Various studies have demonstrated that psychotic patients have poor performance on the Wisconsin Card Sorting Test (WCST), which serves as an indicator of the dorsolateral prefrontal cortex executive functioning. The aim of our study was to compare cognitive performance of patients suffering from chronic psychosis with the first episode patients.

Our sample consisted of chronic schizophrenic and schizoaffective patients in worsening phase, the first episode patients and corresponding healthy controls. All patients were tested by WCST in the second week after the hospitalization, were treated with SGA, and had PANSS score above 60.

The performance of the psychotic patients was equal to the performance of healthy controls in all variables of the WCST, except the average non-perseverative responses (NPR) (p=0.01). NPR score indicates a state rather than shift in a cognitive set, so we performed the analysis of the given working memory test per diagnosis of the patients. The results showed lack of significant difference in the WCST performance between schizophrenic, schizoaffective and healthy subjects, whereas the first episode patients performed significantly worse then controls in the following variables: categories, perseverative errors and conceptualization level (p< 0.05).

Our findings showed difference in cognitive functioning between first episode patients and chronic psychotic patients. Better cognitive performance of chronic psychotic patients could be explained by potentially beneficial effects of the SGA pharmacotherapy to the cognitive status. However, this finding may be also limited by its association with age and relatively modest PANSS scores.

Schizophrenia associated with thermal dysregulation

has been demonstrated in several studies, as well as being noted in the

observations of clinicians for many years. However, while there is an

abundance of research, many of the results have proven to be contradictory,

in particular regarding the confounding effect of antipsychotic medication.

To this end we will review the evidence concerning abnormal

thermoregulation. Understanding the thermal dysregulation may give us an

insight into the pathogenesis of schizophrenia, and a potential role for

orexins in the disease.

To analyse current experimental literature on thermoregulation

in schizophrenia in medicated and unmedicated patients.

PubMed - searched with MeSH term “schizophrenia”, with additional terms;

“thermoregulation”, “orexin” or “hypocretin”.

While there may be disagreements in various studies, the weight of

the early evidence points to untreated schizophrenic patients having lower

baseline core temperatures, while later studies with neuroleptics showed an

increase. Several studies also showed an impaired heat loss in

schizophrenic patients, both in medicated and unmedicated patients.

Meanwhile, orexins have been linked to heat production and heat loss during

sleep. There are also studies showing that orexins are activated by

antipsychotics, and also project to thalamic nuclei that show reduced

volume and connectivity in schizophrenia.

The thermal dysregulation seen in schizophrenia is a complex

process, and the underlying pathogenesis remains to be uncovered. This

mechanism may involve orexins, which may also play a part in both the

pathogenesis of schizophrenia and the relief of symptoms by antipsychotics.

An impairment of several cognitive domains has been largely documented in patients with schizophrenia. The present study aimed to investigate the relationships between cognitive functioning, symptomatic remission and functional outcome in schizophrenia.

The performance on the neuropsychological battery “Brief Assessment of Cognition in Schizophrenia (BACS)” has been investigated in clinically remitted (R) and non-remitted (NR) schizophrenic patients. The associations of neuropsychological performance with psychopathological dimensions derived from PANSS and indices of social functioning (as assessed by the Global Assessment of Functioning scale, the Personal and Social Performance scale, the Quality of Life Scale, the UCSD Performance-Based Skills Assessment-Brief Version and the Psychosocial Remission in Schizophrenia scale) were also explored by means of multiple regression (MR) analyses.

Compared with NR, R patients showed a better performance on tests exploring executive functions, processing speed and verbal fluency. Residual negative symptoms and processing speed were independent predictors of functional outcome, while remission status did not enter the MR function.

Our findings suggest that cognitive abilities, in particular processing speed and executive functions, are preserved in patients who are able to reach clinical remission. Independently from the remission state or residual negative symptomatology, processing speed also predicts functional outcome in schizophrenia. Our findings support the view that cognitive dysfunctions in schizophrenia should be targeted by specific treatment intervention, such as neurocognitive rehabilitation.

Simple schizophrenia (SS) is an uncommon disorder that may go unrecognized. SS occupies an ambiguous position in the current international classification systems, due to its theoretical poor reliability and doubtful validity. Only International Classification of Diseases recognizes SS as a distinct subtype of schizophrenia.

The authors aim to illustrate the practical relevance of this diagnosis, through the presentation of two clinical pictures consistent with SS.

Case 1: 21-year-old woman, attending our outpatient unit since 2007 because of behavioral changes: she used to interact with three stuffed dolls for hours, considering them as the members of a famous rock band. Gradually, these symptoms lost preponderance and became evident a marked decline in her academic functioning, social withdrawal with difficulty in interpersonal contact, affective flattening and significant lack of concern for about her previous interests.

Case 2: 21 year-old man, attending irregularly our outpatient unit since 2006 due to behavioral changes. The patient has showed a progressive clinical picture consisting of puerility, evasive, poor, and sometimes disorganized speech, abulia, apathy, and social withdrawal. Nowadays he has no social relationships and no productive tasks. Despite some ideas of reference, he never presented overt psychotic or affective symptoms.

SS may be a laboring diagnosis due to its insidious nature and preponderance of vague, negative symptoms. These cases illustrate that SS is a suitable diagnosis for some clinical presentations, and the need of improved recognition of this entity. Recent studies suggest SS reintroduction as a valid and reliable subtype of schizophrenia.

Schizophrenic patients are prone to osteopenia and osteoporosis due to various reasons. No research has ever been conducted on this field in Iran.

The aim of this study was to determine the bone mineral density in schizophrenic patients.

In a cross- sectional and descriptive study with random sampling, we used (DEXA) to determine Bone Mineral Density (BMD) in the lumbar and neck femur region of 85 in- schizophrenics and they were compared with general population. Statistical analysis was done finally.

Sixty eight of patients were males. The average age of males and females was 39.61± 6.77 and 36.29± 7.58 years respectively. The mean femur neck BMD of male and female patients were 0.88± 0.16 and 0.87± 0.15 respectively (Pv = 0.76). Mean lumbar BMD of male and female patients was 0.94± 0.18 and 0.96± 0.14 respectively (Pv = 0.761). Liner significant correlation was not found between age and femur neck BMD (P= 0.782). Liner significant correlation was found between femur neck BMD and lumbar BMD (P< 0.001). Frequency of osteopenia in patient with the age of 30-50 years was significantly higher than other patients (P= 0.011). Frequency of femur neck osteopenia and osteoporosis were 50.6% and 4.7% respectively and frequency of lumbar osteopenia and osteoporosis were 40% and 14.1% respectively.

Schizophrenic patients had lower bone mineral density than general population.

Group psychotherapy along with psychopharmacological therapy and sociotherapy is an important and frequently applied therapeutic method. Numerous studies indicate that group psychotherapy affects the functioning in patients with psychotic disorders in terms of improving the cognitive, emotional and social functioning and generally contributes to a better quality of life (Kanas, 1996).

The aim of this study was to assess the impact of psychodynamic oriented group psychotherapy on the quality of life in patients with psychotic disorders and to compare the obtained results with the results of patients with psychotic disorders who did not participate in psychodynamic group psychotherapy.

Patients included in this study have completed psychotherapy group five years ago and were in regular outpatient treatment together with regular application of medication therapy. The applied method was Quality of Life Scale (Krizmanić, Kolesarić). Answers were analyzed qualitatively and quantitatively.

The quality of life in the group of patients who completed long-term psychodynamic group psychotherapy was better than in the group of patients who were not treated in that manner, although there are no statistically significant differences. The most important differences were in the area of intimacy, professional occupation and in the area of family relations.

It can be concluded that long-term psychodynamic group psychotherapy has a positive influence on quality of life of patients with psychotic disorders.

Brief Psychotic Disorder (BPD) is a disease characterized by sudden onset of psychotic symptoms. This disturbance lasts at least 1 day but less than 1 month, and the subject fully recovered premorbid level. In the literature there are few data on its prevalence, established between 4-10% of all psychotic disorders. Although a female preponderance has been postuled, gender differences have not been well studied. Therefore, the aim of the present study is to examined sex differences in brief psychotic disorder.

We conducted a retrospective study to estimate the gender differences in an inpatient psychiatric sample. This sample (n=39) included acute patients admitted in a psychiatry ward with diagnosis of brief psychotic disorder. The clinical and socio-demographic characteristics were analysed for males and females separately.

Of a total of 39 patients with BPD, 74.4% were women (n = 29) and 25.6% male (n = 10). Mean age at diagnosis was 33 +/- 8.65 years. Of the clinical variables studied, none was significantly different between male and female. Men had a higher consumption of alcohol (p< 0’05); there were no differences in axis II. Males had more psychiatric family history (70% vs 48.3%), although not statistically significant. Women had more frequent family history of mood disorders and men of psychotic disorders (p < 0.05).

We found higher prevalence of BPD in women. Males had more family history (mostly psychotic) and more toxic dependence. Further studies are needed with larger samples to determine the existence of sex differences.

The extra pyramidal effects related to the use of neuroleptics are a limiting factor in schizophrenia treatment.

The aim of this study was to identify the neuroleptics prescribed for schizophrenic patients in a public health service, the extra pyramidal symptoms (EPS) incidence and its treatment.

Our restrospective study included 40 patients with mean age of 39.13 ± 2.19 in a treatment period of of 134.17 ± 16.83 days. The data were randomly collected from medical records of these patients.

The patients under study received typical neuroleptics (31.03%),atypical agents (37.93%) or association of both (31.03%). EPS was observed in 65.52% patients of which, 44.83% even though receiving biperiden 2mg, still have EPS. 20.69% were not receiving anticolinergic drug treatment for EPS, but promethazine or anticonvulsants. From the 34.48% who did not showed EPS, 20.69% had biperiden prescription and 13.79 % had been treated with olanzapine, clozapine or risperidone associated or not to clonazepam 2mg. Weigth gain of 5.20 ± 1.14 kg was observed in our total sample.

We suggest the use of EPS evaluation scale (Sympson - Angus or Barnes). 65.52 % of the patients under study had EPS and 20.69% of them had no prescription of central acting anticholinergic drug. 44.83% even though receiving biperiden 2mg, still have EPS.

The purpose of this paper is to highlight the position of mental health patients in terms of treatment choice, advanced directives and evidence to support complementary and alternative medicines (CAM).

Here, a patient with a long-standing diagnosis of schizophrenia outlines her experience of treatment with antipsychotic medication and contrasts this with the success she has had with the use of acupuncture for her symptoms. The evidence behind CAM for mental health problems, including schizophrenia is explored, as is the reliance on antipsychotic medication for people who are acutely mentally ill, over and above any prior requests individuals may make for CAM to be included in their treatment programme.

Following several unsatisfactory treatment episodes with antipsychotic and antidepressant medication, Madlin introduced acupuncture as an adjunct treatment. This enabled her to live independently in the community for over 8 years. Although she continues to be susceptible to psychosis, her experience of acupuncture is that it makes a significant improvement to her quality of life. Madlin feels that access to acupuncture for inpatients might further improve recovery rates and relationships with mental health workers.

Mental Health patients are increasingly asking for access to CAM and the evidence is improving. This might be a good time to for psychiatrists to consider CAM treatment possibilities where patients request them or where there is evidence to support their use.

The aim of the study was an analysis of prolactin concentration in the course of antipsychotic treatment in Polish patients participating in EUFEST study.

Seventy-eight patients with the first episode of schizophrenia were studied, randomly allocated to the treatment with low dose haloperidol (n=23), amisulpride (n=21), olanzapine (n=22), quetiapine (n=11) or ziprasidone (n=1), for the period of 12 months. Prolactin concentration was assessed at baseline and after 6 and 12 months of treatment. Hyperprolactinemia was defined as prolactin concentration >18 ng/ml in males and >25 ng/ml in females.

At baseline, the mean prolactin concentration was 56,5 ng/ml and hyperprolactinemia was observed in 86% of patients, slightly more than in the whole EUFEST group (71%). Prolactin concentration was similar in drug-naïve as in non-drug-naïve patients. After 6 month of treatment, hyperprolactinemia was found in 67% of patients, lowest in haloperidol (29%) and highest in amisulpride group (93%). After 12 months, hyperprolactinemia was observed in 56% of patients, lowest in quetiapine (36%) and highest in amisulpride group (80%).

Hyperprolactinemia was found in a majority of patients with the first episode of schizophrenia, including drug-naïve patients. In the course of one-year antipsychotic treatment, in patients receiving amisulpride, the hyperprolactinemia has been maintained at the initial high level while in remaining groups, a reduction by about 50% of the number of patients having hypeprolactinemia at baseline was observed. We suggest that an abnormality of stress system, could contribute to hyperprolactinemia independent of antipsychotic treatment in the first episode schizophrenic patients.

An increasing number of studies focus on general deficits in identifying, differentiating and recalling of facial emotions in schizophrenia. According to preliminary results antipsychotics alone show only little effect on social cognition. We investigated the effects of new antipsychotics when combined with a computer-based training on affect recognition.

Schizophrenic patients (n=20) receiving treatment with new antipsychotics in combination with a six-week Training on Affect Recognition (TAR) were compared with a randomized group of patients (n=18) receiving Treatment As Usual (TAU). Effects on social cognition were tested with the Vienna Emotion Recognition Tasks (VERT-K). In addition, we investigated neurocognitive performance using the Wisconsin Card Sorting Test (WCST), Testbattery for Attentional Performance (TAP): “Alertness”, “Vigilance” and “Working memory”. Negative symptoms and quality of life were assessed using the Positive and Negative Syndrome Scale (PANSS) and the short version of the WHO-Quality of Life Questionnaire (WHOQOL-Bref).

In comparison to the control group the TAR group showed significant improvements in regard to affect recognition in general as well as in recognizing sad and happy faces. In addition, we found significant improvements for the TAR group regarding executive functions, quality of life and negative symptoms.

Treatment with new antipsychotics alone has only a limited impact on social cognition. A specific combined treatment of new antipsychotics and TAR leads to improved cognition and emotional performance with additional positive effects on functional outcome.

Atypical antipsychotics have been reported to induce severe metabolic side effects such as metabolic syndrome. However, ziprasidone has a safer metabolic profile and metabolic neutral for schizophrenic patient. In this prospective 24-week study, we investigate the improvements in lipids observed in patients switched from other antipsychotics.

150 patients with schizophrenia treated with antipsychotic who were having metabolic risk were switched to ziprasidone. They were analyzed to quantify clinically significant changes in metabolic parameters. At baseline assessment, fasting lipid profile was taken for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. The same assessment was repeated at 4-weeks, 12-week and 24-week. Paired t-test and last observation carried forward (LOCF) were used for the statistical analysis. Preliminary results for those who completed 12 weeks follow up were presented.

13 schizophrenic patients with 7 (53.8%) male and 6 (46.2%) female have completed the 12 weeks follow up. 6 (46.25%) patients were previously treated with olanzapine, 3 (23.1%) were on risperidal, 2(15.4%) were on paliperidone, 1(7.7%) was on haloperidol and 1(7.7%) was on trifluoperazine. There was statistically significant reduction in mean total cholesterol (5.40 ± 0.73 mmol) to (4.99 ± 0.71 mmol) p=0.007, mean LDL cholesterol (3.51 ± 0.65 mmol) to (3.21 ± 0.65 mmol) p=0.047. There was no statistically significant in mean difference for HDL cholesterol and triglycerides.

In short-term, switching to ziprasidone treatment resulted in clinically significant improvements in cholesterol and LDL cholesterol in at-risk patients.

Risk of psychosis is defined by the presence of positive psychotic-like symptoms. In clinical examination, easily detectable perceived negative attitude of other people may also indicate risk of psychosis.

A random sample of psychiatric outpatients completed the PROD screen including questions on interpersonal relationships, functioning and subtle specific (psychotic-like) symptoms. Vulnerability to psychosis (VTP) was assessed employing specific symptoms of the PROD screen. Current risk of psychosis (CROP) was assessed using the BSABS and the SIPS/SOPS. The CROP patients were followed up for 18 months and transition to psychosis was detected. The association between perceived negative attitude of others and reported psychotic symptoms was tested in a random sample drawn from the general population.

In all, 790 outpatients were screened. Of them, 219 VTP and 55 CROP patients were identified. By follow-up, six CROP patients (11 %) had made the transition to psychosis. Vulnerability to psychosis associated with all items of interpersonal relationships and functioning. However, current risk and transition to psychosis associated only with subjectively reported negative attitude of others. In a general population sample, negative attitude of others strongly associated with reported life-time psychotic symptoms conforming thus results obtained from a patient sample.

The subjective experience of negative attitude of other people towards oneself associates with experience of psychotic symptoms and may predict more sever psychotic development. The association between perceived negative attitude and occurrence of subtle psychotic symptoms seems to be detectable both in general and patient populations.

1. 1. No differences were found in the allelic distribution in the investigated genes polymorphisms between the whole schizophrenics and the control group.

2. 2. Associations between DAT: A9 allele, DRD2: del 141C allele, DRD2: Taq1A A1 allele, COMT: Met/Met genotype, MAOA: 4VNTR allel (males only) and GRIK3: SER allel with non responding patients were found.

The goal of this study is to test the efficacy of the Memory Module of the REHACOP (Cognitive Training Program for Psychosis, Ojeda, Peña, 2006), in the improvement of cognition in patients with chronic schizophrenia (CS). Chronic patients present a moderate to severe cognitive performance on verbal memory and the severity of the illness and variables associated to the course of the diagnosis prevent them from improving cognition with traditional treatments.

57 patients with CS (illness duration, 10.17±7.22) were allocated randomly into either REHACOP (N=27) or control group (N=30). The REHACOP group received memory training with structured sessions 3 times per week for 8 weeks. Control group attended occupational therapy with the same frequency and timetables. Verbal Learning and Memory (Hopkins Verbal Learning Test; HVLT) and Working Memory (Digits Backwards from WAIS-III) were assessed at baseline and after the intervention.

Repeated measures of MANOVA showed that the interaction term groupXtime was significant for all the memory measures, suggesting REHACOP group improved significantly when compared to controls. Specifically, the interaction term F value was significant for HVLT learning (F=6.78, p < 0.01), HVLT Long-term memory (F=7.02, p < 0.01) and working memory (Digits Backward (F=10.04, p < 0.01), and Sum (F=11.39, p < 0.01).

Patients with CS improved significantly in all memory impairments when compared to those receiving other treatment. This study supports the efficacy of the REHACOP in the intervention of memory impairments in patients with schizophrenia, in spite of the severity.

Verbal fluency deficits have been pointed out as a possible endophenotype in schizophrenia (Szöke et al., 2008). However, whether these deficits are specific or linked to semantic-verbal inability remains unclear. Additionally, this cognitive domain is already affected in early psychosis and do not improve despite early clinical interventions.

Authors tested the efficiency of a cognitive intervention specifically developed for improving fluency in psychosis.

Ninety patients with first-episode psychosis were randomly assigned to one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy. Patients at the REHACOP group received one month structured group rehabilitation sessions (3 per week) to improve fluency. Repeated assessments of semantic fluency and phonological fluency were conducted before and after the treatment.

Compared to occupational therapy, the experimental group produced significant additional improvements in phonological fluency (F = 6.87, p < 0.01), but not in semantic fluency (F = 0.61, n.s). The composite verbal fluency score was also significant (F = 4.65, p < 0.05). The improvement remained 3 months after the treatment end.

The cognitive treatment using REHACOP has proven to be effective in treating phonological fluency deficits in first-episode psychosis, whereas socialization or communication in group therapy by itself do not. The differential pattern showed by semantic fluency is consistent with the proposal of Szöke et al 2008, who suggest that semantic fluency is a putative endophenotype for schizophrenia with links to genetic basis compared to phonological fluency.

Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties.

Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference)

Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning (F = 9.88, p < 0.01) and processing speed (F = 5.92, p < 0.05) measures, suggesting that the REHACOP experimental group improved significantly when compared to the control group's performance on both domains.

Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.

To assess the psychometric properties of the Spanish version of the SWN scale, an instrument which evaluates the subjective experience of psychotic patients towards neuroleptic treatment.

A validation study (feasibility, reliability, and validity) was conducted in 20 psychiatric centers. Patients were evaluated with the PANSS, the CGI severity scale and the SWN-20. A re-test was conducted one week after baseline. The study included clinically stabilized outpatients diagnosed with schizophrenia (DSM-IV-TR criteria) who were on treatment as usual. The SWN used in this study consists of 20 questions answered on a 6-point Likert scale. The total score ranges from 20 to 120 points (higher scores indicating better well-being). The original version was back-translated and a focus group was conducted to improve the comprehension of the items.

97 patients were included. Seventy-two percent of them (70) were male. Mean age was 35 years (SD = 10.0). Mean SWN total score: 83.5 (SD = 14.0). Internal homogeneity: 0.86. Test-retest in clinically stable patients was 0.89. SWN correlated significantly with the PANSS, but not with the DAI-10. Patients with none-mild clinical affectation had higher SWN scores, indicating a better subjective well-being, and vice versa.

The subjective experience of psychotic patients towards treatment is a key factor in therapeutic adherence, quality of life, and clinical outcome. The Spanish version of the SWN scale showed good psychometric properties in a sample of schizophrenic stabilized outpatients. SWN scale constitutes a valuable addition to evaluate patients’ subjective well-being.