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Electroencephalogram microstates are recurrent scalp potential configurations that remain stable for around 90 ms. The dynamics of two of the four canonical classes of microstates, commonly labeled as C and D, have been suggested as a potential endophenotype for schizophrenia. For endophenotypes, unaffected relatives of patients must show abnormalities compared to controls. Here, we examined microstate dynamics in resting-state recordings of unaffected siblings of patients with schizophrenia, patients with schizophrenia, healthy controls, and patients with first episodes of psychosis (FEP). Patients with schizophrenia and their siblings showed increased presence of microstate class C and decreased presence of microstate class D compared to controls. No difference was found between FEP and chronic patients. Our findings suggest that the dynamics of microstate classes C and D are a candidate endophenotype for schizophrenia., EEG microstate abnormalities have been reported in patients with schizophrenia. Here the authors demonstrate that patients and their siblings show similar microstate abnormalities compared to healthy controls.

Visual backward masking (VBM) deficits are candidate endophenotypes of schizophrenia indexing genetic liability of the disorder. In VBM, a target is followed by a mask that deteriorates target perception. Schizophrenia patients and, to a lesser extent, their unaffected relatives show strong and reproducible VBM deficits. In patients, VBM deficits are associated with strongly decreased amplitudes in the evoked-related potentials (ERPs). Here, to unveil the neural mechanisms of VBM in schizophrenia, circumventing illness-specific confounds, we investigated the electroencephalogram correlates of VBM in unaffected siblings of schizophrenia patients. We tested 110 schizophrenia patients, 60 siblings, and 83 healthy controls. As in previous studies, patients showed strong behavioral deficits and decreased ERP amplitudes compared to controls. Surprisingly, the ERP amplitudes of siblings were even higher than the ones of controls, while their performances were similar. ERP amplitudes in siblings were found to correlate with performance. These results suggest that VBM is deteriorated in patients and siblings. However, siblings, unlike patients, can partially compensate for the deficits by over-activating a network of brain regions.

There seems to be no common factor for visual perception, i.e., performance in visual tasks correlates only weakly with each other. Similar results were found with visual illusions. One may expect common visual factors for individuals suffering from pathologies that alter brain functioning, such as schizophrenia. For example, patients who are more severely affected by the disease, e.g., stronger positive symptoms, may show increased illusion magnitudes. Here, in the first experiment, we used a battery of seven visual illusions and a mental imagery questionnaire. Illusion magnitudes for the seven illusions did not differ significantly between the patients and controls. In addition, correlations between the different illusions and mental imagery were low. In the second experiment, we tested 59 patients (mostly outpatients) with ten visual illusions. As for the first experiment, patients and controls showed similar susceptibility to all but one visual illusion. Moreover, there were no significant correlations between different illusions, symptoms, or medication type. Thus, it seems that perception of visual illusions is mostly intact in schizophrenia.

Background The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. Methods The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the EPA Ambassadors, on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. Results While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations. Conclusions Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers., European Psychiatric Association, The work was funded by the European Psychiatric Association.

Schizophrenia is a severe psychiatric disorder, in which patients experience an abnormal sense of self. While deficits in sensorimotor self-representation (agency) are well documented in schizophrenia, less is known about other aspects of bodily self-representation (body ownership). Here, we tested a large cohort (N = 59) of chronic schizophrenia patients and matched controls (N = 30) on a well-established body illusion paradigm, the Full Body Illusion (FBI). In this paradigm, changes in body ownership are induced through prolonged multisensory stimulation, in which participants are stroked on their back while seeing the stroking on the back of a virtual body. When the felt and seen stroking are synchronous, participants typically feel higher identification with the seen body as well as a drift in self-location towards it. However, when the stroking is asynchronous, no such changes occur. Our results show no evidence for abnormal body ownership in schizophrenia patients. A meta-analysis of previous work corroborates this result. Thus, while schizophrenia patients may be impaired in the sense of agency, their multisensory bodily self-representation, as tested here, seems to be unaffected by the illness.

Depression and schizophrenia are two psychiatric diseases with high co-morbidity. For this reason, it is important to find sensitive endophenotypes, which may disentangle the two disorders. The Shine-Through paradigm, a visual backward masking task, is a potential endophenotype for schizophrenia. Masking is strongly deteriorated in schizophrenia patients, which is reflected in reduced EEG amplitudes. Here, we tested whether masking deficits and associated EEG changes are also found in patients with major depressive disorder. First, we replicated previous findings showing that depressive patients exhibit, at most, only weak masking deficits. Second, we found that the EEG amplitudes of depressive patients were reduced compared to controls and slightly increased compared to schizophrenia patients. As a secondary analysis, we compared the performance in the masking paradigm with three cognitive tasks, namely: the Wisconsin card sorting test, a verbal fluency test and a degraded continuous performance test. Performance in all but the verbal fluency test could discriminate schizophrenia from depression.

Visual backward masking is strongly deteriorated in patients with schizophrenia. Masking deficits are associated with strongly reduced amplitudes of the global field power in the EEG. Healthy participants who scored high in cognitive disorganization (a schizotypic trait) were impaired in backward masking compared to participants who scored low. Here, we show that the global field power is also reduced in healthy participants scoring high (n = 25) as compared to low (n = 20) in cognitive disorganization, though quantitatively less pronounced than in patients (n=10). These results point to similar mechanisms underlying visual backward masking deficits along the schizophrenia spectrum.

Schizophrenia impairs cognitive functions as much as perception. For example, patients perceive global motion in random dot kinematograms less strongly, because, as it is argued, the integration of the dots into a single Gestalt is complex and therefore deteriorated. Similarly, the perception of apparent motion is impaired, because filling-in of the illusory trajectory requires complex processing. Here, we investigated very complex motion processing using the Ternus-Pikler display. First, we tested whether the perception of global apparent motion is impaired in schizophrenia patients compared to healthy controls. The task requires both the grouping of multiple elements into a coherent Gestalt and the filling-in of its illusory motion trajectory. Second, we tested the perception of rotation in the same stimulus, which in addition requires the computation of non-retinotopic motion. Contrary to earlier studies, patients were not impaired in either task and even tended to perform better than controls. The results suggest that complex visual processing itself is not impaired in schizophrenia patients.

Recent genetic, behavioral, and clinical studies suggest that functional psychoses (schizophrenia, bipolar disorder, schizoaffective disorder), previously thought to be distinct from each other, may belong to one continuum. The shine-through masking paradigm is a potential endophenotype of schizophrenia with high sensitivity and specificity for discriminating between patients, their clinically unaffected relatives, and healthy controls. Hence, if schizophrenia, bipolar disorder and schizoaffective disorder belong to one common disease, strong masking deficits are expected to occur in all three diseases whereas no masking deficits are expected for abstinent alcoholic or depressive patients. Indeed, we found masking to be much stronger in psychotic patients compared to controls and to depressive patients and abstinent alcoholics, who performed on similar levels. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Schizophrenic patients suffer from many deficits including visual, attentional, and cognitive ones. Visual deficits are of particular interest because they are at the fore-end of information processing and can provide clear examples of interactions between sensory, perceptual, and higher cognitive functions. Visual deficits in schizophrenic patients are often attributed to impairments in the dorsal (where) rather than the ventral (what) stream of visual processing. We used a visual-masking paradigm in which patients and matched controls discriminated small vernier offsets. We analyzed the evoked electroencephalography (EEG) responses and applied distributed electrical source imaging techniques to estimate activity differences between conditions and groups throughout the brain. Compared with controls, patients showed strongly reduced discrimination accuracy, confirming previous work. The behavioral deficits corresponded to pronounced decreases in the evoked EEG response at around 200 ms after stimulus onset. At this latency, patients showed decreased activity for targets in left parietal cortex (dorsal stream), but the decrease was most pronounced in lateral occipital cortex (in the ventral stream). These deficiencies occurred at latencies that reflect object processing and fine shape discriminations. We relate the reduced ventral stream activity to deficient top-down processing of target stimuli and provide a framework for relating the commonly observed dorsal stream deficiencies with the currently observed ventral stream deficiencies.

Abnormalities in visual processing have been found consistently in schizophrenia patients, including deficits in early visual processing, perceptual organization, and facial emotion recognition. There is however no consensus as to whether these abnormalities represent heritable illness traits and what their contribution is to psychopathology. Fifty patients with schizophrenia, 61 of their first-degree healthy relatives, and 50 psychiatrically healthy volunteers were tested with regard to facial affect (FA) discrimination and susceptibility to develop the color-contingent illusion [the McCollough Effect (ME)]. Both patients and relatives demonstrated significantly lower accuracy in FA discrimination compared with controls. There was also a significant effect of familiality: Participants from the same families had more similar accuracy scores than those who belonged to different families. Experiments with the ME showed that schizophrenia patients required longer time to develop the illusion than relatives and controls, which indicated poor visual adaptation in schizophrenia. Relatives were marginally slower than controls. There was no significant association between the measures of FA discrimination accuracy and ME in any of the participant groups. Facial emotion discrimination was associated with the degree of interpersonal problems, as measured by the Schizotypal Personality Questionnaire in relatives and healthy volunteers, whereas the ME was associated with the perceptual-cognitive symptoms of schizotypy and positive symptoms of schizophrenia. Our results support the heritability of FA discrimination deficits as a trait and indicate visual adaptation abnormalities in schizophrenia, which are symptom related.

Sustained attention deficits measured by the Continuous Performance Test (CPT) have been reportedly proposed as an endophenotype of schizophrenia. One requirement for an endophenotype is that unaffected first-order relatives must show deteriorated performance compared to healthy controls. We investigated 56 schizophrenic patients, 33 nonaffected first-order relatives, and 36 healthy controls in a degraded and an undegraded version of the CPT of the AX type. Performance of relatives and controls was roughly identical whereas schizophrenic patients performed worse right from the beginning. These results add further evidence that a deficit in the CPT performance is not an endophenotype of schizophrenia in accordance with previous studies.

INTRODUCTION: Contextual processing is often strongly deteriorated in schizophrenic patients as found, for example, in higher cognitive as well as lower visual paradigms. In visual detection tasks, impoverished contextual facilitation was attributed to aberrant excitatory neural circuits. On the other hand, we found contextual suppression, possibly related to neural inhibition, to be fast and intact in a visual backward masking task. Here, we combine a suppressive with a "protective" paradigm to further our understanding of the contextual deficiencies of schizophrenic patients in visual information processing. METHODS: Twenty three schizophrenic patients and 18 healthy controls were asked to discriminate the offset direction of a vernier target, which was followed by one of a variety of masks for several stimulus onset asynchronies (SOAs). RESULTS: As in previous studies, patients needed clearly longer SOAs than controls. However, when longer SOAs were taken into account, increases as well as decreases in backward mask strength had comparable effects in patients and controls. CONCLUSIONS: From these results, we suggest that complex spatial processing is fast and intact in schizophrenic patients.

The purpose of this study is to assess the need for a new mental health service called a Protected Living Environment (PLE) in the republic of Georgia. PLE intends to provide residential care for the severely mentally ill (SMI) in the community. Patients and staff members from all six long-term psychiatric hospitals (Tbilisi, Batumi, Rustavi, Khoni, Surami, Bediani) in Georgia have participated in the study. The study includes a quantitative (a structured survey) and a qualitative component (in-depth interviews), which together provide a more comprehensive data. The questionnaire and the questioning route for focus group interviews were self-designed according the recommendations of World Health organization and based on a health facility assessment tool SARA - The Service Availability and Readiness Assessment. The study revealed that consumers and mental health professionals have positive attitudes towards the development of protected residential institutions, which could be an important alternative for residential care and would promote deinstitutionalization and reintegration into society.

For a long time, in Georgia, as in most eastern European and post-soviet countries, mental health services have been mainly ran in large institutions with restricted financial and professional resources. In 2010, Ministry of Health and Social Affairs of Georgia declared the reforms in mental health care system. The ongoing reforms are actively supported by many international organizations, but there still some local and cultural barriers that should be carefully analyzed. The study aimed to identify factors affecting referral to the outpatient mental health services and to describe the trends of common therapeutic interventions. The cases of patients who referred to the outpatient mental health services during one year in 2011-12 have been studied. Investigation the trends of referral to outpatient psychiatric services in Georgia showed that patients with severe and chronic psychosis less likely apply to outpatient psychiatric services. In most of the cases they come for single consultation and revealed significant problems in treatment adherence. Patients from remote areas prefer to visit central outpatient clinic, rather than go to their local, free of charge facilities. The main reasons of referral appeared behavioural (hyperactivity, retardation) and emotional problems (depression, anxiety). Due to insufficient legislative and financial support patients could not receive psychological treatments. The treatment outcome significantly depends on treatment compliance and level of education. Educated patients were much more disciplined in keeping their prescription and appointments. The additional effort need to be focused on improving patients' attitude toward local psychiatric services and enhancing coordination between in and outpatient mental health services.

Investigation of heroin addict patients in post-abstinent state revealed that low mood, anxiety, tension and guilt feeling increased sensitivity toward pain, which mostly experienced as algetic, coenestetick and hypochondriacal sensations. Algetic symptoms highly correlated with psychopathology. Efficient treatment of psychopathological symptoms decreased pain. It is concluded that Atypical antipsychotic quetiapin monotherapy could be used for treating such conditions.

Performance in many everyday situations slows down when age increases. The causes of slowing down may be found on any stage of information processing. Here, we show that the combination of a vernier acuity task and the shine-through backward masking paradigm is a good paradigm to determine temporal processing deficits. The paradigm is relatively robust to optical blur and unlikely affected by motor dysfunctions. Strong masking deficits are found from an age of about 50 years on. (C) 2010 Elsevier Ltd. All rights reserved.

Despite well-established sex differences for cognition, audition, and somatosensation, few studies have investigated whether there are also sex differences in visual perception. We report the results of fifteen perceptual measures (such as visual acuity, visual backward masking, contrast detection threshold or motion detection) for a cohort of over 800 participants. On six of the fifteen tests, males significantly outperformed females. On no test did females significantly outperform males. Given this heterogeneity of the sex effects, it is unlikely that the sex differences are due to any single mechanism. A practical consequence of the results is that it is important to control for sex in vision research, and that findings of sex differences for cognitive measures using visually based tasks should confirm that their results cannot be explained by baseline sex differences in visual perception.

The aim of the study was to examine whether the postpsychotic decline in IQ during schizophrenia are due to a dementing process and psychopathological deterioration or this is a state independent premorbid impairment. The IQ score of 32 schizophrenic patients and 25 normal comparison subjects were evaluated three times during an average of 4,5 years, after short (mean 2,3 years) and long (mean 4,6) follow-up periods. The regression analysis was used to evaluate the association of clinical symptoms and IQ scores at the different period of time. The results were examined and related to changes of negative and positive symptoms of the illness. The schizophrenic group had low IQ score at baseline than the normal comparison subjects but showed comparable stability over time. The raw IQ score slightly increased in both groups in follow-up period. The regression analyses revealed that low IQ score especially in the block design (MT) and non-verbal reasoning (LPS3) subtests could be additional predictors for deterioration of negative symptoms. The IQ score of patients with schizophrenia appears to remain stable regardless of psychopathological decline, and even could be improved by learning and rehearsal.

Schizophrenia (SCZ) patients show deficits in many domains, including cognition and perception. However, results are often mixed. One reason for mixed results may be differences in medication. Very little is known about the role of medication in visual processing. Here, we investigated the effects of typical vs. atypical medication on contrast sensitivity (spatial frequencies ranging from 0.2 to 20 cycles per degree), vernier acuity, and visual backward masking. From a large pool of patients, we selected 50 patients (Study 1, conducted in Brazil) and 97 patients (Study 2, conducted in Georgia) taking either only typical or atypical medication. Patients with atypical medication performed significantly better than patients with typical medication for contrast sensitivity, vernier duration, and backward masking. As a secondary result, we found similar, but not significant, trends for the cognitive tasks (Stroop, Flanker, Trail-Making Test-B, Wisconsin Card Sorting Test and Continuous Performance Test) in the same patients. No correlations were found between demographics, psychopathology, chlorpromazine equivalents and visual processing. A conclusion of our study is that one needs to be careful comparing studies when medication is not comparable.

BACKGROUND: To understand the genetics of schizophrenia, a hunt for so-called intermediate phenotypes or endophenotypes is ongoing. Visual masking has been proposed to be such an endophenotype. However, no systematic study has been conducted yet to prove this claim. Here, we present the first study showing that masking meets the most important criteria for an endophenotype. METHODOLOGY/PRINCIPAL FINDINGS: We tested 62 schizophrenic patients, 39 non-affected first-degree relatives, and 38 healthy controls in the shine-through masking paradigm and, in addition, in the Continuous Performance Test (CPT) and the Wisconsin Card Sorting Test (WCST). Most importantly, masking performance of relatives was significantly in between the one of patients and controls in the shine-through paradigm. Moreover, deficits were stable throughout one year. Using receiver operating characteristics (ROC) methods, we show that the shine-through paradigm distinguishes with high sensitivity and specificity between schizophrenic patients, first-order relatives and healthy controls. CONCLUSIONS/SIGNIFICANCE: The shine-through paradigm is a potential endophenotype.

The aim of the current study is to characterize the prevalence, degree and nature of verbal memory deficit in schizophrenia; to study verbal memory task performance in patient with paranoid schizophrenia and their first degree relatives in order to identify, trait cognitive marker of the disorder. Besides the authors studied, whether nonpsychotic relatives of schizophrenic probands had an elevated risk of deficits in cognitive functioning, and, which of specific factors: gender, age, education, illness duration, diagnosis and psychopathological symptoms influenced the tests performance. Twenty schizophrenia inpatients (10 men; mean age=34.2 years, SD=9.1; mean education=13.6 years, SD=2.6) were recruited from the psychiatric hospital. All patients met DSM-IV criteria for schizophrenia and clinically assessed by SANS (negative symptoms) and SAPS (positive symptoms). The patients had no history of neurological disease, systemic disease known to involve CNS functioning, clinically significant head injury, or mental retardation.twenty-eight nonpsychiatric healthy volunteers (14 men; mean age=35.0 years, SD=10.7; mean education=14.3 years, SD=3.46) were recruited from the community. Schizophrenia patients showed significant impairment of the verbal memory in all domains. In contrast, their first degree relatives having the same education level as the patients did not differ considerably from healthy controls. These results indicate that, probably, the deterioration of explicit verbal memory is not associated with the predisposition for schizophrenia. As the test performance did not correlate with severity of symptoms this finding cannot be attributed to the distractibility due to active psychotic symptoms, or medication effects. Impaired performance on the CVLT task, a measure of explicit verbal working memory, appears to be associated with the cognitive deficits due to the disorder itself.

The prevalence of mental illnesses in society is difficult to measure accurately as current techniques are relatively poor. Mental health professionals argue that data provided by Ministry of Health of Georgia concerning the prevalence of mental illnesses should be treated with great caution as the official rates of mental disorders are likely to be largely underestimated. The most significant reason of this could be focusing on referral to state mental health institution and ignoring the private sector. In order to understand the gap between official data and real needs in mental health care we compare statistical data of state institutions and private practice. The structured questionnaire was used for obtaining referral information from the Asatiani Psychiatric Hospital, Gotsiridze Psycho-Neurological Dispensary and a private psychiatrist.The state institutions with great proportion serve patients with schizophrenia, schizotypal, delusional and organic mental disorders, while patient with mood disorder and neurotic, stress-related and somatoform disorders preferred private psychiatrist. People with different psychiatric problems (e.g. sleep and eating disorders), especially young and elderly patients seldom are seen by psychiatrist.Hence, the official data concerning the prevalence of mental illnesses in Georgia are highly underestimated and could not reflect real demands.

Visual backward masking is strongly impaired in patients with schizophrenia. Masking deficits have been proposed as potential endophenotypes of schizophrenia. Masking performance deficits manifest as strongly reduced amplitudes in the electroencephalogram (EEG). In order to fulfill the criteria of an endophenotype, masking deficits should not vary substantially across time and should be present at the first psychotic event. To verify whether these conditions are met for visual backward masking, we tested patients with first episode psychosis (n = 21) in a longitudinal study. Patients were tested with visual backward masking and EEG three times every six months over a period of one year. We found that the EEG amplitudes of patients with first episode psychosis were higher as compared to those of patients with schizophrenia but lower as compared to those of unaffected controls. More interestingly, we found that the EEG amplitudes of patients with first episode psychosis remained stable over the course of one year. Since chronic schizophrenia patients have strongly reduced amplitudes, we speculate that the neural correlates of masking deficits (EEG amplitudes) continue to decrease as the disease progresses.

Visual paradigms are versatile tools to investigate the pathophysiology of schizophrenia. Contextual modulation refers to a class of paradigms where a target is flanked by neighbouring elements, which either deteriorate or facilitate target perception. It is often proposed that contextual modulation is weakened in schizophrenia compared to controls, with facilitating contexts being less facilitating and deteriorating contexts being less deteriorating. However, results are mixed. In addition, facilitating and deteriorating effects are usually determined in different paradigms, making comparisons difficult. Here, we used a crowding paradigm in which both facilitation and deterioration effects can be determined all together. We found a main effect of group, i.e., patients performed worse in all conditions compared to controls. However, when we discounted for this main effect, facilitation and deterioration were well comparable to controls. Our results indicate that contextual modulation can be intact in schizophrenia patients.