ICD-10 delineates Acute and Transient Psychotic Disorders (ATPD, F 23) as distinct from schizophrenia and affective psychosis. We investigated the descriptive epidemiology of ATPD and predictive validity of the diagnosis, compared its three-year outcomes with affective psychosis and schizophrenia, and explored whether acute onset and early remission identify a distinct good outcome subgroup in non-affective psychoses.

Between 1992-1994, all first-episode psychosis patients in Nottingham were identified and assigned an intake ICD-10 diagnosis. Patients were assessed three years later using established outcome measures and longitudinal diagnosis assigned. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable three-year outcome in non-affective psychotic disorders.

Of 168 cases of first-episode psychosis, 112 received an intake diagnosis of non-affective psychoses (F20-29) and 32 (19%) of ATPD (F23). ATPD diagnosis was stable in women over three years, but not in men. Outcomes of ATPD were better than schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and good premorbid functioning rather than acute onset and early remission.

ICD-10 ATPD criteria identify a diagnostically unstable group of disorders consisting of ‘good outcome’ schizophrenia, affective psychosis and a very small group of ‘true’ non-affective, non-schizophrenic acute and transient psychoses. Although ATPD have a better outcome than schizophrenia, in non-affective psychoses, acute onset and early remission do not independently predict favourable outcome over three years.

To evaluate long-term treatment with ziprasidone versus haloperidol (up to 196 weeks), as assessed by PANSS negative score and and its association with quality-of-life (QLS).

The study included two treatment periods: (i) a 40-week, randomized, double-blind phase comparing ziprasidone (ZIP 80-160 mg/d given BID, N=227; ZIP 80-120 mg/d given QD, N=221) versus haloperidol (HAL 5-20 mg/d, N=151), followed by (ii) a 3-year, double-blind extension phase on the same double-blind medications (ZIP BID N=72, ZIP QD N=67, and HAL N=47, respectively). We adapted the Andreasen et al. approach to define negative symptom remission based on attainment of a score ≤3 (mild or less) for at least 6 months on all 7 PANSS negative symptom items. MMRM and GEE models were applied to analyze mean changes in PANSS negative, negative symptom remission rate, and QLS scores over time.

In the 40-week core study, ziprasidone was associated with greater improvement in efficacy and QLS outcomes than haloperidol, but the differences were not statistically significant (p>0.05). However, MMRM analysis of PANSS negative and QLS scores over 196 weeks demonstrated differential treatment effects favoring ziprasidone (80-160 mg/d BID vs. haloperidol) (all p<0.05). Ziprasidone-treated subjects (given BID) were significantly more likely to achieve negative symptom remission (46%) than haloperidol-treated (32%) subjects (p<0.05) during the continuation phase; while ziprasidone given QD (46%) showed a trend to enhanced remission (p<0.08).

These findings support the potential for enhanced social and functional outcomes during long-term treatment with an atypical antipsychotic agent.

Tobacco smoking is leading preventable cause of death in the United States. High prevalence of cigarette smoking was reported among individuals with mental illnesses, and it is extremely high among patients with Schizophrenia. Aims of this paper were to establish frequency of cigarette smoking among patients with Schizophrenia and determinate the difference in frequencies of smoking among patients with Schizophrenia treated with second generation antipsychotics versus first generation antipsychotics treated group.

Study included 60 patients with Schizophrenia treated with antipsychotics for period of six months or longer. Experimental group included 30 patients treated with second generation antipsychotics, and control group included 30 patients treated with first generation antipsychotics.

In this sample was 75% smokers, and out of this 46.6% consume up to 20 cigarettes per day, 40% consume 20 to 40 cigarettes, 8.8% between 40-60 cigarettes, and 4.4% consume over 60 cigarettes per day. There was no significant differences between groups of patients treated with first and second generation antipsychotics.

Tobacco smoking is very frequent among patients with Schizophrenia. In this study we did not found significant difference in frequency of tobacco smoking between groups of patients treated with first and second generation antipsychotics.

To compare the risk of treatment-emergent diabetes(TED) in schizophrenic patients treated with atypical(AAP) versus typical(TAP) antipsychotic medications.

We conducted a retrospective database analysis on episodes of care initiated after 1/1/2000 using data from the California Medicaid program. We included episodes for patients 18 years or older with schizophrenia who switched medications with a minimum “wash out” period of 15 days and no evidence of diabetes in the previous 6 months. If selection bias was present we used a simultaneous bivariate probit model to estimate the risk of TED in patients treated with AAP in comparison to TAP, otherwise we used a univariate probit model. Sensitivity analyses estimated the effect of olanzapine, risperidone and quetiapine independently versus TAP.

A Wald test of the correlation coefficient of the disturbances suggests that treatment selection is exogenous in our model(rho=0.005(p=0.95)) using a Huber-White sandwich estimator of the variance. The univariate probit model results suggest that AAPs were not associated with an increased risk of TED relative to TAPs(p=0.324). Sensitivity analysis showed quetiapine to be associated with a statistically significant decreased risk of TED relative to TAPs. No statistically significant association was shown with olanzapine or risperidone. A bivariate probit model omitting numerous variables demonstrates selection bias(rho=-0.650(p=0.0029)).

The results of this study show that AAPs are not associated with an increased risk of TED relative to TAPs. Explanatory variables that may explain treatment selection that were included in our model were sufficient to control for choice of therapy.

Rehabilitation should help the mentally ill persons to strength their potentials and reduce the deficits in order to live successfully in community. First Croatian Outpatient Rehabilitation Center is organized in Psychiatric Hospital Vrapce. Its goal is to improve the quality of life in patients with psychotic disorders through a holistic rehabilitation program. The Rehabilitation Centre offers program provided by Multi-disciplinary team. Team evaluates each patient on individual bases and develops a realistic treatment/rehabilitation plan. The key of treatment is combination of case management and group treatment. Rehabilitation program includes a supportive individual therapy, provided by the coordinator and different group therapy (psychoeducation, anti-stigma program, family education, healthy life styles, social skill training, stress cooping and vocational training) and creative groups.

40 patients were evaluated in program in our Center according to frequency of visits and rehospitalisation. Also we followed up the family involvement, the number and types of groups which patients attend and contacts with case manager. The obtained data will be compared with BPRS score and the Satisfactory scale results.

It was evident that patients, who regularly contact their case managers, attend to more than one group and have family support, have the treatment better results on Satisfactory scale and BPRS score.

Community Rehabilitation Center offers highly individualized program which combines case management and group therapy in order to help patients with psychotic disorders to recover and live with higher quality standards in community and its long lasting benefits are expected in future.

Schizophrenia is the most prevalent and disabling mental disorder. Schizophrenia patients experience very much stress in their life and coping strategies play an important role in adjustment with these stressful situations. These patients have problems at their coping strategies. They often use from ineffective and inactive coping strategies.

This corelational descriptive study was conducted to determine the coping strategies in schizophrenia patients in refer to psychiatry clinics of hospitals relative to medical science universities and health service of Tehran in 1385.

90 schizophrenia patients having a characteristics of sample study was selected at two stage by non accident sampling (quota, convenience). From “The Ways of Coping Questionnaire” have been used that after determining face and content validity, it's reliability has been accounted through inner stability α=0/98. Data have been collected by self-reporting and receiving some of information through the medical file and have been analyzed by SPSS software.

Results showed that “Resignation” and “Self - soothing” coping strategies in respectively with averages 50/11% and 47/06% are at first and second level of used coping strategies. “Considering”, “Positive reappraisal”, “Ignoring” and “Acting” with averages 41/38%, 40/86%, 40/67% and 37.03% in respectively at third level of used coping strategies. Also the results showed that the majority of the sample study have used from “Avoidance coping strategies” and minority of them used from “Problem – oriented coping strategies”.

The majority of sample study use from “Avoidance coping strategies”.

Although efficacy of antipsychotic medications is well documented, controlled clinical trials have called into question their effectiveness. We examined the effectiveness of olanzapine and risperidone in schizophrenia in a naturalistic setting.

We used an electronic medical records database at a Veterans Affairs medical center to conduct a retrospective study of all new outpatient medication trials of olanzapine (N= 221) and risperidone (N= 274) over a 2-year period beginning January 1999 in patients diagnosed with schizophrenia or schizoaffective disorder. We defined medication discontinuation as a switch between the two agents (the majority of switches) or self discontinuation by not getting medication supply for over one month.

Sample mean age (± SD) was 48.4 (±11.6) years, 91% were male. Discontinuation rates were high (73%) trending lower in olanzapine (70%) than risperidone (76%) (p= 0.12). Median time to discontinuation was 120 days (95% CI: 105-135), longer for olanzapine (150, 95% CI: 120-180) than risperidone (90, 95% CI: 71-109) (p= 0.04).

Self discontinuation was high (48%) with no significant difference between olanzapine (50%) and risperidone (46%). Switching rate was 25% and more likely to occur in risperidone (30%) than olanzapine (20%) (OR= 1.72, 95% CI: 1.13-2.61).

Effectiveness of antipsychotic medications in schizophrenia may be hampered by high rates of medication self discontinuation in outpatient practice settings. Time to discontinuation suggests olanzapine may be more effective than risperidone. Strategies to address causes of poor adherence should be incorporated in medication algorithms to optimize their effectiveness.

Basic features of group psychotherapy for patients with acute psychosis are:

focus on the sharing of psychotic experiences;

different ways of interactive connections and transpersonal relations between patients and staff members;

different realities represented, realized and interpretated by the participants;

high risk of self stigmatization;

paradoxical tension between the urgency readiness of psychiatric environment and the reflective attitude of group work.

A modified group analytic technique with free-floating discussion (Foulkes) is used to understand psychotic experiences. Group processes and symbolic contents are analysed on structural and communicative perspective.

The maintainance of complex group work clAims:

clear and stable boundaries;

creative possibility of potential space (Winnicott);

relational capacity of the stuff;

and high level of integration between the group and the institutional system.

Co-therapeutic team facilitates integration in both direction:

as a part of the group it helps the socialization of group members on the field of psychological work;

as a part of the whole stuff of the department it supports connections around the group.

The individual team member takes double role in the reality of the group: co-therapist and group member. The integration and conflicts between these roles should be interpretated in the context of the group.

Schizophrenia with negative symptoms implies cognitive deficit, correlated with the hypo frontal phenomena characterized by hypodopaminergism.

The increase of firing through hypoGABA-ergism leads to a glutamate activity exacerbation, emphasizing the cognitive deficit.

The neurotrophic factors increase the regulated release of dopamine/serotonine/GABA neurotransmitters, regulate the synaptic glutamate transmission on the NMDA receptors path and play a role in the protection of the dopaminergic neurons and in maintaining the number of receptors and their functionality .

A clinic observation study included twenty patients with schizophrenia with negative symptoms and cognitive deficit.

Between 2004-2007 a number of 10 patients from this group received second generation antipsychotic and neurotrophic factor (Cerebrolysin), while the other 10 received only antipsychotic drug.

The effects on cognition, global function, as well as daily activities were evaluated at 6, 12 and 18 months.

In the comparative tests on the two groups, the frequency of the individual responses was 30% in the group with associated neurotrophic factor, compared to 10% in the other.

Regarding the definite response for the above mentioned 3 criteria, the frequency of the responses was 10% in the group with associated neurotrophic factor, compared to 5% in the other.

The neurotrophic factor significantly reduces the cognitive decline in: global response, functional response, cognition.

The association of the neuroprotective factor in the treatment with second generation antipsychotic drugs for schizophrenia with negative symptoms reduces the cognitive deterioration counterpoising the neurotransmitters balances (especially GABA and Glutamate), improving the prognosis of the disorder.

Poor adherence to antipsychotics is a major problem in long term treatment of schizophrenia, a relationship between poor adherence and relapse is well documented in the literature. One of the factors that may affect compliance is antipsychotic formulation. The primary objective of the study was to compare patient preference for olanzapine conventional tablet (OCT) with orodispersible tablet (ODT) as measured by a formulation preference question.

A 12-week open label, randomized, crossover, multinational study (Turkey, Romania, Israel, Brazil, Mexico) conducted to estimate the proportion of patients preferring OCT over ODT after 6 weeks of treatment with each formulation. Outpatients with stable schizophrenia (CGI-S<4) on OCT monotherapy for at least 1 month before study inclusion were randomized 1:1. Compliance, drug attitude were measured using DAI-10 and MAF scales; tolerability and safety by AMDP-5 questionnaire and adverse event summary.

From 265 randomized patients,207 were eligible for the analysis and 175 patients answered the preference question. 106(61%) patients preferred ODT, and 48(27%) preferred OCT (p<0.001 adjusted for treatment sequence); 21(12%) expressed no preference. 90% of patients were rated as almost always compliant on both formulations. The adverse event profiles of ODT and OCT were similar: most common (>1%) adverse events were weight increase, hypertriglyceridaemia, and somnolence.

Most of the patients who answered the preference question declared to prefer olanzapine orodispersible to conventional formulation. Given the importance of patient's preference as one of the factors for future compliance, olanzapine orodispersible tablet could be a good choice.

We investigated which factors could influence insight in psychosis.

117 in-out patients recruited in the Psychiatric Service of Santa Maria Hospital, Lisbon (Portugal) diagnosed with schizophrenia, schizoaffective and schizophreniform disease, psychosis also drug induced, were evaluated with SAI to asses insight, MARS for medication compliance, WHOQOOL-BREF for Quality of Life, BPRS and PANSS for psychopathological symptoms, I.A test (Reduced Raven's Matrix) for Intellectual Ability. Bivariate correlations were operated using Spearman correlation coefficient (p<0,01). Regression analyses with stepwise ascending regression were computed to assess predictors for insight.

We found significant negative correlations between SAI total score and Delusions, Conceptual Disorganization, Hallucinatory Behavior, Suspiciousness, Poor Rapport, Stereotyped Thinking, Somatic Concerns, Unusual Thought Content, Lack of Judgment of Insight of PANSS, Self Neglect of BPRS and Professional State. Positive significant correlation was between SAI and MARS total score. The regression analysis showed negative relations between PANSS Poor Rapport, Suspiciousness, Guilt Feelings, Active Social Avoidance and Insight; positive relation between Depression (PANSS) and Insight.

Poor Insight was determined by Poor Rapport and Social Avoidance maybe because patients are less predisposed to compare their situations with the surroundings, showing defensive denial and less criticism towards symptoms. Suspiciousness contributes to poor insight due to distrustful attitude that makes difficult to accept the diagnosis and the idea of being seek. Guilt feelings determine poor insight as they are prodromes of delusions. Depression increases insight as a consequence of the painful feelings that make patients think about their situations.

Perceptual and thought distorsions that are observed in the acute episodes of schizophrenia make the adaptation to reality very difficult, but there are residual symptoms that interfere with coping in the interepisodic phases, also. There are specific coping strategies found by such patients in order to face the difficult challenges of hallucinations, delusions, attentional and memory deficits, but also the social stigma and negative symptoms, like isolation.

We assessed 51 patients, 40 male and 11 female, mean age 39.8, diagnosed with chronic schizophrenia- paranoid (n=22), residual (n=14), catatonic (n=10) and disorganised (n=5) type, according to DSM -IV- TR criteria, in order to establish a correlation between main categories of coping mechanisms and the specific type of schizophrenia. Inclusion criteria: patients included in a cognitive- behavioural therapy and antipsychotic maintenance treatment for at least 4 weeks. Exclusion criteria: axis II comorbidity or severe somatic pathology that could modify patients coping strategies.

Patients with paranoid schizophrenia associated maladaptive coping strategies like alcoholism (36.3%) and aggression (27.2%), those with residual type presented more social withdrawal (71.4%) and self- harming (35.7%), while catatonic and disorganised schizophrenia cases had a high incidence of thought blocking (60% and 40%, respectively) and social isolation (60% in both groups).

There are more frequent types of coping mechanisms in each form of schizophrenia. This is an important fact for focusing the psychotherapy approach on conversion to adaptative coping strategies, using techniques like verbal challenge and reality testing, reatributtion- enhancing methods, activities daily programming.

Patients with schizophrenia that are treated with first generation, but also with several second generation antipsychotics, frequently describe negative changes in self-perception and daily activities due to weight gain. A systematic analysis of the weight gain influence over the body image is necessary because it could offer a perspective over the patient's discomfort, improving his/her chances to therapeutic compliance and a better life quality. Psychotherapy, change of antipsychotics, nutritional counselling, ocupational therapy or physical exercises scheduling could be solutions to these cases.

A group of 34 patients, 18 female and 16 male, diagnosed with chronic schizophrenia (DSM IV TR), mean age 45.3, treated with antipsychotic agents for at least 2 years (haloperidol 15 cases, olanzapine 10 cases, amisulpride 5 cases, risperidone 4 cases) were evaluated in order to configure a body image profile, using self-reports, investigator-based reports and Draw-a-Person-Test (DAP). Patients included in this evaluation presented a mean weight gain of 10%, reported to their premorbid value.

The body image was negative in 82.3% with marked dysfunctional believes about self in 64.7%, while the rest of 17.6% had mild to moderate levels of self-blame or hopelessness automatic thoughts associated to weight gain. Only 17.7% patients had a neutral or positive body image, also their mean weight gain was equally to the negative body image group.

Negative body image is usually associated to weight gain as a side event to antipsychotic drugs, therefore is important to ventilate the patient's dysphoric feelings and to choose the optimal therapy.

Several studies have shown that the level of antibodies to Toxoplasma gondii (T. gondii) in schizophrenia is higher than in controls. And it is hypothesized that the neurotropic intracellular protozoan may contribute to the development of schizophrenia. The present study is to explore whether Bactrim, which is effective to T. gondii, can help to treat Toxoplasma-seropositive patients with schizophrenia.

99 patients who were positive in IgG or IgM antibody to T. gondii were seperated into two groups randomly. One group recceived SMZco tablets (contained 400mg SMZ and 80mg TMP, 6 tablets/d) plus risperidone, and the other group received placebo and risperidone. Both the physicians and the patients did not know whether the patients took SMZco or placebo. The dosage of risperidone was tittered according to the patient's clinical symptoms and the maximum dose is 6mg/d. PANSS scales were used to assess the symptoms before and after treated for 6 weeks.

There was no significant difference in the scores of PANSS at baseline and after treatment. The rate of adverse effects, and the ratio of patients who have combined with benzodiazepine and anticholinergic medicine between the two groups did not differ significantly, while two patients in the SMZ group dropped out because of serious nausea and vomiting. The maximum dosage of risperidone in the SMZ group was lower than the placebo group (P<0.05).

For toxoplasma-seropositive patients with schizophrenia, Bactrim may be helpful by decrease the dose of the antipsychotic medicine.

The neuropsychological basis of first-rank symptoms in schizophrenia (FRS) is still a matter of debate. Three broad explanatory models for FRS have been proposed, each arising from a different perspective: (i) medial temporal lobes pathology (Trimble, 1990); (ii) reduced cerebral lateralisation and interhemispheric transfer (Crow, 1997); and (iii) deficits in self-monitoring of intentions due to prefrontal inhibitory dysfunction (Frith et al, 2000). The aim of the study was to test whether patients with FRS would show deficits consistent with the above models.

A broad range of neuropsychological tests were administered to patients with and without FRS and to healthy controls, comprising tests of verbal and nonverbal memory, measures of cerebral lateralisation and interhemispheric communication, tasks of executive functioning, as well as tests of general cognitive abilities.

On some cognitive tests, results were supportive of theories advocating reduced cerebral lateralisation and self-monitoring impairment. An unexpected finding was that, on many cognitive tasks, the performance of patients with FRS was better than that of patients without FRS, and not significantly different from that of controls. These results could not be accounted for by demographic features or medication effects.

The current study may be the most comprehensive examination of neuropsychological performance in patients with FRS to date. Our results suggest that broad cognitive impairment is not a necessary correlate of FRS.