Although a plenty of instruments for quality of life in mental illnesses was developed, both general and specific instruments could be biased if the process of well-being appraisal is different in different illnesses.

We consider personal appraisal of quality of life as a result of the decision making process, which could have different subjective criteria in mental illnesses.

The aim was to compare the contribution of the quality of life domains to the appraisals of general life satisfaction in mental illnesses.

Three groups of males 17–28 years old (74 with non-psychotic depression, 90 developing recovery after the first psychotic episode and 185 healthy controls) filled quality of life and enjoyment questionnaire (version for mental illnesses) and Happiness Scale.

Moderation analysis reveals that in non-psychotic depression health, emotional sphere and functioning during the day are more important predictors of general well-being than in the two other groups. Patients developing recovery after psychotic episode are less oriented to the emotional and social domains and financial well-being when appraising their life satisfaction than other participants.

Results demonstrate the importance of identifying and working with subjective criteria and process of appraisal of general well-being in patients with mental illnesses. Direct comparisons of quality of life in different clinical groups are biased by different subjective criteria that are important for patients.

Research supported by the grant of president of the Russian federation for the state support for young Russian scientists, project MK2193.2017.6.

The mental health hospitalization unit of Torrecárdenas Hospital consist of a team of professional psychologists, psychiatrists, nurses and occupational therapists who perform different approaches to look after the hospitalized patient. The therapeutic Objective of this unit is the containment and implementation of intensive interventions in a crisis situation in which it has not been possible to achieve an improvement or control of the patient's symptoms in external resources.

We performed a descriptive cross-sectional study with patients hospitalized at the mental health hospitalization unit between September 22 and October 28, taking into account the age, sex, admitted, diagnoses, previous treatments, psychological approach and free hospital stay.

(Fig. 1–3).

The results of this study indicate the most prevalent patient profile has a diagnosis of severe mental disorder. The 66.7% of patients had previous hospital admissions. The 81.5% of hospital admissions are involuntary. The normative psychopharmacological prescription is an atypical antipsychotic as main treatment in our study. We highlight the use of Olanzapine with an 18.52% being consolidated as the first therapeutic option. As adjunctive treatment we have a mood stabilizer such as Valproic Acid with 11.1%; or another antipsychotic such as Paliperidone with the same percentage (11.1%). Regarding hypnotic treatment, it should be pointed out the use of medium-life benzodiazepines (Lormetazepam) with a prevalence of 55.56%.

The authors have not supplied their declaration of competing interest.

Mechanisms of underlying pharmacoresistance have been explored insufficiently. Enzymes of a system for biotransformation of xenobiotic and transporters for drugs are the key participants in the systems of metabolism of antiepileptic drugs (AEDs). Among proteins-transporters, glycoprotein P encoded by MDR1 gene plays an essential role in the processes of uptake, distribution and excretion of AEDs.

The work initiated to study gene MDR1 C3435 T polymorphism and to assess its association with pharmacoresistance formation in patients with epilepsy receiving antiepileptic drugs (AEDs).

Study involved 89 patients with localization-related epilepsy and 55 unrelated healthy subjects.

Distribution of 3435 T/C polymorphism in NDR1 gene was analyzed in the patients with the localization-related epilepsy and nominally healthy donors. The distribution of frequencies of gene alleles was found to correspond to the Hardy-Weinberg equilibrium (Р > 0.05). Incidence of genotypic variants of the polymorphism was as follows, СС was found in 18.6%, СТ and TT were observed in 55.9% and 25.4% of cases. In the controls СС was found in 60.0%, СТ and TT were observed in 33.3% and 6.6% of cases, respectively. The findings are the evidence for significant effect of functionally weak variants in C3435 T polymorphism of MDR1 gene on efficacy of antiepileptic therapy.

presence of T-allele of C3435 T polymorphism of MDR1 gene increases risk of pharmacoresistance in the patients with epilepsy and is a significant and predicting criterion of efficacy and feasibility of the antiepileptic therapy conducted.

The authors have not supplied their declaration of competing interest.

To discuss results of a certain environment and acculturation strategy for development of humanistic research that took place in a psychiatric outpatient service of a university hospital.

Observation of environment of psychiatric supervision for qualitative method in health setting, in period of six months. The first author, doctoral student, psychologist, systematically attended discussions of clinical cases, observing relationship between supervisors and residents. Data were recorded in field diary, followed by free-floating readings and critical analyses. These were also submitted to peer reviewers of the LPCQ-laboratory of clinical-qualitative research.

– The experience, similar to an “internship”, has been confirmed as necessary to conduct qualitative research in this field;

– It allowed accurate apprehension of features of environmental functioning and, above all, cultural dimensions of language of participants;

– This proved pertinent for clearing the theme-problem to be researched;

– Postgraduate researchers, in particular those graduates under other paradigms, have strengthened their methodological knowledge on this field, and have been inserted epistemologically for which they will have built new knowledge;

– Finally, this methodological stage improved the so-called active observation and phenomenological listening of the researchers regarding those observed.

The experience contributed significantly to establishing and validating the qualitative methodological course.

The authors have not supplied their declaration of competing interest.

Psychosis in patients with epilepsy was known in antiquity and was already described in detail in the nineteenth century.

This kind of psychosis can be categorized in relations to seizures: preictal psychosis (before the seizures), during them (ictal) or after the seizures (postictal psychosis)

Through several cases of patients that were treated in our department with the diagnosis of psychosis, previously or during the treatment diagnosed with epilepsy, we analyse the characteristics and diagnostic criteria of these pathologies.

Systematic literature review in up-to-date and Pubmed, looking for reviews on psychosis and epilepsy, in international scientific journals of neurology and psychiatry.

Being able to recognize this several types of psychotic states associated with epilepsy has a clinic and prognosis utility, because made important differences in treatment and in the evolution of the illness.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a disabling, chronic psychiatric disorder that has far-reaching consequences for both patients and their relatives. Management of schizophrenia involves family support and care. In this context, burden of care is a concept related to caregivers and family's members of patients assuming responsibility for these patients. This construct can be conceptualized as a syndrome of varying clustering affecting the general and mental health of caregivers.

This study aims to determine the frequency and clinical correlates of family burden in schizophrenia.

We performed a transversal study in department of psychiatry A at Razi hospital. Thirty principal caregivers of schizophrenia patients were interviewed. Caregiver's burden was assessed using the Zarit scale.

The mean age of caregivers was 48.7 ± 7.15 years. In our sample, 63.3% (n = 19) were parents, 23.33% (n = 7) were brothers or sisters and 13.33% (n = 4) were spouses. The mean score of Zarit was 58.75 ± 9.15. Caregivers had a severe burden in 56.66 of cases (n = 17). Levels of burden were significantly associated with history of aggressive acting out and poor treatment adherence.

Caregivers of schizophrenia patients experience enormous burden which is in part related to clinical features of disease. Further studies are necessary to establish the appropriate interventions in order to reduce and manage general and psychological impact of schizophrenic patients care giving.

The authors have not supplied their declaration of competing interest.

The mechanism linking childhood trauma (CT) to the functional deficits observed in early psychosis (EP) patients is as yet unknown.

To examine the potential mediating effect of depressive symptoms in this well-established association.

Two hundred nine EP subjects aged 18-35 were assessed for functioning and psychopathology after 2, 6, 12, 18, 24, 30, and 36 months of treatment. Patients were classified into early-trauma if they had faced at least one experience of abuse (physical, sexual, or emotional) or neglect (physical or emotional) before age 12, and late-trauma if the exposure had occurred between ages 12 and 16. Psychopathology was assessed with the Positive and Negative Syndrome Scale and the Montgomery-Asberg Depression Rating Scale. Functioning was measured with the Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS). Mediation analyses were performed in order to study whether the relationship between CT and functioning was mediated by depressive symptoms.

When compared with nonexposed patients, early but not late trauma patients showed lower levels of GAF and SOFAS scores over all the time points, excepting after the first assessment. After 30 and 36 months, the effect of early trauma on functioning was completely mediated by depressive symptoms. No mediating effect of positive or negative symptoms was highlighted at those time points.

Mild depressive symptoms mediated the impact of early trauma on long-term functional outcome. Intensifying pharmacologic and/or psychotherapeutic treatment, focused on the depressive dimension, may help traumatized EP patients to improve their functioning.

The authors have not supplied their declaration of competing interest.

Evidence suggests a relationship between exposure to trauma and higher levels of symptoms and poorer functional outcomes in early psychotic patients (EPP). However, the impact of the age at the time of exposure to trauma in this association is as yet unknown.

To examine the potential differential impact of trauma, according to age at the time of exposure, on the level of functioning and on the psychopathological profile of EPP followed-up prospectively.

Two hundred and fifty-five EPP aged 18–35 were followed-up prospectively over 36 months. Patients who had faced at least one experience of abuse or neglect were classified according to age at the time of first exposure (early-trauma: before age 12; late-trauma: between age 12 and 16), and then compared with unexposed patients (non-trauma). The level of symptoms was assessed using the Positive and Negative Syndrome Scale. The Young Mania Rating Scale, and the Montgomery-Asberg Depression Rating Scale. The level of functioning was assessed with the global assessment of functioning.

Comparisons over the 3 years of treatment with non-trauma patients revealed that:

– early-trauma patients showed consistently higher levels of positive (P = 0.006) depressive (P = 0.001), manic (P = 0.006) and negative (P = 0.029) symptoms and showed poorer functional level (P = 0.025);

– late-trauma patients only showed more negative symptoms (P = 0.029) as compared to non-trauma patients.

The age at the time of exposure to trauma has a modulating effect on its impact on symptoms and functional outcome in EPP and it should be systematically examined in clinical and experimental settings.

The authors have not supplied their declaration of competing interest.

Contemporary structural models of several psychiatric disorders propose abnormalities in the structure and function of distinct neural networks. Clinical observations of affective and cognitive changes arising from cerebellar lesions and stimulation permit the hypothesis that the cerebellum may not be irrelevant in some neuropsychiatric states. There is evidence that patients with schizophrenia have altered corticocerebellar connectivity.

To evidence a case with early onset psychosis accompanied with brain structural abnormalities.

Case description.

The patient is 15 years old girl with an acute psychotic episode. For more than two months she had demonstrated odd behavior, getting around all the time purposelessly, abandoned school etc. She presented with disorders of perceptions, disorganized speech, insomnia and fluctuations in her mood and behavior. In her brain, MRI was found vermian atrophy, and CT was found hypocampal glyosis and dilatation of temporal corn.

Although the structural mapping studies have been equivocal, the weight of evidence supports extending the study of cerebellar activity in schizophrenia. For example, the finding that unaffected first-degree relatives of probands with schizophrenia have reduced cerebellar volumes, along with the observation of reduced cerebellar volumes in neurolepticnaïve patients with schizophrenia, suggests that cerebellar atrophy may be a hereditary trait rather than a psychotropic associated epiphenomenon.

The authors have not supplied their declaration of competing interest.

The pathophysiology of psychosis is not fully discovered yet. However, during the last years many different risk factors are shown to prove to have a strong influence within the development of this pathology. Traumatic brain injury (TBI) is one of them.

Show TBI as a psychosis development risk factor.

Case report. A clinical vignette is presented followed by the results obtained in a bibliographic review.

A young 19-year old immigrant man, who lives with his parents in a social exclusion situation is brought to the hospital after having been observed making estrange religious rituals within a local river. During the anamnese he declares that God is “getting in touch with him” while he shows to be changed, with suspicion about being pursued. He also reveals to have suffered a mild-severe TBI with 8 years, having right ear audition problems since then. During the hospitalization some medical test were done, such as MRI, showing the lack of the inner right ear, as well as white matter abnormalities in his right hemisphere, which could be consequence of the TBI. Those findings make us think that this pathology might have been influenced, within other factors, by the traumatic brain injury.

This bibliographic review shows that traumatic brain injury may increase the risk of developing psychosis up to 65% from healthy controls, with a medium gap of 3.3 years between the TBI and the appearance of psychotic pathology.

The authors have not supplied their declaration of competing interest.

Madness and creativity are thought to be related from ancient ages. Nowadays, thanks to new scientific developments and researches we are able to identify common genetic and brain patterns between creativity and psychosis.

Taking the inspiration of a psychotic patient with some shocking drawings, we want to get deep into the actual knowledge about the relation between creativity and psychosis.

Case report and bibliographic review.

A 19-year-old man was brought to the hospital after having been found making strange rituals in the public way. In the anamnese he showed to have experienced mystic delusions and hallucinations. He made some particularly creative drawings.

We made a review which showed that this patients may have a diminished latent inhibition, which could make them experiencing usual live irrelevant stimuli as something very exciting and creative at the same time. Genome wide association studies show also that people having creative jobs and psychotic patients share some genes, which could be linked to this abnormal latent inhibition.

Latent inhibition abnormalities could be related with psychosis and creativity. There are differences within the course of people having this oversensibility, which could be explained due to the presence of protective and risk factors.

The authors have not supplied their declaration of competing interest.

Hashimoto encephalopathy (HE) is an uncommon syndrome associated with Hashimoto thyroiditis. The relationship between these entities is unclear. Even being rare, it appears to be underrecognized.

Report a case of an atypical presentation of psychosis in a patient with elevated serum levels of antithyroid antibodies and review the literature about similar situations.

Access clinical process, research PubMed, using the mesh terms “Hashimoto encephalopathy” and “psychosis”.

A 21-year-old Portuguese female was conducted by authorities to our emergency department after she called for help and was spotted walking barefoot on the streets. Throughout clinical course she presented persecutory ideas, thought blocks, auditory hallucinations, soliloquies, perplexity, total insomnia, bizarre behaviors like coprophagia, trichotillomania and self-injured burns. After some tests, it was found that the patient had high serum levels of antithyroid peroxidase antibody (TPO) and antithyroglobulin antibody (TGO) and reduced folic acid, without other changes. Trials with corticosteroids showed clinical improvement for short periods, as with antipsychotics. No consistent remission was achieved with either approaches.

HE is an uncommon syndrome presenting with high titers of antithyroid antibodies that may preconize an acute state of atypical psychosis. Usually, it responds to corticosteroids and so, has a generally good prognosis when treated accordingly. Evidence suggests that HE is an autoimmune disorder instead of thyroid disease.

The author has not supplied his/her declaration of competing interest.

Main schizophrenia symptoms result from abnormalities in brain function, such as hypofrontality and structural deficits on the prefrontal-thalamic-cerebellar circuit, as shown in brain imaging studies in first-episode SCZ patients. Whether metabolic alterations may be underlying these events is being studied thoroughly.

To assess brain metabolic disturbances in first episode and/or drug-naïve SCZ patients.

We conducted a literature review through Pubmed search for MeSH: schizophrenia, metabolism, glucose, insulin, brain. Controlled studies on first episode and/or drug-naïve SCZ patients were included.

Lower metabolic activity in the frontal regions of the brain is associated to an increase in norepinephrine transmission and decrease in dopaminergic transmission with reduced dopamine efflux in the frontal cortex. This seems to lead to cellular changes resulting in resulting lower blood flow and glucose demand. Molecular analysis of postmortem SCZ patients’ brains has indicated alterations in glucose metabolism and insulin signalling pathways, showing evidence for prefrontal cortex decreased expression of glucose metabolism, namely glycolytic enzymes such as glyceraldehyde 3-phosphate dehydrogenase, hexokinase, phosphoglycerate mutase, enolase and pyruvate kinase and decreased levels and phosphorylation of the insulin receptor and insulin signalling proteins AKT1 and GSK3β. Significantly elevated glucose concentrations in cerebrospinal fluid were observed in SCZ patients, but with no serum levels differences. A SCZ brain specific increased glucose could be explained by preferential utilization of lactate, predominantly produced by astrocytes, over glucose as an energy substrate.

Abnormalities in brain glucose metabolism and insulin signalling seem to appear in early stages of SCZ, suggesting a role in SCZ onset and pathophysiology.

The authors have not supplied their declaration of competing interest.

Parents of children with disabilities are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Childhood disability often imposes a social and emotional burden for children and their families.

With this study we evaluated several parents’ psychological aspects and the emotional behavioral functioning of their children with disability.

To investigate the possible correlation between parenting stress, level of depression in parents and behavior problems in their children, taking in to account the differences between mothers and fathers.

standardized forms (CBCL, PSI, BDI) were completed from 57 (28 mothers) parents of children aged from 6 to18 years, focusing on psychological well-being includes depression, parenting stress, family resilience and family adjustment.

The mean age of our sample was 41.55 ± 5.4. The level of depression and stress index were higher in mothers than in fathers. Parenting stress was significantly associated with children internalizing and externalizing behavior problems in children.

The results of this investigation indicate the importance of examining relations between parenting stress and behavior problems in children with disabilities. Objective of ensuring the rehabilitation process aimed at the welfare of the family. These patterns have implications for both developmental theory and for service provision for individuals with disability and their families.

The authors have not supplied their declaration of competing interest.

Schizophrenia (SCZ) is frequently associated with metabolic symptoms including dyslipidaemia, hyperinsulinemia, type 2 diabetes and obesity. In fact, SCZ patients have been reported to present higher prevalence of these conditions than general population, commonly associated to second generation antipsychotic therapy. Recent studies, however, have demonstrated that peripheral metabolic disturbances can appear at disease onset or drug-naïve patients.

To assess metabolic disturbances in first episode and/or drug-naïve SCZ patients.

We conducted a literature review through Pubmed search for MeSH: schizophrenia, metabolism, glucose, insulin. Controlled studies on first episode and/or drug-naïve SCZ patients were included.

Several studies showed no change in SCZ patients’ fasting blood glucose, while others found increased glucose levels and impaired glucose tolerance in SCZ patients compared to healthy controls in several recent studies. Hyperinsulinemia and insulin resistance have also been identified in antipsychotic-naïve SCZ patients and it has been suggested that early onset patients are more likely to present insulin resistance. In addition, there's evidence of increased circulating levels of chromogranin A, pancreatic polypeptide, prolactin, cortisol, progesterone, thus emphasising that multiple components of the hypothalamic-pituitary-adrenal-gonadal axis may be affected in SCZ. These elevations were associated to normal glycaemia suggesting there may be insulin intolerance during early stages of SCZ, requiring an increased secretion from pancreatic Bcells to maintain normal glucose levels.

Recent studies of first onset and/or drug-free schizophrenia patients have shown impaired fasting glucose tolerance, hyperinsulinemia and insulin intolerance, suggesting that metabolic abnormalities may play a role in SCZ onset and pathophysiology.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a major mental illness with a progressive course. Thirty percent of cases of patients with schizophrenia do not respond to adequate trials of at least 2 different groups of antipsychotics,are currently classified as having treatment resistant schizophrenia (TRS). Clozapine remains the gold standard, treatment of choice for TRS. However, clozapine does not come without its own challenges. Its risk profile, particularly agranulocytosis, reported in 1% of cases, has led to the necessity of weekly blood counts within the first 18 weeks of treatment and subsequently every month with slow dose titration. Clinically, sedation, weight gain and hypersalivation may further hamper the compliance of patients. Non-compliance has been reported to cause rebound psychosis. Recent studies have raised questions as to which antipsychotic is most efficacious for TRS. Thus, we conducted a systematic review of high dose olanzapine treatment for people with TRS.

A systematic review of prospective studies found through search of PubMed, Scopus and hand-searched key papers which included randomized controlled trials and open-label studies which looked at high dose of olanzapine treatment response for TRS.

The study is currently ongoing and preliminary results will be presented at the conference in April 2017.

The gravity of burden TRS brings to patients extends itself to their families, carers and clinicians. Further evidence on which antipsychotic is more efficacious for patients with TRS would have huge implications in terms of health benefits for the patients, better informed clinical decisions and also health economics in general.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a major mental illness with a progressive course. Thirty percent of cases of patients with schizophrenia do not respond to adequate trials of at least 2 different groups of antipsychotics are currently classified as having treatment resistant schizophrenia (TRS). Clozapine remains the gold standard, treatment of choice for TRS. However, clozapine does not come without its own challenges. Its risk profile, particularly agranulocytosis, reported in 1% of cases, has led to the necessity of weekly blood counts within the first 18 weeks of treatment and subsequently every month with slow dose titration. Clinically, sedation, weight gain and hypersalivation may further hamper the compliance of patients. Non-compliance has been reported to cause rebound psychosis. Recent studies have raised questions as to which antipsychotic is most efficacious for TRS. Thus, we conducted a systematic review of high dose olanzapine treatment for people with TRS.

A systematic review of prospective studies found through search of PubMed, Scopus and hand-searched key papers which included randomized controlled trials and open-label studies which looked at high dose of olanzapine treatment response for TRS.

The study is currently ongoing and preliminary results will be presented at the conference in April 2017.

The gravity of burden TRS brings to patients extends itself to their families, carers and clinicians. Further evidence on which antipsychotic is more efficacious for patients with TRS would have huge implications in terms of health benefits for the patients, better informed clinical decisions and also health economics in general.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a chronic mental illness associated with several functional impairments. There has been an increasing interest in the impact of schizophrenia on functioning. The development of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for schizophrenia, a shortlist of 97 ICF categories that are relevant for describing functioning and disability of people living with schizophrenia, has derived from this interest.

This study aims to explore the content validity of this core set from the perspective of psychiatrists.

In a 3-round Delphi survey, psychiatrists experienced in schizophrenia treatment were asked about patients’ problems, resources and environmental factors they treat in patients with schizophrenia.

A total of 352 psychiatrists from 65 countries representing all six World Health Organization regions completed the first round questionnaire. The response rate at the third round was 86%. Answers were linked to 422 ICF categories. Of all these, 109 ICF categories reached consensus (≥ 75% agreement) at the third round. Eighty-seven out of the 97 ICF categories that form the comprehensive ICF core set for schizophrenia were represented in this list. All the comprehensive ICF core set for schizophrenia categories reached consensus except five categories.

The content validity of the comprehensive ICF core set for schizophrenia from the perspective of psychiatrists was largely supported. However, further research is needed including other health professionals (e.g., psychologists, nurses and occupational therapists) to further obtain new content validity evidences.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Improved insight level among schizophrenia patients is predictive for better illness prognosis.

Explore factors connected to insight.

Evaluate the insight level and clinical characteristics of first time hospitalized schizophrenia spectrum patients.

All consecutive first time hospitalized schizophrenia spectrum patients in a psychiatric hospital from 01.01.2016–26.09.2016. Patients were interviewed upon hospitalization and at the discharge with Scale for the assessment of positive symptoms (SAPS) and negative symptoms (SANS), Schedule of assessment of insight-extended (SAI-E), The Calgary depression scale for schizophrenia (C-sch), sociodemographic and clinical data were collected. All participants signed written informed consent and the study was approved by the Riga Stradins University Ethics committee.

From 45 first episode patients, 38 met the inclusion criteria. Mean age was 37.66 years (SD: 11.48 years), the average duration of untreated illness (DUI) was 40.5 months (SD: 57.35 months). Psychopathologic symptoms and insight levels evaluated in scores in the 1st and 2nd interviews were as follows: SAPS 69.11 (SD: 20.78) and 33.61 (SD: 18.04), SANS 63.21 (SD: 25.30) and 40.95 (SD: 24.47), SAI-E 15.50 and 27.24 (SD: 13.24), P < 0.001, C-sch 8.50 (SD: 5.31) and 4.27 (SD: 2.86), P < 0.05. There was no statistically significant correlation between DUI and insight level. A higher level of insight at hospitalization correlated with higher levels of depression: r = 0.569, P < 0.001.

We noticed a tendency that lower insight levels might correlate with longer periods of untreated illness. We found that higher insight levels correlated with higher symptoms of depression.

The authors have not supplied their declaration of competing interest.