Schizophrenia is the psychiatric disorder in which the awareness of pathology is most frequently altered. This merits particular attention, because related to medication compliance and clinical outcome.

To improve the level of insight in stabilized schizophrenia patients by means of two cognitive remediation techniques: Cognitive remediation program for patients with a schizophrenia spectrum disease - ReCoS and autobiographical memory program - RemAu.

The study is based on the results of neurocognitive and insight evaluations before and after treatment of two groups of ten patients with RemAu and twenty patients with ReCoS. The level of insight is evaluated using the SUMD and the PANSS scales. For cognitive capacity we test their concentration level (Trail Making Test, TMT, Stroop), executive functions (Wisconsin Card Sorting Test, WCST), memory (CVLT), autobiographical memory (TempAu) and their global cognitive capacity (WAIS III).

The results have enabled us to highlight the beneficial effects of the RemAu autobiographical reminiscence program on these patients’ insight. Although the ReCoS program does not significantly improve the level of insight, it produces results which are most satisfying with regard to the cognitive profile of each patient.

The patients who have most benefited from the program are those who already had a reasonable cognitive capacity before the treatment. This allows us to conclude that we should deliver a treatment which is directed simultaneously at persistent cognitive disorders and autobiographical memory in order to obtain optimal effect on the level of insight in this pathology.

To evaluate the striatal D3/D2 receptor occupancy of cariprazine (RGH-188) in healthy volunteers and schizophrenic patients, and assess the correlation between cariprazine plasma concentration and receptor occupancy.

Single- (0.5 mg) or multiple-dose (1 mg/day, 14 days) cariprazine was administered to healthy adult males (N=5) in an open-label positron emission tomography (PET) study. In a separate open-label PET study, multiple-dose cariprazine (0.5-3.0 mg/day, 14 days) was administered to adult male schizophrenic patients (N=8). Healthy volunteers had 1 predose and 1 postdose raclopride PET scan; schizophrenic patients had 1 predose and up to 3 postdose fallypride scans. Cariprazine plasma concentrations were determined by LC-MS/MS.

In healthy volunteers, single-dose cariprazine 0.5 mg resulted in low plasma concentration (0.1 ng/ml) and was associated with 12% maximum D3/D2 receptor occupancy; cariprazine 1 mg/day for 14 days resulted in cariprazine plasma concentrations of 2.3-3.4 ng/ml and >70% D3/D2 receptor occupancy. In schizophrenic patients, cariprazine 1.5 mg/day for 14 days resulted in cariprazine plasma concentrations of 2.5-3.4 ng/ml and >70% receptor occupancy; cariprazine 3.0 mg/day resulted in ≥90% occupancy. Predicted Emax values in schizophrenic patients approached 100% D3/D2 occupancy for dorsal and ventral striatum.

D3/D2 receptor occupancy in dorsal and ventral striatum was similar for cariprazine 1.0 mg/day in healthy volunteers and cariprazine 1.5 mg/day in schizophrenic patients. In both, higher receptor occupancy was associated with higher cariprazine plasma concentration. Cariprazine at 1.5 to 3.0 mg/day showed D3/D2 receptor occupancy within the predicted effective antipsychotic range.

There is a growing evidence that oxidative injury contributes to the patophysiology of schizophrenia (Sch), where higher concentrations of nitric oxide (NO) found to be neurotoxic. Data also suggest that bilirubin (BR) can serve as an endogenous scavenger of NO. The aim of this pilot study was to compare the serum levels of BR and NO among patients suffering from Sch, as well as to estimate whether NO serum levels differ between patients and healthy controls.

The study population were consisted of inpatients (n=20) who met DSM-IV diagnostic criteria for Sch confirmed by Structured Clinical Interview (SCID 1) and healthy controls (n=20). In order to exclude psychiatric morbidity in control subjects the same diagnostic procedure was applied. Serum BR levels were measured by the method of Ehrlich. NO concentration in serum was determined by classic colorimetric Griess reaction

In patients with schizophrenia BR serum level were 9.85±1.182 mmol/L ; X±SEM. Serum NO level was significantly higher in patients with Sch (23, 26 ± 1, 76 μmol/L; X±SEM) than in control subjects (14, 36±1, 42 μmol/L; X±SEM, p=0.001). Correlation between serum nitric oxide and BR values were 0.1518.

Results of this study reveal that BR plays possible protective role in NO cell toxic activity. Our finding of increased serum NO levels in patients with Sch indicates its potential role in pathophysiology of this severe psychiatric disorder. However, those results are preliminary and have to be confirmed in sample of larger size.

For the studies, we have used 225 patients from Children's Psychiatric Hospital. 82 of all selection were with schizophrenia spectrum disorders, 27 patients with affective disorders and 116 patients came from control group.

Patients were selected according to their diagnosis (in line with ICD-10) and current clinical status. Each diagnosis and clinical status was coded depending on its severity and course of disease.

The level of Hcy was stated by isocratic HPLC system with fluorometric detection (Shimadzu LC-20, model RF-10AxL).

Correlation of Hcy concentration between schizophrenia's spectrum disorders and control group was r = -0.39 (p< 0.001; t = 22.99).

Mean level of Hcy was 11.94 μmol/L for patients with schizophrenia's spectrum disorders and 11.55 μmol/L for patients with affective disorders versus 7.47 μmol/L in control.

It has been found that the highest level of Hcy in the group of schizophrenia spectrum disorders has been seen in patients with episodic-recurrent course of disease, especially with pronounced affect. For the group with affective disorders the highest level was seen in patients with depressive symptoms with anxiety and mixed affective disorders (r = 0.58; p< 0.001; t = 12.77).

Obtained data are indicative of potential link among the level of Hcy and schizophrenia, and that the level of Hcy is inwrought with affective disorders and anxiety in the course of disease.

To test in first-episode schizophrenia (FES) patients whether early treatment improvement accurately predicts subsequent treatment outcome and to develop a valid definition for early improvement.

188 first episode schizophrenia inpatients were assessed with the Positive and Negative Syndrome Scale (PANSS) at admission and biweekly until discharge within a randomized, double-blind trial. 93 patients were treated with risperidone, 95 with haloperidol. Response was defined as a 40% improvement in PANSS total score from admission to discharge, remission according to the recently proposed consensus criteria and early improvement as an improvement in the PANSS total subscore after the second week. Receiver operator characteristic (ROC) analyses were used to evaluate predictive validity of early improvement and to find the most reasonable cutoff definition according to specificity and sensitivity. A confidence interval for the optimum cutoff was furthermore estimated.

ROC analyses revealed reasonable predictability for response (AUC=0.707) and remission (AUC=0.692) concerning early improvement as a predictor for response/remission. No significant differences were found between the two treatment groups. Early improvement defined as a 46% PANSS total score reduction for response and a PANSS total score reduction of 50% for remission obtained the best results in terms of sensitivity and specificity.

We were able to confirm that early improvement is a valid predictor of subsequent treatment response and remission. FES patients should at least improve up to 30% in the PANSS total score at week 2 to achieve treatment response and remission.

Asenapine is indicated in adults for acute treatment of schizophrenia and bipolar I disorder. Here, the long-term safety and efficacy of asenapine versus olanzapine is described in schizophrenia and schizoaffective disorder patients treated for up to 3 years.

In a 1-year core study, patients were randomized to double-blind treatment with asenapine (5 or 10 mg BID) or olanzapine (10-20 mg QD). Patients completing the core study, and willing to continue treatment, received up to an additional 2 years of double-blind treatment. Safety evaluations assessments included adverse events (AEs), vital signs, body weight, and extrapyramidal symptoms (EPS). Efficacy, changes in Positive and Negative Syndrome Scale (PANSS) total score, was evaluated in the intent-to-treat population using observed cases.

In 440 enrolled patients (asenapine, 290; olanzapine, 150), the mean±SD daily dose was 13.4±4.1 mg for both asenapine and olanzapine; total exposure duration (including core study exposure) was 676.3±148.1 and 692.5±140.7 days for asenapine and olanzapine, respectively. Mean weight gain was 1.6 kg with asenapine and 5.0 kg with olanzapine; incidence of clinically significant weight gain was 28% and 40%, respectively. Incidence of EPS-related AEs was 4.5% with asenapine and 3.3% with olanzapine. AEs occurring in ≥10% of patients treated for up to 3 years will be listed. Mean±SD changes in PANSS total score over the course of the extension study were 1.7±11.0 with asenapine and -0.8±9.5 with olanzapine.

Asenapine and olanzapine were well tolerated and maintained efficacy in patients receiving up to 3 years of treatment.

To explore the relationship between cannabis use and self-report dimensions of psychosis in a population of university students presenting for any reason to primary care.

One thousand and forty-nine students attending the Student Health Unit, National University of Ireland, Galway, completed self-report questionnaires on alcohol and substance misuse, non-clinical dimensions of psychosis (Community Assessmemnt of Psychic Experiences), anxiety and depression (Hospital Anxiety and Depression Scale). Association of cannabis use with psychiatric symptoms was explored whilst controlling for confounds.

More frequent cannabis use was independently associated with greater intensity of positive, negative and depressive psychotic symptoms. The earlier the age of onset of cannabis use, the more positive psychotic symptoms were reported.

These findings support the hypothesis that cannabis use increases the risk of developing psychotic symptoms and that this risk is further increased in those individuals who use cannabis more heavily and commence it at a younger age.

A group of schizophrenic patients perform well in known theory of mind (ToM) tasks. Still most of them have difficulties to understand social situations in real life.

We used a new test of ToM to find out if this group of patients really have the ability to understand other people´s mental states or they might use some compensatory strategies.

49 schizophrenic patients and 38 matched control inviduals were evaluated. Participants were asked to read short stories and answer simple yes/no comprehension questions. We used three experimental conditions: “false-irony” condition (FI), “control” condition (C), and “false-irony with linguistic help” condition (FIH).

P atients with schizophrenia performed sinificantly worse than control subjects in each of the three conditions (FI:p=0.01;C:p=0.04;FIH:p=0.01). Among the 49 patients 22 did well the FIH tasks (44.89%). Among these 22 patients 12 did the FI tasks well (24.48%) and the other 10 did the FIH tasks well (20.4%).

P atients with schizophrenia performed a sinificant impairment in the new ToM test. Beside a group of patients is able to understand other people´s mental states. To understand these situations some patients probably use real mentalisation strategies, some of them can use the given linguistic help as a compensatory strategy, and some patients have difficulties in representing of the mental states of others.

Recent reports show that psychological functions such as working memory, attention and intention produce overlapping functional activation in the inferior parietal region. Task activation related to attention shifting, theory of mind and agency also overlaps in the inferior parietal and posterior superior temporal regions. We hypothesized that schizophrenic symptoms may stem from abnormal activity in these regions.

To understand the relationship between brain abnormalities and symptoms in schizophrenia.

To show that abnormal activity in the inferior parietal and posterior superior temporal regions during working memory is related to certain schizophrenic symptoms.

14 schizophrenic and 14 normal control subjects were tested using functional magnetic resonance imaging (fMRI) in conjunction with a verbal working memory paradigm. Symptoms were assessed using the SAPS and SANS scales.

As hypothesized, activity in the posterior superior temporal sulcus during working memory was correlated with levels of delusions in schizophrenic subjects. Connectivity strength between regions in the inferior parietal and anterior insula language related regions was related to levels of auditory hallucinations.

These regions are part of speech and voice perception and production networks. Voice perception during conversation also involves gesture processing, working memory and dynamic shifting of attention, as well as social cognition (e.g. theory of mind) and self/other (agency) representation. Overactivation of this social communication system could result in the symptoms of schizophrenia. We will present the results in the context of a framework implicating these regions in the generation of most of the symptoms of schizophrenia.

The main aim of this research is to evaluate the connection of various components of social support with chronic posttraumatic stress disorder (PTSD). We set up hypothesis that the level of the perceived social support mediates beneficial effects on various PTSD symptoms. Second hypothesis states that perceived social support is in positive connection with quality of life.

246 outpatients with chronic combat related PTSD participated in this study. On the base of different questionnaires we examined social support, quality of life and PTSD symptomatology (Multidimensional Scale of Perceived Social Support- MSPSS, Trauma symptoms inventory -TSI-A, World Health Organization Quality Of Life-BREF). We tried to identify three main factors of social support by factor analysis of MSPSS. Those factors were used in logistic and multiple regression analysis in order to prove our hypothesis.

In contrast to other researchers, we defined only two factors in MSPSS: “family support” explaining 52.9% of total variability and “peer support” explaining 18.5% of total variability. These factors used as predictors were not shown significant in multiple regression analysis predicting the PTSD symptoms defined by TSI-A. However, the levels of perceived social support were positively correlated with all four domains of quality of life.

Our research shows that role of social support in chronic course of PTSD is questionable, possibly due to personality changes and secondary traumatization, which is being supported by other researchers emphasizing it's importance in the early course of PTSD.

Life expectancy in schizophrenia is shortened, 15 years to 32 years. Increased cardiovascular morbidity is thought to have a major contribution.

A nurse practitioner was appointed for metabolic screening. The cut-off points were according to the NCEP 2005 criteria, except for glucose (cut-off: 6,0 mmol/l).

All outpatients in two FACT teams in Alkmaar were asked to participate in the measurement of the metabolic syndrome. Blood pressure was twice measured at two different visits, that took place 4 weeks apart. If laboratory result was abnormal, the measurement was repeated.

Out of the 204 patients in outpatient care who were asked, 67 refused participation. All in all, 137 patients participated, 91 male (46,3 years (SD: 12,2) and 46 female (51,7 yrs; SD: 11,6) patients. The vast majority (N=126 (92,6%) were Caucasian. Obesity was present in 32% of the male and 48% of the female patients compared to 16% in the general population. Normoglycemia was established in only 72,2% of the population compared to 95% in the same aged general population. Repeated hyperglycemia was present in 24,1% of the population.

In 137 patients with severe mental illness, mean age 48 years, we found that

1. 1. obesity was twice as prevalent as in the patient population.

2. 2. using the conservative NECP 2001 criterion for hyperglycemia, one out of four patients had a confirmed pre-diabetic hyperglycemia.

Intensive screening, therapy and preferably prevention are advised and needed to prevent major medical costs and massive medial consumption in this high-risk population.

There are widespread concerns about the quality of mental health care for ethnic minority groups. This is supported mainly by studies from the U.S. and Great-Britain, raising doubts about the generalisability to (other) European countries. This study investigates ethnic differences in quality of care (QoC) for common mental disorders (CMD) in primary and outpatient mental health care in the Netherlands.

Data from electronic records of 89 primary care practices in 2007 (6,246 cases), and longitudinal data (2001 - 2005) from a nationwide psychiatric case register (17,270 cases). Quality of primary care indicators were ‘detection of CMD’, ‘adequate follow-up’, ‘adequate prescription of psychotropics’ and ‘referral to specialised mental health care’. Outpatient mental health care indicators were ‘waiting times’, ‘treatment intensity’, ‘early dropout’ and ‘early re-registration.

Compared with ethnic Dutch, quality of primary care was less for Turkish clients (CMD less likely to be detected) and Surinamese/Antillean clients (less than adequate prescription of psychotropics). Outpatient mental health treatment was less favourable for Moroccan and Turkish clients (longer waiting times and lower treatment intensity), but more favourable for Surinamese/Antillean clients (shorter waiting times and lower dropout).

The data do not provide sufficient support for a generalising statement that quality of CMD treatment is less favourable for ethnic minority clients. Though negative findings are not to be disregarded, positive findings - which may be related to the promotion of culturally sensitive care approaches in mainstream mental health services - deserve attention as well.

To establish the prevalence of PTSD and other psychiatric morbidity and associated factors among the Bosnian Concentration Camp survivors.

Prospective descriptive study of 750 concentration camp survivors, who were treated at Psychiatric Clinic in Sarajevo, included in the study, which conducted from January 2007-June 2009. These POWs were captured in concentration camps during war time in Bosnia and Herzegovina. Lifetime and Current PTSD, IES-R score and other Psychiatric Morbidity as measured using the SCID and the IES-R.

A DSM-IV-TR diagnosis of current PTSD was made in 555 (74%) of the survivors.75 (10%) suffered from Depression, 120 (16%) from Anxiety disorders. PTSD co-morbidity was in 444 (80%) with Personality Disorders, or with Panic attacks, or with drug and alcohol abuse. Current PTSD was associated with higher IES-R scores and older age, lower income, non-islamic religion, larger household size, older age at incarceration, greater length of incarceration, incarceration in two or more camps, experiencing other traumatic events, family history of mental illness and having other psychiatric illness. After treatment 229 (30.53%) of patients had severe Personality disorders after experienced trauma. Majority of PTSD patients were chronic.

Similar to other former Prisoners of War (POWs) elsewhere, these survivors suffer high PTSD prevalence rates and a special veterans’ service is recommended to address this problem and its associated factors among these and other veterans in Bosnia.

The objective of this work is to check the assumption that changed social and economic factors causes change in some of the characteristics of non-psychotic clients treated in the daily hospital.

The investigation included 77 clients treated in the daily hospital in 1998 and 82 clients in 2008. Distribution of both groups was done according to the age, work status, duration of previous psychiatric treatment and diagnostic categories.

The result of the work indicates that the profile of a non-psychotic client changes showing an increase of the number of the clients over 50 (participated as 22.07% and 47.56% in 1998 and 2008, respectively). The increase of the number of unemployed of 9.09% in 1998 and 42.68% in 2008 was observed. The increase of number of the clients treated less than one year was also observed (23.37% and 50% in 1998 and 2008 respectively). There are no more significant percentage differences regarding affective disorders (32.46% in 1998 and 34.14% in 2008) and in the category of personality disorder and adults behavior disorder (9.09% in 1998 and 9.75% in 2008).

Neurotic stress associated and somatoform disorders were slightly increased in 2008 (50%) in relation to 1998 (40.25%), with significantly increased number of the clients in F 43 diagnostic category, from 7.79% during 1998 to 31,70% during 2008.

The results obtained point out that change in social and economic factors causes changes in the profile of non-psychotic clients in daily hospital.

Many studies describing print media representations of mental illnesses have showed that these depictions are frequently negative and contribute to consequent stigmatization of people with mental illness. The main objective of this international study was to identify predictors of stigmatizing and nonstigmatizing articles on mental illness in Czech Republic, Croatia and Slovakia.

The study sample comprised all articles pertaining to the topic of mental illness (N=450) chosen from 6 most widely read newspapers and magazines identified during five weeklong periods in 2007. The presence of stigmatization and destigmatization statements was coded and articles were grouped in positive, neutral, mixed and negative clusters. Negative/positive ratio (NPR) was used to assess the predictor value of different features of the article regarding stigmatization.

61.8% of articles contained some stigmatizing statements towards persons with mental illness. The highest NPR was found in articles published in tabloids (6.8), on the front page (3.7) and in the articles where psychotic disorder was mentioned (7.4) and mentally ill person figured as a source of information (1.8). Lowest NPR was found in magazines (0.6), articles in later sections (1.7) that mentioned eating disorders (0.3) and scientific surveys (0.1).

There is a high level of stigmatizing statements in the studied articles. As the strongest predictors of stigmatizing content we have identified articles that are published in tabloids and articles with reference to psychosis. Contrary to this, eating disorders had the least stigmatizing depiction as well as articles containing scientific data.

The Social Distance Scale (SDS) has been widely used as a proxy to explore stigmatising attitudes towards mental illness.

To administer a vignette-based questionnaire incorporating the SDS to first year healthcare undergraduates.

To compare the attitudes of participants towards active and resolved cases of mental illness.

567 students were sent an electronic questionnaire containing one vignette selected at random from a possibility of six (describing either active or medically resolved depression, schizophrenia or asthma). Participants then completed the SDS as used by Nordt (2006), to indicate what level of social closeness they would accept with such a person described in the vignette.

180 responses were received (31.7% response rate). Good levels of reliability for the Social Distance Scale were demonstrated (Cronbach's alpha = 0.90). Statistical analysis was performed using SPSS. A linear regression model was applied which explained 18% of the variance. Respondents showed significantly more social distance towards the vignettes describing active cases of depression, schizophrenia and asthma compared to the vignettes describing medically resolved cases (+0.21; p=0.045). Social distance towards the schizophrenia vignette was significantly higher (+0.28; P=0.031) compared to the depression vignette, and social distance towards the asthma vignette was significant lower (-0.413; p=0.001) compared to the depression vignette

Students were more socially distant towards the active cases of mental and physical illness compared to the resolved cases. A hierarchy of social distance existed, with most distance shown towards schizophrenia, followed by depression, with asthma receiving the least social distance.

The Social Distance Scale (SDS) is an established tool in the measurement of discriminatory attitudes towards those with mental illness.

To send an electronic questionnaire incorporating the SDS to both healthcare and nonhealthcare undergraduates.

To compare attitudes using the SDS of both student groups towards vignettes describing active and medically resolved cases of mental illness.

567 first year healthcare and 501 non-healthcare (law and english) university students were sent a questionnaire randomly containing one of six possible vignettes (describing either active or medically resolved depression, schizophrenia or asthma). The SDS as used by Nordt (2006), was then completed, indicating what level of social closeness would be accepted with the person described.

180 responses were received for the healthcare group (31.7% response rate) and 125 for the non-healthcare group (25% response rate). Very good reliability of the Social Distance Scale (Cronbach's a=0.91) was observed in the sample. Statistical analysis was performed using SPSS. A linear regression model was applied which explained 20% of the variance. A significant difference was observed in attitudes between healthcare and non-healthcare students towards both the active and resolved schizophrenia, with the Non-healthcare group expressing higher social distance towards these vignettes (+0.31; P=0.043) compared to the healthcare group. The two groups did not differ significantly in social distance towards the depression and asthma vignettes.

The non-healthcare students were significantly more socially distant towards both active and resolved schizophrenia vignettes. The findings for the remaining vignettes were similar between the two groups.

There is limited knowledge of how individuals reflect on their involuntary admission.

To investigate, at one year after an involuntary admission,

1. (i) peoples perception of the necessity of their involuntary admission

2. (ii) the enduring impact on the relationship with their family, consultant psychiatrist and employment prospects

3. (iii) readmission rates to hospital and risk factors for readmission.

People that were admitted involuntarily over a 15 month period were re-interviewed at one year following discharge.

Sixty eight people were re-interviewed at one year and this resulted in a follow-up rate of 84%. Prior to discharge, 72% of people reported that their involuntary admission had been necessary however this reduced to 60% after one year. Over one third of people changed their views and the majority of these patients reflected negatively towards their involuntary admission.

One quarter of people continued to experience a negative impact on the relationship with a family member and their consultant psychiatrist one year after an involuntary admission, while 13% reported a positive impact. A similar proportion perceived that it had negative consequences in their employment.

Within one year, 43% of all patients involuntarily admitted in the study period were readmitted to hospital and half of these admissions were involuntary. Involuntary readmission was associated with a sealing over recovery style.

Peoples’ perception of the necessity of their involuntary admissions changes significantly over time. Involuntary admissions can have a lasting negative impact on the relationship with family members and treating consultant psychiatrist.