Predicting transition from clinical high risk (CHR) to first episode psychosis has proven difficult. Assessment of oxidative stress biomarkers and the niacin skin flush response (NSFR) may improve prediction accuracy.

To predict transition to psychosis based on combined clinical and blood biomarker.

To analyse data from patients in placebo group of a 12-week trial of omega-3 fatty acid supplementation in CHR. Transition likelihood ratios (LRs) for baseline historical risks, clinical assessments (PANSS subscales and total, GAF), NSFR and blood markers (nervonic acid, superoxide dismutase, glutathione) were calculated. Variables with the highest positive and lowest negative LRs were included in an odds ratio form of Bayes’ rule transition prediction models. Model accuracy was calculated by area under the receiver operating curves (AUROC) of each model.

1-year transition to psychosis was 28% (n=40). Historical data showed no predictability (sensitivity 30%, specificity 100% (AUROC)=0.688, p=0.085). Clinical assessments alone produced a sensitivity of 30% at a specificity of 95% (AUROC=0.83, p<0.0001). The biomarker panel alone predicted transition with 40% sensitivity and 100% specificity (AUROC=0.73, p=0.03). Combining history and clinical assessment provided no improvement above clinical data alone (sensitivity = 30%, specificity = 100%, AUROC=0.85, p< 0.0001). The combination of history, clinical assessment and biomarkers identified transition with a sensitivity of 60% and specificity of 100% (AUROC=0.87, p< 0.0001).

Probabilistic models combining biomarkers and clinical data are able to target high-risk subgroups within CHR and may help to personalise treatment.

A large body of literature has demonstrated that people affected by psychotic disorders show deficits in working memory, in Emotion Recognition (ER) and in data-gathering to reach a decision (Jumping To Conclusions – JTC).

To investigate a possible correlation between working memory, JTC and ER in FEP.

41 patients and 89 healthy controls completed assessments of working memory using WAIS shortened version, JTC using the 60:40 Beads Task and ER using Degraded Facial Affect Recognition Task.

According to the literature, cases had poorer performance in working memory tasks (Digit Span: μ7,72 [ds=2,98] vs μ10,14 [ds=3,10], U=865,00, p=0,00; Digit Symbol: μ5,36 [ds=2,43] vs μ10,05 [ds=3,10], U=455,50, p=0,00; Arithmetic: μ5,46 [ds=2,76] vs μ8,74 [ds=3,24], U=865,50, p=0,00; Block Design: μ4,82 [ds=2,72] vs μ7,60 [ds=3,18], U=912,00, p=0,00), in Beads Task (81,6% vs 51,1%, χ2=10,27, p=0,001, μ2,53 [ds=3,57] vs μ4,23 [ds=4,77], U=1171,00, p=0,006) and in DFAR (total errors: μ21,62 [ds=7,43] vs μ16,58 [ds=8,69], U=554,50, p=0,002). Furthermore working memory tasks in cases group correlated significantly with JTC (Digit Span: r_rho=0,276, p=0,003; Digit Symbol: r_rho=0,275, p=0,002; Arithmetic: r_rho=0,265, p=0,003; Block Design: r_rho=0,292, p=0,001), but only Digit Span with ER (r_rho=-0,239; p=0,021). In addition, we found that JTC and ER were significantly associated (r_rho=-0,281; p=0,004).

Data show that working memory impairments, JTC style and dysfunctions in the facial emotions recognition are phenomena strongly correlated in the group of patients. Preliminary results suggest the importance of early rehabilitation as the impairments detected may lead to difficulties in social and relational adaptation in psychotic patients.

Patients with schizophrenia often experience depressive symptoms, while the overlap between depressive and negative symptoms introduces inherent complexity in making accurate diagnosis and initiating appropriate treatment. Using antidepressant medication (SSRI/SNRIs, tricyclic antidepressants, MAOIs, NDRIs) to treat depressive symptoms associated with schizophrenia is a common therapeutic approach, but remains controversial.

The primary objective of the 'ELPIS” study was to determine the prevalence and degree of depressive symptoms in clinically stable adult Greek outpatients with schizophrenia. Secondary endpoints included management patterns of stabilized outpatients with schizophrenia with depressive symptomatology and comparison between those with and without depressive symptoms.

The target was to explore possible patterns in therapeutic approaches during the maintenance phase of schizophrenia in patients with and without depressive symptoms.

'ELPIS” is a multicentre, national, cross-sectional, observational study of stabilized outpatients with schizophrenia. 392 patients were recruited over a 5-month period (172 with depressive symptoms, 220 without). The study cohort included a single-patient visit within a normal clinical practice setting: all study-related information was collected retrospectively, through medical chart review and patient interview.

Treatment with antidepressants was more common for patients with depressive symptoms (CDSS score>6) compared to patients without (70.1% vs 29.9%, p<0.001).

Treatment with typical antipsychotic was less common for these patients (32.3% vs 67.7%, p=0.04). Differences in use of other medication classes, monotherapy/combination therapy, comorbidities and socio-demographic characteristics were not statistically significant.

Treatment with antidepressants, while still controversial, is more common in patients with schizophrenia with depressive symptoms than in those without.

Deficit in the ability to understand others' mental conditions, opinions, beliefs, fantasies and desires have been reported among schizophrenic patients so far. However, fewer studies have examined the type of positive/negative symptoms and delusions on their social cognition abilities. The main purpose of this study was to investigate the theory of mind (ToM) performance in schizophrenic patients and compare it with healthy controls.

This cross-sectional study conducted at Ibn-e-Sina psychiatric hospital in Mashhad, included 28 schizophrenic patients, aged between 18 and 50, based on DSM-IV-TR criteria and 14 healthy subjects. Evaluation of symptoms was performed by positive and negative syndrome scale (PANSS) test and the ToM assessed by the 'Reading the Mind in the Eyes” Test.

Analysis of variance showed a significant impaired ToM in schizophrenic patients as compared with the healthy controls (p=0.00). But the ToM deficits did not differ in positive and negative symptoms (p=0.951), genders (p=0.286) and the frequency of episodes (p= 0.470). The delusions of persecution and grandeur showed a significant lower ToM performance as compared with the delusions of control (p=0.041).

Although the ToM abilities impairment in schizophrenia has been proved, its relationship with types of symptoms and delusions, and the duration of illness require further investigations. This may help to improve the possible treatments and prevention potentials in future.

Schizophrenia patients with a history of community violence constitute a sub-group of schizophrenia patients (SCZ) that receive much public attention. While brain structural abnormalities are established in SCZ, there are few studies of brain morphology in violent SCZ.

To conduct a pilot study of brain morphology in a SCZ cohort with a history of severe community violence from a high security forensic psychiatric unit.

Investigate differences in hippocampal, ventricular, thalamic, and amygdala volumes in violent SCZ, SCZ, and healthy controls (HC).

Structural 3T MRI scans were acquired of 47 subjects (violent SCZ n=11, mean age 33.2 years (SD 9.0), 91% male; SCZ n= 17, 34.3 years (7.4), 94% male; HC n=19, 33.2 years (9.1), 90% male). Violent offence included murder, attempted murder, or severe assault (with or without weapon) towards other people. The FreeSurfer 5.3.0 software was used to obtain subcortical brain volumes. Effects of age, sex, and intracranial volume were controlled for, and Bonferroni correction was applied.

Violent SCZ had smaller right hippocampal volumes (F(2,42)=4.11, p= .024) compared to HC (padj= .028) and SCZ (pnom= .046). On a trend level, violent SCZ had larger right lateral ventricles than HC (pnom =.032) and SCZ (pnom=.049), and smaller left hippocampus than HC (pnom =.027). No differences in thalamus and amygdala volumes were found.

Violent SCZ may be associated with more pronounced brain abnormalities than non-violent SCZ. Future studies are needed to verify the observed abnormalities and determine the pathophysiological mechanisms and functional consequences.

Schizotypy is regarded as a subthreshold expression or precursor of schizophrenia spectrum psychosis.

Schizotypal personality disorder is a risk factor of the ‘genetic risk and functional decline’ criterion of the ultra-high risk (UHR) criteria for psychosis; and its positive features are part of attenuated psychotic symptoms (APS) of the UHR criteria. Furthermore, schizotypy as assessed with the Wisconsin Scales of Schizophrenia Proneness (WSSP) 'Perceptual Aberration”, 'Magical Ideation”, and 'Social Anhedonia” but not 'Physical Anhedonia” was predictive of psychosis in the community.

Thus, we examined the psychosis-predictive value of the for WSSP in 128 patients seeking help at an early detection service (23+/-7 yrs; 56% male; 81% at-risk for UHR and/or basic symptom criteria) with a median follow-up of 24 (1-101) months by Cox regression.

Within 48 months; 36 patients converted to psychosis. Unexpectedly, none of the four WSSP was a significant predictor of conversion. This negative finding was replicated when the positive (Perceptual Aberration and Magical Ideation) and negative (both Anhedonia scales) dimension were examined. Thus, although schizotypy scales might be able to identify a more extreme range of the psychotic continuum in the community, they lack the ability to further separate ‘true’ from ‘false’ risk cases in a clinical sample already representing this more extreme range of the psychotic continuum.

This indicates that WSSP might be useful rather as an initial screening for persons potentially at-risk for current criteria in the community than as additional predictors in already identified risk patients.

This study directly compares the effectiveness of aripiprazole once-monthly 400 mg (AOM) and paliperidone palmitate once-monthly (PP) on the validated and symptom-focused Heinrichs-Carpenter Quality-of-Life Scale (QLS) in schizophrenia.

A 28-week, randomized, open-label rater-blinded, head-to-head study (NCT01795547) of AOM and PP in adult patients (18-60 years) needing a change from current oral antipsychotic treatment for any reason. The study comprised oral conversion, initiation of AOM or PP treatment according to labels, and treatment continuation with injections every 4 weeks. The primary endpoint assessed non-inferiority and subsequently superiority on change from baseline to week 28 in QLS total score analyzed using a mixed model for repeated measurements.

Of 295 randomized patients, 100/148 (67.6%) of AOM and 83/147 (56.5%) of PP patients completed 28 weeks of treatment. In treated patients, adverse events (AEs) were the most frequent reason for discontinuation; AOM: 16/144 (11.1%), PP: 27/137 (19.7%). The difference in change from baseline to week 28 on QLS total score was statistically significant (4.67 [95%CI: 0.32;9.02], p=0.036), confirming non-inferiority and establishing superiority of AOM compared to PP. The respective changes were 7.47±1.53 for AOM and 2.80±1.62 for PP. AEs occurring at rates ≥5% in either group in the treatment continuation phase were weight increased (AOM: 12/119 [10.1%]; PP: 17/109 [15.6%]), psychotic disorder (AOM: 3/119 [2.5%]; PP: 6/109 [5.5%]) and insomnia (AOM: 3/119 [2.5%]; PP: 6/109 [5.5%]).

Superior improvements on the clinician-rated QLS and lower rates of all-cause discontinuation suggest greater overall effectiveness for aripiprazole once-monthly vs paliperidone palmitate.

Our retrospective study was performed on 80 patients with schizophrenia newly admitted in closed wards of the department of Psychiatry, Farhat Hached Hospital of Sousse, Tunisia during 2010. Eighty HBD with no history of autoimmune or mental diseases served as controls. Search for RF and anti-CCP antibodies were detected by Enzyme-linked immunosorbent assay (ELISA).

RF were significantly more frequent in schizophrenic patients than in controls (17.5% vs 3.75%, p = 0.01) and RF-IgM isotype was more frequent in schizophrenic patients than in HBD 12.5%. Anti-CCP was detected only in seven patients with schizophrenia with a frequency of 8.75% and in five HBD with a frequency of 6.25%. The frequency of serological markers of RA (FR IgG or IgA or IgM or anti-CCP) was significantly higher in patients than in HBD (23.75% vs 11.25%, p = 0.037).

Contrary to literature data, our study found a high frequency of RF in the acute phase of schizophrenia and particularly of the IgM isotype. Thus a large population study would be interesting to confirm this association between the RA and schizophrenia.

In schizophrenia the life expectancy is significantly lower compared to the general population. To monitor their functioning over the course of the illness, a protocol for routine outcome monitoring (ROM) has been developed in the Netherlands.

This study investigated the effectiveness of Routine Outcome Monitoring (ROM) in clinical practice. More specifically, we investigated whether ROM outcomes resulted in treatment in accordance with guidelines for schizophrenia.

Out of the ROM database of 2010 (n=1040), a random sample of 100 patients diagnosed with a psychotic disorder was taken. Data from blood tests, a physical examination, interviews, and standardized questionnaires were used. The prevalence of cardiovascular risk factors, psychosocial problems and sexual dysfunctions was calculated. Offered treatment was investigated with the treatment plans of patients.

The sample consisted of 63 males and 37 females. The average age was 44 and the average duration of illness was 17.7 years. High prevalences of cardiovascular risk factors, psychosocial problems and sexual dysfunctions were found. Cardiovascular risk factors remained untreated in 61% of cases, psychosocial problems remained untreated in 85% of cases and sexual dysfunctions were not treated at all in our sample.

High rates of non-treatment were found for cardiovascular risk factors, psychosocial problems and sexual dysfunctions, despite high prevalences as identified with ROM. Thus, ROM outcomes do not result in treatment in accordance with guidelines for the majority of patients. Steps are necessary to bridge the gap between ROM and treatment to ensure this group of severely mentally ill patients receives the best possible treatment.

Negative symptoms in patients with schizophrenia are strongly associated to disease burden. Aerobic exercise might be beneficial in treating negative symptoms.

The meta-analysis aims to evaluate the effect of aerobic exercise on negative symptoms in schizophrenia.

The Cochrane Library, Medline, Embase, PsycINFO and CINAHL were searched from their inception until 16 March 2014. Randomised controlled trials (RCT's) comparing aerobic exercise with other psychosocial interventions in schizophrenia were included if negative symptoms were assessed. The methodological quality of the studies was assessed with the Clinical Trial Assessment Measure (CTAM).

Nine studies were included (N= 488). Seven out of nine studies had poor methodological quality as measured with the CTAM. The meta-analysis showed a small non-significant treatment effect in favour of exercise interventions (Hedges’ g = -0.310, CI -0.787 0.168) with a power of 75%. The analysis indicates high heterogeneity (Q(8)=37.163 (P<0.000) I2= 75%). A meta-regression analysis showed that more training sessions were associated with a higher decrease in negative symptoms (Hedges’ g = 0.460 -0.006 0.925 (P=0.053)). This was confirmed in a moderator analysis including studies with >20 sessions (Hedges’ g = 0.640, CI -1.281 0.000, Q(5)=24.214 (P < 0.000) I2=79%).

A large significant effect of exercise was found in five studies comparing exercise to TAU (Hedges’ g=-1.370, CI -2.352 -0.389, Q(4)=29.278 (P< 0.000) I2=86%).

This meta-analysis demonstrated a significant effect of aerobic exercise on negative symptoms in schizophrenia compared to TAU, but no effect compared to any other (active) control condition. The quality of the included studies was low.

Sexuality is an important part of health, quality of life and general well being. Most of the studies have concentrated on male sexual dysfunctions and very few studies are done on female sexual dysfunction. But sexual dysfunction is more prevalent in women than in men. Studies from India have reported prevalence of female sexual dysfunction varies from 33.3% to 73.2%.

To study the prevalence of sexual dysfunction in females.

This is a cross sectional study of descriptive and exploratory design, conducted at JSS Hospital, Mysore. A total of 938 female subjects were taken for the study after they fulfilled inclusion criteria and informed consent was obtained from the patients. The method of sampling has been random. All the study subjects were assessed for psychiatric disorders using MINI PLUS.A detailed socio-demographic data was then obtained from the patients. They were further assessed on Arizona Sexual experience scale to screen for sexual dysfunction. This was followed by detailed evaluation of sexual functioning using Female Sexual Function Questionnaire(SFQ 28). Detailed analyses of all the above was done using the statistical package(SPSS) version 16.0. Ethical committee clearance was obtained from the institution for the above study.

This is the first epidemiological study to report prevalence rate of sexual dysfunction in females in general population. The study revealed that sexual dysfunction is prevalent in 26.97% of female subjects. Lack of desire was the highest reported dysfunction(26.8%) followed by arousal difficulty(22.6%),difficulty in Enjoyment(20.8%),Lubrication difficulties(16.5%),difficulty in reaching Orgasm(15.5%) and Pain during intercouse(10.7%) of the subjects.

Sexual dysfunction is widely prevalent in women in India, suggesting it as a public health concern. Low reporting rates and low treatment rates were identified in the sample. Further, women with sexual disorders should be encourged to seek help and treatment from the professionals.

Gender dysphoria is a new diagnostic class in DSM-5 that reflects a new conceptualization of the disorder emphasizing the phenomenon of 'gender incongruence”. It refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Hormone and/or surgery are treatment options available. There is some clinical evidence that patients under gonadotropin-releasing hormone (GnRH) agonists may develop symptoms consistent with various psychiatric disorders with and without psychotic features.

To review new DSM-5 conceptualization of gender dysphoria and psychiatric side-effects of ovocyte stimulation drugs. Also to report one selected clinical case of psychosis after FSH and LH stimulation in a patient under female to male sex reassignment process.

The authors have conducted an online search on PubMed on psychosis after ovocytes stimulation and gender dysphoria and systematically reviewed a case report.

There is little evidence of psychiatric side-effects of GnRH agonist. Case report: 22 years old male with diagnosis of gender dysphoria under female to male sex reassignment process with FSH and LH stimulation to ovocyte preservation that acutely developed psychiatry symptoms of bizarre behaviour, irritability, flight of ideas, soliloquies and erotomaniac delusions that remit on antipsychotic drugs.

Gender dysphoria is a new diagnostic class in DSM-5. There are multiple hormone and/or surgery treatments options. There is little evidence hormone treatments are associated with psychiatric side-effects, namely psychosis. To conduct a well-designed clinical trial on psychiatric symptoms related with hormone treatment in gender dysphoria patients is needed.

Sexual dysfunction is a common condition in patients taking antipsychotic medication, with a reported prevalence of 45-80% in males, and 30-80% in females (1). Ziprasidone induced spontaneous orgasm (2) and priapism (3) were reported in the literature. Here, we report a case of increased sexual arousal after ziprasidone treatment.

A twenty-three-year old, single, female patient was admitted to our clinic with reference and persecutory delusions, auditory and visual hallucinations. Her complaints had been persisting for about one month. Her mental status examination revealed the following: attention and concentration were diminished, speech was slow, delusions of reference and other Schneiderian first-rank symptoms, and hallucinations were present, reality testing was impaired, judgment and abstract thinking skills partially preserved. The patient was not able to tolerate her treatment due to side effects. Therefore, it was changed to ziprasidone 40 mg/day and the dosage was increased gradually. After increasing the ziprasidone dose to 60 mg/day, she complained about increased sexual arousal. No other symptoms suggestive of a manic episode were present, and no other medical causes were detected. The patient also said that she never had a similar period in her life previously. Ziprasidone was tapered slowly, and quetiapine 300 mg/day was started. She indicated that increased sexual arousal disappeared after the cessation of ziprasidone.

Ziprasidone has been reported to cause sexual dysfunction at a much lower rate than other antipsychotics. To the best of our knowledge, this is the first case report of increased sexual arousal with ziprasidone.

Individuals with substance use disorders are at increased risk for acquiring and transmitting sexually transmitted infections. High risk sexual behaviour is common in substance misuse population and hence primary, secondary or tertiary prevention against sexually transmitted infection is likely to improve outcome.

To understand the awareness of sexual health and sexually transmitted infections (STIs) in substance misuse population.

Aim of this study was to explore the awareness of sexual health in substance misuse population using the sexual health self-assessment questionnaire.

A cross- sectional study was conducted of awareness of sexual health in substance misuse population. 50 patients were randomly selected from the outpatient clinics of an addiction team who completed a sexual health self-assessment questionnaire adapted from www.nhs.uk.

All 50 patients took part in the study, out of which 17 (34%) patients answered all 5 questions correctly. 42 out of 50 (84%) answered question 1 correctly, 39 out of 50 (78%) answered question 2 correctly, 29 out of 50 (58%) answered question 3 correctly, 43 out of 50 (86%) answered question 4 correctly and 37 out of 50 (74%) answered question 5 correctly.

It is clear that routine screening and awareness of this co-morbid condition in substance misuse settings followed by appropriate management is likely to have a positive outcome of this co-morbid population. A combination of primary, secondary and tertiary interventions is needed to achieve a meaningful degree of prevention and protection against sexually transmitted infections in substance misuse population.

Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent in patients with primary insomnia, indicating that the two measures are partially independent.

To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG determined sleep.

The aim of this study was to investigate to which extent sleep effort, dysfunctional beliefs and attitudes about sleep, and pre-sleep arousal are associated with subjective insomnia severity and PSG- determined sleep.

47 patients with primary insomnia and 52 good sleeper controls underwent two nights of PSG and filled in the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses adjusted for age, gender, depressive symptoms, and group status were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time.

Subjective insomnia severity was positively associated with sleep effort. PSG determined total sleep time was negatively associated with somatic pre-sleep arousal and dysfunctional beliefs and attitudes about sleep.

The pattern of results suggests that subjective insomnia severity and PSG determined total sleep time are driven by different mechanisms. Being associated with subjective sleep disturbance, which defines the diagnosis of insomnia, the reduction of sleep effort appears to be an important therapeutic target for all patients. Somatic pre-sleep arousal and dysfunctional beliefscould be a target for patients who suffer from markedly reduced PSG determined total sleep time.

Sleep disturbances are common complains among schizophrenia patients. Based on these subjective complaints, treatment often involves hypnotic and/or anxiolytic medications with disturbing side effects that increase patients' drug load. Most hypnosedatives are prescribed based on subjective complaints, but little information is published on the relationship between self-report and recorded sleep in this population.

The present study examined the correlation between subjective and objective evaluation of sleep measures among schizophrenia patients compared with age- and gender-matched controls.

The sample comprised two groups: 30 schizophrenia patients (mean age=48.50, SD=12.45; 17 M, 13 F) and 30 age- and gender-matched controls (mean age= 48.56, SD=12.54; 17 M, 13 F). Subjects subjectively evaluated their sleep patterns using two qualitative reports–the Mini Sleep Questionnaire (MSQ), and Pittsburgh Sleep Quality Index (PSQI), and one quantitative report–the Technion Sleep Questionnaire (TSQ). Additionally, subjects' sleep was continuously monitored for a week with a wrist actigraph (Ambulatory Monitoring, Inc.).

Analysis revealed no significant correlations between subjective and objective measures of sleep in all participants. Interestingly, significant interactions were found between estimation type of the discrepancy (overestimate vs. underestimate) and schizophrenia existence (schizophrenia patients vs. controls) on discrepancy of sleep efficiency [F(1,51)=6.2, p<0.05], sleep percentage [F(1,54)=8.86, p<0.01] and minutes of wake after sleep onset [F(1,51)=9.24, p<0.01]; meaning that schizophrenia patients display greater discrepancies than controls.

The findings indicate that subjective reports among schizophrenia patients are unreliable, and argue for objectively evaluating sleep in this population before prescribing sleep medications.

The appropriate regulation of thoughts and emotions decreases the likelihood of pathogenic activation of stress response (Gross, 2007). Stress is closely related to impaired sleep incross-sectional studies (Akerstedt, 2006) and can elicit profound and lasting effects on sleep (Hall et al., 2004).

To analyze the associations between perceived stress, cognitive coping strategies and sleep difficulties.

549 students (80.1% females) from two Portuguese Universities filled in the Portuguese version of Perceived Stress Scale 10 (PSS, Cohen et al., 1983; Amaral et al., 2014), Cognitive Emotional Regulation Questionnaire (CERQ, Garnefski et al., 2001; Castro et al., 2013) and three questions were used to access sleep difficulties (initiating sleep, sleep maintenance, and early morning awakening).

In the present sample the prevalence for difficulty initiating sleep was 29,8%, of maintaining sleep was 27,9% and of early morning awakening was 30,9%. Considering stress, cognitive coping strategies and sleep, consistent and strongest positive correlations were observed between Perceived Stress and Rumination (from r=.263 to r=.486; p<.01), Catastrophizing (from r=.263 to r=.391; p<.01) and negatively correlated with Positive reappraisal and planning (from r=-.109; p<.05 to r=-.346; p<.01). The correlations between perceived stress and difficulties in initiating and maintaining sleep were from r=.249 to r=.356(p<.01). Strongest correlations were observed between Rumination, Self-blame and Catastrophizing and difficulties in initiating and maintaining sleep (fromr=.152 to r=.258; p<.01).

Rumination, Self-blame and Catastrophizing were the cognitive coping strategies consistently associated with perceived stress and difficulties in initiating and maintaining sleep.

The perception of stress does not automatically lead to prolonged activation. The cognitive representations of stressors need to be prolonged in order to extend their physiological concomitants (Brosschot, Gerin, & Trayer, 2006). It is shown that elevated levels of repetitive negative thinking appear to be causally involved in the maintenance of emotional problems (Ehring & Watkins, 2008).

To analyze the associations between Perceived Stress (PS), Perseverative NegativeThinking (PNT) and Sleep difficulties.

549 students from two Portuguese Universities filled in the Portuguese version of Perceived Stress Scale (Cohen et al., 1983; Amaral et al., 2014), PerseverativeThinking Questionnaire (Ehring et al., 2011; Chaves et al., 2013), and three questions were used to access sleep difficulties (initiating sleep, sleepmaintenance, and early morning awakening).

In the present sample the prevalence on difficulty initiating sleep was 29,8%, of maintaining sleep was 27,9% and of early morning awakening was 30,9%. The strongest correlations were observed between PS and PNT (from r=.338 to r=.520; p<.01), being slighthigher to Cognitive Interference and Unproductiveness dimension. The correlations between PS and difficulties in initiating and maintaining sleep were from r=.314 to r=.366 (p<.01). Considering PNT and Sleep associations, strongest correlations were observed in relation to difficulties of initiating sleep (from r=.206 to r=.222; p<.01) and weaker in relation to difficulties in maintaining sleep (from r=.125 to r=.198;p<.01).

The PS was strongly associated with PNT and both of these variables were associated with sleep difficulties (particularly initiating and maintaining sleep).