Despite advances in the last decade, people with schizophrenia remain disabled by negative symptoms and function poorly in community settings. Until recently negative symptoms were neglected as a treatment target despite apparent recognition of their importance among clinicians.

To examine the impact of negative symptoms on psychosocial functioning in order to assess the importance of such symptoms as a potential treatment target.

295 community based participants with DSM4R schizophrenia were recruited in 11 different European centres and assessed using the following scales: PANSS, GAF, Personal and Social Performance (PSP), Quality of Life Scale (QLS), Functional Recovery Scale in Schizophrenia (FRSS) and PsychoSocial Remission in Schizophrenia (PSRS). Relationships between and negative symptoms and functionality were examined using standard statistical approaches.

In this European cohort negative symptom scores were highly correlated with poor psychosocial functioning in participants living in the community. This significant trend occurred across different scales for measuring functional assessment.

The pharmacological treatment of schizophrenia appears rather becalmed at present. First and second generation antipsychotics appear to have similar efficacy for positive symptoms, different side effect profiles, but little impact on negative symptoms. This study shows a close relationship between negative symptoms and psychosocial functioning: high negative symptom scores are associated with poor functioning. This work supports the view that negative symptoms are a key target for drug development with significant potential benefit for the functioning of individuals. Drug development will increasingly focus on negative symptoms and develop effective adjunctive medication used with existing antipsychotics.

The purpose of this study is to evaluate the clinical and socio-professional functioning status after two years of evolution, on a sample of patients with first episode of psychosis, admitted in the Psychiatric Clinic in Timisoara in 2006.

The initial sample was formed of 41 patients, but at the follow-up point (2008) only 28 patients were still in evidence. Diagnosis was made after ICD 10, BPRS and GAF were used as evaluation tools.

On the initial evaluation 32 % had a diagnosis of persistent delusional disorder, 25 % of short and transitory psychosis, 18% schizophrenia and 25% other psychosis. After 2 years of evolution 46% had a diagnosis of persistent delusional disorder, 25% schizophrenia and only 7 % had acute and transitory psychosis. In 28% of the cases the diagnosis was changed, most of the cases being the ones initially diagnosed with acute and transitory psychosis. The most stabil diagnosis was the persistent delusional disorder. In the majority of the cases we observed a lower socio-professional and family functioning.

The results of this study sugests that the diagnosis of first episode of psychosis is partially predictive for the type of illnes, because a first episode of psychosis can evolve in different pathologies. The socio-professional and family functioning is lower in the majority of cases without a clear connection with the initial diagnosis.

In the last decade the simplification in clinical medicine and the unethiological, general approach is very frequent (the “medicine of consequences”, N. Ilankovic). Because the syndromological diagnoses and (relative) effective symptomatic therapy, in clinical psychiatry in most cases the targets recently are only the phenomenology of behavioral disorders and the hypothezid neurochemical consequences, without precise etiopathogenetic or/and psychodynamic approach.

Researchers have found that both medical and psychiatric comorbidity is common in patients with psychiatric disorders, particularly in children, adolescents and in old age. This nonethiological approach push the mental illnesses and the mental ill patients back in the darkness of unscientific era of middle century.

To schow how many psychotic disorders has real and detectable etiology.

Clinical and etiological analysis of 100 patients with psychotic disorders with data of all clinical laboratory and neuroimaging investigationes.

In most of patient (29%)t he cause of psychotic episode was the substance abuse, in 25% focal and systemic infection (inflammation), in 16% endocrin-metabolic disorders, in 11% brain damage, in 7% cerebrovascular disorders, and in 7% neurodevelopmental disorders.

The real etiological approach in clinical psychiatry open the door to most targeted etiological therapy of psychotic and other mental disorders.

Our goals were to evaluate if the presence of severe delusions negatively affects insight, regardless of diagnosis, and whether or not patients gain insight into their delusions when using a third person perspective.

92 delusional patients with psychotic and psychotic mood disorders were asked to speak about their delusions and were evaluated by means of the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (SAPS and SANS). They were then asked to state whether they thought what they said was believable for them and for the interviewer. After two weeks 79 patients were evaluated with the same scales and listened to a tape where their delusion was re-enacted. They were then asked to state if what they heard was believable for them and for the interviewer.

12 patients thought their delusions was unbelievable for the interviewer at first interview, and 17 patients did the same after the second interview; 4 patients stated what they heard from the tape after the second interview was unbelievable both for them and interviewer. Patients with better insight (patients who stated their delusion was not believable) had a lower SAPS score, a lower item delusion score and a significant improvement of item delusion score at second interview

Several patients gain partial insight when using a third person perspective. The severity of delusions negatively affects insight, regardless of the patient's diagnosis.

Recent studies showed that schizophrenic patients possess adequate attention resources to avoid Stroop colour interference but face difficulty when delays are imposed and multiple attention demands appear. The aim of our study was to use dynamic version of the Stroop interference test based on cognitive remediation techniques within a “training- interference task-test” procedure.

The observed subjects were chronic schizophrenic and schizoaffective patients in worsening phase and the first episode patients who were treated with SGA and having PANSS score above 60, as well as corresponding healthy controls. We trained subjects in Stroop colour interference task and immediately after the training applied different working memory task and subsequently tested the subjects (15 minutes (Stroop Colour task) and >24 hours (Stroop Word task)).

There was an improvement of the cognitive status of schizophrenic and schizoaffective patients similarly as in healthy controls in both the reaction time and response accuracy (p>0.05), whereas the first episode patients performed significantly worse than other two subgroups. This was revealed both in the training and subsequent Stroop Colour interference (Reaction Time: p=0.02, Error Code: p=0.04.

Our findings revealed that chronic schizophrenic patients show same level of achievement as healthy controls despite the demanding experimental design. Poorer results observed in the first episode patients could suggest the favorable effect of the SGA on cognitive functioning, or impose the role of their age. Carefully designed training of cognitive skills could be of high importance in preventing the cognitive deterioration of first episode psychotic patients.

Analysis of correlation between psychopathology and quality of life (QoL) of schizophrenic patients during 4-6 years after the first psychiatric hospitalisation.

Study population included 74 patients. They were assessed at fixed time-points: 1 month and 13 months after the hospitalisation and 4-6 years after the first examination (T1, T2 and T3, respectively). The following instruments were used to assess symptoms, objective and subjective QoL: PANSS (5-factors), Social Functioning Scale (SFS) and WHOQOL.

At T1, the mean PANSS score was 62.4. Significant deterioration was noticed in all groups of symptoms, with the exception of cognitive functions. The greatest deterioration was observed in the negative symptoms and depression/anxiety. At T1, the mean SFS score was 103.4, while mean overall subjective QoL scored 3.3. During the follow-up period, significant improvement of SFS was noticed, with no meaningful change in WHOQOL and concomitant exacerbation of symptoms. QOL was particularly compromised by negative symptoms and depression/anxiety.

Correlation between SFS and negative symptoms varied from -0.61 to -0.76, while those between SFS score and depression/anxiety - from -0.40 to -0.66. Correlation between subjective QoL and negative symptoms as well as depression/anxiety ranged from -0.31 (environment) to -0.64 (physical domain). To a large extent, symptoms were responsible for variance in both SFS and WHOQOL scores.

1. 1) Clinical course of schizophrenia varied, depending on adopted criteria of evaluation.

2. 2) Negative symptoms and depression/anxiety had a particularly deleterious influence on QoL. The role these symptoms varied, depending on time elapsed since the first hospitalisation.

Schizophrenia is a disorder related with decline in cognitive functioning. Deficit of working memory and executive functions in schizophrenia is consistently reported. On the other hand, studies of decision making in schizophrenia bring contradictory results.

The aim of the study was to assess decision making and executive functions in clinically stable schizophrenic patients.

The study included 25 clinically stable schizophrenic patients (7 female, 18 male), aged 31±6 years and 25 age, sex and education years matched healthy controls. Decision making was assessed with Iowa Gambling Task (IGT). Working memory and executive functions were assessed with Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT). Psychometric asessment was provided with Positive and Negative Symptoms Scale (PANSS)

No significant differences in performance on IGT between schizophrenic patients and healthy subjects were found. Schizophrenic patients made more perseverative (t=-4,05; 0,00) and nonperseverative errors (t=-4,35, p=0,002), gave less conceptual level responses (t=-5,35; p=0,00), completed less categories (t=-4,73, p=0,00) and used more cards to complete first category (t=-3,98, p=0,00) in WCST. They also needed more time to complete part A (t=-5,62; p=0,00) and B (t=-4,06; p=0,00) of TMT test.

No significant differences in performance on IGT between schizophrenic patients and healthy subjects were found. On the other hand, schizophrenic patients performed significantly worse on all measures of WCST as well as in TMT test.

Dynamic transformation of paraphilia (connection of new paraphilia‘s forms to already existing) has been connected with the psychotic symptoms and increase of negative symptoms of schizophrenia (r=0.51, p=0.03). Abnormal sexual imaginations appear during manifestation of schizophrenia in puberty age. A syndrome of a metaphysical intoxication, delusional depersonalization coexisted with available sexual perversion. In sexually mature age of patients with schizophrenia, dynamic transformation of paraphilia was associated with increase of negative symptoms. Anabatic of schizophrenia correspond with a degree of aggression sexual perversion. At episodic type of current paranoid schizophrenia with persistent but non-progressive negative symptoms in the intervals between psychotic episodes connected such types of paraphilias, as pedophilia, exhibitionism, visionism. At episodic type of current paranoid schizophrenia with a progressive development of negative symptoms in the intervals between psychotic episodes connected such types of paraphilias, as necrophilia, gomicidomania. In our research pseudopsychopathic schizophrenia combined with multiple disorders of sexual preference (exhibitionism and visionosm) only in two cases. In these cases we are showed connecting pedophilia.

Preliminary results showed relationship between dynamic transformation of paraphilia and clinic and dynamic of schizophrenia.

Clozapine has several major side-effects for example agranulocytosis. There are however several severe cardiac side-effects associated with the use of clozapine.

We present two psychotic patients, who were treated with clozapine. One patient developed myocarditis and the other patient developed cardiomyopathy. These findings raised questions about the frequency of cardiac side-effects due to clozapine treatment.

Awareness of cardiotoxic side-effects of clozapine; Creation of a clinical guideline for myocarditis and cardiomyopathy in clozapine treatment

Two case reports, one male 57 years, suffering from paranoid schizophrenia developing myocarditis, the other a female of 62 years also suffering from paranoid schizophrenia, developing cardiomyopathy during clozapine treatment are presented.

Secondly, an extensive literature search with keywords: Myocarditis; cardiomyopathy, heartfaillure and clozapine has been performed.

The incidence of myocarditis and cardiomyopathy associated with clozapine use are possibly around 1 percent, 10-100 times higher than previously assumed.

Myocarditis and cardiomyopathy are cardiac side-effects of clozapine use which are severe and have a possible fatal outcome. Diagnosis of namely myocarditis can be difficult.

Research suggests that these side-effects might be less rare as thought of until recently. A clinical guideline for monitoring of these side-effects didn’t really exist to this moment. A proposition for a clinical guideline has been made in this presentation consisting of namely: anamnestic findings laboratory tests and ECG controls. Awareness for myocarditis is especially necessary during the first 4 weeks of clozapine treatment.

A considerable amount of data from Western culture suggests that negative family environment can increase the rate of relapse in patients with severe psychiatric disorders. The objective of this study was to explore the effect of family psycho-education intervention on family environment of relatives of patients with severe mental disorders in Iran.

Using an experimental design, with pretest, posttest and a control group, families of 30 patients with severe mental disorders were divided into two groups: six sessions of family psycho-education (intervention group); and no treatment (control group). Family environment was assessed using Family Environment Scale (FES).

Results showed that the family psycho-education program improved cohesion and expressiveness in family members (p< 0.01) but it had no significant influence on conflict (p>0.05).

Family intervention increased cohesion and expressiveness, but it had no significant effect on total family environment score or conflict. One explanation could be that our short- term program focused more on communication skills of family members rather than conflict resolution. Resolving conflict is complex in families of patients and need more time to change. The present study confirmed the need for family psycho-education and availability of resources to offer longer-term family psycho-education program to families of patients.

Low level inflammatory Mild Encephalitis (ME) mechanisms were suspected in a subgroup of treatment resistant hospitalised affective and schizophrenic spectrum disorder patients.

We analysed albumin, IgG, IgA, IgM, oligoclonal IgG and specific antibodies in paired cerebrospinal fluid (CSF) and serum samples from patients with affective (n=24) or schizophrenic spectrum disorders (n=39). Numerical and graphical interpretation of CSF protein data was performed by Reibergrams with reference to a large control group (n= 4100).

In 41% of the psychiatric patients (n=63) we observed CSF pathologies: 14% displayed intrathecal humoral immune responses, 10% slightly increased CSF cell counts (5-8/μL) and 29% had moderate blood-CSF barrier dysfunctions, in 24% as the only pathological sign with normal IgG, IgA and IgM concentrations in CSF (p= 0.9 testing the null hypothesis for intrathecal synthesis with reference to Qmean of the reference group). In the affective (n= 24) spectrum 20% displayed a systemic immune reaction as detected by oligoclonal IgG. In probable 6% of virusspecific, bacterial or autoimmune associated disorder with CNS involvement. Elevated CSF neopterin concentration in 34% of the patients was interpreted as an increased release from astrocytes or from other glia cells.

The low level immune response and barrier dysfunctions are discussed on the base of a ME pathomechanism in subgroups of psychiatric patients. CSF analysis is shown to be a useful diagnostic tool for differential diagnosis in psychiatric diseases.

Antipsychotic polypharmacy and high doses have been associated with poor outcome and increased adverse effects in schizophrenia. However, their relation to cognition has been poorly studied.

40 right-handed patients (mean age: 42.87 years; SD:10.57) with DSM-IV schizophrenia, were recruited in an acute psychiatric ward. They were assessed on the Spatial Working Memory test (SWM) of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wechsler Adult Intelligence Scale (WAIS-III) at a time when they were able to cooperate with neuropsychological testing. The pattern of their pharmacological treatment was also assessed. Statistical correlation and Mann-Whitney tests were performed using the SPSS, as appropriate.

18 patients were receiving antipsychotic polypharmacy (≥2 antipsychotics) and 22 monotherapy. 13 patients received an excessive (≥1000 chloropromazine mEq(CmEq)/day), and 22 a normal antipsychotic dosage. No significant difference was detected on any of the SWM performance measures between the two groups of patients receiving either polypharmacy or monotherapy. These groups did not also differ in the WAIS full scale, performance or verbal IQ scores. When the patients were divided into two groups receiving either an excessive or a normal dose of antipsychotics, these two groups also showed a similar SWM and WAIS performance. The total antipsychotic dose showed negative but nonsignificant correlations with the SWM performance scores.

We did not detect any influence of antipsychotic polypharmacy or excessive dosing on spatial working memory in schizophrenia. This finding supports the independence of working memory deficits from the effects of treatment in schizophrenia.

We observe the schizophrenia process through specific structural terms - specific models and shapes of the internalisation deficit and consequental structural variability.

We describe the specific influence of the developmental deficit on the schizophrenic process by presenting the case of a 17 year old female patient diagnosed with schizophrenic psychosis hebefrenic form. By observing the patient's life history, we interpreted her psychological development throug early introjective configurations, identification process, the phase of forming realistic images of the self and the outher world and the forming of the Ego identity. The current state is explained throug deficit Ego functions.

The bringing up of the patient in an unstable and disturbing primary family group, with the mother suffering from Sch psychosis and a grandmother addicted to alchocol, caused pathological modifications in the introjective process and forming of a confused Ego identity. Fragility, non-differentiality and polar exclusiveness of mental representations, which is dependant on the characteristics of the primary object relationschipts, form an insecure mental structure which the patient uses to schape her perception of herself and the world, which can be phenomenologically recognised in the direct and inner presentation of the devil and god as clear and utterly scharp opposites.

The schizophrenic process is connected to the developmental deficit which is conditioned by the failure to organize and integrate the inherent structures forming the core of individual self organization. This essentialy directs development toward the schizophrenic process.

Poor response of psychotic symptoms to a single antipsychotic drug appears to be the most common reason for combination of two antipsychotic drugs. Antipsychotic combinations are in clinical practice very common, although there are not sufficient evidences of their efficacy from randomized, controlled trials. We evaluated the efficacy and safety of augmenting amisulpride with quetiapine in patients with sub-optimal response to amisulpride.

In this open-label, non-randomized study, 36 patients who were partially responsive to amisulpride after 4 weeks of treatment were assigned to receive up to 600mg/day quetiapine along with an ongoing stable dose of 800mg/day amisulpride. Patients were evaluated at baseline and at week 1, 3, 6 and 8. Efficacy was assessed using Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) scale and for tolerability we used Simpson-Angus Rating Scale (SAS).

Thirty-one patients completed the study. There was an improvement in the mean scores for PANSS (with more than 30%) and CGI after 8 weeks of treatment, with no major changes in side effect profile.

In patients with a suboptimal response to amisulpride, the addition of quetiapine improved overall positive and negative symptoms of schizophrenia. The combination seems to be safe and well tolerated. Augmentation with quetiapine may provide clinical benefits for patients who are only partially responsive to amisulpride alone. Randomized controlled trials are necessary to evaluate the possible role of this augmentation strategy.

Attribution style and reaction to frustration play an important part in both depression and paranoia. The objective was to study the attribution style and frustration reaction between persistent delusional psychosis with depression and persistent without depression.

Fourty patients diagnosed with ICD 10 persistent delusional disorder with a period of evolution of 8 years, was grouped into 2 subgroups:

1. a) with depression and

2. b) without depression.

All are part of the Cases Registrer of Timisoara Psychiatric Clinic (CRPTC) which monitors the functional psychoses from 1985. For each patient was applied in period of remission BPRS (Brief Psychiatric Rating Scale), ASQ (Attributional Style Questionnaire) and Rosenzweig frustration test.

The persistent delusional psychosis without depressive features present a more internal and less stable attributions of the negative events. For the positive events, the stability and globality is higher for those with depression. Concerning the response to frustrating situations, persistent delusional psychosis with depression give answers prevailling extrapunitiveness, whereas those without depression give prevailling need-persistence answers. There are significant similarities between the two groups concerning the type of persisting necessity.

Among the persistent delusional psychosis, those with depressive features demonstrate an agresivity directed more towards exterior in the frustrating situations and associate less the negative events with their own personality than the pure persistent delusional.

The stages of the subjective psychological process of recovery after the first psychotic episode were explored; since psychological functioning, as well as symptoms and social functioning in the critical period probably are the most important long-term outcome predictor variables.

The RSQ (Drayton, et al., 1998) and the STORI (Andresen, et al., 2006) were used to assess 30 patients (72.4% males) recovering from the first episode of a non-affective psychosis, 3 to 9 months after their clinical discharge. The mean age was 24.34 (SD=4.5, range=17-34).

The RSQ stages of recovery were: Tendency toward sealing-over (7.7%), Mixed, sealing-over predominates (42.3%), Mixed, integration predominates (38.5%), and Tendency toward integration (11.5%). The STORI stages of recovery were: Moratorium (11.5%), Awareness (31.0%), Preparation (27.0%), Rebuilding (11.5%), and Growth (19.0%). Significant correlations were found between better recovery stages and patient's adherence to treatment (X2 = 9.579, p = 0.008). Correlations between recovery stages and symptoms, neuropsychological functioning, and other variables were also explored.

Recovery styles of Integration and Growth significantly correlate with treatment adherence, a better symptomatic (less negative and general symptoms) and functional recovery, but not with DUP, stigma, or neuropsychological variables.

Delusional parasitosis, also known as Ekbom syndrome, is the most frequent among the somatic delusions. It may occur at any age but is more common in the elderly, particularly in females. It is a syndrome in which the patient has the false belief that he is infested by some type of insects, lice, worms or other invertebrates, and that they live or grow under their skin or inside their body. Psychiatric interventions are usually rejected by these patients and long-term treatments are frequently abandoned.

A clinical case was followed and reviewed to illustrate the links between somatic delusions, hypochondriasis, somatization and obsessive disorders.

A 58-year-old female presents delusions of infestation. She has a long history of somatization and hypochondria, which can be interpreted as a continuum in the onset of the delusional syndrome. In this case, delusions of infestation are projected onto a third person. Psychophramacological treatment with long acting injectable risperidone was then introduced, as an alternative to drugs previously used.

The effectiveness of pimozide and risperidone for the Ekbom syndrome has been documented in the literature. In our case, we decided to introduce long acting injectable risperidone after several rejections or long-term discontinuation in oral treatments.