The type of treatment used for patients with schizophrenia and an improvement at Day 3 can affect the length of stay and symptom outcome.

To determine the influence of improvement at Day 3 in the lenght of hospital stay and hospital discharge in the case of patients with schizophrenia admitted to acute units.

A multicenter, naturalistic, retrospective study evaluating medical intervention in 1346 patients with schizophrenia in acute units in Spain.

The mean of hospital stay days was 23.3 (range 1–260 days). 49.5% of patients with improvement at Day 3 had a shorter length of hospital stay. 78.7% received treatment with antipsychotics prior to admission. The most common drugs were risperidone, olanzapine and quetiapine. 99.8% and 99.7% were treated during hospital stay and on discharge, respectively. The drugs most commonly used were paliperidone ER, risperidone and olanzapine. 99.8% of patients with improvement measured by GCI at Day 3 and 100% with improvement at Day 5 had improved at discharge. The percentage of patients requiring use of benzodiazepines or physical/mechanical restriction decreased as the days passed.

The three most commonly used drugs during admission were effective, but the action of paliperidone ER is to be noted (its use increased from 4% prior to admission to 43% and 44% during hospital stay and on discharge, respectively). The results of this study appear to confirm that symptom improvement should be obtained as early as the first week of treatment to achieve a shorter hospital stay.

Relapses are common and a higher number of relapses involve a greater cognitive impairment of the patient. Prevention of relapses is therefore the primary objective of treatment.

To establish why a sample of patients with schizophrenia experience relapses and are admitted to acute units as a result.

A multicenter, naturalistic, retrospective study assessing medical intervention in 1346 patients with schizophrenia admitted to acute units in Spain, assessing the following causes of relapses: non-compliance, lack of efficacy, drug abuse, stress and high incidence of side effects.

90.8% of patients were admitted for relapse. Reasons for admission were non-compliance in 67.1% (77.2% due to lack of insight and 30.59% due to drug abuse), lack of therapeutic efficacy in 27.2%, and drug abuse in 24.3%. In addition, stress and a high incidence of side effects in 5.8% of patients were other reasons for relapse.

Non compliance is the main reason for relapses followed by lack of efficacy. The results appear to confirm that drug abuse might influence in a direct (drug abuse itself) or indirect (non compliance because of drug abuse) way in a higher number of relapses.

In patients with acute clinical symptoms, a short hospital stay and prevalent therapeutic objectives aimed at controlling symptoms overcome the clinician's concern for the functionality levels that will be even more significant after discharge.

To establish the clinical condition of patients admitted to acute/short-stay units in the first five days of hospital stay and on hospital discharge.

A multicenter, naturalistic, retrospective, observational study to evaluate clinical assessment (CGI) obtained in patients with schizophrenia after treatment at the time of admission and on hospital discharge.

The mean score of the CGI questionnaire decreases from 5.3 recorded on admission to 4.3 on Day 5 and 3 on discharge. On Day 5 of hospital stay, symptoms had improved in 57.3% of cases. In 30.9% of cases there were no changes and in 1.7% symptoms had worsened. In 86.3% of patients symptoms had improved at discharge. 100% of patients with clinical improvement at Day 5 had a clinically significant improvement on hospital discharge.

Clinical improvement in the first five days after hospital admission appears to lead to a better clinical prognosis on hospital discharge. Hospital discharge should be scheduled from admission, so treatment choice should be geared to looking to control symptoms in the first few days and allow for better social and personal functioning after discharge.

Antipsychotic treatment and psychosocial interventions can reduce the risk of relapse and prevent functional impairment. The DAI questionnaire enables the effect of treatment perceived by patients to be evaluated.

To assess the attitude of patients to treatment on hospital discharge compared when the drug of admission is modified on discharge and when it is maintained.

A multicenter, naturalistic, retrospective study to analyse the immediate clinical outcome after a medical intervention in 1346 patients with schizophrenia in acute units in Spain. Clinical progression of the first five days of hospital intervention and at hospital discharge was collected retrospectively. Afterwards, the DAI questionnaire was completed.

1238 patients completed the DAI questionnaire. The average score was 15.6 (range 10–20). In the group of patients where the main antipsychotic drug during hospital stay was the same as that received at the time of hospital discharge, no statistically significant differences were found vs the group where the antipsychotic was modified (15.6 vs 15.4, p = 0.630).

At acute units the effect of the drug perceived by patients assessed through the DAI questionnaire on hospital discharge is similar for all antipsychotic drugs whether the treatment is modified on hospital admission or not.

Quality assurance (QA) interventions are part of the core competencies that psychiatric trainees need to acquire prior to graduation of residency. The process of developing, implementing and monitoring standards of care for patients on antipsychotic medications is a practical illustration of the teaching of QA methods to psychiatric residents.

We will describe the process used by the residents and faculty of the Outpatient Psychiatry Department of Temple University School of Medicine to create and introduce metabolic follow up protocols for patients on antipsychotic medication.

We will present the challenges encountered in this process.

We will describe the process used to create a monitoring protocol that satisfies expert practice guidelines. In addition, we will examine the social, economic and organizational variables that are a part of our urban outpatient training clinic. We will present the trends of the monthly QA reviews (July 2010 to February 2011). We will introduce the process of identifying and solving obstacles. Finally, we will describe the feedback loops that inform clinicians and faculty about the effectiveness of the QA protocols.

Some of the challenges met include: expert disagreement on the exact particulars of follow-up frequency, patient noncompliance, disparities in health literacy, trainees’ learning curve, changes in medication, and coordination of care among providers.

Teaching QA is a difficult experiential process that articulates many of the skills acquired by residents in their training, from evidence-based medicine to delivery of care and program evaluation.

We introduce clinically-based 6-week structured group day-treatment programme for out-patients with schizophrenia-spectrum disorders in the stabilization phase of the treatment. It consists of family psychoeducation, lifestyle improvement intervention, social skills training and art therapy.

To assess relapse frequency, psychopathology (PANSS) and quality of life (Schwartz Outcomes Scale-10, WHO-QOL BREF and Social Integration Survey) we designed one-year prospective follow-up field study.

After informed consent procedure 144 patients entered the project. Psychopatology and Quality of life were assessed at the entry of the programme, at the end of the programme and at one-year follow-up (N = 86).

Psychopathology decreased after programme significantly and PANSS scores remained low in one-year follow-up. Quality of life assessed by SOS-10 improved after programme significantly. Scores of WHOQOL-BREF raised significantly in Subjective health domain and Psychological health. In one-year follow-up Environment domain improved significantly. Social quality of life (SIS) improved in Behaviour to strangers, Communication, Activities of daily living and Empathy. Quality of life in patients was lower compared to common population, improved after the programme and this improvement was stable in one-year follow-up. One-year relapse rate in participants was 12%.

We conclude that participation at the group day-treatment programme early after discharge is beneficial as it improves quality of life, prevents social isolation and early non-compliance and ensures continuity of care.

This project was supported by Ministry of Education and Youth, CR: CNS 2005–2009 1M0517; Ministry of Health, CR: IGA MZ CR, NS 1036-3 and VZCR MZ0PCP 2005.

Cariprazine is a potent D3/D2 partial agonist with preferential binding to D3 receptors.

To evaluate the efficacy and safety of cariprazine versus placebo in acute exacerbation of schizophrenia.

A multinational, multicenter, double-blind, randomized, placebo- and active-controlled, fixed-dose trial in patients aged 18–60 years with DSM-IV-TR-defined schizophrenia, current psychotic episode < 2 weeks, and PANSS total score between 80 and 120. After 1-week washout, patients received 6-weeks treatment (cariprazine 1.5, 3.0, or 4.5 mg/d, risperidone 4.0 mg/d, or placebo) and 2-week safety follow-up. Risperidone was used to assess assay sensitivity. Primary and secondary efficacy: baseline to Week 6 change (LOCF) in PANSS total and CGI-S scores, respectively. Safety: adverse events (AEs), vital signs, laboratory measures, extrapyramidal symptom (EPS) scales.

Of 732 randomized patients, 64% completed the study. Mean baseline PANSS (98) and CGI-S scores (4.8) were similar across groups. PANSS total score improvement at Week 6 was statistically significant versus placebo for cariprazine 1.5 mg/d, 3.0 mg/d, and 4.5 mg/d (placebo-adjusted improvements: −7.5, −8.9, −10.4, respectively; P < .001; LOCF) and risperidone (−15.0, P < .001, LOCF); significant improvement on CGI-S was demonstrated for all active treatments (P < .05). The most common cariprazine AEs were insomnia, EPS, akathisia, sedation, nausea, dizziness, and constipation. AE discontinuation rates were 15% for placebo, 10%, 5% and 8% for cariprazine 1.5, 3.0, and 4.5 mg/d, respectively, and 9% for risperidone 4.0 mg/d.

Cariprazine significantly improved PANSS and CGI-S scores versus placebo in acute exacerbation of schizophrenia and was generally well tolerated.

Motor symptoms are frequent in patients with schizophrenia. Although recent DTI studies point to white matter alterations of the motor system in schizophrenia little is known about specific changes.

To date there is a lack of approaches with hypothesis driven quantification of specific anatomical fibre tracts. Therefore, we aimed to compare structural connectivity between specific parts of the motor system such as the pre-supplementary motor area (SMA), the SMA-proper, the primary motor cortex and the basal ganglia in patients with schizophrenia and in healthy controls in a DTI-fibre-tracking study.

It is the aim of this study to investigate whether fibre tract integrity of the motor system is altered in patients with schizophrenia.

DTI-data were measured in 21 patients with schizophrenia and in 21 healthy controls. Applying a probabilistic fibre tracking approach the most probable anatomical pathways between key regions of the motor system of each participant have been identified. The resulting probabilistic maps were normalized to obtain values between 0 and 1, normalized into the standard MNI-space and smoothed using an isotropic 3-mm Gaussian kernel. Group comparisons have been calculated using two-sample-t-tests.

First results point to altered fibre tract microstructure of loops including cortical motor areas and the basal ganglia. The data analysis is preliminary. Definite results will be presented at the conference.

Altered motor behaviour might be reflected by altered white matter integrity of loops including cortical motor areas and the basal ganglia.

The study group consisted of 200 hospitalized subjects, including 100 subjects with schizophrenia and bipolar disorder and 100 age-matched controls. All patients were evaluated for a comorbit conditions, concomitant medication, biochemical parameters (glucose, lipids, CRP) and blood pressure.

Two groups were similar in terms of age, gender, blood pressure, glucose and lipids. The overall frequency of previously diagnosed medical conditions such as hypertension, dyslipidemia and diabetes was significantly lower in psychiatric patients compared with nonpsychiatric population, regardless of the similar presence of these conditions according NCEP criteria in two groups. Significantly fewer subjects in psychiatric group received aspirin, statins, antihypertensive and antidiabetic medications. Although more obesity was diagnosed in psychiatric patients; significantly less diet intervention has been performed during hospitalization. While significantly more smokers and more pulmonary hospitalization were in psychiatric group, fewer subjects in this group received instruction for smoking cessation compared with nonpsychiatric population.

Hospitalization is the opportunity to bridge the gap between mental and physical health. However, comorbit medical conditions such as diabetes, hypertension, dyslipidemia and obesity are frequently underdiagnosed and undertreated in hospitalized psychiatric patients compared with nonpsychiatric population.

Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”

20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:

1. - SCID

2. - PANSS

3. - SCIP (schizophrenia cognitive screening)

4. - Scale GEOPTE (social cognition in schizophrenia)

5. - Social Functioning Scale (SOFAS, PSP)

6. - Scale of disease awareness

7. - IPDE (TP)

8. - Hamilton Scale (anxiety-depression)

The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:

1. 1. 60 item-Scale, specific on each chapter, evaluating:

1. - Attention

2. - Concentration

3. - Memory

4. - Comprehension of the main plot

5. - Comprehension of subplots

6. - Dialogues

7. - Other

8. - Self-identification of deficiencies or errors

• 2. Heteroapplied analogical scales

• 3. Semi-structured qualitative interview

Study of explicit memory of schizophrenic patients. Compared with control subjects.

n = 21:

1. - Schizophrenia Group (GE): 14 patients diagnosed with schizophrenia (DSM-IV criteria)

2. - Control Group (CG): 7 subjects with no psychiatric diagnosis.

Data analysis:

1. - Analysis of variance for comparison between groups

2. - Contrast-Test Means for intragroup analysis performance

Variables: gender, age, duration, and medication, as well as attitude, mood, attention, comprehension, difficulty and interest shown in the tests.

Significant differences were observed between schizophrenic and control in cued recall (proportion of hits: GE = 33% +41% Chronic severe, GC = 60%: p = 0.009) and recognition (hit rate: GE = 32% +32% Acute Chronic, GC = 41.11%, p = 0.009) that could be explained by a deficit in encoding and retrieval presemantic. Free Recall No significant (P = 0.0113) There were no significant differences between acute and chronic in Free Recall (P = 0.0864), cued recall (P = 0.255) and recognition (p = 0.998).

In the sample studied was observed:

Explicit Memory Impairement from early stages of schizophrenia.

1. - Impairment of memory processes that require conscious control

2. - Difficulty in voluntary recall, conscious and strategic characteristic of explicit memory, although providing it with keys.

Patients suffering from treatment-resistant schizophrenia pose a difficult therapeutic challenge. Although Clozapine is a well-established treatment in such cases, there is a significant proportion of patients who have to discontinue Clozapine due to life-threatening side-effects, despite achieving good therapeutic response. There is very limited literature on the therapeutic alternatives to Clozapine in the treatment of resistant schizophrenia.

To report a case of resistant schizophrenia responding to high dose Quetiapine, following discontinuation of Clozapine due to neutropenia.

Clinical details of the case: We are presenting a case of a forty-two year old female patient with treatment resistant schizophrenia who achieved remission following treatment with Clozapine, but had to discontinue treatment due to neutropenia, which occurred on two occasions. Clozapine discontinuation resulted in rapid and severe relapse in her condition and re-admission to hospital. Quetiapine was initiated as this stage, but only partial improvement was noted at the manufacturer's stated maximum daily dose of 800 mg/day. Since the drug was being well tolerated the dose was gradually further increased.

The dose of Quetiapine was eventually increased up to 1400 mg/day, which produced significant response and the patient was discharged from hospital. Quetiapine at this dose was well tolerated with minimal side effects.

The above report indicates that high-dose Quetiapine is a viable alternative to Clozapine in treating refractory schizophrenia. The findings from this report support further investigation of this approach in the form of larger scale clinical trials.

Normal pressure hydrocephalus due to idiopathic aqueductal stenosis is an abnormal accumulation of CSF in the cerebral ventricles caused by an obstruction in the Sylvian aqueduct. Although NPH typically presents with the progressive ‘triad’ of cognitive impairment, gait disturbance and urinary incontinence it has been described that it rarely manifests with predominant psychotic symptoms.

A clinical case was followed and reviewed to illustrate the psychiatric symptoms in NPH.

A 32-year-old female was admitted to our acute psychiatric department because she exhibited verbal and physical aggressive behavior while being in an agitated state with persecutory delusions. Symptoms appeared and gradually exacerbated over a 5-year period reaching their climax two weeks before admission. The patient's increased body weight and bradykinetic appearance implied the presence of an underlying organic factor. However her endocrinological workup proved normal and her neurological examination revealed no actual focal deficits. An EEG also proved negative for seizure activity and encephalopathy.

Neuropsychological batteries showed mild cognitive impairment and a CT scan revealed considerable dilatation of the ventricular system due to idiopathic aqueductal stenosis. While a conservative approach was chosen for the treatment of NPH our patient was initiated on atypical antipsychotics showing marked improvement of her psychiatric symptomatology.

Patients without a prior psychiatric history who have soft nonlocalising neurological signs and mild cognitive deficits in association with prominent psychotic symptomatology should raise our index of suspicion and prompt the clinician to explore the existence of an organic factor contributing to a behavioral disorder.

Neurocognitive deficits account for most of the long-term poor functional outcomes of patients with schizophrenia. Effective treatment of cognitive impairment is the most important challenge in the treatment of this disorder.

Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Project produced a battery of 10 tests called the MATRICS Consensus Cognitive Battery (MCCB), designed to asses cognitive treatment effects in clinical trials of patients with schizophrenia.

In this validation study of Polish version of MCCB, 120 patients with schizophrenia will be investigated. 60 of them will be randomly chosen and examined again after 4 week. Altogether MCCB is going to be applied 180 times on 120 patients. The results will be compared with the results of American standardization study of MCCB (MATRICS-PASS).

Until now 19 patients (12 males, 7 females, mean age 25.63 ± 5.14) have been investigated. Following MCCB T-scores in seven cognitive domains were obtained: attention/vigilance (38.33 ± 9.03), working memory (40.95 ± 14.35), verbal learning (38.11 ± 8.37), visual learning (41.37 ± 10.48), reasoning/problem solving (36.95 ± 10.14), social cognition (35.79 ± 10.67), composite T-score (30.22 ± 12.93).

These preliminary results show that MCCB could be successfully adopted into Polish. After the end of validation process MCCB will be an important research tool in studies aiming at improvement of cognitive functioning in Polish patients with schizophrenia.

Non-adherence influences schizophrenia prognosis.

To describe the clinical profiles, modifications of the therapeutic strategies and relapse rate of patients with schizophrenia who are at risk of non-adherence to oral antipsychotic (AP) medication.

A cohort of 597 outpatients whose therapy was modified because of risk of non-adherence to oral AP was followed during 12 months. Authors used Cox regression to analyse the time to relapse.

Patients’ mean (SD) age was 40.1 (11.1) and time since diagnosis was 15.2 (10.0) years; 64% were males. The clinical condition was at least moderate in most patients (CGI-S score ≥4 in 87%). Baseline AP medication was modified in 506 (85%) patients and non-pharmacological therapies in 190 (32%). In both cases, the main reason for modifications was insufficient efficacy. Concomitant medications were modified in 15%. The proportion of patients in AP monotherapy decreased in favour of polytherapy, and 15% started depot formulations.

During 12 months, 90 patients (15%) relapsed. Among relapsing patients, the proportion on monotherapy decreased to 42%, and the depot prescriptions rose to 28%. The risk of relapse was greater among patients with substance use disorder or familial psychiatric antecedents and lower in patients with poor attitude to AP medication or undergoing modifications of their non-pharmacological therapy at baseline.

Non-adherence management was focused on improving efficacy and consisted mainly of modifications of oral AP medication. The recognition and treatment, not necessarily pharmacological, of patients with a poor attitude to medication at baseline might explain their lower risk of relapse.

Schizophrenia is a relatively common chronic psychotic mental illness, which usually continues throughout life. Current diagnosis is based on a set of psychiatrist-applied diagnostic criteria. There can be considerable differences between diagnostic classification based upon either the set of criteria used, or the individual who applies the criteria. For this reason, the development of an objective test to inform the diagnosis could be highly beneficial.

To assess the use of Support Vector Machine (SVM) as a potential diagnostic tool for schizophrenia, with a particular focus on the application of SVM to Magnetic Resonance Imaging (MRI) data.

To show the use of SVM on MRI data to be a potentially viable diagnostic test.

A systematic literature search was carried out using the PubMed database, Web of Knowledge as well as Google Scholar. This search was conducted using the terms ‘Schizophrenia’, ‘SVM’/‘Support Vector Machine’ and ‘MRI/fMRI’. This was followed by the application of criteria relating to relevance to the desired search topic (as assesed by the author). Ten publications were identified as relevant.

Results showed strong evidence that the application of SVM to MRI data can reliably differentiate between patients with schizophrenia and healthy controls.

The results indicate that using SVM to analyse MRI data can be reliably used to identify schizophrenia, although there is some variability between the results produced. The potential of SVM in application to fMRI (as opposed to structural MRI) data is yet to be fully explored.

The aim of the present study was to evaluate the prevalence of alexithymia and its relationships with psychopathological features and suicide risk in a sample of adult patients with a DSM-IV diagnosis of paranoid schizophrenia.

A mixed male-female sample of 60 subjects (30 males and 30 females) was evaluetd with the following rating scales: Toronto Alexithymia Scale (TAS-20), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Calgary Depression Scale for Schizophrenia (CDSS), Scale for Suicidal Ideation (SSI), State-Trait Anxiety Inventory (STAI). RESULTS. 22 subjects (36.7%) were categorized as alexithymic (TAS-20 scores ≥ 61). Alexithymics showed more severe negative and depressive symptoms and increased suicide risk than nonalexithymics.

However, the results of a linear regression with SSI score as dependent variable showed that Difficulty in Identifying and Describing Feelings dimensions of TAS-20 and higher CDSS scores were significantly associated with higher scores on the Scale for Suicide Ideation. Conclusions: The presence of alexithymia in schizophrenia may be related to higher risk of suicide ideation and more severe depressive symptoms, independently by the severity of positive and negative symptoms. However, results are preliminary and limitations must be considered.

Sedation is a frequent side effect of antipsychotic drugs with a high impact on patients’ functioning. We investigated whether patients who were switched from sedative antipsychotics to sertindole, an antipsychotic drug without sedative effect, showed better results in measures of sleepiness, executive functions and working memory than patients with a good tolerance to sedative effect of olanzapine.

18 patients with schizophrenia treated with sertindole (9 females, mean age 27.9 ± 4,1, mean dose 15.6 ± 3.0 mg/d) and 18 sex and age matched patients treated with olanzapine (15.3 ± 6.5 mg/d) underwent EEG recording, Wisconsin Card Sorting Test (WCST), psychomotor vigilance task, filled out Epworth Sleepiness Scale (ESS) and Athens insomnia scale (AIS). PANSS, UKU, BARS scales and DAI-30 were used to rate mental state, medication side effects and subjective attitude to treatment.

At time of the assessment PANSS scores were similar in sertindole (43.6 ± 7.1) and olanzapine (42.3 ± 12.2) groups. Increased slow wave activity (SWA) was found in EEG in 3 patients treated with sertindole and in 10 with olanzapine (p < 0.05). Treatment with sertindole was also related to lower ratings on BARS scale (p < 0.05) and item “prolongation of sleep” in the UKU scale (p < 0.05). However, no superiority of sertindole was found in other used measures.

Although sertindole does not induce SWA in EEG and prolong sleep, patients who were switched to sertindole did not have improved executive functions, vigilance and working memory as compared to patients treated with olanzapine.