Recognition deficits in facial affect tend to be regarded as a vulnerability marker in schizophrenia. Unlike complex electrophysiological markers, recognition of facial emotions is relatively easy to assess and could be a useful test to identify individuals at risk.

To assess the recognition of facial emotions in a Tunisian population, confirming deficit in patients with schizophrenia unlike controls, and to a lesser level in their first-degree relatives. Performance of the designed test, as a vulnerability marker, was discussed.

One test was constructed from photographs of a famous actress face representing the Ekman's six basic emotions: happiness, anger, disgust, sadness, fear, and surprise. Maximum score was six. The test involves first the recognition of gender.

This test has been proposed to three groups: one group of patients with schizophrenia (n = 34), a group of first-degree relatives (n = 27) and a control group (n = 57).

Recognition deficits of emotions have been found in both patients and their first-degree relatives. Those recognition deficits were absent in the control group regardless of age, sex and educational level. The results also showed that this test is quite specific (77%) and sensitive (84%).

The findings suggest that patients with schizophrenia and their first-degree relatives are impaired of facial emotion recognition skills when compared with controls. This impairment may be a reflected endophenotype, and the constructed visual test should be used as a screening tool for people at risk of schizophrenia.

Meta-analyses describe increased physical morbidity and increased mortality on account of somatic diseases among residents with psychiatric diseases. We need more knowledge about how to integrate the prevention and care of somatic illness to this group of residents with severe psychiatric illness.

To investigate if active awareness on the physical health has an effect on residents' physical health.

Randomised controlled intervention study with a 12-month follow-up.

The intervention results in a statistical significance reduction in the unhealthy waist circumference among residents (3.2 cm. p = 0.018). There are improvements in the blood values of cholesterol, LDL, fasting glucose among residents.

Active awareness on the physical health has a positive effect of the physical health of the residents. There are excess physical health problems in people with severe mental illness. The potential and needs for prevention and treatment are considerably.

None.

Clinical assessment of cognitive functioning in schizophrenia and proposal for including of cognitive dysfunction as diagnostic criteria in DSM-IV.

The treatment of cognitive deficits, the most beneficial method for patients.

One of the main validation criteria for psychotic disorders is the stability over time.

The diagnostic evaluation of a group of subjects who presented with a first episode of psychosis, after 10 years of evolution.

To evidence certain factors that might be associated with diagnostic stability.

The study was conducted on a sample of 79 patients who had a first admission in the Psychiatry Clinic of Timisoara, between 1999–2000. There was a cross-sectional analysis of the sample at three intervals (at onset and after 5, respectively 10 years). The parameters we have observed were, as follows: socio-demographical (gender, age at onset, educational level) and clinical-evolutionary (diagnostic, according to the ICD-10).

At the last evaluation, the sample consisted of only 48 subjects, of which 22 (45.83%) had no change in diagnostic, other 22 subjects (45.83%) had suffered a change in diagnostic during the first 5 years after onset, and 4 more subjects (8.33%) had had a change in diagnostic during the first 10 years of evolution. The onset diagnostics, F23 and F32, had later changed towards a different nosological framing. We could not evidence any factors that had an influence on the stability of the diagnostic over time.

The stability of the clinical diagnostic is not a main coordinate of the first episode of psychosis.

Since the introduction of atypical antipsychotics, the treatment of schizophrenia has shown important challenges. The polipharmacy seems to be the rule in daily current practice.

The study evaluated the treatment of patients with schizophrenia at discharge from hospital in terms of demographics, severity of psychosis, type of antipsychotics used, hospitalization duration and necessity of other psychotropic compounds.

To determine the augmentation with benzodiazepine and mood stabilizers in treatment of schizophrenia.

There were recorded data for all the patients with schizophrenia treated with conventional or atypical antipsychotics between January 2009 - December 2010 in the Clinical and PII Departments of Psychiatry and Neurology Hospital Brasov, Romania.

Of 482 individuals, 209 (43.36%) received FGAs at discharge compared with 273 (56.64%) treated with SGAs. There were few patients who received FGAs alone at discharge compared with patients who received mono-therapy with SGAs (p < 0.0001). Combination between FGAs and benzodiazepine was indicated in a percentage lower than in SGAs cases (p = 0.01). The most commonly antipsychotics used alone were clozapine and olanzapine (p < 0,005). Amisulpride necessitated frequently both benzodiazepines and mood stabilizers augmentation. Age of patients treated with quetiapine (p < 0.05) was highest in the group and the age of onset was lowest for clozapine (p < 0.05).

The augmentation with benzodiazepines and mood stabilizers are highly prevalent in treatment of schizophrenia indifferently of antipsychotics used but with some differences in the class of atypicals. Age represents an important factor in choosing of antipsychotic type.

A 34 year old man was referred to our unit for psychiatric evaluation. His psychomotor development was normal until the age of 12, when he started showing progressive loss of cognitive skills and finalized motor activity. Symptoms rapidly worsened and by the age of 20 his language and motor skills were severly compromised. Starting at age 17 he had been treated with both 1st and 2nd generation antipsychotics which did not lead to any changes in symptoms. Family history was negative for psychotic or neurological disorders. The mother had alcohol abuse disorder and the younger sister was diagnosed with generalized anxiety disorder.

At the time of our evaluation patient was receiving 10 mg of Olanzapine. He was vigilant and passively cooperative to examination; he displayed physical immobility, waxy flexibilitas, stereotyped behaviour, camptocormia, echolalia, blunted affect and automatic and repetitive behaviour. Thought content was difficult to evaluate but he denied hallucinations or delusional thoughts.

BP was normal, as well as brain MRI and PET. Screening for Wilson's disease, metabolic diseases and fragile X Syndrome were negatve. DAT scan was also performed and showed no abnormalities. Medication withdrawal didn’t lead to any changes in his status.

The patient's symtoms fulfill the criteria for drug resistant Catatonic Schizophrenia. However the early onset of symptoms, the rapid deterioration of cognitive abilities, the early and extensive motor imparment and the complete resistance to drug treatment make this an interesting case for discussion about differential diagnosis.

To determine the relationship between smoking and: 1) exacerbation of positive symptoms of schizophrenia; 2) reduction of negative symptoms of schizophrenia.

31-year old man, smoker of 30 units-pack-year, with the diagnosis of paranoid schizophrenia since 2009, when he was admitted to the Centro Hospitalar Psiquiátrico de Lisboa. He was treated with risperidone, clozapine, quetiapine and ciamemazine, with reduction of positive symptoms and improvements in functional and social skills. There was persistence, however, of affective incongruity, discrete auditory-verbal hallucinations, attenuated feelings of passivity and residual delusion. During ambulatory follow-up the patient stated, concerning his habits of smoking, that: “when I am not smoking voices are feeble” (sic).

Studies show that some ingredients of cigarette smoke (mainly polycyclic aromatic hydrocarbons) have an accelerating effect on the metabolism of several antipsychotics (i.e. clozapine, olanzapine, members of the phenotiazine group, and haloperidol). Other studies suggest that nicotinic receptor agonists (such as nicotine) may have a therapeutic role in the treatment of cognitive impairments (i.e. dfisturbances in attention and in verbal, visual and working memories) in schizophrenia, and in turn, abstinence from tobacco can lead to deterioration of cognitive and psychomotor performance in this patients population.

1. 1) Exacerbations of positive symptoms may be related to decreased effectiveness of certain antipsychotics in result of an accelerated metabolism induced by cigarette smoking.

2. 2) Nicotine may reduce some negative symptoms of schizophrenia, including cognitive impairment.

The concept of treatment-resistant schizophrenia can be understood in two ways:

1. 1) as the persistence of schizophrenic symptoms in a patient taking a medication supposed to be efficient or

2. 2) as inefficiency of treatments available for certain forms of schizophrenia such as the early-onset form.

To study the relationship between early onset of schizophrenia and ulterior treatment resistance: does early onset of schizophrenia predict response to antipsychotics?

Through a case report and study of existing literature on the subject, we wanted to understand whether early onset of schizophrenia would predict resistance to antipsychotics.

We present the case of a male patient who developed schizophrenia (undifferentiated subtype according to DSM IV) since age 12. He progressively became disorganized, having severe alteration of reality testing, suffering from hallucinations and delusions leading to school dropout and social isolation. He received first and second generation antipsychotics at adequate dosage and during a sufficient time period without improvement of symptoms. We diagnosed treatment resistant schizophrenia according to the Kane criteria. Patient was then started on Clozapine from age 18 leading finally to remission of symptoms but social rehabilitation still needs to be done.

The authors conclude that early onset of schizophrenia potentially predicts poor treatment response. However, other factors such as symptom severity should be taken into account.

Serum bilirubin levels have been reported to be associated with metabolic syndrome (MS) in the community samples. However, there is no study investigating this issue in schizophrenia patients receiving atypical antipsychotics that their metabolic side effects constitute a serious problem.

We investigated the association between serum bilirubin levels and MS and, its stability.

This is a naturalistic, prospective study.The sample of this study consisted of 138 schizophrenia patients receiving atypical antipsychotics.The patients with the first 50th percentiles of serum direct bilirubin levels (low bilirubin group) were compared to those with the second 50th percentiles (high bilirubin group) in terms of MS criteria based on ATP-III criteria. The patients reevaluted after 6 months.The correlation between serum bilirubin levels and MS parameters were examined.

In high bilirubin group, 75.0% of patients were free of MS itself (p = < .001) or its criteria of triglyceride (73.4%), fasting blood glucose (84.4%), HDL levels (61.4%), and waist circumference (53.1%) criterion compared to low bilirubin group (p < .05). At follow-up, significant group differences were still evident for MS itself and for fasting blood glucose and HDL levels. Direct bilirubin levels were significantly correlated with the triglyseride and HDL levels at the baseline and follow-up (p < .05).

We found that high levels of serum direct bilirubin may be associated with the lower risk for MS in schizophrenia patients. Our results have suggested that serum direct bilirubin levels may be used for predicting to MS risk for schizophrenic patients.

Endophenotypes represent intermediate phenotypes on the putative causal pathway from the genotype to the phenotype. Endophenotype abnormalities in domains such as neurophysiology or neurocognition occur in schizophrenia patients as well as their clinically “unaffected” relatives, and reflect polymorphisms in the DNA of schizophrenia spectrum subjects which create vulnerability to developing schizophrenia.

The aim of our study was searching endophenotype traits in schizophrenia among H1MRS results according to Gur at al (2007) following criteria: I. Association with illness—moderate to large effect sizes between schizophrenia patients and controls II. State independent III. Heritability IV.

Found in unaffected relatives at a higher rate than in the general population.

We examined the H1 MRS-NAA, Cho, mI, GLX, Cr metabolite ratios in 9 brain structures: Nucleus caudatus(NC), Nucleus lentiformis(NL), Nucleus lateralis thalami(NLT), Prefrontal cortex(PC), Anterior cingulate gyrus(ACG), Centrum semiovale(CS), Posterior cingulate gyrus(PCG), Hippocampus(H), Cerebellum(CE) of 36 patients with schizophrenia, 33 unaffected siblings, 18 control group.

With the reference to the analyzed 408 neurometabolical variables, criterion I was fulfilled by 25 variables from the following structures: 2NC, 1NL, 5PC, 4CS, 7H, 4NLT, 2CE; criterion IV-145 variables: 24NC, 16NL, 19PC, 13CS, 7H, 13NLT, 22C, 20ACG, 11PCG; criterion II - 15 variables: 4PC, 4CS, 4H, 2NLT, 2C, criterion III - 1NC, 1H, 1NLT.

All four criteria were fulfilled by 2 variables: Glx1/Cr proportions in the left part of Hippocampus, and mI/Cr proportions in the right Nucleus lateralis thalami, which can be considered as potential endophenotypical markers in schizophrenia.

One of the reasons of therapeutic failure in schizophrenia is the poor compliance.Many factors can interfere with the therapeutic adherence. We propose to study the therapeutic compliance in schizophrenia and to determinate the socio-demographic factors that could be associated with the therapeutic adherence.

We studied the relationship between socio-demographic factors and therapeutic compliance in schizophrenia.

It was a cross-sectional study conducted among 95 outpatients with schizophrenia during the months of January and February 2009 in the department of psychiatry D.

54% of patients were observant. The average age of our sample was 41.2 years. We found a slight male predominance with 52.6% of men. Men were more frequently observant than women (58.0% vs 33.3%). The majority of our patients were not married: 82.1%.

96.8% of patients had electricity. 22.1% had heating. 6.3% had air conditioning and 35.8% had hot water. Almost half (42.1%) of patients had a level of primary education. The third had reached high school (32.6%) and 12.6% were illiterate. 5.3% had effectuated a professional training and only 7.4% had studied in a university. Three-quarters of surveyed patients were unemployed (75.8%).

Some socio-demographic factors such as sex and employment status are correlated to the therapeutic compliance. While others are not: age, education, marital status and socioeconomic status. However, other factors should be considered and studied such as clinical features, treatment-related factors and those related to the environment of the patient to better identify and understand the treatment compliance.

Elevated rates of cannabis use have repeatedly been observed among individuals with schizophrenia. Although several studies have investigated the role of cannabis exposure in the onset of psychosis, the clinical presentation and the course of the illness, the effects have been inconsistent.

To assess differences in the clinical characteristics of schizophrenic patients with and without cannabis abuse.

To identify the clinical and therapeutic features of schizophrenic patients who abuse cannabis.

This is a case-control cross-sectional study of schizophrenic patients with either no history of cannabis abuse (NCA; N = 30) or a history of cannabis abuse (CA; N = 30). We used a semi-structured interview, the global assessment of functioning scale (GAF) and the Mini mental State examination (MMSE) to assess the two groups for psychopathologic symptoms and cognitive functioning.

Compared to the NCA group, the CA group demonstrated significantly worse performance on measures of MMSE (25,73 vs 26,6, p = 0,034) and GAF (58,5 vs 66,7, p = 0,001). The CA group was also significantly associated with an increase in antipsychotics side effects (p = 0,01). Only 46,7% of patients with a history of cannabis abuse was adherent to medication while 76,7% of patients who did not use cannabis took their treatment regularly. The difference between the two groups was statically significant (p = 0,019).

As our understanding of the biology of cannabis use and psychosis continues to improve, it may be possible to identify mechanisms by which exposure to cannabis may influence psychosis that may become future targets for intervention.

Empirical evidence suggested systematic differences in clinical features between women and men with schizophrenia. Specifically, high levels of estrogens were suggested to be protective against symptom exacerbations in women with schizophrenia and to contribute to the later age of onset observed in women.

The objective of the study is to characterize the role of estrogens in schizophrenia gender differences.

To support a model of schizophrenia in which circulating sex hormones contribute to the developmental pattern and clinical presentation of the illness.

Based on a case of schizophrenia in a woman with a diagnosis of polycystic ovarian disease, we will discuss the different clinical, epidemiological and experimental data through a studies review.

BM was a 29-year-old, single woman. Since she was 18, BM presented an increasing isolation, persecutory, paranoid delusions and aggression directed toward her neighbors.

On assessment following admission, she exhibited prominent negative symptoms including blunted affect and emotional withdrawal along with auditory hallucinations, mystic delusions, hostility, combativeness and no insight. She met DSM-IV criteria for diagnosis of schizophrenia, undifferentiated type.

Since menarche, BM presented slowly progressing hirsutism and irregular menses that have never been treated. Hormonal studies and pelvic ultrasound confirmed the diagnosis of polycystic ovarian disease.

Hypoestrogenism and long-standing hyperandrogenism, either directly or indirectly, modify symptom expression and account for many of the observed gender differences in schizophrenia.

Contributing to poor global functioning, auditory hallucinations (AH) also interfere with elementary cognitive processes, including auditory discrimination. This is evidenced in schizophrenic (SZ) hallucinators (vs. non-hallucinators) by a greater reduction of the MMN, an auditory event-related brain potential (ERP) generated in part by NMDA receptor activity and normalized with nicotinic (nACh) agonist treatment.

To increase our understanding of NMDA-nACh interactions with auditory processing, using healthy young adults varying in their degree of experience with AH, thereby reducing the confounding influence of illness chronicity and medication associated with the study of SZ patients.

To investigate MMN differences between low and high AH subjects during separate and combined administration of ketamine, an NMDA antagonist, and nicotine, an nACh agonist.

In 40 healthy controls, all rated for AH with the Bell Object Relations and Reality Testing Inventory, MMN to frequency deviants was assessed in a randomized, placebo-controlled crossover design involving the separate and combined administration of a intravenous sub-psychotomimetic dose of ketamine (0.04 mg/kg) and a dose of nicotine gum (4 mg).

In high AH subjects, ketamine reduced MMN, with the resulting amplitude being smaller than that of low AH subjects. This ketamine-induced MMN reduction was evident only with placebo gum; furthermore combined nicotine-ketamine treatment acted to increase MMN in high scorers.

AH in otherwise healthy individuals is associated with heightened sensitivity to NMDA receptor blockade, the effects of which are moderated by nicotinic neurotransmission. Both neurotransmitters may interact to moderate auditory processing and AH in SZ.

Whilst shame has an important role in shaping psychopathology, nonetheless it is often a feeling ignored. Therefore, the etiologic role of psychosis requires further investigation.

This study examined the role of internal shame on psychiatric patients.

The present study evaluated internal shame in psychiatric patients who where cared by the Department of Psychiatry at University Hospital of Alexandroupolis, Greece.

45 patients suffering from schizophrenia participated (18 men and 27 women with mean age 44.09 SD=11.55, ranged 19–75). The measuring tools used were: a) the Experience of Shame Scale (ESS), b) a questionnaire concerning socio-demographic information.

High levels of internal shame were observed among patients. In specific, the average of the internal shame (ESS total) was 52.31 ± 12.76, without having statistically significant difference among gender in their comparison with the t-Test (p = .859). This is much higher than the average normal external shame in Greek population (47.09 ± 13.69). The analysis of variance between age groups showed that age, place of residence and educational level did not affect the internal shame in psychotic patients. Marital status had a significant effect on internal shame of psychotic patients where the application of the Bonferonni criterion found that unmarried participants demonstrated a statistical significant difference from those divorced (p = .020), the latter had higher levels of internal shame.

Psychiatric patients have high levels of internal shame and this shame is a constant factor in placing the individual and not a transient response to specific situations.

It seems that schizophrenia may arise from abnormal neurodevelopment due to aberrant neuron formation and migration and that deletion of Nogo-A (a myelin associated inhibitor of regenerative fiber growth) may lead to schizophrenia-like abnormalities in animal model. Our previous studies reported a high sensitivity of lateral analyses to reveal subtle links and recommended to apply them to validate animal models of diseases accompanied by alterations in brain asymmetry.

Expressions of N-methyl-D-aspartate receptor subunits (NR1, NR2A, NR2B) and activities of subunits-associated synthases of nitric oxide (nNOS, eNOS, iNOS) were evaluated in the right and left cortex of young or old Nogo-A deficient rats.

In young controls, no marked laterality was observed in subunits/synthases excepting iNOS but correlation analyses supported links among some subunits, synthases or subunits - synthases. Drops in NR1 (bilaterally) and in NR2B (in the right side) or asymmetrical alterations in NR1 - nNOS pathway were observed in old controls. In young Nogo-A deficient rats, the increase in iNOS (in the left side) and the disruption in left NR1 - right nNOS or in right NR2A - right eNOS pathways were found. And finally in old Nogo-A deficient animals, we observed the increase in NR1 (bilaterally) and in positive correlation between right eNOS - right iNOS.

Although some changes in subunits/synthases observed in people with schizophrenia were not found in Nogo-A deficient rats, some alterations in laterality support the validity of this model.

The study was supported by MSMT (1M0517) and MZCR (MZ0PCP2005) projects.

Antipsychotic maintenance treatment for patients with schizophrenia has been demonstrated to be the single most important modifiable factor to prevent unplanned readmissions. Effectiveness studies have indicated different risk for drug discontinuation between current antipsychotics.

To evaluate time until discontinuation of antipsychotic treatment, and specifically to investigate if differences between the prescribed antipsychotics could be detected.

396 patients with schizophrenia were included in an open cohort study and followed through treatment until all antipsychotics prescribed at inclusion were discontinued, predictors for time to discontinuation were analysed with univariate and multivariate Cox survival analyses with time until discontinuation as the dependent variable and antipsychotic monotherapy as the predictor variable. The analysis was controlled for common confounders.

65.7% of the patients were men, mean age was 42.4 years, and 12.9% were first-episode patients. 287 were prescribed antipsychotic monotherapy. In the multivariate Cox analysis with time to all-cause discontinuation only clozapine was significant different from olanzapine, Adjusted Hazard Rate (AHR) 0.17 (0.07,0.45) (p = 0.0003), this was also the case for the prediction of time to clinician-decided discontinuation, AHR (0.20 (0.06,0.70) (p = 0.012). In the analysis with time to patient-decided discontinuation as the dependent variable also Second Generation Antipsychotic Long-Acting Injectables (LAI) (AHR 0.26 (0.09,0.77) (p = 0.015) and First Generation Antipsychotic (LAI) (AHR 0.35 (0.16,0.80) (p = 0.013) had significant lower risk for discontinuation.

Clinicians and patients discontinued clozapine at a lower rate than olanzapine, patients also discontinued LAI formulations at a lower rate than olanzapine.