Schizophrenia is a disorder related with decline in cognitive functioning. Deficit of working memory and executive functions in schizophrenia is consistently reported. On the other hand, studies of decision making in schizophrenia bring contradictory results.

The aim of the study was to assess decision making and executive functions in clinically stable schizophrenic patients.

The study included 25 clinically stable schizophrenic patients (7 female, 18 male), aged 31±6 years and 25 age, sex and education years matched healthy controls. Decision making was assessed with Iowa Gambling Task (IGT). Working memory and executive functions were assessed with Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT). Psychometric asessment was provided with Positive and Negative Symptoms Scale (PANSS)

No significant differences in performance on IGT between schizophrenic patients and healthy subjects were found. Schizophrenic patients made more perseverative (t=-4,05; 0,00) and nonperseverative errors (t=-4,35, p=0,002), gave less conceptual level responses (t=-5,35; p=0,00), completed less categories (t=-4,73, p=0,00) and used more cards to complete first category (t=-3,98, p=0,00) in WCST. They also needed more time to complete part A (t=-5,62; p=0,00) and B (t=-4,06; p=0,00) of TMT test.

No significant differences in performance on IGT between schizophrenic patients and healthy subjects were found. On the other hand, schizophrenic patients performed significantly worse on all measures of WCST as well as in TMT test.

Dynamic transformation of paraphilia (connection of new paraphilia‘s forms to already existing) has been connected with the psychotic symptoms and increase of negative symptoms of schizophrenia (r=0.51, p=0.03). Abnormal sexual imaginations appear during manifestation of schizophrenia in puberty age. A syndrome of a metaphysical intoxication, delusional depersonalization coexisted with available sexual perversion. In sexually mature age of patients with schizophrenia, dynamic transformation of paraphilia was associated with increase of negative symptoms. Anabatic of schizophrenia correspond with a degree of aggression sexual perversion. At episodic type of current paranoid schizophrenia with persistent but non-progressive negative symptoms in the intervals between psychotic episodes connected such types of paraphilias, as pedophilia, exhibitionism, visionism. At episodic type of current paranoid schizophrenia with a progressive development of negative symptoms in the intervals between psychotic episodes connected such types of paraphilias, as necrophilia, gomicidomania. In our research pseudopsychopathic schizophrenia combined with multiple disorders of sexual preference (exhibitionism and visionosm) only in two cases. In these cases we are showed connecting pedophilia.

Preliminary results showed relationship between dynamic transformation of paraphilia and clinic and dynamic of schizophrenia.

Clozapine has several major side-effects for example agranulocytosis. There are however several severe cardiac side-effects associated with the use of clozapine.

We present two psychotic patients, who were treated with clozapine. One patient developed myocarditis and the other patient developed cardiomyopathy. These findings raised questions about the frequency of cardiac side-effects due to clozapine treatment.

Awareness of cardiotoxic side-effects of clozapine; Creation of a clinical guideline for myocarditis and cardiomyopathy in clozapine treatment

Two case reports, one male 57 years, suffering from paranoid schizophrenia developing myocarditis, the other a female of 62 years also suffering from paranoid schizophrenia, developing cardiomyopathy during clozapine treatment are presented.

Secondly, an extensive literature search with keywords: Myocarditis; cardiomyopathy, heartfaillure and clozapine has been performed.

The incidence of myocarditis and cardiomyopathy associated with clozapine use are possibly around 1 percent, 10-100 times higher than previously assumed.

Myocarditis and cardiomyopathy are cardiac side-effects of clozapine use which are severe and have a possible fatal outcome. Diagnosis of namely myocarditis can be difficult.

Research suggests that these side-effects might be less rare as thought of until recently. A clinical guideline for monitoring of these side-effects didn’t really exist to this moment. A proposition for a clinical guideline has been made in this presentation consisting of namely: anamnestic findings laboratory tests and ECG controls. Awareness for myocarditis is especially necessary during the first 4 weeks of clozapine treatment.

A considerable amount of data from Western culture suggests that negative family environment can increase the rate of relapse in patients with severe psychiatric disorders. The objective of this study was to explore the effect of family psycho-education intervention on family environment of relatives of patients with severe mental disorders in Iran.

Using an experimental design, with pretest, posttest and a control group, families of 30 patients with severe mental disorders were divided into two groups: six sessions of family psycho-education (intervention group); and no treatment (control group). Family environment was assessed using Family Environment Scale (FES).

Results showed that the family psycho-education program improved cohesion and expressiveness in family members (p< 0.01) but it had no significant influence on conflict (p>0.05).

Family intervention increased cohesion and expressiveness, but it had no significant effect on total family environment score or conflict. One explanation could be that our short- term program focused more on communication skills of family members rather than conflict resolution. Resolving conflict is complex in families of patients and need more time to change. The present study confirmed the need for family psycho-education and availability of resources to offer longer-term family psycho-education program to families of patients.

Low level inflammatory Mild Encephalitis (ME) mechanisms were suspected in a subgroup of treatment resistant hospitalised affective and schizophrenic spectrum disorder patients.

We analysed albumin, IgG, IgA, IgM, oligoclonal IgG and specific antibodies in paired cerebrospinal fluid (CSF) and serum samples from patients with affective (n=24) or schizophrenic spectrum disorders (n=39). Numerical and graphical interpretation of CSF protein data was performed by Reibergrams with reference to a large control group (n= 4100).

In 41% of the psychiatric patients (n=63) we observed CSF pathologies: 14% displayed intrathecal humoral immune responses, 10% slightly increased CSF cell counts (5-8/μL) and 29% had moderate blood-CSF barrier dysfunctions, in 24% as the only pathological sign with normal IgG, IgA and IgM concentrations in CSF (p= 0.9 testing the null hypothesis for intrathecal synthesis with reference to Qmean of the reference group). In the affective (n= 24) spectrum 20% displayed a systemic immune reaction as detected by oligoclonal IgG. In probable 6% of virusspecific, bacterial or autoimmune associated disorder with CNS involvement. Elevated CSF neopterin concentration in 34% of the patients was interpreted as an increased release from astrocytes or from other glia cells.

The low level immune response and barrier dysfunctions are discussed on the base of a ME pathomechanism in subgroups of psychiatric patients. CSF analysis is shown to be a useful diagnostic tool for differential diagnosis in psychiatric diseases.

Antipsychotic polypharmacy and high doses have been associated with poor outcome and increased adverse effects in schizophrenia. However, their relation to cognition has been poorly studied.

40 right-handed patients (mean age: 42.87 years; SD:10.57) with DSM-IV schizophrenia, were recruited in an acute psychiatric ward. They were assessed on the Spatial Working Memory test (SWM) of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wechsler Adult Intelligence Scale (WAIS-III) at a time when they were able to cooperate with neuropsychological testing. The pattern of their pharmacological treatment was also assessed. Statistical correlation and Mann-Whitney tests were performed using the SPSS, as appropriate.

18 patients were receiving antipsychotic polypharmacy (≥2 antipsychotics) and 22 monotherapy. 13 patients received an excessive (≥1000 chloropromazine mEq(CmEq)/day), and 22 a normal antipsychotic dosage. No significant difference was detected on any of the SWM performance measures between the two groups of patients receiving either polypharmacy or monotherapy. These groups did not also differ in the WAIS full scale, performance or verbal IQ scores. When the patients were divided into two groups receiving either an excessive or a normal dose of antipsychotics, these two groups also showed a similar SWM and WAIS performance. The total antipsychotic dose showed negative but nonsignificant correlations with the SWM performance scores.

We did not detect any influence of antipsychotic polypharmacy or excessive dosing on spatial working memory in schizophrenia. This finding supports the independence of working memory deficits from the effects of treatment in schizophrenia.

We observe the schizophrenia process through specific structural terms - specific models and shapes of the internalisation deficit and consequental structural variability.

We describe the specific influence of the developmental deficit on the schizophrenic process by presenting the case of a 17 year old female patient diagnosed with schizophrenic psychosis hebefrenic form. By observing the patient's life history, we interpreted her psychological development throug early introjective configurations, identification process, the phase of forming realistic images of the self and the outher world and the forming of the Ego identity. The current state is explained throug deficit Ego functions.

The bringing up of the patient in an unstable and disturbing primary family group, with the mother suffering from Sch psychosis and a grandmother addicted to alchocol, caused pathological modifications in the introjective process and forming of a confused Ego identity. Fragility, non-differentiality and polar exclusiveness of mental representations, which is dependant on the characteristics of the primary object relationschipts, form an insecure mental structure which the patient uses to schape her perception of herself and the world, which can be phenomenologically recognised in the direct and inner presentation of the devil and god as clear and utterly scharp opposites.

The schizophrenic process is connected to the developmental deficit which is conditioned by the failure to organize and integrate the inherent structures forming the core of individual self organization. This essentialy directs development toward the schizophrenic process.

Poor response of psychotic symptoms to a single antipsychotic drug appears to be the most common reason for combination of two antipsychotic drugs. Antipsychotic combinations are in clinical practice very common, although there are not sufficient evidences of their efficacy from randomized, controlled trials. We evaluated the efficacy and safety of augmenting amisulpride with quetiapine in patients with sub-optimal response to amisulpride.

In this open-label, non-randomized study, 36 patients who were partially responsive to amisulpride after 4 weeks of treatment were assigned to receive up to 600mg/day quetiapine along with an ongoing stable dose of 800mg/day amisulpride. Patients were evaluated at baseline and at week 1, 3, 6 and 8. Efficacy was assessed using Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) scale and for tolerability we used Simpson-Angus Rating Scale (SAS).

Thirty-one patients completed the study. There was an improvement in the mean scores for PANSS (with more than 30%) and CGI after 8 weeks of treatment, with no major changes in side effect profile.

In patients with a suboptimal response to amisulpride, the addition of quetiapine improved overall positive and negative symptoms of schizophrenia. The combination seems to be safe and well tolerated. Augmentation with quetiapine may provide clinical benefits for patients who are only partially responsive to amisulpride alone. Randomized controlled trials are necessary to evaluate the possible role of this augmentation strategy.

Attribution style and reaction to frustration play an important part in both depression and paranoia. The objective was to study the attribution style and frustration reaction between persistent delusional psychosis with depression and persistent without depression.

Fourty patients diagnosed with ICD 10 persistent delusional disorder with a period of evolution of 8 years, was grouped into 2 subgroups:

1. a) with depression and

2. b) without depression.

All are part of the Cases Registrer of Timisoara Psychiatric Clinic (CRPTC) which monitors the functional psychoses from 1985. For each patient was applied in period of remission BPRS (Brief Psychiatric Rating Scale), ASQ (Attributional Style Questionnaire) and Rosenzweig frustration test.

The persistent delusional psychosis without depressive features present a more internal and less stable attributions of the negative events. For the positive events, the stability and globality is higher for those with depression. Concerning the response to frustrating situations, persistent delusional psychosis with depression give answers prevailling extrapunitiveness, whereas those without depression give prevailling need-persistence answers. There are significant similarities between the two groups concerning the type of persisting necessity.

Among the persistent delusional psychosis, those with depressive features demonstrate an agresivity directed more towards exterior in the frustrating situations and associate less the negative events with their own personality than the pure persistent delusional.

The stages of the subjective psychological process of recovery after the first psychotic episode were explored; since psychological functioning, as well as symptoms and social functioning in the critical period probably are the most important long-term outcome predictor variables.

The RSQ (Drayton, et al., 1998) and the STORI (Andresen, et al., 2006) were used to assess 30 patients (72.4% males) recovering from the first episode of a non-affective psychosis, 3 to 9 months after their clinical discharge. The mean age was 24.34 (SD=4.5, range=17-34).

The RSQ stages of recovery were: Tendency toward sealing-over (7.7%), Mixed, sealing-over predominates (42.3%), Mixed, integration predominates (38.5%), and Tendency toward integration (11.5%). The STORI stages of recovery were: Moratorium (11.5%), Awareness (31.0%), Preparation (27.0%), Rebuilding (11.5%), and Growth (19.0%). Significant correlations were found between better recovery stages and patient's adherence to treatment (X2 = 9.579, p = 0.008). Correlations between recovery stages and symptoms, neuropsychological functioning, and other variables were also explored.

Recovery styles of Integration and Growth significantly correlate with treatment adherence, a better symptomatic (less negative and general symptoms) and functional recovery, but not with DUP, stigma, or neuropsychological variables.

Delusional parasitosis, also known as Ekbom syndrome, is the most frequent among the somatic delusions. It may occur at any age but is more common in the elderly, particularly in females. It is a syndrome in which the patient has the false belief that he is infested by some type of insects, lice, worms or other invertebrates, and that they live or grow under their skin or inside their body. Psychiatric interventions are usually rejected by these patients and long-term treatments are frequently abandoned.

A clinical case was followed and reviewed to illustrate the links between somatic delusions, hypochondriasis, somatization and obsessive disorders.

A 58-year-old female presents delusions of infestation. She has a long history of somatization and hypochondria, which can be interpreted as a continuum in the onset of the delusional syndrome. In this case, delusions of infestation are projected onto a third person. Psychophramacological treatment with long acting injectable risperidone was then introduced, as an alternative to drugs previously used.

The effectiveness of pimozide and risperidone for the Ekbom syndrome has been documented in the literature. In our case, we decided to introduce long acting injectable risperidone after several rejections or long-term discontinuation in oral treatments.

Identification of interrelationship immunity with clinical-social adaptation of schizophrenic patients.

We examined 107 schizophrenic's (76,1% - patients with paranoid schizophrenia with continuous and episodic type of course, F20.00, F20.01, F20.02).

The psychometric scale PANSS was used to estimate the dynamics of psychopathological symptoms during treatment. The immunological examination included the definition of phenotypes of surface receptors of immunocompetent cells, level of IgM, IgG, IgA. The research was carried out in two points: first - at admission, second - in 6 weeks of treatment.

Four adaptation types have been revealed: integrative (combining high clinical and social indices, 40,1% of patients); introvert (high clinical and low social indices, 38,3%); extrovert (low clinical and high social indices, 11,2%); destructive (combining low clinical and social indices (10,4%).

It has been shown that patients with extrovert and destructive adaptation types characterizing by great severity of psychopathological symptoms (high score) according to PANSS.

At 1st point Т-immunodeficiency was diagnosed among the schizophrenic patients, which was kept within 6 weeks of treatment. In the therapy course peculiarities of psychoneuroimmunomodulation have been revealed: relatively favorable in immunological aspect are integrative and introvert types of adaptation. In integrative type number of immunocompetent cells does not change and has trend toward normalization. In destructive type greater suppression of T-immunity has been revealed (CD2+-, СD3+-, and СD4 +-lymphocytes decrease); HLADR+-lymphocytes remain high.

Thus, clinical-social differences between groups have been confirmed by data according to immune reactivity.

Self-esteem in schizophrenic patients is low. Self-esteem is the most important factor in these patients improvement and music therapy enhances self-esteem.

This study has been conducted with the aim of examination the effect of music therapy on self-esteem of chronic schizophrenic patients.

In This experimental research regarding pilot study and inclusion criteria, 70 persons of male in-patient chronic schizophrenic patients were determined and allocated in 3 groups: experimental 1(24 persons), experimental 2(22 persons) and control group (24 persons) randomly. Music game was implemented in experimental group 1 and lyric analysis in experimental group 2 for one month, 12 sessions, lasting 45 minutes each. Demographic questionnaire and Coopersmith self-esteem Inventory were measured. In internal consistency assessment, chronbach’.α 0/84 and in test-retest reliability, pearson correlation coefficient 0/89 were determined. SPSS version 15 and one way ANOVA, paired t test, Chi-square, Kolmogorov-Smirnov, levene's tests were used for data analysis.

There was not significant difference between self-esteem of patients in experimental and control groups before music therapy and between experimental groups 1 and 2 after music therapy (P>0/05) whereas there was significant difference between experimental and control groups and in intervention groups 1 and 2 after music therapy (P< 0/05).

Music therapy enhances self-esteem in chronic schizophrenic patients and also there was not considerable change in self-esteem increase between music game and lyric analysis. These two types of music therapy can be used in enhancing self-esteem of these patients.

A primary goal of recovery-oriented mental health services is to increase client voice and empowerment. Shared decision-making (SDM) technologies can help achieve this goal. We report on two projects that aim to increase engagement around antipsychotic medications by people with serious mental illness (SMI).

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Project 1: Using a participatory-action research (PAR) orientation, a partnership between a university and a public MH clinic developed around a shared goal of finding an acceptable SDM intervention targeting medication use by persons with SMI. We solicited input about SDM from national experts and via focus groups of local stakeholders and analyzed the qualitative data.

Project 2: The US Substance Abuse and Mental Health Service Administration (SAMHSA) contracted with Advocates for Human Potential (AHP) to develop a decision aid (DA) for consumers considering use of antipsychotic medication. Based on the results of literature reviews and stakeholder needs assessments, we constructed a multi-module consumer-centered DA that follows the International Patient Decision Aid Standards (IPDAS) for DAs. The DA is still under construction; however, we have completed entering the format and content of several of the modules.

Audience responses to the concept of SDM have been mixed. The PAR group identified multiple barriers to implementing SDM in practice, including consumer factors, information exchange, skill requirement, and outcomes expected from using SDM.

Adapting shared decision-making technologies to mental health settings has unique challenges. We are using the barriers identified by the PAR group to guide creation of the SAMHSA DA.

Forty four years old, single, unemployed male patient with paranoid schizophrenia and congenital myotonia has been presented in this case report. He was hospitalized because of collecting garbages, hostility toward his brothers, fattening many animals, living in very dirty surroundings. His mother was treated as bipolar disorder.

He had muscular disease since childhood, weakness began initially in arms then in legs. There is muscular weakness in both of the proximal and distal extremities. He presented with dirty, old attire. He was indifferent and had flattened affect. His behaviors were bizarre. He made poor eye contact. He had no insight. He was in defensive attitude. There was no hallusinations. He had severe persecutive delusions toward his brothers. Generalized muscular disease with myotonic decharges was diagnoses in EMG. Olanzapine,20mg/day was applied. The patient responded to the medication and the psycotic symptoms were totally disappeared.

It is known that central serebral system may be effected and hypodense areas are seen in the brains of Thomsen type congenital muscular dystrophy which is comorbid with mental retardation (Kamoshıta et al 1963). We assume that an unspecified disorder in the central serebral system might be presented as paranoid schizophrenia in this patient with congenital myotonia and there may be some common aspects among both of these illnesses.

There are no obvious data to sustain that amisulpride-quetiapine-memantine association would induce remision of resistant schizophrenia. The clinical consequences and the challenge of medication for resistant schizophrenia are important. This case report brings additional information about therapy in resistant schizophrenia.

Case Report: 38 years old patient, male, with repeated hospitalizations for schizophreniaparanoid type, from 1989; the precedent psychotic episodes were treated with haloperidol, risperiodone,amisulpride, olanzapine, clozapine and quetiapine. The latest episode was treated with olanzapine (20mg/day- 8 weeks), with failure, and, after that, with clozapine (500mg/day- 8 weeks) without remission. The patient has been hospitalized after olanzapine and clozapine treatment failure and treated with association of two different classes of neuroleptics (amisulpride 800mg/day and quetiapine 200mg/day) and memantine (10mg/day).

The treatment with amisulpride-quetiapine- memantine association induced remission of symptoms and discharge from hospital after 18 days of treatment, sustained by PANSS score reduction (from105 at hospitalization to 40 at discharge). This symptoms remission is important because it happens after clozapine treatment failure, with known efficacy for treatment resistant schizophrenia.

For a patient with schizophrenia-paranoid type, treatment resistant, amisulpride-quetiapine- memantine association had the power to induce remission of symptoms. The combinated multireceptoral D2, 5HT2A, NMDA action of medication may be important in choosing the treatment for resistant schizophrenia.

Many studies have recently been carried out to compare the effectiveness of various antipsychotic agents.

We wished to determine what could be learnt from these studies about the effectiveness of antipsychotics, and whether this should influence choice of treatment.

We carried out a literature search using PUBMED. We directed special attention to large studies comparing medications in schizophrenia. These studies included CUTLASS, CATIE, SOHO, CAFE, and EUFEST (Kahn 2008, Haro 2006, Jones 2006, Lieberman 2005, Perkins 2008), as well as studies by Tihonen 92006, 2009) The studies were critically reviewed.

The different studies measure different aspects of care, at different phases of the illness. This illustrates the need to study schizophrenia through a stage model. Furthermore, different outcome measures are proposed. We believe that discontinuation data, on which some studiesdepend, is a weak measure of effectiveness. Important doubts arise regarding the choice of patients (those requiring switching of antipsychotic) in CUTLASS, and also regarding potential observer bias in this study.

There is much information to be gathered from the results of such studies. However interpretation is made more difficult by problems within the study designs themselves. On balance it does appear that different antipsychotics have different effectiveness. The main difficulty in putting these results into practice is concern among clinicians and patients regarding side effects.

Disturbances of sleeping are very common among patients suffering from mental disease. The purpose of the research is to find a relationship between schizophrenia and disturbances of sleeping, such as problems with falling asleep, arousing at night, waking up untimely in the morning, bad quality of sleeping and its insufficient quantity.

16 patients (3 women and 13 men) with a diagnose of schizophrenia were recruited to the study. The battery of cognitive neuropsychological tests used to assess disturbances of sleeping included: Athen Insomnia Scale (AIS), Beck Depression Inventory (BDI) and Frankfurt Self-feeling Scale (FBS).

In the examined group statistically significant presence disturbances of sleeping was found, and in this connection worse self-feeling were also affirmed.

The above correlations between disturbances of sleeping and worse mood indicate that removing of that disturbances improves mental and physical condition of patients with schizophrenia. The awareness of these correlations may be important in the process of constructing treating programmes for patients.