Determinate folate and vitamin B12 serum levels in a sample of naive psychotic patients and in a sample of healthy population.

For 24 patients with a first psychotic episode serum folate an vitamin B12 were measured, and we take a sample of 30 person from healthy population adjust with age and gender for comparing both groups.

In the sample of psychotic patients 15 patients (62,5%)presents low levels of folate, and 2 (8,3%) vitamin B12 deficiency. In the group with low levels of folate the mean was 1,5 ng/ml, and in the group with low levels of vitamin B12 the mean was 155 pg/ml. In healthy sample, 9 persons presents low levels of folate and there weren’t any vitamin B12 deficiency in this group. We compared the mean of folate levels in both samples and there was a significance difference between them.

Important percentage of patients with a first psychotic episode presents a folate deficiency, in our area, with lower levels of this vitamin than in the healthy population, so maybe is a factor that influence in development of the disorder.

Scientific researches show that the acts of aggression in schizophrenia appear more often than in case different mental disorders. In the literature, however, exists little data which would describe wider this phenomenon. The most often the aggression in schizophrenia is connected with psychopathological symptoms, but also with characteristic the features of frontal lobe syndrome. The most typical symptom in this range is emotional disorders, particularly lability of mood which can lead to occurrence of aggressive behaviours.

The purpose of this research was to assess the intensification and identification of forms of aggression in schizophrenia. Moreover explanation of connection between aggressive behaviours and cognitive functions relating with frontal lobe.

30 patients from first episode of schizophrenia in age 18-30. Researches were realized in Department of Developmental, Psychotic and Geriatric Psychiatry, Medical University in Gdansk.

1. * Positive and Negative Syndrome Scale (PANSS)

2. * The Overt Aggression Scale (OAS)

3. * Wisconsin Card Sorting Test (WCST)

4. * Trail Making Test (TMT)

5. * Color Reading Interference (Stroop)

Shared psychotic disorder (DSM-IV-TR) or induced delusional disorder (ICD-10) is a condition involving the appearance of delusions to two or more subjects who generally live in close proximity. We compare three cases and their management described in Ramón y Cajal Hospital in Madrid.

The first case involves a mother and daughter shared delusion of injury with respect to the neighborhood. In the second case involves two sisters living together, with delusion of persecution and prejudice and without psychiatric history. The third one was admitted to our unit after a suicide attempts. It was a middle-aged man who shared with four members of his family the perception of supernatural entities in his home.

At the first and second cases it was necessary mechanical and pharmacological restraint. One of the therapeutic indications is the separation of subjects and It generated significant moments of tension and resources of the emergency department. In the third case was not accurate mechanical and pharmacological restraint. The most effective in this case was the regulation of sleep-wake cycle and separation of the individual during a time of home and family. In all three cases the perception of illness worked individually and kept contact with the therapists to plan responsible for monitoring the treatment plan and management in the future.

We must be prepared before the arrival of an event of this kind to the emergency of the hospital.It's necessary to elaborate an effective joint therapeutic strategy both during their hospital stay or as outpatients.

Admission experience has been shown to be related to insight and treatment adherence. We evaluated the clinical correlates of the Chinese Admission Experience Survey (C-AES).

A four-week longitudinal correlation study was carried out to investigate the relationship between admission experience and clinical variables. The C-AES was administered to 40 patients with schizophrenia within 48 hours of admission as a baseline, followed by subsequent interviews at two weeks and four weeks post-admission. Degree of insight into disease, attitude towards prescription, medication side effects and psychiatric symptomatology were assessed using established instruments, namely the Scale to Assess Unawareness of Mental Disorder (SUMD), the Drug Attitude Inventory (DAI), the Extrapyramidal Symptom Rating Scale (ESRS), the Scale for the Assessment of Negative Symptoms (SANS) and Scale for the Assessment of Positive Symptoms (SAPS). Regression by Generalised Estimating Equations (GEE) was used to evaluate the relationship between the clinical variables.

An improvement in insight was associated with a reduction in perceived coercion (B = 0.261, p < 0.01) during the four-week treatment. An increase in atypical antipsychotic dosage in milligram of chlorpromazine equivalents predicted insight improvement (B = -0.001, p < 0.01). There was an associated improvement in attitude towards medication (B = -0.027, p < 0.01). These observations were independent on schizophrenic symptoms or extrapyrimidal side effects.

Improvement in insight is associated with a reduction in perceived coercion and a more positive attitude towards prescription, and is predicted by a higher dosage of atypical antipsychotic.

To find out the frequency of medical conditions presented by a population of institutionalized chronic schizophrenic patients.

The target population is a total of 220 schizophrenic patients, 48 men and 172 women, diagnosed following the ICD-10 criteria, institutionalized at least during 5 years in a 76,8% of the patients. The average age was of 64,64 years.

Specific survey applied by the group of investigators aiming to collect socio-demographical data and the medical conditions, using the following psychometric scales: Cumulative Index of Illnesses (CII), Global Assessment Scale (GAS), and Clinical Global Impression (CGI).

Statistical analysis was performed with SPSS v 15.0, including descriptive statistics and correlation analysis.

Diabetes was found in 15% of cases, obesity in 31,7%, overweight in 39%, high blood pressure in 24,5%, high cholesterol serum levels in 21%, high triglyceride serum levels in 8,7%. A 26% of the patients were smokers.

The average number of categories at the CII scale was 4,84 and the average total score was 11,96.

Our patients predominantly are of an advanced age, female sex, and long-term inpatients. The presence of comorbid physical illness is high. The relatively low number of smokers could be explained by the demographic characteristics of our sample.

Course and outcome in schizophrenia are heterogeneous. Numerous studies have shown an association between the presence of negative symptoms and psychosocial and occupational functioning of patients.

To analyse the prevalence of negative symptoms in the course of illness in first episode psychosis and chronic schizophrenia and to establish its relation with the functional outcome.

43 patients with a first-episode psychosis (FEP) from our area were compared with 43 chronic schizophrenic patients and 43 normal controls from a parallel area. They were matched one on one for age, gender and years of education. All subjects were compared regarding psychopathology and functional outcome terms. Patients were examined with Positive and Negative Syndrome Scale (PANSS) for clinical symptom. Longitudinal functionality was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales.

We found significant differences between FEP and chronic patients in negative symptom severity (t = -4.97, p< 0.001) and global assessment of functioning (t = 7.58, p< 0.001). There was no statistically significant difference between the two groups in PANSS positive and general components or Clinical Global Impression. Negative symptom severity was associated with poorer GAF ratings in first episode psychosis and chronic schizophrenia.

Negative symptoms appear to be persistent. In our study negative symptom severity was associated with social and functional impairment, defined as Global Assessment of Functioning Scale score of less than or equal to 60.

Comparison of social functioning of first-admitted schizophrenic patients with healthy subjects and evaluation of the influence of several socio-demographic and clinical variables on social abilities of patients, 1 month (T1), 13 months after hospitalization (T2) and 4-6 years after T1 (T3).

A group of 74 schizophrenic patients: 46 male and 28 female; age 24.7 ± 6.7 and a control group of matched 52 male and 34 female subjects were enrolled. Social Functioning Scale (SFS), Positive and Negative Syndrome Scale (PANSS), Global Assessment Scale (GAS) and socio-demographic questionnaire were used.

In all examinations SFS scores in the patients (T1 - 103.4; T2- 104.4; T3- 107.0), were significantly lower than in the healthy controls - 117.0 (p< 0.001). In longitudinal analysis, a mild improvement was observed in T3 SFS score and in its three subscales (p< 0.05). In cross-sectional analysis, better social functioning was associated with female sex, longer education, activity before admission, and better functioning in the pre-admission period. In regression analyses SFS at T2 was predicted by PANSS (27% of the variance) and at T3 by PANSS and duration of psychotic symptoms (20% of the variance).

Social functioning in schizophrenia is disturbed from the onset of the disease and may be mildly improved in the intermediate follow-up. The duration of untreated illness and severity of symptoms after the first admission, are the independent significant determinants of social functioning in early course of schizophrenia.

To compare “big five” personality trait dimensions in psychiatrically healthy individuals and first episode psychosis (schizophrenia and bipolar disorder).

Clinically stable patients with first episode schizophrenia (22M, 4F) and bipolar disorder (24M, 8F), and psychiatrically healthy subjects (101M, 36F), completed the NEO-FFI personality inventory. The NEO-FFI is a 60-item self-assessment questionnaire that measures the major personality trait dimensions of neuroticism (N), extraversion (E), openness (O), agreeableness (A) and conscientiousness (C); it has good reliability and cross-cultural validity (McCrae et al, J Res Person, 2004;38:179-201). Gender-specific T-scores were analyzed using standard multivariate statistical techniques.

As expected, age correlated with personality dimensions in the entire sample (N= -.144, p= .045; O= -.169, p= .018; A= .228, p= .001; C = .150, p= .037). MANOVA with dimension scores as dependent variables, diagnosis as a fixed factor independent variable, and age as a covariate demonstrated that schizophrenia and bipolar groups were statistically similar on N, A, and C. Both patient groups were significantly higher than comparison subjects on N and lower on A and C (see Figure). All three groups differed significantly on E (schizophrenia < bipolar < comparison), but no groups differed on O.

Personality deviations are present in first episode schizophrenia and bipolar disorder, and are similar to abnormalities previously described in patients with more chronic illness.

Fig. 1

[NEO Dimension Scores by Group]

Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.

To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.

27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).

Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.

We investigated neuropsychiatric patients with non-bacterial meningitis (N-MEN)), assumed chronic low level neuroinflammation (schizophrenic SCH-S and affective spectrum disorders PSYCH-A) and tension headache (CEPH). Cytokines investigated were IL-1beta, IL-2, IL-8/CXCL8, the antiinflammatory IL-10 and IL-17.

to differentiate chronic and acute neuropsychiatric diseases by cytokine profiles and to evaluate cytokine levels in the CSF and peripheral blood to characterize the two compartments

Included were 10 N-MEN, 10 CEPH, 15 PSYCH-A and 16 PSYCH-S patients. Peripheral blood and CSF was taken in parallel. Measurement on a commercial multiplex immunoassayplatform (Mesoscale) by a modified protocol. Statistics: Mann-Whitney-U-Test and Kruskal-Wallis H-Test.

Highest levels of IL1b, IL-2, IL-8 and IL-17 were observed in the CSF of N-MEN, whereas in serum, levels were not or slightly elevated. Significant (p< 0.05) tested in CSF for N-MEM versus CEPH,PSYCH-A,PSYCH-S for IL-8 and versus PSYCH-A,PSYCH-S for IL-17. IL-10 CSF levels were also highest in N-MEM, and significant also versus CEPH,PSYCH-A,PSYCH-S, but IL-10 in serum was even higher than in CSF. We observed in all cytokine (except IL-2) significant differences either in serum or in CSF or both between the diseases; but more frequent CSF than in the serum.

N-MEN patients displayed highest ratios of CSF to serum levels for all cytokines (mean between 1.6 and 63).

Investigation of cytokines in CSF is more sensitive than in serum to detect differences between neuropsychiatric diseases. Cytokine patterns are disease specific. Elevated IL-1beta, IL-2 and IL-8 CSF/serum ratios in N-MEM may indicate an intrathecal synthesis of cytokines.

Antipsychotic treatment has been repeatedly found to be associated with an increased risk for venous thromboembolism (VTE) in schizophrenia. The aim of the study was to ascertain whether markers of thrombogenesis are increased in psychotic patients who have not yet been treated with antipsychotic medication.

We investigated plasma levels of markers indicating activation of coagulation (D-dimers) and platelets (solubile P-selectin, sP-selectin) in a group of nine men and nine women with acute schizophrenia who had not yet been treated with antipsychotics (age 29.8±9.1 years; body mass index 23.3±5.1), and eighteen healthy volunteers matched for age, gender and body mass index.

D-dimers (median 0.38 vs 0.22 mg/l; P=0.049) as well as sP-selectin (median 195.9 vs 111.9 ng/ml; P=0.008) plasma levels were significantly increased in the group of patients with acute schizophrenia as compared to healthy volunteers.

The results suggest that at least a part of venous thromboembolic events in patients with schizophrenia may rather be induced by pathogenetic mechanisms related to psychosis than caused by antipsychotic treatment. Finding an exact cause of VTE in schizophrenia is necessary for its efficient treatment and prevention. We are aware of the pilot character of our data, and continue to involve more patients and healthy volunteers into the research.

This study is designed to determine the prevalence and clinical severity of obsessive-compulsive symptoms/disorder, aggression and suicidal attempts at the same time in schizophrenic patients with considering the severe anxiety, depression and substance abuse as confounding factors.

In a cross-sectional study, 100 schizophrenic patients who were diagnosed with structured clinical interview were selected with simple sampling. They were evaluated with Yale - Brown Obsessive Compulsive Scale (Y/BOCS), Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI), Spilberger State/Trait Anxiety Inventory, Beck Scale for suicide Ideation (BSS) (in the case of recent suicidal attempt), and Overt Aggression Scale (OAS).

Obsessive-compulsive symptoms, obsessive-compulsive disorder and suicidal attempt were seen in 33%, 10% and 12% of patients respectively. Most common form of aggression was against others (55%). Patients did not have important differences from the Severity of schizophrenia, thoughts of suicide and aggression. There were no significant differences between severity of schizophrenia, suicidal ideation and overt aggression in patients with and without obsessive compulsion disorder/symptoms. Severity of overt aggression was related to patients' age and education reversely.

High percentage of aggressive obsessions in this study and lack of significant relationship between severity of aggression and presence of obsessive-compulsion disorder indicates that these patients do not act on these thoughts.

Despite advances in the last decade, people with schizophrenia remain disabled by negative symptoms and function poorly in community settings. Until recently negative symptoms were neglected as a treatment target despite apparent recognition of their importance among clinicians.

To examine the impact of negative symptoms on psychosocial functioning in order to assess the importance of such symptoms as a potential treatment target.

295 community based participants with DSM4R schizophrenia were recruited in 11 different European centres and assessed using the following scales: PANSS, GAF, Personal and Social Performance (PSP), Quality of Life Scale (QLS), Functional Recovery Scale in Schizophrenia (FRSS) and PsychoSocial Remission in Schizophrenia (PSRS). Relationships between and negative symptoms and functionality were examined using standard statistical approaches.

In this European cohort negative symptom scores were highly correlated with poor psychosocial functioning in participants living in the community. This significant trend occurred across different scales for measuring functional assessment.

The pharmacological treatment of schizophrenia appears rather becalmed at present. First and second generation antipsychotics appear to have similar efficacy for positive symptoms, different side effect profiles, but little impact on negative symptoms. This study shows a close relationship between negative symptoms and psychosocial functioning: high negative symptom scores are associated with poor functioning. This work supports the view that negative symptoms are a key target for drug development with significant potential benefit for the functioning of individuals. Drug development will increasingly focus on negative symptoms and develop effective adjunctive medication used with existing antipsychotics.

The purpose of this study is to evaluate the clinical and socio-professional functioning status after two years of evolution, on a sample of patients with first episode of psychosis, admitted in the Psychiatric Clinic in Timisoara in 2006.

The initial sample was formed of 41 patients, but at the follow-up point (2008) only 28 patients were still in evidence. Diagnosis was made after ICD 10, BPRS and GAF were used as evaluation tools.

On the initial evaluation 32 % had a diagnosis of persistent delusional disorder, 25 % of short and transitory psychosis, 18% schizophrenia and 25% other psychosis. After 2 years of evolution 46% had a diagnosis of persistent delusional disorder, 25% schizophrenia and only 7 % had acute and transitory psychosis. In 28% of the cases the diagnosis was changed, most of the cases being the ones initially diagnosed with acute and transitory psychosis. The most stabil diagnosis was the persistent delusional disorder. In the majority of the cases we observed a lower socio-professional and family functioning.

The results of this study sugests that the diagnosis of first episode of psychosis is partially predictive for the type of illnes, because a first episode of psychosis can evolve in different pathologies. The socio-professional and family functioning is lower in the majority of cases without a clear connection with the initial diagnosis.

In the last decade the simplification in clinical medicine and the unethiological, general approach is very frequent (the “medicine of consequences”, N. Ilankovic). Because the syndromological diagnoses and (relative) effective symptomatic therapy, in clinical psychiatry in most cases the targets recently are only the phenomenology of behavioral disorders and the hypothezid neurochemical consequences, without precise etiopathogenetic or/and psychodynamic approach.

Researchers have found that both medical and psychiatric comorbidity is common in patients with psychiatric disorders, particularly in children, adolescents and in old age. This nonethiological approach push the mental illnesses and the mental ill patients back in the darkness of unscientific era of middle century.

To schow how many psychotic disorders has real and detectable etiology.

Clinical and etiological analysis of 100 patients with psychotic disorders with data of all clinical laboratory and neuroimaging investigationes.

In most of patient (29%)t he cause of psychotic episode was the substance abuse, in 25% focal and systemic infection (inflammation), in 16% endocrin-metabolic disorders, in 11% brain damage, in 7% cerebrovascular disorders, and in 7% neurodevelopmental disorders.

The real etiological approach in clinical psychiatry open the door to most targeted etiological therapy of psychotic and other mental disorders.

Our goals were to evaluate if the presence of severe delusions negatively affects insight, regardless of diagnosis, and whether or not patients gain insight into their delusions when using a third person perspective.

92 delusional patients with psychotic and psychotic mood disorders were asked to speak about their delusions and were evaluated by means of the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (SAPS and SANS). They were then asked to state whether they thought what they said was believable for them and for the interviewer. After two weeks 79 patients were evaluated with the same scales and listened to a tape where their delusion was re-enacted. They were then asked to state if what they heard was believable for them and for the interviewer.

12 patients thought their delusions was unbelievable for the interviewer at first interview, and 17 patients did the same after the second interview; 4 patients stated what they heard from the tape after the second interview was unbelievable both for them and interviewer. Patients with better insight (patients who stated their delusion was not believable) had a lower SAPS score, a lower item delusion score and a significant improvement of item delusion score at second interview

Several patients gain partial insight when using a third person perspective. The severity of delusions negatively affects insight, regardless of the patient's diagnosis.

Recent studies showed that schizophrenic patients possess adequate attention resources to avoid Stroop colour interference but face difficulty when delays are imposed and multiple attention demands appear. The aim of our study was to use dynamic version of the Stroop interference test based on cognitive remediation techniques within a “training- interference task-test” procedure.

The observed subjects were chronic schizophrenic and schizoaffective patients in worsening phase and the first episode patients who were treated with SGA and having PANSS score above 60, as well as corresponding healthy controls. We trained subjects in Stroop colour interference task and immediately after the training applied different working memory task and subsequently tested the subjects (15 minutes (Stroop Colour task) and >24 hours (Stroop Word task)).

There was an improvement of the cognitive status of schizophrenic and schizoaffective patients similarly as in healthy controls in both the reaction time and response accuracy (p>0.05), whereas the first episode patients performed significantly worse than other two subgroups. This was revealed both in the training and subsequent Stroop Colour interference (Reaction Time: p=0.02, Error Code: p=0.04.

Our findings revealed that chronic schizophrenic patients show same level of achievement as healthy controls despite the demanding experimental design. Poorer results observed in the first episode patients could suggest the favorable effect of the SGA on cognitive functioning, or impose the role of their age. Carefully designed training of cognitive skills could be of high importance in preventing the cognitive deterioration of first episode psychotic patients.

Analysis of correlation between psychopathology and quality of life (QoL) of schizophrenic patients during 4-6 years after the first psychiatric hospitalisation.

Study population included 74 patients. They were assessed at fixed time-points: 1 month and 13 months after the hospitalisation and 4-6 years after the first examination (T1, T2 and T3, respectively). The following instruments were used to assess symptoms, objective and subjective QoL: PANSS (5-factors), Social Functioning Scale (SFS) and WHOQOL.

At T1, the mean PANSS score was 62.4. Significant deterioration was noticed in all groups of symptoms, with the exception of cognitive functions. The greatest deterioration was observed in the negative symptoms and depression/anxiety. At T1, the mean SFS score was 103.4, while mean overall subjective QoL scored 3.3. During the follow-up period, significant improvement of SFS was noticed, with no meaningful change in WHOQOL and concomitant exacerbation of symptoms. QOL was particularly compromised by negative symptoms and depression/anxiety.

Correlation between SFS and negative symptoms varied from -0.61 to -0.76, while those between SFS score and depression/anxiety - from -0.40 to -0.66. Correlation between subjective QoL and negative symptoms as well as depression/anxiety ranged from -0.31 (environment) to -0.64 (physical domain). To a large extent, symptoms were responsible for variance in both SFS and WHOQOL scores.

1. 1) Clinical course of schizophrenia varied, depending on adopted criteria of evaluation.

2. 2) Negative symptoms and depression/anxiety had a particularly deleterious influence on QoL. The role these symptoms varied, depending on time elapsed since the first hospitalisation.