Induced delusional disorder (also known as shared paranoid disorder or folie à deux) is an uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most commonly a primary case can be distinguished from other one or more cases, in whom the symptoms are induced. the patients implied in the shared delusional symptoms are frequently linked by close relationship bonds, mostly family ties. Its epidemiology remains unclear, because very few data is available. There are some requirements concerning the persons involved for the development of this disorder:

1. 1. Close coexistence and intimate emotional links between the two people are observed;

2. 2. The delusional content is plausible and can be based on past events or expectations;

3. 3. Typically, the induced individual has an easily influenciable personality.

We describe and comment one case of shared paranoid disorder between a 29 year old schizophrenic patient and her 43 years old sister. both share a persecution and prejudice delusion involving the Chinese community of their hometown. after a few days of inward treatment at separated psychiatric wards, the delusional symptoms in the older sister started to improve.

Our intention is making a review on a diagnosis that remains controversial nowadays. Treatment should begin with the separation of the induced and the inducer. Anyhow, a psychopharmacological treatment is required in both individuals. It seems clear, however, that the prognosis of the induced and the inducer is different, according to a variety of factors.

Diagnostic stability in first-episode psychosis shows a wide variability between studies. Amini and cols reported a 50% rate of patients schizophreniform disorder shifting to schizophrenia during the first 12 months period. We report the preliminary follow-up results of our recently ongoing first- episode psychosis unit.

Forty-six patients admitted for a first-episode psichosis to our Inpatient Psychiatric Unit from January 2006 to January 2008 were recruited. Clinical and socio-demographic characteristics were registered during admission period and during the follow-up period.

At admission 52% of the first-episode subjects had a diagnosis of psychosis NOS and 32% a schizophreniform disorder diagnosis. after discharge, most of the patients (72%) had a diagnosis of schizophreniform disorder, 16% psychosis NOS and 8% brief psychotic disorder. Six months later, half of the followed-up patients had a schizophreniform disorder diagnosis, and 23% had a diagnosis of schizophrenia. 30% of the patients were drop-outs, mainly referred to other out-patient services. Patients shifting to schizophrenia were younger, predominantly male (75% vs 50% in non-schizophrenia shift), had a lower proportion of university studies and presented a longer hospitalization period at admission. No differences in familial history of psychosis and cannabis use were found. after one-year follow-up period, 50% preserved a schizophreniform disorder diagnosis and 30% were diagnosed as schizophrenia.

Schizophrenia spectrum disorders have a high stability in first-episode psychosis during first year follow-up. as in previous studies, male gender is one of the factors that best predicts the shift to schizophrenia.

Despite remission being the primary objective following the first episode of schizophrenia, clinically stabilised patients are rarely studied.

To assess the extent and fluctuation of low-level positive symptoms in patients who are in remission following their first episode of schizophrenia, and consider whether symptoms displayed are similar to those exhibited in the prodromal population.

Eleven patients who had recovered for at least six months following one episode of schizophrenia and subsequently fulfilled remission criteria were interviewed four times over the course of three months. Interviews were based on the Structured Interview of Prodromal Symptoms (SIPS), an in-depth assessment of low-level symptoms that is widely used in the prodromal group. Data was compared to equivalent results from the prodromal population (with data provided by the local ED:IT service).

Over the course of the interviews 73% of participants displayed attenuated positive symptoms, predominantly unusual thought content and suspiciousness. 18% experienced brief limited intermittent psychotic symptoms (BLIPS). Analysis with Friedman's test revealed no significant fluctuation in positive symptoms, indicating that they are stable over time. Furthermore, the symptoms exhibited in the sample were closely comparable to those in the prodromal group in the ED:IT service.

The majority of patients in remission are experiencing a form of ‘postdrome’, which appears to be an enduring state. the presence of these symptoms may put patients at an increased risk of relapse. Larger-scale research is required to follow-up this novel preliminary study.

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The study in Krakow investigated the way in which EE and DUP correlated with long term outcomes of the treatment and the course of illness.

58 out of 80 DSM III schizophrenia diagnosed patients took part in 1, 3, 7 and 12 follow-up. the Follow-Up Chart, BPRS, and CFI were used. as the outcome criteria only dynamic of symptoms were included. the dynamic of the symptoms and the relation between DUP and EE were analyzed by repeated measures of ANOVA.

1. 1. General, positive and negative syndromes decreased rapidly after the first hospitalization, and increased slightly between 7 and 12 yrs. (ps < 0.001). the negative syndrome decreased less rapidly during the first year.

2. 2. The dynamic of general and positive syndrome were modified by the DUP and by EE. in long DUP (general syndrome: p = 0.028; positive syndrome: p = 0.001) the dynamic was worse. High EE subjects had more severe syndromes at the admission. after the first hospitalization their results became as good as in the case of low EE (general syndrome: p = 0.004; positive syndrome: p = 0.044).

3. 3. The dynamic of negative syndrome was neither modified by DUP (p = 0.896) or by EE (p = 0.309).

The dynamic of general and positive syndromes were modified by DUP during 12 years follow-up and by EE only in acute state in the first episode. the dynamic of negative syndrome was not modified by DUP and EE.

Previously the GABA(A) receptor beta-2 subunit gene GABRB2 was found to be associated with schizophrenia (SCZ). for SNPs and haplotypes in GRBRB2, the associations with bipolar disorder (BPD), the functional consequences on GABRB2 expression and their relationship to demographic and clinical characteristics in BPD and SCZ remain to be elucidated.

Case-control analysis was performed for association study of GABRB2 with BPD, and its mRNA expression in postmortem BPD brains was examined using quantitative real-time PCR. Quantitative trait analysis was subsequently employed to assess the covariate effects of demographic and clinical characteristics on genotypic correlation of GABRB2 expression in SCZ and BPD.

Significant association of GABRB2 with BPD and reduction in GABRB2 mRNA expression in BPD brains were observed in the present study. Duration of illness (DOI) was found to be a significant covariate for the correlation of the disease-associated SNPs rs1816071, rs1816072 and rs187269 with GABRB2 expression in both SCZ and BPD. for individuals with homozygous major genotypes of these SNPs, while GABRB2 expression increased with age in the controls, it decreased with DOI and age in SCZ, and with DOI in BPD. with age of onset as covariate, these three SNPs were significantly correlated with antipsychotic dosage in SCZ.

These results have thus revealed correlations of GABRB2 SNPs and expression not only with the occurrence of SCZ and BPD, but also with the clinical characteristics of patients, therefore providing support for a shared etiological role played by the gene in both diseases.

Early intervention in psychosis constitutes an important opportunity to change the classic limited outcome associated with the patients who suffer of psychotic disease.

Based on literature review the authors analyse the evidence for early intervention in first psychotic episode.

The evidence for the effectiveness of interventions in early psychosis can be considered in two stages:

1. 1. first stage before the onset of full symptoms of psychosis, in people with high risk of developing psychosis or in the prodrome phase of the illness;

2. 2. second stage includes the therapeutic focus on the period after the first psychotic episode, reducing the duration of untreated psychosis (DUP) and ameliorate the recovery.

Preventing psychosis by intervene in the prodrome or in people with high risk of developing psychosis remains ethically contentious because of the non-specificity of the symptoms. by the contrary there is evidence that early and specialised intervention in first psychotic episode improves outcome. Besides the controversy of the relation between long DUP and poor outcome, there is agreement that clinicians should identify and treat psychosis early with a great impact in patients and their family's life. Effective care during first psychotic episode includes proactive engagement and initiation of low doses of antipsychotics and psychosocial treatments, aiming for maximal symptomatic and functional recovery and the prevention of relapse.

There is evidence that early intervention in first psychotic episode improve clinical effectiveness over standard care. Further studies are important to make evidence more robust.

Treatment adherence is crucial to the therapeutic success in psychiatric disorders. Evaluating factors involved in treatment adherence will allow to modify treatment strategies for greater compliance. the aim of the study was to evaluate factors involved in treatment adherence, including subjective patients’ satisfaction.

The study included in- and outpatients who met the criteria according to DSM-IV TR of schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, psychosis not otherwise specified, brief psychotic disorder and bipolar disorder. the following questionnaires were applied:

1. 1. Demographic and clinical questionnaire;

2. 2. Treatment Satisfaction Questionnaire for Medication Version II (TSQM vII);

3. 3. Medication Adherence Rating Scale (MARS);

4. 4. Schedule for Assessment of Insight (SAI);

5. 5. World Health Organization Quality of Life-BREF Scale (WHOQoL-BREF).

TSQM vII is a self-reporting questionnaire to assess the major dimensions of patients’ satisfaction with their medication, includes 11 items that make up three specific scales (effectiveness, side-effects and convenience).

Twenty patients, between 18 and 65 years of age, were included. an interview was made and the 5 questionnaires were applied. the statistical analysis, using Regression Analysis Stepwise, showed a significant positive correlation between medication adherence, evaluated by MARS, and treatment effectiveness to the patients, evaluated by TSQMvII effectiveness scale (p=0.028). the correlations between the others parameters were not statistically significant.

In this study the authors found that the self-experience of treatment effectiveness, which is a major dimension for treatment satisfaction, had a positive correlation with treatment adherence. Strategies to enhance subjective treatment effectiveness are needed to improve medication adherence.

Abnormalities in event related potentials (ERPs) have long been looked at as markers of disease in Schizophrenia. Over recent years there is a trend in the field to move from averaged trials ERPs analysis in the time-voltage domain, to time-frequency single trials analysis. Oscillations in the Gamma band (30-50Hz) have received particular attention in the context of the theories of core deficits in neuronal synchronization in Schizophrenia. in this study we aimed at replicating previously found Gamma band deficits in a sample of Early Psychosis patients.

EEG was collected from 15 patients and 15 age matched controls using an auditory oddball paradigm. Time-frequency analysis in the Gamma band was performed using a Morlet wavelet transform. We tested differences between the groups using the Wilcoxon rank sum test, given the nonparametric nature of the data, to compare each group's average single trial Gamma power, maximizing the signal-to-noise ratio.

Patients with Early Psychosis showed, following target tones, a reduction in the total power of Gamma band activation (p< 0.01) as well as in induced Gamma band activation (p< 0.01). This was observed in a late latency interval at 400-500ms. the late burst of Gamma activity was not found in the frequent condition, for neither subjects group.

The findings are compatible with previous studies suggesting deficits in the late intrinsically generated cognitive processing of auditory stimuli in Schizophrenia, already present in its early stage. They add further evidence of deficits in neuronal synchronisation in the early stages of psychotic disorders.

To assess the potential factors related to the development of metabolic syndrome (MS) in patients with chronic mental disorders.

Descriptive, cross-sectional study; sample: 140 outpatients with schizophrenia or affective disorders attended for more than 2 years. Dependent variable: metabolic syndrome (Adult Treatment Panel III diagnostic criteria). Independent variables: age, gender, syndromic diagnosis, main treatment, duration of treatment, Global Functioning, type of diet, sedentarism, alcohol consumption, smoking, Primary Care monitoring.

43.6% of patients who had an unhealthy diet showed MS, whereas only 25.6% of those patients that followed healthy food habits met criteria for MS (p< 0.05, chi square; OR=1.23, 95% CI =1.01-1.5). Logistic regression identifies type of diet and GAF scores as the only predictive variables for MS. Bivariant analysis confirms previous data concerning the relationship between age and MS, and shows a negative relationship between alcohol consumption and Body Mass Index, and between alcohol and fasting plasma glucose, particularly among young women.

The lack of a well-balanced dietetic habit appears to be an essential factor in the development of metabolic syndrome. for its prevention, educational programs addressed to patients with severe mental disorders should focus on healthy diet. A sum of effects of age, diet, central adiposity, estrogenic balance and moderate alcohol consumption might argue for the rest of our results.

Suicide is one of the leading causes of death for schizophrenia patients: 9-13% of these patients eventually commit suicide, at least 20-40% make suicide attempts and 1-2% go on to complete in their attempt within the next 12 months. Therefore, suicide in schizophrenia has long been a major area of concern and research efforts. Although neurocognitive deficits are seen as core to schizophrenia, the association between suicidality and neurocognition has received little attention. People with schizophrenia often have impaired working memory and lower IQ. in particular, deficits in long-term memory, working verbal memory, executive functioning, and vigilance have been consistently associated with poor functional outcome in this patient population.

To evaluate the effect of depression in schizophrenia suicidal patients from the point of view of neuropsychological functions.

A clinical sample of 60 patients with schizophrenia was assessed. among them, 30 patients presented a life long history of deliberate self-harm. We performed the assessment of schizophrenia (PANSS, GAS), depression (MADRS), suicidal risk (SIS, BHS), and neuropsychological markers with CogTest battery.

Suicidal behaviour in schizophrenia patients was significantly correlated with negative symptoms (anhedonia) accompanied by poor global functioning and positive symptoms (delusions). Some neuropsychological markers (abstract thinking, reduced capacity to maintain information on-line, working memory, facial emotions discrimination) were significantly correlated with hopelessness.

The most significant neuropsychological dysfunction is represented by working memory impairment which is present in schizophrenia patients with self-harm behaviour even if they have an intact IQ.

To evaluate the efficacy of MGT in treating schizophrenic patients.

7 long-stay male schizophrenic patients took part in the program, which lasted 5 months, 5 sessions of MGT a week. Patients were learning English. Evoked potential N400 was registered at baseline and after MGT in order to evaluate the effectiveness of the therapy. Dynamics of mental state was evaluated with help of PANSS.

During MGT significant changes in motivation, behavior, non-verbal expressions and emotional state of patients were observed. PANSS: negative and positive symptoms became milder, changes are statistically significant. N400 responses of schizophrenic patient do not depend on the congruity of sentence endings. Compared with healthy subjects patients generate N400 with smaller amplitude and larger latency.

Application of MGT can create possibilities for schizophrenic patients for better relationships with the environment, to help them overcome social and emotional isolation. It is very important that activities would be led by the persons who have practical experience to work with schizophrenic patients. MGT may affect patient's response to semantic congruent sentences.

To investigate the effects of quetiapine on auditory information processing by using auditory P300.

We examined 7 patients with schizoaffective disorder, depressive type and 7 age- and sex-matched healthy controls. ERPs were elicited during active auditory “oddball” paradigm. P300 was recorded before and after two weeks of treatment with quetiapine (468.7±143 mg/day).

Baseline P300 latencies were significantly delayed in patients compared with controls. Quetiapine did not change P300 amplitudes. However, it normalized P300 latency. These results suggest that already after two weeks of treatment, quetiapine could have a beneficial effect on the active attention reflected in P300 in patients with schizoaffective disorder. Previous studies with antipsychotic drugs such as olanzapine and risperidone failed to show changes in P300 after this treatment interval.

Quetiapine may be faster than other neuroleptics in ameliorating attentional dysfunction in patients with schizoaffective disorder. However, studies with a larger sample size must be conducted in order to confirm or reject the results of the current study.

The introduction of standardized remission criteria may offer significant opportunities for clinical practice, health services research and clinical trials.

Tardive dyskinesia (TD) is a movement disorder observed in a chronic neuroleptic treatment. Smoking is presumed to increase the prevalence of TD. the question of a cause-effect-relationship between smoking and TD, however, remains to be answered. Purpose of this study was to examine the correlation between the degree of smoking and the severity of TD with respect to differences caused by medication.

We examined 60 patients suffering from schizophrenia and TD. We compared a clozapine-treated group with a group treated with typical neuroleptics. Movement disorders were assessed using the Abnormal-Involuntary-Movement-Scale and the technical device Digital-Image-Processing providing rater independent information on perioral movements.

We found a strong correlation (.80< r< .90, always p< .0001) between degree of smoking and severity of TD. Repeated measurements revealed a positive correlation between changes in cigarette consumption and changes of the severity of TD (p< .0001). Analyses of covariance indicated a significant group-effect with a lower severity of TD in the clozapine-group compared to the typical-neuroleptics-group (p=.010). Interaction-analyses indicated a higher impact of smoking on the severity of TD in the typical-neuroleptics-group compared to the clozapine-group (p=.033) (Diehl et al., 2008).

Concerning a possible cause-effect-relationship between smoking and TD, smoking is more of a general health-hazard than neuroleptic exposure in terms of TD.

In the present study we investigated the correlation between evoked gamma activity and P50 suppression and between induced gamma activity and P300 amplitude on one schizophrenic population. These kind of auditory processing impairments are substantial in schizophrenia.

Thirty-one patients with schizophrenia and twenty-one controls were involved. Electroencephalogram was recorded with 19 Zn electrodes, which were placed according to the international 10-20 system.

P50 suppression was significantly reduced in schizophrenic patients (F(1,53)=9.89, p=0.03). There was a not significant reduction in the early evoked gamma response. Furthermore, we found no correlation between P50 amplitudes and gamma amplitude for the first stimulus in neither groups, while there was a significant correlation for the second click in the control group (R=0.43, p=0.03 for controls, R=0.18, p=0.30 for patients). the amplitude of the P300 auditory evoked potential was significantly reduced at Pz electrode in schizophrenic patients (F(1,53)=11.91, p=0.01). Induced gamma response around the peak P300 latency was diminished in the patient group (F(1,53)=11.12, p=0.002). There was no correlation between P300 amplitudes and gamma amplitude in neither group.

According to our results evoked and induced gamma activity is differentially affected in schizophrenia during auditory information processing. the absence of late induced gamma response during target stimulus detection among patients might reflect abnormal functional connectivity between different cortical areas, and result in inefficient integration and utilization of sensory stimuli.

Traumatic brain injury (TBI) cause a wide range of serious consequences, including psychiatric disorders. Psychosis although uncommon is a very serious consequences with important functional, therapeutical and legal implications.

Our work is based on a systemic review of the articles published related to TBI and psychosis.

Three different features about TBI and their relation with the development of psychotic symptoms are analyzed.

1. 1. Severity: Serious TBI are more related to psychosis. Moderate and minor TBI can develop mental disorders is there is a previous neurological lesions.

2. 2. Localization: Temporal lobe appears affected in most of the patients.

3. 3. Lateralization: Left hemisphere is usually affected.

Left hemisphere traumas appear to cause schizophrenia-like psychosis. Right hemisphere traumas are related to delirious and special types of psychosis.