Schizophrenia is a disorder with chronic course and a need of a long-term antipsychotic treatment to prevent rehospitalizations.

To find a possible association between treatment with different types of antipsychotics and rate of rehospitalizations in patients with schizophrenia spectrum disorders.

To analyze the rate of rehospitalizations in groups of patients treated with typical, atypical and depot antipsychotics.

Data of 1400 patients discharged from hospitalization in 2010 with ICD-10 diagnoses F20.x were obtained from the General Health Insurance Company which covers the majority of the population with chronic mental disorders in Slovakia. The structure of patients according to age and sex represented the whole adult population hospitalized with diagnoses F20.x in Slovakia.

27.4% of patients had 1 to 8 readmissions after the index discharge from hospitalization in the same year. 29347 prescriptions of psychopharmacological drugs were registered for 499886 patient/days in outpatient settings. 14781 prescriptions for antipsychotics consisted of 67.3% prescriptions for p.o. atypical antipsychotics, 16.9% for p.o. typical antipsychotics, 11.5% for atypical depots and 4.2% prescriptions for typical depots. No statistically significant association between prescriptions of particular group of antipsychotics (typical, atypical, depot) and the occurrence of at least one rehospitalization was found.

No association between prescription of certain type of antipsychotic and probability of rehospitalization based on analyses of prescriptions rate could not reflect the clinical reality properly. Further analyses with consideration of dosage, combinations of antipsychotics and rate of prescriptions for individual patient should be done.

A neuro-computational model of the thalamus was developed exhibiting pattern completion and noise filtering capabilities. Pattern completion of sensory inputs in the thalamus might explain a plethora of phenomena like the “filling-in” effect in the blind-dot, visual and auditory Charles-Bonnett syndromes, phantom limbs phenomenon, visual hallucinations like those produced by Lysergic Acid Diethylamide consumption, and musical hallucinations like when propranolol is dropped in the auditory channel.

The aim of this work is to propose the theory that delusions in schizophrenia are the consequence of thalamic pattern completion of defective cortical and hippocampal cognitive patterns. In this way, delusions in schizophrenia might be interpreted as a cognitive hallucination.

A computational model of the thalamus was developed with a grid of 9x9 neurons in its thalamo-cortical layer and 9x9 neurons in its reticular layer. A number of 13122 synapses were altered each iteration during the presentation of 36 alfa-numerical patterns. To test the artificial thalamus, 36 noisy and uncompleted patterns were presented to the network. For assessing the consistency of our work with the existing literature in the area, post-mortem and fMRI studies were collected.

The thalamus model reconstructed 36 testing uncompleted patterns with and without background noise. Post-mortem and fMRI studies in non-medicated patients exhibit defective hipocampal and prefrontal projections to the thalamus as predicted by our theory.

Preliminary neurocomputational studies suggest that delusions in schizophrenia might be the result of pattern completion of defective cortical and hippocampal inputs to the thalamus.

Social functioning is often impaired in patients with chronic schizophrenia and contribute to the poor outcome of the illness. It is unclear how much of this social impairment can be attributed to residual symptomatology and how much to cognitive impairment, often present in patients with schizophrenia. In the present study, the relationships between social functioning, psychopathological remission and cognitive deficits were investigated in 148 subjects with chronic schizophrenia or schizoaffective disorder.

A comprehensive neuropsychological battery was used to assess general cognitive abilities, attention, secondary verbal and visuospatial memory and executive functions. To assess social functioning we used four indices for global social disability, interpersonal relationships, intrapsychic functions and work functioning. Patients were divided in remitted or not remitted according to the criteria proposed by Andreasen. Multiple regressions analyses were carried out, in which the dependent variables were the indices of social functioning while independent variables were remission status, neuropsychological indices, duration of illness, age and education.

The results of multiple regression analyses showed that secondary memory explained 10.6% of the variance for the global disability index, 8% for “intrapsychic functions” 5.8% for “interpersonal relationships” and 4% for “work functioning”; the index of attention explained 2.6% of the variance for the global disability index; the remission status explained 4.6% of the variance for the “intrapsychic functions” index.

Our findings suggest that cognitive impairment is an important feature of schizophrenia and that its relationship with social functioning is independent from and stronger than those between psychopathology and social functioning.

Individuals suffering from schizophrenia reveal difficulties in the recognition of emotional states experienced by other people. Deficits in facial - affect perception tend to be greater for negative facial displays than the positive one, with impairment being greatest for the perception of fear.

The aim of the current study was to investigate the role of semantic satiation of faces in the deficit arising in fear recognition. Semantic satiation is defined as the experience of the loss of the meaning of words or images caused by their prolonged presentation. The satiation effect occurs faster in schizophrenia than in healthy people since it could be considered as a mechanism which reveals patients’ difficulties in fear recognition.

Participants, 30 patients diagnosed with schizophrenia and 30 controls were shown the images of fearful, happy and neutral faces. In satiation conditions each image was displayed 30 times, in control conditions - 3 times. Participants’ task was to define the emotion they were presented with.

Both groups of participants revealed the semantic satiation effect alike for positive, negative and neutral faces. Within the group of patients the satiation effect was greater for fearful and neutral faces than for positive ones, whereas for the healthy controls the satiation of positive and negative pictures were greater than for the neutral ones.

Within the schizophrenic group semantic satiation could be considered as a mechanism which is responsible for the difficulties of fear recognition and for deficits of correct interpretation of emotionally - neutral faces.

Similarly to patients with overt delusions, individuals with subclinical forms of delusions should reveal high ability to select information relevant to their unusual believes and to ignore the ones which undermine their convictions. However, many researches indicate that delusion - prone individuals reveal the reasoning bias making decisions on the basis of too little evidence even if additional information is easily available.

The aim of the current study was to investigate the ability of delusion - prone individuals to select the relevant information among the irrelevant distractors in order to examine whether the susceptibility to delusions is related to either making information selection ability excessive or to impulsiveness which is the cause of hasty decision making.

The participants, 89 undergraduate students, completed the Peters’ Delusions Inventory. According their score on PDI they were divided into two groups: individuals with high and low susceptibility to delusions. All participants completed the Moroń Clock Test which measures the ability to attend selectively to the relevant stimuli among irrelevant distractors.

In the current study the delusion - prone individuals did not reveal the excessive information selection ability, although they made more ‘false - alarms’ mistakes reacting to irrelevant stimuli rather than omitting the relevant ones.

The reaction pattern obtained in the task indicates that delusion - prone individuals are not characterized by excessive ability to select information, although they are more impulsive than individuals who scored low on PDI.

The semantic satiation is defined as a subjective loss of access to the meaning of repeated stimuli. Previous researches revealed that in paranoid schizophrenia this effect occurs faster than in healthy controls, and could be responsible for problems linked with fear recognition.

The aim of the current study was to investigate whether the semantic satiation effect could be the possible cognitive mechanism underlying the problems connected with fearful faces recognition in delusion - prone individuals.

Two groups of students: individuals with high and low scores on Peters’ Delusion Inventory participated in the study. They were presented with photos of fearful, happy and neutral faces. In control conditions all photos were displayed 3 times, in experimental one - 30 times in order to evoke the effect of the loss of access to the meaning of the images. Participants’ task was to decide if the emotion displayed was named correctly.

Within the group of individuals who scored high on the PDI the satiation of fearful faces was greater, than in the control group. Unlike them, individuals who scored low on PDI revealed the greater satiation effect related to happiness.

Individuals with subclinical forms of delusions tend to loss the meaning of fear displayed by other people quicker than individuals who are not delusion - prone. The semantic satiation effect could be considered as a possible cause of difficulties in fear perception.

Although antipsychotics improve positive symptoms effectively, their utility is limited by adverse effects and poor efficacy for the treatment of cognitive symptoms. Nevertheless, cognition is considered a core feature of schizophrenia. For this reason the focus of treatment research in schizophrenia has shifted towards cognitive enhancement the last ten years.

Earlier trials suggest that nicotine ameliorates attention and working memory deficits seen in schizophrenia.

The present study aimed to replicate these earlier findings using a strict methodological design. Additionally, we assessed the effects of nicotine on measures of social cognition and psychomotor functioning, domains that has never been investigated before in this research field. Furthermore an additional study compared the effect of age in relation to the responsivity to nicotine.

In a three-way crossover double blinded randomized placebo-controlled trial, we investigated the effect of 0, 1 and 2 mg nicotine on several cognitive domains (standard cognition, arousal, psychomotor tasks, and social cognition) in 16 smoking and 16 non-smoking schizophrenic patients and in 16 young and 16 elderly healthy volunteers.

Nicotine improves attention in both patients groups and has detrimental effects in the elderly in some cognitive and psychomotor tasks. There is no effect of nicotine on psychomotor functioning, working memory and emotion recognition in patients. Decision making seems to be influenced by nicotine in non smoking patients.

This study brings us a step further in the delineation of the cognitive effect of nicotine.

Schizophrenia is associated with deficits in higher order processing of visual information, steady state visual evoked potential responses recorded over the occipital cortex in patients with schizophrenia suggest a dysfunction of lower level visual pathways, which was more prominent for magnocellular than parvocellular biased stimuli. The magnocellular pathway helps in orienting towards salient stimuli [1]. A magnocellular pathwad deficit could contribute to higher level visual cognitive deficits in schizophrenia dysfunction of the magnocellular pathway may also account for other well described aspects of neurophysiological dysfunction in schizophrenia, for example, the magnocellular pathway projects predominantly to dorsal cortical stream (i.e. parietal lobe), which codes motion perception and spatial localization [2].

30 schizophrenic patients were recruited randomly from Alexandria University Hosiptal. They scored 4 or higher on the Clinical Global Impression Scale for Severity CGI-S. Visual Evoked Potential VEP was done to them and compared to healthy control group.

In the right eye the mean P100 was 104.55 ± 5.62 and 95 ± 5.27 msec in schizophrenic and healthy control group respectively with statistical significant difference. A finding that has been replicated in the left eye where the mean P100 was 105.8 ± 5.41 and 95.85 ± 5.4 msec in the same respective groups

P100 in both right and left eyes are more prolonged in schizophrenic patients compared to healthy control groups.

The World Health Organization Disability Assessment Schedule II (WHODAS II) was developed for assessing disability. This study provides data on the validity and utility of the Spanish version of the WHODAS II in a large sample of patients with schizophrenia.

The sample included 352 patients with a schizophrenia spectrum disorder. They completed a comprehensive assessment battery including measures of psychopathology, functionality and quality-of-life. A sub-sample of 36 patients was retested after six months to assess its temporal stability.

Participation in society (6.3%) and Life activities (4.0%) were the domains with the highest percentage of missing data. The internal consistency (Cronbach's alpha) of the total scale was 0.94, and the test-retest stability reached an intraclass correlation coefficient of 0.92. It became apparent that the six primary factor model represents a better fit with reality than other competing models. Relationships between the WHODAS and measures of symptomatology, social and work-related functionality, and quality-of-life were in the expected direction and the scale was ultimately found to be able to differentiate among patients with different degrees of disease severity and different work status.

Assessment of disability using appropriate tools is a crucial aspect in the context of mental health and, in this regard, the Spanish version of the WHODAS II shows ample evidence of validity in patients with schizophrenia. The most important contribution of this study is that it is the first analysing the Spanish version of the WHODAS II (36-item version) in a large sample of patients with schizophrenia.

In psychiatric research a patient's rationalizing is often considered as a logical process, belonging to higher order functions, and measurable through strategizing, planning and certain aspects of IQ. However, it seems that the concept of rationality has more nuances in it self. We wish to introduce the distinction of a logical deductive rationality vs. a more fluid, inductive, ecologically and experientially bounded rationality. We postulate this as being highly relevant, when testing for characteristics of rationality in schizophrenia.

Our central hypothesis about schizophrenic rationality or reasoning is that it differs from that of healthy controls. We hypothesize that testing rationality in a new way, using our distinction of the rationality-concept, will shed some light on cognitive aspects of the phenomenologically described schizophrenic perplexity or “loss of common sense” as the central autistic feature of the illness.

The basis for the idea and development of the test, are the empirical findings by Kahnemann & Tversky and the Max Planck group led by Gerd Gigerenzer. One of their central explanatory models of healthy rationalizing is that people naturally take ecological and experiential information into account, and one of the core features of the schizophrenia might be that it does not happen sufficiently.

We aim to test if people with schizophrenia (n = 30) have a deficit of practical, milieu-bounded, “common sense” rationality, and preservation or accentuation of theoretical rationality, which, compared to healthy controls (n = 30), could help explaining the autistic “loss of common sense”.

Obsessive-compulsive (OC) symptoms have been observed in many schizophrenia patients. Different etiopathological origins of OC symptoms make this type of schizophrenia to be a heterogeneous entity in phenomenological as well as in therapeutic aspects. The complex nature of the treatment response in this group of schizophrenia patients is unclear.

We present a large case series study describes our experience with clozapine, risperidone, olanzapine, quetiapine, ziprazidone, amisulpiride, sertindole and paliperidone as a sole agents and in combination with different serotonin reuptake inhibitors (SRIs) in patients with OCD-schizophrenia (n = 59) and schizo-obsessive disorder (n = 68).

In patients with OCD-schizophrenia treatment with atypicals (other than clozapine), the better results (significant reduction of OC as well as schizophrenia symptoms) were achieved in combination with SRIs, while the olanzapine showed the fastest overall improvement. In schizo-obsessive patients, treatment with atypicals (including clozapine) as monotherapy was the better therapeutic modality, and the risperidone showed the best results. Quetiapine, amisulpiride, sertindole, paliperidone and ziprazidone (as sole agents and with SRIs) were shown as approximately equal in their antipsychotic and antiobsessive activity and overall safety/tolerability.

The effects of different atypicals (with or without SRIs) on psychotic and OC symptoms are vary, probably due to different origin of OC symptoms. We suggest that:

1. 1) schizo-obsessive patients might be successfully treated with atypicals alone;

2. 2) in OCD-schizophrenia atypicals monotherapy may be less efficient, and in some cases even may worsen OC symptoms, so it should be treated concomitantly with SRIs. Further investigations are needed to substantiate our observations.

Negative, cognitive and residual positive symptoms are a frequent concern in schizophrenia patients despite optimal management with current medication. Also, adverse effects induced by antipsychotics prevent them to be used in the so called high risk patients. Until new drugs specifically designed to address these symptoms are developed, several drugs used in different conditions have been tested.

To assess the evidence regarding the use of non-antipsychotic, alternative drugs, to treat or prevent schizophrenia.

To broaden available pharmaceutical options in the management of unremitting symptoms in schizophrenia patients, beyond commonly used antipsychotics.

A survey of the literature regarding alternative drugs to treat schizophrenia symptoms. Studies available in MEDLINE and published after year 2000 were surveyed. Only drugs assessed in at least one randomized and controlled clinical trial were included.

Several drugs have been studied in the management of resistant symptoms in schizophrenia, mainly negative symptoms and cognitive dysfunction. Also, the management of high risk patients is controversial and raises many ethical concerns. Such alternatives, namely those with a suitable safety profile are appealing.

Omega-3, memantine, acetylcysteine, d-cicloserine, estrogens, psychostimulants and acetylcholinesterase inhibitors have been assessed but only some of these have shown promising results, each for a specific group of symptoms, in different stages of the disease and with a diverse safety profile.

There exist a few alternative drugs with promising efficacy in the management of non-remitting symptoms in schizophrenia. Also, due to its safety profile some may be interesting options to high risk patients.

Recent studies have suggested an association between elevated levels of bilirubin and psychotic spectrum disorders. The aim of our study was to compare the levels of bilirubin in the different psychotic disorders among themselves and with other mental disorders.

Observational, retrospective, in a sample of patients admitted to the Acute Psychiatric Unit between January 2007 and December 2009. We included all patients with plasma concentrations of bilirubin in the blood analysis. We excluded patients with toxic abuse and alterations in the liver reflected in increased transaminases.

The final sample of 523 patients. Patients with psychotic disorder had bilirubin levels significantly higher than patients with other diagnosis (p < 001).

Psychotic disorders were subdivided into 5 groups: schizophrenia (N = 76), schizoaffective disorder (N = 53), delusional disorder (N = 21), brief psychotic disorder (N = 29) and other unspecified psychotic disorders (N = 34). The brief psychotic disorder patients had bilirubin levels significantly higher than other categories of the same spectrum (p < 0.001).

The psychotic spectrum patients have higher bilirubin levels at admission than other diagnostic entities, and this increase is mainly explained by Brief Psychotic Disorder. Bilirubin figures correlate negatively with psychotic symptoms days, so the brief psychotic disorder, is proclaimed as an ideal model for the llaboratory studies about psychotic spectrum disorders.

Effective treatment of schizophrenia needs medication that is taken regularly for a long period of time. Antipsychotic non-adherence is considered to be the main reason for relapse and hospital readmission.

The objective of this study was to estimate the frequency of non-adherence with antipsychotic medication in schizophrenic outpatients and to identify socio-demographic and clinical factors that may influence this behavior.

According to the objectives, the aim of the study was to find factors that have a predictive role in regards to attitude towards antipsychotic medication.

This prospective 6-month follow-up study was conducted in Timisoara Mental Health Center, Romania and included 60 patients diagnosed with schizophrenia according to ICD-10 criteria. Clinical interview and the BPRS-A were applied at baseline. Patients were assessed monthly with BPRS-A and a shorter version of the ROMI scale (Rating of Medical Influences).

46.66% of patients were adherent to treatment and 53.34% were not. Elderly patients were more non-adherent to treatment (p = 0.04), as were single patients (p = 0.05). We obtained significant differences between groups considering the duration of the illness (p = 0.04) and the mean number of hospitalizations (p = 0.02), both being higher in the non-adherent patient group.

The main factors influencing adherence were: age, marital status and duration of the disorder. The most prevalent reasons for adherence were: the daily perceived benefit and relapse prevention. Prevalent reasons for non-adherence were: adverse effect of medication and the fact that medication is not currently needed.

People with major mental disorders are more likely to be violent than other members of the general population. What is contoversial is the influence of the patients’ environnemental violence as regards their aggressive behaviors.

The aim of the study was to assess the violence of patients with psychotic disorders regarding the crime rate in the patients’ community.

We have led a prospective multicentre study in 9 French cities-each of them having different crime rates. Eligible patients were psychotic involuntary patients hospitalized in the cities’acute admission psychiatric wards. During their treatments, any kind of the patients’aggressive behavior has been reported by the OAS (Overt Aggresion Scale).

From June 2010 to May 2011, 95 patients have been included. Seventy-nine per cent of the patients were violent during their hospitalizations. The patients’violence was mostly verbal (65%). In a bivariate analysis, the patients’violence was significantly associated to different factors: male gender, the patients's violence history, substance abuse, manic or mixed disorder, the symptoms severity measured by the BPRS, the insight degree and the crime rate in the city. In a multivariate analysis, the only significant factors associated with the patients’violence were substance abuse, the symptoms severity and the patients’cities’crime rates.

The results are in accordance with the literature on the risk factors of violent behaviors.The environnemental factor-wich was until now not so much studied-also appears highly associated to this risk.

These results suggest that the violence within the psychotic patients’environnement could represent a risk of violence during the treatment.

In clinical trials, good inter-rater reliability reduces error and influences statistical power. PANSS rater differences across cultures are rarely investigated.

To conduct a cross-cultural analysis for European and Japanese PANSS raters, theorized to have unique frames of reference for schizophrenia assessments.

To examine reliability with Gold Standard scores (GS); to compare PANSS subscales.

There were 170 raters from Europe (73) and Japan (97). Analysis: scale-level for internal consistency (Cronbach α) and inter-rater reliability (ICC); item-level using Rasch and Differential Item Functioning (DIF).

Internal consistency for PANSS Positive, Negative, and General Psychopathology subscales exceeded α = .99 for both groups. ICCs were higher for Europeans for all subscales. The average Inter-Item Correlation (IIC) with GS was highest for the Positive subscale (Europe, r = .901; Japan, r = .883). Average IIC with GS was lowest for both groups for the Negative subscale (Europe, r = .453; Japan, r = .323). For Negative items, accuracy with GS for Europeans was 46.58% to 89.04%, and 18.56% to 73.20% for Japanese. For PANSS Total, the average IIC was r = .721 (Europe) and r = .659 (Japan). European raters endorsed higher scores on P1.Delusions, P7.Hostility, N1.Blunted Affect, N5. Abstract Thinking. Japanese raters endorsed higher scores on N7.Stereotyped Thinking.

There were significant differences in several PANSS items, possibly due to disparities between original and translated scale versions, cultural differences in interpreting items, or PANSS scoring parameters. Identifying culturally problematic items can help to tailor PANSS training to diverse geographic regions.

The aim of this study was to evaluate the prevalence of metabolic syndrome and metabolic syndrome criteria in patients with schizophrenia and also to investigate the effects of metabolic syndrome on medical treatment, clinical course.

One hundred-sixteen patients with schizophrenia were consecutively admitted. Waist circumference, blood pressure, body weight and height were measured, and body mass index was calculated. Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia were applied to the patients.

The frequency of metabolic syndrome according to IDF criteria was 42.2% among the patients (46.9% for female and 38.8% for male patients). There was no significant difference between patients with and without metabolic syndrome in terms of age. The frequencies of metabolic syndrome were 62.5% for together taken typical and atypical antipsychotics and 35.7% for taken two or more atypical antipsychotics, whereas the rates of metabolic syndrome of taken only one atypical and only one typical antipsychotics were 45.1% and 13.3%, respectively. The duration of disease in patients with metabolic syndrome was higher than those without.

In this study, the frequency of metabolic syndrome in patients with schizophrenia was consistent with the results of previous studies in our country. Our findings showed that the duration of illness, high scores of BMI, use of clozapine or concurrent use of typical and atypical antipsychotics, depressive and negative symptoms of schizophrenia were significant risk factors.