The general model of cognitive impairment of schizophrenic patient may be summarized as follows:first difficulty interpreting signals from other(predominantly negative symptoms),and on the other an emotionally intense overinterpretation of these(predominantly positive symptomatology). These patients have greater difficulty in understanding the mental states of those around. So cognitive rehabilitation aims to build the capacity of relevant attribute mental states to others and solve specific problems and difficulties of daily life. The aim of the study is to evaluate the correlation between the ability of understanding of mental states and the ability to interpret expressions Machiavellian(manipulative purposes)

Cross-sectional data were analyzed from a study with a sample of 43 patients diagnosed with schizophrenia compared to normal controls matched for age, sex and educational level. As scale measuring instruments used Mach-IV, self-administered questionnaires and a comprehensive neuropsychological battery to assess performance and the PANSS, SAPS and SANS scales

The path analysis were used to evaluate the effects of neuropsychological functions, functional ability and level of functioning in real life. After evaluating the following functions:physical distinction-mental distinction-reality appearance, identification of intent gaze, identifying emotions, ability to deceive, ability to understand the jokes, ability to understand stories, the study showed how schizophrenic patients showed poor workability, deception or strategic thinking ability and a poor ability to “take the place of another”

Cognitive rehabilitation works to help construct representations of others and of oneself and use them flexibly to guide social behavior by encouraging the underlying social interactions involving human capacity to perceive the intentions and dispositions of the other mental functions. In short, an improvement in the therapeutic field biopsychosocial

Caregivers and other family members of loved ones suffering from co-occurring mental health and substance use problems (concurrent disorders) have traditionally been ignored and excluded when their ill loved one becomes involved in the formal treatment system. Although the evidence indicates that family involvement is an important determinant of positive client outcomes, family members continue to identify support / education as unmet needs.

To demonstrate that family internet interventions have the potential to overcome barriers to service delivery, such as transportation, distance, critical mass for group participation, anonymity, and other restrictions that limit access to hospital services.

This presentation will describe a research program that aimed to support families affected by current disorders. It will focus on an original project that used virtual space available through internet technologies to offer facilitated peer support groups to families affected by concurrent disorders. The goal of this pilot study was to test the effectiveness of delivering an online version of a previously evaluated face-to-face family CD support group. Participants will learn about an innovative mixed-methods research initiative that invited family members to participate in an online support / educational group, based on the manual ‘A Family Guide to Concurrent Disorders”.

The author employed an innovative mixed method research design to evaluate several variables related to the recovery process of family members affected by concurrent disorders.

The integrated quantitative and qualitative results demonstrated the effectiveness of the online family group on both subjective and objective variables.

To refocus acute services from an assessment dominated approach to being interventions centred.

To provide staff with accessable, easily navigated and relevant (to those acutely unwell) intervention options to be done with service users in an empowering recovery focused way.

To equip acute care staff of all grades and disiplines to better meet the recovery needs of service users.

To use link node MAPS (Maximising Access to Psychosocial Skills) as a key intervention with a strong evidence base in subtance misuse services and an emerging trend in Mental Health services.

Workshops were facilitated with between 30 – 50 attendess including service users, medical staff, psychologists, occupational therapists, physiotherapists and nurses. These workshops identified the recovery needs of service users when entering acute services. These were experienced in three phases: when i first arrive, what needs to happen for me to get better and planning for discharge. MAPS were then developed specific to each area of need.

A websight was built with all MAPS arranged in a bookshelf and accessable via an icon on each staff members desktop.

300 staff are currently being trained regarding the above. Their evaluation is unanamously positive particularly around it's relevance to service users needs and its easy access.

This is a dynamic toolbox / website owned by staff who will regularly change its content as they find new MAPS and research that works for service users who are acutely unwell.

For weblink details please contact the author.

Late-onset psychoses (LOP) are a heterogeneous group of disorders whose nosology has been controversial throughout history. LOP presents in patients over 45 years of age and Very Late Onset Psychosis (VLOP) over 65. The incidence of VLOP is 0.2% in the general population and 15% among schizophrenics. The ICD-10 and DSM-IV do not have a category for LOP or VLOP and, despite contrary expectations, DSM-V maintains the void.

To emphasize the specific symptoms of VLOP though the study of a case report.

A 73-year-old woman developed psychotic symptoms during the last six years, consisting of auditory and verbal hallucinations and paranoid delusions, without cognitive or functional impairment. The patient and her family denied family history of mental illness.

She was admitted in our inpatient unit. Neuroimaging, laboratory tests, cognitive assessment were done in the inpatient unit without significant alterations. She was treated with Risperidone, Mirtazapine, Ciamemazine, Escitalopram, and Zuclopentixol with improvement of the psychotic symptoms and without important side effects. At the time of hospital discharge, psychotic symptoms had almost disappeared and no behavioral or emotional disorder was observed.

LOP and VLOP e seems much more common than previously thought. One of the main problems is that current classifications do not include specific diagnostic categories for these entities, despite the fact that they have distinctive nosologic features, etiology, treatment and prognosis compared with Early Onset psychosis (EOP). We believe that given an aging population, LOP and VLOP should be considered more often by clinicians.

Schizophrenia is a chronic syndrome of unknown etiology, predominantly defined by signs of psychosis. Over the years, schizophrenia is speculated to be associated with immune or inflammatory reactions mediated by cytokines. It is proposed that chronic inflammation might damage the micro-vascular system of brain and hamper cerebral blood flow. Lupus Erythematosus is an autoimmune disease with multiple manifestations in several organs and systems.

To review the Inflammatory Hypothesis of Schizophrenia though the study of a case report.

We present a case of a 33-years-old with the diagnosis of Lupus Discoid since 17-years-old and with episodic psychotic symptoms developed within 2 years of the diagnosis of the autoimmune disease. He was admitted in our inpatient unit. Neuroimaging and laboratory tests were done in the inpatient unit without significant alterations. He was treated with Olanzapine, Quetiapine and Haloperidol with improvement of the psychotic symptoms and without important side effects. At the time of hospital discharge, psychotic symptoms had almost disappeared and no behavioral disorder was observed.

The comorbility between Schizophrenia and Autoimmune Diseases seems much more common than previously thought. Even when the autoimmune process does not seem to be the direct cause of the psychosis, the inflammatory setting may be considered an important further piece in the puzzle in a genetic-environmental diathesis model.

Schizoprenia has been associated with decreased oxidative defences which may imply lipid peroxidation and consequent damage of neuronal membranes and myelin sheaths. Recently, animal models have shown changes of the oxidative balance caused by cigarrete smoke exposure at prenatal stages. Thus, we study the impact of tobacco over adult schizophrenia patients.

Study the oxidative role of tobacco in adults diagnosed of schizophrenia.

Analyze Isoprostanes (IPs) urine concentrations in patients compared with healthy controls.

We recruited a sample of 29 patients and 25 controls (descriptive data summarized below).

IPs urine concentrations were measured in conjunction with creatinine levels (to normalize the rate of excretion of other analytes). We also evaluated the values of IPs in relation to cigarrete smoke.

There is a smoking by diagnosis interaction on IPs (p = 0.01). IPs values ??were statistically different between smokers and nonsmokers for the 54 participants (p = 0.02). Nonsmokers mean values were lower (2.80 ± 1.55) than in smokers (4.16 ± 2.41). There were significant differences in IPs concentrations of the smoker patients compared with the respective nonsmokers (p = 0.01). By contrast this was not observed in controls.

We suggest that adult schizophrenia individuals may have increased vulnerability to exogenous pro-oxidative agents such as cigarette smoking.

The aim of this study was to examine the the effectiveness of psycho-education delivered via a printed booklet for Schizophrenia patients and their primary caregivers’ in Jordan. It was hypothesised that treatment as usual and psycho-education delivered by a booklet would improve patients’ and primary caregivers’ knowledge of schizophrenia, improve patients’ positive and negative symptoms and reduce their relapse rates, and improve primary caregivers’ burden of care and quality of life better than treatment as usual alone.

A single blind parallel randomized controlled trial was conducted between September 2012 and September 2013 at four mental outpatient clinics in Amman, Jordan. 121 patients with their primary caregivers were allocated randomly to an experimental (Psycho-educational intervention plus TAU in outpatient clinic) group (n = 58) or control (TAU alone) group (n = 63).

Outcomes, measured prior randomization (pre-test), immediately post-intervention and at three months after intervention were patients and primary caregivers’ knowledge of schizophrenia, patients’ positive and negative symptoms and relapse rates, primary caregivers burden of care and quality of life.

Participants receiving psycho-education and treatment as usual had better knowledge of schizophrenia at both post-tests, reduced positive and negative symptoms at post-test 1 and further reduction at post-test 2 compared with participants in control group. Patients hospitalisation and caregivers outcomes had reduced burden of care and better quality of life (P<0.001, all outcomes).

Psycho-education delivered via printed booklets improves outcomes patients and their primary caregivers in Jordan better than treatment as usual. Our hypothesis is supported.

Deficit schizophrenia (DS) with persistent, primary negative symptoms has a confirmed neuroanatomical background, similarly to structures involved in olfaction. Olfactory dysfunction, which includes impaired odor identification, is found in patients with schizophrenia and their family members.

A group of 82 patients with DS and 72 patients with NDS (nondeficit forms of schizophrenia), somatically healthy and without acute psychotic symptoms were subjected to smell identification test using the 16-item Sniffin' Sticks ID test. Demographic and psychometric data were collected.

No differences in the course of the illness, perinatal history and demographic data were found between the DS and NDS groups. No differences in the number of correctly identified odor samples were found. Some differences in the qualitative identification of samples between DS and NDS were found in the groups of female (fewer correct identifications of cinnamon and pineapple smells in DS) and male patients (fewer correct identifications of the smell of rose and more correct identifications of the smell of orange than in NDS).

It is well known that hematopoietic stem/progenitor cells (HSPCs) circulate under steady-state conditions at detectable levels in peripheral blood (PB), with their numbers increasing in response to stress, inflammation, and tissue and organ injury. Tonus of vegetative nervous system regulates mobilization of HSPCs into PB.

To assess the relationship between catecholamines concentration in PB and levels of circulating HSPCs in patients suffering from acute psychosis and anxiety disorders.

We enrolled 30 unrelated individuals with the first-episode psychosis and 30 patients suffering from acute anxiety disorders, and 35 ethnic- and gender-matched healthy volunteers. Mobilization of HSPCs was evaluated by 1) FACS to enumerate the number of stem cells in PB, 2) functional in vitro assays to detect the number of CFU-GM and BFU-E clonogenic progenitors circulating in PB. In parallel we measured level of adrenaline, norepinephrine (NE) and dopamine in PB serum.

We did not observe any significant differences in the numbers of circulating stem cells, as well as clonogenic BFU-E and CFU-GM between normal controls and psychotic patients and patients with anxiety disorders. In particular number of circulating in PB HSPCs was not affected by increased level of adrenaline, norepinephrine and dopamine in patients with psychosis.

Our data argue against an effect of enhanced vegetative nervous system tone on the number of HSPCs circulating in PB in humans.

One hundred ninety-one Polish patients suffering from paranoid schizophrenia were genotyped for polymorphisms of DRD2, DAT1, COMT, MAOA, SERT, 5HT2A, and GRIK3. The patients were randomized to treatment with perazine, olanzapine or ziprasidone monotherapy for 3 months. The intensity of side effects (changes in body weights and extrapyramidal symptoms) was measured at baseline and after 12 weeks of antipsychotic treatment.

After 3 months of therapy, the weight increase was the greatest in the group treated with olanzapine and the least in the group treated with ziprasidone. None of the examined gene polymorphisms was associated with the body weight changes. Perazine treatment was associated with the significantly highest intensity of extrapyramidal symptoms. None of the examined polymorphisms was associated with the changes in extrapyramidal adverse events after antipsychotic treatment.

The selected polymorphisms are not primarily involved in changes in body weights and extrapyramidal symptoms related to antipsychotic treatment in paranoid schizophrenia patients.

Language disturbances are the core symptoms of schizophrenia [Crow,2000]. Considering the influence of migration on the symptoms of schizophrenia [Bhugra, Gupta,2011] and few studies on the interaction of schizophrenia and bilingualism [Bersudsky, et al.,2005], we hope to clarify the linguistic profile of disorder and emphasize the role of language in schizophrenia research.

To examine the linguistic features of schizophrenia in the first (L1) and the second (L2) languages, particularly in fluency as the ability to cope with native and nonnative pragmatics.

Among sixty Russian immigrants to Israel diagnosed with schizophrenia, ten Russian-Hebrew fluent bilinguals met criteria for inclusion in the study (age: M=33.8,s.d.=11.0; length of residence: M=14.6,s.d.=6.8; time of immigration to diagnosis:M=5.3,s.d=3.9; PANSS Total score: M = 94.9,s.d = 9.8). Interviews were analyzed using clinical, linguistic and fluency speech markers. Statistical evaluation included t-test for dependent samples, two-way ANOVA(Fisher LSD post-hoc test).

The mean length of language samples demonstrated more productivity in L1 (Table1). Clinical speech markers associated with thought disorders were similarly represented in both languages. Linguistic markers of schizophrenia occurred more often in L2. Discourse markers, as bilingual phenomenona, reflected more dysfluency in L1.

1) The higher frequency of linguistic schizophrenia markers in L2 shows more impairments in the syntax/semantic components of language, where different neural representations may underlay the two languages in a bilingual brain damaged by schizophrenia. 2) The higher frequency of fluency markers in L1 reflects attempts to maintain verbal fluency, evidenced by the use of L2 lexical items, which afford a compensatory resource for communicative discourse in schizophrenia.

The chronic and debilitating nature of schizophrenia creates a disease with marked clinical and economic consequences. Among patients with schizophrenia the prevalence of smoking is significantly higher than in the general populace. Smoking in schizophrenia appears to be associated with increased psychopathology and disability. However, there is a dearth of Nigerian studies attempting to determine the effects of smoking on clinical outcome among patients with schizophrenia. Understanding the effects of smoking on the severity of disability and psychopathology in schizophrenia would help us to plan appropriate psychosocial interventions for these patients

To determine if comorbid smoking in schizophrenia is associated with increased disability and psychopathology.

• To determine the difference in the severity of disability and psychopathology among smokers and non smokers with schizophrenia.

• To determine the association between dosage of antipsychotics prescribed and disability among smokers and non smokers with schizophrenia.

A cross-sectional descriptive study in which 367 out patients with ICD 10 diagnosis of schizophrenia were recruited. Socio-demographic questionnaire, Present State Examination Schizophrenia and Tobacco sections, Positive And Negative Syndrome Scale and World Health Organization Disability Assessment Schedules were administered.

Current smoking was associated with increased disability (t=2.32, p<0.02) among the participants studied.

The results of this study indicate that smoking in Nigerian schizophrenia patients is associated with significant disability. Effective measures to promote smoking cessation in schizophrenia should be implemented in Nigerian patients.

The Enhancing Motivation in Persons with Schizophrenia Group is a manualised programme designed to tackle needs of those on rehabilitation wards of a psychiatric hospital. A number of theoretical models have been utilized to provide important perspectives on factors promoting motivation and behavior change (social learning theory, motivational interviewing, transtheoretical model). These models, along with the use of specific psychological techniques provide the underpinnings for the group.

In terms of pathways of care, it is the first point in the pathway, paving the way for future psychosocial treatment facilities, work and development. It enables patients to gain some understanding about a variety of mental health issues and offer them a space to explore them in relation to their own experiences.

The aims of the programme include provision of a positive non-threatening experience of working in groups, developing an open channel of communication, helping identify personal targets for treatment and help participants identify a rationale for engaging self-change. The programme also provides staff with some experience of each patient, their motivation and capacity to function within a group.

The programme is delivered on the admission by trained psychologists, consisting of 10 one-hour sessions covering a number of topics, with clear pre- and post-assessment.

The group is in the process of being delivered for the fifth time. Feedback, both anecdotally and from formal assessment had been positive.

Staff and patients alike have offered useful feedback and highlighted the utility of the programme in their experience.

Anomalous experiences such as Basic Symptoms (BS) are considered to be the first subjective manifestation of the neurobiological substrate of schizophrenia. Recently it has been outlined indeed, how various aspects of the phenomenological basic self-disorders occurring in schizophrenia may correlate with neurocognitive disturbances.

The purpose of this study is to explore whether a low or high emotional motor resonance occurring in Schizophrenia Spectrum (SzSp) patients is related to patients' clinical features and to their anomalous subjective experiences as indexed by the Bonn Scale for the Assessment of Basic Symptoms (BSABS).

We employed a validated paradigm sensitive in evoking a congruent facial mimicry (measured by means of facial Electromyographic activity, EMG) through multimodal positive and negative emotional stimuli presentation.

Results showed that SzSp patients more resonating with negative emotional stimuli (i.e., Externalizersfor negative emotions), had significantly higher scores in BSABS Cluster 3 (Vulnerability) and more psychotic episodes than patients belonging to the Internalizers group. On the other hand, SzSp patients more resonating with positive emotional stimuli (i.e., Externalizers for positive emotions), scored higher in BSABS Cluster 5 (Interpersonal Irritation) than patients belonging to the Internalizers group.

Drawing upon a phenomenological-based perspective, we shed new light on the abnormal experiences characterizing SzSp conditions, explaining them in terms of a disruption of the normal self-perception conveyed by the more basic, automatic, low-level emotional motor mechanisms. The importance of adopting a trans-domain approach integrating findings from the phenomenological and the neurophysiological levels of analysis is further emphasized.

Are we making the most of Clozapine?

Clozapine treatment remains the gold standard for treatment-resistant schizophrenia. Currently, clozapine use varies worldwide, from as high as 60% of psychotic patients in China to as low as 2 – 3% of psychotic patients in certain areas of the United States and Canada. Many physicians are reluctant, for a variety of reasons, to prescribe clozapine.

1. 1. To highlight to concerns physicians may have about initiating and maintaining Clozapine therapy in patients with treatment – resistant schizophrenia.

2. 2. To understand the adverse effects that are most pertinent to both physicians and their patients

To understand the barriers to prescribing Clozapine.

The authors obtained contact information for all psychiatrists registered with the College of Physicians and surgeons in Ontario, Canada. Physicians were mailed and invitation to complete a questionnaire online, or receive a paper copy, asking about potential barriers to prescribing Clozapine.

The final results of our project are still under analysis but based on the sampling done so far Clozapine therapy is limited in Ontario, Canada due to concerns of potential adverse side effects associated with clozapine therapy. There is also a limitation of access to resources to initiate and maintain patients on clozapine.

Clozapine use is still limited in many countries including Canada. Providing more education about managing the potential adverse effects and easier access to initiating and maintaining clozapine treatment will be helpful in promoting its use.