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Journal Article 2007; 28(Suppl 1): 95-116 PubMed PMID: 17262005 Citation  Keywords:  Antipsychotic Agents:metabolism, Humans, Patient Compliance, Risk Factors, Schizophrenia:drug therapy, Schizophrenic Psychology, Treatment Refusal,.   

: Adherence to treatment is a general indicator of quality and success of communication between the physician and the patient. It means the extent to which patient behaviour, in terms of taking medications, following diets, or executing life-style changes, coincides with medical or health advice. Nonadherence to antipsychotic therapy in patients with schizophrenia is far more widespread than clinicians assume. Lower nonadherence in therapy based on antipsychotics of the second generation compared with conventional medications has already been indicated by early reports. The consequences of nonadherence include exacerbation of symptoms, an increased relapse rate, psychiatric hospitalization hospitalisation, and less favourable patient prognosis. There are several factors that cause treatment nonadherence in schizophrenia: causes derived from the schizophrenic disorder itself, patient characteristics, causes associated associated with the health-care system, and the antipsychotic treatment itself....

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Journal Article 2007; 28(Suppl 1): 117-133 PubMed PMID: 17262004 Citation  Keywords:  Antipsychotic Agents:adverse effects, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Humans, Long-Term Care, Quality of Life, Schizophrenia:drug therapy, Treatment Outcome,.   

: Health-related quality of life (QoL) represents important measure of treatment outcome in mental disorders. Numerous studies indicate that QoL of people with schizophrenia and bipolar disorder is similar to that of patients with chronic physical conditions. It has been shown that schizophrenia patients can themselves reliably assess their QoL; in addition to the objective scales various self-reporting instruments are used. Patients with bipolar disorder have QoL consistently higher than patients with schizophrenia and similar to that found in people with unipolar depression. Quality of life can be negatively affected by drug-induced side-effects and subjective treatment response. The second-generation antipsychotics (SGA) have superior efficacy on QoL over classical antipsychotics in approximately half of the studies with schizophrenia; in the other half those groups are comparable. However, in none of the trials novel antipsychotics were inferior. All SGA (clozapine, olanzapine, risperidone, amisulpride, quetiapine, ziprasidone, or remoxipride) have been found to be beneficial for patients well-being. The most investigated drugs that convincingly improve QoL in schizophrenia are olanzapine and risperidone (including depot form). Results of several studies indicate that individual antipsychotics may differ in their effects on QoL, with suggested superiority of olanzapine. In bipolar disorder, SGA consistently showed their superiority over placebo in effects on QoL. The most studied SGA in bipolar disorder is olanzapine. More long-term controlled double-blind trials are needed to definitively uphold superiority and different effects of individual SGA on QoL of patients with schizophrenia and bipolar disorder....

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Journal Article 2007; 28(Suppl 1): 135-145 PubMed PMID: 17262003 Citation  Keywords:  Family Therapy, Humans, Patient Compliance, Psychotherapy, Psychotherapy, Group, Schizophrenia:therapy, Schizophrenic Psychology,.   

: The author gives a critical overview of various psychotherapeutic approaches used with persons with schizophrenia and their families. It is emphasized that these approaches are to be used in conjunction with pharmacological treatment and should always be individualized for each patient depending on the phase and severity of illness. Individual psychotherapy, particularly cognitive-behavioural modality, group therapy, and family therapy are described in some detail. Special attention is given to compliance therapy....

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Journal Article 2007; 28(Suppl 1): 147-159 PubMed PMID: 17262002 Citation  Keywords:  Caregivers, Family, Family Relations, Humans, Patient Compliance, Quality of Life, Schizophrenia:therapy, Schizophrenic Psychology, Socioenvironmental Therapy,.   

: Family represents an important supportive social network for most patients with schizophrenia. In order to provide safe and low-stress environment, necessary for the successful long-term treatment of schizophrenia the family must be helped. Family members suffer both emotionally and financially. Their burden is high and quality of life is low. Relatives change their life values and preferences when a severe mental illness occurs in the family and are ready to cooperate. Family interventions constitute an integral part of complex schizophrenia treatment. To be successful interventions must take into account relatives beliefs, perspectives and issues of concern. The goal of this paper is to 1) overview studies on family burden, 2) provide theoretical background for family interventions, 3) describe a family psychoeducational approach as an optimal treatment modification....

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Controlled Clinical Trial 2006; 27(5): 587-594 PubMed PMID: 17159818 Citation  Keywords:  Adolescent, Adult, Basal Metabolism, Brain:metabolism, Brain Mapping, Female, Fluorodeoxyglucose F18:metabolism, Frontal Lobe:metabolism, Humans, Male, Middle Aged, Positron-Emission Tomography:methods, Psychomotor Performance, Schizophrenia:metabolism, T.   

OBJECTIVES: With the aim to indicate the functional anatomical substrate of cognitive dysfunction in schizophrenia we evaluated the relationship between resting brain metabolism and performance on the Trail Making Test (TMT). As the prerequisite analysis we compared the performance in Part A and B of the TMT between schizophrenic patients and controls. Resting brain metabolism was investigated by (18)FDG positron emission tomography (PET) as the probe for the relative regional synaptic strength and density.

METHODS: (18)FDG PET data were analyzed by SPM99 with TMT A and B as the covariate (p< or =0.001).

RESULTS: Schizophrenic patients (N=42) had worse performance in both TMT A and B compared to controls (N=42). In schizophrenic subjects (18)FDG PET did not predict the performance on Part A (psychomotor speed) but predicted that for Part B (set-shifting and flexibility) of the TMT. The (18)FDG uptake in the superior, middle and inferior frontal gyruses bilaterally was associated with better performance in the TMT B. The negative covariation between 18FDG uptake and time spent in the TMT B was detected in the temporal and parietal cortices, pre- and postcentral gyruses, precuneus limbic regions (anterior cingulate, uncus) and the pons.

CONCLUSIONS: Our data indicate that hypometabolism in the frontal lobes and hypermetabolism in the temporo-parieto-limbic regions is the neurobiological basis for deficient TMT B performance in schizophrenia....

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Journal Article 2006; 27(3): 321-326 PubMed PMID: 16807521 Citation  Keywords:  Adult, Dissociative Disorders:complications, Epilepsy:complications, Female, Humans, Kindling, Neurologic:physiology, Male, Schizophrenia:complications, Schizophrenic Psychology, Stress Disorders, Post-Traumatic:complications, Stress, Psychological:compli.   

OBJECTIVES: According to recent evidence, trauma and stress are important etiological factors in pathogenesis of schizophrenia. However, the hypothetical influence of traumatic stress on epileptic-like (or kindling) phenomena in schizophrenia is at this time unclear.

METHODS: In order to discover the influence of trauma, 82 patients with a diagnosis of paranoid schizophrenia and 50 healthy controls were assessed for symptoms of dissociation, traumatic stress and psycho-sensory symptoms of epileptic origin.

RESULTS: We have found significant traumatization and dissociation in patients who met the cut-off score for psychosensory epileptic-like symptoms and also significant correlations among these measures have been found.

CONCLUSIONS: These data suggest a certain role of epileptic-like phenomena in dissociative states in schizophrenia and are in accordance with rare intracranial EEG findings which suggest a certain role of epileptiform events in schizophrenia....

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Journal Article 2006; 27(1-2): 209-213 PubMed PMID: 16648775 Citation  Keywords:  Adult, Double-Blind Method, Female, Humans, Male, Neuropsychological Tests, Psychiatric Status Rating Scales, Schizophrenia:therapy, Schizophrenic Psychology, Transcranial Magnetic Stimulation,.   

: The high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the prefrontal cortex is a promising method for the treatment of negative symptoms of schizophrenia. Using double-blind sham-controlled parallel design, we evaluated the effect of HF-rTMS over the left dorsolateral prefrontal cortex (DLPFC) on negative symptoms in patients with schizophrenia. Sixteen schizophrenia patients with predominantly negative symptoms on stable antipsychotic medication were treated with 20 Hz rTMS (90% of motor threshold, 2000 stimuli per session) over ten days within 2 weeks with six weeks follow-up. The effect was assessed using PANSS, CGI, MADRS and neuropsychological tests. We failed to find any significant effect of active rTMS. Sham rTMS showed a trend for improvement over time on positive and negative subscales of PANSS and MADRS. Between-group comparisons failed to reveal any significant differences on any rating scales except a positive subscale of PANSS after 8 weeks. Results from our study did not confirm that HF-rTMS over the left DLPCF affects the negative symptoms of schizophrenia and alternative rTMS approaches are discussed....

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Journal Article 2003; 24(3-4): 181-184 PubMed PMID: 14523354 Citation  Keywords:  Adult, Biomarkers, Circadian Rhythm:physiology, Humans, Male, Melatonin:blood, Psychiatric Status Rating Scales, Schizophrenia:blood, Schizophrenic Psychology,.   

OBJECTIVE: Aim of this study was to verify if a simple index as night-day plasma MLT level variation is able to confirm the existing data on circadian melatonin alterations in schizophrenia and if a relationship to disease itself instead of the actual clinical state can be suggested.

SETTING AND DESIGN: Ten consecutively admitted male schizophrenic inpatients were examined.

METHODS: The blood samples for melatonin were collected at 3.00 a.m. and 15.00 p.m. and consequently calculated the values of Delta () (MLT h.3.00- MLT h.15.00). We divided the sample into two subgroups: < 30 pg/ml and > 30 pg/ml taking 30 pg/ml as an arbitrary value, based on literature data, that should indicate a physiologically correct value of.

RESULTS: The 70% of the sample was under the 30 pg/ml value of (13.61 +/- 4.0) or was lacking of the characteristic circadian pattern of MLT secretion, whilst the 30% of the sample was over the 30 pg/ml value of (83.60 +/- 16.34) or was in presence of the characteristic circadian pattern of MLT secretion (p=.0001). No correlation was found between values and the scale and subscales scores for the assessment of psychopathology.

MAIN FINDINGS: The data confirm the lack of the characteristic circadian pattern of MLT secretion in schizophrenics.

CONCLUSION: The absence of significant correlation between night / day melatonin level differences and actual psychopathology variables should indicate that the suppression of is mostly related to the disease and independent from the clinical state. A neuroleptic-treatment effect cannot be excluded so far....

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