Hospital staff not infrequently question the effectiveness of treating individuals with long DUPs (duration of untreated psychosis). A street assessment is complex to arrange, involves several different agencies, is expensive and often distressing for the individual concerned. We need to be reasonably sure that we are doing more good than harm in admitting someone to hospital in this way. There is little in the published literature regarding this aspect of psychiatric practice.

We selected a consecutive group of street Mental Health Act Assessments by examining the paper records held by our AMPH (Approved Mental Health Professional) service and cross-referencing these with our electronic case records. We looked at several psycho-social outcome measures one year following discharge from hospital.

Although the number is small, the outcomes are overwhelmingly positive, in spite of notions about long DUP being predictive of poor response to treatment. Most of the subjects were in housing and remained in contact with a mental health team.

The assertive treatment of people rough sleeping with psychosis, even with long DUPs and long histories of street sleeping, can be highly effective.

Clozapine-induced electroencephalography (EEG) abnormalities are common. It has been reported that clozapine-induced EEG abnormalities occur in a dose-dependent manner and correlate with the serum concentration of clozapine (C-CLZ). However, the oppositional results were also reported.

The objective of this study was to investigate the relationship between serum level of clozapine and EEG abnormalities.

Twenty-eight patients were recruited in this study, but five patients were excluded because clozapine was discontinued before post-treatment EEG measurement or measurement of C-CLZ. Ultimately, 23 patients (6 males, 17 females) with an average age of 35 years were enrolled. The subjects were divided into EEG normal and abnormal group. C-CLZ and the serum concentration of metabolite of clozapine (N-CLZ) were measured. The correlation between C-CLZ and daily dose of CLZ (D-CLZ), N-CLZ and D-CLZ were evaluated in each group. C-CLZ per D-CLZ (C/D), N-CLZ per D-CLZ (N/D) and the ratio of C-CLZ to N-CLZ (C/N) were compared between the two groups.

74 serum levels were measured. All patients had normal baseline EEGs, and 10 patients later showed EEG abnormalities. There were a significant correlation between C-CLZ and D-CLZ (EEG normal: rs 0.58, p<0.01, EEG abnormal: rs 0.56, p<0.01) and between N-CLZ and D-CLZ (EEG normal: rs 0.53, p<0.01, EEG abnormal: rs 0.57, p<0.01). There were no significant differences between the EEG normal and EEG abnormal groups in C/D, N/D, C/N.

There was no relationship between the serum concentration of clozapine and EEG abnormalities.

The current study tries to understand the psychopathology of passivity and hallucinatory symptoms, which are symptoms sometimes signified by their conscious experience of attaching internally generated contend to external source. This study focuses on the postulated deficit of patients with these symptoms, and suggests that the specific deficit in action awareness is psychopathologically important and wishes to develop a simple task for clincal assessment.

19 healthy control, 19 psychotic patients control and 19 psychotic patients with the relevant symptoms were recruited in the studiy. Their clinical, social, cognitive, side-effect and motor condition were assessed, and the main experiment task was conducted. In the task, the participants were asked to replicate their own actions in conditions: (1) being passively moved; (2) moving voluntarily and (3) being instructed. The inaccuracy of the replication was recorded, and 1 supplementary experiment was conducted for confounders.

After control the confounding factors, such as the cognitive deficit, result from the main and supplementary experiments suggested that patients with passivity experience and hallucinatory symptoms as a group were having deficit in the awareness of their own actions, such that they showed no improvement when acting voluntary compared to when being passively moved; while this improvement were found in other groups. Moreover, this failure in showing improvement was due to their problems in obtaining information about their own actions.

The simple paradigm developed demonstrated that patients with the relevant psychotic symptoms were closely related to a specific deficit in their awareness of actions.

Schizophrenia is a heterogenous disorder, and has often been subtyped on the basis of family history of psychotic disorders. Compared to those without, a positive family history is associated with an earlier age of onset, greater structural brain abnormalities and poorer clinical course. Given recent emphasis on mirror neuron system (MNS) in attempting to explain psychopathology in schizophrenia; present analysis tried to tease out differences in MNS functioning between these two groups.

With ethical approval, ten consenting right-handed patients with schizophrenia (ICD-10-DCR; M=8; Drug-naïve=2) were recruited and divided into two groups of five each (M=4,F=1): those with (age 29.40±5.85 years, duration of illness 50.80±30.84 months) and without (age 29.60±5.77 years, duration of illness 43.20±43.76 months) family history of schizophrenic illness (group difference p>0.05). MNS activity was assessed using event-related desynchronization of EEG Mu waves in response to biological motion on 192-channel EEG Neurofax EEG-1100K.

On comparison, while patients had significantly lower mu suppression compared to controls (p<0.001); two schizophrenia groups did not differ between themselves, neither on MNS activity nor on psychopathology (p>0.05).

Present study replicates finding of a dysfunctional MNS in schizophrenia patients, and represents a preliminary attempt at comparing two groups of symptomatic schizophrenia patients. In both these groups, MNS dysfunctions were comparable, and commensurate with respect to psychopathology. Thus, MNS dysfunction in schizophrenia might either be inherited or acquired. However, this abnormality forms a common base, and ultimate vulnerability marker, for development of psychopathology during active disease states.

Long acting antipsychotics are an effective option in improving treatment adherence, but tardive dyskinesia can be problem in som cases1

Atypical antipsychotics with long acting formulations offer a safer option for extrapyramidal side effects but it is not clear if they are safer in tardive dyskinesia.

We report a 45 year old male patient with 25 year history of schizophrenia aiming to reveal the effects of paliperidone palmitate on oropharyngeal dyskinesia.

Chlorpromazine, haloperidole, zuclopenthixol, olanzapine and quetiapine were the antipsychotics which were used in the last 12 months. The patient had been using olanzapine 20 mg/day, biperiden 4 mg/day and zuclopenthixol decanoate 200 mg every 2 weeks in the index consultation that the oropharyngeal dyskinesia was observed. Olanzapine was discontinued and since there was need for long acting antipsychotics because of the former history of treatment non-adherence, zuclopenthixol was switched to paliperidone palmitate 150 mg every 4 weeks. Abnormal Involuntary Movement Scale was used weekly to score the dyskinetic movements.

Marked improvement in movement disorder was observed after a switch from zuclopenthixol decanoate to paliperidone palmitate.

Long acting atypical antipsychotics may be a preferable option in patients with tardive dyskinesia if treatment non-adherence is a problem.

Patients with schizophrenia are at greater risk for metabolicsyndrome (MetS) and other cardiovascular risk factors.

Determine the prevalence of MetSand its criteria among patients with Schizophrenia (Sz) according to therevised criteria of NCEP ATP III and assess which component contributed to theincreased risk of the MetS in schizophrenia patients.

Case-control study carried out among patients with Schizophrenia (SZ) and healthy subjects above20 years old. Outpatient clinics of the Psychiatry department and Primary Health Care (PHC) Centres in Qatar. The study based on matched by age and gender of 233 cases and 466controls. Face to faceinterviews were conducted using a structured questionnaire followed bylaboratory tests. Metabolic syndrome was defined using the National CholesterolEducation Program – Third Adult Treatment Panel (ATP III).

The prevalence of MetS among schizophrenic patients (36.5%) weresignificantly higher than healthy subjects (18.7%) (p<0.001). The prevalence of MetS in schizophrenicsubjects was reported to be two times higher than in the general population. The MetS components were higher among schizophrenic patients than healthy subjects. Among the components of MetS, centralobesity (63.9%) was the most common criteria among patients compared to healthysubjects (45.7%) (p<0.001). Schizophrenic patients (27%) were significantly obese than the healthysubjects (13.1%). Female schizophrenia patientswere more likely to have three or more metabolic

The metabolic syndrome was highly malities compared to men.

prevalentin patients with schizophrenia. The female gender was significantly associatedwith a higher prevalence of MetS.

Schizophrenia is a mental disorder characterized by social problems and disorders of thought, behaviour and cognitive functions. These impaired cognitive functions may be associated with alterations in resting state functional connectivity in schizophrenia. Therefore, the present study has been carried out to determine the resting state functional brain connectivity changes associated with schizophrenia in all the resting state networks (RSNs) using independent component analysis approach (ICA) and dual-regression based approach.

The objective of this study was to investigate the aberrant resting-state functional connectivity patterns in schizophrenia patients as compared to healthy controls.

35 schizophrenia patients and 31 healthy controls were recruited for the study and scanned by using resting state functional magnetic resonance (rsfMRI). Pre-processing and post-processing of the resting state functional data were performed using the FMRI Expert Analysis Tool (FEAT), which is a part of FSL (FMRIB's Software Library, www.fmrib. ox.ac.uk/fsl).

Our results showed significantly decreased functional connectivity in the regions of left fronto-parietal network, lateral visual network, medial visual network, motor network and default mode network (DMN) in schizophrenia patients as compared with healthy controls.

The overall findings suggest that the alterations in these resting state network connectivity may, in part, contribute to the impairments in cognitive functions associated with schizophrenia. These findings also suggest that aberrant resting state network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.

The endophenotype concept of schizophrenia represents an important approach in the exploration of the neurobiology of the illness. An important characteristic of an endophenotype, that it can be found among the healthy, first-degree relatives of patients with schizophrenia.

We evaluated two systematic reviews of studies on two potential endophenotypes (theory of mind and informative morphogenetic variants) to confirm the possibility of them as biological and cognitive markers of the illness.

We planned to explore data from theory of mind and informative morphogenetic variant studies among the relatives of schizophrenia patients.

We evaluated two researches of studies published in PubMed, Medline,Web of Science and PsycINFO between the period of 1968 and 2014 (informative morphogenetic variants studies) and 1980 and 2014 (theory of mind studies).

11 studies on the appearence of informative morphogenetic variants in the relatives of schizophrenia patients were found with mixed results, while 15 studies and two meta-analyses were analysed on theory of mind studies among the first-degree relatives of patients with schizophrenia,the exploration of the latter studies showed also diverse findings.

Futher research is needed to clarify theory of mind and informative morphogentic variant alternations as endophenotypic markers of schizophrenia.

Acknowledgement: This study was supported by the National Brain Research Program Grant no. NAP KTIA NAP-A-II/12.

Schizophrenia is a complex disorder, characterized by both genetic and environmental factors and their interactions. Post weaning social isolation (SI) has been proposed as a model of Schizophrenia. Glutamate hypothesis in schizophrenia produce analogous symptoms. In this regards, reduction in NMDA receptor activity has been hypothesized for induction of schizophrenia in clinical studies. Furthermore, NMDA receptors activation play role in various neurodegenerative diseases including phenomenon of spreading depression (SD). SD plays a pivotal role in glutamate release and its action on the NMDA receptor.

In the present study 24Wistar juvenile rats (65-80 gr) were used.

Animals were classified in three groups as SD treated with Social isolation, social isolation, and sham groups. SI was induced by six week post weaning social isolation of puppies, which followed by four consecutive weeks SD induction in SD-social isolation group. Prepulse inhibition (PPI) test and passive avoidance by shuttle box test have been done at the end of experiment.

Our result from behavioral test suggested that SD induction during for week after six week social isolation may be able to help to ameliorate schizophrenia symptoms. Significant changes in cognition tests were seen in SD induced group in comparison with social isolation group.

data from present study revealed that glutamate level in extracellular space which followed by NMDA receptor activation as well as its expression following SD induction perhaps decrease some neurological characteristics of schizophrenia, which could reveal NMDA protective role on schizophrenic patient.

To explore tolerability, safety and treatment response of flexibly-dosed paliperidone palmitate (PP) in adult patients hospitalized for an exacerbation of schizophrenia.

International 6-week prospective open-label non-interventional study. Outcome parameters were changes in Brief Psychiatric Rating Scale (BPRS) total score, Clinical Global Impression-Severity Scale (CGI-S), Personal and Social Performance Scale (PSP), treatment satisfaction (Medication Satisfaction Questionnaire (MSQ)), Extrapyramidal Symptom Rating Scale (ESRS) scores and treatment-emergent adverse events (TEAEs) from baseline to last-observation-carried-forward endpoint.

367 patients (65.9% male, mean age (±SD) 39.8±12.1 years, 85.8% paranoid schizophrenia) were documented. 91.6% completed the 6-week observation period. Mean time from hospital admission to initiation of PP was 9.4±7.7 days. Mean baseline BPRS total score of 50.2±13.6 improved by -6.5±8.6 at day 8 and by -19.3±12.6 at endpoint; 95% confidence interval [CI]-20.7;-18.0; both p<0.0001. At endpoint, 93.6% of patients were rated as improved in CGI-S. Functioning in PSP significantly improved from 49.4±14.7 at baseline by 14.3±12.4 at endpoint (95% CI 12.9;15.8, p<0.0001). Mean ESRS total score significantly decreased from 3.7±5.9 at baseline to 2.0±4.7 at endpoint (p<0.0001). 6.0% of patients were very or extremely satisfied with their previous antipsychotic medication at baseline, and 46.1% with PP at endpoint. TEAEs reported in ≥2% of patients were tremor (2.5%) and schizophrenia (2.2%).

These data support results from previous randomized controlled and pragmatic studies that flexibly dosed paliperidone palmitate is well tolerated and associated with an early and clinically meaningful treatment response and functional improvement in patients hospitalized for an exacerbation of schizophrenia.

To explore the effect of flexibly dosed paliperidone palmitate (PP) on negative, depression/anxiety, patient functioning and extrapyramidal symptoms in adult non-acute schizophrenia patients previously unsuccessfully treated with oral aripiprazole.

International, prospective 6-month open-label study. Outcomes analyzed were changes from baseline (BL) to last-observation-carried-forward endpoint (EP) in Positive and Negative Syndrome Scale (PANSS) negative subscale, PANSS negative and anxiety/depression Marder factors, patient functioning (Personal and Social Performance Scale (PSP) and Mini International Classification of Functioning (Mini-ICF)) and Extrapyramidal Symptom Rating Scale (ESRS).

: 46 patients were analyzed: 73.9% male, mean age 34.4±9.4 years, 78.3% paranoid schizophrenia, 67.4% completed the study. Mean prior oral aripiprazole dose was 22.7±10.7 mg/day. PANSS negative subscale score decreased from 20.3±5.0 at BL to 17.3±6.1 at EP (mean change -3.0±5.0; 95% confidence interval (CI) of change -4.4;–1.5; p<0.0001). PANSS negative symptoms Marder factor score improved from 19.5±5.8 to 16.6±5.9 (95%CI -4.5;-1.3, p<0.0001) and anxiety/depression Marder factor score improved from 10.3±3.6 to 8.5±2.9 (95%CI -3.0;-0.6, p=0.0031). Extrapyramidal symptoms in ESRS total score improved significantly from BL to EP by -0.6±3.4 (95% CI -1.6;0.4, p=0.0456). Patient functioning significantly improved in PSP (from 58.9±13.4 to 62.9±15.2, p=0.041) and Mini-ICF (from 19.0±7.78 to 16.1±9.84; 95%CI -5.1,-0.7; p=0.0079). The only treatment-emergent adverse event reported in at least 5 patients was anxiety (n=6).

Transition from unsuccessful treatment with oral aripiprazole to flexibly dosed paliperidone palmitate in non-acute schizophrenia patients was well tolerated and associated with significant improvements in negative, depressive, anxiety and extrapyramidal symptoms as well as patient functioning.

Mapping cognitive functions in schizophrenia is important for approaching the etiological background of the disease.

To examine the explicit and the implicit learning processes with experimental psychological methods in neurocognitive subgroups identified by us earlier (Szendi et al, 2010).

To find substantial cognitive differences between the neurocognitive subgroups

Patients with schizophrenia (n=19) and matched healthy control persons (n=11) participated in the study. The patients were recruited randomly from the patient pool which constitued the subject base for the original clustering process, we enrolled n=9 patients from the cluster S, and n=10 from the cluster Z. Besides the comprehensive neuropsychiatric assessment, the explicit learning performances were tested by a verbal learning task, while the implicit learning by the Alternating Serial Reaction Time Task.

While the whole group of patients did not differ from the healthy persons regarding either the explicit or the implicit memory tasks, the performances of the two subgroups of patients showed a double dissociation in these tasks. Whereas patients belonging to cluster S could recall significantly less words in the explicit cued recall test after the word-list learning than patients in cluster Z (and the healthy persons), the performance of patients in cluster Z in the implicit sequence-specific learning fell behind the cluster S (and the healthy group).

The double dissociation of explicit and implicit memory's impairments suggests that the neurocognitive background of the two subgroups of schizophrenia (S vs Z) might substantially differ from each other.

Financial support: KTIA_NAP_13-2-2014-0020

To clarify pathophysiology of schizophrenia it is required to decrease the phenomenological heterogeneity, and one of the possible ways is determining neurobiologically valid subgroups.

Employing two concurrent methods – Deficit and Nondeficit (Carpenter et al., 1988) vs. cluster S and Z (Szendi et al., 2010) – the group of patients was divided into two subgroups, and brain volumetric peculiarities of the whole mixed group of patients and of these subgroups were compared with the healthy controls and each other.

This study aims to possibly reveal the most brain structural anomalies by applying concurrent subgrouping methods of patients, and moreover to confront their validity by the results.

High resolution T1 weighted images were performed on n=21 patients with schizophrenia, living integrated in the society and treated in outpatient care, and n=13 healthy control persons. Localised grey matter volumetric deficits were defined with optimised voxel-based morphometry.

Most areas were revealed in the case of the cluster S, which was characterised by an expansive, bilateral brain structural impairment, which mainly affected the heteromodal and partly the unimodal association cortices.

This suggests that the expansive impairment of the association cortices could have a determining role in the etiopathogenesis of the unfavourable cluster of patients with schizophrenia. In the literature, an extent of damage commensurable to our observations specifically on association areas has never been detected – and our systematic neurocognitive subgrouping method provided the possibility for this.

Financial support for the research was provided by KTIA_NAP_13-2-2014-0020 to Mihály Racsmány.

Conformational changes of human serum albumin (HSA) can disturb its main functions.

To reveal serum albumin disturbances using the high-tech approaches in first episode schizophrenia.

First-episode drug-naïve schizophrenic (FES) patients were investigated. There were employed laser time resolved subnanosecond fluorescence spectroscopy (LTRSFS) using specific albumin fluorescent probe and high resolution nuclear magnetic resonance (NMR) 1H spectroscopy.

There were revealed 3 binding sites in albumin molecule with fluorescent decay time of 1, 3 and 9 nanoseconds (A1, A3 and A9 sites, respectively) in healthy volunteers using LTRSFS approach. There was found significant decrease of fluorescent decay time of probe bound to albumin A3 site of FES patients as compared with controls. It points out on the conformational changes in HSA molecule in FES patients. NMR 1H spectra of blood serum and its albumin fraction of healthy donors and FES patients were studied. There were shown clear differences in NMR 1H spectra between these two groups that points out to the conformational changes of albumin molecule in FES patients and disturbances in albumin transport functions. The reaction ability of thiol groups of albumin molecules in FES patients was significantly lower in comparison with healthy persons. It also points out on disturbances of antioxidant albumin properties in FES patients.

High-tech approaches can be useful for the development of new biomarkers for diagnostic and predicting methods and methods for the evaluation of the efficacy of different types of therapy of mental disorders.

Predicting transition from clinical high risk (CHR) to first episode psychosis has proven difficult. Assessment of oxidative stress biomarkers and the niacin skin flush response (NSFR) may improve prediction accuracy.

To predict transition to psychosis based on combined clinical and blood biomarker.

To analyse data from patients in placebo group of a 12-week trial of omega-3 fatty acid supplementation in CHR. Transition likelihood ratios (LRs) for baseline historical risks, clinical assessments (PANSS subscales and total, GAF), NSFR and blood markers (nervonic acid, superoxide dismutase, glutathione) were calculated. Variables with the highest positive and lowest negative LRs were included in an odds ratio form of Bayes’ rule transition prediction models. Model accuracy was calculated by area under the receiver operating curves (AUROC) of each model.

1-year transition to psychosis was 28% (n=40). Historical data showed no predictability (sensitivity 30%, specificity 100% (AUROC)=0.688, p=0.085). Clinical assessments alone produced a sensitivity of 30% at a specificity of 95% (AUROC=0.83, p<0.0001). The biomarker panel alone predicted transition with 40% sensitivity and 100% specificity (AUROC=0.73, p=0.03). Combining history and clinical assessment provided no improvement above clinical data alone (sensitivity = 30%, specificity = 100%, AUROC=0.85, p< 0.0001). The combination of history, clinical assessment and biomarkers identified transition with a sensitivity of 60% and specificity of 100% (AUROC=0.87, p< 0.0001).

Probabilistic models combining biomarkers and clinical data are able to target high-risk subgroups within CHR and may help to personalise treatment.

A large body of literature has demonstrated that people affected by psychotic disorders show deficits in working memory, in Emotion Recognition (ER) and in data-gathering to reach a decision (Jumping To Conclusions – JTC).

To investigate a possible correlation between working memory, JTC and ER in FEP.

41 patients and 89 healthy controls completed assessments of working memory using WAIS shortened version, JTC using the 60:40 Beads Task and ER using Degraded Facial Affect Recognition Task.

According to the literature, cases had poorer performance in working memory tasks (Digit Span: μ7,72 [ds=2,98] vs μ10,14 [ds=3,10], U=865,00, p=0,00; Digit Symbol: μ5,36 [ds=2,43] vs μ10,05 [ds=3,10], U=455,50, p=0,00; Arithmetic: μ5,46 [ds=2,76] vs μ8,74 [ds=3,24], U=865,50, p=0,00; Block Design: μ4,82 [ds=2,72] vs μ7,60 [ds=3,18], U=912,00, p=0,00), in Beads Task (81,6% vs 51,1%, χ2=10,27, p=0,001, μ2,53 [ds=3,57] vs μ4,23 [ds=4,77], U=1171,00, p=0,006) and in DFAR (total errors: μ21,62 [ds=7,43] vs μ16,58 [ds=8,69], U=554,50, p=0,002). Furthermore working memory tasks in cases group correlated significantly with JTC (Digit Span: r_rho=0,276, p=0,003; Digit Symbol: r_rho=0,275, p=0,002; Arithmetic: r_rho=0,265, p=0,003; Block Design: r_rho=0,292, p=0,001), but only Digit Span with ER (r_rho=-0,239; p=0,021). In addition, we found that JTC and ER were significantly associated (r_rho=-0,281; p=0,004).

Data show that working memory impairments, JTC style and dysfunctions in the facial emotions recognition are phenomena strongly correlated in the group of patients. Preliminary results suggest the importance of early rehabilitation as the impairments detected may lead to difficulties in social and relational adaptation in psychotic patients.

Patients with schizophrenia often experience depressive symptoms, while the overlap between depressive and negative symptoms introduces inherent complexity in making accurate diagnosis and initiating appropriate treatment. Using antidepressant medication (SSRI/SNRIs, tricyclic antidepressants, MAOIs, NDRIs) to treat depressive symptoms associated with schizophrenia is a common therapeutic approach, but remains controversial.

The primary objective of the 'ELPIS” study was to determine the prevalence and degree of depressive symptoms in clinically stable adult Greek outpatients with schizophrenia. Secondary endpoints included management patterns of stabilized outpatients with schizophrenia with depressive symptomatology and comparison between those with and without depressive symptoms.

The target was to explore possible patterns in therapeutic approaches during the maintenance phase of schizophrenia in patients with and without depressive symptoms.

'ELPIS” is a multicentre, national, cross-sectional, observational study of stabilized outpatients with schizophrenia. 392 patients were recruited over a 5-month period (172 with depressive symptoms, 220 without). The study cohort included a single-patient visit within a normal clinical practice setting: all study-related information was collected retrospectively, through medical chart review and patient interview.

Treatment with antidepressants was more common for patients with depressive symptoms (CDSS score>6) compared to patients without (70.1% vs 29.9%, p<0.001).

Treatment with typical antipsychotic was less common for these patients (32.3% vs 67.7%, p=0.04). Differences in use of other medication classes, monotherapy/combination therapy, comorbidities and socio-demographic characteristics were not statistically significant.

Treatment with antidepressants, while still controversial, is more common in patients with schizophrenia with depressive symptoms than in those without.