Association of executive function problems and disordered eating behaviours in teens with type 1 diabetes.

AIM: To explore cross-sectional associations between executive function problems and disordered eating behaviours in teens with type 1 diabetes. METHODS: Executive function was assessed by the Behavior Rating Inventory of Executive Function (BRIEF), self-report and parent proxy-report versions. Scores ≥60 (on Global Executive Composite, Behavioral Regulation Index, Metacognition Index or clinical scales) indicated problems with executive function. Disordered eating behaviour was assessed by the Diabetes Eating Problem Survey Revised (DEPS-R) and categorized as follows: <10 low, 10-19 moderate and ≥20 high. RESULTS: In the 169 teens (46% girls, median age 16.0 years [range 13.7-18.7], median diabetes duration 8.9 years [range 1.4-16.6]), 29% had moderate and 12% had high level of disordered eating behaviours. Executive function problems were present in 9% by self report and 26% by parent proxy-report. Among teens with moderate/high level of disordered eating behaviours, 19% had executive function problems by self report (vs. 2% of teens with low level of disordered eating behaviours, p < 0.001) and 33% had executive function problems by parent proxy-report (vs. 20% of teens with low level of disordered eating behaviours, p = 0.056). A greater level of disordered eating behaviours was associated with executive function problems by teen self report on the General Executive Composite (p < 0.001), Behavioral Regulation Index (p < 0.001), emotional control clinical scale (p < 0.001), shift clinical scale (p < 0.001) and by parent proxy-report on the task initiation clinical scale (p = 0.008). CONCLUSIONS: Assessing executive function and screening for disordered eating behaviours in teens with type 1 diabetes could help identify a subset of teens at high risk for adverse outcomes and need for intervention.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population.

INTRODUCTION: Avoidant/restrictive food intake disorder (ARFID) categorises patients with selective and/or restrictive eating patterns in the absence of distorted cognition concerning weight, food, and body image. OBJECTIVE: To examine the sociodemographic and clinical profile of patients with ARFID in comparison to those with anorexia nervosa (AN) and to a non-clinical group (NCG). METHOD: A descriptive, observational, comparative study made up of three groups (ARFID, AN and NCG). Ninety-nine children and adolescents were analyzed by means of a semi-structured diagnostic interview and questionnaires on depression, anxiety, clinical fears and general psychopathology. RESULTS: The ARFID group was significantly younger (10.8 vs. 14.1 years of age), with a greater proportion of males (60.6% vs. 6.1%), an earlier onset of illness (6.2 vs. 13.4 years of age), and a longer period of evolution of the illness (61.2 vs. 8.4 months) compared to the AN group. Clinically, patients with ARFID showed greater medical (42.4% vs. 12.1%) and psychiatric (81.8% vs. 33.3%) comorbidity-assessed with a semi-structured diagnostic interview-greater clinical fear (p < 0.005), more attention problems (p < 0.005) and fewer symptoms of anxiety and depression (p < 0.005)-measured with self-report questionnaires. CONCLUSIONS: ARFID is a serious disorder with a significant impact on the physical and mental health of the pediatric population. Likewise, some of these physical and mental conditions may be a risk factor in developing ARFID. Attention problems and clinical fears in ARFID, and the greater presence of internalised symptoms in AN, were the main differences found in the psychopathological profiles.

Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment.

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with Anorexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alternative to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates transition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP program for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs. 17.9, p<0.001) and at 12 months follow- up (17.9 vs. 19.3, p<0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less intensive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p<0.043). CONCLUSION: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moderate to severe AN. This new model has cost-effectiveness implications as it is a safe resource and is less costly than IT.

Alternativas a la hospitalización total en adolescentes con anorexia nerviosa: Eficacia y características de un nuevo modelo intensivo de tratamiento en hospital de día / Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment

INTRODUCCIÓN: La Hospitalización Total (HT) es el tratamiento de elección para adolescentes con Anorexia Nerviosa (AN) moderada-grave. Sin embargo, ésta es costosa y el riesgo de recaída o reingresos es alto. Una alternativa menos costosa es la Hospitalización Parcial (HP), que puede ayudar a evitar recaídas y reingresos porque facilita la transición del hospital al tratamiento comunitario. OBJETIVO: Evaluar la eficacia de un tratamiento intensivo en HP para adolescentes con AN, el programa de HP para Trastornos de la Conducta Alimentaria (TCA) de 11 horas (HP-TCA-11h), respecto a la recuperación ponderal, evitar ingresos y disminuir estancias en HT. MÉTODO: Se realizó un estudio longitudinal y naturalístico que analizó las variables clínicas y socio-demográficas de los pacientes con AN que fueron dados de alta consecutivamente del HP-TCA-11h, durante los años 2015-2016. RESULTADOS: Se realizaron 77 altas. La edad media fue de 14.4 años (DE: 1.62). La estancia media fue de 28.9 días (DE: 18.5). La media del índice de masa corporal aumentó significativamente al alta (17.2 frente a 17.9, p < 0.001) y a los 12 meses de seguimiento (17.9 frente a 19.3, p < 0.001). Veintinueve (70.8%) pacientes tratados en HP-TCA-11h, que vinieron de un recurso menos intensivo, evitaron el ingreso en HT. Catorce (18.2%) requirieron un reingreso en HP-TCA-11h en dos años. La estancia media en HT disminuyó significativamente (de 33 a 24 días, p < 0.043). CONCLUSIÓN: HP-TCA-11h ha demostrado ser un recurso eficaz como alternativa a la HT para adolescentes con AN moderada-grave. Este nuevo modelo tiene implicaciones coste-efectivas ya que es un recurso seguro y menos costoso que la HT

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with An-orexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alterna-tive to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates tran-sition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP pro-gram for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs.17.9, p < 0.001) and at 12 months fol-low-up (17.9 vs.19.3, p < 0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less inten-sive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p < 0.043). CONCLUSIONS: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moder-ate to severe AN. This new model has cost-effectiveness im-plications as it is a safe resource and is less costly than IT

Ideación suicida y conductas autolesivas en adolescentes con Trastornos de la Conducta Alimentaria / Suicidal ideation and self-injurious behavior in adolescents with eating disorders

Introducción. Es conocida la presencia de ideas suicidas y comportamientos autolesivos en pacientes con Trastornos de la Conducta Alimentaria (TCA), sin embargo, esta asociación no está claramente definida empíricamente. El objetivo del estudio es determinar la prevalencia de ideación suicida y conductas autolesivas en adolescentes con TCA. Un segundo objetivo es estudiar la asociación entre conducta autolesiva e ideación suicida, gravedad de la sintomatología alimentaria, depresiva, ansiosa, motivación para el cambio y perfeccionismo. Metodología. Se evaluaron a 109 pacientes (edad media: 14,74 años (DE:1,53); 87,2% mujeres) con el Inventario de TCA (EDI-2), el Inventario de Depresión de Beck (BDI-II), el Inventario de Ansiedad Estado/Rasgo (STAI), la Escala de Perfeccionismo en Niños y Adolescentes (CAPS) y el Cuestionario de Etapas de Cambio en la Anorexia Nerviosa (ANSOCQ). Resultados. Cuarenta y siete pacientes (43,1%) presentaron ideación suicida y 34 (31,2%) conductas autolesivas. La presencia de ideación suicida no discriminó entre pacientes TCA con y sin comportamiento autolesivo. Los pacientes con comportamiento autolesivo presentaron una puntuación significativamente mayor en todas las escalas del EDI-2, a excepción de Miedo a Madurar, en la puntuación total del BDI-II, STAI y en la CAPS. Se encontró una asociación entre la conducta autolesiva y la motivación para el cambio. Conclusiones. Un porcentaje importante de adolescentes con TCA presentan ideación suicida y comportamientos autolesivos, siendo el perfil psicopatológico de estos pacientes más grave. La presencia de ideación suicida en adolescentes con TCA no tiene necesariamente implicaciones con la conducta autolesiva, este comportamiento podría explicarse como consecuencia de la necesidad de regular emociones negativas intensas (AU)

Introduction. The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism. Methodology. We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). Results. Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for ‘maturity fears’, in the total scores of BDI-II, STAI and CAPS. An association between self-injurious behavior and motivation to change was found. Conclusions. A significant percentage of adolescents with eating disorders present suicidal ideation and self-injurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily mply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions (AU)

Suicidal ideation and self-injurious behavior in adolescents with eating disorders.

INTRODUCTION: The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism. METHODOLOGY: We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). RESULTS: Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for “maturity fears”, in the total scores of BDI-II, STAI and CAPS. An association between selfinjurious behavior and motivation to change was found. CONCLUSIONS: A significant percentage of adolescents with eating disorders present suicidal ideation and selfinjurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily imply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions.

Diagnóstico y tratamiento de la catatonia: a propósito de un caso / Diagnosis and treatment of catatonia: Presentation of a case

La catatonia es un síndrome de alteraciones motoras que se puede observar en varias patologías psiquiátricas y, también, médicas. En las últimas décadas la incidencia de catatonia se ha visto reducida, y se cree que ello se debe en parte a un infradiagnóstico. Es muy importante realizar un diagnóstico precoz para aplicar lo antes posible el tratamiento adecuado. Presentamos el caso de un paciente varón de 19 años que ingresa para tratamiento de un síndrome psicótico al que se le inicia tratamiento con antipsicóticos con respuesta parcial. En la exploración destaca clínica compatible con catatonia, por lo que se descarta causa médica y se inician benzodiacepinas y terapia electroconvulsiva (TEC). Progresivamente disminuyen los signos catatónicos, lo que permite reducir las benzodiacepinas hasta su retirada. Al alta se mantienen los antipsicóticos y la TEC. Para realizar el diagnóstico de catatonia, según el DSM IV solo es necesaria la presencia de 2 de los signos asumidos como cardinales: inmovilidad motora, actividad motora excesiva, negativismo extremo, peculiaridades del movimiento voluntario y/o ecolalia o ecopraxia. La aplicación de escalas clínicas resulta útil como guía para la exploración completa y para cuantificar su gravedad. Existen varias, pero la Bush-Francis Catatonia Screening Instrument (BFCSI) es la preferida para el empleo rutinario, debido a su validez, fiabilidad y fácil administración. Respecto el tratamiento, se ha visto que tanto las benzodiacepinas como la TEC son tratamientos efectivos para la catatonia, y que los antipsicóticos atípicos, en algunos casos, también pueden ser útiles (AU)

Catatonia is a syndrome with motor alterations that can be found in several psychiatric and medical pathologies. The incidence of catatonia has decreased in the last few decades, partly due to its underdiagnosis. An early diagnosis is essential in order to start an effective treatment as soon as possible. We present the case of a 19 year-old male patient who was admitted due to a psychotic syndrome in order to receive treatment with antipsychotics, to which he showed a poor response. A diagnosis of catatonia was made in the psychopathological assessment, and benzodiazepines treatment and ECT were started, after excluding other medical reasons. The catatonic symptoms gradually decreased, and the benzodiazepines dose was reduced and withdrawn as a consequence. The patient was discharged with antipsychotic drugs and ECT treatment. A catatonia diagnosis based on DSM IV requires the presence of at least two of the cardinal signs such as: motor immobility, excessive motor activity, extreme negativism, peculiarities of voluntary movement, and/or echolalia or echopraxia. The administration of clinical scales is useful as a guide to make a complete exploration, and for quantifying its severity. There are several scales, but the Bush-Francis Catatonia Screening Instrument (BFCSI) is preferred for routine use, due to its validity, reliability and ease of administration. Regarding the treatment, it has been shown as both ECT and benzodiazepines are effective treatments for catatonia. The atypical antipsychotics may also be useful in some cases (AU)

Factores de riesgo cardiovascular, riesgo cardiovascular y calidad de vida en pacientes con trastorno mental severo / Cardiovascular risk factors, cardiovascular risk and quality of life in patients with a severe mental disorder

Objetivo: Determinar los factores de riesgo cardiovascular (FRCV), estratificar el riesgo cardiovascular (RCV) y analizar la relación entre RCV y calidad de vida en pacientes con trastorno mental severo (TMS). Diseño: Estudio descriptivo transversal. Emplazamiento: Servicio de Salud Mental, Consorcio Hospitalario de Vic (Barcelona). Participantes: Pacientes con TMS mayores de 18 años. Mediciones principales: Se recogieron variables sociodemográficas, hábitos tóxicos, enfermedades previas, antecedentes familiares de enfermedad cardiovascular prematura, diagnósticos psiquiátricos, y parámetros físicos y analíticos. El RCV se determinó por las escalas SCORE y REGICOR. La calidad de vida se midió con los cuestionarios Euro-QOL y Sevilla. Resultados: Se incluyeron 137 pacientes con TMS, 64,9% mujeres, edad media de 51,1 años (DE: 12,9). Distribución de los FRCV mayores: 40,1% tabaquismo, 37,9% hipertensión arterial, 56,2% dislipidemia y 11,1% diabetes. Un 37,9% cumplían criterios de obesidad y el 48,4% de síndrome metabólico. La media de FRCV mayores fue de 1,5 factores. El RCV fue alto en el 4,6% de la muestra según la SCORE y del 5,4% según REGICOR. Ni los pacientes que acumulaban más FRCV ni los que tenían RCV elevado presentaron puntuaciones peores en calidad de vida. Conclusiones: Los FRCV más prevalentes en los pacientes con TMS son el tabaquismo y la dislipidemia, con prevalencias que superan a la de los estudios de base poblacional. El subgrupo de trastornos depresivos presentó un RCV mayor y peores resultados en la calidad de vida. No se observó relación entre el RCV y la calidad de vida(AU)

Aim: To determine the cardiovascular risk factors (CVRF), level of cardiovascular risk (CVR) and to analyse the relationship between CVR and quality of life in patients with severe mental illness (SMI). Design of study: Cross sectional study. Setting: Mental Health Service, Consorci Hospitalari de Vic (Barcelona). Subjects: Patients over 18 years diagnosed with SMI. Main measurements: Data was collected on, socio-demographic variables, toxic habits, previous pathologies, family history of premature cardiovascular disease, psychiatric diagnoses, physical parameters and laboratory findings. The CVR was determined by the SCORE and REGICOR scales. Quality of life was measured by Euro-QoL and Seville Questionnaires. Results: A total of 137 patients with SMI were included; 64.9% female, and a mean age 51.1 years (SD 12.9). Major CVRF distribution: 40.1% smoking, 37.9% hypertension, 56.2% dyslipidemia, and 11.1% diabetes. The criteria for obesity and metabolic syndrome were met by 37.9% and 48.4% of the patients, respectively. The average major CVRF was 1.5 factors. The CVR was high in 4.6% of the sample by SCORE and in 5.4% by REGICOR. Neither the patients who accumulated more CVRF or those with high CVR scores showed a worse quality of life. Conclusions: The most prevalent CVRF in patients with SMI are smoking and dyslipidemia, with a prevalence that exceeded population-based studies. The subgroup of depressive disorders showed a higher CVR and worse quality of life. No relationships were found between the CVR and the quality of life(AU)

[Cardiovascular risk factors, cardiovascular risk and quality of life in patients with a severe mental disorder]. / Factores de riesgo cardiovascular, riesgo cardiovascular y calidad de vida en pacientes con trastorno mental severo.

AIM: To determine the cardiovascular risk factors (CVRF), level of cardiovascular risk (CVR) and to analyse the relationship between CVR and quality of life in patients with severe mental illness (SMI). DESIGN OF STUDY: Cross sectional study. SETTING: Mental Health Service, Consorci Hospitalari de Vic (Barcelona). SUBJECTS: Patients over 18 years diagnosed with SMI. MAIN MEASUREMENTS: Data was collected on, socio-demographic variables, toxic habits, previous pathologies, family history of premature cardiovascular disease, psychiatric diagnoses, physical parameters and laboratory findings. The CVR was determined by the SCORE and REGICOR scales. Quality of life was measured by Euro-QoL and Seville Questionnaires. RESULTS: A total of 137 patients with SMI were included; 64.9% female, and a mean age 51.1 years (SD 12.9). Major CVRF distribution: 40.1% smoking, 37.9% hypertension, 56.2% dyslipidemia, and 11.1% diabetes. The criteria for obesity and metabolic syndrome were met by 37.9% and 48.4% of the patients, respectively. The average major CVRF was 1.5 factors. The CVR was high in 4.6% of the sample by SCORE and in 5.4% by REGICOR. Neither the patients who accumulated more CVRF or those with high CVR scores showed a worse quality of life. CONCLUSIONS: The most prevalent CVRF in patients with SMI are smoking and dyslipidemia, with a prevalence that exceeded population-based studies. The subgroup of depressive disorders showed a higher CVR and worse quality of life. No relationships were found between the CVR and the quality of life.

Comorbilidad del trastorno por estrés postraumático en pacientes con trastorno mental grave. Implicaciones clínicas / Comorbidity of post-traumatic stress disorder in patients with severe mental illness. Clinical implications

El trastorno por estrés postraumático (TEPT) aparece de forma comórbida con el trastorno mental grave (TMG) en el 16–48% de los casos, una cifra mucho más alta que en la población general (7,8–9,2%). Aunque en estos pacientes con enfermedad psiquiátrica primaria grave el diagnóstico del TEPT es muy frecuentemente obviado. Hay varias hipótesis etiopatogénicas que explicarían la alta prevalencia de TEPT en pacientes con TMG: diátesis del propio trauma; alto riesgo de exposición a situaciones traumáticas; predisposición genética para la psicosis en un grupo de pacientes con TEPT, y efecto del propio tratamiento antidopaminérgico. Las repercusiones del TEPT en pacientes con TMG están bien documentadas en la bibliografía. Los pacientes con TEPT presentan síntomas psiquiátricos más severos, más trastornos por abuso de alcohol y otras sustancias, tienen un mayor número de visitas y hospitalizaciones psiquiátricas, una menor integración laboral, una peor adherencia al tratamiento farmacológico, más conductas de riesgo, intentos de suicidio y autolesiones, y una función cognitiva más pobre. Los antidepresivos, en especial los inhibidores selectivos de la recaptación de serotonina, y la terapia cognitivo conductual serían los tratamientos de elección en el TEPT. Los últimos estudios indican que la terapia cognitivo conductual podría ser también útil en los síntomas postraumáticos de pacientes afectados de TMG. En la práctica clínica es recomendable realizar de forma sistemática una valoración de los traumas sufridos e indagar acerca de la existencia de síntomas postraumáticos en las entrevistas clínicas (AU)

Posttraumatic stress disorder (PTSD) appears by comorbid severe mental illness (SMI) in 16%–48% of cases, higher than in the general population (7.8% to 9.2%). Although these patients with severe primary psychiatric diagnosis of PTSD is often missed. Several etiopathogenic hypotheses could explain the high prevalence of PTSD in patients with SMI: diathesis trauma itself, a high risk of exposure to trauma, genetic predisposition to psychosis in a group of patients with PTSD and antidopaminergic effect of treatment itself. The impact of PTSD in patients with SMI is well documented in the literature. PTSD patients with more severe psychiatric symptoms, more alcohol use disorders and other substances, have a greater number of visits and psychiatric hospitalizations, lower work integration, poorer adherence to drug treatment, more risk behaviours, suicide attempts and self-harm, and poorer cognitive function. Antidepressants especially selective serotonin reuptake of serotonin and cognitive behavioral therapy would be the treatments of choice in PTSD. Recent studies indicate that cognitive behavioral therapy may also be useful in post-traumatic symptoms of patients with SMI. In clinical practice it is advisable to systematically perform an assessment of the traumas and investigate the existence of PTSD symptoms in clinical interviews (AU)