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Introduction: Depression is highly prevalent and clinically significant syndrome in schizophrenia which associates with poor outcome, decreased quality of life and increased mortality rates. It is known that depressive, negative and cognitive symptoms of schizophrenia are linked with prefrontal cortex dysfunction, thus rTMS of this target might be beneficial. Objectives: to estimate the possible association between early cognitive improvement and response of rTMS in depression. Methods: 63 schizophrenia (ICD-10) patients with prominent and persistent negative symptoms (mean PANSS composite index was - 11,03±5,48) and depression (CDSS score ≥ 6) on stable medication were included in the study. Patients received 15-Hz rTMS on the left DLPFC (100% intensity, 15 sessions of 1800 pulses). Patients were assessed weekly with CDSS, PANSS, and with the battery of cognitive tests ("10 words", Benton's test, "Coding", "Switching count", "Verbal fluency test"). The criterion of response was 50% CDSS score reduction after 3 weeks of treatment. Results: The response rate was 63,5% (40 patients). Mean CDSS score reduction was 53,1% (p<0,000001), mean PANSS negative subscale score reduction was 18,3% (p<0,000001). There was improvement in cognitive tests for executive functions and attention switching without significant changes in verbal and visual memory. Rapid cognitive response ("Coding" score increase ≥10% after 1 week) matches with rTMS response (Chi-square 4,03, p=0,0446). Conclusions: rTMS is effective in treatment of depression in schizophrenia. rTMS reduces secondary negative symptoms and improves some cognitive functions. Rapid cognitive response might be a favorable prognostic sign of rTMS treatment course. Further trials are needed. [ABSTRACT FROM AUTHOR]

Introduction DSM-5 criteria for the mixed features specifier exclude symptoms, such as psychomotor agitation, irritability and mood lability. Objectives The goal of the BRIDGE-MIX study was to provide an estimate of the frequency of mixed states (MXS) in depressed patients according to different definitions and to compare their clinical validity. Aims The aim of this sub-analysis is to examine the importance of distinct hypomanic symptoms in mixed depression, including those excluded from DSM-5. Methods A total of 2811 subjects were enrolled in this multicentric cross-sectional study. Psychiatric symptoms, socio-demographic and clinical variables representing risk factors for bipolar disorder (BD) were collected. Multiple comparisons analysis was performed using a Bonferroni-corrected threshold and stepwise-backward logistic regression. Results Two hundred and twelve patients fulfilled DSM-5 criteria for MXS. The most common symptoms in this subset and in the total sample are shown in Table 1 (Tables are not available for this abstract). Logistic regression demonstrated specific associations of psychomotor agitation (Wald 5.092, P = 0.024), impulsivity (Wald 28.47, P < 0.0001), racing thoughts (Wald 12.657, P < 0.0001) and logorrhoea/pressured speech(Wald 230.720, P < 0.0001) with DSM-5 diagnosis of MXS (Table 2). Conclusions The DSM-5 definition of MXS excludes “overlapping” mood criteria, such as psychomotor agitation, irritability and mood lability, among the most frequent features of mixed depression in our sample and in literature. The results of this study highlight the impact of the excluded symptoms on MXS diagnosis. Although these symptoms may be non-specific, their exclusion from DSM-5 may not be justified, in the absence of evidence that the remaining criteria are sufficiently sensitive to identify MXS. [ABSTRACT FROM AUTHOR]