Theory of mind (ToM) has repeatedly been shown to be compromised in many patients with schizophrenia (SCZ). By contrast, the association between ToM deficits and neuro-cognitive functioning (NF) remains uncertain.

To investigate the association between ToM functioning and neuro-cognitive functioning 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. They also completed a neuro-cognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

The performance in the IIT significantly correlated with performance in some neuro-cognitive tests including efficiency in DBZ, number of uncorrected mistakes in ST, number of correct categories in MCST and the time needed to succeed the TMT-A. No correlations were found between performance in the ITT and in memory tasks (HVLT-R and DS).

ToM may rely on some neuro-cognitive functions (mainly attention and executive functioning). Elucidating the exact relationship between ToM and NF may be useful as both are targeted in specific psychotherapeutic interventions.

The authors have not supplied their declaration of competing interest.

It has been suggested that psychotic bipolar patients have more severe cognitive deficits and lower functioning that non-psychotic bipolar patients.

To evaluate neurocognitive and functional performance in stabilized psychotic bipolar patients (BP+), non-psychotic bipolar patients (BP−) and schizophrenia patients (SZ).

To examine whether BP+ might be defined as a more homogenous subtype of bipolar disorder with more severe cognitive deficit and more severe functional impairment.

Fifty TB+, 50 TB−, 50 SZ and 51 controls were evaluated with a comprehensive neurocognitive battery (WCST, FAS, TMT-A and B, Stroop Test, Digits span, letters and numbers – WMS-III−, CVLT, ROCFT, CPT-DS). Moreover, patients were evaluated with clinical scales (PANSS, MADRS, YMRS) and functionality scales (WHOs Disability Assessment Scales, QLS and GAF). IBM SPSS Statistics (version 19.0) was used to the data analysis.

No significant differences were found between three patients’ samples (P < 0.0001). No significant differences in neurocognitive measures were found between BP+ and BP−. Significant differences were found between both groups of bipolar patients and schizophrenia in working memory measures (P < 0.0001). BP+ and BP− showed significant higher functionality than SZ (P < 0.0001), without significant differences in functionality between BP+ and BP−.

The pattern of neurocognitive and functional deficit is similar in BP+ and BP−. The neurocognitive deficit is very similar in both groups of bipolar patients groups in comparison to SZ; functionality is better in both bipolar groups than in schizophrenia patients.

The authors have not supplied their declaration of competing interest.

Empathy, which refers to the ability to understand and share the thoughts and feelings of others, may be compromised in schizophrenia (SCZ). Yet the relationship between empathy and neurocognitive functioning remains unclear.

To explore whether cognitive and affective empathy are associated with the neurocognitive functioning in SCZ.

Fifty-eight outpatients with stable SCZ completed the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Better affective and cognitive empathy correlated with better performance in the ST (less hesitations and less errors). Patients with better cognitive empathy performed better in the MCST (more categories achieved; P = 0.029) and in the LDST (more substitutions per minute; P = 0.031).

Our results bolster support for the presence of an association between NF and the decreased cognitive and affective empathy in schizophrenia.

The authors have not supplied their declaration of competing interest.

The impairment of cognitive and affective empathy among patients with schizophrenia (SCZ) may represent a significant feature of the illness. However, the relationship between those impairment and dimensions of psychosis remains unclear.

To explore whether cognitive and affective empathy are associated with severety of different psychotic symptoms.

Cognitive and affective empathy were evaluated in 58 patients with stable schizophrenia with the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. 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).

Patients with better cognitive empathy had less total CDSS scores (P = 0.036, r = −0.449) and lower CGI-severity scale scores (P = 0.01, r = −0.536). Patients with better affective empathy had lower scores (which means a better improvement) at the CGI-improvement scale (P = 0.03, r = −0.461).

Our results suggest that empathy with its different component is not totally independent of the clinical state of the patient. Further studies are required to confirm whether empathy deficits are state or trait aspects of SCZ.

The authors have not supplied their declaration of competing interest.

Depression is common among patients with schizophrenia and is associated with a wide range of poor outcomes, including psychotic relapse and suicide. The aim of the study is to evaluate the presence of depressive symptoms in patients with schizophrenia and to compare depression intensity in schizophrenic patients and patients with depressive disorder.

In this cross sectional study were included 40 patients from both genders. Patients were divided in 2 groups: (1) examined group: 20 schizophrenic patients who presented depressive symptomatology. Depressive symptoms-evaluated with the 17-item Hamilton Rating Scale for Depression. Inclusion criteria: schizophrenic disorder by ICD-10 (F20.0-F20.9), total score higher than 7 on the HRSD-17 and age between 25 and 65; (2) control group: 20 patients with depressive disorder. Inclusion criteria: recurrent depressive disorder by ICD-10 (F33.0-F33.9), total score higher than 7 on the HRSD-17 and age between 25 and 65. Psychiatric rating scales for clinical evaluation of prominence of symptomatology: 17-item Hamilton Rating Scale for Depression (HRSD-17) and PANSS (Positive And Negative Syndrome Scale).

The prevalence of patients with depressive symptoms among the schizophrenic patients was 45% i.e. out of 20 evaluated patients with schizophrenia, 9 showed depressive symptoms. The total score in the remaining 11 patients on the HRSD-17 was lower than 7 and they were excluded. Difference between the two groups for gender difference was not statistically significant.

The percentage of patients with depressive symptoms among the patients with schizophrenic disorder was 45%. Schizophrenic patients more frequently presented mild and moderate depression in comparison to the control group. In the majority of subjects with schizophrenia and depressive symptoms positive schizophrenic symptomatology was predominant.

The author has not supplied his/her declaration of competing interest.

Chronic hepatitis C virus (HCV) is one of world's most important chronic infections. HCV can be treated using interferon-alpha (IFNα) and ribavirin (RBV). HCV, IFNα and RBV are known to impair mental and physical life quality. Many HCV-infected individuals have life-prevalence of substance use disorder (SUD).

To study life quality (SF-36) in HCV patients with SUD history during antiviral treatment.

SF-36 questionnaire was assessed in 384 HCV patients at baseline, and at 4, 12, 24, and 48 weeks of treatment. ANCOVA models were used to study the association of SF-36 scores and potential risk factors at baseline. Risk factors from baseline scores over time were studied through linear mixed models, adjusting for baseline scores.

At baseline, SUD men had worse mental (P = 0.03) and physical health (P = 0.022), and younger patients had worse social functioning (P = 0.011), and mental (P = 0.001) but better physical health (P < 0.001). Figs. 1 and 2 show the results of mental and physical life quality during treatment from baseline.

This study emphasizes the decrease in life quality in HCV patients with SUD before and during antiviral treatment.

Instituto de Carlos III-FIS: PSICOCIT-PI110/01827,EU “One way to make Europe”, Ministerio de Economia y Competitividad (MTM2012-38067-C02-01), and support of SGR/2014/1135.

The authors have not supplied their declaration of competing interest.

Psychiatry has seen significant progress in recent decades due to scientific advances. However, beyond genes, neurotransmitters and neurocircuits, there is a truly human dimension that escapes all the science. The choices each one makes, even if biologically mediated, and the consequences, even if mediated through individual vulnerabilities, dictate an outcome. That outcome may be a biopsychosocially ill individual. Health professionals trained and up-to-date on the latest research are confronted with challenges that far outweigh what they expected and know what to do with, defying the humanity of even the most humane.

To reflect upon a clinical case of human misery.

To promote growth at a professional and personal level through the process of treating challenging patients.

Presentation of a clinical case.

A homeless person with a history of and current drug use, prostitution, untreated HIV-AIDS, hepatitis B and C, untreated Mycobacterium lentiflavum pulmonary infection, bleeding rectal prolapse, prolonged psychotic manic episode and a very difficult personality has trouble finding and ultimately rejects help from medical professionals and ends up involuntarily admitted to a psychiatric inpatient unit.

Many unsolvable or only partially solvable puzzles end up under psychiatric care. The complexity of human nature escapes all scientific advances. We can put many pieces together but the whole often remains a challenge, a challenge of our values, our motivation, creativity and resilience.

The authors have not supplied their declaration of competing interest.

The consumption of toxic substances often causes agitation, which makes more difficult the pharmacological management of the symptoms.

About one case, a search was performed of the different therapeutic options in the agitation takes place in the context of intoxication.

Thirty-five-year-old male patient diagnosed of dual pathology under treatment since 2003 in our outpatient. The patient shows paranoid schizophrenia disorder due to alcohol, cannabis and cocaine use disorder, summing up different pharmacological treatments with no remission. Whilst the examination is taking place the patient is under alcohol and cannabis effects. His physical and verbal behaviour are aggressive showing psychotic instability. The therapeutic team administers loxapine to its patient.

The inhaled loxapine turned out to be a good alternative in the case given.

Handling agitation when toxics are involved is complex. The new formulation of inhaled loxapine helps to control agitation quickly and it might be a feasible option for this kind of patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The dual pathway model (DPM) attempts to explain the processes that are etiological to the development of Bulimia Nervosa (BN) symptomology by examining both individual and sociocultural risk factors of BN. The DPM, however, is yet to incorporate the sociocultural factor Facebook, which is important given the widespread use of the social media website Facebook. In addition, research has suggested that the personality trait sociotropy may increase vulnerability to developing BN symptoms, however, there is limited evidence examining this factor in the DPM.

To test a revised DPM with the inclusions of social comparisons made on Facebook and sociotropy both (a) cross-sectionally and (b) longitudinally.

Four hundred and seventy females participated at baseline (T1). Four weeks later, 274 females completed the follow-up assessment (T2), which assessed a subset of measures from the baseline assessment.

An acceptable fit for both DM models was obtained through Structural Equation Modeling (SEM) using MPlus (See Figs. 1 and 2).

Prevention and early intervention efforts for both depression and BN should focus on addressing appropriate Facebook and social media use and these interventions should be tailored to individuals scoring high on sociotropy.

The authors have not supplied their declaration of competing interest.

Despite the considerable number of studies that have assessed evidence for a longitudinal relationship between eating pathology and depression, there is no clear consensus regarding whether they are uni- or bi-directionally related.

To undertake a meta-analysis to provide a quantitative synthesis of longitudinal studies that assessed the direction of effects between eating pathology and depression. A second aim was to use meta-regression to account for heterogeneity in terms of study-level effect modifiers.

Meta-analysis results on 30 eligible studies showed that eating pathology was a risk factor for depression (rm = 0.13, 95% CI: 0.09 to 0.17, P < 0.001), and that depression was a risk factor for eating pathology (rm = 0.16, 95% CI: 0.10 to 0.22, P < 0.001). Meta-regression analyses showed that these effects were significantly stronger for studies that operationalized eating pathology as an eating disorder diagnosis versus eating pathology symptoms (P < 0.05), and for studies that operationalized the respective outcome measure as a categorical variable (e.g., a diagnosis of a disorder or where symptoms were “present”/“absent”) versus a continuous measure (P < 0.01). Results also showed that in relation to eating pathology type, the effect of an eating disorder diagnosis (b = −0.06, t = −7.304, P ≤ 0.001) and bulimic symptoms (b = −0.006, t = −2.388, P < 0.05) on depression was significantly stronger for younger participants.

Eating pathology and depression are concurrent risk factors for each other, suggesting that future research would benefit from identifying factors that are etiological to the development of both constructs.

The authors have not supplied their declaration of competing interest.

The use of Performance and Image-Enhancing Drugs (PIEDs) is on the increase and appears to be associated with several psychopathological disorders, whose prevalence in unclear.

We aimed to evaluate the differences–if any–in the prevalence of body image disorders (BIDs) and eating disorders (EDs) in PIEDs users athletes vs. PIEDs nonusers ones.

We enrolled 84 consecutive professional and amateur athletes (35.8% females; age range = 18–50), training in several sports centers in Italy. They underwent structured interviews (SCID I/SCID II) and completed the Body Image Concern Inventory (BICI) and the Sick, Control, One, Fat, Food Eating Disorder Screening Test (SCOFF). Mann-Whitney U test and Fisher's exact test were used for comparisons.

Of the 84 athletes, 18 (21.4%) used PIEDs. The most common PIEDs were anabolic androgenic steroids, amphetamine-like substances, cathinones, ephedrine, and caffeine derivatives (e.g. guarana). The two groups did not differ in socio-demographic characteristics, but differed in anamnestic and psychopathological ones, with PIEDs users athletes being characterized by significantly (P-values < 0.05) higher physical activity levels, consuming more coffee, cigarettes, and psychotropic medications (e.g. benzodiazepines) per day, presenting more SCID diagnoses of psychiatric disorders, especially Substance Use Disorders, Eating Disorders, Body Dysmorphic Disorder (BDD), and General Anxiety Disorders, showing higher BICI scores, which indicate a higher risk of BDD, and higher SCOFF scores, which suggest a higher risk of BIDs and EDs.

In PIEDs users athletes body image and eating disorders, and more in general psychopathological disorders, are more common than in PIEDs nonusers athletes.

The authors have not supplied their declaration of competing interest.

Sensory deficits such as blindness and deafness are very common forms of disability, affecting over 300 million people worldwide according to World Health Organization estimates. These conditions can lead to misinterpretations of the environment, which may contribute to the development of a delusional disorder in predisposed people.

The objective of this study is to establish the prevalence of blindness and hearing loss across delusional disorder.

The aim is to provide useful information regarding this frequent, often disregarded, comorbidity.

Our results proceed from the Andalusian delusional disorder case-register (DelirAnda). We reviewed 1927 clinical histories of patients diagnosed of delusional disorder. Upon having verified the diagnosis following DSM-V criteria, we recollected data on the prevalence of blindness and hearing loss, which were defined based on clinical diagnosis.

One thousand four hundred and fifty-two patients matched DSM-5 delusional disorder criteria. Among them, 49.8% of our sample were women. The overall prevalence of sensory deficits was 7.4%, 3.5% of the patients with delusional disorder were blind, while 3.9% of them suffered from hearing loss.

Our results are consistent with previous studies, such as the Deliremp study, which found a 5.7% prevalence of sensory deficit among delusional disorder patients. These results show a higher prevalence of sensory deficit among delusional disorder patients compared with the general population. However, causality could not be established. Further study should be undertaken regarding the relationship between these two conditions.

The authors have not supplied their declaration of competing interest.

Mental disorders are often comorbid with chronic physical conditions. This relationship has been looked into in some mental disorders, such as depression or schizophrenia. However, very few studies have explored this comorbidity in the delusional disorder.

The objective of this study is to establish the prevalence of common chronic medical conditions across delusional disorder.

The aim is to provide useful information regarding this frequent, often disregarded, comorbidity.

Our results proceed from the Andalusian delusional disorder case-register (DelirAnda). We reviewed 1927 clinical histories of patients diagnosed of delusional disorder. Upon having verified the diagnosis following DSM-5 criteria, we recollected data on the prevalence of 10 different medical conditions, which were defined based on clinical diagnosis.

One thousand four hundred and fifty-two patients matched DSM-5 delusional disorder criteria. Among them, 49.8% of our sample were women. The overall prevalence of medical conditions was 66%. Thirty-one percent of the patients with delusional disorder had only one comorbid physical condition, 20% of them suffered from two conditions, and 15% of them had three or more chronic conditions. The most prevalent physical condition among delusional disorder patients was diabetes, affecting 16% of these patients.

Chronic physical conditions are highly prevalent among patients with delusional disorder. Comorbid physical conditions may have an important impact on the course of delusional disorder. A correct diagnosis and treatment of this comorbidity should be made to help improve the prognosis and life quality of these patients.

The authors have not supplied their declaration of competing interest.

Punding is a stereotypical motor behaviour characterized by a repetitive, excessive and non-goal oriented activity that causes an important loss of time. Since its first description in psychostimulant addicts, data on punding has only derived from studies on Parkinsonian patients treated with dopaminergic drugs. Little is known in the literature about Parkinsonian patient's characteristics who suffer from punding.

We propose to study characteristics of Parkinsonian “punders” in order to investigate the pathophysiology of this phenomenon.

In this retrospective study, we use the “Ardouin Scale of Behavior in Parkinson's disease” database. This database was initially used to design a global scale to detect changes in mood and behavior of Parkinson's disease (PD) patients. We compared different variables between Parkinsonian patients who suffer from punding with non-punder Parkinsonian patients.

Eighty of the 258 patients were identified as punders. In univariate analysis, the punder and non-punder groups differed statistically with regard to the age of diagnostic of PD, hypersexuality and dopaminergic agonist treatment. In multivariate analysis, the punder and non-punder groups only differed statistically with regard to dopaminergic agonist treatment (P = 0.05).

Dopaminergic agonist treatments appear to be more represented among patients with punding in our sample. Impulse control disorders (ICD) are known to be more common in patients treated by dopamine agonists. Punding could be considered as the most severe form of ICD that is linked to psychomotor stimulation and reward mechanisms.

The authors have not supplied their declaration of competing interest.

Alexithymia refers to difficulties in verbal expression of emotions, commonly observed in patients with psychosomatic symptoms. In this context, asthma is described as one of psychosomatic diseases.

Identify clinical profile of asthmatic patients and assess the alexithymia level as well as associated factors.

We conducted a cross-sectional, descriptive and analytic study, including 30 patients followed for asthma at pulmonary outpatient department, Hedi Chaker Hospital, Sfax, Tunisia, during September and October 2015. We collected socio-demographic and clinical characteristics. Asthma control level was assessed by the Asthma Control Test (ACT). Alexithymia was measured using Toronto Alexithymia Scale (TAS 20).

The mean age was 51 ans. Sex-ratio F/M was 14. The mean duration of disease was 11 years. Long-term control medicines were: inhaled corticosteroids, long-acting beta agonists and theophylline respectively in 86.7%, 33.3% and 26.7%. Two thirds of our patients had a bad therapeutic adherence. The average ACT score was 16.8 points. Asthma was uncontrolled in 1/3 and well controlled in 1/3 of cases. The average TAS 20 score was 64.8 points. Twenty percent of patients were non-alexithymic, 13.3% had a probable alexithymia and 66.7% were alexithymic. This score was positively correlated to bad asthma control (P < 0.001), long term evolution (P = 0.002) and use of inhaled corticoids (P < 0.001). It was inversely correlated to ACT score (P < 0.001).

Our study shows the high prevalence of alexithymia in patients with asthma and its negative impact in asthma control. Psychological support aiming specifically alexithymic dimension in these patients is indispensable.

The authors have not supplied their declaration of competing interest.

High rates of psychiatric comorbidity are subject of debate: to what extent do they depend on classification choices such as diagnostic thresholds?

To investigate the influence of different thresholds on rates of comorbidity between major depressive disorder (MDD) and generalized anxiety disorder (GAD).

Point prevalence of comorbidity between MDD and GAD was measured in 74,092 subjects from the general population according to DSM-IV-TR criteria. Comorbidity rates were compared for different thresholds by varying the number of necessary criteria from ≥ 1 to all 9 symptoms for MDD, and from ≥ 1 to all 7 symptoms for GAD.

According to DSM-thresholds, 0.86% had MDD only, 2.96% GAD only and 1.14% both MDD and GAD (Odds Ratio [OR] 42.6). Lower thresholds for MDD led to higher rates of comorbidity (1.44% for ≥ 4 of 9 MDD-symptoms, OR 34.4), whereas lower thresholds for GAD hardly influenced comorbidity (1.16% for ≥ 3 of 7 GAD-symptoms, OR 38.8). Specific patterns in the distribution of symptoms within the population explained this finding: 37.3% of subjects with core criteria of MDD and GAD reported subthreshold MDD symptoms, whereas only 7.6% reported subthreshold GAD symptoms.

Lower thresholds for MDD increased comorbidity with GAD, but not vice versa, owing to specific symptom patterns in the population. Generally, comorbidity rates result from both empirical symptom distributions and classification choices and cannot be reduced to either of these exclusively. This insight invites further research into the formation of disease concepts that allow for reliable predictions and targeted therapeutic interventions.

The authors have not supplied their declaration of competing interest.

Classical homocystinuria (cystathionine beta synthase deficiency) is a rare autosomal recessive disease of methionine metabolism that causes accumulation of homocysteine in the blood and cysteine deficiency. It is characterized by intellectual disability, ectopia lentis, skeleton abnormalities resembling Marfan syndrome and thromboembolic episodes. The majority of patients have psychiatric disturbances as depression, behavioral disorders, personality disorders, obsessive-compulsive disorder and, less commonly, bipolar disorder and psychosis.

To briefly review psychiatric disturbances in patients with homocystinuria and present a case report.

Literature research and analysis of patient's clinical data.

A 22-year-old male was diagnosed with classical homocystinuria at age 4 due to intellectual disability and renal alterations. With aging, other problems emerged: epilepsy; postural tremor; dysesthesia; ectopia lentis; orofacial myofunctional disorder; asthma; and patellar instability. He went to a special education program. At age sixteen, he initiated Child Psychiatry consultations due to anxiety and behavioral changes, as difficulty in controlling impulses, establishing relationships and in the perception of the self. Nowadays, the patient is followed in psychiatric consultations, where he has demonstrated high difficulty to empathize. He is being treated with vitamin supplements; betaine; levetiracetam; clobazam; and propranolol, combined with a special diet.

It is not practical to screen every psychiatric patient for Homocystinuria, but this disease should be considered when there is a family history, early and/or acute onset, intellectual disability, atypical symptoms, unusual response to treatment, progressive cognitive change and other organic disturbances present in this disorder.

The authors have not supplied their declaration of competing interest.

Cavernomas are clusters of abnormal blood vessels found in the brain and spinal cord. The familiar form is an autosomal dominant disorder associated with the presence of multiple cavernomas in both locations.

A 84-year-old man was admitted in our neurologic department for a sudden onset of difficulty in walking associated with loss of urinary sphincter control. Past history included a major depressive disorder with psychotic features since youth, epilepsy since 33 years old and, at 77 years old, he had a hemorrhagic stroke resulting from cavernous malformation haemorrhage. Medication consisted of clopidogrel 75 mg id, risperidone 3 mg id, venlafaxine 37.5 mg bid and clobazam 10 mg id. On neurological examination, he showed psychomotor slowing, dysexecutive syndrome, paraparesis and hypoesthesia with sensitive level by D10. Blood test was normal. Dorsolumbar spine-TC showed intradural hyperdensity by D12-L1, probably because of a hemorrhage lesion, that MRI revelled to be a cavernoma. Brain-MRI demonstrated 3 massive cavernomas in cortical-subcortical right occipital lobe, left lenticular nucleus and left pre-central gyrus and countless small infratentorial and supratentorial cavernomas. We inquired his family and we found out that one of his daughters also had multiple brain cavernomas, diagnosed after a hemorrhagic stroke when she was 55 years old.

Familiar multiple cavernomatosis is associated with neuropsychiatric disorders. We enhance the impact that such a diffuse form of the disease has on the brain network causing atypical psychocognitive symptoms. In all cases a detailed neuropsychiatric family history should be sought and all should be followed regularly clinically and by MRI.

The authors have not supplied their declaration of competing interest.

Psychosis is one of the most prevalent non-motor complications in Parkinson's disease (PD). Risk factors for PD psychosis are advancing age, longer disease duration, severe motor symptoms, presence of dementia, sleep disorders, depression and autonomic dysfunction. Treatment is challenging in this setting because antipsychotic medications are known to worse motor symptoms.

To highlight the therapeutic difficulties in PD-related psychosis.

Case description and literature review.

We report a case of a 74-year-old woman with a 9-year history of PD, who presented a complex psychotic disorder consisting in auditory, olfactory and visual (gulliverian and lilliputian) hallucinations, persecutory and sexual delusions. Additionally, the patient presented euthymic mood, without evidence of cognitive impairment or impulse-control disorder. These symptoms began after dopamine agonist therapy (ropinirole 4 mg/day). Other medical conditions that could justify these symptoms were excluded. Initially, ropinirole was removed, but without psychotic remission. Then, she was treated with antipsychotic medication (clozapine 25 mg/day) with full psychotic remission and without significant worsening of motor symptoms.

Clozapine treatment is frequently delayed, mainly for fear of its side effects, particularly agranulocytosis. However, this antipsychotic drug presents many benefits regarding the management of PD-related psychosis, namely few motor effects and even improvement of motor fluctuations.

The authors have not supplied their declaration of competing interest.