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Introduction: Evidence has shown that neurological soft signs are strongly associated with neurocognitive dysfunction. Therefore, the primary objective of this study was to assess the association between NSS and cognitive impairments in a sample of inpatients with schizophrenia. The secondary objective was to explore the association between NSS total scores and functioning. Methods: The study enrolled 95 inpatients diagnosed with schizophrenia disorders and 45 healthy controls. The neurological evaluation scale (NES) was used to assess neurological soft sign while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive functioning in patients with schizophrenia. Results: Patients with schizophrenia had significantly higher mean scores on the NES total test and subtests than the control group. Higher cognition was significantly associated with lower NES total and subtest scores. Higher functional independence was significantly associated with a lower NES total score (Beta = -.25), lower motor coordination subtest score (Beta = -.04), and lower others subtest (Beta = -.12). When taking the functional independence scale as the dependent variable, a higher NES total score was significantly associated with lower functioning (Beta = -0.03). Conclusion: NSS were associated to neurocognitive impairments in almost every domain among patients with schizophrenia. Further prospective research is still needed to confirm this role.

Background: Clinical staging has been widely used to predict and optimize the treatment of medical disorders. Different models have been proposed to map the development, progression, and extension of psychiatric disorders over time, mainly for schizophrenia. The primary objective of this study was to classify patients with psychosis according to the McGorry staging model and compare factors between the different stages., Methods: This was a cross-sectional study, collecting data from 158 patients hospitalized for schizophrenia/psychosis. The survey included the Mini International Neuropsychiatric Interview (MINI), Positive and Negative Symptom Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Yong Mania Rating Scale (YMRS), Clinical Global Impression (CGI) scale, and the McGorry staging model., Results: Patients have been classified into three clinical stages: relapse of psychotic disorder (43%), multiple relapses (47.5%), and persistent and severe illness (9.5%). A higher mean duration of hospitalization, psychotic symptoms (PANSS total scale and subscales), chlorpromazine equivalent dose, and number of antipsychotic treatments were found among participants in Stage 4 as compared to the other groups. However, a significantly higher mean GAF scale was found among participants in stage 3b as compared to the other groups., Conclusion: Each stage in the McGorry staging model of schizophrenia is associated with well-defined clinical presentations, which help decide the appropriate treatment. Using such models in psychiatry can improve the diagnostic process and potential therapeutic interventions for patients suffering from mental disorders., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Dissecting the heterogeneity of schizophrenia may help foster progress in understanding its etiology and lay the groundwork for the development of new treatment options for primary or enduring negative symptoms (NS). In this regard, the present study aimed to: (1) to use cluster analysis to identify subgroups of Lebanese patients diagnosed with either schizophrenia or schizoaffective disorder based on NS clusters, and (2) to relate the statistically-derived subgroups to clinically relevant external validators (including measures if state and trait depression, stigma, insight, loneliness, social support)., Method: A total of 202 adult long-stay, chronic, and clinically remitted patients (166 diagnosed with schizophrenia and 36 with schizoaffective disorder) were enrolled. A cluster analysis approach was adopted to classify patients based on the five NS domains social withdrawal, emotional withdrawal, alogia, avolition and anhedonia., Results: A three-cluster solution was obtained based on unique NS profiles, and divided patients into (1) low NS (LNS; 42.6%) which characterized by the lowest mean scores in all NS domains, (2) moderate NS (MNS; 25.7%), and (3) high NS (HNS; 31.7%). Post-hoc comparisons showed that depression (state and trait), loneliness and social support could accurately distinguish the schizophrenia subgroups. Additionally, individuals in the HNS cluster had longer duration of illness, longer duration of hospitalization, and were given higher dosages of antipsychotic medication compared to those in the other clusters, but these differences did not achieve the statistical significance., Conclusion: Findings provide additional support to the categorical model of schizophrenia by confirming the existence of three alternate subtypes based on NS. The determination of distinct NS subgroups within the broad heterogeneous population of people diagnosed with schizophrenia may imply that each subgroup possibly has unique underlying mechanisms and necessitates different treatment approaches., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Even though there is an increasing amount of evidence from behavioral and neuroimaging studies to suggest that pathological inner speech plays a role in the emergence of auditory verbal hallucinations (AVH), studies investigating the mechanisms underlying this relationship are rather scarce. Examining moderators might inform the development of new treatment options for AVH. We sought to extend the existing knowledge by testing the moderating role of cognitive impairment in the association between inner speech and hallucinations in a sample of Lebanese patients with schizophrenia., Methods: A cross-sectional study was conducted from May till August 2022, enrolling 189 chronic patients., Results: Moderation analysis revealed that, after controlling for delusions, the interaction of experiencing voices of other people in inner speech by cognitive performance was significantly associated with AVH. In people having low (Beta = 0.69; t = 5.048; p < .001) and moderate (Beta = 0.45; t = 4.096; p < .001) cognitive performance, the presence of voices of other people in inner speech was significantly associated with more hallucinations. This association was not significant in patients with high cognitive function (Beta = 0.21; t = 1.417; p = .158)., Conclusion: This preliminarily study suggests that interventions aiming at improving cognitive performance may also have a beneficial effect in reducing hallucinations in schizophrenia., (© 2023. The Author(s).)

Background: Several subjective scales have been used to measure cognitive complaints in patients with schizophrenia, such as the Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS), which was designed to be clear, simple, and easy to use. This study aimed to examine the ability of SASCCS as a validated tool to collect and assess subjective cognitive complaints of patients with schizophrenia., Methods: A cross-sectional study among 120 patients with schizophrenia was performed between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross, Lebanon. The SASCCS was used to assess how patients with schizophrenia perceived their cognitive impairment., Results: The internal consistency of the SASCCS scale was 0.911, and the intra-class correlation coefficient was 0.81 (p < 0.001), suggesting a good stability over time. The factor analysis of the SASCCS scale showed a 5-factor solution using the Varimax rotated matrix. The SASCCS total score positively correlated with their own factors. A negative correlation was found between the objective cognitive scale and subjective cognitive complaints, which were positively correlated with clinical symptoms and depression. No significant association was found between insight and subjective cognitive complaints., Conclusion: The SASCCS scale showed appropriate psychometric properties, with high internal consistency, good construct validity, and adequate concurrent validity, which makes it valuable for the evaluation of subjective cognitive complaints in patients with schizophrenia., (© 2023. The Author(s).)

Background: There are, to date, limited and inconsistent findings concerning the relationship between insight and psychotic symptoms, despite some evidence in favor of the clinical and therapeutic relevance of the insight construct. We aimed to add to the pool of the available data in this area, by examining the correlations between the severity of insight and positive psychotic symptoms (delusions and auditory hallucinations), while accounting for self-stigma and attitudes towards medication, in a sample of long-stay inpatients with schizophrenia., Methods: A cross-sectional study was conducted at the Psychiatric Hospital of the Cross, between July and October 2021. A total of 82 patients diagnosed with schizophrenia (aged 55.55 ± 10.21 years, 54.9% males) were enrolled. The semi-structured psychotic symptom rating scales, the Birchwood Insight Scale, the Belief About Medicine Questionnaire, and the Internalized Stigma of Mental Illness were used., Results: The mean duration of illness in years was 30.15 ± 11.73, and the mean duration of hospitalization in years was 17.56 ± 9.24. Sixteen out of the 82 patients (19.5%) were considered as having poor insight. Bivariate analyses showed that higher chlorpromazine equivalent dose was significantly associated with more delusions, whereas higher insight was significantly associated with lower delusions. Multivariable analyses revealed that Higher chlorpromazine equivalent dose (Beta = 0.004) was significantly associated with more delusions, whereas higher insight (Beta = - 0.89) was significantly associated with less delusions. No significant associations were found between insight, self-stigma and hallucinations., Conclusion: Our results imply that more impaired insight is associated with greater severity of delusions, above and beyond the effects of self-stigma and medication doses. These findings are valuable to aid clinicians and researchers improve their understanding of the relationship insight-psychotic symptoms, and could help personalize prevention and early intervention strategies in schizophrenia., (© 2023. The Author(s).)

Purpose: to evaluate the relationship between religious hallucinations and religious coping among Lebanese patients with schizophrenia., Methods: We have studied the prevalence of religious hallucinations (RH) among 148 hospitalized Lebanese patients suffering from schizophrenia or schizoaffective disorder in November 2021 exhibiting religious delusions (RD), and their relationship with religious coping using the brief Religious Coping Scale (RCOPE). The PANSS scale was used to evaluate psychotic symptoms., Results: After adjustment over all variables, more psychotic symptoms (higher total PANSS scores) (aOR = 1.02) and more religious negative coping (aOR = 1.11) were significantly associated with higher odds of having religious hallucinations, whereas watching religious programs (aOR = 0.34) was significantly associated with lower odds of having religious hallucinations., Conclusion: This paper highlights the important role of religiosity that has to play in the formation of religious hallucinations in schizophrenia. Significant association was found between negative religious coping and the emergence of religious hallucinations., (© 2023. The Author(s).)

Background: Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses., Study Design: A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool., Study Results: A significantly higher BACS total score (r = -0.33, p < 0.001), higher verbal memory (r = -0.26, p = 0.004), higher working memory (r = -0.20, p = 0.03), higher motor speed (r = -0.36, p < 0.001), and higher attention and speed of information processing (r = -0.27, p = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p = .028), higher chlorpromazine equivalent dose (SB = -.30; p = .001), and taking mood stabilizer medications (SB = -.24; p = .004) were significantly associated with lower cognition., Conclusion: This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia., (© 2023. The Author(s).)

Background: Positive psychotic symptoms of schizophrenia are generally characterized by hallucinations and delusions. We propose to assess the relationship between total composite trauma and positive psychotic symptoms, along with the mediation effect of cognition, fear of COVID-19, insomnia, anxiety, distress, and depression of Lebanese patients with schizophrenia., Methods: A cross-sectional study was carried out, between June and July 2021, by deriving data from 155 long-stay in-patients diagnosed with schizophrenia., Results: Depression, anxiety, and distress but not cognitive impairment, insomnia, and fear of COVID-19) mediated the association between lifetime traumatic experiences and positive psychotic symptoms. Higher traumatic experiences were associated with greater depression, anxiety, and distress, indicating a significant positive total effect on positive psychotic scores. Moreover, higher depression, anxiety, and distress were significantly associated with higher positive psychotic symptoms., Conclusion: Our results contribute to the existing knowledge by suggesting other possible intervention paths through mediating factors. Interventions that improve anxiety, depression, and distress severity may be effective in reducing positive psychotic symptoms among patients with schizophrenia having experienced lifetime trauma., (© 2023. The Author(s).)

Aim: To assess whether fear of coronavirus disease 2019 (COVID-19) is associated with depression, anxiety, and psychosis and to evaluate if these variables are correlated with the interaction between spirituality and fear of COVID-19., Methods: Between September and November 2020, this cross-sectional study enrolled 118 chronic schizophrenia patients. The interview with patients included Fear of COVID-19 Scale, Lebanese Anxiety Scale-10, Montgomery-Asberg Depression Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-12. The results were analyzed by using linear regressions (Enter method), with anxiety, depression, total PANSS score, positive PANSS, negative PANSS, and general psychopathology PANSS subscales as dependent variables. Spirituality, fear of COVID-19, and the interaction of spirituality with fear of COVID-19 were independents variables., Results: Fear of COVID-19 was positively correlated with increased total PANSS scores (Beta=0.90, P=0.030). Higher spirituality was significantly associated with lower anxiety (Beta=-0.14, P=0.009), lower depression (Beta=-0.21, P=0.001), lower total PANSS score (Beta=-0.90, P=0.004), lower negative PANSS score (Beta=-0.23, P=0.009), and lower general psychopathology PANSS score (Beta=-0.61, P=0.001). In patients with high fear of COVID-19, having low spirituality was significantly associated with higher anxiety, depression, and psychotic symptoms., Conclusion: This study suggests a positive correlation between fear of COVID-19 and higher psychosis among inpatients with schizophrenia. The interaction of spirituality with fear of COVID-19 was correlated with reduced anxiety, depression, and psychosis.

Background: Patients with schizophrenia (SCZ) exhibit poorer color discrimination than normal individuals. Although retinal abnormalities, as well as cortical and subcortical alterations, found in patients with SCZ have been suggested to cause this poor color discrimination, the impact of cognitive impairment remains to be determined. Dopamine (DA) and glutamate (Glu), known to be disrupted in SCZ, are also suggested to play a role in color discrimination. Our objective was to investigate the contribution of cognitive impairment to color discrimination deficits in SCZ and to examine if these deficits are correlated to SCZ symptoms., Methods: This study includes 127 patients with SCZ between July and September 2021. The participants completed several questionnaires, specifically the Positive and Negative Syndrome Scale (PANSS), the Montreal Cognitive Assessment (MoCA) test, and the Farnsworth D-15 test, to assess the extent of SCZ symptoms, cognition, and color discrimination respectively., Results: Higher cognition (Beta = - 0.279) was significantly associated with a lower total error score (TES). Moreover, a higher positive PANSS score (Beta = 0.217) was significantly associated with a higher TES. A multinomial regression analysis taking the type of color blindness as the dependent variable showed that female sex (ORa = 5.46) was significantly associated with a certain type of color blindness., Conclusion: Color discrimination deficits in patients with SCZ may be due to the effect of cognitive impairment and/or SCZ itself., (© 2022. The Author(s).)

Background: Till that date, a sparse body of research has been dedicated to perusing psychotic symptoms of sexual type, particularly in psychiatric populations. Our study's objective was to delineate psychotic symptoms with a sexual content, namely sexual delusions and hallucinations, among inpatients diagnosed with schizophrenia in Lebanon, and scrutinize their relationships with the severity of schizophrenia symptoms and childhood abusive events., Methods: We conducted structured interviews with 167 chronic schizophrenia patients, who completed the Questionnaire for Psychotic Symptoms with a Sexual Content, the Child Abuse Self-Report Scale, and the Positive and Negative Syndrome Scale., Results: 36.5% and 50.3% of the participants screened positive for current and lifetime episodes of sexual delusions and/or hallucinations, respectively. Alcohol drinking (aOR (adjusted odds ratio) current  = 2.17; aOR Lifetime  = 2.86) and increased psychological (aOR current  = 1.09; aOR Lifetime  = 1.09) and sexual (aOR current  = 1.23; aOR Lifetime  = 1.70) abuse were significantly associated with higher chances of experiencing current and lifetime sexual hallucinations and/or delusions. Additionally, an increased severity of schizophrenia symptoms (aOR = 1.02) was significantly associated with higher chances of current sexual hallucinations and/or delusions, whereas having a university level of education compared to primary (aOR = 0.15) was significantly associated with lower odds of current sexual hallucinations and/or delusions., Conclusion: In sum, our findings suggest that sexual psychotic symptoms are prevalent in chronic schizophrenia patients, providing support for their associations with antecedents of childhood traumatic experiences, illness severity, and substance use disorders. They endorse the vitalness of preventive measures against abuse, in order to circumvent such phenomenological outcomes. Our study offers the first data on sexual hallucinations and delusions in a non-Western psychiatric population, thus allowing clinicians and researchers to draw featural comparisons across different cultural settings., (© 2022. The Author(s).)

Background: The Montreal Cognitive Assessment (MoCA) is a brief cognitive impairment screening tool suitable for a rapid diagnosis of cognitive functioning. The primary objective was to examine the ability of the MoCA to detect cognitive impairment and functioning (autonomy and social cognition) among Lebanese patients with schizophrenia. The secondary objective was to evaluate factors related to cognition., Methods: A cross-sectional study conducted between July 2019 and Mars 2020 that enrolled 120 in-patients diagnosed with schizophrenia. The MoCA tool and the BACS were used to evaluate the patients' cognitive functioning., Results: The MoCA adjusted total score was significantly correlated with the BACS total score (r = .72, p < .001). The cut-off value of the MoCA for detecting mild cognitive impairment was 21, moderate cognitive impairment was 20.50 and severe cognitive impairment was 19.5. The multivariable analysis showed that the MoCA total score and the BACS score resulted in a non-significant association with autonomy. Also, higher cognition (higher BACS) (B =.10, p < 0.001) was significantly associated with a higher MoCA total score. However, higher depression (B=-.18, p = .02) and higher psychosis (B=-.04, p = .01) were significantly associated with lower MoCA., Conclusion: The Arabic version of the MoCA can be a useful tool for screening cognitive impairment in patients with schizophrenia., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Previous research revealed an absence of any previous studies reporting the impact that pandemics may have on psychotic symptomology, nor on the physical health of people with psychosis in response to the epidemics of the COVID-19. The direction of the impact of the COVID-19 on schizophrenia is unknown, as the risk of infection could vary from patients to patients according to clinical comorbidities, cognitive impairment, acute symptoms, and family support. To the best of our knowledge, no study has provided details on the variation of symptoms in patients with schizophrenia during the quarantine of COVID-19 outbreak. Therefore, the primary objective of the study is to investigate the variation of psychotic symptoms, depression, obsession and quality of life in patients with schizophrenia before and after 5 months of quarantine and evaluate factors associated with these variations during the quarantine period., Methods: A cross-sectional study was performed on a sample of 190 chronic patients institutionalized for schizophrenia for more than 1 year at the Psychiatric Hospital of the Cross. The baseline assessment was done in December 2019; the second assessment was done in August 2020 (5 months after the lockdown)., Results: Getting updates about the coronavirus minimally, some and most of the times were significantly associated with a decrease in positive psychotic and psychopathologic symptoms 5 months after quarantine compared to before it. Practicing religiosity some and all the time versus not was significantly associated with a decrease in negative, psychopathology symptoms and total PANSS score after 5 months of quarantine compared to before it. Finally, female gender (B = 1.77) was significantly associated with an increase in the WHO Domain 3 score (better social relations) after 5 months of quarantine compared to before it., Conclusion: Patients with schizophrenia fare better symptomatically after 5 months of quarantine if they receive constant updates about COVID-19 and if they tended to practice religiosity., (© 2022. The Author(s).)

Objectives: Our aim in this study was to identify affective temperament differences utilizing the TEMPS-A in a large sample size of Lebanese patients with schizophrenia and compare them to healthy controls. Gender differences, demographic factors and degree of psychotic symptoms were also considered. A cross-sectional study was conducted at the Psychiatric Hospital of the Cross (PHC) from March to June 2019. Two-hundred fifty chronic patients with schizophrenia were compared to 250 healthy controls randomly chosen from the general population., Results: Patients with schizophrenia significantly had higher mean depressive, cyclothymic, irritable and anxious temperament scores compared to healthy controls. Healthy controls significantly had a higher mean hyperthymic temperament score compared to patients with schizophrenia. In the group of patients with schizophrenia exclusively, females scored higher in terms of depressive, cyclothymic and anxious temperaments compared to males. In the group of healthy controls, males scored higher in terms of hyperthymic and irritable temperaments compared to females, whereas a higher mean depressive and anxious temperament scores were significantly found in females compared to males. In addition, higher PANSS total scores, as well as higher positive, negative and general subscales scores were significantly associated with higher depressive, cyclothymic, irritable and anxious temperament scores., (© 2021. The Author(s).)

Background: Patients with schizophrenia have a particularly low level of insight into their illness compared to people with other mental health disorders. The objectives of the study were to evaluate: 1) subjective cognitive complaints in individuals with schizophrenia in comparison with health controls, 2) the relation between subjective cognitive complaint (SCC) and objective cognitive performance in the patients group, and 3) factors related to cognitive complaint, such as depression, insight, autonomy, and psychological symptoms., Methods: Cross-sectional study was conducted between July 2019 and March 2020 enrolled 120 patients with schizophrenia disorders, selected from the Psychiatric Hospital of the Cross (HPC) - Lebanon and 60 healthy controls. The Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) was used to measure people living with schizophrenia perception of their cognitive impairment, while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate their cognitive functioning., Results: A significant difference was found between schizophrenia patients and healthy controls in all neurocognition and SASCCS tests. The hierarchical regression analysis showed that the BACS total score (Beta = -.06, p = .04), the PANSS general psychopathology (Beta = .29, p = .003), higher depression (Beta = .75, p = .003) were significantly associated with higher SCC. However, higher autonomy (Beta = - 6.35, p = .001) was significantly associated with lower SCC. A Structural equation model showed that the two most contributing variables were general psychopathology (Standardized Beta (SB): .33, p < 0.001) and autonomy (SB: -.29, p < 0.001)., Conclusion: A significant proportion of patients with schizophrenia could estimate their cognitive impairment. It also showed a positive correlation between depression and activity of daily living with SCC, suggesting that this aspect should be investigated alongside the clinical symptoms when a patient with schizophrenia presents with SCC., (© 2021. The Author(s).)

Purpose: To assess the influence of lifestyle factors, antipsychotic medications, and psychosis symptoms on obesity in a group of male patients with schizophrenia in Lebanon., Design/methods: A cross-sectional study conducted between May and July 2018 enrolling 149 male patients with chronic schizophrenia., Results: We found that 59.1% of the patients were obese/overweight. Older age and higher negative and total positive and negative syndrome scale scores were significantly associated with lower body mass index values., Practice Implications: This study shed light on some factors associated with obesity in male patients with schizophrenia, which may be targeted for the prevention and management of obesity. Some interventions were proposed such as focusing on patients' physical health, psychiatric treatment, and maintaining a healthy diet and a healthy lifestyle., (© 2020 Wiley Periodicals LLC.)

Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT , DRD2 , MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (β = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.

Background: Assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls., Methods: A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session., Results: Mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p < .01). Principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). High Cronbach alpha was found (.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r = .73, p < .001) and healthy controls (r = .78, p < .001). Also, correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p < .05)., Conclusion: Results showed that the Arabic version of the BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls and it is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon.

Background: The impact of command voices (CV) on violent behaviors in patients with schizophrenia remains unclear. The literature has produced mixed results, with no research existing on CV and violence among the Lebanese population. The study objecttives were to (1) evaluate the association between voice beliefs, psychosis severity, treatment, demographic factors and command voices, and (2) evaluate the association between command voices and violence among patients with schizophrenia in Lebanon., Methods: A cross-sectional study, conducted between April and August 2019, enrolled 280 patients with schizophrenia., Results: The results showed that 111 (39.6%) patients with schizophrenia had auditory hallucinations, among whom 93 (83.8%) patients had command voices; from these 93 patients, 53 (57.0%) were compliant with voices. Higher positive (ORa=1.09) and general psychopathology (ORa=1.04) PANSS subscales scores were significantly associated with higher compliance to voices. A higher resistance to beliefs about voices (ORa=0.91) was significantly associated with lower compliance to voices., Conclusions: The prevalence of CV in patients with schizophrenia that report auditory hallucinations, was high in our sample. The vast majority of violent acts committed by patients was in compliance to CV, with a significantly high rate of the violence committed being directed towards property. Our findings were able to connect positive symptoms to higher probability of compliance to CV.

Aim : The study's objective was to evaluate the relationship between vitamin D (VD) levels and cognitive performance in patients with schizophrenia. Methods : A cross-sectional study, conducted between March and July 2016, recruited 196 patients with schizophrenia. The Brief Cognitive Rating Scale (BCRS) and the Morningside Rehabilitation Status Scale (MRSS) were used to measure the severity of cognitive impairment and the level of general functioning in psychiatric patients. Lower scores for both scales indicate a better cognition and functioning respectively. Vitamin D levels of participants were divided into four groups: severe VD deficiency (<10 ng/ml), VD deficiency (10-20 ng/ml), VD insufficiency (20-30 ng/ml), VD sufficiency (>30 ng/ml). Relationships between VD level and cognition and functioning were assessed by analyses of covariance and hierarchical multiple regression, adjusted for age, gender, marital status, education level, sun exposure, physical activity and monthly income. Results : Severe VD deficiency was found in 22 patients with schizophrenia (11.3%), while 45.6% of patients had VD deficiency. Severe VD deficiency was significantly associated with an increase in MRSS score after adjusting for covariates (Beta = 2.44), however, no significant association was found with the BCRS score. Conclusion : These findings suggest that severe VD deficiency in patients with schizophrenia might be associated with low general functioning but could not influence cognitive function.

Background: Abnormalities and contrast sensitivity have already been studied in schizophrenia. However, the relationship between symptom severity in schizophrenia and colour vision sensitivity has not been studied systematically. Aim: Our objective was to evaluate colour discrimination in patients with schizophrenia compared to controls and examine if this colour discrimination is correlated with schizophrenia symptoms' severity. Methods: This case-control study, performed between January and April 2017, included 50 schizophrenic patients and 50 healthy controls matched for age and sex. The Positive and Negative Symptoms Scale (PANSS) was used to determine the schizophrenia symptoms' severity. Colour discrimination was evaluated using the total error score (TES) generated using the Farnsworth D-15 test. The higher the TES, the more severe colourblindness. Results: A significantly higher mean TES was found in schizophrenics (30.32) compared to healthy patients (13.07) ( p  < 0.001). Colour blindness was correlated to the severity of schizophrenic symptoms only in the subgroup of patients with severe schizophrenia. Conclusion: Colour vision defect is a common feature in schizophrenia, and may be more significant when related to psychotic symptoms.KEY POINTSA significantly higher mean TES was found in schizophrenics compared to healthy patients.Colour blindness was correlated to the severity of schizophrenic symptoms only in the subgroup of patients with severe schizophrenia.Colour vision defect is a common feature in schizophrenia, and may be more significant when related to psychotic symptoms.

Background: Toxoplasma multiplication and its persistence into the brain cause a local neuroinflammatory reaction, resulting synthesis of neurotransmitters involved in neurological disorders, especially schizophrenia. The Matrix metallopeptidase 9 (MMP-9) protein can play a major role in this neuroinflammation. It can promote extravasation and migration of infected immune cells into the brain. The objectives of this study are to determine the possible association between schizophrenia and toxoplasmosis and highlight the existence of gene polymorphism encoding MMP-9 protein's in patients presented both schizophrenia and toxoplasmosis., Methods: A case-control study was conducted on 150 patients with schizophrenia (case group), and 150 healthy persons (control group). Groups were matched with age, gender, and place of residence. The survey was conducted using a questionnaire and a serological profile assay for specific IgG and IgM antibodies against T. gondii. Reverse transcription-polymerase chain reaction (RT-PCR) of gene polymorphism encoding MMP-9 was performed on 83 cases selected randomly., Results: Data show a significant association between toxoplasmosis (IgM+/IgG+ serological profile) and schizophrenia. Significant effects of raw meat consumption and contact with cats have been associated with the occurrence of schizophrenia. RT-PCR shows the presence of muted allele of MMP-9 gene in selected cases whose present T. gondii serological profile IgM+/IgG+ and IgM-/IgG+ respectively., Conclusion: Toxoplasmosis may be one of the etiological causes of schizophrenia, and MMP-9 gene polymorphism could be involved in the occurrence mechanism of this pathology following Toxoplasma infection.

Background: The self-evaluation of negative symptoms scale (SNS) is a new easy-to-use self-administered questionnaire allowing clinicians to understand the clinical and genetic factors affecting the negative symptoms in patients with schizophrenia. There was a need to translate and validate this scale in Arabic so that Arab-speaking patients benefit from it. Therefore, the aim of our study was to validate the Arabic version of the SNS in a sample of Lebanese patients with schizophrenia., Methods: The Arabic SNS was used to quantify the disability associated with negative symptoms in patients with schizophrenia (n = 206). Six weeks after completing the SNS, the participants were interviewed again to assess test-retest reproducibility. The validity was confirmed by factor analyses using the principal component analysis technique with a varimax rotation. The Positive and Negative Syndrome Scale (PANSS) was also assessed., Results: None of the items of the SNS scale were removed; all items converged over a solution of five factors that had an eigenvalue > 1, explaining a total of 66.01% of the variance (Cronbach's alpha = 0.879; test part). The mean total SNS score was 17.33 ± 8.43 for the "test", and 16.35 ± 7.50 for the "retest". The correlation coefficients between the SNS total score and the PANSS scale and subscales were as follows: total PANSS (r = 0.044; p = 0.530), positive PANSS score (r = - 0.106; p = 0.131), negative PANSS score (r = 0.204; p = 0.003), and general psychopathological PANSS score (r = 0.03; p = 0.530)., Conclusion: This study is the first to validate the Arabic version of the SNS in patients with schizophrenia. Using this scale would help improve treatment by correctly assessing negative symptoms, thus optimizing treatment options.

Objectives: To assess clinical and genetic factors affecting response to treatment in a sample of patients with schizophrenia (treatment-resistant patients versus treatment responders). We also aimed at examining if these factors are different when we consider two different resistance classifications (the positive and negative syndrome scale, PANSS and the brief psychiatric rating scale, BPRS)., Material and Methods: A case-control study included treatment-resistant patients and good responders. Patients were stratified in two groups based on the established criteria for treatment-resistant schizophrenia using BPRS and PANSS. The study was approved by the ethical committees (references: CEHDF1017; HPC-017-2017) and all patients/legal representatives gave their written consent. Clinical factors were assessed. DNA was obtained using a buccal swab and genotyping for OPRM1 , COMT , DRD2 et MTHFR genes using the Lightcycler ® (Roche)., Results: Some discrepancies between the BPRS and PANSS definitions were noted in our study when assessing the patients' psychopathological symptoms and response to treatment. The multivariable analysis, taking the presence versus absence of treatment resistance as the dependent variable, showed that that family history of schizophrenia, university studies, time since the beginning of treatment and chlorpromazine equivalent dose as well as the COMT gene are associated with resistance to treatment. In addition, a gender-related difference was noted for COMT SNP; men with at least one Met allele were more prone to be resistant to treatment than Val/Val patients., Conclusion: Uncovering the clinical and genetic factors associated with resistance to treatment could help us better treat our schizophrenic patients in a concept of personalized medicine.

Objective: To evaluate the occurrence of cardiovascular (CV), cerebrovascular events and mortality rates, and compare the predictive ability of two scores, Framingham Risk Score (FRS) and Atherosclerotic Cardiovascular Disease (ASCVD), of detecting a cardiovascular event in a cohort of schizophrenic patients. Methods: A cohort of 329 hospitalised schizophrenic patients is being monitored since 1 January 2013. Patients' file review was performed to detect the CV events of interest. Results: Out of the 329 patients with schizophrenia, with a mean study follow-up of 41.07 ± 12.55 months, 29 cardiovascular events were recorded; of those events, we recorded 4 myocardial infarction, 1 stroke, 6 heart failure and 18 cardiovascular deaths. The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance (RR = 1.90, p  = .078). Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival (RR = 3.35, p  = .005). Conclusion: The ASCVD items should be included in the medical assessment in any patient with severe mental illness. Key points The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance. Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival. The ASCVD items should be included in the medical assessment in any patient with severe mental illness.

The objectives were to examine the prevalence of obsessive-compulsive disorder (OCD) in hospitalized patients with schizophrenia and to compare the clinical, cognitive, and functional characteristics of schizophrenia patients with and without OCD. This cross-sectional study, performed between May and August 2018, enrolled 308 patients (200 men and 108 women). The prevalence of OCD in patients with schizophrenia was 3.2%. An increase in patients having a mild β was significantly associated with higher social relationship score (β = 1.68) and the Memory Functioning Scale-Informant (MFS-I) version (β = 5.67). OCD did not affect the positive and negative symptoms of these patients. The prevalence of OCD in these patients was low (3.2%). Schizophrenia patients with and without OCD have comparable clinical profiles with few exceptions. The existence of OCD may affect the social relationship quality of life and the MFS-I version.

Objective: To investigate the prevalence of statin-untreated schizophrenic patients needing treatment according to the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines and to compare the performance of these guidelines to the 2004 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) recommendations., Methods: A cross-sectional study was conducted using medical charts, patient inverventions, and various anthropometric measures between April 2016 and July 2016 at the Psychiatric Hospital of the Cross enrolled 329 patients with schizophrenia (DSM-5 criteria) to determine dyslipidemia and risk for atherosclerotic cardiovascular disease (ASCVD)., Results: Of the patients, 81.25% (130 patients of 160) who need a statin therapy according to the ACC/AHA guidelines would not need a therapy according to the NCEP ATP-III, while only 9.1% of the total population met the criteria for both guidelines concomitantly. A significant difference in favor of the ACC/AHA guideline was found between the 2 guidelines (P < .001). Among the 130 patients who need a statin treatment, 124 (95.4%) had ASCVD ≥ 7.5%, 13 patients (10%) had diabetes, 1 patient (0.8%) had clinical cardiovascular disease (CVD), and none had low-density lipoprotein > 190 mg/dL., Conclusions: Although our results showed the superiority of the 2013 ACC/AHA guidelines over the 2004 NCEP guidelines for detecting undiagnosed dyslipidemia, the absolute benefit or risk of a statin therapy according to these guideline recommendations remains unclear in this population of schizophrenic patients because the actual occurrence of CVD or statin-related adverse events was not investigated in this study. Further studies are needed to evaluate the reduction in CVD by a statin treatment according to both guidelines and thus compare the actual benefit of statin assignment in schizophrenic patients., (© Copyright 2017 Physicians Postgraduate Press, Inc.)

Introduction: The assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. Objectives: The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls. Methods: A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session. Results: The mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p<0.01). A principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). A high Cronbach alpha was found (0.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r=0.78, p < 0.001) and healthy controls (r=0.77, p < 0.001). Also, the correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p < 0.05). The Arabic-BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls. Conclusions: The results showed that the Arabic version of the BACS is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon. [ABSTRACT FROM AUTHOR]

Introduction: The assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS), validated in English and other languages, was developed to cover the main cognitive deficits of schizophrenia and to be administered briefly and easily. Objectives: To test the reliability and validity of the Arabic version of the BACS in a sample of Lebanese patients with schizophrenia. Methods: A sample of 54 stable patients with schizophrenia received the Arabic version of the BACS (version A) in a first session, and a standard battery in a second session. All patients completed each of the subtests of the BACS. Results: The mean duration of completion for the BACS Arabic version was 23.70 ± 5.02 min. A principal components analysis demonstrated that a one-factor solution best fits our dataset (68.29% of the variance). A high reliability analysis of the BACS was found (Cronbach alpha = 0.906). The correlation analysis between the BACS global score and the standard battery global score showed a significant result (r=0.91, p < 0.001). The correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results for verbal memory, working memory, verbal fluency, attention and speed of information processing and executive functions and for motor speed (p < 0.05). Conclusions: These preliminary results showed that the Arabic version of the BACS is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon. [ABSTRACT FROM AUTHOR]