Medication adherence problems increase hospitalization, morbidity and mortality in the patients with the diagnosis of schizophrenia. Indicators of poor adherence to a medication regimen are a useful resource for physicians to help identify patients who are most in need of interventions to improve adherence.

The objective of this analysis was to find out whether symptoms and insight would predict the therapeutic alliance in the treatment of schizophrenia.

We proceeded to a transverse survey with 95 patients affected by schizophrenia followed in ambulatory in the psychiatric department D of the hospital Razi in Tunisia.

A little more than half our patients were not observing. The behavior of observance was positively correlated in the sex: the men were more observant that the women. The clinical shape of the disease, the level of insight, the cognitive state as well as the age of the disease are not connected to the degree of compliance. On the other hand, the positive or negative psychotic symptoms are strongly correlated in the therapist alliance.

The results of this study suggest that simple measures as the psychoeducation for schizophrenics, and control of the psychotic symptoms advance us on the way of improvement of the therapist alliance and consequently the social reintegration of the patient and his quality of life.

Six-week day-treatment programme for out-patients with schizophrenia-spectrum disorders in the stabilization phase of treatment consists of family psychoeducation, lifestyle improvement intervention, social skills training and art therapy.

In one-year prospective follow-up field study we assess relapse frequency, psychopathology (PANSS) and quality of life (Social Integration Survey). We analyze differences between patients participating after their first-episode of psychosis and multi-episode patients.

211 patients entered the project between January 2006 and June 2010. Psychopathology and Quality of life were assessed at the entry of the programme, at the end of the programme (week 6) and at 1-year follow-up (N = 118, males N = 63, average age 28,3; first episode N = 52).

Psychopathology decreased after programme significantly and PANSS scores remained low in one-year follow-up. Social quality of life assessed by SIS improved after programme significantly in Behaviour to strangers, Communication, Activities of daily living and Empathy and remained high in one-year follow-up. Overall one-year relapse rate in participants was 10% (N = 11), in first-episode patients 6% (N = 3).

Participation at the structured day-treatment programme offered to patients early in the stabilization phase of treatment improves quality of life, prevents social isolation and promotes treatment adherence. As a result one-year relapse rate remains low.

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

Duration of the untreated psychosis is considered by some authors as a true independent causal variable which influences the evolution of schizophrenia. For others, its effect on the evolutionary course of the disease is limited in time and it is only present in the short and medium term.

Determine the evolutionary consequences of the duration of untreated psychosis in schizophrenia in the first 5 years after the contact with the care structures.

Retrospective study relating to the patients of the Razi hospital reached of schizophrenia admitted in 2004 and 2005 and followed over 5 years.

Our sample consisted of 91patients.

We found a linear positive association between the duration of the untreated psychosis and the age at admission (p < 0,0005), and a negative correlation with the speed of symptoms control regarding the delusions and hallucinations with index of significance respectively of 0,013 and 0,008, as well as the quality of remission to 2 (p = 0,009) and 5 years (p = 0,001).

We can affirm that the duration of the untreated psychosis is a variable dependant on several other factors, and that it has an unquestionable impact on several evolutionary aspects of schizophrenic pathology.

Schizophrenia is still one of the most difficult diseases to treat, whose direct and indirect costs remain high, both for the patient, family and society.

The duration of the untreated psychosis is one of the factors likely to influence the evolution of this disease. To know the factors that may lengthen the period of care would improve the evolutionary course of the disease.

Determine the factors contributing to the delay in treatment of schizophrenia within the Tunisian population.

Retrospective study of patients in Razi hospital with schizophrenia admitted in 2004 and 2005.

Our sample consisted of 91 patients.

The poor family support (p = 0,032), the death of the mother (p < 0.00005), the lack of social security coverage (p = 0,025) and the large families (p = 0,006) are the modifiable factors highlighted by our study, which contribute significantly to extend the duration of the untreated psychosis.

Other factors that were correlated to longer period of support are: advanced age of onset of disorders (p = 0.013), family history of psychiatric illness (p = 0,03) and of schizophrenia (p = 0,04) and disorganized form of schizophrenia (p = 0,049).

We can stipulate that the application of certain measurements like the improvement and the extension of the social coverage to the poorest classes and most marginalized as well as the fight against the stigmatization of the schizophrenic patients and the mentally ills in general would be more than useful.

Significant alterations of cardiac autonomic function were shown for patients with schizophrenia and their first-degree relatives, implying a genetic association. Cardio-respiratory function, although a core physiological regulatory component, has never been assessed.

To test the hypothesis of altered patterns of breathing in patients with acute schizophrenia, we assessed breathing rate, rhythm and depth, as well as heart rate variability (HRV) and cardio-respiratory coupling in patients (n = 23), their first-degree relatives (n = 20) and controls (n = 30). Control subjects were matched for age, gender, smoking and physical fitness, and were investigated a second time by means of a stress task to identify stress-related changes of cardio-respiratory function.

Patients breathe faster (p < .001) and shallower (p < .001) than controls most pronouncedly during exhalation. Patients' breathing is characterized by an increased amount of middle- (p < .001), high- (p < .001), and very high fluctuations (p < .001). These measures correlated with positive symptoms. Shallow breathing of patients is mirrored by a smaller tidal volume (p < .001) without variability changes. Cardio-respiratory coupling was reduced in patients only, while HRV was decreased in patients and healthy relatives.

Changes of respiratory regulation and decreased cardio-respiratory coupling mirror profound alterations of core physiological function. In contrast to HRV changes, respiratory alterations were observed in patients only and might reflect arousal in acutely ill patients. This assumption is supported by observed changes of breathing and cardiac regulation in healthy subjects during stress. Findings are of high relevance for other research areas such as functional imaging.

Long-acting injectable antipsychotics in early-onset schizophrenia improve treatment adherence, and this may lead to decreased rates of hospital admission, better rates of clinical remission and better psychosocial adjustment.

To compare clinical remission rates, number of hospital readmissions and personal and social functioning after two years between patients with early-onset schizophrenia (EOS;≤ 2 years), either in treatment with long-acting injectable risperidone (LAIR) or oral antipsychotics (OA).

This is a case-control study comparing patients with EOS who initiated LAIR between 2004–2008 (n = 26 cases) with a control group with EOS matched for age and sex (n = 26 controls) treated with OA. The PANSS was administered at baseline; after two years the PANSS, the Personal and Social Functioning Scale (PSP) and the Andreasen remission criteria were administered.

The PANSS score comparison at baseline showed no significant differences between LAIR and OA groups (79.9 vs. 88.5, respectively; CI 95%: −21.6, 4.3; p = 0.185). There were statistical significant differences after two years of treatment in the PANSS scores (47.7 vs. 66.2, respectively; CI 95%: −27.2, −9.8; p < 0.001), the PSP scores (72.4 vs. 59.7, respectively; CI 95%: 4.9, 20.7; p = 0.002) and the clinical remission rates (65.4% vs. 38.5, respectively; p = 0.05). Although no statistically significant, there were differences between hospital readmission rates (19,5% vs. 42.3%, respectively).

Despite case-control studies limitations, data suggest that treatment with LAIR instead of OA in EOS might improve clinical, remission and social functioning rates. This improved effectiveness might be due to a greater treatment adherence achieved with LAIR.

Several factors affect medication adherence in patients with schizophrenia; insight is among the most important ones.

The objective of our study was to assess insight in Tunisian patients with schizophrenia and to determine its impact on medication adherence.

We conducted a survey of all patients hospitalized in the department of psychiatry “C” in the Hedi Chaker University Hospital, in Sfax (Tunisia), during the period from January 2011 to April 2011, and in whom schizophrenia was diagnosed according to DSM IV-TR criteria.

We used the insight questionnaire Q8 and the 10-item version of the Drug Attitude Inventory (DAI) to assess insight and subjective response to antipsychotic treatment, respectively. The DAI is an indicator of future medication compliance.

Forty male patients were included. The mean age was 35 years. The average disease duration was 10.5 years. Paranoid schizophrenia was the most frequent type of schizophrenia (55%). The treatment perception was positive in half of our patients. Disorder awareness was good in only 30% of cases. We found a significant association between low level of insight and negative perception of treatment as measured by the DAI-10 (p = 0.038).

Tunisian schizophrenic patients had a low level of insight. Our results were consistent with data reported in the literature, namely that a low level of insight was associated with poor medication adherence; it would even be a predictive factor. This finding would be valid whatever the cultural context is.

To study the rate of Diabetes, obesity, and metabolic syndrome and associated factors in schizophrenic patients in comparison to a healthy control group.

Matched case-control.

Hamad General Hospital and PHC Centres in Qatar Subjects: 233 schizophrenic with diabetes and metabolic syndrome and in comparison to 613 healthy subjects matched age/gender.

Questionnaire covering socio-demographic characteristics, life-style habits, genetic, biochemistry values and diagnostic screening questionnaire and confirmed using DSM-IV criteria.

The study revealed statistically significant differences between cases and controls regarding ethnicity (p < 0.001), marital status p < 0.001), educational (p < 0.03), occupation (p < 0.001), income (p < 0.001), place of living (p < 0.001), consanguineous marriages (p < .007) and obesity (p = 0.004), family history DM (p = 0.048) and smoking (p = 0.002). History of schizophrenia among parents of cases (27%) was higher than control (14% p < .001). Mean waist circumference was higher (102.7 ± 11 cm) among cases than controls (93.7 ± 12.3, p < .001). Mean systolic and diastolic blood pressure was higher among cases than controls (131.1 ± 15.8 vs. 128.2 ± 16.4, p 0.025 & 81.3 ± 9.5 vs. 79.7 ± 10.4, p 0.047 respectively). Schizophrenic with DM and MS were 12.5 times more likely to be diagnosed with HTN. The logistic regression showed that predictors of schizophrenia with DM and MS were marital status, family history of schizophrenia, family history of hypertension, family history of DM, high density lipoprotein, (p < 0.001).

The study confirmed that DM, obesity and metabolic syndrome are common among patients with schizophrenia, and it may be far more common than in general population.

Insight in schizophrenia is a complex and multidimensional concept. It implies the acceptance of illness, the need long-term treatment, recognition of symptoms as an integral part of disease and impaired social functioning. Enhancing insight into mental illness is the goal of any therapy. However, insight in schizophrenia can lead to negative consequences, especially when we talk about patients with the pronounced security measure of compulsory psychiatric treatment.

Acceptance of disease and critical attitude toward the criminal offense caused by depressed mood in patients, decrease motivation, feeling of worthlessness and low self-esteem. At this stage of treatment risk of suicide is increased.

The retrospective study included 112 patients diagnosed with schizophrenia with the pronounced security measure of compulsory psychiatric treatment who committed criminal offences within or outside the family in the period from 2006. to 2010. The research investigated the connection of insight and a better therapeutic response, and on the other side the connection between insight and its negative consequences on the treatment.

Insight in younger patients, with criminal offense within the family and previous treatment causes depression, self-stigma, feeling of worthlessness and suicidal ideation. Poor insight reduces the risk of depression and suicidal tendencies, but increases the number of hospitalizations and reduced social functioning.

Insight in schizophrenia favorable impacts on treatment and social functioning. But in this specific group of patients it seems that criminal offense, forced hospitalization and social isolation significantly influence the occurrence of depression, negative self-assessment and the risk of suicide.

Schizoaffective disorder is currently one of the controversial nosological categories. This is due to the absence of clear clinical criteria that would also take into account the longitudinal perspective.

Conducting a research on subjects who currently have diagnosis of schizoaffective disorder and who have had a longitudinal evolution of the condition of minimum 15 years.

To highlight the clinical and evolutive characteristics of schizoaffective disorder.

A follow-up study was conducted on a sample of 44 subjects with a F.25 diagnosis according to ICD 10. This sample was assessed during 2010. The parameters analyzed were: socio-demographic (gender, age of onset, level of schooling, family and professional status at onset and at present) and clinical and evolutive parameters (onset diagnosis, evolution period until the establishment of the diagnosis of schizoaffective disorder, number of admissions, genetic component).

Socio-demographic characteristics are similar to those cited in literature. All subjects have had at onset a different diagnosis than schizoaffective disorder (45.5% - F.23, 31.8% - F.20). The time needed for establishing the diagnosis was on average 5.98 years (std.dev = 3.23). The average number of episodes tends to increase in the evolution period between 20–25 years since onset and decreases again after 25–30 years of evolution.

Schizoaffective disorder is a nosological category difficult to be classified from the onset that rarely manifests with the same type of psychotic episode over the time.

Several studies show as a long duration of untreated illness (DUI) is associated with poor outcome in schizophrenic patients.

Purpose of the present study was to evaluate eventual differences in terms of DUI between the diagnostic subtypes in a sample of schizophrenics coming from different geographic areas.

One hundred twenty-five schizophrenic patients of the Psychiatric Clinic of Milan (n = 51) and Moscow (n = 74) were enrolled. SCID-I was administered to all patients and information about DUI were obtained consulting clinical charts, health system databases, and performing interviews with patients and their relatives. DUI was defined as the time between the onset of symptoms and the administration of first antipsychotic. One-way ANOVAs were performed to find eventual differences in terms of DUI between the diagnostic subtypes.

Italian patients showed a longer DUI (4.14 years ± 4.95) in comparison with the Russian ones (1.16 years ±1.43). DUI was found to be longer in paranoid schizophrenics (3.47 years ± 4.19) respect to catatonic ones (0.96 years ± 0.94) (F = 3.56, p = 0.016).

The results of the present study show as the different schizophrenic subtypes can have a different DUI perhaps for the dissimilar clinical severity and social functioning. Studies with larger samples are warranted to confirm the data of the present study.

There is consistent evidence reporting comorbidity between psychotic disorder and obsessive compulsive disorder (OCD), although is scarce the understanding of how this two entities interact and influence each other, especially in their subclinical presentations or prodromal phases.

The authors present a case study in which they describe a young adult presenting obsessive-compulsive and psycotic (subclinical) symptoms, questioning the extension of the comorbidity between Obsessive-compulsive Disease and Schizophrenia and the existence of outcome predictors.

A case report is presented and a literature review of the theme is shortly surveyed.

The case report is about a Young man of 20 years old, who have been developing for about two years obsessive thoughts of doubt concerning is sexuality, death and his mental health.

Additionally, he described sensations of depersonalization, derealization and an intense distress that have been interfering with is function and daily activity. Various studies report substantial presence of OCD symptoms in schizophrenia, suggesting an early appearance in the development of the disease and that they can act as predictor of poorer outcome. Also, recent studies demonstrated that the presence of OCD symptoms may promote transition from psychotic symptoms to psychotic disorder.

In prodromal stages, OCD symptoms may increase the risk and predict development of psychosis disorder, alerting the clinicians to be aware of a possible different presenting forms and risk stages for psychosis.

More research is needed to clarify the mechanisms of interaction between OCD and Psychosis and thus confirm the hypothetical etiologic relationship.

As many studies suggest, schizophrenic spectrum disorders outcome is linked with the duration of untreated first-episode psychosis; the longer is the gap between the onset of the disease and the first medical treatement the worst is the outcome. Cognitive impairment is one of the major predictor of poor outcome.

We study if there is a correlation between a long duration of untreated first-episode psychosis and cognitive impairment in the long term outcome.

Our sample consisted of 41 subjects (27M and 14 F) with a mean age of 48.6 years (SD = 11.91) with a mean age of onset of 23.4 years (SD = 7.68) and a mean duration of illness of 22.1 years (SD = 14.8) who has been diagnosed schizophrenic according to DSM-IV TR through the SCID-I and evaluated with the Wechsler Adult Intelligence Scale (WAIS) to study neuro-cognitive profile.

A long duration of untreated psychosis is associated with redution in the performance scale of association symbols to number (p = 0.04) and performance IQ (p = 0.04) regardless of the duration of illness.

This study confirms an association between long duration of untreated psychosis and cognitive deterioration. The reduced performance suggest a deficit in memory, attention and concentration, speed of performance, coordination,skill and non verbal ability in the sample with the longer DUI.

Poor insight is a distinctive feature of the psychotic spectrum disorders. One of the theories of the etiology of awareness is the neuropsychological view which suggests that there is an association of awareness, cognition and brain changes in psychosis. But the relationship of cognitive reserve, insight and drug use is still an unexplored field in the psychosis literature.

The aim of this research is to analyze the possible moderator effect of cannabis use in the relation between cognitive reserve and insight in psychosis.

A longitudinal study was held with 65 patients with FEP from 3 main hospitals in the Basque Country (Spain). All patients underwent clinical and functional evaluations at base line and longitudinally at one year follow up. Insight was measured using the insight and judgement item (G12) from the Positive and Negative Syndrome Scale (PANSS). The cognitive reserve was measured using the Vocabulary sub-scale from WAIS-III and educational level. Drug use was assessed during the clinical interview.

One year follow-up data were available for 35 patients. Significant relation between the cognitive reserve and G12 item (β = −9.58; p < .05) was found as long as the cannabis use is included as a moderator (β = −9.34; p < .05).

As it is a complex multidimensional concept, a more complete explanatory model of the insight recognizing the functions of the cognitive reserve and others covariates as drug use, defines the role of each variable of the illness and facilitates the objects of treatment definitions.

Basque Government(2008111010), EITB-Maratoia(BIO 09/EM/015).

Genetic factors and gene-environment interactions together contribute over 80% of the liability for developing schizophrenia. Schizophrenia runs in families and there are significant variations in the incidence of schizophrenia, with urbanicity, male gender, and a history of migration being associated with a higher risk for developing the illness.

To collect anamnestic data on 100 schizophrenic clients attending our psychiatric outpatient services.

To investigate the possible implications of psychiatric familiarity on the severity of the illness.

We defined two distinct subgroups of patients on the basis of familiarity and matched patients for age and illness onset. We estimated the global severity of symptoms on the basis of psychometric results and number of hospitalizations during the last three years. We correlated psychometric scores with familiarity for a psychiatric disease.

We confirmed a higher prevalence of psychiatric diagnoses among patients' families compared to the general population: 29% of our patient sample was found to have at least one parent or brother with a reliable psychiatric diagnosis. Surprisingly, we found that patients with a positive familiarity did not show a worse psychopathological profile compared to patients with a silent familiar history.

Families with a complex psychiatric history, in which more than one component attends our services, are strictly supervised in order to prevent stressful life events, generally more frequent in problematic families. This accurate monitoring may have contributed to the slighter intensity of symptoms found in schizophrenic patients with a positive familiarity for psychiatric diagnoses.

We have studied the strategic behaviour of schizophrenic patients playing the Dictator Game (DG) and the Ultimatum Game (UG). The model of Homo economicus predicted by traditional economical theories describes the individual involved in economical negotiations as a selfish, rational trader, whose leading purpose is to maximize his utility function. Neuroeconomy contradicts this model supplying data that show a more emotive, irrational behaviour in normal people involved in bargaining tasks.

To study how people affected by schizophrenia allocate a resource when asked if sharing it or not, and how their behaviour change during a negotiation, in which strategic mentalizing can help to gain some good.

To demonstrate that schizophrenic patients would not show an increment in their offers as Proposers in UG compared to DG and would not refuse unfair offers as Responders.

19 schizophrenic patients and 10 controls were tested with DG and UG. Participants underwent 24 trials of DG as Dictators, 24 trials of UG as Offerers and 24 trials of UG as Responders.

In the schizophrenic group UG mean offers were not significantly higher than DG offers, while controls showed the opposite. Compared to controls, schizophrenic patients showed a higher propensity to accept unfair offers. Moreover schizophrenic patients' behaviour was not influenced by the type of player (avatar vs human being).

Our study presents data that assimilate schizophrenic subjects to homo economicus: in fact, compared to normal people, schizophrenic patients show “more rational” bargaining behaviour, due to ToM deficit.

The long term treatment of schizophrenia must fulfill some medical and functional needs, like: good tolerability for a long time administration, maintaining and improving the patient's psychiatric condition obtained previously and keeping at good levels overall patient's functionality.

Most atypical antipsychotics are effective in the acute phase of schizophrenia, but on long term, the compliance of the patient could get worse due to big amount of tablets, side effects, stigma, diminished ability to think or concentrate, sedation, increase of BMI or prolactin.

To improve patients' compliance by switching from oral treatment to RLAI (Risperidone Long Acting Injection) and keep them away from relapses.

We evaluated 2 patients: first, 26 years, stabilized with risperidone tablets, 8 mg/day; second, 29 years, treated with amisulpride 800 mg/day, both having previously relapses after refusing to take their tablets. We switched them on a treatment with RLAI 50 mg/i.m., twice a month. Evaluations were made weekly during the 6 weeks of stabilization period and a follow-up for a period of 6 months. The well-being of the patient was evaluated by using the following scales: PANSS, CGI-S, CGI-I, the patients' satisfaction with PSMQ questionnaire and activity with WPAI-GH.

1. 1) There was none relapse for both patients.

2. 2) We did not use any corrective co-medication.

3. 3) The patients' satisfaction was greater and the functionality was better, due to a good compliance and fewer side-effects.

Switching from another antipsychotic to RLAI is a good solution to improve the patients compliance, functionality and quality of life overall.

The Total Antioxidant State (TAS), expressed as equivalent to the total antioxidant capacity of blood plasma. It is the cumulative ability to trap molecules, as H2O2 and free radicals such as RO, ROO, and O2.

Our aim is to describe the TAS levels in schizophrenic patients and to analyze if this marker has got a circadian rhythm. The only study in humans on this subject has carried out by Benot et al (1999) in healthy subjects, which has reported that there was a circadian rhythm of TAS, with a peak night at 01:00, which correlated directly with melatonin (MLT).

The sample was comprised by 43 paranoid schizophrenic inpatients.Blood samples were extracted by venipuncture at 12:00 and 24:00 hours. TAS levels were measured three times: at admission, discharge and three months after discharge. Clinical state was assessed by means of the Clinical Global Impression Scale (CGI). TAS serum levels were measured by ELISA techniques.

Our results show that there is statistical significance between 12:00 and 24:00 for the TAS at admission and three months control. This means that at both times, the income and control of the three months, the levels of midday TAS is significantly higher than the midnight TAS. However, these differences did not occur at discharge.Respect to CGI there are differences in clinical status, less high-control.

0,66 ± 0,1420,60 ± 0,158,p < 0,027.

0,64 ± 0,1530,63 ± 0,1350,740.

0,84 ± 0,100,0,76 ± 0,113p < 0,001.

4,37 ± 0,846,3,05 ± 0,754,3,37 ± 0,720.

3,70 ± 0,640,1,77 ± 0,895,2,23 ± 1,455.

Our results point to the fact that serum TAS may be considered as a possible marker of psychopathological descompensation worsening.