Schizophrenia requires a large share of medical resources due to its early onset and chronic and severe nature. Compliance therapy is a therapy specifically designed to improve concordance with treatment for those with major mental illnesses. The aim of present study was to determine whether compliance therapy improves drug adherence and consequently makes better global functioning and improves quality of life in schizophrenic patients.

This randomized controlled clinical trial study was done in Noor hospital in 2008-2009. Patients were randomly assigned to receive the intervention consisting of 8 sessions of compliance therapy, or the control treatment consisting of an equal number of sessions of supportive counseling. All patients were evaluated by Heinrichs Quality of Life scale, Global Assessment of Functioning (GAF) scale, and Positive and Negative Symptoms Scale (PANSS) at baseline, third month and sixth month follow-up after intervention.

76 schizophrenic patients who met criteria of study were enrolled in the trial. Our data showed a significant main effect for interaction of group and time for GAF scale, Heinrichs Quality of Life scale and PANSS.

The findings of our study showed that compliance therapy can improve not only global functioning but also quality of life in schizophrenic patients. In addition, PNASS was improved during the six months follow up in compliance therapy group.

Family burden is considered to be an integrated psychosocial parameter negatively impacting on symptom levels, social functioning and outcomes of children and adolescents with schizophrenic spectrum disorders, and specific measures directly aimed at lessening the burden of these families should be developed.

To assess the influence of burden-focused group therapy (BFGT) with parents on social functioning of children and adolescents with schizophrenic spectrum disorders.

Parents of 126 children with administered standard antipsychotic therapy (aged 8 - 17 years) were recruited into this study. Parents were assigned to eight 90-minutes “module” structured sessions carried out in groups (8 - 9 members) and received a systematic assessment using CGSQ and CGAS at entry and after 1, 3 and 6 month.

Reciprocal effect with negative correlation (r=-0.463, P=0.005) between family burden indicators and children's total levels of functioning was established. BFGT did significantly affect family burden and correlated with positive changes in overall levels of social functioning of children using CGAS (p< 0,05). The largest decline was noted in Subjective burden (from 4.98 to 3.75).

BFGT aimed at managing family burden and improving children's social functioning proved to be one of key components of the psychosocial treatment and rehabilitation of children and adolescents with schizophrenic spectrum disorders in the context of increasing rehabilitation resource of their families. Further controlled studies are required to strengthen the evidence base for effective management of family burden.

For our investigation we observed 167 patients with paranoid schizophrenia according to the criteria of ICD 10. Patients were randomized into 3 groups. Patients of 1st group (n = 52) received sertindole monotherapy 16–20 mg per day, patients of 2nd group (n = 67) received paliperidone 9–12 mg per day and fluvoxamine in combination with zuclopenthixole depot 150–200 mg per day.

Social functioning in patients with schizophrenia significantly improved in all three groups especially in group №3. We suppose that it was connected with activating activity of fluvoxamine.

Thus the results of the study indicate the significance of differences of dynamics of neurocognitive deficit in schizophrenia and the importance of choice of biological therapy for correction of neurocognitive deficit in patients with schizophrenia.The use of modern atypical antipsychotics and drugs which can influence on sigma-receptors can restore the social functioning in young patients with schizophrenia.

To compare socio-demographic and clinical profiles of patricide and matricide patients.

To compare modus operandi in matricide and patricide patients.

A retrospective, descriptive and comparative study was conducted, based on medical charts’ consult. Were included patients suffering from psychotic disorders (DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015, after not being held for insanity according to article 38 of Tunisian Criminal Code. Only patients who committed patricide or matricide were included.

Our sample included 26 patients (13 patricides; 13 matricides). There was non-significant differences between two groups concerning: instructional level (P = 0.277), professional status (P = 0.387) and marital status (P = 0.790). Committers of patricide and matricide did not differ in terms of psychiatric diagnosis (P = 0.242) and substance abuse (P = 0.550). A significant difference was found between the two groups in terms of schizophrenia subtypes, patricide patients suffered from a disorganized schizophrenia whereas matricide patients suffered from paranoid subtype (P = 0.05). Patricide was more frequently associated to a conflictual relationship between son and father (P = 0.05). We did not record a significant difference in the crime weapon or its motivations.

Our results helps draw a profile for parricide patients in order to help identify the ones at risk.

The authors have not supplied their declaration of competing interest.

Cyberchondria is a pathological behaviour linked to excessive online searching of health information.It is frequently associated with health anxiety. It may be regarded as an compulsive behaviour secondary to obsessions about a real or an imagined illness. The coronavirus pandemic of 2019 has brought about a fear of getting infected. In the absence of a definitive cure, the focus largely lies on stringent preventive measures and early diagnosis. Known to present with diverse symptoms, fear of coronaviral infection makes affected individuals search for symptoms on internet for reassurance. Added misinformation further increases stress,anxiety and confusion.

The authors attempt to describe cyberchondria and highlight its increased prevalence during the coronavirus pandemic.

5 cases from different backgrounds were seen in the outpatient clinic during the months of April-July 2020.Consent was obtained from subjects before the study.They were clinically diagnosed with obsessive-compulsive disorder and exhibited cyberchondria in the background of the pandemic.

All of the described 5 cases had prominent fear of contracting or having contracted coronavirus disease-19.All of them were found to have significant scores rang on Yale-Brown Obsessive-Compulsive Severity Scale(ranging from 25-35) and improved after a trial of selective serotonin reuptake inhibitors.

The emergence of cyberchondria during the coronavirus -19 pandemic warrants further introspection.Changes in policy-making to prevent misinformation and present health information in a simple way to prevent confusion in the lay public is a necessity to tackle this problem in the near future.

Nurturing children with neurodevelopmental disorders such as ADHD is associated with psychological burden to the caregivers. Oman has a pyramidal population structure with the bulk of the population are in the pediatric age group. Previous studies have indicated that ADHD is common in Oman.

To measure level of burden of care among caregivers of children with ADHD and the relationship between the degree of burden, subtypes of ADHD and socio-demographic factors.

A cross sectional study conducted in a tertiary hospital in Oman. Arabic-version of the Zarit Burden Interview (ZBI) was used to evaluate the level of burden among the caregivers. The severity and subtypes of ADHD were quantified using Vanderbilt ADHD Parent/Teacher Rating Scale. Socio-demographic background and clinical data were gathered from medical records.

The study included caregivers of 100 children with ADHD. The mean ZBI score was significantly high for the parents of children with ADHD. As for the relationship with socio-demographic background, mothers of children with ADHD reported a higher mean ZBI score compared to fathers. Factors such as income, number of siblings, and severity/subtypes of ADHD played significant roles.

To our knowledge, this is the first study of Arab/Islamic population exploring the burden of care for children with ADHD. Some of the risk factors appear to have direct effects. If this study will withstand further scrutiny, concerted effort is needed in emerging economies such as Oman to address the issue of burden among the caregivers of children with ADHD.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Patients with OCD often show unsatisfactory response to first-line treatment, giving rise to a need for novel therapeutic approaches. Recent studies using tDCS for OCD treatment have shown promise.

To assess efficacy and safety of add-on c-tDCS over pre-SMA compared to sham stimulation in patients with OCD.

In this double-blinded study, fourteen patients with OCD were randomized to receive 10 sessions of either active (Cathode over pre-SMA, anode over right deltoid, 2mA, 20 minutes per session, 2 sessions per day, 2 hours apart) or sham tDCS. YBOCS, HAM-D, HAM-A, CGI, Wisconsin Card Sorting Test (WCST), and Stroop Test were administered at baseline, post-tDCS, and 1 month post-tDCS.

Group×time interaction effect for YBOCS scores with Repeated Measures ANOVA was not statistically significant, however, reduction in scores in active group was higher, with large effect size (YBOCS scores: Obsessions-ηp2=.344, Compulsions-ηp2= .384, Total-ηp2=.392) (Fig.1 & 2). At 1 month, 42.9% patients in active group and none in sham group showed response. CGI-S score (p=0.016, ηp2=.531) (Fig. 3) and four parameters of WCST (Perseverative responses:p=0.038, ηp2=.448;Percent perseverative responses:p=0.026, ηp2=.485;Percent perseverative errors:p=0.038, ηp2=.447;Trials to complete first category:p=0.011, ηp2=.563) significantly reduced in active group. No significant difference in change in depressive and anxiety symptoms between groups, or change in Stroop Test performance was noted. Adverse effects included transient headache and tingling sensation.

Cathodal tDCS over pre-SMA may be effective in reduction of obsessions, compulsions, illness severity, and enhancing cognitive flexibility in patients with OCD, with no major adverse effects. Larger studies are required to confirm these findings.

No significant relationships.

Donepezil is an acetylcholinesterase inhibitor approved by the Food and Drug Administration for the treatment of dementia in Alzheimer’s disease. While it is not curative for Alzheimer’s disease, donepezil has been shown to improve symptoms and slow disease progression; however, cases of rare psychiatric adverse effects, including hallucinations, mania, and increased confusion, have been reported. This report presents a case of donepezil-induced psychosis, which quickly resolved following cessation of the offending medication.

To illustrate a unique case of donepezil-induced psychosis

The patient is an 81-year-old male with a history of late-onset Alzheimer’s disease, mild depression, hypertension, hyperlipidemia, gastroesophageal reflux disease, and myocardial infarction. The patient was prescribed oral donepezil 10mg twice daily to manage his late-onset Alzheimer’s disease. Subsequently, he began developing persecutory delusions, increased agitation toward his family, and auditory hallucinations. His symptoms were worse at night after taking the donepezil, and he regularly requested to have a firearm for self-defense in the late hours of the night. His symptoms progressed for several weeks before his family brought him into the geriatric psychiatry clinic to address his psychosis. The family recognized that these new symptoms started shortly after the patient began taking donepezil and had already started decreasing the dose to half of what was originally prescribed.

This patient experienced symptom remission from psychosis immediately upon discontinuation of donepezil. The patient and his family reported significant improvement with no continuation of hallucinations or paranoia. There was also reported improvement in mood and irritability, and the patient appeared significantly better upon follow-up with geriatric psychiatry. Due to this immediate improvement, the suspected causative factor in the precipitation of psychosis in this patient is the anticholinesterase activity of the donepezil. Although the prescribing information of donepezil details inadequate data proving an association between donepezil and psychotic symptoms, two other published case reports (Yorston GA et al. J Psychopharmacol 2000;14:303-4, Pozzi FE et al. Case Rep Neurol 2022; 14:359-365), along with this one, provide evidence of a causal relationship between the two. The patient was switched to memantine therapy and has remained free of psychotic symptoms thus far.

This case demonstrates the caution required among clinicians when prescribing donepezil for the treatment of Alzheimer’s disease. There needs to be a more focused risk evaluation of potential psychiatric adverse effects in patients treated with donepezil.

None Declared

To evaluate safety, tolerability and overall effectiveness of a titrated- versus fixed-dose switching strategy from risperidone to aripiprazole in a general practice setting.

This 12-week, multicentre, open-label study included patients with schizophrenia (DSM-IV-TR) experiencing insufficient efficacy and/or safety/tolerability issues while receiving risperidone for ≥6 weeks. Patients were randomized to titrated- or fixed-dose switching regimens.

Discontinuations due to AEs were similar between titrated- and fixed-dose strategies (3.5% vs. 5.0%; p=0.448). Titrated- and fixed-dose groups showed improvements (Week 12) in mean PANSS Total scores (–14.8 vs. –17.2; LOCF), mean CGI-I scores (2.9 vs. 2.8; p=0.425; LOCF), ASEX scores (–1.5 vs. –1.9 from baseline; OC), serum prolactin levels (−48.7 vs. −48.5 from baseline; OC) and SWN scores (+8.6 vs. +10.3 from baseline; p=0.223; OC). POM scores indicated a preference for aripiprazole compared with risperidone using either regimen. Both strategies showed improvements (titrated-dose vs. fixed-dose; Week 12; LOCF) in social cognition as indicated by decreased GEOPTE patient (–5.3 vs. –6.1), caregiver (–5.4 vs. –9.9) and index scores (–5.1 vs. –9.8).

Switching to aripiprazole from risperidone can be effectively and safely achieved in a general practice setting through a slow down-titration of risperidone and either a titrated- or fixed-dose switching strategy for aripiprazole.

The authors have not supplied their declaration of competing interest.

Parental reflective function is the ability of a parent to attribute mental states to their child and to themselves. The Parental Reflective Functioning Questionnaire is widely used for the measurement of this construct, the adolescent version of which can be used by parents of children aged 12-18.

The aim of our research was to adapt the adolescent version of The Parental Reflective Functioning Questionnaire to the Hungarian language.

In our study 240 mothers completed the adolescent version of The Parental Reflective Functioning Questionnaire (PRFQ-A), and the Reflective Function Questionnaire (RFQ).

Confirmatory factor analysis did not confirm the original three-factor structure. The principal component analysis resulted in a two-factor structure. Factors corresponded to the original questionnaire’s certainty in mental states (Alpha = .81) and interest and curiosity subscales (Alpha = .70). When analyzing the relationship between parental reflective function and reflective function, the subscales of the parental reflective function questionnaire were examined with two types of median coding in addition to polar coding. During the first median coding, the frequency of scores in the middle of the scales reflected optimal mentalization, while the frequency of extreme values on the scales corresponded to less favorable reflective functioning. With the second median coding, hypermentalization and hypomentalization subscales were also created. The second median transcoding proved to be the most suitable for capturing the relationship between RFQ and PRFQ-A.

The questionnaire proved to be a reliable measure on the Hungarian sample and we recommend using the additional subscales.

No significant relationships.

Police and ambulance personnel are widely believed to have a high prevalence of excessive alcohol consumption. However, the empirical basis for this assumption is scant or non-existent. We assessed the association of alcohol use with burnout and job stress, with ‘drinking to cope’ and neuroticism as two possibly moderating factors in two occupations, the police- and ambulance services.

A comprehensive nationwide questionnaire survey of police (n = 2665) and ambulance personnel (n = 1180) in operational duty. The questionnaire encompassed the Alcohol Use Disorders Identification Test (AUDIT), the Maslach Burnout Inventory, the Job Stress Survey, and the Basic Character Inventory (BCI). A series of multiple linear regression analyses were conducted to examine relationships among the variables.

With a modified AUDIT score of 6 or more, the prevalence for men was 17.7% (police) vs. 16.6% (ambulance personnel). The prevalence for women was 9.1% vs. 7.4%, respectively. Personnel who were male, younger, and with higher levels of neuroticism reported higher levels of alcohol problems. ‘Drinking to cope’ was most strongly associated with higher levels of alcohol problems (standardized beta = 0.29, p < 0.001), and was found to moderate the effect of depersonalization and gender.

The prevalence of hazardous drinking was moderate in both groups. However, among those personnel who drank to reduce stress, males and those experiencing higher levels of depersonalization may be at increased risk of developing alcohol-related problems.

Stuttering is a speech disorder characterized by involuntary repetition, prolongation or cessation of a sound. This dysfluency may be developmental or acquired. Acquired dysfluency can be classified as neurogenic or psychogenic.

This case report aims to describe and discuss a case of psychogenic stuttering, providing an updated review on this disorder.

In and outpatient interviews were performed by Neurology and Psychiatry. Investigation to exclude organic causes included lab exams, electrocardiogram, electroencephalography, computed tomography scan and magnetic resonance imaging. A literature review in Science Direct database, with the keywords “psychogenic stuttering”, was also conducted.

A 63-year-old man was admitted to the Beatriz Ângelo Hospital with an acute stuttering. Speech was characterized by the repetition of initial or stressed syllables, little affected by reading out loud or singing. Comprehension, syntaxes and semantic were not compromised, as weren’t sensory and motor abilities. During admission, stuttering characteristics changed. Multiple somatic complaints and stress prior to the onset and bizarre secondary behaviors were also detected. Work-up didn’t show an organic etiology for that sudden change. An iatrogenic etiology was considered, as sertraline and topiramate were started for depression 1 month before. However, the stuttering pattern, the negative results, the psychological and the social life events suggested a psychogenic etiology.

Psychogenic stuttering finds its origin in psychological or emotional problems. It is best classified as a conversion reaction. The differential diagnosis between psychogenic and neurological stuttering can be challenging.

The authors have not supplied their declaration of competing interest.

An increasing number of studies have described the relationship between velo-cardio-facial syndrome (VCFS) and schizophrenia. in a family-based study, we found that rs10314, a single nucleotide polymorphism (SNP) present in the 3’-flanking region of the CLDN5 gene, was associated with schizophrenia among a Chinese population. High false positive rate is a common problem with the association study of human diseases. It is very important to replicate an initial finding with different samples and experimental designs.

A total of 749 patients with schizophrenia and 383 age and sex matched healthy control subjects in Chinese population were recruited. PCR-based RFLP protocol was applied to genotype rs10314 to see its disease association.

The χ2 goodness-of-fit test showed that the genotypic distributions of rs10314 were in Hardy-Weinberg equilibrium in both the patient group (χ2=1.12, P=0.289) and the control group (χ2=0.22, P=0.639). rs10314 was associated with schizophrenia with an odds ratio (OR) of 1.32 in the male subjects (χ2=5.45, P=0.02, 95% CI 1.05-1.67) but not in the female subjects (χ2=0.64, P=0.425, OR=1.14, 95% CI 0.83-1.57). the χ2 test showed a genotypic association only for combined samples (χ2=7.80, df=2, P=0.02). SNP rs10314 is a G to C base change. Frequency of the genotypes containing the C allele was significantly higher in the patient group than in the control group.

The present work shows that the CLDN5 gene polymorphism is more likely to be involved in schizophrenic men than women, suggesting that this gene may contribute to the gender differences in schizophrenia.

Although spiritual care is commonly regarded as a nursing task, in practice, it is often provided inadequately.

The purpose of this study was to examine relationship between attitude toward spirituality and the attitude and performance of spiritual care among nurses who working in hospitals of Iran university of medical sciences.

This was a correlative-descriptive study. Spiritual Perspective Scale (SPS) and Nursing Spiritual Care Perspective Scale (NSCPS) were used to gather the data. A number of 166 nurses participated in this study.

Findings showed that of nurses’ spirituality attitude score was 4.98 ± 1.1 which indicated high attitude toward spirituality. The total average of nurses’ attitude about spiritual practices was 3.67 ± 0.51, which signified the positive attitude of nurses about spiritual practices. Findings revealed that positive spiritual attitude had a significant correlation with 6 out of 12 expressed spiritual interventions. In addition, spiritual attitude generally had a significant positive correlation with spiritual interventions. The positive spiritual attitude had a significant correlation with only 3 items out of 11 for the attitude toward spiritual practices. There was no correlation between spiritual attitude and the attitude toward spiritual practices.

In spite of the positive attitude, nurses did not perform half of the spiritual interventions which most of them were in line with fulfilling the patients’ religious needs. Establishment of in-service education program regarding spiritual care practice by role play and modeling methods are recommended.

The authors have not supplied their declaration of competing interest.

The relationship between negative symptoms and cognition in schizophrenia is not clear, a number of authors whom studied this relationship came up with inconsistent findings and meta-analyses show that there is a small moderate associations between the two domains.

The aim of this study was to investigate the relationship between cognition and the primary negative symptoms sub-domains.

Sixty-seven female patients with schizophrenia were evaluated using PANSS ans NSA-16 scales. Correlation and regression analyses were used in the present study to investigate the relationship between the primary negative symptoms sub-domains obtained by using the principal component analysis, and cognition evaluated with the PANSS using the 5 factor model as described by Lindenmayer.

No relationship was found between the PANSS Cognitive factor and Negative factor, but when investigating the relationship of the Cognitive PANSS factor with the negative sub-domains: diminished expression (DE) and avolition-apathy (AA), it was shown that there is a significant association between cognition and AA domain, but there was shown no association with the DE domain, and there was just a small association with the composit score of the NAS-16.

Our study reveals the relative independence of cognitive factor from the negative domain of the psychopathology, even though the association with AA domain was clear. These findings also support the need of using appropriate assessment tools in order to get a refined understanding of the phenomenology of schizophrenia.

The authors have not supplied their declaration of competing interest.

According to Millon, personality is a “complex pattern of psychological factors, which are mostly unconscious and express themselves automatically in almost every functional dimension of the subject”. It has been described how personality traits can modify the expression of other mental diseases, leading to confusion in diagnosis and treatment of the patient.

Systematic review of the literature in English (PubMed) and clinical history of the patient. Keywords: “recurrent depression disorder”; “schizoid personality”.

To highlight the importance of making an accurate and detailed diagnostic formulation, in patients with both mental and personality disorders.

Sixty-seven-year-old woman, with many psychiatric hospitalizations, secondary to a recurrent depression disorder with psychotic symptoms and schizoid personality disorder. Both psychiatric monitoring and pharmacological treatment have been erratic. Initially, depressive episodes were considered as symptoms of her personality disorder. However, over the years, it was possible to make a more accurate diagnosis and a better treatment adjustment. In this case, lack of adherence is probably due to multiple factors, but no awareness of illness and personality disorder itself are the most important ones. This fact makes the patient less concerned about her personal care, leading to irregular treatment.

People with schizoid, schizotypal or paranoid personality traits usually have a worse outcome, and they interfere with the functionality of the patient. This explains the importance of making an accurate and detailed diagnostic formulation, in order to benefit the course of the underlying mental disorders.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Language and conversation are deeply interrelated: language is acquired, structured, practiced in social interactions and linguistic resources (specifically syntactic, prosodic and pragmatic aspects) contribute to finely tuning turn-taking. Nevertheless, most studies focused on verbal aspects of speech in schizophrenia, with scant attention to their relation to conversation, where language is experienced at most.

The present study was aimed at investigating a possible association between language impairment and conversational characteristics in a sample of clinically stable patients diagnosed with schizophrenia (N = 35, ages 18-65).

A spontaneous speech sample was recorded. For the assessment of language skills, the Scale for the Assessment of Thought, Language and Communication (TLC) and the Clinical Language Disorder Rating Scale (CLANG) were used, while conversational variables were extracted with an innovative method of semi-automatic analysis. The possible associations were investigated through the Pearson Correlation.

Figure 1 represents graphically the correlational matrix between conversational variables and linguistic scale scores. In the heatmap, blue means negative and red positive correlations, the stronger the colour, the larger the correlation magnitude. Moreover, the significant associations are indicated with stars.

The results suggest that in schizophrenia spectrum disorders the disturbances of language, at a syntactic, prosodic and pragmatic level, have significant impact on communicative interaction.

Thus, conversation analysis might be a promising method to quantify objectively communicative impairment with the benefit of representing an ecological assessment, examining the performance of patients in the real situation of language use, which is social interaction.

No significant relationships.