heterogeneity of negative symptoms. There is a need for further research into personalised treatments that address individual symptom profiles.

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Tardive dyskinesia (TD) is an iatrogenic disorder characterized by a range of movement abnormalities, described as irregular, stereotyped, and choreiform caused by exposure to antipsychotics. This condition can lead to significant or disabling symptoms that affect quality of life. However, the exact mechanism underlying TD remains unclear. Pharmacotherapy of TD includes cholinergic drugs, benzodiazepines, antioxidants, amantadine, propanolol, botulinum toxin, whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy and deep brain stimulation. We successfully treated a chronic schizophrenia patient with comorbid TD using Aripiprazole and botulinum toxin after trying calcium channel blockers in association with Aripiprazole and vitamin E.

To determine the effects of calcium channel blocker drugs (Amlodipine) for treatment of neuroleptic-induced tardive dyskinesia in people with schizophrenia, and the efficiency of botulinum toxin in treating induced tardive dyskinesia.

Through a case report and a literature review, our work aims to study antipsychotics induced tardive dyskinesia and its pharmacotherapy especially the use of calcium channel blocker and botulinum toxin in association with Aripiprazole.

A 22 years male, diagnosed with schizophrenia since the age of 16 years, with one hospitalization. The evolution of his disease was marked by the development of a tardive dyskinesia, cervical and brachial movements disorders with rapid worsening in few months, the patient was treated with olanzapine oral administration. During his follows-up, his tardive dyskinesia disn’t resolve despite switching the incriminated antipsychotic to Aripiprazole, lowering the dose since he was on complete remission. we added benzodiazepines and vitamin E to his treatment, before trying the calcium channel blocker for two months, with no improvement, on the contrary a worsening was noted using the Unified Dyskinesia Rating Scale. The aggravation of the movements was a reason for the patient attempted suicide, after this late incident we chose to try the botulinum toxin injections. His tardive dyskinesia was spectacularly improved within the fisrt injections.

Antipsychotic drugs are known to cause a variety of adverse effects, including tardive dyskinesia. Hence the importance of knowing the pharmacotherapy and non-pharmaco- therapy to manage this effect, through this case report where it tardive dyskinesia got treated after using botilinum toxin injections with a spectacular improvement in its Unified Dyskinesia Rating Scale. In our case, we had no response after adding calcium channel blocker .The effects of calcium channel blockers for antipsychotic-induced tardive dyskinesia are unknown, and it use is still limited.

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The early stages after the onset of a first episode of psychosis (FEP) are crucial for the long-term outcome of the disease. Good outcome can be expected in <50% of patients, but three-quarters of all patients who experience a remission from a first episode of psychosis will have a recurrence of psychotic symptoms within a year of treatment discontinuation. Relapse prevention is key to preventing disease progression and further deterioration. Considerable number of patients experiencing a first episode of psychosis, will eventually transition to a diagnosis of Schizophrenia, so maintenance treatment should be the preferred option even in stable patients after a first episode of psychosis to remain in recovery. There is scarce information about differential effectiveness of antipsycotics in the long term. In such an atmosphere, the idea of polypharmacy with antipsychotics arises and may gain more supporters. Despite its obsolence, and unclear therapeutic benefits, as well as significant health risks, polypharmacy with antipsychotics is relatively common. This practice, due to unwanted effects, can lead to the arbitrary discontinuation of medication, and the consequent relapse of psychosis.

To determine the association of transition to schiyophrenia after the first episode of psychosis with a monotherapeutic or polypharmacy approach to the use of antipsychotics.

A retrospective analysis of all hospitalized patients (87 patients, 65.5% were women), diagnosed with first episode of psychosis during a five-year period was conducted. The rate of relapse, and conversion to schizophrenia was analyzed in relation to the therapeutic approach (monotherapy vs polypharmacy with antipsychotics), within one year after the end of hospitalization due to the first episode of psychosis.

35.6% (31) of the subjects were treated with monotherapy. 25% (8) of them relapsed within a one-year period. 64.4% (56) of patients were treated with polypharmacy. 55.2% (48) of patients were treated with two antipsychotics, and 9.2% (8) with three. 75% (24) of subjects treated with polypharmacy had a relapse of psychosis within a year after discharge. There is a statistically significant difference between the groups of patients (p˂ 0.05).

A significantly higher rate of relapse, and conversion to schizophrenia within a year after the end of hospitalization due to the first psychotic episode exists in subjects who were treated with two or more antipsychotics compared to subjects treated with monotherapy. The practice of polypharmacy with antipsychotics should remain reserved for individual, specially selected patients.

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Cognitive deficits are a fundamental characteristic of schizophrenia, similar to positive and negative symptoms. They lead to significant disability due to their impact on various domains of life.

This study aimed to study the relationship between cognitive impairment and sociodemographic, clinical, and therapeutic factors in patients with schizophrenia.

This study was carried out in the Psychiatry « c » Department at Hedi Chaker University Hospital in Sfax, Tunisia, involving 15 patients with schizophrenia. We used the Screen For Cognitive Impairment in Psychiatry (SCIP) in its literary Arabic version to assess cognitive functions. Data were analyzed using SPSS version 20.0 software.

The mean age of the patients was 40 ± 12.72 years. Among the participants, 80% (n=12) were single. Seven cases (46.7%) had not exceeded primary education. The mean age of illness onset was 27.8 years, and the mean duration of illness was 13.7 years. Five patients (33.3%) had a family history of psychiatric disorders. All patients were receiving antipsychotics (AP), and 13.2% of them were on Haloperidol decanoate (HD). The mean scores for the total SCIP (ST) and its five subscales (verbal learning test-immediate (VLT-I), working memory test (WMT), verbal fluency test (VFT), verbal learning test-delayed (VLT-D), and processing speed test (PST)) were 37.40, 12.87, 14.27, 3.93, 2.47, and 3.93, respectively. A negative correlation was found between age and performance on the ST, WMT, and PST (r values: -0.515, -0.629, -0.615, respectively). Regarding marital status, VLT-I scores were better in single patients (p=0.007). Our study revealed that the low level of education was significantly correlated with several cognitive tests measured by the SCIP, including the ST, VLT-I, WMT, VFT, and PST. Mean scores for ST, VLT-I, WMT, VFT and PST were significantly lower in patients with illness onset after age 40 (p<0.05). The WMT score was significantly lower in patients with an illness duration exceeding 5 years and in patients with a family history of psychiatric disorders (p values: 0.05; 0.021). The PST score was significantly lower in patients on HD (p=0.038).

Sociodemographic, clinical, and therapeutic factors harm the cognitive abilities of patients with schizophrenia. Thus, it is essential to carry out neurocognitive assessments during the follow-up of these patients, taking into account factors likely to predict cognitive impairment.

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Cognitive impairments in schizophrenic patients are present from the first psychotic episode and remain relatively stable over time. These cognitive impairments primarily affect memory, attention, executive functions, and social cognition.

The aim of this study was to assess cognitive functions in schizophrenic patients by comparing them to healthy controls.

Methods: We conducted a cross-sectional, descriptive, and analytical case-control study. It included 15 schizophrenic patients and 15 healthy controls. The study was carried out at the Psychiatry « c » Department outpatient unit at Hedi Chaker University Hospital in Sfax, Tunisia. Both cases and controls underwent interviews to answer predefined questionnaires. We used the Screen For Cognitive Impairment in Psychiatry (SCIP) scale in its literary Arabic version for the assessment of cognitive functions.

The average scores for the total SCIP (ST) and its five subscales (Verbal Learning Test-Immediate (VLT-I), working memory (WMT), verbal fluency (VFT), verbal learning-Test-delayed (VLT-D), and processing speed Test (PST)) were 37.40, 12.87, 14.27, 3.93, 2.47, and 3.93, respectively, for the cases, and 47.27, 15, 18.13, 5.40, 4.33, and 4.40, respectively, for the controls. The cases had significantly lower total SCIP scores than the controls (p=0.05), specifically in the WMT (p=0.02) and VLT-D (p=0.01) subscales. There was no significant difference between the two groups in the VLT-I (p=0.241), VFT (p= 0.202), and PST (p=0.598) subscales.

This study found that cognitive deficits in schizophrenic patients primarily involved impairments in working memory and verbal learning-delayed recall. Early screening for cognitive impairments in these patients should be systematic to specify the deficits and to hasten the integration in the neurocognitive training programs.

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Lambert-Eaton Myasthenic Syndrome is an autoimmune neuromuscular junction disorder characterized by proximal weakness, autonomic dysfunction, and areflexia associated with antibodies against voltage-gated calcium channels. Psychotic symptoms can take place in many auto-immune neurological disorders, but their occurrence in myasthenic syndromes has rarely been observed.

We report a case of a 21-year-old female with primary autoimmune Lambert-Eaton Myasthenic Syndrome due to anti-voltage-gated calcium channels antibodies subtype P/Q, who developed psychotic symptoms three years after motor symptom onset.

The patient attended regular psychiatric follow-ups over three years.

With monthly administration, these psychotic symptoms improved after every cycle of intravenous immunoglobulin therapy. The patient displayed partial insight into the mental symptoms. Different causes of reversible psychosis were excluded, such as autoimmune encephalitis and paraneoplastic syndrome, though the patient tested positive for the anti-voltage-gated calcium channels antibodies subtype P/Q. Owing to muscle strength worsening and psychotic episodes, the patient was put on several treatments, including one admission to a Neurology unit. The patient then experienced psychotic exacerbation, leading to treatment with olanzapine at 20 mg/day. Psychotic symptoms persisted but were less severe, with greater intensity at night. After two years, the patient’s condition showed significant improvement, with olanzapine increased to 25 mg/day.

This is, to our knowledge, the first described case of psychotic symptoms associated with Lambert-Eaton Myasthenic Syndrome. We speculate that voltage-gated calcium channel antibodies could have a role in developing mental symptoms. However, further hypotheses are discussed. Although the patient had received corticosteroid therapy before symptom onset, the timing and dosage make corticosteroid-induced psychosis unlikely. A primary psychotic disorder, such as schizophrenia, is considered improbable due to the atypical nature of the psychotic symptoms. This case underscores the need for further research on the neurobiological mechanisms linking VGCC antibodies to psychiatric symptoms.

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Patients with schizophrenia are at highs risk for constipation and are more likely experienced severe health consequences than the healthy general population. Due to the heterogeneous definition and the health professionals’ long-term attitude of taking condition for granted, constipation has been neglected, and the relevant evidence is insufficient.

This study aims to investigate the prevalence rate of the chronic schizophrenic inpatients, and to address the relevant factors that may be related with their constipation.

The study adopted the cross-sectional study design with the approach of purposeful sampling. Hospitalised patients with chronic schizophrenia in a psychiatric hospital in central Taiwan were enrolled through the advertising posters, and a total of 300 persons were finally included after screening with inclusion/exclusion criteria. Both subjective and objective data were collected by questionnaires which were developed and performed by the research team, and descriptive and inferential statistical analyses were performed with SPSS, version 25. Statistical significance was set at the 5% level.

The definition of constipation was defined as receiving any laxative agent during the study period, and the point prevalence rate of constipation in the chronic schizophrenic inpatients was 74.7%. Three factors were found relevant with constipation with statistical significance. The combined use of first-generation and second-generation antipsychotic medications (OR=3.28 95% CI:1.14-9.46) was regarded as detrimental factors while both increased education years (OR=0.92, 95% CI: 0.87-0.97) and more exercises (more attendance to the twice-a-day self-initiated aerobic exercises) (OR=0.47, 95% CI: 0.23-0.97) were found protective.

The point prevalence rate of constipation was much higher than other similar studies locally or internationally, but, however, such result also faithfully revealed the fact that constipation is literally a ubiquitous health problem among the chronic schizophrenic inpatients. The researchers suggested that performing health education on constipation, enhancing the extent of aerobic exercises and promoting health behaviours for positive cycle, and discussing with the prescribing physicians to simplify the use of antipsychotic agents may mitigate the risk of constipation.

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