Extensive research indicates that obesity, defined by a body mass index (BMI) greater or equal to 30, is common in patients treated with antipsychotic drugs and is frequently associated with carbohydrate and lipid abnormalities leading to metabolic syndrome and diabetes. In contrast, the metabolic health of overweight patients (BMI = 25–29.9) without metabolic syndrome or diabetes has not been thoroughly investigated.

To assess the metabolic health of overweight patients receiving antipsychotic drugs.

We compared standard metabolic parameters (BMI; waist circumference; hemoglobin A1c; fasting lipids; and fasting and post-challenge glucose and insulin) of normal weight, overweight and obese individuals from a consecutive cohort of antipsychotic-treated patients without metabolic syndrome and/or diabetes.

Compared with the normal weight subjects (n = 286), overweight patients (n = 212) had higher fasting insulin resistance as assessed with the homeostatic model (P = 0.023), insulin secretion during the oral glucose tolerance test (P = 0.0037), triglycerides (P = 0.0004) and low-density lipoprotein cholesterol (P = 0.0089), and lower levels of high-density lipoprotein cholesterol (P = 0.0014). The obese (n = 50) were different from the overweight subjects only with respect to higher post-challenge insulin levels (P = 0.0002). The average fasting glucose, post-challenge glucose, and hemoglobin A1c, severity of psychiatric disorders and antipsychotics used were similar in the three groups.

Overweight (BMI = 25–29.9) patients receiving antipsychotics are metabolically closer to the obese than to normal weight counterparts. The findings suggest that interventions promoting weight loss and metabolic health are required for overweight patients even in the absence of metabolic syndrome or diabetes.

Autism and epilepsy often occur together. Epilepsy and other associated conditions have a substantial impact on the well-being of autistic people and their families, reduce quality of life, and increase premature mortality. Despite this, there is a lack of studies investigating the care pathway of autistic children with co-occurring epilepsy in Europe.

We analyzed the care pathway for autistic children with associated epilepsy in Italy, Spain, and the United Kingdom from the perspective of caregivers (using a survey aimed at caregivers of autistic children 0–18 years old), the autistic community, and professionals, in order to identify major barriers preventing caregivers and autistic children from receiving timely screening and treatment of possible co-occurring epilepsy.

Across all three countries, an analysis of the current care pathway showed a lack of systematic screening of epilepsy in all autistic children, lack of treatment of co-occurring epilepsy, and inappropriate use of antiepileptic drugs. A major challenge is the lack of evidence-based harmonized guidelines for autism with co-occurring epilepsy in these countries.

Our findings show both heterogeneity and major gaps in the care pathway for autism with associated epilepsy and the great efforts that caregivers must make for timely screening, diagnosis, and adequate management of epilepsy in autistic children. We call for policy harmonization in Europe in order to improve the experiences and quality of life of autistic people and their families.

In Europe, at discharge from a psychiatric hospital, patients with severe mental illness may be exposed to one of two main care approaches: personal continuity, where one clinician is responsible for in- and outpatient care, and specialisation, where various clinicians are. Such exposure is decided through patient-clinician agreement or at the organisational level, depending on the country’s health system. Since personal continuity would be more suitable for patients with complex psychosocial needs, the aim of this study was to identify predictors of patients’ exposure to care approaches in different European countries.

Data were collected on 7302 psychiatric hospitalised patients in 2015 in Germany, Poland, and Belgium (patient-level exposure); and in the UK and Italy (organisational-level exposure). At discharge, patients were exposed to one of the care approaches according to usual practice. Putative predictors of exposure at patients’ discharge were assessed in both groups of countries.

Socially disadvantaged patients were significantly more exposed to personal continuity. In all countries, the main predictor of exposure was the admission hospital, except in Germany, where having a diagnosis of psychosis and a higher education status were predictors of exposure to personal continuity. In the UK, hospitals practising personal continuity had a more socially disadvantaged patient population.

Even in countries where exposure is decided through patient-clinician agreement, it was the admission hospital, not patient characteristics, that predicted exposure to care approaches. Nevertheless, organisational decisions in hospitals tend to expose socially disadvantaged patients to personal continuity.

Climate change is one of the greatest threats to health that societies face and can adversely affect mental health. Given the current lack of a European consensus paper on the interplay between climate change and mental health, we signal a need for a pan-European position paper about this topic, written by stakeholders working in mental health care.

On behalf of the European Psychiatric Association (EPA), we give recommendations to make mental health care, research, and education more sustainable based on a narrative review of the literature.

Examples of sustainable mental healthcare comprise preventive strategies, interdisciplinary collaborations, evidence-based patient care, addressing social determinants of mental health, maintaining health services during extreme weather events, optimising use of resources, and sustainable facility management. In mental health research, sustainable strategies include investigating the impact of climate change on mental health, promoting research on climate change interventions, strengthening the evidence base for mental health-care recommendations, evaluating the allocation of research funding, and establishing evidence-based definitions and clinical approaches for emerging issues such as ‘eco-distress’. Regarding mental health education, planetary health, which refers to human health and how it is intertwined with ecosystems, may be integrated into educational courses.

The EPA is committed to combat climate change as the latter poses a threat to the future of mental health care. The current EPA position paper on climate change and mental health may be of interest to a diverse readership of stakeholders, including clinicians, researchers, educators, patients, and policymakers.

The authors have not supplied their declaration of competing interest.

In the society we belong to, elders are the target of abuse which is many times generated by the social cultural tendency which promotes different expressions in terms of age, a tendency which also measures capacity in terms of age.

To evaluate elder physical abuse – cases reviewed at the Forensic Institute, Tirgu Mures County, Romania.

An experimental design was used, focusing on elder physical abuse cases involving victims aged 65 or older, who requested a forensic certificate. All cases were reviewed at the Forensic Institute Tg. Mures, Mures County, Romania between 1st of Jan–31st Dec 2014. Variables included: age, gender, environmental origin, physical abuse, sexual abuse, relationship with the perpetrator (relative, known person/neighbor, unknown person, husband/wife), the required number of days of hospitalization, victim previous psychiatric diagnosis, aggressor previous psychiatric diagnosis.

A total of 5252 forensic medical certificates were issued at request by the Forensic Institute of Tg Mures. One hundred and twenty (2.28%) were related to acknowledgement of the aggression of an elderly peIntroductionrson (≥65 years, with an average age of 69.89 years CI: 68.8903–70.8930). The majority of subjects were males (65%), of rural origin (64.17%). The same address as the aggressor's was identified in most of the cases (41.66%). 35.83% were hurt by neighbours/acquaintances, 22.5% were attacked by strangers.

We are aware of that an elder abuse appears to occur most often in domestic home situations, men from rural, more often than women, are involved that victims and may be perpetrated by adult family members, or other persons.

The authors have not supplied their declaration of competing interest.

In schizophrenia, perceptual inundation related to sensory gating deficit can be evaluated “off-line” with the sensory gating inventory (SGI) and “on-line” during listening tests. However, no study investigated the relation between “off-line evaluation” and “on-line evaluation”. The present study investigates this relationship.

A sound corpus of 36 realistic environmental auditory scenes was obtained from a 3D immersive synthesizer. Twenty schizophrenic patients and twenty healthy subjects completed the SGI and evaluated the feeling of “inundation” from 1 (“null”) to 5 (“maximum”) for each auditory scene. Sensory gating deficit was evaluated in half of each population group with P50 suppression electrophysiological measure.

Evaluation of inundation during sound listening was significantly higher in schizophrenia (3.25) compared to the control group (2.40, P < .001). The evaluation of inundation during the listening test correlated significantly with the perceptual modulation (n = 20, rho = .52, P = .029) and the over-inclusion dimensions (n = 20, rho = .59, P = .01) of the SGI in schizophrenic patients and with the P50 suppression for the entire group of controls and patients who performed ERP recordings (n = 20, rho = −.49, P = .027).

An evaluation of the external validity of the SGI was obtained through listening tests. The ability to control acoustic parameters of each of the realistic immersive environmental auditory scenes might in future research make it possible to identify acoustic triggers related to perceptual inundation in schizophrenia.

A large body of literature has demonstrated that people affected by psychotic disorders show deficits in working memory, in Emotion Recognition (ER) and in data-gathering to reach a decision (Jumping To Conclusions – JTC).

To investigate a possible correlation between working memory, JTC and ER in FEP.

41 patients and 89 healthy controls completed assessments of working memory using WAIS shortened version, JTC using the 60:40 Beads Task and ER using Degraded Facial Affect Recognition Task.

According to the literature, cases had poorer performance in working memory tasks (Digit Span: μ7,72 [ds=2,98] vs μ10,14 [ds=3,10], U=865,00, p=0,00; Digit Symbol: μ5,36 [ds=2,43] vs μ10,05 [ds=3,10], U=455,50, p=0,00; Arithmetic: μ5,46 [ds=2,76] vs μ8,74 [ds=3,24], U=865,50, p=0,00; Block Design: μ4,82 [ds=2,72] vs μ7,60 [ds=3,18], U=912,00, p=0,00), in Beads Task (81,6% vs 51,1%, χ2=10,27, p=0,001, μ2,53 [ds=3,57] vs μ4,23 [ds=4,77], U=1171,00, p=0,006) and in DFAR (total errors: μ21,62 [ds=7,43] vs μ16,58 [ds=8,69], U=554,50, p=0,002). Furthermore working memory tasks in cases group correlated significantly with JTC (Digit Span: r_rho=0,276, p=0,003; Digit Symbol: r_rho=0,275, p=0,002; Arithmetic: r_rho=0,265, p=0,003; Block Design: r_rho=0,292, p=0,001), but only Digit Span with ER (r_rho=-0,239; p=0,021). In addition, we found that JTC and ER were significantly associated (r_rho=-0,281; p=0,004).

Data show that working memory impairments, JTC style and dysfunctions in the facial emotions recognition are phenomena strongly correlated in the group of patients. Preliminary results suggest the importance of early rehabilitation as the impairments detected may lead to difficulties in social and relational adaptation in psychotic patients.

Hyperprolactinemia is a common adverse effect of typical and some atypical antipsychotics and can induce side effects associated with decreased quality of life and poor adherence to treatment.

Management options are limited and can lead to decompensation of the patient.

Aripiprazole is a recent antipsychotic with partial agonist activity over the dopamine D2 receptors which can be effective in reducing hyperprolactinemia in patients treated with antipsychotics.

Review the existing literature about the effect of adjunctive treatment with low doses of aripiprazole on antipsychotic-induced hyperprolactinemia.

Search for literature about the topic in PubMed and Goocle Scholar databases using “hyperprolactinemia” and “aripiprazole” as keywords.

We found 6 case reports with 8 patients treated with risperidone, paliperidone, zuclopenthixol and fluphenazine that, with 2,5-10mg of aripiprazole, showed a decrease in serum levels of prolactin. 4 open label studies, with a total of 69 patients, all treated with risperidone, also showed a decrease in prolactin levels for adjunctive treatment with 3-10mg of aripiprazole. Two double-blind and two single-blind RCT vs placebo was found, with a sample of 297 patients treated with risperidone or sulpiride and 5-10mg of aripiprazole, and showed decrease in serum levels of prolactin. In all studies treatment with aripiprazole was not significantly associated with an increase in adverse effects or worsening of clinical symptoms.

The antipsychotic-induced hyperprolactinemia could be partially or totally reversed after adding low doses of aripiprazole to current treatment. It seems to be an effective, safe and well tolerated option.

The extent and profiles of heterogeneity in cognitive functioning among participants in clinical trials of antidementia medication are unknown. We aimed to quantify and identify profiles of heterogeneity of cognition in Alzheimer’s disease.

Individual-level participant data were analyzed from five pivotal clinical trials of donepezil for Alzheimer’s disease (N = 2,919). Based on Alzheimer’s Disease Assessment Scale–Cognitive Subscale total scores from baseline up to week 12, a latent class model was used to identify heterogeneous groups. A logistic regression model was used to examine factors associated with group membership. Sensitivity analysis was conducted, restricted to the donepezil, and then the placebo arm.

The latent class model identified three classes labeled as low scorers (i.e., least cognitive impairment; N = 1,666, 76.04%), improvers (N = 27, 1.23%), and high scorers (N = 498, 22.73%). Logistic modeling showed that donepezil compared to placebo was significantly (p < 0.05) positively associated with membership in the improvers class (OR = 6.88, 95% CI = 2.03, 42.95), and negatively with high scorers (OR = 0.79, 95% CI = 0.64, 0.98). Sensitivity analysis restricted to the placebo, then donepezil arms replicated similar heterogeneity patterns.

Our results inform clinicians regarding the extent of heterogeneity in cognitive functioning during treatment and contribute to trial design considerations.

The authors have not supplied their declaration of competing interest.