The amenable neurochemical base of social phobia still completely has not been clarified, even if has been proposed a potential dysfunction of both serotonergic and dopaminergic brain systems.

Clozapine is the prototype “atypical” antipsychotic drug, defining the role of its individual complex actions. It has been reported that clozapine occasionally involves symptoms from the spectrum of anxiety disorders. These symptoms are attributed in the action of this particular drug mainly on the serotonergic system.

In this study is presented the case of a schizophrenic subject, who developed social phobia at the duration of his treatment with clozapine and while he was found in remission of his psychotic symptoms.

The patient is man of 24 years and has a 3-year history of schizophrenia, paranoid type. In his history also is reported casual abuse of Indian cannabis as well as alcohol.

Presented symptomatology of social phobia the first interval of his treatment with clozapine (14th week) and while the psychotic symptoms had receded. When in his treatment it was added sertraline, the social anxiety disorder was decreased in remarkable degree. The daily dose of clozapine was maintained immutable.

The elements are discussed under the light of new neurochemical opinion but also psychodynamic approach of make, that could explain the appearance of symptoms from the spectrum of anxiety disorders (as the social phobia) in a clozapine-treated psychotic patient, at the duration of remission of his psychotic symptomatology.

Catatonic schizophrenia has been described as being decreasing in prevalence. We present a case of a 16 year-old-girl, previously healthy, who develops catatonic schizophrenia in a 5 months period.

we present the case of a 16-year-old girl, previously healthy, with family history of schizophrenia, develops 5 months prior to hospital admittance isolation from friends and odd behaviour, like suddenly standing still and speechless (thought blocking). She maintains these attitudes and 3 months after, develops delirious thoughts of death with agitation (screaming and undressing). One month prior to admittance she becomes diskinetic and mute, with loss of sphincter control. She is medicated by a neurologist with olanzapine 5mg od and valproate 200mg bid. As her clinical state worsens, she is brought to a central hospital, where she has MRI and lumbar puncture normal. She is observed by neurologists and psychiatrists in the emergency room. Against the psychiatrist opinion, she is admitted to the neurology ward. After repeating MRI and lumbar puncture and searching for neurotrophic viruses and prions´ disease, which all turn out negative, she is proposed for electroconvulsivetherapy (ECT) and transferred to a psychiatric ward.

She is submitted to 14 ECT and medicated with seroquel 300 bid with dramatic improvement.

this case illustrates the secondary role psychiatry is sometimes appointed to in contemporary medicine. Catatonic schizophrenia is a rare disorder and an even rarer form of presentation of schizophrenia. Nevertheless, it exists, and should be taken into account in the differential diagnosis of diskinesia.

Four years of group work for outpatients with psychosis and its influence on various aspects, especially on negative symptoms in psychosis were evaluated.

A small group of 6 to 8 medicated patients is run in co-therapy. A modified, non-structured, psychoanalytic group technique which includes psychoeducation, cognitive techniques, nonstructured conversation and clarifications is used. Patients should be intrinsically motivated and well prepared for group work.

Better control and differentiation of the psychotic symptoms, emotions and improved social functioning were observed. Group situation affects and improves the negative symptoms of psychosis through several important group therapeutic factors €“ instilation of hope, universality, altruism, group cohesiveness, which has developed very slowly. Group members were able to manage transient worsening of their psychosis in an outpatient care.

With its progression of group work, we observed more honest and open conversation about symptoms and real life problems. The most frequent topics discussed were: psychotic symptoms, at the beginning mostly positive symptoms of psyhosis, later on, with the progression of therapy members started to talk about the negative symptoms, interpersonal relations and stigma of psychosis.

The stigma attached to mental illnesses is the main obstacle to better mental health care and to better quality. It affects the priority which is given to the development of mental health services and makes the discipline less atractive than others to the mediacl graduate in search for career. It prevents timely contact of the person suffering from a mental illness with mental health services and makes rehabilitation exceedingly difficult.

Psychosis is a highly stigmatised condition. Our clinical experience with long term groups of patients with psyhosis have shown that long term group therapy has an important destigmatising role.

A small group of 6 to 8 medicated patients is run in co-therapy. A modified, non-structured, psychoanalytic group technique which includes psychoeducation, cognitive techniques, nonstructured conversation and clarifications is used.

In the early phases of group work stigma was manifested as drop-out of at least two members. With the development of group cohesiveness the group started talking about stigma. A feeling of universality in group work is often a fundamental destigmatising step.

Patients fear that their symptoms could be unique. Talking about the psychotic symptoms and feelings helps to differentiate them. Improved control over the problems and their life has an important destigmatising power. Group therapy has a destigmatising role through several group therapeutic factors, especially feelings of universality, altruism and group cohesiveness. Subsequentely, patients with psychosis start using their healthier parts and experience less stigma.

schizophrenia is one of the mental illnesses with the highest risk of suicide, with very high rates of suicide attempts and suicidal ideation. However data regarding suicide attempts by schizophrenia patients is scarce. In this study a large sample of schizophrenia patients who had attempted suicide was characterized.

a fifteen year retrospective analysis of all records of adult patients suffering from schizophrenia admitted to our center was conducted. The index group (N=1094) was comprised of patients who had attempted suicide; the comparison group (N=1094) was comprised of the next admission of a patient suffering from schizophrenia who did not attempt suicide prior to hospitalization.

the index group consisted of 380 women and 714 men, with a mean age of 39.6 + 12.9 years. The comparison group consisted of 302 women and 792 men, with a mean age of 42.9 + 13.7 years. Four variables were identified as significantly differentiating between groups: Patients who had attempted suicide were younger (39.6 vs 42.9 years; p = 0.00), had a higher percentage of females (34.7% vs 27.6%; p = 0.00), with increased rates of co-morbid physical illness (27.5% vs 20.4%; p = 0.00) and with a higher rate of substance abuse (32.1% vs 12.4%; p = 0.00).

this study brings attention to some significant factors associated with attempted suicide amongst schizophrenia patients, especially physical co-morbidity and substance abuse. In order to decrease adverse outcomes in this group of patients these variables should be addressed in risk assessment schemes.

In schizophrenia treatment-compliance is a strong predictor of outcome, it depends on a longer lasting therapeutic alliance. SMS (Short Message Service) sent via mobile phones is an adequate tool to establish therapeutic contingency as was shown in a study on bulimia. This programme compliments outpatient treatment and is based on an exchange of SMS-messages between patient and therapist. On a weekly basis, patients supply information on subjective well-being, sleep, social contacts, and attitude towards medication. The patient's status is then rated as improved, deteriorated, or unchanged compared to the previous week and an adequate feedback message is sent. The study aimed at assessing feasibility and acceptance of this intervention in schizophrenia patients.

Thirty-six patients during inpatient-treatment for diagnoses of schizophrenia and schizoaffective disorder were screened and found eligible for participation. Those who agreed to participation were assessed with the SCID for DSM-IV and received instructions towards the use of the programme, which started after discharge and was designed to last for 4 months in addition to outpatient-treatment as usual.

Eight patients agreed to participation (7 male, 1 female, mean age 29 years), six of whom dropped out during the first three weeks, and only one patient completed the study.

In the presented study, patients suffering from schizophrenia showed a low acceptance rate of additional SMS support complimenting their regular outpatient-treatment. As opposed to our hypothesis and contrary to experiences with bulimia patients integrating an SMS intervention into the treatment of schizophrenia does not seem feasible.

Under naturalistic conditions the influence of monotherapy versus combined therapy on the outcome of psychoeducation was to be investigated. As amisulpride has a very positive receptor profile and causes no sedation, it was of interest to which degree amisulpride has a positive influence on knowledge gain in comparison to other atypicals.

In-patients with schizophrenia (ICD -10: F2) under therapy with atypicals. 8 psychoeducational group sessions; indication for groups independent of psychopathology, insight and compliance. Medication with atypicals non restricted.

94 patients (47% female, 35 years), 40 % (38 of 94) were treated at discharge with a monotherapy and 60 % with a combination of atypicals. PANSS monotherapy at admission: 74; at discharge: 49. Patients with combination therapy had significantly higher values: 92 at admission and 66 at discharge (p<0.001). Knowledge-gain was comparable; monotherapy group: Mean= 6,0 (SD 6,5); combination therapy: Mean=6,9 (SD 12,4) (n.s.). 23 % (22 of 94) got amisulpride (5 in monotherapy and 17 in combination). Concerning safety profile and therapeutic effectiveness the non-inferior hypothesis could be confirmed. Patients with monotherapy of amisulpride at discharge had a mean knowledge gain of 10.7; that was higher than the mean knowledge gain of 6.5 of all patients (n.s.).

Monotherapy with atypicals was only possible among 40 %. Psychoeducation is efficient for severely ill patients with combined therapy as well. Amisulpride monotherapy showed a knowledge-gain higher than the average atypicals. For patients with high expectations concerning rehabilitation, a monotherapy with amisulpride seems to be useful.

Several neuroimaging studies have shown impaired microstructural integrity of corpus callosum in schizophrenia, which may support inter-hemispheric misconnection. However, functional connectivity has rarely been investigated in schizophrenia.

To explore inter-hemispheric communication in a sample of patients with schizophrenia in comparison to healthy controls.

Twenty-five patients with schizophrenia and forty-one healthy controls were studied. Subjects were asked to press a key with the index-finger of their right or the left hand as quickly as possible following appearance of either a single or a double stimulus. Two measures were calculated: the difference between manual reaction times (RT) after the presentation of single stimuli to the ipsilateral (uncrossed response) or contralateral (crossed response) visual hemifield (the so-called Poffenberger Paradigm), as a measure of interhemispheric transfer time (ITT), and the difference between double and single stimuli (the Redundant Target Effect, RTE), as a measure of interhemispheric integration.

Overall, patients with schizophrenia responded faster with the left than with the right hand (Paired sample t-test p=0.019). Importantly, in schizophrenics there was no group difference in ITT but there was a significantly enhanced RTE .

The slower RT for right hand in schizophrenics possibly reflects a general delay of the left cerebral hemisphere in visuomotor RT. Moreover, the enhanced RTE suggests an impairment of interhemispheric integration in schizophrenia.

Correlational methods, unlike cluster analyses, cannot take into account the possibility that individuals score highly on more than one symptom dimension simultaneously. This may account for the inconsistency found in the correlates of schizotypy dimensions. This study explored the clustering of positive and negative schizotypy dimensions in nonclinical subjects and whether schizotypy clusters have meaningful patterns of adjustment in terms of psychopathology, social functioning, and personality.

Positive and negative schizotypy dimensional scores were derived from the Wisconsin Schizotypy Scales for 6.137 college students and submitted to cluster analysis. Of these, 780 completed the NEO-PI-R and Social Adjustment Scale-self report version, and further 430 were interviewed for schizophrenia-spectrum, mood, and substance use psychopathology.

Four clusters were yielded: low, high positive, high negative, and mixed (high positive and negative) schizotypy. The positive-schizotypy cluster presented more psychotic-like experiences and schizotypal, paranoid symptoms, had more affective and substance abuse pathology, and were more open and extraverted. The negative-schizotypy cluster had more negative and schizoid symptoms, worse social adjustment, high conscientiousness and low agreeableness. The mixed cluster was the most deviant on almost all aspects.

Our cluster solution is consistent with few previous reports in schizotypy and schizophrenia, indicating that meaningful profiles of schizotypy features can be detected in nonclinical populations. The clusters displayed a distinct and meaningful pattern of correlates at across different domains, thus providing construct validity to the schizotypy types defined.

Previous studies suggest that the serotonergic pathway may play an important role in prefrontal cortical (PFC) function. The enzyme monoamino oxidase-A (MAO-A) is primarily involved in serotonin catabolism. The MAO-A gene, harbours a variable number tandem repeat (VNTR) polymorphism with high (MAOA-H) and low (MAOA-L) activity variants. Individuals with the MAOA-H allele present with lower amine concentration, higher response inhibition failure and reduced information processing. We therefore hypothesised that these individuals would present with lower PPI levels and working memory performance.

PPI (85-dB prepulse at 30-, 60-, 120-ms intervals) was assessed in 118 healthy males (MAOA-L group n=41 and MAOA-H group n=77). Subjects’ working memory was assessed with the N-back, a PFC-dependent task. PPI data were analysed with repeated measures ANOVA and the N-Back data were analysed with the Mann-Whitney nonparametric test.

Demographic and startle characteristics were similar between the two genotype groups. Analysis of the PPI data revealed higher PPI levels in the MAOA-L compared to the MAOA-H group in all trial types. In addition, the MAOA-L group had significantly more correct responses in the two-back condition.

Compared to MAOA-L, MAOA-H individuals show lower PPI and worse N-Back performance. These results suggest that the MAO-A VNTR polymorphism is an important determinant of sensorimotor gating and working memory, possibly through a PFC mediated mechanism.

Are early warning symptoms used in treatment, and if so what result does this therapy have in practise? Is the presumption correct that therapy with a focus on early warning symptoms results in less new episodes and more compliance towards antipsychotic medicine?

The policy for patients with schizophrenia within GGNet was checked. Moreover, an extensive literature review was conducted using PubMed, the internet in general and research contacts in order to avoid important literature to be left out.

In this study, in line with previous research on early warning symptoms (O'Sullivan & Gilbert, 2003), it was found that they are indeed successfully used in practice (e.g., Birchwood, Spencer, & McGovern, 2000). Moreover, it was also found that patients and their families feel safer and know what to do if new episodes seem to be emerging (e.g., Bosch & Van den Noort, 2008).

Early warning symptoms are indeed successfully used in treatment (e.g., Bosch & Van den Noort, 2008). More research is needed, in order to optimise the techniques that are used in practise. This might result in lower annual cost of rehospitalization for multiple-episode schizophrenia outpatients (e.g., Weiden & Oltson, 1995). Recognising early warning symptoms might be taught, but one point that needs our further attention is the therapyplan that is made after this learning process. How to make this plan work and to optimise the use of early warning symptoms should be a topic for further research.

In August 2008, a book will come out (edited by the authors of this abstract and published by Hogrefe & Huber publishers, Germany) on Schizophrenia, Sleep and Acupuncture. Several international researchers and authors have contributed to this unique book. The authors of this abstract would like to present the background theory of this book, and the results that were found so far by using acupuncture in schizophrenia, sleep disorders as well as the combination of these disorders.

Authors out of different backgrounds contributed their knowledge to the book. This resulted in a very broad theory on schizophrenia and its relation to sleep disorders. Results out of fMRI studies as well as case reports were included. Furthermore, there was an emphasize on the role of neurotransmitters within schizophrenia, sleep as well as acupuncture.

In studies that have been conducted so far, a reduction in antipsychotic doses was possible during times of acupuncture treatment, resulting in less side effects and more compliance to treatment. Furthermore, a reduction in side effects was seen, since acupuncture actively works upon side effects such as headache, dry mouth etc.

More than enough basis was found for further research into this promising new field of treatment in schizophrenia and sleep disorders.

Many studies have examined the potentially beneficial role of social and cognitive rehabilitation in patients suffering from schizophrenia. Schizophrenia is a frequent and severe disorder in spite of the new medication. Cognitive rehabilitation improved by antipsychotic treatment could promote psychosocial processing rehabilitation.

The use in our department of the SAARP module (Social Abilities and Autonomy Reinforcement Program) confirm these data. This progam has been made to manage patients towards a high level of self-sufficiency.

The first aim is to look for solutions for concrete problems in daily life to help patients to realize personal plans. It develops self-esteem and responsibility for patient. It allows a personal realisation and an active social life. This instrument have to be an easy access, for all the staffs wishing for the well-being for patients with schizophrenia.

This study investigates the relationship of neurocognitive functioning and social functioning in patients with program as compared to patients without program. We targeted several domains of SAARP that have been associated with quality of life, and also tested whether the effects of SAARP were related to the age.