Rehabilitation should help the mentally ill persons to strength their potentials and reduce the deficits in order to live successfully in community. First Croatian Outpatient Rehabilitation Center is organized in Psychiatric Hospital Vrapce. Its goal is to improve the quality of life in patients with psychotic disorders through a holistic rehabilitation program. The Rehabilitation Centre offers program provided by Multi-disciplinary team. Team evaluates each patient on individual bases and develops a realistic treatment/rehabilitation plan. The key of treatment is combination of case management and group treatment. Rehabilitation program includes a supportive individual therapy, provided by the coordinator and different group therapy (psychoeducation, anti-stigma program, family education, healthy life styles, social skill training, stress cooping and vocational training) and creative groups.

40 patients were evaluated in program in our Center according to frequency of visits and rehospitalisation. Also we followed up the family involvement, the number and types of groups which patients attend and contacts with case manager. The obtained data will be compared with BPRS score and the Satisfactory scale results.

It was evident that patients, who regularly contact their case managers, attend to more than one group and have family support, have the treatment better results on Satisfactory scale and BPRS score.

Community Rehabilitation Center offers highly individualized program which combines case management and group therapy in order to help patients with psychotic disorders to recover and live with higher quality standards in community and its long lasting benefits are expected in future.

Schizophrenia is the most prevalent and disabling mental disorder. Schizophrenia patients experience very much stress in their life and coping strategies play an important role in adjustment with these stressful situations. These patients have problems at their coping strategies. They often use from ineffective and inactive coping strategies.

This corelational descriptive study was conducted to determine the coping strategies in schizophrenia patients in refer to psychiatry clinics of hospitals relative to medical science universities and health service of Tehran in 1385.

90 schizophrenia patients having a characteristics of sample study was selected at two stage by non accident sampling (quota, convenience). From “The Ways of Coping Questionnaire” have been used that after determining face and content validity, it's reliability has been accounted through inner stability α=0/98. Data have been collected by self-reporting and receiving some of information through the medical file and have been analyzed by SPSS software.

Results showed that “Resignation” and “Self - soothing” coping strategies in respectively with averages 50/11% and 47/06% are at first and second level of used coping strategies. “Considering”, “Positive reappraisal”, “Ignoring” and “Acting” with averages 41/38%, 40/86%, 40/67% and 37.03% in respectively at third level of used coping strategies. Also the results showed that the majority of the sample study have used from “Avoidance coping strategies” and minority of them used from “Problem – oriented coping strategies”.

The majority of sample study use from “Avoidance coping strategies”.

Although efficacy of antipsychotic medications is well documented, controlled clinical trials have called into question their effectiveness. We examined the effectiveness of olanzapine and risperidone in schizophrenia in a naturalistic setting.

We used an electronic medical records database at a Veterans Affairs medical center to conduct a retrospective study of all new outpatient medication trials of olanzapine (N= 221) and risperidone (N= 274) over a 2-year period beginning January 1999 in patients diagnosed with schizophrenia or schizoaffective disorder. We defined medication discontinuation as a switch between the two agents (the majority of switches) or self discontinuation by not getting medication supply for over one month.

Sample mean age (± SD) was 48.4 (±11.6) years, 91% were male. Discontinuation rates were high (73%) trending lower in olanzapine (70%) than risperidone (76%) (p= 0.12). Median time to discontinuation was 120 days (95% CI: 105-135), longer for olanzapine (150, 95% CI: 120-180) than risperidone (90, 95% CI: 71-109) (p= 0.04).

Self discontinuation was high (48%) with no significant difference between olanzapine (50%) and risperidone (46%). Switching rate was 25% and more likely to occur in risperidone (30%) than olanzapine (20%) (OR= 1.72, 95% CI: 1.13-2.61).

Effectiveness of antipsychotic medications in schizophrenia may be hampered by high rates of medication self discontinuation in outpatient practice settings. Time to discontinuation suggests olanzapine may be more effective than risperidone. Strategies to address causes of poor adherence should be incorporated in medication algorithms to optimize their effectiveness.

Basic features of group psychotherapy for patients with acute psychosis are:

focus on the sharing of psychotic experiences;

different ways of interactive connections and transpersonal relations between patients and staff members;

different realities represented, realized and interpretated by the participants;

high risk of self stigmatization;

paradoxical tension between the urgency readiness of psychiatric environment and the reflective attitude of group work.

A modified group analytic technique with free-floating discussion (Foulkes) is used to understand psychotic experiences. Group processes and symbolic contents are analysed on structural and communicative perspective.

The maintainance of complex group work clAims:

clear and stable boundaries;

creative possibility of potential space (Winnicott);

relational capacity of the stuff;

and high level of integration between the group and the institutional system.

Co-therapeutic team facilitates integration in both direction:

as a part of the group it helps the socialization of group members on the field of psychological work;

as a part of the whole stuff of the department it supports connections around the group.

The individual team member takes double role in the reality of the group: co-therapist and group member. The integration and conflicts between these roles should be interpretated in the context of the group.

Schizophrenia with negative symptoms implies cognitive deficit, correlated with the hypo frontal phenomena characterized by hypodopaminergism.

The increase of firing through hypoGABA-ergism leads to a glutamate activity exacerbation, emphasizing the cognitive deficit.

The neurotrophic factors increase the regulated release of dopamine/serotonine/GABA neurotransmitters, regulate the synaptic glutamate transmission on the NMDA receptors path and play a role in the protection of the dopaminergic neurons and in maintaining the number of receptors and their functionality .

A clinic observation study included twenty patients with schizophrenia with negative symptoms and cognitive deficit.

Between 2004-2007 a number of 10 patients from this group received second generation antipsychotic and neurotrophic factor (Cerebrolysin), while the other 10 received only antipsychotic drug.

The effects on cognition, global function, as well as daily activities were evaluated at 6, 12 and 18 months.

In the comparative tests on the two groups, the frequency of the individual responses was 30% in the group with associated neurotrophic factor, compared to 10% in the other.

Regarding the definite response for the above mentioned 3 criteria, the frequency of the responses was 10% in the group with associated neurotrophic factor, compared to 5% in the other.

The neurotrophic factor significantly reduces the cognitive decline in: global response, functional response, cognition.

The association of the neuroprotective factor in the treatment with second generation antipsychotic drugs for schizophrenia with negative symptoms reduces the cognitive deterioration counterpoising the neurotransmitters balances (especially GABA and Glutamate), improving the prognosis of the disorder.

Poor adherence to antipsychotics is a major problem in long term treatment of schizophrenia, a relationship between poor adherence and relapse is well documented in the literature. One of the factors that may affect compliance is antipsychotic formulation. The primary objective of the study was to compare patient preference for olanzapine conventional tablet (OCT) with orodispersible tablet (ODT) as measured by a formulation preference question.

A 12-week open label, randomized, crossover, multinational study (Turkey, Romania, Israel, Brazil, Mexico) conducted to estimate the proportion of patients preferring OCT over ODT after 6 weeks of treatment with each formulation. Outpatients with stable schizophrenia (CGI-S<4) on OCT monotherapy for at least 1 month before study inclusion were randomized 1:1. Compliance, drug attitude were measured using DAI-10 and MAF scales; tolerability and safety by AMDP-5 questionnaire and adverse event summary.

From 265 randomized patients,207 were eligible for the analysis and 175 patients answered the preference question. 106(61%) patients preferred ODT, and 48(27%) preferred OCT (p<0.001 adjusted for treatment sequence); 21(12%) expressed no preference. 90% of patients were rated as almost always compliant on both formulations. The adverse event profiles of ODT and OCT were similar: most common (>1%) adverse events were weight increase, hypertriglyceridaemia, and somnolence.

Most of the patients who answered the preference question declared to prefer olanzapine orodispersible to conventional formulation. Given the importance of patient's preference as one of the factors for future compliance, olanzapine orodispersible tablet could be a good choice.

We investigated which factors could influence insight in psychosis.

117 in-out patients recruited in the Psychiatric Service of Santa Maria Hospital, Lisbon (Portugal) diagnosed with schizophrenia, schizoaffective and schizophreniform disease, psychosis also drug induced, were evaluated with SAI to asses insight, MARS for medication compliance, WHOQOOL-BREF for Quality of Life, BPRS and PANSS for psychopathological symptoms, I.A test (Reduced Raven's Matrix) for Intellectual Ability. Bivariate correlations were operated using Spearman correlation coefficient (p<0,01). Regression analyses with stepwise ascending regression were computed to assess predictors for insight.

We found significant negative correlations between SAI total score and Delusions, Conceptual Disorganization, Hallucinatory Behavior, Suspiciousness, Poor Rapport, Stereotyped Thinking, Somatic Concerns, Unusual Thought Content, Lack of Judgment of Insight of PANSS, Self Neglect of BPRS and Professional State. Positive significant correlation was between SAI and MARS total score. The regression analysis showed negative relations between PANSS Poor Rapport, Suspiciousness, Guilt Feelings, Active Social Avoidance and Insight; positive relation between Depression (PANSS) and Insight.

Poor Insight was determined by Poor Rapport and Social Avoidance maybe because patients are less predisposed to compare their situations with the surroundings, showing defensive denial and less criticism towards symptoms. Suspiciousness contributes to poor insight due to distrustful attitude that makes difficult to accept the diagnosis and the idea of being seek. Guilt feelings determine poor insight as they are prodromes of delusions. Depression increases insight as a consequence of the painful feelings that make patients think about their situations.

Perceptual and thought distorsions that are observed in the acute episodes of schizophrenia make the adaptation to reality very difficult, but there are residual symptoms that interfere with coping in the interepisodic phases, also. There are specific coping strategies found by such patients in order to face the difficult challenges of hallucinations, delusions, attentional and memory deficits, but also the social stigma and negative symptoms, like isolation.

We assessed 51 patients, 40 male and 11 female, mean age 39.8, diagnosed with chronic schizophrenia- paranoid (n=22), residual (n=14), catatonic (n=10) and disorganised (n=5) type, according to DSM -IV- TR criteria, in order to establish a correlation between main categories of coping mechanisms and the specific type of schizophrenia. Inclusion criteria: patients included in a cognitive- behavioural therapy and antipsychotic maintenance treatment for at least 4 weeks. Exclusion criteria: axis II comorbidity or severe somatic pathology that could modify patients coping strategies.

Patients with paranoid schizophrenia associated maladaptive coping strategies like alcoholism (36.3%) and aggression (27.2%), those with residual type presented more social withdrawal (71.4%) and self- harming (35.7%), while catatonic and disorganised schizophrenia cases had a high incidence of thought blocking (60% and 40%, respectively) and social isolation (60% in both groups).

There are more frequent types of coping mechanisms in each form of schizophrenia. This is an important fact for focusing the psychotherapy approach on conversion to adaptative coping strategies, using techniques like verbal challenge and reality testing, reatributtion- enhancing methods, activities daily programming.

Patients with schizophrenia that are treated with first generation, but also with several second generation antipsychotics, frequently describe negative changes in self-perception and daily activities due to weight gain. A systematic analysis of the weight gain influence over the body image is necessary because it could offer a perspective over the patient's discomfort, improving his/her chances to therapeutic compliance and a better life quality. Psychotherapy, change of antipsychotics, nutritional counselling, ocupational therapy or physical exercises scheduling could be solutions to these cases.

A group of 34 patients, 18 female and 16 male, diagnosed with chronic schizophrenia (DSM IV TR), mean age 45.3, treated with antipsychotic agents for at least 2 years (haloperidol 15 cases, olanzapine 10 cases, amisulpride 5 cases, risperidone 4 cases) were evaluated in order to configure a body image profile, using self-reports, investigator-based reports and Draw-a-Person-Test (DAP). Patients included in this evaluation presented a mean weight gain of 10%, reported to their premorbid value.

The body image was negative in 82.3% with marked dysfunctional believes about self in 64.7%, while the rest of 17.6% had mild to moderate levels of self-blame or hopelessness automatic thoughts associated to weight gain. Only 17.7% patients had a neutral or positive body image, also their mean weight gain was equally to the negative body image group.

Negative body image is usually associated to weight gain as a side event to antipsychotic drugs, therefore is important to ventilate the patient's dysphoric feelings and to choose the optimal therapy.

Several studies have shown that the level of antibodies to Toxoplasma gondii (T. gondii) in schizophrenia is higher than in controls. And it is hypothesized that the neurotropic intracellular protozoan may contribute to the development of schizophrenia. The present study is to explore whether Bactrim, which is effective to T. gondii, can help to treat Toxoplasma-seropositive patients with schizophrenia.

99 patients who were positive in IgG or IgM antibody to T. gondii were seperated into two groups randomly. One group recceived SMZco tablets (contained 400mg SMZ and 80mg TMP, 6 tablets/d) plus risperidone, and the other group received placebo and risperidone. Both the physicians and the patients did not know whether the patients took SMZco or placebo. The dosage of risperidone was tittered according to the patient's clinical symptoms and the maximum dose is 6mg/d. PANSS scales were used to assess the symptoms before and after treated for 6 weeks.

There was no significant difference in the scores of PANSS at baseline and after treatment. The rate of adverse effects, and the ratio of patients who have combined with benzodiazepine and anticholinergic medicine between the two groups did not differ significantly, while two patients in the SMZ group dropped out because of serious nausea and vomiting. The maximum dosage of risperidone in the SMZ group was lower than the placebo group (P<0.05).

For toxoplasma-seropositive patients with schizophrenia, Bactrim may be helpful by decrease the dose of the antipsychotic medicine.

The neuropsychological basis of first-rank symptoms in schizophrenia (FRS) is still a matter of debate. Three broad explanatory models for FRS have been proposed, each arising from a different perspective: (i) medial temporal lobes pathology (Trimble, 1990); (ii) reduced cerebral lateralisation and interhemispheric transfer (Crow, 1997); and (iii) deficits in self-monitoring of intentions due to prefrontal inhibitory dysfunction (Frith et al, 2000). The aim of the study was to test whether patients with FRS would show deficits consistent with the above models.

A broad range of neuropsychological tests were administered to patients with and without FRS and to healthy controls, comprising tests of verbal and nonverbal memory, measures of cerebral lateralisation and interhemispheric communication, tasks of executive functioning, as well as tests of general cognitive abilities.

On some cognitive tests, results were supportive of theories advocating reduced cerebral lateralisation and self-monitoring impairment. An unexpected finding was that, on many cognitive tasks, the performance of patients with FRS was better than that of patients without FRS, and not significantly different from that of controls. These results could not be accounted for by demographic features or medication effects.

The current study may be the most comprehensive examination of neuropsychological performance in patients with FRS to date. Our results suggest that broad cognitive impairment is not a necessary correlate of FRS.

Genetic variation of the catechol-O-methyltransferase (COMT) gene has long been thought to confer susceptibility to schizophrenia because of its catalytic activity for dopamine degradation. The negative symptom is a severe form of the illness related to prefrontal hypodopaminergia. In the present study, we attempted to perform a quantitative trait test for genetic association between the COMT gene and the negative symptoms in a Chinese population.

A total of 160 unrelated schizophrenic individuals were recruited for genetic analysis and their symptoms were assessed and scored by Positive and Negative Syndrome Scale (PANSS). The quantitative trait test was performed by the UNPHASED program to see the correlation between scored negative symptoms and some single nucleotide polymorphisms (SNPs) present in the COMT gene.

rs362204 (Del/Ins SNP) showed allelic association with four negative symptoms, including blunted affect (p=0.00008), poor rapport (p=0.00006), passive/apathetic social withdrawal (p=0.0003) and lack of spontaneity and flow of conversation (p=0.001). The rs165656(C)-rs6267(G)-rs4680 (G)-rs362204 (Del) haplotype was strongly associated with both blunted affect (p=0.0245) and poor rapport (p=0.0186).

The present study suggests that COMT may etiologically contribute to the severity of negative symptoms of schizophrenia but its precise mechanism needs further investigating.

to look peculiarities of mental disorders in the elderly in different regions of Lithuania.

We analyzed three regions of Lithuania: Panevėžys region, Palanga region and Varėna region. They are in the different parts of Lithuania. We have chosen data about mental disorders according International Statistical Illness and Health Problems Classification. We collected data with code F20- F25. We have analyzed case-records, which were filled in January 2006.

In Panevėžys region the elderly was 28, 89% (n= 39) of all collected data about mental disorders. Respectively in Varėna region- 42, 86 proc. (n= 6); in Palanga region- 21,05 proc. (n= 4). Average age of elderly was 66, 65 years. Respectively in Panevėžys region- 66,31 years; in Varėna region- 67,17 years; in Palanga region- 69,25 years. 65, 31% of all elderly with mental disorders were women. 75, 51% of all elderly diagnosis was schizophrenia (F20) in all regions. Mental disorders identified before 2006 were 95, 92% and mental disorders identified in January 2006 were 4, 08%. The difference in the disease rate in studied regions correlate with P, Li, Zn, Mn concentrations in the soil and possibly had an effect via the food chain. Also, the drinking water can to be of some importance. Comparing these three regions, there was seen clear natural environment differences. Magnetic field has different activity in these regions. All through Panevėžys region pass the largest tectonic zone in Lithuania.

Risperidone the first atypical antipsychotic available in a long-acting injection formulation. In the United Kingdom is licensed to use in psychosis in patients tolerant of oral Risperidone and the Summary of Product Characteristics clearly defines the methods of initiation and titration.

We performed a naturalistic observation of 25 patients belonging to 3 different community mental health teams and one in-patient facility that have been prescribed Risperidone long-acting injection (RLAI) and collected data about immediate prior use of antipsychotic medication, patient preference, compliance with treatment, documentation of effectiveness and tolerance of Risperidone oral, supplementation with Risperidone oral during the first three weeks, initial dose, intervals between dose changes, monitoring of benefits and side-effects, and reasons for discontinuation.

Only 7/25 patients have been prescribed oral Risperidone prior to the injectable formulation and none had received clozapine. 13/25 received oral supplementation during initiation, 3/25 dose was changed in less than 4 weeks intervals. 14/25 non-compliance was suspected and only 2/25 patients stated a preference for an injectable formulation. 17/25 continued to receive RLAI and those discontinued in 3/25 due to patient refusal, 1/25 not tolerated, 1/25 patient did not attend treatment, 1/25 not effective, 1/25 patient deceased, 1/25 no reason was specified.

prescribing of RLAI did not follow the recommendation from the manufacturers mainly during initiation. Non-compliance with previous medication was the main reason for use of an injectable formulation but use of RLAI seems to be associated with low discontinuation rates.

Clozapine remains the gold standard for the management of treatment-resistant schizophrenia. Due to the need for close medical supervision at initiation it is usually started in hospital although this is no longer mandatory. It is estimated that speed of up-titration will affect length of stay.

Retrospective study of prescription charts of 14 patients representing the most recent who have been prescribed clozapine as in-patients. Data would be compared against the titration doses recommended by the British National Formulary and by the manufacturers (Novartis).

5/14 patients were admitted solely for clozapine initiation. 1/14 did not tolerate it after 5 days. 2/14 patients were re-started clozapine following a period of discontinuation and their discharge dose was achieved faster than initial titration as recommended. 9/14 patients’ titration was slower than recommended by the guidelines with a minimum difference of 113 days if using the slower recommended titration or a maximum of 208 days if using the faster one. None of the patients’ titration appeared to be slowed down due to the presence of emerging side-effects.

Prescribing practice appears to lengthen hospital admissions due to delays in changing doses. This was less relevant for patients admitted exclusively for clozapine initiation. The development of a policy for community initiation and the development of a pre-printed up-titration chart for clozapine are potential solutions to minimise bed occupancy therefore improving both patients’ experiences and bed management.