Jumping to conclusions (JTC) is a reasoning bias where individuals make hasty decisions based on insufficient data. It is commonly observed among patients with delusions and is a risk factor for developing delusions. Several task paradigms have been developed to test JTC, but their convergence in measuring JTC remains unexplored.

This is a pilot test to examine the consistencies between three JTC tasks with a student sample. The relationships between JTC and cognitive abilities were also explored.

Forty-six university students completed the Beads Task, Fish Task and Box Task, as well as assessment of memory, intellectual functioning, executive function, impulsivity and need for closure.

There was a moderate correlation between the beads task and fish task on various measures of JTC (draws to decision [DTD], r=.50, p<.01; confidence, r=.47, p<.01; dichotomous JTC bias, ×2=16.14, p<.001). There was a mild correlation between DTD on the fish task and box task (r=.30, p<.05). General intelligence was associated with DTD and JTC bias (but not confidence) on the beads and fish tasks. Confidence in decision was associated with a higher level of impulsivity and a lower level of set-shifting ability.

Despite differences in materials and design of the three probability-based tasks, results of JTC measured by the beads task and box task were individually consistent with the fish task, and were not correlated between the two. The data-gathering process and the confidence in decision are associated with different cognitive abilities. Further study including a clinical sample is needed.

Patients with chronic schizophrenia require long term treatment. Attitude towards antipsychotic medications is a crucial determinant of medication adherence and is influenced by multiple factors.

The present study was conducted to investigate clinical and socio-demographic correlates of attitude of patients with schizophrenia to the antipsychotic medications and its correlation with psychopathology and insight.

A cross-sectional sample of 361 patients (194 males, 167 females) with schizophrenia diagnosed as per DSM IV, aged 16-55, having illness for ≤ 6 years and not having co morbid psychiatric, physical and substance use disorders, were assessed on Positive and Negative Syndrome Scale (PANSS) . The subjects were also assessed on drug attitude inventory -30 (DAI-30) and schedule for assessment of insight (SAI) to evaluate insight.

Mean age (±SD) of sample was 32.9 (SD 9.25) years and mean duration of illness was 286.39 (± 293.63) weeks. The subjects got a mean (±SD) score on PANSS, SAI and DAI 56.38 (± 17.04), 8.27 (±2.76) and 18.95 (±6.83) respectively. Most (92.8%) of patients had a positive attitude towards antipsychotic medications. A negative correlation (r= – 3.78, p=0.00) was observed between scores on DAI and PANSS and a positive correlation (0.06, p=0.00) was seen between scores on DAI and SAI. No correlation was observed between scores on DAI and other clinical and socio-demographic variables.

Majority of patients with chronic schizophrenia, who are on treatment, have positive attitude towards antipsychotic medications. There is a need for community based studies on the subject.

Patients with schizophrenia have increased somatic morbidity and increased mortality. Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required.

The aims of the study were to investigate whether a three year interventional programme to improve the physical health is effective.

An 'Active awareness” and motivational interviewing approach to increase knowledge and understanding of physical health problems in patients with schizophrenia. The intervention is health promotion activities characterized by attention turned away from disease and focus on health. Patients have an intense monitoring of physical health parameters and individual guidance in healthy food and how to live a physical active life. The intervention is part of a program together with the intervention title: 'Preventing premature death of somatic causes among patients with mental illness and co morbid substance use disorders”, both conducted in The Central Region in Jutland in Denmark.

164 patients are participating. There are wide problems with obesity and very low level of physical activity among patients. The included patients are in a high risk of cardio vascular diseases and diabetes type 2.

The patients have great interest in the program and it is unproblematic getting patients to participate with measurements, questionnaires and the attached supervision.

The intervention seems relevant and manageable in an outpatient’s setting. The preliminary results are promising in the ongoing process of improving physical health and we will implement the programme in daily practice.

The aim of this study was to evaluate the relationship between plasma levels of prolactin and negative symptoms.

One hundred fourteen patients with schizophrenia participated in this cross-sectional study. The patients were assigned to groups with hyperprolactinemia and without hyperprolactinemia. Plasma levels of prolactin and clinical features were compared in these groups.

Negative symptom scores in the group with hyperprolactinemia were significantly higher than the non-hyperprolactinemic group. There was also a positive correlation between plasma levels of prolactin and negative symptom scores. Additionally there was no statistically significant difference between schizophrenia subtypes in terms of prolactin plasma levels. The patients treated with conventionel neuroleptics or novel antipsychotics such as risperidone, paliperidone and amisulpride, had higher prolactin levels than the other patients treated with aripiprazol, olanzapine, quetiapine, ziprasidone and clozapine.

This study indicated that we should be aware of prolactin levels especially when negative symptoms are prominent in patients with schizophrenia. Plasma levels of prolactin could be an important biological marker for the severity of negative symptoms in the treatment of patients with schizophrenia. Thus, this finding may change the present pharmacotherapy for negative symptoms in schizophrenia based on prolactin levels.

Schizophrenia is a psychiatric disorder is defined as the inability to understand reality. This disorder previously named as Praecox that these definitions show a lack of understanding of the schizophrenia in community. So by a qualitative study, social deprivation resulted from the labeling of the illness in the families of patients with schizophrenia were examined.

This study is a qualitative content analysis, using in-depth unstructured interviews to collect data from 20 family members of patients with schizophrenia. Gathered data were analyzed using conventional content analysis, the main themes of the interviews were classified as Level 3 codes.

In this study, the researcher coded transcript interviews was merged into 7 main categories of discrimination and ridicule, shame, need support, isolationism, lack of knowledge, stress and low quality of life.

Based on the results, family members of patients with schizophrenia suffer of discrimination and ridicule, need support, shame, and need support, isolationism, and lack of knowledge, stress and low quality of life.

The most common comorbid disorder in schizophrenic patients is social phobia. It is usually unrecognized problem that may be associated with a highdistortion in managing claims of life. The aim of our study was to determinethe extent to which comorbid social phobia affects the severity and course ofschizophrenia.

Thepublications were indentified in the database Medline and Web of Science usingthe key words 'schizophrenia comorbidity” in combination with the terms “social phobia” or “social anxiety disorder”. Otherrelevant sources of information were obtained from the cited works by importantarticles.

Thecurrent state of research shows that comorbidity with social phobia is morecommon in schizophrenia than in the general population. The incidence ofcomorbid social phobia in psychotic disease states in range from 11 % to 36 %. Social phobia in psychotic patients remains largely unrecognized. If it isundetected and untreated, this comorbidity is associated with more severepsychotic symptoms, worse quality of life and lower self-esteem. It is anotherobstacle for patients suffering from schizophrenia that deterioratesfunctioning in everyday life. It also increases the tendency to socialisolation and overall worsens social adaptation. Patients with comorbid socialphobia and schizophrenia have a higher amount of lifetime suicide attempts, ofwhich they select the ways of suicide with higher lethality and often abusealcohol or addictive substance.

Patients suffering from both schizophrenia and social phobia have a lowerquality of life, impaired functioning in life, a higher incidence of suicideattempts and increased risk of relapse of psychosis compared with those who donot suffer from comorbid social phobia. It is therefore necessary thatphysicians treating the patients with schizophrenia had in mind the possibilityof presence of comorbid social phobia and in case of its occurrence they alsotreat it.

Thought and language disorders are one of the fundamental symptom clusters of schizophrenia. Thought disorders that exacerbate in acute episodes might persist during the illness chronically in a vague form. In severe mental disorders such as schizophrenia, psychosocial functioning is an important dimension as well along with symptoms in phases of diagnosis and assessment. The aim of this study is to investigate the relation of thought and language disorders seen in schizophrenia with the course of symptomatic remission (SR) and psychosocial functioning.

The study was carried out with the sample consisted of 117 patients diagnosed with schizophrenia according to DSM-IV-TR. The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Thought and Language Index (TLI) and the Personal and Social Performance Scale (PSP).

Statistical significance was found between patients in SR and patients not in SR in terms of poverty of speech, weakening of goal, peculiar logic, impoverishment of thought and disorganization of thought. Peculiar logic, peculiar sentence construction and especially poverty of speech indicating negative formal thought disorder were found to predict the dimensions of psychososcial functioning.

Patients in SR show less impoverishment of thought/speech and disorganization of thought compared to patients not in SR. Thought and language disorders are significantly correlated with psychosocial dysfunctioning in schizophrenia. Social activities, personal/social relations and aggressive behaviors are associated aspects with impoverishment of thought and disorganization of thought.

Patients with schizophrenia mightexperience panic attacks and meet the criteria for both schizophrenia and panicdisorder. Classification of mental disorders with hierarchical approach givesschizophrenia the first position before the panic disorder. The panic attacksmight not be well recognized and adequately treated. The aim of this study isto determine the prevalence of panic disorder in schizophrenic patients, torecognise the impact of comorbidity on the clinical picture and the course ofthe disease, and to determine the appropriate/possible treatment.

The articles were identified by the keywords “schizophrenia” and “panic disorder”, or “agoraphobia”, using the Medline and Web of Science search. Additional sources were obtained by studying the references of summaries ofimportant articles.

The prevalence of comorbid panic disorder inpatients with schizophrenia ranges from 16% to 63%, but the results are notconsistent. Etiopathogentical hypothesis of schizophrenia and panic disorderand also the concept of panic psychosis are discussed. There is a limitedbiological evidence to support those hypotheses. Data suggest that patientswith schizophrenia and panic disorder exhibit higher rates of depression, suicidal ideation and increased extrapyramidal side effects. Panic comorbiditymay worsen severity of positive and negative symptoms of schizophrenia and theoverall quality of life.

Panic disorder and schizophreniaoften occurs comorbid. It is found most commonly in patients with paranoidsubtype. Comorbid panic disorder may worsen positive symptoms and lead todepressive symptoms. It negatively affects the quality of life and add up tohigher level of suicidality. The pharmacotherapy with atypical antipsychoticsis preferred, or their combination with clonazepam or alprazolam.

It is not uncommon for people with schizophrenia to exhibit abnormal movements. These abnormal movements could lead to diagnostic difficulties, and represent a therapeutic challenge.

Through a case-report, we illustrate diagnostic difficulties encountred in schizophrenic patients with abnormal movements, mainly if symtoms appear after a trauma.

Mr M.N. is a 30-year-old Tunisian male. His psychiatric family history includes schizophrenia in one sister and and bipolar disorder in one brother. His personal medical history comprises a head trauma following an argument with his brother in law. He was explored by computed tomography .

The patient had a three-year history of disorganised schizophrenia, with two suicidal attempts following frustrations. He was treated by Amisulpride 200mg/day. For two years, he has been presenting weekly and during 45 minutes with crises with loss of contact, stereotyped movements of jittering, denudation, masturbation, obscene words, loss of urine and feces. We objectified these crises twice during hospitalization (video sequence registred). The crises ended after Clonazepam administration. We withdrew antipsychotics and put the patient on Valproic Acid and Clonazepam. Then, one day after introducing Risperidone, the patient presented an other attack. Our therapeutic approach was to maintain the patient on Valproic Acid and Clonazepam, with a good outcome. Normal neurological explorations (Electroencephalography and Magnetic Resonance Imaging) made unlikely the diagnosis of epilepsy.

A more holistic and multidisciplinary approach may be needed to further our understanding of the etiology as well as treatment of these motor syndroms.

DUP is defined as the period between the onset of psychotic symptoms and the beginning of treatment. DUP is often prolonged and associated with poor prognosis.

*Identify the DUP in a population of patients hospitalized, for a first episode of psychosis,

in the psychiatric “A” service in Sfax Tunisia.

* Investigate the clinical and social determinants of DUP.

This is a retrospective study of 50 cases of patients, with a first episode of psychosis, admitted to the psychiatric “A” service during the month of August 2014.

Sociodemographic and clinical characteristics were summarized using a comprehensive semi structured interview.

Sociodemographic data:

The average age of our patients was 37 years.

74% of participants were male.

62% of patients were single.

76% had a low socioeconomic level.

The mean DUP was 72.13 weeks with a range of 0 weeks to 336 weeks.

Data analysis shows that longer DUP was significantly correlated with:

The insidious onset (p = 0.00),

The late age at onset (p = 0.01),

The predominance of negative symptoms (p = 0.04),

The illiteracy (p = 0.008),

The absence of family involvement in help-seeking (p = 0.01).

There was no evidence of an association between DUP and any of the other variables considered: gender, living alone, socioeconomic level and subtypes of schizophrenia.

The present findings suggest that DUP is influenced both by aspects of the clinical course and by the social context.

Genetic and environmental factors involving familial antecedents and prenatal development have been described to increase risk of schizophrenia and to bring forward age at onset.

To evaluate the relationship between age at onset of psychosis (AOP) and parents age and antecedents, OCs and weight and gestational age at birth in patients with a first episode of psychosis.

90 patients with first-episode psychosis were included. Socio-demographic characteristics, clinical variables and drug use were assessed through a questionnaire using the Structured Clinical Interview for DSM (SCID). Family history of psychosis was assessed through the Andreasen interview and OCs were measured using the Lewis and Murray Obstetric Complication Scale. Also age of parents at patient's birth, miscarriages previous to patient's birth, mother's use of drugs during pregnancy and weight and gestational age at birth were investigated.

An earlier AOP was significantly related to earlier use of stimulating drugs (p 0.044), paternal antecedent of psychosis (p 0.044), pre-eclampsia (p 0.000), use of forceps (p 0.001) and need of incubator at birth (p 0.000). Also birth weight was positively related to AOP (r 0.297, p 0.015). Other significant relationship of AOP with obstetric and family variables or drug use were not found.

These findings are consistent with previous studies results which had found association between OCs and low birth weight and AOP. Previous and current results underline the role of the prenatal period in the development of schizophrenia and the importance of careful monitoring of pregnancies of mothers with psychotic disorder.

The combination of several antipsychotic drugs, or these drugs with others such as benzodiazepines orantidepressants, is a widely useddespite the absence of data to support this practice. That is because there arenegative, affective or cognitive symptomswhich not respond well to this medication. The aim of this report is to collectdata regarding the pharmacologicaltreatment of schizophrenia and psychopathologymore persistent, which hinder daily activities of patients.

We have carried out a descriptive observational study in a community mental health unit on52 patients diagnosedwith schizophrenia according ICD-10. We collected data regarding the score scales forpositive and negative syndrome, and schizophrenicpsychopathology syndrome, making asemi-structured interview and scoringeach item from oneto seven according to its degree of severity. Survey data were analyzed using SPSS for Windows(PASW Statistics 18).

The average age of the sample is 40,77 ± 9,90 years and theage of onset is 22,46 ± 9,67. A 61,60% have a treatmentwith two antipsychotics and 23%with three. The percentage of patients taking other antipsychotics differentfrom psychotropic drugs is: antidepressants(30,8%), benzodiazepines (30,8%) andbiperiden (15,4%).

The great majority of patients with schizophrenia in ourpopulation sample are taking at leasttwo antipsychotics and sometimes other drugs like benzodiazepines and antidepressants. Moderate symptoms such as social withdrawal, apathy, relationshipdifficulties, insight or absenceof judgment, remain despite the antipsychotic polytherapy.

Antipsychotic-induced hyperprolactinaemia is associated with sexual dysfunction.1 In pivotal schizophrenia studies, lurasidone was associated with limited elevation of prolactin.2 This post-hoc analysis substantiates the clinical relevance by evaluating the incidence of treatment-emergent adverse events related to sexual dysfunction (SD-TEAEs) in patients with schizophrenia treated with lurasidone compared with active controls or placebo.

22 clinical studies were stratified into short-term, long-term and all Phase 2/3 lurasidone study pools. SD-TEAEs were defined as any adverse events related to sexual dysfunction starting on/after the first dose date and within 7 days of treatment discontinuation.

All reported SD-TEAEs were mild or moderate in severity.

The incidence of SD-TEAEs with lurasidone treatment was comparable to placebo in short-term studies and lower than for risperidone in both short-term and long-term trials. Future studies utilising formal sexual functioning rating scales on a prospective basis should be considered to further examine this issue.

Controlled data on optimization of dosing regimen for antipsychotics in schizophrenia is an unmet medical need.

To evaluate the efficacy of low dose lurasidone in schizophrenia; and to determine optimal dosing for patients not achieving improvement in Positive and Negative Syndrome Scale (PANSS) total score by week 2 of standard dosing.

Patients with schizophrenia were randomized to double-blind treatment with fixed daily doses of lurasidone 18.5 mg (for 6 wks; N=101), 74 mg (for 2 wks; N=198), or placebo (for 6 wks; N=112). After 2 weeks of treatment, patients in the 74 mg group with <20% PANSS improvement were re-randomized to continue on the 74 mg dose, or increase to a dose of 148 mg, for the next 4 wks.

Lurasidone 18.5 mg did not demonstrate significant improvement vs. placebo at Week 6 (−17.6 vs −14.5; P=0.25). In the group with <20% PANSS improvement after 2 weeks (N=95), titration to lurasidone 148 mg resulted in significantly greater improvement in PANSS total score at Week 6 compared with 4 additional weeks of treatment at the 74 mg dose (−16.6 vs. −8.9; p=0.023).

This trial supports the 37 mg/d dose of lurasidone as minimally effective dose in patients with acute schizophrenia consistent with evidence from previous studies. Increasing the dose of lurasidone to 148 mg/d after 2 weeks of nonresponse at 74 mg/d resulted in a significant efficacy advantage with important potential implications for clinical practice.

NCT01821378.

Sponsored by Sunovion Pharmaceuticals Inc.

Elevation of prolactin level is a known adverse effect of antipsychotics. Long-standing hyperprolactinaemia may inhibit reproductive function by impairing gonadal steroidogenesis and is associated with a number of adverse effects such as galactorrhoea, amenorrhoea, gynecomastia, impotence and decreased bone mineral density. Lurasidone is a recently approved atypical antipsychotic agent for the treatment of schizophrenia.

To compare the incidence of treatment-emergent adverse events (TEAEs) related to hyperprolactinaemia in patients treated with lurasidone or active comparators.

Pooled data from two 52-week studies that evaluated the long-term safety and efficacy of lurasidone compared with quetiapine XR or risperidone in patients with schizophrenia were reviewed post-hoc for prolactin levels and TEAEs considered to be related to hyperprolactinaemia.

Prolactin levels decreased marginally in the lurasidone group (median -8.00 pmol/L, N=624) and quetiapine XR group (median -17.39 pmol/L, N=85), and increased in the risperidone group (median 385.00 pmol/L, N=199) (LOCF). The incidence of markedly abnormally high prolactin values (≥5× upper limit of normal) was 2.0%, 1.4% and 4.0% in the three groups, respectively. The hyperprolactinaemia-related TEAEs breast mass, gynecomastia, breast enlargement, breast tenderness, hypogonadism, infertility, pituitary tumors and mammary gland tumors were absent from all groups. Low rates (≤2.5%) of galactorrhoea, amenorrhoea and erectile dysfunction were seen in the lurasidone and risperidone groups, while no TEAEs were recorded in the quetiapine XR group.

This post-hoc review shows that long-term treatment with lurasidone was not associated with a clinically significant increase in prolactin levels and the incidence of associated TEAEs was low.

Beta-thalassemia is a monogenic disease caused by mutations in the beta chain of the haemoglobin molecule. It is widespread in many areas of the world and has a large prevalence among Mediterranean populations[1-2]. Furthermore, many studies recently suggested that a gene situated on chromosome 11, proximal to the genes involved in beta-thalassemia, could induce psychosis in predisposed individuals [3]. Several studies have revealed, through the sequencing of chromosome 11, that a possible genetic susceptibility for schizophrenia could be located on the short arm of this chromosome near the gene involved in beta-thalassemia [4-5-6].

In our case report, we describe a late onset of psychosis disorder in a man suffering from beta-thalassemia.

Mr. A. is a 35 years old man with a history of major beta-thalassemia treated with transfusion therapy, he is HCV positive. No family history of psychiatric disorders. He has never suffered from any psychiatric disorder until January 2014, when he revealed a psychotic episode characterized by persecution delusions, religious hallucinations, remarkable aggressiveness and absent insight. He was so administrered with Paliperidone Palmitate 100 mg 1 fl 1.m./month, obtaining clinical remission after 5 months.

Several studies have assessed the prevalence of depression and axiety in patients with beta thalassemia. Rather few studies have been conducted to assess the comorbidity of psychosis among beta-thalassemia. We have described one rare case in literature that highlights this possible genetic link between these two pathologies. Further studies are needed to better clarify this association.

An under-recognized life-threatening adverse effect of clozapine is the gastrointestinal hypomotility. It represents a serious problem. Clozapine is an atypical antipsychotic which commonly produces ileus. The risk is higher when we associate clozapine to drugs, such us anticholinergic and tricyclic. Ileus can produce the death in our patients, therefore we will check constipation in our daily clinical practice as a measure to avoid these side effectS.

We looked through Medline for articles published since 2005 regarding Clozapine and Ileus. We will present the case of a patient who developed Ileus as the side effect of clozapine.

Constipation is very common in patients with schizophrenia (until 50%). Risk factors developing ileus in psychotic patients are: women, age, anticholinergic drugs, first generation of antipsychotics, clozapine, opioids and tricyclic antidepressants. Taking into account that this side effect can be mortal some recommendations that can reduce gastrointestinal hipomotility in this population are: a high fiber diet, exercise and the use of a softening laxative. In the case a patient treated with clozapine suffers from ileus we should shift the clozapine to aripiprazole or Amisulpride treatment. Moreover, we can use prokinetic drugs and surgery in the most complicated cases. Then, clozapine can be introduced after the ileus problem has been solved.

1 Gastrointestinal hypomotility has a high prevalence in psychotic treatments. 2 Avoiding the use of other drugs that produce constipation. 3 Offer advice to avoid the constipation. 4 If ileus is present, stop the clozapine treatment and shift it to aripiprazole or Amisulpride.

Despite the major developments in the last decades in the treatment of psychotic disorders, schizophrenia is still associated with poor clinical and social outcome. Some studies suggested that duration of untreated psychosis (DUP) is associated with poorer outcome in the long and especially short term evolution.

Studying correlations between longer DUP and social and clinical outcome in schizophrenia

Eligible participants are those, who had a first hospitalization in the period from January 2011 to December 2012

Inclusion criteria were: stabilized patients with diagnosis of schizophrenia according to DSM IV criteria,

Exclusion criteria: Mental retardation or other neurological or severe medical diseases affecting outcome, neuroleptic medication before hospitalization.

DUP is defined as the time separating the first psychotic symptom and first medication contact.

The sample was divided into short and long DUP, using a median split.

Social functioning was assessed by global assessment of functioning (GAF), working status, number of rehospitalization during the two years after admission and quality of life by responding to SF-36 scale in its Arabic version.

28 patients were included (20 men and 8 women) aged from 22 to 50 years old. Median DUP was 39,5 weeks (mean DUP was 65, 86). Even if we noticed that mental and physical scores for the SF-36 were higher in the group with shorter DUP, the score for GAF was comparable for both groups and so was the working status

The impact of DUP is considerable, future challenge is to short this period as possible.