In the past, the first goal of schizophrenia treatment was to reduce psychotic symptoms, mainly positive symptoms. Recently, as a result of an emphasis on patient needs, the concept of quality of life (QoL) has been brought into the treatment. The goal has therefore changed from the alleviation of symptoms to improvement of the patient's satisfaction with social activities. Self-evaluations by people with schizophrenia were previously thought to lack reliability because of the presence of psychopathological symptoms and poor awareness of the disease. Recently the importance of evaluating the satisfaction of patients themselves, however, has been recognized in schizophrenia. Studies on this field showed us, that QoL data from patients with chronic mental illness were reliable and concluded that subjective QoL evaluation was applicable to such patients.

The purpose of the present study was to compare the QoL in patients suffering from schizophrenia in clinical remission with healthy controls and examine the extent of the effects of subjective cognitive functioning on QoL in these patients.

Data were obtained using the quality of life questionnaire (Quality of Life Enjoyment and Satisfaction - Q-LES-Q), and subjective questionnaire for cognitive dysfunction (Cognitive Failures Questionnaire - CFQ) for 40 schizophrenia patients in clinical remission and 40 healthy controls.

Cognitive function correlates negatively with subjective QoL in patients with schizophrenia.

By grant IGA MZ ČR NT11047.

We used Genome-wide association study (GWAS) to explore related genes for schizophrenia with attention and executive function of cognition as endophenotypes.

Trial making tests were used to assess attention and executive function of 98 schizophrenia patients and 60 normal controls. HumanHap660 BeadArray was used to genotype and 464,301 SNPs passed quality control checks. Taking SNPs as analytic factors, age, gender and education years as covariates, trial making tests as quantitative traits, we used PLINK software to complete main effect analyses of the case group and the control group.

2 SNPs residing on PTPRC were associated with attention deficit⌧rs3767742⌧P = 1.83 × 10−5 ⌧rs12409128⌧P = 4.50 × 10−6⌧⌧10 SNPs which locate in UGT2A1, VPS13A and CNTN1 respectively were associated with executive function deficit⌧rs10011630⌧P = 5.88 × 10−8⌧rs4148284⌧P = 5.88 × 10−8 ⌧rs4148283⌧P = 5.88 × 10−8⌧rs4148282⌧P = 5.88 × 10−8;rs7030802⌧P = 2.91 × 10−6⌧rs12343395⌧P = 4.30 × −6⌧rs7035855⌧P = 2.91 × 10−6⌧rs7039192⌧P = 2.91 × 10−6;rs12316203⌧P = 2.91 × 10−6 ⌧rs13328933⌧P = 2.91 × 10−6⌧, moreover, these SNPs have interaction with individual schizophrenia state.

PTPRC, UGT2A1, VPS13A and CNTN1 may be the susceptibility genes for schizophrenia that merit further investigation.

Schizophrenia (SZ) is a syndrome, which is the most common form with paranoid delusions and auditory hallucinations late in early adulthood or in adolescence, and the changed structure of hippocampus, thalamus, amygdale region. Combined imaging with genetics data, we want to obtain genetic susceptibility loci for SZ.

Imaging and genetics data which were obtained from the Mental Health Centre of the West China Hospital. In our study, we applied a genome-wide study of the change structure of brain regions.

We indentified three genes or chromosomal region through having at least 2 single-nucleotide polymorphisms (SNPs) each significant at P < 10−5 for the interaction/main effect model (TBXAS1, PIK3C2G, and IL17A-IL17F).

The genome-wide association study identifies three genes or chromosomal regions, which are related with the volume of hOC3v_V3v_Left hemisphere, Lobule_X_Vermis_Left hemisphere, Lobule_X_Vermis_Right hemisphere and maybe as a risk factor for schizophrenia. This result highlight the usefulness of endophenotype for neuropsychiatric diseases. But these findings are conformed through independent replication studies in future.

Prognostic models discriminate between groups of individuals likely to experience better or worse outcomes and to predict response to treatment.

The premise of the analysis was the assumption that baseline PANSS measurements could be a prognostic factor to inform decisions on the expected response (completion or early-termination) to treatment during participation in a clinical trial.

To examine early patterns/profiles based on PANSS and response to treatment (Study-Completer (SC), Early-Termination (ET)).

Receiver Operating Curves (ROC) was conducted on 809 subjects with SC versus ET. Factor structure assessed whether psychopathology constructs are comparable across SC and ET.

Positive-Symptoms: P5.Grandiosity, P7.Hostility and P4.Excitement are not as good as others in predicting ET. 91.1% ET would have scores of 5, 6 or 7 on P1.Delusions.

Negative-Symptoms: N5. Difficulty in Abstract Thinking and N6.Lack of Spontaneity and Flow of Conversation are not as good in predicting ET. 67.9% ET may have scores of 5, 6 or 7 on N1.Blunted Affect. General-Psychopathology: G3.Guilt Feelings, G6.Depression, G7.Motor Retardation, and G10.Disorientation are not as good in predicting ET. 73.2% ET have scores of 5, 6 or 7 on G9.Unusual Thought Content. Positive Factor accounted for the most variance 15.885%, then Negative factor=14.592%, then Hostile-Excitement=11.973% for SC. For ET, Negative Factor=13.713% variance, cognitive factor=12.451%, Excitement Factor=10.396%.

These findings represent patterns of early detection of response in clinical trials, and have led to the development of sophisticated algorithms that may allow investigators to identify ET and SC, which is important in trial success.

rs10761482 in ANK3 gene showed a significant association with schizophrenia in a genome-wide association study (GWAS). Another marker rs10994336 in ANK3 with the risk of bipolar disorder (BD) which might have more genetic overlap with schizophrenia, had been reported in two meta-analyses of GWAS. In this study, we investigated the association between ANK3 polymorphisms and the susceptibility of schizophrenia in Chinese Han population.

Population-based (schizophrenia patients = 516 and controls = 400) and family based (trios of early onset schizophrenia= 81) study was performed through genotyping the most promising makers rs10761482, rs10994336, and two missenses rs3808942 and rs3808943 near promoter of ANK3. Particularly, we conducted an association analysis for the combined case-control and family samples.

Our population-based study replicated the association between rs10761482 (P = 0.0268 with C allele) and schizophrenia, and detected a novel association with rs10994336 (P = 4.0 × 10−4 with T allele). Haplotype analysis revealed the higher frequencies of C-T, and T-C (rs10761482–10994336) in the cases than controls (P = 0.0032 and P = 0.0012, respectively). In the family study, the C allele of rs10761482 (P = 0.0940) and T allele of rs10994336 (P = 0.0832) were slightly over-transmitted, and T-C was significantly associated with schizophrenia (P = 0.0304). The results from the combined samples analysis were consistent with independent analysis. rs10761482, rs10994336, C-T, and T-C were significantly associated with schizophrenia (P = 3.3 × 10−6∼3.9 × 10−5), whilst rs3808942 and rs3808943 did not reach normal significance.

Our data strongly support ANK3 gene is a schizophrenia susceptibility gene, and also provide further evidence for the shared susceptibility loci between schizophrenia and BD.

rs10761482 in ANK3 gene showed a significant association with schizophrenia in a genome-wide association study (GWAS). Another marker rs10994336 in ANK3 with the risk of bipolar disorder (BD) which might have more genetic overlap with schizophrenia, had been reported in two meta-analyses of GWAS.

In this study, we investigated the association between ANK3 polymorphisms and the susceptibility of schizophrenia in Chinese Han population.

Population-based (schizophrenia patients = 516 and controls = 400) and family based (trios of early onset schizophrenia= 81) study was performed through genotyping the most promising makers rs10761482, rs10994336, and two missenses rs3808942 and rs3808943 near promoter of ANK3. Particularly, we conducted an association analysis for the combined case-control and family samples.

Our population-based study replicated the association between rs10761482 (P = 0.0268 with C allele) and schizophrenia, and detected a novel association with rs10994336 (P = 4.0 × 10−4 with T allele). Haplotype analysis revealed the higher frequencies of C-T, and T-C (rs10761482–10994336) in the cases than controls (P = 0.0032 and P = 0.0012, respectively). In the family study, the C allele of rs10761482 (P = 0.0940) and T allele of rs10994336 (P = 0.0832) were slightly over-transmitted, and T-C was significantly associated with schizophrenia (P = 0.0304). The results from the combined samples analysis were consistent with independent analysis. rs10761482, rs10994336, C-T, and T-C were significantly associated with schizophrenia (P = 3.3 × 10−6∼3.9 × 10−5), whilst rs3808942 and rs3808943 did not reach normal significance.

Our data strongly support ANK3 gene is a schizophrenia susceptibility gene, and also provide further evidence for the shared susceptibility loci between schizophrenia and BD.

Neurological soft signs (NSS) are subtle indicator of brain dysfunction which are present in excess among patients with schizophrenia. Its clinical significance remains unclear despite extensive researches.

To determine the proportion of schizophrenia patients who have motor NSS and then to compare the verbal fluency between these two groups; with and without motor NSS.

This cross-sectional study utilized the Brief Motor Scale (BMS) to investigate the presence of motor NSS in 80 schizophrenia patients attended Universiti Kebangsaan Malaysia Medical Centre (UKMMC) psychiatric clinic. The diagnosis was confirmed by Mini International Neuropsychiatic Interview (MINI). Symptomatology and abnormal motor movement were assessed using the Brief Psychiatric Rating Scale (BPRS) and Abnormal Involuntary Movement Scale (AIMS) respectively. A brief verbal fluency test was administered. Bivariate and multivariate analyses were applied to look for any relationship between study factors.

Majority of schizophrenia patients (68.8%) in this study have motor NSS. The motor NSS were correlated with verbal fluency. Verbal fluency was the only factor that remained significantly correlated with motor NSS after multivariate analysis.

The assessment of motor NSS represents a brief, inexpensive and meaningful tool in psychiatry. Together with verbal fluency, it has the potential as an illness marker and a link between neurobiological research and clinical practice.

Although effective treatment for schizophrenia is available, patient's compliance with treatment prescriptions is notoriously poor. Factors influencing compliance were identified : factors linked to patients, factors depending on the therapeutic relation the clinician and factors due to medications.

To study the relationship between treatment techniques and medication compliance in schizophrenia.

A cross-sectional study of patients with schizophrenia and their parents followed as outpatients in the department of psychiatry D in Razi hospital.

95 patients was recruited punctually. 84 patients (88.5%) were receiving long-acting neuroleptic. Just under half patients (48%) were compliant with their treatment. Almost all observing patients (91%) were receiving long-acting neuroleptic. The average dose of NLP prescribed in patients observing is slightly lower than that of not observed. The number of daily doses of treatment also appeared to influence the adherence behavior. The correlation between adverse events and compliance was statistically significant (p = 0.032).

The management of schizophrenia could be greatly improved by considering the medication related factors leading to non compliance. Medication prescription complexity is important to take under consideration. However, strategies for the improvement of compliance must also take into consideration other factors such us patient- related and interactional factors.

Thirty two women diagnosed PCOS, were included in the study. The questionnaire contains a general part concerning socio-demographic conditions, medical history, health problems, PCOS symptoms Sexual satisfaction was evaluated by “the Female Sexual Function Index” (FSFI).

The mean age of PCOS women was 28.9 ± 5.6 years, Sixty per cent of PCOS women had miscarriages and half of of the sample was treated for infertility.

Eighty five percent of patients with PCOS had a morbid obesity (BMI > 30 kg/m2). Ninety five per cent of PCOS women had an hirsutism Marital sexual dysfunctions were found in 50% of the sample (global score of FSFI < 26). Marital sexual disorders were significantly increased with presence of hirsutism (p < 0.01). BMI had no impact on the sexual satisfaction. Both obese and non obese women with PCOS reported being significantly less satisfied with their sex life in the past month (p < 0.001), finding themselves significantly less sexually attractive (p = 0.03), perceived their husbands as less satisfied with their sex life (p = 0.001), and reporting that excessive body hair affected their sexuality (p = 0.003). BMI also had no significant effect on the frequency of sexual intercourse or sexual thoughts and fantasies.

This study shows many sexual problems affecting patients with PCOS. A medical treatment which aimed to improving PCOS-related symptoms can reduce psychological distress and improve sexual self-worth.

Erectile dysfunction (ED) and premature ejaculation (PE) are common disorders among italian male population aged between 18 and 65 years old (prevalence rate: 20–25%). Several studies demonstrate that the early treatment of the psychological conditions, frequently associated to ED and PE, can positively influence the prognosis.

To evaluate the psychological correlates of sexual dysfunction using a standardized instruments.Methods. 46 male patients aged between 18 and 65 years old affected by EP (60,87%) and DE (47,83%) were administered the Cognitive Behavioural Assessment (CBA 2.0). Analysis of data was carried out using an automatic scoring and creating a graphic profile.

The 28,26% of the participants showed an high score (> 95th percentile) at the STAI X-1 suggesting the presence of trait anxiety; the 39.16% of the subjects reported experiences of social and emotional maladjustment and concomitant introversive personality traits at EPQ schedule (85–@95th percentile at subscales E and P) and depressive mood at scale 8 (questionnaire D). Finally, the 32.60% did not present psychological conditions.

According to the literature, our findings demonstrates an high frequency of psychological distress in patients affected by sexual dysfunction (67%). The use of CBA 2.0 migth represent an useful tool for the diagnosis and early treatment of this kind of population.

Pharmacotherapy of sex offenders is an important part of the treatment of sex offenders.Cyproterone acetate and medroxyprogesterone acetate are commonly used among the patients with severe paraphilia, but they can have serious side effects. Selective serotonin reuptake inhibitors are not recommanded for severe forms of paraphilia like pedophilia. Agonists LHRH is an interesting treatment option because of the administrative way (intra muscular injection) and the tolerance of the medication.

Methodology: Medline was searched for key reviews and papers published during the years 1990 through 2008 that presented data for agonists LHRH treatment for sex offenders (case reports and studies).

We found 9 case reports; three prospective studies, one retrospective study. In total we repported a sample of 178 treated patients with different forms of paraphilia. All the studies used self reports to measure the effectiveness of the pharmacotherapy. Patients reported an important decrease of deviant sexual thoughts. Osteoporosis was the most common side effect.

Agonists LHRH are recommanded for patients with severe paraphilia. We propose a differentiated treatment regarding side effects and symptomatology severity.

Transsexualism is a gender identity disorder soon to be removed from the DSM criteria for mental disorders. The actual developmental/congenital origin of the disorder has yet to be established. One of the theories involves morphological and neuro-hormonal modification in the corpus callosum as a possible substrate.

Diagnostic assessment of a 22 year old female - male transsexual patient with a history of agoraphobia and migraine, reporting intermittent symptoms of numbness of left side of body and cheek and headaches.

Data on personal/family history was obtained and neurological examination was performed. MRI scan was acquired with a 1.5 T Siemens Magnetom system with a standard head coil. Sagittal three-dimensional 3D RAGE, contiguous 1.0 mm slices, 1 acquisition sequences were obtained.

Results and discussion: Family history of anxiety disorder was confirmed. Symptoms appeared following reduction of anxiolytic medication and emotional crisis. Neurological status showed signs of left pyramid deficit. NMR scan findings showed bilateral arachnoid cysts in genu corpus callosum probably of congenital origin. Co-morbidity versus concomitant disorders of psychiatric, neurological and congenital origin were discussed.

Gender identity disorder (GID) is defined as a strong and persisting cross-gender identification, associated to the discomfort with the biological sex with which subjects were born. Over the last years, the question whether GID really represents a true psychiatric disorder and if it should be included within the upcoming editions of the major diagnostic psychiatric systems or not is generating growing controversies.

Although GID represents a major challenge for the whole medical community, involves different specialists and posits relevant treatment issues, the scientific literature concerning the psychological and clinical characteristics of GID is still limited and further studies are needed in the field.

The present research is aimed to explore the psychological, personality and clinical profile of subjects with DIG.

To this aim, 100 consecutive adult patients with a standardized DSM-IV-TR diagnosis of GID, were recruited from those attending the dedicated day-care facilities of the Department of Psychiatry of the University of Bari. All included subjects underwent a psychopathological evaluation including general psychopathology (SCL-90), personality traits (MMPI-2), anxiety and depression (Zung scales for anxiety and depression, respectively) self-rated assessment.

Preliminary analyses confirmed that GID subjects did not show pathological personality traits and did not reach standardized cut-off scores for anxiety, depression, or any other general psychopathological item.

These results are in line with recent findings on the topic and support the notion that transexualism, although possibly causing negative feelings and psychological distress, might be not considered a psychiatric disorder.

To assess the effect of Ginkgo Biloba Extract (GBE) on sexual function in the menopausal women.

In this triple blind randomized placebo controlled trial, 80 healthy volunteers’ 50–60 years old menopause women, whom had been admitted in three health care centers of Tehran University of Medical Sciences (TUMS), got involved during summer and autumn 2010. The instrument of this study had two parts. The first part was personal characteristics, and the second part was Sabbatsberg Sexual Rating Scale (SSRS), which was used for subjective evaluation of the sexual function before and after intervention. The participants received GBE 120–240 mg or placebo daily for 30 days (40 participants in each group)

The most domains of sexual function was significantly more improved in the GBE than in the placebo group and included sexual desire (P < 0.05), sexual pleasure (P < 0.01), orgasm (P < 0.05), importance of sex (P < 0.01) during last month and importance of sex in comparison to previous years (P < 0.007). The mean score of total sexual function in the GBE group had significant difference with placebo group (P < 0.05).

Findings of this study support positive effect of Ginkgo Biloba on menopausal women's sexual function.

Over the last two decades, through the voices of groups including non-governmental organizations, persons bearing sex differentiation disorders have begun to question when and how one should decide in favor of or against surgical intervention following diagnosis.

Semi-structured interviews were held with seven adult patients who showed sex differentiation disorders at birth: Two with 5-alpha-reductase type-2 deficiency and five with congenital adrenal hyperplasia.

To investigate both how sexual identity is structured and the relationship between sexual identity, choice of sex object and sexual difference.

There is no ideal moment to perform surgical reassignment interventions on intersex patients, since the depth of the trauma can be neither predicted nor avoided. Traumatic events and their numerous occurrences are overdetermined, and depend on how parents, medical teams and subjects themselves cope with them throughout life. This fact is closely related to the question of how and when to operate, and who makes any decision to operate in order to “normalize” “abnormal” sex organs. The subject should never be left out of this decision.

This most complex discussion involves many variegated factors, including X and Y chromosomes, testosterone levels, hormone receptor sensitivities, sexual practices, the gender of partners, mannerisms, clothing, accessories, dream content and sexual fantasies, and none of them determine individuals’ identification nor their preferences for this or that sexual object.

Sex is trauma. Neither male nor female nor any other gender identification implies the choice of sex object, genders of partners or sexual practices.

Reviewing notes & drug charts for 6 months duration (Jan to June 2010) for all the inpatients (74) on the 6 Forensic wards at the Littlemore Hospital

Findings:

1. - 3 patients were found (Zopiclone 7.5)

2. - PRN basis

3. - Insomnia: recorded on charts only

4. - Non pharmacologic measures: 1

5. - Documentation: 1

6. - Max duration: No

7. - Revision: No

1. - Hypnotics are rarely used in Forensic units

2. - Only used for couple of days

3. - Zopiclone mainly used

4. - No switching

5. - Documentation: rare

Recommendations:

1. - Non pharmacological (sleep hygiene)

2. - Document entry in notes (medical+ nursing)

3. - Max duration 2 weeks (NICE)

4. - Larger scale (General wards)

1. - Forensic patients:HDAT & RT

2. - Standards followed by Trust

3. - Forensic patients supervised at all times

4. - On call doctor??

5. - Sleep Hygiene encouragement