Brief Psychotic Disorder (BPD) is a disease characterized by sudden onset of psychotic symptoms. This disturbance lasts at least 1 day but less than 1 month, and the subject fully recovered premorbid level. In the literature there are few data on its prevalence, established between 4-10% of all psychotic disorders. Although a female preponderance has been postuled, gender differences have not been well studied. Therefore, the aim of the present study is to examined sex differences in brief psychotic disorder.

We conducted a retrospective study to estimate the gender differences in an inpatient psychiatric sample. This sample (n=39) included acute patients admitted in a psychiatry ward with diagnosis of brief psychotic disorder. The clinical and socio-demographic characteristics were analysed for males and females separately.

Of a total of 39 patients with BPD, 74.4% were women (n = 29) and 25.6% male (n = 10). Mean age at diagnosis was 33 +/- 8.65 years. Of the clinical variables studied, none was significantly different between male and female. Men had a higher consumption of alcohol (p< 0’05); there were no differences in axis II. Males had more psychiatric family history (70% vs 48.3%), although not statistically significant. Women had more frequent family history of mood disorders and men of psychotic disorders (p < 0.05).

We found higher prevalence of BPD in women. Males had more family history (mostly psychotic) and more toxic dependence. Further studies are needed with larger samples to determine the existence of sex differences.

The extra pyramidal effects related to the use of neuroleptics are a limiting factor in schizophrenia treatment.

The aim of this study was to identify the neuroleptics prescribed for schizophrenic patients in a public health service, the extra pyramidal symptoms (EPS) incidence and its treatment.

Our restrospective study included 40 patients with mean age of 39.13 ± 2.19 in a treatment period of of 134.17 ± 16.83 days. The data were randomly collected from medical records of these patients.

The patients under study received typical neuroleptics (31.03%),atypical agents (37.93%) or association of both (31.03%). EPS was observed in 65.52% patients of which, 44.83% even though receiving biperiden 2mg, still have EPS. 20.69% were not receiving anticolinergic drug treatment for EPS, but promethazine or anticonvulsants. From the 34.48% who did not showed EPS, 20.69% had biperiden prescription and 13.79 % had been treated with olanzapine, clozapine or risperidone associated or not to clonazepam 2mg. Weigth gain of 5.20 ± 1.14 kg was observed in our total sample.

We suggest the use of EPS evaluation scale (Sympson - Angus or Barnes). 65.52 % of the patients under study had EPS and 20.69% of them had no prescription of central acting anticholinergic drug. 44.83% even though receiving biperiden 2mg, still have EPS.

The purpose of this paper is to highlight the position of mental health patients in terms of treatment choice, advanced directives and evidence to support complementary and alternative medicines (CAM).

Here, a patient with a long-standing diagnosis of schizophrenia outlines her experience of treatment with antipsychotic medication and contrasts this with the success she has had with the use of acupuncture for her symptoms. The evidence behind CAM for mental health problems, including schizophrenia is explored, as is the reliance on antipsychotic medication for people who are acutely mentally ill, over and above any prior requests individuals may make for CAM to be included in their treatment programme.

Following several unsatisfactory treatment episodes with antipsychotic and antidepressant medication, Madlin introduced acupuncture as an adjunct treatment. This enabled her to live independently in the community for over 8 years. Although she continues to be susceptible to psychosis, her experience of acupuncture is that it makes a significant improvement to her quality of life. Madlin feels that access to acupuncture for inpatients might further improve recovery rates and relationships with mental health workers.

Mental Health patients are increasingly asking for access to CAM and the evidence is improving. This might be a good time to for psychiatrists to consider CAM treatment possibilities where patients request them or where there is evidence to support their use.

The aim of the study was an analysis of prolactin concentration in the course of antipsychotic treatment in Polish patients participating in EUFEST study.

Seventy-eight patients with the first episode of schizophrenia were studied, randomly allocated to the treatment with low dose haloperidol (n=23), amisulpride (n=21), olanzapine (n=22), quetiapine (n=11) or ziprasidone (n=1), for the period of 12 months. Prolactin concentration was assessed at baseline and after 6 and 12 months of treatment. Hyperprolactinemia was defined as prolactin concentration >18 ng/ml in males and >25 ng/ml in females.

At baseline, the mean prolactin concentration was 56,5 ng/ml and hyperprolactinemia was observed in 86% of patients, slightly more than in the whole EUFEST group (71%). Prolactin concentration was similar in drug-naïve as in non-drug-naïve patients. After 6 month of treatment, hyperprolactinemia was found in 67% of patients, lowest in haloperidol (29%) and highest in amisulpride group (93%). After 12 months, hyperprolactinemia was observed in 56% of patients, lowest in quetiapine (36%) and highest in amisulpride group (80%).

Hyperprolactinemia was found in a majority of patients with the first episode of schizophrenia, including drug-naïve patients. In the course of one-year antipsychotic treatment, in patients receiving amisulpride, the hyperprolactinemia has been maintained at the initial high level while in remaining groups, a reduction by about 50% of the number of patients having hypeprolactinemia at baseline was observed. We suggest that an abnormality of stress system, could contribute to hyperprolactinemia independent of antipsychotic treatment in the first episode schizophrenic patients.

An increasing number of studies focus on general deficits in identifying, differentiating and recalling of facial emotions in schizophrenia. According to preliminary results antipsychotics alone show only little effect on social cognition. We investigated the effects of new antipsychotics when combined with a computer-based training on affect recognition.

Schizophrenic patients (n=20) receiving treatment with new antipsychotics in combination with a six-week Training on Affect Recognition (TAR) were compared with a randomized group of patients (n=18) receiving Treatment As Usual (TAU). Effects on social cognition were tested with the Vienna Emotion Recognition Tasks (VERT-K). In addition, we investigated neurocognitive performance using the Wisconsin Card Sorting Test (WCST), Testbattery for Attentional Performance (TAP): “Alertness”, “Vigilance” and “Working memory”. Negative symptoms and quality of life were assessed using the Positive and Negative Syndrome Scale (PANSS) and the short version of the WHO-Quality of Life Questionnaire (WHOQOL-Bref).

In comparison to the control group the TAR group showed significant improvements in regard to affect recognition in general as well as in recognizing sad and happy faces. In addition, we found significant improvements for the TAR group regarding executive functions, quality of life and negative symptoms.

Treatment with new antipsychotics alone has only a limited impact on social cognition. A specific combined treatment of new antipsychotics and TAR leads to improved cognition and emotional performance with additional positive effects on functional outcome.

Atypical antipsychotics have been reported to induce severe metabolic side effects such as metabolic syndrome. However, ziprasidone has a safer metabolic profile and metabolic neutral for schizophrenic patient. In this prospective 24-week study, we investigate the improvements in lipids observed in patients switched from other antipsychotics.

150 patients with schizophrenia treated with antipsychotic who were having metabolic risk were switched to ziprasidone. They were analyzed to quantify clinically significant changes in metabolic parameters. At baseline assessment, fasting lipid profile was taken for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. The same assessment was repeated at 4-weeks, 12-week and 24-week. Paired t-test and last observation carried forward (LOCF) were used for the statistical analysis. Preliminary results for those who completed 12 weeks follow up were presented.

13 schizophrenic patients with 7 (53.8%) male and 6 (46.2%) female have completed the 12 weeks follow up. 6 (46.25%) patients were previously treated with olanzapine, 3 (23.1%) were on risperidal, 2(15.4%) were on paliperidone, 1(7.7%) was on haloperidol and 1(7.7%) was on trifluoperazine. There was statistically significant reduction in mean total cholesterol (5.40 ± 0.73 mmol) to (4.99 ± 0.71 mmol) p=0.007, mean LDL cholesterol (3.51 ± 0.65 mmol) to (3.21 ± 0.65 mmol) p=0.047. There was no statistically significant in mean difference for HDL cholesterol and triglycerides.

In short-term, switching to ziprasidone treatment resulted in clinically significant improvements in cholesterol and LDL cholesterol in at-risk patients.

Risk of psychosis is defined by the presence of positive psychotic-like symptoms. In clinical examination, easily detectable perceived negative attitude of other people may also indicate risk of psychosis.

A random sample of psychiatric outpatients completed the PROD screen including questions on interpersonal relationships, functioning and subtle specific (psychotic-like) symptoms. Vulnerability to psychosis (VTP) was assessed employing specific symptoms of the PROD screen. Current risk of psychosis (CROP) was assessed using the BSABS and the SIPS/SOPS. The CROP patients were followed up for 18 months and transition to psychosis was detected. The association between perceived negative attitude of others and reported psychotic symptoms was tested in a random sample drawn from the general population.

In all, 790 outpatients were screened. Of them, 219 VTP and 55 CROP patients were identified. By follow-up, six CROP patients (11 %) had made the transition to psychosis. Vulnerability to psychosis associated with all items of interpersonal relationships and functioning. However, current risk and transition to psychosis associated only with subjectively reported negative attitude of others. In a general population sample, negative attitude of others strongly associated with reported life-time psychotic symptoms conforming thus results obtained from a patient sample.

The subjective experience of negative attitude of other people towards oneself associates with experience of psychotic symptoms and may predict more sever psychotic development. The association between perceived negative attitude and occurrence of subtle psychotic symptoms seems to be detectable both in general and patient populations.

1. 1. No differences were found in the allelic distribution in the investigated genes polymorphisms between the whole schizophrenics and the control group.

2. 2. Associations between DAT: A9 allele, DRD2: del 141C allele, DRD2: Taq1A A1 allele, COMT: Met/Met genotype, MAOA: 4VNTR allel (males only) and GRIK3: SER allel with non responding patients were found.

The goal of this study is to test the efficacy of the Memory Module of the REHACOP (Cognitive Training Program for Psychosis, Ojeda, Peña, 2006), in the improvement of cognition in patients with chronic schizophrenia (CS). Chronic patients present a moderate to severe cognitive performance on verbal memory and the severity of the illness and variables associated to the course of the diagnosis prevent them from improving cognition with traditional treatments.

57 patients with CS (illness duration, 10.17±7.22) were allocated randomly into either REHACOP (N=27) or control group (N=30). The REHACOP group received memory training with structured sessions 3 times per week for 8 weeks. Control group attended occupational therapy with the same frequency and timetables. Verbal Learning and Memory (Hopkins Verbal Learning Test; HVLT) and Working Memory (Digits Backwards from WAIS-III) were assessed at baseline and after the intervention.

Repeated measures of MANOVA showed that the interaction term groupXtime was significant for all the memory measures, suggesting REHACOP group improved significantly when compared to controls. Specifically, the interaction term F value was significant for HVLT learning (F=6.78, p < 0.01), HVLT Long-term memory (F=7.02, p < 0.01) and working memory (Digits Backward (F=10.04, p < 0.01), and Sum (F=11.39, p < 0.01).

Patients with CS improved significantly in all memory impairments when compared to those receiving other treatment. This study supports the efficacy of the REHACOP in the intervention of memory impairments in patients with schizophrenia, in spite of the severity.

Verbal fluency deficits have been pointed out as a possible endophenotype in schizophrenia (Szöke et al., 2008). However, whether these deficits are specific or linked to semantic-verbal inability remains unclear. Additionally, this cognitive domain is already affected in early psychosis and do not improve despite early clinical interventions.

Authors tested the efficiency of a cognitive intervention specifically developed for improving fluency in psychosis.

Ninety patients with first-episode psychosis were randomly assigned to one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy. Patients at the REHACOP group received one month structured group rehabilitation sessions (3 per week) to improve fluency. Repeated assessments of semantic fluency and phonological fluency were conducted before and after the treatment.

Compared to occupational therapy, the experimental group produced significant additional improvements in phonological fluency (F = 6.87, p < 0.01), but not in semantic fluency (F = 0.61, n.s). The composite verbal fluency score was also significant (F = 4.65, p < 0.05). The improvement remained 3 months after the treatment end.

The cognitive treatment using REHACOP has proven to be effective in treating phonological fluency deficits in first-episode psychosis, whereas socialization or communication in group therapy by itself do not. The differential pattern showed by semantic fluency is consistent with the proposal of Szöke et al 2008, who suggest that semantic fluency is a putative endophenotype for schizophrenia with links to genetic basis compared to phonological fluency.

Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties.

Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference)

Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning (F = 9.88, p < 0.01) and processing speed (F = 5.92, p < 0.05) measures, suggesting that the REHACOP experimental group improved significantly when compared to the control group's performance on both domains.

Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.

To assess the psychometric properties of the Spanish version of the SWN scale, an instrument which evaluates the subjective experience of psychotic patients towards neuroleptic treatment.

A validation study (feasibility, reliability, and validity) was conducted in 20 psychiatric centers. Patients were evaluated with the PANSS, the CGI severity scale and the SWN-20. A re-test was conducted one week after baseline. The study included clinically stabilized outpatients diagnosed with schizophrenia (DSM-IV-TR criteria) who were on treatment as usual. The SWN used in this study consists of 20 questions answered on a 6-point Likert scale. The total score ranges from 20 to 120 points (higher scores indicating better well-being). The original version was back-translated and a focus group was conducted to improve the comprehension of the items.

97 patients were included. Seventy-two percent of them (70) were male. Mean age was 35 years (SD = 10.0). Mean SWN total score: 83.5 (SD = 14.0). Internal homogeneity: 0.86. Test-retest in clinically stable patients was 0.89. SWN correlated significantly with the PANSS, but not with the DAI-10. Patients with none-mild clinical affectation had higher SWN scores, indicating a better subjective well-being, and vice versa.

The subjective experience of psychotic patients towards treatment is a key factor in therapeutic adherence, quality of life, and clinical outcome. The Spanish version of the SWN scale showed good psychometric properties in a sample of schizophrenic stabilized outpatients. SWN scale constitutes a valuable addition to evaluate patients’ subjective well-being.

Patients suffering from schizophrenia display an impairment of memory performance among other cognitive deficits. Long term memory impairment can arise from disturbed encoding and/or retrieval processes subserved by mediotemporal, mesencephalic as well as prefrontal brain regions. We assessed functional and structural integrity of these regions in schizophrenia, specifically during cognitive processes of memory encoding and retrieval.

We assessed in a set of 3 fMRI studies in a total of 50 schizophrenia patients and an equal number of matched controls whether

1. 1) hippocampal/parahippocampal activity during encoding into long term memory is impaired,

2. 2) this impairment is related to the memory deficit,

3. 3) impaired memory retrieval is associated to mediotemporal/prefrontal dysfunction,

4. 4) hippocampal dysfunction is related to symptoms in schizophrenia,

5. 5) mesolimbic novelty detection is defective.

Functional alterations were related to structural brain changes as detected by voxel-based morphometry.

Patients with schizophrenia displayed a markedly impaired memory performance in our studies. It was related to dysfunction of hippocampal areas during memory encoding as well as novelty detection. During novelty detection, patients had a significantly impaired activity in the mesolimbic loop (hippocampus-ventral tegmental area). Prefrontral and mediotemporal hypofunction was evident during memory retrieval. Positive symptoms were related to a more dysregulated hippocampus activity during memory encoding.

Evident memory dysfunction in schizophrenia is related to severely altered neuronal processes subserving memory encoding and retrieval which importantly include defective mesolimbic novelty detection. Dysregulated hippocampal activity is related to positive symptoms in schizophrenia and importantly provides a neurobiological link to cognitive deficits.

To explore changes in functioning with flexible doses of paliperidone ER in a large international study in patients with schizophrenia previously unsuccessfully treated with other oral antipsychotics.

Prospective 6-month open-label study. Functioning was assessed using the Personal and Social Performance Scale (PSP), including four domains:

1. (1) personal and social relationships,

2. (2) socially useful activities including work and study,

3. (3) self care and

4. (4) disturbing and aggressive behavior.

1812 patients were included (59.9% male, mean age 40.1±12.6 years, 75.8% paranoid schizophrenia); most were enrolled because of lack of efficacy (n=1026) or lack of tolerability (n=490) with prior antipsychotic treatment. The median mode dose of paliperidone ER was 6 mg/day. 70.7% of patients completed the study. Most frequent reasons for early discontinuation were patient choice (8.8%), lack of efficacy or adverse event (5.1% each). AEs reported in >= 5% of patients were insomnia (9.2%) and anxiety (7.2%). Mean total baseline PSP score was 57.7±14.5, which improved to 64.1±15.6 at endpoint (mean change +6.4±13.5; 95% confidence interval 5.8;7.0, p< 0.0001); 49.0% of patients improved by at least one 10-point category in PSP. At baseline, 84.3% of patients had moderate to severe functional impairment, mostly driven by at least marked difficulties in socially useful activities (46.4.%) and personal and social relationships (36.4%). These percentages decreased to 30.6% and 22.9%, respectively.

In this large prospective flexible-dose study, results from recent randomized controlled studies are supported that paliperidone ER is associated with a clinically meaningful improvement of functioning in patients with schizophrenia.

To explore tolerability, safety and treatment response of flexible doses of paliperidone ER in adult non-acute patients with schizophrenia previously unsuccessfully treated with oral antipsychotics.

International prospective 6-month open-label study. Endpoints were the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity Scale (CGI-S), patient satisfaction, adverse events (AEs), extrapyramidal symptoms (Extrapyramidal Symptom Rating Scale; ESRS) and weight change.

1812 patients were included (59.9% male, mean age 40.1±12.6 years, 75.8% paranoid schizophrenia); most were enrolled because of lack of efficacy (n=1026) or lack of tolerability (n=490) with prior antipsychotic treatment. The median mode dose of paliperidone ER was 6 mg/day. 70.7% of patients completed the 6-month study. Most frequent reasons for early discontinuation were patient choice (8.8%), lack of efficacy or adverse event (5.1% each) independent of the reason for switching. Mean total PANSS decreased significantly from 79.4±20.4 at baseline to 66.1±21.5 at endpoint (mean change -13.3±19.7; 95% confidence interval -14.2;-12.3, p< 0.0001). The percentage of patients rated mildly ill or less in CGI-S increased from 27.0% to 52.2% at endpoint, and the rate of patients with mild functional impairment increased from 15.8% to 34.9%. AEs reported in greater-than-or-equal-to 5% of patients were insomnia (9.2%) and anxiety (7.2%). Extrapyramidal symptoms in ESRS decreased significantly from 3.5±5.8 to 2.1±4.6 (p< 0.0001). Mean weight gain from baseline to endpoint was 0.3±4.8kg.

These data support results from recent randomized controlled studies that paliperidone ER is safe, well tolerated and effective in patients previously unsuccessfully treated with other oral antipsychotics.

To explore tolerability, safety and treatment response of flexible doses of paliperidone ER in adult non-acute patients with schizophrenia previously unsuccessfully treated with oral risperidone.

International prospective 6-month open-label study. Endpoints were the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity Scale (CGI-S), adverse events (AEs), extrapyramidal symptoms (Extrapyramidal Symptom Rating Scale; ESRS) and weight change.

694 patients were included (59.2% male, mean age 40.0±12.8 years, 74.8% paranoid schizophrenia); most were enrolled because of lack of efficacy (n=366) or lack of tolerability (n=178) with prior oral risperidone treatment. 74.1% of patients (n=514) completed the 6-month study. Most frequent reasons for early discontinuation were patient choice (7.3%) and lack of efficacy (5.2%). The median mode dose of paliperidone ER was 6 mg/day, independent of the reason for switching. For all patients, mean total PANSS decreased significantly from 78.6±20.5 at baseline to 65.6±22.5 at endpoint (mean change -13.0±19.4; 95% confidence interval -14.5;-11.5, p< 0.0001). The percentage of patients rated mildly ill or less in CGI-S increased from 28.3% to 52.5% at endpoint, and the rate of patients with mild functional impairment increased from 16.5% to 36.6%. AEs reported in greater-than-or-equal-to 5% of patients were insomnia (8.8%) and anxiety (7.3%). Extrapyramidal symptoms in ESRS decreased significantly from 3.8±6.1 to 2.3±5.1 (p< 0.0001). Mean weight gain from baseline to endpoint was 0.4±4.3kg.

These data support results from recent randomized controlled studies that paliperidone ER is safe, well tolerated and effective in patients previously unsuccessfully treated with oral risperidone.

To compare the longer-term metabolic effects and efficacy of paliperidone ER and olanzapine in patients with schizophrenia.

Prospective 6-month randomized study evaluating flexible doses of paliperidone ER and oral olanzapine (OLA). Primary endpoint was the change in triglyceride to high-density lipoprotein (TG:HDL) ratio, a sensitive measure of insulin resistance. Additional endpoints were the Positive and Negative Syndrome Scale (PANSS), body weight, lipids, homoeostasis model of insulin resistance (HOMA-IR) and adverse events (AEs).

239 patients were randomized to paliperidone ER, 220 to olanzapine. Demographics and baseline characteristics were comparable. Mean doses were 6.9±1.3 mg/day for paliperidone ER and 11.6±2.3 mg/day for olanzapine. The TG:HDL ratio for olanzapine significantly worsened from baseline to endpoint (0.42±1.19;p< 0.0001); it remained unchanged for paliperidone ER (-0.08±1.10;p=0.4718; between-group difference p< 0.0001). PANSS total scores at endpoint significantly improved (olanzapine -16.6±15.0; paliperidone ER -13.5±15.9; both p< 0.0001 vs. baseline); the between-group difference met prespecified non-inferiority criteria. Endpoint weight change was 3.8±5.9kg for olanzapine and 1.2±4.6kg for paliperidone ER (p< 0.0001). Insulin resistance in HOMA-IR did not change with paliperidone ER (p=0.1507) but significantly worsened with olanzapine (p=0.003 vs. baseline). The most frequently reported treatment-emergent AEs (>=5%) were weight increase (OLA 18.2%;Pali ER 9.6%), insomnia (OLA 1.4%;Pali ER 9.6%), somnolence (OLA 9.5%;Pali ER 3.3%) and schizophrenia (OLA 1.8%;Pali ER 5.0%).

In this randomized controlled study paliperidone ER was superior to olanzapine with regards to insulin resistance, weight gain, lipid changes and other relevant metabolic endpoints. Efficacy was non-inferior between paliperidone ER and olanzapine.

To develop a toolkit (QuIRC) for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care facilities.

The QuIRC was developed by research partners across ten countries: UK; Germany; Spain; Czech Republic; Bulgaria; Italy; Netherlands; Poland; Greece and Portugal. Its content was informed by triangulation of the evidence on critical components of care collated from: a review of care standards in each country; an international literature review; and Delphi exercises. Its final format was agreed by an international panel of rehabilitation and recovery experts. QuIRC scores were compared against service users’ quality of life, autonomy, experiences of care and markers of recovery to assess whether the QuIRc could provide a proxy-assessment of the unit’s promotion of service users’ autonomy and Recovery.

The finalised tool was used to interview managers from 21 units throughout Germany. One hundred and eighty-eight service users were also interviewed. QuIRC domain ratings were compared by facility type and with service user assessments. The QuIRC’s ability to deliver assessments relevant to Germany’s established systems of change at local, regional and national level will be discussed.

Antipsychotics are mainstay treatment in schizophrenia; atypicals including clozapine were widely used. Clozapine was considered different due to its distinct effectiveness. We report the clinical profile of these groups.

In Nithsdale, South-west Scotland, the schizophrenia population was identified by ‘key informant’ method in 2006. The clinical variables were determined and compared between the groups.

The study identified 205 people with schizophrenia (point prevalence: 3.7/1000 general population) of which 131(64%) took part in the study. 22(17%) were receiving typicals, 63(48%) atypicals excluding clozapine, 29(22%) clozapine, 8(6%) combination of typical and atypicals, and 9(7%) were on no antipsychotic medications.

Comparison between atypicals excluding clozapine, typicals and clozapine groups showed: clozapine group were younger than atypicals and typicals (Mean years: 43,54 and 62, p=< 0.001). The length of illness was longer in typicals than atypicals and clozapine (Mean years: 35,24 and 18,p=0.002).

With mental state, clozapine group had higher score in positive subscore of PANSS than that of atypicals and typicals (Mean: 1.83,1.52 and 1.21, p=< 0.001); while there were no significant differences in the negative subscore (Mean: 2.11,2.01 and 1.77, p=0.24).

Tardive dyskinesia was more prevalent in typicals and clozapine groups than atypicals as assessed by AIMS scale (Mean: 41,41 and 18, p=0.02); while there were no significant differences between the three groups in the severity of parkinsonism as assessed by Simpson & Angus scale (Mean: 0.34,0.36 and 0.25, p=0.37).

Atypicals including clozapine were no better than typicals in symptom control or in the neurological side effect profile.