Persistent negative symptoms (PNS) contribute to impairment in psychosis. The characteristics of PNS seen in youth remained under-investigated. We aimed to demonstrate clinical, treatment-related, and psychosocial characteristics of PNS in early-onset schizophrenia-spectrum disorders (EOSD). 132 patients with EOSD were assessed with Positive and Negative Symptom Scale, Brief Negative Symptom Scale, Calgary Depression Scale for Schizophrenia, and Simpson-Angus Scale. Parenting skills and resilience were evaluated using Parental Attitude Research Instrument and Child and Youth Resilience Measure-12. Longer duration of untreated psychosis (DUP) and prodromal phase were found in primary and secondary PNS groups, compared to the non-PNS group. The primary PNS group was characterized by earlier age-onset, lower smoking rates, and more common clozapine use. Resilience and egalitarian/democratic parenting were negatively correlated with symptoms related to motivation/pleasure and blunted expression. More blunted expression-related symptoms and longer DUP in the first episode significantly predicted primary/secondary PNS at follow-up. Using the data from total negative symptom scores and DUP, Receiver Operating Characteristic analyses significantly differentiated primary/secondary PNS groups from the non-PNS counterparts. PNS associated with blunted expression and low motivation/pleasure in the first episode could persist into clinical follow-up. Effective pharmacological treatment and psychosocial interventions are needed in youth.

Grief mania that is evaluated as psychogenic mania in the literature is related to manic episode that emerges after the loss of a loved one. There are not many cases that associate causality of beginning of mania and mourning in the literature. It is known that mania is induced by traumatic events but the cases that do not suit stages of development of grief process are evaluated as pathological grief. In this case, the woman who experienced manic episode after her son's death is presented. This case is prepared because mania should be considered as possible grief reaction. Case presentation: A patient who is 40 years old, married, mother of 4 children is brought by relatives because of aggressiveness, tension, insomnia for 4 days, fast and talk a lot and nonsense laughing attacks. She was presented to hospital for stressful life events 2 years ago and started to be on medication (escitalopram 10 mg) because of depression and fibromiyaliji diagnosis. She used medication for 1.5 years and she did not use any medication for the last 6months. There is no history for mental disorder in her family. Psychological examination: her interest for the environment was increased, self-care ability got better, her temperament was cheerful, her sociability was respectful, amount of talking and tone of voice increased, mimic and gesture was appropriate for her temperament, sleeping decreased, thought flow increased and achieved goal of conversation late. Moreover, there were grandiose delusions and hypervigilance, affect was close to euphoria, her psychomotor behaviours increased and social functioning decreased. According to biochemical and radiological workup, there was no pathological situation. The client started to use Lithium 900 mg/day and Olanzapin 10 mg/day because of the bipolar disorder diagnosis. The patient's blood lithium level was 0.8mEq/L and lithium was used 1200 mg/day and then 10 days later the patient's blood lithium level was 0.72 mEq/L. According to clinical observations, the patient's manic symptoms remained. Furthermore, the patient started to cry occasionally after 1 month and her grandiosity disappeared. The patient was discharged from the hospital after 45 days. The patient met the criteria for manic episode in DSM 5. The patient did not take any medication for last 6 months. Thus, it is considered that this situation was not induced by medication. It puts the patient into risk group because she was treated for depression before but it is not considered as bipolar depression because there were psychiatric history in the family and depression that experienced 2 years ago was related to stressful life events. It is considered that this case experienced grief/funeral mania because there was contiguity between loss of her son and manic episode, the patient did not react this way to previous challenging life events and the patient was outside of the ordinary 5 stages of grief process.

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