Schizophrenia and other psychotic disorders are disorders in which the individual’s assessment of reality is impaired and which progress with exacerbations and become chronic, leading to disability, loss of function, social communication problems and frequent hospitalisations.

The aim of our study was to evaluate the clinical and sociodemographic data of patients followed up in the outpatient clinic for psychotic disorders and hospitalized at least once in any time during their treatment.

The sample of the present study consisted of patients who were followed up in the psychotic disorders outpatient clinic of Selçuk University Faculty of Medicine Hospital and who were hospitalised at least once. Patients were identified by retrospective file search and those with sufficient information about their sociodemographic-clinical characteristics were included. The study approved by the ethics committee of Selçuk University Faculty of Medicine.

Of the 130 patients, 52 (40%) were female and 78 (60%) were male; mean age was 40.8 ± 12.0 years. Almost half of the patients (n=53, 40.8%) had primary school education. 73 (59.2%) of 130 patients were receiving long-acting antipsychotic medication. 100 patients (76.9%) were using oral antipsychotics. 63 out of 100 patients were on clozapine. 22 of 63 patients used clozapine as monotherapy. The mean duration of untreated psychosis (n=90) was 15.8 ± 32.1 months. The mean number of hospitalisations was 3.4 ± 2.5. 15 patients (11.5%) were lived in a nursing home. The mean number of hospitalisations of patients receiving long-acting treatment (3.8±2.9) was significantly higher than that of patients receiving oral treatment only (2.7±1.6) (p=0.004). There was no significant difference in the mean number of hospitalisations when comparing according to the presence of clozapine in the treatment (p>0.05).

The primary goal in the treatment of patients with schizophrenia is to prevent relapses, hospital admissions and improve patients’ quality of life and functioning. Therefore, the variables related to hospitalisations, which are an indirect indicator of the frequency of psychotic episodes, should be well evaluated. Our study was mainly descriptive and evaluated the relationship between several parameters and hospitalisations. It was thought that the high number of hospitalisations in patients on long-acting treatment might be related to the fact that long-acting treatment in our country is mostly started in the late stages of the disease. Large-sample studies of predictive parameters are needed to prevent psychotic episodes and reduce the number of hospitalisations.

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Psychiatric patients, and schizophrenia patients in particular, have a lower average life expectancy than the general population, and the high prevalence of physical illnesses contributes to this. In the case of cancer, the incidence seems to be the same or lower compared to the general population, but on the other, the prognosis is frankly worse.

We aim to collect evidence about the relationship between cancer and schizophrenia.

Based on a clinical case of a patient diagnosed with schizophrenia who died of an occult neoplasm, we conducted a narrative review of the literature concerning cancer screening, incidence, mortality and prognosis in patients with schizophrenia.

A 39-year-old male patient was diagnosed with schizophrenia when he was 26 years older. The patient was single, had no children, lived alone and was retired due to his psychiatric condition.

He was admitted to the inpatient ward in January 2023 due to a psychotic relapse after abandoning the prescribed treatment. He remained hospitalised for 14 days, and oral and injectable antipsychotic therapy was reinstated. He was discharged to the psychiatric day hospital unit to promote psychosocial rehabilitation. During this period, he complained about unspecified back pain but did not present any other physical symptoms.

Two months later, he was evaluated by his psychiatrist as an outpatient, and his general condition had become significantly poorer. He had lost over 20 kilograms, his skin was pale, and he complained of back pain. He was referred to an internal medicine consultation. Still, before it was scheduled, he came to the emergency department and was admitted due to digestive bleeding, asthenia and low back pain, with a weight loss of around 25 kilograms.

An abdominal mass was palpated on physical examination, and the chest x-ray showed a “balloon drop” pattern, indicating pulmonary metastases. Two days after being admitted to the internal medicine ward, he died of cardiac arrest.

It is known that the stigma that mentally ill patients suffer often contributes to a delay in diagnosing medical illnesses. In addition, frequent social isolation and poor social family support do not help these patients seek medical care when their physical condition deteriorates. Low adherence to cancer screening and avoidance of routine health care often add to this delay.

As physicians who often deal with individuals with severe mental illnesses, psychiatrists should be extra aware of risk factors and keep a heightened suspicion of medical conditions. They should also promote the adoption of beneficial health behaviours and encourage participation in cancer screening and other relevant health programs.

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Negative symptoms are present in more than two thirds of schizophrenic patients throughout the evolution of the disorder. These include symptoms related to reduced motivation or pleasure, such as avolition, anhedonia and asociality, and reduced expressivity, including alogia and blunted affect.

We present the case of a 24-year-old man who was admitted to our Psychosis Day Hospital after several psychotic episodes, presenting with prominent negative symptomatology that was imbued with mystical delusional beliefs.

1. 1) To describe the clinical particularities of this case, focusing on the improvement of negative symptoms during the course of treatment at our Day Hospital.

2. 2) To review the available evidence regarding the pharmacological and psychotherapeutic management of negative symptoms of schizophrenia.

A review of the patient’s clinical history and complementary tests were carried out. Likewise, we reviewed the available literature in relation to the management of negative symptoms of schizophrenia in an ambulatory setting.

The patient was admitted to our Day Hospital after four psychiatric hospitalizations due to mystical delusions, ideas of grandiosity and hyper-spirituality, along with prominent negative symptoms at the moment of inclusion at our centre, including social withdrawal, diminished affective response, lack of interest in the academic sphere and poor social drive. Although previous positive symptoms were present in a lesser degree, the patient interpreted the presence of the negative symptoms described above as a “punishment” or “test” from spiritual creatures.

Management of negative symptoms represents a major unmet need in schizophrenia. Modest effect size evidence for pharmacological approaches favours the use of antipsychotic in monotherapy and augmentation of antipsychotic treatment with other agents, such as antidepressants. Scarce evidence regarding psychotherapeutic approaches to these symptoms points to the use of cognitive behaviour therapy and social skills training.

• - Clinical identification and characterization of negative symptoms is crucial when treating patients with schizophrenia, as these are associated with important disability and poorer functional outcomes.

• - Differentiation of primary and secondary negative symptoms is a key aspect in the evaluation and management of schizophrenic patients.

• - This case outlines the coexistence of positive and negative symptoms, and illustrates the challenges in the pharmacological and psychotherapeutic management of these symptoms at a Psychosis Day Hospital.

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Aripiprazole, a D2 receptor partial agonist is suggested to enhance Prefrontal Cortex (PFC) dopamine functioning resulting to an improvement of working memory and GABA transmission related to social functioning. The LAI form of the medication is documented to improve the long-term adherence of the patients resulting in a better assessment of the effects of the drug on behavioral parameters that require a longer time to evaluate.

Hypothesis testing: “Aripiprazole LAI antipsychotic treatment is associated with i) reduced hospitalizations, ii) improved quality of life and iii) patient functioning”.

65 patients participated (Male to Female ratio corresponds to 2:1). 44 of them, the community population manifested psychosis (23 schizophrenia and 21 patients bipolar disorder with psychotic features). The median age was 41 years. 31.8% had dual diagnosis of psychosis and alcohol use disorders, while 25% had dual diagnosis of psychosis and Cannabis Use disorder. 77.3% were on aripiprazole LAI. 21 patients with BD I were prisoners at the Penitentiary of Neapolis of Lasithi of Crete. Median age was 36 years (all men). 90.5% had comorbidity of bipolar disorder type I (BD-I) and alcohol use disorders. 95.2% had comorbidity of BD – I and Cannabis Use Disorder. All were medicated by aripiprazole LAI 400mg/month. For the evaluation of our hypotheses the instruments WHOQOL-BREF questionnaire and the CGI-S scale were used. The quality of life, functionality, and number of hospitalizations were compared in each patient, before the initiation of the LAI medication and during the active treatment period. The minimum of follow-up period was 6 months.

In 44 patients (in community) hospitalizations decreased statistically significantly from 1.3±1.9 to 0.1±0.4 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001). The CGI-S score decreased statistically significantly from 6.0 ±0.8 to 4.0±1.1 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001). The score of the WHOQOL-BREF scale increased statistically significantly from 0.5 ± 0.5, to 2.9 ± 0.8 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001). For the group of 21 patients (imprisoned) hospitalizations decreased from 0.6 ± 1.8 to 0.0 ± 0.0 (Paired Samples Wilcoxon Signed Rank Test p-value=0.066). The CGI-S score decreased statistically significantly from 5.3 ± 0.8 to 3.2 ± 1.3 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001). The quality-of-life scale score increased statistically significantly from 0.9 ±0.6 to 3.09±0.7 (Paired Samples Wilcoxon Signed Rank Test p-value<0.001).

Aripiprazole LAI significantly improves the quality of life and functionality of patients with psychosis. We suggest that the improvement might be related to the beneficial effects of the molecule on the Prefrontal Cortex (PFC).

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Childhood maltreatment(CM) can precipitate a range of psychiatric disorders in individuals. Some research show that CM rates are as high as 85% in schizophrenia spectrum disorders (Larsson et al. 2013). This case report explores an instance of acute catatonic psychosis in an adolescent following a significant episode of physical and emotional abuse.

The aim is to elucidate the clinical presentation, diagnosis, and treatment of trauma-induced acute catatonic psychosis in an adolescent. The report seeks to emphasize the potential link between acute trauma and severe psychiatric disorders in young individuals.

A thorough review of the patient’s clinical records was undertaken, focusing on psychiatric history, symptoms, treatment trials and responses. In parallel, an extensive literature review was conducted to understand the current knowledge on the association between acute traumatic stress and acute psychosis with catatonia.

The patient, a 16-year-old female, presented with severe symptoms of catatonia and psychosis including mutism, posturing, stupor, negativism, auditory hallucinations and persecutory delusions, in addition; eating refusal, urinary and fecal incontinence. Symptoms started immediately following physical and emotional abuse that occurred 10 days ago. She was hitted, insulted and detained for 2 days by her parent’s friends. Abuse reported to social services and judicial authorities. All laboratory and neurologic examinations performed to exclude an organic pathology. No pathologic results founded. Olanzapine 5 mg/day and lorazepam 0.5 mg/day started and titrated to 30 mg/day and 3.75 mg/day doses. Biperiden 4 mg/day started due to extrapyramidal side effects. A significant improvement observed about her catatonic and positive psychotic symptoms but she still had acute stress disorder symptoms. Trauma-focused cognitive-behavioral therapy added to her treatment. Family-based interventions examined for CM. She discharged in full remission after eight weeks of hospital stay. Lorazepam dose reduced and stopped before discharge.

Neurobiological models are trying to enlight the association between experiencing highly stressful or traumatic events, such as child abuse, may impact on later expression of psychotic disorders by increasing stress sensitivity to later adversity (Fares-Otero et al. 2023). This case underscores the potential of acute traumatic stress to precipitate severe psychiatric disorders, including catatonia. It highlights the importance of comprehensive clinical evaluations and the inclusion of trauma history in children presenting with acute psychiatric symptoms. The findings advocate for the integration of trauma-focused interventions in the treatment of similar cases. Further research is needed to understand the pathophysiological mechanisms underlying this association and to develop effective treatment strategies for this vulnerable population.

None Declared

Presentantion of the first psychotic episode of a young man and the investigation of the efficacy of treatment with olanzapine and after cariprazine.

Assessing the response to treatment of cariprazine in a psychotic patient with relevant neuroanatomical findings.

A 25-year old man was admitted to the psychiatric intensive care due to his agggressive behavior and verbal abuse, threatening to kill them both. His medical history included long periods of negatively affected mood, social isolation and talking to himself according to his family

Whent the patient was admitted he was very anxious, alert and extremely aggressive. During the interview he admitted auditory and visual hallucinations alongside delusional ideation with a particular aggression towards his father.

Upon admission his PANSS score was 121. positive scale score was 23.

The patient was treated initially with monotherapy olanzapine, gradually increased up to 20mg OD. Olanzapine caused asymptomatic transaminasemia, a relatively common adverse effect. At this point a change in medication was made and olanzapine was stopped and cariprazine was added gradually increasing its dose from 1,5mg to 6mg OD.

Interestingly the medical investigations (brain CT scan) indicated a calcification in falx cerebri.

After a period of 48 days since admission the patient was clinically improved and was discharged. His PANSS score was 72. Positive scale was 10.

The use of cariprazine as a treatment for a first psychotic episode of a young male improved his PANSS score after a 22-day treatment. According to the literature neuroanatomical findings have been associated with poor prognosis regarding the course of the illness. There needs to be further investigation on the efficacy of the long term treatment for this patient.

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Many patients with schizophrenia are unable to achieve adequate levels of psychosocial functioning and quality of life despite of the remission of illness symptoms. According to previous reports, only one-third of patients with symptomatic remission reach functional remission. While current pharmacotherapy options seem to be relatively effective for different symptoms of schizophrenia (e.g. positive symptoms), more specific psychosocial interventions that could enable functional remission are yet to be developed.

Our objective is to investigate differences in psychopathology, quality of life, functioning, and achieving functional remission before and after specific group treatments developed in our clinic.

We will conduct a prospective study including a consecutive cohort of female patients older than 18 years of age, which fulfilled the criteria for schizophrenia and schizoaffective disorder according to the International Classification of Disorders, 10th revision. Exclusion criteria are intellectual disabilities, mental disorders due to known physiological or neurological conditions, lactation or pregnancy, treatment with medications that can provoke psychosis, alcoholism, and other addictions. Patients will be recruited after finished hospital treatment or during individual outpatient controls. The Recovery Helm will be used at the beginning of the treatment, to make individual treatment plan and include patients in specific programs including day hospital treatment and/or outpatient group programs: psychoeducation, relaxation, metacognitive training, and social skills training. Besides collecting sociodemographic data, pre- and post-treatment assessment will include the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Quality of Life Scale (QLS), and the “Functional Remission of General Schizophrenia” (FROGS) scale.

We will analyze the changes in psychopathology levels, quality of life, functioning, and achieving functional remission between the two assessment points, taking into account different treatment possibilities.

Evaluation of current available programs can help with recognition of specific needs of patients with schizophrenia and provide guidelines for further development of treatment programs that could be helpful in achieving functional remission.

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The treatment of patients with severe psychotic disorders presents significant clinical challenges, and the choice of appropriate therapy is essential to ensure long-term stability1. In this context, long-acting injectable antipsychotics (LAIs) have emerged as a promising therapeutic option. LAIs were developed to counteract poor treatment adherence in patients with psychotic disorders2.

Paliperidone palmitate 3-monthly injectable (PP3M) is a novel formulation of intramuscular injectable paliperidone palmitate with a significantly longer half-life than the once-monthly formulation.

PP3M has shown a longer time to relapse and good safety and tolerability in many studies3.

The aim of this work was to describe the profile of patients initiating PP3M in an acute inpatient psychiatric unit.

A descriptive study was conducted on patients admitted to the acute psychiatric unit from January 2021 to December 2022. The sample included 23 inpatients who initiated PP3M during the admission. Data were collected regarding age, gender, diagnosis, substance abuse, previous antipsychotic treatment, antipsychotic treatment adherence and adverse effects during the admission.

23 patients sample, with an average age of 44.04 years-old, 16 male and 7 female, diagnosed with psychotic disorder (22) and schizoaffective disorder (1). Out of the 23 patients, 7 had active substance abuse upon admission.

Out of the total simple, 9 of them were prescribed LAIs, with 6 on PP1M (Paliperidone palmitate 1-monthly injectable), 2 on PP3M, and 1 on aripiprazole long-acting injection. Twelve were prescribed oral antipsychotics, including 4 on paliperidone, 4 on risperidone, 1 on aripiprazole, 1 on olanzapine, and 2 on other oral antipsychotics. Two patients did not have a previous antipsychotic prescription.

Among the 23 patients, 17 of them did not have previous antipsychotic treatment adherence.

5 out of the 23 patients experienced adverse effects, with 3 of them having extrapyramidal symptoms and 2 hyperprolactinemia.Upon discharge, 11 out of the 23 patients were prescribed antipsychotic monotherapy with PP3M.

In this sample, we observed that inpatients who initiated PP3M in an acute psychiatric unit were males, with psychotic disorders, lacked adherence to previous antipsychotic treatment. Most of them did not experience adverse effects with PP3M during admission.

More research should be done to assess the use of PP3M in an acute inpatient psychiatric unit.

REFERENCES

1. Morris MT, Tarpada SP. Psychopharmacol Bull. 2017 May 15;47(2):42-52.

2. Brasso, C., Bellino, S., Bozzatello, P., Montemagni, C., & Rocca, P. (2017). Neuropsychiatric Disease and Treatment,

3. Edinoff AN, Doppalapudi PK, Orellana C, Ochoa C, Patti S, Ghaffar Y, Cornett EM, Kaye AJ, Viswanath O, Urits I, Kaye AM, Kaye AD. Front Psychiatry. 2021.

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A colombian woman aged 62, with previous diagnosis of paranoid schizophrenia. She retired from working 2 years ago, when she started taking care of her sick husband full-time.

To describe a chronic psychosis case and discuss the treatment options and differential diagnosis.

We used the face-to-face interviews during her last hospitalization and her electronic medical history.

We also made a brief research about the effectiveness of risperidone depot in Pubmed.

Psychiatric history

She’s had 3 hospitalizations, all of them coincided with stressful vital situations. The first one occurred when she was dealing with a job issue. In the second one she was having an economic conflict with her husband. And the third one has coincided with worries about her retirement pension and her caregiver burden.

Current episode

She came to my hospital emergency department distressed because she thought her husband and her were victims of an international drug trafficking plot. She said a colombian drug cartel had sent 9 prostitutes to her village in order to steal from them, by pretending they were cleaning assistants, as a reprisal against her husband, who used to be a military in Colombia . She explained the nature of this event with great details. Also, she said the electric company was involved and they had tried to intoxicate her.

The psychopathological exploration was altered with a correct speech in its form but incoherent in its content. She presented a highly structured delusional plot of prosecution. No major affective disorders were detected. She suffered from reactive insomnia and anxiety.

Evolution

At first, it was torpid, she felt perspicacious and angry about the admission. Later, as the antipsychotic started to work, the symptoms improved and she became calm and collaborative. She has never criticized the delusion plot, but it was encapsulated, and the affective resonance disappeared.

We tried oral aripiprazole and paliperidone but retired both due to bad tolerance. Then we tried risperidone, with good tolerance and response, and started her current monthly treatment with Risperidone 100 mg depot.

After one year, she has kept stable with no relapses and good adherence to the treatment.

Differential diagnosis

The patient meets every diagnostic criteria of Delusional disorder (F22), as she has never experienced hallucinations and the functionality has not significantly decreased through the years. Also, she doesn’t meet the second criteria for Schizophrenia (F20).

It is important to explore the evolution of a psychotic disorder in order to differentiate between a schizophrenia and a delusional disorder, as the prognosis differs significantly.

Using Risperidone monthly depot can be a good option for treating a psychotic disorder (Sampson et al. Cochrane Database Syst Rev 2016. 14;4(4)).

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Stigma related to mental health has serious impact on persons suffering from psychiatric disorders and on their families. Self-stigma occurs when people with mental health problems internalize public attitudes, negative beliefs and stereotypes associated with psychiatric disorders. Stigma and self-stigma can affect every aspect of life and result in discrimination, social exclusion, feelings of low self-esteem, shame, guilt, and can postpone seeking help.

To examine perceived stigma and self-stigma of people treated for psychotic disorders.

We will include male and female patients older than 18 years of age, diagnosed with psychotic disorders, treated as outpatients. Assessment will include sociodemographic data, Internalized Stigma of Mental Illness Inventory – 9-item Version (ISMI-9) * to measure internalized stigma of mental illness, The perceived devaluation-discrimination (PDD) scale to measure perceived stigma, the World Health Organisation Quality of Life-BREF (WHOQOL-BREF) questionnaire, and Clinical Global Impression Scale (CGI).

We will analyse differences in ISMI and PDD scales in patients treated for psychotic disorders.

Understanding self-stigma and societal stigma associated with mental health is crucial in creating programs aimed at well-being of persons treated for psychotic disorders.

None Declared

Long-acting injectable antipsychotics (LAIs) offer advantages for schizophrenic patients compared to oral antipsychotics: less frequent dosing, lower relapse rates, better adherence, and lower healthcare costs. LAIs include paliperidone, aripiprazole, olanzapine, risperidone, and zuclopenthixol. Paliperidone palmitate is the only antipsychotic with two formulations with an administration interval longer than one month (3-monthly and 6-monthly), which could be better for the patient and help ensure treatment continuity, especially in cases of limited access to the health care system.

To assess the satisfaction of patients under treatment with 6-month paliperidone palmitate compared to other long-acting injectable antipsychotics with a higher frequency of administration.

We analyzed the satisfaction level of a sample of patients receiving treatment with LAIs at the Mental Health Center of El Escorial. All patients had a diagnosis of schizophrenia or other psychotic disorders (according to DSM-5). Patients who met the inclusion criteria completed the Treatment Satisfaction Questionnaire for Medication (TSQM), a generic questionnaire of treatment satisfaction that measures four dimensions: side effects, treatment efficacy, comfort of use, and overall satisfaction. Other clinical and socio-demographic variables were collected, as well as the type of injectable, dose, and frequency of administration.

Data from approximately 30 patients will be analyzed and discussed later.

Less frequent administration of LAIs may result in greater patient satisfaction and be just as beneficial clinically. Treatment satisfaction is positively associated with an improvement in psychotic symptoms and seems to be related to better adherence.

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There has been growing evidence to support the hypothesis that inflammation is involved in the pathogenesis of schizophrenia.

The aim of the present literature review was to assess the efficacy of acetylsalicylic acid (ASA) as an adjuvant agent in the treatment of an acute exacerbation of schizophrenia.

We searched randomized clinical trials based on regular searches of MEDLINE, Embase, PubMed.

We included four studies. The results were in favor of the efficacy of ASA in the study where authors targeted early psychosis. Illness duration seems to predict response to anti-inflammatory agents.

Further studies of early stages of schizophrenia are helpful.

None Declared

Lack of adherence to antipsychotic medication in patients with schizophrenia spectrum disorders is a major risk factor for relapse and rehospitalizations which contributes to major social and economic consequences. A high proportion of patients with schizophrenia are partially or completely unaware of their mental disorder.

The aim of this study was to investigate the association between insight and medication adherence.

A total number of 30 outpatients with schizophrenia spectrum disorders ,according to (DSM-V) diagnostic criteria who were attending the department of psychiatry A Razi hospital between august and September 30, 2023 were included in this study. Patients’ insight was measured by the birchwood insight scale. The degree of medication adherence was measured by using Medication Adherence Rating Scale (MARS).

Patients enrolled in the study had a mean (SD) age of 43.2 .There was no significant correlation between patients’ insight and patients’ ages, duration of illness and hospitalization times. In addition, there was no significant association between medication adherence and age, duration of illness, number of hospitalization or social level. Impaired insight was associated with poor antipsychotic medication adherence in patients with schizophrenia spectrum disorders .Higher insight was correlated to higher therapeutic adherence. Our results showed that the level of insight and compliance to treatment are positively correlated.

The results of this study support the hypothesis that insight and treatment adherence are closely related. Interventions to enhance insight may be helpful in improving medication adherence.

None Declared

Self-compassion is defined as the ability to be open to and touched by one’s suffering and to relate to it with kindness and non-judgmental awareness. Although identifying factors related to treatment adherence remains an important challenge in patients with schizophrenia spectrum disorders, self-compassion has rarely been investigated in this population. Further studies are needed to investigate whether self-compassion training can improve treatment adherence in this population.

The objective of the present study was to investigate the relationship between self-compassion and treatment adherence in patients with schizophrenia spectrum disorders.

thirty stabilized adult outpatients with schizophrenia (n=18), schizoaffective disorder (n=11), brief psychotic disorder (n=1) per DSM-5 criteria were included. Self- compassion was assessed using the 26-item Self-Compassion Scale (SCS). Treatment adherence was assessed using the Medical Adherence Rating Scale (MARS). Socio- demographic characteristics, including age, gender, academic level, and mean daily antipsychotic dosages were collected.

There was no significant difference in SCS scores and MARS scores as a function of gender, age, or academic level. The results of the present preliminary study suggest a positive correlation between the SCS total scores and the MARS scores. It was found that higher levels of self-compassion are related with higher levels of treatment adherence in patients with schizophrenia spectrum disorders and lower levels of self- compassion are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups.

The results of the present preliminary study suggest that self-compassion and treatment adherence are closely related. Improving self-compassion in patients with schizophrenia spectrum disorders may improve their level of treatment adherence. Further studies are needed to investigate whether self-compassion training programs could be useful as an extension of standard psychoeducation and cognitive behavioral therapy to improve treatment adherence in this population.

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Self-esteem entails evaluating oneself positively and often involves the need to be special and above average without comparisons with others. It could play a role in many areas of the patient’s life.

The aim of the present study was to find the prevalence of self-esteem and investigate the associations between self-esteem and treatment adherence in patients with schizophrenia spectrum disorders.

This study involved outpatients with schizophrenia spectrum disorders ,according to (DSM-V) diagnostic criteria, attending the Department of Psychiatry A, Razi hospital between august and September 30, 2023. The level of self-esteem was measured with Rosenberg’s Self-Esteem Rating scale (SERS) and treatment adherence with the Medical Adherence Rating Scale (MARS).Socio-demographic characteristics were also collected.

Thirty stabilized outpatients with schizophrenia (n=18), schizoaffective disorder (n=11), brief psychotic disorder (n=1) were included in the study. The mean (SD) age of the respondents was 43.2years; the mean number of Hospital admissions was 4.7.Almost two thirds of this population (63.33% ) had low self-esteem and 36.67 % had high self-esteem. The level of self-esteem did not differ between diagnostic categories. Self-esteem also positively correlated with higher education and negatively with an increased number of hospitalizations. However, no significant association was found between socio-demographic variables and self-esteem. Adherence was further negatively correlated with age and age of onset of disorders. Patients suffering from schizophrenia had the lowest adherence to treatment.The results of the present preliminary study suggest a positive correlation between the SERS total scores and the MARS scores. It was found that higher levels of self- esteem are related with higher levels of treatment adherence and lower levels of self- esteem are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups.

This study shows positive relationship between self-esteem and treatment adherence. Further studies are needed to investigate whether self-esteem is a factor positively influencing adherence to treatment and show if self-esteem training programs like standard psychoeducation and cognitive behavioral therapy could be beneficial to improve treatment adherence among psychiatric patients.

None Declared

This retrospective study analysed the clinical efficacy, tolerability and treatment satisfaction of patients who switched from receiving palmitate paliperidone monthly (PP1M) to palmitate paliperidone six-monthly (PP6M) after 12 months of follow-up. A total of 48 patients (31 men and 17 women) with recently diagnosed schizophrenia were included.

To assess the clinical efficacy, tolerability and treatment satisfaction in a sample of recently diagnosed schizophrenic patients who switched from receiving palmitate paliperidone monthly (PP1M) to palmitate paliperidone six-monthly (PP6M)

The sample included a total of 48 recently diagnosed schizophrenic (1-5 years) from three Mental Health units in the province of Toledo (Spain). The inclusion criteria were a diagnosis of schizophrenia (based on the ICD-10 criteria), the start of treatment with Long Acting Injectable Paliperidone Palmitate six-monthly (previously with palmitate paliperidone monthly), and the non-utilization of another neuroleptic treatment. A series of demographic variables were recorded, PANSS scale was used to to identify the presence and severity of psychopathology symptoms and the CGI scale was used to assessed the severity of the symptoms finally time to relapse was measured (primary outcome). The scales were again applied at baseline, 3 and 6 and 12 months after the start of treatment

N=48 patients (31 males and 17 females), with a mean age of 31 years. 4.3 years of evolution of illness. During the follow-up period only 2 patients (4%) relapsed. Results showed an improvement in PANSS (baseline 50.8, 3 months 41.9, 6 months 37.3, 12 months 26.1), likewise and improvement in CGI was observed (baseline 4.1, 3 months 3.4, 6 months 2.9, 12 months 2.5).

In terms of tolerability, no secundary effects were reported after treatment change, suggesting a good safety profile and predictable tolerability of PP6M. Patient satisfaction with treatment also improved over time. The study reports that 87% of patients accepted the switch from PP1M to PP6M, with reasons for switching including reduced frequency of administration and increased comfort. Most patients (95%) received antipsychotic monotherapy.

In conclusion, this study suggests that switching from PP1M to PP6M in patients with recently diagnosed schizophrenia was associated with maintained clinical stability, good tolerability and improved patient satisfaction with treatment. These findings support the efficacy and clinical utility of PP6M as a convenient and effective treatment option for patients with schizophrenia.

None Declared

First-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. ( Marques et al.. European Psychiatry 2016; 33 S258) The treatment is antipsychotic medications, which are generally divided into two categories: first and second generation antipsychotics, and they are dopamine antagonists or dopamine partial agonists.

The purpose of this presentation is to assess the efficacy of monotherapy treatment with cariprazine of the First Episode of Psychosis (FEP) in a young patient.

A 19-year old man was involuntarily admitted to the psychiatric intensive care unit because of aggressive and inappropriate behaviour towards his mother including threats to kill her and exhibiting his genitals. His medical history included short periods of depressed mood, as well as physical symptoms such as loss of hair and gastrointestinal symptoms, since he was 18 years old.

When the patient was admitted he was cautious and anxious. During the interview he made reference to auditory hallucinations that commanded him to sexually stimulate himself in front of his mother and also persecutory delusions. Upon admission his total PANSS score was 127. The positive subscale score was 21. The patient was treated with monotherapy cariprazine, gradually increasing the dose from 1,5 mg to 6 mg per day . Furthermore, he was adjunctively treated with sertraline, gradually increasing the dose from 50 to 150 mg.

After a period 24 days since admission the patient clinically improved and was discharged. His total PANSS score was 73 and the positive subscale was 9. He suffered no adverse effects from his treatment.

The use of cariprazine as a treatment for a FEP of a young male significantly improved his PANSS score after a 24-day treatment and also his disorganised behaviour. Of note, rapid tranquilization was avoided. According to the literature this is considered satisfactory response to treatment (Leucht et al. Schizophr Res. 2005; 79:231-8.). Nevertheless further investigation on the efficacy of the particular medication is necessary as its use is relatively recent in the treatment of psychosis. (Garnock et al. CNS Drugs. 2017; 31:513-525)

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Chronic mental illnesses can significantly impact an individual’s quality of life and lead to functional disabilities. Scientific interest in overall quality of life and health-related quality of life has been gradually increasing, especially in the context of chronic diseases where the relationship between patients’ long-term functionality and symptom development is not always linear.

Our research aimed to investigate the factors influencing subjective-objective well-being and in patients diagnosed with schizophrenia and schizoaffective disorder. Specifically, we examined the effects of anticipated discrimination on patients’ quality of life, satisfaction with health care, and overall functionality.

We recruited 25 patients from Semmelweis University Department of Psychiatry and Psychotherapy in Budapest, Hungary. To be eligible, patients had to meet the diagnostic criteria for schizophrenia or schizoaffective disorder according to DSM-5, cooperate with pharmacotherapy, and meet remission criteria (Andreasen et al., Am J Psychiatry 2005; 162 441-449). We collected socio-demographic data and clinical history, utilized the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Positive and Negative Syndrome Scale (PANSS) to identify our clinical sample and assess the severity of symptoms. Objective and subjective functionality and well-being were measured using the Lancashire Quality of Life Profile (LQoLP). Self-reported medication adherence were measured with Morisky Medication Adherence Scale (MMAS-8). Additionally, we assessed anticipated discrimination (QUAD), and satisfaction with healthcare (CACHE).

Our findings have unveiled a cross-sectional association between higher self-reported medication adherence and improved quality of life among patients with schizophrenia. Moreover, increased adherence levels, as well as greater satisfaction with healthcare, were linked to enhanced objective and subjective functionality and overall well-being. Additionally, the anticipation of discrimination was found to be associated with reduced quality of life and functionality.

The overall quality of life and objective-subjective functioning in patients diagnosed with schizophrenia and schizoaffective disorder can be influenced by various factors. Further research is needed to gain a better understanding of the factors associated with higher quality of life in patients.

None Declared

Although deficits in neurocognitive functioning and emotional recognition impact treatment outcomes in schizophrenia since the development of the first psychotic episode (FEP), there is still a lack of longer follow-up studies showing the course of these deficits over time.

Our objective is to investigate the changes of cognitive functioning over years in a cohort of patients, since their FEP.

This study is developed as a follow-up of the project Biomarkers in schizophrenia- integration of complementary methods in longitudinal follow-up of FEP, that was conducted in several Croatian psychiatric clinics during the period from 2014 to 2019. A cohort of patients with FEP took part in the project with psychopathology, neurocognitive functioning and emotional recognition assessment at two time points- at baseline, during the subacute phase of a psychotic episode, and after 18 months of follow-up. In this study, patients with FEP who completed the baseline assessment of the project (n=159), will be contacted and included in the follow- up. Follow-up assessment will consist of sociodemographic data including information of their treatment so far, battery of neurocognitive tests (Rey Auditory Verbal Learning Test, Rey–Osterrieth complex figure Test, Wechsler paired memory, trail making test a & b, Digit symbol, Digit span, Semantic & Phonetic Fluency, Stroop 1, 2, 3 and Block design test), emotional recognition test (Penn Emotion Recognition Task) and several scales assessing psychopathology (Positive and Negative Syndrome Scale, Self-evaluation of Negative Symptoms, Scale for the Assessment of Negative Symptoms), functioning (Global Assessment of Functioning, WHO Disability Assessment Scale 2.0), quality of life and recovery. The study is funded by the University of Zagreb programmes (Project No. 10106-23-2394).

We plan to analyze the differences between the three time points (baseline, 18 months, 5 years), taking in account possible correlations with psychopathology, functioning, quality of life and different treatment options.

Identifying specific deficits can help in providing more effective treatment plan including various interventions that can improve treatment outcomes in schizophrenia.

None Declared

As evidence has converged on the feasibility and effectiveness of focused, non-specialized, manualized interventions for treating mental distress in humanitarian settings, challenges persist in how to promote implementation fidelity and rigorously evaluate interventions designed to be more preventive or promotive in addressing risk and protective factors for poor mental health. One such intervention, Baby Friendly Spaces (BFS), is a psychosocial support program implemented for Rohingya mothers and their malnourished children living in refugee camps of Cox’s Bazar, Bangladesh. That follows a place-based intervention model in which various activities may be offered either individually or in groups with no specified sequence.

This presentation describes the process of establishing standards for implementing optimal mental health and psychosocial support (MHPSS) interventions, training BFS workers, and building monitoring and supervision systems to promote implementation fidelity within this flexible support program.

As BFS services were already being offered as part of Action Against Hunger programming, we first conducted an audit of current services, determining that there was limited current standardization or support for implementation. Therefore, a manualized protocol was designed and covered the program curricula and self-care using didactic and practice-based learning. A series of online training sessions were conducted for 13 psychosocial workers and psychologists at centers delivering the enhanced intervention. Following the training, a baseline evaluation of attitudes, confidence, and knowledge for delivering BFS services was administered. We also collaboratively designed a systematic supervision process to meet the staff’s needs with a focus on capacity building and self-care.

Following the initial training, BFS workers receiving the re-training showed similar levels of knowledge, but greater confidence (p=0.01) than MHPSS workers proceeding as usual. Participants reported that the training was useful for their field of work and for improving the quality of their work, and acknowledged they would be able to integrate the new learnings into their work and daily life. The follow-up with the supervision process confirmed their capacity to deliver the services and highlighted the need for workspace improvements, the lack of continuous motivation, their ability to identify specific issues for which they requested additional trainings.

There is a particular need for careful attention to implementation supports and supervision when offering flexible, place-based mental health and psychosocial support interventions. In that process, ensuring a continuity between the training and the supervision is essential for the quality of both the program and the research project.

None Declared