In Borderline Personality Disorder (BPD), pharmacotherapy is used for the treatment of specific BPD pathology facets, such as cognitive-perceptual, affective, or impulsivity symptoms. Due to the polymorphic phenomenology of the disorder, different classes of drugs are used, e.g., antipsychotics, antidepressants, or mood stabilizers.

To evaluate the up-to-date evidence of drug treatment efficacy for BPD.

A systematic review and metaanalysis of randomised controlled trials was done. All randomised comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity and mental health status, tolerability, and adverse effects. With support of the Cochrane Collaboration, a thorough search was conducted to identify both published and unpublished trials. The findings were scrutinized by two reviewers independently.

Twenty-six trials were included, investigating first- and second-generation antipsychotics, mood stabilizers, antidepressants, and omega-3 fatty acids.

Findings indicate beneficial effects for all classes of drugs investigated, and suggest mood stabilizers and second-generation antipsychotic agents as first-line treatments for BPD due to their efficacy in the treatment of different domains of BPD and associated pathology. However, psychotherapeutic treatment should clearly be targeted at predefined specific symptoms.

1. 1. Whether patients with personality disorders of borderline and antisocial type have a specific pattern of neurocognitive deficits.

2. 2. Whether impulsivity measured with clinical rating scales is related with performance on neuropsychological tests of risk taking which is sensitive to ventrofrontal cortex lesions.

20 patients and their age, sex and IQ matched controls participated in the study. Each patient and control was administered validated clinical rating scales in order to:

1. 1. Ascertain the diagnosis with respect to DSM-IV criteria (Structured Clinical Interview for DSM: Personality Disorder.

2. 2. Obtain a measure of clinical impulsivity (Barratt Impulsiveness scale).

3. 3. Ascertain the presence of heritable personality traits (Dimensional Aspects Of Personality Pathology Disorder-Basic Questionnaire).

4. 4. Exclude other major psychiatric disorders (Clinical Psychopathology Rating Scale).

On Neuropsychological testing patients fared poorly on tests sensitive to planning and risk taking compared to controls. Patients had high mean scores on Barratt impulsiveness scale. The high scores were associated with performance on Tower Of London, Bechara test and paired associated learning. Impulsivity was associated with anxiousness and rejection traits of DAPP-BQ. There was a co-relation between some basic dispositional traits of DAPP-BQ with performance on Bechara, Gambling and Paired Associated Learning tests.

Personality disordered patients show broad range of neurocognitive deficits on test s sensitive to frontal cortex.

To establish the social, clinical and forensic differences between murderers with schizophrenia and murderers without any psychiatric disorder and to compare their respective relationship with their victim.

We identified the socio-demographic, clinical and criminological profiles of 14 murderers with schizophrenia from 210 forensic examinations of murderers, and compared their profiles with those of murderers without any mental disorder (n=73).

Murderers with schizophrenia are characterized by a specific socio-professional status (single, living alone and jobless). Previous psychiatric history was significantly more common in the schizophrenia group than in the group of persons without mental disorder, as it was the case as regards previous contact with the police.

Schizophrenic murderers generally commit, alone, a non-premeditated murder. They usually strangle their victim in a sudden attack, whereas murderers without any pathology usually premeditate their crime. 86% of perpetrators with schizophrenia have been in a delirium at the time they committed murder, among four main themes: persecution, thought insertion, mysticism and megalomania.

Victims of murderers with schizophrenia were family members in 21% of cases, acquaintances in 57% and a stranger in 14%. The victim was known to the perpetrator significantly more often in the schizophrenia group than in the no mental disorder group (86% versus 77%, p=0,002).

The main difference between murderers with schizophrenia and murderers without any mental disorder is the psychopathology of the morbid process which underlies the homicide. The most schizophrenics’ homicide was more likely to be against intimates than strangers.

In 2002 the Professor Eggers Foundation started a 2-year-programme for patients suffering from early-onset schizophrenia (EOS) following discharge from a clinic (outpatient care). The aim is with intense residential care and treatment to support recovery and independence. Interactive and psychoeducational family care, coping with persistent symptoms, development of social and emotional competence, independent house keeping, and support of school and vocational training are the main features.

Psychopathology, social and neuropsychological function were assessed with a set of questionnaires and tests at the start, after 1 year and after 2 years on completion of the programme for 12 participants. Living and working situation were monitored. The results were compared with the progress of 12 EOS patients treated as usual (comparison group).

Positive and negative symptoms showed a significantly greater decrease with respect to the comparison group. Social function improved considerably stronger in the participants. Working memory, attention and some executive functions also improved in the participants, while there was a deterioration of speed and selective attention (trend) in the comparison group. Neither group showed changes in measures of intelligence or the subjective quality of life with the exception of increased contentedness with family relations in the participants.

We show the benefits of an early intensive residential training programme for EOS patients. Further research may be able to show if these improvements can be maintained and whether the costs of the programme are economical avoiding continued residential care.

Substance-induced psychoses (SIP) are associated with greater conjugal ties, greater substance dependence, homelessness, parental substance abuse, poorer family support and visual hallucinations, while primary psychotic disorders (PP) have greater symptom severity.

To describe differential characteristics between PP and SIP in a dual diagnosis unit.

We collected sociodemographic, employment data, admission reasons, family substance abuse and main drug of abuse.

• • 23 patients were admitted with psychosis (87% males; mean age 35,6±10,1). Two groups were performed: PP (N=12) and SIP (N=11).

• • Mean length of admission was 17,78±13,17 days. Most prevalent co-occurrent diagnoses were psychotic disorders-cocaine use disorders (43,5%).

• • The only significant difference between PP and SIP was shorter length of admission in SIP (days: mean [s.d]) (26,6±14,9 vs. 13,8±7,5; p< 0.05). Other variables studied were: (1) main reasons for admission: hallucinations/delusions (33,3% vs. 90,9%), suicide ideation (33,3% vs. 0%); (2) main drug of abuse: cocaine (50% vs. 45,5%), alcohol (33,3% vs. 0%), psychoestimulants (0% vs. 27,3%), cannabis (8,3% vs. 18,2%); (3) marital status: married/cohabiting (25% vs. 36,4%), divorced (16,7% vs. 0%), single (58,3% vs. 63,6%); (4) employment: employed (33,3% vs. 50%) and unemployed (66,7% vs. 50%); (5) age, years: mean (s.d): 37,8 (10,6) vs 33,2 (9,5); (6) parental substance abuse (65,7% vs. 83,3%).

• • No significant differences were found between both groups (PP vs. SIP) except for shorter length of admission in SIP.

• • The most frequent co-ocurrent diagnosis was psychotic disorder+cocaine use disorder.

Outcome measures in schizophrenia are defining aspects for deciding the status of recovery based upon which people’ scientific body forms opinions. It is also important in dealing with stigma related to schizophrenia. Recently the concept of ‘recovery’ and’ outcome’ has come under scientific scrutiny. Literature does not show a consistent pattern in outcome. Both short term and long-term outcome show variability, which is often, explained by cultural factors. It has been generally considered that devolved countries have poor outcome than developing, non-industrialized countries. This view has also been challenged recently. The paper draws from the conceptual aspects if our outcome measure are capturing ‘real-life’ situation. We conducted two studies in Mumbai, India:

1. 1. Study of stigma & discrimination, which brought out the facts of families’ expectation and disappointments with level of recovery.

2. 2. A 10 years long term study, to determine recovery status of recovered patients.

The study in Krakow investigated the way in which EE and DUP correlated with long term outcomes of the treatment and the course of illness.

58 out of 80 DSM III schizophrenia diagnosed patients took part in 1, 3, 7 and 12 follow-up. The Follow-Up Chart, BPRS, and CFI were used. As the outcome criteria only dynamic of symptoms were included. The dynamic of the symptoms and the relation between DUP and EE were analyzed by repeated measures of ANOVA.

1. 1. General, positive and negative syndromes decreased rapidly after the first hospitalization, and increased slightly between 7 and 12 yrs. (ps < 0.001). The negative syndrome decreased less rapidly during the first year.

2. 2. The dynamic of general and positive syndrome were modified by the DUP and by EE. In long DUP (general syndrome: p = 0.028; positive syndrome: p = 0.001) the dynamic was worse. High EE subjects had more severe syndromes at the admission. After the first hospitalization their results became as good as in the case of low EE (general syndrome: p = 0.004; positive syndrome: p = 0.044).

3. 3. The dynamic of negative syndrome was neither modified by DUP (p = 0.896) or by EE (p = 0.309).

The dynamic of general and positive syndromes were modified by DUP during 12 years follow-up and by EE only in acute state in the first episode. The dynamic of negative syndrome was not modified by DUP and EE.

To examine the efficacy of second-generation-antipsychotics (SGAs) in the treatment of negative symptoms in Schizophrenia.

Two meta-analyses were carried out using placebo or haloperidol as comparators. Studies were identified by searching for randomized, double-blind, placebo and/or haloperidol -controlled trials reporting data on efficacy of SGAs. Search was extended to the following databases: Pubmed, The Cochrane Central Register of Controlled Trials, Proquest Health and Medical Complete, Science Citation Index Expanded, and Current Contents Connect. The outcome measure used was the change in negative symptoms, choosing a standardized statistic (Cohen's d) to synthesize data.

A total of 46 homogeneous trials (Q=45.18, df=50, p=0.667, I2=0%) were included. In the placebo-controlled meta-analysis, the effect sizes (Cohen's d) obtained for amisulpride, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone were 0.52, 0.34, 0.43, 0.36, 0.40 and 0.46, respectively, favoring active treatment against placebo (p< 0.001 in all cases). Comparing SGAs against haloperidol, showed just a statistically significant trend favoring SGA's in treatment of negative symptoms (Cohen's d = 0.15, p=0.008). Comparisons by drug showed a significant low and low-to-moderate standardized mean favoring SGA: Cohen's d = 0.34, p< 0.001; Cohen's d = 0.27, p< 0.001 and Cohen's d = 0.19, p=0.030, respectively for ziprasidone, risperidone and olanzapine.

Most antipsychotics (aminosulpride, haloperidol, olanzapine. quetiapine, risperidone, ziprasidone) are effective in treatment of negative symptoms, showing moderate effect sizes. Amisulpride and ziprasidone were slightly better than the rest of drugs when compared with placebo. Compared with haloperidol, SGA showed controversial results.

Despite the well established genetic basis of schizophrenia, the relationship between genes and the disorder itself is still elusive. Individual endophenotypes, which reduce the complexity of genetic analyses, allow statistical approaches with quantitative trait methodologies. P200 abnormalities of event-related potentials have been reported in schizophrenia with conflicting results. The present study aims to characterize the P200 in first-episode patients and to compare it with that of first-degree relatives and controls.

ERPs were recorded at 19 sites with an auditory oddball for 21 first-episode patients with schizophrenia (mean age=25.14; SD=6.20), 41 of their first degree relatives (mean age=47.65; SD=15.53) and 19 healthy controls (mean age=26.32; SD=7.16). Potentials were averaged for frequent stimuli and P200 amplitude and latency measures were obtained.

Analysis of midline electrodes revealed significant group effects for P200 peak amplitudes (F(2, 78)=3.315, p=.042), but not for peak latencies. Post-hoc analyses revealed that patients with schizophrenia present significantly lower P200 amplitudes (M=2.466; SD=1.564) than controls (M=5.037; SD=2.500) at Pz (T(38)=3.851, p=.003). No other significant differences were found.

The results obtained do not straight-forwardly support the P200 peak amplitude nor peak latency as an endophenotype of schizophrenia. However, the trends of our results may suggest that the P200 amplitudes of relatives may present intermediate values between healthy controls (with higher amplitudes) and patients (with lower amplitudes). Further statistical analyses will be required in order to disentangle the effects of possible confounding variables.

Several studies have reported limbic structures volume decrease in Post-Traumatic Stress Disorder (PTSD). However, in PTSD the effect of therapy on brain structures has seldom been investigated. The aim of the study was to evaluate the grey matter (GM) loss in occupational related PTSD and to assess the volumetric differences between patients responding (R) and non-responding (NR) to psychotherapy.

Pre-EMDR MRI data of 21 train drives who did develop PTSD (S) and 22 who did not develop PTSD (NS) after person-under-the-train accidents were compared. Within S further comparisons were made between 10 R to Eye Movement Desensitisation Reprocessing (EMDR) therapy and 5 NR. Data were analysed by optimised voxel-based morphometry as implemented in Statistical Parametric Mapping.

As compared to NS, S showed a significant GM volume reduction in precuneus, lingual gyrus, posterior cingulate and parahippocampal cortex. The R>NR comparison highlighted a significant GM reduction in NR in bilateral posterior cingulate, left middle frontal cortex and right parahippocampal, insular and temporal cortices.

Comparing two large groups of subjects significant GM volumetric reductions were found in PTSD in posterior limbic structures. NR showed, as compared to R, volume reduction in cortical structures including posterior cingulate and parahippocampal cortex. These latter two structures seem to be the hallmark for both PTSD diagnosis and therapy outcome prediction.