Clinical trials (CT) are the main scientific support of the recommendations of pharmacological treatment of patients with schizophrenia. However, CT tend to strengthen the internal validity at the expense of external validity and the ability to generalize the results to the clinical population. For this reason, in recent years have developed large practical clinical trials that expand the inclusion criteria to incorporate as many real patients as possible. The first and most significant of these trials was the CATIE study (Lieberman et al, 2005).

To analyze eligibility for participation in CATIE of patients admitted during 2009 in a psychiatric inpatient unit with a diagnosis of schizophrenia.

A total of 145 patients (27.6% females, mean age 39.6+/−12.8 years), consecutively admitted to an inpatient psychiatric ward with a clinical diagnosis of schizophrenia were assessed to test if they would fulfill criteria for participation in CATIE.

60 (41.4%) patients did not fulfill CATIE inclusion criteria. Mental retardation (n = 22, p < 0.001), absence of informed consent (n = 15, p < 0.001) and refusal to take oral medication (n = 12, p < 0.001) were the main factors responsible for not meeting inclusion criteria.

Meeting the criteria was not significantly related to gender or specific diagnosis.

41.4% of patients admitted to a psychiatric inpatient unit with a diagnosis of schizophrenia did not meet criteria for participation in the CATIE study.

Pharmacological treatment of patients with schizophrenia and other psychoses get scientific backing of its main clinical trials. Methodological guarantees these test tend to strengthen the internal validity of the results at the expense of external validity and the ability to generalize the results to the clinical population. For this reason, and to minimize the shortcomings of external validity while maintaining internal validity, has been promoted in recent years to carry out large clinical trials based on clinical practice. This type of test expands the criteria for inclusion, limiting the exclusion criteria to incorporate as many patients as possible. The first and most significant of these trials was the CATIE trial (Lieberman et al, 2005).

Discuss eligibility patients admitted during the year 2009 in a psychiatric inpatient unit with a diagnosis of schizophrenia for participation in CATIE.

A total of 145 patients (27.6% females, mean age 39.6+/−12.8 years), consecutively admitted to an inpatient psychiatric ward with a clinical diagnosis of schizophrenia or other psychoses were assessed to test if they would fulfill criteria for participation in CATIE.

60 (41.4%) patients did not fulfill CATIE inclusion criteria. Mental retardation (n = 22, p < 0.001), absence of consent (n = 15, p < 0.001) and refusal to take oral medication (n = 12, p < 0.001) were the main factors responsible for not meeting criteria. Meeting the criteria was not significantly related to gender or specific diagnosis.

The 41.38% of patients did not meet criteria for participation in the CATIE study.

We decided to examine the employment status of all patients with Schizophrenia actively treated by the Bedford East CMHT and compare this to the employment status of all those in the team who suffered from Bipolar Affective Disorder.

Cases of Schizophrenia and Bipolar Disorder were anonymously identified from a database held by the team and their employment status was established.

124 patients were identified with schizophrenia, 24 with Schizoaffective disorder, and 60 with Bipolar Disorder.

Of the Schizophrenia patients, 91 (73.38%) were unemployed, 15(12%) were employed, 10 (8%) were in voluntary employment and 8 (6.45%) were labelled ‘other’ [housewife, student etc].

Of the Bipolar patients, 32 (53.33%) were unemployed, 14(23%) were employed, 5 (8.3%) were in voluntary employment and 9 (15%) were labelled ‘other’

Of the Schizoaffective patients, 15 (62.5%) were unemployed, 4 (16.66%) were employed, 2 (8.33%) were in voluntary employment and 3 (12.5%) were labelled ‘other’.

Employment Outcomes for serious mental illness were poor, however Schizophrenia patients had a lower chance of returning to employment, partly due to the heterogeneity of the condition. Bipolar patients had twice the chance of gainful employment as Schizophrenic ones.

It is particularly difficult to achieve employment for patients with serious mental illness. This adds to the recently made argument for a more assertive approach by the creation of ad hoc chronic psychosis teams who could give ongoing support to aid patients to return to social inclusion and possibly work.

The authors present a comprehensive-efficacy of pharmacotherapy and rehabilitation in the social house for people with mental health disorders carried out systematically for many years in the 40 year old patient.

Patient 40 years old, male, secondary education, imposed a total inability to work. The first episode of the disease was in his 25 years, a syndrome of depression in a moderate degree, the next episode of schizophrenia-catatonic. In the therapy was used first generation antipsychotics, despite regular medication had not obtained complete remission and frequent exacerbations were the cause of several subsequent hospitalizations. During the last hospitalization in 1997, recognizing the diagnosis was verified with paranoid schizophrenia. After discharge, the patient in accordance with the recommendation began rehabilitation in the social house for people with mental health disorders, which still continue. Because of side effects after the previously used antipsychotic drugs second-generation - ziprasidone was incorporated in 2005. The use of this drug caused a significant decrease in body weight, increased social activity (a return to artistic activities - painting), improving the quality of life. Due to persistent chronic anxiety has been further adjustment of treatment in 2008 included amisulpride and valproate.

The treatment used a comprehensive, full remission of symptoms generation, and a significant reduction in negative symptoms. Currently, the patient actively participates in all activities organized in the environmental treatment of self-help home, living independently in daily activities, carry out the artistic passion of winning prizes at exhibitions and presentations of work.

Patients with mental disease are not in touch with their emotions, they do not recognize them and are incapable of finding alternative ways to face life difficulties.

Consequently, anxiety which evolves from stressful situations literally immobilizes them.

Our aim was to isolate the factors which create stressful situations that lead patients in relapsing.

We studied patients’ inability to cope with their emotions and the stress that follows. We studied 25 patients living in the R.U. “Eurikleia”, 30 patients in follow-up and 50 patients who were hospitalized in the 3rd Psychiatric Department of the Psychiatric Hospital of Athens.

Our therapeutic procedure was the following:

• prescription of atypical anti-psychotics

• completion of the MMPI

• examination of family/personal history

• examination of family dynamics/dysfunctions

• individualized therapeutic intervention for each patient and family evaluation of the results one year later.

Our intervention comprised of family therapy, setting family roles boundaries, patients’ autonomy, agreement in interventions between family and the therapeutic group and patients’ encouragement to take initiatives concerning their personal life.

1. Ø the functionality of the patients had improved

2. Ø there was an important restoration of their sociability

3. Ø there were still deficits regarding their socialization and professional rehabilitation

4. Ø there was improvement regarding their autonomy

5. Ø their dependence had been substituted for interdependence.

Through this study the most obvious conclusion we reached at was the necessity of patients’ and their families’ re-education in order to be able to live a meaningful life.

1. - CISS Coping Inventory for Stressful Situations

2. - Questionnaire of Stressful Events

3. - BSSS Berlin Social Support Scales

4. - PANSS

The prevalence of Human Herpesvirus 8 (HHV8) has never been investigated in schizophrenic patients.

This study aimed to assess the prevalence of HHV8 serum antibodies in schizophrenic patients and in healthy controls.

During a 24 months period, we consecutively enrolled 108 patients meeting DSM-IV criteria of schizophrenia, in psychiatry department of Sousse Farhat Hached hospital (Tunisia). We also enrolled 108 controls among consenting blood donors. They were age and sex matched and free from any psychotic disorder as screened by MINI-Plus.

Psychopathology and severity were measured using PANSS, BPRS, SANS, SAPS and CGI. Sera samples were obtained from patients and controls and then analyzed for the presence of anti-HHV8 antibodies (anti-HHV8) using a sensitive indirect immunofluorescence assay to latent and lytic HHV8 antigens.

A significantly higher prevalence of anti-HHV8 in schizophrenic patients than in healthy controls was found (28.7% vs. 14.8%, p = 0.01). Marital status, educational level, professional activity, poverty, promiscuity, number of children, sexual behavior or presence of risk factors of blood transmission were not associated with HHV8 prevalence (p > 0.05). However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms (SAPS score) (p = 0.01) and the severity of illness (CGI score) (p = 0.02).

To our knowledge, this would be the first report of high HHV8 prevalence in schizophrenic patients, which support the role of this virus in the pathogenesis of schizophrenia. To go on further with this hypothesis, more investigations of HHV8 in schizophrenia are needed.

Sexual dysfunction is reported by up to 80% of schizophrenic patients and seems to be mainly associated with antipsychotic medications.

This study aimed to compare sexual functioning and sexual dysfunction, as assessed by the Arizona Sexual Experience Scale, in drug naïve or drug free schizophrenic patients and in healthy controls.

A consecutive sample of 109 patients meeting DSM-IV criteria of schizophrenia was constituted in psychiatry department of Sousse Farhat Hached hospital (Tunisia), during a 24 months period. They were drug naïve or drug free for at least three months. 109 age and gender matched, consenting controls were recruited among blood donors attending Farhat Hached hospital during the same period. They were free from psychotic disorders as screened by MINI-Plus. Sexual functioning was assessed using the Arizona Sexual Experience Scale (ASEX) in sexually active patients (N = 84) and controls (N = 94).

There were no statistical differences in sexual dysfunction rates between schizophrenic patients (20.6%) and healthy controls (13.1%), according to usual threshold values. Also, global ASEX score was similar in schizophrenic patients (12.93 ± 4.48) as in healthy controls (12.61 ± 2.60). Besides, different ASEX item scores including sex drive, arousal, vaginal lubrification/penile erection and orgasm have not shown any differences between patients and controls. Only sexual satisfaction score was higher in schizophrenic patients than in healthy controls (2.73 ± 0.95 vs. 2.43 ± 0.77; p = 0.02).

Our results showed a low rate of sexual dysfunction in drug free schizophrenic patients without statistical differences with healthy controls. Only sexual satisfaction was lower in schizophrenic patients.

Sexual activity and marital status have received little attention as an important aspect of schizophrenic patients’ care.

This study aimed to compare sexual activity, including sexual intercourses with a partner and masturbation, and marital relationships in patients with schizophrenia and in healthy controls.

A consecutive sample of 109 patients meeting DSM-IV criteria of schizophrenia was constituted in psychiatry department of Farhat Hached hospital (Sousse, Tunisia), during a 24 months period. They were drug naïve or drug free for at least three months. 109 age and gender matched, consenting controls were recruited among blood donors. They were free from psychotic disorders as screened by MINI-PLUS. Sexual activity assessment involved sexual intercourses with a partner and masturbation.

Patients with schizophrenia were less often married than healthy controls (18.3% vs. 54.1%; p < 10-3). Also, they had less often a sexual partner (42.2% vs. 70.8%; p < 10-3) than healthy controls. They reported similar rates of sexual activity (77.1% vs. 86.2%), but less regular sexual intercourses (11.1% vs. 48.1%; p < 10-3) than healthy controls. Also, they reported higher rate (59.6% vs. 24.8%; p < 10-3) and higher prevalence during the last month (9.7 ± 9 vs. 5.04 ± 8; p = 0.017) of masturbatory activity.

In spite of lower prevalence of marital relationships, schizophrenic patients reported as frequent sexual activity as healthy controls. This sexual activity seems to be related to higher prevalence of masturbatory activity, which may be explained by their difficulties to be involved in relationship with a sexual partner.

High prevalence of impaired sexual function in patients with schizophrenia has been reported by several studies. Various factors were incriminated including the disease itself, the low level of social competence and treatmentside effects.

To compare sexual function in drug free schizophrenic patients and six months after initializing antipsychotic treatment.

A consecutive sample of 109 patients meeting DSM-IV criteria of schizophrenia was constituted in psychiatry department of Farhat Hached hospital (Sousse, Tunisia), during a twenty four months period. They were drug naïve or drug free for at least three months. Assessment was performed at two time points:

T0: During an acute phase of the disease as defined by a BPRS global score ≥ 40 T1: six months after antipsychotic treatment.

Assessment of sexual function used the Arizona Sexual Experience Scale (ASEX).

Sexual function was impaired under antipsychotic treatment. In fact, we noticed lower global score of asex (p = 0.03) and lower subscores of drive (p = 0.015), arousal (p = 0.006), erection or vaginal lubrication (p= 0.010), orgasm (p= 0.001) and satisfaction (p= 0.005).

Sexual function was impaired in patients under antipsychotic drugs, according to global score and to diffrent sexual dimensions subscores. This results seem to, prospectively, confirm the implication of treatment in sexual dysfunction occurence among schizophrenic patients.

The well-established relationship between childhood adversity and psychosis is likely to involve other factors such as genetic variants, which could help to understand why not everyone exposed to adverse events develops psychotic symptoms later in life (Van Winkel, et al. 2008; Simmons et al. 2009).

The present study investigated the influence of childhood abuse and neglect on positive and negative psychosis-like experiences in adulthood and the potential moderating effect of the BDNF-Val66Met polymorphism.

Psychosis-like experiences and childhood adversity were assessed in 533 individuals from the general population.

Childhood abuse showed a strong independent effect on the positive dimension of psychosis-like experiences (B = .16; SE = .05; p = .002). Furthermore, this association was moderated by the BDNF-Val66Met polymorphism (B = .17; SE = .09; p = .004).

Individuals exposed to childhood abuse are more likely to report positive psychosis-like experiences. Met carriers reported more positive psychosis-like experiences when exposed to childhood abuse than did individuals carrying the Val/Val genotype.

Therefore, the observed gene-environment interaction effect may be partially responsible for individual variation in response to childhood abuse.

Different studies have confirmed the association between cannabis use and psychosis and, also, the relationship between age at first cannabis use and age at onset of psychosis (Henquet et al 2005, Barnes et al 2006). In a young psychiatric sample, we aimed to investigate the correlation between cannabis use and the age at onset of psychotic and non-psychotic symptoms and whether this relationship is modulated by the genetic variability at COMT, CNR1 and CHRNA7genes.

The sample comprised 157 Caucasian patients (mean age: 17.01 (3.6)) diagnosed following DSM-IV-TR criteria: 80 patients with schizophrenia-spectrum disorders, 77 patients with affective or conduct disorders. Cannabis use was assessed with UNICA-A and DIGS scales (Nurnberger 1994) and 49% individuals were classified as consumers. SNPs were genotyped using Taqman 5′-exonuclease assays.

We observed a positive relationship between age at first cannabis use and age at onset in, both, schizophrenia-spectrum (β = 1.44 p < 0.001) and other psychiatric disorders (β = 0.56 p < 0.002). An interaction was observed between COMT Val158Met polymorphism and cannabis use specifically within schizophrenia-spectrum disorders’ group (β = −2.72 p = 0.04), with Val/Val genotype carriers showing an earlier age of onset than Val/Met carriers, and these, lower than the Met/Met carriers. No modulation effect of CNR1 or CHRNA7 polymorphisms was observed.

Our results seem to indicate the importance of maturation timing and brain development in which exposition to cannabis occurs. We provide new evidence about the COMT modulation effect on the association between cannabis use and age at onset of symptoms, specifically in individuals affected by schizophrenia-spectrum disorders.

An important corpus of scientist evidence is linking psychotic activity and anxiety-related processes (Freeman and Garety, 2003).

We intended to assess differences in Anxiety Sensitivity dimensions between patients diagnosed by psychosis with and without positive symptoms.

Participants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 24 patients had positive symptomatology.

Design, materials and procedure: A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.

We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandîn et al, 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.

Patients with positive symptoms showed a higher sensitivity to cognitive (z = -3.22, p < 0.01) and social anxiety (z = -2.66, p < 0.01), as well as higher punctuations in ASI-total (z = -2.91, p < 0.01), than patients without positive symptoms.

Patients with positive symptoms show significant fears of symptoms of different anxious domains (ASI-total) with regard to patients without this kind of symptomatology. Specially, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive) and about social reactions before their own publicly observable anxiety manifestations (ASI-social).

Cognitive deficits in patients with psychotic disorders have been described both in literature and clinical practice.

Analysis of the cognitive deficits in patients with psychotic disorders.

Observation of 8 subjects performance on the Wechsler Memory Scale (WMS) and Raven's Standard Progressive Matrices (SPM), by the consultation of their psychological assessment clinical files. Subjects are aged between 20 and 29 years old and diagnosed with schizophrenia or other psychotic disorder.

The analysis of the performance on the psychological tests indicated significant differences in the areas of remote memory, attention, calculation, immediate verbal memory, visual memory and non verbal reasoning. No significant differences in the areas of spatial and temporal orientation were observed.

This study confirms the presence of neuropsychological deficits in several areas of memory and non verbal reasoning ability of young patients with psychotic disorders. Neuropsychological rehabilitation is a key area of intervention in such disorders, considering the young age of these patients and the impact that these alterations can have on their social, educational and professional prospects.

The International Diabetes Federation (IDF)(2004) has defined criteria for metabolic syndrome and in patients with schizophrenia four of ten meet the criteria for having the syndrome. Its important too study more about the influence of metabolic syndrome because there association with high morbidity and increased risk of influence on patients health and the treatment itself The aim of the study was to investigate metabolic risk factors influence on quality of life. The method was a prospective cohort study from specialized psychiatric outpatients departments in Sweden. The study recruits consecutively patients diagnosed with schizophrenia and other long-term psychotic disorders (ICD10). A prospective population based study is serving as a control group. Patients are assessed with a psychiatric questionnaire witch included CGI and GAF. Health-related quality of life assessed using the questionnaire EQ5D both in patients and population and health status with BMI, smoke habits and alcohol consume.

The results on patients (n = 777) and population (n = 7238) showed significant differences in lower EQ5D Index in man especially in younger age. The diagnosis of schizophrenia and schizoaffective were the most common in the patient group (n = 481). In patients was nearly 50% non alcoholic users compared to the control group (=population) were the non consumers was 18%. BMI over 35 were more common in the patient group than in the population 13.2% versus 2.8%.

In conclusion there were differences in quality of life between metabolic risk patients with psychosis and the control group.

Attitude towards medication has been associated with compliance, but different variables have been associated with them.

Assess relationship between attitude towards medication and compliance, and to evaluate variables related to treatment associated with them.

Non-interventional, multicentre, cross-sectional study. Outpatients with stable schizophrenia (according to clinical criteria) who had the last acute episode at least 2 months before were included.

941 patients recruited were included in the study, 931 patients were included in the statistical analysis.

Mean score on DAI was 4.2 and in its subscales: 1.6 on general attitude 2.8 on subjective effect 2.8. Mean score on compliance (a component of David's scale of insight), with range from 0 to 4, was: 3.0.

There were statistically significant (p < 0.0001) correlations between this subscale of David's insight scale and total DAI score (r = 0.495), with general attitude (r = 0.480) and with subjective effect (r = 0.419).

Variables related to medication with association statistically (p < 0.005) with DAI (total score and both subscales) were: length of treatment with current antipsychotic, number of total adverse events (AEs), moderate AEs, severe AEs, and total severity of adverse events (sum of severity of each one). All of them, except number of severe AEs, had statistically significant relationship (p < 0.05) with compliance.

Variables related to attitude towards medication (DAI total and both subscale) were very similar to those related to compliance (construct of David's insight scale). Adverse events and length of antipsychotic treatment had a clear clinical relevance. Study sponsored by AstraZeneca Spain, S.A.