Neurosyphilis results from infection of the brain, meninges or spinal cord by the spirochete Treponema pallidum and comprises a wide spectrum of clinical and pathological features including psychiatric symptoms. We report the case of a patient who presented with psychotic symptoms and was diagnosed with late syphilis.

A 45-year-old male with anxiety, insomnia, auditory hallucinations, delusions of persecution and mild cognitive impairment of relative recent onset was admitted to the Department of Skin and Venereal Diseases because of serological evidence of syphilis (TPHA 1:320). Upon admission treatment with olanzapine (15 mg/d) was started. Further evaluation yielded positive syphilis serology (TPHA, RPR and FTA-abs) in serum, slight cerebral atrophy in CT and discrete aneurysmatous dilatation of the aortic arch by heart ultrasonography. CSF findings did not satisfy laboratory criteria for the confirmation of diagnosis of active neurosyphilis. Late (tertiary) syphilis with beginning cardiovascular involvement was diagnosed and treatment with benzathin penicillin was administered. Six months later he was readmitted for a follow-up examination. Psychiatric symptoms were improved.

Although quite rare today, neurosyphilis should be considered in the differential diagnosis of patients with psychotic symptoms and positive syphilis serology, as the appropriate treatment depends on early and accurate diagnosis. Moreover, given the wide use of antibiotics, abortive cases of neurosyphilis with atypical presentation forms must also be considered. Finally, this case suggests that in addition to the appropriate antibiosis, treatment with antipsychotics seems to be effective in controlling psychiatric symptoms emerging in the course of late syphilis.

Working memory dysfunctions are considered to be promising intermediate phenotypes, i.e. biological markers, which may help to discover genetic and pathophysiological factors involved in the pathogenesis of schizophrenic and affective psychoses. However, little is known about the possible role of these brain dysfunctions for differential diagnosis, for instance between schizophrenia and bipolar affective disorder. In the present study we directly compared brain activation during verbal working memory task performance in matched groups of schizophrenic and bipolar patients as well as healthy controls.

12 schizophrenic patients, 14 bipolar patients and 14 healthy controls underwent fMRI during a delayed matching to sample task requiring the maintenance of verbal information in working memory. Data were preprocessed and statistically analyzed using standard procedures as implemented in SPM2.

Both schizophrenic and bipolar patients exhibited significantly increased activation in bilateral dorsolateral prefrontal cortex and in right intraparietal cortex. Abnormal hyperactivations that were unique to either schizophrenia or bipolar disorder were found in bilateral caudate nucleus and the right amygdala, respectively.

Compatible with findings from genetic research into the pathogenesis of schizophrenia and bipolar disorder, the present data show both similarities and significant differences between these two diagnostic categories regarding the patterns of abnormal brain activation that may underlie verbal working memory deficits in these patients.

Childhood subclinical characteristics have not been fully investigated in patients with schizophrenia. To elucidate the picture of them, and to find out indicators which predict later development of schizophrenia, childhood behaviors of the adult schizophrenia subjects were investigated in a questionnaire-based retrospective study.

schizophrenia outpatients (n=50) in his/her twenties and normal healthy subjects (n = 100) were investigated. All patients are diagnosed according to DSM-IV-TR as schizophrenia, and who presents now mainly negative symptoms after passing an acute stage. By modified use of the Child Behavior Checklist (CBCL) as a retrospective assessment questionnaire, the parents of the patients and of control subjects rated their childhood behavior.

A discriminant analysis using all items of CBCL correctly classified 99.0% of the population. Notable in an item-level analysis was an extremely attenuated aggression in personal relations in the schizophrenia subjects. Among eight subscales of the CBCL, those of Withdrawal, Social Problems, Attention Problems and Aggressive Behavior contributed most to the accuracy of the prediction of group membership.

It was suggested that subclinical behavioral and psychological characteristics of schizophrenia already exist in the patients' childhood, among which lack of aggressive behaviors might be one of the core features.

Anomalous subjective experiences are thought to be intrinsic to schizophrenia and considered as constituting the phenotypic validity anchor of the schizophrenia spectrum concept.

Although neglected in modern psychiatry, due to the dominating behaviouristic approach, they nevertheless have been thoroughly investigated in continental European psychiatry, where it has been shown that their presence antedates future psychosis. Anomalous experiences of self-awareness (self-disorders) are a sub-group of subjective pathology, and has been hypothesized to constitute a core phenotype of schizophrenic spectrum disorders. Our research team has participated in the development of a self-disorder scale, EASE, based on empirical studies, clinical experience, phenomenological philosophy and existing psychopathological scales. A part of the EASE-items is overlapping the BSABS. These common psychopathological phenomena have been shown to be predictors of later development of schizophrenic psychosis. Results from three separate studies making the basis of the EASE are presented.

Drawing on the results of our own three separate empirical studies the distribution of self-disorders in patients with schizophrenia, psychotic bipolar illness, schizotypal disorder and other mental illnesses, and relatives with no mental illness is described.

It is shown that self-disorders are common and equally frequent in schizophrenia and schizotypal disorder, and significantly less common among patients with psychotic bipolar illness and other mental illnesses, and almost absent in the relatives without mental illness.

The results support the schizophrenia spectrum hypothesis and points to self-disorders as a phenotype of schizophrenia-spectrum disorders. Self-disorders appears to be possible predictors of schizophrenic prodromal states.

It is well known that schizophrenia is characterized by structural brain abnormalities with neurodevelopmental origin. These abnormalities can be detected with quantitative and structural MRI methods that have an emergent role in psychiatric disorders. In our study we used voxel-based morphometry (VBM) that is the most frequently used structural MRI method.

We compared eight patients with first episode schizophrenia and eight, age-matched healthy subjects to detect focal tissue differences in gray and white matter, and cerebrospinal fluids between groups. High resolution T1 weighted 3D MPRAGE structural volumes were acquired with a 1.0 T Siemens Harmony Expert scanner. Imaging data were preprocessed and voxel based morphometry was performed by SPM2. Optimized VBM method was used.

Similar to earlier studies, patients with schizophrenia showed decreased gray matter tissue density in frontotemporal and insular regions bilaterally. Moreover, the left–sided parietal operculum and the calcarina showed focal decrease in tissue density. Frontotemporal and insular white matter density decrease were detected bilaterally similar to gray matter changes. The left sided precuneus and lingual gyrus were also involved in reduced white matter density. Increased cerebrospinal fluid spaces were detected in the frontal regions and the ventricles.

We detected structural brain abnormalities in the early course of schizophrenia. Our results with the optimized voxel-based morphometry are in line with earlier imaging studies and correspond with neuropsychologically detectable frontotemporal deficits in schizophrenia.

D-serine acts as an endogenous co-agonist at the glycine modulatory site of the NMDA receptor. Significantly decreased D-serine serum levels were reported in patients with schizophrenia in comparison to healthy control subjects. D-serine improved positive and negative symptoms in patients with schizophrenia treated with antipsychotics. We hypothesized that D-serine serum level might be associated with specific characteristics of psychopathology in schizophrenia.

We enrolled fifty patients with schizophrenia into the study. Positive and Negative Syndrom Scale (PANSS) and The Scale for the Assessment of Negative Symptoms (SANS) were used to assess the symptoms of schizophrenia. D-serine serum levels were measured by High Performance Liquid Chromatography.

D-serine serum levels were not associated with PANSS and SANS total and subscales scores in the population of fifty patients. We demonstrated only mild insignificant linear association of PANSS score with D-serine serum level (r=0.20) in the group of men (n=33). The mild insignificant inverse correlation was found in the group of women (n=17) between the total PANSS (r=-0.35) or SANS score (r=-0.30) and D-serine serum level.

We assumed that various biochemical and clinical profiles could lead to identification of specific subtypes of schizophrenia. However, we did not find any significant association between serum D-serine and clinical symptoms in this study. D-serine serum levels had a strong trend to be lower among female patients with schizophrenia as compared to men. The role of gender in the glutamatergic dysfunction associated with schizophrenia deserves further attention.

Medication discontinuation in remitted single episode patients after a period of maintenance therapy is a major clinical decision and thus the identification of risk factors controlling for medication status is important.

Following a first/single episode with DSM-IV schizophrenia and related psychoses, remitted patients who had remained well on maintenance medication for at least one year were randomized to receive either maintenance therapy (with quetiapine 400 mg/day), or placebo for 12 months.

178 patients were randomized. Relapse rates were 33.7% (30/89) in maintenance group and 66.3% (59/89) in placebo group. Potential predictors were initially identified in univariate Cox regression models (p<0.1) and were subsequently entered into a multivariate Cox regression model for measuring the relapse risk. Significant predictors included patients on placebo (hazard ratio, 0.41; CI, 0.25 – 0.68; p=0.001); having more pre-morbid schizotypal traits (hazard ratio, 2.32; CI, 1.33 – 4.04; p=0.003); scoring lower in the logical memory test (hazard ratio, 0.94; CI, 0.9 – 0.99; p=0.028); and having more soft neurological signs (disinhibition) (hazard ratio, 1.33; CI, 1.02 – 1.74; p=0.039).

Relapse predictors may help to inform clinical decisions about discontinuation of maintenance therapy specifically for patients with a first/single episode psychosis following at least one year of maintenance therapy.

We are grateful to Dr TJ Yao at the Clinical Trials Center, University of Hong Kong, for statistical advice. The study was supported by investigator initiated trial award from AstraZeneca and the Research Grants Council Hong Kong (Project number: 765505).

To evaluate decision criteria for initiation of pharmacological long-term treatment (LTT) in patients with schizophrenia

Non-interventional trial in in-patients pretreated with oral risperidone (RIS-SCH-0001). Further treatment strategy was detailed to: monotherapy with (1) long-acting injectable risperidone (LAIR), (2) oral risperidone (oral RIS), (3) no decision taken, (4) other antipsychotics. Study period was limited to 42 days.

Decision groups comprised (1) 29.0%, (2) 43.0%, (4) 11.5% and (3)16.5% of the 321 patients who were included (mean age 40.5y). Reasons for taking the decision for LTT included good efficacy of oral RIS (LAIR 17.2%, oral RIS 41.3%, other decision 2.7.%) and previous lack of compliance (LAIR 40.7%, oral RIS 2.2%, other decision 16.2%). Mean observation period was shorter in groups 1/2 compared to groups 3/4. For patients known at the institution odds ratio for being treated with LAIR was 2.8 as opposed to oral RIS. 130 AEs were reported (47 patients), 1 SAE (somnolence) classified as of possible causality to RIS.

The trial revealed heterogenous reasons for decision taking into LLT in patients with schizophrenia. LAIR but also other depot formulations have been the favored choice in case of lack of compliance. Patients known at the institution were more likely to be treated with LAIR.

According to a recent large-scale Swedish epidemiological study, 5 % of violent crimes are attributable to patients suffering from psychosis., We present the preliminary results of a feasibility study comparing violent and non-violent schizophrenics on underlying potential process such as impulsivity, emotionality using both, psychometrics and neuropsychological correlates.

Male Violents subjects where selected by clinicians on their life time histories of violence and control where paired according to age. Assessment include selected neuropsychological and psychometrics tests: BPRS (Brief Psychiatric Rating Scale), PCL-R (Psychopathy Checklist-Revised), BREF (Frontal Assessment Battery), WCST (Wisconsin Card Sorting Test), Iowa Gambling Task, BIS-11 (Impulsivity Scale).

Violent's performed better in the executive functions (WCST and the BREF), showing a better use of the dorso-side prefrontal cerebral cortex.

Their less good performances in the orbitofrontal functions, (Iowa Gambling Task, BREF), show cortical abnormalities involved in the processes of decision. Lesser capacity to recognize the appropriate feelings seems more present in deliberate violence, determined by the emotional coolness and the absence of fault, than in impulsive violence.

The PCL-R identifies the defect of orbitofrontal activation as the origin of the perturbed emotional integration and the bigger impulsiveness, by the slightest capacity of inhibition of the impulsive decisions.

Our results, especially when compared to literature data, show the existence of dysfunctional cerebral process in schizophrenic violent patients similar to those observed in psychopathy. They outline the need for further clinical and neuropsychological studies to identify pathophysiological processes and estimate the potential recurrence of such behaviours.

Positive effect of olanzapine on cognitive functions in schizophrenia was confirmed in many papers accessible in the literature.

The objective of our study is to evaluate the effect of olanzapine treatment on cognitive functions in patients suffering from schizophrenia during a six-month observation.

Twenty patients with a diagnosis of schizophrenia according to ICD-10 diagnostic criteria for research were examined. 1 day before initiation of olanzapine a baseline assessment was performed. The neuropsychological examination was repeated 28 days, 60 days, 3 months, and 6 months after the beginning of treatment. The use of benzodiazepines was interrupted 48 hours before each assessment, and a continuous co-medication with benzodiazepines never lasted longer than 48 hours. No other additional medication was administered. Cognitrone (COG) and Vienna Reaction Test (RT), both tests being a part of Vienna TEST System, were used. The Positive and Negative Symptom Scale (PANSS) was also used to evaluate general nonpsychotic psychiatric symptoms, positive psychotic symptoms, and negative symptoms. The assessment with the use of PANSS took place on the same days as the neuropsychological examination.

We have shown with the use of neurocognitive battery, that patients treated with olanzapine improved during the treatment. It is notable that this improvement was observed already on the 28th day of the treatment.

The above data here may be useful in encouraging clinicians to use olanzapine across the broad range of schizophrenic patients.

Cognitive deficits and anxiety are common symptoms in patients suffering from schizophrenia.

The aim of the research was to find a relationship between selected cognitive functions and intensity of anxiety as state and trait in people suffering from schizophrenia.

18 patients (9 women and 9 men) with a diagnose of paranoidal schizophrenia (according to ICD-10) were recruited to the study. The battery of cognitive neuropsychological tests used to assess cognitive functions included: trail making tests, part A and B, and Stroop test, part RCNb and NCWd. The intensity of anxiety as state and trait was assessed by means of the Spielberger State-Trait Anxiety Inventory (STAI).

In the examined group statistically significant relation was found between the results of trail making test, part A and B (measuring psychomotor speed and visual spatial working memory), as well as part RCNb of the Stroop test (measuring reading speed), and the intensity of anxiety as state measured with STAI. Another statistically significant correlation was found between results of trail making test, part A (measuring psychomotor speed) and anxiety as trait measured with STAI. No other significant correlations between results of the applied cognitive tests and anxiety as state and trait were found.

The above correlations between cognitive tests results and intensity of anxiety indicate that there must be a modulating impact of emotions on some of measured cognitive functions. The awareness of these correlations may be important in the process of constructing rehabilitation programmes for patients.

Quetiapine immediate release (quetiapine IR) improves PANSS total, positive, negative and general psychopathology scores in schizophrenia. This study (D1444C00132) evaluated the efficacy of once-daily extended release quetiapine fumarate (quetiapine XR) in patients with acute schizophrenia.

This was a 6-week, double-blind, randomised study (n=588) comparing quetiapine XR (400, 600 or 800 mg/day) and quetiapine IR (400 mg/day) with placebo. Efficacy was assessed using ANCOVA analyses of the change from baseline to study endpoint (Day 42) for: PANSS total score; positive, negative and general psychopathology subscale scores; and aggression and depression cluster scores (modified ITT population, LOCF). Changes in individual PANSS item scores were assessed post hoc.

At Day 42, there were statistically significant reductions (ie two-sided p-value <0.05) versus placebo with all doses of quetiapine XR for the change in PANSS total, positive, general psychopathology and aggression cluster scores. Changes in negative and depression cluster scores were statistically significant versus placebo for quetiapine XR 600 mg/day and 800 mg/day. There was statistically significant separation from placebo with quetiapine XR 600 mg/day and 800 mg/day for the change in 6/7 PANSS positive items, 5/7 negative items, and 12/16 general psychopathology items. For those items with no statistically significant separation from placebo, baseline scores were generally low.

Once-daily quetiapine XR is effective across a broad range of symptoms in acute schizophrenia, including positive and negative symptoms, as well as symptoms of general psychopathology, aggression and depression.

7.8%-31.7% of schizophrenic patients have obsessive compulsive disorder (OCD) as well (1,2). In this study, symptom profiles of OCD and OCD with schizophrenia is discussed in terms of similarities and differences and whether these could point towards discrete etiopathogenesis.

100 patients with schizophrenia and 50 patients with OCD, diagnosed using the DSM-IV criteria were included in the study group. The study group was treated at the outpatient clinic of Bakirkoy Hospital for Mental and Nervous Diseases, Istanbul, Turkey. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used.

%16 of the schizophrenia patients had OCD. Y-BOCS obsession severity subscale total, compulsion severity subscale total and general total scores of the pure OCD group and the schizophrenia with OCD group were compared. There was no statistically significant difference. However comparison of obsession and compulsion content in the two groups revealed statistically significant difference in terms of religious obsessions (p=0.002), cleaning/washing compulsions (p=0.009) and controlling compulsions (p=0.008).

Our results were different in terms of the distribution of obsessive compulsive symptoms when compared with other studies about OCD and OCD with schizophrenia (1,4). Paying attention to differences in syptomatology by the clinicians might improve diagnosis and treatment. Neuropathology in pure OCD and OCD with schizophrenia may be diverse.

Some patients with schizophrenia switch medications due to lack of efficacy or side effects; improvement in symptoms and side effects following a switch must be assessed.

In a 12-week, open-label, baseline-controlled, flexible dose switch study, adult outpatients with schizophrenia experiencing suboptimal efficacy or tolerability problems were switched from haloperidol (n=99), olanzapine (n=82), or risperidone (n=104) to ziprasidone (80¬–160 mg/d; dosed bid with food). The primary efficacy evaluation was the BPRS score at Week 12. Safety evaluations included change from baseline in movement disorders (SAS, BAS, AIMS), weight, prolactin, and fasting lipids levels. Statistical tests were 1-sided non-inferiority comparisons with correction for multiple comparisons (0.025/3 significance level), for the primary efficacy endpoint, or 2-sided (0.05 significance level), for secondary endpoints.

BPRS scores improved significantly compared with all 3 preswitch medications at Week 12. Mean change from baseline (SD) for patients switched from haloperidol, olanzapine, and risperidone was –11.3 (16.3), –6.3 (14.2), and –9.9 (13.2), respectively (p < 0.0001 vs baseline). Movement disorders, measured by SAS, BAS, and AIMS, improved significantly for subjects switched from haloperidol and risperidone. Change in weight (kg ± SD) from baseline was 0.4 ± 3.97, –2.0 ± 3.99 (p < 0.001), and –0.6 ± 3.21 for subjects switched from haloperidol, olanzapine, and risperidone, respectively.

Patients switched to ziprasidone demonstrated improvement in symptoms and movement disorders, with a weight neutral effect. Ziprasidone is an appropriate switch option for patients experiencing suboptimal efficacy or poor tolerability with their current treatment.

Early psychosis is not a discrete disorder; rather it is mixed-up state .Different states like depression, anxiety, psychosis, obsession manifest during this period. 20% to 40% of BLIPS positive subjects eventually make transition to psychosis. Large proportion of remaining patients develops anxiety or mood disorders. During early psychosis unitary psychosis, manifest itself in forms of different psychiatric disorders.

An electronic search was made at data based websites including pub med and Blackwell synergy using key words, unitary psychosis, prodrom, early psychosis .This was followed by manual and internet study of relevant articles .

Cognitive deficits and defects of facial recognition were present in both schizophrenic and bipolar prodrom .In 24.2% schizo-obsessive patients reduced size of the left hippocampus was found. 84% subjects reported depressive symptoms before transition to psychosis, 73% of patient of schizophrenia starts with non-specific affective and negative symptoms. In presence of depression, probability of transition to psychosis increased from 4% to 21.7%. In 47.3% of patients, OCD occur before onset of frank psychosis.

High prevalence of comorbidities during prodromal phase indicates that shared common factor is involved. Anxiety, depression and attenuated psychosis are integral components of early psychosis. Overlapping of bipolar and schizophrenic prodrms depicts commonality of origin of two disorders.OCD is associated with schizo-obsessive subgroup. Strong interactive relationship among different disorders could be explained on basis of unitary psychosis.

Presence of unitary psychosis is realized in the studies of early psychosis.

1. 1. To identify a phenomenon of loneliness, levels of depression and anxiety of patients with deep psychopathological disorders.

2. 2. To allocate the role of the phenomenon of loneliness as the differentiation factor of therapy of patients with deep psychopathological disorders.

3. 3. To study and create differential models of therapy of patients with deep psychopathological disorders.

74 patients were surveyed at the Republican centre of mental health in Bishkek city in the age of from 16 till 60 years with deep psychopathological disorders .

1. • Modified UCLA scale for the evaluation of the level of the loneliness,

2. • Standardized Zung depression scale

3. • Standardized Spilberger-Hanin anxiety scale

Patients with organic psychopathological disorders (F06.2) 32 people had less level of loneliness (37.8 (P<0.01)) in comparison with patients suffered from, schizophrenia (paranoic with apathy abulia syndrome) (57,3 (P<0.01)). While the intensity of hypothimic affect of patients with deep psychopathological disorders was higher (46,2 (Р<0.01)), then one of patients with schizophrenia. Anxious level was middle and there wasn't found any verified differences.

1. • Phenomenon of loneliness is one of the clinical and psychological mechanisms causing development of apathy abulia syndrome of patients with deep psychopathological disorders

2. • Phenomenon of loneliness is one of components of differential therapy of patients with deep psychopathological disorders.