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IntroductionDeficits 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 correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period.MethodsParticipants [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.ConclusionsSocial 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.

IntroductionSeveral studies had shown the effectiveness of combined interventions in the treatment of young patients with a first episode of psychosis (FEP). More controversial are the evidence about the stability of the therapeutic outcomes in individuals ultra-high risk (UHR).AimsTo describe the regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department (ReMHD) and also to report preliminary data from a 2-year follow-up.MethodsIn addition with the treatment as usual (TAU), treatment implemented within the regional project for early psychosis (PREP) in the ReMHD comprises the following:– pharmacotherapy according to international guidelines;– a phase-specific individualized Cognitive-Behavioural therapy;– a psycho-educational intervention addressed to family members;– a case management recovery-oriented.Action strategies are preceded by the administration of Reggio Emilia at Risk mental States Battery Checklist as a comprehensive assessment useful to define the severity and the quality of symptoms, the degree of functioning, the subjectivity of suffering, and the perceived quality of life.ResultsThe assessment carried out after 24 months of continuous treatment showed significant improvements in both the psychotic symptoms (positive, negative and general psychopathology PANSS subscales) that the daily functioning (SOFAS).ConclusionsAlthough our sample is still relatively small (n = 50) to draw definitive conclusions, it is emerging the good prognosis for UHR individuals and patients with FEP submitted on PREP treatment implemented in the ReMHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Negative symptoms encompass a broad constellation of psycho-behavioral phenomena, including affective flattening, poverty of speech, alogia, avolition, social withdrawal, apathy and anhedonia. These phenomena obviously exert a substantial impact on personal autonomy, quality of life and broad functional outcomes, ultimately being an important challenge for clinical decision-making and therapeutic support. In recent years, the attention to negative symptoms in schizophrenia has revamped, boosting the development of new rating tools as well as a broader conceptualization of derivative constructs (e.g. apathy, amotivation, anhedonia). However, despite its behavioral expressivity, the in-depth phenotypic characterization of negative symptoms remains partly unaddressed. Similarly, their clinical intertwining with other non-productive clinical features (e.g. anomalous subjective experiences, cognitive-perceptual basic symptoms and schizotypal features) is generally overlooked. Therefore, the current presentation specifically offers a stratified overview of the phenomenology of negative symptoms filtered through lens of clinical psychopathology.Disclosure of interestThe author has not supplied his declaration of competing interest.

Introduction In our opinion there is still confusion about the exact meaning of the term negation. As a consequence of this the importance of negation in the psychotherapeutic work is until now underestimated. Objectives For psychiatrists who work according to Fagioli's human birth theory the concept of negation is fundamental. Negation is a notion that refers to unconscious reality. Aims The task of the psychiatrist is to identify and to interpret the negation in the deformed dream images during the psychotherapeutic process. Methods In contrast to an intentional lie, which is communicated through verbal speech, negation corresponds to unconscious thoughts, which we can find in dreams. During sleep a transformation occurs, language is altered and expressed through images. Negation deforms the image. This deformation of the image happens in an unconscious process. This negation distorts the reality of the patient and his ability to interact with the other. Corresponding the relationship will be aggressive/destructive. The only way to identify this deformation is dream interpretation. Results Through this therapeutic process the patient will be able to intuit and realize instead of negate the positive qualities of the other and integrate these into his reality. Only human interaction that is free from negation enable the patient to overcome the ideo-affective splitting, which allows recovery of positive affects and the possibility of developing evolutive relationships. Conclusions Only a clarification of the term negation allows a psychotherapeutic process with the aim of developing evolutive relationships.

The concept of autism as described by Bleuler and Minkowski constitutes a key element for diagnosis and understanding of schizophrenia. Bleuler in particular emphasized the possibility of non- productive yet symptomatic schizophrenia. This argument seems to us very important because on the one hand the culture linked to DSM risks losing these historical knowledge and limits the diagnosis on productive or behavioral symptoms. Autism is an important clinical feature of schizophrenia and the related disorders of consciousness. Some features of autism are related to the symptom called ‘anhedonia’, considered by some authors and ranging from the ‘feeling of the loss of feelings’ typical of severe depression to schizophrenic abulia-apatia. Our work focuses on the relation between these symptoms (which refer to the reality of consciousness) and an ‘instinctual’ reality that is actualized beyond the level of explicit consciousness. Because these symptoms can roam around a common core, as part of affectivity, may be related to a psychopathological dimension of the second level, unconscious, in which the affective reality is primarily compromised. The annulment drive (Anulliertrieb, ‘pulsione di annullamento’), theorized by Fagioli (1971), as related to loss of vitality, can ‘cancel’ the psychic reality which lies at the foundation of affects and may explain both autism and anhedonia. Fagioli’s theoretical formulations, in fact, include a basic human reality beyond consciousness (i.e. vitality), which gives origin to affective reality.

Socio-emotional competence is a key aspect of schizophrenia, both in terms of psychopathological vulnerability and outcome. In this respect, current research increasingly emphasizes the importance of deficits in facial expression recognition. The focus of the present study is the performance in recognizing six basic emotions (sadness, anger, happiness, fear, disgust, surprise), which play an essential role in shaping daily function and interpersonal interactions. A group of 20 patients diagnosed with DSM-IV schizophrenia were compared with a group of 20 matched controls on a facial expression recognition task, derived from the Karolinska Directed Emotional Faces (KDEF; Lundqvist et al., 1998), and were subsequently assessed with the Positive and Negative Syndrome Scale (PANSS). Facial expression recognition performance was significantly more impaired in patients, and was selectively correlated with the Positive and Cognitive dimensions of the PANSS. Furthermore, significant group differences were found with respect to joy and surprise.

Schizophrenia is characterised by profound distortions of the tacit world-embeddedness, which can be articulated both in flamboyant, characteristic symptoms - such as positive, negative and disorganised ones - or more subtle, quasi-ineffable changes in the structure of subjective experience. Such dislocation from the tacit milieu of common sense, rests in-between the jaspersian articulations of understanding and explanation, and remains problematically unsaturated even in the comprehensive post-jaspersian frames offered by existential, narrative-hermeneutic, psychodynamic, constructivist and cognitive-behavioural modes of understanding.In this context, a phenomenologically-informed approach can illuminate - in the very hic et nunc of the clinical-therapeutic encounter - those structural changes in the field of awareness which constitute the antepredicative, pre-psychological matrix of schizotropic vulnerability.

Auditory hallucinations are a common symptom of schizophrenia and florid psychotic conditions. As observed by Jaspers such psychopathological phenomena entail a rich and complex clinical manifestation that is irreducibly linked to an impression of reality grounded in perception. However, most contemporary research has interpreted the jaspersian description in a literal and rather concrete way, equating hallucinatory experiences to mere disordered perceptions. Besides being theoretically problematic, such reduction of hallucinations to “perceptions without an object” substantially neglects fundamental clinical features of the experiential structures implicated in psychotic states (e.g. flagrance, unescapability, feeling of passivity, self-reference, idiosincracy). In this perspective qualitative-phenomenological analysis maintains a crucial role in disclosing the structure of hallucinatory meaning-generation which is relevant for both clinical practice and research.