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.

Background/Objectives: The concepts of trust and distrust in health systems during health crises are significantly related to public adoption of health behaviors and health outcomes. The aim of this review is to examine trust and mistrust during times of health crisis, such as periods of viral pandemics and epidemics, and how these concepts relate to public health behaviors and, by extension, affect health outcomes. Methods: A focused search was conducted in PubMed and Scopus using a Boolean expression to identify relevant articles written in the English language and published between 2003 and 2023. The research methods comprised content analysis, thematic analysis, and a word cloud visualization to identify frequent themes related to trust and mistrust in healthcare systems. Results: The analysis included 57 studies and revealed that trust in healthcare systems, institutions, and professionals plays a significant role in shaping public health behaviors during health crises. The study also highlighted how mistrust leads to negative health outcomes, such as increased belief in conspiracy theories, vaccine hesitancy, and non-compliance with public health measures. Conclusions: The review emphasizes the importance of building and maintaining trust in healthcare systems to ensure better public health outcomes during crises. It calls for further research to better understand the nuances of trust and mistrust, aiming to inform public health strategies and interventions that could lead to more effective crisis management and improved health outcomes.

Mild cognitive or neurocognitive impairment (MCI) may be more prevalent in rural areas. Differences between rural and urban MCI patients in terms of risk factors, course and prognosis are rarely reported. The present review aims to summarize the latest research on MCI in rural areas. A literature search was performed in the databases of PubMed, Scopus and ScienceDirect for articles published over the last decade. Eleven articles were included in this review, reporting on the differences between rural and urban MCI patients. Several risk factors, such as older age, lack of activities and food insecurity have been associated with MCI in both rural and urban areas, whereas others, such as obesity, adverse childhood experiences and plasma chemokine C-C motif ligand 11 (considered as a potential negative regulator of neurogenesis), differed according to the place of residence. No specific protective factor for rural women has been reported. There is some evidence that MCI may present earlier in rural residents, but that progression to dementia may be more rapid in urban residents. It seems that there may be clinically relevant differences in the onset, course and prognosis of MCI with regards to the place of residence (urban vs rural). Those differences should be taken into account for the design of health policies and service delivery across different settings.

Aim: To study the effect of the serotonin transporting gene L/S polymorphism on several psychological characteristics in a group of Greek University students.Methods: One hundred eighty‐one students were genotyped and classified into two groups: carriers or noncarriers of an S allele. Students were evaluated with a battery of psychological tests (Zung depression rating scale, symptoms check‐list‐90‐R, Eysenck personality inventory); they also answered questionnaires regarding serious past adverse experiences as well as nicotine and alcohol use. Multivariate analysis of variance (MANOVA) was used to check the main effect of genotype and its interaction with both adverse life experiences and scores of psychological tests.Results: No significant differences were detected between the two groups of students regarding scores of the psychological tests. Yet, analysis with MANOVA indicated an interaction between genotype and adversities (λ = 0.838, F_17,158 = 1.802, P = 0.032). Students who both carry at least one S allele and have faced serious past adverse life experiences have scored higher than carriers of the S allele who have not faced adversities on the following: global severity index (F₁₁₇₄ = 5.973, P = 0.016), positive symptoms distress index (F₁₁₇₄ = 4.518, P = 0.035), somatization (F₁₁₇₄ = 4.074, P = 0.045), depression (F₁₁₇₄ = 4.971, P = 0.027), anxiety (F₁₁₇₄ = 8.112, P = 0.005), phobic anxiety (F₁₁₇₄ = 16.421, P < 0.000), and paranoid ideation (F₁₁₇₄ = 5.143, P = 0.025). Among students without adversities, those with the LL genotype have scored higher than S allele carriers on the following: depression (t = 2.680, df = 75, P = 0.009), anxiety (t = 2.629, df = 75, P = 0.010), phobic anxiety (t = 3.350, df = 75, P = 0.001), and paranoid ideation (t = 2.668, df = 75, P = 0.009).Conclusion: The S and L alleles seem to interact differently with serious past life adversities in influencing psychological vulnerability. Adversities seem to have a stronger effect on S carriers. LL genotype might be related to the expression of certain more endogenous psychopathological tendencies. Synapse 63:193–200, 2009.

The implementation of Mobile Mental Health Units (MMHUs) was a decisive step in the psychiatric reform and the development of community psychiatric care in Greece

Expressed emotion (EE) is an established prognostic factor for relapse in schizophrenia. Through critical comments (CC), hostility (H) and emotional overinvolvement (EOI), a relative can be rated as high or low EE, but the role of warmth should also be evaluated in order to consider the influence of a positive affect within the family context. In this study, EE was assessed in a sample of 48 relatives of patients with schizophrenia using the Camberwell Family Interview (CFI). Questionnaires assessing coping (brief-COPE), their wellbeing (World Health Organization Well-Being Index WHO-5) and the socio-demographic variables were also administered. Relatives who expressed a higher level of warmth were found to make fewer CC (5.2 ± 4.6 vs. 8.4 ± 4.6, p = 0.009) and have, on average, higher EOI scores (3.2 ± 1.0 vs. 1.9 ± 1.1, p = 0.002) than those who expressed no or very little warmth. High EE was found to be associated with having fewer family members (p = 0.035), while relatives with a higher level of education expressed less warmth (p = 0.007). Relatives with a low level of warmth had higher maladaptive coping scores and tended to score worse for their overall wellbeing in comparison to relatives who showed a higher level of warmth (28.4 ± 5.0 vs. 24.1 ± 5.2, p = 0.006 and 39.1 ± 20.4 vs. 51.3 ± 22.0, p = 0.073, respectively). Since the role of warmth is important, it should be taken into account when designing family interventions, independently from lowering EE. Customized interventions to promote warmth and the routine screening of relatives are recommended.