To evaluate changes in the use of non-antipsychotic concomitant medication related to schizophrenia in patients enrolled in e-STAR in Belgium (B), Spain (S) and Australia (A) who were initiated on RLAI.

e-STAR is a secure web-based, international, long-term (1 year retrospective and 2 year prospective) ongoing observational study of schizophrenia patients who initiate a new antipsychotic drug during their routine clinical management. Data reported here are for patients enrolled to date in B, S and A who had information available about the use of concomitant medication at baseline and at 6 months after the start of RLAI.

Of 1,605 evaluable patients (B, n=180; S, n=919; A, n=506), 73.7% received concomitant non-antipsychotic medication at baseline. This proportion had reduced to 60.3% at 6 months after the start of RLAI (82.2% to 71.7% for B, p<0.001; 72.8% to 54.8% for S, p<0.001; 72.3% to 66.2% for A, p=0.01). Reductions between baseline and 6 months were overall: for anticholinergics 29.4% to 17.0% and for antidepressants 22.9% to 19.3% (each p<0.05 for B; p<0.001 for S); for mood stabilisers 17.6% to 15.8% (p=0.01 for S); for benzodiazepines 48.9% to 39.0% (p<0.001 for S; p=0.002 for A); for somatic medication 16.9% to 16.0%. Conclusions. Following the start of RLAI, the use of concomitant non-antipsychotic medication for the management of symptoms associated with schizophrenia or its treatment declined significantly at 6 months compared to baseline.

To determine if there are differences in 6 month outcomes in schizophrenia patients with and without a history of SA treated with RLAI.

Spanish patients enrolled in e-STAR, a secure web-based, ongoing, international, long-term observational study of schizophrenia patients, who initiated RLAI have been followed up for 6 months.

Of 1,107 patients enrolled to date 40.1% had a history of SA, including alcohol, prescription medication, and recreational drugs. More males in the SA group (82.2%) than the non-SA group (49.3%); mean age 35.7 and 40.4 years, mean duration of illness 11.7 vs 13.9 years, respectively. At 6 months 92.3% of SA and 94.7% of non-SA patients were continuing RLAI. Baseline mean Clinical Global Impression-Severity (CGI-S) scores were similar (SA 4.77, non-SA 4.63) and 59.0% of SA and 55.0% of non-SA patients had a baseline CGI-S score of 5-7 (marked-very severe illness). At 6 months CGI-S scores had reduced significantly in each group (SA 3.97, non-SA 3.83; both p<0.001 vs baseline) and the proportion with CGI-S scores of 5-7 fell to 27.3% of SA and 22.9% of non-SA patients. Mean Global Assessment of Functioning scale scores significantly improved between baseline and 6 months in each group; SA 46.6 to 56.5, non-SA 46.8 to 56.6 (both p<0.001). Significant reductions in use of concomitant medication in both groups (p<0.001) accompanied these clinical improvements.

Although a history of SA may predict poorer outcomes in schizophrenia, SA patients treated with RLAI are similarly compliant and improve equally well as non-SA patients.

An interim analysis of 1 year outcomes in schizophrenia patients enrolled in e-STAR in Australia and treated with RLAI continuously for 12 months.

e-STAR is a secure web-based, international, long-term (1 year retrospective, 2 years prospective) observational study of schizophrenia patients who initiate a new antipsychotic drug during their routine clinical management.

Currently, 315 patients have received RLAI continuously for 12 months; mean age 39.6 years, 68.9% male, mean duration of illness at baseline 11.8 years. Mean Clinical Global Impression Severity (CGI-S) scores at baseline (4.6) decreased significantly at 3, 6 and 12 months (n=284) (4.0, 3.7, 3.7, respectively; all p<0.001 vs baseline) indicating a reduction in illness severity from moderately-marked to mildly-moderate at month 3 and maintained to 1 year. The proportion of patients with CGI-S scores of 1–3 (not ill to mild severity) increased from 12.7% at baseline to 40.8% at 12 months (p<0.0001). Mean Global Assessment of Functioning (GAF) scale scores improved from 41.7 at baseline (serious impairment) to 56.7 (moderate impairment) at 12 months with improvements evident from month 3 after the start of RLAI (p<0.001 for both timepoints). Other significant improvements included fewer hospital stays (p<0.001) and rehospitalisations (p<0.001), reduced suicidal ideation (p=0.008) and violent behaviour (p=0.03), and decreased use of concomitant psychiatric medication.

These interim data show that a significant degree of clinical improvement and reduction in hospitalisation occurs early at 3 months in patients treated with RLAI and is maintained with continued treatment over 12 months.

Longer DUP (duration of untreated psychosis) is associated with poorer outcome in schizophrenia. Factors unrelated to disease pathology (socioeconomic status, availability of care, recognition of illness and stigma) may contribute to DUP.

Investigating the relation between DUP and fear of stigma in patients and their family members.

38 patients(diagnosed by ICD X as F20-F29), treated at the Institute of Psychiatry,University Clinical Center in Belgrade and their family members(parents or siblings), were assessed through a questionnaire designed for the purpose of this cross sectional study. Data were obtained on fear of being stigmatized and first contact with psychiatrist (in patients) and stigmatization attitudes,estimated DUP,illness mode of onset,initial treatment mode,present evaluation of patients condition,adherence to therapy (in family members).

Patients included in this study were mostly female (68,42%), with high school education (84,2%), single(84,2%), with average age of 30 and 2,53 hospitalizations.

47,37% of family members,as well as 31,58%of patients were afraid of stigmatization by psychiatric treatment-which prolonged DUP. 42,10%of patients felt that they are presently stigmatized.100%of patients have never heard for antistigma programs.

Average period from first behavioral changes to first contact with psychiatrist was 16,34 weeks and 32,6 weeks until starting a continuous treatment (via hospitalization in 57,9%; abrupt illness onset in 42,10%)

Correlation found between DUP and fear of stigma in patients and their family members requires focused antistigma interventions in order to improve psychotic disorders treatment strategies.

To evaluate efficacy and tolerability of quetiapine sustained release (SR) in a 6-week study (D1444C00132).

588 patients with acute schizophrenia (PANSS total ≥70; CGI-S ≥4) were randomised to fixed-dose quetiapine SR 400, 600 or 800 mg/day (once-daily), quetiapine immediate release (IR) 400 mg/day (200 mg twice-daily; 5-day dose-escalation schedule), or placebo. Quetiapine SR doses: 400, 600 mg reached by Day 2; 800 mg by Day 3. Primary endpoint: change from baseline to Day 42 in PANSS total score (LOCF; ANCOVA). Other assessments: PANSS response rate (% patients with ≥30% reduction in total score from baseline); CGI-I response rate (% patients with rating ≤3); CGI-S; AEs.

446 patients (76%) completed the study (similar across groups). LS mean change from baseline in PANSS total score at Day 42 showed significant improvement versus placebo (-18.8): -24.8 (p=0.03), -30.9 (p<0.001), and -31.3 (p<0.001), quetiapine SR 400, 600, and 800 mg, respectively; -26.6 (p=0.004), quetiapine IR. Statistical separation from placebo at Day 42 for: change from baseline in CGI-S (quetiapine SR 600 and 800 mg; IR); PANSS and CGI-I response rates (all active treatments). Most common AEs with quetiapine: somnolence and dizziness. There were no unexpected AEs with quetiapine SR. Incidence of EPS-related AEs was similar to placebo. Two quetiapine SR and two IR patients discontinued due to AEs in Week 1.

Once-daily quetiapine SR (400-800 mg) was effective versus placebo in patients with acute schizophrenia. Rapid dose escalation was well tolerated, with a therapeutically effective dose reached by Day 2.

Seventy-six patients with DSM-IV schizophrenia and 76 controls matched for age, gender, handedness, IQ, and education were scanned with an optimized DTI sequence at 1.5T. FA maps were co-registered using SPM2 and group differences calculated using non-parametric XBAM_v3.4. Mean FA was extracted from each significant cluster and correlated with illness duration in the patients. Cluster FA was compared between the 15 patients with a few days exposure to antipsychotics and 30 matched patients who had been treated for over a year.

At thresholds of <1 false positive (voxel p<0.01, cluster p<0.0005), there were widespread reductions in FA in the patient group. These areas included bilateral cingulum, superior & inferior longitudinal fasciculus, left uncinate and the genu of the corpus callosum. There were no areas of increased FA in patients relative to controls. In our secondary analyses, there were no significant correlations between the mean FA extracted from any of these clusters and duration of illness, and no significant differences between the briefly medicated and chronically medicated groups.

Schizophrenia is associated with FA reductions distributed widely in white matter, but these differences do not correlate with duration of illness, and do not segregate with medication.

There is considerable concern in quality of life research in determining the influence of clinical variables upon the quality of life of schizophrenic patients With reference to the psychopathology, a number of researchers agree that there is an influence upon QoL in schizophrenic patients. In our study, we try to find a possible correlation between the perceived satisfaction in daily life domains in Greek chronic schizophrenic patients residing in intermediate structures, and their positive – negative and general psychopathological symptoms, just five years after their deinstitutionalization.

To that end, the following questionnaires – scales: a) the Baker and Intagliata questionnaire “Satisfaction with Life Domains Scale” (S.L.D.S.) b) the Positive and Negative Syndrome Scale (PANSS) c) the Global Assessment of Fuctioning (GAF) Scale were administered to a random sample of three hundred fifty five (325) chronic schizophrenics, residing in boardinghouses, transitional hostels, protected apartments in the whole Greece.

The total level of perceived satisfaction in daily life domains, as well as partial indexes, were investigated in relation to the intensity of positive - negative and general symptoms of the existing schizophrenic psychopathology at the time of the patients assessments.

We found that the satisfaction of these patients draw from their whole daily life a) is correlated negatively with the illness's positive and general scale, b) there are differences between the perceived satisfaction in relation to the gravity of their positive – negative and general symptoms of schizophrenia.

The educational programs with behavioral components (diet and exercise) for patients with schizophrenia consistently improve patients' overall health. Here we present the one-year outcomes of 515 out-patients with respect to differences between the two health care services.

This program was delivered by trained psychiatric nurses in 10 sessions (in the Czech Republic) and 8 sessions (in the Slovak Republic) lasting one-hour in consecutive groups consisting of 5-8 participants. We compared groups of participants in both countries, as well as the influence of participation in this program on weight control with regard to antipsychotic medication.

Between January 2005 and 2006 210 out-patients with schizophrenia-spectrum diagnoses entered the courses of the Wellness Program consecutively in the centers throughout the Czech Republic and 305 out-patients throughout the Slovak Republic. For the analysis we included only those patients who participated at least 7x in the Czech Republic (N=127) and 6x in the Slovak Republic (N=269). There was no difference in gender distribution and average age. The baseline parameters were different in both countries (body mass index, knowledge about nutrition and exercise), but their improvement was comparable in a weight loss and in improvement of knowledge about nutrition and exercise.

The Wellness Program was successfully accepted in both countries despite the different treatment structure in both countries. Participants were not only able to remember the facts about nutrition and excercise but were also able to use them in real life which is in connection to their weight loss.

It is important to differentiate between adult autism and schizophrenia. In this presentation, the distinction between autism and schizophrenia will be discussed in the light of two cases.

At the time that they applied to our clinic, we investigated autistic and psychotic symptoms and firstly diagnosed them as schizophrenia.With the more detailed history of illness and investigation the diagnose change as adult autism. In the conclusion the cases will be discussed generally.

The most important clinical differences between adult autism and schizophrenia are stereotypic behaviour and speech. Schizophrenic stereotype has anxiolytic character and autistic one has hedonistic structure. Autistic patients are always aware of their environment and they seem to be mute because of their inner speech, but schizophrenic patients are not. On the other hand, schizophrenic stereotype is aimless and spontaneous, while the autistic stereotype has an aim such as an assurance of being same, and is relatively voluntary. All stereotypic behaviours and speech of the autistic patients are target-locked and cannot be blocked or broken. It seems that, as if autistic patients are addicted to stereotypical behaviours. In such cases, the patient's sentences can be lack of certain grammatical elements or can be incomprehensible. The prosody of this speech can follow certain rules. When he is joined in a conversation, it is rather like a monologue. Patients of schizophrenia generally respond positively to a neuroleptic drug, while autistic patients need a combined therapy of neuroleptic and anti-depressive drugs.

Although there is evidence of deficits in facial expression recognition in schizophrenic patients, studies have often included a very limited number of emotions and specific symptom profiles are rarely included in statistical analyses.

A group of 20 patients with schizophrenia or schizoaffective disorder, and a group of 20 normal controls (matched according to sex, age, educational level) were included. All patients were evaluated with the Positive and Negative Syndrome Scale. For the facial expression recognition task, 56 faces were taken from the Karolinska Directed Emotional Faces (KDEF; Lundqvist et al., 1998), which included 4 pictures of faces (2 male and 2 female) for each of the six basic emotions (sadness, anger, happiness, fear, disgust, surprise), in addition to 4 photos of faces with neutral expressions. Participants were asked to choose the emotion that corresponded with the face.

Analysis of variance (ANOVAs) revealed significant differences between schizophrenic patients and normal controls in terms of KDEF performance. Correlations were observed between KDEF performance and the Positive and Cognitive dimensions of the PANSS. Finally, independent t-tests were performed for scores for the specific emotional expressions of the KDEF, which revealed significant differences between the two groups for joy and surprise.

Results reveal that schizophrenic patients present facial expression recognition deficits compared to normal controls, in particular with the emotions joy and surprise. Furthermore, these deficits are specifically associated with the presence of positive and cognitive symptoms.

Epidemiological study of schizophrenia in Spain with a focus on clinical, diagnostic and treatment trends along the year 2005 compared with those observed in ACE 2004 study;

617 psychiatrists from public and private Spanish clinics registered the first four patients with schizophrenia seen at their offices.

A total of 2,430 patients were entered in the study (70% males, 79% unmarried; median age, 37 years) of which, 1,113 had participated in the ACE 2004 study. Twelve percent of patients had a history of illegal drug abuse, 59% had paranoid schizophrenia, 11% had residual schizophrenia, and 6% showed undifferentiated schizophrenia, with a significant skewing to a greater proportion (71% vs. 47%) of the paranoid subtype among “de novo” patients. On inclusion, 9% were suffering an acute exacerbation, 72% showed a stable disorder, and 18% had active symptoms. Up to 96% of patients included “de novo” had been previously treated with antipsychotic drugs, mainly risperidone (27%), and olanzapine (17%). After inclusion in the study, the antipsychotic drugs most frequentely prescribed were aripiprazole (25%), risperidone (18%), olanzapine (10%), and amisulpiride (8%). Training for psychosocial functioning, and occupational therapy (about 15% each) were the most frequent non-pharmacologic interventions (44% of all patients) used before entering in the study.

Patients observed were predominantly unmarried young males with paranoid schizophrenia. The proportion of patients with this subtype was greater than that recorded for patients who previously participated in ACE 2004 study. A trend towards treatment with aripiprazole or risperidone was observed.

The aim of this study is to analyze the diagnosis that received in the first admission a sample of schizophrenia diagnosed patients.

Health histories of schizophrenia diagnosed patients who entered the Brief Hospitalization Unit of Dr R. Lafora Hospital in 2005 are analyzed. A total number of 162 patients is obtained. The diagnosis that received in the first entrance to our hospital is extracted from the health history.

A 64,4% of the patients with diagnosis of schizophrenia in 2005 were diagnosed of schizophrenia in their first entrance. Another 8,6% were diagnosed of psychotic nonspecified disorder. A 7,4% did not receive psychiatric diagnosis. 6,4% brief psychotic episode. A 3,1% psychotic disorder induced by substances. A 2,5% schizoaffective disorder. A 0,6% bipolar disorder. And a 6,2% received other diagnoses.

The data of our study indicated that a 28,2% of the schizophrenia diagnosed patients received another diagnosis previously (a 7,4% did not receive diagnosis to the discharge). Of the previously data, a 21,4% received diagnoses of psychotic disorders different from schizophrenia. This must probably response to temporary criteria for the diagnosis of schizophrenia (brief psychotic episode) prodromical forms (psychotic nonspecified disorder) and to substances use (psychotic disorder induced by substances) that make difficult the diagnosis in the early phases of the disease.

Despite the use of antipsychotics as monotherapy is considered to be the standard treatment for schizophrenia and other psychotic disorders, many studies prove that antipsychotic polypharmacy (AP) is more frequent than expected in accordance to the experts' guidelines.

To analyze the prescription of long-acting risperidone (LAR) for schizophrenic patients discharged after being admitted in our BHU and its relationship with the AP.

This retrospective study reviews the antipsychotics prescribed to those discharged patients diagnosed as schizophrenic who were admitted in our BHU during 2005. A total of 209 patients are included. The data are analyzed in relation to the prescription of antipsychotics for discharged patients on LAR and the antipsychotic combinations for those patients discharged on another antipsychotic regime, both as a complementary treatment and to cover the LAR therapeutic window.

57 patients (27%) were discharged on LAR. 42% were treated with benzodiazepines, 56% with anticholinergics and 16% with mood stabilizers. 79% of patients treated with LAR were discharged with another antipsychotic in combination: oral risperidone (58%), followed by amisulpiride (18%). Similar dosages were used in patients discharged only on LAR and those used in patients prescribed with more than one antipsychotic (p>0.05).

LAR could be an efficient strategy both to enable the treatment compliance and to achieve a monotherapy treatment. Despite LAR is frequently combined with another antipsychotic, in most cases oral risperidone is used, consequently avoiding the use of two antipsychotics of different kind in the same patient.

Use of antipsychotic drugs in monotherapy is considered the standard treatment for schizophrenia and other psychotic disorders. Nevertheless, exist numerous studies that show as the polypharmacy with antipsyhotics (PA) is much more frequent than it would be expected attending to experts recommendations.

The objective is to compare the prescription habits, in reference to the PA as well as to other psychotropic drugs, of 8 psychiatrists of a Psychiatric Hospitalization Unit.

Review of the psychotropic drugs prescribed as maintenance treatment in schizophrenia patients (n=200) at outcome in 2005.

55,5% of 200 studied patients were registered with PA. This frequency oscillates between 78% and the 33,3% based on the psychiatrist. The patients received an average of 3,06 (DS 1,26) of psychotropic drugs; rank between 2,69 (DS 1,10) and 3,38 (DS 0,52) in relation to the psychiatrist. As maintenance treatment at outcome, it was prescribed an average of 1.61 (DS 0.65) of antipsychotics, rank 1.33 (DS 0,49) – 2,00 (DS 0.7). 33,2% patients received anticholinergics (17,1%-100% according to psychiatrist). Benzodiazepines were prescribed to 62,2% of patients (17,1%-100%). Mood stabilizer in the 16,7% of the cases (8%-41%). It is observed that those psychiatrists who use more PA use less benzodiazepines and anticholinergics.

PA extended practice in spite of therapeutic guides recommendations. Although differences between the psychiatrists from the study are observed, most of the patients have 3 psychotropic drugs as maintenance treatment at outcome: 1 or 2 antipsychotics, benzodiazepines and anticholinergic drugs.

There is a subpopulation of schizophrenic patients sometimes referred to as “revolving door” patients due to the frequency of readmissions in psychiatric units. Substance abuse and noncompliance with medication are the most important factors related to frequency of hospitalization. It has been related also with the number of previous admissions.

To describe the profile of the “revolving door” schizophrenic patient.

This retrospective study examines demographic and diagnostic features of the patients who met criteria for schizophrenia and have been admitted in our brief hospitalization unit during 2005. 209 adult patients were included. We compared the data of patients with only one admission (n=132) with those who have been admitted two or more times (n=77) in the period of study.

We detected a significative difference between the two groups in the number of previous hospitalizations. The group with one admission during 2005 had 3.75 previous hospitalizations (SD 5.34) vs. 6.37 previous hospitalizations (SD 5.75) for the group with two or more admissions during 2005 (p<0.01). No differences were found between the two groups about gender, age, the subtype of schizophrenia, substance abuse, the presence of another psychiatric illness, or the length of the stay.

Our study shows that the number of previous readmissions could be used as a main predictor of the risk of rehospitalization. This fact supports the results of other studies. However, we have not found the substance abuse as a predictor of earlier readmission, as other studies do.

When considering antipsychotic treatments for patients with schizophrenia, efficacy must be balanced against the side effects associated with each available treatment option. This balance of benefit versus risk in the choice of treatment should not exclusively depend on the clinical symptoms exhibited by each patient, but should also consider the individual's health and lifestyle characteristics.

A number of agents are available for the management of schizophrenia. To evaluate the advantages and disadvantages of the available antipsychotics, clinicians can use a number of variables to examine available data, such as numbers of patients in the study, the clinical relevance of the scales used to measure efficacy, and statistical significance. In addition, the clinician's evaluation may include a consideration of monitoring of various physiological parameters, which is a requirement with some antipsychotics.

Good practice would dictate the regular monitoring of physical health needs as a matter of course, and may improve patient outcome. Monitoring of parameters such as weight gain, and dental health might enable a more effective relationship between clinician and patient. These physical heath parameters might differentiate patients whose treatment is effective against symptoms and those whose quality of life is being optimised. By drawing on the experience of clinicians, we considered which physical health parameters should be measured routinely, and which measures should be considered on an individual patient basis.

It is straightforward to combine individualised patient monitoring with antipsychotic and behavioural therapy and might increase the impact of treatments on patients' quality of life.

Akathisia occurs less frequently in second generation antipsychotics (SGAs) compared to first generation antipsychotics (FGAs). This analysis was performed to quantify and qualify akathisia in schizophrenia patients receiving one of two SGAs, aripiprazole or olanzapine, or a FGA, haloperidol, in the first 12 weeks of treatment.

A post hoc analysis of the safety dataset was conducted to assess akathisia parameters in three double-blind randomized trials: a 52-week comparison of aripiprazole 30mg/d (n=859) versus haloperidol 10mg/d (n=431); and pooled data from two trials (26- and 52-week) comparing aripiprazole 15-30mg/d (n=504) and olanzapine10-20mg/d (n=505).

In the haloperidol comparative trial, akathisia was reported by 12.5% in the aripiprazole group and 24.1% in the haloperidol group. Akathisia occurred within the first 12 weeks after randomization in 89.6% of aripiprazole-related events and 92.5% of haloperidol-related events. In the olanzapine comparative trials, akathisia was reported by 10.7% of aripiprazole-treated patients and 6.1% of olanzapine-treated patients. Akathisia occurred within the first 12 weeks in 94.4% of aripiprazole-related events and 90.2% of olanzapine-related events. Akathisia was rated as mild or moderate by the majority of patients (≥80% of reports).

Consistent with previous reports, the FGA haloperidol was associated with higher rates of akathisia than the SGAs aripiprazole and olanzapine. Under double-blind conditions, for all antipsychotics, akathisia occurred early in treatment, was time-limited, and of mild to moderate severity. Contrary to previous reports, akathisia was not associated with high rates of discontinuation.