Atypical antipsychotics are actually the first-line treatment in schizophrenia. Obsessive–compulsive symptoms (OCS) are common in patients suffering from schizophrenia and seem to worsen prognosis. Whilst atypical antipsychotics can be a useful augmentation strategy in refractory Obsessive Compulsive Disorder (OCD), their efficacy in case of comorbid obsessive compulsive symptoms in schizophrenia remains unclear.

The purpose of this literature review was to examine the relationships between atypical antipsychotics, Obsessive Compulsive Symptoms (OCS) in schizophrenia.

A systematic MEDLINE database was run using the following key-words: atypical antipsychotics, obsessive compulsive symptoms and schizophrenia (27 articles).

Clozapine, risperidone,olanzapine and quietiapine may induce or exacerbate OCS in patients with schizophrenia due to their anti-serotoninergic properties. There was no study with ziprazidone,aripiprazole nor amisulpiride. For schizophrenic patients with comorbid OCS, the first line strategy appears to be combination therapy with clomipramine or an Selective Serotoninergic Reuptake Inhibitors (SSRIs)(fluvoxamine, sertraline, fluoxétine) and an atypical antipsychotic. Moreover, in these cases, cognitive behavioural therapy should also be considered.

Obsessive Compulsive symptoms and schizophrenia are an ongoing matter of debate in terms of comorbidity or constitution of a specific "schizo-obsessive" subtype. Nevertheless, according to the worsening prognosis of this phenomenon, combination therapy (atypical antipsychotics and SSRIs) remains the most relevant therapeutic approach. Moreover, cognitive behavioural therapy studies in this area are required.

Indicated that the OCD group differed significantly from the social phobia group on generalized self-esteem assessments (p<0.001). Both groups showed a lower self-esteem but there was some evidence of OCD specific effects; depressive cognitions altered significantly self-esteem in OCD patients (p<0.001). Obsessionals were more likely than anxious controls to link their self-worth to other people and their relationships. They also regarded the possibility of causing harm as likely to result in other people making extreme negative and critical judgements of them. The implications for future research and for treatment of OCD are discussed.

Pica is an eating disorder characterized by eating of nonnutritive materials. It has been reported in different population, from certain ethnic groups, children, pregnant woman or organic disorders (eg. mineral deficiency) to psychiatric patients, including psychotic.

To describe a patient who ingest nonfood substances and its relationship with delusions.

X is a 26 year-old male with Paranoid Schizophrenia who came into the psychiatric emergency service because of an acute exacerbation of his mental illness, presenting auditory hallucinations and delusional mysticism. Draws our attention the presence of an aberrant eating behavior ingesting animals, lime, earth and leaves. The patient was hospitalized in the Impatient Psychiatric Unit for examination and treatment.

Several medical tests were performed and the only finding was an idiopathic eosinophilia, considered secondary to pica. He referred that the ingested items provided him from energy and better sight, as an explanation for his eating behavior. No suicidal ideation was objectified. Neuroleptic treatment was prescribed and behavioral and psychotic symptoms improved progressively.

The etiology of pica is unknown. Schizophrenic motivation for deliberate foreign body ingestion is a poorly understood phenomenon. In the case presented, the ingestions seems to be secondary to delusional beliefs that these objects contains properties that the patient lacks, not obeying to suicidal behavior and objectifying parallel remission of the pica and delusional activity. Further research is needed to clarify the etiology and mechanisms of this disorder, as it can lead to serious medical consequences (eg. metal poisoning, parasitosis, intestinal obstruction).

Apropos of a case we show that antidepressant drugs may cause a switch phenomenon in patients diagnosed with a psychiatric illness other than bipolar disorder.

To describe a case of antidepressant-induced mania in a patient with obsessive compulsive disorder (OCD).

X is an 18 year-old male who presented obsession with books and compulsive reading. He went to the psychiatric consultation and initiated treatment with sertraline 25mg. 24 hours later he began with soliloquies, restlessness, verbosity, increased performance of activities without purpose and persistent insomnia.

After the antidepressant was removed, the manic symptoms disappeared and the patient remained euthymic. Treatment with risperidone 1 mg was established and the obsessions and compulsions partially improved.

This case raises the hypothesis of a possible comorbidity between OCD and bipolar disorder.

Huntington's disease (HD) is a genetic disorder characterized by movement disturbances, psychiatric symptoms, and cognitive impairment resulting in a subcortical dementia. It is an autosomal dominant neurodegenerative disease with almost complete penetrance. An increased number of CAG repeats in the 5’ region of the IT15 gene on chromosome 4 is believed to be the responsible mutation. CAG expansion beyond 35 repeats is associated with the expression of HD.

A description of the psychiatric symptoms of Huntington's disease through a possible case.

A 28 year-old, female, was admitted for injury and grandeur delusions, suspicion an mania that had started in the last two weeks. Grandmother and great grandmother diagnosed with Huntington's disease. Transcranial magnetic resonance seemed to show a descent on the peak of the N-Acetylaspartate neuronal marker. Genetic test shower 27 repeats of the CAG, that is, intermediate risk. Olanzapine was started up to 20 mg per day and carbamazepine was started up to 600 mg per day. She had a progressive clinical improvement and in one month was discharged.

The diagnosis of HD is based upon presence of the typical clinical features and a family history of the disease. with the availability of genetic molecular testing, all suspected HD cases can be easily confirmed.

In our case report, because of the medium-risk, genetic advice will be necessary, due to the probability of transmiting the illness onto the descendants, as well as a follow-up to predict its reappearing.

The use of long-acting injectable antipsychotics is useful in patients with low therapeutic compliance.

To present the demographic and clinical data of a case series in which long-acting injectable aripiprazole has been prescribed in an ambulatory Mental Health Center.

Systematic review of the related literature and clinical history of patients in which long-acting injectable aripiprazole had been prescribed from January to March 2015 in a Mental Health Center.

We found 10 patients, whose diagnosis were schizophrenia (4), non-specified psychosis (2), personality disorder (1), bipolar disorder (1), schizoaffective disorder (2), of whom 7 were men and 3 women, with a mean age of 43.8 years old. The mean of years since diagnosis was 15.1 years. In 7 patients, we found concomitant treatment with another antipsychotic agent (low dose quetiapine in all of them); antidepressants in 1 patient, benzodiazepines in 6; mood stabiliser in 5 and biperidene in 1. In relation to previous antipsychotic drugs, we found: aripiprazole 15 mg/day oral (4); long-acting injectable paliperdidone 150 mg/28 days (2) paliperdone 6 mg/day oral (1); combination of paliperidone 6 mg/day oral plus olanzapine 5 mg/day oral (1). Only 4 patients had used long-acting injectable drugs previously in their lifetime. The reason of having initiated treatment with long-acting injectable aripiprazole was sexual disturbance (3); lack of compliance (4); clinical inestability (2) and motor side effects (1).

In our series, we can observe a chronic patient profile, predominantly men with diagnosis of psychotic spectrum.

The authors have not supplied their declaration of competing interest.

Often find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.

Describe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.

Review of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.

A case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.

Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.

Consumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.

Nineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.

A mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).

Inhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.

The authors have not supplied their declaration of competing interest.

Non-attendance at initial appointments is an important problem in outpatient settings and has consequences, such as decreased efficient use of resources and delayed attention to patients who attend their visits, and that compromises quality of care.

To identify and describe the characteristics of patients who do not attend the first appointment in an adult outpatient mental health center, located in Barcelona.

Retrospective study. The sample was made up from all patients who had a first appointment during 2014 in our outpatient mental health centre. Socio-demographic and clinical data (type of first appointment, reason for consultation, origin of derivation, priority, history of mental health problems) were described. The results were analyzed using the SPSS statistical package.

A total of 272 patients were included. Twenty-six per cent did not attend their first appointment; with mean age 39.75 years and 51.4% were male. Most frequent problems were anxiety (41.7%), depression (26.4%) and psycosis and behavioural problems (11.2%). The origin was primary care (83.3%), social services (4.2%) and emergencies (2.8%). Most of them were not preferent or urgent (86.1%). The 51.4% of non-attendees had history or psychiatric problems and 13.9% nowadays are patients of our mental health centre.

It is important to develop mechanisms that can reduce the incidence of first non-attended appointments. In our case, most of them are attended by primary care so we can establish better communication with our colleagues and try to contact to the patients prior to the date of the appointment.

The authors have not supplied their declaration of competing interest.

Several risk factors make older adults more prone to psychosis. The persistent growth in the elderly population makes important the necessity of accurate diagnosis of psychosis, since this population has special features especially regarding to the pharmacotherapy and side effects.

To review the medical literature related to late-life psychosis.

Medline search and ulterior review of the related literature.

Reinhard et al. [1] highlight the fact that up to 60% of patients with late onset psychosis have a secondary psychosis, including: metabolic (electrolite abnormalities, vitamines defficiency…); infections (meningitides, encephalitides…); neurological (dementia, epilepsy…); endocrine (hypoglycemia…); and intoxication. Colijn et al. [2] describe the epidemiological and clinical features of the following disorders: schizophrenia (0.3% lifetime prevalence > 65 years); delusional disorder (0.18% lifetime prevalence); psychotic depression (0.35% lifetime prevalence); schizoaffective disorder (0.32% lifetime prevalence); Alzheimer disease (41.1% prevalence of psychotic symptoms); Parkinson's disease (43% prevalence of psychotic symptoms); Parkinson's disease dementia (89% prevalence of visual hallucinations); Lewy body dementia (up to 78% prevalence of hallucinations) and vascular dementia (variable estimates of psychotic symptoms). Recommendations for treatment include risperidone, olanzapine, quetiapine, aripiprazole, clozapine, donepezil and rivastigmine.

Differential diagnosis is tremendously important in elderly people, as late-life psychosis can be a manifestation of organic disturbances. Mental disorders such as schizophrenia or psychotic depression may have different manifestations in comparison with early onset psychosis.

The authors have not supplied their declaration of competing interest.

The induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.

We report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.

We summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.

The term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.

Our case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.

The authors have not supplied their declaration of competing interest.

Traditionally, cannabis is associated with antiemetic action after acute consumption. However, in 2004 the cannabinoid hyperemesis as paradoxical effect of chronic users, after years of exposure described.

Description of the cannabinoid hyperemesis.

OLOGYA case is presented.

Clinical case of a woman who repeatedly comes to the emergency service because of abdominal, nausea and vomiting pain.

This is cyclical and hardly controllable. The gastroenterology service studied in depth with negative results. She was followed up by mental health borderline personality disorder and she consumed cannabis at an early age, 20–30 joints daily.

When she reaches abstinence in short periods, ceases digestive discomfort. However, aprece digestive symptoms with each relapse. The present case showed improvement with cessation of cannabis so it probably was the cannabinoid hyperemesis syndrome.

The cannabinoid hyperemesis is characterized by recurrent episodes of nausea, vomiting, abdominal pain, and chronic cannabis use. Temporary relief is achieved with hot baths. Ceases when abstinence is achieved. It is a clinical entity that does not have much information and requires further study.

The authors have not supplied their declaration of competing interest.

Children of parents with mental disorder face multiple challenges.

To summarise evidence about parental mental disorder and child physical health.

We searched seven databases for cohort or case–control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive–compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620).

Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04–1.26), asthma (OR = 1.26, 95% CI 1.12–1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74–3.73; diarrhoea: OR = 2.16, 95% CI 1.65–2.84). Evidence was inconclusive for obesity and other atopic disorders.

Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations.

None.