Patients with schizophrenia experience lower quality of life (QOL) than the general population. Improving QOL is both challenging and desirable.

To broaden the understanding of QOL in patients with schizophrenia to facilitate development of treatment strategies.

To assess QOL in patients with schizophrenia and to examine the relation of QOL with a) illness duration b) antipsychotic treatment (defined daily doses, ddd), c) body mass index (BMI) and d) smoking.

In this naturalistic, cross-sectional study patients were interviewed to obtain smoking habits, they completed a QOL questionnaire (WHOQOL-Bref, composed of a physical, psychological, social and environmental domain) and had height and weight measured. Patients were grouped as first-ever diagnosed or long-term ill. Characteristics were correlated to QOL using multiple regression analysis.

82 participated. Mean QOL was comparable to prior studies. A number of characteristics were significantly associated with the four QOL domains. The regression coefficients and significance levels are presented in Table I.

Patients with schizophrenia experienced a low QOL. The following characteristics were significantly associated with lower QOL in a) first-ever diagnosed: high BMI, low ddd and smoking habits and b) long-term ill: high BMI and short illness duration. Changing these might improve QOL in patients with schizophrenia.

The Brief Negative Symptom Scale (BNSS) was designed to address the main limitations of the existing scales for the assessment of negative symptoms in schizophrenia. The first validation of the scale by the same group involved in its development showed good convergent and discriminant validity, and a factor structure which confirmed the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). Nevertheless, the investigated samples of patients with schizophrenia were relatively small.

The present study aimed at providing a further independent validation of the BNSS in a large clinical sample to promote a wider diffusion of the scale in clinical research.

The inter-rater reliability, convergent/discriminant validity and factor structure of the Italian version of the BNSS were evaluated in 912 outpatients with schizophrenia recruited within an Italian multicenter study.

Our results confirmed the strong inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the whole sample (N=912) and in a smaller group of patients without clinically significant levels of depression and extrapyramidal symptoms (N=496). The BNSS factor structure was supported in both groups.

According to our results the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies.

The study was carried out within the project 'Multicenter study on factors influencing real-life social functioning of people with a diagnosis of schizophrenia” of the Italian Network for Research on Psychoses.

In the brain, estrogen plays an important role in neural plasticity and its decline during menopause might result in cognitive impairment and predispose to the development of dementia. Two estrogen receptors – α and ß – mediate estrogen actions either as ligand-activated dimeric transcription factors or as membrane-embedded ER monomers.

To analyze ERß-variants and ApoE-genotype in the population-based SALIA cohort of 834 non-demented, elderly women.

We aimed to explore, whether ERß variants may impact on cognitive performance in interaction with air pollution and APOE.

DNA was isolated from lymphocytes. ApoE-epsilon-variants and ERß SNPs rs944045, rs1256062, rs10144225 and rs2274705 were determined by LCG /KBioscience (Hoddesdon, UK). All participants were assessed for cognitive impairment by the CERAD-Plus test battery. Subtests were merged to a total z-score, that corrected for gender, age and time of education. Long-term exposure to air pollution was backextrapolated from data collected by monitoring stations using a geographic information system.

SNP analysis revealed that 3 ERß variants (rs1256062, rs10144225 and rs2274705) were significantly correlated with lower CERAD z total scores and especially with decline in episodic memory. These effects were strengthened in APOE-epsilon-E4 carriers. Air pollution (NO2, PM2,5) did not worsen the CERAD z total score of the women, but interacting with the ERß variants PM2,5 affected their visuoconstructive practice and NO2 their semantic memory.

In this population-based, prospective study a gene-gene interaction effect of ApoE and ERß on cognitive performance appeared. Moreover, significant gene-environment interactions on cognition were found for air pollution.

P300 is an event-related potential (ERP) thought to reflect attention, working memory and context integration and has been shown to be consistently reduced in patients with Schizophrenia. Despite a possible relation between P300 components and cognitive deficits in Schizophrenia has been hypothesized, few studies addressed this hypothesis.

In the context of a multicenter study of the Italian Network for Research on Psychoses, our study focused on the investigation of auditory P300 component in relation to clinical and cognitive domains in patients with Schizophrenia.

ERPs were recorded in 64 chronic, stabilized patients with Schizophrenia during a standard oddball task. N1 and P3b latency and amplitude were assessed at Fz and Pz, respectively. State of art instruments was used for clinical assessment. Cognitive indices (from the seven cognitive domains of the Measurement and Treatment of Cognition in Schizophrenia, MATRICS) were expressed as Z-scores from an Italian normative sample.

Correlation analysis revealed associations of P3b latency with age, education, PANSS-DIS, processing speed, working memory, St. Hans parkinsonism subscale. In a multiple linear regression model, processing speed was an independent significant predictor of P3b latency.

For the first time, a strong relation between P3b latency and processing speed impairment was shown in Schizophrenia. Processing speed is considered a central factor in the relation between cognitive deficits and functional outcome in chronic schizophrenia. The association with P3b latency might shed lights in the neural basis of this complex construct.

Lurasidone has demonstrated efficacy in the treatment of schizophrenia.

To evaluate the effect of lurasidone on hostility in patients with an acute exacerbation of schizophrenia.

To assess the efficacy of lurasidone for reducing hostility.

Data were pooled from 5 double-blind, placebo-controlled, 6-week studies of lurasidone (40-160 mg/d) in patients with evidence of hostility at study baseline (Positive and Negative Syndrome Scale [PANSS] hostility item score ≥2). Lurasidone was compared with placebo using mixed-model repeated-measures analysis, with and without adjustment for positive symptoms of schizophrenia and somnolence as covariates.

A total of 1148 patients met criteria for hostility at baseline (lurasidone, n=775; placebo, n=373). Lurasidone was significantly superior to placebo in reducing the PANSS hostility item score from Week 1 (P=0.002) through Week 6 (P>0.001). After adjusting for change in positive symptoms, lurasidone significantly decreased hostility compared with placebo from Week 2 (P=0.014) through Week 6 (P>0.05). After adjusting for the presence of somnolence, lurasidone significantly reduced hostility relative to placebo beginning at Week 2 and every assessment thereafter (P>0.05), except for Week 6. Overall, 63.1% of lurasidone-treated patients demonstrated any improvement (≥1 point change) on the PANSS hostility item at study endpoint compared with 55.0% of patients taking placebo (number needed to treat=13; 95% confidence interval, 8-49).

Lurasidone showed a specific antihostility effect in this post hoc analysis; improvement in hostility was significantly greater with lurasidone than placebo and was independent of change in other positive symptoms or somnolence.

Sunovion Pharmaceuticals Inc.

The concept of symptomatic and functional remission represents an important challenge in the care of the mentally ill particularly in patients with schizophrenia. However, the association of symptomatic remission with broader functional outcome was not yet documented in non-developing countries including Tunisia.

To evaluate the frequency of symptomatic remission in a sample of Tunisian out-patients with schizophrenic and to explore the relationship between symptomatic remission and social functioning.

It is a cross-sectional study carried-out on 115 out-patients with chronic schizophrenia (87 males, 28 females, mean age= 37.56 ± 10.2 years). Symptomatic remission was assessed by the eight core items of the positive and negative syndrome scale (PANSS). A score of mild or less on all eight core symptoms constitutes symptomatic remission. This symptom level should be maintained for six months. The social functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (SAS).

The symptomatic remission was observed in 50.4% of patients. The mean score of the SOFAS was 48.47 ± 14.44 and the mean score of the SAS was 56.6 ± 16.84. A significant association was showed between the SOFAS score and the symptomatic remission (P>0.0001) and between the SAS score and the symptomatic remission (P>0.0001).

Patients with symptomatic remission showed a significant trend for better social functioning. These results suggest that the concept of remission has important implications for the treatment of patients with chronic schizophrenia.

To explore the feature of functional connectivity of default mode network (DMN), central-executive network(CEN), and salience network (SN) in patients with schizophrenia during a resting state by functional magnetic resonance imaging (fMRI).

The SPM8, DPARSFA, conn, REST softwares combined with data-driven region of interest analysis were used to compare the functional connectivity (FC) of the DMN, CEN, and SN in 74 patients with schizophrenia(SZ) and 79 age- and gender-matched normal controls(NC). Medial prefrontal cortex(MPFC)was selected as seed region for identifying DMN and CEN; right anterior insula(rAI) for SN.

Compared with NC, SZ showed increased FC with bilateral dorsolateral prefrontal cortex(DLPFC) and bilateral putamen of the MPFC, and increased FC with left middle frontal cortex and precuneus/ posterior cingulate cortex(Pcu/PCC) of the rAI. SZ also showed enhanced interconnectivity strengths of CEN-DMN, CEN-SN, and DMN-SN(p>0.05). Correlation analyses showed that the increased FC between MPFC and left DLPFC significantly negatively correlated with PANSS-negative symptoms(r=-0.224,p=0.030) and increased FC between rAI and Pcu/PCC significantly correlated with PANSS-positve symptoms (r=0.243,p=0.020).

This study provides evidence for resting state functional abnormalities of DMN, CEN, and SN in schizophrenia patients. These aberrant functional connectivities in some key brain regions of the three network could be responsible for the schizophrenic symptoms.

The insight paradox posits that among patients with schizophrenia, better insight is associated with depressive symptoms. However, available studies are characterized by conflicting results.

First, we conducted a systematic review, a meta-analysis and a meta-regression based on 59 available correlational studies. Second, we examined a cross-sectional examination on 80 patients diagnosed with schizophrenia in stable phase of the illness. Measures of depressive dimension were based on the Calgary Depression Scale for Schizophrenia (CDSS) and Beck Depression Inventory (BDI), for insight the Scale to assess Unawareness of Mental Disorder (SUMD). Furthermore, we assessed self-stigma, self-esteem and psychotic symptoms to test mediating and moderating models (Preacher and Hayes models).

In the meta-analysis, global insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14) and symptoms’ attributions (r=0.17). Whereas, insight into the social consequences of the disorder or into the need for treatment were not associated with symptoms of depression. Better cognitive insight was associated with higher levels of depression. Methodological and clinical factors moderated the magnitude of the association between insight and depression. Similar results were observed in the clinical sample, where self-stigma significantly mediated the association between insight and depression.

In conclusion, both literature and clinical findings indicate that better insight is associated with higher levels of depressive symptoms among patients with schizophrenia: interventions that are aimed at improving insight need to take into account the implications of these findings

Cognitive impairment in schizophrenia is a strong predictor of the functional outcome and no effective treatments are available. MATRICS Consensus Cognitive Battery (MCCB) is approved by the FDA as outcome measure for trials of cognitive-enhancing drugs in schizophrenia. CogState Schizophrenia Battery (CSB) provides a briefer cognition assessment with minimal practice effects and a strong correlation between the CSB and MCCB composite scores. We tested the sensitivity of CSB as a cognitive outcome measure in a clinical trial in schizophrenia, where a cognitive-enhancing drug and cognitive training were combined.

49 participants with schizophrenia were enrolled in a double-blind, placebo-controlled study. Participants were randomised to modafinil (200mg/day) or placebo and underwent a cognitive training program for 10 weekdays. CSB was administered twice at baseline to minimise practice effects, at the last day of the intervention and two weeks after the completion of the intervention.

There was a significant time effect at the end of the intervention on the CSB composite score (p=0.042). There was no significant treatment effect on CSB composite score at the end of the intervention (p=0.686) or at follow up (p=0.120).

Multiple administrations of CSB were well tolerated by participants. The significant time effects on the composite score may suggest the operation of practice effects. Several factors could have contributed to the lack of treatment effects on CSB, such as the burden of multiple neuropsychological testing in a relatively brief study, the duration of modafinil treatment and also the intensive nature of cognitive training.

Data show impairment in Social Cognition (SC) in schizophrenia underlining also the diagnostic importance of neuroimaging in this area. So, it seems important to identify possible correlations between SC and structural brain abnormalities.

1)Evaluate differences in emotional recognition between schizophrenics and healthy controls and the structural characteristics of the anterior left and right thalamic radiation (TR) of both groups. 2)Identify possible association between sociocognitive abilities and structural characteristics of the thalamic radiation.

Investigate the relationship between anomalies in integrity and fiber orientation of anterior TR and sociocognitive performance in schizophrenia.

27 Schizophrenics (SCID-I), age-matched with 11 healthy controls, were evaluated with The awareness of Social Inference Test (TASIT) to assess emotion and conversation literally and non-literally remarks recognition. DTI images –with measure of fractional anisotropy (FA) of TR– were collected using 3T-MRI scanner. Mixed-design ANOVA was performed on right and left FA. MANOVA was performed on TASIT.

Deficits in recognition of positive and negative emotions, perceive sarcasm, distinguish between truth and lies were observed. Moreover, significant negative correlations between FA of left TR and scores in “Positive Emotions” (r=-466,p=.019), “Total Emotions” (r=-411,p=.041), “Lie” (r=-451,p=.024) and a negative significant correlation between FA right TR and scores “sincerity” (r=-522,p=.009), were observed.

These preliminary results confirm that SC is impaired in schizophrenia and show that increased FA of left and right TR correlates with lower TASIT scores. These results highlight the role of TR in emotion regulation suggesting that structural anomalies could result in worse sociocognitive performance.

Autism in women is often poorly recognised. Awareness for this diagnosis is on the raise and more and more women with affective disorders, diagnosed as borderline personality disorders, OCD or substance abusers are acknowledged to have an underlying diagnosis of ASD. Diagnosing ‘autism in women is more than merely labelling them with a classification.

The multilayer diagnostic process helps to understand the behavioural problems in relation with the interaction with the (clinical) environment (van Wijngaarden-Cremers 2014). Autism in women represents a new challenging puzzle for health care professionals. Females with ASD may display severe challenging behaviour: aggression, rage and self-harm. These behaviours serve a different goal than in males. In males want to gain objects whereas females want caregivers attention. The disruptive dynamics within a clinical group of females with ASD are due to the deviant communicative style and complex interaction problems. Structure and other strategies, which are useful in early childhood, are no longer appropriate in adulthood. Parents and caregivers are permissive because they think their patient/child should not be held accountable for its behavioural outburst: 'they cannot help it”. This will be illustrated by systematic case studies from our department

The treatment of women with Autism requires the development of new diagnostic, strategic and clinical management skills and competencies in clinical workers.

P.J.M. van Wijngaarden-Cremers, P. van Deurzen, I. Oosterling, W. Groen, M. Langen, A.L. Lagro-Janssen, R.J. van der Gaag. Een veranderende kijk op psychiatrische stoornissen(changing views on psychopathology). Tijdschr Psychiatr.2014 in press.

Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT’s effectiveness across delivery formats in primary care.

To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care.

A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants. Results. Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multimodal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37).

The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT’s economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.

To investigate in non-depressed perinatal women, whichBeck Depression Inventory-II (BDI-II) and Postpartum Postpartum DepressionScreening Scale (PDSS) scores and proportions of symptomatic items significantlydiffer through the perinatal period.

273 women were assessed with the Diagnostic Interviewfor Genetic Studies, BDI-II and the PDSS at the third trimester of pregnancy/T0(mean age =29.42±7.159 years; mean weeks gestation=32.6±3.61),three/T1, six/T2 and twelve/T3 months postpartum.

Significantlyhigher scores in T0 than in T1/T2/T3 and in T1 than in T2/T3 were found for: Total PDSS, Sleeping-Eating Disturbances, Emotional Liability, Total BDI-II andits dimension Somatic-Anxiety. Only T0 and T1/T2 didnot significantly differ in Anxiety/Insecurity, Mental Confusion, and Loss of Self. In Guilty/Shame only T1 was significantly higher than T3. Suicidalthoughts were significantly higher in T0 than T1 and lower in T1 than T2/T3.

Theproportions of symptomatic items systematically and significantly decreased fromT0 to T3 in changes of sleep, loss of interest in sex, feeling overwhelmed. Significantlyhigher symptomatic proportions in T0 than in all post-partum moments were foundfor: loss of energy, irritability, fatigue, changes in appetite, crying, indecisiveness and worthlessness (these last three also higher in T1 than inT3). Agitation was significantly higherin T1 than in T0. All the cognitive-affective symptoms from BDI-II and PDSSdid not differ.

From pregnancy to the twelfth month postpartum the depressivesymptomatology, particularly somatic-affective symptoms, significantlydecreased. However even for the women who are not clinically depressed, theperinatal period requires considerable psychological adjustment.

Good compliance of patients with schizophrenia is an objective criteria of psychiatrist's work effectiveness. However often there is a vicious circle: lack of patient's insight causes refusal of therapy and without therapy according to opinion of many doctors insight is not achievable. In order to break this vicious circle the technique of operated compliance was developed.

assessment of effectiveness of an operated compliance technique.

First several months after the mental illness diagnosis the compliance is the highest since patient's family members mobilize all available resources to maintain «status quo». Noncompliance results from family's disappointment in therapy, the expected effect from which, doesn't correspond to the actual Timely involvement of the family during this period allows to bypass lack of patient's insight and helps to establish continuous supportive therapy.

100 patients first diagnosed with schizophrenia: 50 – experimental group, 50 – control group (had conventional inpatient and outpatient treatment). Length of observation 18±4 months.

clinical-psychopathological, sociological. Endpoints: number of re-admissions, drug compliance, number of disabilities, family's satisfaction.

Results

• Development of a drug compliance is a planned and controlled process that begins during the first visit to psychiatrist.

• Application of the studied technique allows to recruit patient's family to guarantee drug compliance

The self-medication hypothesis suggests that patients diagnosed with schizophrenia might smoke as an attempt to self-medicate theirsymptoms. As a consequence, smoking cessation could worsen their clinical status.

To assess the clinical changes associated with tobacco cessation in a sample of smoking outpatients with schizophrenia.

Sample: 63 smoking outpatients with DSM-IV Schizophrenia from three Mental Health Centers located in Northern Spain [77.0% males; mean age (SD) = 43.90 (8.72); average daily cigarette use (SD) = 27.99 (12.55)]. Instruments: (1) Clinical symptoms: Positive and Negative Symptoms Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI). (2) Pattern of tobacco use: n° cigarettes/day; Expired carbon monoxide (CO ppm). Design: A quasi-experimental design with two groups was implemented: control group (GC − 18 patients not willing to stop smoking), and treatment group [TG − 45 patients in smoking cessation supported by nicotine patches or vareniclina (12 weeks)]. Patients were evaluated at baseline and at week 11 (end of program). Paired sample t-test was used to detect changes in clinical symptoms from baseline to follow-up.

23.1% stopped smoking (from TG). No significant differences were found between baseline and follow-up scores (p>.05) among smokers and abstinent in PANSS subscales, HDRS and CGI.

Tobacco cessation did not have a significant effect on the clinical symptoms of this group of patients. Further studies should analyze the stability of these outcomes at longer follow-ups to confirm our results.