There is evidence that psycho-education courses for caregivers of individuals with schizophrenia improve the short-term outcome of the condition. However, most of the outcome studies are limited to two-year follow-up.

This study is a five-year retrospective case-control follow-up of an original cohort of 63 patients and their 101 caregivers who completed a six-week Caregiver Psycho-education Programme (CPP) for schizophrenia and psychosis between 2002 and 2005, and 60 controls, matched for age, gender and severity of their psychotic illness.

Patients whose caregivers learned more from the six-week psycho-education course had a significantly longer time to relapse (P = 0.04) and a significantly shorter length of stay during their first relapse (P < 0.05). Patients whose caregivers attended the six-week psycho-education course (regardless of how much the caregivers learned) had a significantly better outcome than controls. This included a significantly smaller number of relapses (P < 0.01), longer time to relapse (P < 0.01), shorter length of stay during their first relapse (P < 0.01) and smaller number of bed days over five years (P < 0.01). The odds ratio of controls relapsing, although insignificant at one year, was 4.13 (1.85–9.21) at five years. Outcome was not affected by either the numbers of caregivers attending for each patient, or caregiver gender.

This study, which is among the first to examine outcome over five years, supports the efficacy of psycho-education for caregivers in improving outcome for patients. Caregivers should be encouraged to take up psycho-education where it is available.

Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition characterized by a few consistent, temporally stable symptom dimensions. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a recently developed instrument that allows patient and clinician ratings of dimension-specific symptom severity, as well as estimates of global symptom severity in patients with OCD.

We examined the psychometric properties of the DY-BOCS in a sample of 128 European adult patients with OCD.

The results of the psychometric analyses were overall excellent. The internal consistency across the domains of time, distress and interference for each dimension was high. The subscales of the DY-BOCS were largely independent from one another. The convergent and discriminant validity of the DY-BOCS subscales were adequate. The Global Severity and Interference scales were largely intercorrelated, suggesting that they may be redundant. The level of agreement between self-report and expert ratings was adequate although somewhat lower than in the original validation study.

The results of the present study confirm the excellent psychometric properties of the DY-BOCS reported in the original validation study.

Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.

Total scores and subscale scores from three insight measures and two NSS scales were correlated in addition to factors representing overall insight and NSS which we created using principal component analysis.

There were only four significant associations when we controlled for symptoms. “Softer” Condensed Neurological Evaluation (CNE) signs were associated with our overall insight factor (r = 0.19, P = 0.02), with total Birchwood (r = −0.24, P<0.01), and the Birchwood subscales; recognition of mental illness (r = −0.24, P<0.01) and need for treatment (r = −0.18, P = 0.02). Total Neurological Evaluation Scale (NES) and recognition of the achieved effects of medication were also weakly correlated (r = 0.14, P = 0.04).

This study does not support a direct link between neurological dysfunction and insight in psychosis. Our understanding of insight as a concept remains in its infancy.

Two-hundred and ninety-five chronic schizophrenia patients from 11 centres were included in the study. Symptom severity was measured with Positive and Negative Syndrome Scale for schizophrenia. QoL and functionality was assessed with Global Assessment of Functioning Scale, Quality of Life Scale, Personal and Social Performance Scale, Psychosocial Remission in Schizophrenia Scale, Functional Recovery Scale in Schizophrenia, Performance-Based Skills Assessment-Brief Version and Subjective Well-being under Neuroleptics Scales.

Two-third of the participants (n = 194) were unemployed. Forty (13.6%) of the participants were involved in full-time work/study, 29 (9.8%) people were involved in part-time work/study, 13 (4.4%) people were engaged in work/study below 50% of the time, but their job was classified as regular and independent. Those who work/study had lower symptoms, better functioning and higher levels of QoL. Also those who work/study full-time displayed better results on these measures than the participants involved in part-time work/study. Age, education, severity of negative symptoms, gender and duration of remission were found to be related to employment status in the logistic regression analysis.

Our findings suggest that work/study status is an important component of functionality.

Studies indicate that patient-rated outcomes and symptomatic remission as defined by the remission in schizophrenia working group rely on different assumptions. The aim of this observational study was to assess symptomatic remission by patients with schizophrenia, family members and psychiatrists and to compare their assessments with standardized criteria and clinical measures.

One hundred and thirty-one patients with schizophrenia (DSM-IV), family members and psychiatrists assessed remission within the European Group on Functional Outcomes and Remission in Schizophrenia (EGOFORS) project. Symptoms (Positive and Negative Syndrome Scale [PANSS]), functional outcome (Functional Recovery Scale in Schizophrenia [FROGS]), subjective well-being (SWN-K) and demographic characteristics were investigated.

Remission assessed by psychiatrists showed the best accordance with standardized remission (80%), followed by remission assessed by family members (52%) and patients (43%). Only in 18%, patients, relatives and psychiatrists agreed in their assessments. Good subjective well-being was most important for remission estimated by patients, good subjective well-being and symptom reduction by family members, and finally better symptom scores, well-being and functioning by psychiatrists.

Self- and expert-rated clinical outcomes differ markedly, with a preference on the patients’ side for subjective outcome. Symptomatic remission as assessed by the standardized criteria plays a secondary role for patients and relatives in daily clinical practice. A more thorough consideration of patients’ and caregivers’ perspectives should supplement the experts’ assessment.

This study is a secondary analysis of a clinical trial involving the use of adjunctive SAMe for MDD.

Forty-six serotonin-reuptake inhibitor (SRI) non-responders with MDD enrolled in a 6-week, double-blind, randomized trial of adjunctive oral SAMe were administered the self-rated cognitive and physical symptoms questionnaire (CPFQ), a validated measure of cognitive as well as physical symptoms of MDD, before and after treatment.

There was a greater improvement in the ability to recall information (P = 0.04) and a trend towards statistical significance for greater improvement in word-finding (P = 0.09) for patients who received adjunctive SAMe than placebo. None of the remaining five items reached statistical significance.

These preliminary data suggest that SAMe can improve memory-related cognitive symptoms in depressed patients, and warrant replication.

Subjective explanations of illness concepts and disease can differ from culture to culture. We examined explanatory models of West African patients with schizophrenia in a communitycentred department of psychiatry in Mali, West Africa.

Patients and experts volunteered to be interviewed in the Department of Psychiatry of the University Hospital, Pont G, in Bamako, the capital of Mali. We used semi-structured interviews to explore key psychotic symptoms and explanatory models of psychosis in five experts and fifteen patients with schizophrenia. All interviews were analysed using computer assisted content-analysis with the program Atlas.ti.

African patients displayed key symptoms of schizophrenia such as commenting and imperative voices, inserted thoughts and other phenomena of alien control, which were often subjectively explained as obsession by witches or jinns. Explanatory models differed depending on occidental migration experience and age. The involvement of family members in the treatmentsetting facilitates inclusion and recovery. Experts emphasized the need to integrate traditional and ethno-pharmacological approaches and modern medicine to treat their patients in a culture sensitive manner.

Our data suggests a strong influence of illness concepts on the experience of psychotic symptoms, treatment expectations and health-related behaviour.

Despite massive research on weight gain and metabolic complications in schizophrenia there are few studies on energy expenditure and no current data on physical capacity.

To determine oxygen uptake capacity, respiratory quotient (RQ) and energy expenditure during a submaximal exercise test in patients with schizophrenia and healthy controls.

Ten male patients and 10 controls were included. RQ and energy expenditure were investigated with indirect calorimetry during a cycle ergometer test. The submaximal work level was defined by heart rate and perceived exhaustion. Physical capacity was determined from predicted maximal oxygen uptake capacity (VO2-max).

The patients exhibited significantly higher RQ on submaximal workloads and lower physical capacity. A significant lower calculated VO2-max remained after correction for body weight and fat free mass (FFM). Energy expenditure did not differ on fixed workloads.

RQ was rapidly increasing in the patients during exercise indicating a faster transition to carbohydrate oxidation and anaerobic metabolism that also implies a performance closer to maximal oxygen uptake even at submaximal loads. This may restrict the capacity for everyday activity and exercise and thus contribute to the risk for weight gain. Physical capacity was consequently significantly lower in the patients.

Our previous study (Salokangas et al., 2009) suggested that the subjective experience of negative attitude of others (NAO) towards oneself is an early indicator of psychotic development. The aim of this prospective follow-up study was to test this hypothesis.

A total of 55 young psychiatric outpatients assessed as being at current risk of psychosis (CROP) were followed for up to 60 months and rates of transition to psychosis (TTP) identified. CROP was assessed employing the Bonn Scale for assessment of basic symptoms (Schultze-Lutter and Klosterkötter, 2002) and the Structured Interview for prodromal symptoms (Miller et al., 2002). TTP was defined by a psychotic episode lasting for more than one week. Associations between NAO at baseline and TTP were analyzed by a Cox regression survival analysis.

Eight (14.5%) TTP were identified: four (57.1%) within seven NAO patients and four (8.7%) within forty-six non-NAO patients. In the multivariate Cox regression analysis, NAO at baseline significantly (P = 0.007) predicted TTP.

The prospective follow-up results support our hypothesis that subjective experience of NAO is an early indicator of psychotic in development.

Although many patients with schizophrenia are impaired in mental states attribution abilities, a significant number perform within normal or near-normal ranges in mental state attribution tasks. No studies have analysed cognitive or behavioural differences between patients with – to some extent – preserved mental state attribution skills and those with poor mentalising abilities.

To examine characteristics of “poor” and “fair” mentalisers, 58 patients with schizophrenia performed a mental state attribution task, a test of general intelligence, and two executive functioning tests. “Poor” and “fair” mentalising skills were defined according to a median-split procedure; the median score in the patient group was also within two standard deviations of the control group. In addition, patients’ social behavioural skills and psychopathological profiles were rated.

Patients performing within normal or near normal ranges on the mental state attribution task had fewer social behavioural abnormalities than patients with poor mentalising abilities (even when controlled for intelligence), but did not differ in executive functioning. Fair mental state performers showed less disorganisation and excitement symptoms than poor performers. The degree of disorganisation mediated the influence of mental state attribution on social behavioural skills.

Schizophrenia patients with (partially) preserved mentalising skills have fewer behavioural problems in the social domain than patients with poor mentalising abilities. Conceptual disorganisation mediates the prediction of social behavioural skills through mentalising skills, suggesting that disorganised patients may require special attention regarding social-cognitive skills training.