Major goals in the treatment of schizophrenic out-patients are the reduction and stabilization of psychopathological symptoms, the reduction of relapses and a lasting improvement of the quality of life.

Non-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first episode of schizophrenia (ICD-10 F20.x) with monotherapy of long-acting injectable risperidone (RLAI).

Interim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. Median start and end dose of RLAI was 37.5 mg/2 weeks. More than 80% of RLAI patients showed 75-100% compliance; 63% improved compliance compared to previous treatment. Improvement from baseline to endpoint was significant (p< 0.0001) for total PANSS (31.4±30.0), SF-12 physical (7.6±11.6) and mental health scores (13.4±12.5) and total SWN-K scores (20.7±23.5). Most patients had no relapse (89%) and no hospitalizations (92%) due to underlying psychosis during the observation period under RLAI compared to 59% with at least one hospitalization within the 12 months prior to this study. Mean relapse free time was 208.6±5.1 days. 119 adverse events (AEs; 28 serious AEs) were reported in 47 patients. Most common AEs at least possibly related to RLAI were lack of effectiveness 8.0%, weight increase 8.0%, psychotic disorder 5.7%, anxiety 3.4%, EPS 3.4%.

The results indicate that RLAI has good tolerability and good clinical effectiveness in the therapy of schizophrenic out-patients. High compliance, low hospitalization and low relapse rates under RLAI may help patients achieve stable remission and to master daily life.

Improvement of social and occupational functioning is a major goal in the treatment of schizophrenic patients and therefore may improve reintegration of patients and their ability to lead an independent life.

Non-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first manifestation of schizophrenia (ICD-10 F20.x; duration of disease ≤10 years) with long-acting injectable risperidone (RLAI) in monotherapy. Presented here is the assessment of the treatment based on the Clinical Global Impression (CGI), the Global Assessment of Functioning (GAF), and skills assessing the ability of patients for reintegration as quantified by the short version of the International Classification of Functioning, Disability and Health for Mental Disorders (Mini ICF-APP).

Interim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. GAF total scores improved significantly (24.4±23.7); 76.0% of the patients improved in CGI-C. Mini-ICF-APP total scores improved significantly from 1.96±0.68 to 1.18±0.94 at final observation. All Mini-ICF-APP sub-items improved significantly, particularly within: participation in public roles, non-occupational activities, self maintenance, competency, flexibility, family relations. 119 adverse events (AEs; 28 serious AEs) were reported in 47 patients. Most common AEs at least possibly related to RLAI were lack of effectiveness 8.0%, weight increase 8.0%, psychotic disorder 5.7%, anxiety 3.4%, EPS 3.4%.

Results indicate that treatment with RLAI may improve global functioning of patients by reducing typical disorder of functioning, capacity and participation. Treatment with RLAI may help patients to reintegrate into social and occupational environments.

This non-interventional study (RIS-SCH-4023) examined tolerability and effectiveness of risperidone long-acting injectable (RLAI) versus oral second generation antipsychotics (oSGA: amisulpride, aripiprazole, olanzapine, quetiapine, risperidone or ziprasidone) in schizophrenia under daily routine.

Outpatients receiving RLAI (n=177) or oSGA (n=257) were followed-up for 2 years (m/f 42%/58%; mean age 34.6 years; duration of disease 2.6 years). Outcome measures included PANSS, CGI, relapse rates, treatment adherence and tolerability. Post-hoc analyses focused on baseline between-group differences.

Multivariable analysis using recursive partitioning showed that upon study entry RLAI patients were 3.7 times (CI=2.48-5.59) more likely than oSGA patients to have switched to study medication due to non-compliance and/or to be substance abusers (RLAI= 59.9%, n=106/177 vs. oSGA=28.6%, n=73/255). Despite these differences, both groups demonstrated significant improvements in efficacy measures with no between-group differences. There were no significant differences in discontinuation of study medication over the two years (RLAI 41.2% vs. oSGA 36.6%) or in yearly relapse rate before change of the initial therapy (RLAI 0.48±1.48 vs. oSGA 0.71±2.63). In patients with high adherence (≥75%) to previous treatment (physicians’ estimates, 4-point Likert scale) RLAI vs. oSGA patients had significantly better retention rates (RLAI 57.4% vs. oSGA 35.1%) and times (527.0±32.6 vs. 424.1±22.3 days). Most frequently reported treatment-related adverse events were weight increase (13.0% vs. 9.7%), EPS (7.9% vs. 5.5%), hyperkinesia (6.2% vs. 3.5%), fatigue (5.7% vs. 9.7%).

Results suggest that factors associated with poor outcomes such as poor compliance and substance abuse may be attenuated by treatment with RLAI.

Contemporary researches of the cognitive impairment in schizophrenic patients were conducted in three directions: Cognitive declining as a developmental precursor of schizophrenia, evolution of the cognitive deficit during the illness, and at last, impact of pharmacological treatment on cognitive functioning. The main aim of our study is to evaluate differences between first and second-generation antipsychotics in manifestations and course of the cognitive declining, in patients with first episode of paranoid schizophrenia.

We conducted open label, prospective trial, at the sample of 12 patients during first episode of paranoid schizophrenia. Diagnosis was made according to the criteria of the International classification of diseases 10th revision. The sample was divided in two clusters with 6 patients in each one. In the first cluster, patients received first-generation antipsychotics, and in the second one was administered second-generation antipsychotic - risperidone. Cognitive functions was evaluated by Mini Mental State Examination Test which is modified with adding two simple neuropsychological tests: Clock Drawing Test and Test of Verbal Fluency.

We found more prominent cognitive declining in first cluster patients - particularly mnestic deficit.

First-generation antipsychotics posses more prominent negative impact on cognitive functioning in comparison to second generation antipsychotic - risperidone.

Exelon (ravastigmine tartrate) is dual, reversible cholinesterase inhibitor. FDA has approved its use in treatment of Alchaimer dementia and Dementia combinated with Parkison disease. In addition to this, results based on small clinical studies and case reports showed positive efects of rivastigmin tartrate in therapy applied in numerous pyschiatric disorders.

In this study 15 patients have been observed. According to ICD 10 they all satisfied criteria for diagnosis of residual schizophrenia and had a score of below 24 at MMSE and high scores at NPI 12 and BPRS. During the period of 60 days, apart from antipsychotics and anxiolitics or psychostabilisers, patients also received rivastigmin tartrate in their therapy.

The study showed that rivastigmine therapy produced significant improvements when it comes to cognition and reduction of disorders in the sphere of afective-behavioristic functioning of patients with residual schizophrenia. However, this interpretation cannot be confirmed to be completely valid due to the size of treated group, the absence of the control group, and the length of the observing period.

Dual cholinesterase inhibitors (Acetilcholine and Butirilcholine) may produce improvement in cognition and behavioural performances, as well as the general quality of life of patients diagnosed with residual schizophrenia. Future studies applied on this kind of patients should precisely explain the basic pharmachological mechanisams of rivastigmin tartrate, and approve/disapprove the results of clinical studies and case reports that have been preformed so far.

Since apoptosis is considered to play a role in the pathogenesis of schizophrenia the aim of this study was to examine the Fas and Fas ligand (FasL) system in patients with schizophrenia. FasL is transmembrane protein that induces apoptosis by binding to its specific receptor Fas. The Fas-FasL complex is an important effector of cell death in different cell types.

Serum Fas and FasL levels were determined in 30 patients with schizophrenia (11 females, 19 males), and 30 healthy controls (11 females, 19 males) by the ELISA method.

Serum Fas levels were significantly higher in patients with schizophrenia (4.63±0.96 ng/mL, p< 0.05) than in controls (4.12±0.81 ng/mL). A significant increase in FasL levels was also found in schizophrenic patients (0.099±0.029 ng/mL, p< 0.05) in comparison with those in healthy controls (0.085±0.023 ng/mL). Schizophrenic males showed significantly higher both Fas (4.97 ± 0.83 ng/mL, p< 0.05) and FasL (0.103 ± 0.032 ng/mL, p< 0.01) compared to the control males (4.30 ± 0.93 ng/mL; 0.079 ± 0.011 ng/mL, respectively). A significant positive correlation between patient serum FasL and lymphocyte caspase-3 activity was found.

These results clearly show a disregulated extrinsic apoptotic pathway in patients with schizophrenia.

Determinate folate and vitamin B12 serum levels in a sample of naive psychotic patients and in a sample of healthy population.

For 24 patients with a first psychotic episode serum folate an vitamin B12 were measured, and we take a sample of 30 person from healthy population adjust with age and gender for comparing both groups.

In the sample of psychotic patients 15 patients (62,5%)presents low levels of folate, and 2 (8,3%) vitamin B12 deficiency. In the group with low levels of folate the mean was 1,5 ng/ml, and in the group with low levels of vitamin B12 the mean was 155 pg/ml. In healthy sample, 9 persons presents low levels of folate and there weren’t any vitamin B12 deficiency in this group. We compared the mean of folate levels in both samples and there was a significance difference between them.

Important percentage of patients with a first psychotic episode presents a folate deficiency, in our area, with lower levels of this vitamin than in the healthy population, so maybe is a factor that influence in development of the disorder.

Scientific researches show that the acts of aggression in schizophrenia appear more often than in case different mental disorders. In the literature, however, exists little data which would describe wider this phenomenon. The most often the aggression in schizophrenia is connected with psychopathological symptoms, but also with characteristic the features of frontal lobe syndrome. The most typical symptom in this range is emotional disorders, particularly lability of mood which can lead to occurrence of aggressive behaviours.

The purpose of this research was to assess the intensification and identification of forms of aggression in schizophrenia. Moreover explanation of connection between aggressive behaviours and cognitive functions relating with frontal lobe.

30 patients from first episode of schizophrenia in age 18-30. Researches were realized in Department of Developmental, Psychotic and Geriatric Psychiatry, Medical University in Gdansk.

1. * Positive and Negative Syndrome Scale (PANSS)

2. * The Overt Aggression Scale (OAS)

3. * Wisconsin Card Sorting Test (WCST)

4. * Trail Making Test (TMT)

5. * Color Reading Interference (Stroop)

Shared psychotic disorder (DSM-IV-TR) or induced delusional disorder (ICD-10) is a condition involving the appearance of delusions to two or more subjects who generally live in close proximity. We compare three cases and their management described in Ramón y Cajal Hospital in Madrid.

The first case involves a mother and daughter shared delusion of injury with respect to the neighborhood. In the second case involves two sisters living together, with delusion of persecution and prejudice and without psychiatric history. The third one was admitted to our unit after a suicide attempts. It was a middle-aged man who shared with four members of his family the perception of supernatural entities in his home.

At the first and second cases it was necessary mechanical and pharmacological restraint. One of the therapeutic indications is the separation of subjects and It generated significant moments of tension and resources of the emergency department. In the third case was not accurate mechanical and pharmacological restraint. The most effective in this case was the regulation of sleep-wake cycle and separation of the individual during a time of home and family. In all three cases the perception of illness worked individually and kept contact with the therapists to plan responsible for monitoring the treatment plan and management in the future.

We must be prepared before the arrival of an event of this kind to the emergency of the hospital.It's necessary to elaborate an effective joint therapeutic strategy both during their hospital stay or as outpatients.

Admission experience has been shown to be related to insight and treatment adherence. We evaluated the clinical correlates of the Chinese Admission Experience Survey (C-AES).

A four-week longitudinal correlation study was carried out to investigate the relationship between admission experience and clinical variables. The C-AES was administered to 40 patients with schizophrenia within 48 hours of admission as a baseline, followed by subsequent interviews at two weeks and four weeks post-admission. Degree of insight into disease, attitude towards prescription, medication side effects and psychiatric symptomatology were assessed using established instruments, namely the Scale to Assess Unawareness of Mental Disorder (SUMD), the Drug Attitude Inventory (DAI), the Extrapyramidal Symptom Rating Scale (ESRS), the Scale for the Assessment of Negative Symptoms (SANS) and Scale for the Assessment of Positive Symptoms (SAPS). Regression by Generalised Estimating Equations (GEE) was used to evaluate the relationship between the clinical variables.

An improvement in insight was associated with a reduction in perceived coercion (B = 0.261, p < 0.01) during the four-week treatment. An increase in atypical antipsychotic dosage in milligram of chlorpromazine equivalents predicted insight improvement (B = -0.001, p < 0.01). There was an associated improvement in attitude towards medication (B = -0.027, p < 0.01). These observations were independent on schizophrenic symptoms or extrapyrimidal side effects.

Improvement in insight is associated with a reduction in perceived coercion and a more positive attitude towards prescription, and is predicted by a higher dosage of atypical antipsychotic.

To find out the frequency of medical conditions presented by a population of institutionalized chronic schizophrenic patients.

The target population is a total of 220 schizophrenic patients, 48 men and 172 women, diagnosed following the ICD-10 criteria, institutionalized at least during 5 years in a 76,8% of the patients. The average age was of 64,64 years.

Specific survey applied by the group of investigators aiming to collect socio-demographical data and the medical conditions, using the following psychometric scales: Cumulative Index of Illnesses (CII), Global Assessment Scale (GAS), and Clinical Global Impression (CGI).

Statistical analysis was performed with SPSS v 15.0, including descriptive statistics and correlation analysis.

Diabetes was found in 15% of cases, obesity in 31,7%, overweight in 39%, high blood pressure in 24,5%, high cholesterol serum levels in 21%, high triglyceride serum levels in 8,7%. A 26% of the patients were smokers.

The average number of categories at the CII scale was 4,84 and the average total score was 11,96.

Our patients predominantly are of an advanced age, female sex, and long-term inpatients. The presence of comorbid physical illness is high. The relatively low number of smokers could be explained by the demographic characteristics of our sample.

Course and outcome in schizophrenia are heterogeneous. Numerous studies have shown an association between the presence of negative symptoms and psychosocial and occupational functioning of patients.

To analyse the prevalence of negative symptoms in the course of illness in first episode psychosis and chronic schizophrenia and to establish its relation with the functional outcome.

43 patients with a first-episode psychosis (FEP) from our area were compared with 43 chronic schizophrenic patients and 43 normal controls from a parallel area. They were matched one on one for age, gender and years of education. All subjects were compared regarding psychopathology and functional outcome terms. Patients were examined with Positive and Negative Syndrome Scale (PANSS) for clinical symptom. Longitudinal functionality was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales.

We found significant differences between FEP and chronic patients in negative symptom severity (t = -4.97, p< 0.001) and global assessment of functioning (t = 7.58, p< 0.001). There was no statistically significant difference between the two groups in PANSS positive and general components or Clinical Global Impression. Negative symptom severity was associated with poorer GAF ratings in first episode psychosis and chronic schizophrenia.

Negative symptoms appear to be persistent. In our study negative symptom severity was associated with social and functional impairment, defined as Global Assessment of Functioning Scale score of less than or equal to 60.

Comparison of social functioning of first-admitted schizophrenic patients with healthy subjects and evaluation of the influence of several socio-demographic and clinical variables on social abilities of patients, 1 month (T1), 13 months after hospitalization (T2) and 4-6 years after T1 (T3).

A group of 74 schizophrenic patients: 46 male and 28 female; age 24.7 ± 6.7 and a control group of matched 52 male and 34 female subjects were enrolled. Social Functioning Scale (SFS), Positive and Negative Syndrome Scale (PANSS), Global Assessment Scale (GAS) and socio-demographic questionnaire were used.

In all examinations SFS scores in the patients (T1 - 103.4; T2- 104.4; T3- 107.0), were significantly lower than in the healthy controls - 117.0 (p< 0.001). In longitudinal analysis, a mild improvement was observed in T3 SFS score and in its three subscales (p< 0.05). In cross-sectional analysis, better social functioning was associated with female sex, longer education, activity before admission, and better functioning in the pre-admission period. In regression analyses SFS at T2 was predicted by PANSS (27% of the variance) and at T3 by PANSS and duration of psychotic symptoms (20% of the variance).

Social functioning in schizophrenia is disturbed from the onset of the disease and may be mildly improved in the intermediate follow-up. The duration of untreated illness and severity of symptoms after the first admission, are the independent significant determinants of social functioning in early course of schizophrenia.

To compare “big five” personality trait dimensions in psychiatrically healthy individuals and first episode psychosis (schizophrenia and bipolar disorder).

Clinically stable patients with first episode schizophrenia (22M, 4F) and bipolar disorder (24M, 8F), and psychiatrically healthy subjects (101M, 36F), completed the NEO-FFI personality inventory. The NEO-FFI is a 60-item self-assessment questionnaire that measures the major personality trait dimensions of neuroticism (N), extraversion (E), openness (O), agreeableness (A) and conscientiousness (C); it has good reliability and cross-cultural validity (McCrae et al, J Res Person, 2004;38:179-201). Gender-specific T-scores were analyzed using standard multivariate statistical techniques.

As expected, age correlated with personality dimensions in the entire sample (N= -.144, p= .045; O= -.169, p= .018; A= .228, p= .001; C = .150, p= .037). MANOVA with dimension scores as dependent variables, diagnosis as a fixed factor independent variable, and age as a covariate demonstrated that schizophrenia and bipolar groups were statistically similar on N, A, and C. Both patient groups were significantly higher than comparison subjects on N and lower on A and C (see Figure). All three groups differed significantly on E (schizophrenia < bipolar < comparison), but no groups differed on O.

Personality deviations are present in first episode schizophrenia and bipolar disorder, and are similar to abnormalities previously described in patients with more chronic illness.

Fig. 1

[NEO Dimension Scores by Group]

Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.

To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.

27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).

Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.

We investigated neuropsychiatric patients with non-bacterial meningitis (N-MEN)), assumed chronic low level neuroinflammation (schizophrenic SCH-S and affective spectrum disorders PSYCH-A) and tension headache (CEPH). Cytokines investigated were IL-1beta, IL-2, IL-8/CXCL8, the antiinflammatory IL-10 and IL-17.

to differentiate chronic and acute neuropsychiatric diseases by cytokine profiles and to evaluate cytokine levels in the CSF and peripheral blood to characterize the two compartments

Included were 10 N-MEN, 10 CEPH, 15 PSYCH-A and 16 PSYCH-S patients. Peripheral blood and CSF was taken in parallel. Measurement on a commercial multiplex immunoassayplatform (Mesoscale) by a modified protocol. Statistics: Mann-Whitney-U-Test and Kruskal-Wallis H-Test.

Highest levels of IL1b, IL-2, IL-8 and IL-17 were observed in the CSF of N-MEN, whereas in serum, levels were not or slightly elevated. Significant (p< 0.05) tested in CSF for N-MEM versus CEPH,PSYCH-A,PSYCH-S for IL-8 and versus PSYCH-A,PSYCH-S for IL-17. IL-10 CSF levels were also highest in N-MEM, and significant also versus CEPH,PSYCH-A,PSYCH-S, but IL-10 in serum was even higher than in CSF. We observed in all cytokine (except IL-2) significant differences either in serum or in CSF or both between the diseases; but more frequent CSF than in the serum.

N-MEN patients displayed highest ratios of CSF to serum levels for all cytokines (mean between 1.6 and 63).

Investigation of cytokines in CSF is more sensitive than in serum to detect differences between neuropsychiatric diseases. Cytokine patterns are disease specific. Elevated IL-1beta, IL-2 and IL-8 CSF/serum ratios in N-MEM may indicate an intrathecal synthesis of cytokines.

Antipsychotic treatment has been repeatedly found to be associated with an increased risk for venous thromboembolism (VTE) in schizophrenia. The aim of the study was to ascertain whether markers of thrombogenesis are increased in psychotic patients who have not yet been treated with antipsychotic medication.

We investigated plasma levels of markers indicating activation of coagulation (D-dimers) and platelets (solubile P-selectin, sP-selectin) in a group of nine men and nine women with acute schizophrenia who had not yet been treated with antipsychotics (age 29.8±9.1 years; body mass index 23.3±5.1), and eighteen healthy volunteers matched for age, gender and body mass index.

D-dimers (median 0.38 vs 0.22 mg/l; P=0.049) as well as sP-selectin (median 195.9 vs 111.9 ng/ml; P=0.008) plasma levels were significantly increased in the group of patients with acute schizophrenia as compared to healthy volunteers.

The results suggest that at least a part of venous thromboembolic events in patients with schizophrenia may rather be induced by pathogenetic mechanisms related to psychosis than caused by antipsychotic treatment. Finding an exact cause of VTE in schizophrenia is necessary for its efficient treatment and prevention. We are aware of the pilot character of our data, and continue to involve more patients and healthy volunteers into the research.

This study is designed to determine the prevalence and clinical severity of obsessive-compulsive symptoms/disorder, aggression and suicidal attempts at the same time in schizophrenic patients with considering the severe anxiety, depression and substance abuse as confounding factors.

In a cross-sectional study, 100 schizophrenic patients who were diagnosed with structured clinical interview were selected with simple sampling. They were evaluated with Yale - Brown Obsessive Compulsive Scale (Y/BOCS), Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI), Spilberger State/Trait Anxiety Inventory, Beck Scale for suicide Ideation (BSS) (in the case of recent suicidal attempt), and Overt Aggression Scale (OAS).

Obsessive-compulsive symptoms, obsessive-compulsive disorder and suicidal attempt were seen in 33%, 10% and 12% of patients respectively. Most common form of aggression was against others (55%). Patients did not have important differences from the Severity of schizophrenia, thoughts of suicide and aggression. There were no significant differences between severity of schizophrenia, suicidal ideation and overt aggression in patients with and without obsessive compulsion disorder/symptoms. Severity of overt aggression was related to patients' age and education reversely.

High percentage of aggressive obsessions in this study and lack of significant relationship between severity of aggression and presence of obsessive-compulsion disorder indicates that these patients do not act on these thoughts.