Remission and recovery rates for people who have had a first episode psychosis (FEP) remain uncertain.

We conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies and conducted meta regression analyses to investigate potential moderators.

A systematic literature search of major electronic databases without language restrictions was conducted from database inception until July 1, 2016. Longitudinal studies with follow up greater than 1 year reporting data on remission or recovery rates in FEP were included.

Seventy-nine studies were included representing 19,072 FEP patients (mean age = 26.9 years, male = 59.5%). The pooled rate of remission among 12,301 individuals with FEP was 57.9% (95%CI: 52.7–62.9, Q = 1536.3, P< 0.001, n = 60 studies, mean follow up = 5.5 years). Restricting the analysis to studies, which used the remission in schizophrenia working group (RSWG) criteria (n = 25 studies, n = 6909 patients), the pooled remission rate was 56.9% (95%CI: 48.9–64.5, Q = 656.9). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 37.9% (95%CI: 30.0–46.5, Q = 1450.8, studies = 35, P = 0.006, average follow up = 7.2 years). Recovery rates were higher (P< 0.05) in North America compared to other regions.

Our data suggest that remission and recovery rates in FEP may be more favorable than previously thought. We observed stability of recovery rates after the first two years, suggesting that a progressive deteriorating course of illness is not typical. While remission rates have improved over time, recovery rates have not, raising questions about the effectiveness of specialist early intervention services in achieving improved recovery.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Rare research was reported about assessing the effectiveness and safety of amisulpride in Chinese patients with schizophrenia before we performed the ESCAPE, a multicenter, single-arm, phase IV study (NCT01795183). This study is a cluster analysis of ESCAPE study.

To identify the effectiveness patterns of amisulpride in Chinese patients with schizophrenia.

To examine baseline characteristics of patients as potential predictors of effectiveness.

Time-series cluster analysis was performed to identify effectiveness trajectories bases on Positive and Negative Syndrome Scale (PANSS) scores in Chinese patients with schizophrenia received amisulpride for 8 weeks. Baseline characteristics of patients were examined.

Overall, 295 patients were included for efficacy analysis. Four response trajectories based on positive PANSS were identified (Figure 1): (1) rapid response (cluster 1); (2) gradual response (cluster 2); (3) sustained low level (cluster 3); (4) poor response (cluster 4). Age in cluster 4 was significantly higher than that in cluster 1 and cluster 3 (Table 1, P = 0.0025 and 0.0032, respectively). Similarly, four response trajectories based on negative PANSS were generated (Figure 2): (1) rapid response (cluster 1); (2) gradual response (cluster 2); (3) poor response with moderate PANSS (cluster 3); (4) poor response with high PANSS (cluster 4). Male to female ratio in cluster 1 was significantly lower than that in cluster 2 and cluster 3 (Table 2, P = 0.0042 and 0.0208, respectively).

For the first time, we obtained effectiveness patterns of amisulpride-treated Chinese patients. Age and gender may be predictors of effectiveness.

This study is being funded by Sanofi (China) Investment Co., Ltd.

We expose a woman diagnosed with schizoaffective disorder 2 years ago, before she received several diagnostics. She was admitted to the psychiatry unit with hyperactivity, pressured speech without taking an appropriate turn, flight-of-ideas, irritability, expansiveness, emotional liability, ideas of reference and insomnia without diurnal tiredness. In addition, she admitted having abandoned the medication one month ago. She was diagnosed with maniac episode with psychotic symptoms and the medication was reintroduced. After two weeks, no response was observed so we decided to introduce ability depot 600 mg/3 weeks.

We want to show that is possible the use of ability depot off-label in patients with a special difficulty in handling. Also, we want to show that higher doses are not dangerous and it's possible to study new treatment guidelines for ability depot.

We use the Positive and Negative Syndrome Scale (PANSS) pre (the day of the introduction) and post (at two weeks) treatment with aripiprazol depot; the Clinical Global Impression rating scale (CGI), also pre and post.

We have obtained a punctuation of 180 in PANSS the day of the introduction of the aripiprazol depot and 45 at two weeks. In addition, we obtained 6 in CGI the day of the introduction and 3 at two weeks.

In this case, aripiprazol depot has shown good tolerability and efficacy for the acute phase of schizoaffective disorder at higher doses than recommended in clinical guidelines. The efficacy and safety data are consistent with short-term, placebo-controlled studies of aripiprazol depot conducted in similar populations.

The authors have not supplied their declaration of competing interest.

Detection of clinical-biological predictors of the efficiency of antipsychotic therapy in schizophrenic patients, correction and individualization of therapeutic indication of antipsychotics are relevant questions of modern psychiatry. Immune dysfunctions, disturbance of psychoneuroimmunological interaction, metabolic imbalance worsen clinical pattern of disease, contribute to formation of therapeutic resistance and side effects, and decrease efficiency of treatment of patients.

To detect clinical-immunological predictors of the efficiency of therapy of schizophrenic patients with amisulpride.

We examined 19 schizophrenic patients, aged 18–64 years, who received treatment with amisulpride (Solian). The psychometric scale PANSS was used for evaluation of dynamics of psychopathological symptoms. Therapy efficiency was evaluated using CGI scale. The immunological investigation included identification of phenotypes of surface receptors of immunocompetent cells, level of IgM, IgG, IgA, phagocytic activity of leucocytes. Research was carried out in two points: first–at admission, second–by week 6 of treatment. Predictors of efficiency were identified relying on the analysis of interquartile ranges of clinical-immunological parameters.

Predictors of high efficiency of amisulpride therapy were identified: clinical–total score according to PANSS less than 70, sum of scores according to subscale of negative disorders is more than 31 and immunological–number of HLADR ± lymphocytes below 0.34 × 109/L, СD16 ± lymphocytes more than 0.18 × 109/L.

Complex of informative clinical-immunological criteria is proposed, which enables prognosis of the efficiency of psychopharmacotherapy for patients at admission. It enables optimizing the choice of differentiated therapeutic tactics and heightening the quality of specialized medical care for schizophrenic patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Since their introduction by Delay and Deniker in the 1950s, neuroleptic drugs have significantly modified the evolutionary prognosis of schizophrenia. Their combination has also become a widespread practice.

The aim of this study was to analyze the associations of neuroleptic drugs by describing the characteristics of types and doses, understanding the reasons for these associations and studying the relationship existing in such situation regarding adherence to treatment, tolerance and the number of hospitalizations.

Our study was retrospective, descriptive and analytical. It has been conducted from March, 1st to May, 30th 2015 and involved 70 stabilized patients diagnosed with schizophrenia according to DSM 5. Clinical characteristics were collected from patients and their medical records. Evaluations were conducted using PANSS, MARS and GAS.

Overall, 70 male patients were recruited. The mean age was 40 years old: 30% received classical monotherapy while 70% were treated only by an atypical antipsychotic. Among patients receiving two drugs, 85% received classical bitherapy while 9% were under both classical and atypical drugs. Only 6% received atypical bitherapy. Chlorpromazine equivalent doses in case of monotherapy was 325.92 mg/day, while it reached 1148.65 mg/day in case of drugs association. Administration of a combined therapy had poor tolerance rate and all patients suffered from adverse effects. Adherence to treatment was better while receiving monotherapy (88% versus 45%) and the number of hospitalizations was lower with an average of 3 against 10.

Our study revealed several shortcomings in our current management of patients with schizophrenia and addressed the implication of socioeconomic status on therapeutic outcomes.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Most of elderly onset psychosis present as a consequence of one or more organic processes. We present the case of an 81-year-old patient with diagnosis of a posterior fossa meningioma. It emerged with abrupt positive symptoms of psychosis with important family and social disruption. The interest of the case lies in the low frequency of psychiatric symptoms associated to this type of tumor, given its location. Thus, these symptoms may be explained, by normal pressure hydrocephalus (NPH) secondary to the tumor.

To highlight the importance of performing a complete organic screening in elderly onset psycotic patients.

From the mentioned case, we performed a literature review of psychopathology associated with NPH.

Psychiatric examination demonstrated parasitization delusions and delusional misinterpretations; tactile and visual zoomorphic hallucinations were also present. They were compatible with Ekbom syndrome; anxiety and behavioral disorganization were prominent. We introduced treatment with risperidone 0.5 mg/12 h with important decrease of positive psychotic symptoms. Currently, the patient is waiting for a ventricular-peritoneal shunt.

The NPH usually presents with memory failures, psychomotor slowing, problems in calculating and writing. It may progress to a neurological impairment so intense that may be indistinguishable from Alzheimer's disease. From a psychopathological point of view, affective or psychotic symptoms and/or behavioral disorganization may also appear. In few cases, HNT onset shows with prominent psychiatric symptoms instead of neurological impairment. These symptoms may improve with pharmacological and surgical treatment. Thus, it is important to get an accurate diagnosis.

The authors have not supplied their declaration of competing interest.

Aripiprazole depot is an atypical antipshycotic used to treat positive and negative symptoms of psychosis or acute mania.

Describe the reason why psychiatrists switch the current antipsychotic treatment on to aripiprazol depot, its tolerability and the reasons to stop aripiprazol depot treatment.

Descriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with antipsychotics at two community mental health units.

Switching on to aripiprazole depot principal reasons: promote adherence (25%), persistence of symptoms (25%) and high levels of prolactin or sexual dysfunction (16.66%):

– side effects of aripiprazole depot: insomnia (11.11%), inquietude (8.33%), sexual dysfunction (2.77%) and hypertensive crisis during administration (2.77%);

– 83.33% of the patients are still taking it after one year. The most common reasons to stop or change it were the presence of secondaries (11.11%) and clinical exacerbation (5.55%).

Aripiprazole depot is well tolerated (even better than other antipsychotics). Common side effects are not severe and appear in a small percent of patients.

The authors have not supplied their declaration of competing interest.

Psychological resilience is defined as an individual's ability to adapt to stress and adversity. People with psychotic illness often experience high levels of distress and difficulties adapting.

To assess the relationship between the resilience of people with psychotic illnesses and their quality of life.

Outpatients from multiple settings attending Sligo-Leitrim Mental Health Services, aged 18+ years old with a diagnosis of either schizophrenia, bipolar affective disorder or schizoaffective disorder were approached by their treating teams and invited to participate. Other inclusion criteria were having a family member. Drug induced psychoses or no family member were exclusion criteria. The scales used were the Resilience Appraisal Scale and the schizophrenia Quality of Life Scale. This study is part of a larger study looking at family factors and psychosis.

The study sample was 58 enrolled but only 49 participants completed the 2 assessments, of these 33 were males (67.3%). Data was analysed using SPSS 21. Pearson's correlation coefficient for resilience and quality of life was 0.503, P < 0.001. This shows that higher resilience is associated with better quality of life amongst people with psychotic illnesses. These results could have useful clinical implications. If we can intervene to therapeutically increase resilience, we can eventually improve the quality of life of people with psychoses.

The authors have not supplied their declaration of competing interest.

Psychotherapy methods are evolving for patients with psychosis.

We present a psychotherapy of psychosis that is brain-based, along with results of working with patients using these methods. Patients with psychosis are known to have decreased connectivity of the elements of the default mode network, also known as the story-making brain. These patients are known to tell narratives that lack coherence, of both excessive elements and inadequate elements. These stories are rigid and either cacophonous or rigidly monologic. The key brain area of the precuneus shows diminished connectivity to other brain areas. We present a narrative approach in which patients are assisted through rehearsal and modeling to tell more coherent stories about their life experiences. We work toward achieving a future orientation in which a sequence of actions leads toward an achievement of a future goal. The protagonist encounters obstacles and learns how to overcome them. Through iterative rehearsals, the story achieves more vivid mental imagery and emotional connectivity. Delusions and voices are accepted and incorporated into those stories in ways that provide the patient with improved capacity to cope with their delusions and voices.

We present the results of 59 patients who worked with these techniques and compare them to a matched cohort of patients treated conventionally. The treated patients show statistically significant improvement in positive and negative symptoms and in quality of life.

Brain-based narrative psychotherapy approaches can improve the quality of life and reduce symptoms.

These techniques are worthy of further exploration.

The authors have not supplied their declaration of competing interest.

The research about the benefits of early diagnosis and treatment of first-episode psychosis had significantly increased in last decades. There have been several early intervention programs in psychotic disease, implemented worldwide, in order to improve the prognosis of these psychotic patients.

To present a brief description of the first-episode psychosis intervention team of Tondela-Viseu Hospital Centre–Portugal and its model. We aim to further characterize our population and describe its evolution since 2008.

We aim to clarify the benefits of an early intervention in psychosis.

We conducted a retrospective cohort study of patients being followed by our team from November 2008 to September 2016. Demographic and medical data were collected (such as diagnosis, duration of untreated psychosis, treatments and its clinical effectiveness, relapse rate and hospital admissions) in patient's clinical records. The intervention model protocol of this team was also described and analyzed.

This multidisciplinary team consists of three psychiatrists, one child Psychiatrist, one psychologist and five reference therapists (areas of nursing, social service and occupational therapy). It includes patients diagnosed with first-episode psychosis, aged 16 to 42 years old, followed for five years. The team followed, since its foundation, 123 patients, mostly male. The most prevalent diagnosis are schizophrenia and schizophreniform psychosis. The team is currently following 51 patients.

This team's intervention have progressively assumed a more relevant importance in the prognosis of patients with first-episode psychosis, by reducing the duration of untreated psychosis, the relapse rate and by promoting social reintegration.

The authors have not supplied their declaration of competing interest.

Clozapine is licensed for treatment-resistant schizophrenia and when clozapine is not able to be used, less evidence based practices may be required. Full remission may require combinations or high doses of psychotropic medications having greater potential for interactions and side effects. If this is not successful, symptoms may persist and long-term disability may occur.

To explore safety and efficacy of a rechallenge of clozapine in a patient with treatment resistant schizoaffective disorder, who previously developed pericardial effusion. Collateral history reported best improvement with clozapine compared to other medications.

To improve level of functioning and reduce need for less evidence based choices of medication.

Initial consultation with clozapine monitoring service over prospects of rechallenge. Full medication history and review. Consultation with a cardiologist regarding validity of local monitoring strategy. Obtain consent from the patient and his family. Titrate clozapine slowly. Once clozapine initiated, measure temperature, blood pressure, pulse rate and monitoring of symptoms of pericarditis including chest pain, cough and dyspnoea daily. ECG and echocardiography at baseline and 2 and 4 weeks after initiation of the rechallenge. ECGs monthly thereafter, with a further echocardiogram at 3 months. Weekly troponin and CRP for three months to monitor developing myocarditis and pericarditis.

Successful rechallenge of clozapine with significant reduction in psychopathology, improvement in functioning and no adverse events reported. Reduction of risk enabled transfer to open ward conditions.

There is increasing evidence of successful rechallenges of clozapine however, further research is necessary to aid such clinical decisions.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

For many decades, clinicians were very well aware of lack of insight in patients with paranoid form of schizophrenia. This group of patients is not only less compliant with pharmacotherapy, but also is hard to manage in the rehabilitation setting. This dictates the necessity to develop special approaches to this group of patients, based on clinical data.

Fifty patients with schizophrenia spectrum disorder were randomly recruited to be assessed by PANSS scale and Apathy Evaluation Scale (AES), which was introduced both by trained clinicians (C) and as a self-assessment measure (S). Demographic data was collected along with clinical description on prevailing symptoms during acute phase.

While AES-C scores were very well correlated with PANSS motivation subscale, AES-S scores showed prominent discrepancies both with PANSS items and AES-C version. Lower scores on AES-S were also associated with paranoid schizophrenia and prevailing delusional symptoms in acute phase. As well AES-C/AES-S ratio also correlated with paranoid form and delusional symptoms in manifest psychoses.

Patients with paranoid schizophrenia not only lack insight into positive symptoms, but tend to underestimate their negative symptoms such as motivation and apathy. Clinically, this can be described by overestimated strengths, overstated expectations, exaggerated hopes, mistakenly overrated beliefs. But when faced with reality, these patients are unable to adjust themselves and frequently are negativistic to offered help and therapies.

We assume that paranoid patients should be treated not with straightforward strategies, such as psychoeducation, but with less stigmatizing methods that work on metacognitive and motivational levels.

The authors have not supplied their declaration of competing interest.

Pharmacological treatment is the gold standard in delusional disorder (DD), moreover the second generation antipsychotics (SGA) are widely used in the treatment of DD, in spite of this, none SGA is authorized for the treatment of DD.

To evaluate the evidence available for pharmacological treatment in adults with DD. Especially, that concerning SGA.

A systematic review on pharmacological treatment of DD was conducted. We selected the best evidence available. Then, we analysed them critically, assessing its biases and quality, finally performed a narrative and quantitative synthesis.

The quality of the evidence was very low. There were not randomized clinical trials. n = 385, 177 SGA. Antipsychotics achieved a good response in a 33.6% of the patients. First generation antipsychotics (FGA) did show superiority compared to SGA (39% good response vs. 28%, respectively. P ≤ 0.02). We could not find data about superiority of any drug over other. Pimozide, traditionally considered the most effective drug, did not confirm to be a superior treatment compared to others. Reasons for superiority of FGA were analyzed. The role of another treatments were testimonial, but antidepressants can be a promising treatment.

There is no evidence to make strong recommendations, although antipsychotics in general appear to be an effective treatment for DD. Superiority of FGA against SGA was shown. We need to develop clinical trials in DD and SGA, since their better tolerance profile might be the best candidates to do.

The authors have not supplied their declaration of competing interest.

Toxoplasma gondii infection has been recently associated with schizophrenia and other psychiatric disorders.

The aim of the present study was to evaluate the prevalence of T. gondii antibodies among acute psychiatric patients from Western Romania.

This study included 214 consecutive patients admitted at the psychiatric clinic, Country Clinical Emergency Hospital in Timisoara, Romania, between 30.06.2011 and 12.01.2012. Clinical and laboratory investigations were performed in these hospitalized patients, including serologic tests for T. gondii IgG and IgM antibodies.

The 214 patients aged 19 to 71 years (mean = 42.5), 64.9% were females. T. gondii antibodies were detected in 117 (54.7%) of 214 psychiatric patients. When the data were analyzed by diagnostic groups, T. gondii antibodies were demonstrated in 30 (50.84%) of 59 patients with schizophrenia, in 28 (59.57%) of 47 with persistent delusional disorder, 10 (31.25%) of 32 with acute and transient psychotic disorder, 13 (54.16%) of 24 with schizoaffective disorder and 35 (70%) of 50 with bipolar disorder. A high prevalence of T. gondii antibodies was found among patients with bipolar disorder compared to those with schizophrenia (P = 0.043) acute and transient psychotic disorder (P < 0.0001) and healthy controls (P < 0.0001). Of the 18 patients with schizophrenia and a BPRS score <51, T. gondii antibodies were detected in 13 (72.2%) compared to 17 (41.4%) of 41 in whom BPRS score was >51 (P = 0.03).

These findings suggest that T. gondii infection may be associated with several psychiatric disorders. A high seroprevalence of T. gondii was demonstrated in patients with bipolar disorder.

The authors have not supplied their declaration of competing interest.

The approach to mental illness and specifically in serious mood disorders, long-term treatments that improve adhesion as continuous treatments ensure compliance are needed, they minimize the risk of relapse and readmission and therefore increase the chances to have a good fit and social, relational and even occupational functioning.

We analysed a sample of 42 male diagnosed with schizophrenia, schizoaffective disorder, chronic delusional disorder that starts treatment with Paliperidone Palmitate in outpatients. It is analysed the dose of paliperidone palmitate employed for stabilization and family satisfaction at the time of stabilization is analysed in the study.

The mean dose of Paliperidone Palmitate is 138 mg. The patient diagnosed with schizophrenia are 47.6% and the average dose is 132.5 mg. Chronic delusional disorder is 2.3% and the mean dose 50 mg. Other comorbility mood disorders are 21.4% and the mean dose is 183 mg. Other disorders (F70, F72…) are 28.5% and mean dose 133 mg. The average family satisfaction (minimum 1 up to 5) is 4, with the highest score among patients diagnosed with F20 Schizophrenia.

Long lasting injectable medications achieve important adherence and a high percentage of antipsychotic monotherapy, thus reducing the side effects, although in our sample 8% which has occurred was removed therefrom.

The authors have not supplied their declaration of competing interest.