IOT is a court-ordered treatment in the community. It is used to ensure therapeutic compliance in some patients with severe mental illness. It was proposed for patients with no awareness of illness, high risk of relapse, disrupting behaviour and hospitalization. IOT is being used in the province of Gipuzkoa (Basque Country, Spain) since 1997.

Our objective was to assess the epidemiological and clinical characteristics of the outpatients under involuntary treatment in our province.

This is a retrospective study of the patients under IOT in the province of Gipuzkoa during October 2007 (n=87). The following variables were considered: sex, age, work and living situation, drug abuse, violent behaviours and number of previous hospitalizations.

Gender: male 70.2%; female 29.8 %. Age average: 39.5 (SD 9.6). Living situation: with relatives: 58.7%; alone 20%; in couple: 14.7%; institution: 6.7%. Work situation: inactive 60.8%; protected work 7.8%; incapacitated 3.9%; retired 2%. Diagnosis: schizophrenia 57%; delusional disorder 16.5%; bipolar disorder 8.9%; personality disorder 8.9%; schizoaffective disorder 5.1%; other 3.8%. Drug abuse: none 42.3%; multiple drugs abuse 31%; cannabis 9.9%; amphetamines 1.4%; opiates 1.4%. Violent behaviours: none 39.7%; violence against relatives 37%; violence against others 16.4%; autoaggression: 4.1%; both: 2.7%. Average of previous incomes: 3.79 (SD 3.8).

The most common profile of individuals under IOT in Gipuzkoa was a middle-aged male, affected by a psychotic disorder, drug abuser, with frequent violent behaviours.

Cognitive dysfunction represents an essentials feature of schizophrenia. Patients with schizophrenia have substantial memory deficits.

To examine memory deficits in first episode schizophrenia, characterise the nature of impairment and specify the relationships with the duration of untreated psychosis.

40 first episode schizophrenia patients admitted to the Second Psychiatric Clinic Cluj, Romania and 50 healthy controls were assessed with memory tests from CANTAB battery (Spatial Working Memory, Paired Associates Learning and Spatial Span) and with Rey Auditory Verbal Learning Test. The Positive and Negative Syndrome Scale (PANSS) was used to quantify symptom severity.

Statistical analysis: Results were analysed using SPSS 12 applying ANOVA, ANCOVA, chi square test and Pearson correlations. Duration of untreated psychosis was log10 transformed to reduce skew.

First episode schizophrenia patients scored significantly poorer then healthy subjects on all memory tests. Spatial working memory was impaired due to inadequate strategy use. Worse performance correlated with longer duration of untreated psychosis.

Impairments in memory are already present in first episode schizophrenia patients.

EEX grant 97/2006

In schizophrenic patients,Self – mutilation may have unusual manifestations . Inserting needle in to various parts of body is one of the rare type of self mutilating behavior .. Case presentation : The patient is a 40 years old man with chronic paranoid schizophrenia who is living in the state hospital since 20 years ago. The patient stuck several needles in to his body especially various anatomical region of his face and genitalia .Other forms of self mutilation such as ingestion of thermometer and self injection of aubergine juice were observed in him.

To our knowledge it is one of uncommon self mutilating behavior in a single case. He had inserted needles into parts which he heard hallucinatory voices from them. Other reasons were discussed.

We present the case of a psychotic patient with a previous diagnosis of pellagra, admitted to an acute care unit of Miguel Bombarda Hospital, Lisbon. Pellagra is a systemic disease caused by niacin deficit; its clinical presentation is revised, taking into account psychiatric disease.

We will focus the following items:

1. - definition of pellagra and description of its main clinical symptoms

2. - historical issues of psychiatric symptoms of pellagra

3. - pellagra psychosis – evolution of classifications

4. - neuropsychiatric features of pellagra

5. - diagnosis, treatment and outcome of psychiatric illness of pellagra

Medline Research. Bibliography revision.

Clinical presentation of pellagra includes gastrointestinal, dermatological and neuropsychiatric symptoms.

The first description of pellagra dates back to 1863. In the beginning of the 20th century, approximately 30% of admissions in psychiatry were due to this disorder, which was included in the first classification of mental illness of the American Psychiatric Association.

Pellagra psychosis should be diagnosed in a patient with typical symptoms and signs of pellagra and psychotic symptoms which respond to treatment with niacin.

Pellagra is currently a rare disorder, but the diagnosis should be taken into account in alcoholic patients, undernourished, with anorexia nervosa or tuberculosis treated with isonyazid.

With proper treatment, there is a complete recovery.

To describe a generalizable stochastic-simulation model for schizophrenia treatment related with the cardiovascular associate risk of SGA.

A model to simulate the expected 10-year occurrence of all-type cardiovascular events (CVE) in a hypothetical cohort of 100.000 patients with schizophrenia treated with SGA drugs in Spain was developed. The model considered, as a baseline health state, outpatient treated with SGA with characteristics of patients enrolled in the CLAMORS study; a cross-sectional study in schizophrenia spectrum disorders aimed to ascertain prevalence of metabolic syndrome in such patients together with CHD. Three other states were considered: suffering a CVE, death due to CVE and death due to other causes. The CVE risk for each SGA drugs was estimated through a locally-adjusted Framingham risk equation. Treatment outcomes were simulated using the expected mean change of the cardiovascular (CV) risk factors from the CATIE clinical trial. Death by CVE or others causes were estimated from published literature.

The 10-year rate of CVE following SGA treatment was 0.181, 0.179, 0.176 and 0.172 for olanzapine, quetiapine, risperidone and ziprasidone, respectively. Relative risk was calculated relative to no-treatment, and the corresponding values were 1.03, 1.02, 1.00 and 0.97. The total estimated CVE were 25,269 events; 25,157; 24,883 and 24,514, respectively.

A generalizable, flexible model was developed through stochastic simulation of the CV risk for SGA drugs. The estimated clinical outcomes suggest different levels of CVE risk for each SGA drugs. Ziprasidone showed the lower rate with no association with increased risk for CHD.

The objective of this research is determines the most frequent basic symptom & the most frequent type of schizophrenia in Ardabil hospitals patients.& providing a new classification of basic symptoms in these patients, so that psychiatrics of Ardabil city can use the results of this study to achieve an accurate & also rapid diagnosis of schizophrenia.

This study is a descriptive – analytic one. A sample of 100 patients of both sexes from 17 up to 40 years old was selected. To study the basic symptoms of schizophrenia in them, we used a 44 item questionnaire which was provided through a combination of PANSS & Kitamura questionnaires. To screen the patients with schizophrenia, we used MMPI test. The findings was analyzed by descriptive statistics & through the computer software SPSS. Also a PCA method of factor analysis was used to the hypotheses.

single (62%=49 patients), unemployed (52%=52), with no education (31%=31), negative family history (91%=91), with frequent admission (47%=47). The most frequent basic symptom in these patients was social withdrawal was at second place. the most frequent type was paranoid schizophrenia (44%=44).

The findings have a concordance with results of the last studies about the basic symptoms of schizophrenia & also with DSM-IV & Bleuler& Kraepelin symptoms all of these systems introduce the different fields of a single diagnostic structure rather than antagonist ones.

Anyway, two important factors that were recognized were cognitive disorder. This study suggests that if we recognized emotional symptoms

The objective of this research is studying the basic symptoms in schizophrenic patients and determines the most frequent basic symptom and the most frequent type of schizophrenia in them. Also, providing a new classification of basic symptoms

This study is a descriptive – analytic one. A sample of 100 patients of both sexes(age: 17-4O)was selected. To study the basic symptoms of schizophrenia in them, we used a 44 item questionnaire which was provided through a combination of PANSS (Emsley, 2003) and Kitamura questionnaires. we used MMPI test. The findings were analyzed by descriptive statistics and through the computer software SPSS. Also a PCA method of factor analysis was used to the hypotheses.

single (62%=49 patients), unemployed (52%=52 patients), with no education (31%=31 patients), negative family history (91%=91 patients), with frequent admission (47%=47 patients). The most frequent basic symptom in these patients was attention deficit, and social withdrawal was at second place. Also, the highest frequent type of schizophrenia was paranoid schizophrenia (44%=44 patients).

This study's findings are similar to with the results of the last studies about the basic symptoms of schizophrenia and also with DSM-IV and Bleulerand Kraepelin symptoms . it seems that all of these systems introduce the different fields of a single diagnostic structure rather than antagonist ones.

However, two important recognized factors were cognitive disorder and relationship disorder. This study suggests that if we recognized emotional symptoms and restlessness, we should think of other psychotic disorders.

Against the background of a paradigm shift in the locus of treatment from the hospital to the community, successful housing and re-establishing residential skills therefore are among the main preconditions for the independent living of schizophrenia outpatients. But so far only a few empirically evaluated treatment approaches exist, which specifically focus on improving these skills.

During the last years, we developed a new manualised cognitive-behavioural group therapy program for residential skills (experimental group, EG).

In an international controlled study, the EG was compared to a conventional, unspecific therapy for social skills (control group, CG). EG and CG were conducted in groups consisting of 5-8 patients over a period of 6 month. Assessments were applied before and after therapy and at a 1-year follow-up. Additionally, relapse rates and rehabilitation status were assessed over 5 years after the beginning of therapy. Altogether 54 patients participated in this study (EG: N=26; CG: N=28).

EG patients displayed a significantly higher frequency of change from a high structured in-patient setting to a lower structured outpatient setting and unassisted living compared to CG patients during 5 years of assessment (odds ratio=12.5). Moreover, lower relapse rates, significantly reduced psychopathology and higher treatment motivation of EG patients compared to controls were found. Both treatment groups significantly improved in cognitive and general social functioning.

Due to these results, the newly developed residential skills program could constitute an additional treatment option in the context of multimodal psychiatric rehabilitation.

International literature has recently given great attention to risk factors and early detection of psychosis. According to this research line we have investigated the main characteristics of subjects at first contact for psychotic disorder with one of the three Community Mental Health Centers (CMHC) of Bologna Ovest.

A retrospective study was conducted recruiting subjects with ICD-10 F2 diagnosis (schizophrenia, schizotypal disorder and delusional disorder), psychosis onset between 18-30 years and at first contact with a Bologna Ovest CMHC over a five-year period (January 2002-December 2006).

The identified sample was evaluated on socio-demographic characteristics, history of substance abuse, history of hospital admissions and pathways to CMHCs.

The sample consists of 56 subjects. They are predominantly male (70%), unmarried (95%) and the most of them (79%) lives with their parents. Twenty-four patients (43%) have an eight year education, whereas 22 (39%) a thirteen year one. During the assessed period 24 (43%) subjects are unemployed and 15 (27%) are studying.

The median age of psychosis onset is 23,3 years and a concurrent substance abuse concerns 26 subjects (46%). Twenty-one (37,5%) patients present an history of hospital admissions.

Analyzing pathways to CMHCs we find that 16 (29%) subjects have been referred by hospital wards, 11 (20%) by their family, 10 (18%) by the General Practitioner, whereas 5 (9%) by themselves.

Notwithstanding the small size of the identified sample, this study seems to confirm the main characteristics of subjects at first contact for psychotic disorder reported in literature.

The international literature underlines an high rate of comorbidity between early psychosis and substance abuse associated to poor outcomes.

The aims of the present study are to evaluate the rate of substance abuse among subjects at first contact for psychotic disorder with one of the three Community Mental Health Centers (CMHC) of Bologna Ovest and to consider its influence on the course of the disease.

A retrospective study was conducted on subjects aged between 18-30 years with ICD-10 F2 (schizophrenia, schizotypal disorder and delusional disorder) diagnosis at first contact with a Bologna Ovest CMHC over a five-year period (January 2002- December 2006).

The sample was investigated about the presence of ‘Substance Abuse’ according to ICD-10 criteria. A 1-year follow-up assessment was performed.

Among the 56 patients recruited, 26 (46%) meet the ICD-10 criteria for ‘Substance Abuse’ (Abusers). Cannabis is the most frequently used substance (88%). Psychosis appears 1,1 year before among Abusers compared to Non-Abusers. At 1-year follow-up the 46% of Abusers works or studies compared to 67% among Non-Abusers. Moreover hospital admission concerns the 31% of subjects among Abusers and only the 17% of Non-Abusers group.

This study confirms the high rate of substance abuse among subjects with early psychosis reported in literature and suggests its potential negative influence on the course of psychotic disease. To improve the prognosis of patients with psychotic disorder and concurrent substance abuse it seems necessary promoting an integrated intervention between the CMHCs and the Addiction Services.

Cognitive dysfunctions have been well established in patients with schizophrenia (SZ). Recent studies also showed persistent cognitive impairments in patients with bipolar disorder (BD) in all phases of the disorder including the remission phase. Specific cognitive domains have been considered as candidate endophenotypes in SZ and BD. The aim of this study was to investigate the diagnostic specificity of neurocognitive deficits BD and SZ patients during a stable phase of the illness.

40 patients with schizophrenia (20 female, 30.4 ±8,1 years) were compared with 40 bipolar patients (27 female, 34.7±10.4 years) and 43 healthy volunteers (24 female, 34.7 ± 8.7 years). Executive functions (WCST), attention (CPT), immediate and delayed verbal memory (VLMT) and verbal fluency (RWT) were assessed. Differences in neurocognitive functions between diagnostic groups were analysed for each domain by analyses of covariance (ANCOVA analysis with age, education, IQ, gender and medication as covariates).

SZ and BD patients performed worse than control subjects in the WCST (p<0.001), VLMT (p<0.01) and in the CPT (p<0.03). There was no significant difference in the WCST and VLMT between SZ and BD patients. However, in the CPT, SZ patients showed a significantly greater impairment than BD patients (p<0.001). In BP patients deficits in the CPT were associated with the number of illness episodes.

The findings are comparable to previous results suggesting that the specific profile of the deficits seems to differ between the diagnosis, while the same underlying domains describe neurocognitive functioning in both groups.

A higher prevalence of toxic substances consumption is considered to be under schizophrenia states.These patients are also considered to have a higher possibility than general population of developing different disorders due to the use of substances being the risk above 3 regarding alcohol,5 for cannabis, 6 for opiates, and 13 for cocaine.Two hypotheses were used for explaining this comorbidity: for alleviating its symptomatology and the adverse effects of the antipsychotic treatment, and on the other hand, the use of toxic substances as causal and predisposing effect of psychotic episodes in patients with personal vulnerability.

Sociodemographic description of patients diagnosed as having psychotic disorders with abuse of toxic substances. Establishment of connections between the toxic substance consumption and development of his/her mental disorder.

Methodology: Open retrospective study of two years in which patients diagnosed as having schizophrenia admitted into the University Hospital in Valladolid, Spain: consumers/no consumers.Scales (SAPS, SANS).Hospital Reports(sociodemographic and clinical data).

Preliminary results show the prevalence of the schizophrenic patients with toxic abuse.Predominance of young males that had their first admissions into hospital at very early ages and a higher frequency of hospital readmissions. Likewise in this group positive symptomatology shows a higher predominance and a higher connection with affective disorders. These patients show a better premorbid adaptation, a higher frequency of violent and impulsive behaviours, treatment guidelines with higher doses and higher frequency of resistance to treatment.The order consumption of toxics is tobacco, alcohol, cannabis, cocaine, stimulants, and opiates.However it is not rare to find consumption of multiple drugs.

Schizophrenia is a major mental disorder that have a multifactorial ethiology, but genetic and hyperactivity of dopamine receptors also have an important role.Free radicals such as super oxide, nitric oxide cause cell injury when they are generated in excess or when the antioxidant defenses are impaired. Both of these processes seem to be affect schizophrenia. This study was designed to determine a correlation between schizophrenia and stress oxidative factors.

This study was carried out 60 schizophrenic patients and 180 normal subjects as a control group based on DSM-IV-T.R. criteria. The two groups were paired match based on age, sex, and counfunder factors such as smoking.

For determination of stress oxidative indexes we used three methods such as Saths (for lipid peroxidation) Hu (for thiol groups) and FRAP (for antioxidant capacity).Analysis was done by statistical tests, also correlation severity by odds ratio analysis.

The mean value of thiol groups in schizophrenic group was significantly lower than control group (P=0.0001),and also the mean value of FRAP(Ferric Reducing Ability of Plasma) index was significantly lower than control group (P=0.0001),but the mean value of TBA was more than control group with P= 0.103 was not significant .

There was significantly negative correlation between schizophrenia and thiol groups. This data revealed that antioxidant defense mechanisms might be impaired in schizophrenia,these findings also provided theoretical bases for the development of new strategy in the treatment of schizophrenia, such as antioxidant supplement.