In schizophrenia treatment-compliance is a strong predictor of outcome, it depends on a longer lasting therapeutic alliance. SMS (Short Message Service) sent via mobile phones is an adequate tool to establish therapeutic contingency as was shown in a study on bulimia. This programme compliments outpatient treatment and is based on an exchange of SMS-messages between patient and therapist. On a weekly basis, patients supply information on subjective well-being, sleep, social contacts, and attitude towards medication. The patient's status is then rated as improved, deteriorated, or unchanged compared to the previous week and an adequate feedback message is sent. The study aimed at assessing feasibility and acceptance of this intervention in schizophrenia patients.

Thirty-six patients during inpatient-treatment for diagnoses of schizophrenia and schizoaffective disorder were screened and found eligible for participation. Those who agreed to participation were assessed with the SCID for DSM-IV and received instructions towards the use of the programme, which started after discharge and was designed to last for 4 months in addition to outpatient-treatment as usual.

Eight patients agreed to participation (7 male, 1 female, mean age 29 years), six of whom dropped out during the first three weeks, and only one patient completed the study.

In the presented study, patients suffering from schizophrenia showed a low acceptance rate of additional SMS support complimenting their regular outpatient-treatment. As opposed to our hypothesis and contrary to experiences with bulimia patients integrating an SMS intervention into the treatment of schizophrenia does not seem feasible.

Under naturalistic conditions the influence of monotherapy versus combined therapy on the outcome of psychoeducation was to be investigated. As amisulpride has a very positive receptor profile and causes no sedation, it was of interest to which degree amisulpride has a positive influence on knowledge gain in comparison to other atypicals.

In-patients with schizophrenia (ICD -10: F2) under therapy with atypicals. 8 psychoeducational group sessions; indication for groups independent of psychopathology, insight and compliance. Medication with atypicals non restricted.

94 patients (47% female, 35 years), 40 % (38 of 94) were treated at discharge with a monotherapy and 60 % with a combination of atypicals. PANSS monotherapy at admission: 74; at discharge: 49. Patients with combination therapy had significantly higher values: 92 at admission and 66 at discharge (p<0.001). Knowledge-gain was comparable; monotherapy group: Mean= 6,0 (SD 6,5); combination therapy: Mean=6,9 (SD 12,4) (n.s.). 23 % (22 of 94) got amisulpride (5 in monotherapy and 17 in combination). Concerning safety profile and therapeutic effectiveness the non-inferior hypothesis could be confirmed. Patients with monotherapy of amisulpride at discharge had a mean knowledge gain of 10.7; that was higher than the mean knowledge gain of 6.5 of all patients (n.s.).

Monotherapy with atypicals was only possible among 40 %. Psychoeducation is efficient for severely ill patients with combined therapy as well. Amisulpride monotherapy showed a knowledge-gain higher than the average atypicals. For patients with high expectations concerning rehabilitation, a monotherapy with amisulpride seems to be useful.

Several neuroimaging studies have shown impaired microstructural integrity of corpus callosum in schizophrenia, which may support inter-hemispheric misconnection. However, functional connectivity has rarely been investigated in schizophrenia.

To explore inter-hemispheric communication in a sample of patients with schizophrenia in comparison to healthy controls.

Twenty-five patients with schizophrenia and forty-one healthy controls were studied. Subjects were asked to press a key with the index-finger of their right or the left hand as quickly as possible following appearance of either a single or a double stimulus. Two measures were calculated: the difference between manual reaction times (RT) after the presentation of single stimuli to the ipsilateral (uncrossed response) or contralateral (crossed response) visual hemifield (the so-called Poffenberger Paradigm), as a measure of interhemispheric transfer time (ITT), and the difference between double and single stimuli (the Redundant Target Effect, RTE), as a measure of interhemispheric integration.

Overall, patients with schizophrenia responded faster with the left than with the right hand (Paired sample t-test p=0.019). Importantly, in schizophrenics there was no group difference in ITT but there was a significantly enhanced RTE .

The slower RT for right hand in schizophrenics possibly reflects a general delay of the left cerebral hemisphere in visuomotor RT. Moreover, the enhanced RTE suggests an impairment of interhemispheric integration in schizophrenia.

Correlational methods, unlike cluster analyses, cannot take into account the possibility that individuals score highly on more than one symptom dimension simultaneously. This may account for the inconsistency found in the correlates of schizotypy dimensions. This study explored the clustering of positive and negative schizotypy dimensions in nonclinical subjects and whether schizotypy clusters have meaningful patterns of adjustment in terms of psychopathology, social functioning, and personality.

Positive and negative schizotypy dimensional scores were derived from the Wisconsin Schizotypy Scales for 6.137 college students and submitted to cluster analysis. Of these, 780 completed the NEO-PI-R and Social Adjustment Scale-self report version, and further 430 were interviewed for schizophrenia-spectrum, mood, and substance use psychopathology.

Four clusters were yielded: low, high positive, high negative, and mixed (high positive and negative) schizotypy. The positive-schizotypy cluster presented more psychotic-like experiences and schizotypal, paranoid symptoms, had more affective and substance abuse pathology, and were more open and extraverted. The negative-schizotypy cluster had more negative and schizoid symptoms, worse social adjustment, high conscientiousness and low agreeableness. The mixed cluster was the most deviant on almost all aspects.

Our cluster solution is consistent with few previous reports in schizotypy and schizophrenia, indicating that meaningful profiles of schizotypy features can be detected in nonclinical populations. The clusters displayed a distinct and meaningful pattern of correlates at across different domains, thus providing construct validity to the schizotypy types defined.

Previous studies suggest that the serotonergic pathway may play an important role in prefrontal cortical (PFC) function. The enzyme monoamino oxidase-A (MAO-A) is primarily involved in serotonin catabolism. The MAO-A gene, harbours a variable number tandem repeat (VNTR) polymorphism with high (MAOA-H) and low (MAOA-L) activity variants. Individuals with the MAOA-H allele present with lower amine concentration, higher response inhibition failure and reduced information processing. We therefore hypothesised that these individuals would present with lower PPI levels and working memory performance.

PPI (85-dB prepulse at 30-, 60-, 120-ms intervals) was assessed in 118 healthy males (MAOA-L group n=41 and MAOA-H group n=77). Subjects’ working memory was assessed with the N-back, a PFC-dependent task. PPI data were analysed with repeated measures ANOVA and the N-Back data were analysed with the Mann-Whitney nonparametric test.

Demographic and startle characteristics were similar between the two genotype groups. Analysis of the PPI data revealed higher PPI levels in the MAOA-L compared to the MAOA-H group in all trial types. In addition, the MAOA-L group had significantly more correct responses in the two-back condition.

Compared to MAOA-L, MAOA-H individuals show lower PPI and worse N-Back performance. These results suggest that the MAO-A VNTR polymorphism is an important determinant of sensorimotor gating and working memory, possibly through a PFC mediated mechanism.

Are early warning symptoms used in treatment, and if so what result does this therapy have in practise? Is the presumption correct that therapy with a focus on early warning symptoms results in less new episodes and more compliance towards antipsychotic medicine?

The policy for patients with schizophrenia within GGNet was checked. Moreover, an extensive literature review was conducted using PubMed, the internet in general and research contacts in order to avoid important literature to be left out.

In this study, in line with previous research on early warning symptoms (O'Sullivan & Gilbert, 2003), it was found that they are indeed successfully used in practice (e.g., Birchwood, Spencer, & McGovern, 2000). Moreover, it was also found that patients and their families feel safer and know what to do if new episodes seem to be emerging (e.g., Bosch & Van den Noort, 2008).

Early warning symptoms are indeed successfully used in treatment (e.g., Bosch & Van den Noort, 2008). More research is needed, in order to optimise the techniques that are used in practise. This might result in lower annual cost of rehospitalization for multiple-episode schizophrenia outpatients (e.g., Weiden & Oltson, 1995). Recognising early warning symptoms might be taught, but one point that needs our further attention is the therapyplan that is made after this learning process. How to make this plan work and to optimise the use of early warning symptoms should be a topic for further research.

In August 2008, a book will come out (edited by the authors of this abstract and published by Hogrefe & Huber publishers, Germany) on Schizophrenia, Sleep and Acupuncture. Several international researchers and authors have contributed to this unique book. The authors of this abstract would like to present the background theory of this book, and the results that were found so far by using acupuncture in schizophrenia, sleep disorders as well as the combination of these disorders.

Authors out of different backgrounds contributed their knowledge to the book. This resulted in a very broad theory on schizophrenia and its relation to sleep disorders. Results out of fMRI studies as well as case reports were included. Furthermore, there was an emphasize on the role of neurotransmitters within schizophrenia, sleep as well as acupuncture.

In studies that have been conducted so far, a reduction in antipsychotic doses was possible during times of acupuncture treatment, resulting in less side effects and more compliance to treatment. Furthermore, a reduction in side effects was seen, since acupuncture actively works upon side effects such as headache, dry mouth etc.

More than enough basis was found for further research into this promising new field of treatment in schizophrenia and sleep disorders.

Many studies have examined the potentially beneficial role of social and cognitive rehabilitation in patients suffering from schizophrenia. Schizophrenia is a frequent and severe disorder in spite of the new medication. Cognitive rehabilitation improved by antipsychotic treatment could promote psychosocial processing rehabilitation.

The use in our department of the SAARP module (Social Abilities and Autonomy Reinforcement Program) confirm these data. This progam has been made to manage patients towards a high level of self-sufficiency.

The first aim is to look for solutions for concrete problems in daily life to help patients to realize personal plans. It develops self-esteem and responsibility for patient. It allows a personal realisation and an active social life. This instrument have to be an easy access, for all the staffs wishing for the well-being for patients with schizophrenia.

This study investigates the relationship of neurocognitive functioning and social functioning in patients with program as compared to patients without program. We targeted several domains of SAARP that have been associated with quality of life, and also tested whether the effects of SAARP were related to the age.

Left temporal hypoperfusion has been reported in some cases of schizophrenia. However, left temporal cortex is involved in lexical access. Moreover, difficulties with accessing the lexical-semantic memory store have been proposed in schizophrenia. Therefore, a relation between impaired lexical access and left temporal activity in schizophrenia might be argued.

Here, we report the case of a 33 years old man with disorganized schizophrenia (using DSM-IV-TR criteria) who underwent complete neuropsychological assessment and measurement of cerebral perfusion with 99mTc-ECD (ethyl cysteinate dimer) single photon emission computed tomography (SPECT).

We found evidence for naming disabilities with Deloche and Hannequin's picture naming test of 80 objects. Moreover, a semantic knowledge test (Desgranges and al) suggested the preservation of the lexical-semantic memory store. This was not due neither to mental deficiency (evaluated by WAIS-III and Raven's matrices PM 38), nor to executive dysfunction (evaluated by Frontal Assessment at Bedside, Wisconsin Card Sorting Test, Verbal fluencies, Stroop test and Rey-Osterrieth complex figure), nor to any abnormality of the central nervous system (on the RMI investigation). However, SPECT revealed a left temporal hypoperfusion.

This case report suggests that left temporal hypoperfusion described in some cases of schizophrenia might be related to an impairment of lexical access.

Patients with SMI receive long term intervention with psychotropic agents often associated with weight gain. Weight and lifestyle management programmes may prevent, reduce or reverse weight gain, however most data is short-term. Categorical data is not often reported

A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors commenced 2002 in Ireland. Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes. Groups were led by trained healthcare professionals.

Data is reported up to 24 months from 55 patients (27 male; 28 female) from 6 centres. Mean age 49.4 years (range 21-74). Schizophrenia 63%, Affective disorders 26%, other 11%. Patients completing 1 year - 55% and 2 years 22%. Baseline mean weight 98.6 kg (SD 19.2) decreased to final visit weight 96.9kg (SD 18.4).Paired t –test, p = 0.0030; CI Mean 2.53 (0.9-4.159). Weight increased in 11/55, maintained 7/55 and decreased 37/55.

Weight gain in SMI patients is not inevitable and was found in only 20% of patients attending weight clinics in Ireland. Patients may benefit if similar interventions were widely available.

After the commercialization of Aripiprazole in Spain, two observational studies were proposed, one was conducted when the drug was first launched, and the other when the starting dose of Aripiprazole was modified, in order to understand the switching strategies, the effectiveness, tolerability and adherence to treatment in standard use conditions.

Two multicenter, retrospective, observational studies were carried out involving 200 psychiatrists throughout Spain with approximate 1000 patients treated with Aripiprazole during the previous four months in each one of the studies during 2005 and 2006 respectively.

Both groups of patients had a very similar demographic profile that matches with the general schizophrenic population. In the first study, the main reasons for switching medication were low efficacy (56% of cases) and intolerance (35%), and 44% and 43% respectively in the second study. Despite the poor response to previous treatment, clinical evaluation of effectiveness and tolerability with Aripiprazole was very positive: In the first study, 76% of patients had very good or good effectiveness and tolerability was very good or good in 90%. In the second study, these values were 75% and 93%, respectively. Patterns of change from the previous treatment were switching in 75% of cases in the first study and in 60% in the second study.

Effectiveness of treatment with Aripiprazole is good in patients who had a poor response to their previous antipsychotic treatments. The most frequent and effective pattern for change patients to Aripiprazole treatments is switching.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. Assessments were made every three months for 2 year. We used a protocol including: PANSS, GAF-EEAG, CGI, Young mania, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale, the Information Subtest and Psychosocial Stress Global Assessment (DSM III R). The assessment of prodromal symptoms was retrospectively. The symptoms were based on the late prodromal style described by McGorry (1). A statistical analysis of data was performed.

Objetives

1. • Evaluate the gender differences in the prodomal state and analyse the prognosis according to them.

231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset.

The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.

Evaluate the sex differences in first episode psychosis.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. The patients were treated with risperidone and assessments were made in the first month and then every three months for 2 year. Therefore, we used a protocol including the following scales: PANSS, Global Assessment of Functioning scale (GAF-EEAG), CGI, Young mania rating scale, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale (Cannon-Spoor), the Information Subtest (WAIS) and Psychosocial Stress Global Assessment (DSM III R).

231 patients were included (32.5% women). Males have consistently an earlier onset even after controlling the cofounding factors and poorer premorbid functioning. Women have a shorter DUP, and they are more likely to be married than men and to live with their couples or children. Women have also better adherence to treatment than men. Males don't show differences in negative, positive symptoms or cognitive deficits. There was no difference between the sexes in the dose of the prescribed antipsychotic. There are no clear sex differences in family history and obstetric complications. Sex doesn't have influence on the course of illness in middle-term (2 years).

This paper supports the presence of significant differences between schizophrenic males and women, but there aren't differences in the outcome of the disease.