There is a significant incidence of psychiatric symptoms in patients with multiple sclerosis, the most common after receiving the diagnosis. We describe a man who was admitted for a first episode psychosis and a diagnosis of multiple sclerosis was made moreover.

A 24-year-old man was admitted with a paranoid delusion, auditory hallucinations with emotional response and the believe that their thoughts were being interfered. Blood test and cranial CT were normal. Risperidone was started. He developed ataxia and sensitive disturbances on the right arm. A cranial and spinal cord MRI revealed multiple T2 and FLAIR hyperintense lesions located in supra and infratentorial white matter, lesions in C3, and one lesion in right basal ganglia that enhanced with gadolinium. CSF analysis showed oligoclonals bands. Three years ago the patient had had transient sensitive symtoms. A diagnosis of relapsing-remitting multiple sclerosis was made and was started methyl-prednisolone intravenously. Risperidone was changed for amisulpride 800 mg/day because lack of response. He was discharged after 25 days. Six months later he has attenuated psychotic symptoms without news lesions in MRI. Glatiramer acetate has been started.

The most frequent disorder associated to multiple sclerosis is depression (prevalence of 20%). Psychosis is unusual, transient, sometimes as the onset relapse followed by remission. There's evidence of correlation between psychosis in multiple sclerosis and multiple lesions in temporal periventricular area. We suggest that in our case these two disorders are two separated entities since the enhanced lesion does not correpond with clinical findings.

Tobacco smoking is considered as one of leading preventable causes of death. High prevalence of tobacco smoking was reported among individuals with mental illnesses, and it is extremely high among patients with Schizophrenia. It is possible that antipsychotic drugs side effects are contributing to this negative trend. Objective of this paper was to establish frequency of cigarette smoking among patients with Schizophrenia hospitalized at the psychiatry clinic and to determinate the difference in frequencies of cigarette smoking among patients with Schizophrenia treated with first or second generation antipsychotics.

Study included 60 patients with Schizophrenia treated with antipsychotics for period of six months or longer. Experimental group included 30 patients treated with second generation antipsychotics, and control group included 30 patients treated with first generation antipsychotics. Descriptive statistical methods are used. The levels of statistical significance between parametric data were determined by t- test, and between nonparametric data by chi square test. Level of significance was established at P < .05.

In this sample was 75% smokers, and out of this 46.6% consume up to 20 cigarettes per day, 40% consume 20 to 40 cigarettes, 8.8% between 40-60 cigarettes, and 4.4% consume over 60 cigarettes per day. There was no significant differences between groups of patients treated with first and second generation antipsychotics.

Tobacco smoking is very frequent among patients with Schizophrenia. In this study we did not found significant difference in frequency of tobacco smoking between groups of patients treated with first or second generation antipsychotics.

Spectral delta and gamma activity were recorded in 17 schizophrenia patients and 17 matched controls to study brain dysfunction/inhibition and functional linguistic impairment in different phases of written word processing.

Most of patients were suffering from paranoid schizophrenia and obtained relatively high rating in Delusions (P1) and Conceptual disorganization (P2) of the PANSS. Delta and gamma amplitudes were measured while participants performed three linguistic tasks, i.e., visuo-perceptual, rhyming and semantic judgment.

Compared with healthy controls, patients showed no overall delta and gamma differences, revealing a lack of pharmacological-dependent impairment. However, ANOVAs revealed bilateral delta and gamma distributions in patients and, compared with controls, significant greater delta and lower gamma levels in left anterior sites. Healthy participants showed higher delta amplitude in right vs. left anterior sites and a reversed pattern for gamma amplitude: delta and gamma provided complementary results which suggested that controls, but not patients, activated left anterior regions during the linguistic processing. Patients’ hypofrontality was functionally correlated to their lack of left hemispheric specialization for language: the higher delta amplitude in left anterior sites, the higher levels of P1 and P2 positive symptoms; the higher gamma percentage in right anterior sites, the higher levels of N4 (i.e. Passive/apathetic social withdrawal).

Delta and gamma rhythms are quantitative indices of the amount of neurons engaged in specific cognitive processes and they represent complementary physiological indices of neural inhibition/activation able to measure both the hypofrontality and the functional deficit of language lateralization in schizophrenia patients.

To create an image of therapeutic options available for the first episode psychsis and the way these options influence the evolution of patients.

The present study is part of a larger follow-up study on a number of 121 patients with a diagnostic of first episode psychosis admitted in the Timisoara Psychiatric Clinic and The Day Clinic in the Timisoara Mental Health Center between 2003-2006 and prospectively monitored from the moment of their first contact with psychiatric services.

The average calculated duration of prodrome period and average Duration of Untreated Psychosis (DUP) are similar to the results indicated by most other studies. The results of statistical tests show that: the longest the prodrome, the worse the improvement of illness during course; a longer prodrome is correlated with a higher number of relapses during the patient's illness course and a longer Duration of Untreated Psychosis is likely to lead to an increased severity of illness. Patients’ adherence to treatment is influenced both by the traits of the first psychotic episode and the way the patients perceive the side effects and the general utility of the administered medication.

Psychiatrists have to dedicate more time and interest to establishing a therapeutic alliance with their patients with first episode psychosis; an individualized strategy is required to establish the adequate means and ways of intervention before initiating any type of therapy.

Cognitive deficits in schizophrenia consist of deficits in attention, concentration, fluency, and executive function. Especially the working memory deficits influence everyday function and rehabilitation.

The ame of the study was to investigate a potential of a neurocognitive intervention in schizophrenia (CS) and multiple sclerosis (MS) by application of a computerised working memory training.

So far, 30 ms patients and 14 cs patients were investigated. Patients are allocated to a treatment group or to a control design. At baseline, all participants underwent a comprehensive neuropsychological examination including memory, working memory, attention, concentration, information processing speed, mental flexibility and intelligence. The treatment group performed a computer program (Brainstim®) four times a week over a period of four weeks. After 16 training sessions all participants were evaluated again neuropsychologically.

In both patient groups a significant increase in cognitive performance within the training procedure could be shown. This increase was expressed by an initial exponential function with a steep increase and an asymptotic slope. Pre-post-test-comparisons revealed significant improvement for shortterm and working memory on the neuropsychological outcomes. The program was well accepted by the patients.

This preliminary results show, that working memory might be trained in schizophrenia and thus it might interfere positively the cognitive und rehabilitative outcome.

Estimation of acoustic startle response (ASR) and its prepulse modification in Russian population of patients with schizophrenia and healthy controls.

All subjects were males 25-50 years old. ASR was measured bilaterally by orbicularis oculi electromyographic response to 50 ms 110 dB white band noise. Prepulse at lead intervals of 60, 120 and 2500 ms were delivered according to protocol, recommended by Consortium on the genetics of schizophrenia.

ASR magnitude to pulse alone trials in initial block and habituation didn’t differ significantly between patients and controls. Patients compared to controls displayed reduced magnitude prepulse inhibition that was significant at 60 ms lead interval and reduction was more pronounced at the left eye. Startle latency prepulse facilitation at 60 ms lead interval was observed in patients but not in controls whereas prepulse inhibition of startle latency at 120 ms lead interval was seen in controls but not in patients. ASR amplitude prepulse facilitation (PPF) at 2500 ms lead interval was impaired in patients and this deficit was observed only in drug-naïve subjects. Effects of head trauma and experience of psychoactive drugs intake on ASR prepulse modification were revealed only in controls. High initial amplitude and short ASR latency in patients correlated with excitation level (PANSS scale P4). At the same time, PPF reduction correlated with scales P2, P4, P5, P7 and sum of positive PANSS scales.

Results of present study testify the possibility of ASR prepulse modification use for schizophrenia endophenotyping in Russia.

Study of psychophysiological candidate schizophrenia endophenotypes in relation with neurotransmitters blood level and mental disorders.

23 patients with schizophrenia and 24 healthy subjects performed horizontal antisaccades. Acoustic startle response (ASR) prepulse modification was studied according to protocol, recommended by Consortium on the genetics of schizophrenia. Neurotransmitters blood plasma level was estimated using HPLC.

Significant increase of errors and saccade latencies was revealed in patients compared to controls. ASR prepulse inhibition (PPI) at 60 ms lead interval and ASR prepulse facilitation (PPF) at 2500 ms lead interval were impaired in patients. Analysis didn’t reveal any correlations between ASR and antisaccades measures in patients while in healthy controls high initial ASR amplitude correlated with incorrect antisaccades number and PPF level correlated with antisaccades latencies. Significantly higher individual variability of plasma serotonin, glutamate and taurine content was found in patients compared to controls. Positive correlations of PPI with glutamate and taurine content were observed in patients but not in controls. At the same time, correlation between PPI and serotonine turnover ratio was positive in control group and negative in patients. Antisaccade latencies in controls displayed negative correlation with DOPAC and taurine level while in patients they positively correlated with dopamine and negatively with serotonine turnover ratio. It was also found that antisaccades parameters and ASR measures displayed correlations with different PANSS scales.

These data support the hypothesis that PPI and antisaccades are associated with different neural networks and have different genetic aetiology.

Schizophrenia is a chronic and potentially devastating disease. Patients with schizophrenia have severe and persistent sleep disturbance. Sleep deprivation may foster poor functioning and high levels of thought disorder, hostility, and excitement. Sleep deprivation in patients with schizophrenia have a negative impact on HRQoL. This study was done, as definitive study, to determine the sleep quality and quality of life in schizophrenia.

72 schizophrenic inpatients treated in a mental health care centre with the diagnosis of schizophrenia between March 1st and May 31st, 2009 were included to the study. The data was gathered through personal data forms, PSQI and WHOQOL-Brief Turkish Version.

It was found that there was a meaningful relationship between the age, sleep quality and quality of life of the patients (p< 0.05), it was also defined that sleep quality decreased as the age increased and quality of life decreased since the quality of sleep was decreased. The life quality points, except physical field, of the patients who live alone, hospitalized more than three times a year, do not use their medicine regularly were defined low.

There is a close relationship between the sleep quality and quality of life of the schizophrenia. As the sleep quality diminished, their quality of life decreases. The quality of life of the schizophrenia may be increased by regulating their sleep pattern and supporting their adoption to the illness.

Finally recognized as a powerful co-therapeutic factor, family caregivers of persons suffering from schizophrenia play an important role in the treatment process.

The aim of our study was to examine the family caregivers’ perceptions of antipsychotic medications.

In this study, the European Federation of Associations of Families of people with mental illness self-completion questionnaire was used. Data were collected from 40 family members, the key caregivers of 40 schizophrenic patients.

Average age of a carer was 56, 97 (±11, 48) and 65% of them were females. Parents were dominant, caring for an ill son (37, 5%) or daughter (42, 5%). Family caregivers spent every day caring for the ill relative (100%); mean time of caring was 15, 2 years. Lack of education about condition and treatment side effects were seen as main reasons for drug discontinuation. Nearly half of caregivers (45%) stated forgetfulness as an important factor of treatment non-adherence. Every 6th family member had complains about complicated drug routine and too many medications prescribed. At the same time, they considered that keep taking the medication as recommended is very important for the remission achievement and that reaching remission is a long process which usually requires multiple changes of antipsychotic medications (4 changes on average).

Family caregivers of schizophrenia sufferers share almost the same considerations about antipsychotic medications with professional caregivers. Further closer collaborations between formal and informal caregivers may help to go beyond some obstacles and to get a better treatment adherence.

This was an observational, uncontrolled, 4 week inpatient study, conducted at Unit VII, Clinical Hospital of Psychiatry Prof Dr. Alexandru Obregia, Bucharest. We included in the study 31 inpatients that suited the criteria admitted between January and March 2008. Patients received aripriprazol oral for four weeks. The patients received initially 15 mg aripiprazol. When the symptomatically hadn’t responded in 5 to 7 days we added 15 more mg aripiprazol. The group was divided in 2 parts: in one of them the patients received 15 mg in the morning, and in the other 15 mg in the morning and 15 more at noon.

Treatment efficacy was assessed using PANSS at baseline and at the end of weeks 2 and 4.

The CGI-S was performed at baseline and at the end of weeks 1,4. CGI-I assessments were conducted at the end of weeks 1, 2 and 4.

Clinically important change were not noted with regard vital signs measurements and physical examinations.

At the end of the study a persons gain weight.

The results of the study suggest that aripriprazole was efficacious safe and well tolerated for patients with acute psychosis - Aripriprazol 30mg/day was. Adverse events were generally mild and not treatment limiting. The majority of patients remain on the 30mg/day dose during the study.

Kartagener's Syndrome is a rare congenital malformation and characterized by the triad of bronchiectasis, sinusitis, and situs inversus. We presented a case diagnosed as Kartagener's syndrome and psychotic disorder not elsewhere specified.

The case was a male patient, 32 years old, high school educated, married, with two children. He had a history with increasing psychotic symptoms and two times of suicide attempts for the last two months needed hospitalisation. In the psychiatric examination affect was blunted, there were anxiety, fear due to auditive hallusinations and referance delusions, anhedonia, suicidal thoughts and attempts, secondary depression. Psychiatric disorder predominently with auditive hallusinations and social withdrawal had a duration of three years. He was diagnosed as Kartagener's Syndrome when he was nine years old. The patient was treated with haloperidol 20 mg/day, biperiden 5 mg/day, klorpromazin 100 mg/day during hospitalisation. The psychotic symptoms were reduced within third day. On radiography his heart was seen at the right side of his body, there was bronchial dilatation in the medial and inferior lobes of left lung, thickness of walls of bronches and increased peribronchial density.

We assume that the biochemical disorder that is the cause of the development of Kartegener Syndrome is related with the genetic location which facilitates the development of psychosis or risk of psychosis.

Addictive disorders are frequent in schizophrenia and dual diagnose is the norm rather than the exception. Dopamine transmission is implicated both in addictive disorders as in psychotic diseases. The objective is to know if addiction is one independent dimension in schizophrenia or if it can be included in to the positive, negative or affective syndromes.

We conduct one cross-sectional study on 60 schizophrenia out-patients (43 male; average age: 38.9 years, SD 9.4). The diagnosis were: paranoid schizophrenia 26.7%, schizoaffective disorder 25.0%, residual schizophrenia 21.7%, other schizophrenia subtypes 26.6%. It was applied the PANSS and one addiction composite score (ACS) that reflects the life use of drugs and addiction: tobacco, coffee, alcohol, cannabis, cocaine, amphetamines, hallucinogens, opiates and gambling. For every substance and gambling were scored: first use, frequency, length of use, last time use and harmful consequences. All the scores were transformed in to Z values. Factor analysis using principal components (Varimax rotation) was performed introducing in the model: PANSS positive and negative items, depression item an the ACS.

Five factors were defined, that explains for 78.4 of the variance: negative (N1, N2, N3, N4, N6), disorganized (P2, P4, N5, N7), positive and depressive (P1, P3, G6), hostility (P5, P6, P7) and addictive (ACS).

Addiction is one independent dimension in schizophrenia, differentiated from positive, negative, disorganized and hostility syndromes. We propose the systematic study of addiction as one intrinsic dimension of schizophrenia due to its independence of other dimensions, its high prevalence and its clinical relevance.

The dysexecutive syndrome is present in half of the schizophrenia patients and is highly dependent on the dopamine functioning. We hypothesize that early and mild dysexecutive syndrome in schizophrenia is mainly subjective. The objective is to study the subjective manifestation of the dysexecutive syndrome and its relationship with other symptoms of schizophrenia.

One cross-sectional study was conducted on 60 schizophrenia out-patients (43 male; average age: 38.9 years, SD 9.4). The diagnosis were: paranoid schizophrenia 26.7%, schizoaffective disorder 25.0%, residual schizophrenia 21.7%, other schizophrenia subtypes 26.6%. The dysexecutive syndrome was assessed by DEX Scale (self-applied and applied by one external observer). Using PANSS and one addiction composite score (ACS) it was defined five symptom dimensions: negative (N1, N2, N3, N4, N6), disorganized (P2, P4, N5, N7), positive and depressive (P1, P3, G6), hostility (P5, P6, P7) and addictive (ACS). Basic symptoms were studied with FCQ-III. All the scores were transformed in to Z values. Correlations between DEX and the clinical dimensions were studied using Spearman's Rho coefficient.

Dysexecutive syndrome is associated with basic symptoms (self-applied: r = 0.83, p< 0.001; external observer: r = 0.54, p < 0.001), disorganization (external observer: r = 0.46, p = 0.001), positive and depressive symptoms (self-applied: r = 0.54, p< 0.001; external observer: r = 0.44, p = 0.001) and addiction (self-applied: r = 0.35, p< 0.01).

Basic, hallucinatory, delusional and depressive symptoms in schizophrenia, as well as the disorganized dimension, could reflect the subjective experience of one dysexecutive dysfunction.

Cognitive deficits, in particular that of memory and executive functions, have been linked to functional disability. The treatment with antipsychotic drugs leads to subjective changes in cognitive functioning as well as subjective experience of schizophrenic patients, which both contribute to compliance and treatment outcome. Aim of this study was to evaluate the role of clinical, neurocognitive and pharmacological variables on the subjective perception of cognitive functioning in schizophrenic patients.

The sample was composed of 78 schizophrenic inpatients (M/F=38/35, mean age 41 + 11.6 years) recruited in the Rehabilitative Centres of two Departments of Mental Health in Italy and treated with typical (n= 15) or atypical antipsychotics (n= 63). Patients were diagnosed according to the DSM-IV TR criteria and evaluated with the Frankfurter Beschwerde Fragebogen (FBF) Scale, the SAPS and SANS (Scales fot the Assessment of Positive and of Negative Symptoms). Neuropsychological functioning was assessed by means of the Wechsler Adult Intelligence Scale (WAIS- R).

The results showed that the severity of symptoms was correlated positively with a greater impairment on self perception of mental functioning. Neuropsychological functioning also correlated with self perception of cognitive deficits, with an abnormal subjective experience associated with more neuropsychological disturbances. Atypical antipsychotics were associated with a better insight of cognitive dysfunction.

The results of the study underline the importance to investigate the subjective experience of schizophrenic patients treated with antipsychotic drugs in order to improve treatment adherence and efficacy in schizophrenia.

Symptomatic remission is increasingly perceived as a realistic objective of pharmacological treatment in patients with schizophrenia (2). However the relationships between symptomatic remission, as defined by standardized criteria, and functional outcome remain controversial. In the present study, we designed a one-year follow-up of clinically stable patients with schizophrenia and examined the relationships of clinical remission with several indices of psychosocial functioning.

Thirty-six patients with schizophrenia were included. All the evaluations were carried out both at baseline (T0) and after a one-year follow-up (T12). The categorization in psychosocial remission/non-remission was done by means of the Psychosocial Remission in Schizophrenia (PSRS) scale.

Both at T0 and at T12, R showed, with respect to NR, a better social functioning and a better quality of life. Correlation analysis revealed that the better the psychosocial functioning, the lower the scores on all psychopathological dimensions, except “anxiety/depression” and “hostility” at T0 as well as “anxiety/depression” at T12. At T0, 65% of R resulted also in psychosocial remission; at T12, this percentage reached 90%.

Our findings suggest that symptomatic remission in schizophrenia is associated to functional outcome in the majority of cases, especially when both symptomatic and chronological criteria are met.

To investigate the executive function and learning ability of the patients with first-episode schizophrenia, and its relationship with the patients’ clinical symptoms.

50 schizophrenia patients and 50 healthy controls were tested by the Tower of London (TOL). All the subjects received two phases of the test of TOL continuously, with a break of 1 minute. And Positive and Negative Symptom Scale (PANSS) was used to assess the clinical symptoms of the patients.

Compared with the control group, the number of reply during the 1st phase (x1) and the 2nd phase (x2)of the patients group, was lower (P<0.01); the reaction time during the 1st phase (t1) and the 2nd phase (t2) was longer (P<0.01); while the rate of correct answer during the 1st phase (p1) and the 2nd phase (p2) do not differ. For the control group, x2 was higher than x1 (P<0.01), and t2 was shorter than t1 (P<0.01). However, for the schizophrenia group, there were no difference between x1 and x2, t1 and t2. The value of x1, p1, x2 of the patients were correlated negatively with the PANSS negative subscale score (P< 0.05), and t1 and t2 were correlated positively with the the negative subscale score (P< 0.01). The performance of the TOL did not correlated with the PANSS positive subscale score and general psychopathology subscale score.

The executive function and learning ability of the schizophrenics are impaired and the impairment of the cognitive function is significantly correlated with the negative symptoms of schizophrenia patients.

Persistent sedation is a side effect of antipsychotic drugs, with a substantial impact on quality of live and treatment adherence. Additionally sedation can contribute to weight gain and metabolic disturbances. It impairs also patient's driving skills. In present study we evaluated sedative effects of antipsychotic drugs using three methods that are accessible, and easy to use in psychiatric practice.

59 patients with schizophrenia (mean age 25.1 ± 3.6, 27 M, 22 F) were included to the study before the discharge from an open psychiatric ward. All patients underwent monotherapy with sedative (olanzapine; n=33, mean dose 15.4 ± 5.9), moderate -sedative (risperidone; n=12, mean dose 4.4 ± 1.8) and non-sedative (aripiprazole, sertindole; n=14, mean dose 18.7 ± 6.2, 15.5 ± 3.3) antipsychotics. The patients underwent EEG recordings, 28-minutes long psychomotor vigilance task (Mackworth Clock Test) and filled out Epworth Sleepiness Scale (ESS) and scales for assessment of sleep quality.

Increased slow-wave EEG activity was found in 21 (63.6%) of patients treated with olanzapine, 8 (66.7%) of patients treated with risperidone and 3 (21.4%) of patients treated with non-sedative antipsychotics (p< 0.05). Abnormal results of psychomotor task were found respectively in 10 (30.3%), 5 (41.7%) and 4 (28.6%) of patients (not significant). Mean ESS score was: 6.9 ± 3.3, 8.0 ± 3.0, 5.4 ± 3.7, respectively (not significant).

Signs of sedation were frequent in EEG recordings of patients treated with sedative antipsychotics, however at performance level in psychomotor task the differences between the investigated drugs were less pronounced.

To test the psychometric properties of the Quality Indicator for Rehabilitative Care (QuIRC), refine the toolkit and compare results with service user experiences.

Following the initial development of the toolkit, it was translated into the languages of the partner countries and piloted. It was then refined to maximize a) its inter-rater reliability, b) its usability and c) its ability to deliver assessments relevant to each country's established systems of change at local, regional and national level. Managers of participating units were re-interviewed using the refined tool. 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 tool was piloted in 20 units in each country (a total of 200 units). Inter-rater reliability was assessed using intra-class correlations and Cohen's Kappa coefficients. Factors with low reliability or extreme response biases were dropped. Remaining items were subjected to an exploratory factor analysis to test domain allocation and improve internal consistency. QuIRC domain ratings were compared by country and facility type and with service user assessments. The QuIRC was found to have high reliability, to be easy to use and there was high correlation between domain ratings and service users’ ratings.