Today the scales for measurement of functional status and life satisfaction (GAF, PSP, EQ-5D, SQLS) gain more importance in assessing schizophrenic patients. Autonomy of living is to the great extent the basis of patient well-being. Each of these scales has the criteria, testing ability for independent life, but none of it tests autonomy as a separate object.

Development of a new scale.

Description and validation of a scale for evaluation of autonomy of living in schizophrenic patients.

Forty patients diagnosed with schizophrenia according to ICD−10 (F 20.хх), 13 males and 27 females, aged 49.8 ± 9, disease duration is 22 ± 8.6 years. New scale and PANSS, CGI-S, NSA, BACS, GAF, PSP was administered.

The scale comprises five points (activity, intentional behavior, range of social interaction, specificity of interaction with the doctor (medical conventionality) and autonomy), and total score. The internal consistency of the scale was high – cronbach's alpha 0.83. The construct validity with GAF and PSP was moderate (R varied from 0.36 to 0.55). The total score of the new scale correlated with the PANSS negative subscale score (R = −0.51), with CGI-S score (R = −0.57), and with the BACS total score (R = −0.57).

The scale of autonomy corresponds to the major psycho-diagnostic requirements: internal consistency, construct and discriminative validities. It can be considered a new instrument for assessing the integrative target of treatment and rehabilitation of patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

Schizophrenia is associated with increased physical morbidity and mortality. In particular, cardio-metabolic diseases are more frequent. Several underlying reasons have been discussed, including adverse lifestyle behaviors, or adverse effects of neuroleptic treatment. However, little is known about changes of cardiac and intra-abdominal adipose tissue, both are risk factors for the development of cardio-metabolic diseases.

To compare, cardiac and intra-abdominal adipose tissue between patients with schizophrenia and healthy controls.

Ten physically healthy patients with schizophrenia according to DSM-V were included, and compared to healthy control subjects. Cardiac and intra-abdominal adipose tissue was quantified using magnetic resonance tomography. Further factors assessed comprise the metabolic syndrome, physical activity, smoking behavior, and scores for the assessment of cardio-metabolic diseases (FINDRISK score and modified ESC score).

Cardiac adipose tissue and intra-abdominal adipose tissue was increased in patients with schizophrenia. Further findings were higher diastolic blood pressure, more smoking, less physical activity, and an increase for diabetes and cardiovascular disease risk according to the modified ESC and FINDRISK score.

The new finding in our study is an increase of cardiac adipose tissue, a risk factor for the development of cardiovascular disorders, in physically healthy patients with schizophrenia. Furthermore, the risk for the development of type-2 diabetes mellitus is increased, indicated by higher amount of intra-abdominal adipose tissue, and the results of the FINDRISK score. We conclude that lifestyle alterations, particularly exercise training that has been shown to reduce cardiac and intra-abdominal adipose tissue, should be recommended in patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

The “schizophrenia spectrum” concept allowed better identifying the psychopathology underpinning disorders including schizophrenia, schizoaffective disorder (SZA) and cluster A personality disorders (PD).

To compare the clinical portrait of the schizophrenia spectrum disorders, focusing on the impact of the affective dimension.

Inpatients at the acute psychiatric ward of Perugia (Umbria-Italy) were evaluated with the structured clinical interview for DSM-IV Axis I and Axis II disorders and diagnosed with a “schizophrenia spectrum” disorder according to DSM-IV-TR. The clinical evaluation was conducted using the positive and negative syndrome scale (PANSS). Pearson correlations of the different subscales in the three groups and between the negative scales with the affective symptom “depression” were conducted.

The sample consisted of 72 inpatients (schizophrenia 55.6%, SZA 20% and cluster A PD 19.4%). The negative and the general psychopathology scales directly correlated at different degrees in the three groups (schizophrenia: r = 0.750; P < 0.001; SZA: r = 0.625, P = 0.006; cluster A PD: r = 0.541, P = 0.046). The symptom “depression” directly correlated with 5 out of 7 negative symptoms: blunted affect (r = 0.616, P < 0.001), emotional withdrawal (r = 0.643, P < 0.001), poor rapport (r = 0.389, P = 0.001), passive/apathetic social withdrawal (r = 0.538, P < 0.001), lack of spontaneity & flow of conversation (r = 0.399, P = 0.001).

Our study confirmed the existence of the “schizophrenia spectrum” with combined different disorders lying on a continuum in which negative symptoms mainly correlated with the psychopathological functioning. Noteworthy, the symptoms of the negative scale strongly correlated with the “depression” symptom, underlying the impact of the affective symptoms on the severity of the “schizophrenia spectrum” disorders.

The authors have not supplied their declaration of competing interest.

Treatment resistance to clozapine is estimated at 40–70% of the treated population. Several clozapine potentiation strategies have come into clinical practice although often without evidence-based support.

The aim of our work was to identify the potentiation strategies in ultra-resistant schizophrenia depending on the subtype of schizophrenia.

This is a prospective study conducted on patients with the diagnosis of schizophrenia, based on DSM-IV-TR criteria, and hospitalized in the psychiatric department of the university hospital in Mahdia, Tunisia. The study sample consisted of patients meeting the resistant schizophrenia criteria as defined by national institute for clinical excellence (NICE), and the prescription of clozapine for 6 to 8 weeks was shown without significant improvement.

we have collected 10 patients. The mean serum level of clozapine was 462.25 mg/L. The potentiation strategies were different depending on the subtype of schizophrenia. For the undifferentiated schizophrenia, we have chosen ECT sessions. For the disorganized schizophrenia, we opted for amisulpiride and aripiprazole. For the paranoid forms, we have chosen the association of risperidone and ECT. A psychometric improvement was noted in BPRS ranging from 34 to 40%.

Every potentiation strategy entails a cost, whether it is an additional monetary cost, adverse effects or greater stress to caregivers. The cost/benefit equation should be thoroughly evaluated and discussed before commencing a strategy.

The authors have not supplied their declaration of competing interest.

Previous studies suggested that patients with schizophrenia had an increased prevalence of antibodies against toxoplasma gondii (TG) and that those seropositive patients had higher symptom severity. However, there is no data on the relationship between treatment-resistant schizophrenia (TRS) and TG seroprevalence.

To determine the association between TRS and TG seropositivity, and to further investigate the relationship between TG seropositivity and different clinical features of schizophrenia.

In this cross-sectional study, we included 210 male inpatients with schizophrenia. TG seropositivity was determined by ELFA assay. Treatment-resistance was defined as a failure of at least 2 adequate anti-psychotic trials. Data were analyzed using χ2 test or Mann–Whitney test.

The rate of TG seropositivity in the entire sample was 52.3%, whereas 47.6% of patients met the definition for treatment-resistance. Seropositive patients had twice the rate of treatment–resistance compared to seronegative patients (63.6% vs. 30.0%, P < 0.0001). Moreover, in the seropositive group, the patients were older (47.6 ± 12.2 vs. 39.81 ± 12.01 years, P < 0.0001), had higher number of previous hospitalizations (13.9 ± 11.7 vs. 9.6 ± 8.5, P = 0.0073), and increased Calgary depression scale for schizophrenia (CDSS) total score (7.8 ± 4.5 vs. 6.3 ± 3.8, P = 0.012). There were no differences between the groups in the age of disease onset, smoking, positive and negative syndrome scale (PANSS) total, positive and negative scores, and the life-time history of suicide attempts.

Our results support the hypothesis that TG seropositivity might contribute to treatment-resistance in schizophrenia, at least in male patients.

The authors have not supplied their declaration of competing interest.

Janssen-Cilag research study.

The authors have not supplied their declaration of competing interest.

Certain personality traits are found in persons with high risk for schizophrenia onset and therefore it could be used as diagnostic marker.

To analyze correlations between personality traits and cognitive functions on schizophrenia onset and its course and social adaptation.

This was a retrospective cohort study conducted in Riga center of psychiatry and narcology, Latvia. Study consisted of two parts. In the first part, data on first presentation schizophrenia patients hospitalized in 2006 was collected from medical records. Patients without completed MMPI, Schulte table; visual memory and 10 words recall tests were excluded from study group. The Second part of the study consisted of participant interviews that were held in early 2016 acquiring demographic data and each participant completed a Sheehan disability scale (SDS). Microsoft Excel 2016 and SPSSv22 were used for data operation.

Study group consisted of 11 males and 20 females (35.5%/64.5%). Mean age of participants was 37 years (IQR = 48–33), but mean age at onset of first schizophrenia symptoms was 27 years (IQR = 37–21). 68% (n = 21) of participants had schizoid personality traits as per MMPI and they had higher results on all SDS subscales. There was a negative correlation between the SDS score in the first section with the occupational level in 2006 (P = 0.065) and 2016 (P = 0.040) and marital status in 2016 (P = 0.040) in those with psychopathy scale.

The hypothesis that schizoid personality traits are a leading factor in the onset of schizophrenia, have not been proven. Schizophrenia patients with psychopathic personality traits are likely to have better social adaptation.

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

Increased psychotomimetic response to cannabis is demonstrated in psychosis-prone individuals. Early use of cannabis has poorer prognostic outcomes. However, as yet no cut-off age for early use has been established.

To determine, if age at first use affects later cannabis experiences and to determine if a “critical age” of first use exists for psychotomimetic cannabis experiences.

The cannabis experiences questionnaire (CEQ) (EUGEI version) was administered to a large internet-based non-clinical sample. Regression analysis was conducted of age at first use against CEQ scores controlling for gender, age frequency of use and duration of use. To determine cut-off age: independent ‘t’ tests (parametric) and Mann–Whitney-U tests (non-parametric) were used to determine significance of differences in CEQ scores at cut-off ages from 12-25.

We obtained data for 1115 participants. Younger age at first use was significantly associated with increased psychotomimetic experiences (adjusted P < 0.001). All cannabis experiences were increased in in those commencing at younger age at every cut off age from 17 to 22 (P < 0.001) with maximal difference at 22. Psychotic experiences significantly varied from age of first use of 19 to 22 with maximal difference at cut-off ages 20, 21 and 22 (P < 0.001). Pleasurable experiences were significantly reduced in those commencing later at every cut-off age from age of use 17 to 22 (P < 0.001) with maximal difference between groups at age 20.

Later onset of use is associated with reduced cannabis experiences till the early 1920s. This may have public health implications.

The authors have not supplied their declaration of competing interest.

Although physical restraint (PR) is a non-rarely practice on psychiatry there are few studies that focus the attention on the risk factors for this intervention. PR is a legitimacy practice when is needed and well applied but is not free from side effects. Knowing risk factors might be useful to improve the application of PR.

Study the risk factors involved with the use of PR at patient's home in individuals with schizophrenia before the involuntary transport (IT) to a psychiatric facility.

Is a descriptive and observational study of 267 psychotic patients that were assisted by a psychiatric home care unit (EMSE) in Barcelona during their IT. The sample was divided in two groups, depending on the need of PR. Socio-demographic data were collected as well as positive and negative syndrome scale (PANSS), WHO disability assessment schedule (WHO/DAS), global assessment of functioning scale (GAF), Scale to assess unawareness of mental disorder (SUMD). Aggressiveness was assessed by PANSS-EC consisting of 5 items: excitement, tension, hostility, uncooperativeness and poor impulse.

From the 267 psychotic patients 109 required PR. 154 were male and the average of age was 47. The results were significant in the PR group versus no PR for PANSS-EC (P = 0.000), as well as WHO/DAS (P = 0.017), GAF (P = 0.042), Positive PANSS (P = 0.000), age (P = 0.001) and substance use (P = 0.012). Were no significant for gender, insight or Negative PANSS.

Aggressiveness and violence were the most important PR related factors followed by positive symptoms, age, substance use and global functioning.

The authors have not supplied their declaration of competing interest.

Depot antipsychotic treatment has been a radical change in the evolution and prognosis of patients with schizophrenia. Long-acting injectable aripiprazole is an anti-psychotic dopamine partial agonist. It has a good tolerance in terms of metabolism and prolactine level.

Studying the causes of readmission at the acute unit of Marqués de Valdecilla university hospital (HUMV) in patients treated with Long-acting injectable aripiprazole LAI 400 mg.

This is a descriptive study which pretends to assess the causes of readmission in a sample of 30 patients (12 women, 18 men) with non-affective psychosis, which had entered the acute unit of HUMV from 1st January to 30th September 2016 because of psychotic decompensations and had been treated with long-acting injectable aripiprazole 400 mg.

Out of the 30 patients there were five readmissions during the observation time. Two of them for psychotic decompensation, two because of premature abandonments, with oral aripiprazole supplementation and the last one because of desertion of injectable drug. No gender differences were observed.

It is necessary 15 days of oral supplementation before and after the first dose of long-acting injectable aripiprazole to ensure that adequate therapeutic levels are achieved and to avoid readmissions by misuse of the drug. One of the limitations encountered in this work would be the small sample size and limited observation time. A longer-term research may allow to find more scientific evidence to clarify the clinical safety and efficacy of long-acting injectable aripiprazole in patients with non-affective psychosis.

The authors have not supplied their declaration of competing interest.

Neurosarcoidosis is an uncommon cause of psychosis. It courses with an affectation of the brain, the spinal cord and other areas of the nervous system. It associates both neurological and psychiatric symptoms: cranial mononeuropathy, myelopathy or radiculopathy meningitis, neuroendocrine dysfunction, dementia, delusions, hallucinations.

To review in Pub-Med about neuropychiatric manifestarions of neurosarcoidosis.

We describe the case of 60-year-old woman diagnosed with long evolution schizoaffective disorder with a recent decompensation in the context of a stressful situation. As somatic background to highlight: cognitive impairment (encephalic bilateral and symmetrical frontal atrophy in cranial magnetic resonance) and a probable sarcoidosis with hilia and mediastinal lymph nodes without histologic confirmation. She was hospitalized at the acute care unit because of a descompensation of her schizoaffective disorder. The patient was distressed, with delirious speech, sensoperceptive hallucinations, hypothymia and weigth loss.

Firstly we evaluate the lack of clinical improvement with an anti-psychotic drug in previous hospitalizations. For that reason, we thought in organic mental disorder as an alternative diagnosis. We started treatment with corticosteroids in spite of we did not observe a decompensation of sarcoidosis. In a few days it was remarked a clinical improvement and remission of the delusional and affective clinic.

It is needed to complete the study and continue the monitoring of the patient to see the evolution and drug response. The diagnosis of neurosarcoidosis should be kept in mind for patients with both neurologic and psychiatric symptoms.

The authors have not supplied their declaration of competing interest.

Intramuscular paliperidone palmitate (PLAI) is a long-acting atypical anti-psychotic approved in Romania for the maintenance treatment of adults with schizophrenia.

To determine the efficacy and tolerability of PLAI in a non-compliant patient with previously very low tolerability to oral anti-psychotics. The patient had been on risperidone long acting injection (RLAI) and had significant adverse events (i.e. tremor, akatisia) which persisted even when treated with the lowest dose of PLAI: 50 mg.

Since the efficacy of PLAI was good, and since a lower dose (than 50 mg of PLAI) is not available in Romania, we tried different ways to lower plasma concentration (PC) of the anti-psychotic because the patient presented clinically significant adverse effects (AE).

Initially the time between the injections was extended at maximum recommended (35 days), with a slight effect, then an off label treatment was associated in order to lower the PC of PLAI. We used 300 mg of carbamazepine long acting, that may lower the PC of PLAI up to 30%. For the evaluation of the efficacy and tolerability, we applied: the clinical evaluation, the positive and negative syndrome scale, the Barnes Akathisia rating scale, the Simpson-Angus Scale and the abnormal involuntary movement scale.

After using the above mentioned, strategies, the one that had indeed good results on reducing AE, with no alteration of the psychic status of the patient, was the association of carbamazepine.

In clinical practice, some off label medication associations may be salutary!

The authors have not supplied their declaration of competing interest.

To monitor if the early intervention services (EIS) in Sandwell meet the standard of assessing all patients referred to the team within the set target. To monitor factors that affects the outcome including the source of referral, whether the patients, are known to another team, and the demographic features of the patient.

Providing timely, appropriate and coordinated care for patients presenting with a first episode of psychosis has been a focus for EIS teams to improve outcomes, experiences and in reducing costs. In April 2016, new target times of 5–10 days for referral-to-assessment and 14 days for referral-to-treatment were introduced by the government.

All the referrals that were made since 01/04/2016 were followed up. A comparison was made with the referral-to-assessment and referral-to-treatment target for referrals made before the 01/04/16.

There has been an increase in referrals. Preliminary evidence gathered suggests that there has been a marked improvement in the referral-to-assessment pathway and referral-to-management pathway. Patients referred to the EIS are offered an earlier assessment. Majority of the referrals made are however not appropriate to receive care from the EIS, and are not taken on by the team. All the patients that are accepted by the team are offered a NICE treatment package. Most of the referrals that come from other EIS teams or wards, are accepted by the team, at least for an extended assessment. Referrals from Children services are usually at the point when they are due to turn 18, for a second opinion.

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

The treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.

To know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.

We retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.

A total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.

Second-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.

The authors have not supplied their declaration of competing interest.

Clinical high risk (CHR) for psychosis state is characterized by presence of potentially prodromal for schizophrenia symptoms. The aim of this study was to assess the predictors of transition to first psychotic episode.

The study included 123 CHR subjects. All the subjects were characterized by the presence of one of the group of criteria: (1) UHR criteria, (2) basic symptoms criteria and (3) negative symptoms and formal thought disorders (FTD). The presence of FTD in clinical high-risk individuals was assessed with methods of experimental pathopsychology. The mean length of follow-up was 26 months (SD 18). All subjects were males, mean age = 20.2 (SD: 2.1). We examined the subjects’ performance using the Cambridge automated neuropsychological test battery. We applied survival analyses to determine associations between a transition to psychosis and sociodemographic, clinical and neurocognitive parameters. To determine which items are the best predictors, Cox regression analyses were applied.

The psychosis developed in 39 subjects (31.7%). Global assessment of functioning, positive symptoms, blunted affect, social isolation, impaired role function, disorganizing/stigmatizing behavior, basic symptoms (thought pressure, unstable ideas of reference), neurocognitive parameters (visual memory and new learning, decision making, executive function) significantly influenced the transition to psychosis. A prediction model was developed and included unusual thought content (Wald = 12.386, P < 0.0001, HR = 2.996), perceptual abnormalities (Wald = 4.777, P = 0.029, HR = 1.43) and impaired role function (Wald = 1.425, P < 0.028, HR = 4.157).

Clinical measures are important predictors for transition to psychosis in high-risk individuals.

The authors have not supplied their declaration of competing interest.

Diogenes syndrome was first described in 1975 by Clark to characterize the behavioral disorder in the elderly involving neglect of personal and domestic hygiene and a hoarding disorder or hoarding. He is regarded as a psychiatric disorder in its own right in the DSM V and declines criteria compulsive hoarding disorder (“Hoarding Disorder”). The condition is under diagnosed or its prevalence is important from 3.3 to 4, 6%.

Study through two clinical, etiologic and psychopathological diogenes syndrome (DS) and the main diagnostic and therapeutic difficulties.

Mrs. L. is 57 years old, without children and with a degree in political science. She was taken back by his partner for behavioral disorder type of pathological accumulation of objects. His home has become inaccessible due to the accumulation of multiple stacks of magazines and other items. The meeting allowed to objectify an incurique presentation, delusional and hallucinatory syndrome.

Mrs. BH aged 67, retired, widowed for 17 years. She lives alone after the suicide of his daughter. This would be followed by breast cancer. The patient was admitted following a report of neighbors who discovered that Mrs. BH, isolated for months, sleeping in the garden of her home saw the unhealthy state of the place and the accumulation of waste.

Diogenes syndrome is heterogeneous, covering multiple medical, psychiatric and social situations. Its pathogenesis remains poorly understood and its management refers to any clinician can examine ethical questions the legitimacy of its actions.

The authors have not supplied their declaration of competing interest.

Experiences of depression and anxiety are common among patients with persecutory delusions. It has been theorized that emotional disturbances affect the formation and appraisal of persecutory delusions directly and possibly via increasing the sense of aberrant salience.

Using a time-lagged analysis of experience sampling data, this study modelled the role of momentary levels of negative emotions and aberrant salience in maintaining persecutory delusions in patients with active delusions.

Clinically acute participants with at least a mild level of persecutory delusions were assessed using experience sampling method (ESM; 7 entries per day for 14 days) and clinical rating scales. ESM data of participants who completed at least 30 ESM entries were analysed by using multilevel regression modelling.

The final sample consisted of 14 participants, with a total of 1161 momentary observations. Time-lagged analysis revealed that both negative emotions (B = 0.125, P = .009) and aberrant salience (B = 0.267, P< .001) predicted an increase in persecutory delusions in the next moment. Conversely, persecutory delusions did not predict change in negative emotions or change in aberrant salience in the next moment (ps> .05). Negative emotions also predicted an increase in aberrant salience in the next moment (B = 0.087, P = .009).

Our results supported the hypothesis that both negative emotions and aberrant salience exacerbate persecutory delusions, rather than being merely the sequelae of the symptoms. Our results suggested both direct and indirect (via aberrant salience) pathways from negative emotions to persecutory delusions.

The authors have not supplied their declaration of competing interest.

Delayed post-hypoxic leukoencephalopathy (DPHL) is an underrecognized syndrome of delayed demyelination, where patients manifest neuropsychiatric symptoms after a period of 2–40 days of apparent recovery from a cerebral hypo-oxygenation episode.

We report a case of a patient who successfully recovered from an overdose of heroin, but then suffered a delayed abrupt neurological deterioration.

To improve assessment and recognition of DPHL.

An adequate retrospective collection of clinical data and nonsystematic review of the literature was performed.

A 43-year-old male with schizoaffective disorder who attempted suicide with an overdose of heroin, was successfully revived and return to his previously mental status, but 3 weeks after, he abruptly developed progressive cognitive impairment with akinetic mutism and ataxia. He was admitted to our acute psychiatric unit after brain CT and chemistry analyses were unremarkable. Brain MRI showed diffusely symmetric hyperintensity in the white matter (WM), pronominally the periventricular WM, on FLAIR and T2 weighted sequences. At 16 weeks postoverdose, he presented improvement both cognitive and motor symptoms, lasting deficits in frontal-executive functions.

DPHL is characterized by similar clinical and neuroimaging features regardless of the initial insult. The mean lucid interval coincides with the replacement half-life for myelin related lipids and proteins. Prolonged mild-to-moderate hypo-oxygenation of WM is thought to disrupt myelin turnover. It appears probable that these were responsible for DPHL in our patient rather than a direct toxicity.

DPHL can be diagnosed when clinical history, laboratory assessments and MRI findings are concordant. DPHL requires extensive support care and carries a relatively good prognosis.

The authors have not supplied their declaration of competing interest.

Some have suggested that terrorists are mentally ill and have used labels such as psychopathic or sociopathic, narcissistic, paranoid, are schizophrenic types, or passive–aggressive. Others have argued that although terrorist actions may seem irrational or delusional to society in general, terrorists in fact, act rationally, and there is no evidence to indicate that they are mentally ill/disordered, psychopathic or otherwise psychologically abnormal.

Here we present the case of Mr. A, a 32 year old man diagnosed with schizophrenia, who travelled to Egypt and Syria in attempt to join the ISIS terrorist organization, and discuss the clinical features, treatment processes and two years follow-up of this particular case.

As described in some studies, most terrorists do not demonstrate serious psychopathology and there is no single personality type. Thus, the relationship between terrorism and mental illness mostly refers to the question about pathological travel as part of a religious and messianic delirium.

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