Left temporal hypoperfusion has been reported in some cases of schizophrenia. However, left temporal cortex is involved in lexical access. Moreover, difficulties with accessing the lexical-semantic memory store have been proposed in schizophrenia. Therefore, a relation between impaired lexical access and left temporal activity in schizophrenia might be argued.

Here, we report the case of a 33 years old man with disorganized schizophrenia (using DSM-IV-TR criteria) who underwent complete neuropsychological assessment and measurement of cerebral perfusion with 99mTc-ECD (ethyl cysteinate dimer) single photon emission computed tomography (SPECT).

We found evidence for naming disabilities with Deloche and Hannequin's picture naming test of 80 objects. Moreover, a semantic knowledge test (Desgranges and al) suggested the preservation of the lexical-semantic memory store. This was not due neither to mental deficiency (evaluated by WAIS-III and Raven's matrices PM 38), nor to executive dysfunction (evaluated by Frontal Assessment at Bedside, Wisconsin Card Sorting Test, Verbal fluencies, Stroop test and Rey-Osterrieth complex figure), nor to any abnormality of the central nervous system (on the RMI investigation). However, SPECT revealed a left temporal hypoperfusion.

This case report suggests that left temporal hypoperfusion described in some cases of schizophrenia might be related to an impairment of lexical access.

Patients with SMI receive long term intervention with psychotropic agents often associated with weight gain. Weight and lifestyle management programmes may prevent, reduce or reverse weight gain, however most data is short-term. Categorical data is not often reported

A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors commenced 2002 in Ireland. Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes. Groups were led by trained healthcare professionals.

Data is reported up to 24 months from 55 patients (27 male; 28 female) from 6 centres. Mean age 49.4 years (range 21-74). Schizophrenia 63%, Affective disorders 26%, other 11%. Patients completing 1 year - 55% and 2 years 22%. Baseline mean weight 98.6 kg (SD 19.2) decreased to final visit weight 96.9kg (SD 18.4).Paired t –test, p = 0.0030; CI Mean 2.53 (0.9-4.159). Weight increased in 11/55, maintained 7/55 and decreased 37/55.

Weight gain in SMI patients is not inevitable and was found in only 20% of patients attending weight clinics in Ireland. Patients may benefit if similar interventions were widely available.

After the commercialization of Aripiprazole in Spain, two observational studies were proposed, one was conducted when the drug was first launched, and the other when the starting dose of Aripiprazole was modified, in order to understand the switching strategies, the effectiveness, tolerability and adherence to treatment in standard use conditions.

Two multicenter, retrospective, observational studies were carried out involving 200 psychiatrists throughout Spain with approximate 1000 patients treated with Aripiprazole during the previous four months in each one of the studies during 2005 and 2006 respectively.

Both groups of patients had a very similar demographic profile that matches with the general schizophrenic population. In the first study, the main reasons for switching medication were low efficacy (56% of cases) and intolerance (35%), and 44% and 43% respectively in the second study. Despite the poor response to previous treatment, clinical evaluation of effectiveness and tolerability with Aripiprazole was very positive: In the first study, 76% of patients had very good or good effectiveness and tolerability was very good or good in 90%. In the second study, these values were 75% and 93%, respectively. Patterns of change from the previous treatment were switching in 75% of cases in the first study and in 60% in the second study.

Effectiveness of treatment with Aripiprazole is good in patients who had a poor response to their previous antipsychotic treatments. The most frequent and effective pattern for change patients to Aripiprazole treatments is switching.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. Assessments were made every three months for 2 year. We used a protocol including: PANSS, GAF-EEAG, CGI, Young mania, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale, the Information Subtest and Psychosocial Stress Global Assessment (DSM III R). The assessment of prodromal symptoms was retrospectively. The symptoms were based on the late prodromal style described by McGorry (1). A statistical analysis of data was performed.

Objetives

1. • Evaluate the gender differences in the prodomal state and analyse the prognosis according to them.

231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset.

The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.

Evaluate the sex differences in first episode psychosis.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. The patients were treated with risperidone and assessments were made in the first month and then every three months for 2 year. Therefore, we used a protocol including the following scales: PANSS, Global Assessment of Functioning scale (GAF-EEAG), CGI, Young mania rating scale, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale (Cannon-Spoor), the Information Subtest (WAIS) and Psychosocial Stress Global Assessment (DSM III R).

231 patients were included (32.5% women). Males have consistently an earlier onset even after controlling the cofounding factors and poorer premorbid functioning. Women have a shorter DUP, and they are more likely to be married than men and to live with their couples or children. Women have also better adherence to treatment than men. Males don't show differences in negative, positive symptoms or cognitive deficits. There was no difference between the sexes in the dose of the prescribed antipsychotic. There are no clear sex differences in family history and obstetric complications. Sex doesn't have influence on the course of illness in middle-term (2 years).

This paper supports the presence of significant differences between schizophrenic males and women, but there aren't differences in the outcome of the disease.

Currently there is no consensus regarding how long anti-psychotics medication should be continued following a first/single psychotic episode. Clinically patients often request discontinuation after a period of remission. This is one of the first double-blind randomized-controlled studies designed to address the issue.

Patients with DSM-IV schizophrenia and related psychoses (excluding substance induced psychosis) who remitted well following a first/single-episode, and had remained well on maintenance medication for one year, were randomized to receive either maintenance therapy with quetiapine (400 mg/day), or placebo for 12 months. Relapse was defined by the presence of (i) an increase in at least one of the following PANSS psychotic symptom items to a threshold score (delusion, hallucinatory behaviour, conceptual disorganization, unusual thought content, suspiciousness); (ii) CGI Severity of Illness 3 or above; and (iii) CGI Improvement 5 or above.

178 patients were randomized. 144 patients completed the study (80.9%). The relapse rate was 33.7% (30/89) for the maintenance group and 66.3% (59/89) for the placebo group (log-rank test, chi-square=13.328, p<0.001). Relapse was not related to age or gender. Other significant predictors of relapse include medication status, pre-morbid schizotypal traits, verbal memory and soft neurological signs.

There is a substantial risk of relapse if medication is discontinued in remitted first-episode psychosis patients following one year of maintenance therapy. On the contrary 33.7% of patients discontinued medication and remained well.

Atypical antipsychotics (AAP) are associated with adverse effects such as weight gain and the metabolic syndrome. Weight gain is an important marker to control while using AAP. Our study shows the existent correlations between weight gain, the decrease of neuroprotection and cognitive impairment.

A retrospective study on 16 patients, 10 women and 6 men, diagnosed with schizophrenia (DSM-IV) and multiple episodes (>5 episodes in 3 years) being under treatment with typical antipsychotics (minimum 3 cures, more than 6 months each) and to whom was imposed the switch to atypical antipsychotics because of the poor therapeutical respondence. None of the patients presented EPS of whose intensity to necessitate this switch. After the initiation of the AAP therapy they presented a significant weight gain (>15% of the ideal weight in the first 12 months).

These patients were monitorized for:

1. - social distress factors;

2. - the cognitive evaluation using California Verbal Learning Test;

3. - neuroimagistic evaluation (CT);

4. - PANSS.

All the patients presented a high familial and social distress factors, cognitive impairment and neuroimagistic modifications in cortical areas and ventricular enlargement. On the PANSS scale observing a decrease in intensity of the positive symptoms, and an insignificant modification of the negative symptoms.

The significant weight gain during the first year after the switch to AAP to these patients, can serve as a marker for neurostructural changes, neuroimagistic monitorization being obligatory at the moment of the decision of switching from a typical to an atypical antipsychotic.

The aim was to investigate the cognitive abnormalities in healthy individuals (No Axis I or II disorders) at risk for bipolar disorder (BD) and schizophrenia (SZ)

Participants were 17 BD-R, 15 SZ-R and 23 controls. All participants underwent assessment of IQ, working, verbal memory and learning, visuospatial memory, verbal and visual recall and recognition. Lack of lifetime Axis I and II disorders was screened using Structured Clinical Interview for DSM-IV and symptomatology was assessed with the Brief Psychiatric Rating Scale (BPRS).

No difference was found in IQ. The SZ-R underperformed compared to BD-R and controls in working memory. The SZ-R had increased number of intrusions but did not differ from the BD-R in short delay. The SZ-R showed impairment in long term recall. No effect of learning was found. SZ-R and BD-R underperformed compared to controls in visuospatial memory. SZ-R showed long term memory deficits with higher overall forgetting scores in both visual and verbal tests compared to BD-R and controls. The BD relatives were able to retain more verbal items but comparable visual items to SZ-R. Effect of BPRS total score was found only for BD-R across all measures.

BD-R do not show deficits compared to controls in the dorsal prefrontal cortex (DPFC) like the SZ-R. The SZ-R show impairments in fronto temporal networks that are preserved in BD-R supporting deficits in semantic categories in both encoding and retrieval whereas impairment shown in BD-R may be mainly attributed to the effect of symptoms.

The aim of this project was to investigate the cognitive abnormalities in healthy individuals (No Axis I or II disorders) at risk for bipolar disorder (BD) and schizophrenia (SZ)

Participants were 17 BD-R and 15 SZ-R and 23 controls. All participants underwent assessment of IQ, inhibition, verbal fluency, planning and cognitive set shifting. Lack of lifetime Axis I and II disorders was screened using Structured Clinical Interview for DSM-IV and symptomatology was assessed with the Brief Psychiatric Rating Scale (BPRS).

No difference was found in IQ. Loss of inhibition was found in both SZ-R and BD-R compared to controls whereas SZ-R had slower initiation times. SZ-R also failed to inhibit relatively fast erroneous responses, leading to an effect on error rates but not in reaction times. SZ-R and BD-R produced fewer words compared to controls whereas the former group made more errors. BD-R achieved both comparable number of categories to controls and made equal number of errors whereas SZ-R underperformed compared to former groups in both measures. Effect of BPRS total score was found only for BD-R across all measures apart from inhibition.

Genetic predisposition to SZ may be mediated by deficits in both the Ventral and Dorsal Prefrontal Cortex (VPFC) and (DPFC). In BD-R impairment was limited in the VPFC whereas the DPFC function was preserved. The two disorders share inhibition deficits associated with the VPFC.

Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms. PPD occurs without concomitant change in positive or negative symptoms.

We try to evaluate efficacy of Fluvoxamine, versus efficacy of mirtazapine and venlafaxine in PPD.

25 patients (17 men, 8 female), aged 18-45 years, diagnosed with schizophrenia and PPD by DSM IV criteria. All patients received a second generation of antipsychotic (SGA) .We divided in 3 groups - A (9 patients) treated with SGA + Fluvoxamine (100 mg/day), group B (8 patients) treated with SGA + mirtazapine (30-45mg/day) and group C (8 patients) treated with SGA + venlafaxine (150- 225mg/day). We use BPRS, HAMD, and CGI for severity. Period of study 2 month, with visit at every week. We evaluate efficacy in group A versus efficacy in group B and C.

in group A: 2 drop-out, 6 responders, 1 non-responders; in group B: 1 drop- out, 6 responders, 1 non- responders, in group C: 1 drop- out, 7 responders. The response was faster in group C. The treatment was well tolerated.

The results were similar in all groups, but the most responders were found in patients with family support, in first 3 years of evolution of schizophrenia, with family history of affective disorders, absence of negative symptoms. The response was better at patients who don't have traumatic stress in there children or adolescent period.

The blurring of nosological boundaries across clinical forms of schizophrenia is critical. The aim of the research was to address the relationships between neuropsychological functioning, clinical scales and international diagnosis criteria for a comprehensive diagnosis of schizophrenia.

67 patients diagnosed with schizophrenia according to ICD-10 criteria were included in the current study. The average age of the patients was 33.17 years (SD=9.22). Patients included were not diagnosed with medical or neurological conditions. In clinical assessment PANSS, GAS and CGI tests were used, and also neuropsychological computerized assessment of working memory and implicit learning (WLM, SWM), executive functioning (STDT), time of reaction (SST), discrimination of facial emotional expression (PEAT).

In four forms of schizophrenia (paranoid, catatonic, simplex and non-differentiated), high scores on the negative PANSS scale were revealed, while on the positive PANSS scale, high scores were revealed in two of these forms (paranoid and non-differentiated). Significant correlations were found between delusional-hallucinatory symptoms and deficits in neuropsychological functioning (implicit learning, decision time, perseverance in errors). Significant correlations were found between apathy, social withdrawal, avolition, difficulties in abstract thinking, working memory disorders, attention deficit. Discriminating ability between emotional expressions did not correlate with PANSS scores, however it did correlate with GAS scores.

1. Schizophrenia clinical forms can not be distinguished through PANSS or GAS scores. 2. Neuropsychological assessment appears to be a fine differentiating diagnostic tool between different clinical forms of schizophrenia. 3. Impaired cognitive functioning ads to the dimensional diagnosis of schizophrenia.

Opioid withdrawal, stress or cues associated with opioid consumption can induce opioid craving. If opioids are not available, opioid dependent patients usually search for alternative drugs. Since several non-opioid drugs stimulate the endogenous opioidergic system, this concept may explain their frequent use by opioid dependent patients. We hypothesized that non-opioid drugs alleviate opioid withdrawal symptoms and are therefore consumed by opioid addicts.

We asked 89 opioid dependent patients participating in an outpatient opioid maintenance program to estimate the potential of several non-opioid drugs in being able to alleviate opioid withdrawal.

Values (mean ± SD) for benzodiazepines: 3.2 ± 1.1, tricyclic antidepressants 3.6 ± 1.1, cannabis 3.6 ± 1.0, alcohol 4.1 ± 1.1, cocaine 4.2 ± 1.1, amphetamine 4.4 ± 0.9, nicotine 4.7 ± 0.7, caffeine 4.9 ± 0.5. A worsening of opioid withdrawal was reported by 62% of the patients for cocaine, 62% for amphetamine, 50% for caffeine, 37.5% for cannabis, 27% for nicotine, 26% for alcohol, 8% for tricyclic antidepressants and 3% for benzodiazepines.

Our study shows a low efficacy of non-opioid drugs in alleviating opioid withdrawal symptoms. The data basis of this study was good and the sample was suitable to be asked for estimations of drug-drug interactions. 26% - 62% of the patients even reported a worsening of opioid withdrawal for cannabis, alcohol, cocaine and amphetamine. Only benzodiazepines and tricyclic antidepressants were reported to have a moderate positive effect on opioid withdrawal.

Side effects from a high-dose clozapine treatment for a schizophrenic patient led to massive compliance problems. The dose of clozapine could be halved without recurrence of an acute psychotic symptomatology by concomitantly administering amisulpride The side effects, especially hypersalivation, disappeared almost entirely, which in turn led to good compliance. In a short review we would like to present the pathophysiology and therapeutic options of clozapine-induced hypersalivation.

Despite various attempts at explanation and therapeutic approaches, hypersalivation under clozapine remains a side effect that is sometimes very difficult to get under control. As in our case report, it can lead to quite relevant compromises in compliance. The cause for the observable paradoxical hypersalivation under clozapine which can occur in spite of the anticholinergic effect remains unexplained.

The combination of clozapine and amisulpride with its overall good tolerability represents an option for reducing the sometimes inevitably high doses of a monotherapy, and the associated side effects, such as in our case with clozapine. In addition, making use of synergetic effects and in turn, improving the patients’ compliance would be possible.

Twenty nine schizophrenic patients (16 male and 13 female), aged 17-64 (mean 32) years, participated in this research.

Neuropsychological tests measuring working memory were performed in patients with schizophrenia: psychomotor speed (TMT A), visuospatial working memory (TMT B), verbal functions (Stroop Test and Verbal Fluency).

Age of patients significantly correlated with prolonging the time of carrying out part A of TMT and the first part of the Stroop Test and correlated with smaller number of words in Verbal Fluency Test. The cognitive dysfunction is more prominent in patients in age above 35 years.

Several studies conducted in patients with schizophrenia, posttraumatic stress disorder, delirium tremens and sleep deprivation have put into light disturbances in sleep architecture and cerebral neurotransmission. In addition, clinical practice has emphasized the role played by the sleep deficit in triggering psychotic episodes in vulnerable individuals.The paper focuses on the role played by sleep disturbances in the etiopathogeny of psychotic symptoms in schizophrenia and other psychiatric disorders or organic states accompanied by perception disturbances.

psychiatric disorders and organic states which share the presence of perception disturbances such as hallucinations, flash-backs, oniroid symptoms have been selected. Sleep disturbances that accompany these nosologic entities have been analyzed in correlation with biochemical changes in cerebral neurotransmission and with the effects of psychotropic drugs and of psychiatric co-morbidity.

disturbances in sleep architecture and duration represent an important link in the etiopathogeny of psychotic symptoms. These disturbances could be correlated with disturbances in cerebral neurotransmitters implicated in the pathogeny of psychosis (dopamine, serototnine, GABA).

sleep disturbances do not have to be regarded as an epiphenomenon; instead, they are an important link in the etiopathogeny of psychotic episodes. Keeping this in mind would play an important role in patient psycho-education aiming to prevent recurrences, and in scientific research oriented towards the development of new antipsychotic molecules.

Repeated relapses and hospitalizations of patients with severe mental disorders reduce their quality of life and present a considerable burden on health care systems. Assertive community treatment(ACT) improves outcomes in patients with severe mental illness(SMI) with greatest risk for relapse and disability. In University Psychiatric Hospital Ljubljana assertive community treatment program started in the beginning of the 2006. In presented research first results of this program are assessed.

Two groups of patients with SMI were compared regarding hospitalization and functioning. The first group was discharged to standard outpatient treatment. The second group was included in ACT program described. Inclusion criteria were ICD 10 diagnoses F20-29 and at least two repeated hospitalizations in last year.

For each patient predicted hospitalization for one year was calculated and compared to the actual number of days spent in hospital in last year. In both groups functioning and quality of life were followed by repeated assessments with Health of the Nation Outcome Scale and Leicester Quality of Life questionnaires in 2007 for purposes of outcome measurements.

Actual hospitalization periods are significantly lower in ACT group than in control group. The difference between ACT group actual and predicted hospitalization periods is significantly higher than in control group. Functioning and quality of life in three month follow up is higher and more stable in ACT group.

ACT prevents hospitalization, shortens the hospitalization periods and maintains the level of functioning in patients with severe mental illness with reoccurring hospitalizations and disability.

To evaluate safety, tolerability and overall effectiveness of a titrated- versus fixed-dose switching strategy from risperidone to aripiprazole in a general practice setting.

This 12-week, multicentre, open-label study included patients with schizophrenia (DSM-IV-TR) experiencing insufficient efficacy and/or safety/tolerability issues while receiving risperidone for ≥6 weeks. Patients were randomized to titrated- or fixed-dose switching regimens.

Discontinuations due to AEs were similar between titrated- and fixed-dose strategies (3.5% vs. 5.0%; p=0.448). Titrated- and fixed-dose groups showed improvements (Week 12) in mean PANSS Total scores (–14.8 vs. –17.2; LOCF), mean CGI-I scores (2.9 vs. 2.8; p=0.425; LOCF), ASEX scores (–1.5 vs. –1.9 from baseline; OC), serum prolactin levels (−48.7 vs. −48.5 from baseline; OC) and SWN scores (+8.6 vs. +10.3 from baseline; p=0.223; OC). POM scores indicated a preference for aripiprazole compared with risperidone using either regimen. Both strategies showed improvements (titrated-dose vs. fixed-dose; Week 12; LOCF) in social cognition as indicated by decreased GEOPTE patient (–5.3 vs. –6.1), caregiver (–5.4 vs. –9.9) and index scores (–5.1 vs. –9.8).

Switching to aripiprazole from risperidone can be effectively and safely achieved in a general practice setting through a slow down-titration of risperidone and either a titrated- or fixed-dose switching strategy for aripiprazole.