In schizophrenia, abnormal synaptic pruning during adolescence may be due to an altered Complement system activity. While this hypothesis is supported by C4 overexpression in various brain regions of individuals with schizophrenia, such alterations should be replicated and extended to other brain regions relevant to schizophrenia. Moreover, transcriptional studies of genes coding for proteins regulating the Complement system activity are lacking. Furthermore, it remains unknown whether cerebral and peripheral expression of C4 and Complement control proteins (CCP) are related.

To identify altered expression of C4 and CCP (CSMD1, CSMD2, CD46) coding genes at the cerebral and peripheral levels in schizophrenic individuals.

We explored C4 and CCP coding genes expression at the cerebral and peripheral levels. Using shinyGEO application we analyzed gene expression from eight Gene Expression Omnibus datasets obtained from 196 schizophrenic individuals and 182 control subjects. First, we compared gene expression between schizophrenic patients and controls in postmortem cerebral samples from 7 different brain regions. Then, we compared gene expression between schizophrenic patients and controls in 4 peripheral tissues.

We observed C4 overexpression in the DLPFC, parietal, temporal cortex and associative striatum of schizophrenic individuals. We report altered transcriptional patterns of CCP genes in the DLPFC, hippocampus and cerebellum of schizophrenic individuals. CD46 expression was altered in opposite directions between brain and blood of schizophrenic individuals. No significant alteration of C4 expression was observed in peripheral tissues.

Our results support the hypothesis of an altered Complement system activity in various brain regions of schizophrenic individuals which may disrupt the synaptic pruning process during adolescence.

No significant relationships.

Alteration of GABergic neurotransmission is accused to be sharing in the cognitive impairment in schizophrenia. Exploring the relation between the neuronal expression of GABergic genes and cognitive impairment in living patients through modeling of schizophrenia is an important step to know more about the core of the pathophysiology of this disorder

Altered genetic expression of GAD 67 may have an important role in the pathophysiology of cognitive impairment in schizophrenia

. Reprogramming of human fibroblasts into human induced pluripotent stem cells (hIPSc) then neuronal differentiation was performed in 20 patients presenting with schizophrenia and 20 matched controls. Real time Polymerase chain reaction was done for measurement of genetic expression of GAD 65, GAD 67 and GABA beta 2. The Digit Symbol task, block design, block design task and similarities tasks from the Wechsler Adult Intelligence Scale., Trail A and Trail B making tests in addition to Rey-Osterrieth Complex Figure Test (ROCF) were applied to measure cognitive functions .

There were lower means of GAD65, GAD67 and GABA beta2genetic expression in the patients group with significant statistical difference between the 2 groups. The down regulation of GAD 67 in patients presenting with schizophrenia is positively correlated with impairment in executive functions.

GAD 67 gene expression had the most significant correlations with the cognitive assessment in both patients and controls. The presence of those statistically significant correlations in both groups points to the possible role of GAD 67 gene functioning in the pathophysiology of cognitive impairment in schizophrenia

No significant relationships.

In accordance with the systematics of modern international clinical guidelines (DSM-V, ICD-11), catatonia is qualified as a transnosological formation, which boundaries expandes by including non-psychotic movement disorders (hysterical, affective, negative, etc.). This study presents the psychopathological systematics of movement disorders, based on a new dimensional model of catatonia.

60 patients with an established diagnosis of schizophrenia or SSD (F20, F21, F25.01, F25.11, F25.21, F25.22), catatonic disorders in the structure of which persist throughout the course of the disease or determine the clinical picture of phases.

Clinical, psychometric (BFCRS, SANS, SAPS, HADS), statistic.

Three catatonic syndromes (S.) have been identified. 1. S. of stereotypical catatonia - presented by the mechanism of affiliation with negative symptoms (R between BFCRS Total Score (TS) and Avolition-Apathy SANS – 0,875): tendency to stereotypical activity; general, increasing slowness (SANS avolition-apathy -2,9±0,5; BFCRS TS – 11,1±0,2). 2. S. of parakinetic catatonia - includes paroxysms formes by the mechanism of mental automatism (with the loss of motor acts voluntary effect ) (R BFCRS TS/Persecutory Delusions SAPS– 0,764): irregular polymorphic movement disorders of hyperkinetic and akinetic types, impulsive actions, akinesias (Persecutory Delusions - 2,3±0,4; BFCRS – 19,5±2,3). 3. Affective - catatonic S. - including both the lightest (at the level of recurrent depression) variants of affective-catatonic phases (R BFCRS TS/HADS – 0,732; BFCRS – 5,1±0,4; HADS -15,1±2,4), and more severe affective-catatonic states based on schizoaffective psychoses (R BFCRS TS/SAPS TS– 0,783; BFCRS – 15,3±2,1; SAPS – 3,1±0,2).

Catatonia is not a single dimension, represented by heterogeneous movement disorders, differing both in the mechanism of formation and in the psychopathological structure.

No significant relationships.

Growing old with schizophrenia is a profound challenge. However, impact and course of the disorder vary widely among individuals. The recovery concept has inspired outcome evaluation. In older schizophrenia patients, research on recovery is limited and mainly cross-sectional.

To compare 5-year outcome of clinical recovery (symptomatic remission and adequate community functioning) with outcome of subjective well-being (as a key element of personal recovery).

Our catchment-area based study sample consisted of 73 older Dutch schizophrenia patients (mean age 65.9 years; SD 5.4), including both community living and institutionalized patients regardless of the age of onset of their disorder.

At baseline (T1) 5.5% of participants qualified for clinical recovery, while at five-year follow-up (T2) this rate was 12.3% (p=0.18, exact McNemar’s test). Subjective well-being was reported by 20.5% of participants at T1, and by 27.4% at T2 (p=0.27, exact McNemar’s test). Concurrent clinical recovery and subjective well-being was exceptional, being present in only one participant at T1 and in two participants at T2. Clinical recovery and subjective well-being were not correlated at T1 (p=0.82; phi=0.027), nor at T2 (p=0.71; phi= -0.044).

Transitions over time confirm a dynamic course of schizophrenia in later life, with room for improvement. In our sample, we found no linkage between clinical recovery and subjective well-being. Results suggest that while clinical recovery is relatively rare in older individuals with schizophrenia it is not a prerequisite to experience subjective well-being. In spite of ongoing symptoms a substantial number of older schizophrenia patients report subjective well-being and thus may find ‘wellness within illness’.

No significant relationships.

Family studies provide the opportunity to investigate endophenotypes as a powerful neurobiological platform to better understand the underlying neurobiological mechanisms of schizophrenia spectrum disorders. Shared features between the patients and their first-degree relatives may shed some light on the path to identify potential causes of psychosis, and to implement preventive and therapeutic interventions.

This study aimed to explore and compare neuropsychological measures in first episodes of psychosis (FEP) patients, their first-degree relatives and healthy controls (HC), participants on the PAFIP-FAMILIES project.

Statistical analyses were performed using one-way ANOVA, followed by multiple comparisons test where appropriate. Age, sex and years of education were introduced as covariates.

From 387 eligible FEP patients enrolled in a previous cohort, 133 were included. In addition, 244 of their first-degree relatives (146 parents and 98 siblings) and 202 HC participated in this study (see Figure 1). In general, relatives showed an intermediate neuropsychological performance between the HC and the FEP patients (see Figure 2). Specifically, siblings performed similar to HC in the domains verbal memory, visual memory, working memory, motor dexterity and theory of mind, since their values practically overlap those of HC. The parents presented significant deficits, similar to that of the affected individuals, in executive functions and attention domains.

These findings suggest that executive and attention dysfunction might have a greater family aggregation and could be a relevant cognitive endophenotype for psychotic disorders. The study shows the potential of exploring intra-family neuropsychological performance supporting neurobiological and genetic research in schizophrenia.

No significant relationships.

The modified completion test (MCT) based on the stories by H. Ebbinghaus enables to assess cognitive functions in situation close to a real-life task with an affective load (Burlakova,2016,2020). MCT includes the following stages: 1) filling the gaps in the story; 2) reading and retelling; 3) making up a continuation and a title; 4) retelling the story and its continuation after 30–40 minutes.

The objective was to research diagnostical potential of the second stage of MCT for patients suffering from paranoid schizophrenia with hallucinatory syndrome.

The study included 42 patients (28 female, 14 male) with schizophrenia (disease onset at least 5–7 years ago), aged from 19 to 51 (average age 35±8), receiving treatment. Control group consisted of 44 people (average age 37±6), never sought psychiatric help, never diagnosed with any mental disorders. Groups were organized to be equal in gender proportions, age, and educational level.

In comparison to the control group, the psychiatric patients demonstrated: 1) lower connectedness in narration, lower ability to reproduce main elements of the plot; 2) unusual logic in introduction of new details, extensiveness of such details; 3) lower integrity of mnestic functions, lower ability to maintain concentration. The clinical group: 1) imposed on the text principally different logic, subjectively significant, yet far from the original context; 2) suddenly introduced of new ideas; 3) had confabulations; 4) were altiloquent.

The stage of retelling enables to assess semantic memory, regulatory functions, connectedness of the narration, cogitation and to examine cognitive functions in the context of patient’s personality.

No significant relationships.

Priapism is an abnormally prolonged erection, painful and irreducible, unrelated to sexual stimulation. Around 25-40% of cases are iatrogenic, especially associated with pharmacological treatments, of which antipsychotics (first and second generation) account for 50%.

The aim is to discuss a clinical case to provide further evidence.

The patient was a 37-year-old man with a diagnosis of schizophrenia who was admitted for clinical decompensation. He had stopped antipsychotic treatment three months earlier due to side effects. He reported previous episodes of priapism associated with Risperidone, Aripiprazole, Olanzapine, and Paliperidone. At admission, he was administered Asenapine 20mg with development of priapism. Treatment was stopped. The urologists performed a lavage of the corpora cavernosa and administered adrenaline. In the absence of effectiveness, surgical intervention was successfully performed. Given the psychopathological improvement, he was discharged without antipsychotic treatment and close follow-up.

He presented a new admission one month later. Amisulpride was prescribed up to 800mg/day with good evolution and no adverse effects.

Antipsychotic-induced priapism appears to be related to the blockade of alpha-1 adrenergic receptors in the corpora cavernosa. There is a positive correlation between the affinity for the receptor and the propensity to cause priapism. The dose and duration of the medication do not appear to be correlated. Other risk factors are a history of previous episodes, restarting medication after noncompliance, use of concomitant substances or medications that cause priapism. Our choice of amisulpride was based on the fact that it has no affinity for alpha-1 adrenergic receptors.

No significant relationships.

Schizophrenia (SZ) and bipolar disorder (BD) are severe mental illnesses with large overlapping heritability. Both disorders are associated with altered neurophysiological responses, as measured with magnetoencephalography (MEG) or electroencephalography (EEG), particularly reduced mismatch negativity (MMN) and 40 Hz auditory steady-state responses (ASSR). These deficits could potentially both serve as early markers of illness and provide insight into the underlying pathophysiology as endophenotypes. First-degree relatives to patients with SZ and BD also show some neurophysiological deficits, however whether these deficits can be detected in adolescent offspring of patients is undetermined.

We aim to investigate whether adolescents at familial high risk of schizophrenia and bipolar disorder show aberrant MMN and ASSR compared to population-based controls.

We will investigate MMN and 40 Hz ASSR in 15 year old adolescents (n ≈ 175) born to parents diagnosed with either SZ (FHR-SZ), BD (FHR-BD), or neither SZ or BD (population-based controls, PBC) using MEG. We will first perform sensor-level analyses and subsequently apply dynamic causal modeling (DCM) to investigate effective connectivity and make inferences about the underlying neurobiological mechanisms. We will investigate whether current psychopathology, cognitive status, and genetic risk for SZ and BD predict neurophysiological responses in the adolescents. Investigations are part of The Danish High Risk and Resilience Study - VIA (VIA15), a population-based longitudinal cohort study integrating social, psychological and biological risk factors and outcomes for SZ and BD.

Final results are expected in 2024

The VIA15 study will allow for unprecedented insight into the neurobiological development of schizophrenia and bipolar disorder.

No significant relationships.

Patients with schizophrenia suffer from cognitive difficulties expressed in the form of complaints as well as poor insight. The interaction of these two factors makes the management of these patients more difficult.

To assess subjective cognitive complaints in a population of schizophrenics and study its relationship to insight.

Our study was a cross-sectional, descriptive, and analytical study of 72 stabilized schizophrenics followed up at the outpatient clinic. Subjective cognitive complaints were assessed by the SSTICS, clinical symptoms by the PANSS, and insight by the SAI-E.

The mean age of our population was 46.83± 11.6 years. The patients had a low socio-economic level in 70.1%. They were unemployed in 46.9% , consumed alcohol in 23.6%, and consumed tobacco in 58,6% of the cases. the total score on the PANSS scale was 46. They had an average score of 25 on the total SSTICS score and 20,1 on the SAI-E. Cognitive complaint scores were significantly correlated with improved insight (p=0,00),low socio-economic level (p=0.04),alcoholism (p=0.001) and smoking (p=0.01)

Cognitive complaints in schizophrenia could be influenced by the level of clinical insight and reflect a deep malaise, requiring a more targeted and optimized management

No significant relationships.

Although antipsychotics are first-line treatments for schizophrenia, benzodiazepines (BZDs) are often used as concomitant medications in acutely exacerbated patients due to their anxiolytic and sedative effects. Cariprazine (CAR), a D3-preferring dopamine D2/D3 partial agonist antipsychotic, has been examined in many clinical studies for the treatment of acute schizophrenia, with and without benzodiazepines.

To delineate the effects of benzodiazepine-use during cariprazine treatment in acute schizophrenia.

Pooled data of cariprazine-treated (1.5-6mg/day) and placebo-treated patients from four short-term, randomised, double-blind trials (NCT00404573, NCT01104766, NCT01104779, NCT00694707) were analysed. Baseline characteristics (age, duration of illness) and efficacy outcome parameters (Total and Hostility Factor Score of the Positive and Negative Syndrome Scale [PANSS]) were compared in patients receiving benzodiazepines (for more ≥3 consecutive days) and not receiving benzodiazepines (<3 consecutive days).

Altogether, 36.7% and 40.7% of the CAR-treated and PBO-treated patients required BZDs. BZD-taking was associated with a higher age in both the CAR-treated (p=0.0002) and PBO-treated (p<0.0001) patients, and with longer illness-duration in both treatment groups (p<0.0001). PANSS Total Score at baseline was similar for BZD users and non-users (CAR: LS Mean=96.36 and 96.27; PBO: LS Mean=95.55 and 96.66). Change from baseline in the PANSS Total Score was greater for patients who did not use BZD vs those who did (CAR: LS Mean= -23.8 vs LS Mean 17.2, p<0.0001; PBO: LS Mean= -14.0 vs LS Mean 12.9, p=0.5776).

These findings may suggest that requiring benzodiazepines is a potential indicator of longer illness duration and poorer response in acute schizophrenia.

I am an employee of Gedeon Richter Plc.

The Covid-19 pandemic has had a deleterious impact on populations across the world. Yet it remains unclear how this pandemic is affecting the psychological health of people with a previous history of mental illness.

This study aims to investigate the impact of Covid-19 on patients with established mental disorders.

The PubMed and science direct databases were systematically searched using the keywords combination “Covid-19” and “psychiatric disorders”, “the pandemic” and “mental disorders “, from inception up to November 2021. We adopted a broad inclusion criterion for the study requiring patients to have a pre-existing mental disorder, excluding narrative reviews and preclinical studies. In addition, a search of google scholar was conducted to identify any additional relevant publications.

We have found 26 studies but only 19 met our inclusion criteria. Included studies were published between 2020 and 2021. 2 major results were identified. Symptoms deterioration was reported in individuals with severe mental disorders and those with schizophrenia in particular, such as depressive or anxiety symptoms, substance use and suicidal ideation, due to the psychological stress and physical distancing measures associated with the Covid-19 outbreak. The symptomatic treatments used in Covid-19 had frequent interactions with the most used antipsychotic drugs leading to a substantial increase in relapse rates in people with mental disorders.

The Covid-19 pandemic has a serious impact on individuals with pre-existing mental illness reinforcing symptom severity and psychological stress. Additional studies are needed to strengthen current findings with pre-pandemic records.

No significant relationships.

Aripiprazole LAI is approved for the treatment of schizophrenia in adults. Recently, Europe and Canada approved the use of the two-injection start (TIS) regimen: two separate injections of 400 mg long-acting aripiprazole along with a single 20 mg dose of oral aripiprazole. Aripiprazole showed efficacy in the treatment of adolescents with acute schizophrenia in several controlled trials, leading to its approval for 13-17 year-old adolescents with schizophrenia by the EMA. However, the LAI formulation still remains off-label in adolescents.

To demonstrate the efficacy and safety of the TIS regimen of aripiprazole LAI formulation in a 16 year-old adolescent with schizophrenia.

We evaluated the symptoms of schizophrenia and general severity by means of the PANSS and CGI scales. The scales were administered at hospital admission, after 3 weeks, 5 weeks, and at 4-weeks follow-up.

At the admission the patient PANSS total score was 136, the CGI score of 7. Aripiprazole was started and up-titrated to 30 mg/day. After 3 weeks, the positive symptoms were significantly reduced; due to the persistence of negative symptoms, clozapine 100 mg/day was added. At week 5 the PANSS total score decreased to 81. Due to poor insight we proposed aripiprazole LAI with the two-injection start. One month later, global functioning and illness insight improved; PANSS score was 43, CGI score 2. There was no evidence of akathisia or other side effects.

Aripiprazole LAI showed good efficacy and tolerability in an adolescent with schizophrenia. The two-injection start regimen was a safe and viable option.

No significant relationships.

Psychiatric services in LEDCs face a tripartite challenge: (i) limited financial capital; (ii) scarcity of professionals; (iii) restrictive health beliefs. Inevitably, services developed for the first-world are ill-suited here. Psychiatric services must be designed from the ground up: inspired by but not a replica of best practices in the developed world. The SOUL project in Larkana, Pakistan provides home based assessment by a psychiatrist and fortnightly treatment by a mobile nursing team for schizophrenic patients. Psychoeducation of carers and the community as well as facilitation of work for patients are core aims. This mixed-methods study evaluates the experiences of primary stakeholders - patients and their carers.

1.Are patients and carers satisfied with the care received? 2.Has SOUL been successful in changing health beliefs? 3.How could the programme be improved?

The principal investigator accompanied the team for 4-weeks. Purposive sampling was employed. Satisfaction was assessed quantitatively using the likert based PSQ-18 questionnaire. Thereafter, qualitative data was gathered using semi-structured interviews and analysed using a grounded theory approach. A total of 27 interviews were conducted before data saturation.

100% of interviewees answered ’Satisfied’ or ’Very’ Satisfied to all elements of the PSQ-18. Above all, stakeholders valued that treatment was free and highly accessible (home visits), promoting treatment adherence. They felt psychoeducation events significantly reduced community stigma and made families more likely to seek psychiatrists over faith healers. Provision of respite care was suggested as a future improvement.

SOUL is highly valued by stakeholders and offers an excellent example of LEDC psychiatric care.

No significant relationships.

Oxytocin is considered as potential treatment targeting social dysfunctions in psychoses. However, results of clinical trials are inconsistent which may be due to genetic variation in the oxytocin system involved in social information processing.

To examine the effect of the OXTR polymorphism and its interaction with childhood adversity (CA) on facial affect recognition (FAR) in psychotic patients.

Patients with schizophrenic and affective psychotic disorders (n=934) completed a task that required labeling six basic and three social emotions. The polymorphisms rs53576 and rs7632287 within the OXTR locus were genotyped and dichotomized based on prior research. For 65% of the sample, information on CA defined as parental alcoholism or psychiatric illness was collected. The polymorphisms’ role in FAR was assessed using ANCOVAs adjusted for sex, age, and diagnosis.

After Bonferroni correction, there was a significant effect of rs53576, mainly driven by the difference between genotypes in the affective patients. GG-homozygotes recognized emotions better than A-allele carriers. A nominally significant effect in the expected direction was also found for rs7632287. CA influenced FAR but did not interact with any genotype.

The results provide further evidence that OXTR impacts social cognition and behavior in diverse cohorts, including psychotic patients, with rs53576 GG-homozygotes having enhanced social competencies. However, we have failed to confirm that OXTR modulates the relations between CA and FAR in psychosis. The difference in FAR between genotypes was more pronounced in affective patients, which might be due to more severe FAR deficits in schizophrenia.

No significant relationships.

Everyday social interactions are based on Theory of Mind (ToM) or mentalizing, whose complex processes are involved in understanding, representing one’s own and other people’s mental states. ToM is supposed to have two systems. The implicit ToM seems to be a fast, automatic, non-verbal processing. The explicit ToM is characterized by a slower, but more flexible processing, which is mostly verbal, interpretative. Several studies have described explicit ToM deficit in schizophrenic patients. Less research has investigated implicit ToM in patients, however recently, there has been a growing number of articles examining implicit ToM of patients with schizophrenia.

The aim of our systematic review and meta-analysis is to summarize the results of the implicit ToM in schizophrenia.

A systematic search was performed in four major databases. We included 11 publications. 7 studies; and 5 studies were included the quantitative synthesis and the qualitative synthesis, respectively.

We found significant differences in accuracy, reaction time and brain activation patterns during implicit ToM between schizophrenic patients and controls. The systematic review revealed further alterations in visual scanning, cue fixation, face looking time, and difficulties in perspective taking.

Based on our results implicit ToM is affected in schizophrenia in addition to explicit ToM deficit. However, based on these results we cannot exclude the possibility, that implicit ToM or at least some elements of it might be relatively unaffected (e.g. detection of intentionality), however its effectiveness is limited by non-mentalizing deficits (e.g. certain neurocognitive impairments). Our results may have important implications for the remediation of mentalizing skills.

The research is supported by the Hungarian National Excellence Centrum Grant (FIKP II) and Hungarian Brain Research Program (KTIA-13-NAP-A-II/12).

Long-acting injectable (LAI) antipsychotics and community treatment orders (CTOs) are used in patients with schizophrenia to improve treatment effectiveness through adherence.

Understanding healthcare resource utilization (HRU) and associated costs, and medication adherence in patients with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA) LAI initiation may guide strategies to optimize health.

A retrospective observational single-arm study using administrative data from Alberta was performed. Adults with schizophrenia who initiated SGA-LAI (index date) were included. Medication possession ratio (MPR) was determined; paired t-tests were used to examine differences in HRU and costs ($CDN) between the 2-year pre-index period and 2-year post-index period. Stratified analysis by presence or absence of an active CTO during the pre-post periods was performed.

Among 1,211 patients who initiated SGA-LAIs, MPR was greater post-index (0.84) compared with pre-index (0.45; 95% confidence interval [CI] 0.36, 0.41). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p<0.001); total all-cause HRU costs were $33,788 lower post- versus pre-index ($40,343 [standard deviation, SD $68,887] versus $74,131 [SD $75,941], 95% CI [-$38,993, -$28,583]), and total mental health-related HRU costs were $34,198 lower post- versus pre-index ($34,205 [SD $63,428] CDN versus $68,403 [SD $72,088] CDN, 95%CI [-$39,098, -$29,297]). Forty-three percent had ≥1 active CTO during the study period; HRU and costs varied according to CTO status.

SGA-LAIs are associated with improved adherence, and lower HRU and costs however the latter vary according to CTO status.

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this abstract: SD and MS have no competing interest to declare. LR, SK, KW, and KM are members of the Real-World Evidence

Cardiorespiratory fitness (CRF) can be directly measured and assessed by the cardiopulmonary exercise test (CPET) or estimated from different field tests as the Modified Shuttle Walking Test (MSWT). The CRF in schizophrenia (SP) population may be altered due to sex, age, body composition and core symptoms variables. However, the extent to which each domain influences CRF in this pathology is still unknown.

To analyze the predictive value of body composition and core symptoms in SP for CRF.

Participants (N = 144, 41.7 ± 10.3 yr old) with SP were assessed with (1) body mass index and fat percentage; (2) upright bicycle ergometer using an incremental ramp protocol and the MSWT; and (3) positive and negative symptoms of the disease [“Positive and Negative Syndrome Scale” (PANSS) and “The Brief Negative Symptom Scale” (BNSS)]. In the Stepwise Multiple Regression analyses, those variables which correlated (Spearman’s Rho) significantly with each CFR scores were included

Lower negative symptoms (P<0.001) and positive PANSS (P=0.035) predicted V̇O2peak (L·min−1) (R2=28.3%). Lower negative symptoms (P<0.001), positive PANSS (P=0.006) and fat body mass (P<0.001) explained V̇O2peak (mL·kg−1·min−1) (R2=46.5%). MSWT was predicted (R2=58.9%) by lower negative symptoms (P=0.001), body mass (P<0.001) and total PANSS (P=0.004).

In patients with SP significantly higher CRF was detected in those with lower negative and positive symptoms, as well as lower body mass. Exercise interventions for improving CRF should be promoting in this population for a better control of core symptoms.

No significant relationships.

Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptoms. Negative symptoms are a major health concern and a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. Adequate treatment would mean important progress and Distinguishing primary from secondary negative symptoms may inform about treatment options.

Objective: to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia.

We searched Pubmed and Cochrane Library database for english language articles.

Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes. Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.

Clinically relevant negative symptoms of schizophrenia need to be recognized, assessed, and as well managed as possible in order to achieve improved outcomes for patients. More studies are needed to establish the better approach to negative symptoms.

No significant relationships.

Catatonia is a state of apparent unresponsiveness to external stimuli in a person who is awake. More common in patients with unipolar major depression or bipolar disorder. Common signs: immobility, rigidity, mutism, posturing, excessive motor activity, stupor, negativism, staring, and echolalia. We will discuss a case of a 23 year old male with schizophrenia presented with catatonia and decompensation of his schizophrenia in the context of medication non-compliance. We will discuss findings from litrature pertaining to catatonia and treatment strategies.

- To discuss catatonia, its incidence in different psychiatric disorders. - To discuss literature pertaining to catatonia. - To discuss different treatment strategies

- Case study

- Signs of catatonia: immobility, mutism, withdrawal and refusal to eat, staring, negativism, posturing, rigidity, waxy flexibility/catalepsy, stereotypy, echolalia, or echopraxia, verbigeration. - Diagnosis: Clinical, Lorazepam challenge. Bush-Francis Catatonia Rating Scale (BFCRS) - BFCR scale is used as the screening tool. If 2 of the 14 are positive, prompts further evaluation and completion of the remaining 9 items. - Differential Diagnosis include; Neuroleptic Malignant Syndrome, Serotoninergic Syndrome, Malignant Hyperthermia, Akinetic Mutism, Delirium, Parkinson’s disease. - Lorazepam can be scheduled at interval doses until the catatonia resolves. - ECT in combination with benzodiazepines is used to treat malignant catatonia. - Possible complications are Physical trauma, malignant catatonia (autonomic instability, life-threatening), dehydration, pneumonia, pressure ulcers due to immobility, muscle contractions, DVT, PE

Psychiatrists need to be diligent in evaluating patients with Catatonia for other comorbid psychiatric conditions, addressing these conditions and conducting a thorough assessment and prompt treatment.

No significant relationships.

Clozapine has proven to have a unique efficacy on treatment-resistant schizophrenia (TRS). Nevertheless, studies show that 47%-63% of clozapine-treated patients may fail to respond after around 12-years of treatment (CRS). Several augmentation strategies have been proven to be effective in CRS.

Hereby, we present two clinical cases of CRS successfully managed with brexpiprazole augmentation.

A 48-year-old man without comorbid substance use, treated with clozapine-brexpiprazole augmentation, and a 20-year-old man with comorbid substance use, treated with clozapine-brexpiprazole combination and subsequently with twice-injection aripiprazole (TIA). They were administered with the following assessments at t0, t1-3 (first month), t4-8 (monthly until 6-month follow-up): CGI, BPRS, PANSS, CDSS, Craving VAS, BARS, BIS-11, HRS-A, MADRS, YMRS, AIMS.

At 1-month follow-up, both patients showed a considerable improvement (respectively 75% and 55.9% reduction of PANSS total score). At 6-month follow-up, reached only with the first patient, we noticed a further improvement (an overall 37.5% reduction of PANSS total score from the baseline).

The present work is the first report describing combination treatment strategies with clozapine and brexpiprazole which appear to give promising results.

No significant relationships.