Addictive disorders are frequent in schizophrenia and dual diagnose is the norm rather than the exception. Dopamine transmission is implicated both in addictive disorders as in psychotic diseases. The objective is to know if addiction is one independent dimension in schizophrenia or if it can be included in to the positive, negative or affective syndromes.

We conduct one cross-sectional study on 60 schizophrenia out-patients (43 male; average age: 38.9 years, SD 9.4). The diagnosis were: paranoid schizophrenia 26.7%, schizoaffective disorder 25.0%, residual schizophrenia 21.7%, other schizophrenia subtypes 26.6%. It was applied the PANSS and one addiction composite score (ACS) that reflects the life use of drugs and addiction: tobacco, coffee, alcohol, cannabis, cocaine, amphetamines, hallucinogens, opiates and gambling. For every substance and gambling were scored: first use, frequency, length of use, last time use and harmful consequences. All the scores were transformed in to Z values. Factor analysis using principal components (Varimax rotation) was performed introducing in the model: PANSS positive and negative items, depression item an the ACS.

Five factors were defined, that explains for 78.4 of the variance: negative (N1, N2, N3, N4, N6), disorganized (P2, P4, N5, N7), positive and depressive (P1, P3, G6), hostility (P5, P6, P7) and addictive (ACS).

Addiction is one independent dimension in schizophrenia, differentiated from positive, negative, disorganized and hostility syndromes. We propose the systematic study of addiction as one intrinsic dimension of schizophrenia due to its independence of other dimensions, its high prevalence and its clinical relevance.

The dysexecutive syndrome is present in half of the schizophrenia patients and is highly dependent on the dopamine functioning. We hypothesize that early and mild dysexecutive syndrome in schizophrenia is mainly subjective. The objective is to study the subjective manifestation of the dysexecutive syndrome and its relationship with other symptoms of schizophrenia.

One cross-sectional study was conducted on 60 schizophrenia out-patients (43 male; average age: 38.9 years, SD 9.4). The diagnosis were: paranoid schizophrenia 26.7%, schizoaffective disorder 25.0%, residual schizophrenia 21.7%, other schizophrenia subtypes 26.6%. The dysexecutive syndrome was assessed by DEX Scale (self-applied and applied by one external observer). Using PANSS and one addiction composite score (ACS) it was defined five symptom dimensions: negative (N1, N2, N3, N4, N6), disorganized (P2, P4, N5, N7), positive and depressive (P1, P3, G6), hostility (P5, P6, P7) and addictive (ACS). Basic symptoms were studied with FCQ-III. All the scores were transformed in to Z values. Correlations between DEX and the clinical dimensions were studied using Spearman's Rho coefficient.

Dysexecutive syndrome is associated with basic symptoms (self-applied: r = 0.83, p< 0.001; external observer: r = 0.54, p < 0.001), disorganization (external observer: r = 0.46, p = 0.001), positive and depressive symptoms (self-applied: r = 0.54, p< 0.001; external observer: r = 0.44, p = 0.001) and addiction (self-applied: r = 0.35, p< 0.01).

Basic, hallucinatory, delusional and depressive symptoms in schizophrenia, as well as the disorganized dimension, could reflect the subjective experience of one dysexecutive dysfunction.

Cognitive deficits, in particular that of memory and executive functions, have been linked to functional disability. The treatment with antipsychotic drugs leads to subjective changes in cognitive functioning as well as subjective experience of schizophrenic patients, which both contribute to compliance and treatment outcome. Aim of this study was to evaluate the role of clinical, neurocognitive and pharmacological variables on the subjective perception of cognitive functioning in schizophrenic patients.

The sample was composed of 78 schizophrenic inpatients (M/F=38/35, mean age 41 + 11.6 years) recruited in the Rehabilitative Centres of two Departments of Mental Health in Italy and treated with typical (n= 15) or atypical antipsychotics (n= 63). Patients were diagnosed according to the DSM-IV TR criteria and evaluated with the Frankfurter Beschwerde Fragebogen (FBF) Scale, the SAPS and SANS (Scales fot the Assessment of Positive and of Negative Symptoms). Neuropsychological functioning was assessed by means of the Wechsler Adult Intelligence Scale (WAIS- R).

The results showed that the severity of symptoms was correlated positively with a greater impairment on self perception of mental functioning. Neuropsychological functioning also correlated with self perception of cognitive deficits, with an abnormal subjective experience associated with more neuropsychological disturbances. Atypical antipsychotics were associated with a better insight of cognitive dysfunction.

The results of the study underline the importance to investigate the subjective experience of schizophrenic patients treated with antipsychotic drugs in order to improve treatment adherence and efficacy in schizophrenia.

Symptomatic remission is increasingly perceived as a realistic objective of pharmacological treatment in patients with schizophrenia (2). However the relationships between symptomatic remission, as defined by standardized criteria, and functional outcome remain controversial. In the present study, we designed a one-year follow-up of clinically stable patients with schizophrenia and examined the relationships of clinical remission with several indices of psychosocial functioning.

Thirty-six patients with schizophrenia were included. All the evaluations were carried out both at baseline (T0) and after a one-year follow-up (T12). The categorization in psychosocial remission/non-remission was done by means of the Psychosocial Remission in Schizophrenia (PSRS) scale.

Both at T0 and at T12, R showed, with respect to NR, a better social functioning and a better quality of life. Correlation analysis revealed that the better the psychosocial functioning, the lower the scores on all psychopathological dimensions, except “anxiety/depression” and “hostility” at T0 as well as “anxiety/depression” at T12. At T0, 65% of R resulted also in psychosocial remission; at T12, this percentage reached 90%.

Our findings suggest that symptomatic remission in schizophrenia is associated to functional outcome in the majority of cases, especially when both symptomatic and chronological criteria are met.

To investigate the executive function and learning ability of the patients with first-episode schizophrenia, and its relationship with the patients’ clinical symptoms.

50 schizophrenia patients and 50 healthy controls were tested by the Tower of London (TOL). All the subjects received two phases of the test of TOL continuously, with a break of 1 minute. And Positive and Negative Symptom Scale (PANSS) was used to assess the clinical symptoms of the patients.

Compared with the control group, the number of reply during the 1st phase (x1) and the 2nd phase (x2)of the patients group, was lower (P<0.01); the reaction time during the 1st phase (t1) and the 2nd phase (t2) was longer (P<0.01); while the rate of correct answer during the 1st phase (p1) and the 2nd phase (p2) do not differ. For the control group, x2 was higher than x1 (P<0.01), and t2 was shorter than t1 (P<0.01). However, for the schizophrenia group, there were no difference between x1 and x2, t1 and t2. The value of x1, p1, x2 of the patients were correlated negatively with the PANSS negative subscale score (P< 0.05), and t1 and t2 were correlated positively with the the negative subscale score (P< 0.01). The performance of the TOL did not correlated with the PANSS positive subscale score and general psychopathology subscale score.

The executive function and learning ability of the schizophrenics are impaired and the impairment of the cognitive function is significantly correlated with the negative symptoms of schizophrenia patients.

Persistent sedation is a side effect of antipsychotic drugs, with a substantial impact on quality of live and treatment adherence. Additionally sedation can contribute to weight gain and metabolic disturbances. It impairs also patient's driving skills. In present study we evaluated sedative effects of antipsychotic drugs using three methods that are accessible, and easy to use in psychiatric practice.

59 patients with schizophrenia (mean age 25.1 ± 3.6, 27 M, 22 F) were included to the study before the discharge from an open psychiatric ward. All patients underwent monotherapy with sedative (olanzapine; n=33, mean dose 15.4 ± 5.9), moderate -sedative (risperidone; n=12, mean dose 4.4 ± 1.8) and non-sedative (aripiprazole, sertindole; n=14, mean dose 18.7 ± 6.2, 15.5 ± 3.3) antipsychotics. The patients underwent EEG recordings, 28-minutes long psychomotor vigilance task (Mackworth Clock Test) and filled out Epworth Sleepiness Scale (ESS) and scales for assessment of sleep quality.

Increased slow-wave EEG activity was found in 21 (63.6%) of patients treated with olanzapine, 8 (66.7%) of patients treated with risperidone and 3 (21.4%) of patients treated with non-sedative antipsychotics (p< 0.05). Abnormal results of psychomotor task were found respectively in 10 (30.3%), 5 (41.7%) and 4 (28.6%) of patients (not significant). Mean ESS score was: 6.9 ± 3.3, 8.0 ± 3.0, 5.4 ± 3.7, respectively (not significant).

Signs of sedation were frequent in EEG recordings of patients treated with sedative antipsychotics, however at performance level in psychomotor task the differences between the investigated drugs were less pronounced.

To test the psychometric properties of the Quality Indicator for Rehabilitative Care (QuIRC), refine the toolkit and compare results with service user experiences.

Following the initial development of the toolkit, it was translated into the languages of the partner countries and piloted. It was then refined to maximize a) its inter-rater reliability, b) its usability and c) its ability to deliver assessments relevant to each country's established systems of change at local, regional and national level. Managers of participating units were re-interviewed using the refined tool. QuIRC scores were compared against service users’ quality of life, autonomy, experiences of care and markers of recovery to assess whether the QuIRc could provide a proxy-assessment of the unit's promotion of service users’ autonomy and Recovery.

The tool was piloted in 20 units in each country (a total of 200 units). Inter-rater reliability was assessed using intra-class correlations and Cohen's Kappa coefficients. Factors with low reliability or extreme response biases were dropped. Remaining items were subjected to an exploratory factor analysis to test domain allocation and improve internal consistency. QuIRC domain ratings were compared by country and facility type and with service user assessments. The QuIRC was found to have high reliability, to be easy to use and there was high correlation between domain ratings and service users’ ratings.

An increasing number of studies have described the relationship between celiac disease and schizophrenia. Based on the reported correlations and the overlapping linkage regions on 19p13, the myosin IXB gene (MYO9B) can be considered a highly relevant positional and functional candidate gene for schizophrenia. The present work was undertaken to investigate the association of the MYO9B gene with schizophrenia in a Chinese population.

A total of 329 patients with schizophrenia and 350 healthy control subjects in a Chinese population were recruited. A PCR-based RFLP protocol was applied to genotype 7 single nucleotide polymorphisms (SNPs), including rs7249490, rs7256689, rs2279007, rs8113494, rs2305767, rs1545620 and rs2305764, in the MYO9B gene to investigate their association with schizophrenia.

The X2 goodness-of-fit test showed that the genotypic distributions of all 7 SNPs were in Hardy-Weinberg equilibrium in both the patient group and the control group. Disease association was shown for rs8113494 (X2=12.77, P=0.0003, OR=1.89, 95% CI 1.33-2.68) and rs1545620 (X2=15.44, P=8.379e-5, OR=1.65, 95% CI 1.29-2.12), while rs2279007 was associated with schizophrenia in the female subjects (X2=4.637, P=0.031, OR=0.69, 95% CI 0.49-0.97) but not in the male subjects (X2=1.082, P=0.299, OR=0.85, 95% CI 0.63-1.15).

The present work shows that the polymorphisms of the MYO9B gene are likely to confer susceptibility to schizophrenia. Because the MYO9B gene has been found to be highly expressed in the tight junction gate, it could be considered as a meeting point for the interaction between environmental and genetic factors in the pathogenesis of schizophrenia.

Hyperglycemia and type 2 diabetes mellitus are more common in schizophrenia than in the general population. Presence of type 2 diabetes would limit the use of many atypical antipsychotics and also as a major risk factor for cardiovascular disease, therefore it is important that the role atypical antipsychotics play in this glucose dysregulation is ascertained.

To analyse current experimental literature on anti-psychotic dysregulation of glucose metabolism; reviewing clinical evidence already available.

PubMed - searched with MeSH term “anti-psychotics”, with additional terms; “schizophrenia”, “diabetes”, “glucose”, “treatment”

The central effects of atypical anti-psychotics that may induce a metabolic dysregulation are mediated by neurotransmitter receptor antagonism, particularly the histamine-1 and serotonin-2C receptors. In the periphery, many of the mechanisms postulated are dependent on weight gain and serum fatty acid level. Resistance to anorexigenic endocrine factors and elevated levels of the orexigenic agents adiponectin and ghrelin, may also be induced by certain anti-psychotics. Anti-psychotics could play a role in accelerating an existing insulin resistance as current literature suggests an existing CSF glucose metabolism dysregulation in anti-psychotic drug naïve patients. Deficits have also been implicated in schizophrenia pathogenesis, raising the possibility of co-morbidity.

The clinical implications of this phenomenon are significant and until anti-psychotics are developed, that minimises this metabolic disturbance, precautions should be taken. Dietary counselling, and administration of anti-diabetic drugs such as Metformin may aid the reduction in insulin resistance while switching to more appriopriate anti-psychotics has been shown to be beneficial.

Delivery of information about his/her disease and its treatment to a schizophrenic patient is essential but no consensus exists concerning to what extent and how to deliver the information.

To study the therapeutic impact of internet mediated knowledge an internet site was built particularly for the use of schizophrenic patients and contained information about pharmacotherapy, symptoms management and patients’ rights.

The patients enrolled in the study were randomly divided into 4 groups. Each of the three study groups was given a task to study different topic (pharmacological treatment, symptoms management or patients’ rights) by means of the internet site. The forth group was a control one. Based on analysis of the questionnaires filled out by the patients before and two weeks after the information delivery we have analyzed whether the site is user friendly, emotional responses of the patients, extent of information catching, satisfaction change and contribution to pharmacotherapy.

Patients diagnosed as suffering from schizophrenia and being hospitalized more than once.

28 patients were enrolled, among them 25 being hospitalized. In the study groups, satisfaction from the therapy has improved after browsing the site. Compliance to pharmacotherapy has improved in the groups that had learned about pharmacotherapy and symptoms management. Compliance did not improve in the group instructed on the patients’ rights and in the control group.

Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.

The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.

31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.

Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.

Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement

The aim of our study was to investigate the impact of aerobic endurance training on cognitive performance, psychopathology and subjective well-being in paranoid schizophrenic inpatients.

37 inpatients who met the ICD-10 criteria for paranoid schizophrenia were randomly assigned to either a controlled endurance training (n = 20) or an occupational therapy program (n = 17). Before randomisation and prior to discharge psychopathological symptoms, subjective well-being and cognitive performance were assessed with a comprehensive neuropsychological test battery and psychometric measures. Patients in the aerobic endurance group received about four times per week a 30 minute training session. In the control group schizophrenic patients participated for an equivalent amount of time in an occupational therapy program.

All patients significantly improved in psychopathologic symptoms and subjective well-being. Additionally significant time effects in cognitive functions, except for attention, could be found in both patient groups. However, significant group by time effects could only be demonstrated for working memory, short term memory and verbal learning with an advantage for the sport group.

Concerning verbal memory functions patients could profit by aerobic endurance training in a clinical setting. As cognitive impairments, especially memory deficits are a core feature of schizophrenic illness aerobic endurance training should be an integral part of treatment programs for schizophrenic inpatients.

The goal of the study was to find the potential causes of psychotic episode recurrence and its first symptoms in rehospitalized patients with schizophrenia.

Patients with schizophrenia, who were urgently hospitalized to KUM Psychiatry clinic and had less than three psychotic episodes, took part in the study (N=97). Medical documentation and a structured questionnaire, designed by the authors, were used to evaluate anamnesis data.

The main causes of relapse were: willful discontinuation of psychopharmacotherapy (50% of the cases), spontaneous relapses without any clear exogenous cause (20%), and onetime alcohol intoxication (8%). The patients and their family members indicated the following first symptoms of relapse: anxiety, fear (73%), sleep disorders (62%), aggression (52%), delusions and/ or hallucinations (37%). The symptoms tended to occur in combinations rather than individually.

Causes and symptoms of schizophrenia relapse differ from patient to patient. It is possible to prevent the relapse knowing the common causes and first symptoms, because most of the patients are able to detect the first symptoms themselves.

The goal of the study to explore nursing demands in patients with schizophrenia disorders with long term maintenance treatment at home.

Research was carried out in four Kaunas primary mental health centers. We used standardized International Mental Health Quality Of Life Scale (QOL-36) questionnaire implemented by Phillip W. Long (2003). Our group was randomly selected and consisted of 123 patients with schizophrenia aging from 18 to 65 years.

Several main problems were disclosed: 46% reduced everyday home activities, 68 % mentioned physical fatigue, apathy- 60%, sleep disorders- 81%, memory and attention disorders- 64%, communication problems- 76%. 25% of respondents had suicidal attempt. There were more suicidal attempts in younger patients than others (p < 0,05). We disclosed statistically confident correlation between disease duration and suicidal attempts (p < 0,05). For the senior patients the most often were communication problems (50%), sleep disorders (55%), memory and attention disorders (53%).

The most frequent nursing demands mentioned by patients are caused by memory and attention disorders, as well as sleep disorders. Those problems most frequently occur among older respondents.

A sample of 67 patients receiving care in community mental health services (day hospital) has been evaluated using the SF-36 scale. The results were compared with the population national values of reference to the same scale.

We found statistically significant differences between groups for the following items: General Health (t =-2,81; p=0,004), Vitality (t =-3,37; P=0,000; Social Functioning t =-4.11; p = 0,000); Emotional Role (t =-2,269; p=0,023) and Mental Health (T =-2,67; p = 0,007).

The studied patients have a worse perception it brings over of his general health that the rest of the Spanish population; likewise they perceive a major detriment as for his social functioning that is a rest of the Spanish population. This way, the physical health of the patients with schizophrenia needs a control and a specific follow-up to guarantee that his life expectancy, his quality of life and his social functioning are similar to those of the general population.