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Objectives: Evidence from the literature addressing sex differences in cognition in schizophrenia remains equivocal, with some researchers suggesting that male schizophrenia patients are more impaired than female subjects, while others report no significant sex differences in cognitive functioning. The aim of the present study was to investigate whether the differential pattern of cognitive performance observed in healthy men and women is preserved in male and female schizophrenia patients.Method: Ninety-six schizophrenia patients (56 men) were compared with 62 age- and gender-ratio matched healthy controls (31 men), on a battery of neuropsychological tests that assessed basic cognitive abilities: attention, working memory, abstraction, inhibition, fluency, verbal learning and memory, visual memory, visuospatial skills, and psychomotor speed.Results: As a group, schizophrenia patients were significantly impaired in each of the cognitive domains assessed, with the exception of psychomotor speed. The effect of sex was significant for verbal learning and memory, wherein women outperformed men. No significant group × sex interactions were found in any cognitive domains, indicating that the female advantage typically observed in verbal learning and memory remained the same in the schizophrenia patients.Conclusion: The degree of cognitive impairment is the same for male and female schizophrenia patients. Those sex differences found among the patients were typical of the healthy population as well. Therefore, differential decrements in basic cognitive domains do not appear to account for the favourable course of schizophrenia in women relative to men.

Previous research has suggested that a failure in processing contextual information may account for the heterogeneous clinical manifestations and cognitive impairments observed in schizophrenia. In the domain of language, context processing in schizophrenia has been investigated mostly with single-word semantic priming paradigms; however, natural language comprehension depends on more than semantic relations between words. The present study aimed to systematically assess sentence context effects in homonym meaning activation in patients with schizophrenia. Fourteen patients with schizophrenia and 14 normal controls matched to the patients on sex, age, education and parental education, were examined using a cross-modal priming paradigm. Primes were sentences biasing the first, second, or neither meaning of a sentence-final equibiased homonym; targets were related to either the first or the second meaning of the homonym and appeared after an interstimulus interval (ISI) of 0 ms or 750 ms. Patients with schizophrenia exhibited a trend towards facilitation of both target types following unbiased sentences at ISI = 0 ms, similar to controls. However, in contrast to the pattern of selective target facilitation exhibited by control subjects following first- or second meaning-biased sentences, no significant target facilitation was observed in patients in the same condition. At ISI = 750 ms, patients did no longer exhibit significant target facilitation in any sentence context condition. This pattern of results is compatible with the assumption of a combined impairment in lexical (automatic spreading of activation within the semantic network) and extralexical (working memory) processes in patients with schizophrenia.

Patients with bipolar disorder present deficits in facial emotion perception, both during a manic episode as well as upon recovery. Our goal in the present study was to investigate the ability of remitted patients with bipolar disorder to perceive affective prosody and to explore potential differences in the specific emotions that are troublesome for them. Participants included 19 patients with bipolar disorder I, currently in remission, and 22 healthy comparison subjects, matched on age, education, and gender. An affective prosody test (APT) was administered to all participants. Bipolar patients had significantly lower overall scores on the APT than healthy individuals. This impairment was specific to female patients and certain emotions (e.g., fear and surprise).

The purpose in undertaking the present study was to investigate humor appreciation in patients with schizophrenia. Moreover, we sought to explore the potential relationship of humor appreciation with measures of psychopathology and cognitive functioning among the patients. Thirty-six patients with schizophrenia were compared with 31 normal controls matched for age, sex, and education on a computerized test comprising captionless cartoons: Penn's Humor Appreciation Test (PHAT). The patients were also evaluated on the symptom dimensions derived from the Positive and Negative Symptom Scale (positive symptoms, negative symptoms, cognitive symptoms, depression, and excitement), as well as a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and psychomotor speed. Patients with schizophrenia had significantly lower scores on the PHAT than normal controls. The patients' performance on the PHAT correlated with scores on Penn's Continuous Performance Test, the Stroop Color-Word Test, and the phonological subscale of the Greek Verbal Fluency Test. Our findings indicated impaired humor appreciation among patients with schizophrenia. The relationship found between the appreciation of captionless cartoons involved an incongruous detail and performance on a broad neuropsychological battery suggested that the deficit in humor appreciation in schizophrenia could be attributed to impairment in more basic neurocognitive domains, namely, selective and sustained attention as well as phonological word fluency.

We explored the hypothesis that, while sensitive to different aspects of executive functioning in patients with schizophrenia, the Wisconsin Card Sorting Test (WCST) and the Stroop Test also measure the same construct, namely, inhibitory control. Specifically, our goal was to confirm and extend previous findings [A. Rossi, E. Daneluzzo, P. Mattei, M. Bustini, M. Cassachia, P. Stratta, Wisconsin Card Sorting Test and Stroop performance in schizophrenia: a shared construct, Neurosci. Lett. 226 (1997) 87-90] by demonstrating the independence of this construct from other abilities necessary to successfully perform the tasks. More importantly, we sought to improve on this previous study by eliminating the influence of the variance of speed of responding. We examined 55 patients with schizophrenia and initially found that performance on the Stroop Color-Word condition could, indeed, be predicted only by the percentage of perseverative errors on the WCST, and not variables reflective of other cognitive skills, thus replicating and extending previous findings. Once we removed the influence of speed of responding from our measure, however, thus isolating the inhibitory process, this finding disappeared. Therefore, our findings highlight the importance of isolating the individual components of interest from complex measures before drawing conclusions regarding the cognitive processes underlying particular test performance.

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.

Objective: Our purpose in undertaking the present study was to explore the existence of specific areas of cognitive deficits within the context of generalized poor performance in a group of Greek patients with schizophrenia. We also sought to identify any patients who might be cognitively normal. Method: Participants were 70 patients with schizophrenia and 42 healthy control subjects. The 2 groups were matched on age and male-female ratio but differed in their level of education. A battery of neuropsychological tests was selected to assess executive functions/abstraction, fluency, verbal and spatial working memory, verbal and nonverbal memory, attention, visuospatial ability, and psychomotor speed. Results: Patients with schizophrenia performed more poorly than healthy control subjects, when we controlled for differences in level of education, on executive functions, working memory, verbal memory, nonverbal memory, fluency, visuospatial ability, and attention. In contrast, no significant differences were found between the 2 groups on psychomotor speed. Patients showed a more pronounced deficit on executive functions, verbal and visual memory, and visuospatial ability. Overall, 13% to 62% of the patients with schizophrenia scored within 1 SD of the mean z scores of healthy control group depending on the cognitive domains examined. In the entire sample of patients with schizophrenia, however, no individual scored within 1 SD of the mean z scores of the control group in all cognitive domains. Conclusions: We found a generalized deficit in cognitive functioning in a group of patients with schizophrenia. We failed to find any individual patients who were healthy across all cognitive areas. The current neuropsychological profile, indicating widespread impairment, is comparable to that reported in the international literature and thus appears to be characteristic of schizophrenia. Our findings of increased difficulties with executive functions, verbal and visual memory, and visuospatial ability support previous suggestions of generalized brain dysfunction in the pathophysiology of schizophrenia.

The authors aimed to explore schizophrenia patients' ability to perceive affective prosody. Specifically, certain emotions that may be more troublesome for patients and possible gender differences in prosody perception were assessed. Thirty six schizophrenia patients and 32 age-, education-, and gender-matched healthy comparison subjects assessed on an affective prosody test were examined. Patients were impaired on recognition of affective prosody overall, and their difficulties with prosody perception may be attributed to those emotions with negative valence, specifically anger and sadness. Findings revealed that only male patients were impaired on prosody perception. Deficits in the perception of affective prosody were principally evident in emotions with negative valence and male patients with schizophrenia. Future studies should explore the influence of these deficits on social and interpersonal functioning more directly.

Although atypical antipsychotics are now considered first line treatments for schizophrenia, intramuscular (i.m.) conventional neuroleptics are often still considered necessary in emergency treatment of acute psychoses. This European, multicentre, open-label, active-controlled trial compared oral risperidone plus oral lorazepam to standard care with i.m. conventional neuroleptics with or without lorazepam in the emergency treatment of acutely psychotic patients. Patients were allowed to choose either oral risperidone (a single dose of 2 mg and 2.0-2.5 mg lorazepam; 121 patients) or standard i.m. treatment (conventional neuroleptic with or without lorazepam; 105 patients). No additional treatment was allowed for 2 h. Primary outcome was the percentage of patients with treatment success (asleep or at least much improved on Clinical Global Impression-global improvement scale) 2 h after treatment initiation. Baseline characteristics were similar in both treatment groups. Oral risperidone plus oral lorazepam was more successful at 2 h (66.9%) and significantly non-inferior compared to standard i.m. care (54.3%; P=0.0003), and the incidence of extrapyramidal symptoms (EPS) was lower (1.7%) compared to standard i.m. care (9.5%). In acutely psychotic patients requiring emergency treatment, oral risperidone/oral lorazepam was at least as effective as i.m. conventional neuroleptic treatment with or without lorazepam. Oral risperidone plus lorazepam rapidly reduces symptoms, including aggression, and causes fewer EPS.

The purpose of the present study was to explore the relationship between emotion perception and both psychopathology and cognitive functioning in a group of Greek patients with schizophrenia. Thirty-five patients with schizophrenia were assessed with computerized tests of emotion perception, using visual faces (Kinney's Affect Matching Test, KAMT), prosody (Affective Prosody Test, APT), and visual everyday scenarios (Fantie's Cartoon Test, FCT), as well as a facial recognition test (Kinney's Identity Matching Test, KIMT). The patients were also evaluated with the symptoms dimensions derived from the PANSS (positive, negative, cognitive, depression, and excitement) and a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and visual scanning/psychomotor speed. The three emotion perception and face recognition tests correlated significantly with each other. The KAMT was significantly related to the cognitive symptoms dimension of the PANSS and executive functions. The FCT was significantly related to level of education and attention. Finally, the APT was significantly related to the cognitive symptoms dimension, executive functions, and attention. Our findings regarding the significant relationships of affect perception, both facial and vocal, as well as in everyday scenarios, with several cognitive abilities support the notion that deficits in decoding affective information in schizophrenia could be attributed to impairment in more basic neurocognitive domains. (JINS, 2004,10, 549–558.)

Pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.

The diagnosis of "mental illness" is accompanied by negative implications regarding a person's competence. Self- and other-descriptions about the "patient" are embedded within broader cultural and societal discourses, influencing his/her relationships. The parental role seems to be one of the most sensitive, especially for women. Mothers hospitalized in psychiatric units often have to separate themselves from their children either temporarily, during hospitalization, or permanently, after a loss of custody. However, many studies have shown that mothering remains important for them. We interviewed 20 women, inpatients on a psychiatric unit and mothers of 3.5-18-year-old children, recording their narratives about their children and exploring their thoughts and understanding of the concepts of motherhood and mental illness. We also explored the way in which the mother-child dyad interacted with the family and its social context. Most mothers had a consistent and coherent narrative about their children and they had certain expectations of them. The mother-child bond was strong, even when the children had been removed from their mothers' custody. However, mothers were facing great difficulties with their partner and with the broader family context. Also, the social discourses regarding mental illness, (e.g., violence and incapability for mothering), were extremely oppressive for these women. They felt that they were the victims of societal attitudes even before they became pregnant. These findings suggest the importance of listening to the voices of these women; acknowledging their competence in the therapeutic context; involving them with their families, and in legal and social contexts; and in planning supportive programs for them.

The impaired performance of Alzheimer's disease (AD) patients on the clock drawing test (CDT) relative to age-matched normal controls is a well-documented finding in the literature. On the other hand, there is sparse information regarding the use of this test in schizophrenia. We examined three groups of subjects matched for gender and education: institutionalized patients with schizophrenia (n = 32), patients with AD (n = 32), and normal controls (n = 36). The CDT ("free-drawn", "pre-drawn", and three "examiner" conditions) and Mini-Mental State Examination (MMSE) were administered to all participants. In patients with schizophrenia, symptom severity was assessed with the Brief Psychiatric Rating Scale (BPRS). Patients with schizophrenia were significantly younger than AD patients and normal controls (56.78 versus 71.41 and 66.25, respectively), and normal controls had significantly higher MMSE scores than patients with schizophrenia and AD (27.58 versus 20.75 and 18.44, respectively). In all of the clock conditions, the two patient groups performed significantly poorer than the normal controls, with the exception of the "pre-drawn" clock in which AD patients also performed worse than patients with schizophrenia. Age and duration of illness did not correlate significantly with CDT scores. When MMSE scores were used as a covariate, all significant differences on the CDT among the three groups disappeared, with the exception of the "pre-drawn" clock (AD patients had lower scores than both control and schizophrenia groups). In patients with schizophrenia, scores on the BPRS were not related with any CDT variable. Institutionalized patients with schizophrenia and AD patients showed similar deficits on a neuropsychological test sensitive to changes in visual-analytic function, attention, receptive language, and executive functions such as planning, organization, and simultaneous processing.

The diagnosis of factitious disorder by proxy is still under investigation. Few studies have researched the psychological status and potential underlying psychopathology of the perpetrator, as well as the impact on the child's development and the pathological reactions of rearing a child within the context of a distorted reality. In this article, we present the case of a 12-year-old boy where this diagnosis was suspected. Both he and his parents brought forth false allegations of repeated physical abuse induced by his schoolteacher. The parents presented with shared psychosis and the child presented with conduct disorder, factitious disorder, and emotional problems. We suggest that this case represents a Munchausen by proxy-like syndrome involving both the legal and medical systems. Hypotheses regarding the pathogenesis of symptoms in the child are noted, underscoring the differences between Munchausen by proxy syndrome appearing in infancy with that appearing in older children.

The objective of the present study was to examine whether neurofibrillary tangles densities are increased in elderly patients with late-onset schizophrenia (LOS). A neuropathological examination was performed in 32 consecutive autopsy brain specimens of ten patients with early-onset schizophrenia (EOS; onset of symptoms before the age of 40 years), eight patients with LOS (onset of symptoms after the age of 40 years) and 14 age-matched controls with no known neuropsychiatric disorder. Neurofibrillary tangle densities observed in the CA1 field of the hippocampus, the enthorhinal cortex, and the inferior temporal cortex in patients with LOS, EOS, and controls were not significantly different. All patients with EOS or LOS had Braak stages of III or less, which may correspond to normal aging. Thus, patients with schizophrenia, regardless of the age of onset of their symptoms, are no more prone to the development of Alzheimer's disease than the general population.

In this article a case of schizophrenic-like symptoms in a patient with thrombo-angiitis obliterans (TAO) is presented. His CT and MRI findings indicated a diffuse ischemia in the white matter, suggestive of TAO, not of focal lesions. The patient, except for age, did not have other risk factors for other cerebrovascular diseases. Psychotic symptoms may be the result of cerebral TAO, via deep and periventricular white matter lesions.

Gabapentin is an anticonvulsant agent, also effective in the treatment of mood disorders and anxiety disorders. Three cases of alcohol withdrawal treated with gabapentin are presented. All patients received gabapentin 400 mg tid for 3 days, 400 mg bid for 1 day, and finally 400 mg for 1 day. Withdrawal symptoms subsided and no adverse effects were observed. The possible effectiveness of gabapentin in the treatment of alcohol withdrawal warrants further investigation by systematic and well-designed studies.

Objective: The Scale for the Assessment of Thought, Language and Communication (TLC) is a widely used instrument for the assessment of formal thought disorder. TLC disorders were initially conceptualized as having only two underlying dimensions, a negative and a positive one. But studies of the factorial structure of the TLC have not provided confirmation for the positive-versus-negative distinction. The aim of the present study was to assess the factorial structure of the Greek translation of the TLC. Method: Subjects were 103 patients (69 male, 34 female) with psychotic disorders randomly recruited from both inpatient and outpatient facilities. The TLC was assessed by two raters based on a 20 min clinical interview. Results: Principal component analysis with varimax rotation yielded a three-factor structure; the three factors consisted off items reflecting (i) disorganization of speech; (ii) peculiarities of speech; and (iii) verbosity. The disorganization factor could be further divided into two dimensions reflecting disturbances in the flow of ideas and in the structure of speech. Conclusion: The investigation of the factorial structure of the Greek translation of the TLC scale found no support for the positive-versus-negative distinction of TLC disorders. Three factors (disorganization, speech peculiarities, and verbal productivity) were found to underlie the variance of the scale.

Amygdala lesions result in emotional deficits, such as facial affect recognition, that occurs also in schizophrenic patients, especially paranoid, compared to non-paranoid. The volume of amygdala may be inversely correlated with the number of X chromosomes. Hippocampus lesions can produce symptoms that resemble both the positive and the negative symptoms of schizophrenia. However those volume reductions are not specific findings of schizophrenia, since they are also found in bipolar patients and even in normal elderly persons.

The purpose of the present study was to investigate humor appreciation in a group of remitted patients with bipolar disorder. We examined 19 patients (8 men) with bipolar disorder I, currently remitted, and 22 (9 men) healthy controls, matched on age, education, and gender, on a computerized test comprising captionless cartoons, the Penn's Humor Appreciation Test (PHAT). Residual manic symptoms were evaluated with the Young Mania Rating Scale and residual depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Patients with bipolar disorder performed worse than the healthy group on the PHAT, but this difference was not statistically significant. Performance on the PHAT did not significantly correlate with age of onset and duration of illness, or with residual manic or depressive symptoms measured by Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale, respectively. Humor appreciation, based on captionless cartoons, in bipolar disorder does not seem to be deficient at least during remission, suggesting that this high-order cognitive function may not be considered a trait deficit of the disorder.

Materials and methods Participants were 29 (18 men) outpatients with schizophrenia (SZ), 19 (8 men) remitted patients with bipolar disorder I (BP), and 30 (15 men) healthy controls (HC); all groups were matched to each other for age, sex, and level of education. Symptom severity (positive symptoms, negative symptoms, and general psychopathology) of patients with SZ were assessed with the Greek version of the Positive and Negative Syndrome Scale (PANSS); residual affective symptoms of patients with BP were assessed with the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Sustained attention was measured by means of the Penn Continuous Performance Test (PCPT).

Address: 1Psychiatric Hospital of Thessaloniki, Greece, 21st Department Of Psychiatry, Aristotle University of Thessaloniki, "Papageorgiou"General Hospital, Greece, 3Psychiatric Hospital of Athens "Dromokaition", Greece, 4Psychiatric Hospital of Athens "Dafni", Greece, 5University Hospital of Ioannina, Greece, 6Chania Hospital for Mental Illnesses, Greece, 7Alexandroupoli General Hospital, Greece and 8Sismanoglion General Hospital, Greece * Corresponding author

Summary Component: role limitations-emotional, social functioning, and mental health] and the Health Status item from the EUROQoL-5D. Psychopathology was assessed with the five symptom dimensions from PANSS: positive, negative, cognitive, depression, and excitement symptoms. Results Significant intercorrelations were found among QLS subscales: IRP with IRF [r(38) = 0.65, p < 0.001], IF [r(38) = 0.85, p < 0.001], and COA [r(38) = 0.70, p

Background Schizophrenia and multiple sclerosis are different chronic brain diseases that seriously affect quality of life of a person's life. Assessing health related quality of life (HRQoL) could provide with valuable information health care professionals in order to treat patients with chronic medical conditions more efficiently. The main aim of this study is to compare quality of life of patients suffering multiple sclerosis versus schizophrenic patients.

Background It is well known that semantic characteristics of words have differential effects on word recognition. Recently, attention has been drawn to the effects of the type of ambiguity, i.e. whether a word has different meanings that correspond to different entries in the dictionary and have different derivations (homonymy), or related senses that are all enlisted under the same entry in the dictionary (polysemy). The aim of this study was to investigate the effects of ambiguity type on visual single-word recognition in greek.

Background Patients suffering end stage renal disease (ESRD) are vulnerable to exhibit cognitive deficits due to uremia or other medical parameters. Several studies demonstrated that hemodialysis and peritoneal dialysis have beneficial effects on attention, psychomotor speed, memory and several cognitive domains. The purpose of this study was to investigate differences regarding cognitive functioning among patients suffering ESRD, comparing two treatment methods: hemodialysis vs. peritoneal dialysis.

Background Specific neurocognitive deficits were found to act as "ratelimiting factors" to functional outcome in schizophrenia. Verbal memory, card sorting (executive functioning/set shifting), and verbal fluency restricted the functioning and adaptation of patients with schizophrenia in the outside world. Consequently, it was hypothesized that sex differences in the performance of patients with schizophrenia on some domains of cognitive functioning may contribute to the poorer social course of men with schizophrenia in comparison to women suffering from the disease. The purpose of the present study was to investigate sex differences in a group of patients with schizophrenia relative to healthy controls regarding performance in different domains of cognition.

In the present study, we examined whether there is an impairment in affect matching abilities in remitted patients with bipolar disorder and if this could be attributed to problems with facial perception per se and/or the ability to perceive the relative valence of facial expressions indicating emotions. We examined 19 patients with bipolar disorder I, currently remitted, and 30 healthy controls (15 men), matched on age, education, and gender, using two computerized tests: matching facial identity [Kinney's Identity Matching Test (KIMT)] and matching facial emotional expressions [Kinney's Affect Matching Test (KAMT)]. Patients with bipolar disorder performed significantly worse than the healthy group on the KAMT, but not on the KIMT. Performance on the KAMT and KIMT did not correlate with age of onset and duration of illness, or with manic or depressive residual symptoms. The present findings support the differential deficit hypothesis regarding impaired affect perception in bipolar disorder during remission. Patients' deficits were restricted to the matching of facial emotional expressions despite their intact perception of facial identity.

Objective The authors examined the relationship between poststroke depression and location of stroke. Methods They performed a clinicopathological analysis of 95 consecutively autopsied elderly initial-stroke survivors. Results The severity of brain vessel arteriosclerosis and frequency of brain vascular lesions were not significantly different between 21 cases with poststroke depression and 74 cases without. Earlier death was the only variable significantly associated with poststroke depression. No lesion pattern characterized the depression group. Conclusions Neuropathological data confirm that depression is associated with worse prognosis in elderly stroke patients and lend support to the hypothesis that psychological rather than neurological factors are the main determinants of poststroke depression.

The purpose of this study was to delineate the relationship between positive, negative, cognitive, depressive, and excitement symptom dimensions of schizophrenia and cognitive functioning. Fifty-eight patients with schizophrenia (DSM-IV criteria) were assessed using the Positive and Negative Syndrome Scale (PANSS) and a battery of neuropsychological tests (executive function/abstraction, verbal and spatial working memory, verbal and nonverbal memory/learning, attention, visuospatial ability, and psychomotor speed). The cognitive symptom dimension correlated with executive functions, attention, verbal memory, and spatial ability. Severity of the negative symptom dimension was related to impairment in the structure of the semantic knowledge system, verbal memory, and auditory attention. In contrast, severity of the positive symptom dimension correlated only with impairment in the structure of the semantic knowledge system, and psychomotor speed. Finally, severity of the depressive and excitement symptom dimension was not associated with cognition. Correlations between symptom dimensions and cognitive measures were at best modest. Severity of cognitive and negative symptoms was mainly correlated with deficits on executive functions, semantic memory, and verbal memory, while positive symptoms only with semantic memory. These correlations were modest, suggesting that psychopathology and cognitive deficits in schizophrenia are caused, at least partially, by distinct pathophysiological processes.

The prevalence of smoking cigarettes has repeatedly been found to be greater in schizophrenia as compared with other psychiatric patients and the general population. Patients with schizophrenia have been found to engage in heavy smoking and consumption of higher doses of nicotine, probably by deeper inhalation of cigarettes. The aim of the current study was to assess nicotine exposure through smoking by measuring urinary cotinine, the major nicotine metabolite, in a group of smokers from Greece of smokers with schizophrenia and smokers from the general population. Participants were current smokers and belonged to one of two groups: 35 patients with schizophrenia and 48 healthy controls matched in age, education, and gender. The quantitative analysis of cotinine, the major metabolite of nicotine, in urine samples was performed by a modified high performance liquid chromatography (HPLC). Patients with schizophrenia who smoke presented a significantly larger time interval between last cigarette smoked and urine sample collection, as well as a significantly higher average number of cigarettes consumed daily than normal smokers. Urinary cotinine levels of patients with schizophrenia who smoke did not significantly differ from that of normal smokers when adjusted for average number of cigarettes per day and time interval between last cigarette smoked and urine collection. These results suggest that patients with schizophrenia did not present higher nicotine exposure through smoking compared with smokers from the community. The pharmacokinetic or pharmacodynamic properties of nicotine, as well as patient medications of the patients may explain our findings.

A case of a patient with comorbid schizophrenia and obstructive sleep apnea syndrome (OSAS) who was treated with nasal continuous positive airway pressure (nCPAP) is presented. This treatment led to significant improvement of schizophrenic and depressive symptoms, with only a partial, albeit not trivial, effect on his cognitive functioning. These encouraging results of treatment of OSAS in schizophrenia with nCPAP suggest the need for further and more systematic investigation of sleep and its disorders in psychotic patients.

The purpose of the current study was to investigate whether patients with schizophrenia present disproportionate impairment in semantic, relative to phonemic, fluency. Specifically, we explored whether this impairment could be explained by differential deficits in clustering or switching strategies. The Greek Verbal Fluency Test was administered to 119 patients with schizophrenia and 150 age-, education-, and gender-matched healthy controls. We calculated the total number of words generated, the number of cluster related words, and the number of switches on the semantic and phonological fluency tasks separately. Patients with schizophrenia generated fewer total words, cluster related words and switches than healthy controls on both fluency tasks. When controlling for the total number of words produced, however, the differences between the two groups in the number of cluster related words and switches disappeared. We found a disproportionate impairment in semantic, compared with phonemic, fluency in schizophrenia for total word production and the number of cluster related words, but not for the number of switches. In conclusion, patients with schizophrenia used the same strategies as healthy controls to perform on a word fluency test, but they used them less effectively. Disproportionate impairment in semantic fluency in schizophrenia resulted from a differential deficit only in clustering. Therefore, disproportionately impaired category fluency in schizophrenia may be primarily due to disorganization and not to inefficient access to and retrieval from semantic store.

We investigated previously reported contradictory findings regarding the nature of deficits in emotion perception among patients with schizophrenia. Some studies have concluded that such deficits are due to a generalized impairment in visual processing of faces, while others have found it to be restricted to facial emotional expressions. We examined 37 patients and 32 healthy controls, matched on age and education, using three computerized tests: matching facial identity, matching facial emotional expressions, and discrimination of subtle differences in the valence of facial emotional expressions. Our results showed impaired matching of emotions in patients with schizophrenia. This impairment did not manifest on tasks that depended on perceiving the identity of faces or cues of the relative valence of facial emotional expressions. Our findings support the differential deficit hypothesis of emotion perception in schizophrenia.

Investigations of the usefulness of the Clock Drawing Test (CDT) in schizophrenia have focused primarily on institutionalized or elderly patients. The purpose of the present study was to compare CDT performance of patients with schizophrenia living in the community with that of normal controls. Fifty-three patients with schizophrenia were compared with 66 age- and gender-matched normal controls. The CDT ('free-drawn', 'pre-drawn' and three 'examiner' conditions) and the Mini-Mental State Examination (MMSE) were administered to all participants. In patients with schizophrenia, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Patients with schizophrenia had significantly lower scores on the MMSE and the five CDT conditions than the control group. When MMSE scores and level of education were included in the comparisons as covariates, the differences between the two groups remained significant. MMSE scores of the patients with schizophrenia correlated significantly with four clock conditions: 'free-drawn' 'pre-drawn' and two of the 'examiner' conditions (11:10 and 8:20). Poorer performance on the CDT correlated with higher scores on the PANSS positive symptoms subscale. Qualitative analysis of the clocks that were drawn revealed specific errors in the schizophrenia group relating to frontal processes: difficulty placing numbers in the correct position, failure to indicate the minute targets, displacement of the minute hand from the minute number, and failure to draw a longer minute hand. The fact that the CDT is sensitive enough to detect the cognitive impairment inherent in schizophrenia, as well as being correlated with symptom severity, makes this test useful in roughly assessing cognitive state in schizophrenia.

The purpose of the present study was to assess the impact of smoking on the metabolism of psychotropic drugs in a group of patients with schizophrenia, by measuring CYP1A2 activity. This activity was assessed by the molar ratio (MR) of caffeine metabolites in urine [(AFMU+1U+1X)/17U] and saliva (17X/137X). Participants were 40 patients with schizophrenia: 30 current cigarette smokers and 10 nonsmokers. The two groups (smokers and nonsmokers) differed significantly in their ratio of men to women (83% men and 17% women were among smokers compared with 50% men and 50% women nonsmokers). No other group differences were found regarding age, level of education, PANSS, extrapyramidal symptoms, age of symptoms onset, antipsychotic doses (chloropromazine equivalents), and anticholinergic drug used. Smokers had significant higher MR in urine (P

Several studies have reported a relatively stable level of cognitive deficits among patients with schizophrenia regardless of age, while others have suggested continued deterioration with age. We compared the performance of 42 institutionalized patients with schizophrenia and 42 age- and education-matched healthy controls on a semantic and phonemic verbal fluency test. Each group was divided into young participants (65 years old) and elderly participants (or =65 years old). We found a fluency condition x diagnostic group x age group interaction on total words produced, a fluency condition x diagnostic group interaction on the number of cluster-related words, and a fluency condition x age group interaction on the number of switches. Patients with schizophrenia generally used similar strategies (i.e., semantic or phonemic cluster-related words and switches) as healthy individuals when generating words, but to a lesser degree. We found a disproportionate decline in the elderly schizophrenic patients relative to that of healthy controls only on the phonemic, relative to the semantic test. This decline in performance appears related to the effects of aging rather than severity or chronicity of illness, duration of institutionalization, or a progressive degenerative process associated with the disorder.

The coexistence of bipolar disorder (BD) and multiple sclerosis (MS) is well known. Manic symptoms may represent initial symptoms of MS, at least in some cases, and follow the MS-HLA phenotype frequencies. The purpose of this study was to examine the possible relation of BD and MS based on an HLA family study of a woman with BD and comorbid MS, with family history of BD. Five members of the family from three generations (the patient, her mother, her brother, and her two daughters) were examined regarding the two disorders and the HLA class I and II specificities, performed by serology and molecular techniques. Her deceased father, her brother, and her older daughter suffered from BD. Moreover, in her brother, BD and MS comorbidity was diagnosed. The three affected members and the nonaffected grandmother share the same class I and II, HLA-A2, B18, CW8, DR2, DQ1 haplotype. The shared class II, HLA-DR2, DQ1 haplotype among affected individuals, which is well known to be associated with MS in Caucasians, suggests a possible susceptibility locus for BD, mapped on chromosome 6, very close to the HLA region, underlying the clinical comorbidity of the two disorders.

The purpose of this study was to evaluate the efficacy of topiramate in the treatment of acute manic symptoms. Fourteen patients, admitted with an acute manic episode, were treated with topiramate. All required supplementation therapy with benzodiazepines. Nine patients received topiramate as monotherapy; four of them required zuclopenthixol acutard 100 mg/48 h intramuscularly (im) for not more than 6 days. In three treatment-resistant patients, topiramate was added to the existing therapy. Finally, in two patients topiramate was coadministered with an antipsychotic from the beginning. Patients were assessed every week for 4 weeks with the Bech and Rafaelsen Mania Scale (BRMS). Mean BRMS scores declined from 26.2 to 11.6 in the fourth week (P.001); a significant decline (P.001) was observed after the first week. Response rate (or = 50% reduction of BRMS) was 61.5% (8 out of 13 patients). All patients tolerated topiramate well. Reduced appetite and weight loss was observed in four patients; however, two patients presented weight gain. These preliminary findings provide support for a modest efficacy of topiramate, especially as monotherapy, in the treatment of acute mania.

A case of urinary retention emerging after fluoxetine (20 mg/day) addition to low risperidone doses (2 mg/day) is presented. Severe extrapyramidal side-effects (EPS) also occurred after fluoxetine–risperidone combination. Several possibilities, based on the pharmacodynamic and pharmacokinetic properties of risperidone and fluoxetine, which merit consideration in an attempt to explain our patient's side-effects, are discussed. Extrapyramidal side-effects can be due to an increase of the plasma concentration of risperidone and/or the intrinsic propensity of fluoxetine to produce EPS. Urinary retention may be the consequence of a central serotoninergic mechanism in, or without, combination central D2 blockade.

There are some indications that zolpidem is open to potential abuse. We present four cases of former drug or alcohol abusers with personality disorders, who all developed dependence on zolpidem in high dose.

There are several reports of periodic psychotic disorders that appear in connection with the various phases of the menstrual cycle. Although the pathogenesis of menstrual psychosis has not been systematically investigated, it appears that it might be linked to an estrogen cascade that follows a period of sustained high estrogen levels, as in the case in anovulatory cycles. We present a case of psychosis associated with the menstrual cycle in a patient with polycystic ovary syndrome, a disorder typically characterized by anovulatory cycles, in whom the restoration of normal menstruation with use of metformine led to significant improvement of psychotic symptoms.

We present the case of a patient with Huntington's disease and psychosis, whose motor and psychiatric symptoms improved after administration of galantamine, an acetylcholinesterase inhibitor.