A specific interest regarding quality of life(QoL) of patients with schizophrenia dates back to the de-institutionalisation process. Italy worked on decentralising its mental health services since 1978. It was apparent that capturing psychopathological symptoms alone was not sufficient to reflect relevant outcomes. In particular, information on the social functioning and quality of life is regarded as essential for evaluating long-term outcomes.

The relationship between Quality of life and global functioning and symptoms in outpatients with Schizophrenia.

In the present study we examined all the subjects with a diagnosis of schizophrenia attending a same Community Mental Health Centre in Northern Italy, in 2008. Each patient completed the WHO QoL Instrument - Brief and was administerd the Brief Psychiatric Rating Scale-24 to assess psychiatric symptoms and the VADO Personal and social Functioning Scale to assess the level of functioning.

The population studied subjects showed an intermediate satisfaction on the overall QoL and health; these data can be juxtaposed to the national standard sample rates. QoL resulted positively associated to personal and social functioning, while it was negatively related to psychiatric symptoms.

The QoL in our study is not extremely negative, though schizophrenia is an often an impairing chronic illness. Furthermore, the present research on social functioning, psychiatric symptoms and QoL in people with schizophrenia suggest that symptoms, but, above all, personal and social functioning are important elements to determine QoL. These studies point to the importance of looking beyond symptom-reduction strategies for improving QoL in schizophrenia.

It is well stablished that therapeutic compliance is a fundamental predictive factor in the outcome of first-episode psychosis. Risperidone long-acting injection has demonstrated high remission rates and improvements in treatment adherence.

1. 1- To analyse the efficacy of risperidone long-acting injection vs oral atypical antipsychotics in first-episode psychosis.

2. 2- To describe in both groups the evolution of clinical and cognitive symptoms, functional outcome, quality of life, insight and treatment adherence.

18 patients with a first-episode psychosis treated with long-acting risperidone were compared with 21 first-episode psychosis treated with oral atypical antipsychotic medication. They were matched one on one for age, gender and years of education. All subjects were compared regarding psychopathology and functional outcome terms. Patients were examined with Positive and Negative Syndrome Scale (PANSS) for clinical symptoms. Longitudinal functionality was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales.

We found significant differences between both groups in negative symptom severity and global assessment of functioning. There was no statistically significant difference between the two groups in PANSS positive and general components. Negative symptom severity was associated with poorer GAF ratings.

Our data suggest that risperidone long-acting injection assures treatment compliance and therefore could improve clinical and functional outcome.

Metabolic syndrome is a frequent, severe, undiagnosed physical comorbidity in patients with severe mental disorders.

To develop a predictive model of metabolic syndrome for patients with schizophrenic or bipolar disorders, useful for both clinical practice and research.

Naturalistic, one-year follow-up study conducted in Asturias, Spain. A total of 172 patients with schizophrenic (Sch-P) or bipolar (BD-P) disorders (ICD-10 criteria), under maintenance treatment, who gave written informed consent were included. Metabolic syndrome was defined according to the modified NCEP ATP-III criteria. Multivariate Adaptive Regression Splines (MARS), Genetic Algorithms (GA), and Support Vector Machine (SVM) analysis were performed.

Starting from a large set of demographic and clinical variables, and by means of intermediate MARS and GA models, an SVM model able to classify if a patient with schizophrenia or bipolar disorder suffers from metabolic syndrome with an accuracy of 98.68% (sensitivity 100%, specifity 94.4%) was obtained. The final model only needs 6 variables: Sch-P:

1. (1) Low HDL-cholesterol,

2. (2) Fasting glucose level,

3. (3) Family history of obesity,

4. (4) Triglyceride level,

5. (5) Family history of dyslipidemia, and

6. (6) Use of antidepressants; BD-P: (1), (2), (3),

7. (7) Use of lipid-lowering medication,

8. (8) Use of antipsychotics, and

9. (9) Use of mood stabilizers.

We developed a simple and easy to use predictive model to identify metabolic syndrome in patients with schizophrenic or bipolar disorders.

Van Os et al. (2009) have proposed a Proneness-Persistence-lmpairment model to explain the psychosis continuum, and cognitive models of psychosis have suggested that appraisals of anomalous experiences may be key in determining ‘need for care’.

The present study investigated the interaction between appraisals and safety behaviours in the maintenance of impairing psychotic symptoms.

It was predicted that individuals with psychotic symptoms without a need for care would display fewer threat appraisals and safety behaviours than their clinical counterparts, and that these variables would predict distress.

The study recruited people with persistent psychotic experiences but who had no-need-for-care (Persistence group; n = 39) and individuals diagnosed with a psychotic disorder who were receiving current treatment (Impairment group; n = 28). The participants were assessed on semi-structured interviews of appraisals and safety behaviours in relation to their psychotic experiences and on anxiety and depression questionnaires.

Both groups had similar levels of psychotic symptoms in the last month, including first rank symptoms. However there was a large significant difference between Impairment and Persistence groups in threat appraisals and safety behaviours, with the Persistence group reporting higher levels of both. A mediation analysis found that threat appraisals mediated the relationship between safety behaviours and anomaly-related distress, suggesting that threat appraisals may maintain anomaly-related distress, a defining feature of Impairment status.

These data provide support for the cognitive model of psychosis, with threat appraisals potentially playing a major role in the transition from non-clinical anomalous experiences to clinical psychotic status.

Schizophrenia is a human specific disease, unknown in other primates. Low adiposity during childhood was associated with a greater risk of developing schizophrenia, but this disease has a higher incidence in the obese children and adults, too.

We developed a new hypothesis on the human evolution. According to it, changes in the activity of the IGF1 (insulin-like growth factor1)/insulin pathway (altered in human pathological conditions such as the psychiatric disorders) could be responsible for the appearance of certain specific human traits.

This hypothesis predicts that schizophrenia should result from a deviation of the normal IGF1/insulin signaling in brain in both directions. A drug that increases insulin resistance should improve the condition in the slim patients and worsen them in the obese patients.

A multi-center double-blind study on palmitate paliperidone (pp), the major active metabolite of the antipsychotic risperidone (that increases insulin resistance and stimulates weight gain), was conducted. 25–150 mg eq pp was injected intramuscular (into the deltoid muscle or the gluteal muscle) at 1 week interval for 1 year in a double blind study in patients with acute symptoms.

Our preliminary observations based on the Positive and Negative Syndrome Scale (PANSS) total scores showed that the slim patients had statistically the best response to pp and the worse effects were observed in the obese patients. The study is still ongoing.

These results suggest that schizophrenia is a polarized disease with 2 major phenotypes- one with either insulin sensitivity or obesity and insulin resistance.

Pathways to care and duration of untreated psychosis (DUP) strongly influence the long-term outcome of schizophrenia.

To investigate pathways to care, duration of untreated psychosis (DUP) and treatments received by a sample of individuals aged between 18 and 35 years meeting diagnostic criteria for psychosis.

Pathways to care and DUP were explored by an “ad-hoc” schedule administered to patients and caregivers.

The sample consists of 30 patients. The first episode of psychosis, which occurred at 19.7 (± 4.7) years, was characterized by negative symptoms and disorganized behaviours in more than half of the sample, suicide attempts (28%) and hospital admissions (26%). DUP was 41.6 ± 60.4 weeks, being longer than that reported in international literature. In 76% of cases patients’ relatives asked for a first contact with health professionals, referring the patients to psychiatrists (34% of cases), general practitioners (31%), neurologists (21%) or psychologists (13%). When professionals other than psychiatrists were contacted, the interval between the contact and receipt of appropriate psychiatric treatment (according to the current guidelines) was particularly long (15.2 ± 32.1 weeks). 34% of patients were treated with a monotherapy of psychotropic drugs: 24% with antipsychotics, 7% with anxiolytics and 3% with antidepressants; 48% received a poly-pharmacotherapy. 35% were treated with psychotherapy (in most of the cases cognitive-behavioural therapy), which was the only treatment for 18% of patients.

These results emphasize the need to train health professionals on diagnosis and treatment of first episode psychosis. DUP may be reduced by anti-stigma campaigns among general population.

Correction of the syndrome of hyperprolactinemia is very important problem of psychopharmacotherapy.

Comparative assessment of efficacy by bromocriptin and cabergolin action in syndrome of hyperprolactinemia in patients with schizophrenia and schizoaffective disorder.

120 female patients with diagnosis of schizophrenia (86) and schizoaffective disorder (34) were treated for a long period with risperidon; all of them suffered of hyperprolactinemia. Bromocriptin and cabergolin were used for the treatment of hyperprolactinemia. All patients were separated for 2 groups: patients of the 1st group (n = 64) were treated with bromocriptin (5 mg daily/2 months), patients of the 2nd group (n = 56) - with cabergolin (5 mg weekly/2 months). The level of prolactin was estimated in blood serum using immunoenzyme method.

In the 1st group 48 patients (75%) were responders: prolactin level decreased from 1997 ± 504 m ME/I to 1125 ± 293 m ME/I (p ≤ 0.05) and in 16 (25%) nonresponders prolactin level did not change - 2165 ± 606 m ME/I before and 2190 ± 441 m ME/I after the treatment (p ≥ 0.05). In the 2nd group 48 patients were responders (85.7%) and serum prolactin level was reduced in the range of 30-75% from 2294 ± 634 mME/l to 1109 ± 240 mME/l (p ≤ 0.05). In the nonresponders (8 patients; 14.3%) changes of serum prolactin were insignificant (2514 ± 578 mME/l/ before and 2084 ± 451 mME/l after the therapy; p ≥ 0.05).

Investigation has shown a high level of efficiency of cabergolin (dostinex) and bromocriptin in correction of hyperprolactinemia.

Several studies have shown that patients with schizophrenia have impaired performance in various aspects of social cognition including emotion processing and theory of mind. Most available neuroimaging studies have compared patients and healthy controls during such mental.

To determine whether alterations in brain activation associated with social cognition reflects a heritable trait in schizophrenia.

Sixteen patients with schizophrenia (age 31.3 ± 6.5), 16 non-psychotic siblings (age 31.8 ± 3.5, 6 females) and 16 healthy subjects (age 30.1 ± 9.2, 6 females) underwent BOLD fMRI during emotion processing (Ekman Faces Test) and Theory of Mind (ToM) paradigms: Faces and Reading the Mind in the Eyes tasks. In all cases a gender condition was used as a control task. Random effects analysis was done for each task within groups, measuring signal changes between the target and control conditions of each paradigm, and later a group analysis was done.

In patients, social cognition tasks brought about activations in language areas (left inferior frontal gyrus and structures near tempo parietal junction). The intensity of the activations was minimum in the emotional processing task (basic emotions), and maximum in the detection of complex mental states in eyes. Healthy controls also activated symmetric brain structures on the right side. Unaffected siblings also showed bilateral activation in the same brain structures but asymmetrically distributed (left > right).

These results support the idea that schizophrenia is an illness characterized by abnormalities in the process of brain lateralization.

Patients with schizophrenia show deficits in many cognitive domains and social functioning, social skills, and self management skills in their daily life activities.

To evaluate the relationship between general-social cognition, mental state and social functioning, and impact on quality of life.

Twenty patients with chronic disorder of schizophrenia were evaluated and compared with 20 siblings and 20 healthy controls regarding performance in a series of tests: Cognitive Screening: Word Accentuation Test, MCCB (Matrics Consensus Cognitive Battery) Social Functioning: UPSA (University of California Performance Skills Assessment), TABS (Test of Adaptive Behaviour in Schizophrenia), SSPA (Social Skills Performance Assessment), Beck and Hamilton depression scales, Scale for Positive and Negative Syndrome of Schizophrenia, and SF-36 as indicator of quality of life.

Patients showed significant differences from controls and siblings in MCCB total score (p < 0.001), whereas siblings showed significant differences compared to controls in MCCB total score (p = 0.053). Siblings performed differently from patients (p < 0.001) and controls (p = 0.019) in social functioning measured with TABS. A series of correlations between general cognition and social functioning were demonstrated for patients and their unaffected siblings (not shown).

Results suggest that the performance of nonpsychotic siblings is located between patients and healthy controls, suggesting that social performance measures are (or associated with) intermediate phenotypes of the disease. General and social cognition have a complex relationship with social functioning and quality of life.

Patients with schizophrenia show a deficit in emotion recognition through facial expression and the low sense of familiarity may be a factor involved. However, the emotion facial expression in families of patients could be disturbed and be another factor related to the deficit in emotion recognition and in sense of familiarity in schizophrenia.

To assess the emotion facial expression in a sample of 21 families of patients with schizophrenia and families of healthy controls.

22 healthy volunteers, all of them professionals of mental health, were assessed with the Ekman Test of emotion recognition in unfamiliar people which was photographed by expressing the 6 Ekman’s basic emotions. The task was composed of 42 pictures, half of them from families of patients and the other half from families of healthy control.

Volunteers recognize worse emotions in relatives of patients than in relatives of control group and this difference was statistically significant (Wilcoxon W = -4.13; p = .001). The average of pictures correctly recognized from families of patients was lower than pictures from families of control group (54.28% vs. 82%).

The emotion facial expression in families of patients with schizophrenia seems worse than in families of healthy controls. It could be a factor involved in face emotion recognition deficit in schizophrenia.

Structural and functional deviations in schizophrenic patients with formal thought disorder (FTD) point towards a dysfunction within left sided language network.

Independent component analysis (ICA), a new approach to fMRI analysis, enables to target the question of a network dysfunction directly. Using this method in healthy controls it was possible to identify the language networks separately for the left and the right hemispheres In the present study we use ICA analysis to examine changes of the language network separate for each hemisphere in relation to the severity of FTD.

We hypothesize increasing disintegration with increasing severity of FTD only in the left sided language network while the right language network should remain unaffected.

We investigated 16 schizophrenic patients with different severity of FTD and matched healthy controls using ICA decomposition of the BOLD signal. The spatial similarity of the individual language networks was correlated to the severity of FTD.

The integrity of the left language network decrease with increasing severity of FTD (r = -0.79, p < 0.01), while the integrity of the right language network show no significant correlation to the severity of FTD.

For the first time the isolated breakdown of the left sided language network was linked specifically to schizophrenic FTD. This result unites older manly left hemispheric findings of structural and functional abnormalities in schizophrenic FTD.

Schizophrenia is a disorder, which has the most regression in behavioural, occupational and psychiatry aspects, and it is also important for this patients. the main purpose of this study is to evaluate. The quality of life and global function of schizophrenia patients.

100 schizophrenia patients (with DSM-IV-TR) who had a history of at least 10 years from the beginning of the disorder were collected. Demographic characteristics, type of schizophrenia, living condition and the quality of life scale (QLS) including interpersonal relationship instrumental role, intra psychic foundation and common objects and activities, were filled. Patients’ general functions were evaluated with GAF.

In this study 67% were men and 51% were women. They were residual (55%), Paranoid (11%)and undifferentiated (33%) schizophrenia. They lived in institute (67%) and with their families (28%). The significant association were found to be between married and singles patients in instrumental role (F, 2, 97), P > ./.5) but there weren’t found any association in other domains also the significant. Correlation were found between undifferentiated and paranoid patients in interpersonal relationship (F, 2, 97), P > ./.5).but there weren’t any correlation in intrapsychic foundation and common objects and activities domains. Also there were significant association in GAF (F, 3, 98), P > ./.5)between uneducated and educated participants. The Mean of five domains and genders didn’t have any association together.

Schizophrenia patients’ quality of life is low. which showed the value and reliability of Global Assessment Functioning that usually used for every psychiatrics’ patients for V axis clinical diagnosis and indicated the clinical value of this scale.

Besides psychopathological outcome, the outcome in terms of social functioning is of great importance in first-episode psychosis. This paper has analyzed three components of social functioning: instructional level, professional and marital status.

The objective of this paper is to analyze the social functioning after two years of evolution in a sample of subjects with a first-episode psychosis.

The aim is to determine the way in which the presence of affective elements can influence social functioning in a first-episode psychosis.

43 subjects with a first-episode psychosis have been divided into 2 samples, according to the existence of (sample A) / the absence of (sample B) affective symptoms (depressive or manic). We have to mention that the affective elements have not fulfilled the ICD 10 criteria for an affective episode. These two samples have been analyzed at onset and after two years of evolution, according to the following parameters: instructional level, professional and marital status.

We have noticed that there were changes only regarding the professional status and instructional level. After 2 years of evolution, the number of employed subjects was higher in sample A, compared to sample B. All of the subjects in sample A, which were students during their first episode of psychosis, have managed to finish their studies. Family status was not modified in any sample.

The existence of affective elements in a first-episode psychosis has an influence only regarding the professional status.

Spatial notions’ peculiarities specific to individuals who suffer from schizophrenic spectrum disorders of the different degree of intensity.

Schizophrenia (ICD-10, F20) (30 individuals), schizotypal disorder (F21) (30) and conditionally healthy (60). Exception criteria: organic affection lesions CNS, epilepsy (G40), mental retardation (F70-F79). The experimental base: Moscow mental hospital №13.

To analyze and to describe spatial notions’ peculiarities specific to individuals who suffer from schizophrenic spectrum disorders (sexual differences are taken into consideration).

The following groups of methods were used to achieve the aim of research: methods intended for “direct” space perception research; projective and reflexive techniques; methods intended for the thought peculiarities research.

Blatant violations of the spatial perception were found in experimental group. Sexual differences were defined: more abstract and nonstandard decisions are specific for men, more concrete and fragmentary - women.

It should be noted that errors amount wasn’t rising in the experimental group with the complication of the tasks.

Blatant violations of the spatial perception include emasculation, image distortion, perseveration, notion agglutination, decision paradoxicality, ambivalence etc. These violations are classified as the peculiarity of the negative psychopathological manifestations of thought and perception specific to the schizophrenia.

In some case, spatial idea can expose predisposition to the latent psychic pathology of endogenous origin.

The study focuses on the emotion processing deficits, which are typical for schizophrenia patients. Since abnormalities in this field can be seen in terms of insufficient individuation and failure in the separation process, a context of a close interpersonal relationship was introduced into the testing procedure.

30 schizophrenia patients were compared to a normal control sample (n = 31) on their performance on the lexical decision task (LDT). Two-factor of experimental design had a form of 2 (possible values of the independent variable was healthy /ill) x 2 (experimental conditions). Participants completed the LDT twice -1) in a standard testing situation, and 2) in the relational context condition (the procedure followed the activation of the subjects’ experience with his/her mother). In an e-prime computerized experiment the list of 91 words (names of positive and negative emotions, divided into 9 categories) and 27 nonwords were randomly subliminally exposed. It was hypothesised that in a relational context condition the emotional processing irregularities would be more distinct.

Analyses confirmed the aforementioned theoretical assumptions. A significant condition/group interactional effect was found for anger (F = 4, 56, p = 0, 04) and joy (F = 5, 05, p = 0, 03). The accessibility of the emotion categories mentioned above was higher in the relational condition for patients whereas in the control sample no differences were observed.

The results were interpreted to provide an explanation of separation difficulties in the clinical sample, since simultaneous presence of opposing emotions hinders the process of decision making, including a decision to leave the family of origin.

Vitamin D deficiency has been associated with an increased risk of depression and schizophrenia in some studies. However, a few epidemiological studies do not show consistent results.

Comparing serum level of Vitamin D, parathyroid hormone, Calcium, and phosphorus in schizophrenic and depressed patients with healthy subjects in Iranian people.

In a cross-sectional study, 100 patients with schizophrenia and 100 major depressed ones in Arak-Iran from October 2009 to April 2010, and also 100 healthy subjects were enrolled. After informed consent, serum levels of Vitamin D, Calcium, Phosphorus, and parathyroid hormone were assessed by using routine laboratory methods.

Data was analyzed by using SPSS V17, one-way ANOVA, the post-hoc test of Tukey and also in general linear models.

The three groups were different in Vitamin D (PValue < 0.001). Post-hoc analysis of Tukey showed that Vitamin D level of healthy participants was significantly higher than depressed patients (PValue < 0.001) and schizophrenics (PValue = 0.001) while there was no significant difference between Vitamin D levels in depressed and schizophrenic patients (PValue = 0.563). Serum levels of Ca, P and PTH were the same in three groups.

Our findings suggest that Vitamin D affects the brain independent of hormonal pathways which regulate serum level of calcium. Lack of difference between the serum levels of Vitamin D in schizophrenia and depression suggests that the independent effect of Vitamin D in the brain is a general effect and is not specific for a region or pathway in the brain.