Latency to first pharmacological treatment [duration of untreated illness (DUI)] in psychiatric disorders can be measured in years, with differences across diagnostic areas and relevant consequences in terms of socio-occupational functioning and outcome. Within the psychopathological onset of a specific disorder, many factors influence access and latency to first pharmacotherapy and the present study aimed to investigate such factors, through an ad-hoc developed questionnaire, in a sample of 538 patients with diagnoses of schizophrenia-spectrum disorder (SZ), mood disorder (MD), and anxiety disorder (AD). Patients with SZs showed earlier ages at onset, first diagnosis and treatment, as well as shorter DUI compared with other patients (43.17 months vs. 58.64 and 80.43 months in MD and AD; F=3.813, P=0.02). Patients with MD and AD reported more frequently onset-related stressful events, benzodiazepines as first treatment, and autonomous help seeking compared with patients with SZs. In terms of first therapist, psychiatrist referral accounted for 43.6% of the cases, progressively decreasing from SZ to MD and AD (57.6, 41.8, and 38.3%, respectively). The opposite phenomenon was observed for nonpsychiatrist clinician referrals, whereas psychologist referrals remained constant. The present findings confirm the presence of a relevant DUI in a large sample of Italian patients with different psychiatric disorders (5 years, on average), pointing out specific differences, in terms of treatment access and latency, between psychotic and affective patients. Such aspects are relevant for detection of at-risk patients and implement early intervention programs.

IntroductionNovel psychoactive drugs (NPS) has rapidly increase in the last years in the drug market as a recreational use. Fenethylline is a theophylline, an amphetamine-like drug, having stimulant effects similar to those of other amphetamine-type derivatives. Fenethylline was used as medicament for hyperactivity disorders in children, narcolepsy and depression, but it has also been used as a drug of abuse under the common name of ‘captagon’. The purpose of this report is to review the clinical evidence for the potential of abuse of fenethylline. We propose a case report and literature review.MethodWe conducted a systematic review of the literature with the principal database (PubMed, Enbase, PsychInfo) and we present a case report.ResultsThe effects of fenethylline is characterized by euphoria, derealization, autopsychic and somatopsychic depersonalization, hallucination, agitation and decrease of pain perception.Discussion and conclusionThe primary drug market for fenethyline (as captagon) has traditionally been countries located on the Arabian Peninsula but also North Africa since 2013. To our knowledge, there is no report on the recreational use of fenethylline in literature. The clinical features of fenethylline intoxication were also similar to effects from other amphetamine-like drugs. In our case report, dissociative symptoms are the core of fenethylline intoxication. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed-up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered [1,2].Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe presence of mixed features in bipolar disorder (BD) has been associated with a worse clinical course and high rates of comorbidities including anxiety, personality, alcohol and substance use disorders and head trauma or other neurological problems [1]. A recent study reports the connection of neurosyphilis and mania [2]. The aim of our study is to evaluate an inpatient with a psychotic mixed state due to a medical condition (neurosyphilis).MethodAn inpatient with psychotic mixed state in BD was assessed with: SCID-P, HRSD, YMRS, and a complete internistical examination, blood test exams, urinanalysis, electrocardiogram and ecocardiogram, as well as a first level brain imagin (CT and/or MRI). We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “bipolar disorder”, “neurosyphilis” AND “mixed state”.ResultsA comprehensive diagnostic and laboratory screening was unremarkable except for a positive venereal disease research laboratory (VDRL). Treatment for syphilis was started and we used olanzapine to control the psychiatric symptoms.Discussion and conclusionThe estimated annual incidence of non-HIV STIs (sexually transmitted infections) has increased by nearly 50% during the period 1995–2008 [3]. Our case report underly, like Barbosa et al., the need to evaluate neurosyphilis as a potential cause of behavioural and psychiatric symptoms that simulate a psychotic mixed state of bipolar disorder. Olanzapine control and improve the psychiatric symptomatology in neurosyphilis. Methodological limitations, clinical implications and suggestions for future research directions are considered.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPregabalin is widely used in neurology, psychiatry and primary healthcare, and recently in literature different studies explain the possible misuse [1,2]. Pregabalin has shown greater potency in preclinical models of epilepsy, pain and anxiety, and may have potential in the treatment of cocaine addiction [3]. The purpose of this report is to review the clinical evidence for the potential of abuse and misuse of pregabalin. We propose ten different cases and literature review.MethodTen inpatients with misuse of pregabalin were assessed with: the SCID-P, Anamnestic Folio, HAM-A and DAST. We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “pregabalin”, “misuse”.ResultsAll our patients present: cocaine, alcohol and/heroin positive in drugs urine screening at admission; a significant high level of total anxiety at the HAM-A Tot (P < .001), and especially at the item 7 (P < .001); the misuse of pregabalin is made for sniffing; the predominant symptoms assessed were euphoria, psychomotor activation and sedation.Discussion and conclusionSchifano F et al., [1,2] suggest that pregabalin should carefully prescribe in patients with a possible previous history of drug abuse. Our result identifies a particular population the misuse pregabalin that are abuser of cocaine, alcohol and/or heroin. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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