To compare CATIE, a randomized double blind study, and SOHO, a 3-year prospective non-randomized observational European study of outpatients with schizophrenia, on the Number Needed to Treat (NNT) for all-cause medication discontinuation. NNTs place data into a clinically meaningful context - the number of patients needed to be treated with one antipsychotic instead of another to prevent one negative outcome, defined here as one additional medication discontinuation for any cause.

Rate of medication discontinuation for any cause during the 18 months post initiation was calculated for patients newly initiated on olanzapine (N=4247), risperidone (N=1549), quetiapine (N=583), amisulpride (N=256), clozapine (N=274), oral typicals (N=471) or depot typicals (N=348). Cox models were employed to adjust for treatment group differences at baseline. NNTs with their 95% confidence intervals were calculated and compared with published NNTs for CATIE (Phase 1).

The NNTs for all-cause discontinuation of olanzapine vs. each studied atypical antipsychotic during the 18 month following medication initiation in SOHO were comparable to CATIE: 4.3(95% CI: 3.6–5.3) for olanzapine vs. quetiapine (5.5 in CATIE); 16.1(11.0–28.1) for olanzapine vs. risperidone (10.1 in CATIE); 6.9(5.2–10.1) for olanzapine vs. oral typicals (9.0 in CATIE for olanzapine vs. perphenazine).

The NNTs for all-cause medication discontinuation based on CATIE appeared comparable to NNTs based on SOHO. The NNTs for olanzapine therapy were consistently better when compared to each studied atypical antipsychotic (except clozapine) and when compared to typical antipsychotics. Results should be interpreted conservatively, due to the observational design of SOHO.

There are lacking prospective studies in general population of adolescents about symptoms predicting the onset of first episode psychosis.

Members (N= 9,215) of the Northern Finland 1986 Birth Cohort, an unselected general population cohort, were invited to participate in a field survey during 2001, at ages of 15-16 years. The study included a 21-item PROD-screen questionnaire screening prodromal symptoms for psychosis for last six months (Heinimaa et al. 2003). PROD-screen included nine questions for positive and five questions for negative features. The Finnish Hospital Discharge Register was used to find out new cases of hospital treated mental disorders during 2002-2005.

Of the subjects 17 (0.3%) were treated due to first episode psychosis and 95 (1.5%) due to non-psychotic disorder during the follow-up period. Positive symptoms did not associate with the onset of psychosis, but negative symptoms did. 94% of subjects who got psychosis reported negative symptoms. Respective figure for those who were treated for non-psychotic disorder was 48%, and for those ‘healthy’ without psychiatric hospital treatment 46% (Fisher's exact test: psychosis vs. healthy p<0.001, psychosis vs. non-psychosis p<0.001, and non-psychosis vs. healthy p=0.61).

This study may be the only one exploring prospectively in general population features predicting onset of first episode psychosis. The findings emphasize the importance of negative symptoms in the development of neuropsychiatric disorder of first episode psychosis (Weinberger 1995).

The Academy of Finland, the Signe and Ane Gyllenberg Foundation, the Sigrid Juselius Foundation and the Thule Institute, Finland.

Subjects with family history of psychosis and with prodromal symptoms are at risk for schizophrenia. The aim was to study whether adolescents with familial risk have more commonly prodromal features.

Members (N= 9,215) of the Northern Finland 1986 Birth Cohort, an unselected general population cohort, were invited to participate in a field survey conducted during 2001-2002. At the ages of 15-16 years, the study included a 21-item PROD-screen questionnaire developed for screening prodromal psychotic symptoms with 12 specific questions for psychosis (Heinimaa et al. 2003). The scale measured symptoms for last six months. The Finnish Hospital Discharge Register was used to find out parental psychoses during 1972-2000.

Of the males 24% and 37% of the females were screen positives for prodromal features at the age of 15-16 years. Of the offspring, 1.8% had parents with psychosis. The prevalence of screen positives was 26% in males and 36% in females with familial risk for psychosis.

Prodromal features of psychosis are prevalent in adolescence. It may be difficult to screen adolescent subjects at risk for developing schizophrenia with a questionnaire in a general population, especially as these symptoms do not appear to be more common among subjects with familial risk.

The Academy of Finland, the National Institute of Mental Health, the Signe and Ane Gyllenberg Foundation and the Thule Institute, Finland.

There has been increasing interest in the association between childhood trauma and psychosis. Proposals for potential mechanisms involved include affective dysregulation and appraisals of threat, yet few large-scale clinical studies exist in affective psychosis.

We hypothesise that within bipolar disorder (BD), childhood events will show a significant association with psychosis, and in particular with symptoms driven by dysregulation of mood or with a persecutory content.

2019 participants were recruited as part of our programme of research into the genetic and non-genetic determinants of BD (www.bdrn.org). Data on lifetime ever presence of psychosis and specific psychotic symptoms were determined by detailed structured interview with case note review. Childhood events were recorded after self-report questionnaire and case note information.

There was no relationship between childhood events, or childhood abuse, and psychosis per se. Childhood events were not associated with increased risk of persecutory or other delusions. Significant associations were found between childhood abuse and auditory hallucinations, strongest between sexual abuse and mood congruent or abusive voices. These relationships remain significant after controlling for lifetime ever cannabis misuse.

Within affective disorder, the relationship between childhood events and psychosis appears to be relatively symptom-specific. It is possible that the pathways leading to psychotic symptoms differ, with delusions and non-hallucinatory symptoms being influenced less by childhood or early environmental experience.

1. Upthegrove R, Chard C, Jones, L, Gordon –Smith K, Forty L, Jones I and Craddock N. Adverse Childhood Events and Psychosis in Bipolar Affective Disorder. BJPsych In press BJP/2014/152611

The effects of long-term antipsychotic medication on cognition in schizophrenia are unclear (Husa A.P. et al., Schizophr. Res. 2014).

Understanding how long-term antipsychotic treatment affects cognition is crucial for the development of safe, evidence-based treatment of schizophrenia.

To analyse the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia at age 43 years in a general population sample.

Sixty (33 males) schizophrenia spectrum subjects from the Northern Finland Birth Cohort 1966 were assessed at age 43 years by California Verbal Learning Test, Visual Object Learning Test, Abstraction Inhibition and Working Memory task, Verbal fluency, Visual series, Vocabulary, Digit Span and Matrix reasoning. Cumulative lifetime antipsychotic dose-years were collected from treatment records and interviews. A factor analysis based on the cognitive tests resulted in one cognitive factor. The association between this cognitive composite score and antipsychotic dose-years was analysed by linear regression.

Higher lifetime antipsychotic dose-years were statistically significantly associated with poorer cognitive composite score at age 43 years (B=-0.32, p>0.001), also when adjusted for gender, onset age, remission and number of hospital treatment days (B=-0.42, p=0.008).

To our knowledge, this is the first report of an association between cumulative lifetime antipsychotic dose and cognition in midlife in schizophrenia. Based on this data, the use of high antipsychotic doses may relate to poorer cognitive functioning in schizophrenia after twenty years of illness. These results do not support the view that antipsychotics prevent cognitive decline or promote cognitive recovery in schizophrenia.

The perinatal period is a high-risk period for the development of illness episodes in women with bipolar disorder. Relapse rates vary between 9 and 75% depending on the study. The overall risk of a severe episode is approximately 20%. The impact on women, the relationships with their babies and their families can be devastating. In the UK costs to society are £8.1 billion per year-cohort of births. The advice currently given to women is based of general risk rates. Women's needs of information for decision-making in the perinatal period are not being met.

To review the risk prediction approaches used for women with bipolar disorder in the perinatal period.

To understand the existing risk prediction models and approaches used for prognosis of the risk of recurrence of bipolar disorder for women in the perinatal period.

Systematic literature search of public medical electronic databases and grey literature on risk prediction for bipolar episodes in the perinatal period.

We will present the existing models and approaches used for risk prediction of illness episodes in the perinatal period.

Awareness of existing risk prediction models for recurrence of bipolar disorder in the perinatal period will allow better informed risk-benefit analysis of treatment and management options.

This person-centred approach will help women and clinicians in their decision-making at this crucial high-risk period.

The authors have not supplied their declaration of competing interest.

Higher lifetime antipsychotic exposure has been associated with poorer cognition in schizophrenia. The cognitive effects of adjunctive psychiatric medications and lifetime trends of antipsychotic use remain largely unclear. We aimed to study how lifetime and current benzodiazepine and antidepressant medications, lifetime trends of antipsychotic use and antipsychotic polypharmacy are associated with cognitive performance in midlife schizophrenia.

Sixty participants with DSM-IV schizophrenia from the Northern Finland Birth Cohort 1966 were examined at 43 years of age with an extensive cognitive test battery. Cumulative lifetime and current use of psychiatric medications were collected from medical records and interviews. The associations between medication and principal component analysis-based cognitive composite score were analysed using linear regression.

Lifetime cumulative DDD years of benzodiazepine and antidepressant medications were not significantly associated with global cognition. Being without antipsychotic medication (for minimum 11 months) before the cognitive examination was associated with better cognitive performance (P = 0.007) and higher lifetime cumulative DDD years of antipsychotics with poorer cognition (P = 0.020), when adjusted for gender, onset age and lifetime hospital treatment days. Other lifetime trends of antipsychotic use, such as a long antipsychotic-free period earlier in the treatment history, and antipsychotic polypharmacy, were not significantly associated with cognition.

Based on these naturalistic data, low exposure to adjunctive benzodiazepine and antidepressant medications does not seem to affect cognition nor explain the possible negative effects of high dose long-term antipsychotic medication on cognition in schizophrenia.

Due to constant flow of people in and out of Europe several drugs are now days appearing in European markets that were previously unknown. There is a need to gain awareness and knowledge about these new substances and to recognize their use and learn about their effects and management.

Ayahuascais commonly called yagé is a traditional spiritual medicine in ceremonies among the Indigenous peoples of Amazonian Peru. It is undetected in urine or blood and therefore it is important to understand and ask about its usage during clinical assessment.

Thirty-six years old woman immigrant from South America came to us with auditory hallucinations. About three years ago she was introduced who introduced her to a community of Euto poeple that performed daily rituals of spiritual awareness involving the use of Ayahuasca. She became a part of it and started consuming Ayahuasca daily. She started becoming socially isolated accompanied by delusional and mystical religious ideations. She later began having persecutory delusions and auditory hallucinations that Archangels speak to her about how to create music. Patient was involuntary admitted in a mental health unit and started on risperidone. Gradually her condition improved and she stopped having auditory hallucinations. After being discharged from the hospital, patient was followed on an outpatient basis with injectable risperidone.

Due to the blend of different cultures in Europe, it is necessary to have a better understanding about the cultures, rituals and the substances that are relatively new and are currently been used.

The authors have not supplied their declaration of competing interest.

In the past six decades, extensive research has been done on family therapy from different areas of knowledge such as psychology, psychiatry and social work. Leading to development of different intervention techniques and optimal clinical evaluation with families.

The systemic perspective focus on the study of the dimensions that contribute to the stability and consistency of the members of the family system. The family is an interrelated system, dependent on each other, where there is an influence of the group over the individual, which is why each of its members plays a pivotal role in family therapy. Throughout all these years of evolution of systemic family therapy, many different concepts and techniques have been used, including the ones currently used today.

Knowing the evolution of the different techniques allows us to understand the functioning of families, for example, their links and the elements that constitute it: their roles, the functions performed by each member in the family, communication, standards and power relations.

The descriptive diagnosis of family ties, help us implement intervention strategies that could improve clinical care and diagnostic approach.

The authors have not supplied their declaration of competing interest.

Published rates of HIV infection among psychiatric patients are 3.1% to 23.9%, at least eight times higher than general population. (Nebhinan et al., 2013)

Defects in judgment and insight in patients with psychosis is often associated with lot of anger and impulsiveness, risky behavior and lower treatment adherence. This often led to worsening of clinical status and prognosis. (Uruchurtu, 2013)

A 31-year-old man diagnosed with schizophrenia and HIV four years ago. At the beginning of last year, the patient was hospitalized in the Acute Psychiatry Hospital Unit because of decompensation. Two years after diagnosis of HIV, he stopped taking his medications and was arrested several times because misdemeanours. Furthermore, patient was highly sexually active in the form of unprotected sex with multiple partners, as he had no concept of his disease. In addition to this, he made a delusional interpretation about HIV (known as VIH in Spanish) as Immortal human life (Vida Immortal Humana). He was admitted in the hospital for a month and was treated with medications and psychotherapy, which led to good stabilization, and he gained insight of both of his illnesses. At the moment, one year after this episode, the patient is stable, taking both medications regularly and followed up by his psychiatrist in the Mental Health team.

It is of extreme importance that psychotic patients with HIV receive a good follow-up during life, as decompensation can affect the patients’ health and health of others, with the implicit consequences that it carries. (Uruchurtu, 2013)

The authors have not supplied their declaration of competing interest.

Encopresis is a not very common disorder. The prevalence of this disorder is about 1.5% after the age of 5 years old and decreased even more as age increased, being very rare in adolescence.

Here we present a clinical case of an 11-year-old girl, with a diagnosis of functional encopresis with constipation and overflow incontinence for 4 years.

In this case, we followed a program consisted of 12 sessions combining different techniques that are on experimental phase. The program we designed consist of toilet training, stablishment-token economy- of a diet high in fiber with a progressive remove of laxative medication and a family intervention with both parents that got divorced 4 years ago.

Having both parents the same frame the patient's problem easily started to decrease. In follow-up (6 and 12 months), we observed good toilet habits and not constipations episodes.

Even though all the techniques used were in experimental phase, we considered that because of the chronicity of this problem a multidisciplinary approach was the best option.

The authors have not supplied their declaration of competing interest.