Tetrabenazine is a presynaptic depleter of dopamine, a monoamine storage inhibitor that was first introduced in the 1970s for the management of hyperkinetic movement disorders and which reduces the muscle spasms without systemic side effects, and is also used in patients with generalized or multifocal dystonia [1,2,3]. The aim of this study is to present a case report of a patient treated with tetrabenazine augmentation of clozapine and botox.

SC, a 44-year-old Caucasian gentleman affected by paranoid schizophrenia, had developed chronic extrapyramidal side effects (dystonia and spazmatic torcicollis), due to the continuos treatment with classical neuroleptics. He received botox inijections and antipsychotic treatment (clozapine 400 mg/day). We then prescribed tetrabenazine progressively increased up to 75 mg/day, with a progressive reduction of the spazmatic torcicollis in the subsequent 3-6 months.

A case report with a positive response to the treatment with tetrabenazine augmentation of clozapine and botox.

To our knowledge, this is the first paper reporting an improvement of a dystonia (spazmatic torcicollis) with tetrabenazine augmentation of clozapine and botox treatment. The particular mechanism of action of tetrabenazine could provide an innovative treatment of this negative, adverse and chronic event, with consequent improvement of the quality of life of the patients suffering from it. Further research is warranted to replicate our clinical observations and, in general terms, controlled studies are needed to confirm the efficacy of this treatment.

Negative symptoms are a fundamental dimension of schizophrenia despite their limited role in the diagnostic classifications. Eleven instruments assess specifically the negative symptoms. Among them, only one instrument, the Motivation and Pleasure Self-Report, is based on a self-assessment but only focused on 2 dimensions of negative symptoms, the pleasure and the motivation. Consequently, we developed a new scale, the Self-report of Negative Symptoms (SNS), assessing the 5 consensual negative dimensions (emotional blunting, alogia, social withdrawal, anhedonia and avolition).

To present the SNS and to test the internal consistency and validity of the SNS.

The SNS is a self-assessment constituted of 20 sentences and based on 3-point Likert-scale (0-2). Participants (n=49) completed the SNS and the Birchwood Insight Scale (BIS) and were evaluated with negative symptoms interview using Scale for the Assessement of Negative Symptoms (SANS) and with the Negative Clinical Global Impression score (CGI-). Face and content validities were examined. Internal consistency was calculated by the Cronbach's alpha coefficient. Convergent validity was calculated by the Pearson's correlation coefficient between SNS, SANS and CGI- scores. Divergent validity was calculated by the Pearson's correlation coefficient between SNS and BIS scores.

SNS presents good face and content validities, good internal consistency (α=0.784), convergent validity with SANS (r=0.526, p<0.001) and CGI- (r=0.599, p<0.001) and good divergent validity with BIS (r=-0.008, p=NS).

SNS should be more used in daily practice since it might allow the patients with schizophrenia to develop appropriate coping strategies, regardless of their level of insight.

Midlife progression of schizophrenia shows evidence of longitudinal brain volume decrease and heterogeneous outcomes.

We analyzed the relation between brain volume changes, lifetime antipsychotic medication and clinical outcomes.

Psychotic members (n= 41) and non-psychotic controls (n=75) of the Northern Finland 1966 Birth Cohort were invited for a MRI brain scan and clinical and cognitive assessment at the age of 34 years (mean 10 years after onset of illness). A follow-up was 9 years later at age 43.

Clinical outcomes were heterogeneous and generally poor: 10% were recovered. The mean annual whole brain volume reduction was 0.69% in schizophrenia and 0.49 % in controls, especially in temporal lobe and periventricular area. Symptom severity, functioning level, and decline in cognition were generally not associated with volume reduction. However, decline in social and occupational function was associated with supramarginal gyrus reduction and was independent from antipsychotics exposure. Larger amount of antipsychotics over the follow-up associated significantly with larger brain volume loss. Higher doses of lifetime antipsychotic medication were associated to larger decrease of verbal learning change in a 9-year follow-up.

Brain volume and verbal learning reduction occurs in schizophrenia long after the onset of illness. Antipsychotics may contribute to these reductions. We do not know the real effectiveness and benefits/risks of antipsychotic drugs in schizophrenia from longitudinal and lifespan view. New data does not change current care guidelines but may expand clinical decision making into lower doses, even medication discontinuation in selected groups, and biopsychosocial care.

Psychosis and adult Attention Deficit Hyperactivity Disorder (ADHD) have shared attributes, but evidence that they are associated is sparse and inconsistent.

We tested hypotheses that 1] adult ADHD symptoms are associated with psychosis and individual psychotic symptoms 2] links between ADHD symptoms and psychosis are mediated by prescribed ADHD medications, use of illicit drugs, and dysphoric mood (depression and anxiety).

The Adult Psychiatric Morbidity Survey 2007 (N=7403) provided data for regression and multiple mediation analyses. ADHD symptoms were coded from the ADHD Self-Report Scale (ASRS). Dependent variables comprised auditory hallucinations, paranoid ideation, and identified psychosis.

Higher ASRS total score was significantly associated with psychosis (O.R: 1.11; 95% CI 1.02-1.20; p = 0.013), paranoid ideation (O.R:1.12; CI 1.09-1.14; p<0.001) and auditory hallucinations (O.R 1.11; CI 1.08-1.15; p<0.001) even after controlling for socio-demographic variables, verbal IQ, autism spectrum disorder traits, childhood conduct problems, hypomanic mood and dysphoric mood. The link between higher ADHD symptoms and psychosis variables was significantly mediated by dysphoric mood (psychosis, 21%; paranoid ideation, 23%; auditory hallucination, 11%), but not by prescribed ADHD medication or use of amphetamine, cocaine or cannabis.

Higher levels of adult ADHD symptoms and psychosis are linked, and dysphoric mood may form part of the mechanism. Those with greater levels of ADHD symptoms in adulthood may be at higher risk of psychosis. Our analyses contradict the clinical view that the main explanation for people with ADHD symptoms developing psychosis is abuse of illicit drugs or ADHD medications.

The question of a continuum or a dichotomy between schizophrenia and bipolar disorders is not clearly elucidated.

The objective of the present study was to identify specific functional connectivity (FC) patterns in schizophrenia and bipolar disorders.

Therefore, the aim was to explore FC within the language production network in response to a verbal fluency task in patients with schizophrenia, patients with bipolar disorders and healthy participants. We hypothesized that prefronto-subcortical FC patterns within the language production network differ between the three groups.

Forty nine participants, comprising 15 patients with schizophrenia, 14 patients with bipolar disorders (DSM-IV) and 20 healthy controls were included in the study. FC was calculated using functional magnetic resonance imaging during a verbal fluency task between the activated pair-seed regions.

Firstly, patients with schizophrenia presented a significantly reduced FC compared to controls within two pair-seed regions (medio-frontal cluster – left subcortical cluster and left fronto-lateral cluster – left subcortical cluster) while bipolar patients were not significantly different from healthy participants. Secondly, patients with schizophrenia compared to patients with bipolar disorders exhibited reduced FC within one pair-seed region (medio-frontal cluster – left subcortical cluster).

Our results support the hypothesis of a specific medio-prefronto-striato-thalamic functional dysconnectivity implicated in the pathophysiology of schizophrenia. This fronto-subcortical dysconnectivity in schizophrenia could underlie language production symptoms observed in this pathology and could be a functional brain marker of schizophrenia.

Superoxide dismutase (SOD) is the critical enzyme in the detoxification of superoxide radicals because those are the first species produced in the majority of biological free radical producing reactions. Inconsistent data are present about SOD activity in patients with schizophrenia.

To compare erythrocyte SOD activity in schizophrenic patients who were randomly selected, and separately in the subgroup of patients younger than 34 years.

This study included 68 consecutive patients with schizophrenia (29 males and 39 females) mean age 32.7±9.4 years. The results of whole group were tested with 59 healthy controls and with the subgroup of patients younger than 34 years. SOD activity was measured in erythrocyte hemolysates by Ransod commercially available test.

When we tested the whole patient group SOD activity was not significantly different between the healthy controls and schizophrenics. In the subgroup of patients younger than 34 years SOD levels were significantly higher (1525±279 U/gHb, p<0.01) compared to corresponding control values (1349±191 U/gHb). In younger patients SOD activity was significantly higher in those suffering up to five years (1617±286 U/gHb, p<0.001), in those who had more than one episode (1588±435 U/gHb, p<0.001), as well as in heredity positive (1581±324 U/gHb, p<0.01), and heredity negative patients (1532±262 U/gHb, p<0.05) in comparison with controls. A significant negative correlation was found between the duration of the disease and SOD activity (r=-0.511, p<0.01).

Our results showed that SOD activity is significantly increased in the early phase of the disease, and then declined to control values.

60 outpatients (aged 34.5±8.9, male 73%), 75% schizophrenia and 25% schizoaffective disorder diagnosis, 68.3% fewer than 15 years of schizophrenia evolution, 76.7% fewer than 5 times previous hospitalizations were treated with O-A (41.7%) or depot-A (58.3%) antipsychotics for at least one year. Depot-A treated patients showed a significant higher compliance compared to O-A patients during the all following time, lower PANSS (total, positive and negative) scores and CGI-SSI score (p<0.01), and a delayed relapse incidence and re-hospitalization to more than 1 year in the 48% of patients (relapse % depot/% oral) after 6 months 22.9%/52.0%, and after 12 months 48.6%/4.0%.

There were protective factors which delayed relapse incidence in schizophrenia: Use of sustained-release preparations, family support. There were risk factors for occurrence of relapse in schizophrenia: cocaine, heroin and alcohol consumption, absence of family support, greater severity of patients assessed through CGI-SI, male sex, age older than 25 years and long-term evolution of the disorder. Cannabis use did not affect the incidence of relapse.

Schizophrenia is one of the most severe psychiatric disorders. An early diagnosis and beginning of treatment may lead to a more favorable prognosis of the disease.

We propose to study the clinical and evolutionary characteristics of the onset of schizophrenia.

In this retrospective study, we reviewed the records of 61 patients who were hospitalized for schizophrenia in the department of Psychiatry 'A” in the University Hospital in Sfax (Tunisia), between August 2009 and January 2013.

For each patient, we collected sociodemographic, clinical and evolutionary data.

The average age of disease onset was 25.25 years. The majority of patients were males (78%) and single (85.2%).

Paranoid schizophrenia was the most frequent type of schizophrenia (65.6%). The average duration of untreated psychosis was 2 years 11 months. The main pre-psychotic symptoms were: social isolation (48.6%), heteroaggressiveness (37.3%), irritability (34.2%), insomnia (32.3%), self-neglect (13.1%) and anxiety (4.9%).

Patients were treated with oral typical antipsychotic drugs in 44.3% of cases, conventional depots in 39.3% and atypical antipsychotic drugs in 16.4%.

After a hospital stay of 25 days on average, 47.5% of patients never came back. Patients followed-up at the outpatients unit had regular monitoring in 53.14% of cases and good adherence to treatment in 42.9%.

Our study showed that more than half of patients were lost to follow-up or had poor adherence to treatment. Atypical antipsychotic prescription, having better neurological tolerance, and psychoeducation for the patient and his family, would be beneficial to improve the management of schizophrenia.

With typical onset in late adolescence or young adulthood psychosis often have a chronic and relapsing course with potentially devastating functional implications. Research on the period that precedes the modal age of onset psychosis has become crucial for identifying the very early stage

This study aims to determine the pre-admission clinical, socio-demographic characteristics and prodromes associated to a first psychotic episode

It's a retrospective observational study. Fifty five Tunisian patients admitted in Hedi Chaker hospital between 2007 and 2013 were recruited. Socio-demographic and clinical data were collected and patients were diagnosed using DSM-IV criteria.

The mean age was 26.5. 61.8 %lived in a rural environment.

54.5% had a family history of psychiatric disorder. 12.7% had a history of head trauma

74.5% were schizoid, 1.8 % had avoidant personality disorder, and 1.8% had schizotypal personality disorder

10.9% suffered from irritability. 67.3% had anxiety .38.2% suffered from depression. 20% experienced mood fluctuations

29.1% had frequent fatigue; 10.9% had a loss of interest

18.2% complained about difficulties with concentration, 10.9% had difficulties of recall

14.5% had loss of appetite, 78.2% suffered from sleep disturbance, 23.6 % lost weight.

25.5% had marked impairment in personal hygiene and grooming .70.9% presented social isolation and withdrawal .7.3% had Impairment in role functioning .40% had odd believes.

Since there is a variety of unspecific signs which may precede a first psychotic episode and no specific biological markers; treating even with insufficient evidence may sometimes become an alternative.

The Mismatch Negativity (MMN) is an event-related potential (ERP) sensitive to early auditory deviance detection and has been shown to be reduced in patients with schizophrenia. Moreover, MMN amplitude reduction to duration deviant tones was found to be related to functional outcomes particularly, to social cognition and real-life functioning.

In the context of a multicentre study of the Italian Network for Research on Psychoses, our study focused on the investigation of early auditory discrimination components in relation to functioning in real-life in patients with schizophrenia.

ERPs were recorded in 64 chronic, stabilized patients with schizophrenia during the presentation of standard, duration deviants and frequency deviants tones while watching a cartoon. The Specific Level of Functioning (SLOF) scale was used to measure real-life functioning. Psychopathology, neurocognition and social cognition were measured by state of art instruments. Regression analyses were carried out using SLOF domains as dependent variables and MMN, psychopathology, neurocognition, extrapyramidal symptoms and social cognition as independent predictors.

Latency of MMN entered the regression equation only for the SLOF domain of common activities explaining less variance than social cognition and positive symptoms.

In stabilized patients with schizophrenia pre-attentive deficits, as indexed by MMN and P3a amplitude reduction, do not show any association with psychopathology or functioning. Latency of MMN was an independent predictor of some aspects of functioning with a smaller effect than social cognition and psychopathology domains.

Impulsivity, conceptualized as impairment in planning and poor intentional and inhibitory control, contributes to deleterious outcomes among clinical populations and has severe clinical repercussions. It is also associated with poor clinical outcomes in patients with schizophrenia including substance abuse, suicidal acts, and aggression. However, the role that impulsivity has in schizophrenia is poorly understood.

The current study seeks to examine self-reported impulsivity (Barratt impulsivity scale) in patients with schizophrenia and to evaluate its association with clinic and demographic characteristics.

We administered the Barratt Impulsiveness Scale, version 11 (BIS-11) in validated Arabic version to 40 patients with schizophrenia. Inclusion criteria for patients included DSM-IV diagnosis of schizophrenia; diagnoses were confirmed with the Structured Clinical Interview for DSM-IV Axis-I disorders. Patients were considered to be clinically stable, indicated by at least a month since the last mood episode, no medication changes in the previous 6 weeks.

In this study, schizophrenia patients have reported higher levels of impulsivity on the BIS-11, which is in the direction we found, although it was not significant in our sample.

Impulsivity has been repeatedly identified as a major problem in schizophrenia. The literature revealed several ways of defining and conceptualizing it as well as a variety of measures and an analysis of its consequences. The role of impulsivity in the development of aggression in patients afflicted with schizophrenia and the amelioration of impulsivity by antipsychotic medications is two additional areas that should be researched in the future.

The pregnancy and the postpartum are two periods of intense psychic vulnerability in particular for women suffering from schizophrenia. The role of the family is paramount during this difficult period.

To investigate the role of the family assistance in the triggering of the psychotic decompensation and relapses of women suffering from schizophrenia during pregnancy and postpartum.

This was retrospective descriptive study, including 30 women patients suffering from schizophrenia and mothers of a child of less than two years. Data was collected from patients’ clinical files. Information obtained was recorded on a pre-established questionnaire.

The average age of the patients was 39 years. 80% of the patients were married at the time of the study. The quality of the marital relation was considered to be rather good in 66.66% of the cases, rather bad in 26.66% and was absent for two patients. 40% of the patients faced marital conflicts during the pregnancy and 47% during the postpartum. A good marital support was noticed in 67% of the cases during the pregnancy and 63% of the cases during the postpartum. The patients' mothers were present during the pregnancy in 53% of the cases and during the postpartum in 60%. The patients who were hospitalized for a psychotic decompensation of the postpartum were in 75% of the cases those whose mothers were absent.

The support of the family during the pregnancy and the postpartum is important in the prevention of psychotic decompensation of the patients suffering from schizophrenia.

There is no established a cause of schizophrenia;however it is believed there is involvement of genetic components, environmental and psychosocial factors. Clozapine is anatypical antipsychotic, effectivein improving negative symptoms, but with much side effects. Intervention should not be restricted to patients, but cover theircaregivers. Thus, improvement alsoaffects the lives of caregivers.

To discussmeanings of experiences from patients'family caregivers after clinical improvement using clozapine.

Qualitativestudy. Semi directed interviews with open-ended questions are made. Intentional sample closed by saturationof information. Participants were 13 family caregivers of patients takingclozapine. Interviews were recorded, transcribed and discussed fromMedical Psychology.

We selected two emerging categories:(1) Therapeutic Projectvs Life Project: antagonismor synergy? Despiteperception of improvement, interviews do not see this issue as the main focus. They can mention differences in efficacy between drugs, but remain in idealization of healing; (2) Retakeof both old experiences of own temporality andlife planning: speeches indicate that effective rescue medication allowssome of these experiences because they perceive patients’ improvedquality of life, affection andpragmatism, thought and sensory perception.

Although there are significantchanges, the expectations of family caregivers are more comprehensive. The most successful treatmentwith clozapine was valued, even though desire for complete curecontinues explicit.

The well-known fact about schizophrenic patients is that they have an increased mortality compared to the general population. According to numerous studies the most important cause of increased mortality in schizophrenic patients is cardiovascular disease, whose higher frequency is often associated with an increased prevalence of metabolic syndrome (MS) in these patients.

To determine the prevalence of MS and its components in schizophrenic patients.

Our study group consisted of schizophrenic patients from the University Clinical Hospital Mostar (n=100). The control group consisted of healthy subjects who came to the systematic medical examinations in the Health Center Mostar (n=100). The diagnosis of MS was made according to ATP III criteria.

In the total sample there were 37.5% subjects who met the MS diagnostic criteria. Schizophrenic subjects had a higher prevalence of MS compared to the control group (p=0.013). There were no statistically significant differences in the frequency of the number of MS components between the group of schizophrenic subjects and the control group (p=0.234). Schizophrenic subjects had significantly more frequently low HDL cholesterol concentrations compared to the control group (p=0.001). Schizophrenic subjects with MS had significantly more frequently higher age compared to the schizophrenic subjects without MS (p=0.002). Other sociodemographic variables were not significantly associated with MS in schizophrenic subjects.

The prevalence of MS was statistically higher in schizophrenic subjects compared to the control group. Schizophrenic subjects with MS had a higher age compared to the schizophrenic subjects without MS.

Since the 1950s the mortality rate of people with schizophrenia has been in direct contrast to the general population with an approximate reduction of 25 life years.

To explore the prevalence, clinical correlates and the lived experience of treatment resistant schizophrenia and comorbid metabolic syndrome

The study uses a mixed methods approach. The study components are (1) A descriptive analysis of Physical Health data collected on patients with treatment resistant schizophrenia to determine prevalence and clinical correlates of metabolic syndrome. (2) 25 Semi structured interviews on the lived experience of the comorbid metabolic syndrome.

Sample: Persons diagnosed with Treatment Resistant Schizohrenia

Descriptive analysis of a data set on the physical health of 155 persons with treatment resistant schizophrenia demonstrated 90% of patients exhibeted 2 or more factors of the metabolic syndrome with correlations between female gender,medication absorption and body mass index.

The outcomes of quantitative data analysis and semi structured interviews will be triangulated to provide comprehensive insights of subjective and objective dimensions of the patients experience. The findings of this study will inform client centred reccomendations to improve physical health outcomes for this population according to need.

Despite recent interest in the brain/mind problem and the possible organic correlates of mental disease, relatively few case studies have examined the problem concretely. I examined the effectiveness of neurotherapy for a 68-year-old male schizophrenic patient whose psychotic symptoms displayed qualitative and quantitative changes after a closed-head injury. It was hypothesized that there would be good response to relative beta training applied to regulate the dynamics of brain function.

The patient was diagnosed with schizophrenia in the early 1960s and frequently thereafter hospitalized. Visual hallucinations were the dominant symptom, and art therapy provided some relief, which led to a successful artistic career. In 1989, while actively hallucinating, he suffered a mild TBI in a pedestrian accident, an in consequences, he presented with perseveration, hemispatial neglect, and disturbances of working memory. The patient took part in 20 sessions of relative beta training. Standardized neuropsychological testing and Event Related Potentials (ERPs) before and after the completion of the program were used. As hypothesized, there was marked improvement of neurophysiological, neuropsychological, and psychiatric symptoms, as well as executive dysfunction and behavioral disorders. He also began to paint in a completely different style.

The pathomechanisms of schizophrenia and neurobehavioral disturbances resulting from organic brain damage are not unrelated. Microgenetic theory can provide a basis for explaining the course of symptoms in this and similar cases. Relative beta training produced behavioral changes and small physiological changes. ERPs can be used to assess functional brain changes induced by neurotherapeutic programs.

In this study we sought to explore patterns of neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia spectrum disorders (FES) and healthy controls (HC).

Thirty-five FES patients and 35 age-, gender- and education-matched healthy controls.

A task-related functional connectivity analysis with the use of independent component analysis (ICA).

ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task.

Time-courses of DMN/CEN activity has been analyzed by means of signal power and spectral coherence. There was statistically significant difference in the variable (anti-correlation index, AI) between FES and HC. AI correlated with self-agency judgment task performance in FES.

This finding suggests that the main site of pathology in schizophrenia-spectrum disorders may originate in higher-order regulatory mechanisms subserving DMN/CEN orchestration.

The study was supported by the IGA Ministry of Health, Czech Republic, grant NT/14291.

Since the early description of paranoia, nosology of delusional disorder has always been controversial. The idea of ??unitary psychosis is old but has now taken on new value from the dimensional continuum model of psychosis.

1. To study the psychopathological dimensions of the schizophrenia spectrum. 2. To explore the relationship between the dimensions obtained and the categorical diagnoses. 3 To compare the different diagnoses of the psychosis from a psychopathological and functional point of view.

an observational study with 550 patients was conducted. 373 patients with schizophrenia, 137 patients with delusional disorder, 40 patients with schizoaffective disorder. PANSS was used to assess the psychopathology and GAF for global functioning. Exploratory and confirmatory factor analysis of the PANSS items was performed in order to obtain a dimensional model. The relationship between diagnostic categories and dimensions was subsequently studied with ANOVA tests.

5 Factors,-manic, negative symptoms, depression, positive symptoms and cognition-, similar in composition to other models were obtained. The model yielded the 57.27% of the total variance. The dimensional model obtained was able to explain the differences and similarities between the different categories of the schizophrenia spectrum and the validity of the categories was questioned. The value of the model in order to help establish the diagnosis, prognosis and treatment decision-making was postulated.

The relationship between olfactory and emotional processing is an area of increasing interest in schizophrenia research.

The brain regions like orbitofrontal cortex and amygdala are involved in the processing of olfactory information.

Evaluation of odor identification performance and valence interaction in patients with schizophrenia. Assessment of influence blood concentration of β-endorphin and calcitonin gene-related peptide(CGRP) on odors identification.

50 patients with schizophrenia and 50 healthy controls were included in the study. Schizophrenia symptoms were evaluated using PANSS. University of Pennsylvania Smell Identification Test (UPSIT) was performed in both study groups. Moreover blood concentrations of β-endorphin and CGRP were measured in all participants.

The concentration of CGRP was significantly higher in patients sample (p<0,001). The concentration of β-endorphin was higher but without statistical significance. Controls achieve significantly higher UPSIT score than patients (mean UPSIT 32,48 vs 26,82). Odor identification performance by valence interaction in patients sample revealed significantly more identification errors in response to both pleasant and neutral odors relative to unpleasant odors (p=0,000 vs p=0,055). Patients with higher β-endorphin concentration made more identification errors on pleasant (R_s= −0,292; p= 0.04) and neutral odors (R_s= −0,331; p= 0,019). No relationship between CGRP concentration and UPSIT performance was observed.

Schizophrenic patients present a unique pattern of smell identification characterized by aberrant hedonic ratings for pleasant but not unpleasant odors. Individuals with predominant negative symptoms and higher β-endorphin concentration would also be those with the greatest ability to identify negative odors.