Schizophrenia is a life-shortening disease and life expectancy in patients may be 15–20 years shorter than in the general population, with increasing longevity gap over time. Premature mortality in schizophrenia-spectrum disorders is mainly due to preventable natural causes, such as cardio-vascular disease, infections, respiratory tract diseases and cancer, alongside suicide, homicide and accidents. There is a complex interplay of factors that act synergistically and cause physical morbidity to patients and subsequent mortality. Smoking, alcohol/substance abuse and sedentary life style, alongside disease-related factors, such as metabolic abnormalities and accelerating aging contribute to physical morbidity. Moreover, the symptomatology of psychosis and stigma may limit patients’ access to quality medical care. Interventions to promote physical health in those patients should be multifaceted, and should target all patient-related modifiable factors, but also should address service-related healthcare disparities. Long-term antipsychotic use (including clozapine and long-acting injectables) is associated with substantially decreased all-cause mortality, including suicide and cardiovascular mortality, in patients with schizophrenia despite the well-known cardiometabolic adverse effects of second-generation agents. Integrated care may involve co-location of physical and mental health services, liaison services, shared protocols and information sharing systems, and has emerged as a way to address the physical health needs of those patients. Interventions to address mortality in schizophrenia and related syndromes should take place as early as possible in the course of the patients’ treatment, and could be an integral component of care delivered by specialized early intervention services.

Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research.

Background: Coercive physical measures are commonly used in psychiatric units throughout the world for the management of severe behaviourally disturbed patients. Aim: The aim of this study was to assess the rates of coercive physical measures (seclusion and restraint) used in psychiatric inpatients in the psychiatric unit of a general hospital in Greece. Methods: A retrospective chart review of all admissions to the psychiatric unit of the University General Hospital of loannina during a six-month period was conducted. Differences between patients who were subjected to coercion and patients who did not receive any coercive treatment were statistically analyzed and compared. Results: Of the total of 282 admissions during the study period, 31 (11.0%) cases had been subjected to some form of coercive physical measures: 9.55% and 1.76% were affected by seclusion and mechanical restraint, respectively (one patient had been subjected to both). The mean duration of any one seclusion and mechanical restraint was 64.9 hours and the mean number of seclusion and restraint per affected case was 3.58. Statistical analysis between the group subjected to coercive measures and the group who was not did not reveal any association with demographic data or diagnosis. Coercive measures were found to be associated only with the type of admission at intake. Conclusions: Involuntary admissions were associated with statistically significant higher levels of restraint and seclusion in this patient sample. Strategies that will enhance patients’ follow-up are expected to prevent involuntary admissions and reduce the use of coercive measures.

Background: Admission of a patient in the Intensive Care Unit (ICU) and the recovery process may be stressful for family members. Objectives: This study aimed to explore the families' psychological symptoms and their evolution over the 1^st week of patients' ICU stay. Additional objectives were the estimation of the families' need for support and the estimation of satisfaction regarding the information provided by ICU physicians. Methods: A total of 108 individuals were participated in the study. Participants were interviewed with the Hamilton Anxiety Rating Scale and filled the Beck Depression Scale II on days 1 and 7 of patients' ICU admission. They also filled a self-reported questionnaire which was created by the investigators, involving decision-making procedures; the satisfaction of the families of the patients' care; and the support of the families by medical and nursing staff. Results: Anxiety levels were not significantly different among 2-time points, whereas rates of depressive symptoms raised significantly from 38% (day 1) to 58.3% (day 7). In cases of anxiety changes, age, education, closeness of relationship, and APACHE II score were the factors been associated. Changes in depressive symptoms were not associated with any of those factors. Over a week, there were significant differences in relatives' views on participating in the decision-making procedure, and on expressing their opinion and concerns regarding the treatment process. Their attitudes about receiving support by the ICU personnel and even by mental health specialists, such as psychologists also changed. Conclusions: Over the 1^st week of ICU admission, depressive symptoms in patients' relatives were gradually evolving, while anxiety symptoms fluctuated and they were affected by the severity of the patients' condition. Attitudes toward treatment procedures and the perceived need for support also changed. These findings should be taken into account by the ICU personnel.

Background: The outcome of schizophrenia and related psychoses is generally modest, and patients display high rates of disability. Aims: The aim of the review is to present an up-to-date account of the research on the very long-term outcome of psychotic disorders. Method: We conducted a search in the PubMed and Scopus databases for articles published since the publication of the very long-term data of the World Health Organization’s International Study of Schizophrenia (the ISoS study), over the last 18 years (from 2002 to 2019). Studies were included if they reported on at least 15-year outcome and if they had used valid and reliable tools for the estimation of the patients’ outcome in terms of symptomatology and functioning. Results: A total of 16 studies were included in this review, involving 1,391 patients with schizophrenia and related psychoses. Most were single-center studies, with moderate size samples of patients, and 11 were prospective studies. Very long-term outcome of psychotic disorders varies considerably among studies. Good outcome ranges from 8% to 73.8%, and it appears to be better in developing countries, whereas differences are less apparent among Western countries (8%–40.3%). Studies in different settings have used different methods involving a variety of samples of patients to estimate their outcome, whereas definitions of good and poor outcome also varied among studies. Longer duration of untreated psychosis was associated with worse outcome in some studies. Schizophrenia was found to have poorer long-term prognosis compared to other schizophrenia spectrum disorders. A large proportion of patients, ranging from 19% to 48.2%, were not on medication. Conclusion: Recent evidence on the very long-term outcome of psychotic disorders is in line with previous reports and suggests that prognosis remains rather modest. There are several limitations of current research regarding outcome definitions and study design that should be addressed by future research.