Chronic diseases such as childhood diabetes mellitus constitute a challenge for both the affected children and their families. Childhood diabetes mellitus is characterized by complex therapeutic management and has a profound physical and psychological impact on the whole family and a number of losses for the parents.

To recognize and quantify the factors affecting shame feelings for parents of children with diabetes mellitus.

A cross-sectional design was performed. A sample of 316 parents (110 men–206 women, mean age 40.6 years, SD = 6.0 ranged 17–57) participated to the present study. The questionnaire included: (a) social-demographic characteristics, (b) The Other As Shamer Scale (OAS), (c) The Experience of Shame Scale (ESS). SPSS for Windows 20.0 was used for the statistical analysis.

Age and the place of residence of the parents, the duration and the severity of disease were identified as significant multivariate factors on internal and external shame.

Feeling of shame consist a significant psychological burden of the parents with children suffering from diabetes mellitus. Screening for psychological distress in parents of children is indicated, and preventive interventions are needed, targeted according to the increased needs as suggested in the research results.

The authors have not supplied their declaration of competing interest.

It is reported in global literature that Chronic Obstructive Pulmonary Disease (COPD) may cause a wide range of psychological effects, some of them not fully explored. The aim of this study is to investigate if patients with COPD experience intense feelings of shame.

To find differences in shame experience between males and females, and if there is a correlation of shame with other socio-economic factors.

Using the “Experience of Shame Scale” questionnaire (ESS) in 191 patients with COPD (104 men and 87 women) treated in Primary Health Care services in Greece.

Statistical analysis showed relatively low scores (M 39.5 sd 14.9) for the experience of shame in COPD patients. There is no statistically significant difference of shame for marital status, education level or disease stage. Statistically significant difference shown between males and females (bodily shame P: 0.001, total shame P: 0.031), and between smokers and those who quit smoking. (characterological shame: P: 0.007 behavioral shame P: 0.030, total shame P: 0.009). Also statistically significant difference appears for bodily shame among Body Mass Index (BMI) groups (P: 009) and economic status of the patients (P: 0.008).

Patients with COPD seem to have not heavy burden with experience of shame. Any associations of shame with some patient groups are rather expected for cultural and social reasons.

The authors have not supplied their declaration of competing interest.

Suicide is a major public health issue.

Mentalization is a form of imaginative mental activity about others or oneself that may shed light on the phenomenology of suicide.

To assess the role of a number of variables in suicide risk.

Participants were 156 (73 men and 83 women) adult psychiatric inpatients (age range = 18/74 year). Most of the patients had a major mood disorder (26.3% BD-I, 3.2% BD-II, and 11.5 MDD), psychosis (16.7%), or a schizoaffective disorder (20.5%). All the patients were administered the Mini International Neuropsychiatric Interview (MINI) for assessing diagnosis and suicide risk, and the Impact of event scale, Mentalization Questionnaire, Childhood Trauma Questionnaire. Some patients (18.6%) were admitted for a recent suicide attempt and 34.6% had attempted suicide in the past.

At the MINI, 44.9% of the patients resulted at a moderate to high risk of suicide, and 55.1% at no or low risk of suicide with no difference for sociodemographic variables (sex and age) and diagnosis, but they differed for mentalization and symptoms of intrusions and avoidance caused by a traumatic event. Groups also did not differ for self-reported childhood trauma. Only mentalization was independently associated with higher suicide risk, and patients with moderate to severe risk of suicide were 1.7 times more likely to report more mentalization deficits than those with no or low risk of suicide.

Our study supports the notion that the investigation of mentalization among patients may help in proper assessment of suicide risk.

The authors have not supplied their declaration of competing interest.

The psychotherapeutic unit for psychotic patients in Psychiatric hospital Sveti Ivan, Zagreb, Croatia provides psychotherapeutic and psychosocial treatment for mostly young psychotic patients. Psychotherapeutic program has basically psychodynamic frame and patients participate in small and medium groups. Also, they participate in workshops based on cognitive behavioral principles (anti-stigma, self-concept, emotion, relationships, goals, stress), psycho-education, therapeutic community, work and occupational therapy, recreational therapy.

The aim of this study was to determine effectiveness of this comprehensive program during hospitalization of individuals with first psychotic episode on psychotherapeutic ward. We evaluated the possible changes during treatment in attitudes towards drugs, in quality of life, insight and self-esteem.

Participants were 37 individuals with first psychotic episode, average age: 25.1. They fulfilled: Drug attitude inventory (DAI-10), The World Health Organization Quality of Life (WHOQOL), Insight scale and Rosenberg's Self-Esteem Scale at the beginning of treatment and at discharge from the hospital.

Results show tendency of more positive attitude towards drugs at discharge, as well as tendency of better self-esteem, statistically significant more satisfaction with physical health (P = 0.004), psychological health (P = 0.004) and with environment (P = 0.001), and statistically significant better quality of life (P = 0.000). There was no significant difference in insight.

During psychotherapeutic treatment of individuals with first psychotic episode, positive changes were observed. So, our findings indicate importance of implementing such a comprehensive program in treatment.

The authors have not supplied their declaration of competing interest.

A stigmatizing attitude towards psychiatry and psychotherapy still prevails in Lithuania. It is evidenced by a variety of patterns, especially by a controversial social opinion about a person suffering from mental disorders.

To investigate the experiences of students in Psychiatry and General Practitioner Residency studies and those in Bachelor's and Master's degree programs of Psychology who during their clinical psychiatric practice joined a multi-professional team at the Stress Related Disorders Department as temporary members; and to analyse how their attitude towards psychotherapy changed in the process.

To analyse students’ feedback about their experiences and involvement into the activity of the multi-professional team at the Stress Related Disorders Department (day care) during their clinical psychiatric practice.

Qualitative research methods based on phenomenological sociology were employed in the study. Students responded to five questions in writing during interview. Collected qualitative research material was analysed while applying content analysis.

Eighteen subthemes were obtained and they were matched with the following nine main thematic codes: (1) past, present, future; (2) difficult beginning: “birth”; (3) childbirth pain; (4) childhood challenges; (5) birthing team; (6) adulthood; (7) mourning; (8) joining the team; and (9) future prospect.

Clinical psychiatric practice develops a multidisciplinary attitude towards psychiatry including both pharmaceutical and non-pharmaceutical treatment while using individual and group psychotherapy. Significant experience and attitude of health care students changed during clinical psychiatric practice as they acquired deeper understanding of the meaningfulness of psychotherapy.

The authors have not supplied their declaration of competing interest.

Psychopathology rating scales have been widely used. Studies evaluating the congruence between self and observer-reported ratings show inconsistent results.

Determine whether there was consistency between psychopathology as assessed by patients and clinicians’ assessment in outpatients observed in the Young Adult Unit of our Psychiatry Department (Coimbra Hospital and University Centre-Portugal).

Socio-demographic characterization was undertaken with young adult outpatients observed during nineteen months (1st January 2015–31st July 2016). Brief Symptom Inventory–53 items (BSI-53) and Brief Psychiatric Rating Scale (BPRS) were applied at the first clinical evaluation. Spearman correlation coefficient between General Severity Index (GSI) of BSI-53 and BPRS total score was calculated.

During the mentioned interval 255 outpatients were observed: 64.3% females and 35.7% males; aged between 17 and 39 years old (average: 20.56; median: 20). Fifty percent were diagnosed with neurotic, stress-related and somatoform disorders (ICD-10 F40-48) and 14.1% with mood disorders (ICD-10 F30-39). BPRS and BSI-53 rating scales were administered to 55 patients: 72.5% females and 27.5% males; average age 21.2. A statistical significant correlation was found between BPRS total and GSI score.

Several factors can determine the accuracy of psychopathology self-assessment, including diagnosis and severity of illness. In fact, studies show strong correlation between self and observer assessment of depressive and anxious psychopathology, but no correlation in psychotic psychopathological dimensions. Therefore, the correlation found in this population can be explained by the fact that the majority of patients were diagnosed with neurotic, stress-related and somatoform and mood disorders.

The authors have not supplied their declaration of competing interest.

Executive dysfunctions in psychotic disorders, mainly schizophrenia are well-known phenomenon, however the information about executive functioning in subclinical psychotic states are still scarce. The rationale for focusing on the delusion-proneness (delusion-like states) is suggested role of executive dysfunction in the process of developing delusions.

Our aim is to assess the relationship between delusion-proneness and executive functions.

We would like to assess two cognitive functions: shifting and inhibition and updating, depending on the severity of delusion-like symptoms. We expect that higher delusion-proneness is associated with more pronounced executive dysfunctions, as it is observed in clinical population with existing delusions.

In order to assess delusion-proneness, we used Polish version of Peters et al. Delusions Inventory (PDI). To evaluate shifting and inhibition, two test were conducted–Berg's Card Sorting Task (BCST) and Stroop task respectively. Correlation analysis were performed.

Sixty-four participants (41 women and 23 men) were recruited in this study. Mean age was 28.8, SD = 10.37. Statistical analysis revealed significant negative correlation of PDI distress subscale and BCST non-perseverative errors. The overall score, as well as all PDI subscales correlated negatively also with the Stroop task's total number of errors and positively with the accuracy in incongruent variant.

Contrary to our expectation, results have shown that delusion-proneness is associated with better results in executive functions test, especially in terms of accuracy. These results suggest that executive functions may play a role in the development and maintenance of delusional ideation, however, its relationship may be a bit more complex.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a condition with high impact in terms of disability, also because between 30% and 60% affected individuals do not respond to treatment. It has been proposed that cognitive functioning is strongly impaired in schizophrenia and even more in TRS patients. Cognitive dysfunctions are regarded to worsen psychopathology, psychosocial functioning, and overall course of the illness.

To investigate the impact of Cognitive Remediation (CR) on psychopathology and psychosocial functioning in TRS vs. schizophrenia responder patients.

To determine whether a CR intervention could improve functional outcomes in TRS patients.

We evaluated proximal and distal effects of CR on approximately 20 schizophrenia responders and 20 TRS patients. Patients in each group were randomized to receive CR or not. Patients were assessed in training task performance, neurocognition, functional capacity, symptoms and psychosocial functioning. Evaluations were conducted at baseline, at the end of the 4-month intervention, and at 6-month, 1 and 2 year-follow-ups. The study is still in active recruitment phase.

Both TRS and schizophrenia responder patients exposed to CR exhibited a significant improvement in specific neurocognitive domains, and in psychosocial functioning as assessed by either rating scales (SLOF and PSP) and performance-based measures (UPSA) at the 4-month time-point.

CR improved psychosocial functioning in both group of patients, however, they were more pronounced in TRS patients.

The authors have not supplied their declaration of competing interest.

Clinical, epidemiological and basic research studies have confirmed that estradiol can have protective effects in schizophrenic psychoses. At the same time many patients with schizophrenic psychoses – even antipsychotic naïve at-risk mental state (ARMS) patients show hyperprolactinemia and gonadal dysfunction with estrogen deficiency in women and possibly testosterone deficiency in men.

To investigate the relation between the stress hormone prolactin and the sex hormones estradiol in women and testosterone in men in emerging psychosis.

Forty-seven antipsychotic-naïve ARMS (38 men and 9 women) and 17 antipsychotic-naive first episode psychosis (FEP) (14 men and 3 women) patients were recruited via the Basel Früherkennung von Psychosen (FePsy) study. Blood was taken under standardized conditions between 8 and 10 am after an overnight fast and 30 minutes of rest. We performed a linear regression model to evaluate the association between prolactin and sex hormones including age and current antidepressant use as covariates.

In women, estradiol was negatively associated with prolactin (β = −1.28, P = 0.01) whereas in men there was a positive association of testosterone with prolactin (β = 0.52, P = 0.031).

The often observed estrogen deficiency in women with psychosis could therefore be explained by the stress hormone prolactin suppressing the gonadal axis already in very early untreated stages of the emerging disease.

In ARMS or FEP men prolactin does not seem to influence the gonadal axis in the same way as in women.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The life expectancy of severe mentally ill (SMI) patients is shortened up to 30 years, due to cardiometabolic diseases, partly caused by unhealthy lifestyles behaviors. In residential facilities, adopting a healthy lifestyle is hampered by the obesogenic environment; an obesity promoting environment.

To determine, the effectiveness of a 12 month lifestyle intervention addressing the obesogenic environment to improve cardiometabolic health of SMI residential patients.

The effectiveness of lifestyle interventions in psychiatry (ELIPS) trial is a multi-site, cluster randomized controlled pragmatic trial. Twenty-nine sheltered and long-term clinical care teams serving SMI patients in the Netherlands were randomized into intervention (n = 15) or control (n = 14) arm, including 736 patients (73% psychotic disorder, 63% male, 48 ± 13 years). The intervention aimed to improve the obesogenic environment using a small change approach with a focus on nutrition and physical activity. Primary outcome was waist circumference (WC) after three and twelve month's intervention. Secondary outcomes were BMI and metabolic syndrome.

General linear mixed models adjusted for age, gender, housing facility and antipsychotic medication showed that WC significantly decreased with 1.51 cm (95%CI = −2.99;−0.04, Cohen's d = 0.07) in the intervention group compared to control group after three months and tended to remain lower with 1.28 cm (95%CI = −2.79; 0.23, Cohen's d = 0.06) after twelve months. Metabolic syndrome Z-score decreased after three months with 0.225 SD (95% CI = −0.4038;−0.096, Cohen's d = 0.20), mainly due to lower fasting glucose and WC. No significant effects were found on BMI.

A small change approach targeting the obesogenic environment of SMI residential patients reduces cardiometabolic risk.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Atypical anti-psychotics are associated with an impaired in glucose and lipids homeostasis.

To evaluate, the effect in lipids and glucose levels after switching to long-acting injectable (LAI) aripiprazole.

This was a prospective, observational, 1 year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another anti-psychotic was indicated. We measured basal levels of glucose and lipids at the time to start the study and 1 year after switching to LAI-aripiprazole.

In basal analytic we observed these abnormalities: hyperglycemia (16.7%), high-levels of LDL-cholesterol (33.3%), low-levels of HDL-cholesterol (39%) and hypertrygliceridemia (22.2%). One year after switching to LAI-aripiprazole we found: glucose levels were normalized in all patients; levels of LDL-cholesterol were lower in 66.7% (in 33.3% levels were normalized) and they were higher in 16.7% (in 11% marked a change from normal to abnormal parameters); levels of HDL-cholesterol were lower in 23.3% and higher in 32.2% (in 11% levels were normalized); and finally, levels of tryglicerides were higher in 66.7% (in 8% marked a change from normal to abnormal parameters) and in 16.7% they were lower (in 7.3% levels were normalized).

LAI-aripiprazole has a beneficial effect in glucose and cholesterol levels. Although, it usually increases tryglicerides levels, only in seven cases there was a change from normal to abnormal parameters. Our study suggests that LAI-aripiprazol could be an alternative in patients with schizophrenia who have high levels of glucose and lipids related with atypical anti-psychotics treatment.

The authors have not supplied their declaration of competing interest.

The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link.

The objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated socio-demographic, clinical and toxic variables.

The study included two groups of patients with a DSM-IV diagnosis of schizophrenia who attended the “Ibn Nafis” university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between the first January 2005 and the 31st of August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.

The mean of age in the first group was 37.03 and in the second group was 31.4. No significant difference was found between the two groups regarding the different socio-demographic variables and the age of onset of disease. Significant difference was found between the two groups regarding: personal antecedents of attempt of homicide a (P < 0.003), personal antecedents of attempt of suicide (P < 0.001), a history of previous violence (P = 0.005), untreated psychosis before the act (P < 0.001) poor medication compliance and a low familial support (P < 0.001), antisocial behavior (P < 0.001), addictive behavior (P = 0.007).

Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects.

The authors have not supplied their declaration of competing interest.

Recent studies reported an association between aggression and inflammation. In this study, we examined the association between aggressive behavior and inflammatory markers (serum levels of CRP) in schizophrenia inpatients.

Adult schizophrenia inpatients (n = 145) were prospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 1 mg/dL; n = 45) or normal (CRP < 1 mg/dL; n = 100). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization.

The results show that patients with elevated CRP levels are more aggressive during hospitalization as detected by statistically significant higher scores of aggressive behavior (PANSS-EC score), and by increased rates of physical restraint during hospitalization. No statistically significant differences in the other clinical features, including suicidal behavior.

Our results are consistent with previous findings linking schizophrenia to activation of the inflammatory response system.

The authors have not supplied their declaration of competing interest.

The association between childhood trauma and psychotic symptoms is still not clearly understood. Findings for positive and negative symptoms are confounding. This symptomatic response may differ according to the type of childhood trauma, for example childhood abuse was associated with positive symptoms while childhood neglect was associated with negative symptoms.

This study examined the relationship between childhood trauma and psychotic symptoms in schizophrenic patients after controlling for the possible confounding factors, such as clinical features, depression, and sleep quality.

The childhood trauma questionnaire – short form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia, Pittsburgh sleep quality index, and the suicidality subscale of mini-international neuropsychiatric interview were administered to 199 patients with schizophrenia. We used sequential multiple stepwise regression analyses in which positive symptoms, negative symptoms, overall psychopathology and total symptoms of schizophrenia were dependent variables.

Depressive symptomatology and childhood physical abuse (CPA) significantly contributed to positive, negative, general psychopathology and global schizophrenia symptomatology. Stepwise regression analysis results are presented in Table 1.

Our findings suggest that CPA during childhood could have an impact on psychopathology in schizophrenia.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To present, post hoc analyses from a controlled, prospective study of predominant negative symptoms (PNS) of schizophrenia on baseline patient characteristics, severity of symptoms and their variability among participating countries.

Data were analyzed from a phase 3, randomized, double-blind, active-controlled, parallel-group study in adult PNS patients with schizophrenia (EudraCT Number 2012-005485-36). Subjects with a PANSS factor score for negative symptoms (PANSS-FSNS) ≥ 24 and no pseudo-specific factors (e.g. high positive symptoms, extrapyramidal symptoms, depression) were randomized to cariprazine 4.5 mg/d (dose range: 3–6 mg/d) or risperidone 4 mg/d (dose range: 3–6 mg/d) for 26 weeks. Baseline values of PANSS-FSNS, individual PANSS items, personal and social performance (PSP), and clinical global impression of severity (CGI-S) were analyzed based on the data gained from 11 European participating countries.

Average PANSS-FSNS of patients was 27.6 ± 2.48, reflecting severe negative symptoms. Patients were moderately ill (CGI-S 4.2 ± 0.75), with marked difficulties (PSP 48.4 ± 10.78) predominantly in social functioning. The investigated patient population was fairly homogeneous as shown by small variability in all three scores. Moreover, baseline values in the 11 countries presented low variability while number of enrolled patients per country showed high variance (n = 7–118). Narrative description of symptoms and individual PANSS items rated as most severe and prominent were in high correlation.

Post hoc evaluation of this predominant negative symptom study showed that, this patient population can be identified reliably by psychiatrist. Additional training on the judgment of personal and social relationships can increase the diagnostic accuracy.

Employee of Gedeon Richter Plc.

Negative symptoms have substantial impact on day-to-day functioning of patients with schizophrenia affecting their ability to perform activities of daily living and to maintain personal relationships.

To present post hoc data on day-to-day and social functioning of patients with predominant negative symptom (PNS) of schizophrenia, treated with cariprazine versus risperidone.

Data from 26 weeks, phase 3, randomized, double-blind, active-controlled study in PNS patients were analyzed (EudraCT 2012-005485-36). Subjects with PNS (PANSS factor score for negative symptoms ≥24) were randomized to cariprazine 4.5 mg/d or risperidone 4 mg/d. Change from baseline to end of treatment on the personal and social performance scale (PSP) and PANSS prosocial subscale (P3, P6, N2, N4, N7, G16) was analyzed.

Significantly greater improvements were seen with cariprazine compared to risperidone in the change from baseline to end of treatment on the PSP (LSMD + 4.632 [2.71, 6.56]; P < 0.001) from week 10 onwards (effect size 0.48); in the PSP subdomains of self-care (LSMD −0.2 [−0.3; −0.1]; P = 0.004), personal and social relationships (LSMD −0.2 [−0.4;−0.1]; P < 0.001) and socially useful activities (LSMD −0.4 [−0.5; −0.2]; P < 0.001); in the number of patients who improved at least 10 points on the PSP (OR 2.1; P = 0.001) or shifted to a higher category (OR 2.2; P = 0.001); and on the PANSS prosocial subscale (LSMD −0.8 [−1.41, −0.16]; P = 0.014).

Post hoc evaluation of this study showed that cariprazine treatment is associated with a clinically relevant improvement in patient functioning and social competence compared to risperidone.

Employee of Gedeon Richter Plc.

Negative symptoms and cognitive impairments are both present in patients with an at risk mental state (ARMS) for psychosis and negatively affect functioning and outcome. According to previous studies in patients with first-episode psychosis, negative symptoms are negatively associated with cognitive functioning while positive symptoms do not seem to be associated. Yet, little is known about the specific relationship of negative symptoms and cognitive functioning in ARMS patients.

To evaluate, the relationship between negative symptoms and cognitive functioning in ARMS patients.

Data of 154 ARMS patients were collected within the prospective Basel early detection of psychosis (FePsy) study. Negative symptoms were assessed with the SANS, positive psychotic symptoms with the BPRS, cognitive functioning with an extensive neuropsychological test battery. Multiple regressions were applied and results were controlled for age and gender.

Regression analyses showed a significant, negative association between negative but not positive psychotic symptoms and cognitive functioning, showing the strongest association with verbal fluency (see Fig. 1). However, results mainly did not withstand correction for multiple testing.

The association found between verbal fluency and negative symptoms may be indicative of an overlap between those constructs. Finally, verbal fluency might have a strong influence on the clinical impression of negative symptoms, especially on alogia.

The authors have not supplied their declaration of competing interest.