To examine clinical, electrophysiological differences among subgroups of schizophrenic patients with different QEEG profiles identified by cluster analysis.

Fifty-two schizophrenic patients were studied (age:34.64 ± 10.41, 18–58 years). Digital, resting electroencephalogram was recorded and submitted to quantitative-topographic spectrum analysis (QEEG), and patients’ clinical state was assessed by the Greek version of Positive and Negative Syndrome Scale (PANSS). QEEG data were submitted to cluster analysis, and QEEG, clinical differences were compared using Kruskal-Wallis non-parametric test.

Three groups of patients with different electrophysiological profiles (p < 0.05) were detected by cluster analysis of QEEG data: Group A, characterized by increased levels of relative power in α frequency band, low levels in β, medium levels of relative power in δ, θ frequency bands; Group B, characterized by increased levels of relative power in δ, θ frequency bands and medium in α, β; Group C, characterized by increased levels of relative power in β frequency band, very low in α, medium in δ, θ bands. According to PANSS, group A patients had lower (p < 0.05) levels of agitation, hostility/aggression, difficulty in abstract thinking, stereotypic thought and attention deficit than patients of the other groups.

Cluster analysis can be used to identify characteristically different QEEG profiles of schizophrenic patients. The cluster with increased relative power in the α frequency band, low levels in β, and medium in δ, θ bands was “healthier” in specific PANSS parameters than the clusters with low α and increased relative power in δ, θ and β frequency bands.

To impress the diversity of positive symptoms in patients with schizophrenia.

Case report and review of the literature (PubMed).

Male patient, 43 years old, single, elementary school graduate, living with his mother. First hospitalization.

Persecutory ideas and auditory hallucinations dating from 8 months: he was convinced that his neighbor wanted to harm him; for this reason he had recruited his dog. He noted that the dog was following him when he was going out in the neighborhood, and was very aggressive towards him (he“heard” the dog barking at him continuously). His fear made him stop working (scrap dealer) and he was afraid of coming out of his home. He had even thought of poisoning the animal. Laboratory as well as neuroimaging exams (EEG, brain CT) were normal. The patient was treated with haloperidol (30 mg daily) and olanzapine (15 mg daily). He was discharged after 18 days. Three months later, he spontaneously stopped medication (15 mg olanzapine daily); in three weeks time the same ideas had resurfaced and was “hearing” the neighbor's dog barking again loudly at him. Since then he takes his medication regularly without experiencing any symptoms. Only one relevant article was found in the literature (Dening, T.R., and West, A.“The Dolittle phenomenon: hallucinatory voices from animals”, Psychopathology. 1990; 23: 40–45).

Animals could, rarely, play a key role in the delusional ideas of patients with schizophrenia. This doesn’t make these ideas less debilitating or even potentially dangerous.

There is increasing empirical evidence that links the classical separated psychopathological spectrums neurosis and psychosis. In this sense, anxiety is a factor for delusional/hallucinative development and maintenance (Freeman and Garety, 2003).

We intended to assess differences in Anxiety Sensitivity dimensions between patients with psychosis and a non-clinical sample.

Participants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, were compared with a non-clinical sample (n = 582) from another study (Sandín, Valiente, Chorot and Santed, 2007).

A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.

We used the Spanish validated Anxiety Sensitivity Index-3 -ASI 3- (Sandín 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 present a higher anxiety sensitivity in the General Factor (t = 2.06, p < 0.05) and Cognitive Subscale (t = 3.91, p < 0.001) than nonpatient sample.

Patients with psychosis show significant fears of symptoms of different anxious domains (ASI-total) regarding a non-clinical sample. Particularly, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive).

Patients with severe mental illness are at increased risk of cardiovascular disease because of lifestyle, co-morbidity and medication effects.

The aim of this audit is to ascertain the regularity of metabolic health checks, CVD risk assessment and adequate lipid modification therapy among patients on antipsychotic medication in 3 rehabilitation wards in county Durham and Darlington.

According to audit standards (based on NICE guidelines-Schizophrenia, Lipid Modification, Maudsley guidelines), All patients should have Blood Pressure, Body Mass Index (BMI), CVD risk assessment using appropriate calculator, Fasting blood glucose and Fasting Lipid profile done at least once a year. Lipid modification therapy has to be offered to those with 10 year CVD risk of 20% or greater. All 31 patients in 3 rehabilitation wards were included. We searched for these readings between 1/09/2010 to 30/08/2010 in patient records.

Of 31 patients, 26(84%) had blood pressure, 29(94%) had BMI and 11(35%) had either fasting blood sugar or HbA1c recorded. CVD risk assessment using calculator was not done in any patients. 19(61%) lipid profile done. Of the 19 patients 16 (84%) had abnormal lipid profile. 9 (26%) patients were on lipid modifying drugs, 6 (19%) patients were on appropriate dose of lipid modifying drugs.

Our audit identified a need for systemic assessment of physical health with emphasis on cardiovascular risk management (lifestyle education, lipid modification therapy) which are critical to minimising risks and preventing long term adverse health consequences.

The QUALITY study evaluated Quality-of-Life in schizophrenic patients treated with atypical antipsychotics (AAPs) in the ambulatory setting.

This study was a 9-month, observational, multicentre prospective study. Patients (18–65 years-old) diagnosed with schizophrenia and treatment started with one AAP before visit-1 (minimum: 4-weeks, maximum: 8-weeks) were enrolled into this Belgian study. At visit-1 patients’ demographics and medical history were recorded with follow-up visits after 3-, 6- and 9-months. At each visit, patients completed the Subjective Well-being under Neuroleptic treatment short form (SWN-K), while investigators assessed the Positive and Negative Symptom Scale (PANSS-8) and Global Assessment of Functioning.

121 patients were enrolled: 91 male, mean age 36.7 ± 10.8years. The main AAPs were risperidone (38/121), apripirazole (28/121) and quetiapine (25/121). On average, most mean changes from baseline in SWN-K-subscale scores were positive (between −0.5 and +0.5, range −1.8–1.6) suggesting patients felt better, although there were no treatment-group differences. The associations between baseline SWN-K-subscales and age were small (RC [regression co-efficient] range: −0.03–0.01). PANSS-8-score changes were slightly negative (means between −0.77 and −0.43) suggesting decreased symptom severity. Patients with more severe negative symptoms considered their mental- and physical-functioning to be better throughout the study, indicated by significant correlations between these SWN-K-subscale scores and negative PANSS-scores (RC = 0.19, p = 0.0282; RC = 0.15, p = 0.0258). The associations between SWN-K-scores and positive PANSS-scores were small (RC: 0.01–0.14). The number of hospitalizations decreased during the study (9.6% between visit-1 and 2 vs. 7.5% visit-3 and −4).

Quality-of-life for all patients seemed to improve slightly, without any differences between treatment-groups.

It has been hypothesized that cognitive remediation with adjunctive psychiatric rehabilitation would be associated with greater improvements in functional outcome than standalone treatment approaches (1).

Moving from these observations our group designed an individualized rehabilitation program including a computerized cognitive training (CCT) and social skills training (SST), which showed promising results (2).

A critical evaluation of recent studies examining standalone and combined treatment approaches included the understanding of the differential impact of the two approaches among crucial areas for future research (3).

The present study compared the effects of CCT and SST on several indices of outcome in psychotic patients. Fifty-eight patients with schizophrenia or schizoaffective disorder were randomly assigned to one of two treatment groups: CCT or SST. Changes in cognitive, psychopathological and psychosocial indices after 6 and 12 months were compared between the two groups.

After both 6 and 12 months, an improvement of psychosocial indices was observed in both groups, while cognitive functions improved only after CCT; the improvement of psychopathological indices, observed in both groups, was greater in the CCT group.

Our findings suggest that CCT is associated with a greater impact than SST on different indices of outcome in psychotic patients. Future research should focus on possible synergistic effects of cognitive remediation and social skills training on functional outcome.

Concept of therapeutic adherence in schizophrenia describes the level of agreement between patient's medication taking and the psychiatrist expectations. The literature data reveal the facts that therapeutic adherence is low in the case of chronic evolution of schizophrenia. The sociological concept follows the notion of adherence to treatment for the schizophrenic patient in the patient-family-psychiatrist relation.

To find the level of understanding the concept of therapeutic adherence at the level of schizophrenic patients, their families and psychiatrists, we used a scale with 5 items. This scale was applied to a lot of 30 schizophrenic patients, 30 members of family or caregivers and 30 psychiatrists. The items referred to efficacy of pharmacological therapy, adverse effects of antipsychotics, administration form of antipsychotic (daily or long action), accessibility to medication, the direct relationship between patient and therapeutically team in the moment of taking medication.

For the patients: relationship between patient and psychiatrist, administration form and accessibility to medication.

For the family: accessibility to medication, adverse effects, efficacy of therapy.

For the psychiatrist: adverse effects, efficacy of therapy and accessibility to medication.

For the patients the relation with therapeutically team is the most important element of adherence and is significant correlated with the long action antipsychotics therapy. The concept of adherence must be individualized depending to patient, family and psychiatrist. The results of this study can be a prerequisite for further research. Decrease of adherence to antipsychotics treatment suggests the switch to a long action antipsychotic.

Impaired social cognition is a characteristic feature of schizophrenia, which is associated with the level of community functioning. Socioeconomic games are well-established in behavioral economy and widely used to examine decision-making strategies. They can also provide a useful method in the investigation of social decision-making in psychiatric diseases such as schizophrenia. The strength of these games compared to classic paradigms is that they allow observing subjects directly engaged in interpersonal situations, thus real-time interactions with implicit processes become available to investigation.

Investigating decision-making strategies in schizophrenia patients and healthy controls.

29 healthy controls and 58 patients with schizophrenia were compared by a series of Ultimatum Game interactions in a computerized setting. In this game two players have to split a sum of money. The proposer offers a portion to the responder, who decides to either accept or reject the offer. Rejection results in no income to either of the parties. Cognitive testing included emotion recognition, memory and executive function. Symptoms were assessed by MINI 5.0 and Positive and Negative Symptom Scale.

Association between offer and probability of acceptance was different in schizophrenia patients and controls (Chi2 = 18.8, n = 87, df = 4, p = 0.0009): schizophrenia was associated with an increased likelihood of acceptance at lower offers and a decreased likelihood of acceptance at higher offers. Ratio of inconsistent decisions was significantly higher in the schizophrenia group (Chi2 = 4.7, df = 1, p = 0.03).

Our results suggest that schizophrenia patients are impaired in socioeconomic interactions requiring decision-making, which may result in unstable behavioral strategies.

Cardiac anxiety and its consequences is one of the issues in the research on pain. The special characteristics of people with psychiatric pathology affect the experience of this type of anxiety?

The aim of this study was to investigate the potential relationship between the cardiac anxieties with the experience of psychiatric pathology in persons hospitalized with a psychiatric problem.

The study sample consisted of seventy patients hospitalized in a psychiatric clinic. The Cardiac Anxiety Questionnaire as well a demographic questionnaire was used in order to measure the necessary parameters.

People coming from a small town have greater anxiety for their cardiac function in the total of the questionnaire (P = .026), as well in the subscale of the avoidance (P = .011).

The stressful event of childhood is a factor influencing the anxiety of focalization in cardiac function in adulthood (P = .013). Moreover, schizophrenic patients tend to have higher scores of cardiac anxiety, than patients with bipolar disorder (P = .040).

The genesis of cardiac anxiety depends on the experiences of childhood and the wider social situations. The psychiatric pathology contributes to the appearance of this type of anxiety. The establishment of educational programs for the health care staff would be useful in order to improve the diagnostic ability of the cardiac anxiety especially in the psychiatric population.

People with mental illness are frequently perceived as dangerous, suffering social stigma and exclusion. Deinstitutionalization movement implies a closer contact between citizen and individuals with mental illness. However, social perceptions can be a barrier to social inclusion, provoking unfavorable attitudes. Some studies found that social rejection is different according the pathology. Vogel and Boysen (2008) found that different mental illnesses provoke different attitudes of social distance. Norman and colleagues (2008) found that social distance was associated with the diagnosis, provoking schizophrenia greater social distance than depression.

Compare the perceptions about mental illness (in general), depression, bipolar disorder and schizophrenia.

Data were collected using a translation of Mental Illness Stigma Scale (Day, 2007), fulfill on-line and in an anonym way by 315 Portuguese polytechnic students, studying in brief technological courses. The sample was composed by 69% male and 31% female; mean age 26.5 years.

Students have little contact with people with mental illness (mean = 1.5 in a Likert scale 1–5 points) but they fell comfortable when they contact a friend or a neighbor with mental illness (respectively, mean = 3.2 and mean = 2.7). They present some anxiety when they interact with people with mental illness and they avoid this contact, revealing attitudes of social exclusion. Schizophrenia and bipolar disorder was perceived more negatively than depression.

Deinstitutionalization movement provokes more contact between citizens and individuals with mental illness, but social stigma still exist. Students can learn how to interact with those persons without anxiety and help to do better social inclusion.

Psychosocial Education is defined as give to the patient structured, systematic and didactic information about mental illness and his treatment. Actually is one the most frequent rehabilitation approaches, being used in several mental health departments. The good results obtained by this approach are congruent with the principles and guidelines defined for best practices in rehabilitation process (Rummel-Kluge et al, 2006).

Describe a psycho educative b-learning program develop to reduce self-stigma in schizophrenic individuals.

A psycho educative B-Learning program was developed using the results of other studies. This program was after applied during 4 months with 21 schizophrenic individuals followed in a psychiatric department, evaluated in a pre and pos-test model.

The program includes 10 sessions intentionally prepared for those individuals, given information to reduced self-stigma using topics such us myths, stereotypes, self-esteem, self-confidence, relapse prevention, social interaction, feel include in the community, being able to ask for help and to recover. All those topics where discuss using Moodle platform from Porto University within a group in the presence of the therapist and individually at home. A sociodrama group was also developed.

This approach seems to empower the individuals, allowing them to achieve the program by their own rhythm and to participate within a group but also to be in contact using the Moodle platform, decreasing feeling of loneliness. Primary results seem to be good, with low relapse, low absenteeism in class and some success in finding a job.

Considering the shortcomings of antipsychotics in treatment of negative symptoms of schizophrenic patients, the use of augmentation treatment for decreasing the negative symptoms is highly important.

The aim of this research was to study the effect of selegiline augmentation with antipsychotic drugs in decreasing the negative symptoms of schizophrenic patients.

In this double blind randomized control trial study 70 schizophrenic in- patients who were under treatment with antipsychotics were randomly divided into two intervention and control groups. The patients of both groups were given placebo for two weeks along with antipsychotics. For 12 weeks the intervention group was given selegiline 10 mg/day and control group was given placebo. The patients were evaluated with PANSS scale and Hamilton depression test at the end of first and second weeks and then at the end of every other week for twelve weeks. Then the results were analyzed statistically.

There was no significant difference between intervention and control groups considering PANSS score on first and second weeks, but the difference on 4-14 weeks was statistically significant. There was also no statistically significant difference in Hamilton depression Test between the two groups in first to 10 Th weeks. But the difference was statistically significant in 12–14 weeks.

Augmentation treatment with selegiline can improve the negative symptoms of schizophrenic patients.

Medication non-adherence is a significant risk factor for rehospitalisation in schizophrenia patients. Delayed release formulations like R-LAI may reduce rehospitalisation.

To examine the association between R-LAI use and hospitalisation in schizophrenia patients.

To assess the effect of R-LAI, compared to non-use and use of other antipsychotic drugs, on the risk of hospitalization in real-life settings.

The CGS study recruited schizophrenia patients from 177 public and private wards of psychiatric hospitals across France. Inclusion criteria were schizophrenia (DSM-IV), age 15–65 years, ambulatory/hospitalised for < 93 days at entry. Patients were followed up to 12 months for antipsychotic use and hospitalisation. The recruitment was stratified for long-acting second generation antipsychotic use. Multivariate Poisson regression adjusted for confounding with propensity scores and allowing for autocorrelation was used to estimate relative rates of hospitalisation.

Of 2092 eligible patients, 1859 were included. Their mean age was 38.1 ± 11.1 years, 68.6% were male and 37.8% were hospitalised for < 93 days at entry. A total of 1659 patients (89.2%) were followed up for 12 months, accumulating 933 hospital stays (53.0 per 100 person-years). Compared to other schizophrenia patients, patients on R-LAI were younger, had more often a history of previous hospitalisation for equivalent severity, living conditions and other characteristics. The adjusted relative rate of hospitalisation for R-LAI use against non-use was 0.66 [95% CI 0.46–0.96], and 0.53 [95% CI 0.32–0.88] against long-acting first generation antipsychotics.

Use of R-LAI was associated with lower rates of hospitalization compared to non-use of R-LAI.

The goal of this research was to explore the use of PCR as a marker of inflammation and CVD in patients with Schizophrenia.

A cross-sectional analysis of the BSA administrative claim database was conducted including all men and women, >18 years, with a schizophrenia spectrum disorders (by DSM-IV criteria) diagnosis. PCR measurement together with socio-demographics, evolution, medical history, 10-years CVD risk (Framingham equation) and biochemistry data was extracted for analysis.

705 patients [53.0% men, 48.2 ± 15.8 years (mean ± SD), 5.9 ± 3.2 years of evolution, 79.7% on atypical drugs] met criteria for analysis. Mean 10-year CVD risk was high; 11.9% ± 5.7% and mean PCR levels were 2.6 + 2.5 mg/L with 30.4% showing values above normal's (≥ 3 mg/L). Unadjusted PCR slightly correlated with CVD risk; r = 0.171, p < 0.001. After adjusting by age, sex, evolution, smoking and anti-inflammatory drugs treatment, PCR was linearly associated with 10-year CVD risk stratified by its level of risk (low, moderate, high/very high); respectively, 2.3 (95% CI: 2.1–2.5), 3.1 (2.6–3.5) and 3.7 (3.2–4.1) mg/L; F = 13.5, p < 0.001. Patients with known CVD showed also higher PCR levels; 3.7 (2.9–4.5) vs. 2.5 (2.4–2.7) mg/L, p = 0.008, and higher probability of values above normal's; Odds Ratio = 4.71 (2.01–11.04), p < 0.001.

High PCR levels (above normals) were associated with both known CVD and high/very high 10-year risk of CVD event in patients with schizophrenia. Then, PCR might be a marker of inflammation and CVD in this psychiatric disorder.