The Personal and Social Performance scale (PSP) is widely used to assess social functioning with 4-domain scores and a global score in patients with schizophrenia. However, internal and external responsiveness of the PSP is largely unknown limiting its use as an outcome measure.

The purpose of this study was to examine internal and external responsiveness of the PSP in inpatients with schizophrenia receiving treatments in the acute phase.

Eighty patients were conducted the PSP and the Clinical Global Impression-Severity (CGI-S) at admission and at discharge. The standardized effect size (ES), the standardized response mean (SRM), and paired t-test were used for examining internal responsiveness. We estimated correlations between the changes in scores of the PSP and those of the CGI-S using Pearson's r for investigated external responsiveness.

For internal responsiveness, the ESs and the SRMs of the domains were 0.74–1.74 and 0.68–1.72, respectively. The values of the ES and the SRM in the global score were 1.72 and 1.74, respectively. The paired t-tests showed statistically significant difference (P < 0.001) for the score changes of the four domains and the global score. Regarding external responsiveness, fair and moderate to good correlations (r = 0.35–0.74) were found among the changes in the 4-domain scores and the global score with the those of the CGI-S.

The PSP has sufficient internal responsiveness and substantial external responsiveness in inpatients with schizophrenia receiving treatments at the acute wards. The PSP is useful as an outcome measure for detecting changes of social functioning over time.

The authors have not supplied their declaration of competing interest.

Cognitive deficits in schizophrenia significantly affect illness and community outcomes, and quality of life. Several studies support the neuroprotective properties of polyphenolic compounds resulting in neuronal protection, suppression of neuroinflammation and the potential to promote memory, learning and cognitive functions. Bergamot differs from other citrus fruits for flavonoids and flavonoid glycosides composition (neoeriocitrin, neohesperidin, naringin, rutin, neodesmina, roifolina and poncirina), and for their high amount. For these features, BPF may represent a potential supplement for improving cognitive functions.

The present study was aimed to explore the efficacy of BPF supplementation on clinical symptoms andcognitive functioning in a sample of schizophrenic subjects receiving atypical antipsychotics (APs).

Ten schizophrenic outpatients treated with atypical APs assumed BPF at the oral daily dose of 1000 mg/day for 30 days. Brief Psychiatric Rating Scale, Wisconsin Card Sorting Test, Verbal Fluency Task-Controlled Oral Word Association Test, and Stroop Color-Word Test were administered.

The results obtained indicate that BPF administration substantially improved WCST performances (perseverative responses, P = 0.008; perseverative errors, P = 0.012; total errors, P = 0.011; categories, P = 0.023). Moreover, a trend for others clinical (BPRS) and cognitive variables (Verbal Fluency Task-Controlled Oral Word Association Test, and Stroop Color-Word Test) decrease was observed.

The findings provide evidence that BPF administration may be proposed as an effective therapeutic strategy to improve cognitive outcome in schizophrenia. Further clinical trials with adequately powered and well-designed methodology are needed to better explore the BPF effectiveness on cognitive impairments in schizophrenic patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To compare the efficacy, safety, and tolerability of MIN-101, a compound with high affinities for sigma 2 and 5-HT 2A receptors, to placebo in treating negative symptoms, in stabilized patients with schizophrenia.

This multi-national phase 2b trial enrolled 244 patients with schizophrenia who were symptomatically stable for ≥ 3 months prior to entering the trial and had scores ≥ 20 negative subscale of the PANSS. Patients were randomized to monotherapy with MIN-101 32 mg/day, MIN-101 64 mg/day or placebo in a 1:1:1 ratio. The primary endpoint was the PANSS negative symptom score based on the five factors (pentagonal) model.

Statistically significant reduction in the primary endpoint score was demonstrated for MIN-101 32 mg and 64 mg compared to placebo (P ≤ 0.022, ES 0.45 and ≤ 0.003, ES 0.58, respectively). This was supported by similar effects on most of the secondary measurements including: the PANSS three factors negative symptoms subscale, PANSS total score, CGI, BACS, CDSS, and PSP. There were no statistically significant differences in PANSS positive subscale scores between MIN-101 and placebo. No weight gain or clinically significant changes in vital sings, prolactin levels, routine laboratory values, metabolic indices and extrapyramidal symptom scores (EPS) were observed.

Since positive symptoms and EPS did not change, the improvement in negative symptoms was not secondary to improvement in positive symptoms or EPS, suggesting that MIN-101 might be the first specific treatment to have a direct effect on negative symptoms.

I have received consultant fees from Minerva Neuroscience the sponsor of this trial and own stock of Minerva Neuroscience

Adherence and tolerance to treatment are important factors, which may predict the long-term evolution of a psychosis. Family members may influence prognosis by modulating emotional expressivity and treatment supervision.

To assess the role of family members in the long-term evolution of psychoses.

The present study is retrospective, conducted on patients with psychosis. Data were obtained from psychiatric records extending for a period of four years. The following parameters were analyzed: socio-demographic data, family relationships (parents, spouses) and clinical/evolutive data (onset age for psychosis, number of recurrences).

We analyzed 71 patients, 42 (59.2%) women and 29 (40.8%) men with a mean age of 30.38 years (SD = 9.33). The subjects were diagnosed according to ICD 10 criteria with acute and transient psychotic disorder (50 patients, 70.4%), schizophrenia (13 patients, 18.3%), and schizoaffective disorder (8 patients, 11.3%). Patients who reported conflicts between parents had significantly more recurrences (t = –2.1, P = 0.04), while those who reported satisfactory relationships in their family of origin had fewer recurrences (t = 2.58, P = 0.01) and a later onset age (t = –2.89, P = 0.006). Unmarried/single subjects had the psychosis onset at a significantly earlier age (t = 4.72, P = 0.0001). In addition, these patients had more conflicts between parents (Z = –2.02, P = 0.04) in comparison with married ones.

Conflicts in the family of origin may predispose to a greater number of recurrences and to an earlier disorder onset. The presence of a spouse may represent a protective factor.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a chronic disorder with an early onset and high disease burden in terms of life disability. Its early recognition may delay the resulting brain structural/functional alterations and improve treatment outcomes. Unlike conventional group-statistics, machine-learning techniques made it possible to classify patients and controls based on the disease patterns on an individual level. Diagnostic classification in first-episode schizophrenia to date was mostly performed on sMRI or fMRI data. DTI modalities have not gained comparable attention.

We performed the classification of 77 FES patients and 77 healthy controls matched by age and sex from fractional anisotropy data from using linear support-vector machine (SVM). We further analyzed the effect of medication and symptoms on the classification performance using standard statistical measures (t-test, linear regression) and machine learning (Kernel–Ridge regression).

The SVM distinguished between patients and controls with significant accuracy of 62.34% (P = 0.005). There was no association between the classification performance and medication nor symptoms. Group level statistical analysis yielded brain-wide significant differences in FA.

The SVM in combination with brain white-matter fractional anisotropy might help differentiate FES from HC. The performance of our classification model was not associated with symptoms or medications and therefore reflects trait markers in the early course of the disease.

The authors have not supplied their declaration of competing interest.

Evidence from meta-analyses of randomised clinical trials shows interventions for young people at ultra-high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England.

A self-report online survey was completed by clinical leaders of Early Intervention in Psychosis (EIP) teams (n = 50) within the NHS across the UK.

Of the 50 EIP teams responding (from 30 NHS Trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14–5 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by CAARMS, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression.

Despite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia.

The authors have not supplied their declaration of competing interest.

The effects of chronic antipsychotic administration on the human brain are debated. In particular, first-generation (FGAs) and second-generation antipsychotics (SGAs) seem to have different impacts on brain function and structure in subjects with schizophrenia. Few studies have investigated the effect of chronic administration of FGAs and SGAs on indices of brain function, such as event-related potentials (ERP) or neuropsychological performance.

Within the Italian Network for Research on Psychoses study, subjects stabilized on FGAs or SGAs were compared on P300, an ERP component, thought to reflect attention, working memory and context integration and on neurocognitive indices.

ERPs were recorded in 110 chronic, stabilized patients with Schizophrenia (28 used FGAs) during a standard auditory oddball task. P300 latency and amplitude were assessed at Pz channel. MATRICS Consensus Cognitive Battery (MCCB) was used for cognitive assessment.

Compared with the SGAs group, patients on FGAs showed significant increased P300 latency (P = 0.003; Cohen's d = 0.67) and significant decreased P300 amplitudes (P = 0.023; Cohen's d = 0.38). The two groups did not differ on psychopathology and MCCB scores. Multiple linear regressions revealed that “FGAs vs. SGAs” (β = 0.298, P = 0.002) and MCCB neurocognitive composite T-score (β = –0.273, P = 0.004) were independent predictors of P300 latency, whereas only age (β = –0.220, P = 0.027) was an independent predictor of P300 amplitude.

FGAs seem to affect the functional brain activity more than SGAs, particularly slowing cortical processing. Our results suggest that discrepant findings concerning P300 latency in schizophrenia might be related to the type of antipsychotic treatment used. Longitudinal studies are needed to further address this issue.

The authors have not supplied their declaration of competing interest.

Resilience is commonly defined as positive adaptation to adverse events or as the ability to maintain or regain mental health after exposure to difficulties. According to the bio-psycho-social model, resilience is influenced by self-esteem, coping strategies and personality traits. In schizophrenic patients, resilience seems to affect real-life functioning, while in mood disorders, resilience influences the longitudinal course of the disorder, reducing the frequency of relapses and improving drugs response.

The aim of this study is to asses levels of resilience and self-esteem, coping strategies, perceived quality of life and temperament characteristics in a sample composed by patients with major depressive disorder and patients affected by schizophrenia.

We collected a sample composed by 40 patients with major depressive disorder and 40 patients affected by schizophrenia patients recruited at the “Maggiore della Carità” Hospital in Novara, Italy. The assessment protocol included: Resilience Scale for Adults (RSA), Coping Orientation to Problems Experienced Inventory–Brief (BRIEF–COPE), Rosenberg Self-esteem Scale (RSES), Paykel List Of Stressful Events, Temperamental and Character Inventory (TCI) and Short form 36 (SF-36). Comparison of qualitative data was performed by means of the χ2, a t-test was performed for continuous normal-distribution variables otherwise a non-parametric Mann–Whitney test was performed. Statistical significance was set at P ≤ 0.05.

In patients with major depressive disorder resilience were associated with a good self-perception of physical and mental health, higher self-esteem levels and problem-focused/emotion focused coping strategies. In schizophrenic patients, sample there was no positive correlation between resilience and perceived quality of life. Further implications will be discussed.

The authors have not supplied their declaration of competing interest.

This meta-analysis investigates if dose increase of an antipsychotic drug (high-dose treatment, dose escalation) is advantageous for schizophrenic patients who failed to respond adequately to standard-dose treatment with the same antipsychotic.

Within a systematic literature survey, we identified all randomized controlled trials (RCTs) comparing a dose increase directly to standard-dose continuation treatment in schizophrenic subjects with initial non-response to prospective standard-dose pharmacotherapy with the same antipsychotic. The primary outcome was mean change in the Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcomes were dichotomous response and attrition rates. Study selection and data extraction were conducted independently by two authors. We calculated effect sizes (Hedges's g and risks ratios) using the Mante–Haenszel random-effects model. Meta-regression analyses were performed to explore the influence of the degree of the dose increase on effect sizes.

Five trials (n = 348) examining quetiapine (n = 2, n = 191), ziprasidone (n = 1, n = 75), haloperidol (n = 1, n = 48), and fluphenazine (n = 1, n = 34) were included. We found no significant between-group differences for the mean PANSS/BPRS total score change, even not when itemized according to the individual antipsychotic agents. There were no between-group differences for response and dropout rates. The non-significant meta-regressions indicate no impact of the different amounts of dose increments on effect sizes.

We found no evidence for the efficacy of a dose escalation after initial non-response to standard-dose pharmacotherapy as general advisable treatment strategy. As the high-dose treatment was not accompanied by significant increased attrition rates, appropriate tolerability and acceptability of this pharmacological option can be assumed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The primary purpose of this study is to evaluate the degree of impairment of decision-making capacity in schizophrenia patients compared to non-mentally-ill controls, as determined by the MacCAT-CR instrument.

We analyzed the results obtained from three databases: ISI Web of Science, Pubmed, and Scopus. Each database was scrutinized using the following keywords: “MacCAT-CR + schizophrenia”, “decision-making capacity + schizophrenia”, and “informed consent + schizophrenia.”

We included ten studies in the analysis. Even if schizophrenia patients have a significantly decreased decision-making competence compared to non-mentally-ill controls, they should be considered as competent unless very severe changes are identified during the clinical examination. Using enhanced informed consent techniques significantly decreased the difference between schizophrenia patients and non-mentally-ill controls (except for the reasoning dimension), and should be employed whenever the investigators want to include more severe patients in their clinical trials. Older age, an increased percentage of men gender or inpatient status tend to escalate the score difference of decision-making competence compared to non-mentally-ill subjects in various dimensions of the decision-making capacity. The main limitations of the study are: (1) a decreased number of studies included in the analysis is small (2) only three studies included data about enhanced ways of informing potential subjects.

The authors have not supplied their declaration of competing interest.

Early intervention programs in psychosis have demonstrated efficiency in reduction the duration of untreated psychosis, relapse prevention, socio-professional integration and prognosis improvement. In daily practice, it is evident the clinical heterogeneity of the first episodes of psychosis (FEP), as well as the difficulty in initially assigning a specific diagnosis, being difficult to do the differential diagnosis and verifying, during follow-up, very different clinical outcomes among patients.

Two years after the start of specific consultation for FEP, the authors intended to characterize the followed patients and their evolution, comparing socio-demographic and clinical parameters, with emphasis on diagnosis at the first visit and after two years assessing their variability/stability.

Data research from a 48 patients sample followed up on the FEP consultation.

The diagnostics on the first consultation were 79% psychosis with no other specification (NOS), followed by cannabinoids addiction in 35%. After two years, in 29% of cases, there was a diagnostic change being actually 46% Psychosis NOS, 21% cannabinoids addiction and 17% schizophrenia. Initially, only 39% did not have previous history of toxic substances use, being 75% the current percentage. Six percent abandoned the consultation.

The authors conclude that, in this specific psychiatry consultation, it is important to initially keep an unspecified diagnostic, with further progressive evaluation allowing a more accurate diagnostic, since the initial diagnostic specification is often found to be incorrect, with adverse consequences for the patient. It would be useful to compare the results with a sample of patients under “as usual” treatment.

The authors have not supplied their declaration of competing interest.

Neurobiological models of auditory verbal hallucination (AVH) have been advanced by symptom capture functional magnetic resonance imaging (fMRI), where participants self-report hallucinations during scanning. To date, regions implicated are those involved with language, memory and emotion. However, previous studies focus on chronic schizophrenia, thus are limited by factors, such as medication use and illness duration. Studies also lack detailed phenomenological descriptions of AVHs. This study investigated the neural correlates of AVHs in patients with first episode psychosis (FEP) using symptom capture fMRI with a rich description of AVHs. We hypothesised that intrusive AVHs would be associated with dysfunctional salience network activity.

Sixteen FEP patients with frequent AVH completed four psychometrically validated tools to provide an objective measure of the nature of their AVHs. They then underwent fMRI symptom capture, utilising general linear models analysis to compare activity during AVH to the resting brain.

Symptom capture of AVH was achieved in nine patients who reported intrusive, malevolent and uncontrollable AVHs. Significant activity in the right insula and superior temporal gyrus (cluster size 141 mm3), and the left parahippocampal and lingual gyri (cluster size 121 mm3), P < 0.05 FDR corrected, were recorded during the experience of AVHs.

These results suggest salience network dysfunction (in the right insula) together with memory and language processing area activation in intrusive, malevolent AVHs in FEP. This finding concurs with others from chronic schizophrenia, suggesting these processes are intrinsic to psychosis itself and not related to length of illness or prolonged exposure to antipsychotic medication.

The authors have not supplied their declaration of competing interest.

Antipsychotics are associated with the polymorphic ventricular tachycardia, Torsade's de pointes, which in worst case can lead to sudden cardiac death. The QTc interval is used as a clinical proxy for Torsade's de pointes. QTc interval is prolonged by monotherapy with antipsychotic, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmacy.

To investigate the associations between QTc interval and antipsychotic mono- and polypharmaceutical treatment, respectively, in schizophrenic patients.

To learn more about the impact of antipsychotics on the QTc interval.

An observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the Region of Central Jutland, Denmark. Patients were enrolled from January 2013 through March 2015 with follow-up until June 2015. Data was collected from clinical interviews and clinical case records.

ECGs were available in 58 patients receiving antipsychotic treatment. We observed no difference in average QTc interval for the whole sample of patients receiving monotherapy or polypharmacy (P = 0.29). However, women presented longer QTc-interval on polypharmacy than on monotherapy (P = 0.01).

We recommend an increased focus on monitoring the QTc interval in woman with schizophrenia receiving antipsychotics as polypharmacy.

The authors have not supplied their declaration of competing interest.

Patients with schizophrenia commonly show deficits in executive functioning that allow a person to make plans, solve problems, do many tasks simultaneously and adapt to unexpected conditions. Executive dysfunction is associated with very simple and automatic activities, such as walking in schizophrenia patients. However, no study exists about its relation to postural control in these patients.

To investigate the effect of executive functioning on postural control using dual task paradigms.

Fifteen clinically stable schizophrenia outpatients and 15 healthy controls were enrolled in the study. Postural control was assessed with bilateral stance test using the Balance Master system under three different conditions with eyes open and eyes closed (EC): without a task, during a cognitive task (verbal fluency) and during a motor task (holding a cup of water).

Standing on a foam surface with EC resulted in higher postural sway velocities in schizophrenia patients under all conditions (P = 0.009, P = 0.032, P = 0.013). During a cognitive task, both schizophrenia patients and healthy controls showed higher velocities on firm surface with EC in comparison to the condition without a task (P = 0.023). Both schizophrenia patients and healthy controls did not show higher postural sway velocities during the motor task.

The effect of verbal fluency on postural sway shows the relationship between executive functioning and postural control in schizophrenia patients. Foam surface also higher postural sway velocities in schizophrenia patients in EC condition suggesting the difficulties in integrating the proprioceptive information in the absence of visual input.

The authors have not supplied their declaration of competing interest.

To reach not only clinical but also rehabilitation (especially to improve psychosocial functioning) goals in people with schizophrenia is a need.

To know the retention in treatment and functional outcomes of patients with severe schizophrenia enrolled in a specific and comprehensive programme for 7 years.

A 7-year prospective, observational study of patients with severe schizophrenia (CGI-S of 5 or over) undergoing comprehensive programme (n = 200). Assessment included at the beginning and after 3, 6, 12, 24, 36 and 84 months: the CGI-S, the Camberwell Assessment of Needs (CAN) and the WHO-DAS. Time in treatment, reasons for discharge, laboratory tests, weight, medications, adverse effects and hospital admissions in the previous six years and during the follow-up were registered.

CGI at baseline was 5.9 (0.7). After seven years, 44% of patients continued under treatment (CGI = 4.3 (0.8); P < 0.01); 36% were medical discharged (CGI = 3.4 (1.5); P < 0.001); WHO-DAS decreased in the four areas (P < 0.005) and also CAN (P < 0.01); 8% were voluntary discharges. Ten patients dead; three of them committed suicide (1.5%). Hospital admission decreased significantly (P < 0.001), and also antipsychotic combinations and antiparkinsonian medications. Fifty-five percent of all of them were treated with atypical long-acting antipsychotics, with good tolerability and few side effects (among them, only 4% were voluntary discharges).

Retention of patients with schizophrenia with severe symptoms and impairment in a specific and comprehensive programme was really high. Such good treatment adherence helped to get remarkable clinical and functional improvement. Long-acting medication seemed to be useful in improving treatment adherence.

The authors have not supplied their declaration of competing interest.