Severe mental illness (SMI), which includes schizophrenia, schizoaffective disorder and bipolar disorder, has profound health impacts, even in the elderly.

To evaluate relative risk of hospital admission and length of hospital stay for physical illness in elders with SMI.

To construct a population-based retrospective cohort observed from April 2007 to March 2016, data from a case registry with full but de-identified electronic health records were retrieved for patients of the South London and Maudsley NHS Foundation Trust, the single secondary mental healthcare service provider in south-east London. We compared participants with SMI aged >60 years old with the general population of the same age and residing in the same areas through data linkage by age-, sex- and fiscal-year-standardised admission ratios (SARs) for primary diagnoses at hospital discharge. Furthermore, we compared the duration of hospital stay with an age-, sex- and cause-of-admission-matched random group by linear regression for major causes of admission.

In total, records for 4175 older people with SMI were obtained, relating to 10 342 admission episodes, showing an overall SAR for all physical illnesses of 5.15 (95% CI: 5.05, 5.25). Among the top causes of admission, SARs ranged from 3.87 for circulatory system disorders (ICD-10 codes: I00–I99) to 6.99 for genitourinary system or urinary conditions (N00–N39). Specifically, the diagnostic group of ‘symptoms, signs and findings, not elsewhere classified’ (R00–R99) had an elevated SAR of 6.56 (95% CI: 6.22, 6.90). Elders with SMI also had significantly longer hospital stays than their counterparts in the general population, especially for digestive system illnesses (K00–K93), after adjusting for confounding.

Poorer overall physical health and specific patterns were identified in elders with SMI.

Although diagnostic instability in first-episode psychosis (FEP) is of major concern, little is known about its determinants. This very long-term follow-up study aimed to examine the diagnostic stability of FEP diagnoses, the baseline predictors of diagnostic change and the timing of diagnostic change.

This was a longitudinal and naturalistic study of 243 subjects with FEP who were assessed at baseline and reassessed after a mean follow-up of 21 years. The diagnostic stability of DSM-5 psychotic disorders was examined using prospective and retrospective consistencies, logistic regression was used to establish the predictors of diagnostic change, and survival analysis was used to compare time to diagnostic change across diagnostic categories.

The overall diagnostic stability was 47.7%. Schizophrenia and bipolar disorder were the most stable diagnoses, with other categories having low stability. Predictors of diagnostic change to schizophrenia included a family history of schizophrenia, obstetric complications, developmental delay, poor premorbid functioning in several domains, long duration of untreated continuous psychosis, spontaneous dyskinesia, lack of psychosocial stressors, longer duration of index admission, and poor early treatment response. Most of these variables also predicted diagnostic change to bipolar disorder but in the opposite direction and with lesser effect sizes. There were no significant differences between specific diagnoses regarding time to diagnostic change. At 10-year follow-up, around 80% of the diagnoses had changed.

FEP diagnoses other than schizophrenia or bipolar disorder should be considered as provisional. Considering baseline predictors of diagnostic change may help to enhance diagnostic accuracy and guide therapeutic interventions.

We present the case of a 33-year old man that suffer chronic cocaine and cannabis use since adolescence and at age of 25 develops depressive symptoms and later psychotic symptoms not congruent with mood state. He met criteria for schizoaffective disorder at that moment and was treated with antidepressants and antipsychotic drugs, improving symptomatology even without stopping completely substance use.

To study the relationship between schizoaffective disorder and cannabis and cocaine use, including the neurobiological disturbance secondary to these drugs that can lead to the development of this disorder and the relevance of diagnosing it in context of active substance use.

We carried out a literature review of scientific papers in Medline data base. We used the following terms: “Schizoaffective disorder” “cocaine use” and “cannabis use”. We considered English and Spanish papers for the last 5 years.

After 4 months of cocaine withdrawal and 1 month of cannabis withdrawal, the patient progressively improved depressive and positive psychotic symptoms. However, we reported the persistence of negative symptoms as psychomotor slowdown and cognitive and affective flattening.

The use of cocaine and cannabis is related to depressive and psychotic symptoms in intoxication and can also precipitate chronic psychotic and affective disorders. Induced schizoaffective disorder has not been widely described in literature. Our patient could be a case of schizoaffective induced disorder, but we should consider other pathogenic factors, differential diagnosis and clinical evolution in permanent withdrawal to confirm this diagnosis.

No significant relationships.

Over last decades convincing evident data was accumulated about the positive correlation of religious involvement and better mental health in depression, substance abuse, suicide, stress-related disorders and dementia. The studies of the impact of religion on patients with schizophrenia and schizoaffective disorders are still insufficient and controversial.

To investigate the impact of the religious coping strategies in patients with schizophrenia and shizoaffective disorder with focus on resolution and quality of remission in schizophrenia and schizoaffective disorder.

The pilot 1 year study covers 68 orthodox (group 1) and 55 unbeliever (group 2) outpatients with schizophrenia and schizoaffective disorder in remission on the maintenance therapy in FSBSI MHRC. The groups matched in age (18-60 y.o.), gender, treatment. The orthodox group received religious coping therapy. Number of relapses, remission quality (PANSS), quality of life (QLS), compliance (MARS) were measured 3 times (baseline visit, 6, 12 months). Statistical analysis (regression and correlation) was applied.

Religious coping strategies proposed by Paragment K. (2013) were applied considering the peculiarities of value-semantic structures and selected religious values of the patients as important rehabilitation resource (Kopeyko et al, 2016). Group 1 demonstrated statistically significant better remission at 12-months point – better subjective well-being, social/functional outcomes, higher adherence to medication, less relapses, less psychotic symptoms.

Religion contributes to acquire adaptive functions as the meaning of life, sense of hope, spiritual comfort, supports the overcome the disease burden. Religious coping is an important tool for rehabilitation and preventing the relapses in patients with schizophrenic disorders.

No significant relationships.

Despite existing observations of religious delusions in epilepsy in classical psychiatric literature, such clinical cases are rare in current practice.

To reveal features of disease progression, interference of combined mental pathology, treatment specifics, markers of possible harmful behavior.

Psychopathological, Multichannel eyes closed resting EEG in interictal period.

Patient N, 39 years old, manifested her illness at age 13 with affective bipolar disorder; phases lasted several months each. From age 19, rare recurrent generalized convulsive paroxysms preceded by an aura; non-convulsive paroxysms were observed. The patient was uncritical of paroxysms and discontinued anticonvulsive therapy. At age 29 and 30 she suffered two psychotic attacks (lasting several weeks) with sensory delusions of meaning, staging, persecution, megalomaniacal ideas of apocalyptic content (ideas that she was responsible for possible outbreak of nuclear war, coming of the Apocalypse, her son was the antichrist). Delusional behavior (tried to take the naked infant out into the cold, throwing him out of the window). Anticonvulsive therapy accompanied by antipsychotic medications. Schizoaffective disorder and epilepsy diagnosed. From age 35, acute psychotic attacks with apocalyptic delirium preceded by the same aura lasted maximum one day, followed by partial amnesia. Epileptiform polyspikes (up to 150 μV) registered in the right temporal-central EEG leads.

Presence of religious delusion in combined schizoaffective disorder and epilepsy, requires special approach: combination of anticonvulsants and antipsychotics. Religiosity of patient should be taken into account as well.

No significant relationships.

Social media networks are becoming omnipresent in our lives, and more and more available to everyone including patients with mental illnesses.

Our study aimed to examine the prevalence of social media use in individuals with schizophrenia and schizoaffective disorder, and to examine the association of severity of symptoms with social media use.

A total of 38 patients with schizophrenia or schizoaffective disorder were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax, Tunisia. Socio-demographic information as well as details about their social media use were collected from all the patients. Severity of schizophrenia symptoms was assessed on the Positive and Negative Syndrome Scale (PANSS). A logistic regression was used to explore the association between social media use and clinical characteristics of the participants.

Of the 38 study participants, 23.7% used social media. Facebook was the most popular social media site. The number of social media users were highest among participants aged 21–30 years old, married participants, residents of an urban region, employed participants and patients with a tertiary education level. Age and PANSS negative score were significantly and negatively associated with social media use.

Less than one fourth of patients with schizophrenia and schizoaffective disorder use social media and may be suitable candidates for treatment programs supported by social media platforms , especially those of a young age and a low severity of negative symptoms .

No significant relationships.

Oxcarbazepine (OXC) is an antiepileptic drug used as a mood stabilizer in patients diagnosed with bipolar disorder (BD). OXC has been reported as a source of hyponatremia in its use in both epilepsy and BD.

We present the case of a 53 year-old male patient diagnosed with Schizoaffective disorder, bipolar type who developed hyponatremia during his treatment with OXC.

The patient’s treatment was desvelafaxine 100 mg, Paliperidone depot 150 mg, Oxcarbazepine 600 mg which he had maintained for at least one year. He began to manifest headache, asthenia and mild confusion gradually, with morning predominance, without being clearly suggestive of an acute worsening.

In control analysis, the existence of sodium leveles of 127 and low osmolarity was observed. Therefore it was decided to suspend furosemide, close monitoring of water intake in order to rule out primary polydipsia and extra salt was introduced into the diet. Given the persistence of the symptoms, laboratory abnormalities and ruled out the existence of primary polydipsia, it was decided to suspend treatment with oxcarbazepine. After the discontinuation of the aforementioned drug the analytical findings went back to normal ranges and the symptoms disappeared.

Carrying out control tests in patients with psychiatric pathology and multiple psychiatric treatments is essential to be able to rule out analytical alterations which could be asymptomatic or with nonspecific symptoms that could be attributed to the underlying pathology. The easy reversal of symptoms encourages us to emphasize the study and differential diagnosis of each case.

No significant relationships.

Schizophrenia (SCZ) is considered one of the most disabling mental illnesses with significant family, social and occupational repercussions resulting in impaired quality of life (QOL).

To assess the QOL of patients with SCZ or schizoaffective disorder (SAD) and to analyze the sociodemographic and clinical factors associated with its alteration.

This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years and the sex ratio M/F was 4.5. They were single in 63.7% of cases and unemployed in 61.8%. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average QOL score was 57.7, the average physical health score was 61.1, and the average mental health score was 54.3. Female sex (p=0.02), being single (p=0.039), lack of work activity (p=0.00), tobacco use (p=0.05), and presence of medical history (p=0.034) were statistically correlated with impaired QOL.

QOL in SCZ and SAD is impaired. This result encourages us to conceive of the patient in his whole life and not only from the point of view of the disease.

No significant relationships.

Valproic acid (VPA) is a valuable treatment for bipolar disorder, schizoaffective disorder, and agitation1. However, potential side-effects include sedation, headaches, tremors, ataxia, gastrointestinal issues, neural tube defect, 3 and mild hyperammonemia even in normal liver function test 1 and VPA level.

To illustrate clinical presentation of VIHE and provide literature review on post-VIHE treatment options.

A 59-year-old male with PMH of Diabetes Mellitus, Hypertension, Hyperlipidemia, LVH, COPD, s/p CVA, and PPH of schizoaffective disorder, bipolar type. Patient stable on VPA 1250mg daily and Olanzapine 5mg daily for >2years until recent manic decompensation resulting to up-titration of VPA to 1500mg H.S. Thereafter, he presented with altered mental status, with VPA level (111.4 ug/ml), hyponatremia (119 mmol/L) and hyperammonemia (84 umol/L). Subsequently, admitted as a case of VIHE and hyponatremia.

VPA has shown to cause hyperammonemia alone or when combined with antipsychotics6. VIHE reported in up to 47.7% of patients on VPA1, but symptomatic in approximately 10% of patients on VPA with blood ammonia level about 2-fold the normal range8. VIHE presents with confusion, ataxia, blurred vision, delirium, and seizures3. Treatment options include VPA discontinuation, switch to other mood stabilizers (lithium carbonate, lamotrigine), utilization of medications to lower blood ammonia levels (Lactulose, Rifaximin/Neomycin) ,3 antipsychotic monotherapy, and supplements (Levocarnitine or Carglumic acid) in the prevention, maintenance, and treatment of VIHE. These supplements can be added to VPA if the benefits of re-initiating or continuing VPA outweighs the risk3.

Further research is needed.

No significant relationships.

Technologies such as the phone , the computer , and social media network nowadays are becoming more and more available to everyone including patients with mental illnesses.

Our study aimed to examine the prevalence of technology use in individuals with schizophrenia and schizoaffective disorder.

Study participants were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax , Tunisia. A total of 38 male patients were recruited , from whom the diagnosis of schizophrenia or schizoaffective disorder according to the DSM-5 criteria had been confirmed. Socio-demographic and clinical information as well as details about their technology use were was collected from all the patients.

Of the 38 study participants, 65.8% owned a cell phone , and 52.6% used the cell phone to send or receive messages. A rate of 21.1% owned a computer , 34.2% had internet access and 28.9% had an email account. A rate of 23.7% used social media. Facebook was the most popular social media site. 72% of cell phone owners would like to communicate with their doctor via text messages , and 68% would like to be reminded of their appointments via text messages. Among social media users , 55.6% expressed their interest in a social-media-based doctor-patient communication and appointment reminders.

Our findings suggest that these technologies afford an opportunity to improve the management of these patients.

No significant relationships.

The only FDA approval therapeutic for schizoaffective disorder is paliperidone. Hiperprolactinemia is one of the most frequent side effects induced by first generation antipsychotics (FGA) or by second generation antipsychotic (SGA), such as risperidone and paliperidone. Prolactin related symptoms (PRS) include amenorrhea, galactorrhea, gynecomastia and fluctuations in psychotic symptoms.

To report the case of a patient with schizoaffective disorder difficult to manage due to symptom resistance and PRS, that improved symptomatology when prolactin serum levels were reduced.

Clinical-demographic data collected by clinical interview and clinical process consultation. Non-systematic literature review, searching “psychosis”; “prolactin”; “antipsychotic”; “schizoaffective disorder” on Pubmed database.

We report the case of 33 years-old female, admitted to our psychiatry inpatient unit for persecutory delusions, loosening of association, auditory hallucinations, and irritability with functional impairment. Symptoms began 13 years before. She was medicated with paliperidone 100mg IM monthly, lithium 800mg daily and clozapine 225mg daily. When admitted she wasn’t adhering to oral medication. On physical examination presented some PRS. The serum presented hyperprolactinemia and lithium in non-therapeutic levels. Initially was re-introduced the previous therapeutic without improval. It was made a therapeutic switch to associate aripiprazole 400mg IM monthly and clozapine 225mg daily, and lithium 800mg daily resulting in prolactine normalization and subsequent improval of psychotic symptoms previously presented.

This case reports challenges in management of patients diagnosed with Schizoaffetive Disorder due to therapeutic refractoriness and side effects. PRS can be ruling, therefore impacting therapeutic choices. We propose a possible role of combination of clozapine and aripiprazole in this scenario.

No significant relationships.

Schizoaffective disorder is a psychotic disorder of controversial nosological entity. Affective symptomatology and psychotic features of varying intensity coexist simultaneously in him throughout evolution. The lack of consensus on the existence of this entity determines its diagnostic delay and the absence of specific treatment guidelines.

To review the diagnostic criteria for schizoaffective disorder and the published scientific evidence on the efficacy and safety of the different therapeutic options available. To analyze the efficacy of a multidisciplinary treatment plan implemented in an intensive follow-up program, presenting the evolution of a clinical case.

To review the psychiatric history and psychopathological evolution of a patient diagnosed with schizoaffective disorder from the beginning of an intensive follow-up program in a day center to the present. Review the existing scientific evidence on the usefulness of the treatments used in this nosological entity.

This is a longitudinal and retrospective study of a clinical case in which the areas for improvement are analyzed before implementing a multidisciplinary therapeutic program and the favorable results obtained today. Currently, the patient is euthymic and attenuated and chronic positive and negative symptoms persist that do not interfere with his functionality.

From the implementation of an individualized, personalized and multidisciplinary maintenance treatment plan, an overall improvement in psychopathological stability and functional recovery is observed. Among the psychopharmacological options in this patient, Paliperidone Long Acting Injection (PLAI) stands out for its long-term efficacy and safety.

Schizoaffective disorder remains relatively unknown today compared to other psychiatric disorders. This disorder is however recognized by the international medical classifications DSM 5 and mainly affects many people.

Describe the socio-demographic and contextual clinical characteristics of patients with schizoaffective disorder

We conducted a descriptive retrospective study including patients with schizoaffective disorder (DSM 5) in the psychiatric department G at Razi hospital and who were hospitalized for a period of 1 year from 1 January to 21 December 2020. We collected 57 patients.

The average age of our sample is 40.16 years. The majority of patients (75.4%) were single and the school level did not exceed secondary studies in 64.9% of cases. Most of these patients were unemployed previously working as a day laborer in 47.4%. In addition, the type of schizoaffective disorder was dominated by the bipolar type (94.7%). These patients had a personality disorder in 26.3% mainly schizoid. The psychiatric interview of these patients revealed irritable mood in 47.4%, inappropriate affects in 59.6%, speech of a maniac in 52.6%, delusions of persecution and grandeur in 70.2% with intuitive mechanism (47.4%) and hallucinatory (auditory 45.6%). Disorganized behavior in 50% and catatonic behavior in 5.3% Mental automatism and morbid rationalism in 29.8% Insomnia: 94.7% and concentration disorder: 56.1% Type of treatment was the combination of atypical antipsychotics, mood stabilizers and benzodiazepines 33.3% with regular follow-up in 49.1%

Schizoaffective disorder is one of the most misdiagnosed psychiatric disorders in clinical practice and the need to know its characteristics is a necessity.

No significant relationships.