Little is known about the effectiveness and the cost of care for patients treated in vocational rehabilitation programs, although vocational therapy is an essential part of inpatient treatment or community care of patients with schizophrenia.

As a part of a randomised controlled trial in 5 centres, the long-term direct cost of care for patients with schizophrenia, being treated with different vocational rehabilitation programs during an index-stay in a psychiatric hospital were assessed. Results were compared to controls who received non-specific ergo-therapeutic treatment instead.

Cost differences between study patients and controls were small and not statistically significant. However, cross-centre costs differed considerably.

In spite of standardized inclusion criteria and a randomised assignment of study patients, a selection bias, triggered by the differing vocational rehabilitation programs is assumed as a source of cross-centre cost-variation which might be supported by differing service offers in the study regions.

Since 1980s, several reports, based mainly in hospital registers, have suggested that the incidence of schizophrenia is decreasing. However, changes in capacity of mental hospitals, in admission policy and in diagnostic practice have not always been taken into account.

Our aim was to study 1) how annual first admission rate for schizophrenia varied during a quick deinstitutiolisation period in Finland and 2) how it was associated with changes in admission policy and diagnostic practice.

From the National Hospital Discharge Register, we identified 30 041, 15 to 64 year old patients admitted for the first time for schizophrenia to mental hospital in Finland between 1980 and 2003, as well as numbers of annual inpatient days in and all patients admitted to mental hospitals. Rates for all admitted patients and first-admitted schizophrenia patients (RFASpo) were calculated and analysed with Poisson regression analysis.

RFASpo decreased from 56.4 in 1980 to 29.5 in 1991, stayed stable until 1998 and slightly increased thereafter (30.8 in 1998 and 37.8 in 2003). Changes in RFASpo, coincided with changes in all admissions and periods of official diagnostic classifications. RFASpo varied also between gender and age groups.

In 1980s, decrease of first-admission rate for schizophrenia seemed to be dependent on change in admission policy, in number of mental beds available and in diagnostic practice. In 1990s, increase of first-admission rate for schizophrenia may be associated with economic recession and increased number of beds for adolescents.

Sexual dysfunction was assessed in 34 male outpatients with schizophrenia using a self completed gender specific questionnaire. Patients’ mental state was rated using Positive and Negative Syndrome Scale (PANSS). Current medication was recorded. Quality of life was assessed using Schizophrenia Quality of Life Scale (SQLS).

Sexual dysfunction occurred in majority of patients. Patient with sexual dysfunction reported significantly lower ratings on global quality of life.

People with schizophrenia report high rates of sexual dysfunction. The overall importance of sexuality in the lives of patients with schizophrenia is suggested by significant inverse relationship between sexual dysfunction and global quality of life ratings.

Only few studies have investigated the relationship between childhood trauma and dissociative symptoms in patients with schizophrenia spectrum disorders. Moreover, most of the existing studies did not pay attention to potential relationships between dissociation and psychotic symptoms.

We examined 103 consecutively admitted patients with schizophrenia spectrum disorders using the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale (DES) and the Positive and Negative Symptom Scale (PANSS). Relationships between dissociative symptoms, childhood trauma and psychotic symptoms were examined at admission (t0) and when patients were stabilised (t1).

The DES mean score decreased significantly between t0 and t1 (M=20.1 vs. M=14.5). When patients were stabilized, sexual abuse, physical abuse, emotional abuse and the CTQ total score were significantly correlated with the DES total score (r=.36**, r=.20*, r=.28**, and r=.32**) and different subscales of the DES, most strongly with the amnesia subscale. The amnesia subscale of the DES also showed significant correlations with physical neglect (r=.28**). At t1, positive symptoms as measured by the PANSS were correlated with the depersonalisation subscale of the DES (r=.24*). No relationship existed with negative symptoms.

Our results confirm the relationships between childhood trauma and dissociation in patients with schizophrenia spectrum disorders. Furthermore, they suggest a relationship between dissociation and positive, but not negative psychotic symptoms.

Neurocognitive and functional neuroimaging studies point to frontal lobe abnormalities in schizophrenia. Molecular and behavioural genetic studies suggest that the frontal lobe is under significant genetic influence. We carried out structural magnetic resonance imaging (MRI) of the frontal lobe in monozygotic (MZ) twins concordant or discordant for schizophrenia and healthy MZ control twins.

The sample comprised 21 concordant pairs, 17 discordant affected and 18 discordant unaffected twins from 19 discordant pairs, and 27 control pairs. Groups were matched on sociodemographic variables. Patient groups (concordant, discordant affected) did not differ on clinical variables. Volumes of superior, middle, inferior and orbital frontal gyri were calculated using the Cavalieri principle on the basis of manual tracing of anatomic boundaries. Group differences were investigated covarying for whole-brain volume, gender and age.

Results for superior frontal gyrus showed that twins with schizophrenia (i.e. concordant twins and discordant affected twins) had reduced volume compared to twins without schizophrenia (i.e. discordant unaffected and control twins), indicating an effect of illness. For middle and orbital frontal gyrus, concordant (but not discordant affected) twins differed from non-schizophrenic twins. There were no group differences in inferior frontal gyrus volume.

These findings suggest that volume reductions in the superior frontal gyrus are associated with a diagnosis of schizophrenia (in the presence or absence of a co-twin with schizophrenia). On the other hand, volume reductions in middle and orbital frontal gyri are seen only in concordant pairs, perhaps reflecting the increased genetic vulnerability in this group.

The deleterious effects of childhood trauma are widely known and documented in community samples. Recent studies have shown higher rates of childhood traumatic events in the psychiatric population. These studies suggest that men and women who have experienced childhood trauma and who have severe psychiatric symptoms reliably report their own experiences.

Men and women, (n=184) between the ages of 18-65 years with a history of serious mental illness, capacity to give informed consent, and either English or Spanish fluency, were recruited from various outpatient clinics in New York City. Concepts measured focused on the themes of abusive experiences (psychological abuse, physical abuse, sexual abuse, and witnessing domestic violence) and dysfunctional household environment (substance abuse, mental illness, criminal imprisonment of family member). Data were analyzed in SPSS 13.0 using basic descriptive statistics and linear regression models.

Men (70 or 67.3%) reported nearly twice the rate of physical abuse (30.9%) reported by females (P<.001). Of the men and women in the sample, 26.8% reported having had the childhood experience of sexual and physical abuse. A very small percentage of the sample population reported sexual abuse without accompanying physical abuse (11.6%). Psychiatric co-morbidity was assessed with different screening methods including positive and negative psychotic symptoms, PTSD, dissociative symptoms and affective disorders.

The results suggest a close interaction between repetitive childhood trauma and the complexity of symptoms. A re-conceptualization of the diagnostic criteria as complex PTSD is needed to explain this phenomenon.

Cognitive impairment is well documented in schizophrenia, and improves to some extent with treatment. Early cognitive changes in response to antipsychotic treatment are not well documented. We assessed early (12wk) cognitive changes and their relationships to psychopathology in 20 patients in an interim analysis of an ongoing study.

Patients with a first episode of schizophrenia underwent MATRICS Consensus Cognitive Battery assessment at baseline, 4 and 12wks. PANSS ratings were completed. Treatment with low doses of oral and depot flupenthixol was commenced.

The sample consisted of 4 females and 16 males, with an average age of 21,22 years. The mean modal dose of flupenthixol was 10mg 2 weekly IMI. Two patients were withdrawn due to side-effects. The average premorbid IQ of the sample was on the 91st percentile as estimated by the Vocabulary subtest of the WAISS. Early changes in attention and concentration from baseline were present. Other cognitive domains (speed of processing, working memory, and visual learning) also improved and were correlated with changes in PANSS scores.

Low doses of a long-acting conventional antipsychotic are effective in improving some aspects of cognitive function after a first episode of schizophrenia. The response was rapid, and coincided with improvement in positive symptoms. The failure of previous studies to demonstrate cognitive benefits of conventional antipsychotics may have been related to excessive doses being prescribed.

Due to the limitations of certain antipsychotic treatments with respect to efficacy and safety, clinicians may sometimes wish to switch a patient to another antipsychotic. The comparative risks associated with different methods of antipsychotic drug discontinuation are relatively unknown. The present study compared 3 strategies to determine an optimal method for switching from amisulpride to ziprasidone in patients suffering from schizophrenia or schizoaffective disorder.

This was a 3-month randomized, multicenter, open-label study in three-parallel groups. 102 chronic outpatients with schizophrenia or schizoaffective disorder were randomized at D1 to one of three switching strategies. Strategy I: abrupt discontinuation of amisulpiride before initiation of ziprasidone; strategy II: reduction to 50% of previous dose of amisulpiride from D1 to D7 then discontinuation; strategy III: reduction to 50% of previous dose of amisulpiride from D3 to D7 then discontinuation. At D1 all patients received the same dose of ziprasidone. Main efficacy assessments included the Negative and Positive Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Severity and Improvement (CGI-S and CGI-I). Main safety assessments included the Extrapyramidal Symptom Rating Scale (ESRS), and Barnes Akathisia Scale (BAS).

Clinical improvement was comparable whatever the switching strategy used. Safety and tolerability of ziprasidone in switching were confirmed. The strategy III was associated with an increased incidence of adverse events leading to patient withdrawal during the switch.

similar efficacy results were obtained with the three switching strategies. However, one of them was less well tolerated.

To consider the different levels of remission of negative, positive or disorganization disorders, following Andreasen´s criteria in a population of Schizophrenic and Schizoaffective patients in treatment with Risperidone Consta and the relationship between levels of therapeutic fulfillment and functionality achieved.

138 patients admitted to Acute Unit that required Risperidone Consta have been evaluated. After 6 months of treatment, 80 patients were interviewed and grouped in patients “in remission” and in “not remission”. It applied protocol with demographic data, questions about medication, disease, current status, scale for Remission (Andreasen), DAI, EEAG and WHO/DAS.

The average age was 39 years. The sample was mostly males (63.8%), singles, widowed or divorced (90%), living in a family environment (80%), with basic educational level (84%), unemployed (63.8%), they live in urban areas (71.3%). Diagnoses in order of frecuency were Schizophrenia (87.5%), Bipolar Disorder (5%), Schizoaffective disorder (2.5%), paranoia (5%). The 83.8% of patients supported Risperidone Consta during 6 months and 16.3% abandoned medication. The average time development of the disease was 12.16 years.

Most of patients (80%) achieved remission. Those who achieved remission presents fewer admissions, a higher satisfaction level, a better perception of health, with significant differences. The abandon of the medication is the fundamental reason of not remission of symptoms.

Patients who got remission relate to higher performance (EEAG) and lowest values of disabilities (WHO-DAS), both in employment levels, in family and social life, with significant differences. The fulfillment and therapeutic adherence is an important factor in remission (DAI).

Guidelines of treatment with antipsychotic medication have changed in the last 10 years, following the marketing of atypical antipsychotic medication (1994), being at the beginning the more frecuently use of typical antipsycotics and classic Depot in opposite to oral and depot atypical antipsychotics at the present.

To describe the real situation about the use of antipsychotics in patients with Schizophrenia following hospitalization into the different Acute Hospitalary Units and differences in their first and subsequent admission.

A survey was conducted by different hospitals in our geography from the discharge reports occurred in 2006 on schizophrenic patients.

2424 discharge reports were analized from 6 Acute Hospitalary Units. They were obtained 601 schizophrenic patients (24.79%) that required rehospitalization in 15.2% (N=76). The average stay was two to three weeks. Most patients were diagnosed of Paranoid Schizophrenia (74;75%). The more frecuently used was oral and/or IM atypical antipsychotic medication at 43%, opposite to 22.30 of the atypicals antipsycotics.

The predominant antipsychotic association used was a typical oral antipsychotic with atypical depot (26.47%), followed by the association of typical antipsychotic with oral atypical antipsychotic in 10.625. In readmissions the differences between both groups faded (atypical antipsychotics, 33.57% and combinations with depot, 30.26%)

There has been an evolution in the pattern of use of antipsychotic medication in the last 10 years. From predominant use of typical antipsychotics we have switched to atypical antipsychotics in monotherapy in first place (50% of patients), followed by the association of atypical antipsychotic plus depot.

To investigate delusional beliefs and their dimensions (distress, preoccupation, conviction) across three groups, including patients with schizophrenia, their healthy family members, and normal subjects.

Subjects were 25 patients with schizophrenia, 35 of their healthy first degree relatives, and 35 normal subjects. Frequency of delusional beliefs and their dimensions were assessed using Peters et al. Delusions Inventory (PDI-40). General Health Questionnaire (GHQ-28) was used to examine general mental health.

Frequency of delusional beliefs was higher in the patient group, compared with family group and normal subjects. Scores of all three dimensions of beliefs among the patients were significantly higher than the normal subjects but not more than their family members. In addition, conviction in the beliefs was significantly higher in the family members as compared to normal subjects.

The existence of the delusional beliefs among the healthy family members of patients with schizophrenia and the higher conviction in these beliefs as compared to normal subjects is in keeping with the continuum notion of psychosis. Further investigations are needed to support the notion.

This is the first study of duration of untreated psychosis and pathways to care among patients with first episode psychosis in Iran.

Subjects were patients with a first episode of a nonorganic psychotic illness that were admitted to a university affiliated psychiatric hospital in Iran. Patients were assessed for duration of untreated psychosis (DUP, defined as the duration between the appearance of first symptoms of psychosis and the time when first adequate treatment is received), pathways to care (including any previous helping contacts and referrals to the hospital), and mode of illness onset.

Ninety-one patients were enrolled. Median DUP was 11 weeks, with the mean of 52.3 weeks (range: one day to 17 years). Following the onset of psychosis, most patients were first seen by a psychiatrist (n=23, 25.3%), a traditional healer (n=21, 23.1%) or a general practitioner (n=16, 17.6%). Most of the referrals to the psychiatric hospital was by the family (n=30, 33.1%), and health professionals (n= 29, 31.9%). Acute illness onset and rural place of residence were associated with shorter DUP in multivariate analysis.

DUP in this developing country setting was comparable to several others in western countries. This may be due to the preponderance of acute psychoses in this sample, and different help seeking behavior or health care system. Of special notice, family plays a significant role in the journey toward care.

To assess psychotic-like experiences and their correlates in a large sample of urban dwelling general population in Tehran, the capital city of Iran.

A random sample of 2158 subjects aged 18 -65 residing in a densely populated area in southern Tehran was surveyed. Psychotic-like experiences were assessed with the Symptom Checklist–90–Revised (SCL90-R) symptom dimensions “paranoid ideation” and “psychoticism”. Paykel's Interview for Recent Life Events was used to examine recent and past stressful life events.

Using “moderately experienced” cut-off level, the prevalence of psychoticism symptoms ranged from 9.4% (Having thoughts that are not your own) to 18.4% (The idea that you should be punished for sins); paranoid symptoms were reported in 24% (Having ideas that other do not share) to 50.3% (Feeling that most people cannot be trusted). In linear regression analyses, younger age, single or divorced marital status, past history of a psychiatric illness, and current psychological distress (as measured by GSI score in SCL90-R) were associated with psychoticism dimension, whereas female sex, past history of a psychiatric illness, current psychological distress and recent stressful life events contributed to paranoid ideations.

A considerable proportion of a sample in an urban population in Iran displayed psychotic-like experiences. Correlates of these experiences are similar to those observed for psychiatric problems in general, and does not appear to be specific for psychotic spectrum.

Duration of untreated psychosis (DUP) is considered an important predictor of short-term clinical outcome. Early intervention in psychosis services aim to deliver effective intervention as close as possible to the emergence of psychosis, thereby reducing DUP and promoting early and enduring recovery.

Methodology: A literature review was conducted to explore the evolution of the concept of DUP, synthesise the evidence for its predictive value, compare instruments used to measure DUP and assess the psychometric properties of the Nottingham Onset Schedule (NOS) as a measure of DUP.

Identifying time points when psychosis emerges and remits are conceptually ambiguous and clinically difficult to ascertain. Most DUP measures do not take this ambiguity into account and introduce spurious precision in DUP measurements. Mean DUP therefore varies widely between studies, from 25 weeks to over 700 weeks. The relationship between long DUP and poor outcome is also confounded by an interaction between premorbid dysfunction, insidious onset, delayed help-seeking and poor clinical course. A new instrument, the Nottingham Onset Schedule (NOS) is a relatively simple, clinician friendly scale to measure DUP and has been well-validated.

A standardised measure of DUP is a vital first step to allow comparisons between studies. The NOS provides a standardised and reliable way of recording early changes in psychosis and identifies relatively precise time points for measuring several durations in emergent psychosis. Early intervention services can only reduce DUP if early detection is an inherent part of the service

The Kraepelinian division of endogenous psychoses does not satisfactorily account for Acute and transient psychotic disorders (ATPD), which have been reported world-wide.

All patients with first-episode psychosis identified in Nottingham between 1992-1994 and diagnosed using ICD10 criteria were reassessed three years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable outcome in first episode psychosis.

Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. At three years ATPD diagnosis was stable only in women. ATPD outcomes were better than schizophrenia and similar to affective psychosis. Overall, in non-affective psychoses, favourable outcomes were a function of gender and good premorbid functioning rather than acute onset and early remission.

ICD-10 ATPD criteria identify a diagnostically unstable group of disorders. Acute onset and early remission per se do not independently predict favourable outcome in first episode psychosis. Alternative definitions and criteria for ATPD, including operational criteria for acute onset will be discussed.

ICD-10 delineates Acute and Transient Psychotic Disorders (ATPD, F 23) as distinct from schizophrenia and affective psychosis. We investigated the descriptive epidemiology of ATPD and predictive validity of the diagnosis, compared its three-year outcomes with affective psychosis and schizophrenia, and explored whether acute onset and early remission identify a distinct good outcome subgroup in non-affective psychoses.

Between 1992-1994, all first-episode psychosis patients in Nottingham were identified and assigned an intake ICD-10 diagnosis. Patients were assessed three years later using established outcome measures and longitudinal diagnosis assigned. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable three-year outcome in non-affective psychotic disorders.

Of 168 cases of first-episode psychosis, 112 received an intake diagnosis of non-affective psychoses (F20-29) and 32 (19%) of ATPD (F23). ATPD diagnosis was stable in women over three years, but not in men. Outcomes of ATPD were better than schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and good premorbid functioning rather than acute onset and early remission.

ICD-10 ATPD criteria identify a diagnostically unstable group of disorders consisting of ‘good outcome’ schizophrenia, affective psychosis and a very small group of ‘true’ non-affective, non-schizophrenic acute and transient psychoses. Although ATPD have a better outcome than schizophrenia, in non-affective psychoses, acute onset and early remission do not independently predict favourable outcome over three years.

To evaluate long-term treatment with ziprasidone versus haloperidol (up to 196 weeks), as assessed by PANSS negative score and and its association with quality-of-life (QLS).

The study included two treatment periods: (i) a 40-week, randomized, double-blind phase comparing ziprasidone (ZIP 80-160 mg/d given BID, N=227; ZIP 80-120 mg/d given QD, N=221) versus haloperidol (HAL 5-20 mg/d, N=151), followed by (ii) a 3-year, double-blind extension phase on the same double-blind medications (ZIP BID N=72, ZIP QD N=67, and HAL N=47, respectively). We adapted the Andreasen et al. approach to define negative symptom remission based on attainment of a score ≤3 (mild or less) for at least 6 months on all 7 PANSS negative symptom items. MMRM and GEE models were applied to analyze mean changes in PANSS negative, negative symptom remission rate, and QLS scores over time.

In the 40-week core study, ziprasidone was associated with greater improvement in efficacy and QLS outcomes than haloperidol, but the differences were not statistically significant (p>0.05). However, MMRM analysis of PANSS negative and QLS scores over 196 weeks demonstrated differential treatment effects favoring ziprasidone (80-160 mg/d BID vs. haloperidol) (all p<0.05). Ziprasidone-treated subjects (given BID) were significantly more likely to achieve negative symptom remission (46%) than haloperidol-treated (32%) subjects (p<0.05) during the continuation phase; while ziprasidone given QD (46%) showed a trend to enhanced remission (p<0.08).

These findings support the potential for enhanced social and functional outcomes during long-term treatment with an atypical antipsychotic agent.

Tobacco smoking is leading preventable cause of death in the United States. High prevalence of cigarette smoking was reported among individuals with mental illnesses, and it is extremely high among patients with Schizophrenia. Aims of this paper were to establish frequency of cigarette smoking among patients with Schizophrenia and determinate the difference in frequencies of smoking among patients with Schizophrenia treated with second generation antipsychotics versus first generation antipsychotics treated group.

Study included 60 patients with Schizophrenia treated with antipsychotics for period of six months or longer. Experimental group included 30 patients treated with second generation antipsychotics, and control group included 30 patients treated with first generation antipsychotics.

In this sample was 75% smokers, and out of this 46.6% consume up to 20 cigarettes per day, 40% consume 20 to 40 cigarettes, 8.8% between 40-60 cigarettes, and 4.4% consume over 60 cigarettes per day. There was no significant differences between groups of patients treated with first and second generation antipsychotics.

Tobacco smoking is very frequent among patients with Schizophrenia. In this study we did not found significant difference in frequency of tobacco smoking between groups of patients treated with first and second generation antipsychotics.

To compare the risk of treatment-emergent diabetes(TED) in schizophrenic patients treated with atypical(AAP) versus typical(TAP) antipsychotic medications.

We conducted a retrospective database analysis on episodes of care initiated after 1/1/2000 using data from the California Medicaid program. We included episodes for patients 18 years or older with schizophrenia who switched medications with a minimum “wash out” period of 15 days and no evidence of diabetes in the previous 6 months. If selection bias was present we used a simultaneous bivariate probit model to estimate the risk of TED in patients treated with AAP in comparison to TAP, otherwise we used a univariate probit model. Sensitivity analyses estimated the effect of olanzapine, risperidone and quetiapine independently versus TAP.

A Wald test of the correlation coefficient of the disturbances suggests that treatment selection is exogenous in our model(rho=0.005(p=0.95)) using a Huber-White sandwich estimator of the variance. The univariate probit model results suggest that AAPs were not associated with an increased risk of TED relative to TAPs(p=0.324). Sensitivity analysis showed quetiapine to be associated with a statistically significant decreased risk of TED relative to TAPs. No statistically significant association was shown with olanzapine or risperidone. A bivariate probit model omitting numerous variables demonstrates selection bias(rho=-0.650(p=0.0029)).

The results of this study show that AAPs are not associated with an increased risk of TED relative to TAPs. Explanatory variables that may explain treatment selection that were included in our model were sufficient to control for choice of therapy.