Cognitive impairment is considered to be one of the central features of schizophrenia and it has been so since original descriptions of illness by Kraepelin and Bleuler. Deficits are already present at the first-episode of illness. Some researches conclude that deficits do not change over time, while others suggest that deficits can be reduced. The objective of this research is comparison of cognitive functions of psychotic patients who participated group psychotherapy with those ho did not.

In this paper, by means of Revised Beta Examination (measure of non-verbal intellectual ability) we observe changes in cognitive functioning of 29 psychotic patients who participated in the psychodynamic group psychotherapy within the Early Interventions Program and compare their cognitive achievements with results of matched 32 psychotic patients who received “treatment as usual”. Answers were analyzed qualitatively and quantitatively.

Improvement in cognitive functions was observed in both investigated and control group, but improvement in patients who are participants of long-term psychodynamic group psychotherapy was better than in the group of patients who were not treated in that manner with statistical significance.

Psychiatric hospital “Sveti Ivan” offers an extensive outpatient Early Intervention Program for psychotic patients in the critical period of their illness - up to five years from onset. The program includes psychoeducation workshops for the patients and their family members together, group psychodynamic psychotherapy for the patients and group psychotherapy for the family members. Our results indicate better effectiveness of Program when compared to “treatment as usual”.

Few studies have suggested the efficacy of cognitive-behavioural therapy (CBT) in inpatients suffering from major depressive disorder (MDD). The present study aims at examining the efficacy of Ultra-brief CBT (UCBT) in depressed inpatients.

Twenty-two patients (age>18) admitted to the psychiatric ward of Toulouse University Hospital for MDD were randomised to receive for two weeks either UCBT (n=11) or treatment as usual (TAU) (n=11). UCBT consisted in 6 sessions of CBT while TAU consisted in supportive sessions. Both types of sessions were performed by psychiatric residents. Both groups also received pharmacological and institutional cares. Primary outcome was depressive symptoms assessed by the Beck Depression Inventory (BDI-II) and the Hamilton Depressive Rating Scale (HDRS) before and after treatment (2 weeks).

There were no differences between the groups on any baseline variables. Mean age was 48.4 (SD=12.7) and 36.4% (n=8) were of male gender. Mean baseline HDRS scores were 23.3(SD=6.3) and 19.3(SD=3.9) and BDI scores were 36.7(SD=12) and 36.1(SD=7.5) for the UCBT and TAU groups respectively. At the end of treatment, mean HDRS scores were 12.3(SD=10.1) and 14.4(SD=7.8) and BDI scores were 18.8(SD=16.8) and 20.6(SD=11.4) for the CBT and TAU groups respectively. Both groups displayed a significant decrease on HDRS and BDI scores (all p< 0.05). An analyse of variance showed an interaction time by group in favour of the UCBT group on HDRS score (F=6.66; p=0.018).

Our results suggest that UCBT might be more efficacious than supportive therapy in depressed inpatients.

The International Headache Society (IHS) defined chronic tension type headache (CTTH) in adult patients as attacks of headache that occur on at least 15 days per month over a period of at least 6 months. CTTH is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. Drugs do not adequately benefit many disabled headache sufferers. Behavioral headache treatments are rooted in the conceptualization of headache as a psychophysiological disorder. Such treatments target the patient's headache-related physiological responses (relaxation training, biofeedback) or behaviors, emotions, and cognitions (cognitive-behavioral therapy, stress-management). The aim of present research was examine the efficacy of cognitive-behavioral therapy for reduction of headaches in patient with chronic tension headache.

The method of this study was field/experimental. The target population of the study consisted of patient with CTTH that referred to psychiatric or neurology clinics in kashan. The sample consisted of 38 women with CTTH were assigned randomly to drug plus cognitive behavioral therapy (experimental, n=18) and drug alone (control, n=20) groups. Subjects were completed the headache diary for one week before and after intervention.

An analysis of covariance showed significant differences between experimental and control groups in variable of frequency, intensity and duration of headache attacks. Drug plus CBT was found to be more effective in reducing of headache than the drug therapy alone.

Drug plus CBT is better than drug alone in treatment of tension headache.

Several neurocognitive deficits present in the euthymic state of bipolar disorder suggest that some of them could be seen as vulnerability trait markers of the illness. Psychoeducation proved as effective therapeutic approach which decreases the risk of relapse and prolongs remission. In our study we aimed to examine the psychoeducational effects on cognitive functioning in the sample of euthymic bipolar outpatients.

A neuropsychological tests battery for assessing selective attention (Emotional and Colour-Word Stroop), cognitive control (Emotional Go/NoGo task) and social cognition (Face recognition task and Recognition of emotional expression task) was administered to 29 bipolar euthymic outpatients before and after attendance at six weeks psychoeducation program. The same procedure was applied on 10 bipolar euthymic outpatients without participating in psychoeducation.

Despite statistically insignificant differences between groups in cognitive performance, some considerable within group differences in domains of selective attention and cognitive control of emotional stimuli emerged. In the Emotional Stroop there was faster processing speed of emotional stimuli after psychoeducation compared to baseline in the intervention group which was not found in the control group. Similarly, coping with emotional stimuli in different emotional contexts markedly improved in the intervention group compared to the control group. Changes in social cognition, in particular better recognition of negative affect were found in the bipolar group with psychoeducation but not in the control group.

Though preliminary, our results support psychoeducation as clinically feasible way of cognitive rehabilitation in terms of improved cognitive control of emotional stimuli in bipolar patients.

Schizophrenic patients may be more susceptible to bone fractures because of the mental illness and/or the effects of psychotropic drugs. However, these patients also suffer from other medical conditions which may further increase their risk. The objective of this study was to make a general assessment of previous bone fractures in schizophrenics seen in an Internist's office.

We questioned 115 consecutive patients with the primary diagnosis of schizophrenia, seen in an Internist's office, for a wide variety of medical problems. Of these seventy nine (68.7%) were males and thirty six (31.3%) were females. Their ages ranged from 19 to 81. They were all on psychotropic drugs and under the care of a psychiatrist.

Of the total number of 115 patients, fifty one (44%) gave a history of previous bone fractures. Thirty eight (33%) gave a history of single fractures and thirteen (11.3%) gave a history of multiple fractures. Twenty six (22.6%) involved fractures of the upper limbs and twenty three (20%) involved fractures of the lower limbs and eight (6.9%) involved fractures of both the upper and lower limbs. Thirteen (11.3%) had non-extremity fractures. Of these eight (61.5%) had only non-extremity fractures and five (38.5%) had non-extremity fractures in addition to extremity fractures.

We found a significantly high prevalence of previous bone fractures in this schizophrenic population. Further study is necessary to elucidate whether this elevated risk is due to the mental illness, the use of psychotropic drugs, both, or some other associated etiology.

Hypothyroidism is common in the general population. Since symptoms and signs of hypothyroidism often mimic or overlap those of schizophrenia, they might be an under diagnosis of hypothyroidism in this population. Further, these patients may not be regularly seen by an Internist and may not be subject to routine thyroid profile testing. Treating occult thyroid abnormality is critical in these patients.

We studied the thyroid panel in 64 consecutive patients with schizophrenia seen in an Internist's office. Of these forty six (71.9%) were males and eighteen (28.1%) were females. The age ranged from 19 to 82. They were all on psychotropic medications. None were on lithium or thyroid supplementation. None of the patients exhibited clinical signs or symptoms of hypothyroidism. All of these patients underwent a routine thyroid profile testing.

Of these 64 patients, two (3.1%) patients were found to have elevated TSH. One had normal T3 and normal free T4, indicating subclinical hypothyroidism. The second patient had low T3 and low free T4 indicating overt hypothyroidism. Sixty two (96.9%) patients had an euthyroid profile.

In our study of 64 consecutive schizophrenic patients seen in an Internist's office, two were found to suffer from undiagnosed and untreated hypothyroidism. This limited study suggests that although not as common as suggested by the literature, undiagnosed and untreated hypothyroidism does exist in this population. All patients with schizophrenia should undergo a routine thyroid profile testing as part of a regular medical physical exam.

Both tricyclic antidepressants and some atypical antipsychotics, such as ziprasidone and quetiapine, used as augmentation agents in severe major depression, are known to increase QTc interval to a moderate extent (10-20 msec). Moreover, electroconvulsive therapy (ECT) also increases patients’ propensity to arrhythmias. Finally, females are more prone than males to both drug-induced QTc prolongation and torsades-de-pointes. Thus, the combination of all the above treatments raises serious safety concerns. We investigated the safety of the co-administration of ECT with a tricyclic-ziprasidone-quetiapine combination with respect to QTc interval in six female patients with severe major depression resistant to pharmacotherapy.

Each patient underwent a series of 10-11 sessions of bilateral ECT. QTc intervals were calculated at baseline and several times up to 10 min after seizures cessation in a total of 63 patients/ECT sessions.

A small initial decrease of QTc after the administration of pre-ECT medications was followed by its steady statistically non-significant increase during the first 20 sec after seizure cessation. Thereafter, a steady larger and statistically significant decrease of QTc emerged during the ensuing 21-50 sec interval. Finally, this decrease was gradually reversed within the following 2 min approximately with return of QTc interval to stable baseline levels.

Overall, QTc interval changes remained within normal limits (fixed at 470 msec in women), without the occurrence of any cardiac adverse events, especially severe arrhythmias such as torsades-de-pointes. Our findings suggest that the co-administration of these treatments might be safe, at least with respect to QTc interval changes.

Using high and low doses of cerebrolizin at patients with rezidiual schizophrenia

The purpose of the present research was comparative clinical-pharmacological studying with estimation cognitive functions of high and low doses Cerebrolysinum at patients with residual schizophrenia.

In total 37 patients the majority from which were male (89%), at the age of 50-55 years have been included in research. Duration of disease mainly 5-10 years. All patients had physical inability of 2 groups on mental disease, accepted neuroleptics throughout all illness, and last year - in invariable doses.

Patients in any order were distributed on three therapeutic groups:

1. 1. high doses “Cerebrolysinum” (10 ml) - 17.

2. 2. low doses “Cerebrolysinum” (1 ml) - 10.

3. 3. not accepting “Cerebrolysinum” - 10.

Duration of research - 4 weeks.

By the end of therapy at 10% of patients of 1st group the expressed improvement, at 73% - substantial improvement, and only in 17% cases - minor improvement. In 2nd group of the patients accepting low doses “Cerebrolysinum”, efficiency of therapy was essentially more low: at 27% of patients minor improvement, at 69% - minimum has been reached, and in 4% cases of positive dynamics by the therapy end wasn’t observed. In control group (3rd) at 90% of patients by the end of therapy the condition remains without changes, and 10% - had insignificant deterioration.

Using high doses of “Cerebrolysinum” gives high results in treatment of residual schizophrenia.

The aim of our study is the evaluation of co-administration of N-acetyl-cysteine (NAC) in cognitive functions in a sample of patients affected by schizophrenia diagnosed according to DSM IV-TR criteria, and treated with stable atypical antipsychotic therapy.

We administered NAC (1800 mg/die) to 12 male patients, tested each patient at baseline and re-tested after 90 days using a battery of neurocognitive tests (Wisconsin Card Sorting Test, Verbal Fluency Test, Stroop Test) and PANSS scale for severity symptomatology evaluation. The results obtained in each test at baseline were compared with those at the end of the study.

A significant improvement for WCST error numbers (sig. 0.049), VFT fonemic (sig. 0.049), PANSS positive (sig. 0.028), negative (sig. 0.002) and total (sig. 0.024) was observed.

Our results show that co-administration of N-acetyl-cysteine added to atypical antipsychotic therapy improves the cognitive-executive functions. The effectiveness on reducing positive and negative symptoms was confirmed.

In spite that the patients with long-acting neuropletics(LAN)can drop out and have relapses,its use allows a more long-lasting time and more stable plasmatic concentrations that supply clinical and neurocognitive advantages.

To analyze the symptomatology and neurocognitive differences(P300)among the patients that relapse after withdrawing from the previous treatment with oral antipsychotic as regards those treated with LAN.

34 schizophrenic patients with a history of at least one admission in a acute adult psychiatric ward.All the patients have been assessed with the Positive and Negative Syndrome Scale (PANSS) and with potential auditory evocations(wave P300).

Clinical profile: 73.5% suffers from paranoid schizophrenia.Only 32.4% shows antipsychotic monotherapy;the 61.8% have been prescribed with long-acting Risperidone.

PANSS: The patients who had at least two admissions and who in the previous admission received long-acting Risperidone,showed a PANSS-N punctuation lower than the rest of the patients(21.64±4.6 vs. 25.4±3.2)at the end of the last admission(p=0.037).The same takes place with PANSS-PG at the end of the last admission(30.71 ± 3.8 vs. 3.61 ± 5.89(p=0.012).

P300: The latency measures of P300 are lower in those patients who in the previous admission received a long-acting Risperidone treatment(average of 314±34.65msec vs. 344.67±24.67msec),being the differences statistically relevant(p=0.012).The ranges are higher in the patients treated with long-acting Risperidone in the previous admission(average 5.3 ± 2.44vs.5±2.64 μV),though the differences are not statistically relevant.

At the end of the last admission,the patients who in the previous admission received long-acting Risperidone,showed a PANSS-N,a PANSS-PG and a latency of P300 lower than the rest of the patients but the range of P300 was higher.

Although language deficits have often been reported in schizophrenia, the specific relevance of single linguistic levels of processing is still under debate. Moreover, little is known about language disturbances in bipolar disorder.

The aims of this study were to:

1. 1) investigate micro-linguistic (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) dimensions of speech production and

2. 2) evaluate syntactic comprehension skills in both schizophrenia and, for the first time, bipolar disorder.

A story telling task and a computer-based test of syntactic comprehension were administered to 30 Italian speaking DSM-IV patients suffering from schizophrenia, 30 participants with bipolar disorder and 30 healthy controls, comparable for age and educational level (p>0.05). Analysis of variance with post-hoc correction was performed to compare linguistic performance between groups.

In comparison to healthy participants, patients with schizophrenia had significantly impaired productivity, syntactic complexity and local/global discourse coherence and bipolar disorder subjects showed deficits in mean length of utterance (p< 0.05). Also, both groups of patients collected more grammatical errors than controls (p< 0.05), but they differed in regard to the grammatical type of construction they missed (passive-affirmative and active-negative, respectively).

Our results showed the presence of both micro and macro-linguistic deficits in linguistic production in schizophrenia, but not in bipolar disorder, suggesting that these abnormalities are specific for schizophrenia. On the contrary, syntactic construction comprehension was altered in both schizophrenia and bipolar disorder, potentially representing the target of innovative rehabilitation strategies.

Various studies have demonstrated that psychotic patients have poor performance on the Wisconsin Card Sorting Test (WCST), which serves as an indicator of the dorsolateral prefrontal cortex executive functioning. The aim of our study was to compare cognitive performance of patients suffering from chronic psychosis with the first episode patients.

Our sample consisted of chronic schizophrenic and schizoaffective patients in worsening phase, the first episode patients and corresponding healthy controls. All patients were tested by WCST in the second week after the hospitalization, were treated with SGA, and had PANSS score above 60.

The performance of the psychotic patients was equal to the performance of healthy controls in all variables of the WCST, except the average non-perseverative responses (NPR) (p=0.01). NPR score indicates a state rather than shift in a cognitive set, so we performed the analysis of the given working memory test per diagnosis of the patients. The results showed lack of significant difference in the WCST performance between schizophrenic, schizoaffective and healthy subjects, whereas the first episode patients performed significantly worse then controls in the following variables: categories, perseverative errors and conceptualization level (p< 0.05).

Our findings showed difference in cognitive functioning between first episode patients and chronic psychotic patients. Better cognitive performance of chronic psychotic patients could be explained by potentially beneficial effects of the SGA pharmacotherapy to the cognitive status. However, this finding may be also limited by its association with age and relatively modest PANSS scores.

Schizophrenia associated with thermal dysregulation

has been demonstrated in several studies, as well as being noted in the

observations of clinicians for many years. However, while there is an

abundance of research, many of the results have proven to be contradictory,

in particular regarding the confounding effect of antipsychotic medication.

To this end we will review the evidence concerning abnormal

thermoregulation. Understanding the thermal dysregulation may give us an

insight into the pathogenesis of schizophrenia, and a potential role for

orexins in the disease.

To analyse current experimental literature on thermoregulation

in schizophrenia in medicated and unmedicated patients.

PubMed - searched with MeSH term “schizophrenia”, with additional terms;

“thermoregulation”, “orexin” or “hypocretin”.

While there may be disagreements in various studies, the weight of

the early evidence points to untreated schizophrenic patients having lower

baseline core temperatures, while later studies with neuroleptics showed an

increase. Several studies also showed an impaired heat loss in

schizophrenic patients, both in medicated and unmedicated patients.

Meanwhile, orexins have been linked to heat production and heat loss during

sleep. There are also studies showing that orexins are activated by

antipsychotics, and also project to thalamic nuclei that show reduced

volume and connectivity in schizophrenia.

The thermal dysregulation seen in schizophrenia is a complex

process, and the underlying pathogenesis remains to be uncovered. This

mechanism may involve orexins, which may also play a part in both the

pathogenesis of schizophrenia and the relief of symptoms by antipsychotics.

An impairment of several cognitive domains has been largely documented in patients with schizophrenia. The present study aimed to investigate the relationships between cognitive functioning, symptomatic remission and functional outcome in schizophrenia.

The performance on the neuropsychological battery “Brief Assessment of Cognition in Schizophrenia (BACS)” has been investigated in clinically remitted (R) and non-remitted (NR) schizophrenic patients. The associations of neuropsychological performance with psychopathological dimensions derived from PANSS and indices of social functioning (as assessed by the Global Assessment of Functioning scale, the Personal and Social Performance scale, the Quality of Life Scale, the UCSD Performance-Based Skills Assessment-Brief Version and the Psychosocial Remission in Schizophrenia scale) were also explored by means of multiple regression (MR) analyses.

Compared with NR, R patients showed a better performance on tests exploring executive functions, processing speed and verbal fluency. Residual negative symptoms and processing speed were independent predictors of functional outcome, while remission status did not enter the MR function.

Our findings suggest that cognitive abilities, in particular processing speed and executive functions, are preserved in patients who are able to reach clinical remission. Independently from the remission state or residual negative symptomatology, processing speed also predicts functional outcome in schizophrenia. Our findings support the view that cognitive dysfunctions in schizophrenia should be targeted by specific treatment intervention, such as neurocognitive rehabilitation.

Simple schizophrenia (SS) is an uncommon disorder that may go unrecognized. SS occupies an ambiguous position in the current international classification systems, due to its theoretical poor reliability and doubtful validity. Only International Classification of Diseases recognizes SS as a distinct subtype of schizophrenia.

The authors aim to illustrate the practical relevance of this diagnosis, through the presentation of two clinical pictures consistent with SS.

Case 1: 21-year-old woman, attending our outpatient unit since 2007 because of behavioral changes: she used to interact with three stuffed dolls for hours, considering them as the members of a famous rock band. Gradually, these symptoms lost preponderance and became evident a marked decline in her academic functioning, social withdrawal with difficulty in interpersonal contact, affective flattening and significant lack of concern for about her previous interests.

Case 2: 21 year-old man, attending irregularly our outpatient unit since 2006 due to behavioral changes. The patient has showed a progressive clinical picture consisting of puerility, evasive, poor, and sometimes disorganized speech, abulia, apathy, and social withdrawal. Nowadays he has no social relationships and no productive tasks. Despite some ideas of reference, he never presented overt psychotic or affective symptoms.

SS may be a laboring diagnosis due to its insidious nature and preponderance of vague, negative symptoms. These cases illustrate that SS is a suitable diagnosis for some clinical presentations, and the need of improved recognition of this entity. Recent studies suggest SS reintroduction as a valid and reliable subtype of schizophrenia.

Schizophrenic patients are prone to osteopenia and osteoporosis due to various reasons. No research has ever been conducted on this field in Iran.

The aim of this study was to determine the bone mineral density in schizophrenic patients.

In a cross- sectional and descriptive study with random sampling, we used (DEXA) to determine Bone Mineral Density (BMD) in the lumbar and neck femur region of 85 in- schizophrenics and they were compared with general population. Statistical analysis was done finally.

Sixty eight of patients were males. The average age of males and females was 39.61± 6.77 and 36.29± 7.58 years respectively. The mean femur neck BMD of male and female patients were 0.88± 0.16 and 0.87± 0.15 respectively (Pv = 0.76). Mean lumbar BMD of male and female patients was 0.94± 0.18 and 0.96± 0.14 respectively (Pv = 0.761). Liner significant correlation was not found between age and femur neck BMD (P= 0.782). Liner significant correlation was found between femur neck BMD and lumbar BMD (P< 0.001). Frequency of osteopenia in patient with the age of 30-50 years was significantly higher than other patients (P= 0.011). Frequency of femur neck osteopenia and osteoporosis were 50.6% and 4.7% respectively and frequency of lumbar osteopenia and osteoporosis were 40% and 14.1% respectively.

Schizophrenic patients had lower bone mineral density than general population.

Group psychotherapy along with psychopharmacological therapy and sociotherapy is an important and frequently applied therapeutic method. Numerous studies indicate that group psychotherapy affects the functioning in patients with psychotic disorders in terms of improving the cognitive, emotional and social functioning and generally contributes to a better quality of life (Kanas, 1996).

The aim of this study was to assess the impact of psychodynamic oriented group psychotherapy on the quality of life in patients with psychotic disorders and to compare the obtained results with the results of patients with psychotic disorders who did not participate in psychodynamic group psychotherapy.

Patients included in this study have completed psychotherapy group five years ago and were in regular outpatient treatment together with regular application of medication therapy. The applied method was Quality of Life Scale (Krizmanić, Kolesarić). Answers were analyzed qualitatively and quantitatively.

The quality of life in the group of patients who completed long-term psychodynamic group psychotherapy was better than in the group of patients who were not treated in that manner, although there are no statistically significant differences. The most important differences were in the area of intimacy, professional occupation and in the area of family relations.

It can be concluded that long-term psychodynamic group psychotherapy has a positive influence on quality of life of patients with psychotic disorders.