Co-Occurring Substance Misuse is associated with negative effects on psychiatric illnesses with implications for medication compliance, relapse and treatment outcome.

To contribute to research in the area of Co-occurring Substance Misuse in the Caribbean in general and Jamaica in particular.

To determine the prevalence of Co-occurring Substance Misuse, associated demographic characteristics and reports of interpersonal violence.

A cross-sectional study design was used with consenting patients admitted to the Psychiatric Unit at the University Hospital of the West Indies, Kingston over the period March 2011 to September 2011. Data collection utilized a researcher administered Background Questionnaire. Data analysis was done using the Statistical Package for the Social Sciences Version 18.0 (SPSS 18.0).

Of 100 consenting patients, 36 (36%) were diagnosed as having Co-occurring Substance Misuse, 31 (83.8%) males and 5 (13.5%) females, mean age 27.17 ± 9.6 years, range 14-59 years. Past year alcohol (86.5%), tobacco (86.5%), marijuana (89.2%) and cocaine (13.9%) use were reported, with the majority of patients (94.4%) reporting polysubstance use. The mean age of onset for alcohol was 14.3 yrs, tobacco, 14.8 yrs, cannabis, 16.5 yrs and cocaine 21.4 years. 70% were diagnosed with a Psychotic Disorder and 30% had a Mood Disorder. A high prevalence of interpersonal violence (77.8%) was reported.

There is a high prevalence of Co- morbid Substance Misuse in this sample of patients. Patients should be screened on admission for Co-morbid Substance Misuse and a combined, integrated approach to the management of these patients should be established.

Some coping strategies might serve as protective functions by regulating the negative emotions associated with stress, whereas others may exacerbate the effects of stress and contribute to maladaptation.

To examine the distribution of the Beck Depression Inventory II (BDI-II) scores in the Spanish sample of adolescents from the “Working in Europe to Stop Truancy among Youth” Project (WE-STAY) and study the differences according to the coping style.

Sample: 1409 pupils from 23 schools sited in Asturias (Spain) [48.55% males; mean age(SD) = 15.16(1.22)]. Instruments:

1. (1) Coping Across Situations Questionnaire (CASQ);

2. (2) BDI-II.

7.3% of the sample scored in mild depression, while 4.9% did so in moderate (BDI-II criteria). Significant differences were found by gender in BDI-II scores, females scoring higher in severe, moderate and mild depression (p< .005). Regarding to the coping style, 65.4% of the sample showed internal style. The least representative was the withdrawal style (13.9%). Significant differences were found in the coping style by gender, females scoring higher in both active and withdrawal styles (p< .050). Regarding to the relation between BDI-II scores and coping style, pupils with withdrawal style score higher in severe, moderate and mild depression (p< .000).

Although ideally would be an active style, pupils showed mainly an internal coping style (which includes assessing a situation and looking for a compromise). Coping style was related with the severity of depression. Withdrawal style (which includes denial) is related to a worsening of depression. Thereby, training coping skills may be important.

Patients presenting Personality Disorders and specially Borderline Personality Disorder are often admitted to Psychiatry Units in General Hospitals. Their impulsivity, affective disregulation and difficulties in interpersonal relations complicate the therapeutic atmosphere and cause problematic interactions with staff and other patients.

To improve staff response to behavioural problems of patients presenting Personality Disorder in psychiatric units in the general hospital.

To develop a protocol to guide staff interventions with these patients.

After analyzing the patients flow from the emergency room to discharge and the current proposals in the literature on the subject, we create a protocol addressing more frequent problems using a task group composed of psychiatrists, psychologists and nurses involved in the daily care of these patients.

A protocol is delineated guiding clinicians and staff on how to deal with assistance at the emergency room, entrance to the ward, initial contract and agreement, responses to specific problems during treatment and final discharge.

A protocol to guide the staff dealing with behavioural problem of patients with PD in the general hospital can be developed and provides clinicians with a therapeutic frame that structures the different treatment interventions.

Itzhaky (2012) found significantly lower vitamin D level in patients with schizophrenia than in healthy controls.

Measurement of vitamine-D in bipolar and schizophrenia/schizoaffective outpatients.

Determining the prevalence of vitamin D deficiency in outpatients with bipolar disorder, schizophrenia or schizoaffective disorder in the Netherlands.

Outpatients in the Alkmaar region aged 18w65 years with a bipolar disorder, Schizophrenia/schizoaffective disorder were asked to add vitamin D levels determination to the annual standard blood sample taking.

111 patients, 54 with schizophrenia/schizoaffective disorder and 57 with bipolar disorder, participated. 58 (53%) was male, mean age 47 (SD 9.9) years. 64 (58%) showed vitamin-D insufficiency (< 50 nmol/L), 32 (29%) vitamin-D deficiency (< 30 nmol/L). 7 (6.3%) female patients aged >50 had a serum level between 30–50 nmol/l. No significant differences were found between bipolar disorder and schizophrenia/schizoaffective disorder.

To prevent osteoporosis, vitamin D supplementation is advised with vitamin D-levels below 30nmol/l or below 50 in women >50 years and men >70 years, (Dutch Health Council). Using to this criterion 39 patients (35%) of the study-population needed vitamine-D supplement. If confirmed, addition of vitamine-D levels to the annual somatic screening of patients with bipolar disorder, schizophrenia/schizoaffective disorder is indicated. Limitation: the impact of the season on vitamine-D levels was not corrected for in either population.

Assistance for mentally-ill patients can be performed in psychiatric units of general hospitals. At the Psychiatric Ward at Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil, the assistance offered follows the therapeutic ambient model. Group psychotherapy with clients is one of the approaches provided. The group meetings occur every day, are 1-hour long, and follow theoretical principles of group therapy with inpatients, emphasizing “here-and-now” interventions. They are coordinated by psychiatry residents and observed directly by a group therapist preceptor.

To present a framework of group psychotherapy interventions with inpatients in a psychiatric unit of a university general hospital based on the analysis of one group meeting.

To characterize a group psychotherapy intervention with inpatients in a psychiatric unit as a model for assistance and teaching.

Exploratory and descriptive qualitative research. It was performed a content analysis of an in loco transcription of a group meeting with 11 patients and 4 staff members.

The following themes were discussed: illness-, self- and other perceptions; respect and relationships within the unit; discharge. Patients had participated freely and interacted among themselves. The group’s coordinator guaranteed the meeting’s structure and facilitated discussion and exchanges among patients.

Being concerned with the group’s structure in a therapeutic ambient model is essential for its development. However, it has been noticed that the coordinator’s flexibility tends to favor patients to transpose their experiences along group meetings and the therapeutic ambient to their lives outside the hospital.

Treatment with pegylated interferon alpha (PEG-IFN-α) in patients with chronic hepatitis C (CHC) is associated with depression more frequently than in other diseases treated with PEG-IFN-α.

To prospectively evaluate prevalence, severity and course of depressive symptomatology in CHC patients treated with PEG-IFN-α.

Hamilton Depression Rating Scale (HAMD) was used to asses depressive symptoms in 103 subjects with CHC before PEG-IFN-α (mean dose 152.6±25.6 mcg; duration of therapy 48 weeks) and at the follow-up visits (4th, 12th, 24th, 48th, 72th week). Control group included 103 subjects with CHC without PEG-IFN-α.

There was a significant increase in HAMD scores as early as in the 4th week of PEG-IFN-a therapy compared to baseline scores (38.8% vs. 24.3%). The peak of depressive symptomatology was detected in the 12th week (mean HAMD 9.34¤ 6.93), when a half of patients (49.5%) had HAMD above 7. At the end of the treatment (48th week), 38.8 % had HAMD above 7, and in the 72nd week (24 weeks without PEG-IFN-α), prevalence of depressive symptomatology was decreased to the values lower than at baseline (23.3% vs. 24.3%). The majority (28.2%) had mild depression, whereas moderate and severe depressive symptoms were found in 20.4% and 1%, respectively. No change in prevalence of depression was detected in control group.

Present study is the longest follow-up study of depressive symptoms as a side-effect of PEG-IFN-α in CHC. Our data yielded that the severity of the symptoms was mild to moderate and tends to decrease following therapy completion.

Greece presents the highest prevalence of smokers among Western European countries with a percentage of 37.6%. Studies investigating the psychological parameters associated with habitual smoking, both among the general population as well as among health professionals are focused on anxious and depressive symptoms, without taking into account other possible psychological parameters.

To assess the implication of psychological parameters in the preservation and termination of habitual smoking.

One hundred and four health professionals were randomly selected and asked to fill out the Symptom Check List - 90 - R (SCL-90R) [1]. Participant demographics, smoking habits, amount of daily cigarette consumption, and whether or not participants displayed an intention or effort to quit smoking were all taken into account.

Among smokers, 50% displayed an intention to quit smoking. Smokers who intended to quit displayed the highest levels in subscales of somatization, anxiety, depression and anger. Daily cigarette consumption, among smokers, showed a positive correlation to subscales of obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety as well as of anger, paranoid ideation and psychoticism.

The fact that one in two smokers indicates an intention to quit smoking is both interesting and optimistic regarding possible termination of the smoking habit. Habitual smoking is positively correlated to psychological parameters that should be taken into account when drafting a smoking intervention programme.

Truancy is a serious public health problem that affects adolescents from all countries around the world; however, little is known about the short- and long-term outcomes of potential underlying psychological and mental ill-health for those adolescents who truant. Working in Europe to Stop Truancy Among Youth (WE-STAY) project is developed, as a randomized controlled trial (RCT), in order to examine truancy, and its subsequent association with psychological distress and mental illhealth. The WE-STAY Consortium comprises 10 European countries: Estonia, France, Germany, Hungary, Israel, Italy, Romania, Slovenia, Spain and Sweden serving as the coordinating centre.

The main objectives of WE-STAY are to gather epidemiological information on truancy on European adolescents; and to perform interventional school-based programs for adolescents, aimed at reducing truancy rates and improve mental health of students.

The WE-STAY project is implementing and evaluating outcomes of three different kinds of preventive interventions on truancy, which is compared with a minimal intervention serving as the control arm. Validated psychometric instruments incorporated into a self-report questionnaire is administered at baseline, 1- and 12-month follow-up assessments.

The WE-STAY project is expected to generate valuable information about the behaviour of European adolescents regarding attendance to school. The existing research on truancy is very scarce and affected by methodological shortcomings that make evaluating the effectiveness of their programs difficult. The main philosophy underlying the WE-STAY project is to consider truancy as a warning-sign for psychological and social distress in adolescents.

In patients suffering from neuropsychiatric disorders such as schizophrenia and depression, the neurobiological processes of decision-making are severely compromised. Some recent studies showed that social behavior and the ultrasonic vocalizations parameters in mice, expressed their emotional mood and could be used to analyze the process of decisionmaking. But, remains to highlight the modulation of these parameters under the effect of drugs, used in the treatment of these pathologies.

The aim was to find out the neuropharmacological modulators of decision-making in β2-ko adult male mice, suggested as animal model for schizophrenia, in order to test the pertinence of that model.

We first, administered clozapine used in the treatment of schizophrenia in human. Then, we analysed the social behavior as well as ultrasonic vocalizations parameters by Avisoft® in social interaction condition.

Our results show that adult male mice β2-ko emit ultrasonic vocalizations. Under the effect of clozapine, the emission of ultrasonic vocalizations are regulated by the balance between cholinergic and dopaminergic pathways. The activation of the cholinergic together with the inhibition of the dopaminergic pathways induces a negative emotional state, showed by vocalizations with low frequency of about 50 kHz. The activation of the dopaminergic with the inhibition of the cholinergic system induces a positive emotional state, showed by vocalizations with high frequency of about 60 to 80 kHz.

The administration of clozapine allowed re-establishing the social behavior parameters in β2-ko mice as well as the level of wild type mice but not about vocalization.

Clinical observation is very important to manage risk of people who are acutely ill on psychiatric wards. It is always an area of dispute between different specialities and disciplines in serious untoward incidents(SUI). Three levels of observations have been applied on acute psychiatric words. Assessing practice is important to help identifying positive and negative aspects of clinical practice.

A questionnaire was developed by HN to collect demographic. Medical notes on Westley and Grangewater wards were reviewed. Excel Microsoft Office World Computer Programme was used to analyse the results.

57% were men.

62% were above 41 years of age.

Majority were suffering from schizophrenia and schizoaffective disorders 61%.

64.28 % were admitted as formal patients.

31.42 % were on level I observation.62.53 were informal.

54.76% were risk to themselves, 28.57 % risk to others.

82.3% were on level II observation, 31.42% formal and 68.50% informal.

21.32% were on level III observation. 66.66% were formal and 66.66% had an incident before this level.

This study have shown that patients are assessed properly before they go on any level of care. Some patients need to go on level III as they pose a risk mainly to other people. Regular reviews of patients, especially on high level of observation should be done more promptly, as being on observation is not a comfortable experience to go through and applying the least restrictive practice should always be sought and adopted.

In the Multidisciplinary Melanoma Group (MMG) of Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil, physicians of different specialties (plastic surgery, dermatology, oncology, pathology and psychiatry) work in an integrated way and weekly provide care to outpatients with melanoma. They hold monthly meetings to: discuss administrative issues; update diagnoses, therapies and treatment protocols; discuss research projects, and bring members together.

To present, based on a clinical case report, a reflection about the MMG’s teamwork.

To understand the teamwork of different specialties physicians in providing care to people with melanoma.

Case report and reflection.

Woman, 35 years-old, white, divorced, two sons (11 and 7 year-old). Primary melanoma operated 5 years before and inguinal metastases resected one month prior to the follow up at MMG. Psychiatric approach: tense, dissociated, with no knowledge about the illness’ meaning, worried about the children. Adjuvant oncologic treatment and support psychotherapy were implemented. After few months, she complained of mild fever and fatigue that interfered in relationship with her children. With change in the adjuvant treatment protocol, patient’s situation was discussed and, after risks and benefits evaluation, it was chosen to discontinue her treatment. Patient got closer to her children and more involved in psychotherapy and outpatient treatment.

The proper use of a uniform language, the definition of roles, clear communication and concern with the aim of taking care of people with melanoma in their clinical and emotional needs facilitate the adjustment and cohesion in the MMG.

Dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment within episodic-autobiographical domain, occurring without evidence of significant brain damage on conventional structural brain imaging.

This work’s objectives are establishing greater recognition of possible relations between memory performance and social cognition in patients with dissociative amnesia.

We review data on social cognition (affective and cognitive theory of mind, simulation, empathy, social judgment, moral judgment) from our own patients with dissociative amnesia.

Patients were investigated medically, psychiatrically and with neuropsychological and neuroimaging methods.

Patients with dissociative amnesia show variable degrees of impairments of components of social cognition, based on their comorbid conditions (e.g. concurrent clinical or subclinical depression), types of memory impairments (e.g. extent of retrograde amnesia, presence of autobiographical semantic deficits), pattern of brain metabolic changes, personality characteristics, neuropsychological profile (performance on executive functions or emotional processing) and testing paradigms.

The impairment in dissociative amnesia seems to go beyond the conscious mnemonic deficit, encompassing various aspects of social information processing. Knowledge about the pattern of metabolic and micro-structural brain changes in patients with dissociative amnesia as well as a fine-grained analysis of the neural correlates of various aspects of social cognition might provide an understanding of when and how episodic-autobiographical memory contributes to social cognition. As several studies emphasized, some structures involved in mnemonic processing may also play a role in social perception, cognition and behavioural regulation, including future-minded choice behaviour.

Suicidal behaviours are major public health concerns, associated with many risk factors that vary with sociodemographical features.

To compare the differences between patients visiting the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, as far as their occupational and accommodation status are concerned.

To evaluate the influence of the economic scenery on suicidal behaviours.

Determinants of ER psychiatric consultations were studied prospectively from 2008 to 2011 at the “Maggiore” Hospital in Novara. Comparison of qualitative data was performed by means of the x2 test, or the Fisher’s Exact test in case of expected frequencies less than 5. All tests were two-sided and a P value less than 0.05 was considered as statistically significant.

In a sample of 1888 psychiatric consultations, 281 (14.9%) were due to self-inflicted injuries. The preliminary analysis of socio-demographical features showed that self-harm behaviours are significantly more frequent among employed vs unemployed or disabled subjects (20.1% vs 13.2%; p=0.0005) and among those living in their immediate or own family vs those living alone or in therapeutic facilities (17.0% vs 13.0% vs 8.4%; p=0.012).

In contrast to current literature, our study shows that individuals living in more favourable conditions are at greater risk of attempting suicide. These results might be associated to the current Italian economic scenery, and to emerging difficulties as far as keeping an income to adequately maintain a family are concerned.

Ginkgo biloba extract EGb 761® improved neuropsychiatric symptoms (NPS) in patients with dementia in a series of trials.

To explore the effects of EGb 761® on NPS in patients with mild cognitive impairment (MCI).

A randomized, placebo-controlled, double-blind, 24-week, multi-center trial was conducted, including 160 patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI). Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory (STAI-X1) and the Geriatric Depression Scale (GDS). Further outcome measures were the Trail-Making Test (TMT, Forms A and B) and global ratings of change. Descriptive statistical analyses followed the intention-to-treat principle.

The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761®-treated group and by 5.5 ± 5.2 points in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761® and in 55.7% of those receiving placebo (p = 0.002). Significant superiority of EGb 761® over placebo was also found for the STAI-X1 score, the informants' global impression of change and both TMT scores. There were statistical trends favoring EGb 761® in the GDS and the patients' global impression of change. Adverse events were reported by 37 patients taking EGb 761® and 36 patients receiving placebo; there were no serious adverse events.

EGb 761® improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.

Chronic pain more than a symptom expresses a complex situation in pathophysiological and therapeutic terms. It can become the center of one’s life and be a reflection of suffering experienced in other areas of life. Support through group psychotherapy can enhance a better experience with pain and encourage healthy behaviors in this clientele.

To characterize the groups with chronic pain patients regarding the subjects discussed and the impact of pain on their lives.

Understand the life circumstances of people who suffer from chronic pain.

This is a qualitative participant observation study. 48 group meetings conducted with 12 patients with chronic pain were analyzed. The groups were weekly, lasting an hour, and were coordinated in co-therapy by a psychiatrist and a psychologist.

Themes discussed: health problems; vulnerability to diseases; limitations and perspectives of people with chronic pain; preparation for submission to procedures (surgeries, exams, analgesic blocks); relationship problems with family and friends; unconscious conflicts that feed physical problems; difficulties in interacting with professionals and treatments; economic problems; and sexuality. When patients were able to provide support to colleagues, they felt valued; when they received such support, they felt understood and protected.

It was possible to observe a personal development of participants who stopped complaining or blaming others for their relationship problems and their consequent suffering, going to take responsibility and find solutions more adaptive than the recurrent pain behavior.

Anxiety disorders have been historically described as a feature of Bipolar Disorder (BD), and Obsessive-compulsive-bipolar disorder (OCBD) comorbidity has been referred in literature. A survey reports that 55,8% of obsessive-compulsive patients may develop BD in their lifetime. Another survey estimates it at 21%. Mania in Obsessive-Compulsive Disorder (OCD) can occur either as an independent comorbidity or as a result of an antidepressant-induced switch in a patient in anti-OCD drugs.

The aim of this poster is to describe and discuss some aspects of this psychiatric comorbidity, with emphasis on its diagnosis and management, based on a case report.

This case report describes a 38-years-old married male with 5 years history of OCD treated with an antidepressant, admitted at our psychiatric ward due to a manic episode. Its management and therapeutic approach are described.

A baseline of “neurosis” (versus “psychosis”) in some BD presentations has emerged from recent scientific evidence, which prompts its better understanding. As a complex comorbidity, OCBD represents a diagnostic and therapeutic challenge implying further systematic exploration.

Stigma on psychiatric patients is frequent not only among common people but also in healthcare professionals. Cinema might be useful tool for medical educational purposes and might help reduce negative attitudes towards mental illness.

In the first place, to develop a pilot project of cinemeducation aimed at enhancing awareness and thinking over about psychiatry and stigma in medical students; secondly, to investigate students’ stigmatizing attitudes, empathy, personality and self-esteem and the impact of the cinemeducation intervention on some of these variables.

From October 2012 to January 2013, students will attend six cinemeducation lectures focused on helping relationships. Sociodemographic data will be collected at baseline only, and so will the Temperament and Character Inventory. In order to investigate attitudes towards psychiatry, self-esteem, alexithtymia and empathy, students will be asked to fill in some self-administered scales, both at baseline and at the end of the six lectures. These scales will include: Attitudes Towards Psychiatry Scale, Social Distance Scale, Dangerousness Scale, Mental Illness: Clinicians’ Attitudes Scale, Interpersonal Reactivity Index, Rosenberg Self-Esteem Scale, Toronto Alexithymia Scale.

The correlation among the variables assessed will be investigated in order to understand whether certain personality traits, self-esteem and empathic attitude influence students’ beliefs about psychiatry. The impact of the cinemeducation lectures on stigmatizing attitudes will be investigated as well.

It is known that antipsychotic lower seizure threshold, cause EEG abnormalities and put the patients in the risk for additional seizures. Due to changes in organic substrate, psychosis is very common comorbidity in epilepsy. There is no consensus about treatment options. The purpose of this research was to compare effects of risperidone and olanzapine in treatment of psychotic episode in verified Grand-mall epilepsy. Treatment with bout antipsychotic was parallel.

Psychotic episode in 100 adults (67 males) with epilepsy, Grand-mall type, were measured with BPRS scale. History of diagnosis of epilepsy, Grand-mall type was verified clinically and by EEG. Subject were treated either with olanzapine (n=53) 14.7±2.4 mg per day or with risperidone (n=47) 8.6±3.8 mg per day, orally.

The total BPRS scores in olanzapine group at baseline, in 1st, 2nd and 3rd week were 139.6±34.2, 91.3±21.4, 81.5±19.8, and 72.3±11.1, respectively (p< 0.05). The total BPRS scores in risperidone group at baseline, in 1st, 2nd and 3rd week were 137.1±32.4, 101.6±30.9, 98.4±26.6, and 90.3±19.1, respectively (p< 0.05).

Results of our research showed that risperidone is more effective and comfortable drug than olanzapine in the treatment of psychotic episodes in epilepsy.

Psychiatric symptoms occur quite often in epilepsy and are an important prognostic factor in quality of life of patients with this neurological condition. The psychotic disorders occurring in epilepsy are classified according to their chronological relationship with the seizures. The peri-ictal psychoses occur before (pre-ictal), during (ictal) or after (postictal) the emergence of a seizure. Inter-ictal psychoses occur independently of seizures. Postictal psychosis (PP) episodes are typically of short duration.

Our aim is to show the great importance of seizures control as a way to prevent the onset of psychotic symptoms, thereby improving patient’s prognosis and quality of life.

In this paper we describe a case of a 44-year-old man, with post-traumatic epilepsy and postictal psychotic symptoms.

The search and the recognition of psychiatric symptoms in epilepsy allow a better understanding of the overall clinical case and, therefore, a more effective treatment.

While there is increasing evidence on the association between cannabis use and schizophrenia, it is still unclear whether schizophrenia patients with a cannabis history have another prognosis, with regard to relapse and hospital duration, compared to those without a cannabis history.

A cohort study of 50000 Swedish men with data on cannabis use at ages 18–20. A total of 350 cases of schizophrenia were identified from inpatient care records and followed up from 1970 through 2010. Records of schizophrenia patients with and without a history of cannabis use were investigated with regard to types of diagnoses, duration of first admission, rate of re-admission and total duration of hospital stay.

Schizophrenia patients with history of cannabis use had a higher median duration of first hospital episode (59 days vs 30 days). Patients with a history of cannabis had a higher median rate of re-admission (10 times vs 4 times). Also total number of hospital days was higher in patients with cannabis history compared to those without (547 days vs 184 days) The distribution of types of schizophrenia was difficult to assess since many received a “unspecified” diagnosis, and there was no significant difference between the groups.

Schizophrenia patients with history of cannabis used had significantly higher burden of inpatient care than non cannabis users. Not only does cannabis increase the risk of schizophrenia, but our findings indicate that the type of schizophrenic psychosis may be more severe than schizophrenia cases in general.