Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.

A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.

Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.

CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.

To assess the psychometric properties of the Spanish version of the SWN scale, an instrument which evaluates the subjective experience of psychotic patients towards neuroleptic treatment.

A validation study (feasibility, reliability, and validity) was conducted in 20 psychiatric centers. Patients were evaluated with the PANSS, the CGI severity scale and the SWN-20. A re-test was conducted one week after baseline. The study included clinically stabilized outpatients diagnosed with schizophrenia (DSM-IV-TR criteria) who were on treatment as usual. The SWN used in this study consists of 20 questions answered on a 6-point Likert scale. The total score ranges from 20 to 120 points (higher scores indicating better well-being). The original version was back-translated and a focus group was conducted to improve the comprehension of the items.

97 patients were included. Seventy-two percent of them (70) were male. Mean age was 35 years (SD = 10.0). Mean SWN total score: 83.5 (SD = 14.0). Internal homogeneity: 0.86. Test-retest in clinically stable patients was 0.89. SWN correlated significantly with the PANSS, but not with the DAI-10. Patients with none-mild clinical affectation had higher SWN scores, indicating a better subjective well-being, and vice versa.

The subjective experience of psychotic patients towards treatment is a key factor in therapeutic adherence, quality of life, and clinical outcome. The Spanish version of the SWN scale showed good psychometric properties in a sample of schizophrenic stabilized outpatients. SWN scale constitutes a valuable addition to evaluate patients’ subjective well-being.

It is widely developed the idea of communitary attention of serious mental disorders, instead of being recluded in long stay hospitals. But tomake this project real it is needed a complex sociosanitay support: psychosocial rehabilitation units, protected dwellings…and nowadays some people are still discharged to long term hospitals.

The objective of this work is to demonstrate that clinical characteristics are not determinant and that the main reason that supports the decision is the insufficent social resources spread.

279 inpatients that entered a Psychosocial rehabilitation unit from January 2005 to April 2009 are selected. There are two comparison groups depending on the derivation to long term units. There are compared different variables taking the HoNOS scale as measurement tool. Ths stathistical comparison test used is the Fisher exact test.

HoNOs scale items:

1. 1 Disruptive behaviour

2. 2 Non-accidental self-injury

3. 3 Alcohol/drug taking

4. 4 Cognition

5. 5 Physical illness

6. 6 Hallucinations/delusions

7. 7 Depressed mood

8. 8 Other mental problems

9. 9 Relationship

10. 10 Daily activity

11. 11 Living conditions

12. 12 Activities/occupation

There is not statistical significance when clinical items of the HoNOS scale (item 1 to 8) are compared, instead of item 5 (p=0,001). There appears significance when comparing social items and specially item 9 (p=0,031),11 (p=0,002) and 12 (0,026).

Nowadays there is no difference in the clinical profile of inpatients when derivation. The fact of not having adequate living conditions is determinant in the decision of derivation, showing that socio sanitary resources are insufficient for an optimal communitary system.

To study the short-term effect of treatment with quetiapine on prepulse inhibition (PPI) deficits of the startle reflex in schizophrenia patients.

Using PPI, we studied a group of 21 schizophrenia patients and 16 controls. Seventeen of the patients were re-tested with PPI after 21 days of treatment with quetiapine.

At baseline, an almost significant decrease in PPI was found in the patients as compared to the controls. PPI measurements did not change in the patients after 21 days of treatment with quetiapine, despite their clinical improvement.

Our results suggest that short-term quetiapine treatment may not modify PPI measures in schizophrenia patients.

Electroconvulsive Therapy (ECT) is a safe and effective technique widely used in our area. Scientific literature related to the application of this technique is continuously developing, specifically with regard to the placement of the electrodes, the amplitude of the stimulus pulse administered, the initial charge used, and the anesthetic agent involved.

The primary aim of this study was to analyze technical variables associated with the use of ECT in our hospital, and compare them to the guidelines of the protocol developed in our hospital and international standards.

We performed a review of Clinical Histories of the patients that were treated with ECT in the “Hospital 12 de Octubre” (Madrid, Spain), in the period comprised between January 1st, 2008 and December 31st, 2009. We collected data related to the application of the technique, socio-demographic variables and clinical profiles. We used descriptive statistics to analyze our data.

During this period, 602 ECT sessions were applied. Placement of the electrodes was unilateral in 58% of subjects with Affective Disorders and 8% of subjects with Schizophrenia. The amplitude of the stimulus pulse was 1 ms. Mean charge administered in the initial and final session was 236.85 mC and 357.16 mC, respectively. Etomidate was used as anesthetic in 68% of cases.

ECT technical variables applied in our hospital are adjusted to guidelines of our area and international recommendations. Longitudinal studies are warranted in order to objectively assess techinical variables associated to ECT.

The presence of at least five dimensions in mania has recently been established. This study extends previous findings by comparing the dimensions of pure vs. mixed mania.

One hundred and three inpatients with bipolar I disorder, manic or mixed (DSM IV), were assessed with SCID-I, YMRS and HDRS-21. The five-factor solution found after applying factorial analysis with Varimax rotation was compared between manic and mixed patients.

There were differences between pure mania and mixed states on factor 1 (depression) and factor 3 (hedonism). There was a tendency to present higher values on factor 5 (activation) in the pure manic group. No differences were found in factor 2 (dysphoria) and factor 4 (psychosis).

Hedonism and activation dimensions are present to a lesser degree in mixed states. Although the principal difference between mixed and pure bipolar disorder is the existence of depressive symptoms, the depressive dimension is strongly present in patients with pure mania.

There is need to search for core depressive symptoms in all patients suffering from mania and to evaluate their outcome in clinical trials.

ECT has demonstrated to be an effective and safe biological treatment that can be considered as an alternative to pharmacotherapy, especially for treating severe, resistant and recurrent, affective, psychotic and catatonic symptoms. CECT refers to the one that is started after acute treatment and lasts for a maximum period of 6 months with the objective of preventing relapse. M-ECT is the one that is started once C-ECT has ended with the aim of preventing recurrences. The aim of this study was to explore the evidence for using C-ECT and M-ECT as an alternative to pharmacotherapy.

We performed a search in MEDLINE, PubMed and Cochrane, from 1950 until the present to identify articles in which C-ECT and M-ECT were used as alternative treatments to pharmacotherapy.

C-ECT and M-ECT have demonstrated to be an effective and safe alternative to pharmacotherapy in Unipolar Depression, Bipolar Disorder and Schizophrenia, especially in the prevention of relapse and recurrences. It reduces number and days of hospitalization. In combination with pharmacotherapy, it increases effectiveness of pharmacological treatment. It does not affect cognitive functioning.

C-ECT and M-ECT should be considered as an alternative to pharmacotherapy in the treatment of affective and psychotic, severe, resistant and recurrent symptoms. It is an effective and safe treatment, which prevents relapse and recurrences in severe mental illness, reducing hospitalization rates and health costs.

Pathological Gambling (PG) tends to be a heterogeneous disorder where patients differ with type and severity of gambling behaviour, psychiatric co-morbidity, family history, sex and age of onset. Age of disease onset in PG varies significantly, with many individuals having onset during childhood and adolescence and others in various stages of adulthood. Previous studies have demonstrated that age of onset is an important characteristic for a better understanding of the PG heterogeneity.

(1) To analyze differences in sociodemographic aspects between early-onset PG and non early-onset PG, (2) to study whether early-onset PG is associated with specific psychiatric diagnosis in axis I and II.

We used data from a large and nationally representative community sample of United States (US) adults, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We selected age 25 years as a threshold for early-onset PG.

Individuals with early-onset PG were more likely to be male, never married, and young and to have a lower education level and individual income than non early-onset PGs. Early-onset PG were less likely to have mood disorder (OR = 0.42 (0.19 − 0.94)) and had non-significant higher odds of having substance and anxiety disorders than non early-onset. The odds of having Cluster B disorder were significantly higher among early-onset PGs than non early-onset PGs (OR = 4.11 (1,77 − 9.55)).

Our findings support that subgroups of Pathological Gambling defined by onset age have phenotypic differences.

In order to improve global functioning in psychotic patients is necessary to know the kind of variables influencing those.

To research that of a clinical and epidemiological variables group which of them are associated to a better outcome in global functioning in patients affected by psychosis.

A total of 73 psychotic patients were included in this study. All of them were evaluated through a battery of tests including GAF and SIX, PANSS, S-GPTS and a comprehensive questionnaire for clinical and epidemiological variables. A binary logistic regression analysis was applied to the data set of global functioning scores divided by the median in two halves: better and worse global functioning. The model included the following variables: positive, negative and general psychopatology PANSS subscales, PANSS subtype, first or second generation antipsychotic, stimulants drugs use, tobacco use, sex, age, onset age, number of psychotic episodes and S-GPTS score.

Treatment with second generation antipsychotics and lesser scoring in S-GPTS scale were associated with a better outcomes in global functioning. We found an association between lesser negative symptoms and lesser number of psychotic episodes with a better functioning which showed a marginal statistical significance.

We raise the question about preferential use of second generation of antipsychotics as opposed to older antipsychotics and the necessity of improving adherence to treatment for breaking the vicious cycle between psychotic episodes and a worse global functioning. Further studies with greater sample are needed to explain these and another questions.

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 neuropsychological and overall performance in people with schizophrenia is known. Smoking and stimulant drugs use can improve neuropsychological outcomes, however the existence of drugs use may be a more severe illness marker.

The purpose of this study is to investigate which clinical and epidemiological variables, including stimulant drugs use and smoking, influence on neuropsychological performance in patients with psychosis.

92 patients with different psychosis were assessed with a battery that included SCIP, to assess neuropsychological performance, PANSS, to evaluate psychotalogy, GAF and SIX as global performance measures. We also explore clinic and sociodemographic data. A binary logistic regresion model was applied on scores on the task ‘words’ of the SCIP (memory and learning), dichotomized at the median. The model included: sex, age, onset age, family history, negative scale, positive scale, global psychopatology and PANSS subtypes, estimated premorbid IQ using Barona Index, stimulant drugs use, smoking and funcionality.

The absence of stimulating drugs use and smoking (trials 2 and 3 of SCIP), was associated with better memory and learning in patients with psychosis. Younger age (trials 1-4 and total of words), higher functionality (trials 1,2 and total of words) and premorbid IQ (trials 2 and 4) were also positively associated with better neuropsychological performance.

Stimulant drugs use and smoking could be markers of poorer previous neuropsychological function in psychotic patients. It is necessary to do longitudinal studies evaluating these variables as markers, risk or protective factors of cognitive performance

Delusional disorder is traditionally considered a less severe clinical entity than schizophrenia or schizoaffective disorder. From the dimensional approach to psychiatric diagnostic classification it might be necessary redefine the diagnostic classification of psychosis.

To assess differences found in psychopathology, neuropsychology and functioning among schizophrenia, schizoaffective disorder and delusional disorder.

59 patients were included in this study. 30 out of them presented a diagnostic of schizophrenia, 15 patients delusional disorder and 14 schizoaffective disorder. All of them were assessed through different scales including PANSS, GAF, SIX, SCIP and DKEFS Stroop. To compare the different groups ANOVA, Post hoc Bonferroni analysis and X2 test were carried out.

We found statistically significant differences regarding negative symptoms between patients with schizophrenia and delusional disorder, being those less intense and severe in the last ones. In that way, a inversely proportional trend regarding negative and positive PANNS subtypes between schizophrenia and delusional disorder was observed.

In spite of the fact that the delusional disorder is considered less severe disease than other psychosis we only found a less degree of severity for negative symptoms. Further studies with greater sample size must be conducted.

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.

Catatonia is a neuropsychiatric syndrome described in a variety of medical and psychiatric conditions. Its association with frontotemporal dementia (FTD) has been sparsely described.

We reported two patients with FTD that present a catatonic state.

Case reports

Literature review through Pubmed and report of a clinical cases.

Case 1: Frontotemporal dementia, behavioral variant.

65 year old female who was hospitalized after losing weight due to his active refusal to eat and subsequently was undergone a gastrostomy. Once stabilized physically was derived to psychogeriatric ward where the patient was stuporous, mute, with mannerisms and rigidity. Continued with refusal to take food. On examination she had staring, posturing, echophenomena, automatic obedience, Gegenhalten, ambitendency and perseveration. It featured 12 of 23 symptoms of Bush and Francis Catatonia Rating Scale (BFCRS), scoring 32. She improved completely her catatonic state within one week with lorazepam 2.5 mg /day and zolpidem 10mg/day. Perseverative behavior and mannerisms was maintained.

Case 2: Frontotemporal dementia, primary progressive aphasia

67 years old male who was admitted to psychogeriatric ward because had aggressivity and negativism. On examination immobility, mutism, staring, echolalia, rigidity, negativism, withdrawal, perseveration, Gegenhalten, impulsiveness and combativeness were observed. It featured 11 of 23 symptoms of BFCRS, scoring 22. He was treated with lorazepam 10mg/day and valproic acid 900 mg/day. Catatonic symptoms disappeared a month later. Negativism and impulsiveness persisted slightly.

The catatonic syndrome may occur in patients with FTD. In both conditions symptoms overlap. The response to GABAergic drugs was optimal.

The cognitive processes are rather relevant in order to achieve a comprehensive and integrative recovery in schizophrenia and other psychosis.

To research the different variables implied in cognitive outcomes in psychosis in order to increase our knowledge to establish therapeutic interventions in this field.

An overall of 73 patients were included in the study. We used the SCIP and STROOP tests to measure the cognitive processes. We applied a comprehensive questionnaire for clinical and epidemiological variables including PANSS, SGPTS, GAF and SIX. After that, we constructed a binary logistic regression model with the following variables: positive, negative and general psychopathology PANSS subscales, PANSS subtype, first or second generation antipsychotic, stimulant drugs use, tobacco use, sex, age, onset age, number of psychotic episodes, global functioning and family history.

Having more than two family members affected by any psychiatric disease was associated to a lesser outcomes in short-term and immediate memory. Likewise higher scoring in positive subscale PANSS was also associated to a worse performance in short-term and long-term memory, so stimulant drugs use was also related to a lesser immediate memory and working memory. Finally, a better global functioning appeared as a factor related to a better overall learning.

Our data show that a heavy genetic factor exists as a variable influencing cognitive performance. Moreover, stimulant drugs use and positive symptoms are another variables which can be controlled in order to improve cognitive performance.

Delusional disorder has been traditionally thought to be a disorder that does not evolve to defective states. However, little empirical evidence has been obtained so far comparing these patients with other psychotic conditions. Our aim is to characterize delusional disorder patients as compared to other psychotic patients regarding to their psychopathology, neuropsychological performance and general functioning.

A total of 131 psychotic patients were included in this study. 22 patients with delusional disorder, 109 other psychosis. Psychopathology was assessed via PANSS. DKEFS Colour-Word Stroop test was used to assess neuropsychological performance. Functioning was assessed using GAF. Between groups comparisons were performed via ANOVA and post hoc tests using Bonferroni method were subsequently used. Using the inclusive criterion, PANSS's positive and negative subtypes distribution was investigated in the groups using χ2 tests.

Statistically significant differences between patients with schizophrenia and patients with delusional disorder were found for PANSS's negative scale, the scoring was significantly lower for emotional withdrawal, blunted affect, difficulty in abstract thinking and stereotype thinking. There were no statistically significant difference between the groups regarding the rest of scales of PANSS (positive and general psychopathology), neuropsychological performance and functioning.

Even though delusional disorder is considered as a clinical entity more benign than other psychoses, our data show that these patients are only less seriously affected regarding negative symptomatology. In line with the recent nosological progress, these results would support a dimensional conceptualization of psychosis.