Long-acting injectable antipsychotics have undergone a great development in recent years, becoming useful tools to facilitate therapeutic adherence. Once-monthly risperidone ISM is a new way of treatment which has been commercialized in Spain since September 2022.

In this study we will analyze our clinical experience with this treatment, especially in terms of tolerance and efficacy, during its first year of widespread use.

Longitudinal retrospective study of monhtly risperidone users in a mental health center in the Autonomous Community of Madrid (Spain), between September 2022 and September 2023.

A sample of 13 patients was selected, collecting both sociodemographic (age, gender) and clinical variables (diagnosis, dose, time elapsed, number of hospital readmissions, adverse effects and monotherapy or combined use). A descriptive analysis of the collected data was then carried out.

Monthly risperidone was used in 13 patients: 15% (n=2) were women, and 85% (n=11) were male. The mean age of the patients was 43.6 years. The most frequent diganosis of these patients was “psychotic disorders” (84,6%, n= 11), with other diagnoses such as schizoaffective disorder (7,7%, n=1) and obsessive compulsive disorder (7,7%, n=1).

The doses used of risperidone were 100mg every month in 61,5% of patients (n=8) and 75mg in 38,5% of patients (n=5). The mean time since the first administration was 4.35 months.

Concerning monotherapy, 84,6% (n=11) of patients on monthly risperidone were on antipsychotic monotherapy, while 15,4% (n=2) required more than one antipsychotic. Among the switches made to monthly risperidone, 69,2% (n=9) were previously treated with oral risperidone, 15,4% (n=2) were treated with once-biweekly risperidone long-acting injectable, 7,9% (n=1) with oral paliperidone and 7,9% with aripiprazole monthly injectable.

During the study period, hospital readmissions for psychiatric descompensations occurred in one patient (7,9%, n=1), while the rest of the patients (92,1%, n=12) did not present decompensations that required psychiatric admission.

Moderate or severe effects occurred in one patient (7,9%, n=1), in the form of acute dystonia, which led to the interruption of injectable treatment. The rest of the patients (92,1%, n=12)) did not present severe adverse effects. Minor adverse effects appeared in 3 patients (25%); these adverse effects were already present in the previous treatment with oral risperidone and did not condition the suspension of the treatment.

In the sample analyzed, once-monthly Risperidone ISM had reasonable tolerance levels. Also, it´s shown to be effective in preventing psychotic decompensations and hospital admissions.

Therefore, this new injectable of monthly risperidone represents a therapeutic alternative to consider in order to guarantee therapeutic adherence and improve the quality of life of patients with psychotic symptoms.

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Hydroxychloroquine, an antimalarial drug, is an important therapeutic tool in the management of rheumatic diseases such as Systemic Lupus Erythematosus (SLE) due to its anti-inflammatory action. SLE is a chronic autoimmune inflammatory disease that affects the connective tissue of multiple organs. Neuropsychiatric disturbances in SLE are common; however, lupus psychosis is rare, occurring in 2 to 11% of patients. The literature has described the emergence of neuropsychiatric symptoms as an adverse effect of hydroxychloroquine use, with some patients experiencing clinical depression, anxiety, suicidal ideation, and psychotic symptoms.

The aim of this work is to review the available evidence regarding neuropsychiatric symptoms secondary to the use of hydroxychloroquine.

The case of a 50-year-old woman diagnosed with SLE, with no other relevant medical history, has been evaluated. She was brought to the emergency department due to paranoid and persecutory ideas, as well as self-referentiality, coinciding with the introduction of hydroxychloroquine in her treatment. She was admitted to the University Hospital of Gran Canaria Doctor Negrín with a diagnostic orientation of a first psychotic episode.

The presence of neuropsychiatric symptoms in patients diagnosed with SLE is so common that they constitute a diagnostic criterion for the disease. On the other hand, the medications used for therapeutic management of this disease can lead to the emergence of new neuropsychiatric symptoms or exacerbate preexisting neuropsychiatric clinical manifestations.

The study of this case highlights the challenges in establishing a differential diagnosis between primary SLE symptoms that require an increase in hydroxychloroquine and those caused by its own treatment. It underscores the need for further studies to explore the risk of psychiatric symptoms associated with the use of hydroxychloroquine, as well as its impact on the course of underlying mental disorders.

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relapse and frequent rehospitalizations. The length of stay (LOS) of these patients has been a concern of researchers. The ability to identify determinants of LOS at admission – and, thus, identify patients who are likely to need a longer stay early on – may help treatment planning.

We aimed to investigate socio-demographic and clinical profile of inpatients with schizophrenia, and to identify factors associated with LOS.

It was a retrospective study carried out among 90 inpatients with schizophrenia admitted to the psychiatry “B” department, Hedi Chaker university hospital (Sfax, Tunisia), during the period between January 2015 and December 2019. Data collection was performed through the patients’ medical records. Statistical analysis was performed using SPSS v.25.

The mean age of our patients was 32 years. Among them, 57.78% were women. The mean LOS was 28 days. Factors found to be significantly associated with LOS were: the number of admissions (p<0.001, r=0.404), involuntary hospitalization (p=0.001), violence and disturbance of public order as a reason of admission (p < 0001) and the lack of social support (p=0.039). As for the clinical symptoms, hallucinations were significantly associated with a longer LOS (p=0.001).

Our findings highlighted several factors associated with a longer LOS. This may be helpful to the management of hospitalization and ensuring that any periods of liberty deprivation do not last longer than necessary to provide appropriate treatment.

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Ferroptosis is a programmed form of cell death characterized by excessive accumulation of intracellular iron fraction, uncontrolled lipid peroxidation, impairment of glutathione-dependent antioxidant functions, and loss of oxidative-antioxidant balance. Nerve cells are sensitive to excessive amounts of iron, which impairs the functioning of mitochondria and leads to their death. Ferroptosis has been identified in neurological diseases such as stroke, Alzheimer’s disease, Parkinson’s disease. Features of ferroptotic cells have been observed in models expressing cognitive deficits, and ferroptosis-related genes have been associated with the development of mental illnesses.

The aim of the study was to analyze the available literature on the relationship between the occurrence of ferroptosis and cognitive impairment occurring in mental diseases, such as schizophrenia

The publications found in the PubMed database were analyzed after entering the following entries: ferroptosis, mental illness, cognitive functions, schizophrenia.

Ferroptosis occurs in mental illnesses. Increased expression of the TP53 and VEGFA genes, which are associated with ferroptosis, has been identified in patients suffering from schizophrenia. Animal research confirms that disturbed iron homeostasis causes iron overload in nerve cells, which leads to ferroptosis and has a neurodegenerative effect, as well as deepens cognitive deficits. The use of iron chelator has a neuroprotective effect and reduces the occurrence of cognitive disorders.

Genes associated with ferroptosis may influence the development of schizophrenia, which means that ferroptosis may be involved in the pathophysiology of schizophrenia. Excess iron inside nerve cells, as a feature of ferroptosis, may affect the deterioration of cognitive functioning. Administration of iron chelators protects neurons by reducing the toxic effects of iron.

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“Folie à deux,” or shared psychosis, is a fascinatingpsychiatric phenomenon characterized by the transmission of delusional beliefs and psychotic symptoms from one individual (the “inducer”) to another (the “recipient”) who share a close emotional bond. Despite its rarity, “Folie à deux” presents unique challenges and insights into the understanding of psychosis and the intricacies of interpersonal relationships.

The primary objective of this review is to analyze the recent clinical literature on “Folie à deux” to better comprehend its clinical presentation, diagnostic criteria, etiological factors, and therapeutic approaches. By synthesizing the latest research findings, we aim to enhance the awareness and understanding of this intriguing phenomenon among mental health professionals.

A case report of a couple of a 34-year-old male and a 43-year-old female with a shared delirium. The male was brought to the emergency department by ambulance after being found in the street with behavioral disturbances and delusional symptoms. Individual interviews with both members of the couple revealed shared delirium. He was admitted to the psychiatric ward for the clinical picture consisting of a chronic delusional disorder of years of evolution and and new symptoms such as restlessness and behavioral disturbances.

The review reveals that “Folie à deux” remains a rare but clinically relevant phenomenon, with reported cases spanning diverse cultural and familial contexts. Diagnostic criteria, as outlined in the DSM-5, have been useful in guiding clinicians in identifying and managing cases. The literature emphasizes the importance of a thorough psychiatric evaluation to distinguish “Folie à deux” from other psychopathological conditions. Recent research has also shed light on potential neurobiological mechanisms and genetic factors contributing to shared psychosis. Therapeutically, early intervention and tailored treatment plans are crucial in achieving favorable outcomes. While antipsychotic medications remain a cornerstone of treatment, family therapy and psychoeducation have emerged as valuable adjunctive approaches to address the unique challenges posed by shared psychosis.

In conclusion, “Folie à deux” continues to be a captivating and clinically relevant phenomenon in contemporary psychiatry. This bibliographical review underscores the importance of recognizing and diagnosing shared psychosis in clinical practice. Moreover, it highlights the need for further research to unravel the underlying mechanisms and genetic predispositions associated with this condition. Ultimately, a multidisciplinary approach, including pharmacological, psychotherapeutic, and family-based interventions, holds promise in improving the prognosis of individuals affected by “Folie à deux.”

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Insensitivity to pain in schizophrenia is a complex phenomenon. Understanding schizophrenia’s heterogeneity is crucial for personalized treatments.

Individuals diagnosed with schizophrenia often experience gastrointestinal issues and exhibit elevated levels of depression and anxiety. There is an urgent need to understand how these factors interact and how childhood traumas, a significant risk factor for schizophrenia, can affect gastrointestinal symptoms in these individuals.

The study involved 51 individuals diagnosed with schizophrenia. The hierarchical cluster analysis on the principal components (HCPC) was performed to identify groups of similar observations for test scores and the overall results for 14 tests. Hierarchical clustering was performed using Ward’s minimum variance method. Differences in the results of individual tests between clusters were estimated using the V test.

The schizophrenia group was categorized into three clusters. The patients belonging to the first cluster are characterized by high GAF test scores and low scores on tests for gastrointestinal symptoms, ITQ, CTQ, GHQ-28, STAI, CALGARY, BDI II, SAMPS, SANS, and PANNS. In contrast, patients in the second cluster had scores significantly above the group average on the tests SANS, PANNS, and SAPS and low scores on the tests DBZ RZ, CTQ, STAI, BDI II, ITQ, and GAF. Finally, patients in the third cluster had high scores on the tests BDI II, ITQ, STAI, CTQ, GHQ 28, DBZ RZ, gastrointestinal symptoms, TEC PL, CALGARY, and CISS. High CTQ scores may contribute to increased GSSR scores due to childhood trauma’s potential to trigger chronic stress, affect the nervous system, and induce psychosomatic symptoms, including gastrointestinal problems. Elevated BDI II and STAI scores can also impact GSSR results by disrupting the connection between emotions and the gastrointestinal system.

This research underscores the intricate interplay of various psychosocial and physiological factors that influence the perception of pain related to gastrointestinal symptoms in individuals with schizophrenia.

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According to scientific sources, personal resources in the form of resilience, stress coping skills play an important protective role in the prevention of psychosis recurrence. Weakening the psychological capacity of the patient and increasing stress are risk factors for psychosis.

To study the protective role of such personal resources as resilience and coping with stress in schizophrenia, as well as the influence of negative symptomatology and psychosociorehabilitation intervention on these factors.

Clinical-psychopathological, statistical, and psychometric methods were used (Alfimova-Golimbet’s resilience scale, Amirkhan’s coping strategies questionnaire, and PANSS). Patients of two groups participated in the study: 1 - members of a community organization (OO), n=49, who in addition to psychopharmacotherapy were given comprehensive long-term psychosociorehabilitation (3.7±2.5 years), 2 - patients of the medical-rehabilitation department of a psychiatric hospital (MRO), n=48, in whom the psychosociorehabilitation intervention was shorter (40.3±6.5 days).

The results of the study showed that significant predictors of a favorable course of the schizophrenic process were high indicators of resilience, coping behavior, and a small degree of negative symptomatology. Analysis of the data regarding patients’ coping with stress shows that constructive coping strategies are more frequent in both groups. Thus, “problem solving” (24.3 points in GS and 22.9 points in MPO) and “search for social support” (23.0 points and 22.7 points, respectively), that is patients of both groups are generally oriented to a productive way of coping with difficult situations and are ready to seek help from others in a difficult situation. Notably, the strategy of “problem avoidance” is less pronounced (18.5 points and 19.4 points, respectively). The high resilience scores in the GS group (32.5 points), comparable to the norm in the population (33.1 points), are explained by long-term comprehensive psychosociorehabilitation, while the resilience scores in the MPO group are lower - 28.7 points. Negative symptoms of schizophrenia were equally pronounced in both groups, manifested by difficulties in communication (2.6 points each), passive-apathetic social withdrawal (2.7 points each). Such negative symptoms as blunting of affect and emotional indifference were more pronounced in the MPO group - 3.2 points each vs. 2.8 points in the group from the GS.

High levels of resilience and ability to cope with stress as a result of psychosociorehabilitation intervention allow patients to overcome difficult life circumstances more flexibly. They are associated with less pronounced negative symptoms, which generally helps prevent psychosis relapses and contribute to a more favorable course and prognosis of schizophrenia.

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Mentalizing helps us to understand the behaviour of others in our everyday social interactions. Spontaneous mentalizing without explicit instructions refers to representing mental state attribution. Several studies have described social cognitive deficit in schizophrenia, which largely determines the functional outcome of the disease.

To better understand the involvement of spontaneous mentalizing in schizophrenia, we consider it important to summarize the results of studies that used indirect instruction to measure spontaneous mentalizing performance in schizophrenia.

In our meta-analysis, we conducted a systematic search of four large databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials [CENTRAL], Web of Science). A total of 14 articles were involved.

Based on our findings, the performance of patients with schizophrenia is significantly weaker than in the average population for both scripts with mentalizing interactions (MD: -0.63; 95%CI (-0.90, -0.35); p=0.0021), and with goal-directed movements (SMD: -0.55; 95%CI (-0.97, -0.13); p=0.02). The intentionality of expressions used by patients with schizophrenia is significantly lower compared to the average population (for both animations with complex social interactions: MD: -0.99; 95% CI (-1.39, -0.59); p=0.0003; and with goal-directed movements: MD: -0.31; 95% CI (-0.53, -0.08); p=0.0218). We have found no significant difference neither in appropriateness nor in intentionality of verbal terms between the two goups in the case of animations with random movements.

Based on the meta-analysis, we found poorer performance in schizophrenia in spontaneous mentalizing. We also found poorer performance in tasks with goal-directed movements used as control tasks, suggesting a more pervasive impairment of mentalizing in schizophrenia. These deficits may affect the functional outcome of the disease and could potentially have therapeutic implications.

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Insight is a field of interest in psychosis, due to its influence on the course and prognosis of the desease and as well as adherence to treatment.

The present work aims to evaluate the influence of cognitive and psychopathological variables on awareness of illness in first psychotic episodes.

It is a cross-sectional study of a sample of 26 patients with diagnosis of a first psychotic episode admitted in a Brief Hospitalization Unit, who have been evaluated using the Positive and Negative Symptom Scale (PANSS), the Screening for Cognitive Impairment (SCIP) and the Scale of Non-awareness of Mental Disorder (SUMD).

A positive correlation was found between SUMD and negative PANSS (the worse insight, the greater negative psychopathology) and between the level of cognitive performance and the awareness of having negative symptoms (affective blunting, anhedonia and associability) and their attribution to the desease.

This findings suggest the importance of addressing awareness of negative symptoms from the first episodes in psychoeducational family therapy and rehabilitation programs, taking into account that this process is hindered by the cognitive dysfunctions.

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The sensitive delusion of reference represents a clinical entity described by Kretschmer in 1918, arising in people with sensitive personality. This personality type is mainly characterized by a tendency towards social isolation, introversion, low self-esteem and by a greater sensibility to interpersonal judgement. In this personality type, the presence of specific environmental triggers may provoke a reference delusion of persecutory content, feelings of guilty and injustice. Although eliminated from the current diagnostic classifications, the sensitive delusion of reference represents a key milestone in the history of psychopathology.

The goal of this report is to report on a clinical case of a patient diagnosed with Kretschmer´s sensitive delusion of reference.

The present work consists on a descriptive report of a clinical case through consultation of the patient´s clinical file as well as a survey of relevant articles on Pubmed.

This is a 38 year old, married man with no children. He describes himself as a private, introverted individual, who has little interaction with his peers, and has been very sensitive to criticism ever since his adolescence. His first psychiatry appointment took place in April 2021, following the medical referral of his general practitioner as, according to the patient´s mother and wife, he had been, for quite some time, implying that his mobile phone had been under wire and that someone had been monitoring him. As stated by these relatives, these ideas surfaced after a workplace conflict. At the time, the patient was medicated with olanzapine 10mg and lorazepam 2.5mg before bedtime, exhibiting significant improvements with full remission of psychotic symptomatology. Succeeding the antipsychotic tapering attempt, the patient had begun to suffer from insomnia and recrudescence of psycotic symptomatology, namely, the delusion ideation of persecutory content and auditory hallucinations, as a result, the previous treatment regimen was resumed, which resulted in significant improvements of the clinical picture. Following new observation, in 2023, the patient mentions weight gain and drowsiness during the day, leading to the switch of olanzapine 10mg for aripiprazole 15mg. The current treatment plan consists of aripiprazole 15mg once a day and lorazepam 1mg 1/2 before bedtime, resulting in an improvement of the previous complaints and maintenance of the psychosocial functioning, unaccompanied by psychotic symptomatology.

In conclusion, and relatively to the condition´s prognosis, Kretschmer observed that, although in some situations the episodes were brief and self-limiting, in others, the patients maintained psycothic symptomatology, during the following years. In the present clinical case we recognised the need to sustain the antipsycothic treatment regimen, as the respective dosage reduction lead to an aggravation in symptomatology.

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Attachment styles is intrinsically related to the capacity for forming close social bonds, making it a vital lens through which to understand social functioning.

This study investigates the link between attachment styles and social functioning among women diagnosed with schizophrenia.

We carried out a descriptive and analytical cross-sectional study from May to June 2023, focusing on stabilized female patients diagnosed with schizophrenia or schizoaffective disorder. The study took place in the ‘B’ psychiatry department of Hedi Chaker University Hospital in Sfax, Tunisia. Data on attachment styles and social functioning were collected using self-report questionnaires: the Revised Psychosis Attachment Measure (PAM_R) and the Social Functioning Scale (SFS). In our study, we employed both the Wilcoxon test for paired samples and the Spearman correlation test to assess the differences and correlations between attachment scores and social functioning scores, respectively.

In the study, 41 female patients were included. The participants had a mean age of 49.19, ranging from 19 to 79 years old. Attachment styles were predominantly avoidant (60.97%), followed by anxious (24.39%) and disorganized (14.63%). A significant portion, 39%, exhibited low social functioning. The domains most affected were leisure (63.41%) and employment (60.97%). Our analysis revealed negative correlations between avoidant attachment and social functioning in leisure activities (Spearman’s ρ = -0.057, p < 0.05) as well as between avoidant attachment and independence performance (Spearman’s ρ = -0.040, p < 0.05). Also, the correlation coefficient for anxious attachment and leisure activities is 0.041, demonstrating a positive association (p < 0.005).

These initial findings may imply a potential association between attachment styles and social functioning in schizophrenia.

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Schizophrenia is a complex and multifactorial disorder believed to arise from the interplay between genetic factors and environmental influences. Among these environmental factors, childhood trauma stands out as a significant contributor to the onset of schizophrenia in adulthood.

The objective of this study was to assess the occurrence rates of physical, emotional, and sexual abuse, as well as physical and emotional neglect in a group of Tunisian women diagnosed with schizophrenia spectrum disorders.

We conducted a descriptive cross-sectional study among stabilized female patients with schizophrenia or schizoaffective disorder, in the ‘B’ psychiatry department at Hedi Chaker University Hospital in Sfax, Tunisia, from May to June 2023. We administered the 28-item Childhood Trauma Questionnaire (CTQ).

In this study, 41 female patients were enrolled, with 65.9% diagnosed with schizophrenia and 34.2% with schizoaffective disorder. The average age of participants was 49.19 years, ranging from 17 to 79. The mean score on the Childhood Trauma Questionnaire (CTQ) was 56.34, with scores ranging from 43 to 98. Emotional neglect was the most prevalent form of trauma, reported by 40 patients (97.6%). Following emotional neglect, physical abuse was found in 16 patients (39%), sexual abuse in 10 patients (24.4%), emotional abuse in 6 patients (14.6%), and physical neglect in 2 patients (4.9%).

Based on these findings, our recommendation is to establish government-operated facilities that offer emotional and psychological support, legal assistance, parenting guidance, and medical monitoring in collaboration with educational institutions and social and child protection services for those in need.

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Schizophrenia spectrum disorders profoundly impacts social functioning, affecting interpersonal relationships, work interactions, and self-care. This disorder often leads to cognitive, perceptual, motor, and emotional challenges that result in social withdrawal.

The aim of the study is to identify the specific challenges in social functioning faced by women diagnosed with schizophrenia spectrum disorders.

We conducted a descriptive cross-sectional study among stabilized female patients with schizophrenia or schizoaffective disorder, in the ‘B’ psychiatry department at Hedi Chaker University Hospital in Sfax, Tunisia, from May to June 2023. We collected both sociodemographic and clinical data from the participants. The Social Functioning Scale (SFS) and Global Functioning Scale (EGF) were used to assess social and global functioning, respectively.

Forty-one patients were included: 65.9% had schizophrenia, and 34.2% had schizoaffective disorder. The mean age was 49.19 years, ranging from 17 to 79 years. More than a third (39%) of our patients had significant impairment in global functioning (EGF<50). The average total score on the social functioning scale was 13.65, with a range from 6.29 to 20.29. Additionally, 39% of our patients exhibited low social functioning, and 51.21% had a high withdrawal score. The most impacted domains were leisure (63.41%) and employment (60.97%), followed by interpersonal behavior (58.53%), prosocial activities (48.78%), independence competence (41.46%), and lastly, independence performance (36.85%).

Social skills training is crucial for enabling women with schizophrenia to function well in their environment.

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Attachment refers to the emotional bond between a child and their primary caregiver, reflecting the child’s confidence in the caregiver’s capacity to offer security. Evaluating attachment styles in individuals with schizophrenia spectrum disorders holds significance in pinpointing a potential factor affecting therapeutic relationships. This, in turn, indirectly aids in comprehending the emergence of low adherence as a significant barrier to schizophrenia

The goal of this study is to assess attachment styles in women with schizophrenia spectrum disorders.

We conducted a descriptive and analytical cross-sectional study at the Psychiatry “B” department of Hedi Chaker University Hospital in Sfax, Tunisia, during May and June 2023. Our study involved stabilized female patients diagnosed with either schizophrenia or schizoaffective disorder. We utilized the 26-item Revised Psychosis Attachment Measure (PAM_R) questionnaire translated into Arabic and the Positive and Negative Syndrome Scale (PANSS) score to assess schizophrenic symptoms.

We enrolled a total of 41 female patients in our study, with 65.9% diagnosed with schizophrenia and 34.2% with schizoaffective disorder. The average age of the participants was 49.19 years, ranging from 17 to 79 years old. In terms of attachment styles, avoidant attachment was the most prevalent (60.97%), followed by anxious attachment (24.39%), and disorganized attachment (14.63%). Our study revealed significant associations between avoidant attachment and several factors. Patients who began psychiatric follow-up with hospitalization had a significantly higher level of avoidant attachment compared to those starting with outpatient consultation (p < 0.001). The type of therapy also influenced avoidant attachment, with a significant difference (p < 0.001). Insight into their condition also played a significant role (p < 0.001). Moreover, the age at which psychiatric follow-up began showed a statistically significant correlation with avoidant attachment (Spearman’s ρ = 0.000, p < 0.001). Individuals with higher avoidant attachment tended to have a longer duration of untreated psychosis, supported by a statistically significant positive correlation (Spearman’s ρ = 0.082, p < 0.001). There was also a statistically significant relationship between avoidant attachment and the equivalent dose of chlorpromazine, with a positive correlation (Spearman’s ρ = 0.091, p < 0.001), indicating that individuals with higher avoidant attachment may require higher equivalent doses of chlorpromazine. Finally, higher levels of avoidant attachment were associated with a lower presence of positive symptoms in schizophrenia (Spearman’s ρ = -0.026, p < 0.001).

Insecure attachment is a valuable mechanism for understanding the evolution of schizophrenia spectrum phenomenology and may be a useful target for prophylactic interventions.

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Childhood trauma encompasses instances of sexual, physical, and emotional abuse, along with neglect experienced during childhood and adolescence. Individuals with psychosis, particularly those with schizophrenia, exhibit a heightened prevalence of childhood trauma. One potential mediator in understanding this connection is insecure attachment.

This study aimed to better understand how childhood trauma relates to schizophrenia by examining two aspects of attachment: attachment anxiety and attachment avoidance.

We conducted a descriptive and analytical cross-sectional study among stabilized female patients with schizophrenia or schizoaffective disorder, in the ‘B’ psychiatry department at Hedi Chaker University Hospital in Sfax, Tunisia, from May to June 2023. We administered the 26-item Revised Psychosis Attachment Measure (PAM_R) questionnaire, translated into Arabic, to assess attachment. Additionally, participants completed the 28-item Childhood Trauma Questionnaire (CTQ). We used both the Wilcoxon test for paired samples and the Spearman correlation test to assess the statistic differences and correlations.

We included 41 female patients, of which 65.9% had schizophrenia and 34.2% had schizoaffective disorder. The average age of the participants was 49.19 years. Among the attachment styles, avoidant attachment was the most prevalent (60.97%), followed by anxious attachment (24.39%), and disorganized attachment (14.63%). Regarding childhood trauma, the average total score on the Childhood Trauma Questionnaire (CTQ) was 56.34. Specifically, 39% of patients reported experiencing physical abuse, 24.4% reported sexual abuse, 14.6% reported emotional abuse, and 4.9% reported physical neglect. The Spearman correlation analysis between avoidant attachment and scores on the Childhood Trauma Questionnaire (CTQ) yielded a diverse set of findings. It indicated a significant positive correlation with physical abuse (ρ = 0.004, p < 0.001), a significant negative correlation with emotional abuse (ρ = -0.045, p < 0.001), a significant positive correlation with sexual abuse (ρ = 0.036, p < 0.001), a significant negative correlation with physical neglect (ρ = -0.083, p < 0.001), a significant negative correlation with emotional neglect (ρ = -0.047, p < 0.001), and a significant positive correlation with denial (ρ = 0.080, p < 0.001). On the other hand, the Spearman correlation analysis between anxious attachment and scores on the CTQ showed varying correlations: a significant positive correlation with physical abuse (ρ = 0.094, p < 0.001) and sexual abuse (ρ < 0.0001, p = 0.05).

Our findings indicate that individuals with an insecure attachment style and a history of childhood trauma should be considered a high-risk group, necessitating early clinical intervention, continuous monitoring, and personalized therapeutic approaches designed to alleviate the psychological effects of trauma.

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Menstrual psychosis has an acute onset and is characterised by confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome lasting for a brief duration, with full recovery. These symptoms maintain periodicity in rhythm with the menstrual cycle. The symptoms may appear in the premenstrual phase or may begin with the onset of menstrual flow (catamenial psychoses). Usually, menstrual psychosis has a polymorphism of both psychotic and affective symptoms (Brockington I. Menstrual psychosis. World Psychiatry. 2005;4(1):9-17.). In this article we present a case of menstrual psychosis with premenstrual onset.

A 26 years old, nulliparous single female with one mentally ill relative on her mother’s side (her grandmother) presented with an episodic illness characterized by mood swings, irrelevant speech, irritability, suspiciousness and thought disorder related to her menstrual cycles. She had earlier suffered prolonged attacks of mania, developed a recurrent episodic illness which returned every month for five years. Her menses began at 15. She presented with the history of a few episodes of manic illness starting five days before and ending suddenly with the onset of the menses.

On mental status evaluation during the index episode, the patient was agitated, had labile affect, grandiose and referential delusions and erotomania. A detailed physical examination, routine biochemistry, and gonadal hormonal assay were unremarkable.

She was started on olanzapine 10 mg/day, lithium 1200 mg/day and low-dose clonazepam. Although the severity of the psychotic and affective symptoms gradually reduced during the future menstrual cycles, they did not completely resolve.

The pathophysiology of menstrual psychosis is not exactly understood, but it has been postulated that fluctuation of the sex hormones occurring during the menstrual cycle is responsible. Previous studies have reported the association of psychosis with estrogen withdrawal (Mahé V, Dumaine A. Oestrogen withdrawal associated psychoses. Acta Psychiatr Scand. 2001;104(5):323-331.). Treatment strategies for menstrual psychosis include the use of oral contraceptive pills for the regulation of hormones during the menstrual cycle, in our case patient did not want to use oral contraceptive pills.

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Surgical treatments for people living with epilepsy have the potential to provide patients with an opportunity to achieve relief from seizures, thus improving their quality of life, but they are not free of complications. The psychiatric consequences are a significant concern because of the potential risks; however, psychotic illnesses have not received adequate research compared to anxiety and depression.

To better identify the psychiatric side effects that can develop following epilepsy surgery, especially psychosis, and to take preventive measures to mitigate its occurrence.

Presentation of a patient’s case and reviewing existing literature regarding de novo psychosis following epileptic surgery.

The case of interest is a 31-year-old male patient who, or his relatives, has had no history of psychiatric disorders. From age 21, the patient had focal to bilateral seizures, which were preceded by olfactory auras and could occur up to 4-5 times a week and was then diagnosed with epilepsy. In June 2021, the patient underwent a right anterior temporal lobectomy for his medically resistant seizures after a presurgical evaluation and had a notable decrease in the number of seizures, occurring only during periods of sleep every six months. In the fourth month following the operation, the patient began experiencing auditory hallucinations characterized by negative and judgmental voices. After that, he engaged in an aggressive act by holding a knife and assaulting another person in a public area. He was admitted to an inpatient psychiatry service for 12 days with a diagnosis of a psychotic episode. His symptoms significantly improved, and he was discharged with paliperidone 6 mg/daily treatment. After five months, he discontinued the medication, subsequently experiencing a recurrence of auditory hallucinations and aggression. The patient was admitted to the inpatient psychiatric clinic in June 2022 as a result of experiencing paranoid delusions and engaging in a suicide attempt by self-inflicted wrist laceration using a razor blade, which was consistent with the patient’s delusional beliefs. Following 13 days of hospitalization, he was discharged with amisulpride 800 mg/daily in addition to his antiepileptic treatment. After 15 months of discharge, he showed no signs of active psychotic features, and his functioning was moderate to good.

Current research and reporting of psychiatric outcomes are limited, and the predictive factors and prognosis of psychiatric symptoms in these patients remain obscure. Long-term follow-up is crucial, especially considering the possibility of psychiatric symptoms developing in the months following surgery, as demonstrated by the current case. In addition, preoperative and postoperative assessments may facilitate the management of psychiatric symptoms.

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Schizophreniform Disorder is described pretty similar to schizophrenia, but with the difference of the symptoms duration which have to last for at least 1 month but less than 6 months. Patients have to be back at their baseline functional level once the disorder has resolved. This is a heterogeneous group of patients who have either a disorder similar to schizophrenia or something closer to a mood disorder.

To analyze clinical, psychopathological and epidemiological characteristics of schizophreniform disorder and also review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of maintaining the treatment, because of the abandonment of the treatment, which is a predictor of relapses.

A review of the main impact literature concerning schizophreniform disorder is done during the last five years: prevalence, incidence, pathogenesis and its relationship with other psychiatric disorders encoded in DSM-V are studied.

The etiology is unknown. Psychotic symptoms can be treated with antipsychotics for 3 to 6 months. They usually respond faster than patients with schizophrenia (75% vs 20% respond within 8 days).

The disease has a favorable prognosis, and has similarities with mood disorders. However, some data suggest a close relationship to schizophrenia. In support of the relationship with mood disorders, patients have more affective symptoms and a better outcome than patients with schizophrenia.

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As part of the intervention, patients with severe schizophrenia who are cared for in psychiatric rehabilitation units need psychological treatments. However, there is great variability within the psychotherapy alternatives that are proposed for rehabilitation in schizophrenia, and it is necessary to know which are the most efficient interventions in order to prioritize their inclusion in intervention programs.

To know the level of evidence of the existing psychotherapy alternatives for the rehabilitation treatment in schizophrenia through the systematic review of recently published studies.

Consecutive systematic searches in the scientific literature were used in a sensitive and specific way, aimed at identifying the existence of documents in databases and clinical practice guidelines based on evidence of psychological treatment in schizophrenia. Psychosocial and social approaches and family members interventions were excluded, and the search was limited to the last 5 years. The PICO format has been used, and a subsequent critical reading using the AGREE II tool, considering the inclusion criteria of presenting a score >60% in 4 domains.

The following interventions have been found to be therapeutically effective: Level 1B (Early intervention in Psychosis; Patient and Family psychoeducational intervention; Basic ando social skills training; Social cognition and Metakognition training; Cognitive Remediation; Cognitive Behavioral Individual Therapy; Assertive Community treatment; Supported employment). Level 2B (Family Problem Solving Therapy, Dynamic Psychotherapy; Cognitive Behavioral Group Therapy); Level 2C (Horticultural, Art, Music, Animals Therapies).

Several psychotherapy alternatives are proposed for rehabilitation in schizophrenia, with known level of evidenca in order to prioritize their inclusion in intervention programs.

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Contrary to classical belief, people affected by this disease are at greater risk of developing organic pathologies.This risk has a very complex origin: a greater exposure to risk factors and specific socioeconomic conditions, a high prevalence of risk behaviors, the use of antipsychotics, and a potential common genetic background. (Reynolds et al.Int. J.Neuropsychopharmacol.2021; 24 854–855, Suvisaari J et al. Curr Diab Rep. 2016 16). Multiple studies demonstrate that Schizophrenia confers a high endogenous risk of Diabetes. Before patients diagnosed with Schizophrenia start taking antipsychotics (Andreassen OA et al. Am J Psychiatry. 2017;174 616-617), they have an approximately 3 times higher risk of developing Diabetes compared to the general population. The risk increases 3.6 times after the initiation of antipsychotic treatment compared to drug naive patients(Annamalai A et al World J Diabetes. 2017 390-396)

To study the association between Schizophrenia or other Psychotic Disorders and Diabetes Mellitus in a sample of patients diagnosed with Schizophrenia or other Psychotic Disorders.

This is a Descriptive and Cross-sectional Observational Study. Clinical Histories were reviewed and a personal or telephone interview was established to expand data related to the objectives of the study. The patients were recruited among the patients seen in the specific Severe Mental Disorder consultation who had a diagnosis of schizophrenia or other Psychotic Disorders, according to DSM 5-TR criteria.

From a sample of 93 patients, 24 had Diabetes. The Prevalence of Diabetes in patients with Schizophrenia or other Psychotic Disorders was 25.8%. Of the patients without a diagnosis of Diabetes, 15 of them had values of Glycosylated Hemoglobin (HbA1c) for Prediabetes. Using the Chi-Square Test, statistically significant differences were found between the variable Main Psychiatric Medication and Diabetes. Patients treated with Clozapine, Aripiprazole and Olanzapine had a Prevalence of Diabetes of 40.9%, 33.3% and 28.5%, respectively.

Prevalence of Diabetes in our sample was 3.4 times higher than the 7.51% of the general population in Spain. This presumes a significant importance and impact on the health of these patients. The diabetic patients in our sample were diagnosed with Diabetes years after the diagnosis of the mental illness, which seems to indicate that the causes have to do with lifestyle, dietary habits, weight, and exposure to chronic antipsychotics. Premature death in schizophrenia has several explanations, being of special importance the development of cardiovascular disorders and Diabetes This can be due to many reasons, but it is worth highlighting the metabolic side effects of some antipsychotics and lifestyle. In this sense, it is essential to carefully monitor this group of patients.

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