Employment is important from the point of view of social inclusion and quality of life in individuals with schizophrenia.

To explore employment status in individuals with schizophrenia.

To examine register based employment and disability pension in average 20 years after onset of schizophrenia and compare those to population controls.

Individuals in the Northern Finland Birth Cohort 1966 (NFBC 1966; n=10277) were linked with the registers of Care Register of Health Care, Social Insurance Institution and Finnish Centre for Pensions. Individuals were considered as having schizophrenia, if they had diagnosis until the end of 2006. The sample included 161 individuals with schizophrenia (1.6% of all NFBC 1966 members). Good occupational outcome was defined as working at least 50% of the days during the two-year follow-up (2010 – 2011, age 44-45 years) and not being on disability pension, and poor occupational outcome as being on disability pension.

At the follow-up, 63% of the individuals with schizophrenia had poor and 6% had good outcome. Corresponding figures for population controls without schizophrenia were 4% and 69% (p<0.001). In the congress, we will report also results regarding early biological and psychosocial risk factors of employment status.

Employment rate at midlife in individuals with schizophrenia is low. Better ways of occupational rehabilitation are needed to support employment in individuals with schizophrenia.

Many of so called schizophrenias are symptomatic, secondary cerebral dysfunction (disorders). The unethiological approach and the symptomatic pharmacotherapy, push this patient automatically in group of chronic mental illneses and in big stigmatisation of patients and their family.

Clinical, neuropsychological, laboratoric, neuroimaging and ethiological analysis of sample of 100 patient with schizophreniform clinical pictures.

In 29 % of patients the cause was the substance abuse, in 25 % extracerebral infection/inflammtion, in 16 % endocrine/metabolic disorders, in 11 % brain damage, in 7 % cardiovascular disorders and in 7 % neurodevelopmental disorders.

In about 70 % of ur patients with schizophrenical and schizophreniform psycotic clinical pictures the primary cause were extracerebral. The real ethiological approach and diagnosis in clinical psychiatry is the only way to targeted ethiological therapy and reduction of chronification and stigmatisation of psychiatric patients

Omega-3 polyunsaturated fatty acids (n3-PUFA) are major constituents of the neural membranes. N-3 PUFA take part in several neuronal mechanisms, including modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression. Deficiency in n-3 PUFA has been postulated in the etiology of schizophrenia. Intervention trials supplementing n-3 PUFA were conducted to assess the efficacy of n-3 PUFA in reducing symptom severity in exacerbations of chronic schizophrenia and acute phase of first-episode schizophrenia. The results were n-3 PUFA were found to prevent conversion to psychosis in clinical high risk populations.

To assess the efficacy n-3 PUFA as add-on treatment in relapse prevention in first-episode schizophrenia patients.

We conducted a randomized, double-blind, placebo-controlled, parallel-group single-center 6 months augmentation trial of either 2,2 g per day of n-3 PUFA or placebo added on to an adjustable dose of antipsychotic medication in first-episode schizophrenia patients. Intervention was composed of either 1320 mg/day of eicosapentaenoic acid plus 880 mg/day of docosahexaenoic acid or placebo olive oil. The relapse rate was observed during a follow up period of 12 months.

71 patients completed the study (41% female). Relapse was observed in 4 patients (11.4%) enrolled in n-3 PUFA group and 12 patients (33.3%) in placebo group over a period of 12 months. The difference was statistically significant (log rank test, p=0.0225).

The results indicate, that n-3 PUFA add-on therapy can effectively prevent relapses in first-episode schizophrenia patients.

Increasing evidence supports the important role of illness state and individual characteristics in insight among patients with schizophrenia (SCZ).

To determine factors predicting the lack of insight among patients with SCZ.

It was a cross-sectional, descriptive and analytical study, involving 40 patients with DSM-IV diagnosis of SCZ followed in the outpatient psychiatry department at the Hedi Chaker University Hospital of Sfax inTunisia . The SAIQ (Self Appraisal of Illness Questionnaire) was used to measure 3 domains of insight (need for Treatment, Worry, and Presence/Outcome of Illness) and the PANSS (Positive and Negative Syndrome Scale) was used to measure the intensity of psychotic symptoms.

The average age of our patients was 41 years (21-64 years). The mean duration of disease was 14 years and the number of hospitalization was 2.5.

The scores of insight were independent from sociodemographic factors. The lack of insight in SAIQ was significantly correlated with a greater number of hospitalizations (p = 0.03). The worry subscale was associated with a longer duration of disease (p = 0.04) while the presence/outcome of illness subscale was associated with the intensity of negative symptoms (p = 0.03). There was no correlation between insight and positive syndrome.

Our results show that the lack of insight is closely related to negative symptoms and the duration of the illness in patients with SCZ. Therefore, interventions to better the insight should focus on early diagnosis and psychosocial therapy to improve negative symptoms.

Apart from cognitive impairments in schizophrenia, language dysfunction have been recognized in the earliest reports of the disorder. It has been of great importance in schizophrenia research since many symptoms of the illness are expressed in terms of language or are direct language dysfunctions themselves. It is known that patients with schizophrenia have difficulty to process semantic aspects of language, combining semantic and syntactic information as well as creating lexico-semantic associations. On the other hand, their ability to read and spell single words as well as vocabulary skills acquired early in life remain spared. There is evidence implying that language functions mediated by the right hemisphere may be disturbed in schizophrenia patients

To assess language and communication dysfunctions with schizophrenia patients with the use of standardized neuropsychological tests battery the Right Hemisphere Language Battery – Polish Version (RHLB-PL).

40 schizophrenia patients and 39 healthy controls were enrolled to the study. All of the participants were assessed by the Right Hemisphere Language Battery – Polish Version (RHLB-PL) and schizophrenia patients by PANSS.

Schizophrenia patients performed poorer in most of higher order language functions mediated by the right hemisphere. They not only experienced difficulties with comprehending implicit information (p=.034), understanding humor (p=.002), giving interpretation of metaphors (p=.000), understanding emotional (p=.000) and language prosody (p=.000) and discourse (p=.000), but also had problems to withhold inappropriate commentaries in course of assessment (p=.000).

The results indicate that there are significant differences between schizophrenia – patients and normal controls in extralinguistic processing.

Schizophrenia patients experience severe difficulties in a range of common activities, defined 'functional milestones' (i.e. marriage, employment, self-supported living).

This study investigated the impairment in functional milestones in treatment resistant schizophrenia (TRS), compared to other severe disabling psychiatric conditions. Moreover, we evaluated whether multiple clinical and psychopathological features may be predictors of outcome in such functional milestones.

157 patients were enrolled and subdivided in four groups by diagnosis: anxious-depressive spectrum, bipolar disorder spectrum, schizophrenia responder patients, TRS patients. Demographic, clinical and social data were collected. Patients underwent psychopathological, psychosocial and cognitive functioning assessments. Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance (PSP) scale, Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), List Learning task for Verbal Memory, Digit Sequencing task for Working Memory, Category Instances task for Verbal Fluency and Tower of London task for Problem Solving were administered. Data were analyzed by ×2 test, ANOVA test and Kruskal-Wallis test. Stepwise multivariate regression was used to correlate functional outcomes to clinical and psychopathological variables.

TRS patients were more severely impaired in all psychosocial areas explored, were exposed to higher antipsychotic doses, had a higher number of hospitalizations, had higher scores on psychopathological rating scales and performed worse on the verbal memory task. Outcomes in functional milestones were more correlated to clinical/psychopathological variables in TRS than in the other groups.

Psychosocial impairment, clinical, and psychopathological features generate a vicious circle in TRS, which is less evident in other disabling psychiatric conditions.

The epidemiology of first-episode psychosis (FEP) is poorly understood because of the paucity of systematic studies.

To investigate the incidence and range of diagnostic groups in patients with FEP in the county of Vrancea from Romania and specifically from the Psychiatry Department of the Focsani County General Hospital, in 2011.

This study is in fact a part of a larger ongoing study of 10 years.

We have studied F23 – Brief psychotic disorder as discharge diagnosis (ICD-10), and we tried to the find incidence of FEP.

From the total number of 1408 patient hospitalized in 2011, the diagnosis of F23 was as follows: F23.0=31, F23.1=16, F23.2=9, F23.3=5, F23.4-F23.7=0, F23.8=9, F23.9=23, in total 93.

From that we have excluded the ones with toxic or degenerative (I.e. Dementia) disorders, and in the end we have reached 31 patients, with diagnosis at the end of our study of Acute and transient psychotic disorder (14), Schizophrenia (13), 2 Bipolars, one Schizoaffective Disorder and one Major Depression.

According to the results of the last census in Romania, our county has 340.310 individuals from which about 21.000 are living in other countries. The number of persons present at this census was of about 320.000.

This means that the incidence in our study was of 9.6875 at 100.000 individuals.

In the previous studies, the reported incidence of FPE was between 10 and 30 at 100.000 individuals, but the ones that go towards 30 were, in the end, mostly affective disorders.

Antisocial behavior (aggression, violence, abuse of alcohol and substances) is five times more frequent in schizophrenia compared with other mental disorder and leads to a subtantial burden of disease. Control over this issue represents a main target for therapeutical strategies. Pharmacological models of aggression suggest a glutamatergic hyperactivity overposed to structural cerebral changes. Rapid control of aggression and psychomotor agitation can improve prognosis and evolution of the disease.

To assess the involvement in caregiving as a compound of burden of disease for caregivers of schizophrenic outpatients in the context of antisocial behavior. To correlate the antisocial behavior with cerebral abnormalities in schizophrenia.

Study on a sample consisted of 81 outpatients diagnosed with schizophrenia according to ICD-10 criteria, and their cargivers, in Mental Health Center Craiova, Romania. Involvement Evaluation Questionnaire (Schene, 1992) was used to assess the distress of caregivers, and CT exam was applied to patients.

Agression was present in 56 cases (69.14%), and suicide behavior in 6 cases (7.40%). Alcohol consumption and abuse were present in 30 patients (37.04%), while 20 outpatients (24.69%) were smokers. IEQ has revealed a high level of distress for caregivers (men 98.15±13.62; women 95.27±14.81). CT showed cerebral changes in aggressive patients.

Antisocial behavior and psychomotor agitation increase the level of distress and burden of disease, leading to cerebral abnormalities in schizophrenia. Further researches will compare this sample of patients with others in which psychomotor agitation was controlled by new pharmacological forms of antipsychotics.

Assess the impact of chemical dependency for a somatic pathology in patients with schizophrenia.

During one year, 440 patients admitted to the emergency multi somatic hospital were examined. Inclusion criteria were: age older than 18 years; the presence of “dual” diagnosis; the appropriate category is F2 and F1 ICD-10.

Patients suffering from schizophrenia spectrum disorders, is 2.0% of all incoming patients in the multi somatic hospital. Almost half of these patients (47.7%) have a concomitant diagnosis of addiction (harmful use or dependence on the different types of substances). A somatic pathologies among patients with schizophrenia who abuse substances is represented by different disorders. Poisoning occurred most frequently (29.3%), slightly less frequent in burns (22.3%) and head injuries (20.3%). Infections were observed in 15.9% of patients, mostly were is socially significant transfusion transmitted infections and tuberculosis. Cardiovascular disease, diabetes, and pathology of the gastrointestinal tract occurred less frequently.

Patients with schizophrenia spectrum disorders in conjunction with the substance dependencies often come to the hospital unconscious, significantly longer being treated in the hospital compared with patients with schizophrenia without concomitant substance abuse disorders (low bed/day 12.1 vs 7,2; p <0,05).

Substance abuse in patients with schizophrenia spectrum disorders increases the risk of somatic disorders and degrades during somatic disorders.

An important element of the rehabilitation in schizophrenia is cognitive rehabilitation, aimed at the greatest possible reduction in deficits.

The aim of this study was to examine cognitive functioning in schizophrenic patients with a comorbid addiction to psychoactive substances participating in a cognitive rehabilitation program.

All recruited patients were men, aged between 20 and 45 years. They were examined in the initial period of the stay at the treatment center and after 4-7 weeks of hospitalization, after the stabilization of acute psychotic symptoms. During this time patients participated in the cognitive rehabilitation program. Cognitive function were assessed: Trail Making Test (TMT A & B), Stroop Test, and Verbal Fluency Test. Patients were divided into two groups according to abused substances: a) amphetamine users (n = 15), b) cannabis users (n = 11). As for the medication – 25 of 26 patients were treated with second generation antipsychotics.

After the process of rehabilitation of cognitive functions of all gained patients gained a significant improvement. The type of abused psychoactive substance did not significantly affect cognitive functioning. However, amphetamine-dependent patients achieved better results in some of the cognitive tests. Cognitive rehabilitation does not affect the reduction of psychopathological symptoms. However, in patients addicted to amphetamines a decrease in the severity of these symptoms was found.

Cognitive rehabilitation exerts a positive effect on cognitive functioning of schizophrenic patients with concomitant dependence on psychoactive substances.

In our clinical practice we can be forced, in few cases, to switch from aripiprazole to other antipsychotics due to recurrence of symptoms of schizophrenia. We don’t have much information about the influence of aripiprazole on the onset of action of new antipsychotic.

The action of antipsychotics starts in first two or three weeks. Switch from one antipsychotic to another can influence the onset of action of the last.

Aripiprazole has a strong affinity for D2 receptors (bounded on more than 90% of D2 receptors in therapeutic doses) and a half time of 72 hours. The access to D2 receptors after aripiprazole can be delayed.

We had two case studies, both diagnosed with schizophrenia, multiple episodes, currently in acute episode according to DSM V. Both patients were treated with aripiprazole in the past year, uptitrated to 30mg/day in the last month due to recurrence of positive symptoms. because of persistence of positive symptoms, the patients were switched to olanzapine and respectively to risperidone.

The symptoms of both patients were persistent for 5 weeks. After that time, both patients have a good response to the new antipsychotic. PANSS score had a reduction on positive items only after five weeks after the switch, which means a delay of action of new antipsychotic.

We presume that aripiprazole can delay, in same cases, the onset of action, if switched to another antipsychotic due to persistence in the plasma (long halftime) and his superior affinity for D2 receptors.

Substance abuse is a well established risk factor for First-Episode Psychosis (FEP). We hypothesized that substance use at baseline could be an independent risk factorfor a worse clinical course.

An incidence cohort ofpatients with FEP collected in an 8 year period (2002-2009) at the Bologna WestCommunity Mental Health Centers (CMHCs) was assessed at baseline and at 12 month follow-up. Hospitalizations were used as clinical outcomes.

Substance users had asignificantly higher rate of hospitalizations during the follow-up after adjusting for age, gender and other potential confounders (OR 5.84, 95% CI 2.44-13.97, p≤0.001).

This study showed the independent effect of substance use on FEP course. Clinical implications will be discussed.

Tarricone I, Boydell J, Panigada S, Allegri F, Marcacci T, Minenna MG, Kokona A, Triolo F, Storbini V, Michetti R, Morgan C, Di Forti M, Murray RM, Berardi D. The impact of substance use at psychosis onset on First Episode Psychosis course: results from a 1 year follow-up study in Bologna. Schizophr Res. 2014 153(1-3):60-3.

Allegri F, Belvederi Murri M, Paparelli A, Marcacci T, Braca M, Menchetti M, Michetti R, Berardi D, Tarricone I. Current cannabis use and age of psychosis onset: a gender-mediated relationship? Results from an 8-year FEP incidence study in Bologna. Psychiatry Res. 2013 Nov 30;210(1):368-70.

Schizophrenia (SZ) is a severe mental disorder poor elucidated from the etiopathogenesis prism. Recently, several micro andmacro vascular abnormalities have been consistently implicated in SZ´spathophysiology. The relationship between Angiogenesis and SZ can putatively influence brain hemodynamics, pathophysiology and symptomatology due to its involvement in embryogenesis and neurogenesis. Angiogenesis can provide a framework in which some etiological factors and susceptibility genes for SZ can be linked together.

To explore the link between SZ and angiogenesis, taking into account new insights fromgenetic, molecular, neurochemical, animal, and neuroimaging functional studies.

A non-systematic review of the literature was performed to summarize current knowledge regarding Angiogenesis and SZ usingthe PubMed database.

Recent molecular and neuroimaging studies indicate that angiogenesis could be involved in SZ etiopathogenesis through its role in neurogenesis during neurodevelopment, or by angiomodulation of cerebral blood flow (CBF). A complex multivariate interplay between angiogenic factors, dopamine, neurotrophins, brain angiogenic inhibitors molecules (BAI1-3) and patterns of regional blood flow mayyield to a biological effect.

The role of Angiogenesis in angiomodulation and angioregulation of regional CBF patterns may have direct implications in theclinical heterogeneity of SZ. Studying the effect of antipsychotics on brain microvasculature and on CBF in different stages of the disease, focusing on brain Angiogenesis activation through VEGF or by neurotrophic-based mechanisms, and by complementing the analysis determining related Angiogenesis abnormalities, could reveal more cues behind the crosstalk's between Angiogenesis, CNS development and SZ.

Sexuality is a basic need of every human being. However, it can somrtimes become deviant. Unlike alcohol or drug abuse, suppression of sexual behavior is not an option, only compulsive character must be suppressed in order to allow a full and satisfying sexuality.

The purpose of this observation is to explore the psychological and physical consequences of sexual addiction.

We report the case of a patient with sexual addiction, in order to describe the impact of this addiction on his psychological and physical health.

Mr. JG is 28 a years old man, he has no particular habits and no significant pathological history. He was addressed by his general practitioner for “excessive masturbation”.

His sexual history is characterized by:

• - An excessive interest in pornographic films since the age of 13,

• - An extremely rich fantasy life,

• - Frequent compulsive masturbation, going up to ten times a day.

Through the years, this hyper sexuality has become more important, and masturbation more frequent, which resulted in:

• - Permanent feeling of embarrassment and shame,

• - Ideas permanently focused on sexual thoughts,

• - Fatigue and chronical physical exhaustion,

• - Constant muscle pain and headache, diminished visual acuity.

• - Relationship difficulties, and social maladjustment,

• - Depression and suicidal thoughts.

The evaluation by the Carnes scale found a score of 16/25, which corresponds to a severe sexual addiction.

The boundary between normal and pathological depends on the models and taboos of society, but for physicians, the major criteria for sexual addiction are mental suffering, social maladjustment, and demand of care.

Living with a psychotic illness, it is now possible, in particular thanksto advances in psychopharmacology, and the discovery ofantipsychotic medications. However, even when the patient is stable and free from psychotic symptoms, new challenges arise including control of the medications sides effects. Sexualdysfunction is particularlycommon and can be very troublesome when the patientwant to resume a normal life.

The aim of this paper is to present a case ofsexual dysfunction induced by antipsychotics, and to briefly review the literature on the subject.

We followed-up a 44 years patient withdiagnosis of schizophrenia, and who developed sexual dysfunction secondary toantipsychotic medication. Through Pubmed / Medline we conducted a briefliterature review on the topic using the keywords: “rantipsychotics” and “sexual dysfunction”.

This case demonstrated the importance for the patient of sexual side effects, which manifested itself with several antipsychotics including risperidone, quetiapine, olanzapine, and paliperidone. We can only solved symptoms of sexual dysfunction with aripiprazolein monotherapy.

Sexual function is a determinant of the quality of life aspect of psychoticpatients. The literature reviewshowed that all antipsychotics have the potential to negatively affect sexual function. However, some antipsychotics as aripripazoland ziprasidone are associatedwith lower degrees of sexualdysfunction. Some strategies fordealing with these side effectsare dose reduction, thereplacement for another antipsychotic, the association of aripiprazol, and the association ofan adjunctive therapy to sexuality.