Knowing the opinions of general people about schizophrenia using a survey.

2895 People have answered the survey. 57,2% men and 42,5% men. 71,8% are 20 to 40 years old. Most of them are spanish (91,1%), but 6,5% anser from Latinamerica.

A question about the schizophrenia is given in order to compare with other events schizophrenia-related: : stigmatized, relation with violence, dificulties for living with others; for working alone, need to take drugs, difficult to obtain close relations, difficulties to obtain a job and not to be account.

Survey have been in the mundosalud website (www.mundosalud.es) for free access form 01/06/2006 to 15/09/2006. Everybody is invited to answer and a friendly interface is used in order to make easy participate. No payment is made for answering. During 2006 this web have been visited by 120.000 citizens.

The results stablished that the most important problem considered by the schizophrenic patients is the difficulty for finding a job and maintaining social and personal relations. Besides, stigmatization is noticed very important too.

By the other hand, taking drugs and links between violence and disease are considered as a less important problem by the schizophrenic patients.

The concurrence of psychoactive substance use and schizophrenia is important in its effect on therapeutic responses and patient prognosis. The prevalence of these disorders depends on the methodology used:retrospective studies and those in which drug consumption information was not collected in a structured way present a prevalence of disorders due to substance use between 3-22%.When this information is gathered systematically, the prevalence goes up to 30-50%. Between the variables that predict a high risk of disorders due to substance use we found: young adult male, first hospital admittance at a young age, greater frequency of hospital re-admittance, better previous social adaptation to the disease and higher frequency of violent and impulsive behaviour.We try to determine the association of sociodemographic variables and the prevalence of disorders due to substance use.

331 schizophrenic patients admitted to the Psychiatric Ward of Conxo Hospital.Among these subjects, determination was made of the existence of comorbid disorders due to substance use.A descriptive analysis was carried out based on categorical variables using SPSS.

23 patients presented comorbidity(7%).The overall sample of schizophrenic subjects consisted of 93% males, however, the subjects with comorbidity were 100% male.With respect to marital status, there were a greater proportion of single patients with comorbidity(95%).There was a higher proportion of institutionalized patients in the group with comorbidity and a lower level of education. The comorbid group included more subjects who were unemployed.

schizophrenic patients with comorbidity are single men with poor social capacity.It´s important that we collet the drug consumption information by structured way.

To evaluate efficacy and safety of intramuscular (IM) aripiprazole and IM haloperidol in patients with acute agitation associated with schizophrenia.

Patients (n=232) were randomized to IM aripiprazole 1-mg (0.5 ml of a 2-mg/ml solution), 5.25-mg (0.7 ml of a 7.5-mg/ml solution to approximate 5-mg), 9.75-mg (1.3 ml of a 7.5-mg/ml solution to approximate 10-mg), or 15-mg (2.0 ml of a 7.5-mg/ml solution), IM haloperidol 7.5-mg (1.5 ml of a 5-mg/ml solution) or IM placebo. Over 24 hours, patients received up to three injections, administered ≥2 hours apart. Primary endpoint was mean change from baseline in Positive and Negative Syndrome Scale Excited Component (PEC) score at 2 hours. Secondary endpoints included CGI-I, CGI-S and ACES scores.

Mean PEC improvements at 2 hours were significantly greater with IM aripiprazole 5.25-, 9.75- and 15-mg, and IM haloperidol versus IM placebo (Table). Compared with IM placebo, mean improvements were significantly greater in CGI-S with IM aripiprazole 9.75- and 15-mg, and in ACES with IM aripiprazole 9.75-mg and IM haloperidol (Table). Mean CGI-I was significantly better with IM aripiprazole 5.25-, 9.75- and 15-mg, and IM haloperidol versus IM placebo (Table). Overall, IM aripiprazole was well tolerated, with fewer extrapyramidal side effects versus IM haloperidol.

IM aripiprazole 9.75-mg is effective and well-tolerated for acute agitation associated with schizophrenia.

Assess the effectiveness and safety of transitioning patients with acute schizophrenia from IM to oral aripiprazole.

360 agitated patients (18-69 years) with PANSS Excited Component (PEC) total scores 15-32 and ≥4 on at least 2 PEC items, were randomized to ≤3 IM injections of aripiprazole 10 mg or haloperidol 6.5 mg within 24 hours. Patients (n=304) were transitioned to oral formulations (aripiprazole 10-15 mg/d or haloperidol 7-10 mg/d) for 4 days. Patients were assessed using PEC, Clinical Global Impression-Improvement (CGI-I), and Clinical Global Impression-Severity of Illness (CGI-S) Scale scores, as well as the Agitation Calmness Evaluation Scale (ACES), and the Corrigan Agitated Behavior Scale (CABS). Mean changes from baseline (last value obtained during IM treatment) to endpoint (Day 5, LOCF) were analyzed using an ANCOVA model controlling for treatment, country, and baseline value.

PEC scores were reduced 24 hours after IM injection with either aripiprazole or haloperidol (mean change of -8.3 and -8.1, respectively). Improvements in all other scales were also observed 24 hours following IM injection of aripiprazole or haloperidol. Treatment with oral aripiprazole or haloperidol for 4 days further reduced mean PEC scores (-1.4 aripiprazole, -1.4 haloperidol). Reductions in other scales were also maintained for 4 days following the transition to oral therapies. Incidence of AEs, and changes in laboratory values and vital signs were similar for both phases.

The effectiveness of aripiprazole and haloperidol appears to be maintained in patients with schizophrenia following transition from IM to oral formulations.

Obsessions and compulsions are common in schizophrenic patients. Based on findings of the efficacy of selective-serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder, we designed an open-trial to examine the effect of adding fluoxetine to the ongoing antipsychotic regimen of schizophrenic patients with obsessions or compulsions.

The study population consisted of 16 schizophrenic patients who had obsessive and/or compulsive symptoms. Fluoxetine (20-60 mg/day) was added to the ongoing antipsychotic treatment for 12-weeks. The patients were evaluated before the trial and at weeks 4, 8 and 12 by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

The results showed a significant improvement in obsessions (P < 0.02) and compulsions (P <0.01). At the end point of the study, 9 (56%) of the patients showed significant (more than 50% reduction) in the Y-BOCS score. Although some of the patients experienced somnolence, insomnia or gastro-intestinal problems, but there were no significant clinical side-effects.

It seems that Fluoxetine is an effective medication for treating obsessive and/or compulsive symptoms in schizophrenic patients.

Obsession, compulsion, schizophrenia, fluoxetine

In 1916 Wimmer described psychogenic psychosis as a psychosis secondary to mental trauma.

Currently, psychogenic psychosis is included among acute and transient psychotic disorders (F23) in the ICD-10 and among the brief psychotic disorders (298.8) in the DSM IV-TR.

We review the case histories of patients diagnosed with psychogenic psychosis for the purpose of analysing the stability of the diagnosis and its current validity.

The sample consisted of 15 patients admitted to the Psychiatric Department of the Conxo Hospital in Santiago de Compostela (Spain) with a diagnosis of psychogenic psychosis between 1998 and 2006. A descriptive analysis was made based on a series of socio-demographic and clinical variables. Afterward, in October 2006, patients were followed up in their respective mental health units to verify their current diagnosis and clinical status.

The sample included 14 women and 1 man with mean age of 33,7 years. The most frequent prior personality trait was histrionic (42%). Persecutory delusions (58%) and auditory hallucinations (46%) were the predominant psychotic symptoms. In the months after follow-up, the majority of patients maintained the diagnosis of psychogenic psychosis (73%), while 9% of patients were diagnosed with dysthymia, and 2 patients developed schizophrenia with deterioration.

The majority of patients in our sample diagnosed with psychogenic psychosis maintain a stable diagnosis over time and do not present deterioration.

Psychosis with onset prior to 18 years of age, or early-onset psychosis (EOP), have a poorer prognosis than adult-onset psychosis. Further, a worse functional outcome of patients with EOP has been related to diagnosis of schizophrenia, severity of negative symptoms, behavioral problems, premorbid functioning, childhood onset, and insidious onset. We aim to examine the functional outcome of patients with EOP over a two-year follow-up.

A total of 24 patients with first episode psychosis were enrolled. Subjects underwent a cross-sectional evaluation at the baseline visit that consisted of collecting sociodemographic data, including parental socioeconomic status as measured by the Hollingshead-Redlich Scale. Psychotic symptoms were assessed using the Spanish version of the Positive and Negative Syndrome Scale (PANSS). Social disability was measured with the Global Assessment of Functioning disability scale (GAF). Patients were assessed at a two-year follow-up. A linear regression analysis was used to predict the level of functioning (based on GAF scores) over the two-year follow-up. Variables entered into this equation were: GAF at two-year follow-up (as dependent variable), and gender, age at first onset, parental socioeconomic status, diagnosis, positive symptoms at baseline, and negative symptoms at baseline (as independent variables).

Negative symptoms at baseline were the only significant variable that predict the functional outcome at the two-year follow-up (p= 0.010).

Functional prognosis of early-onset psychosis depends on the severity of negative symptoms, independently of diagnosis.

This study want to assess the most frequent misconceptions associated with patients with schizophrenia between medical personnel.

we applied a questionnaire to three groups: medical students before studying psychiatry, medical personnel working in psychiatric setting and health professionals in general hospital.

health professionals contribute to stigmatisation of mental illness, using inadequate terms in defining psychiatric affection and a inadequate attitude; the majority of third group don't understand mental illness and avoids contact with psychiatric patients.

The study underlines the presence of misconceptions associated with patients with schizophrenia between health professionals and the results could be used for a concrete plan for fighting against stigma of this psychiatric disease.

The aim of the study was to assess the impact of caring for patients with chronic schizophrenia on the mental health status of the caregivers and to investigate how demographic factors and illness severity influence this relationship.

A total of 63 key caregivers of patients with chronic schizophrenia were administered the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R was also administered to 65 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was used to assess the psychopathology severity of the patients they cared for.

Caregivers scored significantly higher on the anxiety (p<0.01), depression (p<0.05), somatization (p<0.05), hostility (p<0.001) and interpersonal sensitivity (p<0.01) sub-scales of the SCL-90-R compared to the health controls group. Caregivers' anxiety and depression were significantly (at p<0.05) related with PANSS total score (ra= 0.56 and rd= 0.65), illness duration (ra=0.55 and rd= 0.50) and lifetime psychiatric hospitalizations (ra=0.62 and rd= 0.49). Score on the somatization subscale of the SCL-90-R was significantly related with illness duration (r=0.61, p<0.05), and low educational level of the caregiver (r=0.57, p<0.01). Finally, score on the hostility subscale was significantly related with PANSS score (r=0.53, p<0.05) and lifetime psychiatric hospitalizations (r= 0.61, p<0.001).

The psychopathological severity of patients with chronic schizophrenia has a negative impact on their caregivers' mental health. Mental health services should aim to assist key caregivers of people with schizophrenic disorders to manage psychological burden.

Sertindole is indicated for patients intolerant to at least one other antipsychotic agent.

The following items were scored as reasons for switching to sertindole: lack of efficacy, side effects, poor quality of life, cognitive impairment, poor compliance and lack of insight from previous treatments. Kendall Tau b correlations were used to compare score rankings.

The majority of investigators ranked either lack of efficacy or side effects the most important reason for switching to sertindole. There was a negative correlation between rankings of these two reasons at European sites -0.39 (p<0.001), -0.32 (p<0.01), respectively.

More investigators in Asia (38%) considered poor quality of life as an important reason for switching treatment than in Europe (21-27%). 14-20% of investigators considered cognitive impairment as a most important reason.

<16% of investigators in all regions considered poor compliance and lack of insight as a most important reason.

In Asia, there was a significant negative correlation (–0.25, p<0.05) between rankings of poor compliance and side effects, where side effects were generally ranked as being more important than poor compliance. Similarly, a significant negative correlation (–0.28, p<0.01) between rankings of cognitive impairment and lack of insight was seen in E Europe.

Lack of efficiency and side effects from previous treatments were the primary reasons for switching to sertindole. Asian investigators probably considered side effects to be the cause of poor compliance whereas E. Europeans probably considered cognitive impairment to be the true cause of lack of insight.

To examine the efficacy and tolerability of quetiapine SR in patients with schizophrenia switched from quetiapine IR.

Randomised, double-blind study (D1444C00146) using dual-matched placebo. Patients clinically stable on fixed doses of quetiapine IR received twice-daily quetiapine IR 400, 600 or 800 mg/day for 4 weeks. Stable patients were then randomised (1:2) to continue taking quetiapine IR or switch to the same total dose of quetiapine SR (active dose once-daily in the evening) for 6 weeks. Primary analysis: % of patients (modified ITT population) discontinuing due to lack of efficacy or with PANSS total increase ≥20% at any visit, using a 6% non-inferiority margin for the upper 95% CI of the treatment difference. Per-protocol (PP) analysis was also performed.

497 patients were randomised (quetiapine SR 331, IR 166); completion rates were 91.5% and 94.0%, respectively. Few patients discontinued due to lack of efficacy or had a PANSS increase ≥20% in both the MITT (n=496) and PP populations (n=393): 9.1% and 5.3% for quetiapine SR and 7.2% and 6.2% for quetiapine IR, respectively. Quetiapine SR was non-inferior to quetiapine IR in the PP population (treatment difference: -0.83% [95% CI -6.75, 3.71]; p=0017) but not in the MITT population (treatment difference: 1.86% [95% CI -3.78, 6.57]; p=0.0431). The incidence (quetiapine SR 38.7%; IR 35.5%) and profile of AEs were similar in both groups.

Clinically-stable patients receiving quetiapine IR can be switched, without titration, to an equivalent once-daily dose of quetiapine SR without any clinical deterioration or compromise in tolerability.

To study the effect of multiple interventions in a patieut.

With schizophrenic disorder, who presents marked impairment in different areous of functioning.

A 36-year-old woman, unemployed ant without social supporting services (systems), was admitted in the Clinic of Psychiatry 1 year ant PANSS, in order to re-evaluates the patient's condition. We also designed a treatment plan of medical intervention and psychosocial rehabilitation, in collaboration with social welfare and the service “Assistance at home”. Moreover, we managed to broaden our interactions inside her (combination)own family (her parents had abandoned her the last few year she had been abandoned by her family the last years) as well as in her wider localsosial enrolment.

We achieved marked improvement of patient's psychopathology with total remission of positive symptoms and almost total elimination of residual symptoms.

GAF scale increased about 52units The patient is now capable to work and participate in several social activities and manifestations.

The global psychical interrantion and the close collaboration of hospital and community psychiatry service offer a distinctly better effect in the treatment of a chronic patient.

Recent structural magnetic resonance imaging (MRI) studies have employed voxel-based morphometry (VBM) to investigate whether there are brain volumetric abnormalities of gray and/or white matter regions in schizophrenia. This VBM study investigated volumetric reductions in corpus callosum (CC) subregions in association with first-episode psychosis (FEP). Also, we investigated whether such changes were related to deficits in interhemispheric transfer of somatosensory information, using the Crossed Finger Localisation Test (CFLT).

122 FEP subjects and 94 controls were examined. MRI processing was performed using Statistical Parametric Mapping. In a subsample of 31 FEP subjects, we investigated correlations between CC volumes and performance on the CFLT. In this task, a fingertip on one hand is touched by the experimenter and the subject's task is to respond by touching with their thumb the corresponding finger on the other hand.

Relative to controls, FEP subjects showed volume reduction in a cluster located in the anterior CC genu (Z=3.77, p<0.001 uncorrected), which retained significance when analyses were restricted to the schizophrenia/schizophreniform subgroup (n=62) compared to controls (Z=3.16, p<0.001 uncorrected). In the subsample of FEP subjects who performed the finger localization task, there were two clusters of significant positive correlation between performance on the CFLT and CC volumes, respectively in the anterior genu (Z=3.77, p<0.001 uncorrected) and the posterior genu (Z=3.30, p<0.001 uncorrected).

These findings indicate the presence of circumscribed foci of reduced CC volumes in association with FEP, and suggest that such abnormalities are related to deficits in interhemispheric transfer of information.

Patients suffering from psychotic disorders are the most common to be admitted to psychiatry departments and treated against their will. All patients in this study were included in the international project EUNOMIA, which is focused on the contemporary use of coercive measures in psychiatry. The purpose of this study was to compare the voluntary and involuntary admitted patients, measured as improvement of psychopathology and social functioning.

120 involuntary and 18 voluntary patients, who met the criteria for an F2 disorder and subjective felt coercion at the admission measured by the McArthur Scale were included. They were assesed three times, in the first week and at the end of first and third month after admission with Brief Psychiatric Rating Scale - BPRS and Global Assessment of Functioning - GAF Scale. Outcome was defined as a change in the total BPRS and GAF scores between first and third observation.

There was no significant difference in the total BPRS (voluntary T1 48.6±13.3, T3 35.5±10.2, and involuntary T1 50.5±12.8, T3 32.2±8.6) or GAF (voluntary T1 38.1±14.7, T3 63.6±10.3 and involuntary T1 29.8±12.8, T3 63.6±17.1) changes, (p<0,05). In the lenght of stay both groups significantly differ, voluntary 30.8±15.9 resp. involuntary 51.5±51.6 days.

Inpatients with schizophrenia who were treated involuntary, improved at the same level as the voluntary ones, however the lenght of hospital stay was shorter by voluntary patients.

Frontal lobe dysfunction has been considered as a core feature in schizophrenia. To the evaluation of this impairment, time-consuming neuropsychological batteries are needed. Recently, Dubois et al (2000) reported a short battery for assessing frontal lobe function in patients with neurological disorders. To evaluate the clinical efficacy of this frontal assessment battery (FAB) in patients with schizophrenia, we performed both FAB and Stroop Color Word Test (SCWT), which is suggested to be a representative task of executive function.

24 schizophrenic patients and 30 sex and age-matched controls were included. FAB, SCWT and Mini Mental State Examination (MMSE) were performed in both groups. The FAB scores were compared with the performance in SCWT and correlated with education level, age and duration of disease. No difference in the MMSE scores between two groups was found.

The FAB global score was significantly lower in the schizophrenia group compared to controls. In the patients group, the conceptualization and the inhibitory control subscores were negatively correlated with mistakes in color-naming task. The FAB total score, the mental flexibility and the programming subscores were negatively correlated with latencies in color-naming, color-reading and in color-word interference task of SCWT. Negative correlation between the FAB scores and the age and duration of disease was also evident.

The FAB is likely to be a useful and brief battery for assessing frontal lobe function in schizophrenia, as it results from the comparison with SCWT.

Frontal lobe deficits have often been reported in patients with schizophrenia. Recently, Dubois et al (2000) reported a short bedside cognitive and behavioral battery for assessing frontal lobe function in patients with neurological disorders. We hypothesized that cognitive functions of frontal lobe in schizophrenia could be evaluated with this battery.

27 patients with schizophrenia and 30 sex and age-matched controls were included. We performed FAB and Mini Mental State Examination (MMSE) in both groups and we correlated the scores of six subtests and the total FAB score with handedness, education level, age and duration of disease.

The FAB global score was significantly lower in the schizophrenia group compared to controls. There was negative correlation between the FAB scores and their age and duration of disease in the schizophrenia patients. Correlation between FAB scores and MMSE scores was evident in both groups.

The FAB is likely to be a useful and brief battery for assessing frontal lobe function in schizophrenia patients.

Deficits in executive functioning in schizophrenia spectrum psychosis have been repeatedly reported. However, their relationship to the duration of disease and its psychopathology remains unclear. The purpose of this study was to compare executive functioning between first episode and chronic psychotic patients. The aim was also to investigate whether positive or negative psychotic symptoms are differentially related to executive functioning. The Stroop Color Word Test (SCWT) was chosen for this purpose, as a representative task of executive function, evaluating shifting ability, concentration and selective attention.

24 patients with one (n=8) or more (n=16) psychotic episodes and 30 sex and age-matched controls were assessed using the SCWT. Patients were also evaluated with the Positive and Negative Syndrome Scale (PANSS).

Patients with one psychotic episode showed significantly higher speed in all subtasks of SCWT compared to patients with more psychotic episodes, but no significant difference in the accuracy between these two groups was proved. Psychotic patients performed worse -in term of accuracy and speed- in SCWT compared to controls. Accuracy but not speed showed correlation with both Positive and Negative symptom dimensions, as well as with the severity of psychopathology (total PANSS).

Deficits in executive functioning in schizophrenia spectrum psychosis, as they are assessed by SCWT, seem to be associated with the duration of the disease and the severity of both negative and positive psychopathology.