Hypergraphia is an extensive writing tendency sometimes coupled with hyperreliogiosity and atypical sexuality, completing a syndrome described by Waxman and Geschwind in 1975 during interictal phases of patients with temporal lobe epilepsy. Nevertheless, it may arise from any temporolimbic lesion, usually in the right hemisphere, in contrast to the schizophreniform psychosis more often seen in left-sided lesions.

A review on the lateralizing significance of temporolimbic lesions, highlighting the (un)specificity of hypergraphia, after a case report concerning a patient with both hypergraphia and schizophreniform psychosis.

Analyse patient's clinical records and PubMed review, using hypergraphia, epilepsy and psychosis as keywords.

We report a 74-year-old male admitted due to aggressiveness. The patient had a traumatic brain injury in his 20s with secondary left temporal epilepsy. He lived in a psychiatric asylum, for almost 40 years, with the diagnosis of schizophrenia, showing fluctuant atypical sexual behavior. After being transinstitutionalized to community nursing-home he developed meningoencephalitis, leading to medication change and behavior relapse. He showed viscosity, circumstantiality, soliloquy, euthymic mood and normal cognition. He wrote profusely, e.g. lists of various categories and letters to eminent clerics and politics. His diary was scanned for illustrative purpose.

Hypergraphia is an uncommon but easy to find symptom that deserves the full attention of the clinician, especially in the differential diagnosis between schizophreniform psychosis and temporal epilepsy.

The authors have not supplied their declaration of competing interest.

Schizencephaly is a rare malformation of the central nervous system, a congenital disorder of cerebral cortical development resulting in the formation of abnormal unilateral or bilateral clefts in the cerebral hemispheres that extends from the pial surface to the ventricle. It often manifests with partial seizures, mental retardation and hemiparesis.

To illustrate a rare case of association between psychosis and schizencephaly and the implication of this association for understanding the biology of the psychosis.

A literature search was performed on PubMed database using the key words schizencephaly, psychosis, brain diseases and retrieved papers were selected according to their relevance. The patient clinical record was reviewed.

The authors report a case of a 59-year-old male admitted into a psychiatric hospital with insomnia, disorganized behavior probably secondary to auditory hallucinations and mystic delusions. He also reported epilepsy and strabismus in his right eye since his childhood and right facial paresis. A head CT scan revealed a left deep cortico-ventricular parieto-occipital communication corresponding to schizencephaly.

Considering the theory that schizophrenia is associated with abnormal brain development, this case report may provide an example of a neurodevelopment abnormality that manifests as psychosis.

The authors have not supplied their declaration of competing interest.

People with schizophrenia show changes in the skills related to emotional intelligence, but little is known about the clinical course of these deficits. Few studies have examined the evolution of emotional intelligence in schizophrenia patients.

To increase knowledge about emotional intelligence deficits in schizophrenia and to study its clinical course and factors related, with particular interest in neurocognitive deficits.

To compare emotional intelligence and other clinical and neurocognitive data in patients with schizophrenia in a different moment of evolution.

Twenty-five patients with schizophrenia for up to 5 years of evolution were compared to 24 patients with schizophrenia for more than 5 years of evolution. The assessment protocol consisted of a questionnaire on socio-demographic and clinical-care data, and a battery of assessment scales, including MSCEIT for emotional intelligence.

Both groups show a deterioration of emotional intelligence. Schizophrenia patients over 5 years of evolution have worse performance in emotional intelligence test that schizophrenic lower evolution. In the schizophrenia group of up to 5 years of evolution, none variables correlate with emotional intelligence. In the schizophrenia group of more than 5 years of evolution, there were moderate negative correlations with the severity of symptoms and depressive symptoms, and moderate correlation of positive sign with functionality, but none of the neurocognitive assessment scales.

There are arguments for the existence of a progressive deterioration of emotional intelligence in schizophrenia. This deficit in emotional intelligence in schizophrenia appears to be present from the first years of the disease.

The authors have not supplied their declaration of competing interest.

The severe disability of schizophrenia and its impairment in real-life functioning can improve with a treatment that stimulates personal resources such as peer-support by psychologist according to Cordiale and Montinari psychoanalytic model (2012) in a multidisciplinary team.

Supportive and narcissistic relationships sharing real life experience, according the cohesion of Self (Kohut 1971), promotes identification processes and improves pharmacological and psychiatrist treatment.

Study participants were recruited for one year, according to diagnostic criteria of DSM V, from schizophrenic patients (n = 12) of a Mental Health Department and of a private psychiatric department (DH) in an age between 23 and 36 years, tested by SAT-P and GAF scale.

All patients were treated with second generation antipsychotic and an integrated treatment with peer-support, (Galderisi et al., 2014).

The valiance of real-life functioning in patients with schizophrenia depends on an integrated intervention that assures a function of flexible and not coercive restraint, allowing to stable relationship with territorial agency (network) (Chiesa, 2008).

The authors have not supplied their declaration of competing interest.

The induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.

We report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.

We summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.

The term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.

Our case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.

The authors have not supplied their declaration of competing interest.

Headache is the most common pain reported by people with schizophrenia. Little research has been conducted into the characteristics and management of headaches in this population.

Determine the prevalence, type and management of headache in people with schizophrenia.

Identify if best practice treatment of headache occurs and if changes are required to assure people receive appropriate management.

One hundred consecutive people with schizophrenia and schizoaffective disorder completed an extensive, reliable and valid headache questionnaire. Based on the questionnaire responses two clinicians independently classified each person's headache as either migraine headache (MH), tension type headache (TTH), cervicogenic headache (CGH) or other headache type (OH). Any discrepancies were resolved by consensus agreement.

Twelve-month prevalence of headache (57%) was higher than the general population (46%) with no evidence of relationship between psychiatric clinical characteristics and presence of headache. Prevalence of CGH (5%) and MH (18%) were comparable to the general population. TTH (16%) had a lower prevalence. Nineteen percent of participant's headache was classified as OH type. No participant with MH was prescribed migraine specific medication. Only 1 of the 5 people whose headache was classified as CGH received manual therapy and none had been prescribed exercises. No people with TTH received manual therapy, exercise prescription or postural review.

It is recommended that education is required for patients and mental health workers about headache classification and the appropriate care pathways for different headache types.

The authors have not supplied their declaration of competing interest.

Centro Hospitalar Psiquiátrico de Lisboa (C.H.P.L.), in Lisbon, Portugal, is the biggest psychiatric hospital in Portugal and one of the oldest still working. Along with acute inpatient clinics it has long duration inpatient units with 226 patients.

Characterize and improve the therapeutic approaches in patients committed to the long duration inpatient unit with long hospitalization times and the diagnose of schizophrenia.

During the month of September 2015 all patients, committed before 2000 who fulfilled the diagnosis criteria ICD 10, F20.X (Schizophrenia) were characterized regarding age, gender, time of hospitalization and were evaluated using the Positive and Negative Symptom Scale (PANSS).

From the original sample (n = 226), 31 patients were included in the study. The mean age was 64.4 years (min 50–max 91) and the majority were male (67.7%; n = 21). The mean years of hospitalization were 28.7 years (min 15–max 60). The average total PANSS score was 99.8 (positive symptoms: 25.4; negative symptoms: 29.9; general symptoms: 44.4).

Although in last decades many psychiatric hospitals were closed and community approaches to treatment of the mentally ill were the direction preconized by several international organizations, some patients still “live” in the hospital. Mostly, as we found in our study, have a severe, refractory disease, sometimes with behaviour changes that unable them to be discharged. With the continuous evolution of psychopharmacological drug treatment, this paradigm may change. Meanwhile other therapeutic approaches should be used to improve the disease symptoms.

The authors have not supplied their declaration of competing interest.

Early diagnosis of schizophrenia is often delayed in first-episode psychosis and this could be viewed as an obstacle for a proper therapeutic approach and optimal clinical management.

Our main objective was to identify baseline socio-demographic variables in first-episode psychosis which are associated with an increased likelihood of diagnosing schizophrenia in the second episode of psychosis. As a secondary objective we aimed to assess the diagnostic stability between first and second episode psychosis.

Data belonging to 100 patients that were twice admitted in Timisoara Psychiatric Clinic, between 2010 and 2015, for two distinct and consequent episodes of psychosis, were analyzed. The first admittance had to coincide with first episode psychosis.

Logistic binary regression showed that a younger mean age (OR = 0.90; 95% CI = 0.85–0.95), a more unfavorable professional status (OR = 3.75; 95% CI = 1.10–12.74) and a lesser quality of social support (OR = 3.47; 95% CI = 1.11–10.82) at the onset of the first episode of psychosis were associated with an increased likelihood for a subsequent diagnosis of schizophrenia.

Identifying an initial socio-demographical profile with a high predictive value for a subsequent outcome towards schizophrenia should encourage using this diagnosis starting with the first episode of psychosis.

The authors have not supplied their declaration of competing interest.

Previous studies show association between sexual dysfunction and antipsychotic treatment.

To study the prevalence and clinical correlates of sexual dysfunction in schizophrenic inpatients treated with antipsychotics. To analyze the influence of sexual complaints in treatment adherence.

Retrospective descriptive study of psychiatric inpatients diagnosed of schizophrenia following DSM-IV-TR) criteria and treated in an acute care unit of Psychiatry in an university hospital in a 12-month period. Patients treated with combination of antipsychotics (typical and atypical) were excluded from the analysis (n = 60). Sexual side effects were evaluated with Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and evaluated in two treatment groups: conventional antipsychotics, and atypical antipsychotics. Patients were asked about subjective experience with other treatments.

The mean age of subjects was 32.4 (SD = 8.7). From the whole sample 38 (63.3%) were men and 22 (36.7%) women. Sexual dysfunction related to treatment was present in 78% of patients. Men were more affected than women and 69% of them related that sexual dysfunction had influenced the decision of treatment withdrawal previous to income. Amenorrhea was more common on risperidone and amisulpride. Analysis of different antipsychotics and its relationship with sexual dysfunction are presented.

Sexual dysfunction is a frequent side effect associated with antipsychotics in schizophrenic patients. The sexual side effects may reduce the quality of life and may increase non-compliance that is usually associated to readmissions and worse prognosis of severe mental illness.

The authors have not supplied their declaration of competing interest.

Duration of untreated illness (DUI) has been considered as a relevant variable used to measure the degree of disabilities that are associated with psychotic disorders. In this paper we describe a cluster of patients with a DUI superior to 1 year according to their symptoms and sociofamiliar functioning.

We compare a group with a DUI superior to 1 year (n = 7) against a group with a DUI inferior to 1 year (n = 17).

The group with a DUI superior to 1 year showed an average age of 4 years younger (21) as the duration of untreated psychosis (DUP) of 1 to 3 months in the 80% of cases and higher percentage of unemployed or without occupation. The 60% were derived from primary care, compared to the 17% of the other group. Although the consumption of toxic substances was similar in both groups, no toxic psychosis were found in comparison with the 35% present in the group with a DUI inferior to 1 year. PANSS’ profile scored more positive and less negative symptoms. Both have similar general psychopathology. There were group differences in the Social Functioning Scale (SFS) with lower scores in the superior to 1 year DUI, in the following scales: Prosocial, Autonomy, Execution and Employment. The Global Assessment of Functioning (GAF) gives an average of almost 8 points higher.

While the SFS shows significant differences in several areas of social functioning, both PANSS’ profile and the family questionnaire do not support greater deterioration, as evidenced in the GAF's average score.

The authors have not supplied their declaration of competing interest.

Psychogenic polydipsia has an estimated prevalence of 6–20% in psychiatric population. Although first described in the 1930s, there are few studies addressing this problem and its management. The high water intake can lead to severe hyponatremia with a mortality rate high enough to merit clinical concern.

Report a case of a schizophrenic patient with psychogenic polydipsia and hyponatremia.

Retrospective review of the clinical file and literature research on this topic.

A 41-year-old man with a long-term schizophrenia presented to the emergency room (ER) with exacerbation of psychotic symptoms. In the prior 24 months, he had stopped medication and began excessive water intake (5 to 10 L/day). He presented with auditory hallucinations, passivity phenomena and persecutory and other delusional thoughts that justified this behavior – “The water will end; I have to stock it, like camels do”. Presently he had an asymptomatic hyponatremia (128 mg/dL), but 6 months before he had been admitted in the ER with vomiting, altered state of consciousness and convulsions secondary to severe hyponatremia (108 mg/dL). During the present hospitalization, organic causes of hyponatremia were excluded and he was started on behavioral measures and antipsychotics. The psychotic symptoms improved and there was no need for water restriction after the first week, with restored natremia values on discharge.

With this case report we intended to raise awareness on this potentially fatal condition that despite its prevalence has no defined diagnostic criteria, nor established controlled trials concerning the effectiveness of treatments.

The authors have not supplied their declaration of competing interest.

Schizophrenic patients show deficits in social cognition, functioning and in interpreting facial expressions. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian Network of Research on Psychosis headed by Prof. Maj and Prof. Galderisi (Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 2014:275–87. Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community. Schizophr Res 2014;159(1):144-50); collection in our centre went on also after the conclusion of the national project.

To identify the correlations among social inference, facial emotion identification and clinical history and therapies in schizophrenic patients.

We recruited patients with Schizophrenia referring to our Psychiatry Ward, AOU Maggiore della Carità, Novara, Italy. Socio-demographic characteristics were gathered; assessment of patients included The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test (FEIT), the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS).

Data collection is still ongoing. In a previous study we pointed out that schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. These features underlie poor and limited social relationships proper to schizophrenia. Our preliminary results revealed thatidentification of facial emotions is influenced by psychopathological symptoms especially by avolition, blunted affect and alogia. Implication will be discussed.

The authors have not supplied their declaration of competing interest.

It is becoming well established that CBT is both effective and cost efficient in the treatment of positive and negative symptoms of schizophrenia. However, there is a need to adapt CBT to the cultural, linguistic, and socioeconomic context of diverse cultural groups. We aimed to establish the feasibility of culturally adaptive cognitive behavior therapy for treatment of psychosis in a low-income country.

This is a rater-blind, randomized, controlled trial of the use of CBT in patients with psychosis from a low-income country. Patients with a DSM-IV diagnosis of schizophreniform disorder were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. Participants were randomized into the intervention group (n = 18) and TAU group (n = 18). The intervention group received 12 weekly sessions of culturally adapted CBT for psychosis (CaCBTp).

There were no significant differences between the two groups at baseline. At three months follow-up, there was a statistically significant improvement in the CaCBTp group on PANSS general Psychopathology subscale, PANSS overall score and Insight scale, as compared to the TAU group. The CaCBTp group had lower scores on PANSS positive, PANSS negative sub-scales, and the two subscales of Psychotic Symptom Rating Scale, but differences were not statistically significant.

Culturally adapted CBT added to pharmacological treatment as usual was acceptable to patients and was helpful in reduction of severity of psychotic symptoms. Adjunctive culturally adapted CBT should be further investigated in this population.

The authors have not supplied their declaration of competing interest.

Patients with schizophrenia requiring long-term institutionalization represent cases with poor outcome, often leading to high costs for patients and family and constituting a huge economical burden for society if patients are young.

The aims were the evaluation of patient hospitalized for long period in a psychiatric hospital for chronic patients.

The objectives of the study were identification of characteristics and predictors of institutionalization in schizophrenia.

Retrospective study of all institutionalized patients with schizophrenia in Brasov County, Romania, with a DSM-IV-TR lifetime diagnosis of schizophrenia institutionalized between 1995 and 2014.

Institutionalized patients between 2005 and 2014 (n = 172) had lower age (51.15 vs. 57.08, P < 0.05) and lower age at institutionalization compared with patients admitted between 1995 and 2004. Lower education level (8.23 vs. 13.22, P < 0.05), only one parent, multiple antipsychotics treatments and suboptimal response under first generation long acting antipsychotics are predictors for institutionalization. Haloperidol is the main treatment option (42.54%) followed by olanzapine 17.1% and clozapine 10.24%.

Our study showed a tendency to institutionalize patients with schizophrenia at the younger age compared with past decades. Early intervention in psychosis, controlled treatment with SGAs should be solutions to avoid institutionalization of young patients with schizophrenia.

The authors have not supplied their declaration of competing interest.

Antipsychotic-induced hyperprolactinemia (> 29 ng/ml in women) is associated with relevant side-effects.

We describe the case of two women aged 50 and 54 years, respectively, diagnosed with schizophrenia who were receiving outpatient treatment with paliperidone depot 100 mg/month and risperidone depot 50 mg/2 weeks, respectively and complained of oligoamenorrhoea and amenorrhoea for at least 6 months.

Routine blood tests showed hyperprolactinemia of 203.5 ng/ml and 306.2 ng/ml, respectively. The patients were evaluated by the Endocrinology unit and an MRI was performed discarding the presence of any primary brain condition. Both patients were switched to LAI aripiprazole due to its partial agonism of D2-brain receptors. At the time of switching both patients were stable in terms of psychopathology.

Changes in prolactin levels 3 months after switching are shown in the Fig. 1. Two months after switching, both patients regained cyclic menstrual function. After 6 months, they still showed psycopathological stability.

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In these two cases, the normalization of prolactin levels and the resolution of oligoamenorrhoea/amenorrhoea were observed as soon as 2–3 months after switching to LAI aripiprazole. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia.

The authors have not supplied their declaration of competing interest.

The Capgras syndrome is a rarely observed condition in patients with different psychiatric diseases, which is characterized with delusional misidentification of people, places, objects, etc.

In this case report we aim to describe the clinical characteristics and manifestation of Capgras syndrome in a female patient with schizophrenia, perform a literature search on the topic and compare our report to literature findings.

A 50-year-old female patient was verbally and physically aggressive to her family members upon admission to our center. The onset of disease was marked 2 years ago when she first started feeling deserted and isolated and had a prescribed therapy for her condition which she did not follow. During the current admission a psychiatric assessment was performed. Delusional misidentification of her family members was observed and consequent food and sleep self-deprivation due to psychosis was noted. The patient denied being suicidal but was intense and psychotic, and reported different objects to have started disappearing mysteriously from her home. The patient was diagnosed with schizophrenia and was treated with haloperidol, olanzapine, chlorpromazine, and biperiden. The patient was discharged in an improved condition, without episodes of obsessive delusions and improved communication with her relatives.

Although according to the literature organic substrate may be found in some patients with Capgras syndrome, in the case presented here it is the dominant psychotic theme, which determined the content of the disease.

The authors have not supplied their declaration of competing interest.

This session explores Human Sacrifice killings in extreme abuse cult settings disclosure of which often leads to a misdiagnosis of ‘Schizophrenia’.

The purpose of the paper is to raise awareness and signpost professional development resources regarding extreme abuse ‘Death Cults’ that operate largely with impunity across the world.

Case study materials and documentary evidence will be utilised to illustrate criminal practices and the impact on survivors.

Accounts of extreme abuse and ritual violence were identified in the context of an adult survivor assessment intervention.

There are supporters of abuse survivors who bore witness to and believe disclosures of extreme abuse and ritual violence, and ‘False Memory’ adherents who consider Ritual Abuse an unfounded ‘moral panic’. Survivors provide chilling accounts of ritual killings in Scott (2001), Becker, Karriker, Overkamp and Rutz (2008) and Epstein, Schwartz and Schwartz (2011). In the wake of institutional abuse enquiries and the ‘unbelievable’ child abuse perpetrated by celebrities like Jimmy Saville and Ian Watkins, a ‘new reality’ is setting in that child abuse is pervasive and knows no limits. Reports of elaborate rituals with ‘mock’ human sacrifices at the highly secretive annual ‘Bohemian Grove’ summer festival point towards a pervasive interest in the occult in high society.

Mental health professionals have a ‘duty of care’ towards their service users. Unless clear and irrefutable counter-evidence is available it is inappropriate to claim that disclosures of extreme abuse and/or human sacrifice rituals are ‘delusions’ and indicative of Schizophrenia.

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

There is a robust association between positive symptoms of schizophrenia and smoking. This relationship extends to psychometric risk for schizophrenia (schizotypy). We sought to determine whether smoking in schizotypy is best understood in terms of self-medicating or risk-taking behaviour. The self-medication perspective holds that individuals with schizophrenia smoke to relieve stress. By smoking, cortisol levels increase, stimulating negative feedback circuits that reduce the hypothalamic-pituitary-adrenal (HPA) axis stress response. Increased HPA activation also stimulates dopamine release, promoting the expression of positive schizotypal experiences. In contrast, the risk-taking perspective holds that elevated dopamine promotes risk-taking behaviour, including substance misuse, by reducing reward sensitivity and increasing sensation-seeking.

Undergraduates (n = 230) reported current and past nicotine use and completed the Schizotypal Personality Questionnaire and a self-report measure of stress sensitivity.

Consistent with risk-taking, positive features of schizotypy predicted having ever smoked (OR = 1.02, P < 0.05) but did not distinguish current smoking from non-smoking (OR = 0.99). The self-medication hypothesis was examined in two ways. When smoking status was regressed onto positive schizotypy and stress, stress was found to predict current smoking (OR = 1.08, P < 0.05) but not having ever smoked (OR = 1.09). Secondly, stress and current smoking interacted to predict positive schizotypy (ß = 0.31, P < 0.05).

Risk-taking and self-medicating each contributed to the relation between smoking and schizotypy, but in different ways. Risk-taking seems to contribute to having ever smoked whereas current smoking seems to reflect self-medicating behaviour.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Psychogenic Polydipsia is defined as the desire to drink liquid in big quantities with an inappropriate activation of the mechanisms of thirst without loss of liquid for urine. This disorder is frequent enough and can derive in a water poisoning, a clinical presentation of high mortality.

Review of the Psychogenic Polydipsia in patients with schizophrenia and theoretical discussion of a case report.

A case report of a 58-year-old male, admitted in hospital with a clinical presentation of hyponatremia with severe low serum osmolarity secondary to Psychogenic Polydipsia. As psychiatric history he has a diagnosis of Paranoid Schizophrenia for forty years in treatment with Paliperidone 6 mg: 1-0-0, Haloperidol 10 mg: 0-0-0.5, Quetiapina 300 mg: 0-0-1, Trazodona 100 mg: 0-0-1, Ketazolam 30 mg: 0-0-1, Diazepam 10 mg: 0-0-1.

Psychogenic Polydipsia is not included in any section of current psychiatric classifications as specific diagnosis. There are several psychiatric disorders that may present with psychogenic polydipsia; however, the most common cause appears to be schizophrenia.

Mechanisms of hyponatremia in patients with schizophrenia are not well clarified; nevertheless, dopamine seems to be the common link between psychogenic polydipsia and schizophrenia.

The authors have not supplied their declaration of competing interest.