The authors aim to identify the main comorbidities in people with schizophrenia and define strategies to prevent it.

Literature review on Medline database.

People with schizophrenia have higher risk to have hepatitis, cardiovascular diseases, diabetes, overweight, sexual dysfunction and obstetric complications. This high vulnerability is associated with higher rates of preventable risk factors, such as smoking, alcohol consumption, use of street drugs, poor dietary habits and lack of exercise. Moreover, some antipsychotic medications used to treat schizophrenia have been associated with higher incidence of physical disease. At last, there are risk factors attributable to patients and healthcare services. Psychiatrists are often not trained in detection and treatment of physical disease. Despite this, there are several attitudes that can reduce the associated morbidity and mortality in people with schizophrenia, such as improving access to healthcare services, integrated healthcare interventions to enable early diagnosis and promotion of healthy habits.

Diagnosis and management of morbidity in people with schizophrenia are more difficult because obstacles related to the patient, the illness, the medical attitudes and the structure of the healthcare services. Regardless these difficulties, the increased frequency of physical disease in people with schizophrenia must be valued due to improved detection and treatment of medical disease will have significant benefits for their psychosocial function and overall quality of life.

The authors have not supplied their declaration of competing interest.

Empowerment has been defined as the ability to act autonomously, the willingness to take risks and being aware of responsibility. The importance of this construct in psychosis has been emphasized by recovery models. An integrant part of the Clinical Interview for Psychotic Disorders (CIPD), the EWPSS is a visual analog scale in which the participants assess their sense of empowerment regarding symptoms (delusions, hallucinations, negative symptoms and disorganization). EWPSS focuses on personal empowerment (self-worth and self-efficacy) as it could apply to symptoms.

To preliminarily assess the psychometric properties of the EWPSS in a sample of participants with psychosis.

The sample comprised 22 participants (68.2% male), 72.7% single, 50% employed, between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The participants were assessed with the CIPD (EWPSS) and Depression, Anxiety and Stress Scales-21.

EWPSS has shown acceptable reliability for all dimensions (with alphas ranging between .54 and .78). Empowerment with delusions was associated with the other dimensions, excepting for empowerment with negative symptoms (which in turn was not associated significantly with any dimension). Empowerment regarding hallucinations and with disorganization were only associated with empowerment with delusions, which was also associated with anxiety symptoms (r = –.52, P = .016).

The EWPSS presented adequate reliability and validity. Further studies intended to explore the factorial structure of the EWPSS are under development.

The authors have not supplied their declaration of competing interest.

There are a number of good standard practices available for prescribing long acting antipsychotics. Adherence to these guidelines will minimise any harm to the service users.

To compare depot antipsychotic prescribing practice with good standard practice guidelines of BNF, Trust and Maudsley guidelines.

To compare practice with standards in the areas of:

– licensed indication;

– dose/frequency range;

– avoiding poly-pharmacy;

– regular review of clinical and side effects.

Case notes of a randomly selected sample of 30 patients from the depot clinic at the City East Adult Community Mental Health Team Leicester, UK were retrospectively investigated. The data collected was analysed and the results were produced. Compliance with the best practice guidelines was calculated and recommendations made based on the findings.

One hundred percent compliance was noticed in licensed indications and dose/frequency within BNF range. However, 14% patients received poly-pharmacotherapy, 86% had regular outpatient review, but only 46% had review of side effects.

Better quality of documentations by the clinicians, improvised technology to elicit automatic review reminders, introduction of checklist for clinics to include review of all clinically important information, wider dissemination of the findings of this investigation, and re-auditing practice to explore impact of this investigation was recommended.

The authors have not supplied their declaration of competing interest.

Several studies have shown that both endocannabinoid system (ECS) and synthetic cannabinoids (SC) might be involved in schizophrenia.

To review recent literature on the role of cannabinoids in schizophrenia. The review includes the evidence of cannabis use as a risk factor for the development of schizophrenia, but also the preliminary evidence for the use of cannabinoid-based compounds in the treatment of psychosis.

The authors made an online search on PubMed for clinical trials and reviews published in the last 12 months, using the keywords: “cannabinoids”, “endocannabinoids”, “phytocannabinoids” and “schizophrenia”.

The use of Cannabis sativa is associated with increased risk of developing psychotic disorders, including schizophrenia, and earlier age at onset of psychosis. Δ9-Tetrahydrocannabinol (THC) has multiple actions in the brain development, including impairment of neuroplasticity, dysregulation of dopamine and glutamate signaling, and, possibly, neurotoxicity. The ECS has been implicated in psychosis both related and unrelated to cannabis exposure. Cannabinoid receptors type 1 (CB1 R) and type 2 (CB2 R), as well as the endogenous ligand N-arachidonoylethanolamine (AEA) and 2-arachidonylglycerol (2-AG) levels, are most likely to be involved in the pathophysiology of this disorder. On the other hand, the antipsychotic effects of some cannabinoids have been investigated in recent studies. Cannabidiol (CBD) and Δ9-tetrahydrocannabivarin (THCV) may have therapeutic potential for the treatment of psychosis.

Emerging evidence suggests an important role of ECB system and SC on schizophrenia. On the other hand, recent studies have shown some phytocannabinoids might represent therapeutic promises in this disorder.

The authors have not supplied their declaration of competing interest.

Some findings in patients with first psychotic episode (FEP) could be related to alterations of stress responses. Alterations of stress response are reflected in the alterations of the HPA axis.

To assess the difference in stress response in FEP patients and healthy controls as well as implications of environment to vulnerability to psychosis.

To assess endocrine and autonomic responses to acute psychosocial stress, their associations with onset of the first psychotic episode as well as the influence of the environmental factors.

We have assessed clinical status through clinical psychiatric interviews, standardized psychiatric scales and validated psychological scales, (LEQ, WHOQOL-BREF, PBI, Rosenberg) in 45 subjects with FEP and 50 age and gender matched controls. All participants were then exposed to the Trier Social Stress Test (TSTT).

Our preliminary findings on a sample of 95 participants indicate a differences between patients and controls in salivatory cortisol measured in 5 time points during the TSST. Patients with FEP experience more levels of baseline cortisole, and less changes during the stress test then controls. Baseline stress levels indicated in the salivatory cortisole levels correlate with perceived self-esteem, psychological and social quality of life.

Our findings support the alterations of stress response, possibly indicating vulnerability to stress in persons with FEP.

This work was funded by the grant of the Croatian Science Foundation No UIP-2014-09-1245 Biomarkers in schizophrenia – integration of complementary methods in longitudinal follow up of first episode psychosis patients.

The authors have not supplied their declaration of competing interest.

Impairment of executive function is the fundamental feature of the cognitive dysfunction in schizophrenia has to be measured throughout the illness regularly. Computerized technologies for assessment of cognitive dysfunction are widely used. However, their applicability in hospitalized schizophrenic patients setting should be specially examined.

Executive function in schizophrenia.

To test the applicability of “CANTAB” neurocognitive battery for measurement of executive function in young hospitalized schizophrenic patients in Russian sample.

Fifteen inpatients diagnosed with schizophrenia according to ICD-10 (F 20.хх), 13 males and 2 females, aged 23.5(SD 3.2), disease duration is 5(SD 1.6) years and 16 healthy individuals, 7 males and 9 females, aged 21.3(SD 0.7). Spatial Working Memory (SWM) (Mnemonic Executive function), Stockings of Cambridge (OTS) (Planning Executive function), Intra/Extra-Dimensional Shift (IED) (Cognitive flexibility) were administered.

The majority of patients and controls easily understood the test instructions. Both groups did not have any difficulties with the touchpad. The “CANTAB” demonstrated sensitivity to the impairments of executive function. As a group, patients with schizophrenia performed significantly worse than controls on almost all tests: SWM–Between errors (P = 0.028), Total errors (P = 0.019), Strategy (P = 0.03), Mean time to last response (P = 0.001); OTS–Mean choices to correct (P = 0.044), Problems solved on first choice (P = 0.009), Probability of error given correct (P = 0.021); IED–Total errors (P = 0.015), Total trials (P = 0.002).

The “CANTAB” is an applicable instrument for assessment of the executive function in young hospitalized schizophrenic patients. It can be used both for experimental and clinical needs.

The authors have not supplied their declaration of competing interest.

Despite the intense discussion of psychiatric comorbidity in psychodermatology, research on psychological components of skin picking and psychogenic itch is limited, especially when it concerns patients’ representation of skin perception and their attitude towards disease.

To characterize psychological traits of skin picking and psychogenic itch disorder by comparing aspects of bodily experience.

To reveal internal relations of different components of bodily experience in skin picking and psychogenic itch.

Thirty patients with skin picking disorder (L98.1) and 18 patients with psychogenic itch (F45.8) participated in the study. The psychosemantic method “Classification of sensations” was used to assess bodily experience. It includes estimation of 80 descriptors from 6 classes of bodily sensations: skin (ex. “itch”), inner body (ex. “sickness”), receptor (ex. “sticky”), emotional (ex. “anxiety”), dynamics (ex. “exhaustion”) and attitudinal descriptors (ex. “bad”). Cluster and factor analysis were performed.

The most significant aspect of bodily experience in skin picking was its dynamics as a transition from irritation to calmness connected with the sensation of itch opposed to all other sensations (there were opposite signs of factor loadings of these variables and they were included in the factor explaining 45% of total variance). In contrast, in psychogenic itch these relations are diffuse and consist of connections between skin sensations and inner bodily sensations and descriptors of emotions reflecting functional origin of disorder.

Traits of psychological components in skin picking disorder and psychogenic itch should be concerned in the complex (psychiatric, psychological and dermatological) treatment of these disorders.

The authors have not supplied their declaration of competing interest.

It is well-known fact that cognitive dysfunction (CD) determines the quality of remission in patients with schizophrenia. However many attempts to demonstrate the link between symptoms and CD failed. The reason for this fact is unclear.

Heterogeneity on basis of the important sign jeopardizes the signal detection.

Assessment of interaction between clinical symptoms and CD in schizophrenic patients in remission with and without residual psychotic symptoms (RPS).

Adult schizophrenic patients in remission with and without RPS (DSM 295.30) on stable treatment not less than 6 months were assessed with PANSS, CGI, BACS. The indices of the testing were compared between groups. The correlation analysis was performed. The correlation was considered significant if R > 0.60.

Ten females and 34 males were divided into two groups according to presence (27 patients) or absence (17 patients) of RPS (PANSS items P1 and P3 > 2 but < 5). The severity of symptoms and CD were equal in both groups, excluding P6 (P = 0.0005), P20 (P = 0.007), P23 (P = 0.0004), and positive subscale PANSS (P = 0.00001). In the group without RPS, we found that CGI score, scores of 10 items of PANSS, scores of PANSS subscales, excluding negative subscale, and total PANSS score highly negatively correlated with total BACS score (average R = –0.70 ± 10). In the group of patients with RPS, no correlations were found.

Patients with RPS has clinical significant dissociation of psychic and cognitive functioning that should be considered in planning, and assessing of results of cognitive enhancers studies.

The authors have not supplied their declaration of competing interest.

By the present, the study of corporeality as a psychological phenomenon in schizophrenia has had a lack of attention. At the focus of works, there have been mainly psychopathological phenomena: cenestopathies, visceral hallucinations and body scheme disturbances. There is an evidence of the necessity for psychological investigations: the execution of radical changes in appearance, a frequent turning to plastic surgery, dysfunctional wearing and transsexuality.

The experimental group consisted of 23 patients in schizophrenia of paranoid type (F 20.00). The control group consisted of 27 healthy subjects.

It is to study the peculiarity of experiencing their own body by patients in schizophrenia.

There are projective techniques, such as: “A Picture of Me”, “Verbal Self-Portrait”, ‘A Picture of Inner Body” and the psychosemantic test “Classification of Sensations”.

There are statistically significant differences (P < 0.005) found between the groups:

– patients with schizophrenia are characterized for their deficit of experiencing their body. It does not refer to “Myself” and is deinvidualized. The body does not serve as a physical presentation of the subject in a social world;

– a wary attitude is observed in relation to body displays in the form of inner body sensations with a minor (than in norm) awareness relatively to the inner arrangement of their own body. This causes the increase of the quantity of intraceptive sensations categorized by patients in schizophrenia as unhealthy or a threat.

The above-mentioned peculiar features of corporeality in schizophrenia make it a source of negative experiences.

The authors have not supplied their declaration of competing interest.

An appropriate early intervention (EI) after the onset of a first episode of psychosis (FEP) is a key factor to prevent relapse, cognitive and functional impairment related to neurotoxicity as it is a critical period in order to get good adherence to treatment. This is the most reported factor linked to relapse. Therefore, interventions focused on getting good adherence to treatment may make the difference in terms of outcome.

To compare relapse rates, symptom severity and level of functionality before and after treatment with Paliperidone Palmitate Long-Acting Injectable (PP-LAI). To analyze prior antipsychotic treatments and side effects registered before and after the introduction of (PP-LAI).

This is a cross-sectional descriptive study. We analyzed a sample of 15 patients, recruited from PAFIP (an specialized EI unit) and treated with variable doses of PP-LAI. They all met diagnostic criteria for schizophrenia according to DSM-IV. Clinical and functional data of the two years before and after treatment intoroduction were recorded.

Twenty-seven percent of the patients resumed their work activity or studies and 33% of the patients increased their social activity. Thirteen percent of the patients improved from negative symptoms. Prior to treatment introduction, more than a half of the simple, had suffered one or two relapses. After treatment introduction, 87% did not experience more relapses while 13% experienced another relapse.

Treatment with PP-LAI is associated to a recovery of functional abilities, and a trend to clinical stability with high adherence to treatment related to few side effects.

The authors have not supplied their declaration of competing interest.

In a recent placebo-controlled, double blind crossover trial (n = 52), we found significant beneficial effects on memory (d = 0.30) and negative symptoms (d = 0.29) after 12 weeks memantine augmentation in patients with clozapine-refractory schizophrenia.

In this open-label 1 year extension study, we report the long-term effects and tolerability of memantine add-on therapy to clozapine.

Completers of the first trial who experienced beneficial effects during 12 weeks of memantine treatment received memantine for one year. Primary endpoints were memory and executive function using the Cambridge neuropsychological test automated battery (CANTAB), the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression Severity Scale (CGI-S).

Of 31 RCT completers who experienced beneficial effects from memantine, 24 received memantine for one year. The small improvement in memory found in the memantine condition in the placebo-controlled trial remained stable in the extension study. Executive function did not improve. After 26 weeks of memantine add-on therapy to clozapine, PANSS negative symptoms (r = 0.53), PANSS positive symptoms (r = 0.50), and PANSS total symptoms (r = 0.54) significantly improved. Even further significant improvement in all these measures was observed between 26 weeks and 52 weeks memantine, with effect sizes varying from 0.39 to 0.51. CGI-S showed a non-significant moderate improvement at 26 weeks (r = 0.36) and 52 weeks (r = 0.34). Memantine was well tolerated without serious adverse effects.

In the one-year extension phase, the favorable effect of adjunctive memantine on memory was sustained and we observed further improvement of positive, negative and overall symptoms of schizophrenia.

P.F.J.S. reports personal fees from H. Lundbeck A/S, outside the submitted work and he is a board member of the Dutch Clozapine Collaboration Group. L.d.H., has received investigator-led research grants or recompense for presenting his research from Eli Lilly, Bristol-Myers Squibb, Janssen-Cilag and AstraZeneca.

Patients suffering from paranoid schizophrenia, require long-term anti-psychotic treatment, which provide, in addition to adequate efficacy both positive and negative symptoms, a good safety and tolerability profile that would ensure adequate adherence to prevent relapse.

To analyze the efficacy, tolerability and therapeutic adherence over a year after the introduction of aripiprazole depot in patients diagnosed with paranoid schizophrenia previously treated with other oral or depot anti-psychotics [1,2,3].

One-year prospective longitudinal study with a sample size of 23 patients diagnosed with schizophrenia in outpatient treatment. Study variables (baseline, 6 and 12 months): Brief Psychiatric Rating Scale (BPRS), clinical global impression (CGI), mean dose of aripiprazole depot, previous treatments, adherence, relapse rate, prolactin levels, sexual dysfunction, BMIs.

Twenty-three patients (71% men, 29% women) diagnosed with paranoid schizophrenia were identified. Improvement was obtained in the different study variables with statistically significant difference (P ≤ 0.05).

Following the introduction of aripiprazole depot in patients diagnosed with schizophrenia previously treated with other oral or depot anti-psychotics in our study, we conclude that maintaining therapeutic efficacy a better tolerability and safety profile, better therapeutic adherence and consequently lower relapse rate were achieved.

The authors have not supplied their declaration of competing interest.

Discrimination towards people with schizophrenia (PWS) by healthcare professionals is responsible of underdiagnosis and undertreatment of these patients. Negative attitudes toward PSW in health care professionals tend to be present since their university studies and are related to their knowledge and experience about the disease.

To assess opinion towards PSW in medical, nursing and psychology students and to investigate the relation with their knowledge of schizophrenia and its causes.

The study involved 133 medical, 200 nursing and 296 psychology undergraduate students. The opinion on mental illness questionnaire, the Devaluation Consumers Scale, and the Devaluation of Consumer Families Scale were administered to the sample. ANOVA and ANCOVA were used to test differences between groups and the relation between causal explanation of schizophrenia and discrimination towards PWS.

Psychology students were more aware than the other student of public stigma towards PWS and their families (F 12.57, P < 0.001; F 32.69, P < 0.001) and expressed a more positive view on treatments’ effectiveness (F 30.74, P < 0.001). Psychology (OR 0.48, 95% CI 0.26–0.88) and nursing (OR 0.29, 95% CI 0.15–0.55) students were more likely to identify psychological and social risk factors as more frequent causes of schizophrenia (vs. biogenetics) and these, in turn, were related to a better opinion towards social equality of PWS.

These preliminary findings underline the relevance of biopsychosocial model of schizophrenia within stigma-reduction programs for health science students.

The authors have not supplied their declaration of competing interest.

Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Dyspareunia after childbirth is quite common and have a range of repercussions to women's lives, including their sexual functioning. It could be affected by different risk factors. While role of obstetric factors including mode of delivery has been largely investigated, the influence of psychosocial factors remains unclear.

Our purpose was to determine frequency of postpartum dyspareunia and identify related psychosocial factors.

Thirty women between 2 and 6 months postpartum were recruited in consultation of maternity and neonatology center of Tunis. Data were taken from medical file and questionnaire designed to record psychosocial data and postpartum sexual function.

The mean age of women was 28.74 ± 8.4 years. Dyspareunia was reported by 43.33% of women. Dyspareunia was not associated to professional status. On the other hand, dyspareunia was significantly associated to fatigue (P = 0.024), lack of familial support (P = 0.03), conjugal conflicts (P = 0.01).

We have found an association between dyspareunia after childbirth and several psychosocial factors, pointing out the influence of social and psychological aspects in the sexual function in women. Thus, management of sexual disorders should take in consideration psychological dimension and involve an appropriate psychological care.

The authors have not supplied their declaration of competing interest.

Suicide risk is increased in eating disorders (ED), and detection is key to prevention. Self-image as operationalized in the structural analysis of social behavior (SASB) model has been shown to be associated with symptoms, treatment dropout, and outcome. SASB is a circumplex organizing self-directed behaviors along affiliation (love vs. hate) and autonomy (set free vs. control) dimensions. In a recent study, SASB related to health care-detected suicide attempts in ED. Methodology in that study ensured high specificity but risked lower sensitivity in suicide variables, and with such a high-threat outcome, research is needed on additional variables related to risk.

We aimed to study associations between SASB self-image and clinician- and self-rated suicidality at presentation and predicted over 12 months in ED patients.

Adult patients (n = 551) from a Swedish clinical database included 19% anorexia, 32% bulimia, 7% binge ED, and 42% other ED. We ran separate regression models for these diagnostic groups using SASB questionnaire data, also controlling for general psychiatric and ED symptoms, and in longitudinal models including baseline of each outcome.

SASB alone was associated with suicidality at presentation (9–67% variance explained) and predictively over 12 months (7–29%), and in the majority of models explained additional variance beyond baseline and clinical variables. Both affiliation and autonomy related to dependent variables in diagnosis-specific patterns.

The findings have implications for both theory and detection tools for suicide risk, as well as suggesting intervention targets to mitigate risk in treatment based on the well-validated SASB theory.

The authors have not supplied their declaration of competing interest.

Patients with severe opioid dependency might be treated with methadone, a pure μ-opioid-receptor, with promising results. Though, as for opioids, side effects are high, and among those, sexual dysfunction is among the most disturbing side effects.

Investigating the influence of Rosa Damascena oil to improve sexual dysfunction among male methadone users.

A total of 60 male patients (mean age: 30 years) with diagnosed opioid dependence and currently under treatment of methadone were randomly assigned either to the verum (Rosa Damascenca oil drops) or placebo condition. At baseline, and four and eight weeks later, patients completed self-rating questionnaires covering sexual dysfunction and happiness.

Over time sexual dysfunction decreased and happiness increased in the verum, but not in the placebo condition.

Results from this double blind, randomized, and placebo-controlled clinical trial showed that Rosa Damascena oil improved sexual dysfunction and happiness among male opioid addicts while under substitution treatment with methadone.

The authors have not supplied their declaration of competing interest.

Sexual dysfunction is a common consequence of cancer treatment that affects at least half of men and women treated for pelvic tumors and more than one quarter of individuals with other malignancies.

Identification of the main sexual dysfunctions related to cancer treatments. Awareness to the importance of addressing sexuality to cancer patients, identifying the main reasons why healthcare providers usually do not.

Literature review concerning researched articles published in Pubmed/Medline as well as related bibliography.

Most sexual problems are not caused by the cancer itself, but by toxicities of cancer treatment. Damage during cancer treatment to pelvic nerves, blood vessels and organ structures leads to the highest rates of sexual dysfunction. The most common sexual dysfunction in men under cancer treatment is the loss of desire for sex and erectile dysfunction. In women, the most common sexual dysfunctions are vaginal dryness, dyspareunia and loss of sexual desire, usually accompanied by difficulties in both the arousal and orgasm phases. According to literature, there are many cancer patients who would like to be informed and advised by their healthcare providers about the consequences of cancer treatment on their sexual health. Unfortunately, this rarely happens.

This work intends to publicize current existing information on sexual dysfunction in oncology, focusing on the prevalence, etiology and clinical presentation. The authors also intend to promote communication about sexual function and possible sexual dysfunctions resulting from cancer treatments.

The authors have not supplied their declaration of competing interest.

The possibility of evaluating cortical morphological and structural features on the basis of their covariance patterns is becoming increasingly important in clinical neuroscience, because their organizational principles reveal an inter-regional structural dependence which derive from a complex mixture of developmental, genetic and environmental factors.

In this study, we describe cortical network organization in anorexia nervosa using a MRI morpho-structural covariance analysis based on cortical thickness, gyrification and fractal dimension.

Aim of the research is to evaluate any alterations in structural network properties measured with graph theory from multi-modal imaging data in AN.

Thirty-eight patients with acute AN, 38 healthy controls and 20 patients in full remission from AN underwent MRI scanning. Surface extraction was completed using FreeSurfer package. Graph analysis was performed using graph analysis toolbox.

In acute patients, the covariance analysis among cortical thickness values showed a more segregated pattern and a reduction of global integration indexes. In the recovered patients group, we noticed a similar global trend without statistically significant differences for any single parameter. According to gyrification indexes, the covariance network showed a trend towards high segregation both in acute and recovered patients. We did not observe any significant difference in the covariance networks in the analysis of fractal dimension.

The presence of increased segregation properties in cortical covariance networks in AN may be determined by a retardation of neurodevelopmental trajectories or by an energy saving adaptive response. The differences between the analyzed parameters likely depend on their different morpho-functional meanings.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Anorexia nervosa (AN) is characterized by dysregulated eating that leads to chronic malnutrition, which may be responsible for several physical complications, including endocrine alterations, such as hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis.

Several studies have shown a dysregulation of the cortisol awakening response (CAR) in symptomatic AN patients. However, it has not been established if the deranged CAR of underweight AN patients is a primary phenomenon or an alteration secondary to malnutrition.

The aim of this study was to explore the salivary CAR in both underweight and weight-restored patients with AN.

We recruited 59 women: 18 undernourished AN patients, 15 weight-restored AN women and 26 normal-weight healthy controls. Saliva samples were collected in the morning, immediately after awakening and after 15, 30 and 60 minutes, in order to measure saliva levels of cortisol. Participants filled in the state-trait anxiety inventory (STAI) to test their anxiety levels in the morning of the test.

Compared to healthy controls, underweight AN patients showed an enhanced CAR whereas the weight recovered patients had a normal CAR. These results were not correlated with levels of anxiety.

For the first time, our results demonstrate that the deranged CAR found in acute AN patients is not present in weight-restored ones, suggesting that altered activity of the HPA axis of symptomatic AN patients is a state-dependent phenomenon.

The authors have not supplied their declaration of competing interest.