Evidence based treatment of schizophrenia as well as antipsychotic drug utility patterns have changed considerably in recent years and the present study aims to investigate the current level of unplanned hospital readmissions in a cohort of patients with schizophrenia, and to determine the risk-reducing effects of current antipsychotic drug treatment.

An open cohort study included all consecutively discharged patients with schizophrenia in a 3-year period (n = 277). The treatment-dependent variables were entered in a multivariate Cox survival analyses with time to unplanned readmission as the dependent variable.

11.2% of patients were readmitted within 30days of discharge, and 44.8% were readmitted within 12months. Antipsychotic monotherapy reduced the risk of readmission by 74.9%. Treatment in CMHC also had a risk-reducing effect. The prescription rate of clozapine in this sample was 10.1%.

The over-all level of unplanned readmissions was in correspondence with the findings of others. Current antipsychotic drug treatment independently offers strong protection against unplanned readmissions. There may be a potential for further optimalizing antipsychotic drug treatment according to treatment guidelines.

Unplanned readmissions are very common for patients with schizophrenia but antipsychotic drug treatment is associated with a strong risk-reducing effect in this regard.

Risk assessment in adult psychiatric and criminal justice populations is traditionally one-sided. Protective factors are neglected, and assessment focuses solely violence risk. However, the contribution of instruments that support assessment of protective factors for a full range of relevant outcomes is not well-established.

1) to identify all relevant studies investigating the predictive efficacy of selected tools (START, SAPROF, DUNDRUM 3, DUNDRUM 4, IORNS) for the assessment of protective factors for a range of adverse outcomes, 2) to synthesise available information through meta-analytic procedures

to determine if protective factors are effective in predicting adverse outcomes

A systematic search of five electronic databases for records up to June 2014. A meta-analysis was conducted using the MEANES macro for SPSS (Lipsey & Wilson, 2001; Wilson, 2012).

Seventeen studies (N=2,198) were included in the meta-analysis. Where multiple studies contributed, the largest and smallest mean weighted effect sizes were for violent reoffending and inpatient victimisation respectively. There were no significant differences between effect sizes of protective and risk scales; of the protective scales, the SAPROF dynamic items and total score performed best. Summary judgments based on consideration of each tool's protective and risk scales and other case-specific factors predicted their corresponding outcomes with only two exceptions.

Protective factors perform equivalently to risk factors for prediction of a range of adverse outcomes. Future research should aim to establish if they generate useful indicators about treatment targets, and if their use is beneficial in improving therapeutic relationships.

Sex and gender differences in schizophrenic psychoses have often been described but treatment approaches so far have hardly taken them into account.

To describe the most important sex and gender differences in schizophrenic psychoses with clinical implications.

Review.

Schizophrenic disorders show a later age of onset in women and a slightly better course, especially in young women. As to pathogenesis, there is some evidence that the age difference might be at least partly due to the female sex hormone estradiol being a protective factor. Differences in course might also have to do with this biological factor, but at the same time with the psychosocial advantages of a higher age of onset and other psychosocial factors.

These gender differences have important implications for assessment and therapy. Thus, we have to consider gender differences in coping behaviour as well as psychosocial burdens and needs deriving from differing roles in partnership, family, household and profession, from dependent relationships, potential abuse and violence. Furthermore, there are specific biological risks such as gonadal dysfunction we have to deal with in both sexes differently. Thus, e.g. women with psychosis can also have very special needs regarding fertility, pregnancy and motherhood. Also, around menopause we have to consider special measures such as replacement of physiological 17-b-estradiol.

Women, but also men, with schizophrenic psychoses should get a gender-sensitive assessment and treatment.

The author has not supplied his declaration of competing interest.

stigma in mental illness is characterized by discrimination towards people affected by mental disorder. Consequence of the paradigm “stigma-injury-discrimination” is the social exclusion of these patients and the denial of their rights. Medical students, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.

To study the attitudes of medical students towards psychiatric patients.

The present study analyzes gender differences in a sample of Italian medical students towards mental illness.

A total of 339 Italian medical students completed a cross-sectional survey, in Rome and Foggia (Italy). We used the Italian version of Community Attitude towards the Mentally Ill test (CAMI) to analyze the students’ attitudes.

There is a substantial difference among the attitudes towards mental disorders in female and male students. Female students have obtained less stigmatizing results in 9 of the CAMI test items (P < 0.05), in Benevolence (P = 0.001) and Social Restrictiveness subscales (P = 0.043) and in the total score (P = 0.013).

These results are in line with those achieved in scientific literature, confirming that women tend to show more humanitarian attitude towards the mentally ill. Even in the original article of the validation of the CAMI test, the authors found better attitudes in women in all subscales, with the exception of Social Restrictiveness subscale (that in our analysis also correlates with the female gender).

The authors have not supplied their declaration of competing interest.

The Insomnia Severity Index ISI is a Questionnaire to screen insomnia in clinics;so,it has been translated to many languages.

To determine the Reliability and validity of the Chinese Translation of Insomnia Severity Index(C-ISI) in patients with Insomnia and compare it with Chinese version of Pittsburgh Sleep Quality Index(C-PSQI).

To show the Reliability and validity of C-ISI for using it in chinese speakers.

English version ISI was translated into Chinese base on standard guidelines then Chinese version was filled in 83 patients with insomnia as a clinical group and 45 persons without sleep complain as the control group by themselves in Neuropsychiatery Department of DongzhiMen hospital. For finding Test-Retest reliability they refilled ISI questionnaire 2 weeks later.

Cronbach-α coefficient of C-ISI for the clinical group, control group and both of them was 0.72, 0.75 and 0.91 respectively. The C-ISI component and total scores in test were significantly correlated with their related components and total scores in re-test (P < 0.05). Mean Ranks for All C-ISI components, total score were significantly higher in clinical group than control group that presents low sleep quality in clinical group. There are Significant correlations between C-ISI component and total scores and C-PSQI components and Total scores in related Items.

C-ISI has acceptable reliability and good sensitivity for assessing insomnia patients ;besides,C-ISI can evaluate the insomnia patients similar to the PSQI-C so it can be used as a good scale to measure sleep quality in Chinese speakers.

Understanding factors related to poor quality of life (QoL) and self-rated health (SRH) in clinical high-risk (CHR) for psychosis is important for both research and clinical applications. We investigated the associations of both constructs with CHR symptoms, axis-I disorders, and sociodemographic variables in a community sample.

In total, 2683 (baseline) and 829 (3-year follow-up) individuals of the Swiss Canton of Bern (age-at-baseline: 16–40 years) were interviewed by telephone regarding CHR symptoms, using the Schizophrenia Proneness Instrument for basic symptoms, the Structured Interview for Psychosis-Risk Syndromes for ultra-high risk (UHR) symptoms, the Mini-International Neuropsychiatric Interview for current axis-I disorders, the Brief Multidimensional Life Satisfaction Scale for QoL, and the 3-level EQ-5D for SRH.

In cross-sectional structural equation modelling, lower SRH was exclusively significantly associated with higher age, male gender, lower education, and somatoform disorders. Poor QoL was exclusively associated only with eating disorders. In addition, both strongly interrelated constructs were each associated with affective, and anxiety disorders, UHR and, more strongly, basic symptoms. Prospectively, lower SRH was predicted by lower education and anxiety disorders at baseline, while poorer QoL was predicted by affective disorders at baseline.

When present, CHR, in particular basic symptoms are already distressful for individuals of the community and associated with poorer subjective QoL and health. Therefore, the symptoms are clinically relevant by themselves, even when criteria for a CHR state are not fulfilled. Yet, unlike affective and anxiety disorders, CHR symptoms seem to have no long-term influence on QoL and SRH.

Combined data are presented from two long-term, phase III studies (D1447C00126; D1447C00127) that examined the efficacy and safety of quetiapine in combination with lithium/divalproex in the prevention of mood events (manic, mixed, or depressed) in bipolar I disorder.

During a stabilization phase (12–36 weeks), patients received quetiapine (400–800 mg/day; open-label; flexible, divided doses) with lithium or divalproex (target serum concentrations 0.5–1.2 mEq/L and 50–125 μg/mL). Thereafter, patients were randomized to double-blind treatment with quetiapine (400–800 mg/day)+lithium/divalproex or placebo+lithium/divalproex for up to 104 weeks. The primary endpoint was time to the first mood event, defined by medication initiation, hospitalization for a mood event, YMRS or MADRS scores ≥20 at 2 consecutive assessments, or discontinuation due to a mood event.

In total, 3414 patients entered the stabilization phase and 1326 were randomized and received ≥1 dose of study medication. Rates of recurrence were 19.3% vs 50.4% for quetiapine and placebo groups, respectively. The risk of recurrence of a mood event was significantly reduced in the quetiapine group relative to the placebo group (HR=0.30, P<0.0001). HRs for the risk of recurrence of manic and depressed events were both 0.30 (P<0.0001). Long-term treatment with quetiapine was generally well tolerated; safety data including glucose changes will also be presented.

Quetiapine in combination with lithium/divalproex is significantly more effective than lithium/divalproex alone in the prevention of mood episodes associated with bipolar I disorder, irrespective of the index episode.

Supported by funding from AstraZeneca Pharmaceuticals LP.

Inpatient equivalent home treatment (IEHT), implemented in Germany since 2018, is a specific form of home treatment. Between 2021 and 2022, IEHT was compared to inpatient psychiatric treatment in a 12-months follow-up quasi-experimental study with two propensity score matched cohorts in 10 psychiatric centers in Germany. This article reports results on the treatment during the acute episode and focuses on involvement in decision-making, patient satisfaction, and drop-out rates.

A total of 200 service users receiving IEHT were compared with 200 matched statistical “twins” in standard inpatient treatment. Premature termination of treatment as well as reasons for this was assessed using routine data and a questionnaire. In addition, we measured patient satisfaction with care with a specific scale. For the evaluation of patient involvement in treatment decisions, we used the 9-item Shared Decision Making Questionnaire (SDM-Q-9).

Patients were comparable in both groups with regard to sociodemographic and clinical characteristics. Mean length-of-stay was 37 days for IEHT and 28 days for inpatient treatment. In both groups, a similar proportion of participants stopped treatment prematurely. At the end of the acute episode, patient involvement in decision-making (SDM-Q-9) as well as treatment satisfaction scores were significantly higher for IEHT patients compared to inpatients.

Compared to inpatient care, IEHT treatment for acute psychiatric episodes was associated with higher treatment satisfaction and more involvement in clinical decisions.

Antonovsky's salutogenic construct of sense of coherence (SOC) includes the dimensions of meaningfulness, comprehensibility and manageability. SOC is assumed to promote and protect health in stressful situations, such as the adaptation to severe illness. There is highquality evidence on this in several areas of mental health, and one could expect dementia to be one of them.

We conducted a literature review to uncover the role of SOC as moderator or mediator in the ability of patients and their partners to cope with the impact of dementia.

We searched the major databases (1994-2012), using selection criteria, data extraction and methodological quality assessment. Nvivo10 software was used to accomplish a rigorous literature review.

The SOC within the dementia context has been explored in 8 different countries. Some studies addressed the caregiver's SOC, but the focus on the person with dementia and a systemic perspective on couples remain largely neglected. There were significant associations between SOC and lower caregiver's burden, and between SOC and higher caregiver's perceived health and quality of life, namely in advanced dementia.

There is a dearth of research-based discussions of the SOC role in living with dementia. Results highlight the importance of studying couples, in a dyadic perspective, while acknowledging the voice of the patients themselves, despite several methodological challenges. Research should address the role of SOC in the individual and family's ability to cope with dementia, especially at the early stages of the process, aiming to provide new insights into dementia care.

Anhedonia is one of the two symptoms, along with depressed mood, indispensable for the DSM-5 diagnosis of major depressive disorder. However, anhedonia in depressed patients is poorly explored in terms of prevalence or correlation with other clinical features.

The HEDONIE study aimed to explore the patterns and course of anhedonia in major depressive disorder.

1657 patients were followed over 10 to 12 weeks and assessed with the QIDS-SR, MADRS, CGI, SHAPS and SDS.

At inclusion, the mean QIDS-SR score was 17.4 ± 4.2 and the mean MADRS score was 32.6 ± 7. The mean SHAPS score was 9.8 ± 3.6 and 86.2% of the patients had a SHAPS > 5, which can be considered as a severe anhedonia. Patients with severe anhedonia had a significantly higher QIDS-SR mean score. The SDS total score was 22.1 ± 4.7. Patients were mainly treated with agomelatine (91, 3%).

At last visit, significant reductions were observed in QIDS-score (−11.0 ± 5.7, P<0.0001), MADRS score (−21. 2 ± 9.3, P<0.0001), SHAPS score (−6.9 ± 4.6, P<0.0001) and SDS score (−12.7 ± 7.8, P<0.0001). The correlation between improvement of anhedonia and improvement of functioning was strong (r=0.646; P<0.0001).

This study emphasizes the high prevalence of anhedonia in depression and the importance of its screening and evaluation, given its consequences in terms of functionality. The improvement in anhedonia and functioning observed in this study may be due to the specific antidepressant efficacy profile of agomelatine, already demonstrated in other trials.

Early life adversity is associated with both metabolic impairment and depression in adulthood, as well as with poorer responses to antidepressant medications. It is not yet known whether individual differences in sensitivity to antidiabetic medications could also be related to early life adversity. We examined whether a history of early life adversity affected the observed changes in metabolic function and depressive symptoms in a randomized trial of pioglitazone for augmentation of standard treatments for depression.

Early life adversity is associated with both metabolic impairment and depression in adulthood, as well as with poorer responses to antidepressant medications. It is not yet known whether individual differences in sensitivity to antidiabetic medications could also be related to early life adversity. We examined whether a history of early life adversity affected the observed changes in metabolic function and depressive symptoms in a randomized trial of pioglitazone for augmentation of standard treatments for depression.

We found that early life adversity significantly impaired the metabolic response to pioglitazone. Effects on depressive symptoms did not reach significance, but nonetheless suggested that pioglitazone could mitigate the depressant effects of childhood adversity, only among those insulin resistant at baseline.

We conclude that a history of early life adversity may impair the body’s ability to respond to insulin sensitizing pharmacotherapy, and furthermore that its contribution to resistant depression may function in part via the generation of an insulin resistant phenotype.

Excessive cortical cerebrospinal fluid (CSF) has been acknowledged as a possible marker of a gray matter loss. This excess in schizophrenia is found predominantly in the prefrontal and temporal regions. We hypothesized that the poorer global outcome and treatment response in males with schizophrenia are related to a greater cortical volume loss as compared to females.

In order to test this hypothesis we have used magnetic resonance imaging (MRI) to study the cortical (prefrontal, temporal, and hemispheric) CSF values in a group of 85 patients with schizophrenia, of whom 56 were males and 29, females. We calculated the residual values of CSF in the patients based on the data pertaining to 45 control subjects and linear regression, from which the normal effects of age and intracranial volume were discounted. These residual scores constitute a quantitative measurement of the excess of CSF due to the disease.

Males, but not females, presented a trend-level significant excess of left prefrontal CSF. The prefrontal and temporal residual values were significantly associated with illness duration in males, but not in females.

These results conform to the worse outcome and the higher severity of structural abnormalities generally found in schizophrenia in male subjects.

Our data support the hypothesis of accelerated prefrontal cortical loss in males, but not in females with schizophrenia.