Mental disorders are emerging as a major contributor to the Global Burden of Disease in developing countries. Nevertheless in Mauritania, as in most low-income-countries, access to mental health care remains inadequate. Psychotic patients suffer from stigmatization, paucity of qualified health professionals, and difficulties to have access to medicines.

The aim of the Nouadhibou pilot program is to demonstrate that access to care of schizophrenic patients could be drastically improved within partnerships between public and private sectors.

The program was set up in October 2008 in Nouadhibou, Mauritania's second largest city.

It combines:

• • A strong awareness campaign about mental disorders, including, radio broadcasts, articles in national news papers, advocacy meetings with elected representatives, stakeholders and the civil society, and information meetings for the population.

• • The development of a psychiatric department in the Nouadhibou general hospital with a staff trained to diagnose and treat psychotic disorders, deliver psycho educational modules, and liaise with health professionals from Nouadhibou area trained to diagnose psychosis.

• • A sustainable supply of high quality antipsychotics (with a preferential pricing policy from sanofi-aventis).

• • A strict assessment of the impact of the program.

The presentation will include the present situation of mental health care in Mauritania, the program's content, the assessment tools and the first results.

Once the impact of this program is established, scaling the project to the rest of Mauritania will require commitments from different partners including the Ministry of Health, pharmaceutical industry, international organizations and funders.

The term ‘family burden’ has been introduced to describe the adverse consequences of life with severely disturbed psychiatric patients. Literature has established a distinction between the intensity of worry and appraisals experienced by caregivers (subjective burden) and the real amount of resources (time, money, health, etc.) spent on the care (objective burden). the use has been extended to people with intellectual disability (ID).

To compare the burden experienced by a group of caregivers to patients diagnosed with schizophrenia and a group of caregivers to people with ID.

179 adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshop in Madrid (Spain) and 356 adults diagnosed of schizophrenia in the Gavá Mental Health Centre in Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Burden experienced by caregivers was assessed with the ECFOS-II / SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva / Objective and Subjective Family Burden Interview). the tool hasan introductory section plus 8 modules which assess different domains of family burden.

Significant differences were found between both groups in all scales except two: Assistance in everyday activities and Effects perceived on the caregiver's health. Total scores also showed significant differences for both groups (p< 0.05).

Results indicate that, despite similar scores in some domains associated to subjective burden, caregivers to people with ID experience a lower level of objective burden than caregivers to patients diagnosed of schizophrenia.

To compare efficacy and medical costs of typital and atypical antipsychotics in treating schizophrenic patients.

250 in patients in general hospital and psychiatric hospital were randomly allocated to one of the two groups, one treated with typital antipsychotics as chlorpromazine, haloperidol and so on with a mean daily dose of 500∼800 mg in chlorpromazine equivalents, and the other with atypical agents in cluding clozapine (mean daily dose of 400∼800mg ), risperidone of 6 mg, or olanzapine of 20 mg.

The total costs of the treatment were (3157±253) Yuan RMB for patients treated with typical agents in general hospital, and (3673±294) Yuan RMB for patients treated with typical agents in psychiatric hospital respectively. the costs for medicine were (774±903) Yuan RMB, (1061±903) Yuan RMB respectively. the costs in atypical group were(1120±390) Yuan RMB and (1637±325) Yuan RMB, and (108±157) Yuan RMB and (240±317) Yuan RMB respectively. the duration of patients treated with typical agents in hospital is longer than that with atypical agents.

It indicates that atypical antipsychotics have similar efficacy to typical agents in treating schizophrenic patients with less costs.

In 2002 the Professor Eggers Foundation started a 2-year-programme for patients suffering from early-onset schizophrenia (EOS) following discharge from a clinic (outpatient care). the aim is with intense residential care and treatment to support recovery and independence. Interactive and psychoeducational family care, coping with persistent symptoms, development of social and emotional competence, independent house keeping, and support of school and vocational training are the main features.

Psychopathology, social and neuropsychological function were assessed with a set of questionnaires and tests at the start, after 1 year and after 2 years on completion of the programme for 12 participants. Living and working situation were monitored. the results were compared with the progress of 12 EOS patients treated as usual (comparison group).

Positive and negative symptoms showed a significantly greater decrease with respect to the comparison group. Social function improved considerably stronger in the participants. Working memory, attention and some executive functions also improved in the participants, while there was a deterioration of speed and selective attention (trend) in the comparison group. Neither group showed changes in measures of intelligence or the subjective quality of life with the exception of increased contentedness with family relations in the participants.

We show the benefits of an early intensive residential training programme for EOS patients. Further research may be able to show if these improvements can be maintained and whether the costs of the programme are economical avoiding continued residential care.

Recent data suggest that schizophrenia is a complex disorder with intricate patterns of neurocognitive impairment supported by specific neurobiological systems, present in schizophrenia patients, regardless of individual or clinical variables. the neurodevelopmental model of schizophrenia states that early insults (pre-, perinatal), late environmental, early and late genetic factors interact in various developmental stages, leading to various individual expressions of the disorder.

To assess specific developmental risk factors in connection with the level of neurocognitive dysfunction in schizophrenia.

Issues concerning family history, parenting style, attachment and early life stress were investigated in correlation with general intellectual functioning, working memory and executive functions in a set of young schizophrenia patients and a control group.

The authors found that certain prenatal insults, complications of delivery and early development, along with the quality of attachment and parenting style, were strongly correlated with the patterns of cognitive dysfunction in schizophrenia patients.

Cognitive impairment might be a trait-like feature, stable throughout the lifetime, occurring years before the onset of the illness. Extending the concept of development to the entire life span could entail that factors with limited timeframe of action may play a role in the epigenetic regulation of certain genes and proteins expressed in specific areas of the brain, in specific developmental stages, which in turn may lead to overt and definitive changes much later in life.

Based on clinical observations individuals with schizophrenia have deficits in a large number of functional domains, including social skills, social cognition, difficulties in perceiving, understanding, anticipating and reacting to social cues and deficient in social networks that are crucial for normal social interaction. (Yager and Ehmann, 2006). Disturbances and disorders in the domains are thought to explain impairments in social functioning that potentially have an direct link to social behavior, social function and interaction with others. in this field and for better and more understanding about schizophrenia, the study aims to investigate reaction time to stimuli in the field of light and sound attention and perception in schizophrenic patients and comparison with normal people.

Method of the research is experimental. 30 schizophrenic subjects were randomly selected from three psychiatric hospitals and compared with 30 normal subjects. Chronoscope apparatus was used to assess reaction time to light and sound stimuli. the apparatus assesses the light and sound stimuli in 0/001 seconds. Independent T test was used to analyze and compare means of experiment group (schizophrenic subjects) with control group (normal subjects).

Analysis of means showed differences between groups. Normal subjects were much more rapid in reaction and responding to light and sound than schizophrenic subjects.

Findings showed schizophrenic subjects because of their affective and emotional disorders and depressed temperament that caused to disorder in abilities and functions, cannot response rapid to light and sound than normal people.

Drug-induced psychosis and drug abuse/dependence in schizophrenia are new clinical problems due to the increasing prevalence of drug consumption in this population. the objective is to know if the abuse/dependence of illegal drugs may influence the duration of acute hospitalization in schizophrenia.

It was conducted a retrospective cohort study on a sample of 256 acute hospitalizations of patients with schizophrenia and related disorders in Valladolid (Spain) between 2004 and 2006. at the moment of admission 82 patients had active drug abuse/dependence and 174 did not. A Cox proportional-hazards regression model was constructed considering drug abuse/dependence as predicting factor and length of stay as result variable.

The mean length of stay was 12.2 days (SD= 7.5) in the group without drug abuse/dependence and 7.7 days (SD= 29.0) in the drug group (means difference p=0.05). When abuse/dependence of drugs is present, the risk of discharge at any moment during the hospitalization increases in 34% (p=0.04). When Global Assessment of Functioning at the moment of admission is included in the regression model, the results remain significant (risk 35%, p=0.047). Clinical status at discharge was significantly better for the drug users group. Drug users were more frequently at his/her first hospitalization (58.2% versus 35.2%; p=0.001).

In schizophrenia, abuse/dependence of drugs is associated with a 34% lower duration of acute hospitalization. This fact might be due to a relevant proportion of drug-induced psychosis who recovers earlier than idiopathic schizophrenia episodes.

To investigate the quality of life of schizophrenic patients, the influence of gender on their social adjustment and to compare male and female attitude to the quality of life.

Clinical and statistical, instruments for assessing Quality of Life (QOL). 200 patients (150 women and 50 men) were evaluated. We have compared clinical picture, socio-demographic factors, parameters of social adaptation and subjective attitude to the QOL in male and female schizophrenic patients.

The research has indicated sex related differences in the compared parameters. Male patients more frequently revealed personality disorders-like symptoms, they had poor social functioning and even social desadaptation, they were prone to aggression, substance abuse. Nevertherless they displayed subjective satisfaction with their QOL. Female patients more often revealed hypochondriacal symptoms but positive variant of social adaptation. at the same time women subjectively were not satisfied with their QOL.

The study has revealed that gender related mechanisms of social adaptation in women were presented by high compliance. Comparative analysis of males and females of the study exposed that gender related mechanisms of social adaptation with the inclusion of attitudes and behavioural patterns connected with regard of health and compliance are universal irrespective of clinical and social factors.

There are considerable gender differences in the subjective perception of QOL among patients with schizophrenia. the study indicate better social adaptation of females based on specific gender mechanisms. Results will contribute to improve treatment and rehabilitation.

In contrast to risperidone, aripiprazole seems to be less frequently associated with hyperprolactinemia or may even lower prolactin levels.

We present three cases of risperidone-induced hyperprolactinemia and resolution by aripiprazole.

Case1. Ms. A was a 31-year-old woman with schizophrenia who was treated with risperidone 4 mg/day. One year after risperidone treatment, the patient complained of galactorrhea, amenohrea and breast tenderness and prolactin level was 99.61 ng/ml. She was switched to aripiprazole 15 mg/day. Two weeks after aripiprazole treatment, the patient's prolactin level decreased to 6.74 ng/ml and she menstruated 1 week later. Case 2. Mr. B was a 23-year-old man with schizophrenia. He was treated with risperidone 6 mg/day. Five months after risperidone treatment, the patient developed gynecomastia and his prolactin level was 73.64 ng/ml. He was switched to aripiprazole 30 mg/day. Four weeks after aripiprazole treatment the prolactin level decreased to 17.10ng/ml and gynecomastia disappeared. Case3. Ms. C. was a 30-year-old woman with schizophrenia. She was treated with risperidone 3 mg/day. Nine weeks after risperidone treatment, she complained of galactorrhea and amenohrrea and prolactin level was 90.6 ng/ml. She was switched to aripiprazole 15 mg/day. Only 7 days after the introduction of aripiprazole, the patient's prolactin level declined to 19.6 ng/ml. Her menses resumed with 3 weeks.

Aripiprazole maybe an effective treatment for resolution of risperidone-induced hyperprolactinemia.

«Schizotypal personality disorder» occupies a special position in the classification of mental disorders. It is not enough investigated, what kind of disorders they are like, their characteristics are, and how they differ from schizoid personality disorder and continuous sluggish schizophrenia. with the aim to define the clinical features of schizotypal personality disorder 58 patients were examined.

• • Schizotypal personality disorder is similar to deficit states, observed at schizophrenia, clinically limited to personality sphere, without the signs of flow of endogenous process and psychotic disorders.

• • Schizotypal personality disorder on the clinical content reminds schizoid, but insignificant ideatory disorders are typical. Dymamic of psychopathy - disposition to decompensation - is never observed.

• • Schizotypal personality disorder can be diagnosed as latent schizophrenia, because the clinical picture is similar. the special value acquires a dynamic aspect typical of the endogenous process.

• • High quality remission of schizophrenia limited of specific personality changes, as a variant of «acquired psychopathy» can be considered as clinically identical to «schizotypal personality disorder».

A content of Schizotypal personality disorder includes a group of disorders of schizophrenia spectrum, different originally, from shizofreniform personality disorders without the signs of dynamics to the different states of development of schizophrenia - initial (latent schizophrenia), and final (high quality remission of schizophrenia as practical completion of schizophrenia process with the formation of certain features of personality). It can explain the special place of «Schizotypal personality disorder» in the classification of psychic disorders.

The alteration of hippocampal and prefrontal structures is linked with schizophrenia cognitive impairment and negative symptoms. the antipsychotics can induced apoptotic mechanisms correlated with the psychopharmacological mechanism of excesive blocking of the D2 receptors. Distress determined increase of the glucocorticoid aggression wich drive to the decrease of neuroprotective capacity at the brain level.

We formed 5 study lots (5 adults rats) and a control lot. the substancies were administrated intraperitoneal, daily, saline solution equivalent to: ziprasidone (1.25mg/kg/day) and haloperidole (0.20mg/kg/day), dexametasone (0.20mg/kg/day):

N1 - Haloperidole; N2 - Dexametasone; N3 - Ziprasidone; N4 - Dexametasone and Haloperidole; N5 - Dexametasone and Ziprasidone; N6 -control lot.

We monitorised the cardiovascular function, respiration and EPS, without signaling any serious deadly adverse event. the rats were sacrificed during the 10th day and 21th day.

Frontal cortex and hippocamp were the most intensely affected even since the 10-th day to the N4 (haloperidole and dexametasone) lot with massive neuronal loss at the VI, V, and IV frontal cerebral layers.

The lots treated with ziprasidone presented significant lesser structural changes in frontal cortex and hippocamp, comparative to haloperidole. the lots treated with dexametasone and ziprasidone (N5) are lesser affected at the cerebral structure level.

Haloperidole has a significant decrease in neuroprotection. Ziprasidone demonstrated an neuroprotective effect.