The survey performed in four European countries (Germany, Greece, Italy, Spain) aimed at characterizing patients with schizophrenia treated in everyday clinical practice in terms of demographic characteristics, presenting symptomatology, and current antipsychotic treatement. We present here characteristics of patients in short term hospitalization.

A survey involving 744 psychiatrists gathered anonimous retrospective data from 3,996 patients with schizophrenia. To ensure representativeness of participating physicians, the dataset was adjusted post hoc. Principal component analysis was used to structure the patient attributes relevant for antipsychotic choice, identifying two discriminating variables (disease severity and socioeconomic level) accounting for 91% of the variance in the data. Methodology is described in full detail by Gorwood (2010).

Out of 3,996 surveyed patients, 21.7% were in short term hospitalization, with a mean of 7.5 previous episodes and 5.5 previous hospitalizations. Two thirds of subjects lived with theirfamily, with primary caregiver in 47% of subjects) being a relative. Most frequently observed symptoms were delusions (in 54% of subjects) and ideals of persecution (in 41% of subjects). 71% of subjects were smokers, 21% had drug and 18% alcohol addiction. 43% of subjects had a verified cardiometabolic comorbidity and 21% were obese. 29% of subjects had verified medication non-adherence. Most frequently used drug was risperidone (in 22% of subjects). Ziprasidone was used in 11% of subjects. 10% of subjects were on depot medication and 19% on orally disintegrating tablets.

Subjects with schizophrenia in current short-term hospitalization have high rates of cardiometabolic risk factors or cardiometabolic comorbidity.

A growing number‘of patients with schizophrenia are using complementary and alternative medicine (CAM) interventions. In this paper, we review the published scientific evidence on the benefits and risks of a natural supplement Sarcosine in patients with schizophrenia. Sarcosine, also known as N-methylglycine, is thought to modulate N-methyl-D-aspartate (NMDA) function through the glycine modulator. It has been investigated as a putative adjunct therapy for a wide variety of disorders ranging from schizophrenia to prostate cancer.

We performed a comprehensive review of schizophrenia literature, focusing on complementary and alternative approached for augmentation treatment. We identified studies published from 01/1985 through 12/ 2010, by searching the PsycINFO, MEDLINE and CURRENT CONTENTS using the medical subject headings sarcosine, schizophrenia, complementary and alternative therapies and N-methylglycine. We found 6 randomized trials for use NMDA-glycine site agonists or glycine transporter-1 inhibitors. Inclusion criteria included randomized assignment, comparison with placebo and use of standardized outcome measures (PANS). The results are summarized in Table 1.

Overall the limited current evidence suggests that intake of 2 g/day sarcosine as adjunctive therapy to certain antipsychotic medication in schizophrenia may have additional benefits on both positive and negative symptoms of schizophrenia. Sarcosine had been tolerated well with no notable side effects in excess of the placebo therapy.

Unfortunately most of these studies are small and the routine use of Sarcosine in schizophrenia cannot be recommended without further evidence. In the meantime, patients need to be informed about the possible risks associated with the use of these interventions.

Adolescents with childhood onset schizophrenia (COS) and adolescents with Asperger syndrome (AS) are characterized by impairments in pragmatics and in cognition.

The study of the specificity of pragmatic and cognitive deficits in COS and in AS is important to highlight some fundamental areas to each disorder and to refine behavioural phenotypes which may provide a link to gene-brain-behaviour.

The present study directly compares the pragmatic and cognitive functions in adolescents with COS and AS.

Twelve adolescents with COS and 14 adolescents with AS, matched on general IQ, verbal IQ and performance IQ, were compared. Pragmatics was explored by the Children's Communication Checklist, a parental report of language and communication in naturalistic context. Cognition was explored by Wechsler Intelligence Scale and by several specific tasks: Theory of Mind (ToM), Figurative Language Comprehension, executive functions (WCST), mental flexibility and working memory (TMT) and inhibition (Stroop).

Compared to adolescents with COS, adolescents with AS exhibited more severe pragmatic impairments in naturalistic context and had more reduced figurative comprehension. In contrast, compared to AS, adolescents with COS exhibited impaired inhibition and deficit in verbal reasoning (subtest “Similarities” of the Wechsler). Both groups had similar results on ToM, WCST and TMT tasks, and on the all other Wechsler’s subtests.

Despite some similarities, adolescents with AS and with COS differed when pragmatics was evaluated in naturalistic context. Cognitive impairments observed in inhibition and in verbal reasoning may be specifically related to thought disorder, a core feature of schizophrenia.

Little is known about patients with schizophrenia treated in everyday clinical practice who have good medication adherence. The survey performed in four European countries (Germany, Greece, Italy and Spain) aimed to characterize these patients in terms of demographic characteristics, presenting symptomatology, and current antipsychotic treatement.

A survey involving 744 psychiatrists gathered anonimous retrospective data from 3,996 patients with schizophrenia. Principal component analysis was used to structure the patient attributes relevant for antipsychotic choice, identifying two discriminating variables (disease severity and socioeconomic level) accounting for 91% of the variance in the data. Methodology is described in full detail by Gorwood (2010).

35% of 3,996 patients were assessed as having good medication adherence. They had a mean 5.0 previous episodes and 3.2 previous hospitalizations, 67% were assessed as having mild to moderately severe illness, and 42% as having mild cognitive dysfunction, and 76% had high or satisfactory insight on the disease. 62% of them were outpatients, 18% were living alone and 72% with the family, with a relative being principal caregiver in 58% of subjects. 48% were smokers, 6% had drug and 6% alcohol addiction. Risperidone and quetiapine were used most frequently (each in 20% of subjects). Ziprasidone was used in 10% of patients.

Approximately 2/3 of the patients with good medication adherence were living with a family. 40% of subjects had mild cognitive dysfunction. Rates of smoking and drug/alcohol addiction were substantially lower than in other patient subpopulations investigated in this survey.

Investigation of spontaneous, mitogen-induced production and serum concentration of IFN-γ, IL-4 and TNF-α of schizophrenic patients with different dynamic of psychopathological symptomatology during therapy.

Clinical Global Impression Scale (CGI, subscale CGI-С) was used to estimate dynamic of psychopathological symptomatology during treatment: 32 schizophrenics were divided into two groups: group 1 (10 patients) - with considerable improvement of psychopathological symptomatology; 2 (22 persons) - with non-considerable improvement or without changes.

Serum concentration, spontaneous, mitogen-induced production of IFN-γ, IL-4, TNF-α by leukocytes of schizophrenics was identified with sets for immune-enzyme analysis in dynamic of treatment (point 1 - during admission in hospital, point 2 - by week 6 of treatment).

In point 1, mitogen-induced production of IL-4, serum IFN-γ, spontaneous production and serum TNF-α significantly exceeded values in control. Simultaneously, in these examined we noticed decrease of induced production of IFN-γ and TNF-α. Group 1 showed higher values of induced production of IFN-γ and lower values induced production of TNF-α as compared with group 2.

In point 2, in patients of group 1, we established significant increase of mitogen-induced and spontaneous production of TNF-α, spontaneous production of IFN-γ as compared with conformable values prior to treatment. Increase of induced production of IL-4 has a trend toward lowering serum concentration of TNF-α, what was shown in both groups.

Thus, schizophrenia is accompanied by disturbances of cytokine levels. We identified that favorable clinical dynamic was followed by the positive dynamic of mitogen-induced production of IFN-γ and serum level of TNF-α.

El following work tries to show the difficulty of adherence to the treatment of our patients and the factors that influence the same one.

To establish an alliance terapeútica in a patient with diagnosis of paranoid Esuizofrenia submitted to dialysis with void conscience of disease.

Secondary chronicle treats itself about a 49-year-old male diagnosed of paranoid Schizophrenia with a renal disease to a chronic familiar GN in phase V in dialysis nowadays. He does not arouse of mental illness.

Renal chronic insufficiency in daily dialysis. Badly TA’s control and irregular follow-up of the diet. From Nefrología’s consultation they request interconsultation and psychiatric treatment.It is sent for nefróloga for valuation of pharmacological treatment by the aim to improve the adherence to his dialysis. From the first moment it considers to work together with nefrología to adapt treatment, being the mediating one the sister-in-law. We initiate treatment with paliperidona 3mgr/día. We remind that it of the nefróloga every day on having come to dialysis. Later we initiate treatment with injectable Risperidona of long duration 25mgr/14 days in increasing dose up to 75mgr/14días with good response.

Though it keeps small conscience of presenting a mental illness, he accepts the treatment, improving both the psychotic symptomatology and the acceptance of his physical ailments.

The multidisciplinary attention in the psychiatric patient and especially in the mental serious patient it is fundamental to obtain a good alliance and adherence to the treatment, and therefore to improve the forecast.

Patients who remain unresponsive to two different antipsychotics should be given clozapine. However, some of the schizophrenic patients had presented an unsatisfactory benefit under clozapine monotherapy or clozapine cannot be used because of toxicity or patient refusal. Finding an efficient therapy represents a tough challenge in this situation, other drugs or drug combinations can be tried.

To choose a therapeutic scheme that improves acute psychotic symptoms and has a good tolerability. Olanzapine has antagonist activity at dopamine, serotonin, muscarinic, α1-adrenergic and histamine receptors. Zuclopenthixol has high affinity for both dopamine D1 and D2 receptors, high affinity for α1-adrenergic and 5-HT2 receptors, a weaker histamine H1 receptor blocking activity, and even lower affinity for muscarinic cholinergic and α2-adrenergic receptors.

2 schizophrenic females patients, hospitalized for an active phase episode. Both patient had perssistent hallucinations during the course of their illness despite the antipsychotic treatment and the good compliance. In the past they followed multiple therapeutic schemes. Antipsychotic medication was adjusted following the clinical outcome. Instruments: PANSS, CGI, weight, glycemia, lipide profile, blood pressure, heart rate, full blood count, hepatic enzymes, EKG, adverse events and relapse (follow-up 6 months).

Olanzapine and zuclopenthixol combined therapy led to psychotic symptoms remission.

In this case olanzapine and zuclopenthixol may represent an option for treatment of refractory schizophrenia. No new side effects have been observed or any unfavorable drug interactions. These results have maintained untill the end of the follow-up period.

Sexuality is an important dimension of life. To promote the well-being and quality of life of people with Schizophrenia, they must experience their sexuality in healthy ways. However, the lack of studies about this topic makes difficult to develop interventions in this area.

Understand the knowledge, beliefs and attitudes related with sexuality of schizophrenic individuals.

Data were collected using a questionnaire intentionally prepared for this study, with questions related to biologic, emotional and social dimensions of sexuality, evaluating: knowledge, beliefs and attitudes about sexuality; sexual activity; emotional intimacy, friendship and social life. The sample was composed by 35 individuals with Schizophrenia: 83% male and 17% female; mean age 41 years.

The data revealed that 86% of the sample is single and only 6% have an affective relationship. They have difficulties to have friends, to have a satisfactory social life, and only 20% have a job. Despite the correct knowledge about sexuality, they reveal difficulties in fulfilling emotional or intimate relationships, they feel lonely and unsatisfied about their sexual life. They also feel negative effects of anti-psychotic drugs, often neglected by health professionals, views as non-preoccupied with the quality of the sexual life of the patients.

The sample valorized being asked about their sexuality, revealing that this topic is forgot by the professionals. It seems necessary to develop interventions regarding the sexuality of those individuals. Our future research is to ameliorate the questionnaire, preparing it to be useful when professionals discuss sexuality with schizophrenic individuals.

Actually, in society, stigma against mental illness stills strong, making difficult to develop recovery and social integration of people suffering from mental illness, witch affects their well-being and quality of life. Studies indicates that stigma can be elicited by different social groups, which include, in addition to the general population, the relatives, the individuals with mental illness and event health professionals (Schulze, 2007).

Compare attitudes and stigma against mental illness from students who will work in mental health teams.

Data were collected using a translation of Attribution Questionnaire - AQ 27 (Corrigan, 2003), fulfil in an anonym way from 486 Portuguese students of Medicine, Psychology, Occupational Therapy and Nursing. The sample was composed by 22% male and 78% female; mean age 20.4 years, 65% at begging of the course and 35% finishing.

The data reveal that the sample has little contact with mentally ill individuals (only 19% have relatives with mental illness). Students from Medicine and Psychology present higher values in stigma dimensions, while Occupational Therapy and Nursing show lower values. Students begging the course shows higher stigma than those finishing. Having regular contact with mentally ill individuals seems to decrease stigma attitudes.

Some attitudes related to stigma were found, contradicting the actual knowledge about mental illness and politics of social inclusion. It seems necessary to modify theoretical topics about mental illness learned by students, and also pedagogical methods. Therefore, stigma and social exclusion will be discuss and avoid since the beginning of the courses.

Despite society argues that all citizens have equal rights and equal opportunities, mentally ill individuals face discrimination, especially in the employment context. Research reported benefits of working and have a job, witch help play social roles and feel useful, key components in social inclusion and recovery of mentally ill individuals.

Employers have an important role in the access of mentally ill individuals into work. They take decisions that affect life opportunities, but, due to their powerful position, their attitudes can influence all enterprise and maintain stereotypes and stigma.

Know perceptions and stereotypes about mental illness in Portuguese employers.

Data were collected using a translation of Attitude Scale for Mental Illness (Hahn, 2002), evaluating dimensions such as separatism, stereotyping, restrictiveness, benevolence, pessimistic prediction and stigmatization. The scale was fulfil using online anonym way, by 50 employers from small (under 250 employees) metallurgic or textile enterprises (60% male, 40% female; mean age 45.9 years).

None of the enterprises have employees with mental illness, neither integration policies. Employers prefer to give a job to people with physical disabilities than to people with mental illness, choosing people with schizophrenia as the last possibility. They have little contact with mentally ill individuals, 96% don’t know governmental policies for job inclusion and only 54% accepts to participate in meetings to understand those policies. Stereotyping, benevolence and pessimistic prediction present highest values.

Employers must be informed about governmental policies using work as a form of social inclusion from mentally ill people.

Psychosocial Rehabilitation is actually understood as essential to promote the effective improvement of quality of life of mental ill people. Recovery is view as a process where individual plays an active role, choosing their own way. In this process, readiness is the interest, desire and motivation of the individual in his rehabilitation, being ready to change.

Develop a methodology to assess readiness of people with mental illness, and known the opinion of health professionals about this methodology.

Using the results of different studies, a methodology to assess readiness was developed and described. This description was after submitted to a focus group with six professionals and to a Delphi panel of 25 professionals, all evaluating the methodology to be used with people with schizophrenia.

The methodology developed includes several steps to apply with mentally ill people. The focus group discusses the methodology and the results agree with the conclusions of other studies and with theoretical constructs about this topic. The Delphi panel yields an agreement rate exceeding 90% and suggests the application of the methodology to people with schizophrenia.

The methodology developed to assess readiness of mentally ill people to change and define their own recovery process seems to be useful and provide a more deep understanding of individual differences linked to the process of recovery. Also seems to provide a translation into quantitative indicators and to identify the overall level of readiness, being a practical tool to support the definition of rehabilitation projects.

Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables.

In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.

One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed and verbal memory.

The reliability of the PSP was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared to high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.

The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.

Failure of antipsychotic treatment in schizophrenia is 80% according to a study by Corrigan and Weiden et al. They reported rates of pharmacologic treatment failure as 50% one year after psychiatric admission and 75% after two years. Between many factors influencing, one is the relationship between the professional and the family. There are different models of family intervention that have been effective in improving relapse rate, symptoms, social and occupational functioning, adherence and knowledge of illness and family burden (Zhang, Yan, Yao, & Ye et al., 1993).

To assess the association and strength between the performance of family psycho education groups and adherence to treatment in a schizophrenic population.

Observational non blinded descriptive study in people with schizophrenia treated in an outpatient service which has 75000 inhabitants of reference population. We divided the patients into two groups whether family psycho education was done or not in the past 5 years. In each group we randomly sampled and reached an n > 30 and then we practiced a 2-year prospective follow-up recording the following variables: diagnosis, disease evolution, comorbidity with affective disorder, GAF and CGI, type of drug treatment both at the beginning and end of follow up, number of therapeutic changes, compliance visits, number of hospital admissions, number of emergency visits and side effects tolerance. After the follow-up we will do a descriptive statistics (Student t, X2, ANOVA) through SPSS version 11.5.

Will be sent at the end of the study.

Partial or non-adherence to medication is high amongst patients with schizophrenia. Many and often overlapping factors are considered to impact on treatment adherence, including: patient-related (lack of insight, psychotic, negative or cognitive symptoms), treatment-related (adverse effects, insufficient efficacy), environmental (living situation, negative attitudes of relatives/friends), and physician-related (patient-healthcare professionals relationship) factors.

The objective of the ADHES EMEA (Europe, Middle East and Africa) survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

To present psychiatrist's opinion through EMEA of potential reasons for partial or non-adherence

The ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA (over 4500 psychiatrists treating patients with schizophrenia).

Across EMEA 37% of psychiatrists viewed lack of insight as the most important reason for their patients stopping medication. 23% of psychiatrists viewed patient's feeling better and thinking it unnecessary to take medication as the most important reason for their patients stopping medication. 7% or less of psychiatrists viewed undesirable side effects, insufficient efficacy, cognitive impairment or drug/alcohol abuse as the most important reasons for their patients stopping medication.

In this survey, psychiatrists estimated that patient’s lack of insight and subjective improvement could constitute the main factors explaining poor adherence. Other factors (i.e., side effects, substance abuse) were regarded as less important. Strategies aimed at raising awareness of maintaining treatment, are warranted within EMEA, with the aim of improving clinical outcomes.

Rates of non-adherence of up to 72% have being reported, in schizophrenia, depending on the method used and the patient population. Rates of approximately 59% over 1 year have been reported for individuals with a first episode. Patients who stop medication are almost five times more likely to experience relapse than adherent patients. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

The EMEA (Europe, Middle East and Africa) ADHES schizophrenia survey was a survey of psychiatrists across the region, treating patients with schizophrenia, designed to canvas their perceptions of assessment, potential reasons and management for partial or non-adherence to medication amongst their patients.

To present methodology and demographics of the EMEA ADHES survey in schizophrenia.

The EMEA ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA. In addition to recording the gender, age and practice setting of the respondents, questions related directly to the issue of partial-/non-adherence in patients with schizophrenia.

The survey was conducted amongst psychiatrists (including neurologists with psychiatric background in Germany) from January - March 2010. Results were obtained from 4722 respondents. Psychiatrists perceived that during the previous month more than half of their patients (53%) were partially or non-adherent across all EMEA regions

The EMEA ADHES schizophrenia survey is a large and geographically broad survey providing insight on psychiatrists’ perceptions of the assessment, causes and management of partial and non-adherence to medication.

Partial or non-adherence to medication is high amongst patients with schizophrenia. Rates of non-adherence of up to 72% have being reported depending on the method used and the patient population. Adherence is essential for optimal long-term patient outcomes in schizophrenia and failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

The objective of the EMEA (Europe, Middle east and Africa) ADHES survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

The aim of this poster is to present psychiatrist's perceptions collected in the EMEA ADHES survey.

The survey was devised to ascertain psychiatrists’ preferred methods of assessing adherence, their perceptions of the level of adherence, reasons for non-adherence and on strategies to improve adherence.

Psychiatrists estimated that during the previous month more than half of their patients (53%) were partially or non-adherent. They estimated that as few as a third of patients who deteriorated after stopping medication was able to attribute this to their non-adherence. 76% of psychiatrists assessed adherence most frequently by asking their patient explicitly. Use of long-acting treatment was the preferred choice to address adherence problems for 62% of respondents.

This EMEA-wide survey illustrates that while respondents recognised the relevance and importance of partial and non-adherence to medication, there remains a need for more proactive management of treatment adherence of patients with schizophrenia to reduce the frequency and consequences of relapse.

The neurodevelopmental hypothesis defends the existance of factors that would cause an early impairment on the normal brain development. The neurodegenerative hypothesis proposes the existance of later and progressive pathological phenomena, responsible of the appearance of clinical manifestations and changes on neuroimaging. Both hypotheses would be complementary. Neurodevelopment is completed during adolescence. Within this period, these deficts on executive functions would become apparent, reflecting a neurodevelopmental impairment. Glutamate is the main excitatory neurotransmitter, present throughout the normal postnatal brain development and maduration. In schizophrenic patients and unaffected relatives, a glutamatergic hypofunction has been found and so, an alteration of the dopaminergic mesocortical limbic and nigrostriatal pathways.

Usage of molecules that are capable of reversing the glutamatergic hypofunction would be potentially benefitial for either positive or negative symptomathology in schizophrenia.

We have performed a review of several clinical trials (on humans and animals) using glutamatergic drugs alone and combined with neuroleptics to diminish behavioural disturbances related to NMDA blockage.

Usage of glycine binding site agonists (glycine, D- cicloserine, D-serine) has been proposed. D-serine is effective both as monotherapy and combined with neuroleptics. D-cicloserine is not effective on negative symptoms. Usage of high doses of oral glycine (30–60 mg a day) on its own has not shown any clinical change but there is an improvement on negative and positive symptoms if combined with neuroleptics.

Nowadays, there is no glutamatergic agonist used in schizophrenia treatment. Out of the three previously mentioned drugs, only D-serine has shown some efficacy.