Currently there is no consensus regarding how long anti-psychotics medication should be continued following a first/single psychotic episode. Clinically patients often request discontinuation after a period of remission. This is one of the first double-blind randomized-controlled studies designed to address the issue.

Patients with DSM-IV schizophrenia and related psychoses (excluding substance induced psychosis) who remitted well following a first/single-episode, and had remained well on maintenance medication for one year, were randomized to receive either maintenance therapy with quetiapine (400 mg/day), or placebo for 12 months. Relapse was defined by the presence of (i) an increase in at least one of the following PANSS psychotic symptom items to a threshold score (delusion, hallucinatory behaviour, conceptual disorganization, unusual thought content, suspiciousness); (ii) CGI Severity of Illness 3 or above; and (iii) CGI Improvement 5 or above.

178 patients were randomized. 144 patients completed the study (80.9%). The relapse rate was 33.7% (30/89) for the maintenance group and 66.3% (59/89) for the placebo group (log-rank test, chi-square=13.328, p<0.001). Relapse was not related to age or gender. Other significant predictors of relapse include medication status, pre-morbid schizotypal traits, verbal memory and soft neurological signs.

There is a substantial risk of relapse if medication is discontinued in remitted first-episode psychosis patients following one year of maintenance therapy. On the contrary 33.7% of patients discontinued medication and remained well.

Atypical antipsychotics (AAP) are associated with adverse effects such as weight gain and the metabolic syndrome. Weight gain is an important marker to control while using AAP. Our study shows the existent correlations between weight gain, the decrease of neuroprotection and cognitive impairment.

A retrospective study on 16 patients, 10 women and 6 men, diagnosed with schizophrenia (DSM-IV) and multiple episodes (>5 episodes in 3 years) being under treatment with typical antipsychotics (minimum 3 cures, more than 6 months each) and to whom was imposed the switch to atypical antipsychotics because of the poor therapeutical respondence. None of the patients presented EPS of whose intensity to necessitate this switch. After the initiation of the AAP therapy they presented a significant weight gain (>15% of the ideal weight in the first 12 months).

These patients were monitorized for:

1. - social distress factors;

2. - the cognitive evaluation using California Verbal Learning Test;

3. - neuroimagistic evaluation (CT);

4. - PANSS.

All the patients presented a high familial and social distress factors, cognitive impairment and neuroimagistic modifications in cortical areas and ventricular enlargement. On the PANSS scale observing a decrease in intensity of the positive symptoms, and an insignificant modification of the negative symptoms.

The significant weight gain during the first year after the switch to AAP to these patients, can serve as a marker for neurostructural changes, neuroimagistic monitorization being obligatory at the moment of the decision of switching from a typical to an atypical antipsychotic.

The aim was to investigate the cognitive abnormalities in healthy individuals (No Axis I or II disorders) at risk for bipolar disorder (BD) and schizophrenia (SZ)

Participants were 17 BD-R, 15 SZ-R and 23 controls. All participants underwent assessment of IQ, working, verbal memory and learning, visuospatial memory, verbal and visual recall and recognition. Lack of lifetime Axis I and II disorders was screened using Structured Clinical Interview for DSM-IV and symptomatology was assessed with the Brief Psychiatric Rating Scale (BPRS).

No difference was found in IQ. The SZ-R underperformed compared to BD-R and controls in working memory. The SZ-R had increased number of intrusions but did not differ from the BD-R in short delay. The SZ-R showed impairment in long term recall. No effect of learning was found. SZ-R and BD-R underperformed compared to controls in visuospatial memory. SZ-R showed long term memory deficits with higher overall forgetting scores in both visual and verbal tests compared to BD-R and controls. The BD relatives were able to retain more verbal items but comparable visual items to SZ-R. Effect of BPRS total score was found only for BD-R across all measures.

BD-R do not show deficits compared to controls in the dorsal prefrontal cortex (DPFC) like the SZ-R. The SZ-R show impairments in fronto temporal networks that are preserved in BD-R supporting deficits in semantic categories in both encoding and retrieval whereas impairment shown in BD-R may be mainly attributed to the effect of symptoms.

The aim of this project was to investigate the cognitive abnormalities in healthy individuals (No Axis I or II disorders) at risk for bipolar disorder (BD) and schizophrenia (SZ)

Participants were 17 BD-R and 15 SZ-R and 23 controls. All participants underwent assessment of IQ, inhibition, verbal fluency, planning and cognitive set shifting. Lack of lifetime Axis I and II disorders was screened using Structured Clinical Interview for DSM-IV and symptomatology was assessed with the Brief Psychiatric Rating Scale (BPRS).

No difference was found in IQ. Loss of inhibition was found in both SZ-R and BD-R compared to controls whereas SZ-R had slower initiation times. SZ-R also failed to inhibit relatively fast erroneous responses, leading to an effect on error rates but not in reaction times. SZ-R and BD-R produced fewer words compared to controls whereas the former group made more errors. BD-R achieved both comparable number of categories to controls and made equal number of errors whereas SZ-R underperformed compared to former groups in both measures. Effect of BPRS total score was found only for BD-R across all measures apart from inhibition.

Genetic predisposition to SZ may be mediated by deficits in both the Ventral and Dorsal Prefrontal Cortex (VPFC) and (DPFC). In BD-R impairment was limited in the VPFC whereas the DPFC function was preserved. The two disorders share inhibition deficits associated with the VPFC.

Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms. PPD occurs without concomitant change in positive or negative symptoms.

We try to evaluate efficacy of Fluvoxamine, versus efficacy of mirtazapine and venlafaxine in PPD.

25 patients (17 men, 8 female), aged 18-45 years, diagnosed with schizophrenia and PPD by DSM IV criteria. All patients received a second generation of antipsychotic (SGA) .We divided in 3 groups - A (9 patients) treated with SGA + Fluvoxamine (100 mg/day), group B (8 patients) treated with SGA + mirtazapine (30-45mg/day) and group C (8 patients) treated with SGA + venlafaxine (150- 225mg/day). We use BPRS, HAMD, and CGI for severity. Period of study 2 month, with visit at every week. We evaluate efficacy in group A versus efficacy in group B and C.

in group A: 2 drop-out, 6 responders, 1 non-responders; in group B: 1 drop- out, 6 responders, 1 non- responders, in group C: 1 drop- out, 7 responders. The response was faster in group C. The treatment was well tolerated.

The results were similar in all groups, but the most responders were found in patients with family support, in first 3 years of evolution of schizophrenia, with family history of affective disorders, absence of negative symptoms. The response was better at patients who don't have traumatic stress in there children or adolescent period.

The blurring of nosological boundaries across clinical forms of schizophrenia is critical. The aim of the research was to address the relationships between neuropsychological functioning, clinical scales and international diagnosis criteria for a comprehensive diagnosis of schizophrenia.

67 patients diagnosed with schizophrenia according to ICD-10 criteria were included in the current study. The average age of the patients was 33.17 years (SD=9.22). Patients included were not diagnosed with medical or neurological conditions. In clinical assessment PANSS, GAS and CGI tests were used, and also neuropsychological computerized assessment of working memory and implicit learning (WLM, SWM), executive functioning (STDT), time of reaction (SST), discrimination of facial emotional expression (PEAT).

In four forms of schizophrenia (paranoid, catatonic, simplex and non-differentiated), high scores on the negative PANSS scale were revealed, while on the positive PANSS scale, high scores were revealed in two of these forms (paranoid and non-differentiated). Significant correlations were found between delusional-hallucinatory symptoms and deficits in neuropsychological functioning (implicit learning, decision time, perseverance in errors). Significant correlations were found between apathy, social withdrawal, avolition, difficulties in abstract thinking, working memory disorders, attention deficit. Discriminating ability between emotional expressions did not correlate with PANSS scores, however it did correlate with GAS scores.

1. Schizophrenia clinical forms can not be distinguished through PANSS or GAS scores. 2. Neuropsychological assessment appears to be a fine differentiating diagnostic tool between different clinical forms of schizophrenia. 3. Impaired cognitive functioning ads to the dimensional diagnosis of schizophrenia.

Opioid withdrawal, stress or cues associated with opioid consumption can induce opioid craving. If opioids are not available, opioid dependent patients usually search for alternative drugs. Since several non-opioid drugs stimulate the endogenous opioidergic system, this concept may explain their frequent use by opioid dependent patients. We hypothesized that non-opioid drugs alleviate opioid withdrawal symptoms and are therefore consumed by opioid addicts.

We asked 89 opioid dependent patients participating in an outpatient opioid maintenance program to estimate the potential of several non-opioid drugs in being able to alleviate opioid withdrawal.

Values (mean ± SD) for benzodiazepines: 3.2 ± 1.1, tricyclic antidepressants 3.6 ± 1.1, cannabis 3.6 ± 1.0, alcohol 4.1 ± 1.1, cocaine 4.2 ± 1.1, amphetamine 4.4 ± 0.9, nicotine 4.7 ± 0.7, caffeine 4.9 ± 0.5. A worsening of opioid withdrawal was reported by 62% of the patients for cocaine, 62% for amphetamine, 50% for caffeine, 37.5% for cannabis, 27% for nicotine, 26% for alcohol, 8% for tricyclic antidepressants and 3% for benzodiazepines.

Our study shows a low efficacy of non-opioid drugs in alleviating opioid withdrawal symptoms. The data basis of this study was good and the sample was suitable to be asked for estimations of drug-drug interactions. 26% - 62% of the patients even reported a worsening of opioid withdrawal for cannabis, alcohol, cocaine and amphetamine. Only benzodiazepines and tricyclic antidepressants were reported to have a moderate positive effect on opioid withdrawal.

Side effects from a high-dose clozapine treatment for a schizophrenic patient led to massive compliance problems. The dose of clozapine could be halved without recurrence of an acute psychotic symptomatology by concomitantly administering amisulpride The side effects, especially hypersalivation, disappeared almost entirely, which in turn led to good compliance. In a short review we would like to present the pathophysiology and therapeutic options of clozapine-induced hypersalivation.

Despite various attempts at explanation and therapeutic approaches, hypersalivation under clozapine remains a side effect that is sometimes very difficult to get under control. As in our case report, it can lead to quite relevant compromises in compliance. The cause for the observable paradoxical hypersalivation under clozapine which can occur in spite of the anticholinergic effect remains unexplained.

The combination of clozapine and amisulpride with its overall good tolerability represents an option for reducing the sometimes inevitably high doses of a monotherapy, and the associated side effects, such as in our case with clozapine. In addition, making use of synergetic effects and in turn, improving the patients’ compliance would be possible.

Twenty nine schizophrenic patients (16 male and 13 female), aged 17-64 (mean 32) years, participated in this research.

Neuropsychological tests measuring working memory were performed in patients with schizophrenia: psychomotor speed (TMT A), visuospatial working memory (TMT B), verbal functions (Stroop Test and Verbal Fluency).

Age of patients significantly correlated with prolonging the time of carrying out part A of TMT and the first part of the Stroop Test and correlated with smaller number of words in Verbal Fluency Test. The cognitive dysfunction is more prominent in patients in age above 35 years.

Several studies conducted in patients with schizophrenia, posttraumatic stress disorder, delirium tremens and sleep deprivation have put into light disturbances in sleep architecture and cerebral neurotransmission. In addition, clinical practice has emphasized the role played by the sleep deficit in triggering psychotic episodes in vulnerable individuals.The paper focuses on the role played by sleep disturbances in the etiopathogeny of psychotic symptoms in schizophrenia and other psychiatric disorders or organic states accompanied by perception disturbances.

psychiatric disorders and organic states which share the presence of perception disturbances such as hallucinations, flash-backs, oniroid symptoms have been selected. Sleep disturbances that accompany these nosologic entities have been analyzed in correlation with biochemical changes in cerebral neurotransmission and with the effects of psychotropic drugs and of psychiatric co-morbidity.

disturbances in sleep architecture and duration represent an important link in the etiopathogeny of psychotic symptoms. These disturbances could be correlated with disturbances in cerebral neurotransmitters implicated in the pathogeny of psychosis (dopamine, serototnine, GABA).

sleep disturbances do not have to be regarded as an epiphenomenon; instead, they are an important link in the etiopathogeny of psychotic episodes. Keeping this in mind would play an important role in patient psycho-education aiming to prevent recurrences, and in scientific research oriented towards the development of new antipsychotic molecules.

Repeated relapses and hospitalizations of patients with severe mental disorders reduce their quality of life and present a considerable burden on health care systems. Assertive community treatment(ACT) improves outcomes in patients with severe mental illness(SMI) with greatest risk for relapse and disability. In University Psychiatric Hospital Ljubljana assertive community treatment program started in the beginning of the 2006. In presented research first results of this program are assessed.

Two groups of patients with SMI were compared regarding hospitalization and functioning. The first group was discharged to standard outpatient treatment. The second group was included in ACT program described. Inclusion criteria were ICD 10 diagnoses F20-29 and at least two repeated hospitalizations in last year.

For each patient predicted hospitalization for one year was calculated and compared to the actual number of days spent in hospital in last year. In both groups functioning and quality of life were followed by repeated assessments with Health of the Nation Outcome Scale and Leicester Quality of Life questionnaires in 2007 for purposes of outcome measurements.

Actual hospitalization periods are significantly lower in ACT group than in control group. The difference between ACT group actual and predicted hospitalization periods is significantly higher than in control group. Functioning and quality of life in three month follow up is higher and more stable in ACT group.

ACT prevents hospitalization, shortens the hospitalization periods and maintains the level of functioning in patients with severe mental illness with reoccurring hospitalizations and disability.

To evaluate safety, tolerability and overall effectiveness of a titrated- versus fixed-dose switching strategy from risperidone to aripiprazole in a general practice setting.

This 12-week, multicentre, open-label study included patients with schizophrenia (DSM-IV-TR) experiencing insufficient efficacy and/or safety/tolerability issues while receiving risperidone for ≥6 weeks. Patients were randomized to titrated- or fixed-dose switching regimens.

Discontinuations due to AEs were similar between titrated- and fixed-dose strategies (3.5% vs. 5.0%; p=0.448). Titrated- and fixed-dose groups showed improvements (Week 12) in mean PANSS Total scores (–14.8 vs. –17.2; LOCF), mean CGI-I scores (2.9 vs. 2.8; p=0.425; LOCF), ASEX scores (–1.5 vs. –1.9 from baseline; OC), serum prolactin levels (−48.7 vs. −48.5 from baseline; OC) and SWN scores (+8.6 vs. +10.3 from baseline; p=0.223; OC). POM scores indicated a preference for aripiprazole compared with risperidone using either regimen. Both strategies showed improvements (titrated-dose vs. fixed-dose; Week 12; LOCF) in social cognition as indicated by decreased GEOPTE patient (–5.3 vs. –6.1), caregiver (–5.4 vs. –9.9) and index scores (–5.1 vs. –9.8).

Switching to aripiprazole from risperidone can be effectively and safely achieved in a general practice setting through a slow down-titration of risperidone and either a titrated- or fixed-dose switching strategy for aripiprazole.

Erectile dysfunction (ED) is not uncommon in male patients with schizophrenia. The illness itself and antipsychotic medications (typical and atypical) have been implicated. Hyperprolactinemia due to pituary D2 blockade is a probable causative factor for ED but adrenergic α1 blockade and anticholinergic activity of neuroleptic drugs in the periphery have also been involved. The availability of three phosphodiesterase-5 (PDE-5) inhibitors, sildenafil, vardenafil, and tadalafil, has altered the management of ED. The aim of the study was to investigate the role of PDE-5 inhibitors in schizophrenic patients with ED

A search was performed in MEDLINE database using the following keywords: ‘erectile dysfunction’, ‘schizophrenia’, ‘phosphodiesterase-5 inhibitors’.

There exist positive reports with sildenafil regarding the role of PDE-5 inhibitors in schizophrenic patients with ED, and only one double-blind, placebo-controlled study. A recent open-label study with vardenafil has confirmed the beneficial effects of PDE-5 inhibitors on patients with chronic schizophrenia.

PDE-5 inhibitors have been shown effective for ED in individuals with schizophrenia. However, the number of studies is small and further investigation is needed to confirm the, up to the present, positive findings.

Now-a-days, obesity and other cardiovascular risk factors (CVRF) became a matter of concern in Schizophrenia, due to their potential relation with atipical antypsychotics. The high prevalence of CVRF in schizophrenic patients is a consensual issue, but there are only a few studies in Portugal.

This is an observational transversal study thats aims to evaluate the presence of CVRF, and to establish the relationship between these ones and anthropometric measurements evaluating global and regional adiposity, in a population of schizophrenic patients.

The authors studied a population of 25 schizophrenic patients followed at our Department of Psychiatry. These instruments were used: PANSS (Positive and Negative Symptoms Scale), and a semi-structured interview, with sociodemografic data, and information about life style, medication and schizophrenia. These informations were completed according to the clinical process. The following measurements were recorded: weight, height, abdominal circunference, lipidic and glicemic values, and blood pressure.

The high frequency of CVRF in the population of this study confirms the importance of regular medical evaluations, in every patients with Schizophrenia, to allow early diagnosis/monitorization of CVRF. However, our results dont confirm the benefit of anthropometric measurements as screening methods, possibly due to our small sample. Curiously, we found a week correlation bettween CVRF and environment factors (as medication or life style), what can reforce the hold ideia of Schizophrenic susceptibility to CVRF.

Mental disease is faced during the past years as a result of various factors, such as the participation of the family which sometimes has a negative aspect in the course of the disease.

Through the study of 15 families of the patients who live in the Residential Unit of Aspropirgos, we present the role of the family environment in the appearance and process of the disease.

We observed the background of 15 patients of the Residential Unit. When they completed a month living in Aspropirgos, we completed their Personal and Social Performance Scale (PSP). At the same time, we accepted the patients’ families in four weekly sessions whose goal was to explore and cope effectively with the problems that led those patients to mental disease. Patients completed the same questionnaire in their 4th and 12th month of their stay in Aspropirgos while we continued to have monthly sessions with their families.

Patients presented a decrease of their functionality in their 4th month in the Residential Unit (around 30%), which was accompanied by the resistance of their families in the suggestions of the therapeutic group. When 4 months were completed we put more strict limits regarding the relationships of the patients with their families, we even forbidded their contact with members who provoked the most severe dysfunction in the patient. At the end of 12 months we concluded that there was an improvement of up to 50-60% compared to patients’ situation in the 4th month.