Schizophrenia is very common, chronic illness affects 1% of population. Cognition dysfunctions are considered as important factors of social and general life impairment. There are many unchangeable risk factors of cognition decline in schizophrenia subjects such as age, duration of illness, and sex.

The aim of study were to examined correlations among age, sex, education, duration of illness and scores in neuropsychological tests.

In our study 220 subjects (116 male, and 104 female) in mean age 41 ± 11,3 with diagnosis of schizophrenia were examined with battery of computerized neuropsychological tests: simple reaction test (SRT), verbal memory test (VMT) and delayed verbal memory test (VMDT), visual working memory test (VWMT). Mean duration of illness was 12 years (min 1 year; max 41 years). Mean duration of education was 11,5 years (min 6 years; max 18 years)

1. 1) Age was correlated with worse scores in every parameters of all tests.

2. 2) Females got lower correct answers and longer reaction time (815 vs. 630 ms) in SRT, remember fewer words in VMT and cards (3,9 vs.4,3) in VWMT.

3. 3) Longer duration of education was correlated with better results in every parameters of all tests except number of correct answers in SRT,

4. 4) Longer duration of illness was correlated with worse scores in SRT, better scores in VMT, VMDT and VWMT.

Cognition decline in schizophrenia is connected not only with factors related with illness. Demographic factors, mostly unchangeable, are take important rule in cognition functioning.

The Personal and Social Performance (PSP) scale is a reliable and valid instrument that utilizes objective parameters for assessment of social functioning in patients with schizophrenia. The aim of this study was to determine the validity and reliability of the French version of PSP in a population of French schizophrenic patients.

Patients with DSM-IV diagnoses of schizophrenia and schizoaffective disorder were recruited and assessed in a cross-sectional design using the PSP, GAF, SOFS, PANSS, CGI severity. Internal consistency for the PSP was obtained and convergent validity was assessed using correlations between PSP, GAF and PANSS factors. Inter-rater reliability was evaluated with intra class correlation coefficient (ICC).

147 in and out patients, at 5 French sites participated in this study. The Cronbach's alpha coefficient of the PSP was good (alpha=0.77). The PSP showed very good inter rater reliability (ICC = 0.90). Pearson correlation coefficient for association between PSP and GAF (r=0.85) and PSP and SOFS (r=- 0.78).are high proving good convergent validity for PSP. Pearson correlation coefficients are moderate when PSP is correlated with 4 of the five PANSS sub factors (r from -0.43 to -0.48). The anxious and depression factor (r=-0.17) showed low correlation with PSP. Spearman Rank correlation coefficient between PSP and CGI severity was r=-0.72.

Our results demonstrate that the PSP scale is a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in acute state.

This presentation will compare preliminary results from the first two European studies being carried out on acupuncture and schizophrenia, one in the UK and one in Germany. Statistical comment will be made on comparable study outcomes and there will be discussion on the methodological successes and challenges of the studies. Implications for future research on acupuncture on acupuncture and schizophrenia in European mental health settings will be explored.

Both studies are using a case study approach, incorporating a wide range of methods, in order to explore the possible effects that acupuncture may have on schizophrenia. Amongst the methods used to explore the possible effect that acupuncture might have, both studies are using the Positive and Negative Symptom Scale (PANSS), and the Pittsburgh Sleep Quality Index (PSQI).

The intervention phase of both studies is currently underway. First results of the PANSS and the PSQI will be presented.

These are the first attempts to carry out research on the possibility of acupuncture as a treatment or an adjunct treatment for schizophrenia in Europe. It is hoped that these results will indicate the way forward in terms of analysis of the remainder of the outcomes of the study and there will be some indication for the possibility for future research in this area.

The purpose of this study is to determine the type of somatic pathology which appears in schizophrenic spectrum psychosis, in a sample of subjects admitted in the Psychiatric Clinic in Timisoara in the year 2008.

The sample studied contained 158 patients (105 with a diagnosis of schizophrenia, 46 with schizoaffective disorder and 7 with acute and transitory psychotic disorder) who were admitted in the year 2008. This sample was evaluated from a clinical (PANSS), global functioning (GAF) and somatic co morbidities perspective.

The case evaluatian showed that 30% of the patients presented also somatic pathology. High incidence presented cardiovascular pathology (8,86%), digestive pathology (7,59%) and respiratory pathology (3,79). Obesity was present in 6,32% of the subjects. There was a category of subjects who presented various types of somatic comorbidities (8,22%).

Subjects with psychotic disorders present a high risc for developing somatic pathology, the most common being the cardiovascular pathology. There was no evidence for differencies in the type of somatic pathology between subjects with schizophrenia and those with schizoaffective disorder.

Neurocognition is impaired in patients with schizophrenia, and almost all patients demonstrate some measure of decline from their expected level. Neurocognitive impairment is a core feature of schizophrenia and is the single strongest correlate of real-world functioning. To date, several instruments can measure neurocognition, but none of them could be used in daily clinical practice because of their long duration of assessment or the high level of training needed to use them. The aim of the present study was to create a scale that measures different neurocognitive domains usually impaired in schizophrenia (attention, work memory, verbal memory and executive functions).

40 patients with schizophrenia according to DSM-IV-TR criteria have been included in the study and 100% of the patients have been able to complete the scale, that was generally well accepted. Neurocognition was also evaluated in some of the patients with the WAIS-III to compare the scores with our new and not validated scale. Psychiatrists, neuropsychologists and ergotherapists administered the scale. Inter-ratter reliability was evaluated. The time to complete the scale was not more than 10 minutes. Results are under analysis and will be presented during the meeting.

Measuring neurocognition in daily practice is crucial to better evaluate the effect on neurocognition of pharmacological and none pharmacological cares in schizophrenia.

Memory impairment has been acknowledged as a core cognitive deficit in schizophrenia, however distinct functional subtypes of memory are differently impaired in these patients.

To assess working memory in schizophrenia patients.

Forty schizophrenia inpatients, mean age 29.1 years from the 3rd Psychiatric Clinic Cluj-Napoca, Romania, were included. Exclusion criteria were mental retardation, history of drug or alcohol use, neurological or systemic conditions, recent electroconvulsive therapy. The control group consisted of 30 healthy subjects (mean age = 29.6). The Word List Memory Test (WLM), the Face Memory Test and the Spatial Working Memory Test on a Cogtest Console were used in the assessment of the 2 groups.

Schizophrenia patients displayed specific impairments of working memory, such as lower learning (42.65 ± 12.87 vs. 51.80 ± 14.31, p = 0.006) and trial-to-trial transfer capabilities (54.82 ± 25.29 vs. 87.21 ± 8.99, p < 0.001), impaired face recognition abilities reflected in lower correct answer proportion (0.66 ± 0.13 vs. 0.83 ± 0.09, p < 0.001), and impaired visuo-spatial memory, when compared to controls (89.42 ± 55.42 vs. 49.37 ± 16.57, p < 0.001). It was specifically observed that higher rates of non-list words were recorded in WLM in the schizophrenia patients group.

The study supports the current data which state that working memory deficits in schizophrenia are consistent, stable and comprehensive, which is particularly relevant for the social functioning of schizophrenia patients. Occurrence of non-list words in auditory memory may explain the mechanism of paranoid delusions.

Alert to the high prevalence and familial association between schizophrenia and mental retardation.

Review relevant literature after the description if a clinical case example; additional diagnostic exams.

Description of a clinical case: Man with 25 years old with mental retardation and first episode of pchicosys.

He and his all family works in the fire department. In his family history there is a mother with pchicosys, father with mental retardation, sister with a post partum depression, aunt with bipolar affective disorder, and two uncles who comet suicide.

In January of 2008, he begins to hear voices, in his work, that call him and ask for help; then he begin to see an old lady in his bedroom's window; he stop sleeping and eating. The family brings him to the emergency room and he's started diazepam (15 mg/day) and olanzapina (20 mg/day) and the symptom remit.

Three days later, he stops the medication and the symptoms came back. He gets very scared and begin to take the medication every day.

He did a brain computerized tomography that excludes organic diseases and psychological tests that confirms mental retardation.

It is well established that prevalence of schizophrenia is around three times greater in those with mild mental retardation and the co-association between mental retardation and schizophrenia is highly familial. Both bipolar illness and major depressive disorder have also increased prevalence in the mental retarded. The prognosis is directly linked with family and social support.

To underline the importance of a correct diagnosis and management of catatonia and complications increasing its morbidity and mortality. Catatonia is a syndrome of altered motor behaviour, mainly classified as a form of schizophrenia. Recent literature suggests catatonia is an independent syndrome, frequent among patients diagnosed with mania/depression or accompanying many general medical conditions and neurological disorders.

We describe the case of a 58-year-old woman with NIDDM in antidiabetic oral therapy and history of schizophrenia, diagnosed when aged 20 and treated with Haloperidol (10 mg/day), Levomepromazine (100 mg/day) and Lorazepam (2.5 mg/day) who was admitted to our clinic for a condition characterized by mutacism, staring into space, muscular rigidity and bilateral arm cogwheeling, initially suggesting a neuroleptic malignant syndrome.

At hospitalization there was no fever, leukocytosis or CPK elevation. She quickly developed altered consciousness, autonomic dysfunction (hypertension, dysphagia, uncontrolled hyperglycaemia) and waxy flexibility finally recognized as a catatonic syndrome, according to DSM-IV-TR criteria. Multiple infections (urinary trait infection, teeth infections leading to sepsis) worsened her clinical condition. The first therapeutic strategy was suspending neuroleptics. Psychomotor symptoms, rated with the Catatonia Rating Scale (CRS), gradually resolved by intravenous administration of Lorazepam high doses (up to 12 mg/day). General medical conditions improved with specific antibiotic therapy, endovenous hydratation and parenteral nutrition. A physiatric rehabilitation program was started, with significative motricity improvement.

This report underlines the importance of the differential diagnosis between catatonia and similar conditions (such as NMS) and the fundamental role of multidisciplinary approach to complications.

The sample was comprised by 38 patients who were admitted in the psychiatric ward of the University Hospital of the Canaries. Thirty eight patients were male and 9 were female with medium average age of 37.41±11.23. Exclusion criteria were psychoactive substance use, presence of acute or chronic organic pathology, treatment with immunosuppressive medication, pregnancy and mental retardation or severe cognitive impairment. There were performed two blood extractions following the circadian rhythm, at 12:00 and at 24:00 hours. One hour before night blood collection, each patient was placed in a reclined position in bed, with the eyes closed, in complete darkness and with eyes covered with a mask. Blood was centrifuged at 3.000 rpm for 10 minutes. Specific biological and psychopathological determinations were performed at admission and at discharge. Psychopathology was assessed with PANSS and by the same psychiatrist. Statistical analyses were carried out with the Social Statistical Package for the Social Sciences (SPSS). MDA was determined spectrophotometrically.

MDA level at night was 1.94±1.54 while MDA level at midday was 2.23±1.36.Mean PANSS negative score was 15.73±6.31.Serum MDA level correlated positively with PANSS negative scores, both at midday and night (midday r=0.39, p< 0.01, midnight r=0.41, p< 0.01).

The total negative subscale score correlated positively with day and night time levels of MDA, therefore we can conclude that MDA may be used as a marker of negative psychopathology.

Major goals in the treatment of schizophrenic out-patients are the reduction and stabilization of psychopathological symptoms, the reduction of relapses and a lasting improvement of the quality of life.

Non-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first episode of schizophrenia (ICD-10 F20.x) with monotherapy of long-acting injectable risperidone (RLAI).

Interim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. Median start and end dose of RLAI was 37.5 mg/2 weeks. More than 80% of RLAI patients showed 75-100% compliance; 63% improved compliance compared to previous treatment. Improvement from baseline to endpoint was significant (p< 0.0001) for total PANSS (31.4±30.0), SF-12 physical (7.6±11.6) and mental health scores (13.4±12.5) and total SWN-K scores (20.7±23.5). Most patients had no relapse (89%) and no hospitalizations (92%) due to underlying psychosis during the observation period under RLAI compared to 59% with at least one hospitalization within the 12 months prior to this study. Mean relapse free time was 208.6±5.1 days. 119 adverse events (AEs; 28 serious AEs) were reported in 47 patients. Most common AEs at least possibly related to RLAI were lack of effectiveness 8.0%, weight increase 8.0%, psychotic disorder 5.7%, anxiety 3.4%, EPS 3.4%.

The results indicate that RLAI has good tolerability and good clinical effectiveness in the therapy of schizophrenic out-patients. High compliance, low hospitalization and low relapse rates under RLAI may help patients achieve stable remission and to master daily life.

Improvement of social and occupational functioning is a major goal in the treatment of schizophrenic patients and therefore may improve reintegration of patients and their ability to lead an independent life.

Non-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first manifestation of schizophrenia (ICD-10 F20.x; duration of disease ≤10 years) with long-acting injectable risperidone (RLAI) in monotherapy. Presented here is the assessment of the treatment based on the Clinical Global Impression (CGI), the Global Assessment of Functioning (GAF), and skills assessing the ability of patients for reintegration as quantified by the short version of the International Classification of Functioning, Disability and Health for Mental Disorders (Mini ICF-APP).

Interim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. GAF total scores improved significantly (24.4±23.7); 76.0% of the patients improved in CGI-C. Mini-ICF-APP total scores improved significantly from 1.96±0.68 to 1.18±0.94 at final observation. All Mini-ICF-APP sub-items improved significantly, particularly within: participation in public roles, non-occupational activities, self maintenance, competency, flexibility, family relations. 119 adverse events (AEs; 28 serious AEs) were reported in 47 patients. Most common AEs at least possibly related to RLAI were lack of effectiveness 8.0%, weight increase 8.0%, psychotic disorder 5.7%, anxiety 3.4%, EPS 3.4%.

Results indicate that treatment with RLAI may improve global functioning of patients by reducing typical disorder of functioning, capacity and participation. Treatment with RLAI may help patients to reintegrate into social and occupational environments.

This non-interventional study (RIS-SCH-4023) examined tolerability and effectiveness of risperidone long-acting injectable (RLAI) versus oral second generation antipsychotics (oSGA: amisulpride, aripiprazole, olanzapine, quetiapine, risperidone or ziprasidone) in schizophrenia under daily routine.

Outpatients receiving RLAI (n=177) or oSGA (n=257) were followed-up for 2 years (m/f 42%/58%; mean age 34.6 years; duration of disease 2.6 years). Outcome measures included PANSS, CGI, relapse rates, treatment adherence and tolerability. Post-hoc analyses focused on baseline between-group differences.

Multivariable analysis using recursive partitioning showed that upon study entry RLAI patients were 3.7 times (CI=2.48-5.59) more likely than oSGA patients to have switched to study medication due to non-compliance and/or to be substance abusers (RLAI= 59.9%, n=106/177 vs. oSGA=28.6%, n=73/255). Despite these differences, both groups demonstrated significant improvements in efficacy measures with no between-group differences. There were no significant differences in discontinuation of study medication over the two years (RLAI 41.2% vs. oSGA 36.6%) or in yearly relapse rate before change of the initial therapy (RLAI 0.48±1.48 vs. oSGA 0.71±2.63). In patients with high adherence (≥75%) to previous treatment (physicians’ estimates, 4-point Likert scale) RLAI vs. oSGA patients had significantly better retention rates (RLAI 57.4% vs. oSGA 35.1%) and times (527.0±32.6 vs. 424.1±22.3 days). Most frequently reported treatment-related adverse events were weight increase (13.0% vs. 9.7%), EPS (7.9% vs. 5.5%), hyperkinesia (6.2% vs. 3.5%), fatigue (5.7% vs. 9.7%).

Results suggest that factors associated with poor outcomes such as poor compliance and substance abuse may be attenuated by treatment with RLAI.

Contemporary researches of the cognitive impairment in schizophrenic patients were conducted in three directions: Cognitive declining as a developmental precursor of schizophrenia, evolution of the cognitive deficit during the illness, and at last, impact of pharmacological treatment on cognitive functioning. The main aim of our study is to evaluate differences between first and second-generation antipsychotics in manifestations and course of the cognitive declining, in patients with first episode of paranoid schizophrenia.

We conducted open label, prospective trial, at the sample of 12 patients during first episode of paranoid schizophrenia. Diagnosis was made according to the criteria of the International classification of diseases 10th revision. The sample was divided in two clusters with 6 patients in each one. In the first cluster, patients received first-generation antipsychotics, and in the second one was administered second-generation antipsychotic - risperidone. Cognitive functions was evaluated by Mini Mental State Examination Test which is modified with adding two simple neuropsychological tests: Clock Drawing Test and Test of Verbal Fluency.

We found more prominent cognitive declining in first cluster patients - particularly mnestic deficit.

First-generation antipsychotics posses more prominent negative impact on cognitive functioning in comparison to second generation antipsychotic - risperidone.

Exelon (ravastigmine tartrate) is dual, reversible cholinesterase inhibitor. FDA has approved its use in treatment of Alchaimer dementia and Dementia combinated with Parkison disease. In addition to this, results based on small clinical studies and case reports showed positive efects of rivastigmin tartrate in therapy applied in numerous pyschiatric disorders.

In this study 15 patients have been observed. According to ICD 10 they all satisfied criteria for diagnosis of residual schizophrenia and had a score of below 24 at MMSE and high scores at NPI 12 and BPRS. During the period of 60 days, apart from antipsychotics and anxiolitics or psychostabilisers, patients also received rivastigmin tartrate in their therapy.

The study showed that rivastigmine therapy produced significant improvements when it comes to cognition and reduction of disorders in the sphere of afective-behavioristic functioning of patients with residual schizophrenia. However, this interpretation cannot be confirmed to be completely valid due to the size of treated group, the absence of the control group, and the length of the observing period.

Dual cholinesterase inhibitors (Acetilcholine and Butirilcholine) may produce improvement in cognition and behavioural performances, as well as the general quality of life of patients diagnosed with residual schizophrenia. Future studies applied on this kind of patients should precisely explain the basic pharmachological mechanisams of rivastigmin tartrate, and approve/disapprove the results of clinical studies and case reports that have been preformed so far.

Since apoptosis is considered to play a role in the pathogenesis of schizophrenia the aim of this study was to examine the Fas and Fas ligand (FasL) system in patients with schizophrenia. FasL is transmembrane protein that induces apoptosis by binding to its specific receptor Fas. The Fas-FasL complex is an important effector of cell death in different cell types.

Serum Fas and FasL levels were determined in 30 patients with schizophrenia (11 females, 19 males), and 30 healthy controls (11 females, 19 males) by the ELISA method.

Serum Fas levels were significantly higher in patients with schizophrenia (4.63±0.96 ng/mL, p< 0.05) than in controls (4.12±0.81 ng/mL). A significant increase in FasL levels was also found in schizophrenic patients (0.099±0.029 ng/mL, p< 0.05) in comparison with those in healthy controls (0.085±0.023 ng/mL). Schizophrenic males showed significantly higher both Fas (4.97 ± 0.83 ng/mL, p< 0.05) and FasL (0.103 ± 0.032 ng/mL, p< 0.01) compared to the control males (4.30 ± 0.93 ng/mL; 0.079 ± 0.011 ng/mL, respectively). A significant positive correlation between patient serum FasL and lymphocyte caspase-3 activity was found.

These results clearly show a disregulated extrinsic apoptotic pathway in patients with schizophrenia.