There is a scarcity of prospective studies addressing the influence of the methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms on antipsychotic-induced metabolic changes in first-episode schizophrenia (FES) patients.

We aimed at investigating metabolic side effects of second-generation antipsychotics (SGAs) with respect to the MTHFR gene polymorphisms in FES patients.

Polymorphisms in the MTHFR gene (C677T and A1298C) were investigated with respect to changes in body mass index (BMI) and waist circumference (WC) together with serum levels of glucose, lipids, homocysteine, vitamin B12 and folate after 12 weeks of treatment with SGAs in 135 FES patients.

The 677TT genotype was associated with significantly higher BMI, WC and serum levels of triglycerides, as well as significantly lower folate levels at baseline. Additionally, the 677T allele was associated with significantly lower folate levels at baseline. The 677CC homozygotes had significantly higher increase in BMI and serum levels of triglycerides. The 677TT genotype predicted significantly higher increase in homocysteine levels and significantly higher decrease in folate levels. These associations were also significant in the allelic analysis. Only the patients with the 677T allele had significantly lower folate levels and significantly higher homocysteine levels at the follow-up. The 677T allele was also related to significantly lower increase in WC. The 1298CC homozygotes had significantly higher weight gain in the course of treatment with SGAs.

The MTHFR gene polymorphisms might predict antipsychotic-induced weight gain in FES patients. In addition, the MTHFR C677T polymorphism might be also predictive with respect to other metabolic adversities of SGAs.

The authors have not supplied their declaration of competing interest.

Theory of mind (ToM) has repeatedly been shown to be compromised in many patients with schizophrenia (SCZ). It now seems to be quite well-established that patients with profound negative or disorganized symptoms perform poorly on ToM tasks. By contrast, findings in patients with predominant positive symptoms are much more ambiguous.

To investigate the relationship between ToM deficits and different symptoms dimensions in SCZ.

Fifty-eight outpatients with stable SCZ completed the intention-inferencing task (IIT), in which the ability to infer a character's intentions from 28 short comic strip stories is assessed. Symptomatology evaluation comprised the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impressions Scale Improvement and severity (CGI).

The number of correct answers in the IIT negatively correlated with both the positive (P = 0.015) and negative (P < 0.0001) scales of the PANSS. ToM deficits were correlated with the conceptual disorganization, hallucinations and the suspiciousness/persecution items.

The patients who had more false answers in the IIT also had significantly higher scores at the positive (P = 0.005), negative (P < 0.0001) and general (P < 0.0001) scales of the PANSS. Worse IIT performance correlated with a higher severity index in the CGI. No correlations were found between IIT scores and CDSS scores.

Our results confirm the relationship between ToM deficits and negative symtomps and suggest that ToM may also be correlated to specific positive symptoms.

The authors have not supplied their declaration of competing interest.

Intervention in the early-stages of psychosis may be able to shape the clinical course; critical period (CP) is best represented by the first 5 years from first admission (FA).

To investigate the effectiveness of pharmacological intervention within and beyond the CP.

(1) To compare hospitalization rates of patients stabilized on treatment with LAIs and CLZ. (2) To determine whether treatment with LAIs and CLZ within CP can influence hospitalization rates.

Data were retrospectively collected from patients diagnosed with non-affective psychoses with FA between 2000 and 2014; 200 patients were then divided into three groups, according to stabilized treatment regimen during the final year of observation: treatment as usual (TAU), CLZ, LAIs. hospitalization duration (HSPD) and frequency (HSP) were calculated for each group.

Despite a major severity before assignment to either CLZ or LAIs treatment, HSPD and HSP in both groups shifted below those observed for the TAU arm. Patients who began treatment with LAIs within the CP showed a highly significant decrease of both HSPD and HSP (respectively 17.4 ± 18 vs. 2.6 ± 8.2; Z = −2.856; P < 0.005 and 1.1 ± 0.8 vs. 0.2 ± 0.5; Z = −3.115; P < 0.005). No significant changes in hospitalization rates were observed for subjects who began treatment with LAIs after the CP.

Our study confirms that treatment with either CLZ or LAIs significantly impacts the course of psychotic disorders. The data seem to suggest that LAIs and CLZ should be considered more effective than conventional oral antipsychotics in the early-stages of psychotic illness. The difference among treatments tends to wane beyond the CP, especially for LAIs.

The authors have not supplied their declaration of competing interest.

Lurasidone has demonstrated low propensity for metabolic disturbance in adult patients with schizophrenia in short-term studies.

To evaluate metabolic syndrome occurrence during long-term lurasidone treatment in patients with schizophrenia.

To compare metabolic syndrome rates with lurasidone versus other antipsychotic agents.

Metabolic syndrome rates (as defined by the US National Cholesterol Education Program-Adult Treatment Panel III) were evaluated in adult patients with schizophrenia treated with lurasidone in 2 long-term, active-controlled studies (quetiapine XR or risperidone). In the quetiapine XR-controlled study, patients completing a 6-week, double-blind, placebo-controlled, fixed-dose trial of lurasidone (74 mg/d or 148 mg/d) or quetiapine XR (600 mg/d) continued on double-blind, flexibly dosed lurasidone (37–148 mg/d) or quetiapine XR (200–800 mg/d) for up to 12 months. In the risperidone-controlled study, patients received double-blind, flexibly dosed lurasidone (37–111 mg/d) or risperidone (2–6 mg/d) for up to 12 months.

Among patients without metabolic syndrome at baseline in the quetiapine XR-controlled study, 2.4% (2/84) of lurasidone-treated patients and 7.4% (2/27) of quetiapine XR-treated patients developed metabolic syndrome at month 12 (P = NS). Of patients without metabolic syndrome at baseline in the risperidone-controlled study, 10.3% (12/117) and 23.2% (16/69) of lurasidone- and risperidone-treated patients, respectively, developed metabolic syndrome at month 12 (P = 0.02).

Long-term treatment with lurasidone was associated with lower rates of metabolic syndrome in patients with schizophrenia compared to treatment with quetiapine XR or risperidone.

Sunovion Pharmaceuticals Inc.

NCT00789698, NCT00641745.

The authors have not supplied their declaration of competing interest.

It has been shown that patients with schizophrenia are super-sensitive towards dopamine-releasing agents such as amphetamine. Here, we studied the effects of amphetamine sensitization on amphetamine-induced dopamine release in healthy subjects.

To measure d-amphetamine-induced dopamine release as measured with the D2,3 agonist radioligand [11C]-(+)-PHNO-PET via change in non-displacable binding potential (BPND) and behavioral measures of d-amphetamine effects with drug effects questionnaire (DEQ) and subjective states questionnaire (SSQ).

To study d-amphetamine-induced sensitization in healthy subjects on a behavioral and neurochemical level with [11C]-(+)-PHNO-PET in order to gain more knowledge on sensitization-induced changes in the dopaminergic system.

Twelve stimulant-naïve healthy male subjects underwent three 90-min [11C]-(+)-PHNO-PET-scans and four oral administrations of d-amphetamine. After a naïve baseline scan, subjects underwent a PET scan with previous ingestion of 0.4 mg/kg bodyweight of d-amphetamine 90–120 minutes before scanning. Subsequently, subjects were sensitized to d-amphetamine with the same dose on two separate days. Thereafter, they underwent another PET scan with previous d-amphetamine ingestion. DEQ and SSQ were administered before, 60 min, 90–120 min, and 210 min after amphetamine ingestion.

We found significant sensitization effects on a behavioral level and on a neurochemical level after four administrations of amphetamine. Items of the SSQ, which showed significant sensitization effects were “outgoing”, “energetic”, “lively”, “alert” and “focused”.

We were able to induce significant behavioral and neurochemical sensitization in healthy humans, which were measured with [11C]-(+)-PHNO-PET for the first time. This sensitization model will be useful for studying the neurobiology of schizophrenia.

The authors have not supplied their declaration of competing interest.

Clozapine is the only drug approved for resistant schizophrenia, but remains underused because of its side effects. Sedation is common, but its management is unclear.

To analyze factors associated with clozapine-induced sedation and the efficacy of common treatment strategies.

To determine clozapine-induced sedation factors and possible therapeutic strategies.

Using two years’ electronic records of a community cohort of resistant schizophrenia spectrum disorder cases on clozapine, we performed three analyses: a cross-sectional analysis of which factors were associated with number of hours slept (objective proxy of sedation), and two prospective analyses: which factors were associated with changes in hours slept, and the efficacy of the main pharmacological strategies for improving sedation.

One hundred and thirty-three patients were included; 64.7% slept at least 9 hours/daily. Among monotherapy patients (n = 30), only norclozapine levels (r = .367, P = .033) correlated with sleeping hours. Multiple regression analyses confirmed the findings (r = .865, P < .00001). Using the cohort prospectively assessed (n = 107), 42 patients decreased the number of hours slept between two consecutive appointments. Decreasing clozapine (40%) or augmenting with aripiprazole (36%) were the most common factors. In the efficacy analysis, these two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects, respectively. The majority (81.8% and 73.9%) did not report differences in the hours slept.

Sedationis common and involves pharmacological and non-pharmacological factors. The only correlation was a weak correlation between norclozapine plasma levels and total sleeping hours. Reducing clozapine and aripiprazole augmentation were the most successful strategies to ameliorate sedation, although both strategies were effective only in a limited numbers of subjects.

The authors have not supplied their declaration of competing interest.

Schizophreniform disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.

A total of 8645 patients were analyzed; 36.21% were female and 63.79% were male (P < 0.0001); 49.04% were white, 39.06% black and 19.9% of other race (P < 0.0001). Rate of hospitalization decreased from 599.22/million to 394.47/million from 1998–2011. Overall mortality was 0.23% and mean cost of hospitalization was 17930.23. The in-hospital mortality reduced from 0.21% to 0.15% (P < 0.0001) and mean cost of hospitalization increased from 9662.88$ to 27,749.68$ from 1998–2011. Total spending on SD related admissions have increased from $47.59 million/year to $853.83 million/year.

While mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $47.59 million/year to $853.83 million/year, which leads to an estimated $806.24 million/year additional burden to US health care system from 1998 to 2011. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.

The authors have not supplied their declaration of competing interest.

Cognitive impairments clearly impact the daily functioning of patients with psychosis.

To assess cross-sectionally whether there are differences in the cognitive domains assessed with the CAI, for considering the real-world functioning of a sample of patients with psychosis.

The sample consisted of 76 patients with a DSM-IV psychotic disorder. Patients were assessed with the cognitive assessment interview (CAI), which is an interview-based measure of cognitive functioning that is intermediate between cognitive functioning and daily functioning, and three subscales of the specific levels of functioning (SLOF), an informant-rated measure of functioning. The CAI was used to assess the patient and an informant, and these scores were integrated into a rater composite score. We divided the sample by a median-split procedure for each of the three functional domains, and then applied ANOVAs to compare the two groups (impaired/not impaired) in the six cognitive domains of the CAI: working memory, attention, verbal memory, problem solving, processing speed, and social cognition.

We found significant differences between the impaired vs. non-impaired groups in most of the cognitive domains assessed with the CAI (Fig. 1).

Interview-based assessment of cognition with the CAI allows for the prediction of everyday functioning in patients with psychosis. Impairment in almost all CAI cognitive domains, except for social cognition, was associated with poorer psychosocial functioning.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a severe mental disorder, with complex symptoms involving psychosis, negative symptoms and cognitive impairment. The Trail Making Test (TMT) has been widely used to assess attention and executive function. Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries allows monitoring of aberrant cerebral hemodynamics during cognitive tasks in this patient group.

We assessed cerebral hemodynamics in the middle cerebral arteries (MCA) using fTCD while patients with schizophrenia and healthy subjects performed the TMT and a control task.

Fifteen patients with chronic schizophrenia and 15 healthy controls performed the TMT-A and -B during fTCD measurements of the MCA. Dependent measures were performance, mean cerebral blood flow velocity (MFV) and the lateralization.

Patients demonstrated an overall decreased speed of solution (P = 0.002), and there was no significant effect of age. They showed a significantly increased flow pattern for the TMT-B (P = 0.005). There were no lateralization differences between diagnostic groups.

There was a performance deficit in patients with schizophrenia for both TMT-A and -B that fits well with results of existing literature. The aberrant hemodynamic response supports the idea that cognitive performance elicits an aberrant cerebral hemodynamic correlate. It adds to the notion that fTCD is a valuable tool to correlate psychological paradigms with brain perfusion in patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

Previous studies have demonstrated that family history is associated with earlier age at onset, severity of positive and negative symptoms, and the duration of untreated illness. Hereditary factors may contribute a vulnerability for antisocial and/or violent behaviour per se, and for other stable characteristics such as aggressive behaviour.

To analyze the impact of family history of schizophrenia and aggressive behavior among members of family on severity of disease and aggressive behavior of patients.

The study population consisted of 120 male schizophrenic patients classified into non-aggressive (n = 60) and aggressive (n = 60) groups, based on indication for admission in hospital (aggression/anything else but aggression). For severity of disease, we assessed psychopathology using the Positive and Negative Syndrome Scale (PANSS), the number of hospitalizations and the total equivalent dose of therapy (collected from medical record). The presence of a family history and aggression in family was assessed using a semi-structured interview of patients and, when available, family members.

Twenty-seven (22.5%) participants were determined to have at least one family member with schizophrenia or another psychotic disorder, with no difference between aggressive (10%) and non-aggressive (12.5%) group. There was no significant interaction between family history and severity of disease (PANSS, number of hospitalizations, total equivalent dose of therapy). Aggressive behaviour in first-degree family member had no influence on aggressive behaviour of patients with schizophrenia.

Family history of schizophrenia does not affect the severity of disease nor aggressive behaviour.

The authors have not supplied their declaration of competing interest.

Dysregulation of the apoptotic process is associated with the etiopathogenesis of schizophrenia, which is observed at the brain and peripheral blood levels. A significant negative correlation between the duration of the disease and serum sFasL concentration was demonstrated by other authors. It was shown that an increased rate of apoptosis is more pronounced in neuroleptic-free patients with the first-episode of schizophrenia than in patients with chronic disease.

Search for a predictor of good response to antipsychotic treatment based on the analysis of the sFasL plasma level and its relationship with clinical symptoms.

Fifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. The concentration of sFasL was measured by ELISA. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted three times: during the active phase of disease (at admission), after 4 weeks of pharmacotherapy, and after reaching remission.

In the schizophrenia group, non-altered levels of sFasL (P = 0.1; U Mann-Whitney test), compared to the control, were detected at admission. The initial level of sFasL correlated negatively (r = −0.33; P = 0.04; Spearman's rank) with blood leukocyte count. Despite clinical improvement, no significant changes in the level of sFasL were observed. However, the sFasL level correlated negatively with the PANSS general psychopathology reduction after 4 weeks of pharmacotherapy (r = −0.7; P = 0.04) and after remission (r = −0.39; P = 0.026).

The results indicate a possible role of sFasL in apoptosis of blood leukocytes and suggest that the reduction of sFasL level can predict level of PANSS general psychopathology after antipsychotic treatment in schizophrenia.

The authors have not supplied their declaration of competing interest.

Basic symptoms are subjective complaints that present at the early states in psychotic disorders and persist in the long-term. They can be studied using hetero applied clinical instruments or self-administered questionnaires. Basic symptoms can be useful as screening tools in at risk populations.

To determine if basic symptoms (subjective cognitive deficits) are associated with the objectively measured cognitive deficit after controlling for functioning and symptomatology.

One observational, transversal, psychopathological and neuropsychological study was performed on a schizophrenia outpatients sample (n = 78). Correlations were measured by using Spearman's Rho coefficient. Basic symptoms were registered by using the Frankfurt Complaints Questionnaire (FCQ-3); cognitive status was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); clinical status was assessed by PANSS and Clinical Global Impression (CGI); functional status was measured with Global Assessment of Functioning (GAF).

All the dimensions were related to subjective complaints: cognitive functioning (r = −.38; P < .001); positive symptoms (r = .54; P < .001); negative symptoms (r = .26; P < .02); general symptoms (r = .41; P < .001); CGI (r = .57; P < .001); GAF (r = −.45; P < .001). The association between subjective and objective cognitive deficit remains significative after controlling for the clinical and functional variables, except when controlling for CGI.

The evaluation of basic symptoms with FCQ-3 is related with an objective cognitive deficit and could be useful as a screening tool.

The authors have not supplied their declaration of competing interest.

In a recent 26-week placebo-controlled, crossover trial (n = 52) we found significant positive effects on verbal and visual memory, and negative symptoms in clozapine-treated patients with refractory schizophrenia.

In this 1-year extension study, we report the long-term effects and tolerability of memantine add-on therapy to clozapine.

To evaluate the persistence of improvements in cognitive functioning and symptoms of memantine add-on therapy to clozapine in schizophrenia.

Completers of the first trial who experienced a beneficial effect of memantine after 12 weeks continued memantine for one year. Primary endpoints were change from baseline to 26 weeks treatment and 26 weeks to 52 weeks treatment on memory and executive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression Severity Scale (CGI-S). Secondary endpoints were change on the Health of the Nation Outcome Scales (HoNOS) and Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS).

Of 32 completers who experienced a beneficial effect of memantine 23 patients continued memantine for one year. Memory improvement was sustained, verbal recognition memory improved even further between t = 26 weeks and t = 52 weeks. Continued treatment with memantine add-on to clozapine was associated with significantly improved PANSS positive, negative and overall score, CGI-S and HoNOS scores.

In the extension phase the positive effect of memantine add-on therapy on verbal memory sustained and positive, negative and overall symptoms of schizophrenia, clinical global status and psychosocial functioning significantly improved. Memantine was well tolerated without serious adverse effects.

The authors have not supplied their declaration of competing interest.

Auditory hallucination (AH) has been always concerned as a main core symptom of schizophrenia. However, the mechanisms of AH are still unclear.

The aim of this study is to further explore the complicated neuroimaging mechanism of AHs from a new insight by using voxel-mirrored homotopic connectivity (VMHC).

Forty-two patients with AH (APG), 26 without AHs (NPG) and 82 normal controls (NC) participated in resting state fMRI scan. Correlation analyses were used to assess the relationships between VMHC and Hoffman scores. Additionally, ROI analysis was used to further know about the functional connectivity between the brain areas with changed interhemispheric FC and the whole brain.

APG showed reduced VMHC in the parahippocapus, fusiform gyrus, rolandic operculum, insula, heschl's gyrus and superior temporal gyrus (STG). Hoffman score of APG group had negative correlation with VMHC in these regions. Besides, ROI analysis supported decreased interhemispheric FC in schizophrenia with AH and verified functional connectivity abnormalities in schizophrenia.

These findings suggest impairment of interhemispheric coordination and whole brain FC in schizophrenia with AH, which may be implicated to the neuroimaging mechanism of auditory hallucination. Furthermore, this research highly support dysconnectivity hypothesis that schizophrenia related to abnormalities in neuronal connectivity.

The authors have not supplied their declaration of competing interest.

Brexpiprazole is a serotonin-dopamine activity modulator that is a partial agonist at 5-HT1A and dopamine D2 receptors at similar potency, and an antagonist at 5-HT2A and noradrenaline alpha1B/2C receptors.

To evaluate the efficacy, safety, and tolerability of brexpiprazole in patients with acute schizophrenia in a meta-analysis of three phase 3 studies with brexpiprazole.

The primary endpoint was change from baseline to week 6 in PANSS total score.

Data from the 3 clinical studies in patients with acute schizophrenia were combined and analyzed using individual patient data meta-analysis. In two similarly designed studies (NCT01396421; NCT01393613), patients with acute schizophrenia were randomized to fixed-doses of brexpiprazole 2 mg/day, 4 mg/day or placebo (a low-dose treatment group was included in each study [0.25 mg and 1.0 mg]; not included in the meta-analysis). In the third study (NCT01810380), patients were randomized to flexible dosing of brexpiprazole (2 to 4 mg/day), placebo, or an active reference (quetiapine extended release). Changes from baseline for brexpiprazole vs. placebo were analyzed using an MMRM approach.

Brexpiprazole 2–4 mg (n = 868) was superior to placebo (n = 517) in change from baseline in PANSS total score (−20.1 vs. −14.3; estimated treatment difference to placebo: −5.8 [95% CI: −8.0; −3.6]; P < 0.001). The proportions of patients reporting TEAEs were similar between the brexpiprazole and placebo treatment groups (57.9% vs. 57.5%). No unexpected safety concerns were observed.

This meta-analysis supports evidence from three individual trials that brexpiprazole is efficacious and safe in treating patients with acute schizophrenia.

The authors have not supplied their declaration of competing interest.

There is no comprehensive evidence on the influence of sleep disturbances (SD) on substance use disorders (SUD) or treatment use patterns of individuals with comorbid disturbances.

To better understand comorbidities and treatment use patterns of individuals with SD and SUD.

We combine 2010–2012 electronic health record (EHR) data from healthcare system in Boston (n = 131,966 person-years) and Madrid, Spain (n = 43,309 person-years). Patients with sleep disturbances (SD) were identified in the EHR through ICD-9 codes and medical records and substance use disorders (SUD) identified by documented treatment for drug or alcohol abuse or dependence. Rates of SUD are compared between individuals with and without SD. Among those with both, adequacy of mental health treatment (defined as eight or more outpatient visits or four or more outpatient visits with a psychotropic prescription) and ER use is compared.

Among the individuals, 21.1% with SD also report SUD, compared to only 10.6% of individuals without SD (P < .01). Those with comorbidities were more likely than their specialty care counterparts without comorbidities to be seen in the ER (57.1% vs. 36.6%, respectively, P < .05). Limiting the sample to only those with both SD and SUD in specialty mental health care (n = 268 in Boston and n = 28 in Madrid), 49.2% of Boston patients received adequate care compared to 38.5% of Madrid patients, and 57.8% of Boston patients had any ER use in the last year vs. 50% of Madrid patients.

SD is correlated with SUD and comorbid patients are more likely to use emergency services.

The authors have not supplied their declaration of competing interest.

Major affective disorders ranging from subthreshold affective temperaments to severe affective diseases and anxiety, are frequently associated with sleep–wake dysregulation. Interestingly, recent studies suggested an active role of Sensory Processing Disorders (SPD) in the emergence of sleep disturbances.

The objective of this study was to investigate the relationship between SPD and sleep quality in subjects with major affective disorders and specific affective temperaments.

This study aimed to examine the sensory profile (expressed in hypersensitivity or hyposensitivity) of patients with major affective disorders and its relative contribution to the prediction of sleep quality while also considering affective temperaments and depression, known as factors that may impact sleep quality.

We recruited 176 participants (mean age = 47.3) of which 56.8% have unipolar depression and 43.2% bipolar disorder. Reduced sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) whereas affective temperaments were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS).

Sensory hypersensitivity, assessed using Adolescent/Adult Sensory Profile (AASP), significantly distinguished between poor and good sleepers. Sleep quality was mainly predicted by the Beck Depression Inventory-II total score and anxious temperament. Yet, sensory hypersensitivity contributed to this prediction mainly in regard to sleep efficiency and related daytime dysfunctions.

The careful assessment of the unique sensory profile and its behavioral/functional influence on patients’ quality of life may help clinicians and health providers in developing targeted treatment interventions.

The authors have not supplied their declaration of competing interest.

Circadian rhythms and quality of sleep have been associated with temperament characteristics in healthy populations. Since temperaments are personality traits concerning the behavioral, motivational and emotional responses, adaptive capacity for sleep and circadian rhythm may also be related with temperament traits.

To identify the determinants of sleep quality (SQ) and biological rhythm (BR) in bipolar disorder, schizophrenia and depression among temperament measures.

Patients with bipolar disorder (BD, n = 49), major depression (MD, n = 35), schizophrenia (SZ, n = 30) and a healthy control group (HC, n = 36) were enrolled. Pittsburgh Sleep Quality Index (PSQI), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) and the Temperament and Character Inventory (TCI) were the measures. One-way ANOVA, Spearman Correlation Test and Linear Regression analyses were the other comparisons.

Determinants of sleep quality were self-directedness in MD [F(1,26) = 6.10, P = 0.020] and BD [F(1,31) = 10.88, P = 0.002] groups. Self-transcendence (P = 0.004), self-directedness (P = 0.038) and persistence (P = 0.05) were the determinants of sleep quality in schizophrenia group [F(3,21) = 9.71, P < 0.001]. Harm-avoidance was the determinant of sleep quality in the HC group [F(1,28) = 7.97, P < 0.001]. Determinants of biological rhythms were harm-avoidance in the BD group [F(1,32) = 9.65, P = 0.004] and self-directedness in the SZ group [F(1,23) = 11.09, P = 0.003] and harm-avoidance (P < 0.001) and self-transcendence (P = 0.039) in the HC group [F(2,27) = 15.81, P < 0.001].

Self-Directedness was associated with circadian rhythm and sleep quality in MD, BD and SZ groups. Extreme temperament features may contribute to emotional and behavioral dysfunction, which may lead to abnormal sleep patterns in psychiatric disorders.

The authors have not supplied their declaration of competing interest.

Since 1897, Émile Durkheim noted that suicides occur more often during the economic changes that disrupt the social structure of society.

The objective of this study is to analyze the consequences of last global economic crisis on mortality by suicide in the EU countries in period 2007–2012.

We extracted data on mortality from the WHO database and unemployment trends from the EUROSTAT database. We had used this data to calculate the effect of unemployment on suicide rate, in pre-2004 and post-2004 EU countries.

If the number of suicides from 2007 was maintained in 2008–2012 period, EU 27 countries would have registered with 16,572 fewer suicides. The increase of suicides is based on the increasing number of suicides in men. The small increase in the suicide rate was recorded in Austria, France, Hungary and Slovenia. Luxembourg was the only country where the number of suicides was lower compared to 2007. In 2008, we can notice a slight decrease in the unemployment rate compared to 2007 and an increase in suicide by 3% in both groups of countries, followed by increasing suicide only in the post-2004 EU, where reach 10% in 2010, followed by a slight decrease in the coming years, while the unemployment rate gradually increases to 46% compared with 2007.

In European Union countries, suicides have increased both before and during the crisis, in periods in which unemployment rose. States that joined the EU after 2004 are more vulnerable in times of crisis.

The authors have not supplied their declaration of competing interest.

An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including substance abuse, depressive disorders, and attempted suicide among adolescents and adults. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship as observed in population studies.

We have tested the association between early trauma and suicide attempts in a sample of suicide attempters from the Eureca International Project and a matched healthy control sample.

We have studied the prevalence of childhood stressful events compared with healthy controls in a multicentre sample of 791 suicide attempters (SA) and 630 healthy controls (C), we have measured childhood parental neglect, physical abuse, sexual abuse, and emotional abuse, using the Childhood Trauma Questionnaire (CTQ). Chi2 tests were performed using SPSS v15.0.

A significant increase in prevalence of childhood trauma was found in the suicide attempters sample for all types of trauma: childhood physical abuse: 25.3% (SA) vs. 11.1% (C) (Chi2 test: 120,108 P = 0.000); childhood sexual abuse: 18.2% (SA) vs. 2.4% (C) (Chi2 test: 88,212 P = 0.000); parental neglect 25.3% (SA) vs. 1.1% (C) (Chi2 test: 164,910 P = 0.000); childhood emotional abuse: 34.9% (SA) vs. 5.6% (C) (Chi2 test: 176,546 P = 0.000).

Suicide attempters were increasingly overrepresented compared with controls if experiencing more than 1 trauma: represented 77% of the sample who suffered 1 type of childhood trauma vs. more than 90% of the sample with 2 or more types of trauma.

A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide.

The authors have not supplied their declaration of competing interest.