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Introduction: The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. In particular, baseline AP exposure in CHR-P individuals may be considered as a functional equivalent of the psychometric transition to psychosis, as already postulated in the original 'Ultra High-Risk' model. Objectives: The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period. Methods: This research was settled within the 'Parma At-Risk Mental States' program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. The acquisition of drug and outcome information was collected both at baseline and across the follow-up period. Finally, logistic regression analyses with dichotomized 1-year outcome parameters (previously showing statistically significant differences in inter-group comparisons) as dependent measures and sociodemographic and clinical characteristics as independent variables were also performed. Results: Hundred and seventy-eight CHR-P individuals (aged 12–25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS 'Positive Symptoms' and 'Negative Symptoms' factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals. Conclusions: The current study suggests that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a realworld clinical setting indicate that the rate of CHR-P individuals who were already exposed to AP at the time of CHR-P status ascription was higher than those reported in recent meta-analyses on this topic. Moreover, our findings confirm that baseline AP prescription appears to increase psychotic transition risk. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Depression is common in schizophrenia and is correlated with suicide risk and poor long-term outcomes. However, the presence of depressive symptoms is often underestimated in both research and treatment, particularly at the illness onset. Objectives: The goals of this study were: (a) to longitudinally observe anxious-depressive symptom levels in patients with First Episode Schizophrenia (FES) during a 24 months of follow-up period, and (b) to examine their associations with other psychopathology and the intervention patients received in an "Early Intervention in Psychosis" (EIP) program during the follow-up period. Methods: The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 159 FES patients both at baseline and across the follow-up. Data were analyzed by linear regression analysis and Spearman's coefficients. Results: Anxious-depressive symptoms had significant longitudinal associations with GAF deterioration and PANSS "Positive Symptoms", "Negative Symptoms" and "Disorganization" subscores. During the follow-up period, FES participants significantly improved the level of anxious-depressive symptoms. This was significantly associated with the number of case management and individual psychotherapy meetings the patient engaged in, as well as with lower antipsychotic doses prescribed during the follow-up period. Conclusions: In conclusion, anxious-depressive symptoms are prominent in FES and at the initial entry into EIP programs. Anxious-depressive symptom severity tends to diminish overtime, especially with the provision of specialized EIP treatments. However, since we did not have a control population studied in parallel, we cannot say whether these results are specific to the protocols of EIP programs or just to the intensity of engagement in care. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Hedonic deficits have been extensively studied in schizophrenia, but little is known about their association with suicidal ideation in early psychosis. Along the clinical staging of psychosis, also Ultra-High Risk (UHR) individuals are characterized by hedonic deficits, which are currently considered as putative predictors of both psychosis conversion and poor social/role functioning. Objectives: The aim of this research was to examine the relationship between anhedonia and suicidal thoughts across a 2-year follow-up period in people with First Episode Psychosis (FEP) and at Ultra High Risk (UHR) of psychosis. Methods: Ninty-six UHR and 146 FEP, aged 13–35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II). The BDI-II "Anhedonia" subscale score to assess anhedonia and the CAARMS "Depression" item 7.2 subscore to measure depression were used across the 2 years of follow-up. Hierarchical regression analyses were performed. Results: No difference in anhedonia scores between FEP and UHR individuals was found. In the FEP group, a significant enduring association between anhedonia and suicidal ideation was found at baseline and across the follow-up, independent of clinical depression. In the UHR subgroup, the enduring relationship between anhedonia and suicidal thoughts were not completely independent from depression severity. Conclusions: Anhedonia is relevant in predicting suicidal ideation in early psychosis. Specific pharmacological and/or psychosocial interventions on anhedonia within specialized EIP program could reduce suicide risk overtime. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population. Objectives: Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlationswith psychopathology and functioning inUHRindividuals; and (3) tomonitor longitudinally its stability after a 24-month follow-up period. Methods: Participants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13-18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis. Results: In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE "Social Cognition" subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms. Conclusions: Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis. [ABSTRACT FROM AUTHOR]

Introduction: Identifying distinct dimensions of negative symptoms in First Episode Schizophrenia (FES) might result in a better understanding and treatment of this invalidating symptomatology. Objectives: Aim of this study was to examine negative symptom structure in FES patients using the Positive and Negative Syndrome Scale (PANSS). Methods: All 147 participants, aged 12-35 years, completed the PANSS and the Global Assessment of Functioning (GAF) scale. A principal component analysis with varimax rotation was performed to investigate PANSS negative symptomstructure in the FES total sample. Results: A 2-factormodel (i.e. "Expressive Deficits" and "Asociality" dimensions) was identified. Only "Expressive Deficits" domain had a significant negative correlation with baseline GAF score. Conclusions: This bipartite solution seems to be adequate to describe the phenomenological variety of negative symptoms experienced by FES individuals at the point of entry in early intervention services. [ABSTRACT FROM AUTHOR]

Paraphrenia is a chronic psychotic disorder similar to paranoid schizophrenia, but with a better-preserved affect and rapport and a much less personality deterioration. It was at first systematically described by Kraepelin in 1913 to define a group of psychotic patients who exhibited characteristic symptoms of dementia praecox, but with minimal disturbances of emotion and volition, and marked delusions. After the publication of Mayer-Gross''s report in 1921, the view to differentiate paraphrenia from schizophrenia was considered to be unfounded and the term ”paraphrenia” was not included in the current DSM-IV-TR diagnostic criteria. Consequently, now this disorder is diagnosed infrequently. However, several authors suggest that the concept of paraphrenia has not lost its usefulness. It seems to be that some psychiatrists recognize the illness, but labelled it as ”atypical psychosis”, ”schizoaffective disorder”, ”delusional disorder” or ”psychotic disorder not otherwise specified” for the lack of a better diagnostic category. Very few systematic studies on paraphrenia have been conducted in the past 70 years. Aim of this work is to describe a case of chronic delusional psychosis who meets the Ravindran''s modern diagnostic criteria for ”paraphrenia redefined”, suggesting that it is possible to define and recognize the illness if the practitioners are induced to use a viable diagnostic entity. Further research would benefit paraphrenia and schizophrenia patients. [Copyright &y& Elsevier]

Background: Sjögren''s syndrome (SS) is a common medical condition which may produce psychiatric disturbances. Psychoactive medications treat psychiatric symptoms, but leave the underlying process unaffected. Aims: To emphasize that psychiatric disorders in primary SS constitute an indisputable clinical reality that each practitioner must be able to recognize and treat. Method: A systematic review on psychiatric manifestations of SS and two case-reports of mental disorder as clinical presentation of primary SS. Discussion: Psychiatric manifestations in primary SS are common and can occur not only during its course, but also at onset of the autoimmune syndrome. A better adapted prescription of corticosteroids and/or immunosuppressive agents (together with specific psychotropic traetments) can induce to a rapid relief of psychiatric dysfunction. Conclusions: Psychiatrists should keep in mind that primary SS is a potential cause of mental disorders when examining patients with multiple somatic complaints and psychiatric symptoms. [Copyright &y& Elsevier]

Paraphrenia is a psychotic disorder described by Kraepelin in 1913. He formulated this concept to define a group of patients who exhibited symptoms characteristic of dementia praecox (marked delusions with or without hallucinations), but with minimal disturbances of emotion and volition, and much less personality deterioration. After the publication of Mayer"s prognostic research in 1921 (which studied the outcomes of 78 paraphrenic patients reported by Kraepelin), the view to differentiate paraphrenia from schizophrenia was considered to be unfounded in Germany. Paraphrenia is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it "atypical psychosis", "schizoaffective disorder," or "delusional disorder" for lack of a better diagnostic category. Virtually no systematic research on paraphrenia has been conducted in the past 60 years. We describe a 30-year-old man affected by sistematic paraphrenia, according to the neo-Kraepelinian description of paraphrenia proposed by Ravindran et al. In 1999 (description compatible with the formats of DSM-IV and ICD-10). Using a questionnaire adapted from this description, our case of paraphrenia were distinguished from those of schizophrenia and delusional disorder. In conclusion, It is possible to define and recognize paraphrenia, because it is a viable diagnostic entity. As in the days of Kraepelin, the problems concerning paraphrenia cannot be neglected when considering the classification of psychotic disorders. [Copyright &y& Elsevier]