Psychoses represent serious psychiatric disorders in which an individual perceptions, thoughts, mood and behavior are significantly altered. Each person who develops a psychosis lives a unique set of symptoms and experiences that may widely vary depending on life circumstances. Although cognitive behavioral psychotherapy (CBT) for psychosis is recommended by main international guidelines, its effectiveness in real-world is still a subject of controversy.

The aim of this study was to evaluate, in an Italian outpatient clinical setting, eventual improvements induced by a 6 months intensive CBT specific programme focused on metacognition and emotional regulation and its consequences on psychosocial functioning and subjective well-being in pharmacologically stabilized psychotic patients.

Eight patients with schizophrenia spectrum disorders (DSM-V), clinically and pharmacologically stabilized, were included in a 6-month program of weekly CBT sessions with focus on metacognition, emotional dysregulation, social functioning and subjective well-being. Patients were assessed with the Metacognitions Questionnaire-30, Difficulties in Emotion Regulation Scale, Heinrichs Quality of Life Scale, The Psychological General Well-Being Index, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale at baseline and at 3 and 6 months, to verify any improvement on these specific domains and, possibly, on general psychopathology.

In this study CBT showed to be effective on all domains evaluated, most notably for younger patients with a short history of disease (<5 years). Metacognitive capacity was the dimension with most evident improvements, followed by the ability to modulate emotions and the consequent improvement in psychosocial functioning and perceived subjective well-being. During the 6 months follow-up none of the enrolled patients experienced symptoms exacerbation or psychotic relapses.

In conclusion, the 6-month CBT treatment showed to be effective for stabilized psychotic patients, improving metacognitive functions, emotional regulation, psychosocial functioning, and subjective well-being. In addition, insight, adherence and the therapeutic alliance improved. The absence of psychotic relapses is not attributable with certainty to the effect of CBT since, for this purpose, longer duration studies on larger case series and with RCT methods are required. However, it is plausible that the improvement obtained in disease awareness and adherence may be a facilitating factor in relapse reduction.

None Declared

Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene–environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum.

The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components).

Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene–environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions.

The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.

Although language deficits have often been reported in schizophrenia, the specific relevance of single linguistic levels of processing is still under debate. Moreover, little is known about language disturbances in bipolar disorder.

The aims of this study were to:

1. 1) investigate micro-linguistic (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) dimensions of speech production and

2. 2) evaluate syntactic comprehension skills in both schizophrenia and, for the first time, bipolar disorder.

A story telling task and a computer-based test of syntactic comprehension were administered to 30 Italian speaking DSM-IV patients suffering from schizophrenia, 30 participants with bipolar disorder and 30 healthy controls, comparable for age and educational level (p>0.05). Analysis of variance with post-hoc correction was performed to compare linguistic performance between groups.

In comparison to healthy participants, patients with schizophrenia had significantly impaired productivity, syntactic complexity and local/global discourse coherence and bipolar disorder subjects showed deficits in mean length of utterance (p< 0.05). Also, both groups of patients collected more grammatical errors than controls (p< 0.05), but they differed in regard to the grammatical type of construction they missed (passive-affirmative and active-negative, respectively).

Our results showed the presence of both micro and macro-linguistic deficits in linguistic production in schizophrenia, but not in bipolar disorder, suggesting that these abnormalities are specific for schizophrenia. On the contrary, syntactic construction comprehension was altered in both schizophrenia and bipolar disorder, potentially representing the target of innovative rehabilitation strategies.

Language disturbances, such as impoverishment, disorganization and dysregulation, are a prominent feature of schizophrenia. Several neuroimaging studies have suggested the superior temporal gyrus (STG) as a likely anatomical substrate of language deficits in schizophrenia. The aim of this study was to verify a correlation between structural measures of STG and Heschl's gyrus (HG) and language dimensions.

An extensive language examination battery, which included narrative and conversational expressive tasks, and syntactic and pragmatic comprehension tests, was administered to 23 schizophrenia patients (mean age±SD= 40.30±11.60) and 21 normal controls (mean age±SD= 42.19±11.05). All subjects also underwent a 1.5T MRI session, and STG and HG were manually traced and volumes were obtained, bilaterally, using Brains2.

Specific language deficits were shown in subjects with schizophrenia compared to healthy individuals (p<0.001), particularly in verbal fluency, syntactic complexity, lexical diversity and metaphor/idiom comprehension. Interestingly, speech fluency significantly directly associated with left STG gray matter volumes in controls (r=0.46, p=0.03) but not in patients (r=-0.27, p=0.21). In contrast, complex syntax and word diversity significantly correlated, respectively, with left and right HG volumes in schizophrenia patients (r=0.45, p=0.02; r=-0.47, p=0.02), but not in controls (p>0.05).

This study confirmed a widespread impairment of language in schizophrenia. Interestingly, distinct language dimensions differently correlated with STG-HG volumes in patients with schizophrenia and controls, particularly with regard to verbal fluency and syntactic measures.

Despite the considerable physical, emotional and social change that occurs during emerging adulthood, there is little research that examines the association between having a chronic health condition and mental disorder during this developmental period. The aims of this study were to examine the sex-specific prevalence of lifetime mental disorder in an epidemiological sample of emerging adults aged 15–30 years with and without chronic health conditions; quantify the association between chronic health conditions and mental disorder, adjusting for sociodemographic and health factors; and, examine potential moderating and mediating effects of sex, level of disability and pain.

Data come from the Canadian Community Health Survey-Mental Health. Respondents were 15–30 years of age (n = 5947) and self-reported whether they had a chronic health condition. Chronic health conditions were classified as: respiratory, musculoskeletal/connective tissue, cardiovascular, neurological and endocrine/digestive. The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess the presence of mental disorder (major depressive disorder, suicidal behaviour, bipolar disorder and generalised anxiety disorder).

Lifetime prevalence of mental disorder was significantly higher for individuals with chronic health conditions compared with healthy controls. Substantial heterogeneity in the prevalence of mental disorder was found in males, but not in females. Logistic regression models adjusting for several sociodemographic and health factors showed that the individuals with chronic health conditions were at elevated risk for mental disorder. There was no evidence that the level of disability or pain moderated the associations between chronic health conditions and mental disorder. Sex was found to moderate the association between musculoskeletal/connective tissue conditions and bipolar disorder (β = 1.71, p = 0.002). Exploratory analyses suggest that the levels of disability and pain mediate the association between chronic health conditions and mental disorder.

Physical and mental comorbidity is prevalent among emerging adults and this relationship is not augmented, but may be mediated, by the level of disability or pain. Findings point to the integration and coordination of public sectors – health, education and social services – to facilitate the prevention and reduction of mental disorder among emerging adults with chronic health conditions.