Catatonia is a complex psychomotor syndrome that can occur in a variety of psychiatric and medical conditions. Neuroleptic malignant syndrome (NMS) shares clinical features with catatonia, such as rigidity, mutism, altered consciousness, and fever, making differential diagnosis difficult. Distinguishing between the two is crucial, as management and prognosis differ significantly.

To present a complex clinical case with overlapping features of catatonia and NMS, highlighting diagnostic challenges and the importance of a multidisciplinary approach.

Descriptive analysis of a case admitted to a psychiatric inpatient unit, complemented by clinical evaluation, laboratory and imaging tests, and a review of the relevant literature.

A 62-year-old male with paranoid schizophrenia on long-term treatment with clozapine and paliperidone was admitted due to mutism, refusal to eat, generalized rigidity, and confusional syndrome. Given the suspicion of NMS, antipsychotics were discontinued, and benzodiazepines plus medical support were initiated.

During hospitalization, he did not develop fever or laboratory abnormalities compatible with NMS, and the clinical picture was reoriented toward catatonia. After complete withdrawal of antipsychotics, there was an abrupt reappearance of delusional symptoms with marked anguish, raising doubts about whether this was part of the confusional state or a new psychotic decompensation. Once laboratory tests normalized and no vital risk remained, the patient was transferred to the psychiatry ward, where paliperidone palmitate was progressively reintroduced, achieving clinical stabilization, partial remission of psychotic symptoms, and gradual improvement of rigidity and psychomotor inhibition.

This case illustrates how catatonia may closely mimic neuroleptic malignant syndrome, generating significant diagnostic uncertainty in patients on long-term antipsychotic treatment. In this situation, the absence of fever and relevant laboratory abnormalities was crucial to rule out NMS. The complete withdrawal of antipsychotics, although necessary during the acute phase, unmasked the patient’s underlying psychotic vulnerability, further complicating the clinical course. Ultimately, the gradual reintroduction of antipsychotic treatment facilitated partial remission of psychotic symptoms as well as progressive improvement of rigidity and psychomotor inhibition. These findings emphasize the importance of a flexible, stepwise, and multidisciplinary approach in managing such complex cases.

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Acromegaly results from chronic overproduction of growth hormone (GH), most frequently due to a pituitary adenoma. Symptoms arise from elevated hormone levels or the tumor’s mass effect itself, leading to acral tissue overgrowth and neurological or visual deficits. Neuropsychiatric symptoms are in a wide range and not well understood.

We describe an uncommon case in which psychosis developed in association with acromegaly caused by a GH-secreting pituitary macroadenoma. By presenting this case, we aim to discuss potential links between the two conditions and contribute to the understanding of this unusual clinical overlap.

A 45-year-old woman was admitted with psychotic symptoms concurrent with an acromegaly diagnosis. Comprehensive assessments included psychiatric evaluation using the Positive and Negative Syndrome Scale (PANSS), also brain and pituitary Magnetic Resonance Imaging (MRI), and laboratory tests. Psychosis was treated with antipsychotics. Endocrine therapy was also initiated in parallel with antipsychotics.

The patient exhibited anger, agitation, and aggression in the emergency service. Physical examination revealed prognathism, macroglossia, and coarse facial features typical of acromegaly. Psychiatrically, she showed disorganized thought and persecutory, referential, and somatic delusions, interpreting bodily changes delusionally. Her psychiatric symptoms began in her 30s, coinciding with the discovery of a headache and a pituitary mass. Over the years, she developed persistent delusions with mystical and persecutory themes and functional decline. The patient exhibited progressive decline in speech and cognitive functions. The MRI showed a 23x28x32 mm lobulated sellar mass, heterogeneously isointense on T1- and T2-weighted images, enhancing with contrast, consistent with a macroadenoma. The lesion invaded the cavernous sinuses, encased the internal carotid arteries, obliterated the suprasellar cistern, compressed the hypothalamus and optic chiasm, and displaced cerebral arteries. (image 1, image 2) Lab tests revealed elevated Insulin Like Growth Factor 1 (IGF-1) and GH levels.

Psychotic symptoms significantly improved following treatment with clozapine (300 mg/day), aripiprazole (30 mg/day), and lanreotide (90 mg monthly). This demonstrates the benefits of combining psychiatric and endocrinological treatment in cases of psychosis with pituitary adenoma.Image 1:Image 2:

While psychosis comorbid with acromegaly is rarely reported, a causal relationship remains unclear. Possible mechanisms include tumor-induced structural, functional, or hormonal brain changes. Case reports like this may provide insight into the neuropsychiatric impact of pituitary adenomas and highlight the need for multidisciplinary management.

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Childhood trauma is a major disruptor of attachment. In psychosis, insecure attachment worsens outcomes, but its link with trauma in first-episode psychosis (FEP) is less documented.

To explore associations between childhood maltreatment and attachment styles in stabilized FEP patients.

We studied 60 outpatients with FEP stabilized for at least 2 months. Childhood trauma was assessed with the Childhood Trauma Questionnaire–Short Form (CTQ-SF), which evaluates five domains of maltreatment: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Attachment was measured with the Experiences in Close Relationships–Revised (ECR-R), assessing two main dimensions—attachment anxiety and attachment avoidance—allowing classification into four attachment styles: secure, anxious, fearful, and dismissing. Symptom severity was evaluated with the Positive and Negative Syndrome Scale (PANSS).

The effects of childhood trauma on attachment showed significant results. The total CTQ score and its subscales—emotional abuse, physical abuse, sexual abuse, and physical neglect—were significantly and positively correlated with insecure attachment. The total CTQ score was significantly and positively correlated with attachment anxiety and attachment avoidance. Emotional abuse was correlated with attachment anxiety and fearful attachment. Physical abuse, physical neglect, and emotional neglect were correlated with attachment avoidance. Sexual abuse was significantly and positively correlated with dismissing attachment.

Childhood trauma is a robust predictor of insecure attachment in FEP, with differential effects depending on maltreatment type. These findings highlight the need for trauma-informed assessment and attachment-focused interventions in early psychosis care.

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Schizophrenia remains a major diagnostic challenge due to its clinical heterogeneity and the lack of objective biomarkers. Deep learning (DL), particularly convolutional neural networks (CNNs), enables automated detection of complex neurobiological patterns from neuroimaging data. This study systematically reviewed and meta-analyzed the diagnostic accuracy of CNN-based models applied to electroencephalography (EEG), functional magnetic resonance imaging (fMRI), and structural MRI (sMRI) for schizophrenia classification.

To quantify pooled sensitivity and specificity of CNN-based deep learning models for schizophrenia diagnosis across EEG, fMRI, and sMRI modalities, and to evaluate heterogeneity and methodological quality among studies.

A systematic search of six databases (Medline, Embase, Web of Science, Cochrane Central, PsycInfo, Scopus) was conducted in July 2024, following PRISMA 2020 guidelines (PROSPERO: CRD42024550691). Eligible studies applied CNN architectures to adult schizophrenia cohorts diagnosed per DSM or ICD criteria, reporting diagnostic accuracy metrics. Two reviewers independently extracted data and assessed quality using a modified QUADAS-2 tool tailored for AI/ML studies. Random-effects meta-analyses were performed to pool sensitivity and specificity; summary receiver operating characteristic (SROC) curves were generated for each modality.

Thirty-five studies (n≈13,100 participants) met inclusion criteria. CNN models achieved a pooled sensitivity of 0.90 [95% CI 0.85–0.94] and specificity of 0.90 [0.84–0.93]. EEG-based models reached the highest AUC (0.94) (Figure 1), followed by sMRI (0.91) (Figure 2) and fMRI (0.88) (Figure 3). Multimodal models combining imaging types outperformed unimodal approaches (AUC > 0.95). Moderate heterogeneity (I²≈40%) was observed across studies.Image 1:Image 2:

CNN-based deep learning models show strong potential to assist schizophrenia diagnosis through neuroimaging and EEG data, achieving accuracies comparable to established clinical biomarkers. Standardization of preprocessing pipelines, external validation, and incorporation of explainable AI techniques are crucial to advance clinical translation.

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Following the development of criteria for symptomatic remission, researchers are now focusing on the social and occupational functioning of individuals with schizophrenia.

This study aimed to assess the prevalence of functional remission and to identify its predictors in patients with schizophrenia.

We conducted a cross-sectional, retrospective and descriptive study in the psychiatry department “G”, in Razi hospital (Tunis), between October 2023 and March 2024. Sixty patients suffering from schizophrenia were included. Functional status was explored with the global assessment of functioning scale (GAF), the social and occupational functioning assessment scale (SOFAS) and the social autonomy scale (SAS). Symptomatic remission was defined according to the remission in schizophrenia working group (RSWG) criteria. All participants were assessed with the positive and negative syndrom Scale (PANSS), the Calgary depression scale in schizophrenia (CDSS), the Birchwood insight scale (BIS), the Simpson and Angus extrapyramidal side effects scale, the mini mental state exam (MMSE), the frontal assessment battery (FAB) and the clock test.

Rates of functional remission were respectively: 63.3% at the GAF scale, 48.3% at the SOFAS and 51.7% at the SAS. Predictors of functional status were: duration of untreated psychosis, schizophrenia subtype, negative symptoms, symptomatic remission, depression and employment status. Executive functions and verbal fluency were also among predictors of functional remission.

Our results confirm the disabling nature of schizophrenia, yet they draw attention to the complexity of the functional remission dimension as well as the possibility of social and professional reintegration with the disease.

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Negative and stress-related symptom domains in schizophrenia often respond suboptimally to antipsychotics. Standardized Withania somnifera root extracts show anti-inflammatory and stress-modulating activity in preclinical work and are being evaluated as adjunctive therapy.

To synthesize clinical efficacy and safety signals for WSE in schizophrenia and outline practical guardrails and research priorities.

We conducted a narrative synthesis (PubMed, Scopus, Web of Science) of 56 publications (2012–Sept 2025). Selection criteria included randomized controlled trials (RCTs) in schizophrenia with PANSS assessments, as well as publications that examined mitochondrial endpoints (mtDNA, ATP, oxygen consumption/OXPHOS) and/or pathway markers (BDNF, SIRT1). Exclusion criteria were brand names, non-standardized blends, and non-English full texts.

We found only one 12-week, double-blind RCT (n=66) in which a standardized Withania somnifera root extract (1,000 mg/day) was added to stable antipsychotics during symptom exacerbation. Compared with placebo, the extract produced greater reductions in negative, general, and total PANSS scores, with no effect on positive symptoms. Inflammatory markers showed no between-group differences. Fewer participants required antipsychotic dose escalation. Tolerability was generally good, with mostly mild, transient gastrointestinal symptoms and somnolence; weight, vital signs, and laboratory values remained stable. Post-marketing reports describe rare idiosyncratic liver injury—typically cholestatic or mixed—with onset at approximately 2–12 weeks and recovery after discontinuation, as well as occasional thyroid-index shifts. No major drug–drug interactions are established. Use is not recommended during pregnancy or lactation.

Preliminary evidence suggests that adjunctive WSE may improve negative and general symptom domains and reduce perceived stress in schizophrenia, without affecting positive symptoms. Preclinical data indicate that standardized root-only W. somnifera may enhance neuronal mitochondrial biogenesis and energetics via BDNF/TrkB/Akt and SIRT1 pathways (e.g., withanolide A, withanoside IV), consistent with stress–mitochondria phenotypes in psychosis. These findings remain exploratory, and WSE should not be used as monotherapy. Replication in adequately powered, multicenter RCTs with standardized extracts, biomarker panels, and prospective safety monitoring is required before clinical recommendations can be made.

schizophrenia, PANSS, adjunctive therapy, Withania somnifera, mitochondrial effects, pregnancy, lactation

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Validated blood biomarkers for schizophrenia remain unavailable. Circulating exosomes (extracellular vesicles, EVs) carrying microRNAs and proteins provide measurable signals. In first-episode psychosis, microRNA panels show high diagnostic accuracy (sensitivity 76–96%, specificity 78–96%, AUC up to 0.94). Brain-derived exosomes reveal disrupted signalling and mitochondrial dysfunction correlating with symptoms. Clinical studies suggest exosomes are promising biomarkers for early diagnosis, therapy monitoring, and pathogenetic research.

To summarize diagnostic characteristics (sensitivity [Se], specificity [Sp], AUC) of exosomal biomarkers in schizophrenia, quantitatively assess their performance, and examine Se–Sp relationships.

Due to scarce randomized clinical trials (RCTs) and limited Se/Sp data, all peer-reviewed studies (2019–2024) were included regardless of design (case–control, cross-sectional, cohort, including three RCTs). Criteria: (1) schizophrenia patients with healthy or clinical comparators; (2) reported Se/Sp and/or AUC. Descriptive statistics (medians/ranges), linear regression (Sp on Se), and Pearson correlation (95% CI) were performed. Between-test differences were assessed with ANOVA, Levene’s test, and Shapiro–Wilk. No individual data were pooled.

Across 12 studies, median Se was 85.35% (range 64.9–100), Sp 86.50% (60.2–100), and AUC 90.25% (66.1–100). Se correlated positively with Sp (r = 0.76, 95% CI 0.34–0.93, p < 0.01); regression slope β = 0.81 (p = 0.004), R² = 0.59. Between-test differences were nonsignificant (ANOVA F = 0.63, p = 0.538). An 11-miRNA exosomal signature achieved AUC 0.94 (95% CI 0.88–1.00) in training and 0.753 (0.61–0.90) in testing. Complement-enriched exosomal proteins (C3, C4, C4BPA, PROS1) discriminated schizophrenia from controls (AUC 0.895) and from bipolar disorder (0.966). Multicenter data support generalizability.

Exosomal biomarkers demonstrate high diagnostic performance (AUC ≈ 0.90; Se/Sp ≈ 85–87%) with consistent Se–Sp association. Panels combining miRNAs and complement proteins are especially promising. Limitations include design heterogeneity and few RCTs. Harmonized EV protocols, blinded multicenter validation, and studies of treatment-response prediction are needed.

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Research indicates that the prevalence of vitamin D deficiency is higher among individuals with schizophrenia compared to the general population. Recent studies suggest that vitamin D deficiency is associated with an increased risk of various chronic diseases—including type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease—which are already highly prevalent in patients with schizophrenia. Vitamin D has also been inconclusively linked to cognitive impairment in this population, as well as to the severity of schizophrenia symptoms.

To examine the effect of vitamin D supplementation on cognitive function, positive and negative symptoms, and glucose and triglyceride levels in patients diagnosed with schizophrenia or schizoaffective disorder.

We will include 40 female outpatients aged 18–65 years with diagnoses of schizophrenia or schizoaffective disorder. Assessments will include sociodemographic data (age, education level, body mass index, smoking, tea and coffee consumption, sun exposure, daily activity level, and diet); the Brief Assessment of Cognition in Schizophrenia (BACS) to evaluate cognitive functioning; the Positive and Negative Syndrome Scale (PANSS) to assess psychiatric symptoms; and laboratory measures of glucose and triglycerides. Data will be collected at baseline and after 12 weeks of supplementation. Patients will receive weekly oral vitamin D drops (25,000 IU).

We will analyze differences in outcome measures before and after supplementation.

Vitamin D levels should be routinely monitored in patients diagnosed with psychotic disorders. Addressing vitamin D insufficiency through supplementation may be a cost-effective and clinically beneficial strategy.

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The prevalence of nicotine smoking in schizophrenia patients is 2-3 times higher than in the general population. As high as 45-80% of schizophrenia patients smoke. Although the number of smokers has decreased in many European countries in the last decade, the number of smokers with schizophrenia remains stationary. Smoking is associated with higher mortality and morbidity. Patients with schizophrenia make few attempts to quit smoking and are less aware of the risks of smoking. The reasons for smoking in schizophrenia patients are various, from genetic predisposition to self-medication to reduce the side effects of medication, and also, social factors can play a role. Nicotine can improve cognitive performance in the short term by acting on nicotinic receptors in the brain. Long-term smoking can negatively affect cognitive performance.

The presented study aimed to evaluate the cognitive performance of smokers and non-smokers with a diagnosis of schizophrenia, divided by duration of illness /smoking.

To assess cognitive functions, we used the MCCB (MATRICS Consensus Cognitive Battery), excluding the social cognition domain. To estimate premorbide intellectual capacity NART (National Adult Reading Test) was used. Basic sociodemographic characteristics (age, gender, and education) and information on the duration of illness were also gathered.

A Sample of 184 patients with schizophrenia was divided into two groups according to smoking status. We included 102 smokers (age: 34 ± 10 years, 19% female) and 82 non-smokers (age: 35 ± 10 years, 18% female). 31% of the sample had a FES (first episode of schizophrenia; first two years of clearly expressed symptoms of schizophrenia), 69% longer-term course of the illness. Non-smokers have higher levels of education and NART in comparison with smokers. FES smokers have similar and, in some domains, even better results in MCCB cognitive testing compared to FES non-smokers. Longer course schizophrenia patients - smokers had significantly worse results in MCCB in comparison with FES smokers, and also non-smokers.

Chronic smoking has a clearly negative effect on health, including mental health and cognitive performance of patients with schizophrenia. Treatment of schizophrenia should also include education about the risk of nicotine smoking and motivation for smoking cessation.

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Individuals with psychosis experience markedly reduced life expectancy and a high burden of cardiometabolic comorbidities. Multiple risk factors for type 2 diabetes (T2D) accumulate in people with psychosis. Despite this high burden, real-world data on T2D management and outcomes among people with psychosis remain limited, underscoring the need for integrated approaches that address both psychiatric and metabolic health.

Aim of the study was to compare baseline cardiometabolic profiles, treatment balance and mortality between those with psychosis and T2D and those with T2D alone.

We identified individuals younger than 60 years with type 2 diabetes (T2D) from the Finnish diabetes register who were also recorded in the psychosis care quality register. The diabetes register includes all Finnish residents who were alive and had a documented diabetes diagnosis in or after 2018. We compared T2D treatment balance and all-cause mortality between those who developed T2D after a prior diagnosis of a psychotic disorder and those with T2D only, with follow-up through the end of 2023.

Table 1 shows the baseline characteristics of the study population. Overall, the psychosis plus diabetes group demonstrated a more favorable cardiometabolic profile at baseline. Individuals with a history of psychosis prior to diabetes diagnosis had a significantly increased risk of mortality compared to individuals without prior psychosis (Table 2, Figure 1). In the Cox proportional hazards model, prior psychosis was associated with more than a two-fold increase in the hazard of death (HR = 2.08, 95% CI 1.90–2.27, p < 0.001). Older age and high clinical risk status were also associated with elevated mortality risk, whereas female sex was associated with lower mortality.Table 1.

Baseline characteristics of the study population

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In this nationwide cohort, individuals with psychosis and type 2 diabetes exhibited lower HbA1c and LDL levels at baseline compared with those with T2D alone, suggesting better glycemic and lipid treatment balance in the psychosis group. Despite the superior cardiometabolic markers, prior psychosis was associated with a increased risk of all-cause mortality.

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Clozapine is an atypical antipsychotic with a unique side effect profile, including serious adverse events such as agranulocytosis, seizures, myocarditis, and pericarditis. Although rare, pericardial effusion has also been reported and may pose a life-threatening risk.

To highlight pericardial effusion as a rare but significant adverse effect of clozapine and to monitor its clinical course.

A case of clozapine-induced pericardial effusion in a patient with treatment-resistant schizophrenia is presented.

The patient was admitted to the psychiatry ward with depressive symptoms, impaired self-care, social withdrawal, and grandiose and persecutory delusions. She had a thirty-year history of treatment-resistant schizophrenia and had been hospitalized five times, having received paliperidone, olanzapine, aripiprazole, and clozapine. At admission, she was not receiving psychiatric treatment and had no history of systemic illness.

During hospitalization, paliperidone and haloperidol were initiated but were ineffective and caused extrapyramidal symptoms. The patient was re-evaluated and clozapine was gradually titrated. At a dose of 100 mg/day, she developed tachycardia (110-120 beats per minute) and orthostatic hypotension, though remained afebrile. Laboratory tests, including complete blood count, biochemical markers, cardiac enzymes, and electrocardiography, were normal except for tachycardia, and no infectious focus was identified.

Before clozapine initiation, she had undergone abdominal ultrasonography for nausea, vomiting, and right upper quadrant pain. Magnetic resonance cholangiopancreatography revealed incidental bilateral pleural effusion. Pulmonology consultation was obtained, and computed tomography pulmonary angiography demonstrated pericardial effusion. Transthoracic echocardiography confirmed a 2 mm pericardial effusion adjacent to the right ventricle, without hemodynamic compromise.

Clozapine was titrated to 200 mg/day per treatment guidelines. In the absence of prior cardiac pathology, a drug-induced cause was suspected. Cardiology advised daily monitoring with electrocardiography, troponin, acute phase reactants and follow-up transthoracic echocardiography. Despite clinical stability, the effusion persisted and gradual discontinuation of clozapine was considered.

Pericardial effusion is a rare but potentially serious complication of clozapine. Early detection and multidisciplinary care are vital. This case underlines the importance of cardiac monitoring during clozapine treatment, particularly when unexplained cardiac symptoms occur.

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The lifespan of patients with schizophrenia is significantly shorter compared to the general population. One of the reasons is the high prevalence of metabolic syndrome in this group. Treatment with neuroleptics reduces levels of dopamine, the main neurotransmitter in the reward system. Researchers have explored links between obesity, anhedonia, and the severity of clinical symptoms of schizophrenia.

To assess the relationship between obesity and the level of anhedonia and self-assessment of mental state in patients with schizophrenia.

Anthropomorphic assessment (height, weight, waist circumference, blood pressure) was performed in two groups of patients with schizophrenia:those with normal weight: BMI < 25 (n=22) and those with obesity: BMI > 30 (n=21).

Patients completed scales assessing the level of anhedonia (SHAPS) and the Severity of Schizophrenia Symptoms Scale (FBS).

Statistical analysis was performed.

The distribution of the presented data was determined to be different from normal in the Shapiro-Wilk test performed, which had a power (alpha) of 5%, with a p-value of <0.05. Therefore, the purpose of the analysis of variables was to use the non-parametric Mann-Whitney U test, resulting in values: p=0.048.

The relationship between normal BMI and BMI in the obesity range and the number of points on the SHAPS scale is statistically significant (Graph 1).

The distribution of the presented data was determined to be different from normal in the Shapiro-Wilk test performed, which had a power (alpha) of 5%, with a p-value of <0.05. Therefore, the purpose of the analysis of variables was to use the non-parametric Mann-Whitney U test, resulting in values: p=0.771.The relationship between normal BMI and BMI in the obesity range and the number of points on the FBS scale is not statistically significant (Graph 2). Conclusion drawn from the analysis:Image 1:

Patients with obesity exhibit a greater number of symptoms of anhedonia compared to patients with normal body weight.

Patients with obesity do not exhibit a greater number of symptoms on the FBS scale compared to patients with normal body weight.

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Metabolic disturbances are common in patients with schizophrenia and are increasingly linked to immune dysregulation. Cytokines such as interleukin-10 (IL-10), an anti-inflammatory mediator, may serve as biomarkers reflecting the interplay between inflammation and metabolic imbalance. Previous studies have shown inconsistent results regarding cytokine profiles in schizophrenia, but recent evidence suggests that IL-10 expression may increase in states of insulin resistance and dyslipidemia (Kamei et al. Genes 2022; 13(2):294).

Metabolic disturbances are common in patients with schizophrenia and are increasingly linked to immune dysregulation. Cytokines such as interleukin-10 (IL-10), an anti-inflammatory mediator, may serve as biomarkers reflecting the interplay between inflammation and metabolic imbalance. Previous studies have shown inconsistent results regarding cytokine profiles in schizophrenia, but recent evidence suggests that IL-10 expression may increase in states of insulin resistance and dyslipidemia (Kamei et al. Genes 2022; 13(2):294).

This study aimed to assess the relationship between pro- and anti-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α) and metabolic indicators (glucose, total cholesterol, triglycerides, insulin, HOMA-IR) in patients with schizophrenia.

A cross-sectional analysis was conducted among 21 adult patients (mean age 31.4 ± 9.2 years; 12 males, 9 females) diagnosed with schizophrenia according to ICD-10 criteria. Blood samples were analyzed for cytokines (IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α) using immunoassay techniques. Metabolic parameters (glucose, total cholesterol, triglycerides, insulin, HOMA-IR) were determined with standard biochemical methods. Pearson’s correlation coefficients were used to assess associations between cytokines and metabolic measures (significance level p < 0.05).

Significant positive correlations were found between IL-10 and lipid parameters: total cholesterol (r = 0.47, p = 0.036) and triglycerides (r = 0.73, p < 0.001). No significant associations were observed between IL-10 and glucose, insulin, or HOMA-IR. Other cytokines (IL-1β, IL-6, IL-8, IL-12, TNF-α) showed no significant correlations with metabolic markers.

In this cross-sectional study of patients with schizophrenia, IL-10 demonstrated a positive association with dyslipidemia, while other cytokines showed no significant metabolic relationships. These findings suggest that IL-10 may act as an immuno-metabolic biomarker, reflecting compensatory anti-inflammatory activity in response to metabolic stress. The results align with previous reports linking IL-10 up-regulation to lipid abnormalities in insulin-resistant states (Tarkowski et al. Front Psychiatry 2021; 12:536257; Chen et al. BMC Psychiatry 2024; 24:6054).

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The identification of psychotic symptoms in individuals with Autism Spectrum Disorder (ASD) poses a substantial clinical challenge. Symptom overlap between ASD and psychosis, combined with diagnostic overshadowing, where comorbidities are incorrectly attributed to autism, complicates early detection and intervention. Research has increasingly focused on the nuances of differentiating these conditions to improve clinical outcomes.

This narrative review aims to (1) explore the difficulties in recognizing psychotic symptoms in individuals with ASD, (2) examine factors contributing to diagnostic overshadowing, and (3) summarize current recommendations for improving differential diagnosis and clinical assessment.

Evidence-based review, through research conducted on PubMed and selection of the most relevant studies on this topic, published in the last decade.

Findings indicate that social deficits, restrictive behavioral patterns, and unusual beliefs characteristic of ASD can mimic or mask psychotic symptoms. Traditional psychosis risk assessment tools often have reduced sensitivity in autistic populations, which may delay recognition and treatment. Diagnostic overshadowing remains a persistent barrier, emphasizing the need for clinician awareness and specialized training. Literature highlights the importance of integrating multiple assessment strategies, including clinical interviews adapted for ASD, caregiver input, and longitudinal monitoring, to improve diagnostic accuracy. Communication deficits, alexithymia, and reduced insight complicate self-report reliability, while clinicians’ biases may lead to both over- and under-diagnosis of psychosis in ASD.

Accurate identification of psychotic symptoms in individuals with ASD requires a nuanced understanding of overlapping behaviors, specialized assessment tools, and increased clinical vigilance. Tailoring evaluation strategies and training clinicians can facilitate differential diagnosis, prevent treatment delays, and improve patient outcomes.

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In the following study, we will try and evaluate the efficiency of Brexpiprazol in treating psychotic symptoms in ten patients with ages between 18-70 years old. We have researched and concluded there is scientific evidence that supports the use of Brexpiprazol to treat psychotic symptoms.

Our aim in this study is to try and evaluate the efficacy of Brexpiprazol (2-4mg) in treating psychotic symptoms and possible side effects. We have evaluated ten patients who have been taking brespiprazol and then evaluated with a Psychotic Symptom Rating Scales (PSYRATS), before and after two months of taking Brexpiprazol to try and see if it was effective for treating these symptoms. Meanwhile if any side effects were reported, they would be recorded (Drake, 2007)

We will evaluate ten patients between the ages of eighteen and sixty-five before and after starting pharmacological treatment with brexpiprazole. At the beginning of treatment, we will use the PSYRATS scale to evaluate positive symptoms, like hallucinations and delusions. After two months, we will re-apply the scale to assess whether there has been remission of these symptoms.

We have evaluated 10 patients, five woman and five men, and we have introduced Brexpiprazol either 2mg, or 4mg in two doses, and evaluated their psychotic symptoms before using this drug and after two months of continuisly taking it. All ten patients had a significant decrease in their auditory hallucination scores, including duration, level of distress, and intensity.

The four patients that along with hallucinations had also delusions, their preoccupation and the intensity of which had decreased

and their life disruption had improved.

In total, there was a decrease of more that 50% of the total puntuation in PSYRATS within the ten evaluated patients. The reported side effects that subsided around the second week were drowsiness and sweating.Image 1:

In conclusion, in these ten patients who were treated with this drug at doses between 2 mg and 4 mg, we can affirm that what was observed was a decrease in hallucinations as well as delusions in those patients who maintained treatment for at least two months.It would be very interesting to be able to evaluate these patients after six months and one year, to be able to assess whether there continue to be a decrease of said symptoms as well as if there are any other side effects to be reported.

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People with schizophrenia have poorer physical health than the general population due to poor diet, lack of physical activities, and high rates of obesity. This population has been reported to have lower quality of life across physical, psychological, and social health. Furthermore, these patients have a higher prevalence of smoking and lower quit rates when compared to general populations. Although smoking increases the risk of cardiovascular events, which are associated with an increased risk of premature death, limited research has compared cardiovascular risk and quality of life across different smoking statuses.

This study aimed to determine demographic and clinical differences in schizophrenia patients, including cardiovascular risks and health-related quality of life, by smoking status.

Baseline data were extracted from a longitudinal study. The primary objective of the study was to investigate the effects of different smoking cessation therapies using fMRI. Between 2022-2024, participants were recruited from local ICCMW centers and psychiatric outpatient clinics in Hong Kong. All participants were patients diagnosed with schizophrenia for more than one year and stable on medication. Smokers were required to agree to quit smoking and not have other substance use disorders. Participants were divided into two groups based on smoking status: never smokers and ever smokers (current and former). Information about cardiovascular risks (including BMI, body fat percentage, blood pressure, blood oxygen saturation, carbon monoxide level, clinical history) was collected. The EQ-5D5L was used to measure quality of life. To identify possible predictors for non-participation, a multivariate regression model was used.

There are 55 never smokers (57.9%) and 40 ever smokers (42.1%) included in the study (N = 95). Significant demographic difference was found in gender (p = 0.022), marital status (p = 0.020), education attainment (p = 0.002), and type of housing (p = 0.002). In terms of clinical differences, BMI and CO level were significantly different between the two groups, with p = 0.022 and p = 0.002 respectively. No significant correlation was found for other indicators, including body fat percentage, systolic blood pressure, diastolic blood pressure, blood oxygen saturation, history of high cholesterol, hypertension, diabetes, and quality of life. After regression analysis in participants and non-participants, the adjusted odds ratios for education level, employment status, and type of housing were 1.63 [95% CI: 0.747-3.559], 2904617146.5 [0], and 0.377 [0.178-0.802] respectively.

The results show that ever-smoking individuals with schizophrenia may have higher cardiovascular risks in some areas. These results should be interpreted with caution due to sampling and self-reporting biases.

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Psychotic symptoms occurring in the context of severe hypothyroidism, contemporarily referred to as myxedema psychosis (MP), have been described in numerous case reports. To date, no systematic primary research studies have been conducted to characterize MP within psychiatric inpatient populations.

We aimed to identify cases of MP using administrative data, determine its prevalence among first psychiatric admissions for psychosis, examine outcomes including risk of readmission, and explore the effect of antipsychotic treatment.

We conducted a retrospective cohort analysis, using provincial administrative databases, of patients admitted for first-presentation psychosis between January 1, 2012, and March 31, 2022. Cases of MP were defined by elevated thyroid-stimulating hormone (TSH) at admission across thresholds of ≥40, ≥60, and ≥80 mIU/L, with analyses repeated excluding patients ≥60 years of age. Patients with a first psychiatric admission with psychosis and normal TSH were used as controls. Cox proportional hazards models were used to compare hazards of readmission. Within the MP cohort, we examined the association of antipsychotic treatment with readmission risk.

The results of survival analyses using different TSH thresholds (with or without an age threshold) are shown in Table 1. At a TSH threshold of ≥60 mIU/L and age <60, MP cases had a significantly reduced hazard of readmission compared with controls. Using this threshold, we identified 28 MP cases, representing a prevalence of 0.12% of first psychiatric admissions for psychosis. Within the MP group, 13 of 28 patients were prescribed antipsychotics three months post-discharge. A non-significant trend was observed suggesting that antipsychotic use was associated with reduced readmission rates.Table 1.

Cox models of psychosis group with TSH and age conditions.

This study represents the first systematic characterization of MP within a psychiatric inpatient population. Our analysis suggested that there is a significant difference in 12-month readmission rates for cases of potential MP compared to matched controls when using criteria of TSH ≥ 60 mIU/L and age < 60. Our findings support preliminary criteria for defining MP and suggest that antipsychotics may help protect against readmission in these cases. Further research is needed to validate diagnostic thresholds and clarify optimal management strategies.

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Negative symptoms (NS) in schizophrenia are associated with the chronicity of the pathological process, its unfavorable course, a small proportion of individuals who achieve remission and a low level of social functioning.

To study NS in schizophrenia at different stages of the pathological process (first episode of schizophrenia, exacerbation and remission).

The research methods included the use of clinical and psychopathological, psychometric methods (PANSS, SANS, SAPS, AES-C, PSP) and statistical methods for processing the obtained data.

The study was based on the examination of 331 patients diagnosed with schizophrenia (252 patients with a predominant clinical picture of NS, 79 patients with a predominant positive symptoms). Among patients with NS, 83 were included in the first episode group, 88 patients in the exacerbation group, and 81 patients in the remission group. Typical patterns of NS dynamics in schizophrenia were identified, which reflect the sequence of development of clinical manifestations at different stages of the disease and are important for predicting the course and building individualized rehabilitation strategies. In the first episode of schizophrenia, such manifestations as emotional flattening (71.4%, DC=7.84, MI=1.17, p<0.01), decreased initiative (74.2%, DC=7.89, MI=1.18, p<0.01) and general passivity dominated, which were partially reversible, in a number of cases masked by affective disorders. In the acute stage, there was an increase in the severity of abulia (64.9%, DC=6.98, MI=1.02, p<0.01), anhedonia and speech inhibition, reactivity to external stimuli decreased, patients became less involved in interpersonal interaction. In the remission stage, generalization of motivational deficit (82.1%, DC=8.83, MI=1.25, p<0.01), prevalence of apathetic-abulic syndrome, deepening of cognitive inertness (when compared with the first episode of schizophrenia) was noted.

It was determined that NS is not a static phenomenon, but has a certain clinical dynamic, within which individual structural components of NS change their intensity, clinical and prognostic significance.

None Declared

Chronic physical illnesses (CPIs) are common in severe mental disorders (SMD) and may shape psychiatric trajectories, yet heterogeneity across multimorbidity patterns is rarely modelled explicitly. We used latent profile analysis (LPA) to identify CPI profiles and examined their association with treatment outcomes.

To derive CPI-based latent profiles in SMD and compare psychiatric rehospitalisations and related outcomes across profiles.

We conducted a retrospective cohort study on 605 patients with SMD. Eighteen binary CPI indicators (European Health Interview Survey) were analysed. Principal component analysis on tetrachoric correlations yielded five CPI components (musculoskeletal; cardiovascular; respiratory–metabolic; metabolic/general health; cerebrovascular). LPA was then fitted to these component scores, comparing four variance–covariance structures and 1–8 classes. The optimal solution was chosen using information criteria, entropy and clinical interpretability. Profiles were compared on the number of rehospitalisations for relapse (primary endpoint) using robust MM-estimation, adjusting for age, sex, education, household income, disorder duration, number of other psychiatric diagnoses, and treatment with antipsychotics, benzodiazepines, mood stabilisers and antidepressants.

We included 605 patients: 326 schizophrenia-spectrum, 223 recurrent major depressive disorder (moderate–severe) and 56 bipolar affective disorder. A four-profile solution provided the best fit and clinical coherence: (1) healthiest/low multimorbidity (mean 1.1 CPI); (2) cerebrovascular–metabolic (2.5 CPI); (3) cardiometabolic–musculoskeletal (3.8 CPI); (4) high-burden musculoskeletal/general health with multiple comorbidities (5.1 CPI). Rehospitalisations differed across profiles: the highest burden occurred in Profile 3, Profiles 1 and 4 showed lower counts, with Profile 2 intermediate; patterns persisted after covariate adjustment.

LPA identified clinically distinct multimorbidity profiles in SMD that were differentially associated with psychiatric rehospitalisations for relapse. Patients with combined cardiometabolic–musculoskeletal burden had the poorest course, whereas low-burden and concentrated high-risk profiles fared better. CPI profiling may support risk stratification and tailored integrated somatic–psychiatric care and inform service planning.

None Declared

The differential diagnosis between conversion disorders and psychotic episodes can present a significant clinical challenge. Both conditions may share striking symptoms such as mutism, immobility, altered states of consciousness, and bizarre behavior, which can lead to diagnostic confusion—especially in emergency settings.

This case study aims to analyze the atypical clinical presentation of conversive symptoms in a patient in the emergency room.

A review of the literature on conversive symptomatology which may occur in psychosis.

A 50-year-old woman with a psychiatric history since age 16, including multiple episodes with psychotic and conversive features—four requiring hospitalization. Her relatives report previous diagnoses of schizophrenia and bipolar disorder, but no records are available due to her international relocation. She is taking quetiapine 50 mg and oxcarbazepine 300 mg.

She arrives at the emergency room with her husband due to mutism. Organic causes are ruled out. On examination: mutism, perplexed gaze, failure to follow commands, and oppositional rigidity that varies and decreases with distraction. She imitates guided movements without difficulty; Hoover’s sign is positive. A conversion disorder is suspected. Diazepam 15 mg and lorazepam 2 mg are administered.

Her husband reports increased anxiety, insomnia, mutism, and immobility over the past week, alternating with periods of normal behavior. Two weeks prior, she became distressed about returning to work. He states that similar episodes have occurred under stress and resolved within days with benzodiazepines.

After 24 hours, she is able to speak and move, but appears confused, with no memory of the episode. She describes a sense of strangeness, makes interpretive remarks, and shows loose associations. Speech is vague and poorly structured. She is admitted and started on olanzapine 10 mg and amisulpride 800 mg.

This clinical case illustrates an acute presentation initially characterized by mutism and immobility, compatible with a possible conversion disorder. However, the partial response to benzodiazepines and the subsequent emergence of psychotic symptoms suggest a different or more complex etiology.

One possibility is a psychotic episode with pseudoconversion symptoms—behaviors that mimic a conversion disorder but are actually expressions of disrupted thought processes. Another potential diagnosis is a brief psychotic disorder with catatonic features. Additionally, a polymorphic acute psychotic disorder (as defined in ICD-10) could explain the abrupt onset, symptom fluctuations throughout the day, and the presence of atypical features.

This is a diagnostically challenging case in the emergency setting, due to its atypical presentation and lack of information regarding the patient’s psychiatric history. Access to her medical records and longitudinal observation would be essential for reaching a clearer diagnostic conclusion.

None Declared