The concept of paraphrenia was first introduced by Kraeplin and has since been a controversial issue. However, a group of patients still represent a diagnostic problem and many remind us of the initial description of Paraphrenia: “The uncertain group between paranoia and dementia preacox”.

Revisit paraphrenia and to transpose it to modern times.

Clinical report and literature review.

“M”., a 68 yo women with no psychiatric history was admitted in with depressive humor, anhedonia, asthenia and structured delusional ideas of guilt and persecution and auditory hallucinations. Antidepressant therapy improved the mood, but with worsening of the psychotic symptoms. With further exploration it was was clear that the mood disorder was secondary to the psychotic symptoms that arose in insidiously. The family described her as very reserved and suspicious and notice that she abandoned many of her daily tasks. MMSE was 26 points and the laboratory results and the Cranial Computed Tomography were normal. There was little response to antipsychotics and the patient is undergoing electroconvulsive therapy with positive results.

Initially thought to be a depressive episode, the psychotic symptoms were the primary manifestation. Although the insidious installation, structured delusional ideas and the preservation of the affects pointed to a delusional disorder, the presence of auditory hallucinations and gradual loss of functionality are characteristic of schizophrenia. Some authors rejected the classic definition of Paraphrenia, but accepted that schizophrenia in the elderly could assume a paraphrenic form. In this case, the clinical picture and evolution are close to the classical description of the disorder.

No significant relationships.

Shared psychotic disorder or Folie a deux is an unusual mental disorder characterized by the transfer of delusions between two or more people who have a close relationship. An individual (inductor or primary) who suffers from a psychotic disorder, influences one or more individuals (induced or secondary). Delusional disorders or schizophrenia are the most commonly diagnosed disorders in the inductor individual.

The objective of this study is to describe the clinical characteristics of an unusual entity such as shared psychotic disorder.

Description of a clinical case of shared psychotic disorder of a family treated in the emergency room during confinement.

47-year-old woman, goes to the emergency room with her husband. No psychiatric history. Both the patient and her husband verbalize delusions of harm and surveillance from neighbors. They also report that two of their children hold this belief. The mother, unlike the rest of the cohabitants, presents disqualifying auditory hallucinations. Her husband decides to take her to the emergency room because he finds her distressed, “between two realities” and aggressive when she is confronted about hallucinations. We start treatment with oral paliperidone in the mother and a subsequent follow- up, and a total remission of symptoms in all cohabitants.

As in other mental disorders, the correct diagnosis and subsequent referral are essential. The separation of the inductor individual from the induced one is useful for the correct management of this disorder. With timely intervention and a regular follow-up, the Folie a deux has a good prognosis.

No significant relationships.

Pisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.

Regarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.

Description of a clinical case by consulting databases of current and scientifically relevant articles.

The clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.

Pisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.

No significant relationships.

“Cotard syndrome” is a rare condition characterized by a constellation of clinical features, including hypochondriac and nihilistic delusions, the most characteristic of which are the ideas that one is dead or that their organs do not exist. It is more commonly associated with psychotic depression and schizophrenia but can also be found in several neurological disorders. In the clinical practice it generally appears as an “incomplete Cotard”, reduced to hypochondriac delusions attributed to the malfunction or occlusion of the organs, usually the digestive tract and abdominal viscera. Consequently it is common for these patients to reject food or medications. In literature it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II.

Literature review on Cotard Syndrome and its link with Multiple Sclerosis, based on a clinical case.

Pubmed and Google Scholar search using the keywords Cotard Syndrome, Multiple Sclerosis.

Hereby we present a clinical case of a 53-year-old female patient, with multiple sclerosis, who presented with hypochondriac and nihilistic delusions and refusal of food and medication. The patient was treated with olanzapine with rapid remission of delusional activity.

Multiple sclerosis is an immunemediated chronic disease, affecting predominantly the sensory and motor function. In addition, psychiatric comorbidity is very frequent with up to 50 % lifetime risk of depression. While various neurological disorders have been described in association with Cotard syndrome, its link with multiple sclerosis has been scarcely reported.

No significant relationships.

Cerebral abscesses are rare, occurring in approximately 0.3–1 per 100 000 patients. Mortality rate still remains as high as 22%. Very few cases of acute psychotic episodes associated with brain abscess have been reported.

To present a case report of a patient with schizofrenia associated with multiple brain abscesses, focusing on clinical features and managing challenges.

Presentation of a clinical case supported by a non-systematic review of literature containing the key-words “brain abscess”, “psychosis” and “schizophrenia”

This is a case report of a male 44-year-old patient with a known history of schizophrenia since the age of 18 and with multiple brain abscesses diagnosed 2 month ago. He was admitted to our inpatient service after discontinuation of her medication resulting in an acute psychotic episode. Antibiotic therapy with rifampicine, metronidazole, trimethoprim and sulfamethoxazole was started. Also, administration of clozapine was initiated (up to 400mg/day) with partial improvement, so aripiprazole was added (up to 45 mg/day), with insufficient response. We suspected of a drug interaction between rifampicine (known potent broad inducer of drug-metabolizing enzymes) and antipsychotic medication, so we decided to change aripiprazole to amisulpride 1200 mg/day, which CYP-catalyzed metabolism appears to be minor. A significant improvement in positive symptoms and mood was observed. The patient has since had no delusions or hallucinations and is living independently at home.

This clinical case highlights the possible association between brain abscesses and relapses in schizophrenia. It is of utmost importance to be aware for possible drug interactions between antibiotic therapy and antipsychotic medication.

No significant relationships.

Schizophrenia is a chronic disease that significantly impacts cognitive functioning. Sex differences in incidence, onset and course of schizophrenia suggest estrogens have a protective role.

Our aim is to review the state of the art on this matter.

Through a selection of the most relevant articles found on PubMed and ClinicalKey searching the keywords: “estrogens” and “schizophrenia”.

Accumulating evidence has led to the hypothesis that estrogens act as a protective factor in women regarding the onset of schizophrenia as their increase in puberty may help delay the onset of symptoms. Also, the estrogens abrupt decline in menopause may account for a second peak of onset and greater severity of the symptoms. During the menstrual cycle, when serum estrogens are at their lowest, there is an increase in the number of psychotic episodes and an exacerbation of psychotic symptoms. Pregnancy leads to an improvement of psychotic symptoms, which then worsen in postpartum. Clinical trials testing the efficacy of estrogens have been promising, which suggest they might be a useful adjuvant treatment. Despite the evidence of clinical efficacy, health risks for women using estrogen therapy should be considered, as they decrease its acceptability as a viable treatment option. The use of selective estrogen receptor modulators (SERMs), as raloxifene, could be a favorable and safer alternative.

In conclusion, estrogens are proving to be a promising option as a complementary therapy for schizophrenia; however, further studies are needed to investigate whether they might be overall beneficial.

No significant relationships.

Several studies have mentioned the link between psychotrauma and psychosis. A direct causal link remains to be discussed.

Evaluate the link between sexual abuse and psychosis.

We report the case of a male patient who developed schizophrenia following sodomy rape. We performed a literature review based on a PubMed search with the following keywords: “rape sodomy psychosis”.

Mr. M., 26 years old, with a personal psychiatric history of chronic psychosis evolving for 10 years, consulted us for follow-up of his schizophrenia. When he was 16, the patient was raped by sodomy by a 40-year-old man under stabbing threat. After this incident, the patient did not verbalize this trauma, he isolated himself, became irritable and aggressive and has had olfactory hallucinations. The symptomatology worsened until the age of 24 when the patient presented a delusional syndrome with a theme of persecution, mysticism, bewitchment by a mechanism of interpretation and visual hallucinations. Then,he was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggression. He had been diagnosed with schizophrenia evolving over 9 years. Treatment with an antipsychotic: risperidone and valproic acid was started. The evolution was quickly favorable but the patient currently presents blunted affect, a sexual disinterest and a strong desire for revenge from his rapist. Treatment adjustment and psychotherapy would be considered.

The onset of subsequent rape psychosis and the persistence of symptoms related to the trauma are arguments in favor of a direct causal link between sexual abuse and schizophrenia.

No significant relationships.

The ICD-10 acute and transient psychotic disorders (ATPD, F23) without symptoms of schizophrenia are considered predominantly reactive psychotic disorders or affective pathology. However, negative symptoms of schizophrenia may be revealed in some of these cases after the psychotic reduction.

To investigate the association between the developmental characteristics of psychosis and the negative symptoms detection after the psychotic reduction of ATPD without symptoms of schizophrenia.

68 adult inpatients with ATPD without symptoms of schizophrenia (F23.0) were examined. Negative symptoms were assessed with the PANSS negative symptom subscale (PANSS-NSS). The sample was divided into two groups: with PANSS-NSS score>14 (n=12) and with PANSS-NSS score≤14 (n=56), respectively. Clinical-psychopathological, psychometric and statistical methods were applied.

The results of the study are presented in Table 1.

*p<0,001

The probability of negative symptoms detection in ATPD without symptoms of schizophrenia is relatively strongly associated with the family history of schizophrenia, poor premorbid social adaptation and functional decline prior to the psychotic onset.

No significant relationships.

Genome-wide association studies (GWAS) have successfully revealed genetic risk variants for schizophrenia (SCZ). However, the vast majority of GWAS largely comprise European samples. As a result, the derived polygenic risk scores (PRS) show decreased predictive power when applied to non-European populations.

A long-term scientific cooperation between the Charité Universitätsmedizin Berlin and the Hanoi Medical University aims to address this limitation by recruiting a large genetic cohort of comprehensively phenotyped schizophrenia patients and controls in Vietnam.

A pilot study was conducted at the Department of Psychiatry of the Medical University Hanoi in 2017. Data collection encompassed i) genome-wide SNP genotyping of 200 schizophrenia patients and 200 control subjects ii) structured interviews to assess symptom severity (PANSS), iii) clinical parameters (e.g. duration of illness, medication) and demography.

SCZ-PRS of the pilot sample (N=400) were generated using different training data sets: i) European, ii) East-Asian and iii) mixed GWAS summary statistics from the Psychiatric Genomics Consortium’s latest discovery sample. Most variance explained was observed using a mixed discovery sample (R2liability=0.053, p=3.11*10-8, Pd <0.5), followed by PRS based on the East-Asian summary statistics (R2liability=0.0503, p=6.78*10-8, Pd <1) and the European sample (R2liability=0.0363, p = 4.26*10-6, Pd <0.01).

With this pilot project we established an efficient recruitment, genotyping and data analysis pipeline. Our results corroborate previous findings indicating that transferability of PRS across populations depends on the ancestral composition of the initial discovery dataset. We therefore aim to expand data collection efforts in the future in order to improve risk prediction across diverse populations.

No significant relationships.

The suspiciousness of a paranoid patient could reach extremes.

To present the lessons learned after an interview with a similar patient.

Case report.

Fifty-two year old woman suffering from paranoid schizophrenia (F20.0). Symptoms almost identical to her previous (two) hospitalizations: delusions of thought reading and of being surveilled by electronic equipment in her house/neighborhood. This time, though, she was additionally convinced of being the object of medical experiments and of being electronically surveilled even within the ward. Treatment: risperidone 12mg/day, lorazepam 3.75mg/day, biperiden 2mg/day. Three weeks after admission, the author noted a slight tremor in her hands (most certainly of extrapyramidal origin). I asked her to place both hands in front of her, fingers wide open, to assess it better. The patient followed with the fingers attached, though. Consequently, I approached my hands to hers -to show how it should be done correctly-, touching them lightly. Then, a spark was generated between our hands. Evidently, it was an electrostatic discharge (I was wearing a wool sweater that day; static electricity could easily accumulate on wool). She became outraged: “what kind of experiments are you doing to me?”, “what electronic devices are you using?”, “this is the proof of what I have been constantly saying”.

The symptoms of psychotic relapses could evolve over time. A clinician should refrain from any strictly unnecessary physical contact with an exceedingly paranoid patient, particularly when the latter claims that is the object of “medical experiments”. The elaborative “ability” of such patients could be, simply, astounding.

No significant relationships.

Of those with schizophrenia, one third develop treatment-resistant illness. Nearly 60% of these benefit from clozapine- the only antipsychotic medication licensed in this group.

As treatment-resistant illness developed in the follow-up of a first-episode psychosis (FEP) cohort, clozapine was prescribed. This study retrospectively compared the clozapine prescribing patterns, within this cohort, to National Institute for Health and Care Excellence (NICE) guidelines. In addition, impact on hospitalisation, physical health monitoring and augmentation strategies employed following clozapine initiation were examined. Factors delaying initiation of clozapine treatment or contributing to its discontinuation were also explored.

The study included 339 individuals resident within an Irish community mental health team catchment area, referred with FEP from 1 January 2005 to 31 August 2016. Data were extracted from electronic medical records.

Within the cohort, clozapine was prescribed to 32 individuals (9.4%). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1–5). The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17–6.25). Following initiation of clozapine, mean hospital admissions per year fell from 2.3 to 0.3 (p=0.00). Mean inpatient days pre- and post-clozapine also decreased (147 vs. 53; p=0.00). In all, 18 patients ceased use of clozapine, 5 temporarily and 13 permanently.

Patients are being prescribed clozapine earlier than previously demonstrated. However, delayed treatment remains common, and many patients discontinue clozapine. Further research is necessary to describe and address factors which contribute to its discontinuation.

No significant relationships.

Dynamic assessment of remission achievement after first-episode psychosis (FEP) is necessary for early detection of post-psychotic depression, negative symptoms and changes in personality traits. The latter allows to decrease suicide risk and optimize treatment and social rehabilitation.

We aimed to analyze achievement of remission after FEP in youth and to define prognostic criteria for psychosis outcome.

Fifty-six patients (16-25 y.o., mean age 19,8 ±2,5 y.o.) after FEP have been receiving follow-up outpatient visits for 3 years. PANSS was applied to assess psychotic symptoms. Depressive symptoms were assessed with HAMD-21.

Remission achievement after FEP is a three-stage process. The stage of reduction and modification of psychotic symptoms is characterized by diminishing personality deterioration and decrease of leading positive symptoms. The second stage, stabilization, is defined through the presence of depressive symptoms with positive (HAMD-21 17,49 ± 7,49) and negative affectivity (HAMD-21 23,68 ± 9,24) with preponderance of emotional, volitional, and cognitive deficits as well as high suicide risk. The third stage, reintegration, is characterized by the combination of negative symptoms with preserved personality resources. There are three reintegration trajectories, with predominant affective or negative symptoms or personality deficits. Mean decrease of PANSS scores was 54,88 ± 6,17 during the overall remission. In the majority of cases (62,5%) the stage of reintegration was finished with the achievement of high-quality remission, coinciding with international remission criteria. The study was supported by RFBR grant 18-013-01214

Our approach to remission assessment allowed us to decrease suicide risk and to provide optimal treatment.

No significant relationships.

Religious delusions is a complex psychopathological phenomenon. The delusional disorders with religious content in young age, the need for an additional detailed study of the conditions of their formation, patterns of the course and outcome of the disease determine the relevance of this study.

To identify the psychopathological features, the conditions of formation, the characteristics of the course of psychosis with religious delusions in young age.

95 patients (62 male and 33 female) with religious delusions (delusion of sin - 33,7%, delusion of demonic possession (40,0%), messianic and antagonistic delusion - 18,9%, oneiroid with religious content – 7,4 %) in psychotic episode (F20, F25 according to the ICD-10) at a young age (16-25 years) were included in the study and examined with clinical-psychopathological, clinical-follow-up and psychometric (PSP, SANS) methods. The average duration of follow-up was 7.4 ± 2.3 years.

In a post-psychotic period it is possible to preserve or form religiosity, as well as a complete reduction of the religious worldview in patients who had been indifferent to religious issues before the first episode of the disease. Though, the formation of residual psychotic symptoms with religious content were noted with greater frequency. The delusions of demon obsession in a psychosis episode is unfavorable prognostic factor.

General psychopathological features of psychotic states with religious delusions, according to the specificity of young age, were identified. A role of the previous religiosity, including overvalued religious ideas, was clarified.

No significant relationships.

The notion of subclinical psychosis is as old as Eugen Bleuler’s work on schizophrenia. It is also consistent with psychodynamic theories (see PDM-2) on the organization of personality on different levels including, among others, a psychotic level of personality organization. Research on the continuum of psychosis has offered substantial support to the view that psychotic phenotypes are significantly more prevalent than clinical psychosis.

This may imply that being “psychotic” is not necessarily being ill. This assumption raises important theoretical and clinical questions: what causes psychosis to manifest itself clinically and, conversely, what possibly prevents it from doing so?

At the same time, it potentially frees psychiatry from certain diagnostic and therapeutic impasses. It allows for a shift of emphasis from misguiding classifications and often frustrating “evidence-based” therapeutic attempts to a more personalized approach.

Diagnosis may thus rely on psychoanalytical “markers” or “indicators” regarding the subject (e.g. deficits in the symbolic register, dysregulated rapport with one’s body, problematic inscription in social relations etc.) at least as much as on symptomic phenomenology. Therapy may also take advantage of and deploy the unique coping strategies employed by the psychotic individual.

The diagnostic and therapeutic insights offered by Lacanian psychoanalysis create the possibility of a fruitful theoretical, diagnostic and therapeutic approach for clinical and subclinical psychotic conditions; indicate that psychoanalysis is indispensable for clinical psychiatry; and signal the possibility of a time-honored alternative to the in-vogue neurocognitive paradigm of “personalized” psychiatry.

No significant relationships.

Schizophrenia is one of the most disabling diseases affecting the patient’s ability to live independently, to be socially active and to work or study1,2. Therefore, identifying predictors of functioning in the first stages of the disease is important to prevent a negative progression of functional outcome in these patients3.

To identify the factors associated with real-world functioning in patients with recent onset of the disease.

Secondary analysis of a cross-sectional, naturalistic study. 84 patients with Schizophrenia (F20), aged 18-71 in their first five years of the disorder under maintenance treatment. Assessments: PANSS, CDS, CGI-S, CAINS; functioning: PSP, cognition: MATRICS. Statistical analysis: student-t test, ANOVA, Pearson correlation and lineal regression.

Mean age (SD): 31.30 (10.08); men: 62.8%. Statistical significant differences (p<0.05) were found in work status, benzodiazepines and antidepressants use. Furthermore, significant correlations (p<0.05) were found with depressive, positive and negative symptoms (avolition, anhedonia, alogia and affective flattening) and cognition. A significant predictive model was obtained that explains the 72.1% of the variance [F(5,74)= 20.952; p< 0.001]. This model included depressive symptoms (B= -0.940; p= 0.001), negative symptoms (B= -1.696; p< 0.001), avolition and anhedonia (B= -0.643; p= 0.001), affective flattening and alogia (B= 1.197; p= 0.003), and visual learning (B= 0.202 p= 0.039).

Negative and depressive symptoms are the main determinants of real-world functioning in patients with recent onset of schizophrenia. Visual learning also contributes to this outcome. On the other hand, the positive relationship between expressive domain and functioning needs furthermore investigation.

No significant relationships.

Psychosis it is a serious medical condition that could happen to anyone while travelling, even without a prior history of mental illness. Some psychotic episodes during travel likely are brief psychotic disorders. This is a poorly understood subject that seems to have an increasing incidence.

This work aims to present a clinical case of a patient who developed psychotic symptoms on her visit to China, and to provide a brief update review of this subject.

We describe a case based on patient’s history and clinical data. We also searched and reviewed cases on “travel” AND “psychosis” and “tourist” AND “psychosis” using PubMed® database.

We report the case of a 41-year-old woman without psychiatric antecedents or substance use who developed psychotic symptoms during a travel to China. Symptoms resolved completely soon after returning to Portugal and admission to the psychiatric emergency service where an antipsychotic treatment was initiated. Psychosis in tourists typically occur in destinations with strong symbolic or mystical connotations and in individuals who travel alone for several days. The most common symptoms are hallucinations, delusions, ideas of reference and agitation. Most patients improved and returned to previous functioning.

To improve the knowledge of travel-related psychosis it is important to identify the cases and the associated biological and clinical factors, later on it may be possible to identify the predictive factors of these psychosis. Further research are necessary to establish a possible association between brief psychotic episode and travel to China, as reports for tourists to Jerusalem and to Florence.

No significant relationships.

The therapeutic effectiveness of mindfulness-based interventions (MBIs) has been shown for various mental disorders. However, for schizophrenia spectrum disorders (SSD), only a few trials have been conducted, mostly in outpatient settings.

This study aimed to investigate feasibility, acceptability, and preliminary effectiveness of a four-week mindfulness-based group therapy (MBGT) for in-patients with SSD.

A pre-registered randomized controlled trial (RCT) was conducted at the in-patient ward for SSD. All measures were employed at baseline, post-intervention (4-weeks), and follow-up (12-weeks). The primary outcome was ‘mindfulness’. Secondary outcomes were rater-blinded positive- and negative symptoms, depression, social functioning, as well as self-rated mindfulness, depression, anxiety, psychological flexibility, quality of life, and medication regime.

N=40 participants were randomized into either four-week treatment-as-usual (TAU; n=19) or MBGT+TAU (n = 21). Protocol adherence was 95.2%, and the retention rate to treatments was 95%. ANCOVA analysis revealed significant improvements in the MBGT+TAU compared to TAU for the primary outcome and negative symptoms. Exploratory analyses showed medium-to-large intervention effects on secondary outcomes mindfulness, positive, negative, and depressive symptoms, psychological flexibility, quality of life, and social functioning for MBGT+TAU and small-to-moderate changes on positive symptoms and social functioning for TAU. No serious adverse effects were reported.

This study supports the feasibility and acceptability of MBGT for in-patients with SSD, including high protocol adherence and retention rates. A proof of concept of the MBIs and corresponding improvements on various clinical and process parameters warrant a fully powered RCT to determine effectiveness, cost-efficiency, and longitudinal outcomes of MBGT for SSD.

No significant relationships.

Worse sleep quality and increased inflammatory markers in women with schizophrenia (Sch) have been reported (Lee et al. 2019). However, the physiological mechanisms underlying the interplay between sleep and the inflammatory pathways are not yet well understood (Fang et al. 2016).

Analyze the relationship between Neutrophil/Lymphocyte (NLR), Monocyte/Lymphocyte (MLR) and Platelet/Lymphocyte (PLR) ratios, and insomnia in Sch stratified by sex.

Final sample included 176 Sch patients (ICD-10 criteria) [mean age: 38.9±13.39; males: 111(63.1%)]. Assessment: PANSS, Calgary Depression Scale (CDSS), and Oviedo Sleep Questionnaire (OSQ) to identify a comorbid diagnosis of insomnia based on ICD-10. Fasting counting blood cell were performed to calculate ratios. Statistics: U Mann-Whitney, logistic regression.

Insomnia as comorbid diagnosis was present in 22 Sch (12.5%) with no differences between sex [14 males (12.6%), 8 females (12.3%)], neither in their age. Female patients with insomnia showed increased NLR [2.44±0.69 vs. 1.88±0.80, U=122.00 (p=0.034)]. However, no differences in PLR and MLR were found, neither in any ratio in males. Regression models using insomnia as dependent variable and covariates (age, PANSS-positive, PANSS-negative, CDSS) were estimated. Females: presence of insomnia was associated with NLR [OR=3.564 (p=0.032)], PANSS-positive [OR=1.263 (p=0.013)] and CDSS [OR=1.198 (p=0.092)]. Males: only PANSS-positive [OR=1.123 (p=0.027)] and CDSS scores [OR=1.220 (p=0.005)] were associated with insomnia.

NLR represent an inflammatory marker of insomnia in Sch but only in female patients. Improving sleep quality in these patients could help to decrease their inflammatory response.

No significant relationships.

Of the many studies describing psychotic symptoms in schizophrenia, few have investigated their direct influence on prognosis.

We aimed to apply natural language-processing (NLP) algorithms in routine healthcare records to identify reported somatic passivity and thought interference symptoms (thought broadcasting, insertion and withdrawal), and determine associations with prognosis by an analysis of routine outcomes.

Four algorithms were thus developed on de-identified mental healthcare data from a large south London provider and were applied to ascertain recorded symptoms over the three months following first presentation to that service in a cohort of patients with a primary schizophreniform disorder (ICD-10 F20-F29) diagnosis. The primary binary dependent variable for logistic regression analyses was any negative outcome (Mental Health Act section, >2 antipsychotics prescribed, >22 days spent in crisis care) over the subsequent 2 years, adjusted for age, gender, ethnic group, neighbourhood deprivation, diagnostic group, and recorded paranoia, persecutory delusions or auditory hallucinations.

In 9,323 patients, final models indicated significant associations of this composite outcome with baseline somatic passivity (prevalence 4.9%; adjusted odds ratio 1.61, 95% CI 1.37-1.88), thought insertion (10.7%; 1.24, 1.15-1.55) and thought withdrawal (4.9%; 1.36, 1.10-1.69), but not independently with thought broadcast (10.3%; 1.05, 0.91-1.22).

Symptoms traditionally central to the diagnosis of schizophrenia, but under-represented in current diagnostic frameworks, were thus identified as important predictors of short- to medium-term prognosis.

No conflict of interest - past support from Janssen; GSK; Takeda; Induction Healthcare; Holmusk; the NIHR; SLaM NHS Trust; the MRC; KCL; the NIHR ARC; KCH NHS Trust; the Academy of Medical Sciences; The Wellcome Trust; BHF; Arthritis Research UK; the Roya

Late-onset psychosis is associated with development of dementia. Search for neuroimaging signs in these patients is important.

This study aimed to assess CT abnormalities and their clinical correlations in late-onset psychosis.

Patients with DSM-V diagnosis of late-onset schizophrenia (LOS, n= 43, age 65.2±9.4, 90% females) and schizoaffective disorder (LOSAP, n=9, age 64.9±5.8, 30% females) underwent CT and cognitive examination before discharge. Atrophy and ventricles enlargement were ranged from 0 (abs.) to 3 (sev.); vascular pathology - from 0 (abs.) to 2 (mult.). Patients were compared with 16 controls (age 58.1±10.8, 50% females). Nonparametric statistic was used.

Patients had more severe frontal (χ2 19.7, р=0.003), temporal (χ2 10.7, р=0.097), parietal (χ2 21.7, р=0.001), cerebellar (χ2 14.8, р=0.005) atrophy and ventricles enlargement (χ2 15.6 р=0.016). 29 % of LOS and 44% of LOSAP patients had leukoaraiosis. All findings correlated with age. In patients ventricular enlargement correlated with number of psychotic episodes (r=0.338, р=0.014), lower MMSE (r=-0.314, p=0.045), immediate (r=-0.508, р=0.002) and delayed (r=-0.404, р=0.016) verbal recall. Temporal atrophy correlated with number of episodes (r=0.439, р=0.001), lower MMSE (r=-0.327, p=0.037) and immediate verbal recall (r=-0.339, p=0.046); cerebellum atrophy - with lower MMSE (r=-0.338, р=0.036) and FAB (r=-0.407, р=0.01); leukoaraiosis - with number of episodes (r=0.503, р=0.001), prolonged hospital stay (r=0.345, p=0.024); vascular pathology – with number of episodes (r=0.336, р=0.015), lower visual recall (r=-0.399, р=0.019), performance time in TMT-B (r=0.404, р=0.024).

Correlations between CT pathology, cognitive dysfunction and number of psychotic episodes may reflect progression of brain pathology due to psychosis.

No significant relationships.