The neurodevelopmental hypothesis defends the existance of factors that would cause an early impairment on the normal brain development. The neurodegenerative hypothesis proposes the existance of later and progressive pathological phenomena, responsible of the appearance of clinical manifestations and changes on neuroimaging. Both hypotheses would be complementary. Neurodevelopment is completed during adolescence. Within this period, these deficts on executive functions would become apparent, reflecting a neurodevelopmental impairment. Glutamate is the main excitatory neurotransmitter, present throughout the normal postnatal brain development and maduration. In schizophrenic patients and unaffected relatives, a glutamatergic hypofunction has been found and so, an alteration of the dopaminergic mesocortical limbic and nigrostriatal pathways.

Usage of molecules that are capable of reversing the glutamatergic hypofunction would be potentially benefitial for either positive or negative symptomathology in schizophrenia.

We have performed a review of several clinical trials (on humans and animals) using glutamatergic drugs alone and combined with neuroleptics to diminish behavioural disturbances related to NMDA blockage.

Usage of glycine binding site agonists (glycine, D- cicloserine, D-serine) has been proposed. D-serine is effective both as monotherapy and combined with neuroleptics. D-cicloserine is not effective on negative symptoms. Usage of high doses of oral glycine (30–60 mg a day) on its own has not shown any clinical change but there is an improvement on negative and positive symptoms if combined with neuroleptics.

Nowadays, there is no glutamatergic agonist used in schizophrenia treatment. Out of the three previously mentioned drugs, only D-serine has shown some efficacy.

Studies about Quality of Life (QOL) in schizophrenia usually involve the validation of questionnaires, the effects of treatments or its association with relevant variables but, so far, the literature about differences in QOL between groups of patients with schizophrenia is scarce.

This work aims to show differences in QOL between groups of patients with schizophrenia defined according to socio-demographic, clinical, psychosocial and use of services variables.

The sample comprised 241 patients that meet the following inclusion criteria: 1) International Classification of Diseases-10 diagnosis of schizophrenia, 2) Global Assessment Functioning scores or GAF ≤ 50 and 3) Illness duration greater than 2 years. Patients were evaluated regarding socio-demographic, clinical, psychosocial and use of service variables. T-tests and analysis of variance tests were used.

There were no differences in QOL between groups of patients with schizophrenia established according to socio-demographic variables. There were significant differences in QOL between groups of patients with schizophrenia defined according to clinical, psychosocial and use of service variables. Patients with schizophrenia who were anxious, disabled, lacked social support and used more social services showed poorer levels of QOL.

Our results are consistent with previous studies that support that, in patients with schizophrenia, the association between socio-demographic characteristics and QOL cannot be considered significant and that QOL is associated with disability, social support, psychiatric symptoms and care needs. This work highlight differences between groups of patients with schizophrenia, which may be a useful information to tailor interventions to this sample population.

The advantages of conventional depots (CDs) in treating schizophrenia have been demonstrated in several studies. Indeed, the use of CDs continues to have a great importance in our psychiatric sectors due to the unavailability of atypical depot formulations.

The aim of this work was to assess the perspectives of patients with schizophrenia towards CDs.

We conducted a cross-sectional survey using fifty schizophrenic/schizoaffective outpatients treated by CDs for at least 3 months. The questionnaire included sociodemographic data, data concerning the disease and perspectives of CDs.

80% of the patients were males. The mean age was 30.7 years. 40% were married and 70% unemployed.

76% were diagnosed as schizophrenic patients (58% undifferentiated, 18% disorganized) and 24% as schizoaffective patients. The average duration of the disease was 15.5 years. The time of the last hospitalization went back to 10.1 years on average.

For all the patients, the initiative of CDs’ prescription was taken by the psychiatrist by reason of the poor adherence (72%) and the inefficiency of the previous treatment (38%). 80% of the patients preferred CDs to oral neuroleptics because the former:

1. - allowed avoidance of oblivion (70%),

2. - were more effective (60%),

3. - made relapses less frequent (50%),

4. - ensured distant intakes of treatment (50%),

5. - were better tolerated (40%),

6. - improved patient's autonomy (32.5%).

The patients in our study have high regard for CDs, which explains their adherence success.

Their autonomy and their tolerance of neuroleptics might be improved by using atypical depot formulations.

Schizophrenia (SZ) remains the most challenging psychiatric pathology at moment despite huge efforts made with the scope to achieve a clear better understanding of its etiology and pathophysiology. at least 1% of world populations suffers from this disease.

An avalanche of recent studies reveals the massive importance of glutamate abnormalities which appear in the debut phases and contribute essentially to the further development of severe symptoms. Old, classical and peculiar dopamine hypothesis starts day by day to become less feasible.

Based on a better understanding will be more efficient to develop more efficient therapeutic products. Based on more accuracy and real understanding of GABA and Glutamate roles in the pathophysiology of SZ is possible for staring more efficient therapies

In this sense we realised a thematical research study from vast bibliographical resources.between 2000–2009 all basic research and clinic-pathological studies, indexed on Pubmed, Medline and Wiley Science Library had been reviewed.

Simple mechanical appreciation shows, unfortunately, that at moment dopamine theory still dominates the etio-pathology of this major psychiatric syndrome. In fact dopamine variations are secondary to glutamate dysfunctions. We don’t need to forget that most of actual treatments-second generation of antipsychotics- had been produced on basis of dopamine hyperfunction theory. The importance of glutamate and GABA deficiencies, which offer a more clear and logical explanation of pathology seen in SZ, cannot be considered as secondary to hypodopaminergic frontality or to hyperdopaminergic inputs from nucleus accumbens.

To evaluate the subjective impact on quality of life and burden of caregivers of chronic psychotic patients and correlate with the impact that the type of patient’s symptoms according to PANSS (negative, positive, mixed or none).

We used the Caregiver's Burden scale to measure quality of life and subjective burden of caregivers of chronic psychotic patients followed up by the Psychotic Disorders Clinic of the Hospital Mental Health Messejana, in Fortaleza, Ceará, and the PANSS for the patients of the relatated caregiver. Then we correlated the data in order to observe whether the patient’s symptoms interfere with the quality of life and the burden of the caregivers.

We observed that most caregivers were women, mothers of patients who had incomplete primary schooling, married, with incomes between one and two minimum wages. In most cases also with incomplete primary degree and mean disease duration was 16.51 (± 9.64) years. We found that higher scores on scales of positive and PANSS general psychopathology in the patient, the worse the quality of life and caregiver burden. In this sample, negative symptoms measured by the PANSS negative scale does not seem to interfere with quality of life and caregiver burden.OuvirLer foneticamente Dicionário - Ver dicionário detalhado

Demographic data did not affect the quality of life of caregivers; the main factors that contributed to a poorer quality of life and caregiver's burden were high scores in positive and general psychopathology of PANSS.

Poor adherence to antipsychotic treatment is a well-recognized challenge among patients with schizophrenia and is associated with increased morbidity and consumption of health care resources.

We evaluated the effect of daily Short Message Service (SMS) reminders on patients’ adherence to antipsychotic medication in schizophrenia.

Clinically stabilized outpatients with schizophrenia and considered to be poor adherent (at least one affirmative answer of Morisky-Green questionnaire -MAQ) to antipsychotic monotherapy were included in a multicenter, randomized, open-label, controlled trial. Participants were randomized to receive a daily SMS reminder on their cell phone to take their medication during 3 months or current standard of care. The primary outcome measure was improvement in adherence rate (mean MAQ score) after 3 months.

254 patients were analysed, 66.5% men. Mean age: 39.7 years (SD = 11.03). Baseline socio-demographic and clinical characteristics were similar between the two groups. No significant differences in baseline mean MAQ scores were observed between groups (2.23, SD = 0.94 and 2.23, SD = 0.85, respectively).

At month 3, mean MAQ score in the intervention group was 1.2 and 1.53 in the control group. Absolute difference in mean adherence rate between groups was −0.33 (95%CI −0.62, −0.03; p = 0.03). Largest change from baseline was observed in question 4 of the questionnaire “When you feel better, do you sometimes stop taking your medicine?” (percentage of affirmative answers in the SMS group vs control was 45% and 59%, respectively, p = 0.02).

SMS reminders, added to standard interventions for schizophrenia management, may help many patients to improve adherence to antipsychotic medication.

Impaired sustained and selective attention have been seen as vulnerability factors to psychotic disorders. Relatives of psychotic patients are a risk population for psychosis, and previous studies have shown that they displayed more attentional deficits compared with healthy controls. Additionally, relatives have more pathological personality and schizotypy, the least considered also to be the expression of the genetic vulnerability to schizophrenia. There are few studies that relate attention to personality factors in relatives of psychotic patients.

To compare attentional performance of siblings of psychotic patients with those of healthy controls, taking into account their pathological and schizotypal personality.

The Spanish version of the SPQ and the DAPP-BQ were administered to a sample of 51 subjects that were divided into four groups by a hierarchical cluster analysis: siblings with high pathological personality (SHPP), siblings with low pathological personality (SLPP), controls with high pathological personality (CHPP), and controls with low pathological personality (CLPP). In all the subjects we assessed a sustained attention index (SUA) and a selective attention index (SEA). We compared the performance of the four groups on these attentional indexes.

We found that SHPP had worse performance on sustained attention compared with CLPP. Specifically this difference was in the reaction time item of the SUA.

The high schizotypy and pathological personality had an influence on sustained attentional performance in the siblings of patients with psychosis, but not in the healthy controls.

The aim of this research is to study whether serum melatonin level is related with positive psychopathology in a sample of paranoid schizophrenia patients.

32 acutely paranoid schizophrenia patients admitted to the psychiatric ward of the University Hospital of the Canary Islands took part in the study. All patients met DSM-IV criteria for paranoid schizophrenia. 22 were males and 9 females. The mean age was 36.7 ± 10.3 (standard deviation). Blood was sampled by venipuncture at 12:00 and 24:00 hours after having rested in bed one hour. This was done to avoid the body postural effect on melatonin levels. Blood extractions were carried out during the first 48 hours after admission. Psychopathology was assessed by the positive subscale of the Positive and Negative Syndrome Scale (PANSS). Melatonin serum levels were measured by ELISA techniques. Pearson correlations between melatonin serum levels and PANSS positive scores at 24:00 and 12:00 hours at admission and discharge were carried out.

The only significant correlation, with a positive sign, was the item Conceptual Disorganisation (P2) with serum melatonin at 24:00 h (r = 0.355, p < 0.046).

Serum melatonin levels may be used as a biological marker of conceptual disorganisation in paranoid schizophrenia inpatients.

This study was partly supported by a grant (PI: 08/115) of the Fundacion Canaria de Investigacion y Salud (FUNCIS).

Early treatment intervention and prevention may minimize the morbidity and persistent disability caused by schizophrenia that occurs over patients’ lifetimes.

Atypical antipsychotics with improved tolerability and less likely to cause movement disorders and secondary negative symptoms, are generally used as first line therapy.

Risperidone long acting injection (RLAI) is currently the only available long acting atypical antipsychotic, combining the better tolerability of an atypical with the benefits of injectable delivery.

To assess the maintained efficacy and safety of risperidone long acting injection after a direct treatment change from any antipsychotic medication in patients with schizophrenia.

Adults with schizophrenia received injections of long acting risperidone 25, 37.5, 50 mg in 14 days interval for 6 months.

Efficacy was measured by:

1. . PANSS (Positive and negative symptoms scale)

2. . CGI-S (Clinical Global Impression- Severity)

3. . GAF (Global Assessment Functioning)

Tolerability was measured with TEAE (Treatments emergent adverse events)

In this study, negative and positive symptoms were significantly improved. Clinical deterioration was substantially ameliorated between baseline and endpoint. Compared to baseline there were significant decreases in the occurrence of suicidal ideation and violent behaviour. Also, the treatment showed good safety and tolerability.

RLAI treatment was associated with a very good efficacy, tolerability, and an excellent improvement of functionality.

Associations between smell identification deficits (SID) and impairments in basic cognitive domains have been shown in patients with neuropsychiatric disorders.

We analyzed social and basic cognitive deficits and SID.

To assess differences in affective decision making tasks in patients with schizophrenia-spectrum disorders, their 1st degree relatives and healthy controls. Methods: We examined 51 patients with schizophrenia-spectrum disorders (49% female, age 33.1 years, SD 11), 21 first-degree relatives (61.9% female, age 49.5 years, SD 17.6, one affected, others non-affected) and 51 matched healthy controls (49% female, age 33 years, SD 12.1). Psychopathology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Subjects were administered the University of Pennsylvania Smell Identification Test (UPSIT), the Facially Expressed Emotion Labelling (FEEL) test, the spatial span subtest of the Wechsler Memory Scale-Revised (WMS-R) and the Mehrfachwahl-Wortschatz Test (MWT-B).

Patients, controls and 1st degree relatives differed in age (p = 0.000), WMS-R (p = 0.000) and FEEL scores (p = 0.007). In healthy controls, patients and 1st degree relatives FEEL correlated with age (p = 0.005, p = 0.003, p = 0.004, respectively). In patients FEEL also correlated with MWT-B (p = 0.000), UPSIT (p = 0.000) and PANSS negative scores (p = 0.016); furthermore, UPSIT correlated with MWT-B (p = 0.001). In 1st degree relatives age correlated with WMS-R (p = 0.04) and FEEL (p = 0.004), both of which inter-correlated (p = 0.006).

We found that SID, basic and social cognition, i.e. affective decision-making processes, inter-correlate in patients with schizophrenia-spectrum disorders and are partly under the influence of negative symptoms. Some of these relationships can also be seen in 1st degree relatives of patients.

People with severe mental illness neglect their physical health needs. They smoke a lot, they drink a lot and they don’t do exercise. They eat unhealthy food and put on weight. Unfortunately, the antipsychotic medication don’t help and some of the drugs are associated with side effects which make these problems worse.

Medical notes of patients who has been on risperidone long term injectable depot for a year, from the first of January till the 30th 2008 were reviewed and information were input on the form.

65 notes were reviewed. 70% males. 70% between 18-50 years. The following was done baseline:

• 50% had physical examination.

• 25% had pulse, blood pressure and ECG.

• Body weight 10%.

• Triglycerides 20%.

• Urea and electrolytes (U&E)15%.

• 40% had their liver function tests(LFT).

• 50% had comorbidity with other physical illness.

The following were done on six monthly maintenance measures:

• Only 5% had maintenance ECG.

• LFT 10%.

  U&E 30%.

• Triglycerides 5%.

Only 50% of patients had physical examination. Only quarter of patients had their BP, pulse and ECG done as a baseline. There was no regular physical follow up and investigation and the investigation which were done sporadically. Physical co-morbidity was 50% of the sample while physical examination and investigations were done in less than half of the sample.

Proper physical assessment and regular follow up should be adopted.

Promotion of healthy living and eating, exercise and monitoring weight should be advised.

Although schizophrenia was previously associated with affected spatial neuronal synchronization, surprisingly little is known about the temporal dynamics of neuronal oscillations in schizophrenia. However, since coordination of neuronal process in time represents an essential aspect of practically all cognitive processes, it might be strongly affected in schizophrenia patients.

To test the hypothesis of abnormal temporal neuronal dynamics in patients with schizophrenia.

We aimed at quantification and comparisons of long-range temporal correlations (LRTCs) in patients and normal subjects.

We measured 21 patients with schizophrenia (n = 18) or schizoaffective disorder (n = 3) and 28 age and gender matched controls. Ongoing neuronal oscillations were recorded with multi-channel EEG at rest condition. EEG was analyzed with spectral analysis and with the detrended fluctuation analysis allowing quantification of LRTCs.

The amplitude of neuronal oscillations in alpha and beta frequency ranges did not differ between the patients and controls. However, LRTCs were strongly attenuated in schizophrenia patients: in centro-parietal areas and fronto-central areas for alpha and beta oscillations, respectively. In addition we observed a negative correlation between the strength of the negative symptoms and LRTCs.

Small values of LRTCs and their correlation with the negative symptoms in schizophrenia patients demonstrate that the temporal dynamics of neuronal oscillations are essential for normal brain functioning. Attenuated LRTCs might indicate a more intermittent neuronal dynamics possibly allowing for more random associations between neuronal activations, which in turn might relate to the occurrence of positive symptoms in schizophrenia.

In schizophrenia, frontal structural and functional deficits are replicated findings.

AK was 40 years old. She had not been appealed to psychiatry department or took any medicine. She had had severe positive symptoms such as, grandiosity, delusions, auditory and visual hallucinations, hallucinatory behaviors, mystic contains of thoughts since her childhood. MRI had been showed that the severe cortical atrophy inconsistent with her age. In the assessment of neurocognitive tests we found that the signs of frontal - prefrontal and temporo-limbic impairment. On Rey Auditory learning test she could remember totally 34 words as a sum of the 1st to 5.th Readings. At 6.th reading she remembered 5 words and at 7th 6 words. At recognition part of the test she had 8 true positive and 3 false positive results. On Auditory trigram test, her score was 25 and on controlled word association test she could tell 20 total words. In digit span test her scores were 4 at forward section and 4 at backwards section. She could not perform trial making test part A or part B. On Stroop test she completed section 5 (main card reading time) at 26 seconds. These results suggested us that she had dysfunction in the cognitive domains such as; working memory, focused attention, short time verbal memory and frontal executive functions.

This sample has been attracted attention to neurodegenerative process notwithstanding without antipsychotic treatments effects.

The suicidal behavior at patients with anhedonia in schizophrenia is one of the burn problems in modern psychiatry.

Anhedonia belongs to negative symptoms in schizophrenia. The suicidal activity at patients with it consists from 7% tо 43%. At those patients fixed the suicidal ideas - 40%, suicidal attempts - 23% and complete suicide - 6,4%.

Study the methods of suicidal behavior at those patients.

The Columbia Suicide severity research scale (C-SSRS).

157 patients with anhedonia. Selected 49 (31, 21%) patients with suicidal behavior on admission or in the past. 23 women and 26 men with a mean age of 34, 37(±1, 92) and mean illness duration of 7, 72(±1, 42). The anhedonia level was 21, 26(±1, 26). 73,48% were the patients with Schizophrenia among them 44,91% with “postpsychotic depression” (295.60), 28, 57% with paranoid schizophrenia (295.30) and 26,52% - patients with affective disorders (296.3×). All patients wished to die. 79,59% (n = 39) had a suicidal attempts and 20,41% (n = 10) had a suicidal ideas. Active suicidal ideas without the suicide plan had 79, 59% patients. The methods of suicidal attempts were poisoning (38, 52%), cutting (25, 64%), hanging (12, 8%), falls (20, 48%), drowning (2, 56%).

Anhedonia in schizophrenia is a risk factor of suicidal behavior. The suicidal behavior declared itself with suicidal attempts much more than suicidal ideas. Suicidal attempts were impulsive and dangerous with risk for life. It point to seriousness and danger results of suicidal behavior.

Studies performed in schizophrenia patients have generally suggested the presence of a compromised antioxidant system, but this is not always consistent with specific observed parameters, which on the whole, show evidences of dysregulation. There are also controversies regarding the oxidative stress status in patients treated with typical vs. atypical antipsychotics.

In this context, the aim of the present work was to evaluate the specific activity of some peripheral antioxidant defences like superoxide dismutase (SOD) and glutathione peroxidase (GPX) and the level of a lipid peroxidation maker (malondialdehyde-MDA), in schizophrenic patients treated with typical (haloperidol) or atypical (olanzapine, quetiapine and risperidone) antipsychotics, compared with age-matched healthy subjects.

The subjects of this study (n = 45), consisted of 35 patients who met DSM-IV criteria for schizophrenia and 10 healthy control age and gender-matched subjects. Patients were of paranoid subtype, with duration of illness for at least 5 years. Nine patients were under haloperidol (1–2 mg daily dose) treatment and 26 (8/10/8) patients were under atypical treatment: quetiapine (300 mg daily dose), olanzapine (20 mg daily dose) or risperidone (2–4 mg daily dose), respectively.

We found a significant decrease in GPX specific activity and also a significant increase of MDA levels in schizophrenic patients, compared to age-matched control group, regardless of their type of treatment. Additionally, an increase in SOD specific activity was observed, mainly in the patients treated with haloperidol and quetiapine.

Further research is necessary in order to elucidate the effects of different antipsychotic agents on antioxidant enzymes.

Previous functional neuroimaging studies in schizophrenia have suggested abnormal patterns of functional connectivity during the resting state. However, little is known about the relationship between specific symptom dimensions and resting-state network (RSN) connectivity.

Using fMRI, this study investigated the relationship between multiple RSN and auditory verbal hallucinations (AVH) in patients with schizophrenia.

Resting state data were acquired from 10 patients with treatment resistant AVH and 14 healthy controls. The data were analyzed using a spatial group independent component analysis, and random effects t-tests were used to compare spatial components between groups (p < 0.001).

16 RSN were identified, from which four networks were selected for further analyses. Within three RSN patients showed increased connectivity of right lateral prefrontal areas and bilateral superior temporal regions as well as decreased connectivity of the anterior cingulate cortex. Correlations were found between measures of AVH severity and functional connectivity of the left anterior cingulate, left superior temporal gyrus and the right lateral prefrontal cortex.

These findings indicate that functional changes of multiple RSN associated with language processing, attention and executive control could underlie persistent AVH in patients with schizophrenia. The relationship between AVH severity and functional connectivity measures suggests that distinct cortical loci of dysfunction could contribute to the phenomenological diversity of AVH.