Urban living has consistently been associated with higher risk of developing schizophrenia when compared to rural living. Exposure to green space has been associated with better mental health outcomes and, more recently, childhood exposure to green space has been linked with lower rates of schizophrenia. The reasons for these findings remain unknown, although lower levels of pollution and psychological factors may play a role.

We aim to review the literature regarding exposure to green space and its relationship with the risk of developing schizophrenia.

We performed an updated review in the PubMed database using the terms “green space” and “schizophrenia”. The included articles were selected by title and abstract.

Growing up surrounded by non-urban environments is associated with lower schizophrenia rates. Upbringing in urban areas is associated with higher schizophrenia rates when compared with non-built-up areas. Schizophrenia risk seems to decrease with vegetation density in a dose-response relationship for urban and agricultural areas. Risk of schizophrenia has been found to be associated additively with green space exposure and genetic liability. No evidence for gene-environment interaction has been reported so far in this regard.

Exposure to green space during childhood appears to lower the risk of developing schizophrenia later in life and can be a preventive strategy. Further research in this area is needed.

Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes.

Our study is aimed to describe the therapeutic adherence and to identify the factors associated with poor adherence among schizophrenic patients.

This was a cross-sectional study conducted at psychiatry consultation of the university medical center of Mahdia, Tunisia. Data collection occurred between the months of January and March 2018, including patients suffering from schizophrenia. The evaluation of adherence was performed using the MARS scale (Medication Adherence Rating Scale).

In our sample of 131 schizophrenic patients, there is a male predominance (76%), as well as unmarried status (58.7%), unemployed (72%). The rate of non compliance treatment was 73%. Low levels of education, poor insight and polytherapy were associated to poor adherence. Although patients aged more than 40 years, who were married and diagnosed with undifferentiated schizophrenia were good compliant to treatment (p<0.05).

We suggest a proper treatment strategy for each patient based on the identification of non adherence risk factors.

Psychiatric diagnoses are derived from expert opinion (1). Since no objective tests or markers are on the horizon, clinical psychiatry is anchored to “the patient’s altered experience, expression and existence, associated with suffering in self and/or others”(2). Many studies have examined diagnostic stability over time. In the last years investigators have been reporting prospective and retrospective consistencies of diagnoses between two time points, specially in first episodes of psychosis (3).

To examine the prospective and retrospective stability of diagnostic categories 2 years after the first episode of psychosis

Data were examined from the First Episode Psychosis Program of Navarra (PEPsNA), a prospective observational study of a cohort of patients with first-episode psychosis in Navarra (Spain). Diagnosis was assigned using DSM-IV-TR at baseline and 24 months later. Diagnoses were divided into 5 categories: Affective psychosis, Schizophrenia spectrum psychosis, Schizoaffective disorder, acute psychosis and other diagnoses. Diagnostic change was examined using prospective and retrospective consistency

A total of 78 first-episode psychosis cases with baseline and 24 months follow-up were identified. Table 1 shows the diagnosis movement matrix, and Figure 1 its graphical representation. Of cases, 71.8% (56/78) had the same baseline and 24 months follow-up diagnosis. Prospective and retrospective consistencies are shown in Table 2

The prospective and retrospective consistencies of Schizophrenia spectrum psychosis and acute psychosis were higher than others. Affective psychosis and Schizoaffective disorder show very variable consistencies

Early Intervention Services for Early-Phase Psychosis have shown efficacy and effectiveness (Correl C, JAMA). In Pamplona, Spain, there is an Early Intervention Program that has been providing multiprofesional assistance for First Psychotic Patients for the last two years.

The aim of this study is to analize the longitudinal effects of the different interventions in several functional variables: GAF, Occupational State, CGI-CogS, QLS, Sofas and WHODAS II applied to 240 patients during two years of follow-up.

We apply an standard evaluation protocol to every patient at different times: premorbid, initial time and at months 6, 12, 18 and 24. We analyse the data with the SPSS statistical program to see the results in these variables.

The GAF scale shows a decline during the first 6 months, but tends to reach and maintain the premorbid levels after a year of treatment. Regarding baseline, patients with normalized jobs or studies are 60.7%. This percentage persists during the next months of follow-up but decline at the 24th month Both the Whodas and Sofas scale show improvement tends. The QLS results show a progresional improvement in every subcale during the whole time of follow-up.

The Early Intervention Services in Psychosis improve, not only psychopatological dimension but also functional areas, what is important for the whole recovery of First Psychotic Patients.

An increasing body of literature supports the hypothesis that immune imbalance towards a pro-inflammatory status in the brain plays an important role in schizophrenia. Anti-inflammatory drugs might compensate this dysregulation, ameliorating the symptoms of schizophrenia. N-acetylcysteine exhibits anti-inflammatory properties and may regulate various neurological pathways, including glutamate dysregulation, oxidative stress, and inflammation, becoming an interesting augmenting drug for schizophrenia treatment.

We aim to review the literature regarding the therapeutic effects of N-acetylcysteine in Schizophrenia.

We performed an updated review in the PubMed database using the terms “N-acetylcysteine” and “Schizophrenia”. The included articles were selected by title and abstract.

The literature suggests that N-acetylcysteine may be a useful adjunct to standard treatment for the improvement of schizophrenia symptoms, as well as the cognitive domain of working memory. Also, this augmentation therapy seems to be beneficial in all illness stages

N-acetylcysteine appears to be a promising agent for augmenting conventional pharmacotherapy in schizophrenia, however, further research is needed to consolidate the current findings.

Individuals with schizophrenia have a shortened average life expectancy, with a lifetime risk of suicide around 5%.

Here we present a case of a patient diagnosed with schizophrenia who developed depressive symptoms with suicidal ideation, reactive to psychotic symptoms. Considering this specific case, the factors that contribute to the increased risk of suicide in these patients are reviewed.

Relevant clinical information was extracted from the patient’s clinical process. In addition, we searched PubmedR database with the terms “Schizophrenia”, “Hopelessness” and “Suicide”.

A 40-year-old male patient, single and unemployed presents a progressive psychotic condition, with 20 years of evolution, with an impact on social and work behaviour. As a background he has a history of depressive episodes with suicidal ideation at the age of 36, following psychotic symptoms. This is a patient with preserved cognitive functioning combined with a high level of education, who understands the impact of his reality on his functioning. In this context, he develops feelings of hopelessness, that are the risk factor for suicide, most consistently reported in patients with schizophrenia.

This case assesses a patient with schizophrenia who has several factors, that contribute to an increased risk of suicide, focusing on hopelessness. In the future, it may be interesting to study in more detail the individual weight of each factor, so that it is possible to accurately predict the individual risk of each patient and, consequently, it is possible to implement preventive strategies.

The use of a modern biopsychosocial model of care for patients with schizophrenia dictates the need for a dynamic assessment of the quality of life of patients at different stages of the disease to identify targets for treatment and rehabilitation measures. It is especially important to determine the available targets in the early stages of the disease in order to select effective complex therapy and improve the clinical and social prognosis.

To determine the socio-biological and clinical factors that have a significant impact on the quality of life of patients with first-episode psychosis.

The sample consisted of patients diagnosed with schizophrenia (n=58). The following research methods were used: 1) clinical-psychopathological; 2) quality of life assessment; 3) clinical-laboratory and functional research methods; 4) statistical. The QL-100 questionnaire was used as a tool for studying the quality of life. The PANSS scale was used to assess the severity of positive and negative syndromes.

The most significant adverse impact on the quality of life indicators are the absence of family, lack of work, low material wealth, active consumption of psychoactive substances, the predominance of negative symptoms and the presence of concomitant somatic disease in the acute phase.

Early identification of problematic aspects of the quality of life in patients with the first-episode psychosis allows us to conduct effective treatment and rehabilitation measures for these patients.

OPEN is a structured intervention program for patients who present with untreated psychosis at an early stage, under the guidance of a case manager and a periodic evaluation performed by a multidisciplinary team.

The aim of the OPEN program is to create an individual care plan, promoting recovery, functionality, quality of life and prevent relapses. One year after implementation of the program, we present the first results.

We performed a retrospective review of the patients’ clinical profiles included in the OPEN program.

Nine patients were included in the program. The most frequent diagnosis was schizophrenia (n=5). By the time of inclusion in the program, 5 patients used cannabis frequently; one patient kept substance use. At the 6th month assessment, 4 in 5 patients showed an improvement in social functioning (Personal and Social Performance Scale; ± 16 points), and a decrease in symptom severity in all (Brief Psychiatric Rating Scale; ± 11 points). Due to COVID-19 pandemics, group interventions were suspended, and some visits were performed by teleconsultation. No patients lost follow-up.

We observed an overall positive result of the first months of this program, regarding both functionality and clinical outcomes. The main obstacle so far is the impossibility of performing group interventions since the start of the contingency measures regarding COVID-19 pandemics. We expect further results of the OPEN program with the inclusion of more patients.

Natural caregivers of patients with schizophrenia are often subjected to stigma by virtue of their association with patients. Affiliate stigma expose caregivers to community rejection, isolation and may have a negative impact on their psychological wellbeing.

This study aimed to assess perceived stigma and burden in a Tunisian population of natural caregivers of patients with schizophrenia and to identify risk factors for developing such disorders.

We conducted a cross-sectional, descriptive and analytical study, including 80 natural caregivers of patients with schizophrenia. We used the Stigma Devaluation Scale (SDS) to assess stigma and the Zarit Burden Interview (ZBI) to evaluate burden.

The average age of natural caregivers was 55.7 years. The sex ratio (M/F) was 0.86. The mean score of perceived stigma in patients was 24.7. That of perceived stigma in caregivers was 15.34. Assessing the burden on caregivers estimated an average score of 58, corresponding to a severe burden. Medium to high burden was found in 78% of participants. Perceived stigma scores were significantly higher among illiterate caregivers, those linking schizophrenia to hereditary causes, among parents, and in case of daily contact with the patient. Scores of perceived stigma in caregivers were also significantly correlated with burden score.

Natural caregivers of patients with schizophrenia are exposed to affiliate stigma and experience an important level of burden. Our findings emphasize the need to support natural caregivers of persons with schizophrenia and to develop strategies to combat stigmatization among patients as well as their natural caregivers.

Motivation deficit is a significant aspect of lack of improvement in patients with schizophrenia especially with predominant negative symptoms (PNS). Therefore, improvement depends not only on symptoms reduction and better social functioning but also on patient engagement which is a key but less investigated aspect of successful treatment.

To investigate and compare patient engagement in PNS patients after cariprazine and risperidone treatment characterized by the 11 items of the Positive and Negative Syndrome Scale (PANSS-11).

In this phase 3 study patients suffering from PNS of schizophrenia (PANSS-FSNS≥24) were randomized to 26 weeks of treatment with either cariprazine or risperidone (target dose 4.5 and 4 mg/day, respectively). To compare the effects of the two drugs on patient engagement the PANSS-11 scale was used. Change from baseline (CfB) on the selected items and PANSS-11 total score were analyzed using mixed model of repeated measures approach without correction for multiplicity.

PANSS-11 total score mean CfB were -11.20 (SD=0.43) for cariprazine-, and -9.44 (SD=0.45) for risperidone-treated patients with a -1.79 (95% CI=-3.01, -0.56) mean difference (p=0.004) in favor of cariprazine. Most item differences were statistically significant (N1, N2, N3, N4, N5, G16) or numerically higher (N6, G7, G13) for cariprazine versus risperidone.

Cariprazine significantly improved patient engagement in patients with PNS of schizophrenia compared to risperidone based on the PANSS-11 post-hoc analysis. These results suggest that cariprazine treatment may improve not only the symptoms and everyday functioning of PNS patients but their engagement with life.

Studies were funded by Gedeon Richter Plc. and Allergan Plc (prior to its acquisition by AbbVie). Dr. Laszlovszky, Dombi, Balogh, Dr Barabassy, Dr Vass, Dr. Szatmári and Dr. Németh are employees of Gedeon Richter Plc.

Although monotherapy is preferable, in every day clinical practice polypharmacy is often unavoidable due to the need of treatment enhancement or cross-titration phases with shorter or longer overlaps of two or more drugs. However, administration of more than one drug treatment is often associated with more side effects.

The aim of the present post-hoc analysis was to examine treatment emergent adverse events (TEAEs) during co-administration of cariprazine with other antipsychotics.

Treatment emergent adverse event data (TEAE) from a randomized, double-blind, parallel-group, active-controlled study (EudraCT Number: 2012-005485-36) in adult patients with schizophrenia having predominant negative symptoms was examined in the first two weeks of the double-blind treatment period, where gradual cross-titration occurred between cariprazine (3-6 mg/day) and other antipsychotics (including amisulpride, aripiprazole, fluphenazine, haloperidol, olanzapine, paliperidone, quetiapine, and sertindole). Thereafter, 24 weeks of cariprazine monotherapy followed.

During the cross-titration period, 17.83% of patients experienced at least one TEAE. The TEAEs were in line with the well-established safety data: nausea (2.61%), insomnia (2.17%), headache (2.17%), akathisia (1.74%) and restlessness (1.3%) were the most common. Most events were mild in severity (66.1% mild, 32.2% moderate, 1.7% severe (insomnia)).

While not definitive, and limited by small sample size, the co-administration of cariprazine with other antipsychotics did not show an unexpected safety profile or overlapping toxicities. This is an important finding, if intermittent or longer co-administration of other antipsychotics are unavoidable with cariprazine treatment.

Studies were funded by Gedeon Richter Plc. and Allergan Plc (prior to its acquisition by AbbVie). Dr Vass, Dr Barabássy, Dr Laszlovszky, Dr Sebe, Dombi, Dr Szatmári and Dr Németh are employees of Gedeon Richter Plc.

Different electrophysiological indices have been investigated to identify diagnostic and prognostic markers of schizophrenia (SCZ). However, these indices have limited use in clinical practice, since both specificity and association with illness outcome remain unclear. In recent years, machine learning techniques, through the combination of multidimensional data, have been used to better characterize SCZ and to predict illness course.

The aim of the present study is to identify multimodal electrophysiological biomarkers that could be used in clinical practice in order to improve precision in diagnosis and prognosis of SCZ.

Illness-related and functioning-related variables were measured at baseline in 113 subjects with SCZ and 57 healthy controls (HC), and after four-year follow-up in 61 SCZ. EEGs were recorded at baseline in resting-state condition and during two auditory tasks (MMN-P3a and N100-P3b). Through a Linear Support Vector Machine, using EEG data as predictors, four models were generated in order to classify SCZ and HC. Then, we combined unimodal classifiers’ scores through a stacking procedure. Pearson’s correlations between classifiers score with illness-related and functioning-related variables, at baseline and follow-up, were performed.

Each EEG model produced significant classification (p < 0.05). Global classifier discriminated SCZ from HC with accuracy of 75.4% (p < 0.01). A significant correlation (r=0.40, p=0.002) between the global classifier scores with negative symptoms at follow-up was found. Within negative symptoms, blunted affect showed the strongest correlation.

Abnormalities in electrophysiological indices might be considered trait markers of schizophrenia. Our results suggest that multimodal electrophysiological markers might have prognostic value for negative symptoms.

Patients are often treated with high doses or combinations of antipsychotics, which may hamper recovery. Dose-reduction (DR) or discontinuation of antipsychotic medication in chronic patients carries the risk of psychotic relapse.

To identify risk factors of psychotic relapse after DR or discontinuation, we (i) determined the rate of relapse after DR or discontinuation in patients with chronic schizophrenia, and (ii) assessed risk factors for psychotic relapse.

From studies on dose-reduction from January 1950 through June 2019 we calculated event rates per person-years including 95% confidence intervals. We extracted: (1) patient characteristics (age, percentage of male subjects, setting, duration of illness), (2) dose-reduction/discontinuation characteristics (start-dose, end-dose, dose-reduction in milligrams and percentage of start-dose, time-period of dose-reduction), (3) follow-up characteristics (time after dose-reduction), and (4) study characteristics (blinding, publication-year and relapse definition).

46 unique cohorts, presenting 1677 patients in which doses were reduced/discontinued were included in meta-analysis. We found an overall event rate per person-years on psychotic relapse of 0.55 (CI95% 0.46-0.65;p<0.0001;I2 =79). Most robust event rates for psychotic relapse were seen for discontinuing antipsychotics, and if not discontinuing, dose-reduction till under 5mg haloperidol equivalents daily (HE). Abrupt reduction yielded higher rates than gradual reduction. During short follow-up time more relapses occurred than in studies with long follow-up time.

In patients with chronic schizophrenia discontinuing, and to a lesser extent DR till end-dose<5mgHE, patients who reduce doses abrupt, inpatients, and patients with a short duration of illness carry highest relapse risk. Most relapses occur during the first half year after DR.

One or more negative symptoms are present in 57,6% of patients with schizophrenia spectrum disorder [Bobes et al, 2010]. These symptoms are responsible for impaired social functioning and have impact on the quality of life. There are no epidemiological studies that analyse the prevalence of negative symptoms and their impact on life quality in Lithuania.

To evaluate the impact of negative symptoms on quality of life in patients with schizophrenia spectrum disorder.

Participants were 48 adults with schizophrenia (n=36) or schizoaffective disorders (n=12). All participants provided informed consent. All participants were administered a sociodemographic data form, Brief Psychiatric Rating Scale (BPRS), Mini-International Neuropsychiatric Interview (MINI). Negative symptoms were assessed by the Self-evaluation of Negative Symptoms (SNS). The Short-Form Health Survey (SF-36) was used to measure health-related quality of life.

The results of SF-36 scales significantly correlated with SNS subscales. All SNS subscales correlated with general health result, vitality, social functioning and emotional well-being as well as in overal quality of life. Signifficant correlations were observed between the total scores of SNS and physical activity (r=-0,404, p=0,004), general health (r=-0,626, p<0,001), vitality (r=-0,683, p=0,004), social functioning (r=-0,53, p<0,001), role limitations (r=0,354, p=0,014), emotional well-being (r=-0,662, p<0,001) in SF-36 scales.

Negative symptoms of schizophrenia such as social withdrawal, diminished emotional range, alogia, avolition and anhedonia are associated with impaired quality of life. We found a strong relation between negative symptoms and quality of life, however further studies can support this point of view.

The first description of syphilis was made in Europe around the year 1493, and although perceived as a disease relegated to its historical importance, recent studies demonstrate that the prevalence of these infections is on the rise. Spanning decades after initial infection, 30% of affected individuals without treatment may develop tertiary syphilis, which includes neurosyphilis. Its notoriously “chameleon-like” presentation implies the necessity to not overlook neurosyphilis as a differential diagnosis in psychiatric settings.

Case report study and discussion.

The authors present a case of affective and psychotic symptoms (including auditory and visual hallucinations and persecutory delusions) of rapid onset in a 61-year old woman without prior psychiatric history. A clinical investigation was conducted, which subsequently revealed a positive Venereal Disease Research Laboratories (VDRL) test. A lumbar puncture was performed and cerebrospinal fluid analysis confirmed neurosyphilis.

Steady improvements in initial psychopathological manifestations were noted after completing recommended treatment for neurosyphilis. After discharge, the patient was medicated with an antidepressant and antipsychotic, demonstrating a complete return to baseline mentation and functionality on follow-up.

This case demonstrates the vital importance of considering syphilis in our differentials, especially due to the wide range of manifesting psychiatric symptoms. Although considered a disease of the past, this case reminds us that syphilis remains present in our society and its timely diagnosis and treatment can ameliorate the debilitating psychopathological manifestations of the disease. Due to the potential difficulties in identifying this great imitator, routine screening tests are still recommended in the psychiatric setting.

Schizophrenia is a chronic mental disorder that has a significant impact on quality of life satisfaction in patients with schizophrenia.

The objective of this study was to examine the impact of socio-demographic factors and psychotic symptoms on quality of life satisfaction in patients with schizophrenia.

Participants were outpatients of Hedi chaker University Hospital Center in sfax, Tunisia, recruited between January and July of 2019, diagnosed with schizophrenia or schizoaffective disorder. A Demographic questionnaire, the Positive and Negative Syndrome Scale (PANSS) and The Quality of life satisfaction and enjoyment Questionnaire (Q-LES-Q) were administered in this study.

50 patients were included in this study with an average age 40,80 ±9,7. The majority of patients were single (72%), unemployed (60%), without medical heredity (80%) and living with their families (92%). The average score of the positive symptom scale (PANS) was 17.46 (SD = 9.1), the negative symptom scale (PANS) was 12.35 (SD = 7.4) and the psychopathological scale (PANS) was of 27.83 (SD = 14.7). the higher the score of the positive symptom scales (p <10-3) the negative scale score (p <0.002) and the psychopathological scale (p <0.001) was high, more the quality of life satisfaction score has been altered.

Improving the quality of life satisfaction of these patients through these different parameters could be a goal of care complementary to the objectives of traditional care.

Individual abilities to perceive internal and external sensations are defined respectively as interoception and exteroception: the dysregulation of these functions can explain many psychotic symptoms. (Ardizzi et al. 2016)

We evaluated the differences in the interoceptive and exteroceptive perception between 39 patients with psychosis and 250 healthy controls using self-administered questionnaires. The association between interoception and exteroception in the two groups was also tested.

The tests we used are AASP (Adolescent / Adult Sensory Profile) and MAIA (Multidimensional Assessment of Interoceptive Awareness). Differences were measured with t-tests, associations with spearman’s correlation.

Significant differences emerged between the two samples in the AASP total score and in its Low registration (LR) and Sensory Avoiding (SA) sub-scales and in the MAIA total score and in all its sub-scales except “Not Worrying” (Fig.1). Different patterns of associations between AASP and MAIA were observed: psychotic patients showed negative correlations between MAIA and AASP in the LR and Sensation Seeking (SS) sub-scales and in the auditory (AU) and tactile (TO) sensory channels. Healthy controls, positive correlations emerged between MAIA and AASP in the Sensation Seeking (SK) sub-scale and in the “perception of movement” (MO) sub-score (Fig.2)(Fig.3).

Higher scores of psychotic patients in AASP and MAIA reveal both a disregulated sensory related behavior and a hightened awareness towards internal stimuli. The negative correlation between the two scales in psychotic subjects highlights the importance of the interaction between internal and external perception in determining the global subjective experience.

Schizophrenia spectrum disorders are related with prolonged stay in hospital and high cost for treating them. As a consequence, the determination of the factors that affect the duration of hospitalization is essential.

The purpose of the study is the determination of the psychosocial characteristics of inpatients in a public psychiatric hospital and their association with the duration of hospitalization.

A total of 103 patients with a diagnosis of Schizophrenia (according to ICD-10) participated in the study. The socio demographic characteristics were recorded and the following psychometric tools were used: NEO- Five Factor Inventory, Connor-Davidson Resilience Scale (CD-RISC25), Multidimensional Scale of Perceived Social Support, Multidimensional Scale of Perceived Social Support (MSPSS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning scale (GAF).All instruments were adapted to greek population. All statistical analysis was performed using SPSS v.25.

The median length of hospital stay was 40,7 days. The number of previous admissions (p=0,010), the type of admission (compulsory or voluntary) (p=0,017), the physical restrain (p=0,043), the duration of restrain (p=0,002) as well as the existence of social support networks and in particular social support from friends (p=0,018), seem to affect the duration of hospitalization.

The present study underlines the signification of the psychosocial factors that could contribute to the prediction of longer hospitals stays, the planning of appropriate interventions and as a result the reduction of hospital costs.

Shown that there is connection between early development and the current speech parameters in adolescents with schizophrenia. With a more pronounced lag in speech, there was a decrease in the actualization of speech semantic links.

Present work aims for a more detailed analysis of the correlations between early speech development and the actual level of development of speech activity in adolescents with schizophrenia.

Sample

Analysis of medical records (medical history) “Syllabic Test”. Parameters: Standard Ratio (SR, SR_2, SR_3); Response Time (RT, RT_2, RT_3). The correlation between the indicators measured by the Spearman correlation coefficient (rs).

There was no statistically significant correlation between the First Words (FW) and SR: rs = -0.031, p> 0.05.FW and SR_2 (rs = -0.004, p> 0.05), FW and SR_3 (rs = 0.107, p> 0.05). In addition, statistically significant correlation did not revealed between FW and RT: FW and RT (rs = 0.067, p>0.05), FW and RT_2 (rs = 0.041, p>0.05), FW and RT_3 (rs = 0.066, p>0.05).

The results obtained on the Syllabic test in adolescent sample correspond to the previously identified indicators in adult patients with schizophrenia. RT tends to increase with an increase in the FW age. The limitations of present study: the lack of objectivity in medical history data (mainly parents interview), small sample size and large heterogeneity of DS of patients.

Clozapine is the drug of choice for patients with an unsatisfactory response to classic antipsychotic treatment. Little is known about the involvement of clozapine in the development of parotid disease.

Identify the clinical characteristics of Clozapine-induced parotitis through a case and literature review.

We report the case of a patient with a refractory schizoaffective disorder, bipolar type and who developed recurrent parotitis while taking clozapine. We conducted a literature review based on a PubMed search of articles published on this subject with the following keywords: ‘parotitis clozapine’.

Miss W., 34 years old, suffers from a severe schizoaffective disorder that has been diagnosed for several years. She has received various psychotropic medications. She suffered from frequent relapses that required recurrent hospital admissions. One year ago, a diagnosis of treatment-resistant schizoaffective disorder was made. The decision to introduce clozapine, associated with mood stabilizer treatment, was made on the basis of her treatment refractory symptoms. She experienced considerable sialorrhea after beginning clozapine treatment. Miss W. developed bilateral recurrent swelling over both temporal-mandibular areas after 6 months of treatment. It often appears after eating and lasts from 4 to 6 hours. There was no change in white blood cell count and she was afebrile. An otolaryngologist was consulted and a diagnosis of clozapine-induced parotitis was suggested. A spasmolytic and an anticholinergic treatment were prescribed and clozapine was continued.

This iatrogenic effect of clozapine must be recognized by clinicians in order to be better prevented.