Axis I anxiety disorders are often comorbid in psychoses and mostly assessed during the hospitalization. In the present study anxiety comorbidity was investigated in 98 patients (with schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features) previously hospitalized for psychotic symptoms.

Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder Fourth Edition (SCID-P), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impressions Scale (CGI), were performed during hospitalization (t0) and subsequently in a phase of clinical remission, lasting for at least 6 months besides a stable pharmacological treatment for at least 3 months (t1). Comorbid anxiety disorders were assessed only at t1 in order to avoid the influence of an acute clinical state.

Our sample confirmed that anxiety comorbidity is a relevant phenomenon in psychoses, being present in nearly half of the patients (46.9%). Our specific prevalences were: obsessive-compulsive disorder (OCD) 20.4%, panic disorder (PD) 24.5%, social anxiety disorder (SAD) 19.4%, generalized anxiety disorder (GAD) 2%, post-traumatic stress disorder (PTSD) 0%. In our sample, patients with schizophrenia had a rate of anxiety disorders (73.9%) significantly higher (p<.05) than those with schizoaffective disorder (31.6%) or bipolar disorder (41.1%). Patients with PD or with OCD showed higher severity of illness only at t0; on the contrary, those with SAD demonstrated greater severity at t1.

PD, OCD and SAD resulted frequently comorbid in psychotic patients; SAD more prevalent in schizophrenia with a negative impact on the course of the illness.

Among pituitary adenomas, prolactin-producing pituitary tumors are the most common type which are treated frequently with dopamine agonists in intrasellar types. The onset of a psychotic disorder concomitant with the tumor complicates the diagnostic algorithm of the psychiatric condition and the following therapeutical approach of both of them.

to elucidate on empirical basis the etiology of the psychotic disorder comorbid with pituitary adenoma in order to find an optimal therapeutical resolution to both conditions.

female patient, 25 years old, was hospitalized for psychotic and expansive symptoms which appeared six months after initiation of bromocriptine treatment for prolactin-producing pituitary microadenoma and had a fluctuated course. All investigations excluded the involvement of another organic factors. The difficulty of the case consisted in finding the differentiated etiology of the persistent psychiatric symptomatology: is it bromocriptine induced or is it a primary mental disorder?

the psychiatric symptoms were treated with antipsychotics – quetiapine1000mg/day, but the maintenance dose had to be reduced to half because the prolactin serum level raised. Three months later the patient relapsed and the antipsychotic dose was raised, which induced high prolactin serum level. Bromocriptine dose was raised as the psychiatric condition worsened and the antipsychotic dose was raised again. Finaly bromocriptine swiched to cabergoline 1,5mg/twice a week. The psychotic symptoms diminished and the remission was reached with prolactin serum level maintained within normal limits with cabergoline.

empiric research found that the most probable cause of persistent psychosis is related to the dopamine agonist use.

Schizophrenia is a chronic mental disorder with unknown etiology. It seems that many endocrine and metabolic abnormalities are present in the schizophrenic patients.This study was done to determine the rate of abnormal plasma glucose levels in schizophrenic patients .

Thirty two schizophrenics patients (16 male & 16 female) encountered in a cross–sectional descriptive survey . The fasting glucose levels of the patients were compared with normal subjects . For comparison of data, student's t. test was used .

Five of the subjects in the patients group had impaired fasting glucose tolerance as defined by the American Diabetic Association Criteria (110 – 125 mg./dl.) In the control group, on the other hand, only 1 person had impaired fasting glucose tolerance (p = 0 .015).

According to the results of this study, and also some others, it seems that abnormal levels of glucose are more common in schizophrenics than total population . It is strongly recommended that patients with schizophrenia be carefully examined for diabetes mellitus or abnormal glucose tolerance .

Investigate how selection criteria and statistical model specifications affect time to all cause discontinuation (TTAD) comparisons across alternative antipsychotics using retrospective database analyses.

231,635 episodes of antipsychotic therapy were identified using data from the California Medicaid (Medi-Cal) program. A series of regression models were estimated for TTAD that altered selection criteria and the list of independent variables used in the models.

Unadjusted TTAD (in days) for typical antipsychotics, olanzapine, risperidone and quetiapine were 92, 175, 182 and 177, respectively. TTAD achieved by patients using conventional antipsychotics was consistently shorter than TTAD achieved with atypical antipsychotics, but estimates varied from -96 days to -44 days depending on selection criteria and model specification (p<0.0001 relative to olanzapine). TTAD using risperidone or quetiapine appeared to be superior to olanzapine in simple models (+11 to +13 days, p<0.000), while virtually no differences across atypical antipsychotics were found when the analysis was restricted to patients with schizophrenia and more complete model specifications were employed. Specifically, screening for schizophrenia reversed risperidone's advantage over olanzapine from +6 days (p<0.0001) to -1.4 days (p>0.05). TTAD results favoring quetiapine over olanzapine were reversed from +7 days (p<0.0001) to – 0.4 days (p>0.05) when covariates for episode type were included in the model.

Differences in duration of antipsychotic therapy exist across diagnostic groups and episode type. Differences also exist in the diagnostic and episode mix across drugs. Therefore, disaggregated patient samples and expanded model specifications provide more accurate estimates of differences in TTAD.

To assess the safety and tolerability of quetiapine XR using pooled data from 3 studies (5077IL/0041, D1444C00132, D1444C00133).

Quetiapine XR (300mg [1 study], 400mg [2 studies], 600mg or 800mg once daily) was evaluated in 3 similarly designed, 6-week, placebo-controlled, double-blind, randomised studies in patients with acute schizophrenia. Matched dose quetiapine IR was included to demonstrate assay sensitivity. Safety assessments included AEs and vital signs.

The pooled safety population included 1684 patients (951, quetiapine XR; 414, quetiapine IR; 319, placebo). Mean (SD) duration of exposure to quetiapine XR, quetiapine IR and placebo was 31.8 (14.9), 29.4 (15.9) and 30.6 (15.6) days, respectively.

The percentage of patients reporting an AE was similar for quetiapine XR (69.5%), quetiapine IR (72.5%) and placebo (61.4%). Serious AE incidence was similar for quetiapine XR (4.4%), quetiapine IR (3.9%) and placebo (4.4%). 6.4%, 7.7% and 7.5% of patients receiving quetiapine XR, quetiapine IR and placebo discontinued owing to AEs, respectively.

The five most common drug-related AEs (≥5%) were: sedation (11.5%, 14.0%, 5.0%), somnolence (10.6%, 11.4%, 3.1%), dry mouth (10.4%, 8.0%, 1.3%), dizziness (7.5%, 6.8%, 3.1%) and orthostatic hypertension (5.8%, 7.5%, 3.8%), for quetiapine XR, quetiapine IR and placebo, respectively. There was no dose relationship with any common AE for quetiapine XR. For completers, mean weight increases were: quetiapine XR (n=555), 1.77kg; quetiapine IR (n=215), 2.19kg; placebo (n=163), 0.26kg.

Once-daily quetiapine XR (300-800mg/day) was well tolerated in patients with acute schizophrenia. The tolerability profile was consistent with the known safety profile for quetiapine IR.

We study the predictive power and associations of several psychological scales with respect to hospitalisations due to schizophrenic psychoses.

Temperament and Character Inventory, Physical Anhedonia Scale, Social Anhedonia Scale, Perceptual Aberration Scale, Hypomanic Personality Scale, Bipolar II Scale, and Schizoidia Scale were included in the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort (N=4,926). We compared subjects without any previous hospitalisations to those with previous hospital diagnoses (concurrent validity) and to those who in the eight year long follow-up were hospitalised due to schizophrenic psychosis (predictive validity). We also compared the subjects with schizophrenic psychoses and subjects with other psychiatric disorders (discriminant validity).

In most scales, subjects with schizophrenic psychoses differed from healthy subjects. The Perceptual Aberration Scale was the best scales for concurrent (Effect Size, d = 1.89) and discriminant validity (d = 0.64). Subjects having a high score in Hypomanic Personality Scale were in the highest risk for schizophrenic psychoses (OR 10.72; 95% CI 2.87-40.06).

Subjects with schizophrenic psychoses differed in most of the scales from healthy controls and from subjects with other psychiatric disorders. Many of the scales were useful predictors for future hospitalisations due to schizophrenic psychoses; however scales were not very diagnosis specific. The predictive power of the scales is limited, these scales are probably not useful as screening instruments but can be used in several ways when studying e.g. risk factors or genetics of schizophrenic psychoses.

Lack of insight is present in 50-80% of schizophrenic patients and is associated with poorer prognosis and negative outcome. The aim of our study was to evaluate possible differences in symptomatology and functioning between schizophrenic patients with poor or good insight.

One undred twenty one patients with a DSM-IV-TR diagnosis of schizophrenia in a stable phase were evaluated with PANSS, CDSS, GAF, and QLS. The Scale for the Assessment of Unawareness of Mental Disorder, SUMD, was used to assess three domains: awareness of mental illness, the need for treatment, the social consequences of illness. SUMD cut-off of 3 was used to differentiate patients with good insight from those with impaired insight. Independent sample t-test was performed to compare these two groups on clinical profile, quality of life and global functioning.

No significant differences were found between poor and good insight groups on socio-demographic variables. Significant differences (p< .01) were observed between patients with poor and good insight, for all the three dimensions of SUMD, in GAF, PANSS positive and PANSS general symptomatology. Patients with worse awareness of illness presented more severe negative symptoms (p= .001) and less depressive symptomatology (p= .008). Patients with impaired awareness of need for treatment and the social consequences of disorder presented lower scores in QLS occupational role (p< .02).

These findings suggest a link between insight, symptomatology and outcome that can be explained by a clinical model which considers insight related to how a particular symptom is created.

Comorbidity has been defined as the coexistence of somatic and psychiatric diseases with diferent physiopatology in the same person, and it can appear simultaneously to the schizophrenia or during the patient's lifetime. There are two types of comorbidity: episodical or taking place during the lifetime of the patient. We can diffferenciate between comorbidity itself (in cluster, dependent or associated) to the so-called pseudo-comorbidity. Besides, comorbidity has been classified as a co-syndrome and it is considered a prognosis indicator of this disease, which can determine an increase in the rates related to relapses, worse response to treatment, less capacity to cope with social situations, and suicide in patients suffering from schizophrenia.

177 schizophrenic patients were assessed for affective symptoms and suicide behaviour. 24.3% were suffered for depression. 35% had a previous record of autolytic attempts. The rate of suicide history were higher among depressed schizophrenics (50%) than non-depressed schizophrenics (20%) (p<0,05).

We point out the clinic importance of suicide in schizophrenic patients suffering from depression. Moreover, the study shows the necessity to carry out longitudinal studies to recognize indicators of depression in advance and establish the diagnosis of depression, and, also, to acknowledge the importance of the gender factor in the depression of schizophrenic patients.

Antipsychotic treatment is known to be associated with secondary sexual dysfunction (SD). Recognition and treatment of this adverse effect has received growing attention. Until now, all antipsychotic agents were thought to potentially cause SD mediated by increased prolactin. Our aim was to observe whether aripiprazole modifies SD in patients with schizophrenia after 3 months of treatment.

Multicenter, observational, open-label, prospective, three-month study with single group of aripiprazole treated patients. Sexual activity was assessed using CGI-S and CGI-I for SD; SALSEX scale, validated for Spanish, 3 times after initiating study drug. Patient's clinical status was evaluated by CGI-S and CGI-I for psychotic disorders, and by BPRS Scale.

Result: 42 patients (70% men), 38 completed the study. Incidence of SD at 3 months was null for all patients studied. As period of treatment advanced, the Salsex score decreased, showing a mean overall reduction of –5 points (SD 3.6). Largest reduction was observed in subgroup of patients with SD in baseline visit, who exhibited a mean reduction of –6 points (SD 3.1).

Men with SD in baseline evaluation showed more marked improvement than women at 40 days of treatment (p=0.0447). However, recovery was similar for both groups at 90 days of treatment.

In schizophrenia, SD secondary studies to antipsychotics are important in establishing effectiveness of these agents in chronic treatment. After 3 months of aripiprazole treatment, no SD was observed in patients. Patients who presented SD at study initiation improved over course of 3 months treatment with aripiprazole.

Successful long-term schizophrenia management should aim at delivery of information about the disease, treatment adherence support, cognitive decline prevention and family atmosphere improvement. We introduce clinically-based 6-week structured integrated program for out-patients with schizophrenia-spectrum disorders in the stabilization phase of the treatment. It consists of the new psychoeducational program PREDUKA (Patient and Relatives Education), life style improvement intervention, social skills training, cognitive remediation and information technology aided relapse prevention program (ITAREPS).

To assess the feasibility and effectiveness we designed one-year prospective follow-up field study.

Preliminary analyses (N=71; first episode N=29) on baseline and 6-week outcomes data on psychopathology (PANSS) and quality of life (Schwartz Outcomes Scale-10, WHO-QOL-BREF and Social Integration Survey) showed significant improvement in PANSS total score and all PANSS domains scores. Compared to healthy controls quality of life was lower in patients including those with first episode. Immediately after the program quality of life improved significantly; in Group activities, Appropriateness and Hygiene domains reached normal controls.

Our short-term data suggest that participation at the program early after discharge is beneficial as it improves quality of life, prevents social isolation and early non-compliance and ensures continuity of care.

This project was supported by CNS 2005-2009 1M000237520 MSMT CR and VZCR MZ0PCP 2005

The NIMH MATRICS initiative established a consensus about separate neurocognitive and social cognitive domains relevant in the treatment of schizophrenia. We designed a cognitive-behavioural group therapy program (INT) covering these treatment targets. INT represents a further development of the cognitive components of Integrated Psychological Therapy (IPT) and is partly computer based. INT intends to restitute and compensate neurocognitive and social cognitive (dys-)functions with a strong focus on the patients’ daily life context, in facilitating intrinsic motivation and resources.

INT has currently been evaluated in an international multi-centre study in Switzerland, Germany and Austria, which is supported by the Swiss National Science Foundation. INT is compared with treatment as usual (TAU). INT patients receive 30 therapy sessions twice a week, lasting 90 minutes each. A comprehensive assessment battery is applied before and after therapy and at a 1-year follow-up. 102 outpatients participated in the study.

INT is highly accepted by the patients. Only 8% of the patients dropped out of the study. Compared to TAU, INT patients obtain superior outcomes in neurocognitive and social cognitive variables, negative symptoms, insight and social functioning after therapy and at follow-up. Additionally, only the INT group show higher correlations between self-rated deficits in neurocognition and objective psychometric test performances after the treatment phase.

Results support INT as a new and effective cognitive remediation approach within a multimodal treatment concept.

Available evidence suggests that, compared with women, men have earlier age of onset of schizophrenia, poorer course and medication response, fewer affective symptoms and worse premorbid social and intellectual functioning. However there is a lack of data concerning gender differences in patients treated against their will.

54 male and 65 female patients, who met the criteria for an F2 disorder according to the ICD-10 at the admission were included. They were assessed three times, in the first week and at the end of first and third month after admission. A broad range of structured assessment instruments has been used to assess psychopathology, social functioning, subjective quality of life, perceived coercion concerning admission, satisfaction with the treatment, socio-demographic characteristics, etc.

The results indicates that there is no significant difference when comparing changes in total scores in psychopathology, satisfaction with therapy and quality of life. But there is a gender discrepancy when comparing certain single items from the scales, e.g. men were more severely impaired in ratings of grandiosity and unusual thought content, while women manifesting slightly better social functioning. Also in some socio-demographic features, in the use of coercive measures and in the reasons why are they applied gender plays a role.

In the majority of observed aspects concerning involuntary treatment, we have not found radical differences when it comes to gender. However, there are distinct disparities mainly in social functioning sphere, particular quality of life components and the motives for using coercive measures.

Earlier research has shown that schizophrenic individuals process complex sound in aberrant ways (Olsson.O., Dissertation, Lund, 2000). It has also been shown that they abnormally perceive forward and backward masking (Källstrand et al., Psychiatry Res. 2002 Dec 15; 11 (1-2); 115-25). Experiments described in those studies indicate that in schizophrenia, brain-stem activity is involved, where primitive sorting of sound elements takes place. Brain Stem Response Audiometry (BSRA) shows that e.g. dissimilar spectra significantly separates schizophrenics from healthy subjects (Nielzén.S., 15th AEP Congress, March 2007, p. S86). The present study aims at demonstrating effects of loudness change of complex sound stimulation.

Eighteen paranoid schizophrenic patients were compared with 25 healthy volunteers regarding BSRA recordings from 2048 sweeps of loud noise stimuli (76 dB) and 2048 quieter ones (73 dB). Analysis of latencies in ms and amplitudes in micro-volts of the peaks and troughs was performed.

The amplitude of the highest peak of the region 1-4 ms was significantly lower with quiet noise for the schizophrenic group (P=.0002).

The schizophrenics showed significantly prolonged latencies of the highest peak during 4,5-9 ms with the quiet noise (P=.046); they had a significant longer latency from left than from right electrode (P=.049).

The results corroborate earlier cumulative BSRA results. These have been collected in a model – S-Detect – which is used as an objective decision support for the diagnosis of schizophrenia.

Mismatch negativity (MMN) and its neuromagnetic analog (MMNm) are event-related brain responses elicited by changes in a sequence of auditory events and indexes of early cognitive processing. It consistently detects neural pre-attentive information processing deficits in schizophrenia. So far, MMN can be assessed with different methods (electroencephalography, EEG; magnetoencephalography, MEG) and different paradigms using the “traditional” oddball (20% rare deviants) or the so-called “optimum” (50% rare deviants varying in one of five parameters each) designs but the latter has not been applied to schizophrenia as yet.

Both designs were compared in 12 patients with schizophrenia and 12 healthy controls using MEG and EEG. Automated, observer-independent data analysis rendered the procedures suitable for clinical applications.

The optimum design was fastest to detect MMN changes. MEG had the best signal-to-noise ratio. In addition MMN was mostly reduced in schizophrenia if measured with MEG in the optimum paradigm.

Optimized MMN paradigms - especially MMNm - improve sensitivity and speed for the detection of schizophrenia endophenotypes. Dysfunctions in this disorder may lie primary in the fast and automatic encoding of stimulus features in the auditory cortex. Of note, these MMN optimum measures may not reflect one unitary mechanism that is equally affected in schizophrenia.

Several studies from different countries demonstrate that cardiovascular mortality is the main cause of death for schizophrenia patients as well as for the population although patients with schizophrenia have a doubled cardiovascular mortality risk. The general population of Sweden has during recent years experienced remarkable declines in mortality from cardiovascular disease resulting in increased overall life expectancy. It is unclear whether patients with schizophrenia have experienced these benefits.

Standardized mortality ratios (SMR) for schizophrenia patients in Sweden during 1970 through 2003 were analyzed, using data from national registers on diagnosis and causes of death. Secular trends for SMR were calculated in Poisson regression models.

SMR was for schizophrenia patients for all causes of death 2.33 for men and 2.35 for women, cardiovascular death 2.08 for men and 2.15 for women, coronary heart disease 1.91 for men and 2.06 for women, and for myocardial infarction 1.75 for men and 1.86 for women. Age-standardized mortality ratios for schizophrenia patients increased significantly (p<0.001) for both men and women for all causes of death, cardiovascular disease, coronary heart disease and acute myocardial infarction. Among schizophrenia patients, there were 3,410 excess deaths from cardiovascular causes.

The substantial improvements in recent years in mortality from cardiovascular disorders in the general population were not observed among patients with schizophrenia. For the medical care system and for psychiatry the increasing differences in mortality from cardiovascular disease between the general population and patients with schizophrenia are a major clinical and public health concern.