Identification of interrelationship immunity with clinical-social adaptation of schizophrenic patients.

We examined 107 schizophrenic's (76,1% - patients with paranoid schizophrenia with continuous and episodic type of course, F20.00, F20.01, F20.02).

The psychometric scale PANSS was used to estimate the dynamics of psychopathological symptoms during treatment. The immunological examination included the definition of phenotypes of surface receptors of immunocompetent cells, level of IgM, IgG, IgA. The research was carried out in two points: first - at admission, second - in 6 weeks of treatment.

Four adaptation types have been revealed: integrative (combining high clinical and social indices, 40,1% of patients); introvert (high clinical and low social indices, 38,3%); extrovert (low clinical and high social indices, 11,2%); destructive (combining low clinical and social indices (10,4%).

It has been shown that patients with extrovert and destructive adaptation types characterizing by great severity of psychopathological symptoms (high score) according to PANSS.

At 1st point Т-immunodeficiency was diagnosed among the schizophrenic patients, which was kept within 6 weeks of treatment. In the therapy course peculiarities of psychoneuroimmunomodulation have been revealed: relatively favorable in immunological aspect are integrative and introvert types of adaptation. In integrative type number of immunocompetent cells does not change and has trend toward normalization. In destructive type greater suppression of T-immunity has been revealed (CD2+-, СD3+-, and СD4 +-lymphocytes decrease); HLADR+-lymphocytes remain high.

Thus, clinical-social differences between groups have been confirmed by data according to immune reactivity.

Self-esteem in schizophrenic patients is low. Self-esteem is the most important factor in these patients improvement and music therapy enhances self-esteem.

This study has been conducted with the aim of examination the effect of music therapy on self-esteem of chronic schizophrenic patients.

In This experimental research regarding pilot study and inclusion criteria, 70 persons of male in-patient chronic schizophrenic patients were determined and allocated in 3 groups: experimental 1(24 persons), experimental 2(22 persons) and control group (24 persons) randomly. Music game was implemented in experimental group 1 and lyric analysis in experimental group 2 for one month, 12 sessions, lasting 45 minutes each. Demographic questionnaire and Coopersmith self-esteem Inventory were measured. In internal consistency assessment, chronbach’.α 0/84 and in test-retest reliability, pearson correlation coefficient 0/89 were determined. SPSS version 15 and one way ANOVA, paired t test, Chi-square, Kolmogorov-Smirnov, levene's tests were used for data analysis.

There was not significant difference between self-esteem of patients in experimental and control groups before music therapy and between experimental groups 1 and 2 after music therapy (P>0/05) whereas there was significant difference between experimental and control groups and in intervention groups 1 and 2 after music therapy (P< 0/05).

Music therapy enhances self-esteem in chronic schizophrenic patients and also there was not considerable change in self-esteem increase between music game and lyric analysis. These two types of music therapy can be used in enhancing self-esteem of these patients.

A primary goal of recovery-oriented mental health services is to increase client voice and empowerment. Shared decision-making (SDM) technologies can help achieve this goal. We report on two projects that aim to increase engagement around antipsychotic medications by people with serious mental illness (SMI).

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Project 1: Using a participatory-action research (PAR) orientation, a partnership between a university and a public MH clinic developed around a shared goal of finding an acceptable SDM intervention targeting medication use by persons with SMI. We solicited input about SDM from national experts and via focus groups of local stakeholders and analyzed the qualitative data.

Project 2: The US Substance Abuse and Mental Health Service Administration (SAMHSA) contracted with Advocates for Human Potential (AHP) to develop a decision aid (DA) for consumers considering use of antipsychotic medication. Based on the results of literature reviews and stakeholder needs assessments, we constructed a multi-module consumer-centered DA that follows the International Patient Decision Aid Standards (IPDAS) for DAs. The DA is still under construction; however, we have completed entering the format and content of several of the modules.

Audience responses to the concept of SDM have been mixed. The PAR group identified multiple barriers to implementing SDM in practice, including consumer factors, information exchange, skill requirement, and outcomes expected from using SDM.

Adapting shared decision-making technologies to mental health settings has unique challenges. We are using the barriers identified by the PAR group to guide creation of the SAMHSA DA.

Forty four years old, single, unemployed male patient with paranoid schizophrenia and congenital myotonia has been presented in this case report. He was hospitalized because of collecting garbages, hostility toward his brothers, fattening many animals, living in very dirty surroundings. His mother was treated as bipolar disorder.

He had muscular disease since childhood, weakness began initially in arms then in legs. There is muscular weakness in both of the proximal and distal extremities. He presented with dirty, old attire. He was indifferent and had flattened affect. His behaviors were bizarre. He made poor eye contact. He had no insight. He was in defensive attitude. There was no hallusinations. He had severe persecutive delusions toward his brothers. Generalized muscular disease with myotonic decharges was diagnoses in EMG. Olanzapine,20mg/day was applied. The patient responded to the medication and the psycotic symptoms were totally disappeared.

It is known that central serebral system may be effected and hypodense areas are seen in the brains of Thomsen type congenital muscular dystrophy which is comorbid with mental retardation (Kamoshıta et al 1963). We assume that an unspecified disorder in the central serebral system might be presented as paranoid schizophrenia in this patient with congenital myotonia and there may be some common aspects among both of these illnesses.

There are no obvious data to sustain that amisulpride-quetiapine-memantine association would induce remision of resistant schizophrenia. The clinical consequences and the challenge of medication for resistant schizophrenia are important. This case report brings additional information about therapy in resistant schizophrenia.

Case Report: 38 years old patient, male, with repeated hospitalizations for schizophreniaparanoid type, from 1989; the precedent psychotic episodes were treated with haloperidol, risperiodone,amisulpride, olanzapine, clozapine and quetiapine. The latest episode was treated with olanzapine (20mg/day- 8 weeks), with failure, and, after that, with clozapine (500mg/day- 8 weeks) without remission. The patient has been hospitalized after olanzapine and clozapine treatment failure and treated with association of two different classes of neuroleptics (amisulpride 800mg/day and quetiapine 200mg/day) and memantine (10mg/day).

The treatment with amisulpride-quetiapine- memantine association induced remission of symptoms and discharge from hospital after 18 days of treatment, sustained by PANSS score reduction (from105 at hospitalization to 40 at discharge). This symptoms remission is important because it happens after clozapine treatment failure, with known efficacy for treatment resistant schizophrenia.

For a patient with schizophrenia-paranoid type, treatment resistant, amisulpride-quetiapine- memantine association had the power to induce remission of symptoms. The combinated multireceptoral D2, 5HT2A, NMDA action of medication may be important in choosing the treatment for resistant schizophrenia.

Many studies have recently been carried out to compare the effectiveness of various antipsychotic agents.

We wished to determine what could be learnt from these studies about the effectiveness of antipsychotics, and whether this should influence choice of treatment.

We carried out a literature search using PUBMED. We directed special attention to large studies comparing medications in schizophrenia. These studies included CUTLASS, CATIE, SOHO, CAFE, and EUFEST (Kahn 2008, Haro 2006, Jones 2006, Lieberman 2005, Perkins 2008), as well as studies by Tihonen 92006, 2009) The studies were critically reviewed.

The different studies measure different aspects of care, at different phases of the illness. This illustrates the need to study schizophrenia through a stage model. Furthermore, different outcome measures are proposed. We believe that discontinuation data, on which some studiesdepend, is a weak measure of effectiveness. Important doubts arise regarding the choice of patients (those requiring switching of antipsychotic) in CUTLASS, and also regarding potential observer bias in this study.

There is much information to be gathered from the results of such studies. However interpretation is made more difficult by problems within the study designs themselves. On balance it does appear that different antipsychotics have different effectiveness. The main difficulty in putting these results into practice is concern among clinicians and patients regarding side effects.

Disturbances of sleeping are very common among patients suffering from mental disease. The purpose of the research is to find a relationship between schizophrenia and disturbances of sleeping, such as problems with falling asleep, arousing at night, waking up untimely in the morning, bad quality of sleeping and its insufficient quantity.

16 patients (3 women and 13 men) with a diagnose of schizophrenia were recruited to the study. The battery of cognitive neuropsychological tests used to assess disturbances of sleeping included: Athen Insomnia Scale (AIS), Beck Depression Inventory (BDI) and Frankfurt Self-feeling Scale (FBS).

In the examined group statistically significant presence disturbances of sleeping was found, and in this connection worse self-feeling were also affirmed.

The above correlations between disturbances of sleeping and worse mood indicate that removing of that disturbances improves mental and physical condition of patients with schizophrenia. The awareness of these correlations may be important in the process of constructing treating programmes for patients.

To determine the clinical profile of patients diagnosed of delusional disorder (DD) admitted to a psychiatric ward.

Retrospective chart review of inpatients with diagnoses of delusional disorder (DD) according ICD-10 criteria admitted to a psychiatric ward (Hospital de Conxo, Santiago de Compostela) between January 1998 and December 2008. Sociodemographic and clinical variables were collected, with special attention to comorbidity and presumed risk factors.

The sample consisted in 56 inpatients (30 women, mean age 54 ± 11). 64.3% were single including never married (33.9%), divorced, separated and widowed and 33.9% lived alone. The most frequent type of DD was persecutory (67%) followed by mixed type (16%). 16.1% presented hallucinations (most frequent auditory). In comparison with the other types, patients with persecutory delusions usually lived alone (p < 0.05). Most frequent comorbidities were substance abuse and affective disorders. Familiar background of psychoses was recorded in 21.4% and history of emigration in 12.5%. 5.4% suffered deafness. During the period studied 53.6% were admitted two or more times. After the most recent admission 32.1% were on depot antipsychotic.

In concordance with other previous reports, DD seemed to be more prevalent in women in middle or late adulthood and persecutory were the most frequent delusions. In our sample, most patients were not married and high prevalence of family antecedents of psychoses was found. It could be related with its hospital origin; then it could be hypothesized living alone and having familiar background of psychoses to be risk factors of hospitalization.

Second generation antipsycotics (SGAs) represent an essential treatment for Psychotic Disorders. However SGAs cause weight gain and metabolic disorders with an unknown mechanism.

The aim of this study is to investigate whether weight gain may be caused by a reduction in resting energy expenditure (REE).

We recruited 34 pazients who received a clinical diagnosis of Bipolar Disorder I, Schizoaffective Disorder or Schizophrenia. Patients were in antipsychotic monotherapy (clozapine, olanzapine or aripiprazole). We measured REE by indirect calorimetry and we calculated theorical REE utilizing LARN and Harris-Benedict (H-B) equation.

The difference between the average value of REE measured in patients (1295Kcal/die) and the average value of REE estimated by LARN and H-B equation (1719Kcal/die and 1741Kcal/die) was respectively 423Kcal/die and 445Kcal/die: both the differences resulted statistically significative (p< 0.01). This reduction of REE results in a weight gain of 1,7 kg in a month.

It is necessary to inform patients about the side effects of SGAs. Lifestyle counseling and pharmacological assistance, or switching to another antipsychotic are possible strategies.

Promoting client empowerment in mental health service and treatment is linked with positive outcomes and is considered an indicator of quality recovery-oriented services. However, most public mental health services do not yet fully implement this goal.

Recognizing that shared decision-making (SDM) technologies have the potential to encourage more effective communication and collaboration, SAMHSA and Advocates for Human Potential are developing SDM resources for public mental health services and the people they serve.

We report on field tests of one resource, a decision aid (DA) for consumers considering use of antipsychotic medication.

After conducting a literature review and analysis of decision support materials, we performed consumer and provider needs assessments to guide DA development. We constructed a 7-module Webbased consumer-centered DA that follows IPDAS standards. We tested the prototype with groups of consumers and providers available to the team.

Responses to the DA have been mixed. Some providers are concerned about “sharing” treatment decisions with clients and feel there is too much information in the DA. Some consumers want more information yet feel the DA is too long. Both groups express enthusiasm about the use of a DA for antipsychotic medication.

Adapting SDM concepts and tools to public mental health settings has unique challenges. Traditional assumptions about competency of people with mental health diagnoses have resulted in a history of provider-dominated decision-making. While DAs are designed to help balance power in the clinical encounter, we recognize that there are more obstacles to overcome.

A randomized, controlled study showed that a telephone-based nursing strategy was effective to improve adherence to antipsychotic treatment in clinically stable outpatients with schizophrenia. Post hoc analysis was carried out to identify factors associated with intervention success.

Patients (n= 865) were randomized to receive monthly telephone calls from a nurse or standard clinical follow-up. Calls were performed at weeks 4, 8, and 12, consisting of a brief semistructured interview to assess adherence and attitudes toward medication (DAI-10). Primary endpoint: difference in the percentage of adherent patients after phone follow-up versus control group at week 16. Non conditional logistic regression with backward stepwise procedure was used to identify variables involved with adherence improvement.

410 (96.7%) patients fulfilled adherence criteria in the intervention group vs 402 (91.1%) in the control group. A difference of 5.5% was found between groups (95% CI 2.3, 8.6%; p= 0.0007).

The telephone intervention was significantly associated with an improvement in adherence in those patients with a prior negative attitude toward treatment (OR 4.7, 95% CI 2.4, 9.0; p< 0.0001), but there was not a significant association in patients with a previous positive perception (OR 1.2, 95% CI 0.8, 1.9; p= 0.36). A slight concordance was obtained between adherence improvement after the intervention and the improvement in attitude toward treatment (kappa 0.21, 95% CI 0.15, 0.27).

A nurse telephone follow-up could be a complementary and easy to implement strategy to improve therapeutic adherence, particularly in those patients with negative attitudes toward antipsychotic treatment.

A sample of 67 patients receiving care in community mental health services (day hospital) has been evaluated using the SF-36 scale.

The results were compared with the population national values of reference to the same scale.

We found statistically significant differences between groups for the following items: General Health (t =-2,81; p=0,004), Vitality (t =-3,37; P=0,000; Social Functioning t =-4.11; p = 0,000); Emotional Role (t =-2,269; p=0,023) and Mental Health (T =-2,67; p = 0,007).

The studied patients have a worse perception it brings over of his general health that the rest of the Spanish population; likewise they perceive a major detriment as for his social functioning that is a rest of the Spanish population. This way, the physical health of the patients with schizophrenia needs a control and a specific follow-up to guarantee that his life expectancy, his quality of life and his social functioning are similar to those of the general population.

In our work we propose to use the adult developmental eye movement test (A-DEM) of Gene Sampedro et al, for the study of saccadic movements in schizophrenia.

To study the importance of saccades and attention in a sample of institutionalized patients with schizophrenia in a Unit of Psychosocial Rehabilitation.

Sample formed by 30 people.15 patients and 15 controls. 15 patients were corresponding to all the schizophrenic patients admitted in January, 2009 in a Unit of Psycosocial Rehabilitation of Conxo's Psychiatric Hospital. The 15 of the group control were selected of random form between sanitary personnel without psychiatric pathology, homogenizing the variables chronological age and sex with regard to the group of investigation.

The A-DEM vertical half to 44.37 seconds in the control group versus 59.54 seconds in the sample of patients. Regarding the results of the horizontal A-DEM obtained an average score of 47.07 seconds compared to control group obtained 60.68 seconds in the group of patients. The schizophrenic patients are characterized for having an attention diminished in 87 %, opposite to 47 % of the group control that they have a normal attention and 40 % increased. These differences of saccadic movements and of the attention are statistically significant.

Schizophrenic patients have few saccades both horizontally and vertically slower than normal people.

Schizophrenic patients show a marked deficit of attention to the normal population.

It has been shown that a disorder of self-monitoring and/or self agency may underlie positive symptoms in schizophrenia, such as hallucinations and delusions of control. The objective of our study was to explore the deficit of these constructs in a sample of schizophrenic subjects by means of low-cost virtual reality.

15 schizophrenic subjects and 10 age matched control subjects were tested in two different sessions of a Microsoft Xbox videogame (Dungeons & Dragons: Heroes), in which two players had to cooperate by fighting against various enemies in a virtual space. In each session an avatar was assigned to the test subject: in the first session the test subject's avatar was distinguished by a different coloured circle from the tester's one. In the second session the test subject's avatar was identical to the tester's one. Before playing the game, the schizophrenic test subjects and controls were evaluated on a neuropsychological battery including visuo spatial and executive abilities. Clinical characteristics of the schizophrenic subjects were also assessed.

While in the first session patients and normal controls performed similarly, in the second session schizophrenic subjects confused their own avatar more often with the tester's one compared to normal controls (ANOVA Sig.,035). A regression analysis identified visuospatial abilities and set shifting as best predictors of performance in the videogame, while there was no correlation between the performance in the videogame and the clinical variables.

Low-cost virtual reality can be used to explore deficits of self monitoring/self agency in schizophrenia.

The study aimed to investigate episodic memory in schizophrenic patients, their biological relatives and comparison with normal people.

20 schizophrenic patients, 20 their biological relatives and 20 normal people were randomly selected and William's individual episodic memory test (WIEMT) was administered on them. In the research, to the participants were presented 15 target words (5 pleasant, 5 unpleasant,5 neutral words).The participants were asked to recall a past memory associated with target words. ANOVA test was used to analyze the data.

Finding showed significant differences among groups. Majority of schizophrenics oriented to choose neutral and somewhat unpleasant stimuli (words) and recall their past memory with depressive and unpleasant matter and their relatives too. But majority of normal people choose the better and pleasant words with good and pleasant their past memory.

Our results reveal that deficits in episodic memory can be regarded one of the most prominent cognitive deficits in schizophrenia and should thus be taken seriously in both its diagnosis and treatment. So it stresses the importance of assessing memory function impairments in clinical settings. Also choosing the neutral (and not pleasant) stimuli (words) may cause tendency to depressed mood and it can impair social cognition in schizophrenia that may be an important predictor of social dysfunction.

Niether the patient alone in schizophrenia, but the spouse & children and other members involved are all facing several difficulties.

Here in a population of schizophrenic patients all treating in the author's rural district clinic in 2009 are evaluated for ther familial stess& burden.The cost seems high even in a rural society in India, where joint family situation exists.

The current loss involving a schizophrenic patient after more than 5-10yearsof suffering is reassed to find an insight to this grave problem, still rampart in different countries of the devoloping world.

180 patients who were diagonosed as suffering from scizophrenia as per ICD-10 creria was evaluated.They were 96 male, 84 females with onset of ilness 5-10 yrears back & in the age group 28-42 with a median age of 35 years.

1. 1. Maritalstatus & satisfaction was assesed first, with a divorce of 7in female and 4 inmale groups. There was desertion of spouse in13 case in male group & living apart status in10 females.Sexual lfe in the last 6months was was absent in 24 females & in10 of male group, those living together.Satisfaction in sex was reported poor by 30% of females &25% of males.

2. 2. Living status & where there is a fall in previous 5years was repoted as 30% in female groups & nearly 50% in male groups.

3. 3. Childrearing & education was poor in40% of male &55% in females.

Societal burden in few parameters is immense.

I In all dimensions burden&cost is high.

In indian rural population setting where true literacy rate seldom croses more than 70% in women, the perception of depressive illness and the symptoms presentation are varied & predominately somatic.

Symptoms type variation & the degree of their educational status are corelated here to observe any deviancy.

Symptom type & litaracy status can show an association in depressed women in a clinic.

About 280 women in the age group 21-51 with a median age of 36years were taken here for assesment, who were diagonosed as suffering from depressive disorder asper DSM-4, either MDD or Bipolar depression. they all attended a mind care clinic(Mono-Susrusha), in a Ditrict HQTRS town Midnapore,126 k.m away from stte capital city of Kolkata.

5 basic symptoms were quried here as those were the major presenting features,

1. 1. Headpain or head discomfort or pain around neck

2. 2. Pain in lower extremeties or other sites

3. 3. sleep diturbance, loss of appetite or libid diminution

4. 4. Lack of pleasure or lossof interests to all daily activities

5. 5. Sucidal ideas

Next their litracy status illrtarate(20%), junior school(55%), highschool(12%),graduate,postgrauate &above(12%) uncertain in 1% cases.were assesed.

A tally was made to their educationalstatus&above symptoms.

Somatic, bodily pain symptoms were mostly presenting feature in illetarate & lower school educated women.Biological(3rdlisted), lack of pleasure & suicidal urges were echoed mainly in higher educated women group of graduate&above.

Suicidal urges are more percieved in depressed educated women &somatic symptom predominancy were observed more in illterate &junior level educated group.

Close collaboration and communication between specialist psychiatric services and primary care is essential in achieving an effective and efficient level of patient care.

To assess the rate of six monthly communication between specialised psychiatric service and primary care and to determine from patients records those that may be suitable for discharge back into primary care.

A retrospective chart review of all patients attending the relevant local psychiatric out-patient clinic was carried out to identify parameter relevant to the objectives of the study. This was followed by a multidisciplinary discussion to determine the appropriate ongoing care for the patients. The data was analysed with SPSS (version 17).

A total of 105 patients’ charts were reviewed in the audit. Overall, only 36% of patients’ charts had a record of communication with primary care in the last six months. Only one variable,’ changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00. It was recommended that 60% of the patients needed continuing care with psychiatric services, 35.2% could be discharged back into primary care and 4.8% could be managed jointly between psychiatric services and primary care.

A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care. It also identifies patients who could be discharged back into primary care.

This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.

Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.

One hundred and fifty four new referrals, of whom 41 were non-Irish, presented over a sixmonth period. Results showed no difference between Irish and non-Irish patients in terms of sociodemographic variables. Alcohol problems and subsequent need for detoxification and counseling were significantly increased among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.

There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilization and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.