To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Psychomotor agitation is the most common behavioural disorder observed in emergency and psychiatry departments. This syndrome is characterized by excessive or inappropriate motor or verbal activity and important emotional tension. Psychomotor agitation may be associated with medical conditions, substance intoxication/withdrawal and in a significant number of cases with schizophrenia or bipolar I disorder.
The objective of this protocol was to provide up-to-date guidance to identify, manage and treat patients with an episode of acute agitation, considering the consensus clinical knowledge, current ethical standards and available therapies. This protocol is aimed to be a patient-centric tool helping to anticipate and prevent the escalation of agitation symptoms.
The method followed to elaborate this document was through a combination of comprehensive bibliographical review (complied in the article “Assessment and management of agitation in psychiatry: expert consensus” by Garriga M. et al. (World J Biol Psychiatry, 2016), interaction with patients, and the clinical experience in our centre.
The elaboration of this protocol resulted in a document that contains guidelines to identify, manage and treat patients efficiently, ethically and safely. One of the novelties of the protocol is the addition of dichotomies based on the patients’ willingness to cooperate. The information is summarized in easy-to-use algorithms for non-specialized healthcare professionals.
This protocol may provide the basis of a new standardized treatment paradigm for psychomotor agitation which may help improve the patient's experience and therapeutic alliance with the healthcare professional and optimize resources in healthcare centres.
Disclosure of interest
COI: The preparation of the protocol was funded by an unrestricted grant from Ferrer International. The company had no say on protocol content. Dr Vieta has received funding for research projects and/or honoraria as a consultant or speaker for from the following companies and institutions: AB-Biotics, Allergan, AstraZeneca, Bial, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Elan, Eli Lilly, Farmaindustria, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Shire, Solvay, Sunovion, Takeda, Telefónica, Institute of Health Carlos III [Instituto de Salud Carlos III], Séptimo Programa Marco (ENBREC), Brain and Behaviour Foundation (NARSAD) and Stanley Medical Research Institute.
The aim of this randomized clinical trial follow-up at three months was to evaluate the effectiveness of an educational intervention with a focus on diet and physical activity (PA) to change the amount of PA, body mass index (BMI) and the waist circumference (WC) in patients with severe mental illness.
We recruited 332 outpatients with severe mental disorders undergoing treatment with antipsychotic medication from Mental Healthcare Centers of Barcelona. They were randomly assigned to an intervention or a control group. The patients in the intervention group participated in a group PA and diet educational program. The blinded measurements at 0 and 3 months were: the level of PA (IPAQ questionnaire), BMI, WC, blood pressure, dietary habits (PREDIMED questionnaire), quality of life (SF-36 questionnaire) and laboratory parameters (cholesterol, triglycerides, glucose).
The average age was 46.7 years and 55% were males. Schizophrenia had been diagnosed in 67.1% of them. At 3 months, the average weekly walking METs rose significantly in the IG 266.05 METs (95%CI: 16.86 to 515.25; P = 0.036). The total MET average also rose although not significantly: 191.38 METs (95%CI: 1.38 to 381.38; P = 0.086). However, the BMI decreased significantly more in the CG, by 0.26 kg/m2 (95%CI: 0.02 to 0.51; P = 0.038), than in the IG. There were no significant differences in the WC.
The short-term results suggest that the intervention increases the level of PA, but does not improve physical or laboratory parameters.
Clinicaltrials.gov NCT01729650 (effectiveness of a physical activity and diet program in patients with psychotic disorder [CAPiCOR]).
Flysch-type, syn-orogenic deposits of Carboniferous age occur in relation to the emplacement of a large allochthonous nappe stack in the Variscan belt of NW Iberia. New U–Pb age populations of detrital zircons obtained using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) are considered together with others from previously dated samples to establish the relationships between sedimentation and thrusting. The age populations of four syn-orogenic formations are compared with those of the pre-orogenic sequence in the Autochthon and Parautochthon, representing the Gondwanan passive margin, and in the Allochthon, formed by peri-Gondwanan and oceanic terranes. In addition, a new structural study has been carried out to understand the relationships between the syn-orogenic deposits and the development of Variscan structures. The aims are to identify the sources of sediments and to establish the relationship between Variscan structural evolution and syn-orogenic sedimentation. Development of a forebulge outwards from the allochthonous front, deduced from the structural study, suggests the existence of depocentres that hosted the syn-orogenic sediments. Together with the trend shown by the more recent zircons in each formation, that are younger towards the external zones, the data suggest that sedimentation occurred in progressively migrating depocentres formed in front of the allochthonous wedge during its emplacement. The zircon age populations point to the Allochthon as the main source of detritus for the syn-orogenic basins, with perhaps a limited participation of the Parautochthon and Autochthon in the younger formations.
We present a simultaneous photoemission spectroscopic, low-energy electron diffraction and low-energy electron microscopic study of the metal-insulator transition of strained VO2. The fraction of rutile structure is extracted from the microscopic measurements throughout the transition, and compared with the fraction of the metallic electrons from photoemission data. We find that at intermediate temperatures, while the system is predominantly monoclinic-like in structure, the electronic component of the transition is much further advanced. Our results provide direct evidence for a monoclinic-like metallic phase of VO2 that is easily accessible at ambient temperatures and pressures.
We present a detailed depth-sensitive study of the evolution in correlated electron behavior from the surface of the prototypical correlated oxide, SrxCa1-xVO3, to its bulk. Photoemission measurements of varying surface sensitivity are employed to directly compare both the spectral weight and energetics of the correlated electron features, and resonant soft x-ray emission spectroscopy is used as a bulk-sensitive reference. The surface component, which still contributes significantly to photoemission at 2.2 keV, is characterized by a transfer of spectral weight into the incoherent lower Hubbard band and the corresponding shift of these states towards lower binding energy.
Hippocampal abnormalities have been demonstrated in schizophrenia. It is
unclear whether these abnormalities worsen with age, and whether they
affect cognition and function.
To determine whether hippocampal abnormalities in chronic schizophrenia
are associated with age, cognition and socio-occupational function.
Using 3 T magnetic resonance imaging we scanned 100 persons aged 19–82
years: 51 were out-patients with stable schizophrenia at least 2 years
after diagnosis and 49 were healthy volunteers matched for age and
gender. Automated analysis was used to determine hippocampal volume and
There were differential effects of age in the schizophrenia and control
samples on total hippocampal volume (group×age interaction:
F(1,95) = 6.57, P = 0.012), with steeper
age-related reduction in the schizophrenia group. Three-dimensional shape
analysis located the age-related deformations predominantly in the
mid-body of the hippocampus. In the schizophrenia group similar patterns
of morphometric abnormalities were correlated with impaired cognition and
poorer socio-occupational function.
Hippocampal abnormalities are associated with age in people with chronic
schizophrenia, with a steeper decline than in healthy individuals. These
abnormalities are associated with cognitive and functional deficits,
suggesting that hippocampal morphometry may be a biomarker for cognitive
decline in older patients with schizophrenia.
Poor insight has been associated to positive and negative symptoms in schizophrenia. However, the impact of antipsychotic treatment on insight in delusional disorder (DD) has not well defined.
Our purpose was to investigate the impact of long-acting atypical antipsychotics (PPLAI, RLAI) on insight in DD patients.
We conducted a prospective and observational study by including 60 consecutive cases of DD outpatients, which were followed up for at least 6 months. Outcome variables: Scores in the first three items of the SUMD for Insight, PANSS for psychopathology, HRSD-17 for depression and PSP for functionality. The sample was divided into two groups according to the treatment received: oral or long-acting atypical antipsychotics (RLAI or PPLAI). T and Chi-square tests were used. Insight differences between both groups were investigated by applying Analysis of Covariance.
At baseline, DD patients treated with long-acting injectable antipsychotics had higher scores in awareness of social consequences. Although no statistically significant differences were found, after 6 months of treatment, patients receiving long-acting injectable antipsychotics showed a tendency of improvement of awareness of illness, awareness of the effects of medication and awareness of social consequences. Statistically significant treatment group*PANSS total score interactions were found for awareness for social consequences. After controlling for SUMD baseline and PANSS total scores, DD patients treated with long-acting antipsychotics showed an improvement of awareness of the effects of medications and social consequences.
Patients receiving long-acting injectable antipsychotics showed an improvement in psychotic symptoms and insight dimensions.
Recent meta-analysis in schizophrenia report that patients treated with long-acting injectable antipsychotics (LAI) show a significant improvement in hallucinations. However, little evidence supports their efficacy in non-prominent hallucinations in delusional disorder (DD) patients.
To examine treatment effectiveness of LAI antipsychotics (PPLAI and RLAI) with other oral antipsychotics in DD with non-prominent hallucinations.
A prospective and observational study was carried out by including 60 consecutive cases of DD outpatients, as part of the DEVCODEL Study. All patients were followed up for at least 6 months. Outcome variables: Scores in PANSS, HRSD-17 items, PSP for functionality, and C-SSRS for suicide. To investigate whether differences between treatment groups were biased by confounding variables, scores in assessment scales at 6 months served as dependent variables, and hallucinatory and treatment groups were included as between-subject factors when analysis of covariance (ANCOVA) was applied.
24(40%) patients had non-prominent hallucinations. Although not statistically significant, when uncorrected for influencing factors, DD patients receiving PPLAI or RLAI (n=27;45.5%) were less frequently treated with antidepressants (32%vs.68%) and showed lower suicidality (44.4%vs.55.6%). Patients treated with PPLAI or RLAI had lower scores in psychotic symptoms and suicidal ideation intensity, and higher functionality. After adjustment, patients with non-prominent hallucinations receiving PPLAI or RLAI showed a tendency of improvement in functionality, lower scores in PANSS positive (p=0.003) and negative (p=0.047) subscales, and suicidal ideation severity (p<0.001) compared to those treated with oral antipsychotics.
Non-prominent hallucinatory patients treated with PPLAI or RLAI showed a significant improvement in psychopathology and suicidal ideation.
Some classical authors reported that 1/3 of psychotic women suffer from gynecological diseases. Thus, in recent years, special attention has been paid to the gynaecological health of women with chronic psychosis.
To study gynaecological conditions (oestrogen and non-oestrogen dependent disease) and to investigate clinical correlates in delusional disorder (DD).
90 DD women of a sample of 115 DD patients were attended at our Department of Psychiatry, from 2000 until 2013. Outcome variables: presence/absence of inflammatory and non-inflammatory gynaecological disorders or related-conditions according to ICD-10 criteria. Sociodemographic and clinical data were secondary variables. For comparisons, T and Chi-square tests were performed. Multinomial logistic regression was applied to investigate multivariate differences.
Thirty-six(40%) women had a gynaecological disease (oestrogen dependent disorders: 92%). A tendency to lower rates of affective comorbidity and less antidepressant prescription was shown in women with a gynaecological disease, and had higher unemployment rates than those without gynaecological conditions (p=0.030). Within the gynaecological group, the most common illness was leiomyoma of uterus (n=9;25%), followed by misscarriage (n=6;17%). Histerectomy (n=7;19.4%) was the most common surgical treatment. Patients without gynaecological disorders had a later age at first psychiatric appointment and were more frequently admitted (p=0.001). After controlling for age at first appointment and admissions, differences in affective comorbidity remained significant (p=0.020), however, differences in antidepressant prescription and employment status were no longer significant.
Women with DD might be at particularly risk of non-inflammatory oestrogen dependent gynaecological disorders and attended earlier at our outpatient clinic.
Recent evidence supports an association between oestrogen levels and severity of psychopathology in women with schizophrenia. However, few studies have investigated differences in the psychopathology of premenopausal and postmenopausal female delusional disorder (DD).
To investigate whether men, premenopausal and postmenopausal women differ in age at onset and psychopathology.
Psychopathological symptoms were assessed in 64 outpatients with DD (DSM-IV-TR), as part of the Study on the Development and Course of Delusional Disorder in mean-age and the Elderly (DEVCODEL Study), at baseline and after 6 months. Scores in the PANSS scale, PSP for functionality, HRSD-17 items, C-SSRS for suicide and the first three items of the SUMD Scale were outcome variables. ANOVA and Chi-square tests were performed. Psychopathological differences between groups were investigated by applying Analysis of Covariance.
68.8% of the sample were postmenopausal women. When compared to premenopausal women and men, postmenopausal women had a lateonset disease (p<0.001) and attended later our outpatient clinic (p<0.001). Furthermore, postmenopausal women showed lower scores in awareness of mental disorder and awareness of the achieved effects of medication, a tendency of higher scores in depressive symptoms and higher severity of suicidal ideation at baseline. After 6 months, men and premenopausal women had lower scores in the positive PANSS subscale (p=0.041) than postmenopausal women. These findings in psychopathology held significant after adjustment for age and accumulated years of disease.
Our results support the notion that postmenopausal DD women have higher severity in psychopathology in comparison with premenopausal women and men.
Oestrogens may be a protective factor in psychosis. Women with schizophrenia have a later age of menarche, fewer pregnancies and earlier age of menopause. However, little information is available focusing on delusional disorder (DD).
To evaluate gynaecological variables and psychopathology in women with DD.
To investigate the relationship between age of menarche and onset, and psychopathology in DD.
Forty-five outpatients with DD (DSM-IV-TR) were recruited at the Hospital Clinic of Barcelona, from 2008 to 2012. Twenty-five females underwent a demographic and gynaecological questionnaire. HRSD-17 for depression, PANSS for psychopathology, PSP for functionality and C-SSRS for suicide were assessed. The sample was divided into two groups according to the age of menarche: 12 years or less and more than 12.
Mean age of menarche (SD) was 12.6(1.4) years, mean age of menopause 49.1(3.15), mean age at onset of DD was 49.9(12.58). 33.3% of the sample did not receive gynaecological service in the last 3 years. The group with the earliest age of menarche was older [67.33(11.67) vs.56(9.6); p=0.026], presented an earlier age of menopause [46.80(2.84) vs.50.71(2.29) p=0.018] and latest onset of DD (53.50(14.32) vs.47.44(11.5); p=NS], than those with later age of menarche. No differences were found regarding psychopathology, suicidal behaviour or functionality.
Although a small sample size, this is the first study to specifically examine gynaecological variables in DD. A low compliance rate in gynaecological service use was found. An earlier age of menarche was associated to an earlier age of onset of DD.
ADHD in adults is associated with a significant impairment in many life activities increasing the risk of chronic stress in everyday life. Previous studies reported normal cortisol awakening response (CAR) in children with ADHD without comorbidities, nevertheless there is a lack of studies in adults.
The aim of the present research is to examine CAR in adults with ADHD and to assess possible differences between the combine and inattentive subtypes.
Patients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample consisted of 50 adults, age between 18 and 51 years (mean 35.24 ± 9.21) fulfilling current diagnostic criteria for ADHD (DSM-IV criteria). All patients were naïve to stimulant medication. Psychiatric and organic comorbid disorders were excluded. To assess CAR, four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening.
The mean increase in CAR for the whole group of patients was 10.34±8.79 nmols/l. T-test comparisons showed no significant differences in the mean increase of CAR between the inattentive (mean: 9.47±9.04 nmols/l) and combine (mean: 11.25±8.67 nmols/l) subtypes (t=0.610; z=0.546).
Despite there were no significant differences in salivary CAR between ADHD subtypes in adults, the mean increase of CAR was higher in combine than in the inattentive subtype. Salivary CAR needs to be further explored as an index of vulnerability to stress in these patients.
Suicide is one of the leading causes of premature death among people with psychotic disorders. However, little is known about treating suicide in delusional disorder.
To investigate effectiveness of PPLAI in delusional disorder (DD) patients.
To compare effectiveness of PPLAI vs,other atypical antipsychotics (OAA) in psychopathology and suicidality.
Prospective observational study including 45 DD outpatients (DSM-IV-RT) attended at the Department of Psychiatry (Hospital Clinic- BCN) from 2008 to 2012 and followed up for 6 months. Demographic and clinical variables were recorded. Hamilton Rating Scale for Depression-17 (HRSD-17), PANSS for psychopathology, Personal and Social Performance Scale (PSP) and Columbia Suicide Severity Rating Scale (C-SSRS) were assessed at baseline and after 6 months. The sample was divided into four groups according to which treatment they received: oral risperidone, Risperidone Long Acting Injection (RLAI), OAA and PPLAI. For comparisons, Kruskal-Wallis and Chi-square tests were used.
Eighty-two per cent were women. Mean age (SD) at onset: 46.9(11.8) years. 6 patients received oral risperidone, 23 OAA, 7 RLAI and 9 were treated with PPLAI. No statistically significant differences were found regarding demographic features, motives leading for consultation, depressive comorbidity and antidepressant prescription. After 6 months, patients treated with PPLAI presented lower frequency of ideation (0% vs.11.1%;p=0.027) and suicidal behaviour (0% vs.2.2%;p=NS). The group receiving PPILD presented a significant increase in functionality (PSP) (p=0.046) and an improvement in PANSS negative subscale scores (p=0.017).
Patients receiving PPLAI showed a decrease in suicidality, an improvement in psychotic symptoms and functionality.
Although gender differences in schizophrenia are well known, this topic in delusional disorder (DD) has been poorly studied. Previous studies have shown an earlier mean age at onset in men than in women, and in those with depressive co-morbidity.
To examine demographic and clinical differences by gender in DD.
To compare depressive co-morbidity and suicidality between men and women.
Ninety-seven patients with delusional disorder (DSM-IV-RT), attended at the Department of Psychiatry (Hospital Clinic-BCN) from 2000 to 2012, were included and followed up for one year. Demographic and clinical features at index admission, pharmacological treatment, compliance, presence of depressive co-morbidity and suicidal behaviour at follow-up were recorded. For comparisons, T, Chi-square tests and analysis of covariance (ANCOVA) were used.
Seventy-six per cent were women and the most common delusional idea was delusion of persecution (74.2%). Gender differences regarding demographic features and depressive co-morbidity were not found. 22.7% of the sample presented suicidal ideation and 12.4% attempted suicide during follow-up. Women became ill later than men (50.07 vs.44.57 years), but when ANCOVA model is used with age at onset as dependent variable, sex as factor, and depressive co-morbidity and suicidal behaviour as covariates, this difference was not significant for sex effect. Women attempted suicide more often than men (13.5% vs. 8.7%) and showed less compliance during the evaluation period.
No gender differences in age at onset, types of DD, presence of depression and severity of global functioning were found. Women showed higher suicidal behaviour.
Ahe adult patients with attention deficit hyperactivity disorder (ADHD) are characterized by an increased vulnerability to daily life stressors. Cortisol awakening response (CAR) can be used as an index of the adrenocortical activity that relates to chronic stress. Although gender differences in cortisol response have been explored in children with ADHD, there is a lack of gender studies in adults with this disorder.
The aim of the present study is to evaluate possible gender differences in CAR in adults with ADHD.
A total of 50 patients (22 female, age 37.00±8.62 years, and 28 male, age 33.86±9.57 years), with ADHD were recruited from the program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. Patients fulfilled current DSM-IV diagnostic criteria for ADHD. Psychiatric and organic comorbid disorders were excluded and all the patients were naïve to psychostimulant treatment. Four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening (work days).
Mean increase in CAR was 10.39±8.68 nmols/l for men and 10.29±9.13 nmols/l for women. T-test comparisons showed no significant gender differences in CAR in adults with ADHD (t= 0.033, z=0.974).
As reported in children, adults with ADHD show no differences in CAR. Albeit these results are still preliminary, they suggest some gender differences in CAR between adults with ADHD and cortisol response in general population.
The Catalina Real-time Transient Survey (CRTS) currently covers 33,000 deg2 of the sky in search of transient astrophysical events, with time base-lines ranging from 10 minutes to ~7 years. Data provided by the Catalina Sky Survey provide an unequalled base-line against which > 4,000 unique optical transient events have been discovered and openly published in real-time. Here we highlight some of the discoveries of CRTS.
Due to the high prevalence of depressive symptoms in PC (Ayuso, 2001) is relevant to know the impact of the psychoeducation in the management of these symptoms to decrease the prevalence in the PC population.
To compare the effectiveness of a psychoeducational group intervention in patients with mild/moderate depression in PC.
242 participants older than 20 years with ICD-10 mild/moderate depression were recruited through nurse/general practice in 12 urban primary health care centers in Barcelona city. Randomization was realised by means of a computer program. Exclusion criteria: severe mental disorder, major depressive disorder, use of secondary mental health services and acute medical illness. The intervention group (IG) received a psycoeducational group program (12 weekly 1,5h sessions) leads by two nurses. The program was an adaptation of Coping With Depression (CWD) (Lewinsohn, 1989). The control group (CG) received TAU. Outcome measures: Sociodemographic, BDI and EuroQol-5D questionnaires pre-post intervention.
232 patients were included, IG (n = 121) and CG (n = 112), of whom 86 patients had mild depression (BDI≤ 18) and 146 moderate depression (BDI≥ 19). The sample characteristics were as follow: 90% women with mean age of 53,27 (SD = 12,72)The intervention was associated with significant improvements in BDI (t(230) =-2.25; p = 0.025). Separately analyze the sample: Patients with mild depression: (t(83) =-2.52; p = 0.014).Patients with moderate depression: (t(141) =-2.62; p = 0.010). Posttest results show that this intervention has statistically significant effect on depressive symptoms in overall sample and in mild/moderate depression separately.
The psychoeducational intervention is effective treatment in both mild and moderate depressive symptoms in primary care.
Search for novel multi-functional materials, especially multiferroics, which are ferromagnetic above room temperature and at the same time exhibit a ferroelectric behavior much above room temperature, is an active topic of extensive studies today. Ability to address an entity with an external field, laser beam, and also electric potential is a welcome challenge to develop multifunctional devices enabled by nanoscience. While most of the studies to date have been on various forms of Bi- and Ba based Ferrites, rare earth chromites are a new class of materials which appear to show some promise. However in the powder and bulk form these materials are at best canted antiferromagnetics with the magnetic transition temperatures much below room temperature. In this presentation we show that thin films of YbCrO3 deposited by Pulsed Laser Deposition exhibit robust ferromagnetic properties above room temperature. It is indeed a welcome surprise and a challenge to understand the evolution of above room temperature ferromagnetism in such a thin film. The thin films are amorphous in contrast to the powder and bulk forms which are crystalline. The magnetic properties are those of a soft magnet with low coercivity. We present extensive investigations of the magnetic and ferroelectric properties, and spectroscopic studies using XAS techniques to understand the electronic states of the constituent atoms in this novel Chromite. While the amorphous films are ferromagnetic much above room temperature, we show that any observation of ferroelectric property in these films is an artifact of a leaky highly resistive material.
A prodrome in schizophrenia is the period when some signs and symptoms are present but the full-blown criteria are not yet met.
We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. Assessments were made every three months for 2 year. We used a protocol including: PANSS, GAF-EEAG, CGI, Young mania, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale, the Information Subtest and Psychosocial Stress Global Assessment (DSM III R). The assessment of prodromal symptoms was retrospectively. The symptoms were based on the late prodromal style described by McGorry (1). A statistical analysis of data was performed.
• Evaluate the gender differences in the prodomal state and analyse the prognosis according to them.
231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset.
The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.