The conditions for the use of study medications are different in a clinical trial than when the same drugs are marketed and administered to larger population groups. This study was proposed after the recent change in the range of doses marketing of Aripiprazole in our country and following a change in the range of doses used.

To identify the type of patients treated with aAripiprazole during 4 months (May 06) after the change in the SmPC (10-30 mg dose) and to establish the doses used. To identify the proportion of patients switching to aAripiprazole from previous antipsychotic treatments due to reduced efficacy or low tolerance to the previous drugs.

This is a retrospective, observational, multicenter study. Data will be collected from the medical records of 1000 patients treated with aAripiprazole during the four months prior to the study initiation, with a minimum of 1 month treatment. The information will be gathered by 200 psychiatrists each one providing 5 cases. Data collection was initiated in October 2006 and is expected to last two months. The sample size based on the primary objective obtained will enable a 95% confidence interval with a maximum acceptable error of 3% to estimate the proportion based on the primary objective.

The collection of data will enable us to know how psychiatrists prescribe aAripiprazole, considering the type of patient, dosage regime, switching strategy of antipsychotic treatment (by identifying the ratios of treatment switches) under standard conditions of use.

Six hundred psychiatrists from private and public Spanish clinics registered the first four patients with schizophrenia seen at their offices during 2004. Sociodemographic characteristics, diagnostic criteria, clinical features, and therapy patterns, including adherence to treatment, were recorded.

A total of 2,154 patients were included in the study (86% ≤50 years old; 69% males; 79% unmarried), half of them had elementary school studies only while a 28% had a university degree. Male to female significant differences were observed regarding patterns of cigarette, alcohol, and illegal substance comsumption. A 69% of patients had paranoid schizophrenia, 13% presented with residual schizophrenia, and the remaining 18% had other types. The paranoid and hebephrenic types were the predominant types seen in patients ≤50 years old, while residual schizophrenia was most frequently seen in patients >50. When admitted into the study, 10% of patients were in an acute phase, 19% showed active symptoms, and the remaining 71% showed a stable disorder. Antipsychotic medications more frequently prescribed before enrolment were risperidone (29%), olanzapine (19%), and clozapine, quietapine, amisulpiride and haloperidol (7% each). The most common non-pharmacologic therapy prescribed to patients before entering the study was occupational therapy.

Patients included in this observational study were predominantly males <50 year old who presented with paranoid schizophrenia. Almost all patients had received antipsychotic medication before entering the study, mainly risperidone and olanzapine.

Different neuropsychological studies have consistently found an attention, memory and executive function deficit in schizophrenic patients. The Positive and Negative Syndrome Scale (PANSS) evaluates different clinical aspects of schizophrenia. Factor analyses of this scale suggest the existence of a “cognitive factor”, constituted by several items pertaining to the different subscales. In order to have an acceptable concurrent validity, this “cognitive factor” should correlate with the execution of neuropsychological tasks. Our objective was to study the correlation between the PANSS “cognitive factor” and the execution of neuropsychological tasks evaluating attention, memory and executive functions.

Thirty-five schizophrenic patients were evaluated using the Continuous Performance Test (CPT), the Rey-Osterrieth Complex Figure Test (Rey CFT) and the Wisconsin Card Sorting Test (WCST). Bivariate partial correlation between the neuropsychological variables and the PANSS “cognitive factor” was examined. In order to obtain this cognitive component, and based on previous studies, items P2, N5, PG10 and PG11 were used.

The PANSS “cognitive factor” was significantly correlated to CPT omission errors (r=0.45; p=0.006), Rey CFT recall after 5 minutes (r=-0.34; p=0.049), Rey CFT recall after 30 minutes (r=-0.40; p=0.020), WCST perseverative responses (r=0.36; p=0.035), and WCST perseverative errors (r=0.35; p=0.041).

The existence of significant correlations between the PANSS “cognitive factor” and performance on neuropsychological tasks evaluating attention (CPT), memory (Rey CFT) and executive functions (WCST) supports the concurrent validity of this factor.

The Positive and Negative Syndrome Scale (PANSS) evaluates different psychopathological aspects of schizophrenic patients. Scores on the negative subscale of the PANSS have been associated with clinical and neuropsychological differences in these patients. Our aim was to study the relationship between PANSS negative scores and different clinical and neuropsychological variables in a sample of schizophrenic patients.

Our sample of 174 schizophrenic patients was split into two groups according to scores on the negative subscale of the PANSS: a group of 85 patients (55 male and 30 female; mean age 38.0 years, SD 9.3) with scores below the median (“low negative PANSS” group), and a group of 89 patients (58 male and 31 female; mean age 37.3, SD 8.4) with scores above the median (“high negative PANSS” group). The neuropsychological task used was the Wisconsin Card Sorting Test.

Significant clinical differences were found between both groups. In the “high negative PANSS” group a lower age of illness onset was found (p=0.030), as well as a lower age at first psychiatric admission (p=0.002) compared to the “low negative PANSS” group, without there being significant differences in current age (p=0.570). Regarding cognitive functions, “high negative PANSS” patients achieved fewer categories (p=0.005) and made more perseverative errors (p=0.031) than “low negative PANSS” patients.

Schizophrenic patients with higher scores on the negative subscale of the PANSS had an earlier age of onset of their illness and exhibited poorer cognitive functioning than patients with lower scores.

This study evaluated the efficacy and tolerability of ziprasidone after a switch from conventional and atypical antipsychotics in acute schizophrenic patients who required alternative medication.

A total of 189 patients with acute exacerbation of schizophrenia were switched to 8 weeks of open-label treatment with ziprasidone (80 mg/d for the first 2 days, then adjusted to 40-160 mg/d). Current treatments were discontinued over Days 1-7. Primary efficacy measure was the change from baseline in PANSS total score.

A total of 82.5% of patients switched to ziprasidone due to inadequate efficacy and 16.4% due to poor tolerability (most frequently weight gain). A total of 136 patients (72%) completed the study. After switching to ziprasidone, the mean change (ITT-LOCF)in PANSS total score from baseline to end point was statistically significant (n = 183; baseline score 112 ± 19; mean change -25 ± 25.5; P <.0001). A significant improvement was observed from Week 1. Ziprasidone was generally well tolerated, with 12.7% of patients discontinuing due to adverse events. Movement disorder and sexual dysfunction occurred infrequently, accompanied by baseline-to-end–point reductions in Simpson Angus Scale total score and serum prolactin levels. Switch to ziprasidone showed a significant mean baseline-to-end–point decrease in weight (-1.0 ± 3.1 kg; P< .0001) and a nonsignificant increase (5 ms) in mean QTc interval.

Eight weeks of treatment with ziprasidone significantly reduced overall psychopathology in acute schizophrenic patients switched from other antipsychotics and was well tolerated, with a neutral effect on body weight.

This study evaluated the efficacy and tolerability of intramuscular (IM) ziprasidone and the transition to oral formulation in patients with acute schizophrenia and agitation, whose severity of symptoms required IM treatment

Patients (n=150) were switched from their current treatments to 8 weeks of open-label treatment with ziprasidone. Patients received up to 40 mg/die IM ziprasidone at Day 1 and were then switched to 80-160 mg/die oral ziprasidone as soon as clinical status permitted. The primary efficacy measure was the change from baseline in PANSS total score. The effect of ziprasidone IM on agitation was evaluated using the validated 7-item Behavioural Assessment Rating Scale (BARS) scale

In the intent-to-treat population, the reduction in total PANSS score at study end point versus baseline was statistically significant (n = 150; -37.24; baseline 126.71; P< .0001). Regarding agitation, 142/150 (95%) patients were responders (BARS score 3-4), with a median time to response of 0.50 hours. A total of 61.3% of patients completed the study, 25% experienced treatment-related adverse events, and 5% discontinued due to adverse events. The most frequently reported adverse events were insomnia (6%), somnolence (4%), hypotension (3%), and extrapyramidal disorders (2%). No significant change was observed in weight or any clinical laboratory parameter

IM-to-oral ziprasidone proved effective and well tolerated in the treatment of patients suffering from acute exacerbation of schizophrenia with agitation, offering the possibility of continued treatment from the acute agitated state through to maintenance treatment without having to switch chemical entity.

The criteria of remission in schizophrenia has been reviewed and updated by Dra. Andreasen and collaborators. They define remission of the severity of the diagnostic symptoms of schizophrenia when the patient obtains a punctuation ≤3 for each of the 8 main items of the PANSS (positive and negative syndrome scale) during a period of 6 or more months.

The aims of this project is to investigate whether there is a significant difference in the rate of remission, as defined by Dra Andreasen et. al., in group of patients treated by either Lon-Action Injectable Risperidone (LAI Risperidone) or conventional depot: Flufenazine decanoate or Zuclopentixole decanoate.

We examined the criteria of remission by Dra. Andreasen in 46 patients with schizophrenia, 21 patients treated with LAI Risperidone and 25 patients treated with conventional depot.

By analysing the data obtained after 12 months, the rate of remission in patients treated with LAI Risperidone was 56,4% and the rate of remission in patients treated with conventional depot was 20%. (significant difference p<0,05).

LAI Risperidone clearly increases the rates of remission in schizophrenic patients and favours the use of an antipsycotic monotherapy treatment. This results can lead to an improvement in patient compliance to the antipsycotic treatment and therefore a better quality of life and a better progress of the disease.

Disability is presented in schizophrenic patients because of different factor; one of them is neurocognitive disfuntion and the others are non cognitive symptoms.

Recent studies have argued that social cognition is important for the patient and that the repercussions of there that basic cognitive disorders on their lives and social integration are serious.

The aims of this project was analized disability in schizophrenic patients, and we analized their relationship with gender, evolution of the disease and psychopathological symptons.

We studied schizophrenic social Cognition in relation to a control group.

Our study included 49 schizophrenic patients all diagnosed with ICD-10 Criteria and a control group of 40 normal subject.

measues: PANSS Scale

WHO-Disability Diagnostic Scale (WHO-DDS)

Social Cognition Scale (GEOPTE)

Total disability and all of their subscales were not significantly diferent with the gender.

Total disability and all of their subscales is significantly higher in the group of long evolution of the disease(p<0.01)

The psychopathological symptoms that they directly correlate with the disability are the negative symptoms, specially the affective symptoms.

The social Cognitive deterioration is significantly higher in the group of schyzophrenic patients than in the control group.(P<0,0001)

There is not relationship between Disability and Gender.

There is a direct relationship between disability and evolution of the disease.

Of an psychopathological symptoms (PANSS Scale) the affective symptoms bear the strongest relationship with disability.

Schizophrenic patients suffer a higher social cognitive deterioration than the control group.

Better understanding of functional outcome predictors in schizophrenia has become key in order to face new challenges of the disease. The ESPASS survey aimed at evaluating the impact of antipsychotic therapy initiation or switch on psychosocial functioning in a sample of schizophrenic patients.

The primary objective was to evaluate the change from baseline to 6 months in EAS total score (psychosocial functioning scale). Other criteria were the change in the IAQ total score, CGI-S, and PASAP (satisfaction with care)

5962 were included by 1169 investigators. Mean age was 37±12, 62% were male, 72% single, 62% were outpatients, 34% of the patients were on therapy for 10 years or more, 47% had paranoid schizophrenia subtype. Prior to baseline, 23% had no antipsychotic therapy, 25% had a conventional and 52% had an atypical antipsychotic. 8% of the total sample were naïve to antipsychotic therapy.

Obesity mostly affected patients treated with atypicals in comparison to conventional antipsychotics (20% vs. 15%). The EAS total score was 46±20 with lower sub-scores in following domains: money earning, management of belongings, social and private relationships. Mean CGI-S score was 4.7±1.0 and IAQ total score was 22±4. 26% of the patients participated in a psychosocial rehabilitation program for 3 to 4 years.

While improving social functioning has clearly become key in the treatment of schizophrenia, only 26% of the patients were involved in an adequate rehabilitation program and 25% had a conventional antipsychotic.

The sexuality of schizophrenics is a neglected dimension. The majority of schizophrenics experience a progressive deterioration in their social and sociosexual functioning. This deterioration often starts before the first psychotic episode and would be one of the negative symptoms of schizophrenia. All type of antipsychotics can lead to sexual dysfunctions. Impaired sexual functioning is believed to negatively impact treatment compliance as well as the quality of life.

The frequency of sexual dysfunctions in patients taking classic antipsychotics is not known. This study attends to ascertain the level of sexual dysfunction in such patients.

The level of sexual dysfunction was assessed in 41 patients taking classic antipsychotic medication and 28 normal controls. All the participants were physically healthy. We examined the following complaints or symptoms loss of libido, anorgasmia, impotence, premature ejaculation, galactorrhea, gynecomastia for males; amenorrhea, dysmenorrhea, dyspaurenia, galactorrhea, loss of libido and anorgasmia for females.

There were a significantly higher proportion of persons with sexual dysfunctions in the schizophrenic group compared with the normal controls. There were no significant differences in the demographic characteristics (age and gender) between the 2 groups. Male patient had normal levels of libido but were highly likely to report erectile and ejaculatory dysfunctions.

Patient taking conventional antipsychotic medication report high levels of sexual dysfunction. The high level of sexual dysfunctions indicated that clinicians should monitor and openly discuss these issues with patients in order to improve overall satisfaction and adherence to treatment.

Clinical trials suggest that patients receiving atypical antipsychotics are less likely to develop movement disorders than those receiving conventional antipsychotics. We determined incidence of treatment-emergent TD during long-term treatment of schizophrenia or schizoaffective disorder with aripiprazole or haloperidol.

In a post hoc analysis of pooled data collected from two 52-week double-blind trials involving 1,294 patients treated either with aripiprazole 20-30mg/d (n=861) or haloperidol 5-10mg/d (n=433), treatment-emergent TD was identified based on Research Diagnostic Criteria (RDC) extracted from the Abnormal Involuntary Movement Scale (AIMS) (Schooler-Kane criteria).

In patients without baseline TD (n=1,177), the rate of new-onset TD at any time point following randomization was 5.09% for aripiprazole-treated patients and 11.76% for haloperidol-treated patients (p<0.0001). Using a stricter definition of RDC-defined TD on the last two study visits, new-onset TD was seen in 0.25% of aripiprazole-treated patients versus 4.09% of haloperidol-treated patients (p<0.0001), and was mild in 100% of aripiprazole-treated patients, and mild in 68.75% and moderate or severe in 31.25% of haloperidol-treated patients. Mean baseline to endpoint increase in AIMS score was significantly greater in haloperidol- versus aripiprazole-treated patients in both LOCF (n=1177, p=0.0001) and OC (n=427, p<0.0001) analyses.

Aripiprazole is associated with a significantly reduced risk of new-onset tardive dyskinesia compared with haloperidol in patients with schizophrenia or schizoaffective disorder treated for up to 52 weeks. Aripiprazole's dopamine D2 partial agonist and/or serotonin 5HT2A antagonist receptor binding profile may contribute to this.

The schizophrenic patients have a standardized mortality rate greater than expected for the rest of the population. The metabolic syndrome has high prevalence among them, that prevalence of the metabolic syndrome in schizophrenic patients and the sociodemographic, antropometric, clinical, and psychopharmacological variables which are related to it. We aimed to know the coronary risk and its relation with the metabolic syndrome.

Cross-sectional study. We include 136 patients, between 18 and 65 years old, admitted throughout the year 2004 in the Hospital Universitario de Gran Canaria Dr. Negrín with a schizophrenic diagnose and more than two years of evolution, validated through the SCID-I. Metabolic syndrome and coronary risk were defined according to the criteria of the NCEP-ATP III.

The prevalence of the metabolic syndrome was 36% (95% CI = 29.4 - 45.59). It is outstanding the high prevalence of abdominal obesity (78.7%) in women. We can't find any relation between the metabolic syndrome and the different studied variables. The coronary risk in the next 10 years is moderate in 52.3% and high in 2.9% of the cases. The increase in the risk associates with suffering the metabolic syndrome and taking antipsychotics.

The metabolic syndrome is highly prevalent in schizophrenic patients and, therefore, the prevention, diagnosis and treatment of its components is an essential aim to reduce the cardiovascular risk of these subjects.

The management of psychotic symptoms is critical to schizophrenia treatment. However, monitoring patients' physical health, in particular how this impacts life expectancy, quality of life and compliance, should be considered because of its significant influence on short and long term health outcomes.

Between June and October 2006, 54,618 European psychiatrists in 12 countries received a survey containing 10 questions addressing physical health. Responders rated areas of concern, physical health monitoring and impact of antipsychotic therapy.

Among the first 3,764 psychiatrists, 84% consider physical health very important, with weight as the major concern for 63%. The top concerns in terms of impact of physical health are compliance (41%) followed by increased mortality risk (38%). While 88% say they undertake physical examination, only half do so on a regular basis. The most problematic side effects of antipsychotic treatments are weight gain (56%), metabolic impact (29%), extrapyramidal symptoms (21%) and sedation (7%), but only 1% report insomnia as an issue. When considering treatment related weight gain, 85% provide diet and lifestyle education with 55% monitoring weight, however, 66% of this intervention is unsuccessful.

The results show a substantial interest and awareness in the management of physical health in schizophrenia. Psychiatrists are monitoring to a certain extent but management strategies are often unsuccessful. Effective physical health programs in schizophrenia, including close monitoring and weight management, have yet to be optimized across Europe.

In the last years a greater attention to the clinical results that result in the quality of life of the patients, surpassing the clinical concept of recovery (positive symptoms, to extend it to the long-term symptoms(remission).

To determine the different levels of remission of negative, positive symptoms or of conceptual disorganization, evaluating the clinical and epidemiological factors related to the attainment of the remission, identifying factors of good prognosis.

138 patients with acute psychotic episode attended in a psychiatric unit in 2004 were studied. Six months later all patients were cited for a second interview, evaluating 80 patients. Three items were evaluated: remission, compliment and functioning, utilizing remission criteria of Andreassen y cols (2005), the Drug Attitude Inventory (DAI), the Global Activity Evaluation Scale (EEAG) and the Discapacity Assessment Scale de la OMS (WHO-DAS).

The majority of the patients (80%) obtained the psychopathologic remission. The greater remission related to high levels of performance (EEAG) and smaller values of disability (WHO-GIVE) in all the subscales of functionality (familiar, social and labor), with significant differences. The therapeutic adherence was an important factor in the remission (DAI), with high statistical meaning (alpha=0,000).

The finds support the use of the criteria of remission and they suggest a clinically significant association among the clinical state, the levels of health and the family, labor, and social functioning. The improvement in the psychopathologic would favor the attitude of the patients toward the medication and the therapeutic fulfillment.

More than 21% of Galician people exceed 65 years, and 10% has more than 75 years. In the last decade elderly population increased around 3%, being situated in the 21% and expecting that reach the 30% in 2050.

To determine patients over 65 years attended by emotional symptoms in a psychiatric unit in the last 10 years, evaluating the sociodemographic characteristics and analyzing biological and psychosocial factors related.

Descriptive retrospective study of patients over 65 years attended in a psychiatric unit between 1996 and 2006 that received a diagnosis of Affective disorder utilizing DSM-IV and ICD-10 classification criteria.

478 patients over 65 years were obtained, of a total of patients (%), with 246 diagnosed of affective disorder (55,6%). Average age of 72,15 years, with predominance female (proportion 2:1), mainly single, divorced or widowed (55,7%). However the majority live together with their couple (41,9%) or family (31,7%), urban residence (63,4%), inactive work situation (96%), retired (48,5%) or sick-leave (47%). The main diagnoses were Major Depressive Disorder (37%) and Bipolar Disorder (32%), 18% Distimia or Adjustment Disorder.

In spite of the increased rate of elderly population in the last 10 years this is not translated in a change of the profile sociodemographic, labor and clinical dates in elderly patient with affective disorder admitted in an acute psychiatric unit in our influence area, in comparison with a previous study of the years 1996-1999.

Cognitive dysfunction are considered core deficit in schizophrenia. The cognitive domains more impaired are attention, verbal memory and executive function. The study of this dysfunction can be used to understand the etiology and pathogenesis of schizophrenia. Cognitive deficits have frequently been reported in the unaffected first degree relatives of schizophrenia patients.

To investigate whether cognitive deficits found in patients with schizophrenia are also found in non-affected relatives.

We compared schizophrenic patients (n=31), first-degree relatives (26) and normal controls (n=22). The neurocognitive domains assessed included executive functioning, verbal memory, attention and language function.

Schizophrenic patients demonstrated cognitive impairments across most domains compared with control subjects. First degree relatives were significantly impaired compared with control subjects only in attention and verbal memory; no significantly differences were observed in language function. The relatives of schizophrenia patients have impairments in memory function and attention compared to controls but they are less impaired compared to schizophrenic patients. The schizophrenic patients performed on executives tasks significantly worse than either their relatives or normal subjects, but unaffected relatives did not differ from controls.

Cognitive deficits found in patients with schizophrenia are also found in non-affected relatives. Adult relatives of schizophrenic patients have wide but not severe cognitive impairments. The largest deficits were observed for verbal memory and attention.

It is known that the consequences of stigmatization towards people with severe mental illness reflect themselves in a lack of self-esteem and consequently in low level of initiatives to improve one's status in the community. The burden of stigma may cause denial of participation in the stigmatized group. So far, there were few studies to compare the mentally ill patients' perception of the »other« mentally ill with the perception of future professionals in mental health services.

We have compared stigmatizing attitudes of students with attitudes of patients with severe mental illness.

The patients expressed higher stigmatization scores towards people with severe mental illness than the students.

Negative attitudes of patients with severe mental illness towards their own group present a serious problem. Actions are needed to improve their identification and reduce the perceived need for exclusion from their group.

There is growing evidence of need to improve and strengthen educational programs with antidiscrimination and proper information about possibilities for recovery of mental illness. The overview of research of effective antistigma interventions prove that direct contact and personal testimonies of patients improve the discrimination attitudes among professional groups not trained in mental health and among secondary schools' students. Taking a psychiatric history is a key educational objective in psychiatric clerkship in Slovenia and students are faced with testimonies of psychiatric patients. They are however provided only with the contact with severely ill (hospitalized) patients and therefore with little chance to witness their recovery and improved functioning.

The results of the presented research proved that students' fear from patients with severe mental illness is reduced, but not their stereotypes in a six months clerkship at the psychiatric hospital.

More effective educational interventions are needed to improve students' attitudes. There are several suggestions coming from different parts of the world to change prejudice and they share importance of direct contact with recovered patients. This is not achievable in psychiatric hospitals where growing numbers of severely ill patients are gathered, but only in community settings, where these patients work and live in their natural environments. Closer involvement of psychiatrists with other physicians in the clinical and educational programs with a shift of part of psychiatric teaching from psychiatric institutions to family medicine is another strategy recommended, which could also reduce the stigma attached to psychiatric profession.