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.

The study of literature data of the treatment of pregnant women with schizophrenia and making recommendations on the management of this category of patients.

Theoretical analysis of a number of scientific works of foreign researchers, which studied questions of application of psychotropic drugs in patients with schizophrenia during pregnancy.

The important source of problems for patients with schizophrenia is a protection against pregnancy. The number of children born in mentally ill mothers has increased at least three times. Hereditary factors in children born from two parents with schizophrenia plays, an important role: approximately 46–68% of these children may develop schizophrenia. In studies on psychotic means, there were no increase in number of anatomical anomalies or deviations in the development associated with this treatment. Low doses do not have a deleterious effect on fetal body weight, duration of pregnancy, fetal or neonatal mortality, as well as the frequency of malformations and deformities. Neither oral nor deposited anti-psychotic drugs are not associated with malformations and malformations of the fetus.

(1) The drugs should be administered at the lowest effective dose for the shortest possible time and decrease in the dose during the last days before the birth. (2) Pregnant women with acute psychotic disorders are dangerous, both for herself and for the child. (3) After the birth due to high risk of recurrence or exacerbation of schizophrenia taking anti-psychotic drugs should be in full dose.

The authors have not supplied their declaration of competing interest.

Single-photon emission computed tomography (SPECT) is a valid method for measuring regional cerebral blood flow (rCBF). Recent studies regarding rCBF in patients with first episode psychosis (FEP) reported heterogeneous results, but were limited with small sample size. Neuroimaging can help us in setting the diagnosis of illness, as well as in following the progress and finding more effective treatment for psychotic disorders.

To compare, baseline alterations of the rCBF using SPECT with psychopathological status in FEP during acute phase.

To investigate the changes of rCBF in patients with FEP during acute phase.

We conducted a study on 40 drug – naïve patients with FEP at acute phase of illness during their hospitalization at Zagreb University hospital centre. The diagnosis was confirmed using diagnostic and statistical manual of mental disorders, fifth edition. rCBF was measured with SPECT and psychopathological status rated with the Positive and Negative Syndrome Scale.

Our findings showed moderate to severe parieto-temporal perfusion deficits, mild to moderate parieto-fronto-temporal perfusion deficits or borderline perfusion deficits in all but one patient.

Our results showed alteration in rCBF at the beginning of the illness that indicate a biological market of psychotic disorder.

The authors have not supplied their declaration of competing interest.

Much research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.

This study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.

Retrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.

Between 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.

The evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.

The authors have not supplied their declaration of competing interest.

The aim of this analysis was to evaluate the economic consequences of a new treatment approach in the treatment of schizophrenia in the Italian setting. In terms of direct costs, in Italy was estimated that the main driver were represented by hospitalization and residential cost (71% of total direct cost per patient), followed by semi-residential services (13%), anti-psychotic and other drugs (8%) and ambulatory services (8).

A probabilistic cost consequence model was developed to estimate the potential cost reductions derived from an early treatment with atypical long-acting injectable anti-psychotics (aLAIs) drugs. A systematic literature review was carried out to identify direct and indirect costs associated to the management of schizophrenic patients in Italy. The model projects a scenario analysis in order to estimate potential cost reductions applying a new model management (MoMa) based on patient recovery and early aLAIs treatment.

Overall, the total economic burden associated with schizophrenia was estimated at €2.7 billion per year. A total of 50.5% of the economic burden was related to indirect costs and 49.5% to direct costs. Drug costs correspond to 10% of the total expenditure in terms of direct costs, while hospitalization and residential costs accounts for 81%. Scenario analysis demonstrate a potential cost reduction between 200 million and 300 million based on the effects of MoMa over the reduction of hospitalization and residential costs.

This analysis was the first attempt to translate clinical management aspects in economic consequences and will be a useful instruments for decision maker.

The authors have not supplied their declaration of competing interest.

Impairment of insight in psychotic disorder is associated with adverse impact in treatment compliance, outcome and social functioning although its underlying mechanisms are still unknown. Social cognition and more specifically Theory of mind have been proposed to be correlated to insight. However, the relationship between both factors is still not well defined.

To study the association between social cognition and insight into mental illness in individuals with early psychosis included in the first episode of psychosis program of Hospital del Mar.

From the 94 patients included in the first psychotic episode program between January 2011 and January 2016, thirty-eight patients were evaluated six months after the episode. The three initial items of SUMD (Scale Unawareness of Mental Disorder) were used to measure insight and MSCEIT (Mayer-Salovey-Caruso Emotional Intelligence Test) was used to assess social cognition. Linear correlation analysis by Pearson correlation was conducted.

Insight results of SUMD six months after the first episode of psychosis were significantly associated with several subsections of MSCEIT, such as experiential area total punctuation (r = –0.574; P = 0.025), emotional facilitation section (r = –0.633; P = 0.011) and the facial emotion perception task (r = –0.572; P = 0.026).

Results suggest an association between insight and emotional perception and facilitation performance in first episode patients, which may suggest a role of social cognition in psychosis insight impairment. Further research to better define the participation of social cognition in insight into psychosis alteration is mandatory to understand the etiology of insight, define treatment targets and consequently improve the disorder prognosis.

The authors have not supplied their declaration of competing interest.

To evaluate the use of micronutrients (minerals and vitamins) as adjunctive therapies for psychosis when added to conventional medications.

Rural primary care and psychiatry clinic in Northern New England, USA.

People over age 18 diagnosed with a psychotic disorder on medications.

Fifty consecutive clients during one month's time were invited to participate; 19 completed a one-month open-label phase of the addition of a micronutrient to their medication regimen; all 19 then withdrew rather than risk randomization to a placebo. We then compared the response of those 19 over 24 months of micronutrients + medication to the 31 people who declined participation enriched by an additional 28 consecutive patients recruited over the second month of the study for a total of 59 who received medication without micronutrients.

All clients were evaluated with the Positive and Negative Symptom Scale and the Clinical Global Impression scale at study baseline and after 3, 6, 9, 12, 15, 18, and 24 months. Psychosis was confirmed with clinical interview using DSM IV-TR criteria. All participants had normal physical examinations and laboratory studies.

Outcomes were similar for both groups until 15 months, though the micronutrient group used significantly less antipsychotic medication throughout that time (P < 0.001). At 15 months, the micronutrients + medication group exhibited significantly fewer symptoms than the medication only group, a difference that was even stronger at 24 months.

Micronutrients may be a beneficial long-term, adjunctive strategy for people with psychotic disorders, allowing for smaller doses of antipsychotic medications.

The authors have not supplied their declaration of competing interest.

Some patients with the diagnosis of a psychotic disorder wish to minimize or avoid medications.

We report qualitative and quantitative data on a group of patients as a proof of concept study–that management with minimal or no medication is possible.

A series of 60 adult patients presented with psychosis and engaged with us in dialogical psychotherapy, medication, and lifestyle management over at least six months in an effort to minimize or eliminate medication. An additional 209 patients presented for treatment but did not continue for six months. An anonymous, matched comparison group of 60 patients of the same age, socio-economic status, diagnosis, and severity of illness was generated from the electronic health records at another large clinic where one of us also worked (LMM). We quantifed symptom level using the Brief Psychiatric Rating Scale, the Positive and Negative Syndrome Scale, two depression rating scales, the Clinical Global Inventory, and the Revised Behavior and Symptom Identification Scale. Narrative interviews of all 269 patients generated qualitative data.

Thirty-nine patients managed well without medication; 16 managed well on low-dose medication. Four individuals required progressively higher levels of medication and one decompensated. The overall cost-benefit was favorable in creating fewer hospitalization, crises, and diminished suicidality.

The results suggest the need for individualized approaches that are client-centered and build upon the previous successes of the person, enroll family and friends in a community effort, and collaborate with those communities to apply those approaches desired by the people themselves.

The authors have not supplied their declaration of competing interest.

To determine the relationship between smoking status and clinical characteristics of schizophrenic patients.

It was a cross-sectional study. One hundred and seventy-five schizophrenic outpatients were assessed by the Positive And Negative Syndrome Scale (PANSS), the Global Assessment of Functioning Scale (GAF), the scale of measurement of abnormal involuntary movements (AIMS) and by the rating scale akathisia caused by a drug Thomas Barnes. Current smokers (n = 85) were compared to non-smokers (n = 90) on clinical variables.

The mean number of cigarettes was 15 cig/day. In our sample, current smokers account for half of the patients and were exclusively men. Smokers were significantly more single patients (76.5 vs. 58.9, P = 0.01). There were no significant differences between smokers and non-smokers regarding clinical variables, including age of onset of the disease, the duration of the disease, the severity of positive and negative symptoms, and GAF scores. Smoking was significantly associated with more frequent prescription of conventional neuroleptics (98.8 vs. 92%, P = 0.03) and poorer adherence to treatment (77 vs. 62.2%, P = 0.02). There were no significant differences between the 2 groups regarding the average doses of neuroleptics, the presence of extrapyramidal signs, scores on the AIMS score and akathisia.

Smoking is common in patients suffering from schizophrenia. Smoking status should be considered in the assessment of neuroleptic treatment in schizophrenia.

The authors have not supplied their declaration of competing interest.

To evaluate the impact of treatment with paliperidone extended release for 6 months on sleeping profile in schizophrenia patients.

A total of 984 patients meeting the DSM-IV criteria for schizophrenia who switched their antipsychotics to be paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We assessed patients in terms of demographic profile, sleep quality and daytime drowsiness as visual analog scale.

Patients in our studies received paliperidone ER treatment for 6 months. About 70% completed the treatment. Sleep quality and also daytime drowsiness were significantly increased in patients compared with their baseline. The predictive factors that have effect on sleep profile improvement were completion of the study and baseline PANSS score.

Patients receiving paliperidone ER were found to have improvement in sleep quality and also improvement in daytime drowsiness, especially in patients within completion group and the higher baseline PANSS score.

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

Reduction of mental productivity and motivation in patients with schizophrenia is one of the core features of negative symptoms of schizophrenia spectrum disorders. Lack of motivation affects social functioning and outcomes, reduces effects of psychosocial treatment and rehabilitation.

To research AES abilities in measuring motivation in patients with schizophrenia spectrum disorders. The aim of the study was to investigate correlations of Russian translation of clinician-rated and self-rated versions with PANSS amotivation subscale and negative subscale items.

Fifty patients with schizophrenia spectrum disorders were recruited to participate in the study and were assessed with PANSS, AES-C and AES-S by trained raters. Only patients in “stabilized” state that met inclusion criteria of PANSS total score ≤ 80 points were eligible for consecutive AES assessment.

Overall, moderate positive correlations were established between AES-C and PANSS amotivation subscale N2 and N4 items, N6 item and total PANSS negative subscale. No significant correlations with G16 item were registered. AES-C and AES-S versions also showed positive Spearman correlations (r = 0.43; P < 0.05), while no correlations between AES-S and amotivation PANSS items were registered.

Moderately strong correlations between AES-C and PANSS N2, N4 and N6 items show feasibility of AES-C version in terms of measuring motivation in patients with schizophrenia spectrum disorders. Results of AES-S analysis demonstrate certain problems in patients’ abilities in self-assessing motivation. Patients with prevailing paranoid syndrome showed poorer results in AES-S scores.

AES-C is a sensitive psychometric tool with good properties in measuring amotivation in patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

Intramuscular paliperidone palmitate (PP) is a long-acting, atypical antipsychotic for ntramuscular (IM) administration in the treatment of patients with schizophrenia.

To study efficacy and quality of life in patients with schizophrenia and schizoaffective disorders treated with long-acting paliperidone palmitate.

A non-randomized, prospective naturalistic study was performed in out-patients with schizophrenia and schizoaffective disorder unsuccessfully treated with oral antipsychotics. Efficacy of PP over time was evaluated by using BPRS 24-items (Brief Psychiatric Rating Scale) Quality of life was evaluated by the QL-Index (Quality of life Index) at T0 and at most recent visit (T1).

Data were available for 16 outpatients consecutively prescribed PP and naturalistically treated attending at the Psychiatric Clinic, University of Sassari. Patients were predominantly male (n = 9; 56.2%), with schizophenia (n = 10; 62.5%). Three patients dropped out (18.8%). Mean time on PP treatment was 870.0 days (sd 217.02) at a mean PP maintenance dose of 97.82 ± 37.17 mg eq. BPRS mean total score at T0 was 55 (sd 14.5) and at T1 was 44.8 (sd 11.8). Ql-Index mean total score was 5 (sd 1.6) at T0 and 7.2 (sd 2.4) at T1. Paired sample test showed a statistically significant difference in deacreasing symptoms at BPRS over time (P = 0.009) and in improving Quality of life at QL-Index (P = 0.017). The analyses showed a significant improving at the following BPRS sub-items: Depression (P = 0.021), Hostility (P = 0.022), Suspiciousness (P = 0.005), Hallucinations (P = 0.050), Unusual thought content (P = 0.029), Self-neglet (P = 0.028), Conceptual disorganization (P = 0.044), Emotional withdrawal (P = 0.028) and Distractibility (P = 0.014).

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is a wide range of studies focusing on the use of cannabis in first episode psychosis (PEP). Literature using child and adolescent samples is scarce.

To determine the prevalence and clinical differences between cannabis users and non-cannabis users of early onset first episode psychosis (EOP), and adult onset first episode psychosis (AOP).

One hundred and forty patients were recruited in adult (AOP subsample, n = 69) and child and adolescent (EOP subsample, n = 71) mental health services. The Positive and Negative Syndrome Scale was used for psychotic symptoms and the Calgary Scale for affective symptoms. The Chi2 test analysed clinical differences between users and nonusers within subsamples, and in the total sample a Pearson correlation was used for the relationship between age at cannabis use and PEP.

The prevalence of lifetime use of cannabis and the average age at first use were 48% and 13.82 years (± 1.15) in the EOP subsample, and 58% and 17.78 years (± 3.93) in the AOP subsample. Within EOP, cannabis users were older (P = .001), had fewer negative symptoms (P = .045) and less depressive symptoms (P = .005). Within AOP, cannabis users were younger (P = .018) and had greater severity of positive symptoms (P = .021). Age at first cannabis use and age at PEP were positively correlated.

Cannabis use is prevalent in adult and early onset psychosis. Cannabis users differ clinically from non-users, and the earlier the use of cannabis, the earlier the onset of psychosis.

The authors have not supplied their declaration of competing interest.

Several studies had shown the effectiveness of combined interventions in the treatment of young patients with a first episode of psychosis (FEP). More controversial are the evidence about the stability of the therapeutic outcomes in individuals ultra-high risk (UHR).

To describe the regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department (ReMHD) and also to report preliminary data from a 2-year follow-up.

In addition with the treatment as usual (TAU), treatment implemented within the regional project for early psychosis (PREP) in the ReMHD comprises the following:

– pharmacotherapy according to international guidelines;

– a phase-specific individualized Cognitive-Behavioural therapy;

– a psycho-educational intervention addressed to family members;

– a case management recovery-oriented.

Action strategies are preceded by the administration of Reggio Emilia at Risk mental States Battery Checklist as a comprehensive assessment useful to define the severity and the quality of symptoms, the degree of functioning, the subjectivity of suffering, and the perceived quality of life.

The assessment carried out after 24 months of continuous treatment showed significant improvements in both the psychotic symptoms (positive, negative and general psychopathology PANSS subscales) that the daily functioning (SOFAS).

Although our sample is still relatively small (n = 50) to draw definitive conclusions, it is emerging the good prognosis for UHR individuals and patients with FEP submitted on PREP treatment implemented in the ReMHD.

The authors have not supplied their declaration of competing interest.

(1) Comparison of executive functions between the investigated groups; (2) determining the relationship between their particular aspects within the groups; and (3) drawing up their neuropsychological profile.

One hundred and forty-eight schizophrenia patients, divided into two groups: patients with DS (n = 70) and NDS (n = 78). Patients were matched for sex, age, number of years of education and their overall cognitive functioning. For the assessment of executive function, we used the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), Verbal Fluency Test Phonemic (VFT P), Stroop Color Word Test (SCWT) and Go/No Go task (GNG).

The DS patients compared with the NDS ones obtained lower scores in WCST and TMT (relative flexibility). We did not observe any inter-group differences in VFT P, SCWT (relative inhibition) or the GNG. In both patient groups, there appeared significant correlations between their WCST and TMT scores. The general neuropsychological profiles were similar in both groups. The DS patients exhibited slightly greater interference within concept formation and non-verbal cognitive flexibility. Such problems may therefore be specific to that particular subset of schizophrenia. Our results may be useful for the development of new rehabilitation activities, which may increase the chance of the patients’ better social functioning.

The authors have not supplied their declaration of competing interest.

Relapse after first-episode psychosis (FEP) is a frequent problem, which can lead to patients’ poorer functioning and response to treatment. Its prevention is one of the most important and challenging targets in the treatment of psychotic disorders.

To characterize and evaluate relapse rates after FEP, during the course of 3 years, of a group of patients admitted at a psychiatry department.

A retrospective observational study was conducted. Patients with a FEP between ages 18 to 40, admitted at the Clinic of Psychiatry and Mental Health at São João Hospital Centre between January 1, 2007 and September 30, 2013. Only patients with, at least, 3 years of follow-up at the clinic were included.

Final sample of 58 patients, 39 of which were male (mean age = 26.4 years). Forty patients were excluded by not completing the 3 years follow-up at our department. The cumulative relapse rates were 32.8% at 12 months, 53.4% at 24 months and 63.8% at 36 months. Patients with at least one relapse were younger (25.78 years vs. 27.52 years) and had shorter periods of first hospitalization (19.25 days vs. 23.52 days). These data did not reach statistical significance. Non-adherence to prescribed medication was described in 73.0% (n = 27) of patients at the time of relapse. Eight of them (21.6%) presented with cannabis use.

Although no statistical significance was reached, our findings are consistent with other studies. A future study with a bigger sample would be important in achieving statistical significant results.

The authors have not supplied their declaration of competing interest.