Schizophrenia is generally a lifelong condition. Despite high mortality, most survive into old age. Few prospective longitudinal studies have analysed trajectories from early-mid adulthood into old age.

Systematically review longitudinal studies of the progression of schizophrenia into old age, focusing on cognition, functioning, co-morbidity, mortality and quality of life.

Advance understanding of the course of schizophrenia and highlight interventions that improve outcomes and even achieve a state of wellbeing in later life.

Electronic search of PubMed, PsychINFO and Scopus. Search terms: (ageing OR ‘older adult’ OR elderly OR geriatric OR ‘late life’) AND (schizophrenia OR schizoaffective OR schizophreniform’). Articles and books searched manually.

The course in later life is variable. Many remain symptomatic and mortality and somatic comorbidity increase. Higher rates of decline in cognitive functioning affect ability to function independently. However, many individuals have a favourable clinical course and may stop receiving treatment altogether. 18–27% achieve recovery in old age. Growing evidence base for interventions that alleviate symptoms, improve social and cognitive functioning and quality of life. Inequalities remain in the quality and range of treatment interventions available to older people with schizophrenia.

Early introduction of regular psychiatric and somatic assessments and prompt and adequate treatment of symptoms and comorbidities throughout the life course are essential. Cases of remission/recovery are often excluded in clinical research. This risks presenting a biased, somewhat pessimistic description of the illness course into later life. Evidence base for interventions needs improvement and future trials must include older participants.

In spite of good development of laboratory and instrumental methods of diagnostics of brain and mental disorders, there remains an insufficiency of methods for etiology differentiation, especially clinical-psychopathological in psychiatry.

is to evaluate the differential diagnostic's opportunities in estimation of clinical phenomena's complexity for identification of neurotic, organic or endogenous genesis of disorders.

expert estimation, statistical.

As the experts 7 certified specialists (psychiatrists, psychologists and others) were involved.

In the research the academically definitions and the clinical case descriptions of the following clinical phenomena were estimated:

1. - Conversion, obsession, neurasthenia, phobia, derealisation/depersonalization, anxiety (partly specific for neurotic, stress-related and somatoform disorders);

2. - True hallucinations, confusion, amnesia, fixation hypomnesia, anecphoria (partly specific for organic mental disorders);

3. - Pseudo hallucinations, delusion of control, automatism, paralogia, emotional withdrawal, autism, ambivalence (common symptoms of schizophrenia);

4. - Inability to feel, sadness, lassitude, euphoria, excitement as the signs of endogenous affective disorders.

5. - Mainly non-specific phenomenon - persecutory delusions.

Thus were obtained 14 estimates for each item on a 100-point scale.

Dispersion of majority ranges was too high to get significant differences. But 6 from 7 experts significantly (p<0.05) and 1 tendentionally (p<0.01) rated 3 symptoms (autism, conversion and paralogia) as relatively more complex as compared with 7 more simplex phenomena (anxiety, confusion, euphoria, excitement, neurasthenia, phobia and sadness) by U-Wilcoxon-Mann-Whitney criteria.

established ranges of psychopathological phenomena's complexity reveal non-linear relations to etiology but in some cases they can be useful instrument of differential diagnostics of mental disorders.

Most patients (70%) discontinuing tobacco smoking will relapse within 6 months. A major challenge is the understanding of the processes involved in relapse. High cigarette craving has been proposed as a predictor of relapse. A recent study suggests that low inhibitory control capacities (low ability to inhibit prepotent responses) were correlated with high nicotine dependence. In this study, we focused on the link between inhibition capacity, craving, tobacco dependence and relapse.

134 smokers willing to quit smoking were consecutively included and followed prospectively. Tobacco dependence was assessed with the Fagerstorm test. We used the Hayling task to measure their inhibitory capacity and a specific questionnaire to measure tobacco craving (TCQ 12). Assessments were performed at baseline, 1, 3 and 6 months after smoking cessation. Any relapse in smoking during the follow-up was evaluated.

There was an association between lower inhibition capacities and higher dependance level at baseline. Low inhibition capacities were an independent predictor of relapse at 6 months (logit R 2 = .08, F (2,134) = 10.851, p <. 004). In contrast, although level of tobacco dependence and craving predicted relapse in the short term (first month), they did not predict relapse at 6 months.

These results suggest that inhibition capacities may predict smoking relapse in the long term (6 months) better than usual measures of craving. In clinical practice, an inhibition test, which is short and feasible, could be of interest to identify smokers at higher risk of relapse.

The case group consisted of 29 CAH girls and 11 CAH boys. The typically developing group consisted of 35 girls and 25 boys. K-SADS was used to screen the children for co-morbid psychiatric diseases. Progressive Coloured Matricies was used to determine their IQs. The play activity questionnaire to study their sex-typed play. Hormonal profile (testosterones, progesterone and delta 4 androgens) was done for the cases.

we hypothesized that elevated prenatal exposure to testosterones will cause masculinization of behavior and play in girls with CAH but will not affect boys.

Girls exposed to high levels of androgen prenatally, because of the genetic disorder congenital adrenal hyperplasia, show increased male-typical play. They preferred to play with masculine object items (cars and trucks), rough-and-tumble play and war play. They were less interested in pretend play than the typically developing girls. No differences were seem in the active and adventurous play. CAH girls showed preference for boys as playmates.

CAH boys showed the same pattern of behavior as the typically developing group but with restricted (less) interest in most of the play items.

All cases were on glucocorticoid treatment so the hormonal levels were within range.

Depressive disorders have the highest inpatient utilization rates in German health care. The aim of this study was to evaluate response, remission and non-response rates as well as predictors of response in depressive inpatients.

Consecutively admitted inpatients with a depressive episode (F32.0-2, F33.0-2) were assessed at admission and at discharge for depression (Beck depression inventory II, BDI-II) and general psychopathology (Brief Symptom Inventory, BSI). Most frequent cause for admission was nonresponse to prior outpatient treatment.

A total of 2323 inpatients with depression (M=48.02 years, SD=11.79) was included. 46.7% of patients received concomitant antidepressants. Mean duration of inpatient treatment was 53.16 days (SD=23.31). For completers, BDI-II decreased from 29.36 (SD=9.36) at admission to 14.00 (SD=10.96) at discharge (Effect size: 1.64). Response rates were 75.5% (BDI-II) and 68.7% (BSI) and remission rates 62.2% (BDI-II) and 40.8% (BSI). Non-response rates, also including minor responders, varied between 23.4% (BDI-II) and 27.4% (BSI). A comparison between patients with and without concomitant antidepressants showed a significant time and group effect, but no significant interaction effect.

Responders showed significantly higher depressive symptoms (BDI-II) and higher scores on the scales anxiety and phobic anxiety (BSI) at admission. They had fewer inpatient pretreatments before index admission. Furthermore, therapy motivation was identified as predictor for response.

The results demonstrate that about two thirds of depressive patients show response after a multimodal inpatient treatment. Future studies should focus on early identification of non-responders as well as on the development of treatment strategies for these patients.

To study the pragmatic language deficit in ADHD children.

This study included 62 consecutive newly diagnosed ADHD children according to Diagnostic and Statistical Manual of mental disorders IV-TR criteria, their age ranged from 6–8 year. Then they were referred to the Phoniatric unit, Kasr Al-Aini for pragmatic assessment. Forty four normal control children (age and sex matched), were included in the study. The included samples were subjected to the protocol of language and pragmatic assessment applied in Kasr Al-Aini. Twenty-four children with ADHD were excluded as they had history of delayed language development. Four control children were also excluded because of phonetic errors. The 38 ADHD children and 40 controls were subjected to the following psychiatric assessment: Semi-structured interview to confirm that the patients have ADHD, Wechsler Intelligence scale for children (WISC), and Conner's’ Parent Rating Scale-Revised: long version (CPRS-R: L).

ADHD children got less significant scores in intention, narrative, conversation and total pragmatic scores than controls. There was significant negative correlation between inattention Conners’ subscale with intention and narrative pragmatic subscales. Also, significant negative correlation between social problems Conners’ subscale and intention and conversation.

ADHD children have pragmatic deficits than controls

Neurocognitive deficit (executive functions, verbal and spatial learning and memory, visual processing and attention) is a core feature of schizophrenia.

The main objective of this study is to identify the cognitive deficit in adolescents with early onset psychosis (EOP - schizophrenia, schizoaffective disorder, depression with psychotic features). The secondary objective is to examine if the cognitive deficits are global or specific.

This study is longitudinal, during a period of one year and a half. Twenty-eight adolescents at first psychotic episode (15 with EOP and 13 with other psychotic disorders) agreed to participate to this study and were assessed during their hospitalization in a university clinic for child and adolescent psychiatry, in Cluj-Napoca, Romania. The age of patients ranged from 10 to 17 years. The diagnosis was based on DSM-IV criteria. 32 healthy adolescents, volunteers, formed the control group and were matched by age and gender. All the patients and the adolescents from control group were assessed for intelligence level using Raven Test and those with mental retardation were excluded. The neurocognitive functioning was assessed with Trail Making A and B, verbal fluency tasks, Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test.

Adolescents with EOP at first psychotic episode had signicant neurocognitive dysfunction as compared to healthy adolescents from the control group.

Our results are consistent with those of previous studies and it is clear that many adolescents with early onset schizophrenia show substantial impairment across multiple domains of neurocognition.

Legal drugs are changing the standards of drug consumption. These substances, labelled ‘not for human consumption’ are sold as incense, bath salts or pills, tricking sanitary authorities and Food and Drug Administration. Despite the absence of clinical trials, they grant a feeling of safety by being freely sold over the internet and smart-shops, and by ending the fear of control, since medical analyzes do not detect them. This makes them appealing and their popularity is steadily growing.

The authors aim to describe the results of analysis made to several legal drugs samples available online and its potential implications.

Review of PubMed’ studies between 2010 e 2012, using as key-words: ‘legal drugs’ and ‘purchase online legal highs’.

Studies of substance labeling found a lack of information, since 81,9% of the analyzed products did not report side effects and 86,3% did not specify medical interactions. A study done six months after mephedrone's prohibition in the U.K., showed that 62,5% of products still presented this substance, as well as unlisted components. Three subsequent studies revealed that the majority of the drugs listed the active principle on the label, but a significant percentage also showed unlisted substances.

In addition to the dangerous effects and interactions of the unlisted substances, consumers and sellers, misled by the nomenclature ‘legal’, may be committing an illegality when buying these drugs. Despite governmental efforts, the gap between the identification of a potentially harmful substance and its prohibition, makes difficult to prevent this potential flagellum.

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their premorbid adjustment.

In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganized, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9- month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analyzed.

During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 45% to 25%. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.

A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are executed.

GXR, a selective α2A-adrenergic agonist, is a non-stimulant ADHD treatment approved in the USA for children and adolescents, and in Canada for children.

To evaluate long-term maintenance of efficacy of GXR in children and adolescents with ADHD who respond to an initial open-label, short-term trial.

To determine if there is a higher rate of treatment failure for placebo vs GXR during the double-blind randomised-withdrawal phase (RWP) (NCT01081145).

Patients (6–17 years) meeting DSM-IV-TR criteria for ADHD, baseline ADHD Rating Scale-IV (ADHD-RS-IV) ≥32 and Clinical Global Impressions-Severity (CGI-S) ratings ≥4 were enrolled. Following 7-week dose optimization and 6-week maintenance periods on open-label GXR (1–7 mg/day), eligible patients entered a 26-week, double-blind, RWP with GXR or placebo. The primary endpoint was rate of treatment failure (≥50% increase in ADHD-RS-IV total score and ≥2-point increase in CGI-S at two consecutive visits, compared to the RWP baseline). The key secondary endpoint was time-to-treatment failure. Safety assessments included treatment-emergent adverse events (TEAEs), electrocardiograms and vital signs.

Of 528 patients enrolled, 316 (60.0%) entered the RWP. At study end, 49.3% (GXR) and 64.9% (placebo) (95%CI; −26.6, −4.5, p<0.01) of patients had relapsed (Figure). Time-to-treatment failure was 56 days (placebo) versus 218 days (GXR), p=0.003. During the RWP, the most common GXR TEAEs (≥5% patients) were headache, somnolence and nasopharyngitis.

GXR demonstrated long-term maintenance of efficacy versus placebo in children and adolescents with ADHD.

Internet Gaming Disorder is listed in DSM-5 under conditions for further studies and is defined by nine criteria adapted from pathological gaming and addiction. Given this call for further structured research, it seems necessary to have a detailed look at the affected persons.

We interviewed 20 male adolescents (14 to 20 years old) of an inpatient treatment center for Addictions and Pathological Video Gaming.

. We aimed at a description of video game addicted patients regarding their addiction, video gaming behavior, comorbidities (Axis I, II), medical peculiarities, cognitive abilities, environmental abnormalities and experiences of impairment.

SCID-I, -II as well as a semi-structured Interview for video game addiction were conducted and analyzed according to common standards. Cognitive performance and symptoms of ADHD were assessed.

All subjects could be identified as excessive video gamer or internet users. In addition, most of them fulfilled criteria of a current video game addiction. Most patients showed average IQ-scores. Some patients fulfilled criteria of either an Axis I or an Axis II disorder (mostly anxiety and affective disorder or defiant oppositional behavior), others showed disorders on both Axes. Only a few patients didn’t show any comorbidity. Furthermore, family conflicts or bullying experiences were often reported.

Video game addiction was shown to lead to suffering and to neglecting important areas of life. Other comorbid mental disorders as well as family conflicts and bullying experiences need to be considered in this population. We claim for longitudinal research to untangle the question of causality.

Excessive problematic use of the internet has been a topic of discussion in the academic literature for many years. Problematic internet use (PIU) has been grown world-wide about 2 billion users.

The aim of this study is to explore the characters of internet use among the medical students, and discover the prevalence of internet mal use and its risk factors.

A cross-sectional study of 321 medical students at Assiut University Medical School using the Internet Addiction Scale was carried out.

The current study found that the most important correlates for Internet Addiction among Assiut Medical Students were mother's education, sex, residence, suicidal ideation.

Internet Addiction is an important behavioral disorder affecting medical students and may interfere with their normal life and studies.

The association between depression, hopelessness and anxiety is relatively ignored in the literature of the Arab World, particularly using Beck Depression, hopelessness, and anxiety inventories.

To examine the relationship between depression, hopelessness and anxiety in a Kuwaiti adolescence.

The participants were 616 (308 boys & 308 girls) first year Kuwait University students. The genders were matched in age (18.15±0.36 & 18.18±0.38, t=0.94, p>.05), and BMI (24.12±3.27 & 23.50±4.85, t=0.54, p>.05). The Arabic versions of Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS) and demographic surveys were administered to participants in the class. All participants read and signed a consent form before test administration. Independent Sample t Test, the exploratory factor analysis, correlation matrices, and stepwise regression model are used in this study.

Internal consistency of scores were satisfactory for the BDI-II, BHS & BAI inventories respectively (Cronbach's alpha = .83, .85, .90). The girls scored significantly higher than boys did on the BDI-II (t=10.25, p<.001), BHS (t=13.53, p<.001) & BAI (t=11.76, p<.001). A correlation of .59 between the BDI-II and BHS to .42 with BAI. Meanwhile the correlation of .33 between BHS & BAI. A principal-axis factor analysis with oblique rotation suggested one factor, accounting for 63.27% of the common variance. Multiple regression revealed that the main predictor of depression was hopelessness.

The current data provides strong evidence that among Kuwaiti depressed teenagers feel hopeless and anxious.

Immune dysfunction is thought to play a critical role in the pathophysiology of bipolar disorder (BD). Better insight into the genetic control of innate immune responses is of importance due to possible interactions with environmental risk factors such as infectious agents, particularly early in life.

Given the importance of Toll-like receptors (TLRs) in innate immunity, we analysed the association of selected genetic variants of TLR-2 and TLR-4, both major sensors of pathogenic infectious and non-infectious structures, with BD.

Explore possible implications of the innate arm of the immune response in BD.

Genomic DNAs from 572 BD patients and 202 controls were analyzed for the distribution of polymorphisms on the TLR-2 and TLR-4 loci using TaqMan®. Associations were examined using Chi-square test.

We found that TLR-4 rs1927914 AA and rs11536891 TT genotypes were more frequent in BD patients than in controls (corrected p; pc = .02 and .02 respectively) particularly in early-onset BD (EOBD) patients (pc = .004 and .006) born during the summer season (pc = 02 and .002 respectively). We also found that TLR-2 rs3804099 TT and rs4696480 TT genotypes were significantly more prevalent in EOBD group as compared to the late-onset BD (LOBD) subset, the latter only after excluding patients with positive family history of psychiatric disorders (pc=0.024 and 0.002 respectively).

We report an association between BD and TLR-2 and TLR-4 genetic variants suggesting an important role for pathogens in disease development.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) persist into adulthood in many patients.

Analyse post hoc the impact of sex and age on the efficacy of lisdexamfetamine dimesylate (LDX) in the treatment of adult ADHD.

In NRP104.303, a 4-week, double-blind, forced-dose study, adults with ADHD were randomized (2:2:2:1) to receive LDX 30, 50 or 70 mg/day, or placebo. NRP104.304 was a 12-month, open-label, dose-optimized, extension to NRP104.303. In both studies, the primary efficacy outcome was the change from baseline in ADHD Rating Scale (ADHD-RS) total score.

In NRP104.303 (N=420), least-squares mean changes from baseline to endpoint in ADHD-RS total score (standard error) were significantly greater for LDX (range across doses, −16.2 [1.06] to −18.6 [1.03]) than placebo (−8.2 [1.43]). Post hoc analyses revealed similar improvements with LDX in sex (male, LDX −16.7 [1.50] to −18.6 [1.53], placebo, −8.9 [2.12]; female, LDX −15.5 [1.56] to −19.3 [1.46], placebo −8.0 [2.02]) and age (18−39 years, LDX −15.3 [1.34] to −18.9 [1.31], placebo −5.6 [1.87]; 40−55 years, LDX −16.1 [1.81] to −17.1 [1.87], placebo −12.8 [2.52]) subgroups. In study NRP104.304 (N=349), improvements from baseline to endpoint in mean (standard deviation) ADHD-RS total score were similar between the overall population (−24.8 [11.7]) and sex and age subgroups (male −24.5 [11.5]; female −25.2 [12.0]; 18−39 years −25.3 [11.4]; 40–55 years −24.1 [12.2]).

In short- and long-term adult studies, LDX was associated with improvements in ADHD symptoms in sex and age-related subgroups.

Supported by funding from Shire.

is to assess the cognitive function and cerebral structure in children with type 1 diabetes 5 years after the onset of disease who are exposed to recurrent episodes of moderate and severe hypoglycemia.

In this cross-sectional comparative study forty patients with type 1 diabetes 5 years after the onset of disease and 40 healthy control subjects age and sex matched were included. All diabetic children and controls were subjected to neuropsychologic (NP) testing, and 20 diabetic children were subjected to magnetic resonance imaging (MRI) scans of the brain. Diabetes onset age, preceding severe hypoglycemia exposure, and diabetes duration were examined as potential correlates of cognitive and neuroradiological differences. No participants had previous neuropsychological pathology.

Children with type 1 diabetes performed more poorly than control subjects on measures fluid intelligence (performance IQ), memory, attention, excutive function, problem solving, abstract reasoning ability and knowledge (general and social knowledge). Diabetics and control groups had not differed on a measure of full-scale and verbal IQ. There was significant association between the severity of hypoglycemia and cognitive dysfunction. MRI brain showed subcortical arteriosclerotic leucoencephalopathy (SASL) in 55% of subjects, prominent perivascular (Virchow. Robin) space in 60%, and prominent lateral ventricle in 15% of the cases.

Children with type 1 diabetes who exposed to frequent hypoglycemic episodes have poorer neuropsychological profiles than healthy control subjects and have structural MRI brain changes.